Elvira van Groningen - February 2024 Performers’ health
Playing a musical instrument is a highly physical form of art (Détári & Nilssen, 2022) and to reach the highest standards of performance, musicians must be physically, as well as mentally and emotionally, fit (Wynn Parry, 2004). However, in the hugely demanding music scene, many musicians suffer from anxiety, injury and pain to the point that their performance is affected (Ackerman et al., 2012; Kenny et al., 2014; Kok et al., 2016). Frequently reported risk factors include poor posture, mechanical issues related to instrumental technique, poor body awareness, practice habits and psychological factors (Araújo et al., 2021; Blanco-Piniero et al., 2017; Waters, 2020), with many of these relating to mindsets and habits formed in the education environment and one-on-one teaching setting (Norton, 2016; Waters, 2020). Even though postural deficits, for example, are very common among musicians (Blanco-Piniero et al., 2015), most are not aware of their own malalignment (Valentine, 2004) and similar shortcomings can be observed in music students’ general awareness of the psychological and physical challenges facing them (Ginsborg et al., 2009; Williamon & Thompson, 2006). They consequently show a low level of responsibility for their performance-related health; however, given the right support most of the aforementioned problems are said to be preventable (Ackerman, 2021; Waters, 2020).
The instrumental teacher
Music students first and foremost turn to their instrumental teacher for support and advice, including on matters regarding their health and playing-related problems (Ioannou and Altenmüller, 2015; Norton, 2014; Williamon & Thompson, 2006). Furthermore, they tend to align their views with their teachers’ (Haddon, 2014), hence the music teachers’ significant responsibility in fostering health awareness (Perkins et al., 2017) and a positive learning experience that incorporates healthy strategies, both psychological and physical (Altenmüller, 2016). In the absence of adequate training, however, teachers are not well equipped to advise their students (e.g., Clark & Lisboa, 2013; Williamon & Thompson, 2006) and their knowledge of how to promote healthy posture and lifelong performance and practice habits is limited (Farruque & Watson, 2014; Norton, 2016). Music students’ education is most commonly based on tradition and personal experience, rather than on scientific principles (Clark et al., 2014). For example, while proper posture is widely recognised as important for good technique and the prevention of playing-related pain (Ackerman, 2021), not many teachers are able to define what this is exactly (Quarrier, 1993). Crucially, aside from the fact that teachers often fail to pay attention to the biomechanical quality of their students’ technique, in some cases they even neglect and dismiss physical complaints being made, thereby playing an active role in forming negative health-related behaviours (Détári, 2022).
Educational goals
An important goal of the curriculum in music education is to prepare students ‘to enter the workforce with the necessary skills to pursue a career in music’ (Gaunt & Papageorgi, 2014, p. 264). Sadly, a large majority of musicians feel that their education has not prepared them well enough to deal with the demands of being a musician (James, 2000). Managing, and indeed preventing, performance-related pain is a core skill in the profession, making it the duty of educational institutions to care for their students appropriately (Farruque & Watson, 2014).
According to Farruque & Watson (2014, p. 321), these skills ‘should not be seen as being separate from performance technique, but rather an integral component, which in the long run will enhance performance.’ Awareness of the physical aspects of music making is said to be central to achieving advanced technical skills (Farruque & Watson, 2014), which is one of the aims of a musician’s education (QAA, 2019). Furthermore, the Subject Benchmark Statement: Music published by the Quality Assurance Agency for UK Higher Education (QAA, 2019) states that the best teaching occurs in a research informed environment, containing the mutually beneficial interaction between students, teachers and academics.
Body awareness: effects and education
Lots of research has shown the benefits of body awareness on music performance. Studies have demonstrated an array of positive effects on anxiety levels, sound, musical expression, concentration, stage presence and wellbeing (e.g., Araújo et al., 2021; Dora et al., 2019; Minafra, 2018; Paparo, 2022; Salonen, 2018). Moreover, enhanced physical awareness plays a role in both preventing injury and in rehabilitation (Clark et al., 2013) through its direct links to the functioning of the musculoskeletal system, leading to more efficient movement and instrumental technique (Araújo et al., 2021). Although both students and teachers have been shown to benefit from further training (Hildebrandt and Nubling, 2004), health courses, including somatic methods, are usually directed at the teachers of the future, rather than those currently well-established (Farruque & Watson, 2014). Given the continually high incidence of playing-related problems and the fact that teachers have significant influence over their students, there is much call for change (Ackerman, 2021).
Teachers at all stages of music education are advised to receive better training (e.g., Farruque & Watson, 2014; Ginsborg et al., 2009; Ioannou & Altenmüller, 2015; Waters, 2020; Williamon & Thompson, 2006) in order to develop an appreciation and knowledge of the physical aspects of music-making, and thus the ability to provide vital guidance (Farruque & Watson, 2014). The basic biological principles can be taught and mastered with relative ease (Guptill & Zaza, 2010), and the increased awareness should at least enable teachers to refer their students to health practitioners and appropriate literature (Waters, 2020).
Integration into instrumental teaching
Positively, those who have been educated on injury prevention have been shown to pass their knowledge on to their students (Guptill & Zaza, 2010; Hildebrandt and Nubling, 2004). However, to help students reach their full potential and acquire good technique, physical awareness could be included as a teaching strategy, rather than merely as a means of injury prevention (Farruque & Watson, 2014). With sound pedagogical practice, students can be taught to recognise fatigue, understand why playing with pain is not acceptable and develop healthy technique with proper body mechanics, posture and body awareness (Salonen, 2018). For example, to start encouraging students to be aware of their sensations and alignment, teachers could ask questions like ‘Where can you feel your body expanding through the breath?’ (Paparo, 2022) or ‘Are you pushing your ribcage/pelvis forward right now?’ Another simple way of encouraging more physical awareness is incorporating mental rehearsal and simulated movement (i.e., playing one’s ‘air instrument’) into teaching and practice sessions, with a focus on the bodily movements (Minafra, 2018).
To optimise performance and limit the chance of injury, the long-term educational goal should be to include body awareness as a normal part of instrumental music teaching, so that this can be fully integrated into the lifestyle and habits of the developing musician (Farruque & Watson, 2014). In this way, wellbeing can be an intrinsic part of the music education process while simultaneously supporting educational objectives. In the words of Salonen (2018): ‘Empowering musicians with the knowledge and skills for mindful music-making free from biomechanical deficits is both the goal and the solution.’
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