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Playing healthy staying healthy: bringing it together: what are the key wellness/health principles for the music teacher?

In an ideal world, all playing-related problems would be prevented by proper and effectively applied strategies for practice and performance. Since this world doesn't exist, both students and teachers must be content with mitigation or minimization of these problems. The good news is teachers now have methods of recognizing and handling playing-related problems. In addition, prevention strategies exist for musicians without problems and for those trying to prevent recurrence of previously treated problems.

There are a few basic tenets in healthy music making upon which both music educators and performing arts medicine professionals can agree:

1. Playing should be physically efficient; some authors describe this as "playing relaxed."

2. Playing should not be painful.

3. Playing should not cause physical damage to the body, specifically to the musculoskeletal system or the hearing apparatus.

4. Playing should not cause mental stress, fear or anxiety.

Playing-related problems are common in all musicians and especially so in students. Studies have shown the greatest percentage of these affect the musculoskeletal and neurological systems. Causes include painful overuse, or the physical product of playing time x intensity that exceeds a student's ability to adapt or adjust; and technique-related, resulting from abnormal or excessive posture and/or force in playing. Symptoms of these disorders are mostly musculoskeletal and occur especially in the hand/wrist/forearm and neck/upper spine regions. They are produced by muscle strain, chronic overuse and tendinitis/tenosynovitis. Neurological problems, usually relating to nerve compression or dystonia, are much less common.

Psychological/emotional difficulties are widespread also, seen in musicians of all ages, instrument skills and degree of talent; the most prevalent one seems to be performance anxiety, sometimes known as "stage fright." Like physical problems, they can be devastating to a learning experience or a performing career; both circumstances can benefit from early recognition and treatment.

Music teachers are in a unique position to take a proactive approach to the health and well-being of their students and themselves. They form a first line of defense against development and worsening of difficulties associated with making music. However, they will be more effective by knowing some of the principles and skills for dealing with student problems:

1. Educating themselves and their students about the types of playing-related health problems, so that both groups will be able to recognize them when they occur.

2. Teaching students protective healthy physical and mental approaches to provide a solid base for playing with comfort, freedom and ease of expression. These strategies can be useful in both treatment and prevention of playing-related problems.

3. Assessing the effectiveness of such behaviors and modifying them as required. If problems persist, knowing when to refer a student to a health professional for additional evaluation and care. It is crucial to have an accurate diagnosis for any problem, so effective musical and medical treatment can be instituted.

4. Recognizing the importance of a gradual return to playing when the problem is under control or resolved. Increasing practice time, intensity and repertoire slowly and painlessly has been found to be most effective in preventing recurrences of the problem or the development of a new or associated one. Like large-muscle sports athletes, musicians need time and graduated practice efforts to regain muscle strength, endurance, coordination and control lost during treatment and rehabilitation.

5. Promoting a positive relationship and encouraging openness with students so they feel free to discuss healthy approaches to playing and to notify the teacher at the first sign of trouble, thus perhaps circumventing a more serious issue.

Healthy and preventative behaviors can be employed by both students and teachers in a variety of domains.

The Practice Domain

Common thought recommends students learn how to schedule their practice times effectively and to plan ahead for major performances, auditions and juries. Many arts-medicine specialists recommend playing 25 minutes out of every half-hour, with 5 minutes devoted to both physical and mental rest. Varying practice content, intensity and repertoire can help prevent overuse. Students should not persist in playing difficult passages over and over, especially if little musical progress is being made. To avoid frustration and stress when things are not going well, it's always worthwhile for the student to stop playing, breathe deeply a few times, visualize the desired/ideal result, then proceed again with the passage.

To minimize the possibility of performance anxiety, learning material thoroughly before a performance is always wise. Being adequately prepared helps decrease or prevent excessive mental stress, which often manifests itself physically in the use unneeded force and intensity in playing.

The Technique Domain

Excessive and/or improper use of a musician's body while holding, supporting and/or playing an instrument is an important and common cause of muscle overuse and misuse. Avoiding these behaviors can be employed both in preventing and rehabilitating musicians' playing-related musculoskeletal problems. Body alignment and posture while seated at the piano or holding other instruments should be appropriate for both the instrument and the player's individual body size and configuration. The observant teacher will recognize quickly any persistent deviations from the ideal playing setup and be able to offer modifications or corrections to the student in a timely fashion.

When considering the best way to hold or support other instruments, it's wise to consider all available possibilities; a wide choice of supports, straps, harnesses, thumb/finger rests and floor pegs are available, and trial-and-error testing of these, preferably with the teacher in attendance, is perhaps the most efficient way of determining the proper setup for a particular instrumentalist. In some cases, musculoskeletal overuse may be caused by a mismatch between the musician and the instrument--attempting to play something that is too large for one's anatomy (examples include violas and tubas, as well as attempting to start young, small students on a low-voiced instrument that they cannot carry, lift or fit their fingers around easily.)

The term "playing relaxed" was used above; this author advocates such an approach for all musicians, adjusting muscle force when holding/playing the instrument to the specific demands of the situation. It means using only the muscles required to do the job, keeping unneeded muscles relaxed. This approach results not only in improved posture but more efficient and effective playing.

The Environmental Domain

Again, in an ideal world, seating, lighting and sound-level issues would be nonexistent. But such is clearly not the case, to which any pit or jazz-band musician quickly will attest. Adaptations exist to improve all three segments of this domain, and both teacher and student must be alert to their possibilities. Seating should conform to the individual's size, including overall height, torso and limb lengths, and be appropriate for the instrument being played; this will encourage efficient posture and body alignment.

Lighting should be at least adequate to see the music (and director, when one is present), an often difficult situation in orchestra pits and even in some practice and rehearsal rooms. Musicians should not have to peer, squint or move the music close to the face. In some cases, the question arises as to whether the musician's vision is normal; it's a common, but less-well-known fact that unrecognized refractive problems can masquerade as low-light problems.

Damage to the hearing apparatus from excessive sound levels, like that from musculoskeletal overuse, is dependent on intensity and duration. Since noise-induced hearing loss is untreatable, prevention is the only recourse. Many techniques exist to control sound exposure for instrumentalists, vocalists and their teachers/conductors; choosing the most effective one for a particular set of circumstances can be challenging and perhaps expensive, but ultimately well worthwhile. Both student and teacher have roles in this process. Two primary goals of the process are 1) reducing the daily amount of time exposed to high-intensity sounds and 2) using some form of hearing protection when exposure is inevitable. It is important for students to assess their own hearing regularly and use individual hearing protection that is offered, and for the director to control rehearsal practices to limit excessive sound level exposures. Much loud playing may not be recognized at first; the regular use of a sound pressure level meter can be very enlightening and also can help monitor the effect of any strategies used to limit exposure during practicing and rehearsals. From an institutional standpoint, modifying practice and rehearsal rooms to limit high sound levels often is justified in the long-term as protection for those who use them.

Education remains the key to achieving the goals of safe, healthy and pain-free playing or singing. Both teacher and student benefit by learning protective and therapeutic methods of encouraging and showcasing musical talent while preventing or mitigating playing-related physical and mental difficulties. An increasing number of reliable sources are becoming available through organizations such as the Performing Arts Medicine Association, the National Association of Schools of Music and MTNA. As more musicians and teachers avail themselves of this information, we are coming ever closer to that ideal world.

Dr. William J. Dawson, a retired orthopaedist performing arts medicine consultant/ editor and active bassoonist/instrumental teacher, is past president of the Performing Arts Medicine Association, a worldwide lecturer and clinician, and the author of Fit as a Fiddle: The Musician's Guide to Playing Healthy.
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Title Annotation:Musician Wellness Series
Author:Dawson, William J.
Publication:American Music Teacher
Geographic Code:1USA
Date:Apr 1, 2015
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