The lived experience of professional musicians with playing-related injuries: a phenomenological inquiry.
01 Jun 2011-Medical Problems of Performing Artists (Med Probl Perform Art)-Vol. 26, Iss: 2, pp 84-95
TL;DR: Improvements to healthcare delivery and education of musicians, music teachers, and healthcare professionals are needed following the experience of professional instrumental musicians who have experienced playing-related injuries.
Abstract: The purpose of this study was to understand the lived experience of professional instrumental musicians who have experienced playing-related injuries. The study used a hermeneutic phenomenological methodology developed to examine this lived experience. In-depth interviews were conducted with 10 professional musicians, followed by a focus group where preliminary findings were presented to participants and their feedback was sought. Other sources of lived experience included participant-observation by the researcher, who is a musician and has experienced injuries, and biographic and artistic representations of musical performance and its loss, including literature, films, and television. The findings were summarized in a visual representation unique to this study. The representation illustrates three roles-musician, worker, and teacher-that are participated in, and disrupted by, the experience of being injured. In addition, the experience of a playing-related injury takes place within the context of a healthcare system which was perceived as insufficient to meet their needs: specialized care was rarely available and, if available, was not local or timely; treatment operated on a fee-for-service model when many musicians had meagre incomes and lacked coverage for these services; and treatment provided often failed to allow musicians to continue to perform at the level they had previously achieved. Finally, the representation illustrated four existentials-lived time, space, body and social relations-that permeated the experience. This study suggests that improvements to healthcare delivery and education of musicians, music teachers, and healthcare professionals are needed. Language: en
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TL;DR: Evidence from RCTs and CTs suggests that AT sessions may improve performance anxiety in musicians, and future trials with well-established study designs are warranted to further and more reliably explore the potential of AT in the interest of musicians.
Abstract: Musculoskeletal disorders, stress and performance anxiety are common in musicians. Therefore, some use the Alexander Technique (AT), a psycho-physical method that helps to release unnecessary muscle tension and re-educates non-beneficial movement patterns through intentional inhibition of unwanted habitual behaviours. According to a recent review AT sessions may be effective for chronic back pain. This review aimed to evaluate the evidence for the effectiveness of AT sessions on musicians’ performance, anxiety, respiratory function and posture. The following electronic databases were searched up to February 2014 for relevant publications: PUBMED, Google Scholar, CINAHL, EMBASE, AMED, PsycINFO and RILM. The search criteria were “Alexander Technique” AND “music*”. References were searched, and experts and societies of AT or musicians’ medicine contacted for further publications. 237 citations were assessed. 12 studies were included for further analysis, 5 of which were randomised controlled trials (RCTs), 5 controlled but not randomised (CTs), and 2 mixed methods studies. Main outcome measures in RCTs and CTs were music performance, respiratory function, performance anxiety, body use and posture. Music performance was judged by external experts and found to be improved by AT in 1 of 3 RCTs; in 1 RCT comparing neurofeedback (NF) to AT, only NF caused improvements. Respiratory function was investigated in 2 RCTs, but not improved by AT training. Performance anxiety was mostly assessed by questionnaires and decreased by AT in 2 of 2 RCTs and in 2 of 2 CTs. A variety of outcome measures has been used to investigate the effectiveness of AT sessions in musicians. Evidence from RCTs and CTs suggests that AT sessions may improve performance anxiety in musicians. Effects on music performance, respiratory function and posture yet remain inconclusive. Future trials with well-established study designs are warranted to further and more reliably explore the potential of AT in the interest of musicians.
88 citations
Cites background from "The lived experience of professiona..."
...Musculoskeletal disorders are commonly addressed with physical therapy, but specialised care for musicians is rarely available [10]....
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TL;DR: The Sound Practice orchestral musicians work health and safety project used formative and process evaluation approaches to develop evidence-informed and clinically applicable physical therapy interventions, ultimately resulting in favorable outcomes.
Abstract: Playing a musical instrument at an elite level is a highly complex motor skill. The regular daily training loads resulting from practice, rehearsals and performances place great demands on the neuromusculoskeletal systems of the body. As a consequence, performance-related musculoskeletal disorders (PRMDs) are globally recognized as common phenomena amongst professional orchestral musicians. These disorders create a significant financial burden to individuals and orchestras as well as lead to serious consequences to the musicians’ performance and ultimately their career. Physical therapists are experts in treating musculoskeletal injuries and are ideally placed to apply their skills to manage PRMDs in this hyper functioning population, but there is little available evidence to guide specific injury management approaches. An Australia-wide survey of professional orchestral musicians revealed that the musicians attributed excessively high or sudden increase in playing-load as major contributors to their PRMDs. Therefore, facilitating musicians to better manage these loads should be a cornerstone of physical therapy management. The Sound Practice orchestral musicians work health and safety project used formative and process evaluation approaches to develop evidence-informed and clinically applicable physical therapy interventions, ultimately resulting in favourable outcomes. After these methodologies were employed, the intervention studies were conducted with a national cohort of professional musicians including: health education, onsite injury management, cross-training exercise regimes, performance postural analysis, and music performance biomechanics feedback. The outcomes of all these interventions will be discussed alongside a focussed review on the existing literature of these management strategies. Finally, a framework for best-practice physical therapy management of PRMDs in musicians will be provided.
66 citations
TL;DR: This mixed format (research and discussion) article addresses the relationship between occupation and health by including findings from a phenomenological study of the lived experience of professional musicians with playing-related injuries.
Abstract: This mixed format (research and discussion) article addresses the relationship between occupation and health. The conceptual discussion is deepened by including findings from a phenomenological study of the lived experience of professional musicians with playing-related injuries. Participants described decreased awareness of time and of their bodies when they were healthy, particularly when experiencing flow. Participants described flow as detrimental to their health, and used strategies to disrupt flow in order to continue in their chosen occupation. This choice can be seen as unhealthy, particularly in cases where the musician has been advised to decrease or stop playing for health reasons. However, occupational science theories favour individual choice in occupations. This apparent contradiction can be resolved if the definition of health is broad and includes justice and freedom to choose.
43 citations
Cites background from "The lived experience of professiona..."
...Being injured can cause deep emotional upset and impact musicians’ abilities to perform in other occupations that are meaningful to them (Guptill, 2011a, 2011b)....
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TL;DR: An exercise DVD was well received and appeared to be effective, convenient and safe in managing occupational-specific musculoskeletal disorders in musicians.
Abstract: BACKGROUND Professional musicians report a high prevalence of performance-related musculoskeletal disorders (PRMDs). Excessive muscle tension and fatigue have been reported as important factors contributing to PRMDs. AIMS To evaluate feasibility and effectiveness of a specific exercise programme delivered via a digital video disc (DVD) targeting PRMDs and associated risk factors. METHODS Volunteers from eight Australian symphony orchestras undertook two or more sessions per week over 12 weeks. Questionnaires were administered pre- and post-intervention with items including the frequency and severity of PRMDs, perceived exertion during different playing situations, per formance effects of the DVD and satisfaction rates. Musicians who had also participated in an equivalent face-to-face programme prior to this DVD trial compared the two interventions. RESULTS One hundred and forty-four out of 576 musicians volunteered (25% uptake), and 50 participants completed a mean 2.1 (SD 0.42) sessions over the 12 week period (41% compliance). PRMD frequency and severity were significantly reduced post-intervention (P < 0.01). Participants reported benefits of the DVD on strengthening muscles, increasing ease of movement and improving flexibility related to playing. Despite this, perceived exertion levels during private practice, rehearsal and performance remained the same (not significant). Seventy-eight per cent of participants scored their overall experience of the use of the DVD as good or excellent. Owing to its convenience and detailed exercise demonstrations, the DVD was rated as better or much better overall than the face-to-face classes by 55% of participants who had experienced both. CONCLUSIONS An exercise DVD was well received and appeared to be effective, convenient and safe in managing occupational-specific musculoskeletal disorders in musicians.
35 citations
Cites background from "The lived experience of professiona..."
...This is reported to be due to a perceived risk of employment termination and fears that peers and orchestra management will judge their playing skills negatively as a consequence [6,7]....
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TL;DR: The results suggest that learning through experience might help musicians adapt to changes related to their bodies, and maintaining health was perceived by these musicians as a dynamic balance.
Abstract: Objective To identify professional musicians' representation of health and illness and to identify its perceived impact on musical performance. Methods A total of 11 professional musicians participated in this phenomenological study. Five of the musicians were healthy, and the others suffered debilitating physical health problems caused by playing their instruments. Semi-structured interviews were conducted, transcribed verbatim and analysed. Thematic analysis, including a six-step coding process, was performed (ATLAS-ti 6). Results Three major themes emerged from the data: music as art, the health of musicians, and learning through experience. The first theme, music as art, was discussed by both groups; they talked about such things as passion, joy, sense of identity, sensitivity, and a musician's hard life. Discussions of the second theme, the health of musicians, revealed a complex link between health and performance, including the dramatic impact of potential or actual health problems on musical careers. Not surprisingly, musicians with health problems were more concerned with dysfunctional body parts (mostly the hand), whereas healthy musicians focused on maintaining the health of the entire person. The third theme, learning through experience, focused on the dynamic nature of health and included the life-long learning approach, not only in terms of using the body in musical performance but also in daily life. Conclusions The centre of a musician's life is making music in which the body plays an important part. Participants in this study evidenced a complex link between health and musical performance, and maintaining health was perceived by these musicians as a dynamic balance. Our results suggest that learning through experience might help musicians adapt to changes related to their bodies.
27 citations
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Journal Article•
TL;DR: Information from a systematic review of published information on the incidence and prevalence of playing-related musculoskeletal disorders (PRMDs) in classical musicians indicates that the prevalence of PRMD in adult classical musicians is comparable to the prevalences reported for other occupational groups.
Abstract: BACKGROUND: Work-related musculoskeletal disorders cause pain, disability and loss of employment for many workers, including musicians. Although performing arts medicine is a growing field, the health problems of musicians remain under-recognized and under-researched. Therefore, the author undertook a systematic review of published information on the incidence and prevalence of playing-related musculoskeletal disorders (PRMDs) in classical musicians. METHODS: Seven databases were searched for the period 1980 to 1996. The main textbook and performing arts medicine journals were searched manually, as were reference lists of all relevant papers. The author also contacted individuals familiar with the literature of performing arts medicine. Studies were included for review if they reported PRMD incidence or prevalence in classical musicians. Of the 24 studies identified, 18 cross-sectional surveys and cohort studies were reviewed. The author subjectively assessed the studies using criteria modified from an existing evaluation scale and used 4 criteria for data combination. On the basis of prevalence values from the eligible studies, chi 2 tests for heterogeneity were performed. RESULTS: Only one study estimated PRMD incidence. Ten of the 17 prevalence studies were ineligible for data combination, because of low response rates and other methodological problems. In the 7 eligible studies, PRMD point prevalence ranged from 39% to 87% in adult musicians and from 34% to 62% in secondary school music students. The best estimates of PRMD prevalence were derived from the 3 studies that excluded mild complaints; these studies indicated that PRMD prevalence was 39% and 47% in adults and 17% in secondary school music students respectively. Statistical combination of data across studies within each demographic category was not possible. INTERPRETATION: Available data indicate that the prevalence of PRMD in adult classical musicians is comparable to the prevalence of work-related musculoskeletal disorders reported for other occupational groups. Several recommendations for future research are outlined.
263 citations
TL;DR: In this article, the authors reflect upon their personal experience of chronic progressive multiple sclerosis in order to provide a phenomenological account of the human experience of disability and argue that the phenomenological notion of lived body provides important insights into the profound disruptions of space and time that are an integral element of changed physical capacities such as loss of mobility.
Abstract: In this paper I reflect upon my personal experience of chronic progressive multiple sclerosis in order to provide a phenomenological account of the human experience of disability In particular, I argue that the phenomenological notion of lived body provides important insights into the profound disruptions of space and time that are an integral element of changed physical capacities such as loss of mobility In addition, phenomenology discloses the emotional dimension of physical disorder The lived body disruption engendered by loss of mobility includes a change in the character of surrounding space, an alteration in one's taken-for-granted awareness of (and interaction with) objects, the disruption of corporeal identity, a disturbance in one's relations with others, and a change in the character of temporal experience The loss of upright posture is of particular significance since it not only concretely diminishes autonomy but affects the way one is treated by others Such a change in posture is, therefore, particularly disruptive in the social world of everyday life An understanding of the lived body disruption engendered by disability has important applications for the clinical context in devising effective therapies, as well as for the social arena in determining how best to resolve the various challenges posed by chronic disabling disorders
194 citations