Particular problems associated with different groups of musicians
Different types of music-making tend to be associated with particular health problems, and a brief summary is given below. Many problems such as musculoskeletal conditions and stage fright are common to all types of performers.
1. Pianists and keyboard players
Pianists find that static postures and high repetition of fine motor movements can lead to musculoskeletal problems (especially in elite players), and these are mostly of the upper body, affecting the back and the upper limbs. A study (Greic, 1989) showed that 50% of pianists had back disorders while 22% developed disorders of the forearms and wrists 2.
Common problems are repetitive strain injury, back and neck pain, tendonitis, bursitis, carpal tunnel syndrome, focal dystonia, shoulder pain and arthritis or injuries to the hands. The carpometacarpal joints are very important in playing the piano and are prone to osteoarthritis, especially in women.
Pianists with small hands can struggle to play some works in which large hand stretches are required, and it is possible to obtain smaller keyboards. Having the piano stool at the right height, and posture and technique when playing are especially important to avoid injuries, as is stopping playing when pain is experienced.
Accordion players can sustain injuries from carrying and holding such a heavy instrument.
BAPAM (British Association of Performing Arts Medicine) has a very useful factsheet ‘The Healthy Pianist’ on it’s website 3.
Singers are at risk of vocal cord disorders, with nodules on the cords being particularly common and troublesome. Polyps, sores, and virus-induced growths can all cause problems, together with infections and conditions leading to vocal cord paralysis. Singers may also suffer from gastric reflux.
Early diagnosis of vocal cord disorders is needed for successful treatment.
The British Voice Association is available for help, and BAPAM has a useful factsheet on it’s website (www.bapam.org.uk) relating to vocal health problems in performing artists which includes a section on BAPAM recommendations to GPs regarding voice clinic referrals 4. BAPAM also has a factsheet for singers ‘Fit to sing’ on it’s website 5.
3. String players
String players are particularly injury prone, with RSI again being a common problem. Violinists and viola players are at high risk due to the highly asymmetrical position in which they have to play, and can also develop problems with thoracic outlet syndrome which can be career threatening and extremely painful, while cellists are often prone to back and shoulder problems. Chairs with variable height legs are now available to cellists to help to improve posture and to avoid some injuries. Many injuries in string players are due to posture, overuse injuries or nerve compression.
Other problems include focal dystonias, ulnar nerve problems, carpal tunnel syndrome, tendonitis, bursitis, tenosynovitis, de Quervains tenosynovitis, cubital tunnel syndrome, trigger finger or thumb, back, neck and shoulder pain, temporomandibular joint dysfunction and allergic dermatitis. Violinists and violists are also prone to developing violin ‘hickey’—an area of dermatitis on the neck which can be sore and become infected. Snapped strings and injuries from a desk mate’s bow when performing or rehearsing in a small space are also sources of danger.
Cellos, double basses and harps are also large heavy instruments, and injuries can be incurred from transporting them.
4. Woodwind players
Woodwind players are at risk of a number of conditions. These include overuse and musculoskeletal problems of the hand, wrist and forearms, neck and back pain, entrapment neuropathies such as carpal tunnel, and inflammatory conditions such as de Quervains tenosynovitis 6. Wind players can also suffer from infections caused by sharing instruments that have not been cleaned properly, dental problems, raised intra-ocular pressure, pharyngeal pouches, hernias, hearing problems, lip muscle injuries, contact cheilitis and gastro-oesophageal reflux.
Flautists are injury prone due to the posture involved in playing their instrument, and run an increased risk of thoracic outlet syndrome and inflammatory conditions such as de Quervains tenosynovitis. Clarinettists can have problems with the muscles of the first webspace of the right hand and the ligaments at the base of the thumb and the radial side of the wrist, and saxophonists and bagpipers can develop a rare hypersensitivity pneumonitis ‘saxophone lung.’
Bassoons are surprisingly heavy, and bassoonists can develop neck and lower back problems. This can be helped by using a chest harness to take the weight of the instrument, and young players often use spikes for this purpose.
5. Brass players
This group of instrumentalists are at risk of lip problems, musculoskeletal problems, contact cheilitis, tinnitus and hearing problems, pharyngeal pouches, hernias, raised intraocular pressure and pneumothorax.
Trumpeters are at most risk of embouchure collapse. Satchmo’s syndrome (rupture of the orbicularis oris muscle) is commonest in trumpeters, but can also affect French horn and trombone players. This can lead to an inability to maintain high notes. Trombone, trumpet and tuba players are also at risk of TMJ problems 7, and trumpeters are at higher risk of laryngocele and even on rare occasions CVAs. Trumpeters and tuba players can also contract hypersensitivity pneumonitis (saxophone or bagpipers lung), particularly if their instruments have not been cleaned properly.
Guitarists are prone to musculoskeletal injuries such as tendonitis, neck and back pain and tennis elbow. Other common problems include hearing loss, tinnitus, carpal tunnel syndrome (particularly if the instrument is slung too low), ulnar nerve injuries, focal dystonia, thoracic outlet syndrome, guitar string dermatitis, tuft finger fractures, and injuries from snapped strings to the face or the eyes.
The BAPAM has a very helpful factsheet on ‘The acoustic guitar’ for musicians which suggests multiple ways in which guitarists can avoid injuring themselves 8.
The commonest maladies in percussionists are tendonitis, RSI and carpal tunnel syndrome, and upper limb and lower back problems frequently occur. Drummers are at risk from hearing loss, and rarer problems include the (admittedly very low) risk of contracting anthrax from drums.