Archive for the ‘Injury Risk and Prevention’ Category

What have athletes known for years that musicians are just beginning to apply to their practice and performances?

Monday, February 7th, 2022

The College Music Society

Answered by Randall Dick: February, 2022.

Randall Dick, M.S., FACSM, is a member of the American College of Sports Medicine. He has worked for 20 years with the National Collegiate Athletic Association, managing its sports medicine and injury prevention programs. He has authored more than 50 peer-reviewed publications and served on the US Lacrosse Sports Science Committee and as a consultant for Major League Baseball injury surveillance. He began developing the Athletes and the Arts initiative after a conversation with the New Orleans-based Preservation Hall Jazz Band Randall leads this organization, an initiative that works to integrate sports medicine principles and wellness into the performing arts field. Since 2008 he has worked with de-identified healthcare data at Eli Lilly and Company and IBM Watson Health.

Q: What have athletes known for years that musicians are just beginning to apply to their practice and performances?

A: Like athletes, performing artists:

  • Practice and/or perform almost every day
  • Often play through pain and need pain management
  • Compete or are in challenging environments
  • Experience little or no “off season’’
  • Sometimes face extreme competition
  • Risk the temptation of substance abuse
  • Face significant risk of career-threatening injury

Issues facing both performing artists and sport athletes include:

  • Travel / jet lag
  • Nutrition / hydration
  • Overuse
  • Optimize performance
  • Mental health

Sport athletes have access to nutritional information to help them understand what and when to eat, as well as medical support for injury prevention, management, and rehab. In addition, they have access to film reviews (with the help of athletic trainers and coaches) so they can work on modifying posture, mechanics, pitch, Moreover, they have a sport psychologist to help them get out of a slump. Sadly, the performing artist (musicians, dancers, and actors) has many of the same needs but with little to no access to these same resources.

The Target Audience

Athletes benefit from a system that educates not only themselves but also medical professionals, coaches, trainers, and even parents about how to optimize health and performance.

Performing artists would greatly benefit from the following:

  • Having teachers who can provide them with the names of appropriate medical professionals, should a student need to establish a health care relationship.
  • If possible, should an injury occur, perform for a health care professional, so they understand one’s craft
  • Document a week of typical activities (it would be beneficial if students would provide this information to a physician, therapist or other medical professional if needed)
  • Testing and education for musicians on music-induced hearing disorders as teachers should educate students about hearing preservation

Educators /Instructors in the performing arts should consider the following:

Medical Professionals seeing performing artists need to consider the following:

  • Know you are seeing a performing artist and understand the volume and intensity of the activity
  • Consider an annual pre-participation exam targeted to the specific activities of the performer
  • Use a team-approach whenever possible—medical professionals, teachers, therapist(s)

Lessons Learned from sport’s research that can be applied to performing artists

Practice and Performance:

  • The NUMBER of practice hours may hurt rather than help at some point – less is more
  • Consider FOCUSED practice segments with different goals in each session
  • Quantify the VOLUME and INTENSITY of performing arts activity(this should become standard practice of all performers using a simple tool for tracking performance hours for an appropriate session broken out by HIGH, MODERATE or LOW intensity)
  • Large ACUTE increases in time spent physically practicing increases the risk of injury. If the AMOUNT or INTENSITY of practice must increase, do it gradually and include adequate breaks

Recovery / Cross-training:

  • Emphasize the importance of both mental and physical rest and recovery
  • Employ alternative mental and physical activities that contribute to performance but use alternative muscle groups or mental focus—mental practice away from the instrument can strengthen skills

Mental Health:

Youths in today’s culture are driven to train early and extensively. Early specialization and extensive training creates well-documented risks of over-use injury, burnout, stress, and less enjoyment in youth sports and in the performing arts as well.  The importance of a coach or an instructor in establishing a safe and healthy environment is key for both sport athletes and performing artists.

A 2021 collaborative article published by the International Olympic Committee emphasizes the importance of attending to mental as well as physical health. See: Gouttebarge V, Bindra A, Blauwet C, et al, International Olympic Committee (IOC) Sport Mental Health Assessment Tool 1 (SMHAT-1) and Sport Mental Health Recognition Tool 1 (SMHRT-1): towards better support of athletes’ mental health, British Journal of Sports Medicine, 2021;55:30-37 at:

The System

Sport organizations such as the National Federation of State High School Association, the National Collegiate Athletic Association (NCAA) and various other governing bodies develop standards, guidelines and rules around practice and competition to enhance health and safety. For example, the NCAA has various guidelines shared with all institutions in a Sports Medicine Handbook and restricts formal practice of a sport to 20 hours a week.

Such oversite management would greatly benefit performing artists as well and provide them with accepted guidelines upon which to base practice, performance, and general participation.  A few examples are emerging, including The National Association of Schools of Music (NASM) Health and Safety Standard for all NASM accredited schools that reads in part: “It is the obligation of the institution that all students in music programs be fully apprised of health and safety issues, hazards, and procedures inherent in practice, performance, teaching and listening.” And “Music program policies, protocols, and operations must reflect attention to injury prevention and to the relationships among musicians’ health;” Specific methods for addressing these issues are the prerogative of the institution.”  See NASM Handbook 2020-21: – F.; 2.d.p. 67-68:  and NASM Advisories – NASM-PAMA: 

Measuring optimal performance and incorporating researched concepts

Compared to sports, optimal performance in the performing arts environment is currently somewhat subjective. This area could benefit from repeatable quantifiable measures around performance so one can accurately measure how performance changes after an intervention.  For example, in sports, practice limits are imposed for safety by NCAA, Little leagues and USA football while there is not really any formal limits or guidelines imposed as a standard protocol in the performing arts with regard to length and intensity of rehearsals.  If such measures were established, it would open the door to a variety of alternative training options (such as track athletes doing pool workouts) that could then be evaluated to see if they achieve a desired result and would possibly reduce overuse and/or injury on specific body areas.

Final thoughts and summary

Sport athletes benefit from established research and targeted education to themselves and the medical personnel and coaches who work with them.  Many of these findings are applicable to performing artists and would help to optimize their health and performance as practicing artists.  In addition, further research should be conducted in this population to better understand their unique characteristics and needs.

As jazz musician Jon Batiste, a classically trained graduate of Julliard (both bachelors and master’s degrees) and Ambassador for Athletes and the Arts stated:

“The conservatory environment is very different.  I went to Julliard six years and never in any of my lessons was there any instruction about nutrition or any sort of quantifiable method to determine the pros and cons of playing long hours.   If I missed a note, I was just told to do it again, to practice more”.

“…Music is healing and if you want to heal other people, you’ve got to heal yourself first. The healthier we are as musicians and the arts community in general, the better the world will be.”

Please also see:

Is Ballet A Sport? Doctors And Dancers Think So

Monday, December 2nd, 2019

Comparing the athleticism of ballet dancers and football players: read and listen to this interview-based articleIs Ballet A Sport? Doctors And Dancers Think So—presented on IdeaStream.

Expert Roundtable: Music & Hearing on the 100th Anniversary of Recorded Jazz

Monday, September 18th, 2017

Published on

The Hearing Review

EXPERT ROUNDTABLE: Music & Hearing Loss | February 2017 Hearing Review

Introduction to Special Issue

By Marshall Chasin, AuD, Bethany Ewald Bultman, and Dan Beck, Guest-editors

On February 26, 1917, the first jazz recording was pressed for the Victor record label, featuring the Original Dixieland “Jass” Band’s Dixie Jass One Step and Livery Stable Blues. The record was released 3 months later, and represented what might be viewed as a seminal moment in music—the far-reaching influence of jazz recordings have changed music and musicians forever after.

Read the full article

CMS Musicians’ Health Webinars 2017-2018

Sunday, September 17th, 2017

“The Role of Collegiate Faculty and Administrators in Addressing Musicians’ Health”

Shortly after our committee was established in 2015, the College Music Society’s Committee on Musicians’ Health was privileged to host eight webinars on the broad topic of musicians’ health, offering administrators, faculty and students a diverse range of practical strategies for addressing these important topics within the music curriculum.  These take on special importance as the National Association of Schools of Music (NASM), in collaboration with the Performing Arts Medicine Association (PAMA), published a series of Health Advisories on the topics of hearing health, musculoskeletal health, vocal health and, yet to be published, mental health, with the intention of urging postsecondary schools and departments of music to pursue ways to integrate this important information into the music curriculum.  Since the first Webinar posted on the CMS website in December 2015, through its eighth Webinar in December 2016, these Webinars are now approaching 7,000 views in total.  We are pleased to work together with CMS in developing this valuable resource to help address these essential issues.  Our earlier Webinars can be viewed at the following link:

Go To Webinars

NOTE: These webinars are only available to non-CMS members once they are archived, which happens approximately 10 days after they air. CMS members may view them as they air, as a benefit of membership.

Athletes and the Arts – What Musicians Can Learn from Athletes – Randall Dick (Athletes and the Arts) & Dr. John Snyder (Loyola University)

A Musician’s Guide to the Brain: What We Need to Know and Why – Dr. Lois Svard (Bucknell University)

Addressing Issues on the Maintenance of Health and Safety in a Music Program – Dr. Linda Cockey (Salisbury University)

How to Prevent Practice Wear and Tear from Progressing to a Playing Related Musculoskeletal Disorder (PRMD”) – Dr. Serap Bastepe-Gray (Peabody Conservatory)

Challenges and Opportunities for College Professors Regarding Inclusion of Mental Health Courses in the Music Curriculum – Dr. Julie Jaffee Nagel (Michigan Psychoanalytic Institute)

Vocal Health Protocols in Academic Institutions – Dr. Emily Martin (Bucknell University)

Mindfulness Practice for Collegiate Music Students and Faculty – Dr. Vanessa Cornett (University of St. Thomas)

Hearing Wellness for Music Educators – Dr. Heather Malyuk (Sensaphonics Hearing Conservation)

We are now pleased to add to our offerings with our second series of Musicians’ Health Webinars which will run from Fall 2017 through Spring 2018.


September 15, 2017:  

Providing Collegiate Music Students the Same Healthcare that Collegiate Athletes Get” – Dr. Jeffrey Russell

Musicians undergo high physical demands and are prone injury. As future professional musicians and music teachers, university music majors deserve the same specialized healthcare offered to intercollegiate athletes. The webinar will outline how this is done at Ohio University and offer strategies for developing a similar program at your institution.

Dr. Jeff Russell serves as Assistant Professor of Athletic Training and Director of Science and Health in Artistic Performance (SHAPe) at Ohio University, where he is an athletic trainer and leads a multi-faceted performing arts medicine initiative he designed for Ohio University’s dance, music, theater, and marching band programs.


October 20, 2017:

“Demystify the Voice” – Dr. Rachael Gates

Learn what is actually happening when you “lose your voice” hear vocal myths debunked, explore diet and lifestyle choices to improve performance, understand common voice pathologies, find out about surgical techniques and precautions to take before undergoing general anesthesia, and more!

Soprano, Opera Director and Singing Health Specialist, Dr. Rachael Gates is has sung in Germany, Russia, Italy and the U.S.  She has taught at Northwestern University, The Hartt School of Music, Yale, Michigan State, and is currently Assistant Professor of Voice and Pedagogy at Grand Valley State University.  Her book, The Owner’s Manual to the Voice (Oxford) is available at The Metropolitan Opera Shop.


November 17, 2017:

“Playing With Pain: When Too Much Music Becomes a Problem” – Dr. William Dawson

The neuromusculoskeletal system is most commonly involved in playing/singing-related overuse, and pain is the commonest symptom. Dr. Dawson discusses the reasons for individual differences in prevalence, explains how both student and teacher can recognize the signs and manage the problems, and provides preventive strategies to preserve a budding musical career.

Dr. William Dawson is Past-President of the Performing Arts Medicine Association. An arts-medicine specialist, author, editor, and lecturer, he is the medical consultant to the International Double Reed Society. A symphonic bassoonist and double-reed specialist for more than 65 years, Dr. Dawson has taught low reeds privately for 20 years.


December 8, 2017:

“The Emotional Practice Environment:  How Thoughts and Moods Can Influence Muscle States and Injury Risk” – Jennie Morton

Habitual thought patterns and current emotional states are not always considered in the development of musculoskeletal injury.  This presentation will explore the neurobiological mechanisms that allow emotions and thought patterns to influence muscle tension and the perception of pain, and provide strategies for recognizing and managing these issues in both practice and performance.

Jennie Morton is a former classical ballet dancer, musical theater performer, and lead singer with a Big Band, who is now a Registered Osteopath specializing in treating instrumental musicians, vocalists and dancers.  She is the Wellness Professor at the Colburn School, adjunct faculty at Chapman University (College of Performing Arts), is on the Board of Directors of the Performing Arts Medicine Association (PAMA), and the Health and Wellness Committee for the International Society for Music Education (ISME).  She was instrumental in creating the MSc Performing Arts Medicine degree program at University College London, for whom she remains an Honorary Lecturer, and has published many articles in the field of Performing Arts Medicine.  Her book, “The Authentic Performer: Wearing A Mask and The Effect On Health” was published in 2015.


February 16, 2018:

The Role of the Teacher in Keeping Our Students Healthy” – Gail Berenson

Like athletes, musicians are using their bodies as they practice and perform, spending hours preparing for their moment in the spotlight. Teachers are the first line of defense for a music student, helping to educate students in injury-preventive strategies and offering accurate and sound advice, should an injury occur. This presentation will focus on injury preventive techniques, productive practicing strategies, building a healthy teaching environment, and defining the role teachers play in helping their students remain healthy.  Attention will be given toward encouraging students to cultivate a resourceful and imaginative practicing attitude, learning essential time management skills for more efficient practicing and developing a thoughtful working agenda that will enhance their problem-solving abilities.

Gail Berenson, Professor Emerita of Piano at Ohio University, Athens, is a powerful advocate on musicians’ health issues. She chairs the College Music Society’s Committee on Musicians’ Health, ISME’s Musicians’ Health and Wellness Special Interest Group and is the founding chair and continuing member of the NCKP Committee on Pianists’ Wellness.  Past President of Music Teachers National Association, she was the recipient of its 2015 MTNA Distinguished Service Award.


March 23, 2018:

“Team Teaching a Wellness Course” – Dr. Linda Cockey, Dr.Pat Lamboni, and Dr. Robert McBrien,

Teaching a course that educates students about musicians’ health and safety can be accomplished in many ways. This discussion will review how three professors have combined their different disciplines (music, athletic training and psychology) to develop a course that teaches the essential skills music students need in developing a musculoskeletal and psychological awareness as a musician that directly applies to healthy practice and performance techniques.

Dr. Linda Cockey teaches at Salisbury University where she is professor of piano and co-instructor of the Wellness in Performance course. She chair’s the editorial board for MTNA’s e-Journal, is a member of CMS’s musician’s health committee and a member of the wellness committee for the National Conference on Keyboard Pedagogy (NCKP). She is author of MTNA’s Annotated Bibliography on Wellness Resources.

Dr. Pat Lamboni, Head Athletic Trainer at Salisbury University, is an instructor in the Athletic Training program and co-developer with Drs. Linda Cockey and Bob McBrien for a Wellness class within the music program at Salisbury University. Lamboni works with over 450 athletes annually and 21 varsity teams where he is responsible for their care, prevention, management and rehabilitation after an injury occurs. He is a member of the Athletic Trainers Association where he has also presented.

Dr. Bob McBrien is a Professor Emeritus and adjunct professor at Salisbury University (MD). In Wellness in Performance he teaches effective peak performance skills within a Wellness model. McBrien is a certified Tai Chi instructor and author of articles about stress management. For many years before an early retirement, he was Director of the Student Counseling Center at SU.

Go To Webinars

Australia’s major symphony orchestras welcome report on orchestral health and safety – MEDIA RELEASE

Wednesday, July 12th, 2017


For immediate release


Australia’s major symphony orchestras welcome report on orchestral health and safety

The Adelaide, Melbourne, Queensland, Sydney, Tasmanian and West Australian Symphony Orchestras welcome the delivery of a major report on world’s best practice in occupational health and safety for orchestral musicians.

The first of its kind internationally, the Sound Practice project involved the collaboration of the six symphony orchestras, along with Orchestra Victoria and the Australian Opera and Ballet Orchestra. Funded by the Australian Research Council and the Australia Council for the Arts, the project was set up in response to recommendations of a 2005 review of orchestras carried out by James Strong.

A team of internationally renowned professionals led by Dr Bronwen Ackermann, a biomedical scientist based at the University of Sydney, conducted a five-year study into the current WHS practices and policies of Australian orchestras. In addition to assessments and interventions, the team has published multiple academic articles on all aspects of musicians’ health and safety. In addition to a report, the team has produced a practical handbook for use by orchestral musicians.

Health and safety of musicians and all employees is a key priority for Australia’s six symphony orchestras, which collectively employ over 2500 people. “We are pleased that this report highlights the significant measures taken by the orchestras to ensure the health and wellbeing of our employees” stated Vincent Ciccarello, Managing Director of the Adelaide Symphony Orchestra.

“We have worked with Bronwen and her team to identify areas where we can strengthen our WHS practices and will implement their recommendations, as well as making the Health Handbook available to all musicians.”

Chief Executive of the Queensland Symphony Orchestra, David Pratt added “Like the other orchestras, QSO was delighted that so many of its musicians were able to participate in this long-term study. We look forward to sharing the report and its accompanying handbook with the whole orchestra”.

The Sound Practice final report and Health Handbook for Orchestral Musicians will be made available to the public through the participating orchestras’ websites, as well as from the Australia Council for the Arts.

MEDIA: For further information please contact Kate Lidbetter at Symphony Services International: or 0429 334 701.

Adding aquatic fitness to physical training routine

Wednesday, February 15th, 2017

From Athletes and the Arts affiliate Drum Corps International:
“Jersey Surf adds aquatic fitness to physical training routine”, by Chris Weber, 02/08/2017
150 members of Drum Corps International took over the natatorium at Camden County Technical School for an 80-minute high-intensity training session in the pool.
Read and watch the details

Preventing Overuse Injuries in Instrumentalists

Sunday, January 8th, 2017

There are basically two types of injuries: acute and overuse. Acute injuries are usually the result of a single, traumatic event. Overuse injuries, on the other hand, occur to tendons, muscles, joints, and other tissues as a result of repetitive activity that creates small amounts of trauma over time. Common examples include carpal tunnel syndrome, wrist tenosynovitis, and muscle/fascia pain syndrome. Instrumentalists often sustain overuse injuries in the hand, wrist, and arm muscles and tendons, as well as weakness and spasms in the arm, shoulder, and upper back muscles.

Read More

Download the PDF

Expert Consultant:  Jeffrey A. Russell, PhD, ATC

Injury Prevention: What Musicians Can Do

Tuesday, November 1st, 2016

Submitted by Music Teachers National Association (MTNA)
MTNA webinar by Christine Guptill
Streamed live on Oct 21, 2016

Since many musicians’ injuries are related to practice habits, music teachers can and should play a vital role in injury prevention from the start. This webinar offers some clinical and research-based information to help teachers and students identify risks and prevent problems before they start.