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Performing Artists: Musicians and Vocalists
Where do injuries come from 
Overuse 
Accidents 
Improper Form 
Improper Adjustments
Warm up 
Move through the entire range of motion 
Neck, shoulder, arms, wrists, fingers 
Gradual increase of speed and tempo 
Gradual increase of range of sound 
Standard or preparatory
“Rest” Breaks 
Active recovery 
Movement to counteract muscle 
imbalances 
Movement to increase overall body 
circulation 
Cool Down
Combined effects of work 
Time at rehearsal 
Time at play 
Difficulty of piece 
Number of pieces
Posture 
Standing general posture 
Seated at 
instrument 
Hypermobility 
Ergonomic aids
Instrument Fit 
Alterations to fit mobility 
issues 
Carrying of instruments 
Playing posture 
Mouthpieces 
Hand placement
General physical condition 
Need for endurance in play/performance 
Posture 
Counterbalance imbalances due to 
holding single position 
Strengthening 
Flexibility 
Stability 
Increased focus
Pain/Discomfort 
Pain / Discomfort 
Worsens with play? 
No Yes 
Worsen next day? Can change of position lessen? 
Yes 
Lessen int. but sharp or Can decrease Adjust and play 
Try again radiating(deep ache)? intensity lessen? 
Yes 
Play thru Play but Get seen play at decreased time/ 
Get evaluated and treated intensity and GRADUALLY increase 
Yes 
Yes 
No 
No 
No 
No
Thank you 
Shannon Ashe, MEd, ATC, CSCS 
Clinical Coordinator for Athletic Training 
Education Program 
Department of Kinesiology 
School of Health Professions 
sashe@samford.edu 
205-726-4143

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Prevention of musculoskeletal injuries in performing artists

  • 2. Where do injuries come from Overuse Accidents Improper Form Improper Adjustments
  • 3. Warm up Move through the entire range of motion Neck, shoulder, arms, wrists, fingers Gradual increase of speed and tempo Gradual increase of range of sound Standard or preparatory
  • 4. “Rest” Breaks Active recovery Movement to counteract muscle imbalances Movement to increase overall body circulation Cool Down
  • 5. Combined effects of work Time at rehearsal Time at play Difficulty of piece Number of pieces
  • 6. Posture Standing general posture Seated at instrument Hypermobility Ergonomic aids
  • 7. Instrument Fit Alterations to fit mobility issues Carrying of instruments Playing posture Mouthpieces Hand placement
  • 8. General physical condition Need for endurance in play/performance Posture Counterbalance imbalances due to holding single position Strengthening Flexibility Stability Increased focus
  • 9. Pain/Discomfort Pain / Discomfort Worsens with play? No Yes Worsen next day? Can change of position lessen? Yes Lessen int. but sharp or Can decrease Adjust and play Try again radiating(deep ache)? intensity lessen? Yes Play thru Play but Get seen play at decreased time/ Get evaluated and treated intensity and GRADUALLY increase Yes Yes No No No No
  • 10. Thank you Shannon Ashe, MEd, ATC, CSCS Clinical Coordinator for Athletic Training Education Program Department of Kinesiology School of Health Professions sashe@samford.edu 205-726-4143

Editor's Notes

  1. Overuse: Average performing artist rehearses hours a day. More so when learning a new piece. Accidents: In other words, acute injuries. Much less likely but still possible Improper form: There are various schools of thought to the play of each instrument and in how to hold onesself singing. Form that causes pain is an indication of something not working right. Alexander Technique: unconscious change – directed by teacher through physical biofeedback conscious change: - awareness of a habit - inhibition – thought and action stopping (not changing just not doing) - conscious control – directing appropriate change Feldenkrais Method: break down movement into its learned components if technique is not producing or is causing pain, see where they skipped in learning process and recreate no “right and wrong” Physicals: Specific for musicians Proposed by Neward and Weinstien in ‘95 include specific history: practice schedule exercises – wu, cd, specific to instrument, other activities training / education level Previous treatments: including Feldenkrais and Alexander Musculoskeletal – include posture with and without instrument hypermobility identified other muscle specific changes (fasciculations, atrophy, strength imbalances)
  2. ROM – need to make sure full ROM is achieved bilaterally to limber muscles that will be called upon during play and prevent imbalances Speed and Tempo need to be eased into Range of sound, especially vocal, need to be eased into Standard – Scales Preparatory – shortened version of piece to reherse/play or known piece that can gradually increase range and speed
  3. Use cool down to counteract imbalances during play and to reestabilish full bilateral range of motion
  4. Rehearsal begins with warm up. Need to factor in any performance times occuring on same day Need to factor in any individual lessens on same day Difficulty of piece can cause overuse and abuse issues Multiple technique changes can cause stress
  5. Standing general posture – forward head tilt pelvic tilt affects balance and body recovery Seated at instrument – pelvic tilt head tilt lumbar/thoracic Hypermobility – some may be needed ain’t broke don’t fix it…unless there is some underlying pathologies Ergonomic aids – multiple aids out there to adjust for mobility issues with various instruments braces to encourage proper posture – neck, back, shoulder, elbow, wrist
  6. Hand size Arm length Playing posture – rounding of shoulders lead to nerve entrapment Mouthpieces – in addition to standard issues of mouth, also position of head when in contact with mouth piece Hand placement – neutral wrist, pressure through finger tips whenever possible.