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Teaching Health & Outline of Today’s Talk

Safety with •  State of prevention education

•  Prevalence of injuries
Curriculum 2010 •  Risk factors for injuries
•  Musicians’ mental health
© Christine Guptill •  Common injuries and treatment
BMus, BSc, MS(OT), PhD •  Demonstration
Christine_Guptill@alumni.uwo.ca

Introduction Prevalence of Injuries

•  Who I am and why I do this •  84% lifetime prevalence in professionals
–  BMus oboe performance •  Physical, emotional, hearing loss
–  Registered occupational therapy •  The key: early education on prevention;
–  Research dedicated to musicians’ health educate the educators
–  Board member and vice-chair research at
Performing Arts Medicine Association
•  What instruments do you play?

State of Prevention Education State of Prevention Education

•  US: Health Promotion in Schools of Music •  Present in Ontario curricula, both
•  UK: British Association for Performing Arts elementary and secondary
Medicine •  More presence in secondary
•  Netherlands: starting an RCT at 5 •  Ask for training from OTF!
conservatories
•  Canada: Not required for schools of music;
discussion just beginning

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Elementary Curriculum
•  Health & Safety in Arts Education
Ensure that safe practices are followed in all
performance tasks. For example, have students
do warm-up exercises before dance activities,
drama activities, and singing.
Secondary Curriculum
•  Health & Safety in the Arts: Students must be
able to demonstrate knowledge of the equipment
being used and the procedures necessary for its
safe use. In planning learning activities to help
students achieve the arts curriculum
expectations, teachers need to ensure that
students have opportunities to consider health
and safety issues.
Grade 11
•  Grade 11: explain the importance of and demonstrate safe
and healthy practices associated with practicing, performing,
and listening to music (e.g., ergonomic considerations
associated with playing various instruments and using
computers; connections between respiratory health and the
rehearsal environment; safe sound levels in rehearsal and
performance settings and when listening to recorded music)
•  Teacher prompts: “What are some common injuries or
physical problems that musicians are subject to? What
measures could they take to help reduce the incidence of
these injuries?” “Why is it important for a vocalist to conduct
warm-up exercises before a performance? What are some
appropriate exercises?”
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Elementary Curriculum
•  Grade 8: maintain straight and relaxed
posture when singing or playing; keep
instrument, hand, arm, and/or mouth in
playing position; use proper breath,
bow, or stick control
Grades 9 & 10
•  Grade 9 & 10: identify and describe key
physical and health considerations associated
with practicing, performing, and listening to
music (e.g., the correct body posture for
playing their musical instrument; the function
of the major muscles and the skeleton in
performance situations; the risks from
exposure to loud sounds and the precautions
necessary to protect hearing when performing
or listening to loud music)
Grade 12
•  Grade 12 (university/college preparation):
demonstrate an understanding of performance-related
injuries connected to the field of music and ways of
minimizing such injuries (e.g., the impact on the
auditory system of repeated exposure to loud sound;
injuries that can result from poor posture, playing
position, or technique; the purpose of various types of
protective or ergonomic equipment)Teacher prompt:
“What types of repetitive strain injuries are a concern
for musicians? What can be done to reduce their
incidence?”
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Grade 12 AMU4E Risk Factors: Non-modifiable

•  Workplace Preparation: Demonstrate an understanding of •  Gender
safe and healthy practices related to the field of music, with
an emphasis on maintaining a healthy lifestyle and •  Instrument played
preventing performance-related injuries (e.g., create a radio
ad outlining the importance of hearing protection for
•  Size of the player
musicians and audiences; create an online or video public •  Age
service announcement on the issue of drug and alcohol
abuse in the music industry and its impact on careers and •  Joint hypermobility (?)
families)
•  Teacher prompt: “How would you describe the sound levels
at a rock concert? What phenomena produce similar levels
of sound? In which occupations are workers exposed to
similar levels? What precautions do these workers take?”

Risk Factors: Semi-modifiable Risk Factors: Modifiable

•  BMI •  Posture & positioning
•  Unfamiliar instruments •  Breaks
•  Repetitive movements •  Warm-up and cool-down
•  Sudden increase in time spent playing •  Practice techniques
•  Stress and anxiety
•  Awkward body positions
•  Technical difficulty of repertoire

Stretching Stretching: Try it!

•  No evidence that it prevents injury in •  Wrist flexion/extension
musicians •  Shoulder stretch: front, back, and corner
•  DON’T bounce, overstretch •  Neck/back extension
•  DO hold stretches for 15-30 sec. •  Neck side stretch
•  DO warm up first

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Posture & Position Warm Up

•  Sit tall and loose •  Warm the body (hands, feet, etc)
•  Stand with soft knees
•  Physical AND musical warm-up
•  Wear comfortable clothes, supportive shoes
•  Breathe into ribcage •  Long, slow, mezzo forte tones
•  Neutral joints: not too bent or straight •  Beautiful sound
•  Sitting: right angles or forward •  If stretching: warm up first
•  Stand height: line of sight to conductor
•  MOVE! 

Cool Down Smart Practice

•  It’s important!
•  Long, slow, mezzo piano tones
•  If applying cold, do so now
•  If stretching: at the end
•  Practice difficult passages slowly
•  Build muscle memory
•  Be precise with fingering, not tense
•  Change rhythm
•  Start passage one note before and after,
then 2, etc

Smart Practice (cont’d) Tension

•  Practice rests •  Be aware of tense body parts:
•  Take breaks every 15-30 minutes –  Knees
–  Shoulders/neck
•  Mental rehearsal
–  Hands
•  Visualization –  Temples
•  Prepare, don’t crash practice –  Jaw
–  Eyes

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Tension (cont’d) Watch Out For:

•  Relaxation during warm up, cool down •  Pain
•  Check for tension during rests, breaks
•  Numbness, tingling, pins & needles
•  Have a friend watch you for tension
•  Plan fingering, bowings to minimize effort •  Waking up with sore hands/wrist
–  E.g.: Alternate fingerings (e.g. right hand, then
left, then right)
•  Rest instrument on knee, in other hand

Musicians’ Mental Health Perfectionism

•  1/4 to 1/3 of musicians experience anxiety,
depression, nervousness
•  Affects physical health too!
•  Goes along with the personality of
musicians
•  Adaptive: to be good, one must be a
perfectionist
•  Tip: Students should not compare
themselves to edited, professional
recordings

Physiology of Stress What To Do

•  Increased heart rate
•  Increased blood pressure
•  Digestive problems
(nausea, diarrhea)
•  Trembling/shaking
•  Sweating
•  Shortness of breath
•  Numb fingers •  Control: do things they think will help
•  Clammy hands
•  Dry mouth
•  Accept symptoms as normal
•  Headache, dizziness •  DON’T over-practice
•  Slower reaction time •  Get some sleep!
•  Decreased fine motor
skills

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What To Do What To Do
•  Positive thinking •  Visualization
–  Focus on present –  See the audience, music, instrument
–  What do you do well? •  Distraction
–  Monitor self-talk –  Go out and do something else!
–  Talk to friends/family who think you are great! •  Massage
•  Muscle relaxation
•  Deep breathing

Relaxation: Try it! Exercise

•  Eyes closed •  Decreases depression, stress, tension
•  Hands, feet, legs, arms tight! •  Increases cardio fitness
•  Relax •  Increases core strength
•  Listen to breath •  Yoga/Alexander/Feldenkrais: body
•  Thoughts are like leaves awareness
•  Shoulders, legs, belly, temples, jaw,
tongue, eyes
•  If mind drifts, bring it gently back to breath

Nutrition Hearing
•  Low fat •  Non-custom earplugs ~9 dB
•  Balance:
•  Custom 15-25 dB; cost $150-200
–  fruits/vegetables (B, C vitamins)
–  Protein •  Limit hours of exposure
–  Complex carbohydrates
•  8 hours, 85 dB
•  Smoking
•  Alcohol
•  3 dB exchange rate:
•  HYDRATE –  88 dB for 4 hours
–  91 dB for 2 hours
–  94 dB for 1 hour

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Hearing
•  Monitor sound in classroom!
–  Visual display at front of room?
•  Lots of free apps for sound monitoring
•  Treble brass very directional; on risers
•  Carpet; curtains; ceiling
HELP, my student is hurt!
•  Review key points from earlier slides
•  Review technique with experienced player/
private teacher
•  Get to know practitioners with expertise in
PRMD
•  Medical Problems of Performing Artists
•  My 2010 article in MEJ
Common Injuries
•  Upper extremity (hand, elbow, shoulder)
•  Back and neck
•  Facial musculature and teeth
•  Skin disorders (mouthpiece, wood finish)
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Vocal Strain
•  Hydrate, hydrate, hydrate
–  No caffeine; no mint
•  Reflux common, underdiagnosed
•  Breathe into intercostals
•  Use an FM system
•  See a Speech Language Pathologist
(SL-P)
First Steps to Recovery
•  Check setup, posture
•  Discuss sleep habits (curled wrists, arms
over head, on stomach)
•  Rest from other activities (carrying case,
computer, Wii, texting)
•  Examine practice routine
•  Incorporate rest into playing
Common Injuries: Muscle/tendon
•  Pain, esp. with movement/use
–  Tendonitis
–  Tenosynovitis
–  Epicondylitis (tennis/golfer’s elbow)
–  Repetitive strain (RSI), overuse syndrome
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Muscle/Tendon Injuries Muscle/Tendon Injuries

•  Red, swollen, sharp pain •  Dull ache
–  Ice: indirect, 15-20 min, 4x daily –  Joint pain; older injury
–  Best after activity –  Heat - moist is best; hot water bottle
–  Substitute: cold water soak, 5 min –  15-20 min, 4x/day
–  Rest from aggravating activities –  Lots of stretching

Common Injuries: Nerve Demonstration

•  Numbness, tingling, pins/needles, itching •  Volunteers?
•  Can be result of swelling!
–  Carpal Tunnel Syndrome
–  Cubital Tunnel Syndrome
–  Guyon’s Canal Syndrome
–  Thoracic Outlet Syndrome
•  Check position, pressure, sleep

Thank you!