Injury Risk Factors for Musicians

Playing a musical instrument, like all activities in the performing arts, carries a certain amount of inherent risk of developing an injury. However, identifying the injury risk factors instrumentalists face isn’t always easy since nearly all injuries instrumentalists suffer are chronic injuries (also called “overuse injuries”). It’s much easier to identify risk factors for a traumatic injury, because these injuries are typically caused by a single incident (like a fall or collision), whereas chronic injuries are caused by a combination of a number of predisposing factors and events.

Risk Factors

The things that put an instrumentalist at risk of developing an injury can be classified as either internal or environmental. Generally speaking, internal risk factors can be controlled or even eliminated while environmental risk factors are harder to control. The best way to mitigate the injury risk presented by environmental factors is to develop healthy accommodations and coping strategies that do not compromise safety.

Internal Risk Factors

The internal factors that contribute to injury can be classified into one of three categories: the overall physical health and fitness of the body, how the body is used during a given activity, and psychological well-being and coping strategies.

• Overall Physical Health and Fitness of the Body
• Poor cardiovascular fitness/conditioning
• Inadequate muscle strength and endurance, especially in the trunk/core and upper extremities
• Improper posture
• General fatigue
• Poor Nutrition (inadequate Caloric intake, unbalanced meals, irregular eating schedule) and unhealthy heating/snacking habits
• Dehydration
• Poor sleeping habits, irregular sleep schedule, inadequate amount of sleep
• Poor balance ability and joint position sense (proprioception)
• Lack of agility
• Illness or otherwise-compromised immune system
• How the Body is Used During a Given Activity
• Using certain muscle groups more than their counterparts leads to muscle imbalances. Typically: short, tight flexors and lengthened, improperly-used extensors
• Repetitive movements (see this article on tendinitis for an explanation of how repetitive movements lead to microtrauma, which can lead to an “overuse injury”)
• Maintaining an uneven position, especially when holding or supporting a weight. Examples:
• upper strings (left arm supports instrument while right arm is generally much lower)
• bassoon (instrument goes to the side of the body)
• flute/piccolo
• transporting an instrument in its case (other than small woodwind)
• potentially heavy
• bulky case
• straps may promote carrying instrument case to one side of the body instead of supporting it across entire body (or there is only a handle, so you must carry it on one side)
• carrying other objects at the same time (backpack/bag, food/drink, stand and music, chair, etc.)
• Maintaining a relatively static posture and position for an extended period of time (leads to fatigue)
• Improper mechanics/technique
• Poor posture
• Long periods of activity (even a relatively static activity like playing an instrument) with inadequate breaks
• Psychological Well-Being and Coping Strategies
• Mental fatigue/decreased attention
• Excess muscle tension caused by psychological distress
• Inability to adequately cope with negative stress
• Striving for perfection, when it becomes an obsession and interferes with daily life and life-sustaining activities and behaviors (eating, sleeping, etc.)
• Psychological distress caused by environmental risk factors (see below) and the physical, emotional, and psychological demands of playing an instrument. This distress can lead to further internal risk of injury by causing:
• Poor physical and mental health
• Poor sleeping, eating, and hydration habits
• Withdrawal from other activities, including social situations, exercising, and relaxation time
• Higher-risk practice habits like long hours, high-intensity or high-repetition sessions, and a decline in the amount, length, and quality of breaks
• Excess muscle tension

Environmental Risk Factors

A musician’s risk of injury can be significantly amplified by a number of environmental factors experienced during rehearsals and performances. The most common environmental risk factors encountered by instrumentalists relate to:

• The number, length, and intensity of rehearsals
• The degree of difficulty of the repertoire and the musician’s familiarity with it
• The legibility of the score
• The lighting conditions
• Acoustic properties of the environment
• The musician’s proximity to certain other instruments and instrumentalists
• The ambient temperature affecting both the instrument and the musician
• The comfort of the chair/stool, if applicable

While these factors pose a threat to the performer in a variety of interrelated ways, they can generally be grouped into 4 mechanisms through which they increase the performer’s risk of injury: factors that cause physical fatigue or repetitive microtrauma; factors that negatively influence posture, technique, or mechanics; factors related to the safety of the playing environment; and factors that contribute to psychological distress. The following table identifies how environmental risk factors and mechanisms interact.

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