In 2002 the University of North Texas ran a study to discover what medical issues brass musicians suffer from as a result of playing their instrument. There were a total of 739 subjects taking part in the study who were categorised by gender and instrument with an exception of tuba, euphonium, and baritone horn being grouped into ‘lower brass’. It was revealed that “60% of the brass musicians reported having one or more musculoskeletal problems. The trombone group reported the highest rate (70%)” (K. Chesky, 2002, p.93).The variables of the musicians included age, gender, height, weight, years of formal college instruction in music, hours of practice per day, and number of exercise hours per week as seen in Figure 1.0. To measure the musculoskeletal effects, each participant was required to select which areas of the body they felt pain or tension out of sixteen options and grade it on a five point scale as explained in the Figure 1.1.
From the results of the musculoskeletal sites seen in Figure 1.2 and 1.3, it was determined that for trombone players the four body parts with the highest prevalence rates were “the left shoulder (22.8%), left hand (20.7%), and left wrist (20.2%)” (K. Chesky, 2002, p.94). The body parts that recorded the highest pain severity levels were the right elbow (2.66), left elbow (2.47), left lower back (2.06) and right finger (2.00). In general this aligns with the demands of the instrument given that typically the weight of the trombone and resistance against the embouchure is supported and generated by the left hand. In comparison, the right arm, wrist and hand need to remain fluid and relaxed in order to operate the slide efficiently. Typically as the right arm operates in motion and the left arm is static (for right-handed musicians) - the right arm, wrist and hand is generally given more attention. It makes sense then that with less attention being brought to the left arm that this is where the problems arise.
The study revealed that only 33% of the participants reported that they stopped playing due to fatigue and all four groups reportedd high severity rates in the right elbow and the left and right lower back with a mean of 2.66, 2.41 and 2.42 respectively. The high severity rates in multiple body parts across all participants suggests that the musicians in the study are not taking enough breaks to move or stretch. This implies that rest remains a wider issue for this group of brass musicians. This is an issue that is spoken on further in the interview with Amelia Rosenberger.
This study offers an in-depth take on musculoskeletal injuries in the brass profession as the results are split by instrument. The study also included a large number of participants who were experienced in the profession. However, there are some limitations to this study. Firstly there is a highly unbalanced gender ratio which means the results do not fully represent the female experience with injury in the brass profession. Another demographic that is not fully represented by this study is musicians that have had to end their career due to injury. The results only represent musicians currently living with injury, not musicians who are unable to play due to injury. This is a demographic that I explore later in the Chapter. Furthermore, the participants were chosen on a recruitment basis which allows for selection-bias. Therefore it is important to view the results as based on a sample rather than generalising them to brass musicians outside of the study. So whilst I believe this is an effective study that offers insight into injury in the brass profession, it is important to consider these limitations when analysing the results.
To summarise the findings of the University of North Texas Health survey we can see that musculoskeletal and non-musculoskeletal injuries are suffered by brass musicians at a severity level that warrants concern. The areas that require most attention from brass musicians as a whole are the lower back and right elbow and for trombone players the areas of highest concern are the left side of the upper body and lower back. There also appears to be a wider issue of playing through fatigue.
Playing-related injuries are a devastating issue in the music profession. According to the results of a survey carried out at the International Conference of Symphony and Opera Musicians (ICSOM), “82% of ICSOM musicians reported experiencing a medical problem, and 76% listed at least one problem as severe in terms of its effects on their performance.” (M. Fishbein, 1987, p5). In my motivation to discover what body parts are most prone to injury in brass playing musicians, it is important that I assess the existing research on this topic to gain insight into the field of injury prevention and to provide comparable data for my own case study. To accomplish this I analyse and critique the data produced from a study carried out at the University of North Texas. The aim of the study was to discover the medical problems most prevalent in brass musicians.
From the 739 musicians that took part in the study, 189 were trombone players. Interestingly, despite the participants being chosen on a recruitment basis still only 10% are female. This is important to consider as the results displayed “consistently higher prevalence rates for females compared with males. In many cases, the prevalence rates were more than twice as high for the females” (K. Chesky, 2002, p.94). Therefore, by having only 10% of the participants representing a demographic that displays the highest prevalence rates, it calls for a greater need for research in this area.
There have been multiple studies carried out to determine the effectiveness of yoga as a method of reducing performance anxiety and they predominantly present similar positive results. A champion of this subject is Professor of Medicine at Brigham and Women’s Hospital Sat Bir Khalsa who has dedicated his academic life to promoting the health benefits of yoga. Conducting and evaluating interventions to treat insomnia, post-traumatic stress disorder, chronic stress, and anxiety disorders, he is one of the leading experts in Yoga Therapy. He has also contributed to four papers investigating the psychological and physiological effects of a yoga intervention on musicians (Khalsa, Sat Bir. 2016), (Stern, J et al. 2012), (Khalsa, S. B. 2009), (Khalsa, Sat Bir. 2006). All four papers present positive results in both psychological and physiological well being, and further solidifies the case for yoga to be included in the music curriculum.
In 2007, Sat Bir Khalsa carried out an intervention over six-weeks with 135 musicians with an average age of 16 attending the prestigious summer course of the Boston University Tanglewood Institution. The aim of the study was to determine if yoga is an effective method at reducing music performance anxiety (MPA), mood disturbance, and the prevalence of playing-related musculoskeletal disorders in young musicians.The participants were split into two groups with 84 participants in group 1 receiving three 1-hour Kripalu yoga and meditation classes a week and group 2 receiving no yoga tuition - therefore acting as a control group. Three methods were used to collate the results: The Performance Anxiety Questionnaire (PAQ), The Profile of Mood States (POMS), The Performance-Related Musculoskeletal Disorders (PRMD) questionnaire. From the results of the Figure 1.4 we can see that over the course of the summer programme MPA reduced for both groups however, in all three categories MPA was reduced significantly more in the yoga participants’ group than in the control group.
Having determined that there is a direct link between performance anxiety and muscle tension (Miller, S. R., & Chesky, K. 2004, p12-20) and that yoga is an effective method of reducing performance anxiety from reviewing Sat Bir Khalsa’s case studies, it validates that integrating the mental as well as the physical practices of yoga will support the treatment of a playing-related injury.
