To You and Your Students’ Good Health: Q & A Column 2022

Compliments of the CMS Committee on Musicians’ Health

The Musicians’ Health Committee, comprised of medical professionals and music faculty, all strong advocates for musicians’ health, is happy to bring you a Q & A column for this month's CMS Newsletter. If you like this idea, please send us your musicians’ health-related questions which we will direct to our committee members, or other professionals with whom we have contact, to be answered in future newsletters. Linda Cockey and, Heather Malyuk Committee Co-Chairs.

Q:“What does Positive Psychology offer to teachers preparing their music students for upcoming performances?”
Answered by Robert McBrien, PhD, Professor Emeritus, Salisbury University: December, 2022.

Dr. McBrien (Dr. Bob) is a career educator with a broad base of university teaching and over 25years experience as the Director of Counseling Services. He is a Licensed Clinical Professional Counselor in Maryland (Ret.) Along with personal and group counseling he provided performance psychology-based counseling to athletes and students dealing with stage-fright. His earlier experiences in Education include Elementary classroom teacher, Guidance Counselor in public schools in Connecticut and Assistant Professor of Education at Salisbury University (Maryland). For over 25 years, under the leadership of Dr. Linda Cockey, Dr. Bob has been involved with developing and teaching a 3-credit course in SU’s Music Department titled, “Wellness in Performance”. From its inception the focus for instruction was to use “student -as- athlete” approach to lessons. Retired for over 20 years, Dr, McBrien continues to teach. He now teaches Tai Chi for Wellness and Fall Prevention to other retirees locally.

A: Positive Psychology (PP) offers knowledge, skills and practices which offer solutions to the host of stressors, pressures and mind-body reactions that interfere with a performer’s goal of presenting a “peak performance.” A “strengths-focused” psychology, PP is recognized for its “positivity.”
PP offers students a set of skills and effective methods for preparing students for their recital, audition or solo.

Following is a list of the topics covered in our Wellness in Performance 3 credit course:

The difference between the Sympathetic Nervous System (SNS) and the Parasympathetic Nervous System (PNS) and the steps to take to activate the PNS.
Effortless Diaphragmatic Breathing, also known as Yoga Breathing,
Deep Muscle Relaxation (DMR) for stress management,
Four Square breathing and other Mindfulness training methods,
Use of Visualization a.k.a. guided imagery,
The psychology and effective applications of Affirmations

With this “tool kit” students learn and practice the four steps to a Peak Performance.
The four steps are:

Use breathing, relaxation or mindfulness techniques to achieve calm, alert relaxation (PNS).
Steps to visualize a past positive “best” memory of a musical performance (Mental Recall),
Create 3 or 4 affirmations related to your “best” performance (i.e., “I am calm, I am focused”). Affirmations
Visualize yourself in the future performing your music and you are calm and focused
(Mental Rehearsal).

Readers interested in learning from the masters of Positive Psychology, Performance Psychology and Peak Performance Training can take advantage of many YouTube videos, especially TED talks. Always look for videos from academic sources. You can search any of the topics presented here and learn from folks who are masters of these evidence-based methods work.

Suggested Positive Psychology resources as listed below:

Martin Seligman, PhD. (TED Talk): The New Era of Positive Psychology: https://www.ted.com/talks/martin_seligman_the_new_era_of_positive_psychology?utm_campaign=tedspread&utm_medium=referral&utm_source=tedcomshare
Barbra Fredrickson, PhD. (Not a TED talk): Positive Emotions Transform Us.
Greater Science Center: https://greatergood.berkeley.edu/video/item/positive_emotions_transform_us
Carol Dweck, PhD. (TED talk): The Power of Believing You Can Improve: https://youtu.be/F_S96JEhJAc
Angela Duckworth, PhD. (2018) Grit: The Power of Passion & Perseverance. New York: Scribner. TED Talk: https://www.ted.com/talks/angela_lee_duckworth_grit_the_power_of_passion_and_perseverance?language=en
Amy Cuddy, PhD. (TED talk):Your Body Language May Shape Who You Are https://www.youtube.com/watch?v=r7dWsJ-mEyI
Kelly McGonigal, PhD. (TED talk): How to Make Stress Your Friend: https://www.ted.com/talks/kelly_mcgonigal_how_to_make_stress_your_friend?language=en
Lucas Rockwood. (TED talk): Change Your Breath, Change Your Life: https://www.google.com/search?client=safari&rls=en&q=Change+Your+Breath,+Change+Your+Life&ie=UTF-8&oe=UTF-8 - kpvalbx=_EKlFY7mhAaXk5NoPrt6qsAw_25
Mihaly Csikszentmihalyi, PhD. (TED talk): Flow, The Secret of Happiness: https://www.ted.com/talks/mihaly_csikszentmihalyi_flow_the_secret_to_happiness?language=en
Richard Davidson, PhD. (TED talk): How Mindfulness Changes the Emotional Life of the Brain: https://www.youtube.com/watch?v=7CBfCW67xT8

Q:“What are tinnitus and hyperacusis, and how can I best manage the symptoms that occur if I have either one or both?"
Answered by Marc Fagelson, PhD: October, 2022.

Marc Fagelson, PhD, is a professor in the Department of Audiology, at East Tennessee State University. Fagelson, is a nationally known expert on tinnitus, has written numerous articles on tinnitus, and has authored a TED-Ed video on tinnitus which has garnered over 6 million views. For further information regarding his work, see: https://www.etsu.edu/etsu-news/2020/08-august/fagelson-ted-ed.php.

A: Tinnitus and hyperacusis, or disordered sound tolerance (DST), are common symptoms associated with damage – sometimes subtle and not revealed in the standard hearing test – to the hearing system. At the same time, pathology or damage that produce these symptoms, such as noise exposure, aging, or the effects of some medications, usually cannot be repaired or fixed. This is why a consistent cure, such as provided by an antibiotic for an ear infection, remains elusive.

Large scale studies of patients with tinnitus and DST reveal the conditions are most commonly subjective as they are evident only to the affected person. Injury that degrades auditory system integrity often produces predictable consequences; tinnitus and DST emerge as consequences of the central nervous system’s (CNS) adaptive response to decreased function. The complexities of the peripheral and central auditory pathways suggest multiple potential sites for damage, and similarly, multiple targets for the CNS to employ an adaptive response; not surprising that tinnitus and DST are associated with action across numerous complex generator sources and mechanisms. The CNS, often without a person’s conscious awareness, implements compensatory adjustments – neuroplasticity – in response to changes in peripheral function. Tinnitus and some forms of sound intolerance could therefore be conceived of as by-products of normal CNS function, perhaps an auditory version of limping in that most people who sprain an ankle limp without consciously deciding to limp, their CNS adapts to the injury in real time and automatically (that is, unconsciously) changes the person’s gait.

Tinnitus and DST are perceptual events that influence, and are influenced by, the physical and psychological state of the patient. Tinnitus and DST are rated as more severe by those patients who also experience anxiety and depression. Similarly, it is common for patients bothered by tinnitus and DST to report that the symptoms worsen emotional state. For example, the sudden onset of a tinnitus sound coupled to a traumatic event will likely produce a more intrusive tinnitus, one linked to traumatic memories and related emotions, when compared to a gradually-emerging tinnitus that a patient attributes to the natural effects of aging and hearing loss. The sound itself, perhaps a high-pitched tone, may be similar for the two patients, yet their ratings of severity and tinnitus-related handicap may vary substantially due to the different emotional responses provoked by tinnitus. Therefore, management of tinnitus and DST rely at least in part to addressing a patient’s emotional state. This is one reason that cognitive-behavioral therapy provides the strongest evidence base as an intervention for these stubborn symptoms.

Although it is well-known that no “silver bullet” cures exist for tinnitus and DST, several intervention approaches can influence the severity of the symptoms. Common practice affirms that when tinnitus is accompanied by hearing loss, the hearing loss should be managed first. In some cases, the use of a hearing aid improves not only communication, but provides tinnitus relief through a combination of interference (or masking) and reduced listening effort during routine activities. Other sounds, such as rain falling, ocean waves, or machine-made versions of such sounds can improve a patient’s sleep. We often suggest that a patient may fall asleep on rainy nights more easily than on quiet nights, and the majority agree. Provision of a sound generator, or smartphone apps, may contribute to a better sleep environment.

With regard to DST, sound enrichment is also an important element of intervention. Particularly for musicians, the observation that some environments are uncomfortable, or perhaps painful, may impose, at first, restrictions regarding performing and rehearsing. Over time, the problems may generalize to other situations and places. The intuitive response in such cases would be to employ hearing protection in an increasing number of environments. Unfortunately, doing so in many cases worsens the problem. One way to think about this situation is to consider the aforementioned auditory mechanism damage. If the CNS is provided by the hearing system a signal weaker than that provided in the past, then an adaptive response would logically feature some form of amplification or enhancement of the neural response. The more deprived the auditory input, as would be produced by hearing protectors, may increase the vigor with which the CNS adapts. We urge patients with sound tolerance issues to practice desensitization, allow for exposures to sound rather than avoiding and overprotecting. This is a lot of ask of a patient, and it is a good idea to carry hearing protectors when adverse environments are anticipated. Use of the protectors should be minimized, ideally reduced over time.

While the use of sound to manage tinnitus is intuitive, it is also important to recognize the value of counseling. If tinnitus evokes no emotional response, then it should not be as intrusive as a tinnitus sound that affects emotional state. Counseling facilitates the patient’s understanding of sound disorders and therefore contributes the patient’s response to bothersome sound-related disorders. Because bothersome tinnitus includes both sound and emotional response, the most effective interventions address both components.

Q:“How can I promote regular exercise within students’ daily lives that maximizes the use of their limited time as well as providing significant benefits?”
Answered by Lesley McAllister, D. M.A.: August, 2022.

Lesley McAllister, D. M.A., is Professor of Piano and Director of Keyboard Studies at Baylor University. She has presented research on yoga for musicians and mind/body relaxation techniques at several national and international conferences and her work has been widely published in such journals as American Music Teacher and the MTNA E-Journal. A certified RYT-200 yoga instructor, she is author of The Balanced Musician: Integrating Mind and Body for Peak Performance and Yoga in the Music Studio, which was recently released by Oxford Press.

A: While the importance of exercise is widely advocated on social media and in the press, many college students think that exercise is mainly for weight control, or for the “athletic” or “health-conscious.” Some even think that physical health should take a backseat to the importance of serious musical study. These students may find it eye-opening to realize that a regular exercise routine unleashes a sequence of changes leading to better stress management, more energy and endurance, and even improved musical performance. For musicians, exercise reduces both the frequency and severity of performance-related musculoskeletal disorder^[i] and anxiety.^[ii] We as their teachers can tell them these things, but usually what it takes to initiate change is personal experience. In my Performer Wellness course at Baylor University, a two-day-a-week fitness routine is a course requirement, and it is often one of the most impactful projects in the class. As one student stated in his final essay,

The compelling nature of exercise is that the beneficial effects create a positive feedback cycle. This motivated me to exercise more... I found that exercising created a sense of accomplishment in me, which led to better motivation, which led to more productivity... I felt happier and more confident. Furthermore, knowing that I am making a conscious investment of my time and energy toward my future made me extra optimistic.

This is a common theme in these end-of-semester essays: that the more students exercise, the more they want to exercise because they feel so much better, mentally and physically. So how do we set our students on the road to well-being through a consistent fitness routine? In addition to discussing the benefits of exercise with students, there are three additional tools we can use: first, to determine how it will fit into their schedule; second, to find something they enjoy; and third, to set reasonable, gentle goals with accountability.

While students often say they do not have time for exercise, careful planning helps them set aside a specific daily time to care for their bodies. It surprises me how many college students plan out class schedules without listing specific times for practice, meals, and sleep. Often the end result is skipping breakfast, practicing through meals, and staying up late to finish coursework or practice; exercise is often the last priority. Creating a detailed schedule at the beginning of the semester instills good habits to carry students through stressful weeks when they might be tempted to forgo self-care.

When teachers work to develop a sense of community in their studios, they might find that students collaborate in non-musical activities, as well. As a Faculty-in-Residence at a women’s residence hall at Baylor, I organize goal-oriented fitness activities that are most successful when attended by partners or small groups. These include a 30-day “plank challenge” called “7 at 7” in which students arrive at 7:00 for a 7-minute core-strengthening workout. I offer regular yoga classes and students are always more likely to attend if friends will be there. In my Performer Wellness class, students who partner up to walk, run, or attend classes are much more likely to enjoy and stick with their routine. A studio teacher could invite a Pilates, yoga, tai chi, or Nia teacher to lead a class for the studio, or even set up a regular time that students can join together to watch short instructional videos on YouTube. The schedule for the university’s fitness classes should be made available to all students, with incentives for participation. I have had students use a punch card to keep track of the number of classes they attend in a month, with prizes awarded to the most active. Keep in mind that there might be some students, such as those with eating disorders or physical limitations, who should not be asked to exercise or whose fitness regimen should be structured by those with appropriate training.

What types of exercise should we recommend to our students? Probably the most important consideration is finding something they enjoy. Dance and step classes provide a cognitive boost along with the simple joy of moving in rhythmic response to music. Other students like time alone to decompress; a walk or run outside allows them to connect with nature, initiating a parasympathetic response to contrast their work in the practice room.

I recommend that students try to balance cardiovascular exercise with resistance or weight training when possible because while both types are helpful in preventing repetitive stress injury, they each provide distinct benefits. Musicians will be more likely to stick with a routine if they understand its value in music study. Mind/body programs like yoga and Pilates offer strength training while increasing body awareness and the ability to release unnecessary tension. They improve core stability, which is fundamental for good posture and alignment, injury prevention, and freedom of motion while playing. Mindful movement in these and other programs like tai chi help students release anxiety and move into a “flow” state more quickly. With strength training, instrumentalists should avoid working out the muscle group that they use in playing their instrument.

Cardiovascular exercise provides a brain boost, strengthens the immune system, improves sleep, and is a natural treatment for state and trait anxiety. It lowers the resting heart rate and helps musicians learn to self-regulate their own activation levels, making it a powerful antidote to performance anxiety. It also benefits learning and skill acquisition. Students might be encouraged to participate in cardio exercise for about 30 - 45 minutes, three to five times a week, and can even use it on the day of a performance to cope with anxiety.

Some students will want to challenge themselves with “tough” workouts, but when they do so, they risk burnout, muscle strain, or overexerting themselves to the point of exhaustion. When that happens, they are likely to quit or—more seriously—to get injured. To be consistent in the long term, students need to be realistic about what they can accomplish and gentle in their expectations of themselves. I tell my students that “anything worth doing is worth doing poorly.” A simple 15-minute walk, if that is the only time available, is much better than nothing at all.

As students begin to find a routine that works for them, exercise offers a powerful way to boost confidence, reduce anxiety, and improve mental health. The importance of this cannot be underestimated with so many young people suffering the effects of the pandemic in what the American Academy of Pediatricians has declared a mental health crisis in our country.^[iii] Students benefit when they receive encouragement from both their peers and their teacher, whose advice is most meaningful when actively modeled. Teachers who care for themselves will be better able to care for their students and model well-being for them.

^[i] E.Vl Rodrigues, et al., “Effects of Exercise on Pain of Musculoskeltal Disorders: A Systematic Review,” Acta Ortop Bras 22, no. 6 (2014): 334-338.

^[ii] S.J. Petruzzello, et al., “A Meta-Analysis on the Anxiety-Reducing Effects of Acute and Chronic Exercise: Outcomes and Mechanisms,” Sports Medicine 11, no. 3 (1991): 143-182.

^[iii] American Academy of Pediatrics. “AAP-AACAP-CHA Declaration of a National Emergency in Child and Adolescent Mental Health.” https://www.aap.org/en/advocacy/child-and-adolescent-healthy-mental-development/aap-aacap-cha-declaration-of-a-national-emergency-in-child-and-adolescent-mental-health/?campaign_id=9&emc=edit_nn_20220104&instance_id=49344&nl=the-morning&regi_id=122784469&segment_id=78602&te=1&user_id=d3b74e95eb65f5d9f261672b2addc702. Accessed January 5, 2022.

Q:“Can you write the story of your physical and emotional experiences?”
Answered by Jennie Morton B.S.c. (Hons) Osteopathy, MS Psychology: June, 2022.

Jennie Morton is a former professional performing artist who is now an Osteopath specializing in the field of Performing Arts Medicine. Based in Los Angeles, she provides treatment and prevention strategies for physical and emotional challenges, as well as performance coaching for all artists. Jennie is a former Board Member and Symposium Chair for the Performing Arts Medicine Association (PAMA), co-creator of the M.S.c. in Performing Arts Medicine program at University College, London, and is the author of several articles and three books on the topic of health in the arts. Jennie lectures to artists and healthcare professionals on physical and emotional health for performers and offers online coaching and courses via her website: www.jenniemorton.com.

A: In a word, “Yes”! So much of what we experience in the world is a result of our belief systems that are cultivated through the physical and emotional experiences we have encountered in our lives. Experiences lead to beliefs and beliefs lead to behaviors. For example, if you were bitten by a dog when you were young, you will likely now view all dogs as dangerous and experience a physical stress response when you encounter one, regardless of whether or not this now appears irrational to your logical mind. Similarly, if you messed up a particular phrase during a performance, now every time you have to play that passage again you experience a stress response. So, our future experiences can often become a kind of “self-fulfilling prophecy” based on past encounters—we are writing our future script! However, this doesn’t mean that we are now helpless actors stuck in a tragic play—we can improvise! The first step is awareness: you have to recognize when you are running an old story. Let’s use the example of a passage that you always seem to mess up. Before you even start playing, you’re already telling yourself the story of all the ways you’re going to miss that note, how your teacher is going to respond, and generally what a terrible player you are (we are always our best critics!). You are setting yourself up nicely for the very thing you want to avoid. You are creating a stress response in your body that is now going to create the conditions for you to do exactly what you predicted—mess up! The strange thing with our body chemistry is that when we fulfill the prophecy and scrunch the note, we get the release of a little chemical reward—it’s the body’s “I told you so!” moment. We actually derive a small amount of satisfaction that we acted as predicted—we can become addicted to our own failure! Like any addiction, we need to knock that behavior on the head and make another choice. So how do we do that?

The nervous system, that is mediating our responses to behaviors, is highly context specific: for example, if you always practice in the same room, facing the same direction after having your morning coffee, whenever the nervous system encounters those same parameters, it will run the usual program. A simple strategy is to change the scenery. Even turning your stand around and facing a different way can wipe the slate clean.

You also need to pay attention to the stories you are telling yourself. When you hear yourself running the old narrative of “I always mess this part up,” you need to stop and challenge it. Why am I telling myself this story? Does it serve me anymore? Can I choose a different story? Also, check in with what’s happening in your body. Has your breathing changed? Are your shoulders tightening up? Is your mouth dry and your hands sweaty? Using deep breathing techniques, shaking out the body, and even having a little laugh at yourself can all help to break the cycle and re-set the body’s response—then you can start to tell yourself another story. Visualize yourself playing that passage beautifully. See yourself being rewarded with applause for your beautiful performance. Hear your teacher congratulating you. Check in with what it feels like in your body to be receiving praise. Now take this sensation into playing the piece and re-write the script—let this become the self-fulfilling prophecy. As you change your mindset, you are literally changing your physiology!

The moral of this story is that if you don’t like the story you are telling yourself, write a better one!

For more information on anxiety management, check out the free resources on my website at www.jenniemorton.com. For more information on how our thoughts affect our biology, then I highly recommend reading The Biology of Belief by Dr Bruce Lipton.

Q:“When should a musician start seeing a Physical Therapist and how do you find a provider?”
Answered by Janice Ying, PT, DPT: April, 2022.

Dr. Janice Ying is the founder of Opus Physical Therapy and Performance in Los Angeles, CA - a physical therapy practice specializing in rehabilitation and wellness for performing artists. She currently serves as the Wellness Professor at the Colburn School - Conservatory of Music and is an Adjunct Clinical Instructor at the University of Southern California - Division of Physical Therapy and Biokinesiology.

Experiencing an injury that affects your ability to play is not only stressful, but can have long-lasting consequences if not properly addressed. A large percentage of playing-related injuries among musicians stem from overuse, rather than due to a sudden traumatic onset, like in sports injuries. Physical Therapists are the experts when it comes to human movement and can help you develop strategies not only to overcome injuries, but to prevent them in the first place.

Here are some things to consider when deciding whether or not to seek care from a Physical Therapist:

Identify what factor(s) may be contributing to your symptoms. Was there a recent change in your playing load or practice schedule? Learning a new technique? Picked up a new hobby? Identifying and potentially modifying some of these things may help resolve your symptoms. You may want to work with your teacher or professor in the early phases to find a solution.
How long do the symptoms last? How quickly symptoms come on and/or take to resolve after you’ve stopped the painful activity may be a good indicator whether to seek help or not.
What type of symptoms are you experiencing? If you feel numbness, tingling and/or weakness, it is recommended that you seek care sooner rather than later.
How long have you been feeling these symptoms? When it comes to injury care, sooner is always better than later.

Generally, I would suggest trying to make modifications on your own and if there is no improvement or even a worsening of your symptoms, wait no longer than 2 weeks before reaching out for help. That is, unless you are experiencing very concerning symptoms such as weakness, excruciating or persistent pain, then seek help as soon as possible. Many states in the US now have direct access for physical therapists, which allows patients to go directly to a PT without a physician’s referral. This can often cut down on wait time to receive care. Every state law is different, so be sure to ask your PT if there are any limitations or restrictions if choosing to go this route.

Here are some things to consider when choosing a Physical Therapist:

Find a therapist who understands the physical and cultural demands of instrument playing - or one who will take time to do so. There are a number of physical therapists across the country who have specialized in treating instrumental musicians. Below are two directories to help find a performing arts medicine specialist in your area. If you do not live in an area that is easy to access one of these specialists, take time to find someone that will listen to you and put in the effort to truly understand your goals and develop an individualized plan to help you get there.

Performing Arts Medicine Association (PAMA)Directory: https://pama.memberclicks.net/referral-directory
American Physical Therapy Association (APTA) Directory (Under ‘Practice Focus’ choose Performing Arts Physical Therapy): https://aptaapps.apta.org/APTAPTDirectory/FindAPTDirectory.aspx
Ask your friends and colleagues about their recommendations. Trying to sort through the pool of healthcare professionals on your own often can feel like throwing a dart blindfolded. Ask your colleagues about their experiences to help narrow the field. However, always keep in mind that what worked for one person may not always be the right fit for you.
What is their training background and experience? Physical therapy is a diverse field with many different approaches. Find someone whose treatment approach is in line with your own preferences.
If playing related, bring your instrument (if applicable) and have them watch you play. While your therapist may not know how to play your instrument (bonus points if they do), they should have the skills to analyze the task and look at your playing from a biomechanical perspective to see if there are any positions or movements that may be contributing to your symptoms.
Assemble your healthcare team BEFORE there is a problem. Being proactive and establishing a relationship with your healthcare providers prior to there being a problem is always recommended.

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

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:

Place practice sessions and performances in perspective so students understand the process of preparing for a performance with “practice performances” before the ultimate performance or concert
Discuss optimal performance and how to achieve a satisfying end result, discussing rationale goals and avoiding wishing for “perfection”
Be the Wellness Voice – Look for reliable information at reputable sources such as:
-https://internationalmusician.org/staying-healthy-as-a-musician/
-https://www.mtna.org/MTNA/Learn/Wellness_Resouces/Athletes_and_the_Arts.aspx
-National Association of Teachers of Singing (NATS): https://www.nats.org

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: https://bjsm.bmj.com/content/bjsports/55/1/30.full.pdf

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: https://nasm.arts-accredit.org/about/current-notices/current-notice-nasm-handbook-2020-21-published/ and NASM Advisories – NASM-PAMA: https://nasm.arts-accredit.org/publications/publications-a-z/

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:

Website: athletesandthearts.com
Associated Athletes and the Arts (AATA) podcasts: http://athletesandthearts.com/aata-podcasts/