Music Physiology and Musicians' Medicine

Making music, free of pain

Throughout the course of a musical career, even as early as during music school, numerous musicians develop characteristic bodily and psychic problems, which are at least in part due to playing their instrument or singing. This type of occupation-specific illness in musicians was mentioned in texts as early as the 15th century. A detailed account of the illness was presented at the beginning of the 20th century in monographs by the doctors Julius Flesch and Kurt Singer. However, professional musicianship and singing has only been a widely examined field of medicine since the 1980s. Since then, the taboo surrounding this topic has noticeably lessened, while pedagogues and physicians are much more sensitive to the importance of specific, preventative healthcare for musicians. However, the increasing demand for medical assistance for musicians is also linked to an intensification of the job market situation for musicians, with the continuous increase in instrument-technical demands and often perfectionistic expectations from both the musicians and the audience.

The most common problems which musicians suffer from are

 

●      acute or chronic pain syndrome
●      performance anxiety
●      stress
●      other job-related psychomental demands

 

The painful problems concerning the musculoskeletal system are primarily caused by long-term, excessive use of a non-ergonomic “tool of the trade”, as the way in which instruments are built generally does not cater to our natural, physical capabilities. The instruments often necessitate an unnatural body posture near to our physiological boundaries. Furthermore, the development of medical problems is related to several different factors, including the specific bodily and psychological disposition of the musicians, their occupational and private social circles, the repertoire they play, their practice habits, and their personal technique while playing the instrument. Non-musical injuries and illnesses can also become a serious hindrance for an aspiring professional musician. Even more factors can come into play while working in an orchestra.

Music-related illnesses are characterized by many different factors and are accompanied by various symptoms which are rarely, if ever, found in patients with other professions. For this reason, a specific type of care, similar to that found in sports medicine, is necessary. This type of care requires physicians and therapists with a profound knowledge of the field of professional music and the various conditions which professional instrumentalists and singers are put under.

To consolidate and share the knowledge attained by various persons in musician’s medicine, the Deutsche Gesellschaft für Musikphysiologie und Musikermedizin e.V. (DGfMM) was founded in 1994. The organization now has more than 500 members. Similar organizations have been founded over the past decade in the United States, Australia, England, France, the Netherlands, Austria, Switzerland and other countries, creating an opportunity for an intensive international exchange of information through conventions. Today, there are numerous national and international publications centered around musician’s medicine in various books and academic journals.

Because the different symptoms in musicians can relate to every medical field and the disorders are commonly based in pedagogical or methodical contexts, comprehensive care for musicians is only possible through interdisciplinary discourse. For this reason, professionals from the different fields related to music education and vocational accompaniment for musicians work together in the DGfMM. These fields include instrumental and vocal educators, physicians, dentists, instrument builders, ergonomists, physical therapists, psychotherapists, respiration therapists, teachers of the F.M. Alexander-Technique, teachers of the Feldenkrais method and similar forms of therapy and students in the fields of music and medicine. The goal is to work together and therapeutically attend to sick musicians as a team, and in doing so to guarantee multimodal, qualified, musician-specific diagnostics and therapy.

Musiciansmedicine, though, presents only a part of the overall problem of sick musicians. A broad understanding and sensitivity toward musicianshealth as well as targeted prevention of musician-illnesses is of the utmost importance. This type of information must be present in music education to prevent complaints as soon as they occur and nip them in the bud. Therefore, among professionals in the field, music physiology is seen as just as important as musicians medicine. The term physiology describes the study of normal vital processes: To sing or play an instrument without pain, and later to develop individualized strategies to remain healthy, it is important to be informed of the various processes which happen in the body while playing music and to possess at least some basic knowledge about the anatomy, physiology, biomechanics, and psychology which relate to these processes. In these areas, music educators vary widely in their knowledge and, subsequently, in their teaching. For this reason, it is necessary to include seminars and classes about the basic physiology of music making at music schools and other similar institutions. This will enable students to pass on their own knowledge of music physiology once they graduate and begin teaching. In this way, the knowledge comes full circle, when music physiology is taught thoroughly to younger children and becomes a natural part of  music education. Incorporating the early recognition of potential risk factors as well as focussing on physiological basics at the beginning of music education could effectively prevent many music-related illnesses.

The desire to implement this type of healthcare for musicians comes not only from medical professionals, but also from music students, orchestra musicians. instrumental and vocal teachers, and trade associations: many musicians do not feel that their studies adequately prepared them to deal with the stresses of everyday life in professional music. In orchestras, too, there is often a lack of active care and support by medical professionals or physical therapists, who are able to provide general and specific prevention measures and teach orchestra members a healthy way to deal with health-related problems.

To provide music-specific health support and lower the number of occupation-related health problems in musicians in the long term, members of the DGfMM create prevention programs and offer learning opportunities at various conservatories and other institutions of musical education. By providing:

●      Lectures
●      Seminars
●      Courses
●      Consultation

The DGfMM imparts practical information, sensitization, prevention and individual care. Today, these events and others regarding musicians’ health are held at most of the conservatories in Germany. However, some places still lack a well-structured, balanced concept of how musicians’ health should be taught. This creates a need for obligatory basic courses, which can be supplemented through optional, practical-oriented options as well as an opportunity for individual medical consultation. The DGfMM has developed firm recommendations implementing music physiology and musiciansmedicine in the process of music education.

 

Qualified prevention and practical musicians’ medicine is only possible with a foundation in hard science. The DGfMM declares itself to be a science-oriented association. Its goal is to support research and science, not only in the fields of physiology and pathophysiology (the study of unhealthy vital processes) as they relate to music, but also relating to bodily and psychic illnesses in musicians. Regularly held conferences, symposia, publications, support for individual scientific projects, awarding a science prise, as well as the publication of the scientific journal “Music Physiology and Musicians’ Medicine” as a body of the DGfMM should help to achieve this goal. Libraries in conservatories throughout Germany carry the journal in their catalog.