Performance Health: A Guide for Instrumentalists

General Health and Self-care

A healthy lifestyle will support optimal performance. Despite all possible pressures and impediments, sensible self-care, especially when practised in a supportive environment, will augment the mental and physical aspects of practice, preparation and performance – and their rewards.

Self-awareness

Identifying as a musician or with one’s instrument is an important component of perceived identity but only part of it (it’s the ‘job’). Giving adequate attention to other roles in life, people, relationships, other interests etc. will help provide a secure foundation should there be problems with, or loss of, performance/career prospects.

Health Maintenance

Rest, sleep, regular exercise and good nutrition are all important and should receive due attention. Even a minor degree of dehydration can impair cognitive and performance skills.

Some players choose one of the many special techniques which support physical fitness, body awareness and/or mental health – Pilates, Yoga, Alexander Technique, Feldenkrais method, ‘relaxation’ techniques, Mindfulness etc. These can help both general health and performance skills. Anything that promotes improved awareness of the body, its movements and sensitivity to superfluous tensions is worthwhile – whether at or away from the instrument. Vigorous sports with high risk of injury are not advised.

Activities of Daily Living

It is quite possible to have a near perfect approach to playing and still experience ‘playing related’ adverse symptoms which actually result from normal daily activities, hobbies or sports, e.g. gripping bags, utensils, tools including pens and pencils; thumb texting; time at computer keyboard; bending over laptop; housework and DIY; lifting and transporting suitcases or children; an unsuitable pillow for sleep.

Hypermobility

Commonly found (if looked for!). In any one individual, very flexible or ‘bendy’ joints may be widespread or may be confined to one or two joints. They are commonly associated with symptoms and affected performers are advised to see a performing arts specialist. They should not attempt to further extend the already increased range of movement in such joints with ‘stretches’, which should only be done cautiously to release any unwanted muscle tightness after playing.

Carrying and Moving

Carrying and moving instruments and accessories should be done in ways which reduce load and maintain a neutral posture (use straps, wheels, trolleys – which should be pushed not pulled – etc.). A load on the back should be place low and symmetrically. Though not ideal, even carrying a heavy bag with one hand should not involve undue effort – a hanging arm and curled fingers should hold a padded handle with ease (no gripping, elbow bending or shoulder lifting required).

Mental Health

Good mental health is nowadays increasingly discussed and accorded due importance. It is clear that any health issue will have social and psychological aspects as well as the physical: this ‘biopsychosocial model’ takes all such factors into account. Dealing with possible performance anxiety is only one aspect of mental wellbeing. Underlying personality traits, occupational and domestic issues, or an addiction may make it difficult to maintain an equilibrium. Feeling the need for perfection is burdensome. Sources of support for mental, social and economic wellbeing are available. Never hesitate to ask for help.

Work-related Factors

Whilst employers have a general ‘duty of care’, work must often be undertaken in a less than ideal environment, ranging from poor (even hazardous) conditions to unsatisfactory relations with management and co-workers. Some Health and Safety regulations exist for employee protection (e.g. for hearing protection) but there is no obligation to provide a general occupational health service to the workforce. Lighting, temperature, humidity or air conditioning may present issues. Musician’s hearing is dealt with in our ‘Don’t Lose the Music’ factsheet. Union support may be available.

Illness and Injury

Episodes of intercurrent illness, e.g. an acute respiratory illness, may be common. Recovery time should be allowed for and paced accordingly. Pacing also applies following a strain or injury which affects playing.

Technique

We do not confine the concept of ‘technique’ to the craft of playing and related pedagogical issues, but see it as encompassing everything to do with how we ‘carry out a task’ – all aspects of playing, performing, practice schedules, avoiding unwise habits etc. By this measure, around 60% of problems seen in Performer’s Clinics relate to ‘technique’ rather than ‘medical’ or ‘surgical’ problems. We do not presume to advise on the player’s craft, but may frequently spot unhelpful habits. Poor ergonomics is often a factor and examples are described below. Seeing an expert in the particular instrument may help.

As seen by performance health practitioners, most ‘risk factors’ for adverse physical and emotional events are well described. Whilst the mental challenges to accomplished playing can be many and varied, a much shorter list of common predictable physical factors, once spotted, can be addressed.

Given this, the prospects for rectifying many problems are rather good. A healthy ‘technique’ should not provoke adverse symptoms and one must not play through pain.

Practising

Physical warm ups away from your instrument are strongly recommended.

Excessive repetition of vigorous and difficult passages, or any prolonged sessions without rest breaks, risk injury. Some repertoire may not suit an individual’s physical build. A new instrument, new teacher, long rehearsals imposed by others, and building up to a performance or audition are recognised causes of increased adverse symptoms and injury risk. If you lose track of time, use a timer! A 5-minute break every 30 minutes, with muscle and postural release, is a sound safety measure.

Aiming for a ‘higher level’ in practice or exercise regimes should be taken with care, especially new or difficult techniques. Allow only a modest increase in time or energy spent every few days. Do not play through discomfort or pain. This also applies also when returning to playing after illness or injury. Allow some time after playing for reflection, unwinding emotionally and cooling down (using some of the milder warm up exercises and some stretches to regain symmetry and eliminate any tensions).

Tensions in Performance

Recognising and eliminating unnecessary tensions and effort in playing is fundamental to teaching, learning and maintaining an adequate instrumental technique. All such tensions impair fine control and playing skills. Tension will spread like wildfire to other parts and, as well as affecting the movement required, can extend all the way to knees and ankles and also result in faulty breathing patterns, breath holding, facial grimaces, jaw clenching, etc.

Commonly Observed Habits

Those likely to impair skilled performance or lead to adverse symptoms include: exaggerated spinal curves, head on neck postures that are too forward, head jerking, shoulder(s) pushed forward, unnecessary shoulder lifting, hand and wrist too often bent away from neutral – not aligned with the forearm, gripping the instrument all the time (especially with the thumb, and including with the head for upper strings), clinging on instead of releasing, using unwarranted effort or force, playing with fingers too curled or too straight, not addressing ‘collapsing’ finger joints (can be addressed with exercises). Again, an expert BAPAM physiotherapist or an instrumentalist might be able to help).

Improved self-observations will be helpful, in addition to those of a teacher or an independent expert. It might include using a mirror or video camera, or maintaining and scrutinising the playing posture after the instrument is removed by someone else.

Even the most experienced players should not shun the option of seeking professional advice to explore technical problems and eliminate any bad habits, as well as sharing interpretive issue.