Our culture puts unattainable demands on all our greatest performers. Just as we would chastise David Beckham for missing a penalty in a World Cup match we would also condemn a cellist for hitting a bum note while playing in a live orchestral performance.



No matter how much practice you get you can’t always be perfect. We are exposed to flawless music recordings everyday and expect live performances to always reach the same exceptional quality, even though a CD would have undergone numerous re-recordings until it was completely faultless.

Excessive audience criticism is then extended to the performers themselves. In an anxious attempt to reach perfection, especially when competing, musicians become their own worst critics. They can become obsessed with reaching optimum standards, practising extensively, causing physical harm to their bodies and generally burning themselves out.

Psychological personal injury

As the curtain pulls back and you are revealed centre stage, in the spotlight, ready to perform the opening solo. Your heart begins to flutter, your mouth completely dries out and you feel sick to the stomach.

While a few nerves before a performance can help you to maintain focus too much adrenaline can be highly counterproductive. Most performers will, at some time in their musical career, suffer from performance anxiety. This can include full-blown panic attacks which cause the body to seize up, breathing difficulties and shaking. Sleep loss and the inability to eat or keep food down are also common.

According to the British Association for Performing Arts Medicine, which funds health clinics for musicians, only 5% of client sessions concern mental health issues. This low figure is not believed to be a true reflection of the situation but an indicator of how such issues in orchestras are still very much a taboo subject.

A career as a professional musician is extremely stressful, and like all performers there is no let up, you just have to keep on performing. This attitude means that even when musicians begin to feel the strains, they will bury their heads in the sand as they are afraid of losing their job or may simply feel that they have no one to confide in.

Rather than treating their mental or emotional health problems it is not unusual for musicians to turn to substance abuse. Beta-blockers are a favourite as musicians claim that the drug suppresses their anxiety while others will turn to the bottle in an attempt to drown their fears. Such action of course causes even greater psychological damage as many musicians are then also faced with addiction.

However, any type of personal injury, psychological or physical, that is left untreated will undoubtedly worsen. Also, any physical injuries that go untreated can develop into psychological trauma as musicians are left fighting excruciating pain which puts them under even greater pressure.

Physical personal injury

70% of personal injuries experienced by musicians are musculoskeletal. The most common of which are back, neck and shoulder pain and repetitive strain injury; direct results of constantly playing their instruments.

Back, neck and shoulder pain is usually experienced by musicians that adopt a poor posture and incorrect ergonomic technique while practising and performing. Most practice for more than 6 hours every day without sufficient rest, thus increasing the strain.

The repetitive motion of moving a bow back and forth while playing a violin or cello, or the strumming of a guitar, can put a tremendous strain on your muscles. Hand and arm pain, numbing and tingling to the fingers are all symptoms of repetitive strain injury. For more details about RSI visit http://www.rsi.org.uk.

Most are familiar with the term tennis elbow; musician’s elbow is also very common. A strain could begin anywhere such as the wrist and then worsen to the extent that you develop a serious neck injury.

Painful overuse can also lead to carpal tunnel syndrome. Read more about carpal tunnel syndrome.

Methods of treatment

A personal injury such as RSI can not be treated by taking a pill. Rest is of course the most effective treatment as it allows time for the injury to repair. However, to many musicians the prospect of not playing for a while can be frightening. They do not have the support that they need and may feel that they are going to lose their place in their band or orchestra.

The Healthy Orchestra Charter, a new joint initiative between the Association of British Orchestras and the Musicians’ Benevolent Fund, aims to establish national guidelines for the physical, mental and emotional health of orchestral musicians throughout the UK.

Orchestras must demonstrate that they are adequately supporting players’ needs to gain approval by the charter. Twenty-two professional orchestras including the London Philharmonic Orchestra, Royal Liverpool Philharmonic Orchestra, the Royal Opera House and five Scotland-based organisations have already signed up to the charter and specialist services are up and running.

It is believed that services such as neurology, physiotherapy, general practice, hypnotherapy and the Alexander Technique, where by clients learn how to get rid of harmful tension in their own bodies, are the way forward to helping musicians with both psychological and physical personal injuries. For more details visit http://www.mbf.org.uk

Another popular method for dealing with musicians’ personal injuries is chiropractic care. This is essentially restoring good heath through adjustments of the spine. Chiropractors manually manipulate the spinal column by bending and twisting the patient into various positions or deliver a quick, gentle thrust to the vertebrae with a small rubber tip. Water, light, massage, ultrasound, electric, heat therapy and the application of straps, taping and braces are also used.

One of the most effective treatments is to counsel patients about lifestyle changes. Specifically, some chiropractors encourage their patients to bring their musical instruments along to a consultation. The musician can then demonstrate the posture and position they hold while playing. As a result, the source of their personal injury can be identified and treated successfully. The specialist can also suggest a change in technique so that the musician avoids any further damage.

To find a chiropractor in your area visit http://www.gcc-uk.org.

Advice for musicians suffering from personal injuries

Dr Sarah Mickeler, a former professional musician, is now a chiropractor who concentrates on musicians’ personal injuries. She suggests the following advice:

Don’t be a hero. Take a little break every 30 minutes while practising.

Never play through the pain. If your body is telling you there is something wrong do something about it. You will only make it worse by ignoring it.

Be aware of your ergonomics. Make sure that your chair fits you properly, that you don’t have to strain to see the stand and conductor and that your arms aren’t contorted oddly in order for you to play properly.

Seek the help of a professional who can help you to overcome your current personal injury, avoid future injury and enhance your overall performance.