Classical Music from Germany – Current trends

Musicians’ Diseases – the dark side of a dream profession

Ralf DombrowskiMusicians are stars, shining figures in the firmament of social admiration. Disorders that arise from the often extreme one-sided stress of the body do not therefore belong to the general perception of the profession. But awareness of this dark side is increasing in German orchestras, universities and beyond. An overview of a still new field of research.

The brazilian guitar player Badi Assad had to stop playing for a while because of dystonia, learned meanwhile mouth percussion and singing and is now back on stage, photo by Ralf DombrowskiBadi Assad, famous guitar player suffered for a while from dystonia, photo: Ralf Dombrowski

The avid music listener is often surprised to learn that such a “pleasant’ job as that of making music has its dark side, which manifests itself in chronic pain, loss of fine motor control, hearing and anxiety disorders. Musicians, like high-performance athletes, work at the limit of their physiological and psychological capacities, since they usually must, and want to, deliver an optimum performance. Even minimal functional disturbances of the physiological system first manifest themselves in performance, and emotional tension can cause an impoverishment of the range of artistic expression.

Especially the violin is unfavourably designed from an ergonomic point of view and cause extreme stress on the musculoskeletal system, photo by HMTM / Eckart AltenmüllerMoreover, many musical instruments are unfavourably designed from an ergonomic point of view and cause extreme stress on the musculoskeletal system. The present form of the violin, for example, was developed at the end of the sixteenth century, a period when the lower positions were played predominantly in a comfortable posture for short spaces of time and no one thought of hours-long practicing of technical difficulties such as those presented by Paganini Caprices.

Stress beyond art

The often very complex and rapid sequence of movements in musical performance are specified down to the smallest detail both in their temporal and their spatial coordinates. And there is probably hardly another profession in which quality of performance is so constantly checked. Colleagues, conductors and the audience are stern judges in an increasingly intense competition. Health-related performance deficits threaten professional status and career. Ill musicians therefore suffer from severe psychological stress: they have usually begun their professional training in childhood, define themselves largely in terms of their musical skills and continue in most cases to enjoy performing music even well into old age. Disorders that affect the playing of instruments are consequently often accompanied by diminished self-esteem and cause great anxiety.

What disorders does the musician’s doctor see?

Many pianists and organists suffer from pains in the forearms ('tendonitis') and dystonian problems, photo by HMTM / Eckhart AltenmüllerPain syndromes are by far the most common medical disorders of musicians. About forty-five percent of the musicians suffer or have suffered pain disorders for a period of more than six weeks. The symptoms typically appear in those regions of the body that are stressed by posture maintenance strain in forced positions or by prolonged repetitive movements. Thus typical for players of high-held string instruments are left shoulder pains and neck pains, for pianists and organists pains in the forearms (“tendonitis”) and in the lumbar spine. For clarinettists and oboists pains may appear in the area of the right thumb due to the strain of holding the thumb rest. Most often the pains occur after extreme stress and are confined to the time actually playing the instrument. Daily activities are often not affected. Typical triggers are prolonged playing times in preparation for major concerts, auditions and competitions. The rehearsal of new movement sequences, the change of instrument and newly introduced physical activities (for example, additional work at the PC) are also triggering factors.

In second place are the anxiety disorders. It is estimated that forty percent of all musicians and seventy percent of music students suffer from performance anxiety, which often leads to terminating their careers. Compared with the general population, anxiety symptoms occur about three times as often in musicians.

The flamenco guitar player Gerardo Nuñez suffered from dystonia in his forefinger of the right hand and had to learn some playing techniques again with the ring-finger, photo by Ralf DombrowskiIn third place come the neurological disorders, and here musicians’ dystonia is especially disastrous. This involves loss of fine motor control due to involuntary muscle spasms. The movement disorder is task-specific, occurs during playing of the instrument and is usually painless. It can occur as hand dystonia at the piano (for example, involuntary furling of the fingers) or as embouchure dystonia with wind instruments (loss of tone control when blowing) and affects an estimated two percent of professional musicians. Finally, we should mention the hearing disturbances triggered by music, which are currently the object of intense preventive measures in occupational medicine.

Health care for musicians: a social challenge

The prevalence of health problems amongst musicians makes clear that especially prevention is urgently needed. This is also apparent from polls, according to which only seventeen percent of orchestra musicians believe their educational institutions prepared them sufficiently for their daily work routine. The German Association for Music Physiology and Musicians’ Medicine (DGfMM) seeks to establish a comprehensive specialty for “the principles of health for musicians”. Educational institutions would address the treatment of professional stressors and of the musician’s body and offer practical courses in these subjects. Many universities and conservatories have now set up such lectureships. Advanced training for doctors as “specialists for musicians” would also be desirable.

Under the auspices of the DGfMM, doctors, psychologists and therapists from all over Germany who are interested in an evidence-based medicine for musicians have joined together. In addition, it is important to provide a scientific basis for the specialty of medicine for musicians. This would be best achieved by founding further institutes for the subject. So far facilities where musicians can receive competent medical consultation and treatment exist at the University for Music, Theatre and Media in Hanover and the music academies of Berlin, Detmold, Dresden, Freiburg, and Cologne.

Research centres for medicine for musicians exist in the areas of neurology in Hanover and in the areas of psychosomatic and phoniatric disorders in Freiburg. Research in the area of voice care and kinesiology is being conducted at the Music Academy in Dresden. There is still no special medical designation such as “musicians’ medicine”, but there is additional professional training under the name of “Music Physiology in Everyday Artistic Life”, which is organised by the music academies in Berlin and Hanover. The already mentioned DGfMM also organises annual symposia on topics of medicine for musicians.

Selected bibliography

Altenmüller, E, Wiesendanger M, . Kesselring J.: Music, Motor Control, and the Brain. Oxford University Press, 2006

Altenmüller E, Rode-Breymann S.: Krankheiten grosser Musiker und Musikerinnen: Reflexionen am Schnittpunkt von Musikwissenschaft und Medizin“. Olms-Verlag Hildesheim, 2009

Spahn, C., Richter B. Altenmüller E.: Musikermedizin. Schattauer-Verlag Stuttgart 2011

Klöppel, R., Altenmüller E.: Die Kunst des Musizierens. Schott-Verlag, Mainz 2013

Eckart Altenmüller
is professor for musician's medicine at the Hanover University of Music, Drama and Media.

Translation: Jonathan Uhlaner
Copyright: Goethe-Institut e. V., Internet-Redaktion
November 2013

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