University woodwind students’ experiences with playing-related injuries and their management: a pilot study

Jessica Stanhope; Steve Milanese; Karen Grimmer

doi:10.2147/JPR.S49620

. 2014 Mar 7;7:133–148. doi: 10.2147/JPR.S49620

University woodwind students’ experiences with playing-related injuries and their management: a pilot study

Jessica Stanhope ¹, Steve Milanese ^2,^✉, Karen Grimmer ¹

PMCID: PMC3952899 PMID: 24634587

Abstract

Background

This study aimed to determine the experiences of university classical woodwind students with playing-related injuries (PRIs), the impact of these PRIs, the management selected by students with PRIs, and the perceived effectiveness of this management.

Materials and methods

All classical woodwind students enrolled in vocational education training or undergraduate courses at a university were sent an email with a link to an online survey. Only those aged 18 years and older were eligible. The survey obtained data regarding demographic information, details of PRI experienced (location, if they lasted for more than 3 months, and if they were current), and the impact of these, as well as the types of management strategies tried and their perceived effectiveness. Data were analyzed using descriptive statistics, and comments were reported descriptively.

Results

Fourteen students returned the survey; however, one of these only completed the questions regarding demographics, and was therefore excluded. A total of 62% of participants reported having experienced a PRI. Common locations for PRI were the wrist/hand/fingers, lower back, and neck. Reducing practice time by half and missing playing commitments were the most commonly reported consequences of PRIs. Playing-related management strategies were most frequently trialed, with these and passive nonplaying-related strategies perceived to be the most effective.

Conclusion

PRIs are common in this population, with a range of consequences reported. While it is encouraging that students had tried and found effective playing-related management strategies, active nonplaying-related strategies should be encouraged, particularly in preference to passive nonplaying-related strategies. This was a small-scale study, and the results are only applicable to the institution investigated; therefore, similar larger-scale studies are recommended to determine the generalizability of these findings.

Keywords: woodwind, injury, pain, prevalence, management, treatment, musician

Background

Musculoskeletal problems are commonly experienced by musicians.¹^,² These problems may have a significant impact upon the individual, with musicians who have been injured reporting a negative impact upon social relationships,³ the loss of a form of expression,³ loss of identity,³ and an impact on financial well-being.⁴ Furthermore, musicians are reportedly reluctant to discuss their injuries for fear of destroying their reputations,⁴ and may avoid seeking care from health and medical professionals, as they fear they will be told to stop playing, and because they perceive these professionals to lack the experience required to treat musicians.⁴^,⁵ It is important to determine the management sought by university woodwind students for musculoskeletal problems and their views towards it, as well as the consequences of such problems to enable appropriate management and support to be implemented.

A systematic search (see Supplementary materials for the search strategy) was conducted to identify studies investigating the experiences of university woodwind students with musculoskeletal symptoms. Throughout the published literature, various terms and definitions have been used to describe these musculoskeletal symptoms;²^,⁶ hence any musculoskeletal symptoms were considered relevant. Seven studies⁷^–¹³ were identified (Figure S1); all investigated the prevalence of musculoskeletal symptoms (Table 1). This revealed that there is a particular need to better understand instrument-, location-, and duration-specific prevalence of musculoskeletal problems in this population. No studies investigated the incidence of musculoskeletal problems or the impact of these on the individual or their playing. Ackermann et al⁷ was the only study to report on the management strategies utilized, as well as the strategy that was perceived to be the most effective.

Table 1.

Summary of the type of data published

	All woodwind	Flute	Clarinet	Saxophone	Oboe	Bassoon
Lifetime prevalence anywhere/any duration
Pain	^b	^a
Injury	^d
Musculoskeletal problem	^c
Pain or injuries		^a
Tingling		^a
Weakness		^a
Numbness		^a
Duration prevalence – location-specific
Pain		^a
Lifetime prevalence – location-specific
Problem		^g	^g	^g
Pain		^a
Point prevalence – location-specific
Pain whilst playing	^f
Seeking treatment (during the university studies)		^e	^e	^e	^e	^e

Demographic	Number (% of respondents)
Sex
Female	10 (77)
Male	3 (23)
Age (years)
18–19	6 (46)
20–24	3 (23)
25+	4 (31)
Program
Certificate IV in Music (Classical performance)	2 (15)
Bachelor of Music (Classical performance, first year)	4 (31)
Bachelor of Music (Music education, second year)	1 (8)
Bachelor of Music (Classical performance, third year)	5 (38)
Honours Degree of Bachelor of Music (Classical performance)	1 (8)
Major instrument
Flute	6 (46)
Clarinet	2 (15)
Saxophone	1 (8)
Oboe	1 (8)
Bassoon	1 (8)
Recorder	2 (15)

	n (% of all participants)
	Ever	Longer than3 months	Current
Body regions
General
Neck/shoulder regions	5 (38)	1 (8)	4 (31)
Back	6 (46)	3 (23)	2 (15)
Upper limb	6 (46)	1 (8)	4 (31)
Jaw	1 (8)	0 (0)	0 (0)
Detailed
Neck (left side)	2 (15)	0 (0)	2 (15)
Neck (right side)	4 (31)	1 (8)	3 (23)
Upper back (left side)	0 (0)	0 (0)	0 (0)
Upper back (right side)	2 (15)	1 (8)	1 (8)
Middle back (left side)	1 (8)	0 (0)	0 (0)
Middle back (right side)	1 (8)	0 (0)	0 (0)
Lower back (left side)	3 (23)	2 (15)	1 (8)
Lower back (right side)	2 (15)	1 (8)	1 (8)
Shoulder (left)	1 (8)	0 (0)	0 (0)
Shoulder (right)	3 (23)	1 (8)	1 (8)
Arm (left)	2 (15)	1 (8)	1 (8)
Arm (right)	1 (8)	1 (8)	0 (0)
Wrist/hand/fingers (left)	4 (31)	1 (8)	2 (15)
Wrist/hand/fingers (right)	6 (46)	1 (8)	3 (23)
Jaw (left side)	1 (8)	0 (0)	0 (0)
Jaw (right side)	1 (8)	0 (0)	0 (0)

Woodwind player	flute OR flutes OR flautist^* OR flutist^* OR musician OR music student^* OR woodwind^* OR wind player^* OR Instrument player^* OR instrumentalist^* OR musical instrument^* OR wind instrument^* OR instrumental music OR stud^* music^* OR saxophon^* OR clarinet^* OR oboist^* OR oboe^* OR bassoon^*
University student	universit^* OR colleg^* OR tertiary OR conservat^* OR student^* OR studying OR education OR training
Musculoskeletal symptoms	muscul^* OR overuse^* OR injur^* OR muscle^* OR pain^* OR discomfort OR strain^* OR sprain^* OR disorder^* OR condition^* OR syndrome^* OR disease^* OR problem^* OR disab^* OR symptom^* OR weak^* OR numb^* OR medical^* OR health^*
Prevalence/incidence	preval^* OR inciden^* OR rate^* OR frequen^* OR common^* OR percent^*
Impact	consequen^* OR impact^* OR experienc^*
Management	manag^* OR therap^* OR treat^*

	No chance				Extremely likely
6 months	□	□	□	□	□
12 months	□	□	□	□	□
5 years	□	□	□	□	□
Ever	□	□	□	□	□

	No chance				Extremely likely
Missed playing commitments	□	□	□	□	□
A negative impact on your playing reputation	□	□	□	□	□
A week off from playing	□	□	□	□	□
Ending your career	□	□	□	□	□
Reducing your playing time by half	□	□	□	□	□
Financial problems	□	□	□	□	□
Three months off from playing	□	□	□	□	□
A month off from playing	□	□	□	□	□
Social isolation	□	□	□	□	□

	Not at all				Extreme impact
Not enough breaks when practicing	□	□	□	□	□
Poor posture/hand position	□	□	□	□	□
Sudden increase in playing intensity (eg, harder pieces)	□	□	□	□	□
Sudden increase in playing time	□	□	□	□	□
Carrying your instrument	□	□	□	□	□
Overpracticing	□	□	□	□	□
Playing with discomfort	□	□	□	□	□
Insufficient warm up (eg, playing long notes, slow scales)	□	□	□	□	□
Poor general physical fitness	□	□	□	□	□
Cramped playing conditions	□	□	□	□	□
Poor awareness of injury prevention	□	□	□	□	□
Stress (eg, performance anxiety)	□	□	□	□	□
Moving equipment (chairs, stands)	□	□	□	□	□
Facilities (eg, chairs, temperature, lighting)	□	□	□	□	□
Instrument setup (eg, thumb rests, reeds, neck straps, key height)	□	□	□	□	□

	No effect				Will completely prevent an injury
Warm-up (eg, long tones, slow scales)	□	□	□	□	□
Yoga	□	□	□	□	□
Regular massage	□	□	□	□	□
Stop playing as soon as you experience discomfort	□	□	□	□	□
Pilates	□	□	□	□	□
Aerobic exercise (eg, running, rowing)	□	□	□	□	□
Stretching	□	□	□	□	□
Muscle-resistance exercises (eg, weights, Thera-Band)	□	□	□	□	□
Alexander technique	□	□	□	□	□
Osteopath	□	□	□	□	□
Bowen therapy	□	□	□	□	□
Physiotherapy	□	□	□	□	□
Relaxation techniques	□	□	□	□	□
Feldenkrais	□	□	□	□	□
Regular practice breaks	□	□	□	□	□
Chiropractor	□	□	□	□	□

	Has prompted a change	Would prompt a change
Reading about injuries	□	□
Advice from a health/medical professional	□	□
Experiencing an injury that impacts on your playing	□	□
Starting to get symptoms (before they start impacting on your playing)	□	□
Having a class/workshop about injuries	□	□
Knowing someone who has experienced an injury	□	□
Advice from your teacher	□	□
Advice from other students/colleagues	□	□

	Not at all important				Extremely important
Have a ‘no pain, no gain’ attitude	□	□	□	□	□
Understand the physical requirements of playing	□	□	□	□	□
Have a good posture/hand position	□	□	□	□	□
Understand injury prevention	□	□	□	□	□
Carefully structure practice sessions	□	□	□	□	□
Have good playing technique	□	□	□	□	□
Do exercises (stretches and strengthening to reduce injuries)	□	□	□	□	□

	Completely disagree				Neutral				Completely agree
Injury prevention is the responsibility of the teacher	□	□	□	□	□	□	□	□	□
Injury prevention is the responsibility of the individual musician	□	□	□	□	□	□	□	□	□
Injury prevention is the responsibility of the university	□	□	□	□	□	□	□	□	□
Injuries can be prevented	□	□	□	□	□	□	□	□	□
If I had an injury, I would tell my teacher	□	□	□	□	□	□	□	□	□
If a musician has an injury, it reflects poorly on their teacher	□	□	□	□	□	□	□	□	□
Musicians should understand injury prevention	□	□	□	□	□	□	□	□	□
Discomfort is a normal part of playing	□	□	□	□	□	□	□	□	□
Health professionals need a good musical understanding to advise and treat musicians	□	□	□	□	□	□	□	□	□
I would not tell another musician if I had an injury	□	□	□	□	□	□	□	□	□
Musicians who have had an injury are at higher risk of future injury	□	□	□	□	□	□	□	□	□
Musicians who have had an injury should not be professional musicians	□	□	□	□	□	□	□	□	□
Musicians who have had to have time off because of an injury must not want to be musicians bad enough	□	□	□	□	□	□	□	□	□
Teachers should teach injury prevention	□	□	□	□	□	□	□	□	□
Injuries are an excuse for time off	□	□	□	□	□	□	□	□	□

	Completely disagree				Neutral				Completely agree
Changing my posture/hand position would have a positive effect on my playing long term	□	□	□	□	□	□	□	□	□
Learning more about good posture/hand position will make me a better teacher	□	□	□	□	□	□	□	□	□
It is too difficult to change my posture/hand position	□	□	□	□	□	□	□	□	□
Changing my practice structure will help improve my playing	□	□	□	□	□	□	□	□	□
Changing my posture/hand position will help prolong my career	□	□	□	□	□	□	□	□	□
The discomfort and fatigue from doing exercises will make it hard to practice afterwards	□	□	□	□	□	□	□	□	□
Having a good posture/hand position will improve the way in which my performance is perceived, even if the sound is the same	□	□	□	□	□	□	□	□	□
Doing exercises will help decrease my injury risk	□	□	□	□	□	□	□	□	□
Doing exercises is embarrassing	□	□	□	□	□	□	□	□	□
Changing my practice structure will help decrease my injury risk	□	□	□	□	□	□	□	□	□
Doing exercises will improve my playing reputation	□	□	□	□	□	□	□	□	□
I need to practice for long durations to be able to perform for long durations	□	□	□	□	□	□	□	□	□
Changing my practice structure will help prolong my career	□	□	□	□	□	□	□	□	□
It is too difficult to change my practice structure	□	□	□	□	□	□	□	□	□
Doing exercises will help improve my posture	□	□	□	□	□	□	□	□	□
Doing exercises will improve my playing	□	□	□	□	□	□	□	□	□
If I found time to do exercises, I may as well practice	□	□	□	□	□	□	□	□	□
It would take too much time to change my posture/hand position	□	□	□	□	□	□	□	□	□
Changing my posture/hand position would affect my playing negatively in the short term	□	□	□	□	□	□	□	□	□
Doing exercises will help prolong my career	□	□	□	□	□	□	□	□	□
Changing my posture/hand position will help decrease my injury risk	□	□	□	□	□	□	□	□	□
There is not the space to do exercises at university	□	□	□	□	□	□	□	□	□
My duration of practice in one session is dictated by practice room availability	□	□	□	□	□	□	□	□	□
I don’t have the time to do exercises	□	□	□	□	□	□	□	□	□

	No help				Extremely helpful
Relaxation techniques	□	□	□	□	□
Massage	□	□	□	□	□
Heat	□	□	□	□	□
Cortisone injections	□	□	□	□	□
Stretching	□	□	□	□	□
Alexander technique	□	□	□	□	□
Yoga	□	□	□	□	□
Bowen therapy	□	□	□	□	□
Pilates	□	□	□	□	□
General body training	□	□	□	□	□
Warm-up	□	□	□	□	□
Stop playing as soon as you experience discomfort	□	□	□	□	□
Regular practice breaks	□	□	□	□	□
Time off from playing	□	□	□	□	□
Medications	□	□	□	□	□
Muscle resistance exercises (eg, weights, Thera-Band)	□	□	□	□	□
Reduce playing hours	□	□	□	□	□
Feldenkrais	□	□	□	□	□
Chiropractor	□	□	□	□	□
Physiotherapy	□	□	□	□	□
Osteopath	□	□	□	□	□
Ice	□	□	□	□	□

PERMALINK

University woodwind students’ experiences with playing-related injuries and their management: a pilot study

Jessica Stanhope

Steve Milanese

Karen Grimmer

Abstract

Background

Materials and methods

Results

Conclusion

Background

Table 1.

Materials and methods

Ethics approval

Recruitment

Survey

Data analysis

Results

Table 2.

Table 3.

Figure 1.

Figure 2.

Discussion

Limitations

Conclusion

Supplementary material

Systematic Search

Table S1.

Survey

Survey preliminary information

Survey questions

Acknowledgments

Footnotes

References

Associated Data

Supplementary Materials

Table S1.

ACTIONS

PERMALINK

RESOURCES

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