Last summer, as we watched the 2016 Summer Olympics, being aware that we might witness some dramatic injuries only added a touch of titillation to the spectacle. Indeed, there were many broken bones, dislocated joints, shattered collarbones, fractured vertebrae and concussions during the Games. Physical trauma is just part of sports, and we are accustomed to it.
We’re far less aware of the degree of injury in musical performance. Violinists aren’t carried off the concert stage on stretchers and pianists don’t sustain concussions from falling Steinways, so the lack of drama is misleading. In addition, the musician aims for a degree of mastery that makes it appear as if he or she is not under extreme strain, so we only see the occasional moist brow or telltale armpit stains. But however confident and relaxed the performer may appear, the possibility of injury is very high. The lifetime prevalence of injury for musicians is 84 percent, and the chance of a musician playing while injured is 50/50, which is much higher than for athletes. Traumatic sports injuries take the players off the field and into treatment. The chronic strain of musical injury can be hidden, allowing the musician to carry on in a state of pain that ultimately can destroy a career.
And those are just the physical risks. The psychological and emotional risks of a musical career, including the ongoing stress of stage fright, constant travel, financial insecurity and relentless competition, to name only a few, are staggering. And often the two can’t be separated.
While famous injured professional musicians are legion, James Anagnoson, Dean of the Glenn Gould School, points out that the risk has been rising for young musicians. “There are more advanced players at a young age than ever before,” he comments. “Taking on colossal repertoire too soon because they have reached a high level of proficiency. We should ban the Wanderer Fantasy from their studios.”
An organised effort to help artists prevent injury and control damage only began within the last generation, with the establishment of The Performing Arts Medicine Association in 1988. Today it’s becoming standard for aspiring young musicians to develop an awareness of the physical and mental risks they run in order to acquire skills and establish habits to deal with them. This week I sat in on the first class of the Performance Awareness course at the Glenn Gould School to see how they prepare their exceptionally gifted young musicians to meet the intense demands of the program in a healthy way that will sustain them throughout the career they are training to launch.
Anagnoson opened the class with a few comments that combined realistic candour, effervescent optimism, and colourful anecdotes that, like a complex chord, struck a sobering but motivating note at the same time.
“You’re young and fearless, but you need to be aware that physical and mental stress is part of what we do. Even though you’re far more aware than any previous generation, you may still not fully realise how many musicians hit the wall,” said Anagnoson, before turning the floor over to Dr John Chong, the medical director of the Musicians’ Clinics of Canada. The characteristics of that wall, and how to avoid hitting it, was Chong’s focus for the rest of the class.
Chong’s persona of a Puckish dude with a ponytail and major street smarts eliminates the generation gap between his 63 years and the twenty-something kids in the class. He’s exactly the right age for credibility— a fatality of the unenlightened era when over-eager piano prodigies injured themselves from over performance, the way he did at age 14. The concert stage’s loss is the musicians’ gain, as he’s become a leading authority on musicians’ health, bringing hard scientific data as well as a wealth of clinical experience to the field since 1986.
“The science of musicians’ physiology has exploded in the last ten years,” said Chong as he projected charts, graphs, brain scans and other slides illustrating the profound impact of musical training on the mind, body and personality of the musician. One of the slides features two images of a part of the brain called the arcuate fasciculus which is an auditory-motor track. One is the arcuate fasciculus of a musician, the other of a non-musician. The arcuate fasciculus is larger and more developed in the musician’s brain, as a result of performing auditory-motor mapping tasks throughout life. Another shows a grey brain scan with a rainbow splash of colour that is the rush of dopamine that is released when a pleasurable piece of music is heard. Several slides illustrate the physiological processes that lead to injury, including several on stress and its effect on the central nervous system. Chong draws on relatively recent and powerful data that shows that stress is far more than an unpleasant emotional sensation, but a toxic whole-body event that puts the entire system into overdrive, with disastrous medical outcomes. This includes galvanising research such as the Adverse Childhood Event Study, which shows a clear line between specific negative childhood experiences and later adult health problems, and the 2009 Nobel-Prize winning research that showed mental habits such as rumination, seeing red, and negative mind wandering lead to shortened telomeres, ultimately reducing longevity. He stops short of suggesting that musicians are uniquely prone to this or doomed to experience it, but his implication is clear: if this is part of your inner world, now is the time to deal with it.
The class ends with a demonstration of one way to dodge the injury bullet, Surface Electromyography Feedback. A volunteer from the class brings his viola to the front of the room, where Chong applies a variety of patches to his skin, in areas where the muscles are used to play the instrument. As the electrodes connect, a series of lines in four different colours appear on the screen behind the musician, showing the muscle activity in these areas. This provides useful information about whether a certain muscle is over working or working intermittently, or working optimally. In the case of this volunteer, we were all surprised, the young man most of all, to see that even when he appeared to be at rest, his shoulder muscles were active. Simply by looking at the screen and making a conscious effort to relax the area, he eliminated the strain. Without the feedback, he would not have known that his shoulders were under more strain than necessary because he couldn’t consciously feel it. Now he is aware, and in a sense, forewarned. One might say, “forewarned is fore-shouldered”.
It’s clear that Chong sees self-monitoring and self-regulating as the key to resilience. Other techniques and skills will be taught by a variety of experts throughout the course, and if the students at Glenn Gould put them into practice, they are sure to have lower rates of injury and burn out than earlier generations.
The rest of us have a lot to learn from a course like this.
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