Uit Australiƫ komt een artikel van ABC-News over de blessures door overbelasting en de rol van het taboe in die problematiek. Helaas gaat de schrijver voorbij aan de invloed van langdurige stress op het ontstaan van fysieke en psychische problemen.

 Orchestral musicians prone to overload injuries, urged to address 'taboo' problems early.

By Luke Rutledge, ABC-News

Bron: www.abc.net.au/news/2014-05-20/orchestra-musicians-urged-to-speak-out-over-strain-injury-taboo/5461850

PHOTO: Musicians believe excess muscle tension, long practice sessions and insufficient rest were the top
attributing factors to injury. (Queensland Symphony Orchestra)

Most of Australia's classical musicians are suffering from injuries due to poor playing techniques, and experts say more needs to be done to educate the industry and overcome what is still largely considered a taboo topic.


Nicola Manson worked as a professional musician for 17 years, playing for the Queensland Symphony Orchestra (QSO) as a violinist, when she was suddenly forced to retire and find a new career.
Ms Manson suffered from tennis elbow, an injury that affects the tendon which allows the arm to move up and down.
After a year of therapy, including cortisone injections and acupuncture, Ms Manson had to face the inevitable – she quit her playing career and began working for the QSO admin team.
"Everybody defines themselves to a degree by what they do – their career – and musicians certainly do... and I certainly did. I was a violinist," Ms Manson said.
"I expected to stop playing when I wanted to, not because I had to.
"So it was kind of shocking at my age to find myself going back to square one and learning how to do something entirely different."

Common risk factors for musicians
• Excess muscle tension: 82.4 per cent
• Long practice sessions: 82.0 per cent
• Insufficient rest: 80.5 per cent
• Poor posture: 77.9 per cent
• Muscle fatigue: 76.8 per cent
• Sudden increase in playing: 75.5 per cent
• Repertoire scheduling: 71.7 per cent
• Stress: 69.6 per cent
• Lack of fitness: 67.0 per cent
• Insufficient warm-up: 66.7 per cent
Source: Musculoskeletal Pain and Injury in Professional Orchestral Musicians in Australia, by Bronwen Ackermann, Tim Driscoll and Dianna Kenny

Unfortunately, Ms Manson's injury is not uncommon among musicians.
Repetitive Strain Injuries (RSI), or overuse and overload injuries as they are now commonly called, affect a significant number of professional and amateur orchestral musicians.
A 2012 survey of members from Australia's eight professional orchestras found 84 per cent of musicians had experienced pain or injuries that interfered with their playing.
The paper, which was funded by the Australia Research Council and The Australia Council for the Arts, found more than 50 per cent of those who had suffered from pain said they returned to work before recovering properly.
For a standard Saturday evening performance, the QSO typically rehearses for two days, which include five rehearsals totaling 13 hours of playing, plus any individual practice by players to prepare the music.
Sydney University musculoskeletal anatomy lecturer Doctor Cliffton Chan said musicians commonly suffered overuse injuries because they repeated movements very quickly for long periods of time.
"At the end of the day when you add that force up, you're putting a lot of strain and force through very specific structures, and often musicians play many hours of the day with very minimal rest," Dr Chan said.
"So there's insufficient time for those structures to recover... you get damage such as micro-tears in the tendons or muscles.

I expected to stop playing when I wanted to, not because I had to.

Nicola Manson - former QSO violinist

 "When you do get that regularly, you build up an inflammatory process, and in those cases you can get some type of tendonitis and overload injury."
Dr Chan said posture contributed to musician injuries, as orchestral players use the front of their body more than their back.
"They're lifting the instrument at the front, they’re holding the instrument at the front, they’re holding up their arms at the front for long periods of time," Dr Chan said.
"So they’re very over-developed in those muscles, and when that happens over many years, you adopt a posture where you're very hunched forward, your shoulders are rounded forward and your head is poking forward."
Dr Chan said musicians should treat their practice routines like a sport.
"They've definitely got similarities with athletes in terms of what they need to know about their body, nutritional needs, hydration needs, preventative exercise needs," Dr Chan said.
"Your typical sports person – such as a runner – doesn't just train for running, they do a lot of other sports to balance out the muscles they don't use while running, and musicians should be exactly the same."

Musician injuries: a 'taboo' topic
But overuse injuries are largely considered a taboo topic within the musician community, according to Dr Chan.
He said sustaining an injury should not be surprising, and musicians should think like athletes when it comes to seeing physiotherapists.

PHOTO: 84 per cent of Australian orchestral musicians say they have experienced pain or injury that has interfered with their playing. (Queensland Symphony Orchestra)
"It's still very taboo to have an injury of any sort," Dr Chan said.
Doctor Karen Lonsdale, a lecturer at the Sultan Indris Education University in Malaysia, said musicians in the past had been unwilling to talk about their injuries.
"There's a fear that, 'Ok, if I talk about my pain then maybe I won’t get work, maybe someone will think I've got a bad technique or I can't cope'," said Dr Lonsdale, whose doctorate focused on musculoskeletal disorders in flute playing.
"More recently, these issues have come to light and the studies have been so consistent that the message is now getting out there that this is just a normal part of being involved in a physical activity, and that activity itself is quite taxing on the body," she said.
In the past, the cause of overuse injuries in musicians was largely un-diagnosable.
Doctor Therese Milanovic, a pianist who suffered from tendonitis while studying music at university, did not understand how serious her injuries were until the pain prevented her from using her hands.
"The thing is, if you don't address why the problem happened, it comes back," Dr Milanovic said.
"I think I paid $150 to see a specialist who told me I had a long neck and that was my problem.
"Then another five years after that I just completely couldn't play, and I was at the point where I had to face reality and say, 'I'm 25, I can't play the piano, at some point I'm going to have to consider a different career choice and one that doesn't use my hands'."
But Dr Milanovic was one of the lucky ones – she travelled to the United States where she received therapy known as the Taubman Approach, which included hours of observations, study and lessons.

The idea that something that I loved was causing me so much discomfort was difficult to reconcile.

Doctor Therese Milanovic - pianist
After one month of intense therapy, Dr Milanovic's injuries were cured and she was able to return to the piano.
She has since trained to become a certified teacher in the Taubman Approach with the Golandsky Institute, which works with musicians to help overcome playing-related injuries, as well as provide better training for teachers.
Through research and study, Dr Milanovic now understands the reasons behind her injuries.
"I was sitting too low, the fingers were very curled, there was a lot of stretching and twisting," Dr Milanovic said.
"At the time it was a bit difficult to swallow because music was the thing that was the most important aspect of my life, and the idea that something that I loved was causing me so much discomfort was difficult to reconcile."
Education key to preventing injuries
QSO workplace health and safety officer Judy Wood says the orchestra uses an exercise program along with a physiotherapist and a massage therapist to minimize the risk of injuries.
"I think musicians are beginning to understand that they're a little bit like athletes and that you've actually got to look after your body a bit," Ms Wood said.
"The trick is to educate the health professionals – to educate the physios, the doctors and the specialists.
"And that is happening a bit, because there's more material out there for them to read and some of them actually make an effort in understanding musician injuries."
But Dr Milanovic warns that musicians whose injuries force them to retire are the ones who fall off the radar.
"It can be absolutely devastating, because obviously we don't do music for the money," Dr Milanovic said.
"We pursue this path because we absolutely love it and we can't live without it.
"And when that's taken away from you, it's not only your career and your passion, but it's also your means of expressing yourself and communicating."