" DISCLAIMER: The ILO does not take responsibility for content presented on this web portal that is presented in any language other than English, which is the language used for the initial production and peer-review of original content. Certain statistics have not been updated since the production of the 4th edition of the Encyclopaedia (1998)."

Thursday, 24 March 2011 15:57


Written by
Rate this item
(0 votes)

The musician relies on the skilled use of the muscles, nerves and bones (neuromusculoskeletal system). Playing an instrument requires finely controlled repetitive motions and often entails working in unnatural postures for extended periods of practice and performance (figure 1). These demands on the body can result in specific types of health problems. In addition, adverse working conditions, such as excessive sound exposure levels, prolonged periods of performance without rest, and inadequate preparation for new and difficult repertoire or instruments may affect the health of musicians in all age groups and at all levels of performing ability. Recognition of these hazards, accurate diagnosis and early treatment will prevent occupational disabilities that may interfere with, interrupt or end careers.

Figure 1. Orchestra.


Neuromusculoskeletal Problems

Studies from the United States, Australia and Canada suggest that around 60% of musicians will face career-threatening injuries during their working lifetime. Clinical cross-sectional studies have examined the prevalence of muscle-tendon disorders, of peripheral nerve entrapment syndromes and motor control problems. These studies have revealed several common diagnoses, which include various overuse syndromes, including strain of the muscles and connective tissue which control the bending and extending motions in the wrist and fingers. These syndromes result from the repetitive forceful movement of the muscle-tendon units. Other common diagnoses relate to pain in body parts which are involved in prolonged strain from awkward and imbalanced postures while playing musical instruments. Playing the instruments in the groups described below involves putting pressure on the branches of the nerves in the wrist and forearm, the shoulders, arm and neck. Occupational cramp or muscle spasms (focal dystonia) are also common problems which often can affect performers at the pinnacle of their careers.

String instruments: Violin, viola, cello, bass, harp, classical guitar and electric guitar

Health problems in musicians who play string instruments often are caused by the manner in which the musician supports the instrument and the posture assumed while sitting or standing and playing. For example, most violinists and violists support their instruments between the left shoulder and chin. Often the musician’s left shoulder will be elevated and the left chin and jaw will bear down in order to allow the left hand to move over the fingerboard. Elevating a joint and bearing down at the same time leads to a state of static contraction which promotes neck and shoulder pain, temporomandibular joint disorders involving the nerves and muscles of the jaw, and thoracic outlet syndrome, which can include pain or numbness in the neck, shoulder and upper chest area. Prolonged static sitting postures, particularly while assuming a bent posture, promote pain in the large muscle groups which support posture. Static twisting rotation of the spine is often required to play the string bass, harp and classical guitar. Heavy electric guitars are usually supported by a strap over the left neck and shoulder, contributing to pressure on the nerves of the shoulder and upper arm (the brachial plexus) and thus to pain. These problems of posture and support contribute to the development of strain and pressure of the nerves and muscles of the wrist and fingers by promoting their faulty alignment. For example, the left wrist may be used for excessive repetitive bending motions which result in strain of the extensor muscles of the wrist and fingers and the development of carpal tunnel syndrome. Pressure on the nerves of the shoulder and arm (lower trunks of the brachial plexus) may contribute to problems with the elbow, such as a double crush syndrome and ulnar neuropathy.

Keyboard instruments: Piano, harpsichord, organ, synthesizers and electronic keyboards

Playing a keyboard instrument requires assuming a similar posture to that of typing. Often the forward and downward orientation of the head to look at the keys and hands and repetitive upward movement to look at the music causes pain in the nerves and muscles of the neck and back. The shoulders will often be rounded, combined with a forward head poking posture and a shallow breathing pattern. A condition known as thoracic outlet syndrome can develop from chronic compression of the nerves and blood vessels that pass between the muscles in the neck, shoulder and rib cage. In addition, a musician’s tendency to bend the wrists and curl the fingers while keeping the hand/finger joints flat places excessive strain on the wrist and finger muscles in the forearm. Additionally, the repeated use of the thumb kept in a position under the hand strains the thumb muscles which extend and binds the finger extensor muscles across the back of the hand. The high repetitive force needed to play large chords or octaves may strain the capsule of the wrist joint and result in ganglion formation. Prolonged co-contraction of the muscles that turn and move the arms up and down can lead to nerve entrapment syndromes. Muscle spasms and cramps (focal dystonia) are common among this group of instrumentalists, sometimes requiring long periods of neuromuscular retraining to correct movement patterns which can lead to these difficulties.

Wind and brass instruments: Flute, clarinet, oboe, saxophone, bassoon, trumpet, french horn, trombone, tuba and bagpipes

A musician who plays one of these instruments will vary his or her posture according to the need to control airflow since posture will control the area from which diaphragmatic and intercostal breath is drawn. Playing these instruments depends on the way the mouthpiece is held (the embouchure) which is controlled by the facial and pharyngeal muscles. The embouchure controls sound production of vibrating reeds or the mouthpiece. Posture also affects how the musician supports the instrument while sitting or standing and in operating the keys or valves of the instrument that govern the pitch of the note played by the fingers. For example, the traditional French open-holed flute requires sustained adduction and flexion (bending forward) of the left shoulder, sustained abduction (drawing away) of the right shoulder and rotation of the head and neck to the left in slight movement. The left wrist is often held in an extremely bent position while the hand is also extended in order to support the instrument by the curled left index finger and both thumbs, counter balanced by the right little finger. This promotes strain of the forearm muscles and the muscles which permit extension of the fingers and thumbs. The tendency to project the head and neck forward and use shallow breathing increases the chances of developing thoracic outlet syndrome.

Percussion instruments: Drums, timpani, cymbals, xylophone, marimba, tabla and taiko

The use of sticks, mallets and bare hands to strike various percussion instruments results in rapid pulling back of the wrists and fingers at impact. The impulse vibration caused by striking the instrument is transmitted up the hand and arm and contributes to repetitive strain injuries of the muscle-tendon units and the peripheral nerves. Biomechanical factors, such as the amount of force used, the repetitive nature of the playing and static load placed on the muscles can add to the injuries. Carpal tunnel syndrome and nodule formation in tendon sheaths are common in this group of musicians.

Hearing Loss

The risk of hearing loss from music exposure depends on the intensity and duration of exposure. It is not uncommon to have exposure levels of 100 dB during a quiet passage of orchestral music, with peak values of 126 dB measured at the shoulder of an instrumentalist in the middle of the orchestra. At the position of the conductor or teacher, levels of 110 dB in an orchestra or band are common. Exposure levels for pop/rock and jazz musicians may be significantly higher, depending on the physical acoustics of the stage or pit, amplification system and placement of speakers or other instruments. The average duration of exposure may be approximately 40 hours per week, but many professional musicians will perform 60 to 80 hours per week on occasion. Hearing loss among musicians is far more common than expected, with approximately 89% of professional musicians who were found to have suffered musculoskeletal injuries also showing an abnormal hearing test result, with a hearing loss in the 3 to 6 KHz region.

Personal ear protection can be used but it must be adapted for each instrument type (Chasin and Chong 1992). By inserting an acoustic attenuator or filter into custom-moulded earplugs, the intensity of higher frequency sounds transmitted by ordinary earplugs is reduced to a flat attenuation as measured at the eardrum, which should be less damaging to the ear. The use of a tuned or adjustable vent in a custom earplug will allow the lower frequencies and some harmonic energy to pass through the earplug unattenuated. Earplugs can be designed to provide a slight amplification to alter perception of the singer’s voice, thus allowing the artist to reduce the risk of vocal strain. Depending on the psycho-acoustical nature of the instrument and surrounding music exposures, substantial reduction in risk for the development of hearing loss can be obtained. Improvement in the perception of the relative intensity of the musician’s own performance may reduce the risk of repetitive strain injuries by a relative reduction of the force of repetitive movements.

There are practical strategies for reducing the exposure of musicians that do not interfere with music production (Chasin and Chong 1995). Loudspeaker enclosures can be elevated above floor level, which results in minimal loss of low-frequency sound energy, while preserving sufficient loudness for the musician to perform at a lower intensity level. Musicians who play high-intensity, highly directional instruments such as trumpets and trombones should be on risers so that the sound passes above the other musicians, thereby lowering its impact. There should be 2 m of unobstructed floor space in front of the orchestra. Small stringed instruments should always have at least 2 m of unobstructed space above them.



Read 2134 times Last modified on Tuesday, 06 September 2011 12:22


Part I. The Body
Part II. Health Care
Part III. Management & Policy
Part IV. Tools and Approaches
Part V. Psychosocial and Organizational Factors
Part VI. General Hazards
Part VII. The Environment
Part VIII. Accidents and Safety Management
Part IX. Chemicals
Part X. Industries Based on Biological Resources
Part XI. Industries Based on Natural Resources
Part XII. Chemical Industries
Part XIII. Manufacturing Industries
Part XIV. Textile and Apparel Industries
Part XV. Transport Industries
Part XVI. Construction
Part XVII. Services and Trade
Education and Training Services
Emergency and Security Services
Entertainment and the Arts
Arts and Crafts
Performing and Media Arts
Entertainment and the Arts Resources
Health Care Facilities and Services
Hotels and Restaurants
Office and Retail Trades
Personal and Community Services
Public and Government Services
Transport Industry and Warehousing
Part XVIII. Guides

Entertainment and the Arts Additional Resources

Click the Button below to view additional resources for this topic.


Entertainment and the Arts References

American Academy of Orthopedic Surgeons. 1991. Protective equipment. In Athletic Training and Sports Medicine. Park Ridge, IL: APOS.

Arheim, DD. 1986. Dance Injuries: Their Prevention and Care. St. Louis, MO: CV Mosby Co.

Armstrong, RA, P Neill, and R Mossop. 1988. Asthma induced by ivory dust: A new occupational cause. Thorax 43(9):737-738.

Axelsson, A and F Lindgren. 1981. Hearing in classical musicians. Acta Oto-Larynogologica 92 Suppl. 377:3-74.

Babin, A 1996. Orchestra pit sound level measurements in Broadway shows. Presented at the 26th Annual Meeting of the American Public Health Association. New York, 20 November.

Baker, EL, WA Peterson, JL Holtz, C Coleman, and PJ Landrigan. 1979. Subacute cadmium intoxication in jewellery workers: an evaluation of diagnostic procedures. Arch Environ Health 34:173-177.

Balafrej, A, J Bellakhdar, M El Haitem, and H Khadri. 1984. Paralysis due to glue in young apprentice shoemakers in the medina of Fez. Rev Pediatrie 20(1):43-47.

Ballesteros, M, CMA Zuniga, and OA Cardenas. 1983. Lead concentrations in the blood of children from pottery-making families exposed to lead salts in a Mexican village. B Pan Am Health Organ 17(1):35-41.

Bastian, RW. 1993. Benign mucosal and saccular disorders; benign laryngeal tumors. In Otolaryngology-Head and Neck Surgery, edited by CW Cumming. St. Louis, MO: CV Mosby Co.

—. 1996. Vocal fold microsurgery in singers. Journal of Voice 10(4):389-404

Bastian, R, A Keidar, and K Verdolini-Marston. 1990. Simple vocal tasks for detecting vocal fold swelling. Journal of Voice 4(2):172-183.

Bowling, A. 1989. Injuries to dancers: Prevalence, treatment and perception of causes. British Medical Journal 6675:731-734.

Bruno, PJ, WN Scott, and G Huie. 1995. Basketball. In The Team Physicians’s Handbook, edited by MB Mellion, WM Walsh and GL Shelton. Philadelphia, PA: Mosby Yearbook.

Burr, GA, TJ Van Gilder, DB Trout, TG Wilcox, and R Friscoll. 1994. Health Hazard Evaluation Report: Actors’ Equity Association/The League of American Theaters and Producers, Inc. Doc. HETA 90-355-2449. Cincinnati, OH: US National Institute for Occupational Safety and Health.

Calabrese, LH, DT Kirkendal, and M Floyd. 1983. Menstrual abnormalities, nutritional patterns and body composition in female classical ballet dancers. Phys Sports Med 11:86-98.

Cardullo, AC, AM Ruszkowski, and VA DeLeo. 1989. Allergic contact dermatitis resulting from sensitivity to citrus peel, geriniol, and citral. J Am Acad Dermatol 21(2):395-397.

Carlson, T. 1989. Lights! Camera! Tragedy. TV Guide (26 August):8-11.

Chasin, M and JP Chong. 1992. A clinically efficient hearing protection program for musicians. Med Prob Perform Artists 7(2):40-43.

—. 1995. Four environmental techniques to reduce the effect of music exposure on hearing. Med Prob Perform Artists 10(2):66-69.

Chaterjee, M. 1990. Ready-made garment workers in Ahmedabad. B Occup Health Safety 19:2-5.

Clare, PR. 1990. Football. In The Team Physicians’s Handbook, edited by MB Mellion, WM Walsh, and GL Shelton. St. Louis, MO: CV Mosby Co.

Cornell, C. 1988. Potters, lead and health—Occupational safety in a Mexican village (meeting abstract). Abstr Pap Am Chem S 196:14.

Council on Scientific Affairs of the American Medical Association. 1983. Brain injury in boxing. JAMA 249:254-257.

Das, PK, KP Shukla, and FG Ory. 1992. An occupational health programme for adults and children in the carpet weaving industry, Mirzapur, India: A case study in the informal sector. Soc Sci Med 35(10):1293-1302.

Delacoste, F and P Alexander. 1987. Sex Work: Writings by Women in the Sex Industry. San Francisco, CA: Cleis Press.

Depue, RH and BT Kagey. 1985. A proportionate mortality study of the acting profession. Am J Ind Med 8:57-66.

Dominguez, R, JR DeJuanes Paardo, M Garcia Padros, and F Rodriguez Artalejo. 1987. Antitetanic vaccination in a high-risk population. Med Segur Trab 34:50-56.

Driscoll, RJ, WJ Mulligan, D Schultz, and A Candelaria. 1988. Malignant mesothelioma: a cluster in a Native American population. New Engl J Med 318:1437-1438.

Estébanez, P, K Fitch, and Nájera 1993. HIV and female sex workers. Bull WHO 71(3/4):397-412.

Evans, RW, RI Evans, S Carjaval, and S Perry. 1996. A survey of injuries among Broadway performers. Am J Public Health 86:77-80.

Feder, RJ. 1984. The professional voice and airline flight. Otolaryngology-Head and Neck Surgery, 92(3):251-254.

Feldman, R and T Sedman. 1975. Hobbyists working with lead. New Engl J Med 292:929.

Fishbein, M. 1988. Medical problems among ICSOM musicians. Med Prob Perform Artists 3:1-14.

Fisher, AA. 1976. “Blackjack disease” and other chromate puzzles. Cutis 18(1):21-22.

Frye, HJH. 1986. Incidence of overuse syndrome in the symphony orchestra. Med Prob Perform Artists 1:51-55.

Garrick, JM. 1977. The frequency of injury, mechanism of injury and epidemiology of ankle sprains. Am J Sports Med 5:241-242.

Griffin, R, KD Peterson, J Halseth, and B Reynolds. 1989. Radiographic study of elbow injuries in professional rodeo cowboys. Phys Sports Med 17:85-96.

Hamilton, LH and WG Hamilton. 1991. Classical ballet: Balancing the costs of artistry and athleticism. Med Prob Perform Artists 6:39-44.

Hamilton, WG. 1988. Foot and ankle injuries in dancers. In Sports Clinics of North America, edited by L Yokum. Philadelphia, PA: Williams and Wilkins.

Hardaker, WTJ. 1987. Medical considerations in dance training for children. Am Fam Phys 35(5):93-99.

Henao, S. 1994. Health Conditions of Latin American Workers. Washington, DC: American Public Health Association.

Huie, G and EB Hershman. 1994. The team clinician’s bag. Am Acad Phys Asst 7:403-405.

Huie, G and WN Scott. 1995. Assessment of ankle sprains in athletes. Phys Assist J 19(10):23-24.

Kipen, HM and Y Lerman. 1986. Respiratory abnormalities among photographic developers: A report of 3 cases. Am J Ind Med 9:341-347.

Knishkowy, B and EL Baker. 1986. Transmission of occupational disease to family contacts. Am J Ind Med 9:543-550.

Koplan, JP, AV Wells, HJP Diggory, EL Baker, and J Liddle. 1977. Lead absorption in a community of potters in Barbados. Int J Epidemiol 6:225-229.

Malhotra, HL. 1984. Fire safety in assembly buildings. Fire Safety J 7(3):285-291.

Maloy, E. 1978. Projection booth safety: New findings and new dangers. Int Assoc Electr Inspect News 50(4):20-21.

McCann, M. 1989. 5 dead in movie heliocopter crash. Art Hazards News 12:1.

—. 1991. Lights! Camera! Safety! A Health and Safety Manual for Motion Picture and Television Production. New York: Center for Safety in the Arts.

—. 1992a. Artist Beware. New York: Lyons and Burford.

—. 1992b. Art Safety Procedures: A Health and Safety Manual for Art Schools and Art Departments. New York: Center for Safety in the Arts.

—. 1996. Hazards in cottage industries in developing countries. Am J Ind Med 30:125-129.

McCann, M, N Hall, R Klarnet, and PA Peltz. 1986. Reproductive hazards in the arts and crafts. Presented at the Annual Conference of the Society for Occupational and Environmental Health Conference on Reproductive Hazards in the Environment and Workplace, Bethesda, MD, 26 April.

Miller, AB, DT Silverman, and A Blair. 1986. Cancer risk among artistic painters. Am J Ind Med 9:281-287.

MMWR. 1982. Chromium sensitization in an artist’s workshop. Morb Mort Weekly Rep 31:111.

—. 1996. Bull riding-related brain and spinal cord injuries—Louisiana, 1994-1995. Morb and Mort Weekly Rep 45:3-5.

Monk, TH. 1994. Circadian rhythms in subjective activation, mood, and performance efficiency. In Principles and Practice of Sleep Medicine, 2nd edition, edited by M. Kryger and WC. Roth. Philadelphia, PA: WB Saunders.

National Institute for Occupational Safety and Health (NIOSH). 1991. Environmental Tobacco Smoke in the Workplace: NIOSH Current Intelligence Bulletin 54. Cincinnati, OH: NIOSH.

Norris, RN. 1990. Physical disorders of visual artists. Art Hazards News 13(2):1.

Nubé, J. 1995. Beta Blockers and Performing Musicians. Doctoral thesis. Amsterdam: University of Amsterdam.

O’Donoghue, DH. 1950. Surgical treatment of fresh injuries to major ligaments of the knee. J Bone Joint Surg 32:721-738.

Olkinuora, M. 1984. Alcoholism and occupation. Scand J Work Environ Health 10(6):511-515.

—. 1976. Injuries to the knee. In Treatment of Injuries to Athletes, edited by DH O’Donoghue. Philadelphia, PA: WB Saunders.

Pan American Health Organization, (PAHO). 1994. Health Conditions in the Americas. Vol. 1. Washington, DC: PAHO.

Pheterson, G. 1989. The Vindication of the Rights of Whores. Seattle, WA: Seal Press.

Prockup, L. 1978. Neuropathy in an artist. Hosp Pract (November):89.

Qualley, CA. 1986. Safety in the Artroom. Worcester, MA: Davis Publications.

Ramakrishna, RS, P Muthuthamby, RR Brooks, and DE Ryan. 1982. Blood lead levels in Sri Lankan families recovering gold and silver from jewellers’ waste. Arch Environ Health 37(2):118-120.

Ramazzini, B. 1713. De morbis artificum (Diseases of Workers). Chicago, IL: University of Chicago Press.

Rastogi, SK, BN Gupta, H Chandra, N Mathur, PN Mahendra, and T Husain. 1991. A study of the prevalence of respiratory morbidity among agate workers. Int Arch Occup Environ Health 63(1):21-26.

Rossol, M. 1994. The Artist’s Complete Health and Safety Guide. New York: Allworth Press.

Sachare, A.(ed.). 1994a. Rule #2. Section IIC. In The Official NBA Basketball Encyclopedia. New York: Villard Books.

—. 1994b. Basic Principle P: Guidelines for infection control. In The Official NBA Basketball Encyclopedia. New York: Villard Books.

Sammarco, GJ. 1982. The foot and ankle in classical ballet and modern dance. In Disorders of the Foot, edited by MH Jahss. Philadelphia, PA: WB Saunders.

Sataloff, RT. 1991. Professional Voice: The Science and Art of Clinical Care. New York: Raven Press.

—. 1995. Medications and their effect on the voice. Journal of Singing 52(1):47-52.

—. 1996. Pollution: Consequences for singers. Journal of Singing 52(3):59-64.

Schall, EL, CH Powell, GA Gellin, and MM Key. 1969. Hazards to go-go dancers to exposures to “black” light from fluorescent bulbs. Am Ind Hyg Assoc J 30:413-416.

Schnitt, JM and D Schnitt. 1987. Psychological aspects of dance. In The Science of Dance Training, edited by P Clarkson and M Skrinar. Champaign, IL: Human Kinetics Press.

Seals, J. 1987. Dance surfaces. In Dance Medicine: A Comprehensive Guide, edited by A Ryan and RE Stephens. Chicago, IL: Pluribus Press.

Sofue, I, Y Yamamura, K Ando, M Iida, and T Takayanagi. 1968. N-hexane polyneuropathy. Clin Neurol 8:393-403.

Stewart, R and C Hake. 1976. Paint remover hazard. JAMA 235:398.

Tan, TC, HC Tsang, and LL Wong. 1990. Noise surveys in discotheques in Hong Kong. Ind Health 28(1):37-40.

Teitz, C, RM Harrington, and H Wiley. 1985. Pressure on the foot in point shoes. Foot Ankle 5:216-221.

VanderGriend, RA, FH Savoie, and JL Hughes. 1991. Fracture of the ankle. In Rockwood and Green’s Fractures in Adults, edited by CA Rockwood, DP Green, and RW Bucholz. Philadelphia, PA: JB Lippincott Co.

Warren, M, J Brooks-Gunn, and L Hamilton. 1986. Scoliosis and fracture in young ballet dancers: Relationship to delayed menarcheal age and amenorrhea. New Engl J Med 314:1338-1353.

World Health Organization (WHO). 1976. Meeting on Organization of Health Care in Small Industries. Geneva: WHO.

Zeitels, S. 1995. Premalignant epithelium and microinvasive cancer of the vocal fold: the evolution of phonomicrosurgical management. Laryngoscope 105(3):1-51.