Playing-related injury is a common and serious problem amongst student and professional musicians, yet awareness of injury risks in the musician population remains low and few studies have investigated instrument-specific injury types. This study sought to understand the physical, environmental, psychosocial, behavioural and cultural factors that underpin right shoulder injuries amongst orchestral and student cellists. Using right shoulder injuries as a case, the study aimed to present primary knowledge about this injury type and then investigate a range of possible influencing factors in orchestral workplaces and tertiary teaching institutions.
The study aimed to: examine the physical causal mechanisms of right shoulder injuries amongst cellists; investigate the lifestyle and playing conditions that contribute to high rates of injury; establish the influence of current practices in music education on health outcomes for professional and student cellists; and explore the psychosocial, behavioural, and cultural factors that influence injury risk.
The project utilised a mixed method case study approach. The quantitative component involved physical testing and questionnaires administered to a group of 25 student and 47 professional orchestral cellists. The physical testing and questionnaires measured general and shoulder injury frequency, severity and location for the student and professional cellists as well as gathered demographic information and data on lifestyle, and playing habits that may contribute to injury risk. The physical testing evaluated a series of physical measurements such as right shoulder flexibility, range of motion and strength. An EMG pilot study on muscle recruitment patterns during cello-bowing was also undertaken. The qualitative methods were interviews undertaken with orchestral cellists and managers from a single orchestra and student cellists from two tertiary teaching institutions. These interviews were aimed at investigating the influence of attitudes, behaviours, psychosocial factors and institutional culture on injury risk for musicians.
The results of the physical testing indicated that right shoulder pain was common amongst cellists but instance of injury, site of pain, and severity were dependent on skill-level and gender. The pain profiles arising from this research, as well as the muscle recruitment patterns, suggest the role of impingement-type pathologies. The questionnaire component illustrated the differing lifestyle and playing habits of professional and student cellists and their possible influence on player shoulder health. The project suggested prevention protocols that could be effective at decreasing the risk of right shoulder pain in the cello playing population.
The student interviews on health awareness in tertiary schools of music indicated that music students have low levels of injury awareness and often exhibit poor injury behaviours such as playing through injury and showing reluctance to seek medical attention. Music education institutions and teachers were also perceived to be ill-equipped to deal with injury issues when they did arise.
The qualitative research undertaken in the orchestral workplace showed that stress was perceived to be a significant injury risk and that stressors could be divided into psychosocial and combined psychosocial/physical risks. Musicians’ lack of control over work organisation and tasks was outlined as a significant impediment to creating safer working environments. Attitudes, behavioural norms and workplace culture were seen to influence injury risk: negative attitudes to injury leading many musicians to play through pain, often contributing to long-term dysfunction. Once injured, musicians found the injury experience to be psychologically traumatic and socially isolating. Contact with the workplace as well as artistic outlets were seen to be helpful in adjusting to injury, and collegial and management attitudes were important in facilitating supportive environments for recovery. Overall, injured musicians found that standard insurance and medical practices were a poor fit with the specialised rehabilitation requirements of professional musicians.
The project suggests a range of recommendations that are aimed at addressing both the individual risk factors for injury identified in this study, as well as broader institutional and cultural elements. The underlying thesis arising from the study is that addressing the health concerns currently characterising professional orchestras and education environments requires an integrated approach that engages music educators, administrators, performers and managers as key actors in the health creation process. Fostering ‘healthy playing cultures’ and achieving lasting changes to practices and behaviours could lead to safer, more cost effective and sustainable playing environments for musicians.