In light of such findings as these, Conservatoria and indeed, teachers in all settings, need to be accountable in providing “healthy and safe environments” for students and staff, to which Kreutz, Ginsborg and Williamon attest (2009, p. 48). This incorporates basic physical requirements such as adjustable piano benches in each room with a piano, but also provides access to well-informed pedagogy. One study notes that students predominantly rely on their major study teacher for health advice (Kreutz et al., 2009, p. 57). Britsch (2005, pp. 41-42) also warns that students might be reticent to voluntarily disclose these matters, and, as such, that sensitive handling is appropriate. Yet, due to the nature of their training, few teachers have the skills with which to help their students; most have “poor understanding” of risk factors (Bragge, Bialocerkowski, & McMeeken, 2006b, p. 71; also see Gaunt, 2007, p. 219). However, if a conservatoire does not employ staff with specific training in musicians’ health, students in need of this information should have the option of studying externally with a trained teacher in this field, as is the case in Queens College in New York (2011).
Unfortunately, in many institutions and private studios provide “little or no emphasis on care of the body, prevention of injury and psychological well-being” (Williamon & Thompson, 2006, p. 413). In Australia at least, discussion of identifying PRMDs and associated symptoms is absent from the music education curricula (Allsop & Ackland, 2010, p. 75). Even if conservatoria were to establish a commitment to open, progressive learning, through offering access to professional development on musicians’ health for both staff and students via workshops, guest lectures, and tuition, as Zaza notes, it is difficult for a student to make changes to their technique without the support of their teacher (1993, p. 120). As a means of bypassing unwilling pedagogues, if that is an issue, Lederman suggests healthy practices could be embedded into education curricula (1994, p. 74). Such courses may encompass principles of healthy movement, developing awareness of body feedback and warning signs, before specifically addressing instrument-specific challenges and application to the repertoire.
Gaunt’s research also suggests that unless students could see the direct applicability and benefit to their playing, lectures on health were seen as time that could have been better spent practising (2007, pp. 214, 221). As Brandfonbrener has found, many artists are reticent to alter their approach unless they are certain their performance skills will be enhanced (2003, pp. 232, 239), making injury prevention alone unappealing. Steinmetz notes that most musicians do not consider that pain may impact on performance standard, and may even be unaware of their discomfort (2009). As Brandfonbrener states, musicians are “experts at denial”, and can be “so psychologically involved while playing that they remain oblivious to all but the most severe pain” (2003, pp. 232, 239).
To counteract this reluctance to acknowledging PRMDs, such programs may instead focus on “healthy virtuosity” rather than “injury prevention”. This approach aligns with other wellness programs in highlighting the positive, such as some psychologists who promote performance success rather than addressing performance anxiety (see Graham-Pole & Lander, 2009, p.13; also Greene, 2002). Similarly, promoting greater skill, increased facility, and higher-level performance results, with decreasing risk of PRMDs as a side effect, is surely an attractive proposition for musicians.
Clearly, PRMDs are a significant problem today, requiring strategic action on a number of challenging issues within the field of instrumental pedagogy. One of these is training more teachers in coordinate instrumental technique. Often, technique is passed down over generations. Regularly, tenets remain unchallenged for a number of reasons, including insufficient awareness of principles of coordinate movement, devotion to one’s teacher, and pride in one’s pianistic historical lineage or school of technique.
Few teachers have specific training in healthy pianism, yet injured students still often consult their teacher mentor first if symptoms of PRMDs appear. Thus, the probability that the student will receive inappropriate advice is high, while the cause of the symptom remains unresolved. There remains a tendency to accept pain as normal, or even necessary, heightened by a prevailing culture of silence, and further fuelled by social, professional and financial implications if one does admit to PRMDs. Within this context of denying one’s physical responses, the emphasis on experiential learning, and how the embodied musician can interact healthily and skilfully with their chosen instrument, is slight.
The Taubman Approach is one such technique that encompasses a comprehensive, vast understanding of healthy pianism, and trains teachers who are expert in assisting others cultivate coordinate piano technique, analysing the specific physical requirements underneath the printed score, diagnosing technical issues on remarkably subtle levels, and providing systematic, logical solutions.
Extract from Learning and Teaching Healthy Piano Technique: Training as an Instructor in the Taubman Approach. Available through: http://www.theresemilanovic.com/phd-published/
Allsop, L., & Ackland, T. (2010). The prevalence of playing‐related musculoskeletal disorders in relation to piano players’ playing techniques and practising strategies. Music Performance Research, Special Issue Music and Health, 3(1), 61-78.
Bragge, P., Bialocerkowski, A. E., & McMeeken, J. (2006b). Piano teachers’ perceptions of risk factors associated with injuries in elite pianists. Australian Journal of Music Education(1), 70-81.
Brandfonbrener, A. G. (2003). Musculoskeletal problems of instrumental musicians. Hand Clinics, 19(2), 231-239.
Britsch, L. (2005). Investigating performance-related problems of young musicians. Medical Problems of Performing Artists, 20(1), 40-47.
Gaunt, H. (2007). Learning and teaching breathing and oboe playing: Action research in a conservatoire. British Journal of Music Education, 24(02), 207-231.
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Greene, D. (2002). Performance success: Performing your best under pressure. New York: Routledge.
Kreutz, G., Ginsborg, J., & Williamon, A. (2009). Health-promoting behaviours in conservatoire students. Psychology of Music, 37(1), 47-60.
Lederman, R. J. (1994). The coming of age of Performing Arts Medicine. Western Journal of Medicine, 160(1), 73-74.
Williamon, A., & Thompson, S. (2006). Awareness and incidence of health problems among conservatoire students. Psychology of Music, 34(4), 411-430.
Zaza, C. (1993). Prevention of musicians’ playing-related health problems: Rationale and recommendations for action. Medical Problems of Performing Artists, 8(4), 117-121.