The Musician Behind the Music

The demands of playing an instrument are staggering. Homer Smith, a neurologist, states that “perhaps in no other human activity, do memory, complex integration and muscular co-ordination surpass the achievement of the skilled pianist” (cited in Fry, 2000, p. 245). A pianist may play 20-30 notes per second, the result of 400-600 distinct motor actions, excluding wrist, forearm, shoulder, and torso movements. By doing so, as neurologist Wilson observes, “Musicians operate the nervous system close to the limits of its functional capacity” (cited in Tubiana, 2003, p. 303). Yet, “The musician in full flight is an operational miracle, but a miracle with peculiar and sometimes unpredictable vulnerabilities” (Wilson, cited in Sacks, 2007, p. 294).

 Musicians’ physical issues are not new. Although Ramazini first documented writers’ cramp in 1713, de Boulounge recorded the first musician’s injury in 1861, Poore observed “pianist’s cramp” in 1887 (Fry, 2000 p. 441). However, scientific studies on PRMDs did not emerge until the early 1980s. Prior to this, Taubman found “many teachers denied that the problem existed, and no one wanted to listen” (cited in Del Pico-Taylor & Tammam, 2005, p. 19).

 Numerous reasons for this deferred investigation into PRMDs can be surmised. Musicians may mask or adapt to problems, such as substituting fingering to conceal dystonic symptoms (Tubiana, 2003, p. 304). As Fry notes, this tendency can be a by-product of the competitive music industry (1986b, p. 53). Another prevailing attitude was the association of PRMDs with inferior musicianship. This was defied when pianistic giants Leon Fleischer and Gary Graffman revealed their devastating injuries in the New York Times (Dunning, 1981). Within the same year, 500 pianists sought treatment from the same hospital as Graffman and Fleisher (Grindea, 1998, p. 17).

 The overwhelming response to the New York Times article played a major role in initiating the discipline of Performing Arts Medicine. By 1985, several international conferences on performing arts health were established in the US. The first dedicated journal addressing performers’ health issues, the Medical Problems of Performing Artists, appeared in 1986 (Bragge, 2006, p. 8; also see PAMA [Performing Arts Medicine Association], 2009). Numerous landmark studies were undertaken in the 1980s, including The International Conference of Symphony and Opera Musicians (ICSOM), which surveyed 2212 of orchestral musicians, exposing respondents had PRMDs of sufficient severity to impact on their performance (Fishbein, Middlestadt, Ottati, Straus, & Ellis, 1987/1998, p. 5).

 The performing arts medicine field has since evolved into a recognised global discipline, with centres across North America, Europe, and Australasia (Watson, 2009, p. xiii). Nonetheless, despite advances in understanding, performing arts medicine is still relatively new, with disagreement across significant areas including causality, prevention, and best treatment.

Extract from Learning and Teaching Healthy Piano Technique: Training as an Instructor in the Taubman Approach. Available through:


Reference List:

Bragge, P. (2006). Performing arts medicine: Past, present and future. Victorian Journal of Music Education, 2004-2006, 6-14.

Del Pico-Taylor, M., & Tammam, S. (2005). The wisdom of Dorothy Taubman. Clavier, 44(10), 19, 46-47.

Dunning, J. (1981, June 14). When a pianist’s fingers fail to obey. New York Times, pp. 1, 24-25.

Fishbein, M., Middlestadt, S., Ottati, V., Straus, S., & Ellis, A. (1987, reprinted 1998). Medical problems among ICSOM Musicians: Overview of a national survey. Medical Problems of Performing Artists, 13(1), 1-8.

Fry, H. J. (1986b). Incidence of overuse syndrome in the symphony orchestra. Medical Problems of Performing Artists, 1(1), 51-55.

Fry, H. J. (2000). Overuse syndrome. In R. Tubiana & P. C. Amadio (Eds.), Medical Problems of the Instrumentalist Musician (pp. 245-272). London: Martin Dunitz.

Grindea, C. (1998). Fleischer Syndrome. Journal for the International Study of Tension in Performance, 9(Oct), 17-19.

Sacks, O. (2007). Musicophilia: Tales of music and the brain. London: Picador.

Tubiana, R. (2003). Musician’s focal dystonia. Hand Clinics, 19, 303-308.

Watson, A. H. (2009). The biology of musical performance and performance-related injury. Lanhan, MA: Scarecrow Press.


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