Why Technique & Musical Intention aren’t enough: Rethinking Musicians’ Health & Performance.

Since 2012, I’ve been privileged to speak at major Musicians’ Health Conferences around the world. And one theme keeps surfacing again and again among experts: musicians’ health is a silent epidemic.

In this blog, I want to unpack the science behind this statement, share some of my personal insights, and reflect on how we, as individuals and as institutions, must take responsibility to shift the culture and stop allowing this epidemic to persist.

Musicians’ Health and Performance as One

Musicians often view technique and health as two separate domains. But science, and experience, say otherwise.

● Posture training improves movement, reduces strain, and enhances sound (Azor etal., 2024; Röijezon et al., 2017).

● Musicians themselves cite poor posture as a leading injury risk (Ackermann & Adams, 2004)

● Core activation and stability reduce back pain and improve coordination (Mirshahi et al., 2023; Selkow et al., 2017; Steinmetz et al., 2010)

● And perhaps most importantly, every instrument carries its own physical demands. A German study of 614 musicians showed consistent instrument-specific injury patterns (Zalpour et al., 2021).

Playing music is physical. The way we use our bodies, our shoulders, wrists, fingers, core, and posture, is intimately tied to how we sound, how we feel, and how long we can keep playing.

We spend hours performing precise, coordinated movements, often in asymmetrical postures and under high demands for both accuracy and endurance (Williamon, 2004). But that mastery often comes at a cost.

A recent study found that 85% of Norwegian orchestra musicians reported work-related pain in the previous month alone (Eliassen et al., 2024). Injuries in the neck and shoulders are disturbingly common (Paarup et al., 2011; Kok et al., 2016).

And yet, we are rarely taught how to move in ways that protect our health. This includes the complex coordination of shoulders, fingers, hands, and wrists, where we perform hundreds or even thousands of micro-movements every day.

The Hidden Challenge: Playing Through Pain

I’m absolutely certain of this: if those 85% of orchestra musicians living with pain could play beautifully without it, they would.

If the solution were as simple as “relax your shoulders,” “have heavy arms,” or “release wrist tension,” they’d already be doing it. But that isn’t enough.

A major part of the solution lies in knowing how to sit, and how to engage and coordinate the muscles needed for playing, not only to reduce pain, but to produce beautiful tone, maintain legato, and do it with ease. This kind of muscular coordination helps offload the shoulders, arms, wrists, and hands, instead of overloading them.

Just think about it: something as basic as sitting while playing is rarely taught in main instrument lessons, even over years of university-level study.

Most string and wind players who end up in orchestras did almost all their lessons standing. Then, after winning an audition, they go on to sit and play for the next 40 years, often without ever being taught the coordination required to sit and play with ease and control.

At best, some may have had general body awareness training, but even that is often separate from main instrument instruction, and rarely includes how to engage the right muscles while making music.

What Needs to Change — and How We Can Start

It’s time we acknowledge that musicians are athletes of fine motor control, and deserve support as such.

This means:

● Educational Programs must include anatomy, movement training, and injury prevention.

● Institutions must take responsibility for fostering healthy learning cultures, not just focusing on performance outcomes (which, in truth, are enhanced by better movement).

● We, as musicians, must take ownership of our bodies and training.

The good news? Change is possible. And it starts with education, awareness, and support, on both the individual and systemic level.

That’s exactly why I founded the Timani Certification Course back in 2013. I firmly believed this kind of knowledge should be foundational, like music theory or ear training. But I couldn’t wait around for institutions to fully integrate it, so I created the Musicians’ Health and Movement Institute, where we teach Timani: a method that builds body awareness in musicians through the lens of anatomy and physiology.

If you’re curious about what this work can bring to you and your students, and ready to deepen your knowledge and transform your performance and teaching, the Timani Certification Course, already attended by nearly 200 musicians from around the world, was created for exactly that purpose.

Links:

Book a teacher to give a Timani workshop or lecture at your institution

Join the Timani Certification Course and deepen your understanding of the body related to music

performance and health

Check out our “Play With Ease” online course and other courses for professional musicians

References:

Ackermann, B. J., & Adams, R. D. (2004). Perceptions of causes of performance-related injuries by

music health experts and injured violinists. Perceptual and motor skills, 99(2), 669–678.

https://doi.org/10.2466/pms.99.2.669-678

Azor, S., Marko, M., Adamčák, Š., & Bartík, P. (2024). Harmonizing musculoskeletal health:

transformative effects of 8-week intervention program on posture in music students. Physical

Education of Students, 28(2), 78–84. https://doi.org/10.15561/20755279.2024.0204

Eliassen, I., Trouli, H., & Steder, F. B. (2024). Prevalence of musculoskeletal pain and associated

factors among professional orchestra musicians in Norway. Scandinavian journal of public health,

14034948241248496. Advance online publication. https://doi.org/10.1177/14034948241248496

Kok, L. M., Huisstede, B. M., Voorn, V. M., Schoones, J. W., & Nelissen, R. G. (2016). The

occurrence of musculoskeletal complaints among professional musicians: a systematic review.

International Archives of Occupational and Environmental Health, 89, 373-396.

Mirshahi, M., Najafi, R., Golbakhsh, M., Mirshahi, A., & Pishkuhi, M. A. (2023). Effectiveness of a

Core Stability Exercise Program on Pain and Function in Musicians with Chronic Low Back Pain: A

Randomized Controlled Trial. Medical problems of performing artists, 38(4), 207–213.

https://doi.org/10.21091/mppa.2023.4025

Paarup, H. M., Baelum, J., Holm, J. W., Manniche, C., & Wedderkopp, N. (2011). Prevalence and

consequences of musculoskeletal symptoms in symphony orchestra musicians vary by gender: a

cross-sectional study. BMC musculoskeletal disorders, 12, 223. https://doi.org/10.1186/1471-2474-

12-223

Röijezon, U., Berg, J., Larsson, A., & Sundkvist, P. (2017). Sitting postures' effects on movement

behavior and musical performance among high string musicians – a pilot study. Luleå University of

Technology.

Selkow, N. M., Eck, M. R., & Rivas, S. (2017). TRANSVERSUS ABDOMINIS ACTIVATION AND

TIMING IMPROVES FOLLOWING CORE STABILITY TRAINING: A RANDOMIZED TRIAL.

International journal of sports physical therapy, 12(7), 1048–1056.

https://doi.org/10.26603/ijspt20171048

Steinmetz, A., Seidel, W., & Muche, B. (2010). Impairment of postural stabilization systems in

musicians with playing-related musculoskeletal disorders. Journal of Manipulative and Physiological

Therapeutics, 33(8), 603–11. 266 217

Williamon, A. (Ed.). (2004). Musical excellence: Strategies and techniques to enhance performance.

Oxford University Press.

Zalpour, C., Ballenberger, N., & Avermann, F. (2021). A Physiotherapeutic Approach to Musicians'

Health - Data From 614 Patients From a Physiotherapy Clinic for Musicians (INAP/O). Frontiers in

psychology, 12, 568684. https://doi.org/10.3389/fpsyg.2021.568684