French Horn Players’ Attitudes Regarding the Accurate Application of Anatomical Knowledge in Optimal Playing Philosophies
By Ashley Skyring
A thesis submitted in fulfilment of the requirements for the degree of Master of Philosophy
Faculty of Medicine and Health I certify that I understand that, if my candidature is successful, my thesis will be lodged with the Director of University Libraries and made available for immediate use.
The University of Sydney
Brisbane, June 2019 Abstract
This thesis entitled “French Horn Players’ Attitudes Regarding the Accurate Application of Anatomical Knowledge in Optimal Playing Philosophies” written in requirement of a Master of Philosophy (Medicine), University of Sydney, was instigated by a desire to overcome my own artistic limitations as a French Horn player and to explore the role accurately applied anatomical knowledge might play in understanding and overcoming these limitations. Through a literature review, concepts around the application of accurate anatomical information from various sources to inform optimal playing philosophies were explored. An in-depth understanding of anatomical structures was acquired and followed by the development of 3D modelled anatomical resources in consultation with Dr Bronwen Ackermann, PhD, MPH, BAppSc(PT) and Dr Mark Halaki, PhD, MSc, Bsc. These were used as a resource to support gathering both qualitative and quantitative data. The attitudes of French Horn players were examined in a mixed method study including surveys and in-depth interviews with professional and highly regarded French Horn players. Data showed that French Horn players have limited knowledge of functional anatomy and that this could potentially contribute to the development of Playing Related Medical Disorders (PRMDs). The study also identified that aspiring horn players would value more knowledge of functional anatomy, demonstrated the important role of medical professionals in mediating this knowledge, and recommends that it would be appropriate that study of functional anatomy be incorporated into tertiary study of the French Horn, however applicability, appropriacy and context are also contributing factors to the usefulness of this data.
Acknowledgements
I would like to thank Dr Bronwen Ackermann, PhD, MPH, BAppSc(PT) and Dr Mark Halaki, PhD, MSc, BSc for their continued support during my candidature. Without their insight and collaborative efforts this thesis would not be possible.
My gratitude and thanks also goes to Assoc. Prof. Peter Luff for his magnanimous support, enthusiasm and guidance, which has bolstered the quality of this work in the most meaningful of ways.
This thesis is dedicated to my ever-loving friends, family and partner, who have provided me with unquestioning support over the last three years.
CHAPTER 1. INTRODUCTION ...... 4
1.1 Background ...... 4 1.1.1 What is a horn ...... 4 1.1.2 How is it learned ...... 4 1.1.3 Elite Horn Performance ...... 5 1.1.4 Challenges of horn playing...... 6 1.1.5 Focus of this study ...... 7
1.2 Motivation behind this study ...... 7
CHAPTER 2. LITERATURE REVIEW ...... 7
2.1 Overview ...... 7
2.2 Introduction ...... 8
2.3 Methods ...... 8
2.4 Literature extraction ...... 8
2.5 Tools ...... 11
2.6 Academic literature summary ...... 11 2.6.1 PRMD types and prevalence rates ...... 12 2.6.1.1 The role of functional anatomy for informing performers, preventative programs and collaborative educational models...... 14 2.6.1.2 PRMDs considered with poorly applied or insufficient anatomical knowledge ...... 14 2.6.1.2.1 General PRMDs ...... 15 2.6.1.2.2 Posture focused ...... 17 2.6.2 Neurological considerations ...... 18 2.6.2.1 Intrinsic knowledge ...... 18 2.6.2.1.1 Plasticity ...... 18 2.6.2.1.2 Degradable neural pathways ...... 18 2.6.2.1.3 Inaccurate proprioception ...... 18 2.6.2.1.4 Disproportionate representations ...... 18 2.6.2.1.5 Multimodal and adaptive sensory perception ...... 19 2.6.3 Limits of current research ...... 20 2.6.4 Challenges with the One-on-one (Master-Apprentice) model of teaching ...... 21 2.6.5 Summary of peer-reviewed literature...... 22
2.7 Non-peer reviewed (grey) literature summary ...... 22 2.7.1 Unpublished routines ...... 23 2.7.2 Method books ...... 23 2.7.3 Additional Pedagogy ...... 23 2.7.4 Non-peer-reviewed articles ...... 24
2.8 A comparison of the academic versus pedagogical literature ...... 24
CHAPTER 3. METHODS ...... 25
3.1 Overview ...... 25
3.2 Design ...... 25 3.2.1 Development of the theoretical contribution map ...... 25 3.2.1.1 Theoretical Contribution Map ...... 25 Page 1 of 86 3.2.1.2 1) Problems identified ...... 25 3.2.1.3 2) Importance ...... 26 3.2.1.4 3) Goals ...... 26 3.2.1.5 4) Theoretical background ...... 26 3.2.1.6 5) Development of Methods ...... 26 3.2.2 Developed Research Questions ...... 26 3.2.3 Resource development ...... 27
3.3 Participants ...... 27 3.3.1 Ethics...... 28
3.4 Data collection ...... 28 3.4.1 Surveys ...... 28 3.4.1.1 Performer survey (Appendix 7) ...... 28 3.4.1.2 Medical professional survey (Appendix 9) ...... 29 3.4.2 Interviews ...... 29 3.4.3 Recruitment ...... 30 3.4.3.1 Interview demographics...... 31 3.4.3.2 Performer survey demographics ...... 31 3.4.3.3 Medical professional survey ...... 31 3.4.4 Interview analysis tools and data management ...... 32 3.4.4.1 Interview Recording protocol ...... 32 3.4.4.2 Interview Transcription protocol ...... 32 3.4.4.3 Interview analysis tools and protocol ...... 32 3.4.4.3.1 Development of nodes and coding comments to them...... 33 3.4.4.3.1.1 Data driven nodes...... 33 3.4.4.3.1.2 Theory driven nodes ...... 35 3.4.5 Survey analysis protocols...... 36 3.4.5.1 Survey Data Analysis tools and protocol ...... 36
CHAPTER 4. RESULTS AND DISCUSSION ...... 36
4.1 Overview ...... 36
4.2 Theme 1. Regarding extrinsic/cognitive sources for understanding functional anatomy ...... 36 4.2.1 Knowledge from defined sources – survey data...... 37 4.2.1.1 Sources considered the most useful - survey...... 37 4.2.2 Knowledge from defined sources – interview data ...... 37 4.2.2.1 Sources considered the most useful – interview data ...... 38 4.2.2.2 Perceived problems with pedagogical sources ...... 38 4.2.3 Anatomical representation in pedagogical sources ...... 39
4.3 Theme 2. Blended modalities of learning ...... 40 4.3.1 Somatic Bodywork ...... 40 4.3.1.1 Accent Method Breathing (AMB) ...... 40 4.3.1.2 Alexander Technique (AT) ...... 41 4.3.1.3 Body Mapping (BM) ...... 41 4.3.1.4 Analysis of somatic methods ...... 41 4.3.2 One-on-one (Master/apprentice) pedagogical model ...... 42 4.3.2.1 Challenges with one-on-one horn pedagogy ...... 42 4.3.2.1.1 Teaching styles ...... 42 4.3.2.1.2 Awareness challenges ...... 43 4.3.2.1.3 Attitudes towards PRMDs at conservatoriums ...... 44
4.4 Theme 3. Intrinsic knowledge ...... 45 4.4.1 Intrinsic knowledge ...... 45 4.4.2 Sensory perception...... 45 4.4.2.1 From the survey data ...... 45 Page 2 of 86 4.4.2.2 From the interviews ...... 47 4.4.2.3 Perceptions of air use ...... 48
4.5 Theme 4. Playing-related Musculoskeletal Disorders (PRMDs) ...... 51 4.5.1 PRMDs from the Survey...... 51 4.5.2 Treatment by medical professionals ...... 51 4.5.3 Developed understanding of functional anatomy ...... 52 4.5.4 From the interviews ...... 53 4.5.5 Risk of developing PRMDs from descriptions within interviews ...... 54
4.6 Theme 5. Appropriacy, applicability and context regarding the application of accurately applied functional anatomy ..... 54 4.6.1 From the survey ...... 55 4.6.1.1 Disparity between ‘importance’ and ‘confidence’ ...... 55 4.6.1.2 Improving communication ...... 56 4.6.1.3 Filtering contrasting philosophies ...... 57 4.6.1.4 Information provided through open text fields in survey ...... 58 4.6.2 From the interviews ...... 59 4.6.3 Challenges ...... 60 4.6.3.1 Analysis around the lack of defined sources ...... 60 4.6.3.2 Application of functional anatomy ...... 61 4.6.3.2.1 Considerations of ongoing research ...... 62 4.6.3.2.2 Considerations of differences between brass family instruments ...... 63 4.6.3.2.3 Informing aspects of performance ...... 64 4.6.3.2.4 Collaboration with medical professionals and preventative programs ...... 64 4.6.4 To enable ownership of learning ...... 65
4.7 Bolstering education ...... 66
4.8 Clearer nomenclature ...... 66
4.9 Recruitment of French horn players and teachers in research projects ...... 66
CHAPTER 5. CONCLUSIONS ...... 67
5.1 Current attitudes of Horn players towards the application of anatomical knowledge to optimise their playing philosophies ...... 68
5.2 Horn players’ perceived best-practice approaches to using accurately applied knowledge of anatomy to develop optimal playing philosophies ...... 69
5.3 Difficulties exist for Horn players to translate anatomical knowledge into practice to achieve optimal artistic results ...... 69
5.4 Disparities and similarities exist between playing philosophies, particularly among high-ranking Horn players? ...... 70
5.5 Potential benefit of incorporation of anatomical knowledge into playing philosophies for aspiring horn players ...... 70
CHAPTER 6. RECOMMENDATIONS ...... 70
CHAPTER 7. REFERENCES ...... 71
Page 3 of 86 Chapter 1. Introduction
This study aims to investigate whether the playing philosophies of French horn (herein known as “horn”) players are appropriately informed by an understanding of functional anatomy and what might serve to contribute to their understanding. This information may be applied to provide a basis for improving their performance abilities as well as to prevent or reduce Playing Related Musculoskeletal Disorders (PRMDs), but whether this occurs or not is not yet known.
While there is still much debate around some aspects of horn performance in the both academic research and individual high-ranking players’ philosophies, a review of the broad literature on this topic identifies that a developed understanding of functional anatomy has been suggested to be associated with improved performer health. Career limiting playing-related problems occur to horn players of all levels (Árnason, 2018; Lederman, 2011; Lewis, 2007; Neunecker, 2017), and this in part may result from ambiguity in the teaching and learning process, whereby the musician typically does not learn how to best use their body or mind during playing to prevent health or musical performance issues from occurring.
In an artform where the brass instrument is often considered to be just an extended resonance chamber and the body is considered the actual instrument (Dixon, 2010; Farkas, 1956; McWilliam, 2012; Nelson, 2006; Steenstrup, 2007), discussion of Playing Related Musculoskeletal Disorders (PRMDs) and accurately applied anatomy appears to play a very minor role in playing and teaching philosophies. Why is this so?
This thesis will explore perceptions of French horn musicians towards anatomical, physiological and kinesiological information, applied specifically to music performance skills. The data is analysed with respect to five main themes of; extrinsic/cognitive knowledge; blended modalities of learning; intrinsic knowledge; playing related medical disorders; appropriacy, applicability and context. 1.1 Background 1.1.1 What is a horn
The French Horn, pictured right (Figure 1), is a musical instrument of the Brass family. When compared to other brass instruments, it has a mouthpiece that is proportionately small compared to the size of the bell and the length of the brass tubes. It is primarily used in classical, operatic or theatrical “pit” orchestras. The horn resonates and amplifies the vibration emanating from the horn players lips, often call a ‘buzz’. This is known in acoustics as a lip reed instrument (Newton, Campbell, & Gilbert, 2008). There are many varieties of French horn but for the purposes of this study all variations of the instrument known as a French horn will referred to as ‘horn’ as all of them use the body in a similar way.
Figure 1. A French horn being played by the author 1.1.2 How is it learned
As occurs in performance domains, some people are better at playing the horn than others. Though individual learning methods vary, the primary learning methods that aspiring horn players use to develop their ability are a combination of ‘trial and experience’ and kinaesthetic registration of muscular actions supported by one-on-one lessons with high- ranking performers or pedagogues at specialised music education institutions or in private lessons (Altenmüller, Ioannou, & Lee, 2015; McWilliam, 2012; Shoebridge, Shields, & Webster, 2017; Steenstrup, 2007, 2016; Yancich, 1971). Horn players also learn by watching and listening to other performers and reflecting on their own performance outputs (Frederiksen, 1996; Greene, 2002; Nelson, 2006).
The ‘one-on-one/master-apprentice” pedagogical model is the primary way that knowledge is transferred from high- ranking performers or pedagogues. Each high-ranking performer or pedagogue will have a unique philosophy regarding
Page 4 of 86 both how they themselves perform the most difficult musical tasks under the considerable psychological pressure of performance conditions, as well as what instructions should be given to individual students in order to enable the student to develop the ability to do the same. Subjective instructions are usually given, which the aspiring professional then must integrate into their own playing philosophy and develop their own neural networks to try to emulate these subjective instructions (Bowman, 2017, p. 1).
Historically, here is no prerequisite for pedagogues to undergo study of functional anatomy or physiology respective to the body parts they use to help teach others how to play the horn (Persson, 1994, p. 79). Although the ‘one-on-one’ pedagogical model is considered essential (Carey & Grant, 2012, p. 19), there are a considerable challenges, as demonstrated in peer-reviewed academic literature which will be addressed in the literature review chapter of this thesis (Altenmüller, Ioannou, et al., 2015; Bowman, 2017; Carey & Grant, 2012; Carey, Bridgstock, Taylor, McWilliam, & Grant, 2013; Chan & Ackermann, 2014; Fuhrmann, 2009; Gillespie, 2016; Ioannou, DiS, & Altenmüller, 2015; Persson, 1994; Woldendorp, Boschma, Boonstra, Arendzen, & Reneman, 2016). 1.1.3 Elite Horn Performance
Playing the French Horn at an elite level is a highly complex physical task, requiring simultaneous coordinated actions of the entire body, controlled by various complex neural networks (Chesky, Devroop, & Ford III, 2002; Farkas, 1956; Hirano et al.; Iltis, 2013; Iltis, Schoonderwaldt, Zhang, Frahm, & Altenmüller, 2015). Altenmüller, Ioannou, et al. (2015) observe that “Performing music at a professional level is probably one of the most complex human accomplishments. Extremely fast and complex, temporospatially predefined movement patterns have to be learned, memorized, and retrieved with high reliability in order to meet the expectations of listeners. Performing music requires not only the integration of multimodal sensory and motor information, and its precise monitoring via auditory and kinaesthetic feedback, but also emotional communicative skills, which provide a “speaking” rendition of a musical masterpiece.”
Training on a musical instrument has been estimated to take at least 10,000 hours within 10 years of deliberate practice to achieve a high level of skill (Altenmüller, Ioannou, et al., 2015; Brandfonbrener, 2010; Ericsson, Krampe, & Tesch- Römer, 1993). Historically and currently, the master-apprentice pedagogical model is considered ‘indispensable, intense and intricate’ part of instrumental and vocal learning (Carey & Grant, 2012; Gaunt, 2011), however studies conducted within music education institutions have identified flaws with this model (Carey & Grant, 2012; Carey et al., 2013; Gaunt, 2011), some of which are also reflected in the pedagogical texts that are frequently used by horn players of all levels. As identified in the performing arts medicine literature, accurately applied knowledge of anatomy and physiology is largely absent, ambiguous, subjective and prone to misinterpretation. (Árnason, 2018; Blanco-Piñeiro, Díaz-Pereira, & Martínez, 2015; Blanco-Piñeiro, Díaz-Pereira, & Martínez, 2017; López & Martínez, 2013; Medoff, 1999; Roset-Llobet, Rosinés-Cubells, & Saló-Orfila, 2000; Shoebridge et al., 2017). These components, when combined with this volume of training and the pressures associated with a competitive study and work environment, makes performers highly vulnerable to injury (Ackermann, 2010).
To become a professional horn player, an aspiring horn player needs to demonstrate their skill by passing an audition for an available position within an ensemble. An audition requires aspiring horn players to play a set of the most difficult passages written for the instrument across a broad range of musical tasks usually in front of an esteemed music panel (Manfredi, 2011). Passing or ‘winning’ or an audition is a combination of technique, musicality, ability to manage audition stress, ability to take risks, and luck (Manfredi, 2011, p. 50).
The horn has a commonly used pitch range of ~4 octaves (Rimsky-Korsakov, 1964) and a dynamic range of ‘almost inaudible’ to ‘well above comfortable’ (O’Brien, Wilson, & Bradley, 2008). A career as a horn player may cross several paths and while it is not prescriptive, will generally fall into one of the following sub-categories:
• The most accomplished elite level players are able to financially support themselves by performing the most difficult solos from the repertoire while standing in front of an orchestra, overcoming considerable pressure to thrill and entertain audiences through interpretation of the artistic work by the composer. They also will typically earn money by sharing their expertise through running intensive teaching sessions with students in the form of ‘masterclasses’. Page 5 of 86
• High horn specialists are usually employed as section or associate principal players who specialise in high pitch range, exposed, difficult, solo passages within the orchestra. • Low horn players tune their abilities to excel in the low pitch range orchestral music which has a different set of challenges due to the construction of the instrument. • ‘Rank and file’ horn players fill out the rest of the section and while they do not necessarily specialise their skill as much as either high or low specialists, they are expected to perform in all ranges and carry out a number of still demanding musical tasks.
All professional horn players are expected to master their skills and perform with a broad range of artistry and musical expressions. 1.1.4 Challenges of horn playing
Horn playing is difficult because it is a mental, physical and artistic endeavour that includes the interdependence of core components such as breathing and breath support (Aliverti & Pedotti, 2014; Altose, 2007; Bārdiņš & Marnauza, 2014; Bouhuys, 1964; Nesmith, 2012), posture (Ackermann, O'Dwyer, & Halaki, 2014; Kera & Maruyama, 2005; Lee, Chang, Coppieters, & Hodges, 2010; Ohlendorf, Wanke, Filmann, Groneberg, & Gerber, 2017; Price, Schartz, & Watson, 2014; Shoebridge et al., 2017), both conscious and subconscious neurological pathways (Altenmueller & McPherson, 2008; Hudson, Gandevia, & Butler, 2011; Lederman & Md, 2002; Lederman, 2011), embouchure formation (Bowman, 2017; Lewis, 2007; Steinmetz et al., 2014; Woldendorp et al., 2016), and the subtle manipulation of internal resonance chambers (Iltis, 2013; Iltis, Frahm, et al., 2017; Iltis, Gillespie, et al., 2017; Iltis, Schoonderwaldt, et al., 2015). Brain, mind and body all play a part. Without regular practice to maintain and improve these technical components an individual’s capacity to play the horn diminishes, even after a professional level of performance has been achieved. In addition, the horn player is expected to perform all these complex physical tasks while applying artistry to interpret and express the composers’ musical intentions. Providing context, Altenmüller, Ioannou, et al. (2015) write;
“Most musicians work at the upper limit of their sensory-motor capabilities and strive to push their limits even further ahead in order to be faster, louder, and more expressive. As musicians say, “there is always a colleague, who plays this piece faster, louder and more beautiful.” This is in part also true for sports, but in music, fine motor skills predominate. Therefore, musicians are frequently denoted colloquially as “small muscles’ athletes”
Due to the complex interactions required between the musicians’ brain, mind, body, the instrument and the musical tasks at hand, each individual horn player will have a ‘playing philosophy’, whether or not they are conscious of it. A playing philosophy is the amalgamation of the thought patterns and approaches the player integrates into their playing and exists in the mind of the performer. Although philosophies may contain some similar components, no two philosophies will be precisely the same (Altenmüller & Schlaug, 2015), and many philosophies will change and develop over time. It is commonplace to observe wide differences of opinion in relation to specific playing philosophies, with heated arguments at times arising between horn players, regardless of their performance level. An individual will be exposed to contradicting philosophies and will often apply different approaches from one period of their career to another. As represented in the forthcoming data, sometimes a player will have a philosophy that contradicts another of their own. Horn players often develop philosophies with either inaccurate or limited understanding of anatomy, or a misinterpretation of how they are using their own bodies.
When considering the combination of these contradictory philosophies with indeterminable levels of anatomical knowledge, it is unsurprising that biomechanical imbalances may occur, and career-threatening performance-limiting medical problems arise, as documented in peer-reviewed literature (Ackermann et al., 2014; Árnason, 2018; Berque & Gray, 2016; Blanco-Piñeiro et al., 2015; Blanco-Piñeiro et al., 2017; Chesky et al., 2002; Ioannou et al., 2015; Klein, Bayard, & Wolf, 2014; Knapik et al., 2007; Kok, Huisstede, Voorn, Schoones, & Nelissen, 2016; Lewis, 2002; López & Martínez, 2013; Ohlendorf et al., 2017; Papsin, Maaske, & McGrail, 1996; Roset-Llobet et al., 2000; Shoebridge et al., 2017; Stanhope, 2016; Taylor, 2016; Watson, 2009; Woodman & Moore, 2012).
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There are also challenges with regard to the intrinsic knowledge required to play the horn, including neurological concepts including: plasticity; degradable neural pathways; inaccurate proprioception; disproportionate representation; multimodal and adaptive sensory perception (Altenmueller & McPherson, 2008; Altenmuller & Ioannou, 2016; Altenmüller, Ioannou, et al., 2015; Altenmüller & Schlaug, 2015; Altose, 2007; Altose, Dimarco, Gottfried, & Strohl, 1982; Corfield, Roberts, Guz, Murphy, & Adams, 1999; Dayan & Cohen, 2011; Ericsson et al., 1993; Gillespie, 2016; Guerraz et al., 2012; Harver, Balrd, Mcgovern, & Daubenspeck, 1988; Klein et al., 2014; Kolb & Whishaw, 1998; Mckay, Evans, Frackowiak, & Corfield, 2003; Morris, Harrison, & Klieve, 2013; Proske & Gandevia, 2012; Revelette & Wiley, 1987). 1.1.5 Focus of this study
This thesis focusses on attitudes and perceptions regarding the application of accurate anatomical information, its role in optimal playing philosophies, and the PRMDs that are perceived by medical professionals who treat and research horn players that may stem from poorly informed playing philosophies. 1.2 Motivation behind this study
I instigated this study having encountered artistic limitations, even after more than 10 000 hours of dedicated, focussed practice within the 10-year period that it purportedly takes to achieve the standard of a professional horn player (Ericsson et al., 1993). I sought to consider the role that anatomical knowledge might have in improving playing philosophies and performance outcomes, reflecting on both my own and those of the pedagogues I have encountered. I personally observed that injury is a risk to horn players; anatomical information was largely absent or difficult to apply accurately from pedagogical materials; and that clear and unambiguous discussion of the role of anatomy was uncommon in horn teaching.
The initial aims of this study were to:
1. Investigate best-practice approaches that use accurately applied knowledge of anatomy to develop optimal playing philosophies. 2. Understand more about the difficulties with translating anatomical knowledge into practice. 3. Document disparities between horn players in relation to anatomical knowledge. 4. Know how important horn players think this anatomical knowledge is and how much is a good amount. 5. Explore how learning about the body can assist in optimising what we feel from the body.
These were refined into the following research questions:
1. What are the current attitudes of Horn players towards the application of anatomical knowledge to optimise their playing philosophies? 2. What are Horn players’ perceived best-practice approaches to using accurately applied knowledge of anatomy to develop optimal playing philosophies? 3. What difficulties exist for Horn players to translate anatomical knowledge into practice to achieve optimal artistic results? 4. What disparities and similarities exist between playing philosophies, particularly among high-ranking Horn players? 5. What can the outcomes of the study offer for aspiring Horn players with regard to the benefit of incorporation of anatomical knowledge into their playing philosophies? Chapter 2. Literature Review 2.1 Overview
This literature review explores a wide range of both academic and grey literature sources that offer perspectives into the complexities surrounding the application of functional anatomical knowledge into horn players’ playing philosophies.
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Due to both the nature of the study and the disparity of available literature, a narrative review was favoured over a systematic review.
Two main groups of literature were explored and a ranking system was applied to both. The first group included academic sources from peer-reviewed journals that offer evidence based, defensible information on one or more aspects of horn performance or health, and the second encompassed pedagogical sources that play a role in many horn players philosophies. This ranking system was developed and applied to both these academic and grey literature sources, which have thus been categorised by topic, though some sources span multiple topics. Academic topics include types and prevalence rates of injuries, as well as studies that investigate aspects of posture, breathing mechanics, embouchure function, velopharyngeal function, kinesiological studies with the use of Real Time – MRI and electromyography, physiotherapeutic studies, neurological studies, educational psychology and acoustics and air-flow studies. Grey literature includes horn, brass and to a limited degree singing method books, unpublished routines, additional pedagogy such as psychological performance books. 2.2 Introduction
Playing Related Musculoskeletal Disorders (PRMDs) are prevalent amongst horn players of all levels and take many forms, described in detail below with reference to their causes, with the common feature being that in some way playing their instrument has been associated with some kind of adverse health outcome. Musicians are often compared to sporting athletes (Camerino, Castañer, & Anguera, 2012; Stanhope, 2016), yet where applied anatomical knowledge plays a strong supportive role in sports science, including athletes development, maintenance and recovery of optimal sporting philosophies, the same cannot be said for French horn players (Altenmüller & Schlaug, 2015; Stanhope, 2016).
Academic sources investigating proprioception illustrate important and deeply rooted factors that are often overlooked in the development of playing philosophies from kinaesthetic experiences. Riva (2018) observes that “Our experience of the body is not direct; rather, it is mediated by perceptual information, influenced by internal information, and recalibrated through stored implicit and explicit body representation (body memory)”. Guerraz et al. (2012) add that “Our results indicate that kinesthesia is the product of cooperative integration processes in which the relative contribution of each (neurological fibre) channel to the final percept depends strongly on the experimental conditions and individual sensorial preferences”. A mediated experience of the body and the individual nature of kinesthesia contribute to the complexities of horn playing. Shadmehr, Smith, and Krakauer (2010) identify that “our ability to produce a lifetime of accurate movements lies not in the fact that we are born with an invariant set of actuators, precise set of sensors, or fast transmission lines, but rather in that we are born with a nervous system that adapts to these limitations and continuously compensates for them. If left uncompensated, these inherent limitations could give rise to systematic errors in our movements”, highlighting challenges with sensory perception and error correction. Beyond pedagogical exchanges, Altenmüller, Ioannou, et al. (2015) identify that the development of “kinesthetic senses constitute another basis of high-level performance. They allow for the control and feedback of muscle- and tendon- tension as well as joint positions, enabling the continuous monitoring of finger-, hand-, or lip-position in the frames of body and instrument coordinates (e.g., the keyboard, the mouthpiece)”. 2.3 Methods
Limited scientific peer-reviewed research was identified on this specific topic and accordingly, a narrative style review was chosen to be the most appropriate way to collate and analyse existing evidence (Ferrari, 2015; Maxwell, 2006). To add methodological rigour, a four-phased tool-supported methodology was used as outlined by Bandara, Gorbacheva, and Beekhuyzen (2015) where 1) literature was extracted, 2) organised and prepared for analysis 3) analysed in terms of relevance and 4) presented. 2.4 Literature extraction
Scoping searches were conducted in Google Scholar, Embase, Scopus, Ovid, Medline, PubMed, and PsycINFO with keywords such as (horn OR french horn OR brass) AND (performance OR health OR anatomy OR medical OR dysfunction) with appropriate filters applied. Literature was organised in EndNote x7 and coded using Nvivo 12 Plus. Useful Page 8 of 86 databases were identified, and key search terms were refined. References of the most relevant articles were checked. A journal finder was adapted from the University of Sydney’s comprehensive Journal finder to examine journal rankings to determine if they were classified as peer-reviewed for the purposes of this study. Academic grey literature was examined and, as the study progressed, methodological filters were applied to refine search results.
A screening process was implemented in order to identify useful sources and exclude sources that do not meet selection criteria, as represented in figure 2 below. After reviewing each source, it was rated according to the extent that it addressed one or more of the research aims or research questions. In total 449 sources were considered, with 270 sources being included in this thesis based on relevance to the aims and goals.
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Figure 2. Screening flow-chart
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2.5 Tools
EndNote X7 and NVivo 12 Plus (version 12.2.0.443) have been used to organise, map, describe the contribution, provide relevance and demonstrate interconnectedness according to the aims and research questions. 2.6 Academic literature summary
Academic sources often relate to more than one field however they have been broken-up into main topic areas as described below. Peer-reviewed sources remain the highest ranking, however dissertations, theses and Medical reference books have been included.
Sources come from many fields and cover a broad range of topics related to horn performance. The participants and scopes of included studies vary considerably. Some highly rated studies investigate aspects of horn performance alone, e.g. (Borgia, Horvath, Dunn, Von Phul, & Nizet, 1975; Douglass et al., 2017; Gillespie, 2016; Iltis, 2013; Iltis, Frahm, et al., 2017; Iltis, Gillespie, et al., 2017). Some highly rated studies investigate aspects of horn performers alongside other brass or wind instruments, e.g. (Ackermann et al., 2014; Bārdiņš & Marnauza, 2014; Bowman, 2017; Chesky et al., 2002; Conway, Eros, Hourigan, & Stanley, 2007; Fletcher, 2008b; Fuhrmann, 2009; Hornsticks, 2018; Iltis, Schoonderwaldt, et al., 2015; Kruger, McClean, & Kruger; Price et al., 2014; Steinmetz et al., 2014; Woldendorp et al., 2016). Some highly rated studies investigate aspects of neurology of musicians, which applies to horn performance, e.g. (Altenmüller, Ioannou, et al., 2015; Altenmüller & Schlaug, 2015; Dayan & Cohen, 2011; Lederman & Md, 2002; Lederman, 2006; Lederman, 2011; Palghat, Horvath, & Lodge, 2017; Riva, 2018; Schünke, 2016). Some highly rated studies investigate aspects pedagogical approaches used at universities/conservatoriums, e.g. (Carey & Grant, 2012; Johnson, 2002; Kohut, 1985; Millican, 2013, 2016; Whitener & Whitener, 1990), and some are more general and apply to majority of orchestral performers, e.g. examining aspects of posture, somatic bodywork training, preventative courses, and some examine prevalence rates of PRMDs, e.g. (Ackermann, 2012; Berque & Gray, 2016; Chan, Driscoll, & Ackermann, 2013b; Fotiadis, Fotiadou, Kokaridas, & Mylonas, 2013; Leaver, Harris, & Palmer, 2011; Nygaard Andersen, Roessler, & Eichberg, 2013; Steinmetz, Scheffer, Esmer, Delank, & Peroz, 2015; Steinmetz, Zeh, Delank, & Peroz, 2013; Viljamaa, Liira, Kaakkola, & Savolainen, 2017). Topics have been identified as per table 1 below
Table 1. Sources categorised by relevant literature topics.
Posture (Ackermann et al., 2014; Ade, Broxterman, & Barstow, 2013; Albarrati, Zafar, Alghadir, & Anwer, 2018; Baadjou et al., 2017; Baadjou et al., 2011; Barnas et al., 1993; Blanco-Piñeiro et al., 2015; Blanco-Piñeiro et al., 2017; Blanco-Piñeiro, Díaz-Pereira, & Martínez Vidal, 2018; Cailliet, 1990; D'Yanchenko, 1994; Griffiths & McConnell, 2012; Han et al., 2016; Hudson et al., 2015; Kera & Maruyama, 2005; Ko, Jung, Kim, & Oh, 2018; Koulouris et al., 1989; Kwan et al., 2018; Lee et al., 2010; Navajas, Farre, Rotger, Milic-Emili, & Sanchis, 1988; Obayashi, Urabe, Yamanaka, & Okuma, 2012; Ohlendorf et al., 2017; Price et al., 2014; Ramsay et al., 2011; Romei et al., 2010; Shoebridge et al., 2017; Sundberg, Leanderson, von Euler, & Knutsson, 1991; Thrall, Lane, Carroll, & Lip, 2007; Zafar, Albarrati, Alghadir, & Iqbal, 2018)
Breathing (Bardins, 2014; Bārdiņš & Marnauza, 2014; Bouhuys, 1964; Fuhrmann, Franklin, & Hall, 2011; Katz, mechanics Arish, Rokach, Zaltzman, & Marcus, 2018; Kera & Maruyama, 2005; Ko et al., 2018; Lee et al., 2010; Obayashi et al., 2012; Petersen, Taylor, Murray, Gandevia, & Butler, 2010; Pettersen, 2005; Phillips & Sehmann, 1990; Price et al., 2014; Romei et al., 2010; Sehmann, 2000; Thorpe, Cala, Chapman, & Davis, 2001)
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Embouchure (Bek, Arslan, Kütükçü, & Odabaşi, 2008; Frucht, 2000; Frucht, Fahn, & Ford, 1999; Frucht, 2009; function Frucht et al., 2001; Haslinger, Altenmüller, Castrop, Zimmer, & Dresel, 2010; Haslinger et al., 2017; Hirano et al.; Iltis et al., 2016; Iltis & Givens, 2005; Kourakata, Moriyama, & Hara, 2001; Lederman, 2001; Long, 1940; Mantel et al., 2016; Morris, Norris, Perlmutter, & Mink, 2018; Satoh, Narita, & Tomimoto, 2011; Steinmetz et al., 2014; Storms, Elkins, & Strohecker, 2016; Termsarasab & Frucht, 2016; van der Weijden, Kuitert, Berkhout, & van der Weijden, 2018; Woldendorp et al., 2016)
Velopharyngeal (Chan, Driscoll, & Ackermann, 2013a; Ghoneima, Imburgia, Halum, Van Dis, & Kula, 2015; Iltis, function Schoonderwaldt, et al., 2015; Kwan et al., 2018; Long, 1940; Schwab & Schultze-Florey, 2004; Shanks, 1990; Sokolowski & Lang, 2017; Stasney, Beaver, & Rodriguez, 2003; Syamal & Bryson, 2017; Tan, Leung, Tang, & Zwahlen, 2017)
Neurology (Altenmuller & Ioannou, 2016; Altenmüller, Ioannou, et al., 2015; Corfield, Murphy, & Guz, 1998; Douglass et al., 2017; Haslinger et al., 2010; Hummel, Andres, Altenmüller, Dichgans, & Gerloff, 2002; Iltis, 2013; Iltis et al., 2016; Karpati, Giacosa, Foster, Penhune, & Hyde, 2016; Mantel et al., 2016; Petersen et al., 2010; Schumacher et al., 2013; Shadmehr et al., 2010; Silva et al., 2018)
Air-flow and (Altenmüller, Ioannou, et al., 2015; D'Yanchenko, 1994; Dettmann et al., 2006; Fabre, Gilbert, acoustic Hirschberg, & Pelorson, 2011; Fréour, 2013; Ghoneima et al., 2015; Kruger et al.; Lawson & Lawson, properties 1985; Morris et al., 2018; Musicians; Patrizia et al., 2018; Pilafian & Sheridan, 2007; Plitnik & Lawson, 1999; Steinmetz, Seidel, & Muche, 2010; Storms et al., 2016; Tan et al., 2017; Walker, 2017; Wolfe, Chen, & Smith, 2010; Wolfe & Smith, 2008; Yoshikawa, 1995)
Educational (Árnason, 2018; Camerino et al., 2012; Chan & Ackermann, 2014; Conway et al., 2007; Ioannou et psychology al., 2015; Klein et al., 2014; Lee, 2018; López & Martínez, 2013; Maxwell, 2006; Medoff, 1999; Palghat et al., 2017; Patrizia et al., 2018; Sehmann, 2000; Shoebridge et al., 2017; Woodman & Moore, 2012)
All of these sources provide evidence based, peer-reviewed information that relates to horn playing. Some studies regarding aspects of musician health, such as somatic training, do not include horn players, but do include brass players and illustrate examples in line with this study and have been included where there is no similar study that also involves horn performers. 2.6.1 PRMD types and prevalence rates
Injury (aka Playing Related Medical Disorders, PRMDs) is a risk to horn players at all levels (Berque & Gray, 2016; Blanco- Piñeiro et al., 2015; Blanco-Piñeiro et al., 2017; López & Martínez, 2013). Data regarding horn players’ injuries has been collected from players working in professional orchestras (Berque & Gray, 2016; Cebriá i Iranzo, Pérez-Soriano, Igual Camacho, Llana Belloch, & Cortell-Tormo, 2010; Chan et al., 2013a; Chan et al., 2013b; Chesky et al., 2002; Kok et al., 2016; Lederman, 2003; Ohlendorf et al., 2017; Papsin et al., 1996; Steinmetz et al., 2014), studying in conservatoriums (Árnason, 2018; Blanco-Piñeiro et al., 2015; Blanco-Piñeiro et al., 2017; Conway et al., 2007; Ioannou et al., 2015; Klein et al., 2014; Kok, Vlieland, Fiocco, & Nelissen, 2013; López & Martínez, 2013; Medoff, 1999; Roset-Llobet et al., 2000; Shoebridge et al., 2017; Woodman & Moore, 2012) and from being treated in clinics from around the world (Ackermann et al., 2014; Burkholder & Brandfonbrener, 2004; Morris et al., 2018; Moura, de Carvalho Aguiar, Bortz, & Ferraz, 2017; Woldendorp et al., 2016). PRMDs that affect horn players are rarely trivial, and yet as awareness of the potential
Page 12 of 86 seriousness of these conditions is not high, performers will often consult specialists when it is too late (Roset-Llobet et al., 2000).
These studies observe the types of injuries and performance limitations that present in horn or brass players and are discussed below to give an understanding of the scope and complexity of potential injury facing horn players. The relationship of anatomical knowledge and injury is then explored.
Types of injuries include: embouchure dystonia - said to affect 8% of brass players in Germany (Neunecker, 2017; Steinmetz et al., 2014); velopharyngeal insufficiency; increases in diastolic blood pressure; tightness of the lips including the facial muscles; joint (TMJ) and jaw pain (Chesky et al., 2002); musculoskeletal problems (Lederman, 2003); rupture of the orbicularis oris (Cebriá i Iranzo et al., 2010); problems in the neck and lower back (Berque & Gray, 2016); facial swelling, muscle weakness or loss of control (Kok et al., 2016); physical impairments and restricted ability to perform music (Blanco-Piñeiro et al., 2017).
Symptoms of craniomandibular dysfunction (CMD, also known as temporomandibular dysfunction, or TMD, meaning problems of the jaw or skull) in professional brass musicians has been studied, showing concerning prevalence levels (Steinmetz et al., 2013). Of the 24 professional horn players included in this study, symptoms included; present pain in the face 1 (4%), pain in the face last month 5 (21%), teeth grinding 7 (29%), jaw clenching 7 (29%), jaw locking 4 (17%), pain in the teeth/ jaw 12 (50%), pain in the teeth/ jaw last 3 months 7 (29%), pain in the TMJ 6 (25%), and pain in temporomandibular joint last 3 months 3 (13%). These results led the researchers to observe that “There is a need to enhance awareness of CMD to optimize early medical diagnosis and treatment.”, and “Musicians reporting orofacial pain within the last month were more likely to report pain in other body regions as well.” (Steinmetz et al., 2013).
The following year, the same lead researcher completed another study titled ‘From Embouchure Problems to Embouchure Dystonia? A Survey of Self-Reported Embouchure Disorders in 585 Professional Orchestra Brass Players’ (Steinmetz et al., 2014), in which 135 (62%) of the 218 horn players reported musculoskeletal disorders with 33.5% experiencing embouchure fatigue. Other symptoms include Muscle fatigue (56.4%), Lip pain (22.5%), Local erythema/mouthpiece imprint (30.3%), Soreness lip mucosa due to dental pressure (12.4%), Tooth pain (7.8%), Pain/pressure larynx (5.5%), Pain jaw joint (5.0%), Tension shoulder/neck/head (53.7%), and Other (13.8%). The signs of embouchure disorders in the horn players in this study were reported to occur in the High range (29.8%), Low range (17.0%), Flexibility (7.8%), Low to high (14.2%), High to low (7.8%), Both directions (13.3%), Holding long notes or “shaking” (25.7%), Tone quality (25.7%), Beginning of notes or “attack blockage” (36.7%), Accuracy (36.7) Breaking off long notes (17.0%), Attack in tongued passages (14.2%), Cramping (30.3%), Lip cramping (14.2%), Tongue cramping (12.4%), Larynx cramping (6.9%), Cramping of breathing (13.3%), and Coordination (11.0%) (Steinmetz et al., 2014).
The study by Steinmetz builds on the work of (Frucht, 2009), who described six different phenotypes of embouchure dystonia, that manifest as “embouchure tremor, lip-pulling, lip-lock, jaw and tongue dystonia or Meige syndrome (involuntary dystonic movements of the upper and lower face)”, by observing that “The present data from 585 professional brass players reveal distinct impairments in the embouchure system. These could in part be considered as early symptoms or signs of embouchure dystonia. Data collected also showed that 9.2% of the horn players required sick leave and of the 585 total participants the average length of the embouchure crisis was 41.3 months.” This shows that embouchure dystonia is diverse, prevalent and has a serious impact on horn players’ capacity to maintain their livelihood and means of artistic expression.
Steinmetz goes on to conclude that “it is possible that attempts to optimize the embouchure and breathing technique prior to the embouchure crisis are an early reaction to subtle embouchure problems. Therefore, it is not possible to determine whether changes in embouchure or breathing technique are the cause of, or a reaction to, embouchure disorders.” The role of anatomical knowledge, although not explored in the above studies, could contribute to either the changes in embouchure or breathing technique or the reaction to the disorders.
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2.6.1.1 The role of functional anatomy for informing performers, preventative programs and collaborative educational models.
Many studies that explore PRMDs relevant to the aims of this study include a blend of developing participants’ understanding of functional anatomy, preventative programs or collaborative educational models.
Peer reviewed research investigating the effects of developing understanding of functional anatomy specifically for informing horn performance is scarce, however parallels and trends can be drawn from research projects that focus on other fields of performance such as singing. Studies that include horn performers, as outlined below, only apply anatomical knowledge generally. In the other studies, understanding of anatomy precedes understanding of how it functions during musical applications, and although the cohorts may not include horn performers these studies present insights into the usefulness of this approach.
Research in the field of singing pedagogy has identified that the study of anatomy is vital to understanding the structure of the body (Morris et al., 2013). Anatomy alone does not give full understanding of anatomical function; however, it precedes the development of understanding function. These researchers also identify that “in order to make judgements about the current vocal pedagogical approaches to teaching breathing, breath management or support, it is necessary to have a firm understanding of how the respiratory system is structured and functions.” As there are many correlations between singing pedagogy and brass performance in many brass pedagogy books (Farkas, 1956; McWilliam, 2012; Nelson, 2006; Steenstrup, 2007; Wekre, 1994), as well as in the playing philosophies presented in the results chapter, this implies that similar approaches towards applying anatomical knowledge and understanding can aid in making judgements about the applicability of functional anatomy to horn performance philosophies .
2.6.1.2 PRMDs considered with poorly applied or insufficient anatomical knowledge
Research has identified a link between PRMDs and inaccurate, poorly applied or insufficient anatomical knowledge of biomechanical structures (Altenmüller, Ioannou, et al., 2015; Árnason, 2018; Blanco-Piñeiro et al., 2015; Blanco-Piñeiro et al., 2017; Chan & Ackermann, 2014; Ioannou et al., 2015; Klein et al., 2014; Kok et al., 2016; Lederman, 2003; López & Martínez, 2013; Medoff, 1999; Roset-Llobet et al., 2000; Shoebridge et al., 2017; Stanhope, 2016; Woodman & Moore, 2012).
The posture of students has been explored and identified as being poor (Blanco-Piñeiro et al., 2018). In a 2015 study focussing on student perspectives regarding PRMDs, the researchers (Ioannou et al., 2015) found that majority of the 180 students reported “inappropriate technique and/or abnormal body posture as the main cause (76.3%) and, to a lesser degree, practicing without breaks (28.8%), extensive practicing (26.3%), and other reasons (24.4%)”. In a study addressing education and prevention (Árnason, 2018) found that increased body awareness saw a significant decrease in PRMDs of the 23 student cohort, indicating that low body awareness levels play a role in risk of developing a PRMD.
Studies investigating effectiveness of somatic bodywork training for musicians have also drawn from the body of evidence from academic literature authored by medical professionals, though not always peer reviewed, to show us that “studio teachers are usually the primary source of support and information on health-related matters but may not have adequate training and knowledge (Clark & Lisboa, 2013; Pierce, 2012; Williamon & Thompson, 2006). Similarly, Norton and Greasley (2014) found that college-going musicians experiencing a performance-related problem usually seek advice from their teacher, a friend or family member. Yet most music teachers are ill-equipped as they are often informed only by their own experience and opinions (Palac & Grimshaw, 2006; Pierce, 2012). Ioannou et al. (2015) found that music conservatory teachers did sometimes talk to their students about health promotion although the frequency was low.” (Salonen, 2018, p. 95)
A study into PRMD prevalence rates in Greece including 20 brass performers has summarised that “there is a high frequency of injury among professional-level musicians … highlighting the obvious need to develop prevention programs.” (Fotiadis et al., 2013) However, as identified in a study investigating orofacial problems in brass players in
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Spain, the researchers observed that “In the field of medicine, few centers specialize in health disorders of musicians. In Spain, there is only one (Institut de Fisiologia i Medicina de l'Art, Terrasa). Elsewhere, at other universities, there are no health education courses included in the official course content of music degrees. The acquisition of basic knowledge about anatomy, physiology, ergonomics, and postures appears to be essential in order to change the musicians' attitude. That kind of knowledge, together with the incorporation of programs of physical conditioning and body-work, appear to be the proper tool in order to enhance musicians' quality of life. In our understanding, this knowledge should be transmitted at the beginning of the musicians' instruction. In addition, the realization of that knowledge should be carried out by means of preventive work oriented to the teachers as well as to the musician himself.” (Rodríquez- Lozano, 2011)
2.6.1.2.1 General PRMDs
Regarding the relationship between subjective body awareness and prevention education of PRMDs, Árnason (2018) conducted an intervention study, where some participants took part in a PRMD prevention course, and some did not. Results of the study indicate that those who took part in the course showed improved scores of “subjective rating of body awareness during practice and during activities of daily living” when compared to those who did not. The researchers also identified that for the participants who did not participate in the course, a concurrent slight decrease in scores “underscores the importance of this kind of education”
Similarly, in an intervention study in Zürich where some students attended weekly classes in “Physiology of Music and Performing Arts Medicine,” and some did not, the researchers identified that “based on the pre-to-post measurements in the test group, playing-related symptoms, general symptom frequency, and emotional disturbances and anxiety level decreased; general coping with work as a musician and security in performance situations improved”. (Spahn, Hildebrandt, & Seidenglanz, 2001)
A program was also conducted at the University of Indianapolis Department of Music by Barton and Feinberg (2008) in which education, health promotion and preventative strategies were taught to students. The researchers concluded that “The outcomes indicated that students improved in their overall knowledge of the content covered in this educational module and that this increased knowledge was retained 6 weeks later. Interestingly, self-perceived application of health promotion and injury prevention strategies did not improve significantly at the completion of the course but did so 6 weeks later, possibly indicating that behaviour change takes longer to incorporate into one’s daily routine”
These studies indicate the effectiveness of incorporating musician’s health training, which includes developing understanding of musically applied anatomy function. As these examples are represented in courses that run between 8 weeks and 12 months, these studies also indicate a considerable amount of time is required to learn and absorb information about such complex structures.
Although the results of these courses indicate their value for musicians, it is important to observe that the nature of the content covered in these courses has been relatively general in nature and thus has its limits when applying the same philosophies to horn performance. Árnason (2018) covered “a basic introduction of the musculoskeletal system and its function, the most common risk factors for PRMDs, and the most common injuries affecting musicians”, with practical sessions also being general. Barton and Feinberg (2008) did not describe the content of their 8-week course, however data captured in their surveys indicates that the content is very general in nature. As well as practical teaching units, Spahn et al. (2001) presented 17 x 2-hour lectures on musician health covering a broad range of relevant topics such as basic anatomy, posture, breathing, neurology and mental aspect/. However, function of the velopharynx, tongue or embouchure were not included so this does not contribute a specific understanding of the implications for horn players.
Ioannou et al. (2015) conducted a study titled Approaches to and Treatment Strategies for Playing-Related Pain Problems Among Czech Instrumental Music Students in the Czech Republic, where 13.3% of the 180-student cohort were Brass performers. 41 general questions were asked about health, PRMD issues, treatment strategies, tutors’ and
Page 15 of 86 institution’s attitudes, and students’ perspectives on body physiology awareness. The key points coming from the results of this study, through quotes from the text, are;
• “Based on students’ reports, abnormal body posture seems to play a crucial role in the development of PRMD problems, with females being more susceptible to it than males.” • “When PRMDs appear, students in the first instance tend to seek help from their instrumental tutors. Medical doctors remain the second option.” • “The majority of affected students reported that medical doctors only partially solved their problems, and a remarkably large proportion (35%) tends not to ask for medical advice at all.” • “49% of all students affected by PRMDs believed that inappropriate technique and/or abnormal body posture was the main cause.” • “The majority of students believed that physiological/anatomical knowledge should be mandatory.” • “When asked more specifically whether basic knowledge of the anatomy/physiology of the human body would have enabled them to avoid PRMDs, 43.4% reported positively, 21.1% negatively, and 35.4% “I do not know.”” • “61% of students found the idea of introducing anatomy/physiology courses in music schools as a “good idea,” and the vast majority favored the affiliation of a suitable medical specialist to their music school.” • “77.1% of the music students believed that music schools need and should have a medical specialist/doctor who would deal with students’ PRMD problems.” • “These results underline that closer attention should be paid to body posture, although further studies based on objective measures should clarify whether “correct” posture could prevent musculoskeletal problems among performers.” • “Alternative solutions enabling affected students to overcome PRMD problems during their studies seem to be essential. Therefore, a redesigned curriculum, based on a collaborative effort between institutions, tutors, and medical specialists, should be examined and promoted.”, which is also supported by Spahn, Richter, and Zschocke (2002), and Zaza (1993) • “It is clear that students realize the necessity and importance of efficient management and prevention of PRMD problems during their studies and are willing to augment their knowledge of PRMD issues.”, which is also supported by Žuškin et al. (2005, p. 250)
López and Martínez (2013) conducted a study titled Strategies to Promote Health and Prevent Musculoskeletal Injuries in Students from the High Conservatory of Music of Salamanca, Spain, in which included 146 students. Of these students, 4 horn performers were involved, 2 being allocated to the control group and 2 to the intervention group, where the intervention group were provided with information about the most frequent medical problems of musicians, warm-up habits, postural hygiene, effective prevention strategies, and different treatment options for these pathologies. The researchers identified that “While the students in the experimental group improved their body awareness by 91% and the frequency of their injuries decreased by 78%, there was no improvement in the students from the control group at the end of the experiment” and concluded that “The results of our study have demonstrated the effectiveness of this type of course and show that such courses should be included in the academic curriculum of superior conservatories.”(p. 100), adding that “The improved body awareness and physical condition that the students in our study experienced highlights that there is a significant lack of theoretical practical information related to ergonomics, postural habits, and the prevention of physical injuries in the curriculum of the high conservatories of music.” (p. 106). This implies that courses such as these are effective and beneficial, and should be included at conservatoriums as there is a lack of this knowledge and high injury prevalence rates.
In a study investigating pedagogical approaches in Australia, (Wijsman & Ackermann, 2018) identify that “Developing an effective means to provide tertiary students musicians with the opportunity to learn about performance health will enhance their self-efficacy and promote long-term healthy practices” … “Identifying appropriate and effective health education strategies that can be embedded into Australian music teaching contexts at all levels will promote health awareness, injury prevention, and help to ensure that educators and institutions exercise appropriate duty of care in relation to the health and safety of their staff and students”. This that courses such as those included in this literature review should be included at all levels and will benefit life long healthy practices. Page 16 of 86
Salonen (2018), conducted a 13-week intervention study focusing on an occupational health course incorporating the Body Mapping technique, including a literature review that takes a similar approach to the present study, however is more extensive, being a PhD. The key points emerging from this study are:
• “The underlying physiological and psychological mechanisms for performance injuries are multidimensional and involve both individual and music-related variables as well as a myriad of social, environmental, and cultural factors.” • “Overall, however, scholars agree that integral elements of tertiary education in musicians’ occupational health include body and movement awareness and biomechanical principles for injury prevention as well as optimal performance.” • “The literature underscores the need for a biopsychosocial perspective in the provision of musicians’ health education.” • “The study underscores the need for musicians’ health education to be embedded in tertiary musicians’ training, the beneficial impacts of comprehensive musicians’ occupational health education, and the value of Body Mapping as a somatic education component.” • “The results provide information on essential course content, the advantages of interdisciplinary collaboration, the need for practical activities, the optimal duration, the value of peer learning and support, the importance of cooperation with music teachers, and the consideration of students’ motivation to attend and their readiness for change.” • “Most importantly, the findings emphasise the reciprocal interactions of physiological, psychological, behavioral and musical aspects of music-making, and suggest that Body Mapping may be highly effective in terms of the integrated teaching of musicians’ biopsychosocial and artistic requirements.”
Zaza (1993) also adds context, identifying that care needs to be taken when implementing such courses, indicating that we must “scrutinize prevention programs, because ill-advised prevention efforts may do more harm than good”. This implies that interventions such as developing understanding of biomechanical structures as applied to musicians should be approached carefully
The topics covered in the above studies are general in nature, however, the results identify the perceived usefulness of developed understanding of anatomy in a collaborative environment to augment playing philosophies. The above sources imply that there is significant potential for well-defined anatomical and biomedical information to support educational models used at conservatoriums.
2.6.1.2.2 Posture focused
Posture health related to general musical performance has been explored in depth via a series of observational studies by a team of researchers in Spain. In these studies, common postural defects were identified among music students (Blanco-Piñeiro et al., 2015), an extensive literature review of postural issues was presented (Blanco-Piñeiro et al., 2017) and an intervention study conducted involving posture experts (Blanco-Piñeiro et al., 2018). Key points coming from these studies, and other researchers, are that musicians in general tend to have poor posture and that the inclusion of re-education programs should be at the core of music teaching syllabuses and should be designed specifically for each instrument (Ackermann et al., 2014; Ade et al., 2013; Albarrati et al., 2018; Baadjou et al., 2017; Baadjou et al., 2011; Barnas et al., 1993; Blanco-Piñeiro et al., 2015; Blanco-Piñeiro et al., 2017; Blanco-Piñeiro et al., 2018; Cailliet, 1990; D'Yanchenko, 1994; Griffiths & McConnell, 2012; Han et al., 2016; Hudson et al., 2015; Kera & Maruyama, 2005; Ko et al., 2018; Koulouris et al., 1989; Kwan et al., 2018; Lee et al., 2010; Navajas et al., 1988; Obayashi et al., 2012; Ohlendorf et al., 2017; Price et al., 2014; Ramsay et al., 2011; Romei et al., 2010; Shoebridge et al., 2017; Sundberg et al., 1991; Thrall et al., 2007; Zafar et al., 2018). Results also suggest that “more attention should be paid to improving the strategies of music teaching so as to favour improved understanding and control of posture by students, with consequent improvements in physical health and musical performance.” (Blanco-Piñeiro et al., 2018)
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2.6.2 Neurological considerations
2.6.2.1 Intrinsic knowledge
Intrinsic knowledge refers to “the integration of multi-modal sensory and motor information, the generation of appropriate action plans, the selection and retrieval of highly refined movement patterns from procedural motor memory, and the initiation of movement. In most instances, these movements are highly overlearned, and they depend on feed-forward programming of the anticipated – mostly audible – results and on real-time feedback.” (Altenmuller & Ioannou, 2016, p. 80).
Although instruction from pedagogues and cognitive learning methods inform experimentation and development, horn players learn by doing, as reflected in the interview data gathered in this research project. The neural networks that play a role in the development and retrieval of highly refined movement patterns are fine-tuned over the estimated 10 000 hours of deliberate practice within 10 years it takes to reach professional level (Ericsson et al., 1993).
Problems exist for horn players in processing sensorimotor experiences, in that much of the functional anatomy used to play horn is not directly visible, while research regarding the sensory afferents responsible for our ability to sense what is happening internally is ongoing (Mckay et al., 2003). Compounding this are complications and considerations of the human sensory perception, although covering this topic this falls outside the scope of this thesis.
2.6.2.1.1 Plasticity
Brain plasticity refers to the brain's ability to change structure and function, with experience providing a major stimulant for this to occur (Kolb & Whishaw, 1998). Our understanding of the molecular and cellular mechanisms underlying these adaptations is far from complete. Brain plasticity may occur on different time scales. For example, the efficiency and size of synapses may be modified in a time window of seconds to minutes, the growth of new synapses and dendrites may require hours to days. Other changes require up to several weeks (Altenmüller & Schlaug, 2015).
“Technological and methodological advances in neuroimaging and in non-invasive brain stimulation in humans, together with novel findings stemming from animal-based studies, provide new insights into the neuroplastic mechanisms that underlie motor skill learning, suggesting that skill acquisition is sub-served by multiple mechanisms that operate across different temporal scales” (Dayan & Cohen, 2011).
2.6.2.1.2 Degradable neural pathways
In professional musicians, subtle degradations of the functions of the cerebellum, for example as a consequence of long- term alcohol consumption or of the basal ganglia in the beginning Parkinson’s syndrome, frequently selectively impair highly virtuoso performance, thus demonstrating the importance of possessing a 100% intact central nervous system to obtain peak performance quality (Altenmueller & McPherson, 2008, p. 130).
2.6.2.1.3 Inaccurate proprioception
A study was conducted in Germany examining motions of the glottis in horn players using RT-MRI. The researchers observed that “After the study, four of the players commented that they did not know they were closing up so much in the high register. One even commented, “If my teacher saw this she would kill me!”.” (Gillespie, 2016). This is not surprising when in the field of vocal pedagogy, Morris et al. (2013) notes that “the [vocal] instrument also has quite limited kinaesthetic awareness and even limited sensory information available from many of its components”.
2.6.2.1.4 Disproportionate representations
No direct studies have been conducted regarding the accuracy of sensory perception of internal biomechanical structures involved in horn performance. The closest being the investigation of perceived effort of respiration in Page 18 of 86 individuals with obstructed airways, simulating asthmatic conditions (Altose, 2007; Altose et al., 1982; Corfield et al., 1999; Harver et al., 1988; Revelette & Wiley, 1987), while others regard accuracy of sensory perception of arm or legs movements under different conditions (Guerraz et al., 2012; Proske & Gandevia, 2012). A very recent study into the accuracy of perceptions regarding both three dimensional volume and one dimensional length of body parts from a sample of healthy adults has shown that judgements of proportions resemble the somatosensory homunculus (Sadibolova, Ferre, Linkenauger, & Longo, 2019, p. 74).
“The proportions of both - the motor and the sensory homunculus - are markedly distorted since they are determined by the density of motor and sensory innervation of the respective body parts. To put it more simply, our brain does not represent muscles but rather movements” (Altenmueller & McPherson, 2008, p. 125).
Although these studies are not directly speaking to horn performance, what can be observed is that there is a level of disproportion present with many of the biomechanical functions important for horn performance.
The contrasting opinions of the horn players in this study, in relation to their perceptions of their own anatomy when playing, would appear to reinforce this report of the individualised self-interpretation of sensations of body use when playing.
2.6.2.1.5 Multimodal and adaptive sensory perception
Multimodality refers to the varied and numerous different types of sensory sources available to us. Sensory information can come from many different types of sensors e.g. biomechanical stress, vibration, pressure, balance (mechanoreceptors), position of body-part (proprioceptors), etc (Harver et al., 1988; Ko et al., 2018). Our brains then interpret the multitude of information available to it from all the different sensory sources of all body parts (Proske & Gandevia, 2012).
“Performing music requires the integration of multimodal sensory and motor information, and its precise monitoring via auditory and kinesthetic feedback … Furthermore, the kinesthetic senses constitute another basis of high-level performance. They allow for the control and feedback of muscle- and tendon-tension as well as joint positions, enabling the continuous monitoring of finger-, hand-, or lip-position in the frames of body and instrument coordinates (e.g., the keyboard, the mouthpiece)”. (Altenmüller, Ioannou, et al., 2015, p. 89)
The relevance of considering multimodality is important to consider as analysis of data continues regarding participants sensory perceptions. Differences in an individual’s neurological makeup, with different brains in different bodies, may play a role in explaining the different perceptions of similar playing related biomechanical structures.
“Subtle changes in kinesthetic feedback result in an alteration of the motor program, and in some individuals long-term loss causes severe disturbances of the motor program and even focal dystonia” (Altenmüller, Ioannou, et al., 2015, p. 90)
Riva (2018) through others;
“As noted by Olaf Blanke (2012), the body is the most multi-sensory “object” in the world; it requires the processing and integration of different bodily signals in the premotor, temporoparietal, posterior parietal, and extrastriate cortices. In addition, our experience of the body is not direct […], but it is:
• mediated by perceptual information; • influenced by internal information: Interoception, the sense of the physiological condition of the body; Proprioception, the sense of the position of the body/body segments; and Vestibular Input, the sense of motion of the body; • recalibrated through stored implicit and explicit body representation (body memory).”
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“Our ability to produce a lifetime of accurate movements lies not in the fact that we are born with an invariant set of actuators, precise set of sensors, or fast transmission lines, but rather in that we are born with a nervous system that adapts to these limitations and continuously compensates for them. If left uncompensated, these inherent limitations could give rise to systematic errors in our movements”. (Shadmehr et al., 2010)
The above sources present information regarding the complexities associated with accuracy of intrinsic knowledge. When considered together, they imply that what horn players perceive of the internal structures the have considerable effects on a performers ability to play horn are different between individuals and are in a consistent state of change within an individual, making descriptions of the use of internal anatomical structures based on sensation difficult. 2.6.3 Limits of current research
The above articles clearly demonstrate that anatomical information plays a role in supporting musician health, however there are limitations in regards to how these studies relate to horn playing specifically. Where anatomy can be applied to voice as a result of information gained through electrolaryngography and electroglottography (D'Amario & Daffern, 2017), the same cannot be said for horn players as descriptions of the roles of the biomechanical structures of the embouchure, remain inconclusive (Bek et al., 2008; Frucht, 2000; Frucht et al., 1999; Frucht, 2009; Frucht et al., 2001; Haslinger et al., 2010; Haslinger et al., 2017; Hirano et al.; Iltis et al., 2016; Iltis & Givens, 2005; Kourakata et al., 2001; Lederman, 2001; Long, 1940; Mantel et al., 2016; Morris et al., 2018; Satoh et al., 2011; Steinmetz et al., 2014; Storms et al., 2016; Termsarasab & Frucht, 2016; van der Weijden et al., 2018; Woldendorp et al., 2016).
Holistic understanding of functional anatomy required to play horn is ongoing. Researchers in this field, such as Professor Peter Iltis, have conducted studies with the use of Real Time – Magnetic Resonance Imagery (RT-MRI). These pioneering studies represent the first of their kind and have captured footage of the function of different internal biomedical structures which are currently not safely observable by any other means. Studies examine the movements of the vocal folds and larynx (Iltis, Gillespie, et al., 2017), the tongue and jaw while trilling (Iltis, Frahm, et al., 2017), and the use of the tongue to change the size and shape of the oral cavity across different pitch ranges and have compared differences between elite and dystonic participants (Iltis et al., 2016; Iltis, Frahm, et al., 2015). Most of the studies are conducted with elite level performers as a control group, though some have been conducted with advanced students.
This work uses pioneering, award winning, and expensive equipment and has provided us with a “novel way to visualize [anatomical] structures and their movements during performance” (Iltis, 2013), however there are also limits. Due to the design of this equipment, all data is collected with the participants having to lay on their back, altering the roles of abdominal musicals that might be recruited to play a role in either posture, respiration or both (Kera & Maruyama, 2005; Perry, Similowski, Klein, & Codd, 2010). Additionally, footage is captured on one 2D plane at once, and although different planes can be put together side-by-side, simultaneous 3D analysis of all internal structure is not yet possible. Furthermore, images or videos of the sagittal plane (the mid line of the body, halfway between the left and right ears) are used to measure oropharyngeal area, however there is no measurement of important muscles/fibres just left or right of the mid line, i.e. Chondroglossus, Hyoglossus, Inferior Longitudinal Muscle, or Styloglossus which are all different muscles of the tongue. These muscles can affect oropharyngeal volume and air stream direction but are not on the mid- line and hence, are not represented when measuring area of the mid-line(Schünke, 2016), lowering the accuracy of measurement.
The results of these studies have presented some trends of the elite level players regarding some aspects of the use of some functional anatomy, however results also indicate differences between these elite level players. For example, lip trill study indicated that when trilling as fast as possible, 7 performers employed only the use of their tongue, while 3 employed both the tongue and jaw, and 1 performer used the jaw only (Iltis, Frahm, et al., 2017). Results indicate that diverse approaches are possible and though there is a trend, there are also exceptions within this elite group of horn professionals.
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Similarly, when studying the use of the tongue to change the size and shape of the oral cavity across different pitch ranges during horn performance, the results from different studies including results of the above-mentioned RT-MRI studies and my study, which present conflicting results. For example, (Iltis et al., 2016; Iltis, Frahm, et al., 2015, re: Oral cavity motor strategies) all indicate that “It is apparent that elite players employ vertical movement strategies of both the tongue and jaw that systematically decrease the size of the airway for ascending notes and increase its calibre for descending notes”, meaning that the elite players in these studies raised their tongues up and forward, though not touching the teeth, in order to get into the high register. These studies observe that the participants with embouchure dystonia differed in that they were not seen to raise their tongues as much.
These results are not congruent with results from another RT-MRI study by the same authors, also in 2015 (2015, re: MRI comparisons of brass players), or by data from this study presented by participants who also participated in the 2016 study. In the (2015, re: MRI comparisons of brass players) study, the researchers compare differences in the use of the tongue to get into the high register across four different brass instruments and observe that “For the tuba and trombone, the trend was for a decrease in total area as a function of both anterior and posterior areas as the performer progressed from the lowest to the highest notes … These patterns were not replicated in the horn and trumpet players, and in fact, the total oropharyngeal area of the trumpet player tended to increase across the 2 octaves, largely as a function of larger posterior area values.” (Iltis, Schoonderwaldt, et al., 2015, re: MRI comparisons of brass players). This indicated that the horn player did not change their tongue shape of position to get into the high register, which is supported by data collected in this study, presented in the Results and Discussion chapter following.
Again, it can be seen that there are trends but there are also exceptions, indicating that there are combinatory elements of functional anatomy used to play horn that are yet to be fully understood scientifically. Prescriptive methodologies must be approached with caution, and as such, horn players are self-responsible for determining the level of usefulness of any piece of information given to them. This study focusses on the perceived benefits that developed understanding of functional anatomy can have on both the transfer of playing philosophies, and to guide experimentation with accurate information. 2.6.4 Challenges with the One-on-one (Master-Apprentice) model of teaching
In a recent study into the one-on-one model of teaching Carey and Grant (2012) identified that even though generalisations are risky, it is still overwhelmingly considered “invaluable, even irreplaceable”, however there are challenges, such as conflicting viewpoints on anatomical function within the pedagogical literature e.g. “In brass playing pedagogy the most essential and simultaneously the most difficult element to teach is the process of breathing. The analysis of viewpoints on breathing presented in popular textbooks on brass instrument playing and their comparison with physiological processes of natural breathing reveal essential discrepancies, which actually make instrument playing difficult, create muscular tensions and even health problems undesirable for the musicians.” (Bārdiņš & Marnauza, 2014). PRMDs are also observed to be “aggravated because of poor instruction and musicians' awareness of the physical problems” (Rodríquez-Lozano, 2011)
A number of studies identify the value in pedagogues working along-side medical professionals in a collaborative context, including a further study by G. M Carey et al and another by Hildebrandt & Nubling.
In this study, (Carey et al., 2013) recommends that professional development initiatives for teachers focus on those areas that indicate the most opportunity for making pedagogical practices more transformative, including an:
• Approach to diagnosis - building a collaborative approach to identifying and solving problems through which both student and teacher learn; and • Approach to meaning-making - taking a collaborative approach to building knowledge in which shared meanings can be discussed and elaborated rather than simply teacher specified.
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In the study in Zurich by Hildebrandt and Nubling (2004), which was conducted in order to ‘establish whether instrumental teachers and their students would derive any benefit from advanced education and training in musicophysiologic theory and practice’, twenty-six instrumental teachers and 66 of their students (allocated to the test or the control group) participated in an evaluation that was to be assessed by means of standardized questionnaires. During a summer semester, teachers in the test group attended a 2-hour weekly course focusing on the sensory and psychomotor systems of musicians, whereas teachers in the control group were excluded from these courses. No horn players were involved, however the study did involve two trumpet teachers and their students as part of either the control or intervention cohort. Based on a pre-to-post measurement, the teachers in the test group, in contrast to the teachers in the control group, noted that they had become more responsible for instructions and more precise related to playing movements. When compared with the control group, the student test group in retrospect noted a change in the teaching style of their teachers in verbal instructions and in guidance of posture and playing-related movements.
The results of the study indicated that teachers who elected to receive advanced training subsequently were convinced that they had changed their teaching style and had begun paying careful attention to the functional dynamics of sensorimotor and psychomotor activity. These outcomes may be transferable to horn pedagogy. 2.6.5 Summary of peer-reviewed literature
To summarise, a wide range of injuries and performance limitations can occur to horn players at all levels. Many different fields of research offer information related to horn performance, though translating this information into practice is difficult.
There is proportional relationship between functional anatomy that is more easily observed, the amount of detailed information represented in peer-reviewed sources, the extent to which musicians use that anatomy and the applicability of the information. For example, posture is comparatively much easier to observe when compared to the muscles of velopharyngeal function, there are a many peer-reviewed studies that focus on posture (30) and posture is an element of every musicians’ biomechanics, hence the detailed information about posture is more prevalent and applicable. (Ackermann et al., 2014; Ade et al., 2013; Albarrati et al., 2018; Baadjou et al., 2017; Baadjou et al., 2011; Barnas et al., 1993; Blanco-Piñeiro et al., 2015; Blanco-Piñeiro et al., 2017; Blanco-Piñeiro et al., 2018; Cailliet, 1990; D'Yanchenko, 1994; Griffiths & McConnell, 2012; Han et al., 2016; Hudson et al., 2015; Kera & Maruyama, 2005; Ko et al., 2018; Koulouris et al., 1989; Kwan et al., 2018; Lee et al., 2010; Navajas et al., 1988; Obayashi et al., 2012; Ohlendorf et al., 2017; Price et al., 2014; Ramsay et al., 2011; Romei et al., 2010; Shoebridge et al., 2017; Sokolowski & Lang, 2017; Sundberg et al., 1991; Thrall et al., 2007; Zafar et al., 2018).
Oppositely, for example, function of the velopharynx as applied to horn performance is comparatively much more difficult to observe, with fewer peer-reviewed sources (8) and applies to only horn players, hence detailed information about velopharyngeal function is difficult to apply (Hézard, Fréour, Caussé, Hélie, & Scavone, 2013; Iltis et al., 2016; Iltis, Frahm, et al., 2015; Iltis, Gillespie, et al., 2017; Iltis, Schoonderwaldt, et al., 2015; Schwab & Schultze-Florey, 2004; Shanks, 1990; Syamal & Bryson, 2017). 2.7 Non-peer reviewed (grey) literature summary
In terms of cognitive forms of knowledge transfer, pedagogical literature plays a predominant role in the development of many horn players due to its relative focus and perceived applicability towards horn performance. Included sources are drawn from available: technique or method French Horn books; broader pedagogical books covering performance elements applicable to French Horn playing; and articles in lay press and media. In addition, commonly used teaching routines, forming a typical part of the master-apprentice model of music teaching, were included due to their important influence on learning the French Horn.
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The level of detailed study of anatomy of the authors is also largely unknown. For example, in a doctoral dissertation, Fuhrmann (2009) draws from an interview with Arnold Jacobs (Part 2), in which, “Jacobs explained that although he was not trained in medicine or physical therapy, he viewed himself as a therapist to some extent” (Bobo, 1981). 2.7.1 Unpublished routines
Unpublished routines from high-ranking players or pedagogues form a large part of most horn players philosophies (Bain, 2017; McDonald, 2007; Nelsen, 2018; Sanders, 2012). These opinion-pieces are usually printed out for the author to use in lessons and supports the author’s communication of playing philosophy. Some of the material is relatively similar and sometimes even borrowed from one another e.g. harmonics exercises. They list exercises to do, ways to do them, what the player should attention to, and are usually general in nature. Students studying these routines with the author will benefit from feedback that can only come from having the author present in lessons and are given individually specific information on relative aspects depending on what can be observed by the author, however these routines are often used without even one lesson with the author and are then subject to the interpretation of the student or the non-author teacher working with the student. Anatomy is either referenced in an overly-simplified manner, not often discussed in detail, or is completely absent. 2.7.2 Method books
Method books (Arban, 1936; Dixon, 2010; Ericson, 2007; Farkas, 1956; Fox, 1974; Franz & Saenger, 1906; Graham- Crump, 1988; Little, 1978; Pilafian & Sheridan, 2007; Rider, 2006; Schuller, 1962; Severson & McDunn, 1983; Singer & Ballou, 1956; Stevens, 2000; Thévet, 1960; Yancich, 1971) differ from routines in that they are intended to present more information so that the authors opinions can be applied largely without the author present. Where anatomy is referenced, it is usually of a general or ambiguous nature, and is usually represented as a two dimensional image with descriptors. More recent books are accompanied by an online presence, usually in the form of online video hosting services, e.g. YouTube.
More recent books are incorporating functional anatomy in various forms, such as (Epstein, 2012) which references results published in various RT-MRI studies involving elite level payers in Germany, (Nesmith, 2012) which includes anatomical references, approached from the school of Alexander Technique, and ‘Playing from the Core Method’ (Hyytinen, 2016), not available in English at the time of writing, approaches horn playing referencing the school of Pilates. 2.7.3 Additional Pedagogy
Additional pedagogy books form a large part of the grey literature that can be philosophically applied to horn playing. Some authors have also published articles in peer-reviewed journals, though majority are opinion pieces. Medical reference books (Aliverti & Pedotti, 2014; Altenmüller, Finger, & Boller, 2015; Altenmüller, Ioannou, et al., 2015; Altenmüller & Schlaug, 2015; Bird & SpringerLink, 2016; Camerino et al., 2012; Hesse-Biber, 2010; McKinley, O'Loughlin, & Bidle, 2013; Schünke, 2016) are not peer-reviewed though they often stem from peer-reviewed research, usually carried out by the authors and can contain very detailed information about the body. Some accessory books are aimed at musicians in general or contain general information that can be applied to horn playing (Biel, 2014; Conable & Conable, 2000; i Llobet, 2007; Kleinman & Buckoke, 2013; Kohut, 1985; Porter, 1967; Taylor, 2016). Books aimed to present the authors opinions in the fields of Singing, Brass or horn performance pedagogy offer a wide range of opinions (Chapman, 2017; Farkas, 1962; Fox, 1974; Johnson, 2002; Lewis, 2002; Lo & Frucht, 2006; Nesmith, 2012; Pilafian & Sheridan, 2007; Reynolds, 1997; Ridgeon, 1986; Steenstrup, 2007, 2016; Wekre, 1994; Whitener & Whitener, 1990), and books that deal with psychological or philosophical aspect of performing arts are often used by horn players (Ericsson & Pool, 2016; Frederiksen, 1996; Gallwey, 1974; Green, 2003; Greene, 2002; Herrigel, 2004; McAllister, 2013; McWilliam, 2012; Nelson, 2006).
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2.7.4 Non-peer-reviewed articles
Non-peer-reviewed articles (Belfrage, 1993; Conway et al., 2007; Dalrymple, 2008; Holt, 2016; Iltis, 2013; Kemp & Smith, 2012; Lederman, 2011; Pherigo, 2014; Sataloff, 2000; Taylor, 2014) are published in special interest journals such as The Horn Call and cover a vast range of topics.
Care must be taken when considering these opinion pieces as they can present information as fact, yet as they are not reviewed academically they may contain incorrect information. For example from page 22 of the Horn Call, April 1993, in the article titled Damage Due to Overstrain in Brass-Players the author describes aspects of breathing mechanics incorrectly: “When the abdominal muscles contract (inhaling)” (Belfrage, 1993). It is unknown whether the parentheses around ‘inhaling’ came from the author or the editor of that issue of The Horn Call, but it is incorrect according to medical and academic literature (Aliverti & Pedotti, 2014; Bārdiņš & Marnauza, 2014; Bouhuys, 1964; Katz et al., 2018; Kera & Maruyama, 2005). A reader who presumes that this is correct would likely develop co-contractual inefficiency, leading to overstrain, which is ironic, given that the article was attempting to suggest ways to avoid this. 2.8 A comparison of the academic versus pedagogical literature
As outlined above in the academic literature, a number of medical problems relating to horn performance continue to limit aspiring players and threaten already existing careers, yet there is a distinct theoretical divide between academic literature and the grey literature that makes up the bulk of horn pedagogy (Galliers & Stein, 2017). Detailed anatomical knowledge is not well represented in pedagogical approaches and the most heavily relied on learning tool is kinesthetic registration of body parts with disproportionate, adaptive, inaccurate and plastic representation in the brain.
The importance of anatomical knowledge is outlined in Medical problems of the Instrumentalist Musician by Tubiana and Amadio (2003), where the authors identify that “musicians and especially their teachers should understand the normal mechanics of movement in order to become aware of non-physiological movements”
Singing pedagogy, in contrast, has a much more inclusive attitude to applying anatomical knowledge, successfully incorporating applied physiology into holistic pedagogical models such as represented in Singing and Teaching Singing (Chapman, 2017). Within this book, peer-reviewed sources are referenced alongside case studies to establish that core components of physical performance are supported by cognitive knowledge and understanding of functional anatomy. These core components then form the nucleus around which elements of performance orbit.
To summarize, a wide range of injuries and performance limitations can occur to horn players at all levels. Many different fields of research offer information related to horn performance, though there are limits to this research and translating this information into practice is difficult. Detailed anatomical knowledge is not well represented in pedagogical approaches and the most heavily relied on learning tool is kinesthetic registration of body parts with disproportionality small representation in the brain.
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Chapter 3. Methods 3.1 Overview
The literature review highlights that horn players are at risk of developing PRMDs, but that the extent of anatomical study by the authors of pedagogical texts, or the direct contribution of particular structures to injury is largely unknown. Sensory perception and neurological pathways are complex, adaptable and unique, yet due to the complexity of the anatomy involved, kinesthetic registration of and top-down motor commands are the primary learning methods used. One-on-one teaching is still considered integral in performer education, however there are complexities and problems with this model. Amongst horn players, medical professionals and researchers who specialise in medical problems of performing artists, there are varied perspectives on the importance and application of accurate knowledge of functional anatomy in order to avoid and overcome playing-related musculoskeletal disorders (Ackermann, 2010; Blanco-Piñeiro et al., 2017; Watson, 2009).
A theoretical contribution map was developed in order to clearly identify the problems, importance, goals, and theoretical background, which were then used to establish methods. A mixed method approach was used including surveys and interviews. The research questions, as outlined in the introduction, were developed to guide the study, and resources developed to aid communication using digital 3D models. Participant populations were identified, the data collection methods were implemented, then data was collected, and the results analysed. The theoretical contributions of this study are presented in Chapters 5 and 6.
It was established that a more up-to-date visual resource was needed to clearly communicate aspects relating to anatomical knowledge as the current methods of transferring anatomical knowledge to horn players about anatomy used to play horn are in the form of 2D static images on a page with limited descriptive text.
Two methods were chosen to gather both quantitative and qualitative data, as it was felt that either on its own would be insufficient. Using a parallel convergent study method, on-line surveys were able to be independently completed over the same time frame as semi-structured interviews were being conducted. 3.2 Design 3.2.1 Development of the theoretical contribution map
3.2.1.1 Theoretical Contribution Map
The development of a theoretical contribution map (Galliers & Stein, 2017) enabled the problem to be clearly described, its importance identified, for it to be contextualised by relevant theory and prior knowledge, appropriate methods to be chosen and to predict the potential contribution to knowledge. This process also allowed for any other aspects of the study that demonstrate its interestingness to be identified. The theoretical contribution map is summarized below and presented in full at appendix 1.
3.2.1.2 1) Problems identified
As identified from the literature review, injuries can arise as a result of poorly informed playing philosophies in which functional anatomy is either absent by choice, misunderstood, or unavailable. Anatomy is not well covered in pedagogical materials for horn players, and there has been limited academic study of anatomy and horn playing. Complex neurological considerations such as disproportional sensory perception, kinaesthetic registration and proprioception are not well recognised in playing philosophies or literature commonly accessed by horn players. This resulted in the initial aims of the research being developed into the following research questions (Section 3.2.2).
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3.2.1.3 2) Importance
Player attitudes towards the role of anatomical knowledge in horn playing have not been explored academically. Information around aspects of horn playing that have scope to benefit from accurate application of functional anatomy have not been explored, nor have perceptions around its usefulness in filtering information that is often contrasting.
3.2.1.4 3) Goals
To investigate horn players’ attitudes and perceptions by asking:
• What are the current attitudes towards the application of anatomical knowledge? • What are the perceived best-practice approaches when using accurately applied knowledge of anatomy to develop optimal playing philosophies? • What difficulties exist with translating anatomical knowledge into practice? • What disparities and similarities exist between playing philosophies? • How can the individual identify if more or less understanding of anatomy is appropriate?
3.2.1.5 4) Theoretical background
The theoretical background was established around the benefits that functional anatomical knowledge has had in other fields of human performance, particularly in the arts. Additionally, peer-reviewed or medical texts providing insight around individual aspects related to horn performance were considered in terms of what insights they might offer to inform best-practice playing philosophies, such as breathing mechanics, where anatomical knowledge plays a role in clear nomenclature.
Even though scientific research is ongoing regarding elements of horn performance, training in understanding functional anatomy is considered important from the perspectives of medical professionals who treat PRMDs, yet this training is not easily accessible.
3.2.1.6 5) Development of Methods
A mixed-method interdisciplinary design was chosen due to the intricate, subjective and complex nature of the topics, and the depth of insight required to further contribute to the present epistemology (Aboelela et al., 2007; Andrew, Salamonson, Everett, Halcomb, & Davidson, 2011; Guest, 2013; Hesse-Biber, 2010; Queirós, Faria, & Almeida, 2017). Additionally, the mixed-method model has been used successfully to investigate aspects related to pedagogical approaches used in conservatories as well as exploring new models of research pedagogy, (Carey & Grant, 2012; Harrison & Grant, 2015). 3.2.2 Developed Research Questions
1) What are the current attitudes of Horn players towards the application of anatomical knowledge to optimise their playing philosophies?
2) What are Horn players’ perceived best-practice approaches to using accurately applied knowledge of anatomy to develop optimal playing philosophies?
3) What difficulties exist for Horn players to translate anatomical knowledge into practice to achieve optimal artistic results?
4) What disparities and similarities exist between playing philosophies, particularly among high-ranking Horn players?
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5) What can the outcomes of the study offer for aspiring Horn players with regard to the benefit of incorporation of anatomical knowledge into their playing philosophies? 3.2.3 Resource development
It was identified that many performer perceptions have been formed without accurate knowledge of functional anatomy. In a study regarding the ‘Effectiveness of Three-Dimensional Digital Animation in Teaching Human Anatomy in an Authentic Classroom Context’, data supported that 3D digital animations were effective instructional multimedia material tools in teaching human anatomy especially in recalling anatomical knowledge requiring spatial ability (Hoyek, Collet, Di Rienzo, De Almeida, & Guillot, 2014). Hence, to assist perceived accuracy, and to offer a degree of anatomical clarity to participants, seven distinct yet interconnected functional areas of the body that play a role in horn performance were identified by a specialist musician physiotherapist to inform this study. The functional areas are: posture; inhalation; exhalation below the glottis; upper respiration (velopharyngeal function); jaw; tongue and; embouchure, and are represented in detail in appendix 2. These individual functional areas were digitally modelled in a 3D environment using AnatomyTV (© Informa UK Ltd, trading as Primal Pictures, 2018. Primal Pictures, an informa business. www.primalpictures.com www.anatomy.tv).
After digital modelling, a short ~30 second video of each functional area was created using ActivePresenter (Free Version 7.3.3 Copyright © 2009 – 2018 Atomi Systems, Inc.). Each 3D model was rotated on the screen as the screen was being recorded. This adds considerable depth, relativity and clarity far beyond that of the static 2D images present in non-digital literature. In this study the digital models, presented to interviewees on an iPad and embedded within the online delivery of the surveys, were not performing any playing related tasks, did not reference genetic differences and were deemed ‘illustrative only’. Footage was then built into the online surveys and presented during all interviews. Stills from the footage and links to their online location can be found in appendix 2. 3.3 Participants
Three populations were identified:
1) Aspiring horn professionals, as they are subjected to pedagogical approaches at the educational institutions where anatomical knowledge is perceived by researchers to be lacking (Árnason, 2018; Conway et al., 2007; Ioannou et al., 2015; López & Martínez, 2013; Medoff, 1999; Shoebridge et al., 2017), 2) Current or retired high-ranking professionals and pedagogues, to examine the range of attitudes that coexist with the ability to perform at an elite level. (Frederiksen, 1996; McWilliam, 2012; Nelson, 2006), and, 3) Medical professionals who have treated one or more horn players for playing-related conditions as they have a level of anatomical or physiological expertise and have hands on experience of the injuries that occur to horn players as well as the playing philosophies that preceded the injury, as well as experience providing useful information in order to assist the horn players’ recovery (Ackermann et al., 2014; Burkholder & Brandfonbrener, 2004; Morris et al., 2018; Moura et al., 2017; Woldendorp et al., 2016).
The inclusion criteria for the three populations selected to participate in this study were as follows:
• Population A) Professional horn players o A horn player who has passed an audition for a fully professional orchestra, defined as an orchestra in which a full-time musician would be able to support themselves financially without another source of income. o Priority was given to Feature Soloist, High horn specialists, High rank and file, Rank and file, or Feature Low horn specialist, though many individuals will cross between these subgroups. • Population B) Aspiring professional French horn players Page 27 of 86
o A horn player who aspires to pass an audition for a fully professional orchestra, defined as an orchestra where a full-time musician would be able to support themselves financially without another source of income. • Population C) Medical Professionals o Medical professional who has treated one or more French horn players for a playing-related condition. 3.3.1 Ethics
This project was approved by the University of Sydney Human Research Ethics Committee (protocol number 2017/612). Through the Human Research Ethics Committee application process, this project was identified as being ‘low risk’.
All data collection was preceded with a University of Sydney Human Research Committee approved Participant Information Statement outlining their involvement in the study. The interview Participant Information Statement can be found at appendix 3, the performer survey Participant Information Statement can be found at appendix 6 and the medical professional survey can be found at appendix 8. All interview participants were then asked to sign a University of Sydney Human Research Committee approved Participant Consent Form to ensure that they understood the information provided about the study, were 18 or more years of age, and wished to proceed with the interview, see appendix 4. All survey participants were asked to check mandatory boxes to ensure that they understood the information provided about the study, were either a professional horn player, aspiring professional horn player or professional horn teacher (performer survey, appendix 6) or a medical professional who has treated a horn player for a playing related condition (medical professional survey, appendix 8), were 18 or more years of age and wished to proceed with the survey, giving consent.
All participants indicated that they are 18 or more years of age and speak English. 3.4 Data collection 3.4.1 Surveys
Two different surveys were designed and delivered via SurveyMonkey™ for the two different categories of participants. One survey for horn players, and another survey for the medical professionals. The key differences between the two surveys are outlined below.
3.4.1.1 Performer survey (Appendix 7)
Demographic data was captured to divide the respondents into their relative population of being either a professional or an ‘aspiring’ professional, as well as if they teach. The survey then proceeded to cover the topics of: device usage (quick overview of what a device is) and assistive therapies; detailed study of anatomy; perceived importance and usefulness of detailed study, aspects relating to ‘the zone’; and details of any treatment by a medical professional.
Next, the respondents were asked to consider the short ~30 second video resources of each distinct yet interconnected area of the body used to play horn e.g. posture, inhalation function, exhalation function below the glottis, upper respiration, jaw, tongue and embouchure function, as detailed earlier in the resource development section above (see appendix 2). After each short video, respondents were asked about their perceptions relating to their confidence in knowing how that area of the body functions, as well as if knowing and understanding what the muscles of that area did was important to them. Lastly, respondents were asked whether they would like more knowledge of anatomy and to consider its potential to develop or interfere with their playing or teaching; how accurately they believed their perception of anatomy was; and their perceptions regarding the communication of horn playing concepts with the incorporation of accurate anatomical principles.
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3.4.1.2 Medical professional survey (Appendix 9)
Demographic data was captured relating to the respondents’ practice, specialisation, information about the different variations of horn player clients they have treated, factors around the problems they addressed, perceived importance of their clients’ understanding or misunderstanding of anatomical function and importance of developing their clients’ knowledge. Respondents were then asked to consider the short ~30 second video of each distinct yet interconnected area of the body used to play horn (posture, inhalation function, exhalation function below the glottis, upper respiration, jaw, tongue and embouchure function). After each short video respondents were asked about their perceptions relating to their diagnosis and treatment of each area. Lastly, respondents were asked questions regarding aspects of interconnectivity and how much they perceived different components, such as practice habits, related to their clients’ problems. 3.4.2 Interviews
A total of 22 semi-structured interviews were conducted one-on-one the principal researcher. The blank script can be found in appendix 5. All interviews were conducted between the 9th of January 2018 and the 1st of November 2018.
Completed transcriptions have not been included in appendix as they contain identifiable information, which is a University of Sydney Human Research Ethics Committee restriction.
The interview started by talking about the performers’ routine as this is something that most horn players are very familiar with and would feel very comfortable talking about. This included topics such as the separate components of their routine, perceptions of air use, singing, and developmental tools such as a mirror. The interview then started to deepen into topics such as the study of anatomy and using an understanding of anatomy to avoid playing-related complications and inefficiency. The participants were then presented with the short ~30 second videos on an iPad showing of each distinct yet interconnected area of the body used to play horn (posture, inhalation function, exhalation function below the glottis, upper respiration, jaw, tongue and embouchure function), and given some time to consider these videos. Deeper topics were then discussed such as concepts of bodywork. A largely open-ended question was then presented where the participant was asked to talk about any of the following topics that resonated with their playing philosophies:
Development of efficient ‘mechanism’ with the aid of accurate knowledge of functional anatomy; Playing philosophy – Preparation; Playing philosophy – Performance; Development of mechanism using sensation; Development of mechanism with kinesiology; The shortfalls of using anatomy to assist performance preparation considering the amount that we don’t know about French Horn performance; and Relationship between ‘Mechanism’ and ‘the zone’.
A prepared document with short, clear descriptions of the above points was available to aid consistency and is attached at the end of the blank interview script (appendix 5).
The interviewee was then shown an image of the cortical homunculi and read an excerpt discussing adaptive neurology (as can be seen in appendix 5) as the topic moved onto accuracy of perceptions, followed by the topics of contrasting approaches, device usage, pedagogy, consultation with a medical professional if applicable and perceptions regarding research of this nature.
Later in the interview participants were asked questions about playing related injuries, however this topic was usually brought up by the participant far earlier in the interview.
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Not all questions were necessarily covered in all interviews due to a variety of factors. 3.4.3 Recruitment
Passive snowball sampling was used, including emails and social media recruitment for both quantitative (survey) and qualitative (interview) data collection methods. High ranking horn playing individuals previously known to the research team were invited to participate directly and were asked to share the invitation around the horn community via email forwarding and social media networks.
Invitations were also sent to publicly available performer, medical professional and orchestra management email addresses.
Conscious efforts were made to address gender balance. Historically, there is an uneven distribution of orchestral positions in favour of male performers. Allmendinger, Hackman, and Lehman (1996) constructed a report summarising issues from 78 professional orchestras in Germany, United States of America and the United Kingdom, where they found that on average 25% of performers were female. Similarly in their study of embouchure problems which included 585 brass player participants in Europe, 10.29% of all respondents identified as female, with 20.64% of the horn players identifying as female (Steinmetz et al., 2014). Analysis of table 2 below indicates that on average, between all respondents, 38.79% identified as Female. Of the Professionals who completed the survey, 37.50% identified as Female. Of the Aspiring players who completed the survey, 42.50% identified as Female, and of the professionals who participated in interviews, 36.36% I identified as Female.
Information about all participants is presented in table 2 below.
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Table 2. Study participants Of Of Of Of Of Of Medical Performer which which which which Interview which which professional Survey are are are are participants are are survey Male Female Male Female Male Female Professional horn 48 30 18 - - - 22 14 8 players total Elite level/soloists 3 2 1 - - - 9 6 3 Section or 24 8 16 - - - 8 6 2 Associate principal “Rank and file” 21 9 12 - - - 5 2 3 Aspiring horn players 40 23 17 ------Medical professionals - - - 4 3 1 0 0 0 Total 88 47 41 4 3 1 22 14 8
3.4.3.1 Interview demographics
Twenty-two interviews were conducted with professional horn players who originate from Australia, Britain, Canada, Costa Rica, Croatia, Germany, Norway, and the USA, and work all over the world, including 14 males and 8 females. Twenty identified as being horn teachers, 2 did not, though all have been known to teach and have conducted masterclasses. 9 are identified as being Elite level soloists, 8 as Section or Associate principal and 5 as Rank and file.
After 68,947 words of data had been transcribed within the study time constraints, no new themes appeared to be emerging and so it was considered by the research team that this would be sufficient to start data analysis for this Master of Philosophy level thesis. At this time, it was decided to close data collection from the surveys as well so that datasets could be triangulated during analysis.
It was hoped to also interview medical professionals that have treated horn players to gain a different perspective on horn players’ knowledge of anatomical function. Recruitment of medical professionals proved difficult and only 1 interview was conducted with this information therefore not able to be included in the study results.
3.4.3.2 Performer survey demographics
106 initial responses were collected. Participants who did not progress past section 7 (of 10) were considered incomplete and removed. 88 responses are included in the analysis, with 40 being aspiring horn players and 48 being professionals. Of the 88 total included responses, 11 respondents completed section 7 but did not progress to the end of the survey. These responses have been included in the analysis up to the completed level.
3.4.3.3 Medical professional survey
The snowball technique proved to be ineffective and only 4 responses are included in the analysis. Due to this relatively small number of participants, insufficient data was captured and this data could not been analysed.
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3.4.4 Interview analysis tools and data management
3.4.4.1 Interview Recording protocol
Interviewees were asked to read and understand the University of Sydney Human Research Ethics Committee approved Participant Information Statement and read, understand and sign the University of Sydney Human Research Ethics Committee approved Participant Consent Form preceding all interviews. A digital copy of each signed consent has been saved separate from all other data on the university’s password-protected secure server. Interviews were recorded on an iPhone 5 as a voice memo (.m4a file) and saved to the university’s password protected secure server, separate from all other data. Each participant has been given a randomly generated two-digit number, which has been documented and kept separate from all other data. All data analysis from this point is considered de-identified, though due to the popularity of some participants, any identifying comments they have made about themselves or others which would make them easily identifiable has not been presented.
3.4.4.2 Interview Transcription protocol
All de-identified interview recordings were then transcribed into a Microsoft Word 365 template, which was saved under a file name corresponding to the randomly generated number attributed to each individual participant. Participants were given two opportunities to indicate their desire to review the transcription, at the start and at the end of the interview. Each participant who indicated that they would like an opportunity to review their transcript was then sent a copy of their own, de-identified transcript to review and make changes to, should they wish. Only one participant altered their transcript, and only to add clarity of one comment and more detail to some of responses.
3.4.4.3 Interview analysis tools and protocol
Transcripts were imported into NVivo 12 Plus (version 12.2.0.443) which was used to analyse qualitative data. Data- driven codes and, Theory-driven codes were created and continually reviewed as per figure 3 (DeCuir-Gunby, Marshall, & McCulloch, 2011)
In order to establish reliability, consistency and transparency, a codebook was created as per the guidelines set out in (DeCuir-Gunby et al., 2011) as illustrated below in figure 4.
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Figure 3 Circular process of coding. (DeCuir-Gunby et al., 2011)
Figure 4 Steps for developing a codebook. (DeCuir-Gunby et al., 2011)
3.4.4.3.1 Development of nodes and coding comments to them.
Analysis of qualitative data in a qualitative data analysis tool such as Nvivo 12 plus, requires ‘coding’ text to ‘nodes’. Simply put, a node is like a bucket, where all data about a topic could be collected, for example, when a comment was made about the participants’ perception of how they used their air, this comment is highlighted and placed in the “perceptions of air use” node. Comments can be coded to more than one node. All transcripts were analysed and coded to relevant nodes, gradually building up each bucket and adding new buckets where appropriate. Nodes that come from the data itself, are known as data driven nodes. Nodes that come from the theoretical contribution map, based on the research questions, are known as theory driven nodes (DeCuir-Gunby et al., 2011).
After nodes have initially been established, they are then reviewed and developed according to their relevance. Nodes can then be explored by relating them to other nodes or querying the data set using sophisticated software functions.
3.4.4.3.1.1 Data driven nodes
From the data itself, 85 different nodes emerged. To aid organisation and analysis, nodes were categorised as being a parent node with subsidiary child nodes. Examples are provided below in table 2.
Table 2. Data driven nodes codebook Data driven nodes codebook Parent node Qualification Child node Comment example example Knowledge When a participant discussed MRI or X-ray It’s very interesting. I would be interested to go in an learning from literature or other RT-MRI if I had the opportunity sources separate from their own Study of It’s interesting because I had a student who was a personal experience. anatomy doctor and I learned a lot from her by talking about some factual information about anatomy. Page 33 of 86
Kinaesthetic I think less about kinesiology before and during registration performance, but I do think about it at home in the mirror Mechanism When a participant discussed an Embouchure I look at my face in the mirror and observe what aspect of biomechanical happens when I activate different muscles, for function. example the levator labii inferioris aleque nasi. Posture It’s so important to create space for freedom of breathing and support, and not curving your back into the back of the chair Support It’s so important to create space for freedom of breathing and support, and not curving your back into the back of the chair Mental When a participant discussed Focus If I’m focused and playing to a high level, it’s because aspects anything relating to the mind. all of those things are happening efficiently and well. I’ll notice stuff if it’s not going well, and I notice stuff before and I’m nervous then I’ll notice how I’m feeling and I can remind myself what I need to do Singing A lot of mental sing, and then trying to tie the singing to the image of what I want and having it clear in my head. Sensory The warm up is as much mental as it is physical perception because the physical act of warming up can be very quick. So my warm up is more about... I would call it calibration. Mode or To help guide the type of source Expository I feel very strongly that we don’t have a lot of sensors quality of of the comment. inside the mouth, as backed up by linguistics information professors. First person When I find something I like, I try to write it down because I know I’m going to forget otherwise Self- I think it probably is effective, because whether or not contradicting both parties are aware that they are using the wrong terminology they are most likely thinking about the same thing, but maybe not, and that can cause problems. Perceptions When a participant discussed Kinaesthetic Weather that knowledge is gained through sitting topic primarily related registration down in class room situation or educational system perceiving sensory feedback or where you’re learning about it, or whether you have had the opportunity to sit down and pay attention to what your body is telling you, both of those are valid ways to learn what these things are. Feeling air I don’t know how I feel the air. It just goes through the horn. Sensory I always worry about things that are very specific feedback about parts of our horn technique where we will have no true sensory feedback, like talking to a student about the size of aperture when they’re buzzing. Routine When a participant discussed Variation of I do routine in various forms. The design of the what, how, why they did what routine is to provide a skeleton for setting up a they did to maintain their mechanism that I want to play with on a daily basis. playing. Buzzing Buzzing, in which I gradually buzz from the mid-range to as low as possible, then the middle register to as Page 34 of 86
high as possible. I do this to engage the muscles in all the ways I know they are going to be used throughout the rest of the routine, re-connecting with the muscles. Mirror use When I was younger I DID develop an embouchure problem, so I had to keep a mirror right in front of me to make sure to make sure that my mouthpiece was exactly in the right place all the time and that I wasn’t moving it laterally or up and down. Self-care When a participant discussed Hydration Arnica cream on the lips at night is one thing, but I’m a ways that they looked after huge believer in hydration. I will drink a lot of water themselves away from the horn. and hydrolyte Fatigue I think general information about efficient muscle use, muscle fatigue and recovery is incredibly important Stretching Because of the particular posture we have when playing the horn, she explained what the pitfalls might be, specifically that the pectoral muscles may become shortened if we don’t stretch them, and otherwise the result will be pain in the middle of the back in between the shoulder blades and underneath the neck, which we all experience some time because we spend many hours carrying the weight of the instrument in this unhealthy posture.
3.4.4.3.1.2 Theory driven nodes
The initial aims of the study were turned into research questions to enable the further development of a meaningful coding approach as analysis progressed, further refinements needed to be made to the theoretical approach being used as to line up better with the raw data. They are represented below in table 2.
Table 2 Theory driven nodes Initial aims and goals Developed research questions Nodes 1) to investigate best-practice 1) What are the current attitudes of 1) Attitudes towards application of approaches when using accurately Horn players towards the application of knowledge. applied knowledge of anatomy to anatomical knowledge to optimise their develop optimal playing playing philosophies? → philosophies. → 2) to understand more about the 2) What are Horn players’ perceived 2) Perceived best-practice difficulties with translating best-practice approaches to using approaches to using knowledge of anatomical knowledge into practice. accurately applied knowledge of anatomy → anatomy to develop optimal playing philosophies? →
3) to document disparities between 3) What difficulties exist for Horn players 3) Difficulties translating anatomical knowledge → to translate anatomical knowledge into knowledge into practice practice to achieve optimal artistic results? →
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4) to understand how important 4) What disparities and similarities exist 4) Disparities and similarities horn players think this knowledge is between playing philosophies, and how much is a good amount→ particularly among high-ranking Horn players? →
5) to explore how learning about the 5) What can the outcomes of the study 5) Perceived benefits of this study body can assist in optimising what offer for aspiring Horn players with we feel from the body. → regard to the benefit of incorporation of anatomical knowledge into their playing philosophies? →
3.4.5 Survey analysis protocols
3.4.5.1 Survey Data Analysis tools and protocol
Data collected from the surveys through SurveyMonkey™ was exported to Excel 365 ProPlus (version 1803) where responses were classified as being sufficiently complete or not. Pivot tables were used to analyse data and identify trends. Data was then exported to SPSS (version 24), where Chi Squared functions and Fisher’s Exact test were used to identify significance. Tables presenting relevant data are included in the Results and Discussion chapter. Chapter 4. Results and Discussion 4.1 Overview
The data gathered from both surveys and interview results revealed five main identified themes. Each theme is represented by mixed method data integrating results from a survey (quantitative) and interview (qualitative) data, and then aligned with relevant literature. These are presented one at a time, though there is a high degree of interconnectivity between them all.
Quantitative data tables show that both populations are in agreement regarding many topics addressed, though some differences were observed between the opinions of the two main categories, i.e. professional players and aspiring players. To a lesser extent, further differences within both of these main categories were evident between the opinions of those who do not teach and those who do, which form sub-categories and are represented in most tables, though these are not statistically significant in all cases.
To aide readability, participant quotes are aligned in the centre of the page where appropriate, and are in “red, and italicised”. 4.2 Theme 1. Regarding extrinsic/cognitive sources for understanding functional anatomy
This refers to information that comes from an external source, specifically in terms of literature or other methods of learning about functional anatomy used to play horn.
It has been described by Eckart Altenmüller, a leading neurologist and researcher at the Institute of Music Physiology and Musicians’ Medicine in Hannover (Germany), that as well as the “emotional communicative skills, which provide a Page 36 of 86
‘speaking’ rendition of a musical masterpiece… Performing music [also] requires the integration of multimodal sensory and motor information, and its precise monitoring via auditory and kinesthetic feedback” (Altenmüller, Ioannou, et al., 2015, p. 89). This reliance on auditory and kinesthetic feedback is well represented and it clearly plays a fundamental role in all philosophies, however problems arise when kinesthetic feedback is misinterpreted or misrepresented either by individuals, and/or in pedagogical texts and/or teachers’ playing philosophies and described later in this chapter (Bārdiņš & Marnauza, 2014; Blanco-Piñeiro et al., 2015; Fletcher, 2008b; Fuhrmann, 2009; Gillespie, 2016; Ioannou et al., 2015; Persson, 1994; Salonen, 2018; Wijsman & Ackermann, 2018; Woldendorp et al., 2016). Here, we first investigate to which extent unbiassed, accurate, and academic information are used, as well as which sources are considered the most useful. 4.2.1 Knowledge from defined sources – survey data
The survey asked respondents “Have you done any detailed study with regard to the anatomy used to play the horn?”. Of the 88 who responded to this question 15 (17%) indicated that they had done “A great deal”, 21 (24%) indicated that they had done “A fair bit”, 34 (39%) indicated that they had done “A little” and 18 (20%) indicated that they had done “none”. 4.2.1.1 Sources considered the most useful - survey
The 70 respondents who indicated that they have done some level of detailed study with regard to the anatomy used to play the horn were then asked to indicate what sources were either “very useful”, “moderately useful” etc. The vast majority (86%) indicated Horn books, followed by Brass method books (66%), free online sources (61%), medical reference books (39%), and paid online sources (21%) as either “very useful” or “moderately useful”. It is possible, given the responses, that some respondents understood the question to be “regarding usefulness towards horn performance” rather than “regarding the sources’ usefulness towards detailed study of the anatomy used to play the horn”.
The 70 respondents were given the option to give details of the sources that were most useful if they wished. Of these 19 individuals responded with sources and these varied considerably. One respondent indicated peer-reviewed sources in the form of “Research done about brass players together with medical doctors, experience and understanding about teaching, studies about musicians coaching, NPL, Mental training. Studying the literature.” Some indicated sources that can be identified as opinion pieces also containing scientifically defensible information such as “The Breathing Book for Horn” (Nesmith, 2012) “Horn Playing from the Inside Out, Third Edition” (Epstein, 2012) or “Playing from the Core” (not available in English at the time of writing)(Hyytinen, 2016). Some indicated body awareness sources not specifically directed at horn performance, such as “A yoga anatomy book which I find very useful”, or “Pilates method books.” One respondent indicated “the IHS website/journal; Horn Matters website”, which both contain a considerable number of opinion pieces, however neither journals are actually peer-reviewed. Some indicated sources from other fields of pedagogy "If in doubt, breathe out" (Morris & Hutchison, 2016), “https://bulletproofmusician.com” or “trombonechat.com.” Popular pedagogical opinion pieces such as “The Art Of French Horn Playing” (Farkas, 1956), “Thoughts On Playing The Horn Well” (Wekre, 1994) and “Arnold Jacobs: Song And Wind” (Frederiksen, 1996) were also mentioned. Some also considered that “Talking to people who are experienced in the field of interest” constituted ‘detailed study’. 4.2.2 Knowledge from defined sources – interview data
All of the interview participants were directly asked if they have done any detailed study of anatomy. Interestingly, in contrast to the survey, all 22 participants responded either “no” or “not really”. It is important to note that some individuals participated in both interviews and the survey. For some of these individuals, it can be seen that their results are different in person.
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4.2.2.1 Sources considered the most useful – interview data
Two of the interviewees are also authors of pedagogical texts. Though this would add considerable value, the titles cannot be revealed as this would discolse the participants’ identity.
Similar to the survey data, many of the same sources were mentioned as well as some additional pedagogical sources. Conflicting opinions were common, with renowned pedagogue Farkas mentioned by 8 different interviewees both positively and negatively, as were Jacobs by 7 and Wekre by 5. Some of the comments in relation to the sources are highlighted below.
It was common that participants would cite texts authored by their former teachers.
E.g. “Mastery of the French Horn: Technique And Musical Expression, by Michael Höltzel, my teacher, which I’ve only come to now, again because I have first-hand experience with his teaching so a lot of the ideas were transmitted to me in lessons.” #73
Some interviewees referred to literature based on Alexander technique, that included references to anatomy;
E.g. “I really like What Every Musician Needs to Know About Their Body.” #30
Non-literature based learning, such as attending presentations by researchers in in the field, have been mentioned.
E.g. “No, but I’ve picked up things as I’ve gone along. Some has come from books, but most has come from International Horn Symposium workshops. Peter Iltis for example” #79 and
E.g. “Annie Bosler delivered a lecture at the IHS in Brisbane which included orofacial stretching and massage techniques, as can be seen in part in her TED talk video with mention to Dr Jaume Rosset I Llobet” #79
It can be seen that an individual’s perception of the usefulness of a source will, to an extent, depend on the participant’s experience, with the more useful sources also being combined with other media, i.e. having lessons with the author, or receiving information in the form of a presentation.
It is also clear from these responses that sources containing detailed information on anatomy are not strongly represented, indicating a level of disconnectedness between useful horn pedagogy and detailed study of anatomy.
4.2.2.2 Perceived problems with pedagogical sources
Some interviewees gave their perceptions regarding problems with cognitive methods, identifying a level of disconnectedness between sources and first-person experiences.
E.g. “I know I don’t know all of the horn literature there is, but of the literature I do know, it doesn’t fit my opinion. There isn’t much that is founded in science; it’s too much for entertainment. I don’t like it if it’s generalised. It must be looked at from different sides and respect that there are so many types of people, but can, keeping in mind that there are a lot of exceptions, give rudimentary information on how the playing muscles function together. If the basic information is there, then its good soil for every plant. The basic elements must be there first. I’m very strict in the beginning with my students, and then I let them become individual.” #95
This view reflects the importance of individuals developing their own philosophies based on accurate information. Further perceived problems with pedagogical sources is that they are prone to misinterpretation or being taken out of
Page 38 of 86 context, where the reader of a source will quickly find limits of its usefulness unless accompanied by someone who has either authored the source, or had firsthand experience in successfully applying its content.
E.g. “Sometimes people misunderstanding what they’re reading. I can remember picking up a method book and trying to work through it but it didn’t work for me at all, then I took the book to a teacher who has approached it differently and, with the different approach have discovered that it works really well. It can be tricky. The Maggio system is another example of this.” #30
E.g. “It’s easy to take things out of context. Especially with the lack of clarification that comes from not being face to face” #38
E.g. “There’s not a lot of it. It’s really complex to the point that a high school student may not take the time to understand it, especially considering that it might be exactly what they need to help them” #38
The lack of dynamic feedback is another problem, as clearly outlined by one interviewee.
E.g. “The way that I learn is by getting instant feedback from someone in a room. A book can’t give you that. Having pictures and descriptions is one thing, but unless you’re feeling it and doing it with immediate feedback it doesn’t do that much from me. The void between the cognitive information and registration of sensations is too large to be relatable or applicable.” #20
Interviewees were asked about their perceptions of the shortfalls or problems with literature in regard to good pedagogy/performance are. Responses indicate that attempting to provide information or describe the function of complex biomechanical structures in pedagogical sources is problematic;
E.g. “When the topics are on air support and embouchure function.” #40
E.g. “It’s a shortfall of method books that there isn’t enough visual information” #21
This identifies problems with pedagogical sources if the author is not present to guide the interpretation of their published work, and provides insight as to why many high-ranking European horn pedagogues do not write prescriptive texts, as evident by the volume of high ranking pedagogues and the low volumes of pedagogical texts. Similarly, why privately-published sources/routines are primarily intended for use within lessons with the authors, e.g. Bain (2017); McDonald (2007); Nelsen (2018); Sanders (2012). This highlights the complexity of horn performance and illustrates the risk of misinterpretation should a pedagogical source be interpreted without due care and/or the presence of the author. However, even with direct involvement of the authors, pedagogical sources still present elements of risk, as outlined below. 4.2.3 Anatomical representation in pedagogical sources
The above mentioned pedagogical sources present some anatomical information with varying levels of detail. It was common to encounter disagreement between individuals in relation to their opinion of the usefulness of each source. All pedagogical sources require the author to interpret the functionality of their own complex biomechanical and neurological structures at some level, in order to transfer their perceptions into musical performance via text and images. This is usually based on anecdotal evidence.
The level of detailed study of anatomy of the authors is also largely unknown. For example, in a doctoral dissertation, Fuhrmann (2009) draws from an interview with Arnold Jacobs (Part 2), in which, “Jacobs explained that although he was not trained in medicine or physical therapy, he viewed himself as a therapist to some extent” (Bobo, 1981). Other aspects of Jacobs’ philosophy that are not in line with current peer-reviewed research are discussed below. An author of a pedagogical source, who also participated in this study, commented that “No. I feel like I’m still in training” when asked about detailed study of functional anatomy. Page 39 of 86 It is not the purpose of this study to devalue the contribution of pedagogical authors, though it can be seen in some cases that there are some important disparities between peer-reviewed, scientifically defensible information and philosophies or opinions developed largely based on perceptions and experiences. 4.3 Theme 2 – Blended modalities of learning
‘Blended modalities of learning’ refers to situations when the cognitive knowledge is combined with kinaesthetic input, overcoming some of the limitations of cognitive methods. This study will be limited to some popular somatic bodywork and one-on-one tuition methods. These modalities have been chosen due to their relevance in terms of transferring knowledge with the inclusion of various levels of functional anatomy, aimed at musicians, even though conveyers of courses may not be medical professionals (Carey & Grant, 2012). Some of these methods are described below. 4.3.1 Somatic Bodywork
Examples of somatic bodywork are Accent Method Breathing, Alexander Technique and Body Mapping as detailed below. These bodywork teaching techniques are usually taught by musicians and have been used at institutions as an accessory learning method for students to develop body awareness and relate this to their playing. Research is only starting to emerge, with mixed reports to date on the efficacy of using these techniques on physical aspects of performance.
Although Feldenkrais, yoga and Pilates are also somatic bodywork methods, they will not be discussed here as the peer- reviewed sources present limited applicability to horn performance (Lee, 2018). Overall, interviewees had mixed impressions of somatic methods and although no studies to date have reported that their participants have included horn players, one interviewee at a leading conservatorium mentioned that “They are important, particularly accent method breathing.” #40
4.3.1.1 Accent Method Breathing (AMB)
Accent Method was developed for the remediation of speech and voice difficulties but in the past 20 years it has also been used to help develop breathing and support in singers (Morris et al., 2013). It is anecdotally common for wind and brass players to seek help with breathing techniques from vocal teachers, where this has traditionally been a far greater focus for performance training.
Currently, there are no academic articles examining AMB in relation to horn or brass performance. In relation to singers, Dr Ronald Morris, a speech pathologist and singing teacher, studied its effects on singing as part of his Doctoral Dissertation. Summarising the study, students were divided into two groups, control and experimental. The course ran over 10 sessions in the space of a university semester.
“Session One for the experimental group only begin with an explanation of the method, its anatomical correlates and how the classes will be structured. Students were then, throughout the 10-session course, taught more about the different muscles of respiration via a series of well-structured exercises in various positions” p143
It can be seen in this case that developing the participants’ level of anatomical knowledge played a role in this study. The results of the study showed that the experimental group, who received AMB, demonstrated highly significant changes, showing improvement to their average dynamic range and the maximum number of semi-tones being sung. The panel of judges also demonstrated a greater preference for the experimental group’s singing recordings post intervention than they did for the control group’s post intervention recordings (Morris et al., 2013). Whether this technique may translate into effective breathing techniques for wind and brass musicians is yet to be shown scientifically.
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4.3.1.2 Alexander Technique (AT)
Alexander technique is named after Frederick Matthias Alexander (1869–1955), the Australian-born actor and elocutionist who developed this approach. Similar to AMB, there is limited academic research conducted between AT and French Horn performance.
In a recent systematic review of the academic literature on AT as it relates to musicians (Klein et al., 2014) assessed 237 citation and found that “12 studies were included [in their review] for further analysis, 5 of which were randomised controlled trials (RCTs), 5 controlled but not randomised (CTs), and 2 mixed methods studies.” Klein concluded that:
“Evidence from RCTs and CTs suggests that AT sessions may improve performance anxiety in musicians. Effects on music performance, respiratory function and posture yet remain inconclusive. Future trials with well- established study designs are warranted to further and more reliably explore the potential of AT in the interest of musicians.”
The horn method book based around AT titled The Breathing Book: Horn Edition (Nesmith, 2012) was mentioned positively by one interviewee;
E.g. “I really like What Every Musician Needs to Know About Their Body.” #30
Despite a lack of evidence to support any physical or anatomical changes observed as a consequence of undertaking AT lessons, anecdotal evidence from interviewees suggest that AT can be beneficial for elements of horn performance.
E.g. “Alexander technique taught me a lot about posture during a time when there was a lot going on outside of work and my playing was very tense. It was more about mindfulness and easing the tension I was feeling”. #22
E.g. “I don’t know about Feldenkrais or accent breathing, but I’ve had good experiences sending students to Alexander technique teachers.” #93
4.3.1.3 Body Mapping (BM)
AT has played a role in the development of a newer form of somatic training labelled ‘Body Mapping’ by its creators, William and Barbara Conable (A Cellist and an AT instructor respectively), who are also published (Conable & Conable, 2000). While there is little evidence of Horn players being involved in research projects regarding Body Mapping, it is specifically aimed at musicians. There have been studies demonstrating its effectiveness at conservatoriums, providing excellent reviews of the literature aligning performance with aspects of anatomical knowledge in a manner relevant to this study by Salonen (2018). Another Doctor of Musical Arts dissertation studied theoretical applications of BM to aspects of posture for trumpet performance, but did not include other participants in their discussions (Holt, 2016), who concludes that “by debunking misinformation present in traditional trumpet pedagogy, providing correct and relevant anatomical information, and principles from which to apply this anatomy, body Mapping has the potential to prevent injury and enable freedom of movement to trumpet players of all ages and abilities.”
4.3.1.4 Analysis of somatic methods
The aims of somatic methods are to interconnect knowledge of functional anatomy with kinaesthetic registration (Salonen, 2018, p. 117). There is currently no scientific evidence regarding somatic bodywork methods with horn performance, and where breathing is concerned it is unclear as to whether it is incorporated as a form of relaxation/mental focussing (Klein et al., 2014), or if is more directed towards physical performance applications (Morris et al., 2013).
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The positive results that have come from some of the studies involving other brass or singing instrumentalists indicate that somatic methods may have the potential to be of benefit to horn players where the method addresses aspects of posture and elements of breathing (Buchanan & Hays, 2014; Holt, 2016; Lee, 2018; Salonen, 2018). 4.3.2 One-on-one (Master/apprentice) pedagogical model
One-on-one pedagogy is considered as a blended modality as any lesson will contain extrinsic data of one form or another combined with kinaesthetic registration. The one-on-one pedagogical model is still considered “essential to students’ learning and development” (Carey & Grant, 2012). Illustrating this, even though all interview participants met the selection criteria of having gained full time employment in a fully professional orchestra, some participants continue to seek out one-on-one lessons, with one participant having recently returned from a recent trip to London, Germany, Los Angeles, Chicago and New York where they attended around 15 one-on-one lessons from many different high- ranking performers.
4.3.2.1 Challenges with one-on-one horn pedagogy
Recent studies examining one-on-one pedagogy have also identified considerable flaws. A detailed analysis of problems relating to one-on-one horn pedagogy falls outside the scope of this study, however, some important factors are discussed in the following peer-reviewed academic sources. The cohorts in these studies are made up of many different players of different instrument types. Most include horn, though not all studies provide precise cohort details. All are conducted at conservatoriums, musician specific medical clinics or musician research facilities. Extended quotes have been provided throughout this sub-chapter as attempting to paraphrase these quotes would not do the authors justice and remove important context.
4.3.2.1.1 Teaching styles
In a 2013 study titled Characterising One-to-one Conservatoire Teaching: Some Implications of a Quantitative Analysis (Carey et al., 2013) the authors identify that there are two key types of pedagogical approach among the teacher- participants.
“Type 1: transformative pedagogy places emphasis on a depth of student understanding and ownership. It is characterised by a ‘deep’ approach to learning orientation on behalf of the teacher, and pedagogical agility in terms of its collaborative, explorative, scaffolded, meaningful and contextualising qualities.
Type 2: transfer pedagogy contrasts with transformative pedagogy in that the approach is largely didactic. It is characterised by instruction, scaffolding that promotes mimicry, less flexibility, orientation towards assessment and decontextualised learning.” (Carey et al., 2013)
The researchers go on to characterise teacher participants:
“Unweighted indexes running from 0 to 1 based on the two pedagogical style factors were produced, and teachers were compared based on these indexes. All of the teachers exhibited characteristics of both teaching styles, but generally the teachers who participated in this study tended to adopt a Type 2 (Transfer) style, characterised by a definite and determined notion of excellence, an orientation towards assessment as an end point and a predefined approach to pedagogy. This predefined approach included general verbal scaffolding of engagement along with clear directions relating to specific tasks and modelling or demonstration. A smaller number of teachers adopted a Type 1 (Transformative) style, characterised by a deep, sense-making and collaborative approach to pedagogy, an emphasis on contextualisation of learning within the student’s broader life and career, and agility in pedagogical choices.
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While some student-participants expressed preference for transfer-style pedagogy, the majority preferred transformative teaching. Some students experiencing a transfer-style approach to teaching spoke of their ‘loss of energy’ and a sense of lacking ownership of their learning.” p362
The researchers then go on to outline that professional development and growth, particularly for those teachers exhibiting primarily a ‘transfer’ style of teaching should be focussed on, particularly in terms of pedagogical agility and building a responsive instructional ‘toolkit’, strengthened by a collaborative approach to problem solving and building knowledge (Carey et al., 2013, p. 365)
4.3.2.1.2 Awareness challenges
Academic authors focussing on brass pedagogy have also identified additional challenges which apply to the one-on-one pedagogical model;
“There is little assurance that good teachers are aware of potential risk factors with regard to developing practice habits, general attitude to being a performer, repertoire, and teaching style” (Dommerholt, 2009)
“Since body use, practice habits, pedagogical techniques, and personal, physical, and psychological health seem to play a role in the progression of symptoms, addressing these areas may be wise preventative measures. Unfortunately, trends in brass pedagogy may contribute to the development of embouchure dystonia.” (Fletcher, 2008b)
“The pedagogy of abdominal breathing may be confusing to students.” (Fuhrmann, 2009)
“To avoid using quite inadequate but by generations inherited approaches to teaching/learning breathing during playing, it is essential to know physiological processes of natural breathing and try to maximally approximate the brass playing breathing process to them” (Bārdiņš & Marnauza, 2014)
“While the participants were experts in their fields of performance, they generally lacked both flexibility in their pedagogical strategy and knowledge of the dynamic nature of teaching and learning. The results of the present study, therefore, emphasise the need for teacher training in musical performance.” (Persson, 1994)
“More attention should be paid to improving the strategies of music teaching so as to favour improved understanding and control of posture by students, with consequent improvements in physical health and musical performance.” (Blanco-Piñeiro et al., 2015)
“Pedagogues have a responsibility to adapt and maintain an open mind toward new scientific developments that can help them be better teachers.” (Gillespie, 2016)
Challenges with one-on-one pedagogy can also come from teachers misinterpreting how they are using their anatomy. [identifying information has been removed]
E.g. “When I was at [university name], the legendary [pedagogue] was teaching there. He would tell his students that when you ascend above the staff, especially approaching a high C or D, you should drop your tongue and be more open in the throat as you go up to keep the sound broad. Not one of his students could play above the staff. Then they would say “Mr [pedagogue], I can’t do it”, then he’d grab their horn and say “watch”, and go (*interviewee sings an octave leap from middle register to high register while changing from “aw” to “ee”*). He would close his throat, but to his body it felt like he was keeping it open, and you could easily see that something was lifting in his throat area. I think this study is the key to getting rid of old, Victorian, hung-over, bad pedagogy.” #19
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4.3.2.1.3 Attitudes towards PRMDs at conservatoriums
A recent study into PRMDs at a Czech Conservatorium in which 24 brass performers participated, though the researchers did not specify the type of brass instrument specifically (Ioannou et al., 2015). The researchers asked both students and teachers questions regarding attitudes towards musician health and the cause/treatment of PRMDs:
“Students indicated the most frequent reactions for tutors to be: “you occasionally have to take some time off” (44.6%), “it’s nothing serious, it happens” (33.1%), and “I believe that your bad technique is the main reason (25.7%)”. […] Elsewhere, 76.1% of all subjects (n=180) reported that their tutors mentioned during teaching how important a healthy body is for musicians. The frequency with which this was mentioned was 1.5% in “every lesson,” 21.9% “very often,” 52.6% “sometimes,” and 24.1% “rarely.” (Ioannou et al., 2015)
“According to students’ reports, instrument tutors mostly advised them to take some time off when PRPs occurred. These results could also explain why “resting” was the main solution for overcoming PRP problems. Tutors also tended to mention that instances of PRMDs are nothing serious and, when PRMD problems occurred more frequently, tended to focus on inappropriate technique. Moreover, they were reluctant to send students to medical professionals […]. Nevertheless, these results do not mean that instrument tutors do not take PRMD issues seriously, since a high percentage of students reported that their tutors mentioned during teaching how important a healthy body is for instrumental musicians.”(Ioannou et al., 2015)
This indicates that within this study, teachers were ill-equipped to identify and address PRMDs. Ioannou et al. (2015) conclude, through others, that;
“Asking for help seems to still be a taboo among musicians. A large minority, representing one third of affected students (35%), tends not to seek help at all. Similar high proportions of students who did not attempt to solve their PRP problems or who did not ask for any professional advice have also been reported by Shoup (1995) and Spahn et al. (2002). This high percentage could be explained firstly by high psychosocial pressures among music communities, since injuries may be interpreted as a sign of deficient technique. Furthermore, many teachers and students still adhere to a “no pain, no gain” mentality, believing that suffering for their art is the normal price to be paid for excellence. Finally, the fact that PRMD problems are complex to treat could lead to insecurity and mistrust with respect to interventions, and even to fatalism. Nevertheless, those students who tended to seek help resorted first to their instrumental tutor and second to medical doctors. This could suggest that the role of instrument tutors should not be limited to instrumental teaching; instead, they should additionally be trained in preventing and recognizing PRP problems of their students as well.”
Wijsman and Ackermann (2018, p. 3) identify that “Paradoxically, despite this lack of fundamental health knowledge among music teachers, they are often the first people consulted by students regarding performance-related health problems." (Williamon and Thompson, 2006; Norton et al., 2015a)
Adding to these challenges Woldendorp et al. (2016), in his papers that focuses on classification of the brass players’ embouchure, concludes that “Unproven or unsubstantiated beliefs about the way sound is produced in a wind instrument are common, and these beliefs are the implicit foundation for educational methods to achieve good, i.e., functional, embouchure and for the educational or therapeutic approach to embouchure problems.”
And Salonen (2018, p. 95), through others, shows us “that studio teachers are usually the primary source of support and information on health-related matters but may not have adequate training and knowledge (Clark & Lisboa, 2013; Pierce, 2012; Williamon & Thompson, 2006). Similarly, (Norton & Greasley, 2014 found that college-going musicians experiencing a performance-related problem usually seek advice from their teacher, a friend or family member. Yet most music teachers are ill-equipped as they are often informed only by their own experience and opinions (Palac, 2006 #791; Pierce, 2012). Ioannou et al. (2015) found that music conservatory teachers did sometimes talk to their students about health promotion but with low frequency.
Page 44 of 86 Although it is not always clear from the above sources how much of the above information directly involves one-on-one horn pedagogy, they are all relevant to horn pedagogy in general. It is clear that the level of understanding of functional anatomy plays a role in the level of effective pedagogy and that there are considerable complications around communication about technique for pedagogues.
As summarised by (Persson, 1994), pedagogues mean well with their pedagogical approaches, however the above information indicates that the application of functional anatomy and identification of PRMDs is complex, leaving many pedagogues unsupported as there is limited training available to them.
Appropriacy, applicability and context regarding the application of functional anatomy to horn playing has its limits, as discussed later in Theme 5, however it is clear that when pedagogical approaches are developed without regard for applied functional anatomy, students are at greater risk of developing a PRMD, discussed later in Theme 4. 4.4 Theme 3. Intrinsic knowledge 4.4.1 Intrinsic knowledge
Intrinsic knowledge and the neurological factors around sensory perceptions and motor function have been outline in the literature review, where (Altenmuller & Ioannou, 2016, p. 80) describes the integration of multi-modal sensory and motor information, (Kolb & Whishaw, 1998) describe plasticity, (Altenmueller & McPherson, 2008, p. 130) describe how neural pathways can break down over time, (Gillespie, 2016) accounts for performers indicating their lack of awareness when they see in their own RT-MRI footage, (Harver et al., 1988; Ko et al., 2018) identify the complexities around the different type of neurological information available to the brain, and Olaf Blanke (2012) have expanded on the adaptability of the our perceptions
This relates to horn performance as evidenced by the following data, perspectives on horn performance are unique.
E.g. “I learned by searching. I was always curious. No one could really explain to me what ‘support’ means. I just did it and discovered and tried to, like a singer, open it and discover. They didn’t really have many books and the books I could find were very simple. There isn’t any source that I could say was definitive. I have my own version.” #95 4.4.2 Sensory perception
4.4.2.1 From the survey data
Survey respondents were asked how accurate they believed their perception of anatomical knowledge is, based on what they felt, as per table 3 below
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Table 3. Participant responses Based on what you feel when you play the horn, how accurate do you believe your perception of anatomical function is? Extremely Very Somewhat Not at Not Grand Row Labels accurate accurate accurate all accurate so accurate Total Aspiring - total 0 4 24 1 3 32 Who don’t teach 0 1 11 1 1 14 Who do teach 0 3 13 0 2 18 Professionals - total 4 15 20 2 4 45 Who don’t teach 0 2 5 0 0 7 Who do teach 4 13 15 2 4 38 Grand Total 4 19 44 3 7 77 Total Total very positive middle Total negative Combined totals 23 44 10 77 Percentages 30% 57% 13% 100%
Interpretation of this question requires reflection on the factors that might contribute to how a participant may perceive anatomical knowledge as being accurate. One such factor may be the degree to which the participant feels they are able to apply their acquired anatomical knowledge to manipulate their anatomy in a manner that results in the desired artistic outcome.
As identified in theme 1, the majority of participants in the survey responded that they had done some detailed study of anatomy. However, this is not supported by the cited resources used, with participants identifying predominantly horn and brass pedagogy text sources, that typically contain limited accurate anatomical information with little referencing.
Horn players may perceive they have knowledge of anatomy from these limited sources, but this does not necessarily reflect their having reliable knowledge of anatomy. They may reasonably believe they are successfully applying their varying sources of knowledge and achieving the desired artistic outcome with this reflecting the experience of up to 30% of this cohort.
Of this 30% who felt that their perception of anatomical information is “accurate”, 5 (22%) indicated that they have not done any detailed study with regard to the anatomy used to play the horn, and that medical reference books or articles were not applicable to their musical studies. In addition, 3 (13%) and 5 (22%) of horn players indicated that medical reference books or articles were either ‘neither useful nor detrimental’ or ‘slightly useful’ respectively, while 6 (26%) and 4 (17%) horn players indicated that medical reference books or articles were ‘moderately useful’ or ‘very useful’ respectively. Simplifying this data, for 13 (57%) of this sub-group, medical reference books or articles have played an insignificant role in their acquiring of anatomical knowledge, yet they believe that their perception of anatomical function is “accurate”. It is interesting that majority of this 30% have limited actual knowledge of anatomy, yet they perceive that their knowledge of anatomy is accurate based on what they feel when they play the horn.
57% of the 77 players who answered this question believe their knowledge of anatomical function is only somewhat accurate. Interpretation of this result invites us to reflect upon what is creating this uncertainty. There are many factors that could influence this including:
• Factors around sensory perception, as addressed above. • Limited knowledge of anatomy based on reputable scientific or medical sources, addressed in Theme 1. • Inaccurate applications of anatomy influenced by teaching philosophies and analogies used in teaching, addressed in Theme 4
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• Difficulties faced applying their knowledge of anatomy successfully to create the desired artistic result, addressed in Theme 5.
Speaking to this uncertainty, a comment made by a high ranking brass pedagogue, Dennis Wick, describes the speculative process of teaching and learning a brass instrument (Fletcher, 2008a).
“The players/teachers do what they do. They tell the students what they think they do. The students then try to do what they think the teachers (think they) said about what they think they do.”
4.4.2.2 From the interviews
Relating to neurological plasticity and adaptability, comments made in the interviews reflect the importance of “checking-in” or “re-calibrating” at various stages of both preparation for performance and within live performance itself. Some reflected checking posture;
E.g. “On a day to day basis, simply to do a quick check-up to make sure that everything is balanced or in the right spot you’ll know if you need to get a chiropractic adjustment or something.” #79
E.g. “At long distances I use a mirror to check my posture and control.” #95
E.g. “I’ve started using video more in teaching, especially if there’s a concert situation, then we would typically get together the next day and discuss the video together by just asking questions and making remarks. We can check on stage craft and posture” #73
Some discuss checking respiratory function;
E.g. “When I do my breathing exercises I check to see if my chest is expanding and contracting. I try to feel and be aware of everything involved.” #30
E.g. “There is a high degree of variation in my routine. The only thing I do consistently is check in with my breath” #20
Some refer to embouchure function;
E.g. “Practicing is an everyday check-up of whether the lips are maybe a little bit stiff from the day before and to equalise the muscle tension” #95
E.g. “Buzzing is a good daily check-in to get some good vibration in the lips without too much rigor, structure or resistance” #16
E.g. “I think I can calibrate my muscles and jaw position to know how to interact with the air during the act of purifying the sound” #88
Some discuss checking-in as part of general maintenance or trouble-shooting;
E.g. “If you’re not taking care of yourself and checking in, then sub-optimal things can creep in. I guess if you’re more aware of your anatomy and recognise when something feels different or wrong or good I guess your awareness is better, so you’ll fix it or adapt or something like that” #20
E.g. “I think our approaches towards horn playing have to change as our bodies do. It’s good to have general anatomical, kinesthetic habits as you’re going along listening and calibrating as you’re going with it” #88
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E.g. “My warm up is more about... I would call it calibration. I would calibrate everything. I would get the air moving properly. I would get the embouchure working properly and get my brain working properly, as in a relaxed but focused state” #40
And for some, re-calibration can play a role during live performance;
E.g. “When things are going ok on stage and you’re feeling good I tend to let it go and flow with it. If I’m feeling not so great, I will go back into my knowledge shell and unpack while I’m playing in middle of a performance. Unpack everything. Get it all the knowledge in order. Re-calibrate. I can do that on the fly, but I can only do that because I believe I have fairly good physiological knowledge of what’s happening while I’m doing it.” #40
These responses indicate that even at professional level, within the cycle of finishing one day of playing, sleeping, then starting again the next day, perceptions of such fine sensorimotor functions are in a constant, yet subtle, state of change.
4.4.2.3 Perceptions of air use
From the interview data it can be seen clearly that air use is perceived as one of, if not the most important aspect of horn performance by all interviewees. When asked about the role air has in their playing philosophy, responses such as the following were very common:
E.g. “It’s huge. Air is the most important thing” #38
E.g. “It’s the number one priority for me when I play the horn” #40
E.g. “I place massive importance on breathing and air” #14
E.g. “Air is support, as I interpret it to be. Support is the most important thing” #84
E.g. “For me the air is 100% the guiding force. Air is the most important thing” #37.
E.g. “Air is of course essential.” #73
For others, “air” is the one of the most frequently used words in their transcript. Others base their entire routine “on breathing and blowing”. For a detailed list, see appendix 10.
The same level of agreement could not be found when interviewees were asked how they felt the air. Air use emerged as a dominant theme within the interviews also represented in appendix 10, and demonstrates that there is a high degree of variability and ambiguity around perceptions.
Though interviewees perceive that air use is important, some express that they don’t focus on the actions underpinning this:
E.g. “I do very little work in which I’m thinking about the air.” #91
E.g. “I don’t theorise about the air” #14.
Some refer to specific anatomical concepts or actions;
E.g. “Open throat, the intercostals muscles expanding and contracting.” #30
E.g. “No movement in the shoulders or the throat” #25
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E.g. “I learned about breaking the old rule of not raising the shoulders, so I could be freer to take a bigger breath” #53,
Many also reference the lower torso though in different ways;
E.g. “I don’t want to even call it support; more just, activation of the larger muscles down there” #53
E.g. “I guess I feel it in my core and all of my torso, so not just my stomach but also my ribs, side of my torso and the back.” #82
E.g. “I use a lot of intra-abdominal pressure” #93
E.g. “I think about the point 2 inches below my belly button pushing out and for me that’s the core to what I’m doing” #37
E.g. “My abdomen distends and relaxes completely” #40
Some refer to singing pedagogy for applications of the use of air to horn playing;
E.g. “I used a combination Jacobs pedagogy, with voice training. The classic Italian appoggia school” #19
E.g. “It’s drawing from singing pedagogy” #40
E.g. “I call it ‘vocal air’. I’m surrounded by singers” #88
Some refer to the way air use is portrayed by somatic teaching techniques;
E.g. “…and then my imagery is that the air travels out of my upper chest (passing through the sternum, as opposed to the upper respiratory tract) with a forward momentum and that creates a relaxed feeling in my throat and my neck, so, to remove tension. It’s like Feldenkrais, but it’s not strictly adhering to Feldenkrais” #40
E.g. “I, in theory like to think of, especially when I’m seated, it really coming from my feet” #38.
Majority of interview participants refer to analogies and imagery to help create the perception or sense of how to use air during horn performance:
E.g. “Kind of like a weight lifter lifting a couple of hundred pounds (~90kg)” #93
E.g. “The way I feel the air could be compared to a ’foundation’” #84
E.g. “I still like the idea that the air is the violin bow, the air is what makes the horn vibrate” #21
E.g. “It feels like a cleansing thing. I feel like I’m taking in a cool, clear, cleansing breath and then when I’m breathing out I experience it as being warm, focused and projected.” #79
E.g. “…and keeping a feeling of fullness or fatness. To me it was like shifting my center of gravity lower in my torso in order to keep the air pressing outwards at all times within the lungs and torso allowing a sense of heaviness.” #16
E.g. “I feel it as being a non-static energy, it’s always in motion and is part of the relaxation of the muscles and it’s a part of the energy, so it’s always in motion.” #95
E.g. “Another way we can talk about air is by having images: Warm air, cold air, fast air, slow air, and all of these kinds of things.” #73,
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E.g. “I try to imagine it as an ‘air cushion’ like those crazy hovercrafts in the Florida marshlands. That’s how I try to think of support; so that it’s flexible, so that it’s not hard or harsh and that you can really depend on it when more support is necessary and thinking downwards and also thinking as low as the belt line maybe, which is probably going too low, but I think it serves two purposes; one is so that you really feel the support there because we do have abdominal muscles there and on the other hand also when we get a little bit nervous and tense while performing, what happens is that sometimes our shoulders and neck etc., will get tense.” #73
E.g. “Thinking in my mind that I have these two deflated balloons in my chest and as I inhale I’m trying to fill up the balloons as much as I car” #22
E.g. “Air is the fuel that drives the car.” #82
Some have developed pedagogical approaches that compartmentalise functionality to a degree;
E.g. “3) is from the vocal folds down and is the engine of the car. 2) is from the vocal folds to just behind the lips which is the whole cathedral and shaping and you’re sitting in the car, and 1) is from about a centimeter behind the lips to the small part of the mouthpiece and that’s the front wheels of the car” #88
Some discuss timbre-less fricatives, i.e. a very soft whisper, without the use of vocal folds creating sound waves that resonate in the velopharynx or oral cavity;
E.g. “h(aaaaaaaaaa), h(uuuuuuuuuu), h(oooooooooo),” #62 combined with
“Natural functions such as laughing, not supporting consciously” #62
Some discuss sensing flow:
E.g. “I feel the air flowing.” #40
E.g. “I can only talk about when the air feels good or when the air feels bad as opposed to how I actually feel it. If it feels uninhibited, unrestricted by embouchure or tongue, then I know it’s good air” #20
E.g. “we feel how the air is travelling” #25
Some describe a lack of concern regarding properties of acoustical physics:
E.g. “… whether it’s acoustically correct or not I don’t care, it’s a psychological thing” #21
E.g. “I don’t actually care if this is accurate in terms of acoustical physics” #88.
Some acknowledge the level of disparity between methods taught by different brass pedagogues:
E.g. “It’s really true that if you ask 10 brass teachers or instructors or singers to describe what they’re doing they’ll give you different answers, as your study is probably showing.” #73
And some simply acknowledge that they don’t have a sensory perception of the air during horn playing:
E.g. “I don’t know how I feel the air. It just goes through the horn” #53
All of these 22 perceptions are unique, representing fundamental aspects of individualism in playing philosophies. While these perceptions play roles in the philosophies of horn players who have won auditions for professional orchestras,
Page 50 of 86 some of the comments contradict or oppose others. In-depth analysis around factors that contribute to each individual’s perception falls beyond the scope of this thesis due to the vast range of anatomical variables as well as differences in neurological perception.
Differences exist between body shapes may add insight to the array of different sensory. In a study comparing the differences in breathing between sexes using 3D analysis, it was discovered that size and shape differences have an effect on lung geometry and muscle recruitment strategies (Torres‐Tamayo et al., 2018) 4.5 Theme 4. Playing-related Musculoskeletal Disorders (PRMDs)
The extensive academic literature covering PRMDs of brass players and other wind musicians which included horn players has been already covered in the literature review. Adding to this body of evidence, respondents from this study were asked about their own PRMDs. 4.5.1 PRMDs from the Survey
Of the 70 respondents who indicated that they have done some level of detailed study, these respondents were questioned as to why they sought further relevant knowledge. The most common motivation reasons reported by participants included:
• General performance optimisation (60%) • Career longevity (maintenance) (53%) • Muscle control development (46%) • “As a teacher seeking to support a student” (44%) • Pain concerns (37%) • Sensory awareness development (34%) • Injury (playing related) (31%) • Muscle strain concerns (30%) • Detailed study was incorporated in their training (24%) • Injury from an activity unrelated to playing but having an effect on their playing (e.g. sporting injury) (9%), and; • “Other” (11%)
Respondents were allowed to indicate multiple motivations and, as can be seen from the numbers above, the vast majority had multiple reasons. Almost all (97%) of these respondents indicated suffering from some form of PRMD, i.e. either pain concerns, injury (playing related), muscle strain concerns, or injury from an activity unrelated to playing. 84% of these participants also indicated prevention or optimisation-based motivations, i.e., either performance optimisation, career longevity, muscle control development, or sensory awareness development. 4.5.2 Treatment by medical professionals
The survey also asked questions regarding treatment from a medical or health professional e.g. General Practitioner (GP/doctor), Physiotherapist (general), Physiotherapist (music specialist), Ear nose and throat specialist, Kinesiologist, Myologist/massage therapist, Neurologist, Occupational therapist, Osteopath, Psychologist, Speech pathologist, or other.
Analysis of the raw data indicates that 58 participants attended between 580 and 768 consultations with medical professionals These consultations come at considerable expense to these respondents. As reported by Árnason (2018); Berque and Gray (2016); Blanco-Piñeiro et al. (2017); Ioannou et al. (2015); López and Martínez (2013); Stanhope (2016); Žuškin et al. (2005), if performers had more understanding of functional anatomy included in their music training, this may reduce these high expenses incurred by needing any of these interventions.
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Of the 8 respondents who had considered, but decided against seeing a medical professional, 5 indicated that they doubted that the medical professional would know much about playing the horn, 4 indicated cost, and 3 indicated that they were unfamiliar with how a health professional would address playing related issues or optimisation.
The 59 respondents who indicated that they have consulted with a medical professional were asked about their experience, as represented in table 4 below.
Table 4. Of the 59 who have seen one or more medical professionals, which are you likely to recommend? Neither Very likely nor Very Grand likely Likely unlikely Unlikely unlikely Total Physiotherapist (music specialist) 12 6 1 19 Other 8 2 2 12 GP (doctor) 6 14 5 2 4 31 Physiotherapist (general) 6 14 2 2 1 25 Psychologist 5 6 2 13 Ear nose and throat specialist 4 6 5 15 Osteopath 3 5 1 9 Kinesiologist 3 3 Speech pathologist 1 1 2 Neurologist 1 1 1 3 Occupational therapist 3 3 Myologist 1 1
(Other = Acupuncturist, Audiologist, Breathing specialist, Chiropractor, Dentist (3), Dermatologist, Rheumatologist, Voice Massage therapist (3))
(Data bars correspond to each medical professional type separately)
It can be seen also with the “other” row, and the specialist medical professionals, that individuals also seek out medical professionals with specific skills relevant to their particular PRMD.
Experiences with different types of medical professionals varied. Trends are difficult to identify due to the small numbers and the vast array of PRMDs that might present in the individuals. Doctors or general physiotherapist received the most consultations, and it can be seen that specialist musician physiotherapists are more likely to be recommended, presumably due to the specialised training and/or experience. This is supported by (Roset-Llobet et al., 2000) who identifies that “Doctors in general are not able to understand and therefore to solve these problems with sufficient efficiency.” 4.5.3 Developed understanding of functional anatomy
Respondents who consulted medical professionals were then asked if they returned to optimal playing, and if medical professionals developed their understanding of how their anatomy functions.
Tables 5 and 6. Representation of developed understanding in respondents who consulted with medical professionals
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Table 5 Table 6 The 50 horn players who returned to optimal were asked The 9 participants not returned to optimal were asked to to indicate if the health care professional developed indicate if the health care professional developed their their understanding of how their anatomy functions understanding of how their anatomy functions Understanding Understanding Understanding Understanding of functional of functional of functional of functional anatomy anatomy NOT anatomy anatomy NOT developed developed developed developed None of the health care None of the health care professionals developed professionals developed my understanding 15 my understanding 6 Physiotherapist (music Ear nose and throat specialist) 13 specialist 2 Physiotherapist (music Physiotherapist (general) 10 specialist) 1 Osteopath 6 Psychologist 0 GP (doctor) 4 Osteopath 0 Ear nose and throat 3 Speech pathologist 0 Psychologist 2 Occupational therapist 0 Occupational therapist 2 Myologist 0 Kinesiologist 2 Neurologist 0 Speech pathologist 1 GP (doctor) 0 Neurologist 1 Physiotherapist (general) 0 Myologist 0 Kinesiologist 0 Total 44 15 Total 3 6
Respondents were able to tick multiple boxes for this question, depending of the number of different medical professionals they have visited. While 15 (30%) of the 50 horn players who returned to optimal playing did not have their understanding of anatomy developed, it can be seen that for 70% of these 50 horn players, the development of their understanding of how their anatomy functions played a role in their recovery. For 6 (66%) of the 9 horn players who did not return to optimal playing, there was no development of their understanding of how anatomy functions. While this topic needs to be further investigated, it appears, on the basis of this data, that learning more about how their body works in relation to horn playing may play a useful role in recovering from injury. 4.5.4 From the interviews
Attitudes from interviewees regarding consultation with medical professionals are generally positive, but also reflect conditional criteria.
E.g. “If you’re looking for how to play the horn, I don’t think that there’s much of a point to it, but if you’re looking to solve a particular issue then that’s a really good place to get the whole picture.” #14
E.g. “Completely support it.” #40
E.g. “I think it’s good preferably if they teach us how to do prevention work and not contact them when it’s too late. If we can learn from physical therapists on how to stay healthy and sane and do what we need to do. There are a number of doctors now who also try to treat dystonia but again, once it starts, you’re in trouble. They’ve claimed that they’ve had
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some success with Botox treatment of the hands for pianists, but with embouchure I think the outcome is grim. So yes, consulting professionals as a means of prevention. I know of a German musician physio therapist” #73 4.5.5 Risk of developing PRMDs from descriptions within interviews
Given that the “transfer” style of pedagogy is generally adopted over the “transformative” style (Carey et al., 2013), some comments from interviewees may contribute to the risk of developing a PRMDs should they be transferred to others.
For example, regarding the “the most important” topic of air use, one interviewee mentioned that they
“used a term once in a lesson that it’s almost like you’re vomiting out air, because it’s open and unrestricted”.
The act of vomiting requires the contraction of the diaphragm (downwards) and other abdominal muscles to create high intra-abdominal pressure, forcing stomach contents (below the diaphragm) to be expelled (Perry et al., 2010, p. 10). If taken out of context by relating breathing out to vomiting, this description would place anyone attempting to replicate it at high risk of developing co-contractual inefficiency, or overstrain PRMD (Meinke, 1998).
Similarly, while describing the perceived amount of effort required to play a difficult high horn part in a concert, the following comment was made by a male interviewee:
“I played Beethoven VII last night and I came out with a sore back which I think is purely due to a lot of bearing down, like giving birth”
Again, child birthing requires the use of the diaphragm, as documented by Gandevia (1993, p. 347) “When the diaphragm contracts together with the abdominal muscles, intra-abdominal pressure may exceed 150cmH2O. Such expulsive manoeuvres occur with defecation, parturition [child birthing] and lifting heavy objects, but do not necessarily prevent ventilation if the glottis is open and the subject pants.”
The use of different combinations of abdominal and respiratory muscles to produce a large number of different bodily functions relating to breathing, posture and intra-abdominal pressure is complex (Perry et al., 2010). It is possible that these comments reflect a misinterpretation by these horn players of their own sensory perception, combined with a less-than-accurate knowledge of functional anatomy. It is possible that they are perceiving only the amount of effort and the general body area that this effort is being generated, but not the actual combinations of the different anatomical structures. As outlined in theme 3, sensory perception is variable, plastic and disproportionate while some extents remain to be fully understood by neurologists (Altenmueller & McPherson, 2008; Altenmüller, Ioannou, et al., 2015; Altenmüller & Schlaug, 2015; Conable & Conable, 2000; Dayan & Cohen, 2011; Mckay et al., 2003; Riva, 2018; Sadibolova et al., 2019; Salonen, 2018; Shadmehr et al., 2010).
These examples illustrate the risks associated with self-perception without the underpinning anatomical knowledge, creating potential risk of non-ideal horn playing biomechanics and potential to develop PRMDs. 4.6 Theme 5. Appropriacy, applicability and context regarding the application of accurately applied functional anatomy
Appropriacy, applicability and context play fundamental roles in establishing the usefulness of cognitive information in the application of functional anatomy to horn playing. Purely understanding the role of individual anatomical structures does not give the information necessary to understand the way the muscles will work together in synergies (groups) to create the incredibly complex and interconnected series of actions required to produce music.
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4.6.1 From the survey
4.6.1.1 Disparity between ‘importance’ and ‘confidence’
Survey participants were presented with very clear and complete visual anatomical information in the form of slowly rotating digital 3D models (appendix 2) of each of the 7 functional areas of the body used during horn performance, one at a time, and asked to rate their level of agreement with two statements; “I feel confident that I know how these muscles work in regards to horn playing” and “Knowing and understanding what these muscles do in regards to horn playing is important to me”. While these models present clear information about anatomy in excellent detail without requiring participants to know muscle names or details (Hoyek et al., 2014), they are not dynamically demonstrating any aspect of horn performance. They only represent the musculature of each of the seven difference functional areas of the body used to play horn. The data from all the digital 3D models and all participants has been compiled together into two tables below. Table 7 regarding “importance” and table 8 regarding “confidence”.
Table 7. Total count of all horn players level of agreement regarding the importance of knowing and understanding what the muscles of each of the seven functional areas of the body used to play horn. Strongly Strongly Grand agree Agree Disagree disagree Not sure Total Total posture 21 45 7 1 8 82 Total inhalation 28 41 4 1 6 80 Total exhalation 27 44 4 1 3 79 Total upper respiratory 26 35 7 3 8 79 Total jaw 26 35 7 3 7 78 Total tongue 32 38 2 1 5 78 Total embouchure 40 34 1 1 1 77 All-together totals 200 272 32 11 38 553 All-together percentages 36% 49% 6% 2% 7% 100% Strongly agree & Disagree & Strongly Grand Agree disagree Not sure Total Simplified all-together totals 472 43 38 553 Simplified all-together percentages 85% 8% 7% 100%
Page 55 of 86 Table 8. Total count of all horn players level of agreement regarding their confidence that they know how the muscles of these seven different areas of the body work in order to play the horn. Strongly Strongly Grand agree Agree Disagree disagree Not sure Total Total posture 6 48 20 3 5 82 Total inhalation 11 53 11 2 3 80 Total exhalation 11 49 13 3 3 79 Total upper respiratory 5 30 27 10 7 79 Total jaw 8 42 20 5 3 78 Total tongue 16 30 23 5 4 78 Total embouchure 22 40 11 3 1 77 All-together totals 79 292 125 31 26 553 All-together percentages 14% 53% 23% 6% 5% 100% Strongly agree & Disagree & Strongly Grand Agree disagree Not sure Total Simplified all-together totals 371 156 26 553 Simplified all-together percentages 67% 28% 5% 100%
As can be seen by the simplified all-together percentages, there is a disparity between the level of agreement regarding the importance of knowing and understanding how these muscles work to play horn (Agree = 85%, Disagree = 8%), versus the level of agreement regarding players confidence in knowing and understanding how these muscles (Agree = 67%, Disagree 28%). There is a statistically significant difference in distribution of the ratings for perceived confidence and perceived importance (2(4)= 120.049, p<0.001). When looking at the simplified all-together percentages there is a statistically significant difference in the perceived confidence and perceived importance (2(1)= 76.139, p<0.001). This indicates that although the vast majority perceive that it is important to know about how the body functions to play horn, players are not as confident regarding knowing and understanding how their bodies function.
4.6.1.2 Improving communication
After viewing the models (appendix 2) respondents were then asked “Do you think communication about horn technique could be improved by incorporating more accurate understanding of anatomy?”. The overwhelming majority indicated positively, as per table 9 below.
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Table 9. Do you think that accurately applied knowledge of anatomy can be useful for developing approaches towards horn playing? No - No - Yes - Yes - probably definitely Grand definitely probably Not sure not not Total Aspiring - total 19 13 0 0 0 32 Who don’t teach 10 4 0 0 0 14 Who do teach 9 9 0 0 0 18 Professionals - total 20 22 1 2 0 45 Who don’t teach 0 7 0 0 0 7 Who do teach 20 15 1 2 0 38 Grand Total 39 35 1 2 0 77 Grand Total positive Not sure Total negative Total Combined totals 74 1 2 77 Percentages 96% 1% 3% 100% 4.6.1.3 Filtering contrasting philosophies
Similarly, respondents were asked if they thought that accurate knowledge of functional anatomy can aid in filtering useful information/approaches/opinions from those which are not?”, to which, the vast majority (86%) indicated a positive response as per table 10.
Table 10. When considering contrasting approaches/methods/opinions to horn playing, do you think that accurate knowledge of functional anatomy can aide in filtering useful approaches/methods/opinions from those which are not? No - No - Yes - Yes - Probably Definately Grand Definitely Probably Not sure not not Total Aspiring - total 17 11 4 0 0 32 Who don’t teach 8 5 1 0 0 14 Who do teach 9 6 3 0 0 18 Professionals - total 23 15 4 3 0 45 Who don’t teach 4 2 1 0 0 7 Who do teach 19 13 3 3 0 38 Grand Total 40 26 8 3 0 77 Total positive Not sure Total negative Combined totals 66 8 3 77 Percentages 86% 10% 4% 100%
This data indicates that in general, perceptions around the usefulness of functional anatomy aiding the communication of approaches/methods/opinions about horn playing is overwhelmingly positive.
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4.6.1.4 Information provided through open text fields in survey
While in-depth context is difficult to explore via survey data collection, one comment made at the end of the survey by a professional horn player who is a well-established performer and pedagogue at a leading European conservatorium/academy outlines important aspects.
E.g. “I think it is important to know and understand how anatomy works to be able to teach and play better. The research also tells us that concentrating to those things while performing is not a good way to perform, so teachers job is to teach the right technique, let it sink in and help students to go to "autopilot level" and use different kind of images and triggers to make the body respond in an specific way while performing => and let the body do the work without analyzing. You can`t be “in the zone"/”in flow” when you are analyzing and controlling the body, so musicians need more than just knowledge, they need to combine these two things together to master their performing skills in my opinion.” Survey Respondent
Speaking to this, a control/intervention study in Zurich was conducted by (Hildebrandt & Nubling, 2004), where 26 instrumental music teachers and 66 of their students, of which two trumpet teachers took part. Teachers in the intervention group attended a 2-hour weekly course focusing on the sensory and psychomotor systems of musicians over the course of a summer semester. Through this larger verbatim quote, included as it summarises contextual considerations fully and clearly, the researchers identified that:
“Although there can be no question about a preliminary analysis of motion patterns and the potential usefulness of their physiologic and anatomic implications, the complex physical interactions and fine-tuning procedures that are demanded by musical performance tend to defy precise analysis. Typically, it is impossible for the mind to remain cognizant of physiologic or anatomic factors while performing except perhaps during extremely slow passages. It certainly is not possible for these cognitive processes to keep pace during rapid and fluid movements or technically demanding passages involving rapid and complex cascading movements or vibrato or trills. A therapeutic strategy based on an analysis of an individual’s playing style can be time-consuming and still fail to render the desired results. In contrast, a nonanalytical instructional strategy calls for quick and spontaneous execution, eschewing a pedantic and hair-splitting analysis of discrete components. One approach that has proved successful with various instruments is contingent on the teacher having a preliminary conceptual model of the musical objectives he or she wishes to achieve. This assumes that the performers already are familiar with the all of the technical details of a composition and have a clear mental concept of the relevant dynamics and rhythm. Playing and health problems inevitably result when teachers attempt to incorporate a physiologic and anatomic agenda when issuing instructions that ostensibly are about an act of making music. In the case of wind instruments, any attempt to influence lip and tongue coordination usually ends in complete failure if the player is not encouraged always to focus on his or her own internal (mental) concept of the snippet of sound he or she will have to produce in the immediately ensuing instant. p64”
Subsequently it was concluded:
“the integration of physiologic course components within instrument playing and singing syllabuses is vital for the prevention not only of directly playing-related health problems, but also general health problems. The project described herein has succeeded in showing that it is possible to modify and influence the instructional style of teachers and obliquely implement a preventive strategy for the benefit of music students. The hypotheses postulating that teachers who received advanced special training would modify their teaching style and strategies and that their students not only would notice this change passively but also would themselves modify their own playing habits could be confirmed at least partially. To this extent, it would be reasonable to argue that this pilot project has achieved its most important goal—to bring the participants of the test groups a considerable step forward.” p68
Mental aspects such as state of mind are of utmost importance for horn performance and this discussion of mental aspects did play a part in all data collection, however due to the broadness of the topic, it falls outside the scope of this Page 58 of 86 study which focusses on the biomechanical aspects of performance limitations and problems that come from poor transfer of knowledge:
E.g “If you’re a player who has problems then I think that it’s highly likely that an understanding of anatomy is going to assist you’re horn playing. If you’re a teacher then I think it’s really important to have not only a functional understanding, but also the ability to impart your understanding onto students when needed… If you’re struggling to play the instrument, then getting into ‘the zone’ is going to be a much bigger ask” #14 4.6.2 From the interviews
Comments made during the interviews reflected diverse opinions. Considering that all interviewees responded “no” or “not really” when directly asked if they have done any detailed study of anatomy, it is important to consider perspectives on the application of accurately applied functional anatomy as being more speculative than verifiable.
All interviewees were asked “Do you think that knowledge of how it is possible for muscles to work against each other can help avoiding playing related complications and inefficiency?” (question 12). Full responses are available in appendix 11. The vast majority of responses ranged between positive to extremely positive, with “absolutely” or “of course” being commonly used. One exception was an interviewee who asked to pass on the question, “because I don’t know enough about how the muscles actually work” #73. All interviewees provided context, with the majority elaborating on their perception, providing context such as:
E.g. “Possibly. I feel like it could also be a little too much information for a player who is not experiencing problems.” #16
E.g. “Yeah. Again, if you are able to feel these things, then it’s useful. If you’re not able to feel these things, then it’s not useful. It would depend entirely on how you are able to apply the knowledge”. #68
E.g. “Yeah, possibly. It depends how many bad habits have developed in the player. If a problem develops as a result of bad playing at a young age, then to solve that problem, an understanding of the anatomy involved may very well be the key to more efficient and better playing.” #14
All interviewees were asked “Do you think that accurately applied knowledge of anatomy can be useful for developing effective approaches towards horn playing considering the adaptive nature of our sensory feedback available to us?” (question 21). Full responses are available in appendix 12. Again, the vast majority of responses ranged between positive to extremely positive, with “absolutely” or “of course” being commonly used. Contextual considerations were raised by some, such as:
E.g. “It’s valuable to have enough knowledge, understanding and awareness of our own bodies, as long as people understand how to perceive and feel it. I think general information about efficient muscle use, muscle fatigue and recovery is incredibly important, as long as the issues that they have are directly related to that. It’s important to acknowledge that there could be other issues as well though, so as long as it’s considered in relation to musical aspects it can be extremely valuable.” #68
E.g. “I think that some people would freak out at that sort of depth of technology, to put it that way. We are very physical beings. What feels right when we’re using our bodies correctly in all of the parts that we need to in order to make ourselves efficient players, with the support, freedom of movement and building the embouchure. The mental capacity of the players I’ve work with in my career vary considerably.” #62
E.g. “I think our approaches towards horn play have to change as our bodies do. It’s good to have general anatomical, kinesthetic habits as you’re going along listening and calibrating as you’re going with it.” #88
All interviewees, with one exception due to time restrictions, were asked “When considering contrasting approaches, do you think that accurate knowledge of musically applied anatomy can support the filtering process?” (question 22). Full Page 59 of 86 responses are available in appendix 13. Yet again, the vast majority of responses ranged between positive to extremely positive, with “absolutely” or “of course” being commonly used. Some adding elements of conditional appropriacy, such as:
E.g. “These days I encourage the students to question every piece of information they get. Some stuff, inherently, you’re going to know that ‘ok, that’s not going to work’, or that it’s not going to be worth trying, but as long as it fits into the overall philosophy you’re developing you can see how it can actually apply to what you’re doing and it’s worth perusing and there’s no necessary time limit I don’t think on how long you would look at it for because it also doesn’t necessarily need to be a huge shift and a lot of changes will happen incrementally with information so being open to experiment but start developing an overall philosophy of playing and an overall philosophy of how you want to develop a mechanism will open you up to being able to plug that information in, not jerking from one idea to another but seeing how it will actually compliment your playing. Yes, accurately applied knowledge of anatomy can help, but I would say in that sort of situation I would not directly contradict directly the comment if I didn’t believe it, I would just point to student to question and experiment to see if that’s actually useful information” #25
And other interviewees responded with comments, aligning with the findings of Lehmann and Ericsson (1997), who links the associated specific physiological, psychomotor, and cognitive adaptations to the acquired nature of skills”;
E.g “The younger the players, I think, the more ‘kneading’ they need and when we talk about how to ideally serve a young talented player I think the recommendation would be to stick with one teacher for a while, and then when there’s a certain amount of knowledge learned then they are able to receive more information from different sources. So, in order not to have directly contrasting I think it’s good to work in teams where there’s an overlap. I’ve been very lucky in that I have a colleague, [name removed], who knows more about the technical aspect and embouchure. I think we do not contradict each other, and I think that’s why we’re getting good results. Now weather the young players would be able to have musically applied knowledge of anatomy in order to filter this, maybe that’s wishful thinking because this surely can only be acquired“. #73
E.g. “I think I’ve been lucky in that I haven’t really been exposed to too much stuff that I find negative or detrimental, but yes, there have been time where I haven’t been able to feel things according to some teachers, which is a bit of an alarm bell for me. Either I’m not doing something correctly or ...
… I do think it’s a good idea to consult a lot of different teachers, not as a regular thing, just touching base. It’s also a good idea to observe a lot of different people perform, because if you get information that doesn’t sit quite right with you, then you have a forum and some context for that. There are a couple of things I’ve been told that haven’t really resonated with me at all, but to have the courage as a student to dismiss it and say “well, actually, I think I was doing better before. I might steer away from that information” is a skill that’s easier to have when you’re surrounded by a lot of other people. Not everyone has that luxury” #68
E.g “Absolutely, but it’s difficult for the younger students. They respect their teachers. It’s not so easy when one authority says ‘this is how you do it’ then another authority says ‘no, this is how you do it’” #53
As can be seen from these responses, applicability, appropriacy and context are important to consider. This is addressed in theme 5. 4.6.3 Challenges
4.6.3.1 Analysis around the lack of defined sources
Both the survey and interview results indicate that limited detailed study has been carried out by participants with the use of academic sources that contain unambiguous descriptions of anatomy. Though there have been considerable advances, the lack of horn studies analysing anatomical function make it difficult to fully understand synergistic relationships of muscles during optimal performance. Applying anatomy without these studies is complex and requires Page 60 of 86 very detailed knowledge of these structures to be more likely to understand correctly anatomical roles of the various muscles involved. Drawing on my personal experience as well as data gathered from the study some reasons for this may include:
• Lack of availability/access to medical sources • High degree of specialised terminology in anatomical texts • The large amount of time required to study and extract applicable content • Most texts are authored by non-musicians, and so relevant applications are lacking • The complexity of the dynamic way these structures work together is hard to comprehend • The effort spent trying to gain understanding of these structures may not show enough benefits • Fundamental elements of horn performance are not yet fully understood • There is a scarcity of sources specifically focused on horn performance • Learning with the aid of cadavers can be confronting for individuals and is only possible in a biomedical laboratory
As mentioned earlier, purely understanding the role of individual anatomical structures does not give the information necessary to understand the way the muscles will work together in synergies (groups) to create the incredibly complex and interconnected series of actions required to produce music. All horn players are different. Differences in biological structure such as the shape of the oral cavity and face musculature can have an effect on what works for each player, as detailed below.
4.6.3.2 Application of functional anatomy
In depth analysis of academic literature indicates a number of considerations around the application of functional anatomy to horn playing. Many sources have included, concluded with, or provided examples where information about functional anatomy has played a role in musician health. Many referenced here include horn performers. Many include brass performers but do not indicate which instrument. Some indicate no horn performers but include either brass performers or other non-brass performers. Some are adjunct, providing neurological information related generally to all performers. Topics include:
• Reviews of existing literature • Posture and its impact during performances • Incorporating anatomical information in somatic bodywork studies • Strategies to promote musician health • Raising awareness and management of PRMDs • Orofacial problems • Dystonia • Supporting music teachers with music-physiology training • Educational psychology • Promotion of student’s ownership of learning
All offer insight into the application of functional anatomy to horn playing, though some are more closely related than others.
The below sources all offer insight into appropriacy, applicability and context when elements of the study incorporate development of anatomical understanding. Many studies crossover one or more of the following points, where they:
• give examples where study of anatomy has helped individuals and providing examples where studying anatomy has been beneficial • identify that anatomically poorly-informed playing philosophies can benefit from developed understanding of functional anatomy Page 61 of 86
• identify that accurate anatomical information is a prerequisite for understanding elements of physiology • raise awareness of PRMDs in the form of preventative programs for students at conservatoriums • identify the benefits of collaborative programs, where medical professionals have worked with musicians. • identified that although there are clear benefits of working collaboratively, there are limits due to the degree of specialization required, and the lack of medical professionals with said specializations. • Identify that the somatoperception and kinesthetic registration of individuals can benefit from more accurate anatomical information. • Identify complexities and differences between individuals and brass instruments types • Identify the limits of current research
4.6.3.2.1 Considerations of ongoing research
In addition to literature already discussed, some further difficulties have been identified in regards to appropriacy, applicability and context regarding the application of functional anatomy to horn playing.
The lack of specialised centers or university courses is problematic for the incorporation of basic knowledge about anatomy, physiology, ergonomics, and postures. Rodríquez-Lozano (2011) identifies one such clinic in Spain, but goes on identify that “there are no health education courses included in the official course content of music degrees”. Similarly, when considering the number of music institutions around the world, when compared to the number of studies indicating such programs being incorporated in developing philosophies, it is clear that access is problematic.
Attitudes of highly trained musicians can be problematic, as according to Lederman (2011), who identifies that some individuals can project the same high and sometimes unrealistic expectations onto a medical professional as they do themselves. Lederman continues on to identify the necessity of collaborative approaches, “by including the teacher or coach in the process, and by outlining the therapeutic modalities and expectations clearly, successful treatment of these playing-related problems can be achieved in the large majority of musicians.”
Many of these observations are also presented in the work of researchers who study musician health, though with less of their participants being horn or brass performers (Buchanan & Hays, 2014; Hildebrandt & Nubling, 2004; Kaufman- Cohen & Ratzon, 2011; Salonen, 2018) and some studies investigating music pedagogy broadly (Carey & Grant, 2012).
Fuhrmann (2009, p. 10) observes that “Breathing technique is considered to be a crucial component of instrumental music pedagogy. However, not all concepts of breathing presented in the music and performing arts literature are based on a sound understanding of respiratory physiology”. Similarly, Bārdiņš and Marnauza (2014) observe that “In brass playing pedagogy, the most essential and simultaneously the most difficult element to teach is the process of breathing. The analysis of viewpoints on breathing presented in popular textbooks on brass instrument playing and their comparison with physiological processes of natural breathing reveal essential discrepancies, which actually make instrument playing difficult, create muscular tensions and even health problems undesirable for the musicians.”
Information about the use of the tongue in different registers of the horn is still ongoing. In the series of RT-MRI studies conducted by the Professor Peter Iltis and his team, the use of the tongue between the low range and high range of elite level horn players has been examined. In some results, the researchers identified that the tongues of some individuals did not move much. In other results the researchers were able to identify that some performers were moving their tongues forward and up in order to get into the high range. Some of the elite level performers who participated in both the current research and that of Professor Iltis revealed that they saw their own video results, which confirmed to them that they did not raise their tongues anywhere near as much as the other players with one performer remarking;
E.g. “I’ve watched the MRI footage of even the really good players push their tongue up a little bit. It’s not necessary. I looked at my video. I didn’t do it. I’m one of the exceptions. You don’t have to raise your tongue, but it helps if you haven’t got optimal condition in the embouchure and abdominal rib cage. I know that some other high-ranking players Page 62 of 86
did it and I’m sorry to go against the grain. It’s not a physical necessity. I don’t think it’s related to my genetics or anything. I think it that makes life easier for those who do it because when they do it, they narrow the air flow meaning you can get faster air and that of course has an effect on the regime of oscillation inside the mouthpiece, but then you’ve compromised on your optimal resonance. It might still be acceptable for the guys playing at the top level, but you’ve compromised it somewhat by pushing the tongue up.” #62
And another responding;
“I try to keep my tongue down to keep the sound and openness in the high range as well. This could be seen in the MRI as well. I was a little bit more open than my colleagues. It could be seen in some of the footage that other horn players were using their tongues to get high, but the sound also became narrower. For me the goal is to stay open. Maybe others who are very narrow have other resonance chambers. The most important is that it should be open in the high register, but it also depends on where you come from. If someone has a small oral cavity then they must create the openness, if someone has a larger oral cavity, then it doesn’t matter if the tongue goes higher. It’s difficult to generalise.” #95
This information indicates that although research methods have come a long way, and we are already able to use this research to inform applicability of playing philosophies towards best practices, there are still exceptions, hence, combinatory elements of functional anatomy that are yet to be correlated. It is important for an individual to identify topic areas where philosophies are less likely to translate between brass instruments, or more likely or possible for differences to exist between players.
4.6.3.2.2 Considerations of differences between brass family instruments
“Borrowing” pedagogical approaches from external sources, away from the horn, is common. Reflection of different physical characteristics between different brass instruments has potential to provide a level of filtration between useful and not-useful playing philosophies or pedagogical approaches originating from other brass instrumentalists. As outlined in the section titled “Anatomical representation in pedagogical sources” from Theme 1, different brass instruments require different hypopharyngeal pressures (Stasney et al., 2003, p. 155), where “The French horn requires the highest hypopharyngeal pressure at each frequency” compared to the trumpet, trombone and tuba. As mentioned above, differences in shape and size of the oral cavity have been observed between horn, trumpet, trombone and tuba when moving from the low range to the high range (Iltis, Schoonderwaldt, et al., 2015). Motions of the glottis have been observed as being different to suggestions of keeping the throat open, as prescribed by tuba pedagogues (Iltis, Gillespie, et al., 2017), and observed by Bouhuys (1964), tuba or low resistance/high airflow demand brass instruments may have very different demands from brass instruments such as the Horn or trumpet that typically have much higher resistance and airflow volume demands.
In a study investigating Jacobs’ philosophy that the same pharyngeal pressure was required to play the same note, regardless of the instrument on which the note was played as reported by (Frederiksen, 1996), Stasney et al. (2003) “were not able to substantiate Jacobs’ theory that enharmonic frequencies resulted in equal pressures regardless of instrument”, and concluded that:
“Enharmonic frequencies played on different brass instruments require different hypopharyngeal pressures. The French horn requires the highest hypopharyngeal pressure at each frequency.”
Importantly adding that:
“Frequencies greater than 512 Hz in the French horn and greater than 1,024 Hz in the trumpet require hypopharyngeal pressures greater than 110 cm H2O. Proper posture and laryngeal tension should be stressed in instruction of these brass instruments to avoid excessive hypopharyngeal pressures. The pressures required to play frequencies greater than 512 Hz on the French horn and greater than 1,024 Hz on the trumpet might be too high for the young developing larynx and pharynx” (Stasney et al., 2003, p. 155) Page 63 of 86
It is possible that the same philosophies may not be directly transferrable between all brass instruments, and attempting to do so without considering fundamental differences and appropriacy has potential to be detrimental.
To summarise, while there may be exceptions and there may be similarities, it is very important for an individual to consider physical differences between brass family instruments when considering pedagogy that comes from these instruments. With the ongoing research that is at times producing contradictory answers, it is again important for an individual to identify topic areas where philosophies are less likely to translate between brass instruments, or more likely or possible for differences to exist between players.
4.6.3.2.3 Informing aspects of performance
Posture is far easier to observe than the complex internal biomechanical structure used to play horn. A number of studies have been conducted regarding musicians’ posture as outlined in the literature review (Ackermann et al., 2014; Blanco-Piñeiro et al., 2015; Blanco-Piñeiro et al., 2017; Blanco-Piñeiro et al., 2018; Kera & Maruyama, 2005; Ohlendorf et al., 2017; Price et al., 2014; Shoebridge et al., 2017; Sundberg et al., 1991). Where articles are also investigating the roles that understanding and control of posture, the researchers have suggested that “more attention should be paid to improving the strategies of music teaching so as to favour improved understanding and control of posture by students, with consequent improvements in physical health and musical performance” (Blanco-Piñeiro et al., 2015).
Other studies identify that PRMDs should be more frequently addressed at universities, with results aligned with the results from the present study, where “The majority of students believed that physiological/anatomical knowledge should be mandatory” (Ioannou et al., 2015). Árnason (2018) observed that “Over the 9-month study period, significant interactions were seen for subjective body awareness scores (between groups over time) during practice (p=0.026) and during ADLs (p=0.004), as the Prevention/Intervention Group had greater positive change over time.
4.6.3.2.4 Collaboration with medical professionals and preventative programs
Studies including horn players in collaboration with health sciences have identified that the inclusion of study of anatomy has played a positive role in the improvement of posture (Blanco-Piñeiro et al., 2018) as well as in courses, programs, or clinics where general awareness of common musician PRMDs are studied (Kok et al., 2013; Lederman, 2011; López & Martínez, 2013).
Other studies which include brass players, but do not mention which instruments specifically, have also identified a range of collaborative scenarios in order to promote healthy playing philosophies:
“The present study points to the necessity for more specialized doctors in the field of musicians’ medicine and emphasizes the importance of closer collaboration between physicians, instrumental tutors, and students. The promotion of Medical Problems of Performing Artists lectures or seminars dealing with wellness in music schools could enhance students’ knowledge concerning prevention of PRMDs problems, which remain complex to treat.” (Ioannou et al., 2015)
“In summary, there is a high frequency of injury among professional-level musicians in Greece reported in our study, highlighting the obvious need to develop prevention programs.” (Fotiadis et al., 2013)
“The perceived benefits of collaborative learning environments, if they in fact pertain, may indicate that one-to- one need not – indeed, perhaps should not – dominate the field of tertiary vocal and instrumental learning and teaching. For students, situating one-to-one experiences within a suite of learning contexts may mitigate some identified risks with the one-to-one approach.” (Carey & Grant, 2012)
“In such a domain where sound quality is the primary goal and playing styles can be diverse, it seems sensible to take a collaborative approach incorporating the expertise of the musician and the healthcare professional in
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achieving the goal of improving both sound and movement quality during performance”. (Chan & Ackermann, 2014)
“Relevant education and advice should be provided to musicians early in their injury whilst preventative information needs to be delivered early and throughout their careers. Specific training and workplace demands must also be carefully considered in the comprehensive management of the musician’s injuries. Finally, proactive steps at music institutions and organizations should be taken, such as implementing onsite health prevention and management services for musicians, as playing-related problems in this population is not only highly prevalent and persistent but can also become greatly debilitating ultimately jeopardize a musicians’ career.” (Chan & Ackermann, 2014)
Importance and usefulness of preventative programs have clearly demonstrated their effectiveness in some aspects of performance relative to horn playing, as addressed in the literature review. To summarise, studies in Spain, Greece, the Czech Republic, Switzerland, Finland, Iceland, and North America, Australia, have demonstrated that body awareness increases and injuries decrease (López & Martínez, 2013; Salonen, 2018); posture improves (Blanco-Piñeiro et al., 2018); and teaching styles improve (Hildebrandt & Nubling, 2004). Studies including horn players have also echoed the high prevalence rate of PRMDs for musicians (Fotiadis et al., 2013; Viljamaa et al., 2017; Žuškin et al., 2005) and highlight the obvious need for preventative programs (Ioannou et al., 2015; Steinmetz et al., 2010; Wijsman & Ackermann, 2018) while drawing attention to problems, such as the lack of access to such programs (Rodríquez-Lozano, 2011) and the length of time it can take to run such courses (Roset-Llobet et al., 2000).
These sources summarise the importance of collaborative learning environments, particularly in conservatoriums and universities where many of the 10 000 hours of focussed practice take place, while the sudden increase of workload for aspiring professionals in the first years of specialised study can lead to PRMDs. 4.6.4 To enable ownership of learning
Research in the field of pedagogy has outlined potential benefits of positioning one-on-one pedagogy in a wider and more diverse field of pedagogical practice (Carey & Grant, 2012). It is clear from data collected in this study and others outlined above that many are “in favor of the introduction of anatomy/physiology classes in music schools” (Ioannou et al., 2015).
It is demonstrated above that incorporation of courses that focus on musician health, including anatomical study are usually conducted over a university semester or year. This give us an indication the time frame required to undertake study of complex biomechanical structures, yet as indicated above, study of anatomy from detailed sources has played a limited role in pedagogical approaches.
As observed though our data, perspectives on sensing the most important aspects of horn performance are highly individual. Speaking to this individuality, interviewees commented about the need horn players to figure things out for themselves:
E.g. “I think from a practical standpoint, we all need to become our own teachers at some point” #16
E.g. “These days I encourage the students to question every piece of information they get. Some stuff, inherently, you’re going to know that ‘ok, that’s not going to work’, or that it’s not going to be worth trying, but as long as it fits into the overall philosophy you’re developing you can see how it can actually apply to what you’re doing and it’s worth perusing and there’s no necessary time limit I don’t think on how long you would look at it for because it also doesn’t necessarily need to be a huge shift and a lot of changes will happen incrementally with information so being open to experiment but start developing an overall philosophy of playing and an overall philosophy of how you want to develop a mechanism will open you up to being able to plug that information in, not jerking from one idea to another but seeing how it will actually compliment your playing.” #25
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Research is still ongoing regarding our understanding of complex biological structures required to play horn as outlined above.
Participation in a prevention and education course may be beneficial for music students due to improved subjective body awareness and attitude toward prevention strategies (Árnason, 2018)
As one Participant expressed “I think there’s a whole host of new technology that we didn’t have available to us when we were in school. I think it’s really exciting” #79, however it is clear that we are still a long way from having a holistic understanding of the function of biomechanical structures from individual to individual. 4.7 Bolstering education
Perceptions from interviewees who also teach suggest that learning about anatomy is difficult for students, with concerns about it being “really complex to the point that a high school student may not take the time to understand it, especially considering that it might be exactly what they need to help them” #38. Speaking to this and drawing from the “whole host of new technology” #79 mentioned above, a controlled trial study that investigated the use of 3D animations to bolster the anatomical education of kinesiology student was conducted by (Hoyek, Collet, Di Rienzo, De Almeida, & Guillot, 2014). In this study half of the students engaged with 3D animations in order to assist in recalling anatomical knowledge requiring spatial ability. The researchers found that these models were effective because “1. when constructed with respect to the cognitive load theory, 3D animations facilitate the comprehension of spatially demanding anatomical knowledge; 2. The students and the teachers usually appreciate them” and encouraged developers to construct newer interactive models for more specific learning applications. This suggests that the use of 3D models could be successfully applied in a horn pedagogy context to bolster anatomical knowledge requiring spatial ability. 4.8 Clearer nomenclature
As represented in the data, horn players will have their own way that they develop their philosophies. From the academic literature, it is clear that communication of different strategies is bolstered by the incorporation of better anatomical understanding of pedagogues. This would more than likely also extend to pedagogy. 4.9 Recruitment of French horn players and teachers in research projects
Many of the above studies have been conducted through universities, clinics and professional orchestras where horn players and teachers have been invited to participate, yet after the recruitment processes have been completed by the researchers, French horn performer participants have been underrepresented or totally absent. The recruitment of this study has been substantially bolstered by my presence at an international horn symposium and I am delighted that much of the horn community involved in this study are enthusiastic about this avenue of research. Other researchers above have not been so fortunate, making data collection and its applicability difficult for those wishing to conduct meaningful research in this field. As more research and attention to musicians PRMDs requires sufficient participant numbers, the types of studies that are conducted tend to focus more on broader problems such as posture, as well as head neck and shoulders issues, as PRMDs in these areas of the body are much more prevalent. Unfortunately, this means that less attention has focussed on matters that speak to horn performers, such as the study of optimal use of anatomical and internal structures. Should further research continue in this field, it is important that horn players become involved in order to gain insight on best practices.
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Chapter 5. Conclusions
The results from this research indicate that there is a call for the understanding of functional anatomy to play a more prevalent role in the development of optimal playing philosophies and the transfer of knowledge. This is supported by some existing literature in health and horn performance domains. The data and literature also indicate that when it comes to appropriacy and context, there are a considerable number of complexities that make understanding of functional anatomy and its applicability difficult to define.
This conundrum is not unique to horn playing philosophies and has been considered at length within singing pedagogy, where understanding of functional anatomy plays a supportive role in the development of “core components” (Chapman, 2017). These core components are considered to be the nucleus around which artistry and performance aspects orbit, such as the model presented in the pedagogical method book Singing and Teaching Singing: A Holistic Approach to Classical Voice by (Chapman, 2017), figure 5 below. Within this book, peer-reviewed sources are references throughout each chapter, outlining pragmatic examples and case studies where the application of functional anatomy has played an important role in the development of an optimal philosophy.
Figure 5. The Full Nucleus/satellite model as presented in Singing & Teaching Singing, (Chapman, 2017). Image used with the permission of Professor Chapman
The outcomes of this research have been incorporated into a model, developed and modified from the Chapman theoretical model as applied to horn playing (figure 6 below) There is a risk of presenting such complexity in a concise and static, 2 dimensional model as its application would have to take into account that as there is less objective evidence regarding the roles of complex biomechanical structures when compared to singing, making intrinsically learned knowledge a core component.
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Where these models are similar in terms of appropriacy, applicability and context, is that the core components are all able to be supported and developed with understanding of functional anatomy and PRMD education. Performance aspects are developed around these core components, enabling artistic freedom for the performer, however the lines here should not be black and white in order to accommodate for the fundamental aspects of individualism in playing philosophies represented in the above data.
Figure 6. The proposed full nucleus/satellite theoretical model, adapted for horn performance with permission. 5.1 Current attitudes of Horn players towards the application of anatomical knowledge to optimise their playing philosophies
Horn players, particularly aspiring horn players, would like more knowledge of functional anatomy, particularly in terms of filtering, or better being able to apply and understand playing philosophies. This is supported by the wider academic literature.
There is a clear trend in these results that cognitive information regarding anatomy used to play the horn is being sought, yet horn books, brass method books and free online sources were all considered to be more useful than medical reference books, which contain the most accurate information. This clearly indicates a void in the literature regarding the transfer of knowledge in terms of applying functional anatomy to horn performance.
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5.2 Horn players’ perceived best-practice approaches to using accurately applied knowledge of anatomy to develop optimal playing philosophies
It is clear from the literature and responses from the present study that best-practice perceptions are relative to individual experience. In general, players who have had to recovered from PRMDs indicate that increased understanding of anatomical function has played a role in their recovery. In contrast, players who have not developed PRMDs expressed the opinion that including extra study of complex anatomy might be detrimental to horn players who do not need it. 5.3 Difficulties exist for Horn players to translate anatomical knowledge into practice to achieve optimal artistic results
Understanding of complex biomechanical structures such as embouchure, tongue and velopharyngeal function, is difficult as these internal structures are not easily examined, involve a considerable number of fine and intricate muscles all working together. The use of 3D interactive digital models can assist the learning of anatomy (Hoyek, Collet, Di Rienzo, De Almeida, & Guillot, 2014), however current 3D models are static and not applied to horn performance. Research regarding the combined use of anatomical structures in horn performance is progressing, and is demonstrating that differences between individuals exist even at an elite level. While individualised pedagogical training may encourage different anatomical strategies, other factors may also influence the application of anatomy to playing the horn. For example, genetic differences regarding the shape and size of biomechanical structures also makes identification of the role of different anatomical function difficult. Cognitive sources containing detailed and accurate information about these complex internal biomechanical structures is not aimed at horn players, meaning that further study in this area by horn players requires considerable hours of study, as well as the understanding of medical terminology not often discussed within music education institutions.
Cognitive sources containing detailed and accurate information about these complex internal biomechanical structures are not aimed at horn players, meaning that further study in this area by horn players requires considerable hours of study, as well as the understanding of medical terminology not often discussed within music education institutions.
Examination of neurological structures identifies further difficulties when considering the adaptive, plastic, disproportionate and multimodal nature of the sensory information available to us, making cognitive information difficult to translate into practice for individuals. Developing an understanding about some of the underlying neurological aspects related to horn performance is considered useful by leading researchers in the field (Altenmueller & McPherson, 2008).
• The amount of study of functional anatomy through defined sources is limited, making judgements about participants perceptions of the application of functional anatomy in playing philosophies speculative.
The sources considered most useful are usually authored by individuals whose level of understanding of functional anatomy is unknown and can contain information that is not consistent with modern research or in-depth understanding of functional anatomy.
Page 69 of 86 5.4 Disparities and similarities exist between playing philosophies, particularly among high-ranking Horn players?
From the questions asked to gather the survey data, there was no statistically significant difference between the perceptions of those who are aspiring and those who are professional horn players. However, statistically significant differences were found amongst all respondents when considering perceptions between the importance verses the confidence of knowing about the functional of biomechanical structures, indicating a knowledge gap and a degree of uncertainty.
From the interview data which included only professionals, similarities existed when considering the perceived importance of air use as being one of the most important aspects of horn performance. Adversely, vast differences exist between all 22 interviewees perceptions of how they were using their air.
Understanding the role of functional anatomy in horn performance was commonly perceived to be important during the interviews, however differences existed around the question of how understanding of anatomy is obtained, with appropriacy, applicability and context being key points to consider. 5.5 Potential benefit of incorporation of anatomical knowledge into playing philosophies for aspiring horn players
In addition to providing a broad understanding of the challenges facing both aspiring and professional Horn players, outcomes include:
• Identification of a high degree of variability in perceptions of professional horn players’ philosophies and attainment of a position in a professional orchestra is possible to achieve despite this variability and irrespective of the degree of knowledge of anatomically applied anatomy. • Discussions regarding some professionals’ playing philosophies that may have the potential to increase risk of PRMDs if an aspiring professional should the aspiring professional attempt to replicate performance tasks based on some of the existing descriptions of playing philosophies offered by professionals and high-ranking players. • Describing the potential benefits of using elements of functional anatomy to support the development of the core components of figure 6 above, around which artistry and performance orbit has been used successfully in singing pedagogy. This indicates that there is the scope for such an adapted theoretical model to be beneficial towards horn playing philosophies and approaches. Chapter 6. Recommendations
Recommendations of this study speak primarily to addressing the outcomes of Research Question 1 - that aspiring horn players would value more knowledge of functional anatomy. As there is no academic course currently available to fulfil this desire, it is recommended that there is scope for the development and implementation of a somatic bodywork course aimed at horn players, though it is likely that such a course would also be beneficial to other brass performers.
Such a course would be best delivered early on in university level studies as a foundational and preventative course of study. It is envisioned the course would have value if it were to incorporate information on PRMDs for horn players, including study of anatomy. This would form a foundation for gaining understanding of functional anatomy and physiology related to horn performance, as well as drawing from above mentioned academic studies. Course aims would potentially enable and empower aspiring horn performers to acquire better understanding of how their bodies function to make music on the horn, and to understand important neurological components regarding the paradigmatic mindsets of performance preparation and performance itself.
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If incorporated into university level studies, knowledge of PRMDs and functional anatomy would in time become prevalent in players of all levels and eventually permeate and propagate through the master-apprentice model with the outcome of better understanding of functional anatomy by horn players of all levels and less prevalence of PRMDs. Chapter 7. References
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Appendix 1) Theoretical contribution map 2) Anatomical footage 3) Semi-Structured Interview Participant Information Statement 4) Semi-Structured Interview Consent Form 5) Semi-Structured Interview Script 6) Performer Survey Participant Information Statement & Consent 7) Performer Survey 8) Medical Professional Survey Participant Information Statement & Consent 9) Medical Professional Survey 10) Importance of Air Use and Perceptions of Air Use by Interviewees 11) Question 12 Do you think that knowledge of how it is possible for muscles to work against each other can help avoiding playing related complications and inefficiency? 12) Question 21 Do you think that accurately applied knowledge of anatomy can be useful for developing effective approaches towards horn playing considering the adaptive nature of our sensory feedback available to us? 13) Question 22 When considering contrasting approaches, do you think that accurate knowledge of musically applied anatomy can support the filtering process?
1) Theoretical contribution map
Theoretical Introduction Methods: contribution: Injury is a risk to horn players; anatomical information was largely absent, or • 3 Surveys for 3 populations 1) medical professionals, 2) aspiring difficult to apply accurately in pedagogical materials; discussion of the role of The contribution professionals 3) current high-ranking professionals/pedagogues. anatomy was uncommon in horn teaching; and artistic limitations instigated the this study makes • Interviews with current high-ranking professionals/pedagogues. consideration of the role that increased anatomical knowledge might have in centers on improving playing philosophies. • Resources were developed to facilitate communication about anatomy (moving images) identifying the Narrative literature review role that increased In relation to the outlined theory regarding the role(s) that anatomical These focused on - knowledge can play indicated that: 1) What they perceived they knew about anatomy. 2) Where they got anatomical 1) injuries do arise as a result of inaccurate anatomical knowledge their knowledge from. 3) If they valued knowledge of anatomy. 4) Their knowledge can 2) anatomy isn’t well covered in pedagogical materials for horn players attitude to anatomy as part of their playing philosophy. 5) Injuries they play in: 3) there has been limited academic study of anatomy and horn playing have experienced.
Results: 1) the prevention Problems Pro horn players perceptions of how they are using different areas of their of injury Horn Players playing philosophies are diverse. PRMD’s are prevalent. anatomy differ wildly particularly in terms of “air use”, yet “air use” is Development of understanding the anatomy is largely unknown. Clear, (inefficient in commonly considered the most important aspect. Attitudes regarding the accurate, applicable information regarding the use of the body is largely breathing unavailable. Misunderstandings in pedagogical approaches are common. application of accurate anatomical can be both supportive and strategies leading problematic/unhelpful, depending on the area of the body and this to herniation, individual. Kinesthetic registration and trial-and-experience are widely Research Questions regarded as the primary learning methods. Only when problems occur do posture, 1) What are the current attitudes of Horn players towards the application of players then consider the importance of applying anatomical knowledge. symmetry, etc); anatomical knowledge to optimise their playing philosophies? 2) What are Horn players’ perceived best-practice approaches to using 2) improving accurately applied knowledge of anatomy to develop optimal playing philosophies? pedagogy by being 3) What difficulties exist for Horn players to translate anatomical knowledge Theoretical background able to better into practice to achieve optimal artistic results? communicate Sports people have physios, etc. 4) What disparities and similarities exist between playing philosophies, about technique particularly among high-ranking Horn players? Vocalists have speech pathologists, etc. 5) What can the outcomes of the study offer for aspiring Horn players with i.e. role of regard to the benefit of incorporation of anatomical knowledge into their Horn players have other horn/brass players. anatomy in playing philosophies? efficient playing;
Importance 3) applying Player attitudes towards the role of anatomical knowledge in horn playing have anatomical not been explored. knowledge to
inform Goals experimentation Investigate horn players attitudes and perceptions by asking: What are the and optimisation current attitudes towards the application of anatomical knowledge? What are the perceived best-practice approaches when using accurately applied of technique to knowledge of anatomy to develop optimal playing philosophies? What produce a better difficulties exist with translating anatomical knowledge into practice? artistic result What disparities and similarities exist between playing philosophies? How (sound, range, can the individual identify if more or less understanding of anatomy is expression, appropriate? efficiency etc).
2) Anatomical footage
The anatomical footage used was created by uploading short videos to the gif generating site, Giphy. Each gif was then linked to the corresponding question in the online survey, which access the gif when the respondent got to that question.
Footage is not used here due to technical limitations, however, screen shots of the slowly rotating models are included, as are links to the same gif file that survey respondents viewed.
Posture. For access to the footage used, please follow this link https://media.giphy.com/media/BzxPu4FLQ3gasKuPDw/source.mp4
Inhalation. For access to the footage used, please follow this link https://media.giphy.com/media/xTkcEPFGASlD9Ij2rC/source.mp4
Exhalation below the glottis. For access to the footage used, please follow this link https://media.giphy.com/media/3o8dFGWXBH9RpiiA9i/source.mp4
Upper respiration (velopharyngeal function). For access to the footage used, please follow this link https://media.giphy.com/media/xTkcETC0ZuFix2VM8o/source.mp4
Jaw. For access to the footage used, please follow this link https://media.giphy.com/media/xTkcEAqbV4CyyLzv1K/source.mp4
Tongue. For access to the footage used, please follow this link https://media.giphy.com/media/3o8dFkVHL1TEkVtbG0/source.mp4
Embouchure. For access to the footage used, please follow this link https://media.giphy.com/media/3AjNPVxoOptmw/source.mp4
3) Interview Participant Information Statement Discipline of Biomedical Science School of Medical Sciences Sydney Medical School
ABN 15 211 513 464
Dr Bronwen Ackermann, PhD, MPH, BAppSc(PT) Room L110A Dr Mark Halaki, PhD, MSc, BSc Cumberland Campus C42 Ashley Skyring, BMus(Hon), GDip, MPhil candidate The University of Sydney NSW 2006 AUSTRALIA Telephone: +61 2 9351 9472 Facsimile: +61 2 9351 9520 Email: [email protected] Web: http://www.sydney.edu.au/
French Horn Epistemology*, Accurately Applied Knowledge of Anatomy and their roles in Performance Optimisation
(*Epistemology is the investigation of what distinguishes justified belief from opinion)
PARTICIPANT INFORMATION STATEMENT
(1) Purpose of this study
This is an invitation to participate in a study about anatomical knowledge and French horn playing. It aims to compare the approaches of Professional Horn Players, (non-professional) Horn players and Medical professionals who work with musicians regarding accurate and musically applied knowledge of anatomy and how it can be used to optimise aspects of performance, avoid playing related injury and prolong professional careers.
You have been invited to participate in this study because you have insight into Horn playing as a Horn player, or as a Health Care Professional who has treated one or more Horn players. This Participant Information Statement tells you about the research study. Knowing what is involved will help you decide if you want to take part in the study. Please read this sheet carefully and ask questions about anything that you don’t understand or want to know more about.
Participation in this research study is voluntary.
By giving consent to take part in this study you are telling us that you: • Understand what you have read. • Agree to take part in the research study as outlined below. • Agree to the use of your personal information as described. • Are 18 years of age or more. • Are proficient in the English language
(2) Who is running the study?
Ashley Skyring is conducting this study as the basis for the degree of Master of Philosophy (Medicine) at The University of Sydney. This will take place under the supervision of Dr Bronwen Ackermann, (PhD, Specialist Musicians' Physiotherapist) and Dr Mark Halaki (PhD, Senior Lecturer in Exercise and Sports Science)
French Horn Epistemology*, Version 2, 8 - January HREC Ethics approval Project Number: Page 1 of 3 2018 2017/612 (*Epistem (3) What will the study involve for me?
This Semi-Structured Interview will consist of open ended questions and discussion on matters relating to: • The understanding of anatomy (or/ knowledge of the body) and its use by Horn players. • The role(s) that applied knowledge of anatomy can play in regards to injury prevention, career longevity and performance optimisation.
A copy of the questions can be provided prior to the interview upon request.
If you agree to participate, we will coordinate a time and location for the interview via email or telephone. If an in person interview is not possible, a Skype meeting can be arranged instead. The interview will be audio recorded for later transcription and analysis. You will be able to check the transcript to make sure you are happy with all responses prior to analysis.
Please note the information you provide in your interview will be anonymous.
All questions will be about aspects of French Horn performance
‘French Horn’ will herein be referred to as ‘Horn’ and will cover all variations of the instrument from the baroque Horn to the modern day Horn
(4) How much of my time will the study take?
This Semi-Structured interview will take approximately one hour.
(5) Do I have to be in the study? Can I withdraw from the study once I've started?
Being in this study is completely voluntary and you do not have to take part. Your decision whether to participate will not affect your current or future relationship with the researchers or anyone else at the University of Sydney.
If you decide to take part in the study and then change your mind later, you are free to withdraw at any time. You can do this by emailing Ashley Skyring at [email protected] or Dr Bronwen Ackermann at [email protected].
You are free to stop the interview at any time. Unless you say that you specifically indicate that you are happy for us to analyse what we have recorded, any recordings will be erased and the information you have provided will not be included in the study results. You may also refuse to answer any questions that you do not wish to answer during the interview.
(6) Are there any risks or costs associated with being in the study?
Aside from giving up your time, we do not expect that there will be any risks or costs associated with taking part in this study.
(7) Are there any benefits associated with being in the study?
We cannot guarantee that you will receive any direct benefits from being in the study.
(8) What will happen to information about me that is collected during the study?
The audio recording taken in this study will be saved as a randomly generated number (de-identifying it) and stored securely on a password protected computer and the University of Sydney Secure Server. The interviewer will keep
French Horn Epistemology*, Version 2, 8 - January HREC Ethics approval Project Number: Page 2 of 3 2018 2017/612 (*Epistem
participant details secure and separate from the recorded interviews. Results will be published in French horn and health professional journals and form part of a Masters thesis, but participants will not be individually identified. Following 5 years, stored data will be destroyed.
By providing your consent, you are agreeing to us collecting personal information about you for the purposes of this research study. Your information will only be used for the purposes outlined in this Participant Information Statement, unless you consent otherwise.
Your information will be stored securely and your identity/information will only be disclosed with your permission, except as required by law. Study findings may be published, but you will not be identified in these publications.
(9) Can I tell other people about the study?
Yes, you are welcome to tell other people about the study.
(10) What if I would like further information about the study?
When you have read this information, Ashley Skyring and Dr Bronwen Ackermann will be available to discuss it with you further and answer any questions you may have. If you would like to know more at any stage during the study, please feel free to contact:
Ashley Skyring Dr Bronwen Ackermann Telephone: Telephone: +61 2 9351 9472 Email: [email protected] Email: [email protected]
(11) Will I be told the results of the study?
You have a right to receive feedback about the overall results of this study. You can tell us that you wish to receive feedback by ticking the relevant part on the participant consent form. This feedback will be in the form of the final written version as published in the thesis or other publication. You will receive this feedback after the study is finished.
(12) What if I have a complaint or any concerns about the study?
Research involving humans in Australia is reviewed by an independent group of people called a Human Research Ethics Committee (HREC). The ethical aspects of this study have been approved by the HREC of the University of Sydney [INSERT protocol number once approval is obtained]. As part of this process, we have agreed to carry out the study according to the National Statement on Ethical Conduct in Human Research (2007). This statement has been developed to protect people who agree to take part in research studies.
If you are concerned about the way this study is being conducted or you wish to make a complaint to someone independent from the study, please contact the university using the details outlined below. Please quote the study title and protocol number.
The Manager, Ethics Administration, University of Sydney:
• Telephone: +61 2 8627 8176 • Email: [email protected] • Fax: +61 2 8627 8177 (Facsimile)
This information sheet is for you to keep
French Horn Epistemology*, Version 2, 8 - January HREC Ethics approval Project Number: Page 3 of 3 2018 2017/612 (*Epistem Discipline of Biomedical Science 4) Semi-Structured Interview Consent Form School of Medical Sciences Sydney Medical School
ABN 15 211 513 464 Room L110A Dr Bronwen Ackermann, PhD, MPH, BAppSc(PT) Cumberland Campus C42 Dr Mark Halaki, PhD, MSc, BSc Ashley Skyring, MPhil candidate, MSc The University of Sydney NSW 2006 AUSTRALIA Telephone: +61 2 9351 9472 Facsimile: +61 2 9351 9520 Email: [email protected] Web: http://www.sydney.edu.au/
French Horn Epistemology*, Accurately Applied Knowledge of Anatomy and their roles in Performance Optimisation
(*Epistemology is the investigation of what distinguishes justified belief from opinion)
PARTICIPANT CONSENT FORM
I, ______[PRINT NAME], agree to take part in this research study.
In giving my consent I state that:
I understand the purpose of the study, what I will be asked to do, and any risks/benefits involved.
I have read the Participant Information Statement and have been able to discuss my involvement in the study with the researchers if I wished to do so.
The researchers have answered any questions that I had about the study and I am happy with the answers.
I understand that being in this study is completely voluntary and I do not have to take part. My decision whether to be in the study will not affect my relationship with the researchers or anyone else at the University of Sydney now or in the future.
I understand that I can withdraw from the study at any time.
I understand that I may stop the interview at any time if I do not wish to continue, and that unless I indicate otherwise any recordings will then be erased and the information provided will not be included in the study. I also understand that I may refuse to answer any questions I don’t wish to answer.
I understand that personal information about me that is collected over the course of this project will be stored securely and will only be used for purposes that I have agreed to. I understand that information about me will only be told to others with my permission, except as required by law.
I am 18 or more years of age
I can speak English proficiently (Please Turn Over)
French Horn Epistemology* HREC approval project number 2017/612 Page 1 of 2 Version 1, 19-June-2017 I consent to:
Audio-recording YES NO
Video-recording YES NO
Being contacted about future studies YES NO
Reviewing transcripts YES NO
Would you like to receive feedback about the overall results of this study?
YES NO If you answered YES, please indicate your preferred form of feedback and address:
Postal: ______
______
______
Email: ______
______Signature
______Print Name
______Date
French Horn Epistemology* HREC approval project number 2017/612 Page 2 of 2 Version 1, 19-June-2017
Master of Philosophy, University of Sydney French Horn Epistemology, Accurately Applied Knowledge of Ethics Project Number: 2017/612 Anatomy5) and Semi-Structuredtheir roles in Performance Interview Optimisation Script from 22/03/2018 to 22/03/2022 Ashley Skyring Semi-Structured Interview Script Performers
Introduction to interview (2-3 minutes) Hello and thank you kindly for taking part in this interview. Your insight and thoughts are highly valuable to the French Horn community and when combined with the other methodologies used in this study will contribute towards best practice research.
Firstly, some Human Research Ethics Requirements
This project has ethics approval from the Human Research Ethics Committee, University of Sydney as per the participant information sheet.
Can I ask you to confirm that you have read and understood the participant information sheet, are happy for this interview to be recorded and wish to continue?
As per the participant information sheet, the information you provide in your interview will be anonymous.
If you are concerned about the way this study is being conducted or you wish to make a complaint to someone independent from the study, please contact the university using the details provided at the bottom of the Participant Information Sheet.
You are free to stop this interview at any time. This recording will be erased and the information you have provided will not be included in the study results unless you say that you want us to keep them. You may also refuse to answer any questions.
Do you have any questions regarding your participation in this interview?
The basic structure of this interview is linear in nature, but may jump around a little depending on your answers. If there is time, we may come back to any questions if desired.
The date and time is [______]
Page 1 of 7 French Horn Epistemology, Accurately Applied Knowledge of Master of Philosophy, University of Sydney Anatomy and their roles in Performance Optimisation Ethics Project Number: 2017/612 Ashley Skyring from 22/03/2018 to 22/03/2022
Body of interview (~55 minutes)
Routine (10-15 minutes) Q01. Please talk me thorough your routine briefly. What do you do, what do you focus on, and why? Possible prompts: Flexibility, Stability (long tones), legato exercises, tonguing variations, dynamic extremes, low range, high range, stopped, mouthpiece buzzing, trills, flutter tongue, power, endurance, interval training, intonation, pitch accuracy, (mouthpiece pressure?), tone quality, combinations of any or all of the above
Q02. How do the different components relate to your playing philosophy?
Q03. What role does air have in your playing philosophy? How do you feel the air?
Q04. Do you do any off instrument exercises or stretches in any part of your routine? If so, what do you do, how do you do them and why?
Q05. Does singing play a role in your playing philosophy? Please elaborate.
Visual feedback Q06. Do you use any methods of visual feedback, such as a mirror or video? If so, what are you looking for and why?
Q07. What do you consider when you watch someone else play?
Q08. Have you, or do you use visual imitation as a developmental tool? (as opposed to auditory imitation only), if so who do you imitate? Are there high ranking players that you respect, but specifically don’t want to look like?
Q09. Do you consider anatomical differences when you watch someone play? (e.g. “dimples”, tongue length, teeth and jaw structure)
Q10. Are you familiar with the Sarah Willis MRI video on YouTube? Did you find it interesting? Would you consider using Real-Time MRI to see inside your own body while playing?
Study of anatomy Q11. Did detailed study of functional anatomy play a role in your training?
If so, how did you study it? If not, do you wish it did? What did you study specifically? How useful has it been? Did you find that learning about anatomy made things more complicated?
Page 2 of 7 French Horn Epistemology, Accurately Applied Knowledge of Master of Philosophy, University of Sydney Anatomy and their roles in Performance Optimisation Ethics Project Number: 2017/612 Ashley Skyring from 22/03/2018 to 22/03/2022
Concepts of Contractual inefficiency Context: Contractual inefficiency is where two muscles work against each other, either voluntarily or involuntarily when not needed or necessary, resulting in the overuse of muscles.
Q12. Do you think that knowledge of how it is possible for muscles to work against each other can help avoiding playing related complications and inefficiency?
Possible break. Stop and restart recording. Line up images
Context: Preliminary research into this study has indicated seven areas of the body that play key roles in French horn performance. In lay terms, they are; (1) the muscles of posture, (2) the muscles of inhalation, (3) the muscles of exhalation below the neck, (4) the muscles of the neck and throat, (5) the muscles of the jaw, (6) the muscles of the tongue, and (7) the muscles that make up the embouchure.
They are computer generated, they are not dynamic, they are not modelled to reflect horn performance, they do not represent genetic differences, but they are clear and represent muscles that are used to play horn.
Concepts of body work Q13. Regarding the desirable qualities and colours at the core of your sound, what strategies have you developed that enable you to understand which muscles you utilise?
Q14. When you’re playing well in the high register, what areas of your body do you feel are the most active?
Q15. On the not so good days (if you have them anymore), what do you feel and what do you do to recover?
Q16. Do you think that ‘understanding how these areas of the body work’ can play a role in ‘understanding what you’re feeling when you play’?
Q17. Do you think that symmetry of jaw, teeth, tongue and embouchure is important? If so, why? In this context, “Symmetry” can mean, size, shape, function, use of, activation range, etc
Mental aproaches, sensations and getting in the zone Q18. Open discussion about following interconnected points;
• Development of efficient ‘mechanism’ with the aid of accurate knowledge of functional anatomy. • Playing philosophy – Preparation • Playing philosophy – Performance • Development of mechanism using sensation • Development of mechanism with kinesiology • The shortfalls of using anatomy to assist performance preparation considering the amount that we don’t know about French Horn performance • Relationship between ‘Mechanism’ and ‘the zone’
Page 3 of 7 French Horn Epistemology, Accurately Applied Knowledge of Master of Philosophy, University of Sydney Anatomy and their roles in Performance Optimisation Ethics Project Number: 2017/612 Ashley Skyring from 22/03/2018 to 22/03/2022
Q19. What are your perceptions regarding the use of accurate knowledge of anatomy in a musical context, where appropriate, to optimise performance when compared with phrases or opinions that discourage consideration of what is actually happening in the body?
Accuracy of perceptions These are models of Motor and Sensory homunculi. They represent the disproportionate Motor function and sensory feedback we get from the body caused by the differing number of nerve endings located in the different body parts.
Motor function = ‘doing the thing’ or ‘telling the story’.
Sensory feedback = ‘feeling the thing’ or ‘reading a book’
https://stati c.propublica.org/assets/article/20160713-limb-graphic-homunculus-b.jpg
Q20. Does this resonate with you?
Neurologists have stated that "our ability to produce a lifetime of accurate movements lies not in the fact that we are born with an invariant set of actuators, precise set of sensors, or fast transmission lines, but rather in that we are born with a nervous system that adapts to these limitations and continuously compensates for them. If left uncompensated, these inherent imitations could give rise to systematic errors in our movements" (Shadmehr et al, 2010)
Q21. Do you think that accurately applied knowledge of anatomy can be useful for developing effective approaches towards horn playing considering the adaptive nature of our sensory feedback available to us?
Contrast in approaches Context: often, players and teachers will have approaches towards horn playing that are both dogmatic in nature and directly contrasting each other.
Page 4 of 7 French Horn Epistemology, Accurately Applied Knowledge of Master of Philosophy, University of Sydney Anatomy and their roles in Performance Optimisation Ethics Project Number: 2017/612 Ashley Skyring from 22/03/2018 to 22/03/2022
Q22. When considering contrasting approaches, do you think that accurate knowledge of musically applied anatomy can support the filtering process?
Device usage Q23. Do you, or have you used any devices, such as BERP, visualiser, non-pressure trainer, PETE, your own, etc? If so, please talk me though your experience. Possible prompts: What device(s)? When? How does it work? How do you use it? How long for (sessions)? How long (overall time period)? How effective? Were there/are there any complications?
Q24. Do you use a posture cushion (aka posture wedge), or a chair that tilts forward?
Pedagogy Q25. In regards to teachers who have helped you the most, what pedagogical attributes did you find to be most important?
Q26. Do you think analogies are sometimes used in place of anatomical knowledge? If so, why do you think this occurs?
Q27. Do you think that the current methods of developing understanding of how the body moves to make music on the horn are sufficient? Effective? Accessible?
Q28. Do you thing that applying anatomical knowledge could/would/does [depending on answer to above] enhance horn teaching?
Q29. What do you think makes good literature?
Q30. What, if any, literature has resonated with you?
Q31. What are the shortfalls or problems with literature in regards to good pedagogy/performance optimisation?
Treatment questions Q32. What are your thoughts on passive body work like massage/acupuncture?
Q33. What are your thoughts on consulting professionals such as Doctors, Speech Pathologists, Specialist Musician Physiotherapists who have had to study anatomy in detail?
Q34. Do you do any self treatments such as massaging your face muscles? If so, why and how?
Q35. What are your thoughts on active body work away from the Horn, such as Feldenkrais Method, Alexander technique, Accent breathing method, etc? Page 5 of 7 French Horn Epistemology, Accurately Applied Knowledge of Master of Philosophy, University of Sydney Anatomy and their roles in Performance Optimisation Ethics Project Number: 2017/612 Ashley Skyring from 22/03/2018 to 22/03/2022
Biological function Q36. Do you consider aspects of biological function, such as nutrition, hydration, blood circulation and lactic acid?
Approaches towards research Q37. Do you know anyone who has done any research like this? Do you value this type of research?
Recreation Q38. Are there any physical activities you do, or have done, away from the horn that have an effect your playing in a positive or negative way?
Additional information (~1-5 minutes, depending) [Depending on time] Would you like to go back to any questions?
Do you have any questions or wish to clarify or add anything?
Have you received an invitation to participate in the Questionnaire?
Would you like an opportunity to review the transcript from this interview?
Would you like to receive feedback about this study?
Would we be able to contact you again in regards to future studies?
Thank-you Thank you ever so kindly for taking part in this interview.
Page 6 of 7 French Horn Epistemology, Accurately Applied Knowledge of Master of Philosophy, University of Sydney Anatomy and their roles in Performance Optimisation Ethics Project Number: 2017/612 Ashley Skyring from 22/03/2018 to 22/03/2022
Definitions
Anatomy: The study of parts of the body, Eg. what it is, where it is, what it attaches to, its shape and size.
Physiology: The study of the human response and adaptation to exercise. It deals with the underlying biomechanics responsible for the effects of exercise on human health.
Kinesiology: The study of human movement, function and performance. It deals specifically with the mechanics of movement.
Playing philosophy How we think about what we do mentally and physically when Preparation: preparing our bodies for performance.
Playing philosophy How we think about what we do mentally and physically when Performance: performing.
Mechanism: The way that we use our bodies to play. Simular to Kinesiology, but applied to horn playing biomechanics. Can include both sensory and motor function.
Page 7 of 7 6) Performer Survey ParticipantFrench Information Horn Performer Statement Questionnaire & Consent- USYD Ashley Skyring
Consent Form
Hello and welcome to the Questionnaire for French Horn performers.
This questionnaire is part of a larger interdisciplinary study which focuses on how we know what we know about aspects of horn playing and considers ways that accurately applied knowledge of functional anatomy may be of benefit by reducing playing related injury and optimising performance.
Please continue on to the Participant Information Sheet, which is a Human Research Ethics Committee Requirement.
PARTICIPANT INFORMATION SHEET
This Participant Information Statement tells you about the research study. Knowing what is involved will help you decide if you want to take part in the research. Please read following carefully and ask questions about anything that you don’t understand or want to know more about.
Purpose of this study You are invited to take part in a study about anatomical knowledge and French horn playing. It aims to compare the approaches of Professional Horn Players, (non-professional) Horn players and health care professionals who work with musicians regarding accurate and musically applied knowledge of anatomy and how it can be used to optimise aspects of performance, avoid playing related injury and prolong professional careers.
Who is running the study? Ashley Skyring is conducting this study as the basis for the degree of Master of Philosophy (Medicine) at The University of Sydney. This will take place under the supervision of Dr Bronwen Ackermann, (PhD, Specialist Musicians' Physiotherapist) and Dr Mark Halaki (PhD, Senior Lecturer in Exercise and Sports Science).
What will the study involve for me? This study will involve completing an online survey into the relationships between approaches towards horn playing and how accurately applied knowledge of anatomy can assist in the following without getting in the way of artistic expression:
· Avoiding playing related injury · Performance optimisation · Career longevity
All questions will be about aspects of French Horn performance.
‘French Horn’ will herein be referred to as ‘Horn’ and will cover all variations of the instrument from the baroque Horn to the modern day Horn
How much of my time will the study take? Between 20-30 minutes.
Who can take part in the study? You are invited to take part in the study if you are 18 years and above and are a professional, aspiring professional French Horn player, or professional Horn teacher.
Do I have to be in the study? Can I withdraw from the study once I've started? Being in this study is completely voluntary. Your decision whether to participate will not affect your current or future relationship with 1 the researchers or anyone else at the University of Sydney. If you decide to take part in the study and then change your mind later, you are free to withdraw at any time.
Are there any risks or costs associated with being in the study? We do not expect that there will be any risks or costs associated with taking part in this study.
Are there any benefits associated with being in the study? We cannot guarantee that you will receive any direct benefits from being in the study.
What will happen to information about me that is collected during the study? The personal information collected will be used for the purpose of the study and will be kept strictly confidential, except as required by law. The study findings may be published, but you will not be individually identifiable in these publications.
Can I tell other people about the study? Yes, you are welcome to tell other people about the study.
What if I would like further information about the study? When you have read this information, Ashley Skyring and Dr Bronwen Ackermann will be available to discuss it with you further and answer any questions you may have. If you would like to know more, please feel free to contact:
Ashley Skyring Telephone: Email: [email protected]
Dr Bronwen Ackermann Telephone: +61 2 9351 9472 Email: [email protected]
Will I be told the results of the study? The results of the study, in a form of lay summary, will be provided to you as per request. If you wish to receive one, please indicate so and provide your email address at the end of the survey. The report will be emailed to you once the study has completed.
What if I have a complaint or any concerns about the study? Research involving humans in Australia is reviewed by an independent group of people called a Human Research Ethics Committee (HREC). The ethical aspects of this study have been approved by the HREC of the University of Sydney HREC: Project Number: 2017/612. As part of this process, we have agreed to carry out the study according to the National Statement on Ethical Conduct in Human Research (2007). This statement has been developed to protect people who agree to take part in research studies.
If you are concerned about the way this study is being conducted or you wish to make a complaint to someone independent from the study, please contact the university using the details outlined below. Please quote the study title and protocol number.
The Manager, Ethics Administration, University of Sydney:
· Telephone: +61 2 8627 8176 · Email: [email protected] · Fax: +61 2 8627 8177 (Facsimile)
If you wish to download a copy of this Participant Information Sheet, please click on this link to open a PDF in a new window.
This survey includes images accessed through google drive and giphy.com. If you are starting the survey on a server that restricts access to these sites (ie, government server) we recommend for you to restart the survey through a different server.
Although this survey can be completed on a smart phone, we recommend the use of a Mac, PC or tablet.
2 * 1. Please read and click the statements below before proceeding to the next page.
I have read and understood the information provided about I am 18 or more years of age. the study and wish to proceed with the survey.
I am a professional French horn player, aspiring professional French horn player or professional French horn teacher.
7) Performer Survey French Horn Performer Questionnaire - USYD Ashley Skyring
1. a) Demographics
* 2. Approximately how many years have you been playing the french horn?
* 3. During an average week, please indicate the number of hours you would spend practicing per day
* 4. During an average week, please indicate your current rehearsing workload.
* 5. During an average week, please indicate your current performing workload.
* 6. In which country did the most beneficial period of your training occur?
* 7. What gender do you identify as?
Female Other
Male Prefer not to say
* 8. Have you won an audition for a full time, part time or casual position in afully professional orchestra? (Fully professional orchestra = an orchestra in which a full time player is able to support themselves without other means of income.)
Yes No
3 French Horn Performer Questionnaire - USYD Ashley Skyring
1. b) Audition winner questions
* 9. How many auditions for fully professional orchestras have you won?
1 4
2 5 or more
3
* 10. In which country have you been based for the majority of your professional career?
* 11. Approximately how many years have you played in a fully professional orchestra?
* 12. For the majority of your orchestral career, which title would best describe your regular playing position?
Soloist Associate Principal
Section Principal Rank & File/Section player
Other (please specify)
* 13. For majority of your orchestral career, what would best describe your professional involvement with your orchestra(s)?
Full time - Permanent Part time - Contract
Full time - Contract Casual
Part time - Permanent Freelance
Other (please specify)
* 14. Have you retired from professional orchestral playing?
Yes Semi-retired
No
4 French Horn Performer Questionnaire - USYD Ashley Skyring
1. c) Student - Semi professional
* 15. Please indicate your current status.
Student - Undergraduate Semi-professional
Student - Post graduate Amateur performer
Freelance performer
Other (please specify)
* 16. Are you currently preparing or aspiring to audition for a fully professional orchestra?
Yes No
French Horn Performer Questionnaire - USYD Ashley Skyring
1. d) Do you teach?
* 17. Do you teach french horn?
Yes
No
French Horn Performer Questionnaire - USYD Ashley Skyring
1. e) Teacher questions
5 * 18. What would best describe your regular teaching establishments? (more than one option is ok)
High school Private - intermediate
Middle school Private - university/conservatorium/college/academy level or above Primary school University/conservatorium/college/academy Private - beginner
Other (please describe)
* 19. How many years have you been teaching the horn professionally?
0 - 5 years 15 - 20 years
5 - 10 years 20 years +
10 - 15 years
* 20. During an average teaching week, approximately how many 1 hour lessons would you give?
* 21. During an average 1 hour lesson, approximately how many minutes would you be playing?
0 30 60
French Horn Performer Questionnaire - USYD Ashley Skyring
2. b) Devices
6 * 22. Please select the devices you find useful?
B.E.R.P Variable resistance compound gauge
Breath builder Mouthpiece pressure tool
Air bag Aperture guide
Lip rings/buzz visualiser Conduit style breathing pipe
Pencil (when held in the embouchure) Spirometer
P.E.T.E Not sure what it's called
Other (please specify)
French Horn Performer Questionnaire - USYD Ashley Skyring
2. bb) Usefulness of devices
* 23. Please rate the usefulness of each device.
Very useful Fairly useful Of limited usefulness
B.E.R.P
Breath builder
Air bag
Lip rings/buzz visualiser
Pencil (when held in the embouchure)
P.E.T.E
Variable resistance compound gauge
Mouthpiece pressure tool
Aperture guide
Conduit style breathing pipe
Spirometer
Not sure what it's called
[Insert text from Other]
7 French Horn Performer Questionnaire - USYD Ashley Skyring
2. a) Performance maintenance and improvement.
* 24. Which best describes the approach you currently take to maintaining and improving your or your students' horn playing?
A practice routine with very consistent elements, plus A practice routine that varies constantly, plus detailed study detailed study of repertoire. of repertoire.
A practice routine with some repeated elements and some elements that vary, plus detailed study of repertoire.
* 25. Which of the following are included in the approach you currently take to maintaining and improving your horn playing? (select all that apply)
Practice in front of a mirror for posture. Interdisciplinary study.
Practice in front of a mirror for embouchure. Regular breaks.
Watching and listening to outstanding professionals live or Stretching face muscles. on video. Stretching breathing muscles. Listening to audio of outstanding professionals. Use of devices. Reviewing video recording of yourself with audio. None of the above. Reviewing audio recording of yourself.
French Horn Performer Questionnaire - USYD Ashley Skyring
2. c) Away from the horn
8 * 26. Please select any of the following supportive therapies/methods that you have experience with in order to support your horn playing.
Accent method breathing Meditation
Alexander technique Pilates
Breathing gym Yoga
Feldenkrais method I do not have any experience with supportive therapies
Massage/acupuncture
Other (please specify)
French Horn Performer Questionnaire - USYD Ashley Skyring
2. cc) Effectiveness of supportive therapies
* 27. Please indicate how effectiveness of the supportive therapy in regards to optimising or improving your horn playing.
Moderately Neither effective
Very effective effective Slightly effective nor detrimental Detrimental
Accent method breathing
Acupuncture
Alexander technique
Breathing gym
Feldenkrais method
Massage/acupuncture
Meditation
Pilates
Yoga
[Insert text from Other]
French Horn Performer Questionnaire - USYD Ashley Skyring
9 2. d) After playing...
* 28. After playing the horn, is there anything you do to aid your physical recovery such as massage or stretching?
No
Yes (please briefly describe)
French Horn Performer Questionnaire - USYD Ashley Skyring
3. a) Have you done any detailed study of anatomy?
* 29. Have you done any detailed study with regard to the anatomy used to play the horn?
Yes - A great deal Yes - A little
Yes - A fair bit No
French Horn Performer Questionnaire - USYD Ashley Skyring
3. b) Detailed study - if yes
10 * 30. What instigated your detailed study? (Please check all that apply)
As a teacher seeking to support a student Sensory awareness development
Career longevity (i.e. Biomechanical maintenance) Muscle control development
Detailed study was incorporated in my training Muscle strain concerns
Injury (playing related) Pain concerns
Injury unrelated to playing (i.e. Sporting accident) Performance optimisation (general)
Other (please specify)
* 31. If applicable, please rate the usefulness of the following study methods.
Moderately Neither useful
Very useful useful Slightly useful nor detrimental Detrimental N/A
Brass (general) method books, opinion pieces or articles
French horn specific method books, opinion pieces or articles
Medical reference book or article
Online resources (free)
Online resources (not free)
Other
If possible, please give details of the most useful sources (titles, websites, authors, etc)
French Horn Performer Questionnaire - USYD Ashley Skyring
4. a) Importance and usefulness of detailed study
11 * 32. Do you find this type of footage useful for developing strategies to maintain and improve your playing?
(Image used with permission from Dr Peter W. Iltis, et al, and with kind thanks to Sarah Willis)
Extremely useful Not so useful
Very useful Not at all useful
Somewhat useful Not sure
* 33. Do you think it is important to have detailed knowledge about the specific anatomy used to play the horn?
Yes No
* 34. Do you think it is useful to have detailed knowledge about the specific anatomy used to play the horn?
Yes No
French Horn Performer Questionnaire - USYD Ashley Skyring
5. a) The zone
12 * 35. Think about times you have been ‘in the zone’ when playing the horn.
Please rate your level of agreement with the following statements-
Strongly
Strongly agree Agree Not sure Disagree disagree N/A
Knowing that the preparation I have done for performance is efficient and effective helps in enabling me to "get in the zone".
Once "in the zone", it is possible to shift mental focus and attention to matters of functional anatomy and still "be in the zone".
On occasion, even when "in the zone", it is sometimes necessary to shift mental focus and attention to matters of functional anatomy if I notice that some aspects of my playing are not going to plan.
French Horn Performer Questionnaire - USYD Ashley Skyring
6. a) Have you been treated by a medical professional?
* 36. Please select any health care professionals from whom you have received treatment for a playing related condition or performance optimisation.
GP (doctor) Neurologist
Physiotherapist (general) Occupational therapist
Physiotherapist (music specialist) Osteopath
Ear nose and throat specialist Psychologist
Kinesiologist Speech pathologist
Myologist I have not received treatment from a health care professional
Other (please specify)
13 French Horn Performer Questionnaire - USYD Ashley Skyring
6. b) Consultation considerations
* 37. Regarding the most significant concern you have experienced, approximately how long was it from when you first noticed the playing related concern to when you saw the health care professional?
That same Within a 6 months or
day week 1-2 weeks 2-4 weeks 1-2 months 2-6 months more
GP (doctor)
Physiotherapist (general)
Physiotherapist (music specialist)
Ear nose and throat specialist
Kinesiologist
Myologist
Neurologist
Occupational therapist
Osteopath
Psychologist
Speech pathologist
[Insert text from Other]
14 * 38. Regarding the most significant concern you have experienced, approximately how many appointments did you attend?
1-2 3-4 5-6 7-10 11-20 More than 20 Not sure
GP (doctor)
Physiotherapist (general)
Physiotherapist (music specialist)
Ear nose and throat specialist
Kinesiologist
Myologist
Neurologist
Occupational therapist
Osteopath
Psychologist
Speech pathologist
[Insert text from Other]
* 39. Did the health care professional examine you while playing?
Yes No Not sure
GP (doctor)
Physiotherapist (general)
Physiotherapist (music specialist)
Ear nose and throat specialist
Kinesiologist
Myologist
Neurologist
Occupational therapist
Osteopath
Psychologist
Speech pathologist
[Insert text from Other]
15 * 40. If applicable, please select the health care professionals who were most helpful in developing/returning you to optimal performance levels.
None of the health care professionals I have seen have Neurologist been sufficiently helpful. Occupational therapist GP (doctor) Osteopath Physiotherapist (general) Psychologist Physiotherapist (music specialist) Speech pathologist Ear nose and throat specialist [Insert text from Other] Kinesiologist
Myologist
French Horn Performer Questionnaire - USYD Ashley Skyring
6. c) Not returned to optimal playing
* 41. Please check the box if the health care professional developed your understanding of how your anatomy functions.
None of the health care professionals developed my Neurologist understanding. Occupational therapist GP (doctor) Osteopath Physiotherapist (general) Psychologist Physiotherapist (music specialist) Speech pathologist Ear nose and throat specialist [Insert text from Other] Kinesiologist
Myologist
French Horn Performer Questionnaire - USYD Ashley Skyring
6. d) Returned to optimal
16 * 42. Please check the box if the health care professional developed your understanding of how your anatomy functions.
None of the health care professionals developed my Neurologist understanding. Occupational therapist GP (doctor) Osteopath Physiotherapist (general) Psychologist Physiotherapist (music specialist) Speech pathologist Ear nose and throat specialist [Insert text from Other] Kinesiologist
Myologist
French Horn Performer Questionnaire - USYD Ashley Skyring
6. e) Returned to optimal with developed understanding of anatomy
* 43. Regarding your development/return to optimal playing, how important do you consider the role of 'understanding functional anatomy' has been?
Extremely important Not so important
Very important Not at all important
Somewhat important
French Horn Performer Questionnaire - USYD Ashley Skyring
6. g) Likelihood of recommendation
17 44. How likely are you to recommend this type of health care professional to a friend with a similar french horn playing related concern?
Neither likely nor
Very likely Likely unlikely Unlikely Very unlikely
GP (doctor)
Physiotherapist (general)
Physiotherapist (music specialist)
Ear nose and throat specialist
Kinesiologist
Myologist
Neurologist
Occupational therapist
Osteopath
Psychologist
Speech pathologist
[Insert text from Other]
French Horn Performer Questionnaire - USYD Ashley Skyring
6. h) Considered but not seen
* 45. Have you every considered, but decided against seeing a health care professional?
Yes No
French Horn Performer Questionnaire - USYD Ashley Skyring
6. i) Considered but not seen
18 * 46. What were/are the primary reasons for not consulting health care professionals? (Please check all that apply)
Cost I doubt this person would know much about playing the Horn I'm unfamiliar with how a health professional would address playing related issues or optimisation Prefer not to say
Other (please specify)
French Horn Performer Questionnaire - USYD Ashley Skyring
7. a) Introduction to models
The areas of the body that contribute to playing the horn can be divided into seven distinct yet interconnected areas. These areas and their corresponding muscles were compiled during preliminary stages of this study with the aide of a specialist musician physiotherapist.
All images (gifs) were obtained with permission from Anatomy Tv © Informa UK Ltd (trading as Primal Pictures), 2018. Primal Pictures, an informa business www.primalpictures.com www.anatomy.tv.
French Horn Performer Questionnaire - USYD Ashley Skyring
7. b) Posture
19 Please take a moment to consider the function of posture during horn playing. We will also include posture of the head and neck for the purposes of this study.
* 47. Please rate your level of agreement with the following.
Strongly agree Agree Disagree Strongly disagree Not sure
I feel confident that I know how these muscles work in regards to posture.
Knowing and understand what theses muscles do in regards to posture is important to me.
* 48. If applicable, please rate the usefulness of posture cushions (aka posture wedge) or a tilted chair when playing seated?
Extremely useful Not so useful
Very useful Not at all useful
Somewhat useful N/A
French Horn Performer Questionnaire - USYD Ashley Skyring
20 7. c) Inhalation
Please take a moment to consider the muscles of inspiration.
If you wish to see the detailed list for inhalation, please click on this link to open the PDF in another window for reference.
* 49. Please rate your level of agreement with the following.
Strongly agree Agree Disagree Strongly disagree Not sure
I feel confident that I know how these muscles work in regards to inhalation.
Knowing and understand what theses muscles do in regards to inhalation is important to me.
French Horn Performer Questionnaire - USYD Ashley Skyring
7. d) Exhalation
21 Please take a moment to consider the muscles of expiration.
Please note that some sections have been removed for display purposes.
If you wish to see the detailed list for exhalation, please click on this link to open the PDF in another window for reference.
* 50. Please rate your level of agreement with the following.
Strongly agree Agree Disagree Strongly disagree Not sure
I feel confident that I know how these muscles work in regards to exhalation.
Knowing and understand what theses muscles do in regards to exhalation is important to me.
French Horn Performer Questionnaire - USYD Ashley Skyring
7. e) Upper respiration
22 Please take a moment to consider the function of the muscles of the wind pipe (trachea) up to the back of the mouth
If you wish to see the detailed list for upper respiration, please click on this link to open the PDF in another window for reference.
* 51. Please rate your level of agreement with the following.
Strongly agree Agree Disagree Strongly disagree Not sure
I feel confident that I know how these muscles work in regards to Upper respiration.
Knowing and understand what theses muscles do in regards to Upper respiration is important to me.
French Horn Performer Questionnaire - USYD Ashley Skyring
7. f) Jaw
23 Please take a moment to consider the muscles of jaw function.
If you wish to see the detailed list for the jaw, please click on this link to open the PDF in another window for reference.
* 52. Please rate your level of agreement with the following.
Strongly agree Agree Disagree Strongly disagree Not sure
I feel confident that I know how these muscles work in regards to Jaw movement.
Knowing and understand what theses muscles do in regards to Jaw movement is important to me.
French Horn Performer Questionnaire - USYD Ashley Skyring
7. h) Tongue
24 Please take a moment to consider the muscles of the tongue.
Please note that some sections have been removed for display purposes.
If you wish to see the detailed list for the tongue, please click on this link to open the PDF in another window for reference.
* 53. Please rate your level of agreement with the following.
Strongly agree Agree Disagree Strongly disagree Not sure
I feel confident that I know how these muscles work in regards to tongue function.
Knowing and understand what theses muscles do in regards to tongue function is important to me.
Symmetrical function of the tongue is important to me.
French Horn Performer Questionnaire - USYD Ashley Skyring
7. i) Embouchure
25 Please take a moment to consider the muscles of embouchure function.
Please note that due to genetic differences some muscles may be absent or grouped slightly differently for some individuals.
If you wish to see the detailed list for the embouchure, please click on this link to open the PDF in another window for reference.
* 54. Please rate your level of agreement with the following.
Strongly agree Agree Disagree Strongly disagree Not sure
I feel confident that I know how these muscles work in regards to embouchure function.
Knowing and understand what theses muscles do in regards to embouchure function is important to me.
Symmetrical function of the embouchure is important to me.
French Horn Performer Questionnaire - USYD Ashley Skyring
8. a) Horn playing and usefulness of understanding anatomy
26 * 55. Having looked at the anatomy pictures in the previous questions and considered your understanding of anatomy, which of the following statements do you agree with the most with regard to horn playing and understanding of anatomical function -
I would like more detailed knowledge and think it has I would not like more detailed knowledge and do not think it potential to further develop my teaching and/or playing. has potential to further develop my teaching and/or playing
I would like more detailed knowledge but do not think it has I would not like more detailed knowledge and have potential to further develop my teaching and / or playing. concerns that it could interfere with my teaching and/ or playing. I would like more detailed knowledge but have concerns that it could interfere with my teaching and/ or playing.
French Horn Performer Questionnaire - USYD Ashley Skyring
9. a) Accuracy of perceptions
* 56. Based on what you see when you or others play the horn, how accurate do you believe your perception of anatomical function is?
Extremely accurate Not so accurate
Very accurate Not at all accurate
Somewhat accurate
* 57. Based on what you feel when you play the horn, how accurate do you believe your perception of anatomical function is?
Extremely accurate Not so accurate
Very accurate Not at all accurate
Somewhat accurate
* 58. Do you think that accurately applied knowledge of anatomy can be useful for developing approaches towards horn playing?
Yes - definitely No - definitely not
Yes - probably Not sure
No - probably not
French Horn Performer Questionnaire - USYD Ashley Skyring
27 10. a) Communication of horn playing concepts
* 59. How much do you think analogies have influenced how you conceptualise horn playing?
Substantial positive influence Some negative influence
Some positive influence Substantial negative influence
No influence
* 60. Do you think analogies can be taken out of context?
Yes - definitely No - definitely not
Yes - probably Not sure
No - probably not
* 61. Do you think communication about horn technique could be improved by incorporating more accurate understanding of anatomy?
Yes - definitely No - definitely not
Yes - probably Not sure
No - probably not
* 62. When considering contrasting approaches/methods/opinions to horn playing, do you think that accurate knowledge of functional anatomy can aide in filtering useful information/approaches/opinions from those which are not?
Yes - Definitely No - Definitely not
Yes - Probably Not sure
No - Probably not
French Horn Performer Questionnaire - USYD Ashley Skyring
Email address
28 * 63. Please provide your email address. (all email addresses are kept hidden and separate from responses, however, if you do not wish to provide an email address, please go back to the previous question and un- check all boxes before clicking 'next')
French Horn Performer Questionnaire - USYD Ashley Skyring
Feedback
64. Please indicate if any of the following statements apply to you.
I would like to receive feedback in the form of a lay I would consider participating in a semi-structured interview summary. as part of this study if I meet the selection criteria.
I would like to receive feedback in the form of the final written published work.
I have a question about this study (please use the space below to ask your question).
French Horn Performer Questionnaire - USYD Ashley Skyring
Comments
65. Please use this space if you have any comments.
French Horn Performer Questionnaire - USYD Ashley Skyring
29 Thank you
Thank you kindly for completing this survey. We really appreciate it. We welcome you to contact the research team directly if you wish to.
Ashley Skyring - Dr Bronwen Ackermann - [email protected]
30 8) Medical Professional SurveyMedical Professional Participant Questionnaire Information - USYD Statement Ashley Skyring & Consent
Welcome to the questionnaire for medical professionals who have treated French Horn players
This questionnaire is part of a larger interdisciplinary study investigating how accurately applied knowledge and understand of functional anatomy and physiology can be used to limit performance related injuries and optimise performance in French Horn players, and what role it has played in the playing philosophies of high ranking performers. You have been invited to complete this survey as you are a medical professional who has treated a French Horn play with a playing related condition.
Although this survey will work on your computer, tablet or phone, we recommend it be responded to on a computer or tablet.
Please continue on to the Participant Information Sheet, which is a Human Research Ethics Committee Requirement
1 PARTICIPANT INFORMATION SHEET
This Participant Information Statement tells you about the research study. Knowing what is involved will help you decide if you want to take part in the research. Please read following carefully and ask questions about anything that you don’t understand or want to know more about.
Purpose of this study You are invited to take part in a study about anatomical knowledge and French horn playing. It aims to compare the approaches of professional Horn Players, non-professional Horn players and health care professionals who work with musicians regarding accurate and musically applied knowledge of anatomy and how it can be used to optimise aspects of performance, avoid playing related injury and prolong professional careers.
Who is running the study? Ashley Skyring is conducting this study as the basis for the degree of Master of Philosophy (Medicine) at The University of Sydney. This will take place under the supervision of Dr Bronwen Ackermann, (PhD, Specialist Musicians' Physiotherapist) and Dr Mark Halaki (PhD, Senior Lecturer in Exercise and Sports Science)
What will the study involve for me? This study will involve completing an online survey into the relationships between approaches towards horn playing and how accurately applied knowledge of anatomy can assist in the following without getting in the way of artistic expression:
· Avoiding playing related injury · Performance optimisation · Career longevity
All questions will be about aspects of French Horn performance.
‘French Horn’ will herein be referred to as ‘Horn’ and will cover all variations of the instrument from the baroque Horn to the modern day Horn.
How much of my time will the study take? Between 15-40 minutes, depending on your experience treating horn players.
Who can take part in the study? You are invited to take part in the study if you are minimum 18 years of age and a health care professional who has experience treating French horn players with playing related medical condition.
Do I have to be in the study? Can I withdraw from the study once I've started? Being in this study is completely voluntary. Your decision whether to participate will not affect your current or future relationship with the researchers or anyone else at the University of Sydney. If you decide to take part in the study and then change your mind later, you are free to withdraw at any time.
Are there any risks or costs associated with being in the study? We do not expect that there will be any risks or costs associated with taking part in this study.
Are there any benefits associated with being in the study? We cannot guarantee that you will receive any direct benefits from being in the study.
What will happen to information about me that is collected during the study? The personal information collected will be used for the purpose of the study and will be kept strictly confidential, except as required by law. The study findings may be published, but you will not be individually identifiable in these publications.
Can I tell other people about the study? Yes, you are welcome to tell other people about the study.
2 What if I would like further information about the study? When you have read this information, Ashley Skyring and Dr Bronwen Ackermann will be available to discuss it with you further and answer any questions you may have. If you would like to know more, please feel free to contact:
Ashley Skyring Telephone: Email: [email protected]
Dr Bronwen Ackermann Telephone: +61 2 9351 9472 Email: [email protected]
Will I be told the results of the study? The results of the study, in a form of lay summary, will be provided to you as per request. If you wish to receive one, please indicate so and provide your email address at the end of the survey. The report will be emailed to you once the study has completed.
What if I have a complaint or any concerns about the study? Research involving humans in Australia is reviewed by an independent group of people called a Human Research Ethics Committee (HREC). The ethical aspects of this study have been approved by the HREC of the University of Sydney HREC: Project Number: 2017/612. As part of this process, we have agreed to carry out the study according to the National Statement on Ethical Conduct in Human Research (2007). This statement has been developed to protect people who agree to take part in research studies.
If you are concerned about the way this study is being conducted or you wish to make a complaint to someone independent from the study, please contact the university using the details outlined below. Please quote the study title and protocol number.
The Manager, Ethics Administration, University of Sydney: · Telephone: +61 2 8627 8176 · Email: [email protected] · Fax: +61 2 8627 8177 (Facsimile)
If you wish to download a copy of this Participant Information Sheet, please click on this link to open the PDF in another window.
* 1. Please read and click the statements below before proceeding to the next page. 9) MedicalI Professionalhave read and understood Survey the information provided about I am 18 or more years of age. the study and wish to proceed with the survey
I am a health care professional who has experience treating French horn players with playing related medical condition.
Medical Professional Questionnaire - USYD Ashley Skyring
Demographics.
3 * 2. Please indicate your profession(s) relating to treating horn players.
Dentist Occupational therapist
Exercise Physiologist Osteopath
Kinesiologist Physiotherapist
Medical practitioner - including surgeons Psychologist
Myologist Speech pathologist
Neurologist
Other (please specify)
3. Do you have a clinical special interest?
* 4. Over approximately how many years have you treated horn players? (Please enter a whole number or a decimal number. Eg, one year = 1, half a year = 0.5, one and a half years = 1.5)
* 5. On average, approximately how many horn players would you treat per year?
6. If possible, on average per client, please indicate the minimum number of visits typically required for effective treatment.
7. If possible, on average per client, please indicate the maximum number of visits typically required for effective treatment.
8. If applicable, please briefly comment on any experience you have playing a brass instrument. If possible, include aspects such as time/duration, ability levels and any ensembles you may have played in.
4 * 9. The clients I have treated have been at the following level(s). (Please check all that apply)
Primary or high school age student Professional performer
Studying horn at a tertiary institution Professional horn teacher
Adult amateur horn player Not Sure
Semi-professional performer
Medical Professional Questionnaire - USYD Ashley Skyring
Preliminary section.
* 10. What were the primary concerns of the Horn player(s) who came to you for treatment? (Please check all that apply)
Career longevity Sensory function disorders
Biomechanical concerns Muscle strain concerns
Injury (playing related) Pain concerns
Injury unrelated to playing, but effecting playing (e.g. Performance optimisation Sporting accident)
Motor control disorders
Other (please specify)
* 11. Regarding the Horn players you have treated, which of the following problem areas have you addressed? (Please check all that apply)
Pathologies e.g. blood work, adrenal function, dry lips Orofacial
Breathing - Inspiration Posture
Breathing - Expiration below the glottis Psychological
Dental Throat
Muscles of mastication Tongue
Neurological Soft palate
Nutritional
Other (please specify)
5 * 12. Do you incorporate 'on-instrument' assessment of your clients? (Do you have them play in front of you?)
Yes - always No
Yes - when possible
Medical Professional Questionnaire - USYD Ashley Skyring
* 13. Please briefly elaborate any reasons regarding why 'on-instrument' assessment of your clients does not take place.
Medical Professional Questionnaire - USYD Ashley Skyring
Client misunderstanding 1
* 14. How important is the clients' level of understanding of functional anatomy in regards to successful treatment?
Extremely important Slightly important
Very important Not at all important
Moderately important
* 15. Have any of your client(s) displayed a substantial misunderstanding of the function of any part of their anatomy in regards to their playing related problem? (eg. A client who has misunderstood the function or location of their thoracic diaphragm during exhalation, directly or indirectly leading to a playing related problem. This is different to the client(s) not having any understanding of what a thoracic diaphragm is or does which is addressed in following questions)
Yes Not sure
No
6 Medical Professional Questionnaire - USYD Ashley Skyring
Client misunderstanding 2
* 16. On average, please indicate how much the misunderstanding(s) contributed to your clients performance problems.
Greatly contributed Somewhat contributed Minimally contributed Not at all contributed
* 17. Do you ask these client(s) about the source of their missunderstanding(s)?
Yes No
Medical Professional Questionnaire - USYD Ashley Skyring
Client misunderstanding 3
18. If possible, please describe the source of the missunderstanding(s)
Medical Professional Questionnaire - USYD Ashley Skyring
Client lack of understanding 1
* 19. Have any of your client(s) displayed a substantial lack of understanding of the function of any part of their anatomy in regards to their playing related problem? (This is different to the client(s) having an understanding that is incorrect)
Yes Not sure
No
7 Medical Professional Questionnaire - USYD Ashley Skyring
Client lack of understanding 2
* 20. Please rate your level of agreement with the following.
Strongly Strongly
agree Agree Neutral Disagree disagree Don't know N/A
The clients' lack of knowledge of functional anatomy in regards to their problem area(s) has been a major cause of their problem
The clients' lack of awareness in regards to their problem area(s) has been a major cause of their problem
Medical Professional Questionnaire - USYD Ashley Skyring
Importance of developing clients knowledge
* 21. How important do you consider the improvement of the clients' knowledge of anatomical function as part of their treatment?
Extremely important Slightly important
Very important Not at all important
Moderately important N/A
Medical Professional Questionnaire - USYD Ashley Skyring
Introduction to body
8 The next series of questions make up the bulk of this survey. They are in relation to the seven distinct functional areas of the body used together during horn playing.
Medical Professional Questionnaire - USYD Ashley Skyring
Introduction to body, continued
The seven distinct functional areas being considered in this study are: (1) Posture, including head and neck posture (2) Inspiration function (3) Expiration function, up to the glottis (4) Upper respiration function (phonation, including laryngeal/pharyngeal/hyoid/soft palate function), (5) Jaw function (6) Tongue function (7) Embouchure* function
Question skip logic has been applied to this survey so you will not be required to answer questions unrelated to your practice.
If you are a neurologist, please respond to questions regarding the area affected by the neurological condition.
*'Embouchure' in this context is the term used to describe the muscles that are used to manipulate the lips, which, once blown through, create a regime of oscillation critical to horn playing, much like the muscles of phonation in singers.
Medical Professional Questionnaire - USYD Ashley Skyring
Posture introduction
9 Please take a moment to consider the function of posture during horn playing. We will also include posture of the head and neck for the purposes of this study.
Please note that some sections have been removed for display purposes
* 22. Have you treated a horn player with a playing related posture problem?
Yes No
Medical Professional Questionnaire - USYD Ashley Skyring
Posture
10 * 23. In regards to treating posture in Horn players, please indicate your level of agreement.
Strongly Strongly
agree Agree Neutral Disagree disagree Don't know N/A
I consider the asymmetrical nature of the playing position of the instrument in relation to posture when treating clients
Posture has an effect on breathing capacity (volume)
Posture has an effect on the upper airway
I feel I can accurately identify issues related to the posture of the Horn player
I am confident in treating performance-related posture problems in Horn players
* 24. Do you, or have you used any devices to diagnose playing related problems of posture in Horn players?
No Yes
If possible, please briefly describe
* 25. Do you, or have you used any devices or strapping techniques tot reat playing related problems of posture in Horn players?
No Yes
If possible, please briefly describe
11 * 26. Regarding playing related problems of posture in Horn players, please select the components below that you feel are important to consider during your assessment.
Balance in relation to other other functional areas of the Medical tests (i.e. blood tests) body used during horn performance Performance ability Clients' anatomical awareness Range of motion Clients self assessment Strength Coordination Symmetry Flexibility
Medical imaging (i.e., MRI)
Other (please specify)
* 27. On average, how much do you think your clients' level of understanding of posture may have impacted on the playing related problem?
Severe Minor
Major Insignificant
Moderate N/A
Medical Professional Questionnaire - USYD Ashley Skyring
Inspiration introduction
12 Please take a moment to consider the muscles of inspiration.
This gif was obtained with permission from Anatomy Tv © Informa UK Ltd (trading as Primal Pictures), 2018. Primal Pictures, an informa business www.primalpictures.com www.anatomy.tv.
This group of muscles were compiled during preliminary stages of this study. If you wish to see the detailed list, please click on this link to open the PDF in another window for reference.
* 28. Have you treated a horn player with a playing related inspiration problem?
Yes
No
Medical Professional Questionnaire - USYD Ashley Skyring
Inspiration function
* 29. In regards to treating inspiration issues in Horn players, please indicate your level of agreement.
Strongly Strongly
agree Agree Neutral Disagree disagree Don't know N/A
I am confident in accurately identifying inspiration problems
I am confident in treating inspiration problems
13 * 30. Do you, or have you used any devices to diagnose playing related problems of inspiration in Horn players?
No Yes
If possible, please briefly describe
* 31. Do you, or have you used any devices to treat playing related problems of inspiration in Horn players?
No Yes
If possible, please briefly describe
* 32. Regarding playing related problems of inspiration in Horn players, please select the components below that you feel are important to consider during your assessment.
Balance in relation to other other functional areas of the Medical tests (i.e. blood tests) body used during horn performance Performance ability Clients' anatomical awareness Range of motion Clients self assessment Strength Coordination Symmetry Flexibility
Medical imaging (i.e., MRI)
Other (please specify)
* 33. On average, how much do you think your clients' level of understanding of inspiration may have impacted on the playing related problem?
Severe Minor
Major Insignificant
Moderate N/A
Medical Professional Questionnaire - USYD Ashley Skyring
Expiration introduction
14 Please take a moment to consider the muscles of expiration.
This gif was obtained with permission from Anatomy Tv © Informa UK Ltd (trading as Primal Pictures), 2018. Primal Pictures, an informa business www.primalpictures.com www.anatomy.tv.
Please note that some sections have been removed for display purposes.
This group of muscles were compiled during preliminary stages of this study. If you wish to see the detailed list, please click on this link to open the PDF in another window for reference.
* 34. Have you treated a horn player with a playing related expiration problem?
Yes
No
Medical Professional Questionnaire - USYD Ashley Skyring
Expiration function, up to the glottis
15 * 35. In regards to treating expiration issues in Horn players, please indicate your level of agreement.
Strongly Strongly
agree Agree Neutral Disagree disagree Don't know N/A
I am confident in accurately identifying expiration problems
I am confident in treating expiration problems
The activation of the pelvic diaphragm has a role in efficient expiration
The activation of the thoracic diaphragm has a role in efficient expiration
* 36. Do you, or have you used any devices to diagnose playing related problems of expiration in Horn players?
No Yes
If possible, please briefly describe
* 37. Do you, or have you used any devices to treat playing related problems of expiration in Horn players?
No Yes
If possible, please briefly describe
* 38. Regarding playing related problems of expiration in Horn players, please select the components below that you feel are important to consider during your assessment.
Balance in relation to other other functional areas of the Medical tests (i.e. blood tests) body used during horn performance Performance ability Clients' anatomical awareness Range of motion Clients self assessment Strength Coordination Symmetry Flexibility
Medical imaging (i.e., MRI)
Other (please specify)
16 * 39. On average, how much do you think your clients' level of understanding of expiration may have impacted on the playing related problem?
Severe Minor
Major Insignificant
Moderate N/A
Medical Professional Questionnaire - USYD Ashley Skyring
Upper respiration introduction
Please take a moment to consider the muscles of Upper respiration function, which include phonation, including laryngeal/pharyngeal/hyoid/soft palate function for the purposes of this study
This gif was obtained with permission from Anatomy Tv © Informa UK Ltd (trading as Primal Pictures), 2018. Primal Pictures, an informa business www.primalpictures.com www.anatomy.tv.
This group of muscles were compiled during preliminary stages of this study. If you wish to see the detailed list, please click on this link to open the PDF in another window for reference.
* 40. Have you treated a horn player with a playing related upper respiration function problem?
Yes
No
17 Medical Professional Questionnaire - USYD Ashley Skyring
Upper respiration function (phonation, including laryngeal/pharyngeal/hyoid/soft palate function)
* 41. In regards to treating upper respiration function issues in Horn players, please indicate your level of agreement.
Strongly Strongly
agree Agree Neutral Disagree disagree Don't know N/A
I am confident in accurately identifying upper respiration function problems
I am confident in treating upper respiration function problems
* 42. Do you, or have you used any devices to diagnose playing related problems of upper respiration function in Horn players?
No Yes
If possible, please briefly describe
* 43. Do you, or have you used any devices to treat playing related problems of upper respiration function in Horn players?
No Yes
If possible, please briefly describe
18 * 44. Regarding playing related problems of upper respiration function in Horn players, please select the components below that you feel are important to consider during your assessment.
Balance in relation to other other functional areas of the Medical tests (i.e. blood tests) body used during horn performance Performance ability Clients' anatomical awareness Range of motion Clients self assessment Strength Coordination Symmetry Flexibility
Medical imaging (i.e., MRI)
Other (please specify)
* 45. On average, how much do you think your clients' level of understanding of upper expiration may have impacted on the playing related problem?
Severe Minor
Major Insignificant
Moderate N/A
Medical Professional Questionnaire - USYD Ashley Skyring
Jaw introduction
19 Please take a moment to consider the muscles of jaw function (muscles of mastication).
This gif was obtained with permission from Anatomy Tv © Informa UK Ltd (trading as Primal Pictures), 2018. Primal Pictures, an informa business www.primalpictures.com www.anatomy.tv.
This group of muscles were compiled during preliminary stages of this study. If you wish to see the detailed list, please click on this link to open the PDF in another window for reference.
* 46. Have you treated a horn player with a playing related jaw function problem?
Yes
No
Medical Professional Questionnaire - USYD Ashley Skyring
Jaw function
* 47. In regards to treating jaw function issues in Horn players, please indicate your level of agreement.
Strongly Strongly
agree Agree Neutral Disagree disagree Don't know N/A
I am confident in accurately identifying jaw function problems
I am confident in treating jaw function problems
Symmetrical jaw function is important to Horn playing
20 * 48. Do you, or have you used any devices to diagnose playing related problems of jaw function in Horn players?
No Yes
If possible, please briefly describe
* 49. Do you, or have you used any devices to treat playing related problems of jaw function in Horn players?
No Yes
If possible, please briefly describe
* 50. Regarding playing related problems of jaw function in Horn players, please select the components below that you feel are important to consider during your assessment.
Balance in relation to other other functional areas of the Medical tests (i.e. blood tests) body used during horn performance Performance ability Clients' anatomical awareness Range of motion Clients self assessment Strength Coordination Symmetry Flexibility
Medical imaging (i.e., MRI)
Other (please specify)
* 51. On average, how much do you think your clients' level of understanding of jaw function may have impacted on the playing related problem?
Severe Minor
Major Insignificant
Moderate N/A
Medical Professional Questionnaire - USYD Ashley Skyring
Tongue introduction
21 Please take a moment to consider the muscles of the tongue.
This gif was obtained with permission from Anatomy Tv © Informa UK Ltd (trading as Primal Pictures), 2018. Primal Pictures, an informa business www.primalpictures.com www.anatomy.tv.
Please note that some sections have been removed for display purposes.
This group of muscles were compiled during preliminary stages of this study. If you wish to see the detailed list, please click on this link to open the PDF in another window for reference.
Please note that the Mylohyoid muscle has been considered in the muscles of upper respiration.
* 52. Have you treated a horn player with a playing related tongue function problem?
Yes
No
Medical Professional Questionnaire - USYD Ashley Skyring
Tongue function
22 * 53. In regards to treating tongue function issues in Horn players, please indicate your level of agreement.
Strongly Strongly
agree Agree Neutral Disagree disagree Don't know N/A
I am confident in accurately identifying tongue function
I am confident in treating tongue function
Symmetrical tongue function is important to Horn playing
* 54. Do you, or have you used any devices to diagnose playing related problems of tongue function in Horn players?
No Yes
If possible, please briefly describe
* 55. Do you, or have you used any devices to treat playing related problems of tongue function in Horn players?
No Yes
If possible, please briefly describe
* 56. Regarding playing related problems of tongue function in Horn players, please select the components below that you feel are important to consider during your assessment.
Balance in relation to other other functional areas of the Medical tests (i.e. blood tests) body used during horn performance Performance ability Clients' anatomical awareness Range of motion Clients self assessment Strength Coordination Symmetry Flexibility
Medical imaging (i.e., MRI)
Other (please specify)
23 * 57. On average, how much do you think your clients' level of understanding of tongue function may have impacted on the playing related problem?
Severe Minor
Major Insignificant
Moderate N/A
Medical Professional Questionnaire - USYD Ashley Skyring
Embouchure introduction
Please take a moment to consider the muscles of embouchure function.
This gif was obtained with permission from Anatomy Tv © Informa UK Ltd (trading as Primal Pictures), 2018. Primal Pictures, an informa business www.primalpictures.com www.anatomy.tv.
This group of muscles were compiled during preliminary stages of this study. If you wish to see the detailed list, please click on this link to open the PDF in another window for reference.
* 58. Have you treated a horn player with a playing related embouchure function problem?
Yes
No
Medical Professional Questionnaire - USYD Ashley Skyring
24 Embouchure function
* 59. In regards to treating embouchure function issues in Horn players, please indicate your level of agreement.
Strongly Strongly
agree Agree Neutral Disagree disagree Don't know N/A
I am confident in accurately identifying embouchure function
I am confident in treating embouchure function
Symmetrical embouchure function is important to Horn playing
* 60. Do you, or have you used any devices to diagnose playing related problems of embouchure function in Horn players?
No Yes
If possible, please briefly describe
* 61. Do you, or have you used any devices to treat playing related problems of embouchure function in Horn players?
No Yes
If possible, please briefly describe
25 * 62. Regarding playing related problems of embouchure function in Horn players, please select the components below that you feel are important to consider during your assessment.
Balance in relation to other other functional areas of the Medical tests (i.e. blood tests) body used during horn performance Performance ability Clients' anatomical awareness Range of motion Clients self assessment Strength Coordination Symmetry Flexibility
Medical imaging (i.e., MRI)
Other (please specify)
* 63. On average, how much do you think your clients' level of understanding of embouchure may have impacted on the playing related problem?
Severe Minor
Major Insignificant
Moderate N/A
Medical Professional Questionnaire - USYD Ashley Skyring
Interconnected aspects
* 64. If applicable, please rate your level of agreement with the following.
Strongly Strongly
agree Agree Neutral Disagree disagree Don't know N/A
The clients' lack of muscular strength in regards to their problem area(s) has been a major cause of their problem
The clients' lack of balance between the different functional area(s) has been a major cause of their problem
26 * 65. If applicable, please rate your level of agreement with the following.
Strongly Strongly
agree Agree Neutral Disagree disagree Don't know N/A
When diagnosing problems, I consider these seven distinct functional areas of the body involved in horn playing as being interconnected.
When developing treatment plans, I consider these seven distinct functional areas of the body involved in horn playing as being interconnected.
* 66. For this next question please consider the above components in two categories in order to relate them generally. (1) Breathing mechanics (2) Orofacial function
How much do you think…
Immensely A great deal Somewhat A Little Not at all
Breathing mechanics problems affect orofacial function in Horn players?
Orofacial function problems affect breathing mechanics in Horn players?
Medical Professional Questionnaire - USYD Ashley Skyring
27 * 67. Please indicate how much the following components contribute to you clients performance problems.
Greatly Somewhat Somewhat Completely
Contribute contribute Neutral unrelated unrelated Don't Know N/A
Clients practice habits
Clients mental aspects
Sex of client
Profession of client
Volume of playing demands on client
68. What, if any, resources have you found to be most useful in regards to gaining best-practice insight to treating Horn players specifically?
Medical Professional Questionnaire - USYD Ashley Skyring
Email address
* 69. Please provide your email address. (all email addresses are kept hidden and separate from responses. If you do not wish to provide an email address at all, please go back to the previous question and un-check all boxes before clicking 'next')
Medical Professional Questionnaire - USYD Ashley Skyring
Feedback
28 70. Please indicate the following if it applies to you.
I would like to receive feedback in the form of a lay I would consider participating in a semi-structured interview summary. as part of this study. (Selection criteria apply. A copy of the interview script can I would like to receive feedback in the form of the final be sent to you ahead of time) written published work.
I have a question about this study (please use the space below to ask your question)
Medical Professional Questionnaire - USYD Ashley Skyring
Comments
71. Please use this space if you have any comments.
Medical Professional Questionnaire - USYD Ashley Skyring
Thank you
Thank you kindly for completing this survey. We really appreciate it.
We welcome you to contact the research team directly if you wish to.
Ashley Skyring - Associate Professor - Bronwen Ackermann - [email protected]
29 ) Importance of Air Use and Perceptions of Air Use by Interviewees
Importance Perception related to feeling the air 10#91 “…it’s the most … I do very little work in which I’m thinking about the air.” important part of horn playing, but …
#25 The foundation of “no movement in the shoulders or the throat” his routine “based “the expansion is happening lower down” on the use of “we feel how the air is travelling” breathing and “the air is continually driving through that resistance (of flutter-tonguing)” blowing” #19 “Air” = 11th most “breathing from full inflation and then allowing the body to come back to stasis and that frequently used creates the wind-flow” word “Jacobs, combined with voice training. The classic Italian appoggia school where you take a deep inhalation. The belly goes out, and you don’t let it come back in when you’re exhaling. That’s where the support comes from” #37 “For me the air is “the air is guiding me in terms of fast or slow, therefore, what note I play.” 100% the guiding “I know just enough to be slightly dangerous to myself” force “I think about the point 2 inches below my belly button pushing out and for me that’s the For me air is the core to what I’m doing” most important” #93 “breathing is really “There are a lot of theories about breath support” important” “I use a lot of intra-abdominal pressure, kind of like a weight lifter lifting a couple of hundred pounds (>90kg), with the transverse abdominal muscle” #68 “‘essential’ would be “coming back to the concept of air or how I’m using my air is almost always part of the my first answer. “ solution for me. It’s not always the full solution but it can lend itself to discovering a way to do something, so I find it’s important in the way I approach things” #62 Air = the most Discussed air use via non-vibrating vocal sounds, but with a ‘whisper’ sound of a vowel, frequently used eg “h(aaaaaaaaaa), h(uuuuuuuuuu), h(oooooooooo),” word “natural functions such as laughing, not supporting consciously. Starting completely relaxed and going “h(aaa)” and feel what the body is doing to eject the air” “If you’ve got everything absolutely relaxed and do this, this ejection of air spontaneously gives you a note if you get it in the middle” “this natural ejection of air which comes from something like a cough or a laugh” #53 “The air plays a “I was lucky to have two lessons with Arnold Jacobs” large role. I always “I learned about breaking the old rule of not raising the shoulders so I could be freer to intuitively use the air take a bigger breath for quality.” “I don’t know how I feel the air. It just goes through the horn” (probably the only truly honest answer) “If the music needs better legato, better tone quality, better projection, better whatever, then, using more air, more speed of air etc. should be considered one of the tools. This is opposite to some of the philosophies of my brass colleagues who often philosophise to just blow more and everything will sound better.” “I don’t want to even call it support; more just activation of the larger muscles down there” #84 “Air is support, as I “It is then guided by various muscles in your throat, embouchure and things like that, but interpret it to be.” the air is the media that transfers this energy from one place to the other” “Support is the most “The way I feel the air could be compared to a ’foundation’” important thing” “It’s like its own separate entity” “I create it using my stomach muscles and the control that I have with the diaphragm and things like that” #14 “I place massive “but I don’t use basic anatomical information to inform how my body works” importance on “Air is the fuel that drives the car. I’m largely intuitive about it. I don’t theorise about breathing and air” the air” #88 “It’s the most I have a few thoughts. I call it ‘vocal air’. I’m surrounded by singers” important thing.” “more air can sometimes get us into trouble because we blow too hard and the lips have to tighten to balance that force. For me the air is the sound. Instead of the lips vibrating against each other, I like to believe that the air hits the lips and whenever it hits at a certain angle, density and size, the air vibrates between the lips, maybe into the horn, and when it hits the small part of the mouthpiece it starts to create a little storm, but then the air also vibrates in my mouth and into my chest. I don’t actually care if this is accurate in terms of acoustical physics” #30 “For me the air is “I don’t know exactly, but I try to feel warm air, open throat, the intercostals muscles the gasoline of the expanding and contracting.” car. It produces and moves the sound.” #21 I mentioned starting I grew up in the whole ‘Wind and Song’ school of Jacobs. I knew about it and all my notes with just air teachers breached to me about taking huge amounts of air and blowing the air out earlier. When I do freely. Having grown up with that, I did it automatically so I didn’t know why they made that successfully it such a big deal out of it, and then I found that I was breathing too much and blowing too gives me a good much air out, so I’ve had to reduce that a bit. I found this out through bad experience.” sound “I still like the idea that the air is the violin bow, the air is what makes the horn vibrate, whether it’s acoustically correct or not I don’t care, it’s a psychological thing” #79 It’s very important “it feels like a cleansing thing. I feel like I’m taking in a cool, clear, cleansing breath and to have an then when I’m breathing out I experience it as being warm, focussed and projected. I’m awareness as to also very conscious of the expanding of the lungs and then when I breathe out I’m aware how you’re using of the flow of not only the breath, but also of energy that comes along with the breath as your air. its leaving.” #20 “I think it’s “During recent lessons in Europe, some teachers did speak about tongue placement; everything.” everything being forward so you could spin the air faster or that the air was not getting “The air is really interrupted. It was always coming from an air angle. Richard Watkins, Simon important. It was all Raymonds, Tim Jones, Angela Barns, Jörg Bruckner, Erik Terwilliger, Sarah Willis, Stefan relative to air.” Dohr, David Cooper, Fergus McWilliam, Andrew Bain (interviewed), Gail Williams, Julie Landsman, Leelanee Sterrett (interviewed).” “I can only talk about when the air feels good or when the air feels bad as opposed to how I actually feel it. If it feels uninhibited, unrestricted by embouchure or tongue, then I know it’s good air” “almost like you’re vomiting out air, because it’s open and unrestricted” #16 “It’s everything. It’s “I feel like the air really has to come from down low feeling in the support system” the basis of being “I had to become a more efficient player, and part of that was taking in the air and able to do keeping a feeling of fullness or fatness. To me it was like shifting my centre of gravity anything.” lower in my torso in order to keep the air pressing outwards at all times within the lungs and torso allowing a sense of heaviness.” ( this describes appoggia) #82 “Air is the fuel that “I would like to say ‘freely’, but sometimes that’s not the case. I try not to get restricted drives the car.” in the throat. I guess I feel it in my core and all of my torso, so not just my stomach but also my ribs, side of my torso and the back.” “I played Beethoven VII last night and I came out with a sore back which I think is purely due to a lot of bearing down* like giving birth” #95 “[Air plays a] 50 “I feel it as being not a static energy, it’s always in motion and is part of the relaxation of percent [role in my the muscles and it’s a part of the energy, so it’s always in motion.” philosophy]” #40 “It’s the number one “I feel the air flowing.” priority for me when “the focus of the air is on the intake. So my abdomen distends and relaxes completely, I play the horn.” so, fill as best as I can, and then my imagery is that the air travels out of my upper chest (as opposed to the upper respiratory tract) with a forward momentum and that creates a relaxed feeling in my throat and my neck, so, to remove tension” “It’s like Feldenkrais, but it’s not strictly adhering to Feldenkrais. It’s drawing from singing pedagogy. “ #73 “Air is of course “There are different ways that you can describe air. It’s just about maybe concentrating essential.” on the one had on how you feel when things are going well rather than concentrating on the problems and not asking ‘well, what am I doing wrong’ when things aren’t working, but the other way around and ask ‘when I’m happy with my playing, how does it feel?’. That’s one way. Another way we can talk about air is by having images: Warm air, cold air, fast air, slow air, and all of these kinds of things.” “It’s really true that if you ask 10 brass teachers or instructors or singers to describe what they’re doing they’ll give you different answers, as your study is probably showing.” “I try to imagine it as an ‘air cushion’ like those crazy hovercrafts in the Florida marshlands. That’s how I try to think of support; so that it’s flexible, so that it’s not hard or harsh and that you can really depend on it when more support is necessary and thinking downwards and also thinking as low as the belt line maybe, which is probably going too low, but I think it serves two purposes; one is so that you really feel the support there because we do have abdominal muscles there and on the other hand also when we get a little bit nervous and tense while performing, what happens is that sometimes our shoulders and neck etc., will get tense.” #38 “It’s huge. Air is the “I like to think of it primarily as coming from the bottom. I like to fill from the bottom most important and really it to just flow” thing.” “I in theory like to think of, especially when I’m seated, really coming from my feet. That way it’s really just controlled a full body experience” #22 “The greatest “I think it’s a difficult thing because as a teacher, what I tend to notice is that a lot of players that I know students don’t realise the effort involved” are the ones who “it’s all about the amount of air you can put through the horn, weather you’re playing use their air well.” loud or soft, it’s all to do with the speed of your air. I think that it’s one of the most fundamental aspects of playing the horn” “In terms of how I feel it, for me it’s all about filling up the lungs, thinking in my mind that I have these two deflated balloons in my chest and as I inhale I’m trying to fill up the balloons as much as I can”
) Question 12
Q12. Do you think that knowledge of how it is possible for muscles to work against each other can help avoiding playing 11related complications and inefficiency?
“Yes. Absolutely. I remember at the conservatorium there were many instances of people working so so so hard and not getting results. This could be helpful knowledge.” #91
“Yes. Stands to reason. Very helpful. I can tell if I’m using them effectively because I’ll get less tired, I’m more accurate and I’ll have more control over everything too. I don’t think I know enough about anatomy to know if I’m 100% efficient or not, but I’m not sure how much I need to know or want to know.” #25
“Oh, absolutely!” #19
“I think it could, but I don’t know anything about it.” #37
“Of course. We have to play healthily, and we have to play for the long haul.” #93 “Yeah. Again, if you are able to feel these things, then it’s useful. If you’re not able to feel these things then it’s not useful. It would depend entirely on how you are able to apply the knowledge.” #68
“You said it, it’s about efficiency. It’s about having a balanced embouchure so that the muscles can work parallel and you haven’t got an imbalance from one side or the other. There are exceptions that play on strange embouchures which can work for those individuals, but as a general rule of thumb it’s got to be two thirds top, one third bottom and straight under the nose.” #62
“Yes, is the simple answer, but on the other hand I think it can be translated to more simple terms such as “when you feel that your face is starting to go dead, take small breaks”. Even when I’ve been in a busy orchestral rehearsal where I had much to do and a recording session scheduled in the evening, I just told my second horn “I’m going to fake it at times today” because I need to save my lips. My teacher [name removed] recommended 20 hours break before a concert and I tried it. The thing is that if you’re playing all the time you get strong, and with the 20 hour break you get soft as well and things get easier, but then if you have things to do the next day you are going to be bad because you’re not going to be as strong anymore. [Name removed], who is a soloist said that as the solo work is usually before intermission then they usually play a symphony afterwards and he says that THAT is when he practices.” #53
“I can say that every once in a while that I have experienced that when it comes to swallowing, but certainly never with horn playing, though I can understand that some people may have a problem with muscles not working in tandem and working against each other and therefore making things less efficient. Efficiency is one of the prime things. Going back to my daily routine and making sure that everything is working right, I feel like I achieved efficient playing long ago and I use the routine to reinforce this efficient playing on a daily basis so that my body doesn’t forget or incorrectly learn what is supposed to be happening.” #84
“Yeah, possibly. It depends how many bad habits have developed in the player. If a problem develops as a result of bad playing at a young age, then to solve that problem, an understanding of the anatomy involved may very well be the key to more efficient and better playing.” #14
“One hundred-million-thousand percent yes. My injuries have been a lot of my lips turning into old tyres and losing an octave off my range, which would happen once a year with Canadian Brass. In 2005 and again later, I’d been getting overly sleep deprived a couple of days in a row, and I think the cells of the muscles were breaking down and muscles against muscles etc, where making it swell up and get super stiff. Other short-term injuries come from a lot of over tightening while making them vibrate and respond to playing needs while over supporting them.” #88
“Sure, because if you learn how it feels to be tense, you can understand the difference when you’re relaxed.” #30
“For sure. I went through some bad times five or six years ago and Annie Bosler did a whole talk at the IHS in Brisbane about the muscles in the mouth and how they work with each other, against each other, what you have to be careful about and how you have to watch out for certain things. So I was aware of it and I did her stretching exercises but I didn’t apply it that much to my playing. I kind of liked the idea my entire life of “I’ll just play, I’ll be fine. Just pick the horn up and play. Don’t think about it too much”. I did that for a long time and then I ran into some problems. Suddenly I had to start thinking about what exactly is going on in there anyway and how it all works. Above all I started to study facial anatomy charts really closely so see why different parts of my face got swollen and why different parts won’t loosen up. I became very aware of this only after I encountered some problems.” #21
“I can imagine it can only help.” #79
“Yes. If you know what’s happening then you can understand when it shouldn’t be happening and hopefully relax or undo it.” #20 “Possibly. I feel like it could also be a little too much information for a player who is not experiencing problems.” #16
“Yes, absolutely. I think problem for a lot of people is the constriction of the airflow with the back of the tongue and the soft palate, etc. If you say “øøøøøøøøeeeeeee” demonstrates how much constriction is happening when you change to the “eeeeee” sound. I see these as to things that are working against each other. I’m sure there are other examples that don’t help us when we’re trying to play horn, that’s just one that I can think of.” #82
“Yes. For example, people can often use more than 1kg of pressure and of course you need to activate the muscles to balance the mouthpiece pressure. Some muscle activation strategies are in contrast with muscles that should be relaxed, such as the deep neck flexors. I think you can find that the solution is with support because you must balance this pressure with something. When the support muscles of breathing are responsible for generating the air pressure required to balance the pressure from the mouthpiece, the neck is then able to be in a good position and the muscles that allow head to move freely on the upper-most vertebrae are able to remain relaxed. The opposite of this is when the deep neck muscles are used to balance the force from the mouthpiece, creating tension in the neck.” #95
“Yes I do.” #40
“I have to almost pass on this question because I don’t know enough about how the muscles actually work. The first thing though when I read this question was about a definition of how an embouchure is formed. I think it’s in the Farkas book where he explains the concept of the ‘puckered smile’. I’m really not well enough informed to give you any meaningful answer to that and I do try to play as relaxed as possible. In regards to contractual inefficiency while exhaling, even if you get an anatomical explanation I have doubts whether that helps the player because they might become a little too self-conscious and again I think it’s better to think in images or ideas or movement. I believe more in examples such as blowing a gentle stream of air towards a hanging sheet of paper or describing the sort of sound you want to get rather than getting too specific on it. It’s useful information, but in teaching I’m actually trying to go away from this knowledge because for me they’re too specific and people start to try to feel something that’s really difficult to control. The only way I can control it is with a good quality sound and a general relaxed appearance. I’ll be the first one interested in reading the results of your study and if it contributes towards explaining things better to the students I will be delighted.” #73
“Absolutely.” #38
“Absolutely.” #22
1 ) Question 21
Do you think that accurately applied knowledge of anatomy can be useful for developing effective approaches towards horn2 playing considering the adaptive nature of our sensory feedback available to us?
“Yes. Absolutely. If you have targeted knowledge about what you have to be working and exercising, that’s better than just going in blindly and spending a lot of time finding out what works and how to do it correctly. It could be really helpful.” #91
“Yes. Makes sense.” #25
“Oh, absolutely. I think if brass players had a better idea about how the anatomy works and functions, and how it goes about creating what we’re doing on a brass instrument, we can wipe out focal dystonia. I think focal dystonia is this really evil mixture of psychology and self-esteem and the narrative that goes on inside the brain, tied to bad function. I tell this to my colleagues and they always laugh at me because it’s pretty true. I tell them that I don’t know a single bad brass player who has gotten focal dystonia. Every brass player who has been hit with dystonia has been at the peak of their career playing in great ensembles, and then they get hit. It’s the stress tied with bad function.
I think the question of “how much knowledge is a good amount” depends on the person. I think some players will have the mental capacity to be able to take in all that information and assimilate it and not get overloaded. I think for some players it has to be as basic as possible for them to not shut down. I think the information should be available absolutely as much as possible. Pedagogically it’s a tool in a tool kit. You can’t apply it to everybody. Not everyone is going to have an intellect that can handle it.” #19
“Yes. Absolutely. ‘How much knowledge is a good amount’ is a tough question. I don’t know until I’m in the situation but for me I think the more knowledge the better. I don’t believe in “analysis equals paralysis”, but I only have my experience. It’s not a problem for me but it might be a problem for someone else. I think it should be left up to the individual to figure out.” #37
“Absolutely. I think that ‘how much is a good amount of knowledge?’ is a difficult question. I think it differs with different people. Regarding Howard Gardener’s theory of multiple intelligences; he wanted to show that the IQ test wasn’t the only form of intelligence. Kinesthetic intelligence, auditory intelligence, visual intelligence, cognitive intelligence etc. I adapt my teaching to the prevalent intelligence of the student. Some like really specific information and some are at the other extreme. I think it varies.” #93
“It’s valuable to have enough knowledge, understanding and awareness of our own bodies, as long as people understand how to perceive and feel it. I think general information about efficient muscle use, muscle fatigue and recovery is incredibly important, as long as the issues that they have are directly related to that. It’s important to acknowledge that there could be other issues as well though, so as long as it’s considered in relation to musical aspects it can be extremely valuable.” #68
“I think that some people would freak out at that sort of depth of technology, to put it that way. We are very physical beings. What feels right when we’re using our bodies correctly in all of the parts that we need to in order to make ourselves efficient players, with the support, freedom of movement and building the embouchure. The mental capacity of the players I’ve work with in my career vary considerably. The speed of being able to translate visual sensory perception into action varies greatly from student to student. All aspects of mental ability differ right across the board and that is going to stay like that. I think having a good mental processing speed is important for sight reading and processing what’s going on in an ensemble situation. It’s very difficult to say that a study in this area will help because we are born with a particular mental capacity.” #62
“Yes, to a certain point, but if it takes too much space people will think about this rather than the ‘pudding’. For example, there are problems with the book Teaching Brass by Kristian Steenstrup. First of all, teaching brass isn’t just about the stuff he writes about. It’s about teaching a human being. Secondly, he took notes from Jacobs. He recorded every lesson and he presents this in the book with a lot of anatomical detail of the names of the muscles, very detailed. Many of the other people in Chicago who took lessons from Jacobs had different experiences. I know an Italian man who got to hear lessons with other people as a student, as he was helping Jacobs with the Solfege side of things. He told me that Jacobs treated people completely differently according to their personalities. He told me some people including Steenstrup needed to know the details and the names and that these things made him feel better and safer and improved his pedagogy, but if others were told all that stuff it would mess them up. Steenstrup was never on the level of those who won jobs but I’m just saying that because I think that Jacobs pedagogical approach in this regard is a good example of when it’s too much information. I think the best part of the book that I like is the chapter called Psychology of Breathing. There is a good book written in Danish and English called The Art of Breathing by a Danish flute player and a Danish bass trombone player who got together and tried to explain Jacobs’s philosophy, before Steenstrup. They try to really play down the details. If there is a drawing of muscles, it is like a child’s drawing so as to not make it too complicated. So, there are other people who have tried, with more success.” #53
“To me that’s a no-brainer. Of course! You have to be aware of the different parts of your body and what roles they play when you’re playing any musical instrument or doing any sort of physical activity that requires a certain amount of finesse, concentration or perhaps things that would require the development of skills over the years. You have to know what your body is doing. You can’t expect it to happen by itself. Weather that knowledge is gained through sitting down in class room situation or educational system where you’re learning about it (cognitive), or whether you have had the opportunity to sit down and pay attention to what your body is telling you (kinesthetic), both of those are valid ways to learn what these things are. I don’t think it has to be one or the other. I think that a mix of the two would be best, so that if you have an issue with the self-awareness that you can consult with somebody who has more of a textbook aspect of it so that they might be able to point you in the direction.
One of the first messages I got out of that book is that there are no teachers or students. You are your own teacher and all you can do is go to someone who might be able to give you hints about how you might approach conquering an issue or sorting out a problem. This is the same thing. I don’t think that there’s any academic way that somebody would be able to say “this is how it works” anymore than somebody whose approach is purely sensory would be able to overcome all issues.
Regarding the question of how much anatomical knowledge is a good amount, I would say that the proof is in the pudding. If you’re able to solve the issues that you might have, or find that you’re comfortable with the advancement you’re achieving in the goals that you’re achieving as a horn player, then you probably know enough as a horn player, then you probably know enough because if there’s an issue you’ve needed help with you’ve been able to consult with somebody who can tell you “well, it’s your ‘whatever’ muscle, or whatever”. If text book people can’t help you then maybe either you don’t know enough about anatomy and can’t apply or interoperate what they’re saying, or maybe they need to try playing horn so that they can experience what horn players are going through. I’ve seen people do things that I can’t do, like roll their stomach in a way that I can’t. Obviously, we all have nerve endings that control each of these muscles, but whether or not we have access to it in our own heads is a different question.” #84
“Yes, I do. In the cases of some sort of inefficiency to do with your playing and your physical approach to playing, that sort of understanding is useful, but I don’t think it’s necessary. That’s to do with learning verses innate know-how. One being imparted and one coming from within. It’s a combination of the two. We do what works for us and feels natural. I think it’s more important for the mentors and teachers than it is for performers. If I were to take on a large teaching load, I would consider it important to be able to tale about this topic in a way that imparted it clearly.” #14
“I think our approaches towards horn play have to change as our bodies do. It’s good to have general anatomical, kinesthetic habits as you’re going along listening and calibrating as you’re going with it. I think my teeth are moving out of line and I have changed anatomical things. I think knowledge about what I’m changing could help for sure, especially in my teaching. These pictures of the homunculi are really interesting as far as what else might change. I also now have some twitches in my cheek and lips, and the more tired I am or if I’ve driven for a while then my arm goes numb and shakes at times. I realised as I was doing a concert earlier this year that my arm was fine during the day time and my neck was a little sore but not shaking. It did shake in the concert. I just attributed it to getting more tense in the performance. That was a physical anatomical thing and I think that knowledge of where and how this sort of thing can happen to me can help. Since then I’ve improved my posture. I think this is awareness of the best sort of system to be using. We are changing with age and the French horn doesn’t have a fixed system, just looking at all of the crazy successful embouchures when combined with different postures and genders etc.” #88
“Well, I have two things to say about this. I work a lot on trying to feel every part of my body. From a very young age I think that I have really good sensory perception over by whole body and I have good control too. 4 or five years ago I start having terrible pain around my abdomen and I ended up in hospital. I said to my wife “I think I have something in my right kidney”. The doctors didn’t find anything that day, so they sent me home. The next day I had an ultrasound and they found a lot of kidney stones in my right kidney.
The other thing is that my wife, who is a flautist, was having trouble controlling her embouchure. She was unable to play a single steady note. The thing is that there is very little information and very few people who can help with this sort of thing, especially in my country. So we start researching as much as we could, but I think that the thing that has help the most is when we started doing yoga and meditating. It’s funny because she wasn’t very aware of her body and had problems with co-ordination. She started doing some other hanging-cloth based acrobatics and she started recovering. She’s nearly 100%” #30
“I think I would approach this from an ageing horn player perspective because that’s my experience. I and many other older horn players have asked ‘What is going on? Why can’t I play the way I used to play?’ and you don’t know why. You’re doing everything exactly the same. Some people just say ‘oh, I’m just getting old. I can’t do it anymore, and they stop, but a lot of us aren’t there yet and are still performing at a very high level and we want to know what’s going on with our bodies. I notice, as an older guy, that I can’t play as long as I used to be able to play and I need more recovery time afterwards. I have to be more aware of what the muscles of the mouth, abdomen and back are actually doing. I don’t think the body is born with the ability to play horn. We have a nervous system that we train and develop in order to do these things. Then you get into the conservator and you reach a point where the mechanism is in place, and you get into the professional world and it’s running great. It’s kind of downhill from there because routine sets in. You may not warm up as much as you used to because you don’t need to in the orchestra. There’s also a thing with your memory. Your mind remembers the performance. A lot of time your memory does not recall the rehearsals and the problems you had leading up to performance. Then you’ll come back to your horn, two weeks or three weeks after a performance, you’ll try to play, and you’ll want to be at the same level you were at that last concert but that’s not going to be the case. You have to start from the beginning, from the preparation point. This is less apparent when you’re younger because you’re always held at a certain level when you’re playing every day, but as you get older certain highlights in your performance when you were in the zone and everything was working properly in the body stay in your mind and you want to have those all the time. You tend to forget what you had to do in order to get to that point in order to get into the zone. So yeah, you have to be more aware of your body and retrain it all the time.
Another one is dehydration. When you take a long flight, or are travelling in the car, or are in dry climates, you get very dehydrated and your lips swell up. I don’t know why it took me till my fifties to figure this out because it wasn’t a problem in the past, but it’s become a problem with age.
Jet lag has an effect on concentration too. When we were touring with the quartet, the first day in a new city was always free so that we had a chance to acclimatise to where and when we were. One day was not always enough time but more or less, the excitement of being on the road and touring kind of overrides it” #21
“Absolutely, especially when you see people who are suffering from focal dystonia or overuse syndrome, which I imagine this study will tie into quite nice, but also on a day to day basis, simply to do a quick check-up to make sure that everything is balanced or in the right spot you’ll know if you need to get a chiropractic adjustment or something. A problem that many of us have is sitting in airplanes for hours. It takes some time to re-establish equilibrium when you stand up. Getting off a long-haulz flight and going straight to a concert hall is a nightmare that we often experience and have to deal with, but I think if we are more aware of what we are supposed to be doing and when then we can bring ourselves back into alignment quickly and more efficiently.
For me I would say that a good solid amount of background knowledge that can become automatic at a certain point is the right amount of knowledge. Where it starts to take over the function of the ears or get in the way of the music, I would say would probably be the tipping point for me. If I’m thinking about my levator labii superioris aleque nasi instead of what I’m playing, then I’m lost. This knowledge is a really good thing to learn, to know and to have as part of the background of your awareness rather than making it the forefront.” #79
“Yes, because I guess it’s like you say, as you say, if you’re not taking care of yourself and checking in, then sub-optimal things can creep in. I guess if you’re more aware of your anatomy and recognise when something feels different or wrong or good I guess your awareness is better so you’ll fix it or adapt or something like that.
I’m just thinking of players who get dystonia, for example a colleague of mine who wasn’t checking in with their playing all the time and then, all of a sudden, can’t play, if they were maybe more aware of what it felt like and could maybe realise ‘this’ wasn’t engaged or ‘that’ felt weird, then maybe things would be better.” #20
“Yes.
I’ve thought a little bit about this now that I’m teaching more. I find that I don’t always have the language or tools to help some students understand, for example, the mechanism of articulating as I understand it. For myself I would like a way to translate what I feel as sensations into a visualisation anatomically, something that I could use to describe sensations more accurately to people. I think it would be interesting to just think about, but I do know other people for whom even that much might be sort of paralysing in terms of over thinking it. I guess something that would allow me to describe the sensations that I experience and maybe not go beyond that but just in having a different way to understand or talk about what is happening and not necessarily try to fix the problem, just a more concrete way to talk and think about it.” #16
“Absolutely. I think that if you look at a completely different thing, for example archery. I’ve seen a man shut his eyes, pull an arrow out of his holster, put it in his bow, ready himself, shoot it at the ground, pull four more arrows out and put them in exactly the same spot within a 5-10 cm round circle on the grass, with his eyes shut. So his senses, muscle memory, directional memory have all played a part. It’s something that has always fascinated me; how people do that. If you relate this to horn playing, it’s like hitting a high C many times in a row while putting your horn down in between each note. So there there’s something somewhere that’s either sensory of physical that makes you capable of doing that.” #82
“Yes. Of course.” #95
“Yes. 100%, and I’ve proven it within myself.” #40
“Yes. Definitely. I’ll mention again later that Feldenkrais, Yoga, and a little Alexander technique, or any of these disciplines should serve as guidelines for us to find the best ideal, ergonomically I guess, best position for us since the instrument is unfortunately built in a way which does not consider ergonomics. It’s only possible to a degree to do this, but I will agree with your proposal for sure, except it’s a bit of a lost battle because it’s not the most natural thing to spend hour in this position, so we have to find the best way.” #73
“Absolutely. Sometimes I’ll go with the old adage of “paralysis by over analysis” as there will be involuntary things happen as the body tries to fix things, but for me I think that knowing how your body works and correlates is something that should be taught everywhere. Not just from the perspective of a mental game, but also physical performance. The question of “how much is a good amount?” is hard to say and it varies on the person. Within the context of a university it’s something that you have to tread on very lightly because you don’t need a horn classroom turning into a health class. You also need to be appropriate about it as some things can’t be learned using cognitive learning methods.” #38
“Most definitely.” #22 1 ) Question 22
When considering contrasting approaches, do you think that accurate knowledge of musically applied anatomy can support3 the filtering process?
“Yes. I think it’s really important. If you’re heard two contrasting methods from equally fine players, then looking at the science behind it is the only way to go to work out what should work best and not going to injure people. It’s really important” #91
“These days I encourage the students to question every piece of information they get. Some stuff, inherently, you’re going to know that ‘ok, that’s not going to work’, or that it’s not going to be worth trying, but as long as it fits into the overall philosophy you’re developing you can see how it can actually apply to what you’re doing and it’s worth perusing and there’s no necessary time limit I don’t think on how long you would look at it for because it also doesn’t necessarily need to be a huge shift and a lot of changes will happen incrementally with information so being open to experiment but start developing an overall philosophy of playing and an overall philosophy of how you want to develop a mechanism will open you up to being able to plug that information in, not jerking from one idea to another but seeing how it will actually compliment your playing.
Yes, accurately applied knowledge of anatomy can help, but I would say in that sort of situation I would not directly contradict directly the comment if I didn’t believe it, I would just point to student to question and experiment to see if that’s actually useful information” #25
“Well I think it’s everything! I think an appropriate knowledge of function widows out improper information. There’s so much that is taught that is just wrong. I’ll give you an example. When I was at University of California, the legendary Vince DeRosa was teaching there. Vince would tell his student that when you ascend above the staff, especially approaching a high C or D, you should drop your tongue and be more open in the throat as you go up to keep the sound broad. Not one of his students could play above the staff. Then they would say “Mr DeRosa, I can’t do it”, then he’d grab their horn and say “watch”, and go (imitates octave leap to top C using vowel change from “aw” to “ee”). He would close his throat, but to his body it felt like he was keeping it open, and you could easily see that something was lifting in his throat area (indicates near Hyoid).
I think this is the key to getting rid of old, Victorian, hung-over, bad pedagogy.” #19
“Yes” #37
“Yes. Absolutely. I cringe when I hear bad information. For example, it’s hard for me as a researcher and MRI study participant to hear high level principle horn players teaching to use mouthpiece pressure to get into the high range. I think it’s irresponsible to say things like that. If you don’t know what true breath support is it probably better to say “I don’t know” rather than refuting other strong, scientifically informed opinions.” #93
“I think I’ve been lucky in that I haven’t really been exposed to too much stuff that I find negative or detrimental, but yes, there have been time where I haven’t been able to feel things according to some teachers, which is a bit of an alarm bell for me. Either I’m not doing something correctly or ... I do think it’s a good idea to consult a lot of different teachers, not as a regular thing, just touching base. It’s also a good idea to observe a lot of different people perform, because if you get information that doesn’t sit quite right with you, then you have a forum and some context for that. There are a couple of things I’ve been told that haven’t really resonated with me at all, but to have the courage as a student to dismiss it and say “well, actually, I think I was doing better before. I might steer away from that information” is a skill that’s easier to have when you’re surrounded by a lot of other people. Not everyone has that luxury.” 68
“Absolutely, but it’s difficult for the younger students. They respect their teachers. It’s not so easy when one authority says ‘this is how you do it’ then another authority says ‘no, this is how you do it’, but one of the things that has helped me is the business of static verses flexible use of the muscles, for example on shows like Strongest Man on Earth where strong guys compete in various tasks. One of the things they had to do was just lift a heavy ball and just hold it for as long as they could. Some held it for 22 seconds and some held it for like 14 seconds, which shows that the business of static is really difficult. For me, I didn’t really have the strong embouchure like some others have, but I had the flexibility. I did really enjoy when I had to play something high then a little break and then something low. Others have told me that they find it difficult and kind of get stuck up there, but for me it’s the other way around. It’s because they stiffen up because some authority told them to not change their embouchure.” #53
“In terms of allowing the chest and shoulder to rise during inhalation as mentioned earlier, it’s not that you can’t do that, and I presume that I, as well as many other horn players, when there’s something coming up and you’ll need that extra bit of air, then it’s ok to raise the shoulders, but what that might incorrectly imply, is that I’m going to use gravity pulling my shoulders down to create the foundation I mentioned earlier. It’s just a bit more air. The foundation still needs to come from the huge muscles mass in the abdominal area, that some horn players have more than others, where you have a huge reservoir of muscular energy, which if channeled properly can be used to create beautiful things through the instrument.” #84
“Yes, for sure. I do because it just helps you separate the bull-dust or lead you down paths that would be wasted energy or in fact impact your playing in a negative way. I think there’s a lot of onus on the teachers to have their pedagogical approaches together in this regard” #14
“Yes. It’s not bulletproof because of the weird exceptions here and there, but this is a case ‘more being more’ and now it depends on how the information is being used as to whether it’s helpful or not because there are so many variables. It’s not a case of ‘if [this] then {that}’, because once there’s a few variables in the mix, and there are so many variables that we don’t really about. We need it in the discussion for sure.” #88
“Well, I think that you must be very aware of how your body works and you must know what works for you and what doesn’t. I remember for example being in a class with Dale Clevenger. He was really clear about “this is the way I play. If you want to sound like me you need to play this way. It’s not the only way to play but it’s the way you are going to do it this way”, and my horn teacher has the philosophy that he can tell you something, you must then go into the practice room and discover if it works for you. If it doesn’t, you can try something different.” #30
“Well sure! I mean, this is all a very new field of study, right? There hasn’t been very much at all written about it. Right now there is a lot of attention towards focal dystonia. Marie Louise Neunecker wrote a really revealing article about it which was really beautifully researched. She said in the article that of the studies she’s seen of older players most, none of them recovered from it. Because your psychology kicks in as well. Bringing more focus to be more cautious about this is good because people aren’t really aware that they can really hurt themselves. In the past years I’ve received email from Hollywood horn players and I’ve met horn professors who are playing all the time and they tell me that they have this weird focal dystonia thing going. I almost got it. I tell them to do some research. I always tell them to read Neuneckers’ article. It’s the first time I’ve seen somebody talking very frankly about the topic. I think that knowledge of how that can happen to you, knowledge of tension especially to the lower back etc are things that you learn the hard way. When you’re young, you may not be aware of that and you might as well teach younger students to be aware of it and not just give a student a horn and say, “go practice”. It’s kind of taking from The Inner Game of tennis a little bit, which is something I grew up on as well in terms of just visualising what you want to do and your body will do it and that worked while I was young, but as I’ve gotten older I realise I can’t do that anymore. Without letting it mess me up, I have to be aware of what I’m doing physically.” #21
“I think that is the bridge actually, between these different schools actually. I think that you’re got people who are very doctorate based and have a specific method, others who are extremely intuitive, but I think that it’s the awareness of the body that can sew both of these approaches together.” #79
“Yes and no. In theory, yes. But when it comes to pedagogy I don’t think I would respond well to someone say “you need to move this muscle there for this effect” maybe to a certain extent, but what I’m trying to say is that everyone learns in a different way I suppose and it’s about, weather that particular teacher can explain the anatomy or not, how they voice it to the individual student depending on how the student learns more effectively.” #20
“Yes.” #16
“Yes. If you have an understanding of the anatomy, that can help everyone, but I don’t think it’s compulsory. There are a lot of people who don’t understand anatomy and still play the horn pretty well.” #82
“This is not really possible because I am one of those who see that there is one healthy way and there are just maybe 10 percent who play with another system which might be good for them, but I see all the best horn players from all around the world who have the same system that I developed for myself. I feel a little bit confirmed that this is for a normal, ergonomic way to play for 40-50 years. There are other ways that are limited so I think there is not so much possibility for variation.” #95
“Yes. Approaches need to be scientifically defensible.” #40
“The younger the players, I think, the more ‘kneading’ they need and when we talk about how to ideally serve a young talented player I think the recommendation would be to stick with one teacher for a while, and then when there’s a certain amount of knowledge learned then they are able to receive more information from different sources. So in order not to have directly contrasting I think it’s either good to work in teams where there’s an overlap. I’ve been very lucky in that I have a colleague, Rodolfo Epelde, in Madrid who knows more about the technical aspect and embouchure. I think we do not contradict each other and I think that’s why we’re getting good results. Now weather the young players would be able to have musically applied knowledge of anatomy in order to filter this, maybe that’s wishful thinking because this surely can only be aquired. You need to trust the person who’s instructing you for a little while. Of course you can filter the process “I like this”, “I don’t like that”, but I think you have to take the whole package at one time and then move on later.
It’s a very good question but in other words, even if it’s dogmatic in nature I think that it needs to be strong leadership and some kind of direction in the beginning, then later on, maybe getting even more information from different players.
As part of a response to an earlier question, I can remember reading in Daniel Bourgue’s book that he suggested to change the vowel sound when moving into the high register which is in contrast to the lessons I had with Ifor James where he would say that he was thinking of a neutral “üüüüüü” or “øøøøøøø” sound across the whole range without changing the tongue. It’s interesting to try both and see what works for you” 73
“I think it can. With a lot of what we do being focused on things like hand position, posture, support and use of air in the body etc, I think it’s one of those things that I find is very critical and the reason is that we know what works for ourselves and we know what we’re doing, but in order to be good teachers we need to be able to see what we’re doing that works and say ‘my student can’t do what I do, so how do I adapt and how do I tell them or show them what might work’. I think that’s probably one of the most critical things we do as teachers is to show our students how our body is the instrument.” #38
“Yes, I definitely do. I think that there’s no such thing as a set-and-forget with the horn. I tend to be a bit more experimental with my teaching. I’ll analyse weather something I’m doing works for the student or not. Everybody is so different.” #22