Musicians´ Health and Performance 1St Nordic Conference 2013

THE NORTHERNMOST UNIVERSITY of Technology in Scandinavia MHPNC Musicians´ Health and Performance 1st Nordic Conference 2013

Piteå, Sweden, 13-14 June 2013 Welcome to Acusticum, Piteå, for the first Nordic Conference in music medicine. The Conference is a new forum for researchers and clinicians, as well as musicians and music teachers with a special interest in Musicians´ Health and Performance

1 www.ltu.se/mhpnc2013 Contents

About the Organizers ...... 4

Welcome to Scandinavia’s most Northern University of Technology ...... 4

Organizing Committe Members...... 5

Program Committee Members ...... 5

Conference Overview ...... 7

Time Schedule ...... 8

Day 1 - Thursday June 13 ...... 8

Day 2 -Friday June 14 ...... 9

Keynote Speakers ...... 10

Abstracts ...... 11

Keynote presentations ...... 13

Workshop presentations ...... 14

Scientific presentations ...... 16

Clinical presentations ...... 25

Musical Performance ...... 31

Sponsors and Collaborators ...... 31

The world’s most modern organ at Luleå University of Technology

2 3 About the Organisers

Welcome to Scandinavia’s most Northern University of Technology Organizing Committe Members Luleå University of Technology is Scandinavia’s most northern university of technology, and offers world-class n Melt Levin, Conference Coordinator research and education. Our main campus is located in Luleå, a city with approximately 75,000 residents and which Office of Marketing and Communications Luleå University of Technology, Sweden lies 120 km south of the Arctic Circle. It takes about an hour to fly to Luleå from Stockholm. n Ulrik Röijezon, Assistant Professor, , Chair of Conference Our university is young. It was established in 1971 with 50 students and a small number of employees. Now, we are Dept. of Health Sciences, Luleå University of Technology, Sweden one of the country’s largest higher education institutions with 17,000 students and 1,600 employees. The other cam- n Lars Nyberg, Professor puses are located in Kiruna, Piteå, Skellefteå and Filipstad. Dept. of Health Sciences, Luleå University of Technology, Sweden We are foremost a university of technology, with specialised education primarily within civil engineer programmes, n Ulrika Lindstrom, PhD Student but we also offer creative and artistic subjects such as dance, music and theatre. We also provide the opportunity to Dept. of Health Sciences, Luleå University of Technology, Sweden study subjects such as philosophy and media with various specialisations. Program Committee Members Departement of Health Sciences n Lars Nyberg, Professor The Department of Health Sciences is part of the Faculty of Humanities and Social Sciences and offers several Dept. of Health Sciences, Luleå University of Technology, Sweden programmes, including: Physical Therapy, Occupational Therapy, Health Guidance, Radiography, Nursing and several n Ulrik Röijezon, Assistant Professor Specialist Nursing programmes. Dept. of Health Sciences, Luleå University of Technology, Sweden The department’s activities are based on the Luleå campus. Several of the programmes and most of the single n Teresia Nyman, PhD subject courses are offered in the form of distance education. Research and post-graduate studies are conducted Karolinska Institutet and KTH Royal Institute of Technology, Stockholm, Sweden within, e.g., Physical Therapy, Occupational Therapy, Nursing, Health Promotion, Sports Science and Medicine, and n Svend Erik Mathiassen, Professor Pharmacology. Dept. of Occupational and Public Health CBF, Centre for Musculoskeletal Research, University of Gävle, Sweden Musicians´ Health and Performance 1st Nordic Conference 2013 n Karen Søgaard, Professor The Conference is a new forum for scientists, clinicians, musicians and music teachers with a special interest in inst. of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark Musicians´ Health and Performance, and is arranged by the Department of Health Sciences at Luleå University of n Birgit Juul-Kristensen, Associate Professor Technology. inst. of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark MHPNC 2013 will be the first Nordic Conference devoted to musicians´ health and performance and provides an n Annchristine Fjellman-Wiklund, Associate Professor opportunity to take part of and discuss recent progress in the area of music medicine. Dept. of Community Medicine and Rehabilitation, Umeå University, Sweden The goal of the Conference is to bring together scientists, clinicians and musicians with special interests in various n Helene Paarup, PhD aspects of musicians´ health and performance to share their knowledge and ideas. The results of the Conference are Dept. of Occupational and Environmental Medicine, Odense University Hospital, Denmark expected to promote further research and development, and promote national and international collaborations within n Helena Börjesson this area. Betania FHV, Stockholm, Sweden Topics covered include, e.g., musculoskeletal disorders, stress, hearing, health promotion, sensorimotor control and n Lotte Nygaard Andersen, PhD Student learning, performance, creativity, and related interventions. inst. of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark

4 5 Conference program MHPNC2013

MHPNC - luleå University of Technology

Day 1 - Thursday June 13 Day 2 - Friday June 14

Black Box Class Room Black Box Class Room 08:00-09:00 Registration 08:00-09:00 Registration

09:00-09:20 Welcome Speech 09:00-10:00 Keynote 3 - Fredrik Ullén

09:20-09:40 Scientifi c Presentation 1 09:20-10:20 Workshop 1 Katarina Porander 09:40-10:00 Scientifi c Presentation 2 Body control while 10:00-10:20 Scientifi c Presentation 3 playing music 10:00-10:20 Scientifi c presentation 9

10:20-10:50 Coffee break 10:20-10:50 Coffee break

10:50-11:50 Keynote 1 - Bronwen Ackermann 10:50-11:10 Scientifi c presentation 10 10:50-11:50 Workshop 3 - Bronwen 11:10-11:30 Scientifi c presentation 11 Ackermann embouchure 11:30-12:30 Workshop 4 - Kjell Fageus 11:50-12:10 Scientifi c Presentation 4 11:50-12:10 Clinical presentation 1 Mental training 11:50-12:10 Clinical presentation 3 12:10-12:30 Scientifi c Presentation 5 12:10-12:30 Clinical presentation 2 12:10-12:30 Clinical presentation 4

12:30-13:30 Lunch 12:30-13:30 Lunch

13:30-14:00 Lunch Concert 13:30-14:00 Clinical presentation 8 - Finland 13:30-14:00 Clinical presentation 5 The health care of the musicians - the fi nnish perspective

14:00-14:20 Scientifi c Presentation 6 14:00-14:50 Workshop 2 14:00-14:30 Clinical presentation 9 - Denmark 14:00-14:30 Clinical presentation 6 artist- och Musikerhälsan i establishment of a clinic for music- 14:20-14:40 Scientifi c Presentation 7 Malmö Playing situations ians at a University hospital with instruments 14:30-15:00 Clinical presentation 10 - Sweden 14:30-15:00 Clinical presentation 7 14:40-14:50 Scientifi c Presentation 8 The process of teamwork - artist och Musikerhälsan i Malmö

14:50-15:30 Coffee break 15:00-15:30 Coffee break

15:30-16:20 Keynote 2 - Karen Søgaard 15:30-16:50 Panel discussion - Future directions? research, clinical specialisation and occupational health services for musicians´ health & performance

16:20-18:00 Reception och networking 16.50-17.00 Closure

19:00- Conference dinner at Stadshotellet i Piteå

6 7 Day 1 - Thursday June 13 Day 2 - Friday June 14 Black box Black box 09.00-09.20 WELCOME SPEECH - Mai Lindström, Head of Dept of Health Sciences 09.00-10.00 Keynote 003 Fredrik Ullén and Christer Wiklund, Head of Dept. of Arts, Communication and Education THE MUSIC PERFORMING BRAIN 09.20-09.40 Scientific 001 Lotte Nygaard Andersen, Kirsten Kaya Roessler, Henning Eichberg 10.00-10.20 Scientific 009 Lotte Nygaard Andersen, Camilla Marie Larsen, Helene Paarup, PAIN AMONG PROFESSIONAL ORCHESTRAL MUSICIANS: Birgit Juul-Kristensen, Eleanor Boyle, Karen Søgaard A CASE STUDY IN BODY CULTURE AND HEALTH PSYCHOLOGY EFFICACY OF ‘SPECIFIC STRENGTH TRAINING’ OR ‘GENERAL FITNESS TRAINING’ 09.40-10.00 Scientific 002 Jesper Hvass Schmidt, Ellen Raben Pedsersen, Helene M Paarup, AND INFLUENCE ON SELF-ASSESSED PHYSICAL FITNESS IN PROFESSIONAL SYMPHONY Jakob Christensen-Dalsgaard, Ture Andersen, Torben Poulsen, Jesper Bælum ORCHESTRA MUSICIANS - A RANDOMIZED CONTROLLED PILOT TRIAL HEARING LOSS, TINNITUS AND HYPERACUSIS IN RELATION TO SOUND EXPOSURE 10.20-10.50 Coffee break OF PROFESSIONAL SYMPHONY ORCHESTRA MUSICIANS

10.00-10.20 Scientific 003 Ian MacDonald, John Rubin, Shashi Hirani, Edward Blake, Ruth Epstein 10.50-11.10 Scientific 010 Annika Schönning AN INVESTIGATION OF ABDOMINAL MUSCLE RECRUITMENT FOR SUSTAINED LIFELONG LEARNING - A STUDY ABOUT ORCHESTRA MUSICIANS IN “THE THIRD AGE” PHONATION IN 25 HEALTHY SINGERS 11.10-11.30 Scientific 011 Camilla Marie Larsen, Lotte Nygaard Andersen, Helene Paarup, Eleanor Boyle, Birgit Juul-Kristensen, Karen Søgaard 10.20-10.50 Coffee break MUSCULOSKELETAL TROUBLES IN PROFESSIONAL ORCHESTRAL MUSICIANS: THE INFLUENCE ON GENERAL HEALTH AND PLAYING PERFORMANCE? 10.50-11.50 Keynote 001 Bronwen Ackermann MUSICIANS’ HEALTH – PAST, PRESENT AND FUTURE 11.30-12.30 Workshop 004 Kjell Fagéus ARTISTIC MENTAL TRAINING FOR STAGE AND EDUCATION 11.50-12.10 Scientific 004 Ulrik Röijezon, Birgit Juul-Kristensen MOTOR CONTROL ALTERATIONS IN MUSICIANS 12.30-13.30 Lunch WITH MUSCULOSKELETAL PAIN DISORDERS 13.30-14.00 Clinical 008 Miikka Peltomaa 12.10-12.30 Scientific 005 Birgit Juul-Kristensen, Ulrik Röijezon THE HEALTH CARE OF THE MUSICIANS - THE FINNISH PERSPECTIVE HYPERMOBILITY AMONG MUSICIANS – ADVANTAGE OR DISADVANTAGE? Finland

12.30-13.30 Lunch 14.00-14.30 Clinical 009 Peder Jest 13.30-14.00 Lunch Concert – Kristallkvartetten (Crystal Quartet) ESTABLISHMENT OF A CLINIC FOR MUSICIANS AT A UNIVERSITY HOSPITAL Denmark 14.00-14.20 Scientific 006 Cinzia Cruder 14.30-15.00 Clinical 010 Karin Engquist, Ing-Marie Olsson, Inga-Britt Niemand FITNESS TRAINING TO IMPROVE MUSICIANS’ HEALTH, WELLBEING AND PERFORMANCE ARTIST- & MUSIKERHÄLSAN - DESCRIBING THE PROCESSES OF TEAMWORK TO HELP 14.20-14.40 Scientific 007 Cecilia Wahlström Edling, Anncristine Fjellman-Wiklund STUDENTS AND PROFESSIONAL MUSICIANS WITH INJURIES, BOTH IN TERMS OF PAIN, STRAIN AND JOY - MUSICIANS´ PERCEPTIONS OF THE WORK SITUATION REHABILITATION AND PREVENTION IN SYMPHONY ORCHESTRAS Sweden

14.40-15.00 Scientific 008 Marit Danielsen 15.00-15.30 Coffee break WHEN MY FEET HELP ME PLAY PIANISSIMO. A CASE STUDY OF THE TIMANI-TECHNIQUE AS AN EXAMPLE FOR EMBODIED MUSIC PERFORMANCE TEACHING 15.30-16.50 Panel discussion - Future directions for research, clinical specialization and occupational health services for musicians´ health & performance? 15.00-15.30 Coffee break Moderator Svend Erik Mathiassen

15.30-16.20 Keynote 002 Karen Søgaard 16.50-17.00 Closure RISK FACTORS FOR MUSCULOSKELETAL DISORDERS, WHY ARE MUSICIANS AT RISK AND DO WE HAVE RESEARCH-BASED SUGGESTIONS FOR PREVENTION? Class room

16.20-18.00 Reception and networking 10.20-10.50 Coffee break

Class room 10.50-11.50 Workshop 003 Bronwen Ackermann EMBOUCHURE AND BREATHING WORKSHOP FOR PRACTITIONERS 09.20-10.20 Workshop 001 Katarina Porander 11.50-12.10 Clinical 003 John Macfarlane, Boni Rietveld GOOD BODY CONTROL WHILE PLAYING MUSIC THE PREVENTION OF COMPLAINTS IN MUSICIANS 10.20-10.50 Coffee break 12.10-12.30 Clinical 004 John Macfarlane, Boni Rietveld HYPERMOBILITY AND THE MUSICIAN 11.50-12.10 Clinical 001 Kim Eriksen1, Helene M. Paarup MUSIC STUDENTS AND THE ALEXANDER TECHNIQUE 12.30-13.30 Lunch

12.10-12.30 Clinical 002 John Macfarlane, Boni Rietveld 13.30-14.00 Clinical 005 Kerstin Dahmén, Andreas Sjögren MALIGNANCIES PRESENTING AT A PERFORMING ARTS MEDICINE CLINIC MUSICIANS AND HEARING PROBLEMS

12.30-13.30 Lunch 14.00-14.30 Clinical 006 Grete, Ege Gronlund 13.30-14.00 Lunch Concert – Kristallkvartetten (Crystal Quartet) HOW TO PLAY MUSIC IN HARMONY WITH YOUR BODY - MUSIC PHYSIOLOGY, A PREVENTION SUBJECT TO AVOID STRAIN INJURIES IN MUSICIANS 14.00-15.00 Workshop 002 Ing-Marie Olsson, Karin Engquist, Inga-Britt Niemand 14.30-15.00 Clinical 007 Mary McGovern WORKSHOP FOCUSING ON VARIOUS PLAYING SITUATIONS THE ALEXANDER TECHNIQUE FOR MUSICIANS WITH SPECIFIC INSTRUMENTS 15.00-15.30 Coffee break 8 15.00-15.30 Coffee break 9 16.20-18.00 Reception and networking Keynote Speakers Fredrik Ullén, PhD, Professor Fredrik Ullén is professor of cognitive neuroscience at the Karolinska Institutet, Stockholm. He is a very successful Swedish researcher who combines his research career with an international career as a concert pianist, and is also a member of The Royal Swedish Academy of Music. Fredrik Ullén’s research involves neural mechanisms of expertise, in particular musical expertise. His research focuses on exercise effects on the brain, learning skills, the brain’s handling of rhythm and timing, and creativity. Presentation: THE MUSIC PERFORMING BRAIN

Karen Søgaard, PhD, Professor Karen Søgaard is professor at the Institute for Sports Science and Clinical Biomechanics, University of Southern Denmark in Odense, Denmark. She has over 25 years research experience in exercise physiology, biomechanics, ergonomics and epidemiology. Her main focus is in physical education, health promotion, prevention and rehabilitation of musculoskeletal disorders. Karen Søgaard is an authority in occupational health medicine and will give her view of Abstracts musician medicine within the broader context of occupational medicine for conference program 2013 Presentation: RISK FACTORS FOR MUSCULOSKELETAL DISORDERS, WHY ARE MUSICIANS AT RISK AND DO WE MHPNC HAVE RESEARCH-BASED SUGGESTIONS FOR PREVENTION?

Bronwen Ackermann, PhD, PT Bronwen Ackermann is Australia’s leading specialist physiotherapist in the area of musicians’ health research, injury prevention and clinical treatment. She is an active clinician and researcher, working in the Sydney Medical School at the University of Sydney. She currently leads the Linkage grant, Sound Practice, with all the major Australian orchestras as industry collaborators to address occupational health risks within the orchestral workplace. Bronwen Ack- ermann’s research interests include investigating better clinical movement analysis protocols for musicians, refining targeted rehabilitation and injury prevention strategies, and investigating physiological characteristics of elite music performers. Presentation: MUSICIANS’ HEALTH – PAST, PRESENT AND FUTURE

10 11 Keynote presentations

Keynote 001 MUSICIANS’ HEALTH – PAST, PRESENT AND FUTURE

Bronwen Ackermann Discipline of Biomedical Science, Sydney Medical School, Lidcombe, NSW 1825, Australia.

Abstract This presentation will present an overview of the emergence of the field of music medicine and the typical injuries faced by this population. Research to date has proposed a number of key risk factors leading to injury in performers, and the common injuries seen in the clinical setting. A particular challenge faced today by clinicians and researchers is that our methods of assessment and rehabilitation have not been targeted to meet the needs of this hyper-functioning population and are based on traditional models of deficit-based assessment and injury management that only returns performers to a general population norm. Goals and strategies of future research will be discussed including task analysis of injured musicians in this population, the need for establishing potential boundaries of ‘how much is too much’, the challenges of implementing injury surveillance and prevention programs, and extending our clinical management to encompass the needs of elite performers.

Keynote 002 RISK FACTORS FOR MUSCULOSKELETAL DISORDERS, WHY ARE MUSICIANS AT RISK AND DO WE HAVE RESEARCH-BASED SUGGESTIONS FOR PREVENTION?

Karen Søgaard Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark

Abstract It is well known from work physiology, that repetitive and high frequency movements is a risk factor for development of musculoskeletal disorders. Aggravating factors are low degree of variation, high demands on precision both in relation to timing and level of force as well as high mental demands and irregular working hours. For many musicians this is a description of their occupational exposure both during practice and performance. There- fore, it is not surprising that a literature search on musculoskeletal disorders among musicians reveals a large number of papers documenting a high frequency of playing related disorders. There is a considerable relation between disorders in different locations and the instrument played, which clearly indicate an ergonomic factor. Of notice is that female musicians and string players are most at risk for attracting symptoms. For musicians, musculoskeletal disorders not only cause pain and decreased quality of life but may also have an effect on performance and the chances to continue as a musician. Therefore, there is a crucial need for good prevention and treatment of musculoskeletal disorders among musicians. Good ergonomics aims to fit the task to the man and usually involve both an adjustment of tools and work place as well as the advice to increase variation as much as possible during the repetitive work task. Obviously these advices are hard to follow for a musician. Recently, the concept of intelligent physical exercise training has been evaluated and especially for sedentary jobs with high repetitive movements has shown a pain relieving effect. Such an approach may also benefit musicians if it can be tailored to their specific needs.

Keynote 003 THE MUSIC PERFORMING BRAIN

Fredrik Ullén Dept. of Neuroscience, Karolinska Institutet, SE-171 77 Stockholm, Sweden

Abstract Musicians have become one of the most commonly used model groups in studies of expertise and brain plasticity, and the neurobiology of music is today a well-established field of research within cognitive neuroscience. In this talk, I will summarize some major findings that have emerged from research on the brains of musicians, and discuss a number of current key questions in the field. Topics to be discussed include effects of musical training on the anatomy and function of the brain, whether there are sensitive periods for musical training during development, transfer effects of musical training on other abilities, and specific effects of training musical improvisation. I will also present a recently started collaborative research programme, Humans Making Music, where we study a number of broad questions 12 relating to the neuropsychology of music from a behavior genetic perspective. 13 Workshops

Workshop 001 Workshop 004 GOOD BODY CONTROL WHILE PLAYING MUSIC ARTISTIC MENTAL TRAINING FOR STAGE AND EDUCATION

Katarina Porander Kjell Fagéus Ergokinetics company, Espoo, Finland Freelance, Stockholm, Sweden

Abstract Abstract The presentation contains practical demonstrations with music students. The teacher participates with their student The purpose of this training is that musicians may perform at their own highest level with flow. The training follows a and present the physical problems in playing. The physiotherapist is working on the body by doing different exercises progressive line and provides a physical and mental space where the musicians can feel calm, confident, and free to and after that transfer a better body function to playing. A balanced and naturally working body and good playing try, play, fail and succeed. Our individual learning stories will have a prominent place. Stories will be used as a “mirror technics goes hand in hand, this is what we will experience in this workshop. Musculoskeletal injuries will happen as gallery”, where the musician can reflect himself or herself. The progressive line and the space rig a setup where a result of insufficient body control and incorrect training. Music education that emphasized body consciousness is knowledge and experience creates by itself - from within the musicians. Participants are trained in mental strengths, important when preventing injuries, but it also makes playing easy and relaxed. In the end of the workshop there will strengths in traditional sense and more profound allowing oneself being human, sensitive and vulnerable. be a discussion about the importance right ergonomics and the role of the physiotherapist in music education and training of teachers.

Workshop 002

WORKSHOP FOCUSING ON VARIOUS PLAYING SITUATIONS WITH SPECIFIC INSTRUMENTS

Ing-Marie Olsson, Karin Engquist, Inga-Britt Niemand Artist- och Musikerhälsan, Malmö, Sweden

Abstract Workshop about different playing situations depending on which instrument you are playing. Ergonomics with focus on stable positions and balanced movements while playing in sitting or standing positions (1, 2, 3 ). Special focus at the interplay between the musician and the instrument (4). Tension and pain (5 ) is common problems for the musicians and for the students. We want to illustrate the analysis and the change with starting-point from a string instrumentalist (6), a wind instrumentalist (7) and a pianist (8 ). Presentation of the function of the shoulder girdle because of it´s complexity and how to find strain-free movements. Some improving exercises will be presented.

References 1. Dropsy J. Den harmoniska kroppen: en osynlig övning. Borås: Natur och Kultur; 1993. 2. elphinston J. Total stabilitetsträning: Prestationsutvecklande, skadeförebyggande, övningar och teori. Stockholm: SISU Idrottsböcker; 2006. 3. roxendal G, Winberg A. Levande människa: Bassal Kroppskännedom för rörelse och vila. Falköping: Natur och Kultur; 2002. 4. Chamagne Ph. Prévention des troubles fonctionnels chez les musiciens: aleXitère; 1996 5. Ingvar M, Eldh G. Hjärnkoll på värk och smärta. Stockholm: Natur och Kultur; 2012. 6. Sazer V. New Directions in Cello Playing. Los Angeles: ofnote; 1995 7. Pearson L. Body Mapping for Flutists. Chicago: GIA Publications; 2012 8. Mark Th. What every pianist needs to know about the body: Chicago: GIA Publications, Inc.; 2003

Workshop 003 EMBOUCHURE AND BREATHING WORKSHOP FOR PRACTITIONERS

Bronwen Ackermann Discipline of Biomedical Science, Sydney Medical School, Lidcombe, NSW 1825, Australia.

Abstract Background: For singers, woodwind and brass players, precise control of the breathing apparatus, jaw and facial muscles are critical to reach and sustain optimal performance levels. Very little research has been done with musicians, particularly wind players, and much of the existing respiratory research is based on respiratory diseases or maximal airflow topics. Purpose of workshop: The aim of this workshop is to give a summary of existing evidence on breathing mechanisms and facial muscle activity patterns, including new research conducted on 115 wind musicians characterizing these patterns into instrument-specific demands. Following this, clinical methods of assessing and rehabilitating breathing and embouchure dysfunction based on functional anatomy and scientific evidence will be discussed and 14 practiced. 15 hearing thresholds of 6.3 dB compared to the musicians with lowest exposure. Trumpet players and the left ear of 1st Scientific presentations violinists had significant elevated hearing thresholds compared to other musicians. 1st violinists had on average 5.6 (95% confidence interval (CI) 2.4- 8.9) dB poorer hearing on their left ear compared to the right ear which was related Scientific 001 to the asymmetric exposure. Approximately one third of the musicians complained of hearing associated symptoms. No statistic significant relationship between increased exposure and increased risk of tinnitus and hyperacusis could PAIN AMONG PROFESSIONAL ORCHESTRAL MUSICIANS: be observed. A CASE STUDY IN BODY CULTURE AND HEALTH PSYCHOLOGY Conclusions: Most of the symphony orchestra musicians had normal hearing but they had a work-related risk of developing additional noise induced hearing loss. Increased risk of tinnitus and hyperacusis in relation to the expo- 1 2 1 Lotte Nygaard Andersen , Kirsten Kaya Roessler , Henning Eichberg sure could not be observed. The observed additional noise induced hearing loss was at the expected level based on 1Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark, reference values from cumulated sound exposure (3). 2Institute of Psychology, University of Southern Denmark, Odense M, Denmark References Abstract 1. Schmidt, JH, Pedersen, ER, Juhl, PM, Christensen-Dalsgaard, J, Andersen, TD, Poulsen, T, Bælum, J. Sound Introduction: Professional musicians experience high rates of musculoskeletal pain(1, 2), but only few studies have exposure of Symphony Orchestra Musicians. Ann.Occup.Hyg 2011;55:893-905 investigated how this pain is accepted by musicians. 2. international Organization for Standardization. ISO7029. Acoustics -- Statistical distribution of hearing thresholds Aim: To investigate the culture of pain and to explore how professional musicians experience and cope pain. as a function of age. International Organization for Standardization; 2000. Methods: Ten semi-structured in-depth interviews were conducted; eight with musicians and two with professional 3. international Organization for Standardization. ISO1999. Acoustics -- Determination of occupational noise expo- elite athletes. In addition, a concert and two rehearsals were observed. The audio-taped interviews were transcribed sure and estimation of noise-induced hearing impairment. International Organization for Standardization;1990. verbatim. Configurational analysis was used to interpret the material as a whole.

Results: Musicians often experience pain as a consequence of prolonged repetitive work early in their career. Such Scientific 003 pain is only compounded by the lack of breaks during concerts and rehearsals. Orchestras seldom give opportunities for adjustments required for individual instruments, for breaks or for action to prevent pain. Musicians’ strong sense AN INVESTIGATION OF ABDOMINAL MUSCLE RECRUITMENT of coherence and the experience of pain as integral to their identity have encouraged musicians to develop flexible FOR SUSTAINED PHONATION IN 25 HEALTHY SINGERS coping strategies. Ignoring pain and potential damage is an accepted concomitant to striving for perfection. A musician does not focus on pain but on the music. Ian MacDonald, John Rubin, Shashi Hirani, Edward Blake, Ruth Epstein Conclusion: For the musician pain has a significance beyond being something that can simply be removed by a University College London, London, UK practitioner. Pain tells both an individual and a cultural story that is crying out to be heard. Abstract References Objectives: The purpose of this study was to investigate the baseline muscle thickness and recruitment patterns 1. Zaza C. Playing-related musculoskeletal disorders in musicians: A systematic review of incidence and prevalence. of the transversus abdominis muscle [TAM] and the internal oblique muscle [IOM] during semi-supine phonation in a Canadian Medical Association Journal. 1998 1998;158:1019-25. group of healthy performers. 2. leaver R, Harris EC, Palmer KT. Musculoskeletal pain in elite professional musicians from British symphony Study design: This 2x3x2 within groups, repeated measures study examined changes just prior to vocalising a sim- orchestras. Occupational medicine (Oxford, England). 2011 Dec;61(8):549-55. ple vowel (/a:/), the absolute changes in millimetres and the percentage change measures calculated for three voice qualities (modal, opera and belt), and at two pitches (low and medium ). Scientific 002 Methodology: The convenience sample had 12 males and 13 females, with an average age of 21.9 years (sd=4.28). HEARING LOSS, TINNITUS AND HYPERACUSIS IN RELATION TO SOUND A control was labelled “modal voice” (no technical preparation) and “opera quality” and “belting quality” were chosen for the athleticism required. Measurements were taken with ultrasound [Sonosite Micromaxx US] of the baseline EXPOSURE OF PROFESSIONAL SYMPHONY ORCHESTRA MUSICIANS thickness and % recruitment during voicing, of the two deep abdominal muscles. A transducer was placed trans- versely across the abdominal wall on a point between the inferior angle of the rib cage and the iliac crest and 10cm 2 ,4 1 ,4 1 ,4 Jesper Hvass Schmidt , Ellen Raben Pedsersen , Helene M Paarup , from the umbilicus until the antero-medial aspect of the transversus abdomens was visualised. On-screen callipers Jakob Christensen-Dalsgaard3, Ture Andersen2 ,4, Torben Poulsen5, Jesper Bælum1 ,4 were then used to take a very clear measure from a frozen M-mode image. Correlations between TAM and IOM ab- 1Dept. of Occupational and Environmental Medicine, Odense University Hospital, University of Southern Den- solute change scores; TAM and IOM percentage change scores; and muscle changes (absolute and percentage) and 2 mark, DK, Odense, Denmark, Dept. of Audiology Odense University Hospital, University of Southern Denmark, age, were examined. Gender differences in the 4 types of change scores within each combination of pitch and quality 3 DK, Odense, Denmark, Institute of Biology, Centre for Sound Communication, University of Southern Den- were conducted with one-way ANOVAs. Alpha level was set to 0.05. mark,, Odense, Denmark, 4Institute of Clinical Research, University of Southern Denmark, Odense, Denmark, 5Centre for Applied Hearing Research, Department of Electrical Engineering, Technical University of Denmark,, Results: In terms of absolute contractions (changes in the actual millimetre thickness of the muscle) the IOM was Lyngby, Denmark always greater than the TAM. However, in terms of percentage changes in muscles, the TAM was always greater than the IOM. Changes in absolute measures are related between the IOM and the TAM; however, percentage changes in Abstract the TAM and IOM are generally not correlated significantly. The AT M as a percentage change was recruited preferen- Background: Professional symphony orchestra musicians are exposed to loud sounds from music but it is still tially and significantly in most vocal qualities tested. Although there were differences in muscle mass and recruitment debated whether increased sound exposure leads to an increased risk of noise induced hearing loss and hearing patterns between genders, and males had thicker muscle mass at rest, these differences were not conclusive. associated symptoms such as tinnitus and hyperacusis (1). Tinnitus and hyperacusis may be particular predominant Conclusions: Overall this study supports the argument that the peri-abdominal muscles do indeed play a role in in a population of musicians since musicians especially pay attention to audiologic symptoms. supporting the “performing” or athletic voice in healthy subjects, and will hopefully act as a database for further Objectives: To estimate the hearing status objectively and subjectively of classical symphony orchestra musicians research in individuals with healthy and injured voices. and to investigate the hypothesis that occupational sound exposure of symphony orchestra musicians leads to elevated hearing thresholds and increased risk of hearing associated symptoms. Scientific 004 Design: The exposure was estimated by binaural sound measurements of the sound exposure during concerts, rehearsals and personal practice. 212 musicians from five symphony orchestras took part in audiometric testing and MOTOR CONTROL ALTERATIONS IN MUSICIANS WITH the test results were analysed in relation to the individual exposure. The musicians’ individual exposure was estimat- MUSCULOSKELETAL PAIN DISORDERS ed on the basis of sound measurements and data from a cross sectional self-reported questionnaire regarding the exposure time. The mean hearing threshold at the frequencies 3, 4 and 6 kHz, corrected for age and gender (2), was Ulrik Röijezon1, Birgit Juul-Kristensen2 ,3 used as objective outcome and subjective outcomes were hearing loss, tinnitus and hyperacusis. 1Department of Health Sciences, Luleå University of Technology, Luleå, Sweden, 2Institute of Sports Science Results: Most of the musicians had better hearing at 3, 4 and 6 kHz for age than expected. Musicians with an and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark, 3Institute of Occupational 16 average annual exposure above 90.4 dBA and with a mean exposure time of 41.7 years showed significant elevated Therapy, Physiotherapy and Radiography, Bergen University College, Bergen, Norway 17 Abstract musicians, although the studies of this group are few. Therefore, larger epidemiological studies are necessary to Musculoskeletal pain disorder (MSD) is a common cause for long-term work absenteeism among both women and confirm an association between GJH and musculoskeletal disorders in musicians, and whether specific precautions men in the western world, including the Nordic countries. Musicians represent a profession highly afflicted with pain or preventive strategies should be taken for this group. disorders, especially the areas of the neck, shoulder, arm, hand and the upper and lower back. During the last decades an abundant amount of research has reported associations between MSD and motor control References disturbances. Common findings include altered neuromuscular coordination and reduced movement precision, as 1. Juul-Kristensen B, Hansen H, Simonsen EB, Alkjaer T, Kristensen JH, Jensen BR, et al. Knee function in well as reduced strength, endurance and mobility. These disturbances can be of importance for recurrence and dura- 10-year-old children and adults with Generalised Joint Hypermobility. The Knee. 2012;19:773-8. tion of the disorders, but also for work ability. Presumably, this can be of specific significance, with risk for absentee- 2. Remvig L, Jensen DV, Ward RC. Epidemiology of general joint hypermobility and basis for the proposed criteria ism among professions with high demands on motor control. for benign joint hypermobility syndrome: review of the literature. J Rheumatol. 2007;34(4):804-9. Musicians are highly dependent on fine motor control, such as fast and accurate finger movements, as well as 3. Brandfonbrener AG. Joint laxity and arm pain in a large clinical sample of musicians. Med Probl Perform Art. postural and muscular endurance. Although the amount of research on motor control in pain disorders is extensive, 2002;17(september):113-5. only a few studies have investigated sensorimotor functions among musicians with musculoskeletal pain disorders. 4 larsson LG, Baum J, Mudholkar GS, Kollia GD. Benefits and disadvantages of joint hypermobility among Altered posture has been reported, where one study reported dysfunction of the postural stability systems of the low musicians. NEnglJ Med. 1993;329(15):1079-82. back, shoulder and neck among musicians with playing related disorders (1). However, this study lacked an asymptomatic control group. A couple of studies have reported increased sensorimotor disturbances of the hand and arm Scientific 006 among music students with symptoms compared to asymptomatic controls (2, 3). A few studies have investigated muscle activity of superficial neck-shoulder muscles in musicians with neck pain while playing the violin or viola, but FITNESS TRAINING TO IMPROVE MUSICIANS’ HEALTH, the results are incoherent reporting both increased and reduced muscle activity, e.g. (4, 5). WELLBEING AND PERFORMANCE Taken together, altered motor control appears to be a concern for musicians with playing related MSD. There is, though, a need for further investigation into motor control functioning among musicians and the association with Cinzia Cruder MSD, especially whilst playing musical instrument. Increased insights in this area can be of important value for pre- Research and development Division of the University school of music, Lugano, Switzerland vention and rehabilitation strategies. Abstract References This research consists of a Doctorate program’s proposal and will develop fitness assessments and exercise pro- 1. Steinmetz A et al. Impairment of postural stabilization systems in musicians with playing-related musculoskeletal grammes tailored to specific instrumental groups, thereby complementing the more general research already under- disorders. J Manip Physiol Ther. 2010 Oct;33(8):603-11. taken in similar institutions. 2. Daenen L et al. Sensorimotor incongruence triggers sensory disturbances in professional violinists. Rheumatology. The training required to reach the highest levels of performance is significant for musicians. The achievement and 2010 Jul;49(7):1281-9. improvement of musical competences and technical abilities are subject to the use of the body, sometimes in un- 3. Baskurt Z et al. Assessment of kinesthetic awareness and fine motor dexterity in music students with natural positions, by means of continuous and repeated movements; it will come as no great surprise that musicians performance-related hand disorders. Healthmed. 2012;6(10):3395-402. experience susceptible changes in musculature, bone structure, circulation and respiration to the same degree as 4. Berque P, Gray H. The influence of neck-shoulder pain on trapezius muscle activity among professional violin expert performers in other domains (1). At length, a daily practice routine accompanied by straining and repetitive and viola players. Med Probl Perform Art. 2002 Jun;17(2):68-75. movements can even degenerate into chronic health problems and musculoskeletal injuries which may affect musi- 5. Park KN et al. Comparison of Electromyographic Activity and Range of Neck Motion in Violin Students with and cians irreparably. without Neck Pain During Playing. Med Probl Perform Art. 2012 Dec;27(4):188-92. The causes of these musculoskeletal symptoms have been documented mainly as being over practising, insufficient rest breaks, poor posture, poor physical condition, change of instrument or inadequate instrument set-up, difficult repertoire, and stress of a demanding lifestyle (2). Concerning the importance of prevention to avoid ill health within the profession, musicians can been seen (at least Scientific 005 to some extent) as athletes of the upper body. However, all athletes warm up before and cool down after practice HYPERMOBILITY AMONG MUSICIANS – ADVANTAGE OR DISADVANTAGE? and performance because injuries are common if muscles are not exercised. Zaza and Farewell (3) demonstrated that warming up before, taking breaks during practice and cooling down after practice and performance can prevent Birgit Juul-Kristensen1 ,2, Ulrik Roijezon3 performance-related pain and injuries. 1Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark,, Odense,, Denmark, Unfortunately, musicians often tend to underestimate the long-term consequences of bad habits and stress on their 2Institute of Occupational Therapy, Physiotherapy and Radiography, Bergen University College,, Bergen,, Nor- physical and mental health. Indeed, according to Williamon et al. (4), musicians tend not to score well on standard- way, 3Department of Health Sciences, Luleå University of Technology, Luleå,, Sweden ized tests of physical fitness. Giving the physicality of musicians’ work, it would be thus suitable to develop specific and tailored exercises, focused on strengths and weaknesses of each instrument. Abstract Nonetheless, studies directly relating to instrument-specific fitness are conspicuously missing from the literature, and Generalised Joint Hypermobility (GJH) is a condition frequent seen in several hereditary diseases of connective therefore musicians must turn to generic recommendations from other fields, such as exercise science, sport and disorders. It is defined from the maximal range of motion, often by the Beighton score, representing the laxity of the dance. involved ligaments. GJH is a genetic feature, but also susceptible to training. GJH in adults is, when present with The main aim will be to improve musicians’ health and wellbeing by changing individual musicians’ attitudes toward symptoms, characterised by functional limitations (1), decreased muscle strength, stability, proprioception, and an health music making and by creating a step change in educational and employment contexts. altered gait and muscle activity pattern. References There are no precise prevalence rates of adults with Generalised Joint Hypermobility (GJH), but a recent review 1. Allard F, Starkes JL. Motor-skill experts in sports and other domains. In: Ericsson KA, Smith J, editors. reports a varying prevalence for adults from 2-57% depending on age, gender and ethnic origin. For children the Toward a General Theory of Expertise: Prospects and Limits. Cambridge: Cambridge University Press; prevalence varies from 7-36%, primarily depending on the tests and criteria (especially the cut off-points) used for 1991. p. 126-152. diagnosing GJH. GJH is more frequent in females/ girls than males/boys (2). 2 Wynn Parry CB. Managing the physical demands of musical performance. In: Williamon A,editor. Several studies found GJH to be frequent among performing artists, such as ballet dancers, gymnasts, and even Musical Excellence. New York: Oxford University Press; 2004. p. 41-60. musicians (3) and hypothesized an association between GJH and development of musculoskeletal disorders. As an 3 Zaza C, Farewell VT. Musicians’ Playing-Related Musculoskeletal Disorders: An Examination of Risk Factors. example, professional dancers have higher physical fitness (walking distance, muscle strength, estimated VO2-max) american Journal of Industrial Medicine. 1997; 32(3): 292-300. than a matched control group, but for those with GJH, this advantage was not present. 4. Williamon A, Wasley D, Burt-Perkins R, Ginsborg J, Hildebrandt W. Profiling musicians’ health, wellbeing, In a study of musicians a clear association was found between forearm and hand pain and GJH in 35% of female and and performance. In: Williamon A , Pretty S, Buck R, editors. Proceedings of the International Symposium 17% of male musicians (3), and also an increased prevalence of knee and spine symptoms in musicians with GJH on Performance Science 2009. Association of European Conservatoires; 2009. p. 85-90. (4). It has been suggested, that when playing music GJH is even an advantage, especially for joints that move quickly (wrists, elbows), but a disadvantage for joints that should stabilise (knees, back). However, one study did not find such association between symptoms and GJH in pianists. 18 In summary, there seems to be some association between musculoskeletal injuries and GJH, presumably also in 19 Scientific 007 for music performance teaching and 2) suggest how an understanding for functional anatomy and the body as lived “expressivity center” can be a part of music teachers’ professional knowledge, and what methodological and ethical PAIN, STRAIN AND JOY - MUSICIANS´ PERCEPTIONS OF THE WORK considerations this implicates. SITUATION IN SYMPHONY ORCHESTRAS Triangulation of perspectives was a goal for the analysis and was enabled by merging different data that content as follows: 1) Participating observation, 2) Written notes from three musicians, 3) Video recordings of master class situ- Cecilia Wahlström Edling1 ,2, Anncristine Fjellman-Wiklund1 ations, 4) In-depth interviews with the three musicians with use of stimulated recall and 5) Background and follow-up 1Department of Community Medicine and Rehabilitation, Physiotherapy, Umeå University, 901 87 Umeå, interviews with the teacher. Sweden, 2Umeå Center for Gender Studies, Umeå University, 901 87 Umeå, Sweden Preliminary results show that when the three musicians learn how to perform with the principles explained in the course, a “wow factor” occurs: The three musicians explain their own sound as ‘richer’, ‘more resonant’, ‘open- Abstract er’, ‘having more core’, ‘less forced’. The three musicians’ explain their experiences of performing as ‘feeling more Introduction: Musicians perform demanding work tasks under psychological pressure (1). Work-related musculo- stable’, ‘finally experiencing what support is’, ‘releasing tension’, ‘being confused’, ’being surprised’, ‘feeling free in skeletal symptoms as well as stress and stage fright, are common problems in symphony orchestras (2). Research the body’, ‘getting more space for the breath’. The three musicians start to use the learnt anatomy terminology to shows that physical work-load interplay with psychosocial factors in the genesis of musculoskeletal symptoms (3). express their more articulated and nuanced understanding of their bodies as being an important part of their instru- This study aimed at exploring how musicians in symphony orchestras perceive and deal with their work situation and ment. related symptoms. It is discussed how terms from human movement science could contribute in the field of music education as an Methods: The study had a qualitative approach with semi-structured interviews. Three women and three men in empowering methodology that takes into consideration musicians’ health challenges and the relationship between professional symphony orchestras were interviewed. The interviews were tape-recorded, transcribed and analyzed musical expression and experienced movement. according to a phenomenographic approach. References Results: Four themes emerged from the interviews. There were High external and internal demands, ascribed as part 1. Holmes P, Holmes C. The performer’s experience: A case for using qualitatitve (phenomenological) methodologies of the requirements of the profession. The orchestra was described as a collective, dependent on the individuals to in music performance research. Musicae Scientiae. 2013;17: 72-85 produce high quality concerts. No mistakes or excuses were accepted from themselves or their colleagues. Physical 2. Jensenius AR. Musikk og bevegelse [Music and movement]. Oslo, Norway: Unipub; 2009 demands such as tiring, locked work postures and not being allowed to choose chair or take a break when needed were addressed. The loud work environment contributed to stress. The informants experienced Mental and physical symptoms. They felt nervous, vulnerable and exposed, both during rehearsals and concerts. This made it difficult to Scientific 009 control the instrument and tone quality. Muscle tension, stiffness and pain were described, in connection to periods with high work-load or through the professional lifespan. Hearing problems were vividly described. The musicians EFFICACY OF ‘SPECIFIC STRENGTH TRAINING’ OR ‘GENERAL FITNESS had Multiple ways of handling the work situation, often in combinations. Body awareness and mental training tech- TRAINING’ AND INFLUENCE ON SELF-ASSESSED PHYSICAL FITNESS IN niques were used to focus better on work tasks and to cope with symptoms. Physical exercise was considered to PROFESSIONAL SYMPHONY ORCHESTRA MUSICIANS - A RANDOMIZED be important in order to cope with the physical demands. Physical exercise could also make muscle pain become CONTROLLED PILOT TRIAL worse. It was difficult to find relief from musculoskeletal symptoms. The musicians often played despite of pain and had difficulties getting adequate treatment. The musicians loved the music and to perform it, and expressed both Joy Lotte Nygaard Andersen1, Camilla Marie Larsen1, Helene Paarup2, Birgit Juul-Kristensen1 ,3, and satisfaction. High demands on perfection contributed to symptoms, but also to good concerts. Some colleagues Eleanor Boyle1, Karen Søgaard1 were close friends, and positive feed-back from them was important, although too seldom communicated. 1Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark, Conclusions: This study contributes to a deeper understanding of the work situation in a symphony orchestra and 2Department of Occupational and Environmental Medicine, Odense University Hospital, Odense C, Denmark, what difficulties to handle. Health promotion programs including teaching young music students how to cope with 3Institute of Occupational Therapy, Physiotherapy and Radiography, Bergen University College, Bergen, Nor- such situations, and how to prevent musculoskeletal symptoms, at an early stage in the career is important. way

References Abstract 1. Wahlström Edling C, Fjellman-Wiklund A. Musculoskeletal disorders and asymmetric playing postures of the upper Introduction: Among professional musicians playing-related disorders are frequent with a point prevalence from extremity and back in music teachers - A pilot study. Med Probl Perform Art 2009; 24: 113-118. 39% to 87% (1). This is probably due to static contractions and repetitive movements during long rehearsals and 2. liljeholm Johansson Y, Theorell T. Satisfaction with work task quality correlates with employee health. concerts. Holding and playing an instrument for many hours implied high demands of precise and accurate grasps Med Probl Perform Art 2003; 18: 141-149. that cannot be performed without a certain muscular endurance and strength (2). Although, there is still no evidence 3. Fjellman-Wiklund A, Sundelin G, Brulin C. Musicianship and teaching: Positive health factors in music teachers. for training methods, effective training appears to represent a balance between the musician’s health and the quality Med Probl Perform Art 2002; 17: 3-10. of playing (1). The aims of the study were, 1) to evaluate efficacy of two interventions on general pain and physical capacity, 2) to evaluate interventions influence on self-assessed physical fitness. Methods: A total of 23 professional symphony orchestra musicians were randomly allocated to either 1) specific strength training group (SST, n=12) or 2) general fitness training group (GFT, n=11). The participants conducted 3 × 20 Scientific 008 minutes training each week at the workplace for 9 weeks. WHEN MY FEET HELP ME PLAY PIANISSIMO. General pain was rated on a 100 mm visual analog scale (VAS) prior (PRE) and post (POST) intervention. Aerobic A CASE STUDY OF THE TIMANI-TECHNIQUE AS AN EXAMPLE power was estimated in a submaximal bicycle test. Self-assessed physical fitness was evaluated with a questionnaire containing five items; aerobic fitness, muscle FOR EMBODIED MUSIC PERFORMANCE TEACHING strength, endurance, flexibility and balance rated on a Likert scale. Results: At baseline the two groups did not differ on age, gender, BMI, grip strength, aerobic power or general pain Marit Danielsen (p=0.18-0.73). From PRE to POST GFT increased significantly in aerobic power (Δ=5.9(0.93 to 10.9) ml/kg/min) com- Bergen University College, Bergen, Norway pared to the decrease in SST (Δ=-1.8 (-3.9 to 0.34) ml/kg/min) (p<0.01). Abstract From PRE to POST, SST showed a significant reduction in pain (ΔVAS=-14.9 (-29.9 to 0.3) mm) (p=0.05), while GFT With phenomenology and embodied music cognition as theoretical and methodological framework (1, 2) I investigate decreased non-significantly (ΔVAS=-6.3 (-13.6 to 1.0) mm) (p=0.09). However, GFT increased in self-assessed muscle with a qualitative approach what happens when three advanced musicians are at a course with a music performance strength from PRE to POST (Δ=-0.7(-1.2 to -0.3)) (p<0.01). teaching approach that claims to be based on the body’s premises. The teaching approach is developed by a Norwe- Discussion and conclusion: This study showed a clinically relevant lowering of general pain in SST. GFT achieved gian pianist with a special interest for anatomy and biomechanics, and it seems to be based on a holistic perspective an increase in aerobic power but this increase in cardiorespiratory fitness was generally not reflected in the mu- on musicians’ health where physiological and psychological challenges for music performers are seen as a whole. sicians’ own assessment of their physical fitness. However, GFT assessed an increase in muscle strength which The research question I pose is the following: How can knowledge about the body and attention to music performers’ could indirectly be related to a perceived improvement in functional capacity. The clinical relevance of the increase in bodily experiences contribute to music performance teaching? The purpose with the study is 1) to achieve insight self-assessed muscle strength may be questioned and more studies on interventions with training tailored to improve 20 in what happens with the three musicians’ sound quality and experiences of performing when the body is subject musicians’ physical fitness are needed. 21 References ed high 12-month prevalences of MSK symptoms between 83 to 97% (3). Knowledge is scarce regarding the effect 1. Zaza C. Playing-related musculoskeletal disorders in musicians: A systematic review of incidence and prevalence. of MSK pain on general health and how upper body pain affects performance among musicians. First aim was to Canadian Medical Association Journal. 1998 1998;158:1019-25. investigate the relationship between physical pain in all body regions and self-reported general health. Second aim 2. Wilke C, Priebus J, Biallas B, Frobose I. Motor activity as a way of preventing musculoskeletal problems in was to investigate if upper extremity (UE) MSK pain impacted playing performance. string musicians. Medical problems of performing artists. 2011 Mar;26(1):24-9. PubMed PMID: 21442133. Methods: Baseline data from a RCT of professional orchestral musicians (n=23). General health assessment and epub 2011/03/29. eng. level of general physical pain were based on SF-36 Health-Survey. All participants were divided into two subgroups based on pain during the past four-weeks rated on a Likert Scale. ‘No’ or ‘only very light’ pain formed the ‘no-pain’- Scientific 010 group(NoP) while ‘light pain’ and three other levels formed the ‘pain’-group(P). Participants who in the Disability of Arm, Shoulder or Hand questionnaire (DASH) reported primary pain in the UE LIFELONG LEARNING defined the group with UE troubles. Impact on playing performance was based on selected questions from the music A STUDY ABOUT ORCHESTRA MUSICIANS IN “THE THIRD AGE” module of the DASH-questionnaire classified as either ‘having’- or ‘not having’-difficulties with playing their musical instrument or as ‘having’- or ‘not having’-problems with spending the usual amount of time doing work within past Annika Schönning week. Maximal pain was defined as highest marked score within UE on a pain manikin. Stockholm Royal Philharmonic Orchestra, Stockholm, Sweden Results: At baseline NoP and P did not differ on age, gender, BMI, years of playing the instrument and type of instrument played (p=0.33-1.00). All participants reported general health status as either ‘good’ (NoP:5, P:6) or ‘very good’ Abstract (NoP:4, P:8) with no significant difference in distribution between pain groups (p=0.41). What differentiates orchestra musicians from most other professional groups is that their learning period is extremely Of the 23 participants, 18 (78%) reported primary troubles related to UE, while 13 (72%) of these had ‘difficulties’ with long; those who continue the hobby of their youth into a musical profession may have prepared their professional playing their musical instrument. No significant difference in level of maximal pain was found between those with ‘no life for 15, perhaps 20 years (1, 2, 3, 4). Their working life could be described as a continuation of their student years difficulties’:3.0±1.9 and those with ‘difficulties’:4.6±2.1 (p=0.16). with everlasting new study tasks, but with an implacably prompting time factor. Age has an inevitable impact on the Additionally, 14 (78%) participants had ‘problems’ with spending their usual amount of time doing work. There were professional life of the musicians (5) and the musicians self-criticism forces them to quit before they “have become a no significant differences in level of maximal pain between ‘no-problems’:3.3±2.1 and ‘problems’:4.4±2.2 (p=0.35). problem”. Musicians are highly intolerant against everything that negatively affects the quality of the play and which Conclusion: In spite of musculoskeletal troubles, musicians reported a good general health status independent of may impair the reputation of the orchestra. Musicians must play their parts well, but the high demands for admission physical pain. There were many reported difficulties with playing performance, but difficulties were not associated to the orchestra usually guarantee that the musician has the capacity to do so during their whole professional life (5). with level of maximal pain. Since data were analyzed secondary to a RCT we acknowledge the possibility of low But not even the expert commands the practised skills forever, expertise demands a continuos grounding. According power. to Brodsky (6) it is remarkable that so little research has addressed the full life span of musicians although orchestras now to 40 % consists of musicians older than 50. Brodsky does not refer to own studies within the area but discuss- References es results which could emanate from future research; have orchestra musicians in general more resistance or higher 1. Leaver R, Harris EC, Palmer KT. Musculoskeletal pain in elite professional musicians from British symphony ability to recover than the general population? Is it because of the life-long musical training, or is it a life-style of play- orchestras. Occupational medicine (Oxford, England). 2011 Dec;61(8):549-55. PubMed PMID: 22003061. ing and performing that somehow makes the musicians – more than the rest of the population – immune to aging, Pubmed Central PMCID: PMC3428866. Epub 2011/10/18. eng. Brodsky wonders. My study describes individual learning strategies as well as collective learning among experienced 2. Zaza C. Playing-related musculoskeletal disorders in musicians: A systematic review of incidence and prevalence. orchestra musicians in “the third age”; 50 to 65 years old. I have interviewed seven string-musicians working in the Canadian Medical Association Journal. 1998 1998;158:1019-25. three largest symphony orchestras in Sweden. The results show that their work methods change over time in relation 3. Paarup HM, Baelum J, Holm JW, Manniche C, Wedderkopp N. Prevalence and consequences of musculoskeletal to their experiences but also due to physical and mental wear. It was obvious that there is a problem to verbalise the symptoms in symphony orchestra musicians vary by gender: a cross-sectional study. BMCMusculoskeletDisord. learning process and to differentiate individual from collective learning. The musicians´ thoughts about strategies to 2011 2011;12:223. maintain the best individual playing condition during their whole professional life were subordinated the development of the collective. The study wants to initiate a discussion about individual “restoration” of orchestra musicians in “the third age”. Scientific 012 Poster presentation

References A COMBINATION OF CONSTRAINT INDUCED THERAPY AND MOTOR 1. Bloom BS, editor. Developing Talent in Young People. New York: Ballantine Books; 1983. CONTROL RETRAINING IN THE TREATMENT OF FOCAL HAND DYSTONIA 2. ericsson KA, editor. The development of professional expertise: Toward measurement of expert performance IN MUSICIANS – A LONG TERM FOLLOW UP STUDY and design of optimal learning environments. New York: Cambridge University Press; 2009. p. 405-431. 3. McPherson GE, Williamon A. Giftedness and talent. In: McPherson GE, editor. The Child as Musician. Patrice Berque1, Heather Gray2 ,3, Angus McFAdyen4 a Handbook of Musical Development. New York: Oxford; 2006. p. 239-256. 1Department of Physiotherapy, Glasgow Royal Infirmary, Glasgow, Scotland, UK, 4. Sloboda JA et al. The role of practice in the development of performing musicians. British Journal of Psychology. 2School of Health and Life Sciences, Glasgow Caledonian University, Glasgow, Scotland, UK, 1996; 87: 287-309. 3Institute of Health and Wellbeing, University of Glasgow, Glasgow, Scotland, UK, 4AKM-STATS, Glasgow, 5. Smith DWE. The great symphony orchestra. International Journal of Aging and Human Development. 1988; 27(4). Scotland, UK 6. Brodsky W. Rationale behind investigating positive aging among symphony orchestra musicians. Musicae Scientiae. 2011; 15(1): 3-15. Abstract Purpose and relevance: Focal hand dystonia (FHD) in musicians is a painless task-specific motor disorder charac- terized by involuntary loss of control of individual finger movements. It is associated with decreased cortical inhibi- Scientific 011 tion, and maladaptive cortical reorganization showing fusion of the representational zones of the digits in the primary somatosensory cortex.1 Research investigating the long-term effects of rehabilitation strategies for FHD is lacking. MUSCULOSKELETAL TROUBLES IN PROFESSIONAL ORCHESTRAL MUSICIANS: The aim of this study was to investigate the long-term effects of a combined behavioural therapy intervention, aimed THE INFLUENCE ON GENERAL HEALTH AND PLAYING PERFORMANCE? at normalising finger movement patterns. Methods: Eight musicians with FHD volunteered to take part. One year of intensive constraint-induced therapy and Camilla Marie Larsen1, Lotte Nygaard Andersen1, Helene Paarup2, Eleanor Boyle1, motor control retraining at slow speed were the interventions.2 A quasi-experimental repeated measures (within-sub- Birgit Juul-Kristensen1 ,3, Karen Søgaard1 ject) design was used, with 9 testing sessions over 4 years. Video recordings of the subjects playing two pieces 1Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, M, Denmark, were used for data analysis. The Frequency of Abnormal Movements scale (FAM),3 the change in metronome speed 2 Department of Occupational and Environmental Medicine, Odense University Hospital, Odense, C, Denmark, achieved during motor control retraining,4 and two ordinal dystonia evaluation scales (DES) were chosen as outcome 3 Institute of Occupational Therapy, Physiotherapy and Radiography, 3Bergen University College, Bergen, measures. It was hypothesized that there would be significant differences in AF M scores achieved over the 4-year Norway period. Abstract Results: The results from the two-factor repeated measures ANOVA for the main outcome measure, the FAM scale 22 Introduction: Musculoskeletal (MSK) symptoms are frequent in orchestral musicians (1,2). A recent study of report- scores, revealed that the mean number of abnormal movements per second of instrumental playing decreased sig- 23 nificantly by approximately 80% for both pieces over the 4-year period (F = 7.85, df = 8, p < 0.001). Tukey’s post-hoc test revealed that statistically significant improvements occurred after 6 months of therapy (p-values between p < Clinical presentations 0.001 and p = 0.044). Although the results were not significant between month 12 and follow-up at year 4, the trend revealed that the progress achieved during the first year of intensive retraining was maintained at year 4. Clinical 001 Conclusions and implications: A 1-year period of intensive task-specific retraining may be a successful long-term strategy for the treatment of musician’s FHD, with a significant trend towards normalisation of movement patterns MUSIC STUDENTS AND THE ALEXANDER TECHNIQUE over time. Indeed, the progress achieved during the initial 12-month period was maintained at follow-up at year 4. Results also suggest that retraining strategies may need to be carried out for at least 6 months before statistically Kim Eriksen1, Helene M. Paarup2 significant changes are noted. 1Royal Academy of Music, Copenhagen, Denmark, 2Odense Universitets Hospital, Odense, Denmark

References Abstract 1. Elbert T, Candia V, Altenmüller E, Rau H, Sterr A, Rockstroh B, Pantev C, Taub E: Introduction: In the last couple of decades the interest for scientific research of Alexander Technique (AT) has alteration of digital representations in somatosensory cortex in focal hand dystonia. increased and so has research within musicians’ health. Among musicians AT has been popular for years as a means Neuroreport 1998; 9:3571-3575. to alleviate playing-related musculoskeletal problems and facilitate performance1,2. Many major music conservato- 2. Berque P, Gray H, Harkness C, McFadyen A: A Combination of Constraint-induced Therapy and Motor Control ries offer AT to their students. Among musicians improvements in performance after AT lessons have been objectively retraining in the Treatment of Focal Hand Dystonia in Musicians. Med Probl Perform Art 2010; 25:149-161. assessed1,3. AT is known to affect different aspects of motor behavior and can result in changed postural regulation 3. Spector JT, Brandfonbrener AG: A new method for quantification of musician’s dystonia: the frequency of when standing as well as in increased adaptability of muscle tone - and posture changes and reduced muscle activity abnormal movements scale. Med Probl Perform Art 2005; 20:157-162. have been demonstrated1,4. Musculoskeletal problems are frequent among professional orchestra musicians with 4. Sakai N: Slow-down exercise for the treatment of focal hand dystonia in pianists. Med Probl Perform Art 2006; one-year prevalence rates of more than 80%5,6. The musculoskeletal disorders in professional musicians are often 21:25-28. repetitive strain injuries. The majority of symphony orchestra musicians have experienced that musculoskeletal problems interfere with their music playing5. Scientific 013 Poster presentation Aims: The overall aim was to apply AT on academy music students to direct themselves in their motion pattern while playing in order to facilitate that they apply as little force as possible when playing and that playing positions are HEALTH SURVEY OF ORCHESTRA MUSICIANS adjusted to be less strenuous. A PILOT STUDY ON JAZZ MUSICIANS IN A BIG BAND Methods: This 12 weeks course in AT with one lesson per week was held at The Royal Danish Academy of Music in 2012. Mostly 8-10 students were present although 17 had assigned to the course. Students were instrumentalists Joakim Söderena1, Dennis Nyqvist1, Ulrik Röijezon1 and singers from different classes. The AT course was group-based and comprised hands-on guidance as well as 1Department of Health Sciences, Physiotherapy, Luleå University of Technology, Luleå, Sweden verbal explanation to teach the students how to reduce improper postural and movement habits, and to alter habitual movement responses to pain into coordinated movements requiring less effort. However, no specific measuring of Abstract any effect of the course was planned on forehand. Background:Musculoskeletal pain and psychosocial disorders are wide spread in the adult population and have been reported to be the most common causes for work absenteeism among men and women in Sweden (1). High Discussion: Based on the consecutive dialogues with the students during the course it turned out that the students prevalence of musculoskeletal and psychosocial complaints have been reported among musicians (2, 3). Most pre- appeared to attend the course for different reasons; some due to having musculoskeletal problems while others vious research have involved classical musicians, music teachers and students, while little is known about the health intended to improve their playing. While working with the coordination of their playing positions the sound of their situation among professional jazz musicians. playing was improved and some experienced less tensed/sore muscles. However, no specific follow-up was planned to ensure that the students were able to continue improving with their playing positions without the AT teacher. Objective: The aim was to display the prevalence of musculoskeletal disorders, hypermobility, health, psychosocial Objective measures of the effect of AT courses for academy students explored by using qualitative and quantitative situation and physical activity among professional jazz musicians in a Swedish big band orchestra. research methods should be performed. Method: Professional musicians in one big band orchestra were offered participation. The study had a cross sectional design, where participants completed a questionnaire at one occasion. Musculoskeletal pain was measured with References Nordic Questionnaire; hypermobility with a Swedish version of the Five-part questionnaire; health with SF-12; psy- 1. Valentine et al. The effect of lessons in the Alexander Technique on music performance in high and low stress chosocial factors with Demand-Control-Support questionnaire, SOC-13 and seven Mood adjectives (scoring 0-10), situations. Psychol Music 1995;23:129-41. where three adjectives were positive and four negative. Physical activity was measured with IPAQ. 2. Woodman, Moore. Evidence for the effectiveness of Alexander Technique lessons in medical and health-related conditions: a systematic review. Int J Clin Pract 2012;66:98-112. Result: Five of ten musicians in the big band orchestra volunteered to participate and all five completed the ques- 3. Jones. Voice production as a function of head balance in singers. J Psychol 1972;82:209-15. tionnaire. The participants were all men, 38-50 years of age, playing wind instruments. Two of the five musicians 4. Cacciatore et al. Increased dynamic regulation of postural tone through Alexander Technique training. reported pain within the last year and week, localized to neck, shoulder, arm and upper back. None reported inability hum Mov Sci 2011;30:74-89. to play at their regular level due to musculoskeletal symptoms. No general hypermobility was found, i.e., no partici- 5. Paarup et al. Prevalence and consequences of musculoskeletal symptoms in symphony orchestra musicians vary pant scored two or more on the five part questionnaire. Mean values for SF-12 were 52.1 ±5.5 and 49.2 ±8.7 for PCS by gender: a cross-sectional study. BMC Musculoskelet Disord. 2011;12:223. and MCS, respectively. Mean values for Demand was 14.8 ±3.0 (7 questions), Control 11.8 ±1.6 (4 questions) and 6. Leaver et al. Musculoskeletal pain in elite professional musicians from British symphony orchestras. Support 9.4 ±1.9 (6 questions). Mean index score for SOC was 5.5 ±1.9 (with sum of scores divided with number of Occup Med 2011;61:549-55. questions). All three positive Mood adjectives were scored relatively high with mean values ranging 5.8-6.8, while the negative Mood adjectives where scored relatively low with mean values ranging 2.0-3.4. Physical activity at least once a week on high intensity was reported by four participants, while only one performed daily walks with duration of ten minutes or more. Clinical 002 Conclusion:A relatively low prevalence of musculoskeletal pain and psychosocial distress where found among MALIGNANCIES PRESENTING AT A PERFORMING ARTS MEDICINE CLINIC the participants. The small group is a major limitation of the study, why generalizations of results are limited. Future research with larger groups of jazz musicians is warranted. John Macfarlane, Boni Rietveld MC Haaglanden, The Hague, The Netherlands References 1. AFA Försäkring. Allvarliga arbetsskador och långvarig sjukfrånvaro, 2012. Abstract 2. Paarup HM, Baelum J, Holm JW, Manniche C, Wedderkopp N. Prevalence and consequences of musculoskeletal We report here four performing artists who were referred for an opinion about their musculo-skeletal complaints, and symptoms in symphony orchestra musicians vary by gender: a cross-sectional study. BMCMusculoskeletDisord. this resulted in 4 widely differing diagnoses. 2011 2011;12:223. 3. Holst GJ, Paarup HM, Baelum J. A cross-sectional study of psychosocial work environment and stress in the A: 22 year-old male amateur musician with 3 months of low back pain, worse after activity but also occurring at night. 24 Danish symphony orchestras. Int Arch Occup Environ Health, 2012 Aug;85(6):639-49. The pain was central and did not radiate to the buttocks or legs. There were no paraesthesiae. He denied skin, joint 25 and eye complaints and had no morning stiffness. Two weeks later he presented with a painful testis. This led to the Clinical 004 diagnosis of testicular cancer with para-aortic metastases for which he received an operation and chemotherapy with success. HYPERMOBILITY AND THE MUSICIAN B: 50 year old amateur ballroom dancer who had 3 weeks’ pain in the lower back with some radiation to both legs but no paraesthesiae He complained of nocturnal pain but no morning stiffness. He denied skin, joint and eye John Macfarlane, Boni Rietveld complaints. There was no compression pain. Standard radiographs showed an compression fracture of T 12 . The MCHaaglanden, The Hague, The Netherlands subsequent MRI suggested a tumor, later confirmed to be a non-Hodgkin Triple B lymphoma for which he is receiving Abstract radiotherapy, a corset and chemotherapy. It is self-evident that hypermobility might be an asset for dancers. For musicians this is less certain. Of course a high C: 58 year old dance teacher (and smoker) with pain in the right elbow two months after heavy physical effort. The degree of dexterity is required but this does not necessarily have to be linked to any hypermobility. Indeed, in our pain was mainly localized to the medial epicondyle but radiated to both the upper and lower arm and was made experience, hypermobility can be detrimental for optimal performance. worse by use. A radiograph of the right elbow disclosed a lytic lesion in the distal humerus. A thorax radiograph First we should consider what is meant by hypermobility. It is common practice to use the Beighton Hypermobility showed an abnormal hilus and some atelectasis. Lung carcinoma was confirmed by bronchoscopy and she has Criteria (1) . The scale is from 0- 9 and, if limited to only the arms, then the scale is 0 to 6. For the majority of musi- received radiotherapy to the humerus and lung and she is at present in a stable condition after 3 chemotherapies. cians the Beighton score is often irrelevant because their increased laxity occurs in one or more of the following joints D: 33 year old professional singer who complained of intermittent pain in the left hip area, gradually worsening over :- 1st carpo-metacarpal (cmc), 1st metacarpal-phalangeal (mcp), inter-phalangeal joint of the thumb, the proximal- 3.5 years with increasing difficulty in mobility but experiencing temporary relief by repeated manual therapy. A radio- and/or distal inter-phalangeal (pips and dips). None of these joints is specifically included in the Beighton scoring graph showed extensive lysis around the acetabulum and a speckled appearance of the os ischium. An urgent MRI scheme. It is quite possible for a musician to have a low Beighton score and still be very hypermobile in the hands. confirmed the suspicion of a chondrosarcoma in the os ischium with invasion of the small pelvis. She has undergone Though the majority of complaints in musicians concern the upper extremity, the legs can be affected:- ankle instabil- several extensive operations including for recurrences.. For the last 4 years she has been in good health. ity, hypermobility and muscle weakness have been seen in organists and drummers. Important clinical lessons can be learned from these patients. The development of the Brighton criteria for the better recognition of the (benign) hypermobility syndrome has result- Even healthy performing artists with musculo-skeletal complaints, seemingly attributable to poor posture or overuse, ed in an improved assessment of many with chronic pain (2). The minor criteria include features more reminiscent of may have an underlying malignancy. such connective tissue disorders as Ehlers -Danlos and Marfan’s syndrome. The specific joints mentioned above are not named but the term arthralgia can surely include those listed. References The consequences of hypermobility for the musician include muscle weakness, tendon irritation, (sub)-luxations, pain Macfarlane JD, Rietveld ABM. Malignancies in a Performing Arts Medicine Clinic. Clin Rheum 2013 (accepted). and premature arthrosis. The treatment options are limited but even just providing information can be beneficial. There is a place for muscle strengthening exercises (core-stability, shoulder stabilization, hand physiotherapy) and various orthotics such as thumb base splints and silver-ring splints. Attention should be paid to posture, both with and without the instrument. Clinical 003 The management of pain requires teamwork and sometimes help from a psychologist.

THE PREVENTION OF COMPLAINTS IN MUSICIANS References 1. Beighton PH Horan F. Orthopedic aspects of the Ehlers-Danlos syndrome. John Macfarlane, Boni Rietveld J Bone Joint Surg [Br]. 1969; 51: 444-453. MC Haaglanden, The Hague, The Netherlands 2. Grahame R. The revised (Brighton 1998) criteria for the diagnosis of benign joint hypermobility syndrome (BJHS). J Rheumatol. 2000;27:1777-1779 Abstract The experience acquired in 20 years of seeing musicians at a performing arts medical centre enables us to formulate Clinical 005 some ideas on the prevention of complaints in performers. It is well accepted that prevention has three categories and it is from the secondary(preventing injury worsening) and tertiary (learning from injury) situations that advice can MUSICIANS AND HEARING PROBLEMS be formulated. Prevention is in mind when choosing an instrument. Clearly age and size are important when viewing the instrumen- Kerstin Dahmén, Andreas Sjögren talist-interface. The weight and size must be taken into account and there are now many aids and possibilities for Artist- och Musikerhälsan, Malmö, Sweden adaptation. Recently more attention has been paid to keyboard span. A common fault in musicians is bad posture; in particular the head and shoulders are too far forward. In the approach Abstract to this problem then the results obtained with Feldenkrais Method, Alexander Technique and Mensendieck therapy What is the influence of subjective hearing problems as tinnitus and hyperacusis and how do we cope with them and are encouraging. There are several factors we have learned by experience that are often present when a musician what type of treatment can we offer them? complains. These include excessive playing, a new teacher, a new technique, a different instrument or new (more As we already know through the result of studies about hearing problems of Kim Kähäri the subjective problems are difficult) repertoire. usually more common among the musicians than in the general population, and more common than hearing loss. In Artist- och Musikerhälsan we have also gone through a questionnaire among orchestra musicians in south of Swe- There is physical effort involved in making music. Heart rates increase considerably during practice, rehearsal, and den (not published) where we saw the same result as of Kähäri. concert, up to 79% of the maximum theoretical heart rate and the energy expenditure can rise by 32% even when And there are often problems of the sound level of the hall where musicians are playing and an impressive stress sitting. In addition the respiratory rate, blood pressure and blood lactate concentrations rise as well as the perceived level. Discussion about sound levels that the ear can stand and protective possibilities. degree of exertion. An obvious overlap with sporting activities exists and aerobic training has certainly been beneficial. There are other aspects which deserve attention such as attention deficit-hyperactivity disorder, music performance Clinical 006 anxiety, focal dystonia, hypermobility, arthrosis; for some of these preventive measures can be taken .A common HOW TO PLAY MUSIC IN HARMONY WITH YOUR BODY- MUSIC PHYSIOLOGY, complaint in musicians concerns myalgias in the lower arms; this is often linked to muscle contractures and some- A PREVENTION SUBJECT TO AVOID STRAIN INJURIES IN MUSICIANS times to a reduced independence of the flexors of the fingers. This cumulative experience has resulted in an information sheet which sets out various pieces of advice in relation Grete Ege Gronlund1, 2 to practising techniques, posture, stretching exercises, aerobic training and giving up smoking. Top music-making 1The Grieg Academy, Bergen, Norway, 2Haukeland University Hospital, Bergen, Norway is similar to top-sport and lessons can be learned from the sports-world. Perhaps the medical and psychological screening of future music students is the next development. Abstract Introduction: The subject Music physiology was developed in 1971 by physiotherapist Lulle Lærum at Bergen References music conservatory. She formed the subject on what she experienced was the need for the young music students Rietveld ABM, Macfarlane JD, Haas GJF de. Some thoughts on the prevention of complaints in musicians and danc- that suffered from different kinds of strain injuries. In addition to a general education on the subject she also gave the 26 ers. Clin Rheum 2013 (accepted). students individually hours. 27 Purpose: The purpose for the subject is to teach the students what to do to avoid strain injuries in order to strenght References their performance and hopefully be able to have a long career as musicians. Alexander, Frederick Matthias. 1932. Reprint. The Use of the Self. Chaterson Ltd., London Method: It is a practical subject where the students learn different exercises to use before, during and after playing Carrington, Walter. 1989. On Categorizing the Alexander Technique. The Alexander Journal no. 10. music. We also focus on the initial positions and the different working positions for the different instruments. The stu- Jones, Frank Pierce. 1976. Body Awareness in Action. Shocken Books Inc., New York. dents get theoretical information on different health topics to increase their understanding about how it effects them McCullough, Carol Porter. 1996. The Alexander Technique and the String Pedagogy of Paul Rolland. Research Paper, to play music at this high level. The subject also discuss health issues and there are individual consultations where Arizona State University, USA. the students bring their instruments. Barlow, Wilfred. 1973. The Alexander Principle. Arrow Books, London. Results: Students evaluate the subject each year. I now present some sentences from their evaluation on the subject of 2012: “I am glad the subject was so practically since it is a short course. It made me able to get better routines of rehearsal Clinical 008 at The Grieg academy”. THE HEALTH CARE OF THE MUSICIANS - THE FINNISH PERSPECTIVE “I warm up the whole body before I start to play and I see that it make my rehearsal more effective.” “After the education I vary my position when I rehearse. I change between to sit and to stand, so I don`t use the same muscles through the rehearsal. I also take more breaks when I play my instrument.” Miikka Peltomaa University of Helsinki, Helsinki, Finland “It was nice having the individual consulting. I got some feedback concerning my sitting position and way of playing that was important to me”. Abstract Conclusion: The students give positive evaluation of the course. It turned out that many of them already had prob- The history of the musicians´ medicine is probably as old as is the history of the musicians. However the organized lems when they began at The Grieg Academy. In order to primary prevent playing related injuries it is important that and systematic professional activity in musicians´ health care is not older than a few decades. In Finland regular musicians are taught to play in harmony with their body when they start to play an instrument. education of musicians´s medicine begun in 1997. The Finnish Musicians´ Medicine Association was established in Keywords: prevention, Music physiology, physiotherapy, strain injuries, musicians 2000 and today the association has more than 300 members including medical doctors, physiotherapists, nurses and - most importantly – musicians and students. The association organizes regular educational meetings for its members References and promotes musicians´ health care in many ways in Finland. The presentation gives an overview of the past and Holst GJ, Paarup HM, Baelum J. A cross-sectional study of psychosocial work environment and stress in the Danish presence of the Finnish musicians´ medicine and provokes ideas to stimulate Nordic collaboration in this field. symphony orchestras. Int Arch Occup Environ Health, 2012 Aug;85(6):639-49. Paarup HM, Baelum J, Holm JW, Manniche C, Wedderkopp N.Prevalence and consequenses of musculoskeletal symtoms in symphony orchestra musicians vary by gender: a cross sectional study. BMC Musculoskeletal Disorders, 2011 Oct 7;12:223 Clinical 009 Dommerholt J.Performing arts medicine-Instrumentalist musicians Part 1-General considerations. Journal of Body- ESTABLISHMENT OF A CLINIC FOR MUSICIANS AT A UNIVERSITY HOSPITAL work & Movement Therapies. 2009 Oct;13(4):311-9 Foxman I, Burgel BJ, Musician Health and Safety. Preventing Playing-Related Musculoskeletal Disorders. AAOHN Peder Jest1 ,2 Journal 2006,54(7):309-316. 1Board, Odense University Hospital, Odense, Region Syddanmark, Denmark, Samama, A. Muscle control for musicians. 2nd ed. Alma Mater Publishers. Bergen,1993. 2Dept. Occupational and Environmental Diseases, Odense University Hospital, Denmark

Clinical 007 Abstract The establishment of a clinic for health problems in performing artists (initially a clinic for diseases that afflict profes- THE ALEXANDER TECHNIQUE FOR MUSICIANS sional musicians) requires the presence of certain key elements; There must be a demand for the clinical solution; clinical expertise in multiple specialties is a necessity and scientific research must support the evidence-based Mary McGovern clinical areas. In order to ensure the qualitative aspects of daily business as well as a continued development of the Alexander Technique Private Practice, Frederiksberg, Denmark area, it is necessary to work with a clinical department with functions in daily clinical work combined with knowledge of organisational/industrial psychology, social issues and occupational and environmental diseases. Abstract Odense University Hospital has collaborated with the University of Southern Denmark in the establishment of a clinic The Alexander Technique is a practical form of health education. It has a substantial history of helping musicians for performing artists (musicians) starting June this year. The proces that forms the basis for the clinic hinges on reduce injury and fatigue and improve technique, physical freedom, musical freedom, stamina and tonal quality. specific managerial tasks. The road from idea to reality is long and winding, and involves complex research regard- Teachers of the Alexander Technique are trained to observe the influence of people’s use of themselves upon func- ing many and varied issues, and at different levels. Focused efforts must be directed towards: planning that involves tion, especially on the functioning of the postural mechanisms and the mechanisms of respiration. By means of the many people with differing interests; financial decisions; negotiations among the involved clinical specialties; good skilled use of his hands and verbal instructions, the teacher helps the pupil to change inappropriate ways of using physical environments; employment of clinicians and researchers; strategic desicions on the board of directors and himself so that he lengthens in stature rather than shortens, so that he widens rather than narrows, so that he frees political acceptance of an unusual health area (1, 2,3). up rather than being stiff. The teacher does this by conveying sensory experiences that physically demonstrate the Applied leadership and managerial obligations involved in this highly complex proces will be presented, and future meaning of the words he uses in teaching. possibilities will be discussed. The relationship between the head, neck and back is of central importance to human balance, coordination and movement. Frederick Matthias Alexander (1869-1955), after whom the Alexander Technique is named, described this References relationship as “the primary control” since it precedes and determines the coordination and use of all the other parts 1. Strube H. dansk specialklinik for musikere [A Danish Specialized Clic for Musicians]. Musikeren.02 jan 2012. of the body. 2. Scmidt JH. Hearing changes in classical musicians and risk factors. [Ph.D. Thesis]. Odense, Denmark. This primary control is of great significance to instrumentalists who want to hold their instrument without compromis- University of Southern Denmark ;2011 ing the functioning of their organism. “Misuse of the primary control [...] is always reflected by misuses somewhere 3. Paarup HM. A questionnaire-based cross-sectional study of musculoskeletal problems, stress, and psychosocial else; this appears in the form of awkwardness, fatigue, and Wilfred Barlow, a London physician and a pupil of Alexan- work environment among symphony orchestra musicians in Denmark. [Ph.D. Thesis]. der, calls “maldistributed muscle tension,” or overtension at one place accompanied by undertension (lack of tone) at Odense, Denmark University of Southern Denmark; 2012 another (Jones 1976, 184).” Violinists and violists, for example, are faced with particular problems in relation to the primary control, since the head, neck and shoulder are directly involved in supporting the instrument. If the player’s head is placed on the chin rest in such a way that the neck loses its natural length and freedom, the body will follow by decreasing in stature. If, on the other hand, the head is freely balanced on a fully lengthened neck, the body will continue to lengthen despite the burden of the weight of the instrument on the left side and the considerable burden of holding both arms up. This expanded, buoyant state of the organism is often compromised by the force of our subconscious, detrimental habits. 28 These habits can be changed, and the Alexander Technique can make an important contribution to the process. 29 Clinical 010 ARTIST- & MUSIKERHÄLSAN - DESCRIBING THE PROCESSES OF TEAMWORK Musical Performance TO HELP STUDENTS AND PROFESSIONAL MUSICIANS WITH INJURIES, Music is performed by the local ensemble Kristallkvartetten (the Chrystal Quartet). All members in Kristallkvartetten BOTH IN TERMS OF REHABILITATION AND PREVENTION. have studied classical music at the School of Music in Piteå, Luleå University of Technology. Various repertoires are performed during the Conference, including a lunch concert on Thursday 13. The lunch con- Karin Engquist, Ing-Marie Olsson, Inga-Britt Niemand cert includes novel art music with strong association to the area of Norrbotten, specifically written for Kristallkvarten Artist- och Musikerhälsan, Malmö, Sweden by composers who are former students at the School of Music in Piteå. Music which has been written with support from Swedish Arts Council, Norrbottens läns landsting and Kluster. Abstract The base for the teamwork is a psychosomatic perspective (1, 2,3) and how the stress reaction influence the individ- Further information about Kristallkvartetten is found at www.kristallkvartetten.blogspot.se ual. When the individuals coming for the first consultation it´s important to listen to their story about the problem, how they deal with the situation and how they react and which strategies they are using. The functioning in the playing situation with the instrument is also important. The team include different competences as medical doctor, physiotherapist with competence in body awareness, psychologist, behavior scientist, Alexander teacher and audiologist and also contacts with teachers of different instrument. Most common problem for musicians are pain and for the professionals located in neck and shoulders and for the students pain in forearms and hands is also common. Performing anxiety and subjective hearing problems are other problems we have to deal with. Risk factors for developing pain are stress (4, 5, 6, 7) without recovery, poor ergonomics that is poor position and/ or unbalanced movements (8)together with the instrument, high demands from their own thoughts or high demands from the environment. The plan for rehabilitation is always individual from what we know about how the person deals with practice routines, training for needed body stabilization and smooth and free movement. Knowledge of daily life style and the meaning of stress is also a common subject. Preventive strategies including seminars at different schools and working places, where we are concentrating about the meaning of stress and ergonomics together with the instruments. The experiences with the professional musicians are that the preventive knowledge is most interesting for them, when musicians have got into troubles. At the Academy of Music in Malmö the physioterapist has courses in ergonomics. The Alexander technics are very useful as a preventive strategies.

References 1. Downing G. Kroppen och ordet: kroppsorienterad psykoterapi- teoretisk bakgrund och klinisk tillämpning. Borås: Natur och Kultur; 1997. 2. Bader Johansson C, Elmgren Frykberg G. Rörelse och interaktion: Om grundmotorik, stress och självreglering. lund: Studentlitteratur; 2013. 3. Roxendal G. Ett helhetsperspektiv- sjukgymnastik inför framtiden. Lund: Studentlitteratur; 1987. 4. Theorell T, red. Psykosocial miljö och stress. Lund: Studentlitteratur; 2003. 5. Green B. with Gallwey W. T. The Inner Game of Music: New York: Doubleday; 1986 6. Railo W. Bäst när det gäller: Farsta: Sveriges Riksidrottsförbund; 1986 7. Salmon P.G. & Meyer R.G. Notes from the Green room: Toronto: Lexington Books; 1992 8. Dropsy J. Den harmoniska kroppen: en osynlig övning. Borås: Natur och Kultur; 1993.

Sponsors and Collaborators Finally, a great Thank You to our sponsor and collaborators, with whom we share this important interest in Musi- cians´ Health and Performance! Without your support we could not have realized this Conference. Thanks to: n Swedish Council for Working Life and Social Research n Musikerförbundet n SYMF, Sveriges yrkesmusikerförbund n Norrbottens läns landsting n Qualisys AB

30 31 SVERIGES YRKESMUSIKERFÖRBUND Luleå University of Technology 2013 2013 Technology of Luleå University

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