ESSENTIAL 10: HEALTH AND SAFETY ISSUES FOR MUSICIANS
Health and Safety Issues[1]
The Cincinnati Christian University Music and Worship Department considers the health and safety of all students, faculty, staff, and visitors to our campus to be of utmost importance. Our objective is to conduct our business in the safest possible manner consistent with the Occupational Health & Safety Act, and other applicable state or local legislation. The department recognizes that a safe working and learning environment is beneficial to employee and student performance. In so far as is possible, all facilities of the department are free of recognized hazards and unsafe conditions. Safety must be a cooperative effort between all employees, students, and visitors. It is the responsibility of all persons using the department’s facilities, resources, and equipment to conduct themselves appropriately, to report any recognized hazards to an appropriate university official, and to avoid placing themselves or others in a dangerous situation. We ask all students, faculty and staff of the department to fulfill their obligation to make this a safe and healthful environment in which to work and learn.
OCCUPATIONAL HEALTH PROBLEMS FOR MUSICIANS
Musicians, as well as other performing artists, may have their careers interrupted by, interfered with, or terminated by occupational health problems involving the musculoskeletal system.
What Are Musculoskeletal Disorders?
Musculoskeletal disorders (MSDs) are injuries of muscles, nerves, tendons, ligaments, joints, cartilage or spinal discs. MSDs usually occur over time and are rarely the result of an instantaneous or sudden event like falling down. Other terms used interchangeably with MSDs are: Repetitive Strain Injury (RSI), Repetitive Motion Disorder (RMD), Overuse Syndrome, and Cumulative Trauma Disorder (CTD). Medical terms used to describe MSDs include tendonitis, bursitis, and carpal tunnel syndrome to name a few.
What Risk Factors Contribute to MSDs?
Risk factors contributing to MSDs are: exertion of force, repetitive movement, awkward postures, and duration of musical performance. There are other risk factors for certain, but these are recognized as the most common and when they occur at high levels and in combination with one another, the risk for developing an MSD multiply.
Exertion of Force
Force is defined as the amount of effort required to perform a task or job. The amount of force you can exert depends on your posture and the number of exertions performed. More force = more stress on the body. Making music should never hurt or cause injury. If it hurts, you are doing something incorrectly.
Repetitive movements
Movements or motions performed over and over are repetitive movements. An awkward posture or position held for long periods of time are also considered repetitive movements. Repetitive movements cause continual stress on the body without adequate muscle recovery time. Muscle rest is important and vital for all musicians.
Awkward Postures
The body is fearfully and wonderfully made. Masterfully designed, the body has natural positions that allow all parts to work together efficiently and without harm to one another. Sadly, we usually work against these natural positions and place the body in unnatural and awkward positions or postures. These awkward positions cause the joints to be held or moved away from their natural position. When joints are forced to go to or beyond the end of range of motion, the greater the stress is put on the soft tissues (muscles, nerves, tendons) of that joint.
Duration of Musical Performance
We tell you practice makes perfect, but excessive practice/performance is unwise. Eager to grow, student musicians can permanently injure themselves if they are not aware of their limitations. Situations that can cause you to practice unsafe practicing include, but are not limited to: a change in technique or instrument; intense preparation for a performance; preparation of a new and difficult repertoire; prolonged periods of performance without rest.
Practice smart practice.
AVOIDING INJURY/STAYING HEALTHY
The National Association of Schools of Music Handbook (2011-2012, p. 67) states, Health and safety depend in large part on the personal decisions of informed individuals. Institutions have health and safety responsibilities, but fulfillment of these responsibilities can and will not ensure any specific individual’s health and safety. Too many factors beyond any institution’s control are involved. Individuals have a critically important role and each is personally responsible for avoiding risk and preventing injuries to themselves before, during, and after study or employment at any institution.
HEARING HEALTH
The National Association of Schools of Music (NASM) and the Performing Arts Medicine Association (PAMA) have developed a comprehensive overview of hearing health issues for postsecondary schools and departments of music. Information of a medical nature is provided by PAMA; information regarding contextual issues in music programs, by NASM. The following information on hearing health is provided by the National Association of Schools of Music (NASM) and the Performing Arts Medicine Association (PAMA).
• Your hearing can be permanently damaged by loud sounds, including music. Technically, this is called Noise-Induced Hearing Loss (NIHL). Such danger is constant.
• Noise-induced hearing loss is generally preventable. You must avoid overexposure to loud sounds, especially for long periods of time.
• The closer you are to the source of a loud sound, the greater the risk of damage to your hearing mechanisms.
• Sounds over 85 dB (your typical vacuum cleaner) in intensity pose the greatest risk to your hearing.
• Risk of hearing loss is based on a combination of sound or loudness intensity and duration.
• Recommended maximum daily exposure times (NIOSH) to sounds at or above 85 dB are as follows:
T 85 dB (vacuum cleaner, MP3 player at 1/3 volume) – 8 hours
T 90 dB (blender, hair dryer) – 2 hours
T 94 dB (MP3 player at 1/2 volume) – 1 hour
T 100 dB (MP3 player at full volume, lawnmower) – 15 minutes
T 110 dB (rock concert, power tools) – 2 minutes
T 120 dB (jet planes at take-off) – without ear protection, sound damage is almost immediate
• Certain behaviors (controlling volume levels in practice and rehearsal, avoiding noisy environments, turning down the volume) reduce your risk of hearing loss. Be mindful of those MP3 earbuds. See chart above.
• The use of earplugs and earmuffs helps to protect your hearing health.
• Day-to-day decisions can impact your hearing health, both now and in the future. Since sound exposure occurs in and out of school, you also need to learn more and take care of your own hearing health on a daily, even hourly basis.
• It is important to follow basic hearing health guidelines.
• It is also important to study this issue and learn more.
• If you are concerned about your personal hearing health, talk with a medical professional.
• If you are concerned about your hearing health in relationship to your program of study, consult the appropriate contact person at your institution.
Links to the following articles are highly recommended for reading and reference.
Protecting Your Hearing Health
http://nasm.arts-accredit.org/site/docs/PAMA-NASM_Advisories/5a_NASM_PAMAStudent_
Information_Sheet-Standard.pdf
Protecting Your Hearing Every Day
http://nasm.arts-accredit.org/site/docs/PAMA-NASM_Advisories/4a_NASM_PAMAStudent_
Guide-Standard.pdf
ADVICE FOR CARE OF THE VOICE
Information below is provided by the Texas Voice Center. For more information on vocal health,
visit www.TexasVoiceCenter.com
Hydration
The vocal folds need to be lubricated with a thin layer of mucus in order to vibrate efficiently. The best lubrication can be achieved by drinking plenty of water. A good rule of thumb (if you have normal kidneys and heart function) is to drink at least two quarts of water daily. Dr. Van Lawrence, world renowned laryngologist, often said, “Drink until you pee pale.” Caffeine and alcohol pull water out of your system and deplete the vocal folds of needed lubrication. Caffeinated drinks include coffee, tea, and soft drinks. Small amounts of these beverages are acceptable but must be counterbalanced by drinking more water. Another factor that can affect lubrication is a dry air environment. The cause can be from gas furnaces, air conditioners, and climates with a low amount of moisture in the air. Using a
humidifier at night can compensate for the dryness.
The air in airplanes is extremely dry. It is recommended that you avoid alcoholic and caffeinated beverages and drink at least 8 ounces of water per hour while flying.
A recommended a favorite gargle recipe of Dr. Lawrence is: Combine ótsp. of salt, ótsp. of baking soda, ótsp. of clear corn syrup, and 6 oz. of warmed, distilled water. Gargle quietly and gently for two long, boring minutes. Do not rinse and use as often as necessary to help your dry, irritated throat.
In addition, Entertainer’s Secret®(800 308-7452) throat spray is an effective way to help moisturize the vocal folds (follow the directions on the label).
Throat Clearing & Harsh Coughing
Throat clearing and harsh coughing are traumatic to the vocal cords and should be reduced as much as possible. One of the most frequent causes for throat clearing and coughing is thick mucus (due to dry vocal folds) or too much mucus (as with a cold) on or below the vocal folds. The safest and most efficient way to clear mucus is by using a gentle, breathy productive cough where there is high airflow with little sound. This can be achieved by using the following strategy: take in as deep a breath as possible, momentarily hold your breath, and produce a sharp, silent “H” sound while you expel the air.
Drugs
Antihistamines:Antihistamines are sometimes prescribed to treat allergies and are present in some over-the-counter cold medications. Antihistamines should rarely be used because they tend to cause dryness. Prescription nasal steroid sprays such as Nasacort®(Phone-Poulenc Rorer), Nasonex®(Schering), Flonase®(Allen & Hansburys), etc. will often relieve the symptoms of nasal allergy without the drying side effects of antihistamines.
Analgesics:Aspirin products and non-steroidal anti-inflammatory drugs (ibuprofen) should be used with caution as they cause platelet dysfunction and this may predispose to bleeding. Tylenol®(McNeil Consumer Products) is the best substitute for pain relief.
Mucolytic Agents:The most common expectorant is a preparation of long-acting guaifenesin to help liquefy viscous mucus and increase the output of thin respiratory tract secretions. Drugs, such as Mucinex©, may be helpful for singers who complain of thick secretions, frequent throat clearing, or postnasal drip. Awareness of postnasal drip is often caused by secretions that are too thick rather than too plentiful. Mucolytic agents need to be used with a lot of water through the day, to be effective.
Local Anesthetics:Avoid the use of over-the-counter local anesthetic preparations for the throat. Singing under their influence is like trying to play the piano with gloves on.
Progesterone:Question the use of drugs that are progesterone-dominant, such as birth control pills. They may cause virilization of the female larynx and a loss in the upper vocal range. There may be no other alternative for your individual situation, however, so consult your gynecologist.
Laryngopharyngeal Reflux Disease and Recommendations to Prevent Acid Reflux
What is Reflux?
When we eat something, the food reaches the stomach by traveling down a muscular tube called the esophagus. Once food reaches the stomach, the stomach adds acid and pepsin (a digestive enzyme) so that the food can be digested. The esophagus has two sphincters (bands of muscle fibers that close off the tube) to help keep the contents of the stomach where they belong. One sphincter is at the top of the esophagus (at the junction with the upper throat) and one is at the bottom of the esophagus (at the junction with the stomach). The term REFLUX means “a backward or return flow,” and refers to the backward flow of stomach contents up through the sphincters and into the esophagus or throat.
What are GERD and LPRD?
Some people have an abnormal amount of reflux of stomach acid that goes up through the lower sphincter and into the esophagus. This is referred to as GERD or Gastroesophageal Reflux Disease. If the reflux makes it all the way up through the upper sphincter and into the back of the throat, it is called LPRD or Laryngopharyngeal Reflux Disease. The structures in the throat (pharynx, larynx, vocal folds and the lungs) are extremely sensitive to stomach acid, so smaller amounts of reflux into these areas can result in much more damage.
Why Don’t I have Heartburn or Stomach Problems?
This is a question that is often asked by patients with LPRD. The fact is that very few patients with LPRD experience significant heartburn. Heartburn occurs when the tissue in the esophagus become irritated. Most of the reflux events that can damage the throat happen without the patient ever knowing that they are occurring.
Common Symptoms of LPRD
Hoarseness, chronic (ongoing) cough, frequent throat clearing, pain or sensation in throat, feeling of lump in throat, problems while swallowing, bad/bitter taste in mouth (especially in the morning), asthma-like symptoms, referred ear pain, post-nasal drip, singing difficulties (especially with high notes).
Medications for LPRD
The most effective treatment for LPRD may be drugs in the class known as proton pump inhibitors. Included in this group are Prilosec®, Prevacid®, Protonix®, Aciphex®, or the new medication known as Nexium®. Ask your physician which may be appropriate for you.
Self-Destructive Behaviors
Avoid smoking cigarettes. They are bad for the heart, lungs, and vocal tract. Also, avoid other irritant inhalant substances and mind-altering drugs. Tobacco and marijuana are irritants to the vocal tract. When you sing you must be in control of all body systems: physical, spiritual, and mental. Smoking is disastrous for the speaking and singing voice.
Requirements For A Healthy Voice
• Try your best to maintain good general health. Get adequate rest to minimize fatigue. If you do become ill, avoid "talking over your laryngitis" – see your physician and rest your voice.
• Exercise regularly.
• Eat a balanced diet, including vegetables, fruit and whole grains.
• Maintain body hydration; drink two quarts of water daily.
• Avoid dry, artificial interior climates and breathing smoggy, polluted air.
• Limit the use of your voice in high-ceilinged restaurants, noisy parties, cars and planes.
• Avoid throat clearing and voiced coughing.
• Stop yelling – avoid calling from room to room.
• Avoid hard vocal attacks on initial vowel words.
• Use the pitch level in the same range where you say, "Umm-hmm?"
• Speak in phrases rather than in paragraphs, and breath slightly before each phrase.
• Reduce demands on your voice – don’t do all the talking!
• Learn to breathe silently to activate your breath support muscles and reduce neck tension.
• Take full advantage of the two free elements of vocal fold healing: water and air.
• Vocal athletes must treat their musculoskeletal system as do other types of athletes; therefore, vocal warm-ups should always be used prior to singing. Vocal cool-downs are also essential to keep the singing voice healthy.
Some additional suggestions for good vocal care
• If you need to get someone’s attention, use non-vocal sounds such as clapping, bells or whistling.
• Move closer to those with whom you are speaking.
• Face the person(s) with whom you are speaking.
• Use amplification, as needed, if possible.
• Reduce your speaking time in noisy environments, such as in automobiles and airplanes.
Optimal Speaking Techniques
• Use good abdominal/diaphragmatic breathing and support.
• Learn to use your voice with as little unnecessary effort and tension as possible.
• Take frequent breaths when speaking long sentences.
• Maintain a smooth legato speech pattern with clear articulation.
• Allow the neck, jaw, and face to be relaxed.
• “Place” or “Focus” the voice appropriately.
• Speak at a normal rate of speed.
• Use good vocal inflection.
Water
• 75% of Americans are chronically dehydrated.
• 37% of Americans mistake thirst for hunger.
• Even MILD dehydration will slow down one’s metabolism as much as 3%.
• In a University of Washington diet study, one glass of water before bed prevented midnight hunger pangs 100% of the time.
• Lack of water is the #1 cause of daytime fatigue.
• Preliminary research indicates that 8 to 10 glasses of water daily significantly eases back and joint pain for 80% of sufferers.
• A mere 2% drop in body fluids can trigger fuzzy short-term memory, trouble with basic math, and difficulty focusing on a computer screen or printed page.
• Drinking at least 5 glasses of water daily decreases the risks of colon cancer by 45%, breast cancer by 79%, and bladder cancer by 50%.
SELF-EDUCATE
Your studio teacher is a great source of knowledge and wants to help each student learn how to avoid injury and acquire safe and healthy skills. Ultimately, it is the student’s choice and responsibility to stay educated and stay healthy. The department encourages each student to increase their knowledge regarding occupational health risks for musicians by reading. Below is a sample list of books about injury prevention and related topics.
MUSICIANS' INJURIES: A Guide to their Understanding and Prevention.
by Nicola Culf, Parapress Ltd, Guilford, 1998. ISBN 1-898594-62-7
THE MUSICIAN'S SURVIVAL MANUAL: A Guide to Preventing and Treating Injuries in
Instrumentalists. Richard Norris, M.D., International Conference of Symphony and Opera Musicians, 1993. ISBN 0-918812-74-7
THE ART OF PRACTICING: A Guide to Making Music from the Heart.
Madeline Bruser, Bell Tower, 1997. ISBN 0609801775
THE MUSICIAN AS ATHELETE: Alternative Approaches to Healthy Performance.
by Dorothy Bishop, Kava Publications, 111-32nd Ave. N.W. Calgary, Alberta, Canada, T2M 2P7
TENSIONS IN THE PERFORMANCE OF MUSIC : a symposium., edited by Carola Grindea ; foreword by Yehudi Menuhin ; preface by Allen Percival London : Kahn and Averill, 1978
A NEW APPROACH TO VIOLIN PLAYING.
Kato Havas (Bosworth Pub), Bosworth & Co. Ltd, 14/18 Heddon St. Regent St., London W1R 8DP
THE TEACHING OF ACTION IN STRING PLAYING: Basic Principles of String Playing.
Paul Rolland, Boosey & Hawkes, c1986
http://www.sharmusic.com/Shop-Shar/Media/Books/Teaching-Of-Action-In-String-Playing-by-
Rolland.axd
PREVENTION AND CORRECTION OF CHRONIC INJURY FOR HARPISTS.
by Laurie Riley Box 249 Vashon WA 98070 Price $7 plus shipping $1.
E-mail: harp@seanet.com
UNDERSTANDING DRUM TECHNIQUES.
Dave Hughlett, To order: send $15.00 (bank check or US currency) to:
IFPAM, 55 West Lindsley Road, North Caldwell, NJ 07006
KEEP YOUR VOICE HEALTHY: A Guide to the Intelligent Use and Care of the Speaking and
Singing Voice, Friedrich S. Brodnitz, 2nd Edition Paperback October 1987 ISBN 089079331X
CHANGE YOUR VOICE, CHANGE YOUR LIFE: A Quick, Simple Plan for Finding and Using Your Natural, Dynamic Voice, Morton Cooper, 1986 ISBN 0064637123, 1996 ISBN 0879804378
REBELLION OF THE BODY: Understanding musician's focal dystonia, Dr. Joaquin Farias, GALENE EDITIONS April 2010,http: / /www.amazon.com/REBELLION-Understanding-musicians -Dys toniaebook/ dp/B003JMF9WA
THE ANATOMY BOOK FOR MUSICIANS: A Guide to Performance Related Muscle Pain
by Susan L. Weiss, CMT., Muscle Dynamics, 1996, P.O.Box 431, Glenview, IL 60025
(888) 729-3770
INDIRECT PROCEDURES: A Musician's Guide to the Alexander Technique.
Pedro de Alcantara, Oxford [England]: Clarendon Press ; New York : Oxford University Press, 1997.
ISBN 0198165692
CURIOSITY RECAPTURED: Exploring Ways We Think and Move
Jerry Sontag, Editor, MORNUM TIME PRESS, October 1996 ISBN 0964435217
OTHER RESOURCES
Andover Educators and Body Mapping, http://bodymap.org/main/
The university library owns many of the books published by Andover Educators. Their website is a helpful source f useful links, articles, and recommended reading.
The American Society of the Alexander Technique http://www.amsatonline.org/
The largest professional organization of teachers of the Alexander Technique in the United States, they offer a proven approach to self-care. The Alexander Technique teaches how to unlearn habitual patterns that cause unnecessary tension in everything we do.
The Performing Arts Medicine Association, http://www.artsmed.org/
The Performing Arts Medicine Association (PAMA) is a non-profit professional organization for physicians and other professional persons who are involved in treatment and/or research in the field of Performing Arts Medicine.
The Singers Resource, http://www.thesingersresource.com/vocal_health.htm
This website contains several articles on vocal health related issues from noted centers for vocal health.
Musician’s Health, http://www.musicianshealth.com/
Musician's Health is an educational web site devoted to the understanding and the explanation of
musician's injuries, along with guidelines regarding injury prevention, optimizing your musical performance, and for achieving an optimum state of health.
SAFETY FOR THE MUSIC STUDENT AND STUDENT WORKER
As stated earlier, The Cincinnati Christian University Music and Worship Department considers the health and safety of all students, faculty, staff, and visitors to our campus to be of utmost importance. Each student is responsible to conduct themselves in a manner which promotes the highest level of safety to themselves and to those around them. The department staffs a music crew made up of student workers. They work and serve the department in a variety of ways. They move equipment for concerts, set up equipment for rehearsals, function as stage managers and organize our music libraries. This is a vital and needed service of the department. The following guidelines apply to all students who use the music and worship facilities and/or work on the crew.
Choral Riser Safety
Portable choral risers are designed to provide a stable surface to hear and see singers. All choral risers used by the Music and Worship Department at Cincinnati Christian University University are made by the Wenger Corporation, a high performance company. Accidents occur when the risers are not roperly set up or properly maintained.
Set up
• Follow instructions – Wenger provides instructional labels with important safety information. Follow all instructions. Only CCU Music Crew members may move or set up risers.
• Inspect – Look for damage or loose items as the risers are set up.
• Lock riser legs in place – Make sure that the diagonal brace is properly locked in place, and close cover to ensure legs remain locked. Check to make sure the legs are perpendicular and not at an angle.
• Test all risers – Before using risers, stand on each section to ensure stability. Make sure risers do not rock or tip.
Annual Maintenance
• Inspect for damage – Report damaged risers by submitting a work order request to the Music & Worship Department Office.
• Tighten any loose bolts – Tighten bolts with care to prevent damaging components. Report missing bolts by placing a work order request to ensure replacement of the same type of bolt.
• Remove dirt and debris – Clean carpet lint and dirt from hinges and lock mechanisms.
• Lubricate all joints – Use WD-40 spray lubricant on all hinges and moving parts. Flex all moving parts to ensure smooth operation.
PIANO/ELECTRONIC KEYBOARD CARE
The Department of Music and Worship has invested thousands of dollars in securing and maintaining quality instruments for the university. All students are asked to treat these instruments with the highest level of care and to report damages directly to Jeannine Geans, Department Coordinator. The following guidelines will help insure years of good service from our pianos:
• Do not place any form of liquid on or near pianos and electronic keyboards – Any form of open or spillable liquid (including lidded coffee cups) is forbidden in the practice rooms and Piano Class Lab. Voice students taking a bottle of water into their lesson must place the bottle away from the studio piano. Students who ruin or damage an instrument will be responsible for the cost of repair or replacement.
• We ask each student to help keep the surface of each piano they play free from scratches, chipped paint, and dents.
• Keep pianos plugged in at all times – Each piano is fitted with a climate control devise that requires electricity to work. If you see a piano that is not plugged in, please plug it in.
• Keep grand pianos covered when not in use – Each grand piano in the department is to be covered when not in use. If you see a grand that is uncovered, please place the cover on the piano.
• Do not move pianos from room to room – Pianos may not be moved without the permission of Dr. Read. CCU Music Crew members are the only persons authorized to move pianos once permission is granted. Pianos must be covered when being moved. A minimum of two crew members must be present to move a piano.
[1]Adapted from the Health and Safety document of the Cedarville University Department of Music and Worship, Beth Cram Porter, author, 2013.