Injury Prevention for Musicians. Book Review by Joanna White
September 16, 2014 (No Comments) by Peter Westbrook

Injury Prevention for Musicians: Two Books Reviewed by Joanna White

Horvath, Janet. Playing Less Hurt, An Injury Prevention Guide for Musicians. (New York: Hal Leonard Books, 2010. Print.)

Klickstein, Gerald. The Musician’s Way, A Guide to Practice, Performance, and Wellness. (New York: Oxford University Press, 2009. Print)

If you play or teach the flute, chances are you or your students have experienced pain or injury at some point as a result of playing. While most of us are aware of problems such as repetitive motion strain or hearing loss, there are other less common issues that afflict us and turn up in our students. We are not always thoroughly trained in injury prevention or taught to recognize every sign of danger, and we might not know what to do or where to get help in case of injury. I will highlight two books that may not be familiar to flutists; both have extensive information about prevention of specific injuries for musicians.

PlayingLessHurtJanet Horvath’s award winning book, Playing Less Hurt, An Injury Prevention Guide for Musicians (New York: Hal Leonard Books, 2010. Print), should be essential reading for performers and teachers. Horvath, associate principal cellist of the Minnesota Orchestra is convincing in her plea for our awareness; she is a constant advocate for performance health. Easy to read, this volume includes scientific information along with photos, diagrams, and multitudes of suggestions, solutions, and meticulous resource lists. While it was originally written in 2000, it has been revised three times, most recently in 2010, keeping up with the rapidly advancing field of performance medicine. Horvath also has a website, which includes a resource list and blog posts about her topics,

Horvath, in her book, gives reasons that musicians are susceptible to injury. She lists risk factors and danger signals critical for both performers and for teachers who have a great responsibility to keep their students of all levels safe. She gives detailed explanations of injuries such as back and disc problems, muscle and tendon disorders, nerve entrapments, hand and forearm pain, and other conditions like Raynaud’s disease, focal dystonia, fibromyalgia, TMJ, and arthritis, among others. There is even a brief section on performance anxiety and the use of beta-blockers.

Janet Horvath

Janet Horvath

The author discusses preventative and restorative approaches including stretching, strengthening, and comfort. Chapter 15 discusses hearing loss, a critical topic not often discussed in music schools. Finally Horvath gives suggestions for what to do if you do get hurt and how to come back from injury. She gives concrete information about often asked questions like: when it is safe to use heat as opposed to ice? She even includes a chapter on instrument modifications, discussing splints, slings, supports, and orthotics.

How to practice, a topic many of us teach, is discussed in detail in Horvath’s book. Body-safe playing including warm-ups, stretches, and lists for injury prevention, can be found within. Hand drawn diagrams show the author’s favorite ways to stay flexible.

The resource list, essential for any player and teacher wanting to know where to turn, will be the hardest part of the book to keep up to date but we can turn to the Playing Less Hurt website for updates. Resource categories (in the book) include: Books, Organizations, Websites, Videos, Products, and Clinics. Particularly valuable are the detailed listings of medical personnel in many specialties.

It is timely to revisit the topic of performance health as music schools come to the realization that it is critical to train performers and teachers in injury prevention and recognition of symptoms. One Northwestern University School of Music study (2008 findings) done by the late Alice Brandfonbrener, known for being a pioneer in performance medicine, showed that 84% of freshmen instrumentalists struggled with pain. (Horvath, p. 87) An unrelated study by Medical Problems of Performing Artists reported that 68% of teachers spent less then five minutes teaching injury prevention in a lesson. (p. 87) Since, as the Horvath points out, rigorous demands are placed upon performing musicians, it is critical that this disconnect between prevalence of problems and large numbers of organizations and teachers without knowledge of how to address them be narrowed.

Horvath reports on the Health Promotion in Schools of Music Project, a group that presented findings to the National Association of Schools of Music [United States] in 2005 and 2006. (Horvath, p. 86-7) The group made clear recommendations to schools that train musicians and teachers that they incorporate new information about performance health into their philosophies and curricula. NASM has begun to take a more active stance in promoting healthy playing. For example, along with the Performing Arts Medicine Association, (PAMA,) NASM now lists basic information about hearing loss on its website: (

Professional orchestras have also become more aware of new standards, providing proper chairs and shields for hearing protection.

????????The Musician’s Way: , A Guide to Practice, Performance, and Wellness
by Gerald Klickstein (New York: Oxford University Press, 2009. Print), another valuable resource, is divided into three major sections: Artful Practice, Fearless Performance, and Lifelong Creativity. Part III is specific to performance health, but the first two sections also go a long way in the promotion and development of healthy musicians because Klickstein emphasizes a musical, artful, and mindful approach to learning and practice. There are also photos of stretching exercises and a whole section on taking breaks.

In the first chapter on prevention, there are sections on: musician’s injuries (with particular attention to causes of injuries,) warning signs, how we should respond to warning signs, a huge section on injury prevention, and information on recovery. The simple injury prevention basics are invaluable for performers, and teachers should know them; the ideas are logical, practical, and easy to incorporate.

In the second prevention section, Klickstein discusses balance and sitting and standing, which many of us are familiar with from Alexander Technique and Body Mapping. Photographs are included although they are not specific to flute. There is also an extensive section on hearing loss prevention.

Gerald Klickstein

Gerald Klickstein

Klickstein, an international classical guitarist and Professor of Music at the University of North Carolina School of the Arts, has also become known for his Musician’s Way Blog: [which is part of the companion to the book at, Ed.] Here he adds to and updates the information in his book and you can sign up to receive his newsletter as well. Reference lists under the wellness section of the website include: Injury Prevention for Instrumentalists, Locate a Medical Specialist, Alexander Technique, Feldenkrais Method, Ergonomics, Reference, General Health for Musicians, Hearing Protections, and blog posts on topics like “Fight or Flight,” and “Safely increasing Practice Time.”

Organizations like PAMA now provide websites and organize conferences where musicians, educators, administrators, and medical professionals come together to share information about the prevention and treatment of musical maladies, and many groups have specific websites about individual problems such as performance anxiety, musician’s dystonia, and many more. The journal, Medical Problems of Performing Artists, devoted to music medicine also can be found online. Thanks to the work of Janet Horvath, Gerald Klickstein, and others like them, information about performance health issues is much more widely disseminated than when the earlier edition of Playing Less Hurt was published in 2000. If more musicians and teachers read and use these books and learn about facts and resources, musicians with performance problems will feel less alone and we will all be a step closer to “playing less hurt.”


Joanna White

Joanna White

Dr. Joanna Cowan White, professor of flute at Central Michigan University, performs as principal flutist of the Saginaw Bay and Midland Symphony Orchestras, and records with her chamber groups, Crescent Duo and Powers Woodwind Quintet on White Pine Music and Centaur Records. She has been Secretary of the National Flute Association and has written articles for Flute Talk, Flutist Quarterly, The National Association of Wind and Percussion Instructors, and Der Rohrblatt, among others. She is also a published poet.

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