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119

PLAYING-RELATED HEALTH RISKS AMONG STUDENTS 
AND TEACHERS OF MUSIC DEPARTMENT AT THE KOPER 

ART SCHOOL

Matej PLEVNIK1, Ines BAŽON, Rado PIŠOT1 

1 University of Primorska, Science and Research Centre, Institute of Kinesiology Research

Corresponding author:
Matej PLEVNIK

University of Primorska, Science and Research Centre, Institute of Kinesiology Research
Garibaldijeva 1, 6000 Koper, Slovenia

e-mail: matej.plevnik@zrs.upr.si

ABSTRACT

The study of a musical instrument demands several hours of practicing on a daily 
basis as well as playing and performing. Consequently, the musician can be subjected 
to various health risks during his or her study process but also afterwards. Health 
problems depend on the individual physical and mental fitness, but also on the features 
and structure of the instrument as well as on the playing technique, which consists of 
repeated movements and mainly of static body position. Because of the possibility of 
chronic injuries, especially neuromuscular disorders but also others, it is important for 
the musician to regularly maintain his or her physical and mental fitness and movement 
performance by preventive and compensating activities and immediate action in case of 
pain or when noticing the first signs of medical problems or limitations. The study in-
cluded 43 students (16.7 ± 1.5 year; 31 females and 12 males) and 15 teachers (36.9 ± 
8.8 years; 7 females and 8 males) that attend and teach at the Music Department of The 
Koper Art School, which is a part of The Koper High School. The aim of the study was 
to recognize the risk factors in health status that occur as a consequence of playing a 
music instrument. A questionnaire consisting of 26 questions was used in the research. 
The results of the study showed that a half of the interviewed students practices every 
day but teachers practice less (p = 0.04). Therefore, teachers value the importance of 
physical (p = 0.013) and mental (p = 0.000) fitness more than students. Teachers also 
estimate their current physical and mental fitness to be higher (p = 0.003). 89.7 % of 
the respondents feel pain of discomfort during or after playing, out of these 95.3 % are 
students, and 73.3 % are teachers. These musicians state that they most frequently feel 
pain in the back and neck area and in the shoulders and wrists. 36.2 % of the musicians, 

original scientific article                                       UDC:  616-001:78.071
received: 2016-01-27



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ANNALES KINESIOLOGIAE • 6 • 2015 • 2

41.9 % of students and 20 % of teachers, affirmed to have had strains or pain, both of 
physical and psychological nature. It is indispensable for both students and teachers 
to be aware of suitable preventive, practicing and therapeutic measures. Preventive 
activities and control over risk factors can contribute significantly to the motivation for 
playing, to the quality of producing and reproducing musical works and to the absence 
of pain, discomfort and injury occurrences among musicians. 

Keywords: musician, health, pain, prevention, education.

ZDRAVSTVENA TVEGANJA IGRANJA NA GLASBENI 
INŠTRUMENT DIJAKOV IN UČITELJEV UMETNIŠKE GIMNAZIJE 

KOPER

IZVLEČEK

Študij glasbenega inštrumenta in petja zahteva vsakodnevno in večurno vadbo, 
igranje ter nastopanje. Posledično je glasbenik v procesu študija, pa tudi kasneje, 
tako lahko izpostavljen različnim zdravstvenim tveganjem. Pojav zdravstvenih težav 
je odvisen od psihofizičnih predispozicij posameznika, hkrati pa tudi od značilnosti in 
zgradbe inštrumenta ter tehnike igranja na inštrument, ki je sestavljena iz ponavljajočih 
se gibov in pretežno statičnega položaja telesa. Zaradi možnosti pojava kroničnih 
poškodb, predvsem živčno-mišične narave in drugih zdravstvenih tveganj, je pomemb-
no, da glasbenik redno skrbi za svoj psihofizični status in gibalno zmogljivost tako s 
preventivnimi aktivnostmi kot tudi s takojšnim ukrepanjem v primeru pojava bolečine 
oziroma opažanju prvih zdravstvenih zapletov in omejitev. V študiji je sodelovalo 43 
dijakov (16.7 ± 1.5 let; 31 žensk in 12 moških) in 15 učiteljev (36.9 ± 8.8 let; 7 žensk 
in 8 moških), ki se izobražujejo oziroma poučujejo na Umetniški gimnaziji Koper. Cilj 
študije je bil prepoznati dejavnike tveganja za zdravstveni status kot posledico igranja 
na glasbeni inštrument. V raziskavi smo uporabili avtorski vprašalnik s 26 vprašanji. 
Rezultati raziskave so pokazali, da polovica anketiranih dijakov vadi vsak dan, učitelji 
manj (p = 0.04). Učitelji tako pomen telesne pripravljenosti (p = 0.013) kot tudi pomen 
psihične pripravljenosti (p = 0.000) vrednotijo višje kot dijaki. Učitelji prav tako višje 
ocenjujejo tako svojo trenutno telesno kot tudi psihično pripravljenost (p = 0.003). 
Bolečine oziroma neugodje v telesu med igranjem in po njem čuti 89.7 % vseh v razis-
kavo vključenih glasbenikov, med njimi 95.3 % dijakov in 73.3 % učiteljev. Glasbeniki 
navajajo najpogostejše bolečine v predelu hrbta, vratu, ramenskega obroča in zapestij. 
O obremenitvah in poškodbah, bodisi telesne ali psihične narave, je poročalo 36.2 % 
glasbenikov, med temi 41.9 % dijakov in 20 % učiteljev. Ozaveščenost glasbenikov, 
tako dijakov kot tudi njihovih učiteljev, o ustreznih preventivnih, vadbenih kot tudi tera-



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pevtskih, ukrepih je nujna. Preventivne aktivnosti in nadzor nad dejavniki tveganja 
pomembno prispevajo k motivaciji za igranje, h kakovosti ustvarjanja in poustvarjanja 
glasbenih del ter k odsotnosti bolečin, neugodja in pojavu poškodb glasbenikov.

Ključne besede: glasbenik, zdravje, bolečina, preventiva, izobraževanje

INTRODUCTION

Music and society have always been closely related. In ancient societies, music was 
a means for connecting with the spiritual world. At first, humans did not have instru-
ments so they created music with clapping and stomping. Instruments spread widely 
during the development of the first civilizations. The newly acquired musical profession 
was highly regarded in society. The Egyptians and Ancient Greeks, as well as other na-
tions, appreciated music very much. Not only did it have an important role in everyday 
life, professional concert playing was diffused, too. Music developed greatly through 
history. Since the second half of the 20th century technological progress reflected also 
in the musical sphere. Mass media, such as radio, television and internet spread music 
and contribute to its importance in economy (Blažič Primožič & Čerič, 2004; Čerič & 
Šramel Vučina, 2008). Amateur and professional musicians usually begin their educa-
tion in elementary music school, most of them by the age between 6 and 8. Education 
in music schools is part of the public education system in Slovenia. Each year around 
25.500 children and youths enrol in music educational programmes (European Music 
Union, 2010). Some of the children decide to continue their music education in high 
school or at university; many of them upgrade their knowledge in music institutions 
abroad. The study of a musical instrument demands several hours of practicing on a 
daily basis which can lead to various health risks. 

Musicians are top athletes who execute, dominate and control tiny movement skills 
and can undergo tremendous physical, functional and cognitive strain while studying 
and playing musical instruments both during their performance or other artistic pro-
duction. In order to produce music with a musical instrument, many years of studying 
and playing are necessary. It is by playing that we can achieve temporal and spatial 
precision, moreover, also exceptional control over the execution of fine movements 
(Plevnik & Gerževič, 2015). Playing a musical instrument demands the execution of 
fine movements, including movements of the hands and fingers, arms, legs and torso. 
However, it can also involve locomotor movement, such as walking in place or around 
which is common in wind orchestras or choruses. Playing a musical instrument is there-
fore a physical activity that puts strain primarily on small muscle groups of fingers and 
arms, but also on large muscle groups that are responsible for maintaining an optimal 
body posture, often in forced and non-physiological positions. Pearce and Rohrmeier 
(2012) talk about a wide range of links between playing music and listening to it on 
one hand and human cognition on the other. They describe music as a “complex cogni-



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tive system”. Listening, performing and interacting with music require a wide range 
of cognitive functions and processes from the musician, including auditory analysis, 
perception of the musical structure (voice, intonation, rhythm, tempo, volume etc.), 
attention, learning and memorizing (a composition and its features), shaping expecta-
tions, emotions, social cognition etc. A musical performance on a professional level is 
one of the most demanding tasks for the human nervous system. If we combine this all, 
we can assume that a musical performance is made at least of the cognitive and mo-
tor aspects. The cognitive aspect, along with the general cognitive functions, regards 
the understanding of the musical structure (harmonies, tonalities, phrasing, auditory 
perception), whereas the motor aspect concerns the actualisation of a movement within 
its spatial and timely characteristics (precision, speed, punctuality, rhythm, softness) 
(Plevnik & Gerževič, 2015).

Health problems are common among musicians; their occurrence depends on sev-
eral factors, namely: the individual psychophysical predisposition, the characteristics 
of the instrument and the playing technique (Gaserzer & Neugebauer, 2011). The most 
common health problems among musicians are musculoskeletal, neurological, audito-
ry, skin and psychological conditions (Heinan, 2008). The listed conditions can hinder a 
musician from producing and reproducing music effectively and can even prevent him 
or her from playing the instrument completely due to pain and injuries (Gambichler, 
Boms, & Freitag, 2004; Gasenzer & Parncutt, 2006; Hansen & Reed, 2006; Hojs & 
Bilban, 2010; Carli & Bilban, 2012; Lee et al., 2013). Črnivec (2004) conducted a study 
among the musicians of the Slovene philharmonic orchestra and describes that 50 to 
76 % of the musicians suffer from musculoskeletal conditions, mostly because exces-
sive strain on tendons, tendon sheaths and tendon and muscular insertions. Also com-
mon are back conditions due to regular strains in non-physiological positions which 
are the result of the static nature of the task, neurological damage due to excessive 
pressure and occupational hearing impairment. Musicians of the Slovene philharmonic 
orchestra claim that the symptoms start occurring after 60 to 93 minutes of playing the 
instrument. Pain and discomfort usually first occur in the shoulder girdle, followed by 
the lumbar and lower back area, backline, wrists, elbows, thoracic spine, fingers, lower 
limbs and forearms (Črnivec, 2004). Leaver, Harris, and Palmer (2010) conducted a 
study that included professional musicians from the top orchestras in Great Britain 
and the results showed that 86 % of the musicians experienced pain in the 12 months 
prior to the research, mainly in the neck, lower back and shoulder area. The study also 
showed that pain problems occur more often with female musicians and musicians with 
a general feeling of being unwell; the occurrence of pain also depends on the instrument 
category. Different studies have shown that approximately one half of professional 
musicians and music students face musculoskeletal injuries, women more often than 
men and violinists and pianists more often than other musicians (Robinson & Zander, 
2002; Paarup, Baelum, Holm, Mannuche, & Wedderkopp, 2011). Robinson and Zander 
(2002) state that playing a musical instrument is the second most frequent form of risk 
exposure for bone and muscle injuries, right after using the computer. A study (Chan, 
Driscoll, & Ackermann, 2013) conducted among Australian professional musicians in 



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orchestras, showed that the most common conditions occur in the shoulders, neck and 
backline, followed by tingling sensation, loss of muscle control and force production 
(Robinson & Zander, 2002; Norris, 2011). 

Overuse injuries can be defined as acute or chronical. Acute overuse injuries oc-
cur when a musician overuses the tissue to the extent of feeling the consequences the 
following day, which can occur in form of muscle pain and rigidity in the areas that 
were subjected to overuse (e.g. arm, hand). Chronical overuse injuries develop during a 
longer period of time and in a less obvious manner (Shafer-Crane, 2006). They begin as 
slightly unpleasant sensations that can advance to severe pain over the period of weeks 
and months (Norris, 2011). Table 1 shows the most common musculoskeletal injuries 
linked to playing a specific musical instrument. 

Table 1: Musculoskeletal injuries associated with specific instruments (adapted from 
Robinson & Zander, 2002).

Violin / Viola
Neck pain
Thoracic outlet syndrome 
(left)
Carpal tunnel syndrome (left)
Cubital Tunnel Syndrome 
(left)
Rotator cuff tendinitis (right)
Extensor carpi radialis tendi-
nitis (right)
Temporomandibular joint 
dysfunction

Flute
Thoracic outlet syndrome 
(left and right)
Ulnar nerve entrapment (left)
Extensor carpi radialis tendi-
nitis (left)
Back and neck pain
De Quervain’s syndrome 
(left and right)
Focal dystonia of ring and 
little fingers (left)

Bassoon
Back and neck pain
Temporomandibular joint 
dysfunction
Dental problems
Strain of the teres major mu-
scle and the pectoralis major 
muscle (right)
De Quervain’s syndrome

Keyboards (piano / organ / 
accordion)
Thoracic outlet syndrome
Medial and lateral epicon-
dylitis
Tendinitis of wrist flexors 
and extensors
Carpal tunnel syndrome
De Quervain’s syndrome
Dorsal wrist ganglion
Focal dystonia of thumb, fin-
ger, hand, and foot muscles

Percussion
Lateral and medial epicon-
dylitis
Flexor carpi ulnaris tendinitis
Extensor carpi radialis ten-
dinitis
De Quervain’s syndrome
Carpal tunnel syndrome
Achilles tendinitis

Guitar
Triceps tendinitis (right)
Focal dystonia of index and 
middle fingers and thumb
(right)
Thoracic outlet syndrome 
(left)
Carpal tunnel syndrome (left)
Flexor carpi ulnaris tendinitis 
(left)
Strain of dorsal interosseous 
(left



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Clarinet
Carpometacarpal joint strain 
(right)
Carpal tunnel syndrome
De Quervain´s syndrome 
(right)
Lateral epicondylitis (right 
and left)
Temporomandibular joint 
dysfunction

Cello / String bass
Neck pain
Ulnar nerve entrapment (left)
Flexor carpi ulnaris tendinitis 
(left)
Rotator cuff tendinitis (right)
Extensor radialis tendinitis 
(right)

Oboe
Extensor carpi radialis tendi-
nitis (right)
Lateral epicondylitis (right)
Ulnar nerve entrapment 
(right)
Posterior interosseous nerve 
entrapment (right)
Back and neck pain
De Quervain’s syndrome

 Trumpet
Maxillofacial and lip trauma
Pharyngeal dilatation

Saxophone
Back and neck pain
Extensor carpi radialis tendi-
nitis (right and left)
Temporomandibular joint 
dysfunction

Vocals
Vocal cord strain
Facial and neck muscle strain
Focal dystonia of vocal cord 
muscles

Trombone
Focal dystonia of lip
Lateral epicondylitis (right)
Strain of the orbicularis oris 
muscle

The reasons for the emergence of pain are mainly long-term playing in a non-physi-
ological position of the body, the presence of stress and psychological pressure, insu-
fficient breaks, the lack of warming up before playing, bad posture while playing the 
instrument, repetitive movements, muscle tension, too much power used in the body 
movements and the wrong playing technique. Poor general physical condition of the 
musician and consequently fatigue also significantly contribute to the occurrence of 
pain and injuries (Robinson & Zander, 2002; Dragulin, 2011). Playing an instrument of 
an unsuitable size or one that is ergonomically unsuitable also accelerates the occurren-
ce of pain and injuries (Gasenzer & Parncutt, 2006).

The aims of this study were to use the questionnaire to identify: 1) the occurrence of 
early health problems of students and 2) the difference between students and teachers 
in health status and their approach to playing and practicing the musical instrument.

METHODS

Subjects

The sample consisted of 43 students (16.7 ± 1.5 years; 31 females and 12 males) 
who were enrolled in the academic year 2014 / 15 in the first, second, third or fourth 
year of Music Department of The Koper Art School, a part of The Koper High School, 



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and their 15 teachers (36.9 ± 8.8 years; 7 females and 8 males). The participation in the 
survey was voluntary. 75 % of the respondents were students and 52 % were teachers. 
The study included all groups of instruments, namely string instruments (N = 8), wind 
instruments (N = 16), brass instruments (N = 11), percussions (N = 1), plucked string 
instruments (N = 5) and keyboard instruments (N = 16).

Project Procedure

For the purpose of this research we developed a questionnaire with 29 questions. 
The questions were divided in several parts, namely a) main characteristics about the 
subject and his / her playing habits and musical traditions, b) questions about lifestyle, 
c) questions about anxiety, fatigue and injuries and d) approaches to playing a musical 
instrument and medical particularities of the musician. Questionnaires were distributed 
in printed form to students and teachers.

Data Analysis

The data was analysed and edited in Microsoft Office Excel 2013. We used the 
method of descriptive statistics, Spearman’s rank correlation coefficient and the t-test 
for independent samples for calculating the analysis of the mean differences. The data 
is presented as an arithmetic mean ± standard deviation (AM±SD).

RESULTS AND DISCUSSION

The study results show many differences in the answers to the research questions 
between students and their teachers. The answers significantly identify the causes un-
derlying the health problems as well as differences in the approach to playing and prac-
ticing musical instruments between the students and their teachers.

At the time of the study, the students had practiced their musical instrument on 
average 9.3 ± 2.1 years, while their teachers 27.7 ± 9.9 years (p = 0.000). Among the 
students, the shortest period of playing is 2 years and the longest is 15 years, whereas 
among the teachers, the shortest period is 15 years and the longest period is 45 years. 
Among students, the beginning of formal musical education by enrolling in the music 
school is on average at the age of 7.4 ± 2.1 years and among teachers 9.3 ± 2.2 years. 
The students play on average 6.1 ± 1.2 days per week, whereas the teachers 5.5 ± 0.8 
days (p = 0.04). A half (49 %) of the students practice every day, meanwhile, only 2 te-
achers practice regularly every day. The students practice an average of 3.1 ± 1.2 hours 
per day; on the other hand, the teachers practice 2.8 ± 1 hour per day. Most students and 
teachers take a break while playing and practicing the musical instrument. Students’ 
breaks are slightly longer (15 ± 10.3 min; 11.9 ± 6.6 min), all of them usually take 2 



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breaks. Statistically, there are no significant differences in the duration and frequency 
of breaks between the students and the teachers. Musicians, participating in the survey, 
evaluated the importance of physical and mental fitness for their work on a scale from 
1 (“not important”) to 6 (“very important”). Musicians also assessed their physical and 
mental fitness and state of health on a scale from 1 (“low”) to 6 (“extraordinary”). There 
is no statistically significant difference in evaluating the health status among students 
and teachers (4.3 ± 1.2; 4.5 ± 0.9).

Table 2: Assessment of the importance of physical fitness and current physical fitness.

Assessment of the importance of 
physical fitness

Assessment of current physical
fitness

Students 4.7 ± 1.3 2.9 ± 1.1
Teachers 5.4 ± 0.8 3.5 ± 1.3
Total 4.8 ± 1.2 3.1 ± 1.2

p = 0.013

Teachers evaluate the importance of good physical fitness higher; their own asses-
sment of their physical fitness was also better (Table 2). Teachers also give a higher 
value to the importance of good mental fitness; their assessment of their own current 
mental fitness is also higher (Table 3). Both, students and teachers, evaluated the impor-
tance of physical and mental fitness higher in comparison to their assessment of their 
actual physical and mental fitness. A distinct decrease in physical (movement and func-
tional) capacity can be seen in this period, due to the consequences of many individuals’ 
lifestyles in the modern society (World Health Organization, 2014).

Table 3: Assessment of the importance of mental fitness and current mental fitness.

Assessment of the importance of 
mental fitness Assessment of current mental fitness

Students 5.2 ± 1.0 3.8 ± 1.3
Teachers 5.9 ± 0.4 4.8 ± 0.9
Total 5.4 ± 0.9 4.1 ± 1.3

p = 0.000 p = 0.003



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36 % of the musicians participating in the survey, namely 17 students and 4 tea-
chers, believe that they exaggerate when practicing the musical instrument. The most 
common reason for exaggeration are upcoming concerts, followed by their own high 
expectations and an increase in the repertoire (Figure 1). What is interesting is that 
12 % of the students state that the reasons for their exaggeration are the demands of 
others, parents or teachers.

Figure 1: Reasons for exaggerations in playing.

Students and teachers experience fatigue after playing an instrument. Both, students 
and teachers assessed it with the average value of 3.7 ± 1.1, on a scale from 1 (“not 
tired at all”) to 6 (“very tired”). The musicians who express a higher degree of fatigue 
after playing also assessed their general health status to be worse (r = -537, p = 0.000, 
N=58). Statistically, the link between the assessment of fatigue after playing and the 
evaluation of their own physical capability is not expressed. The phenomenon of stage 
anxiety before performances is present with both students and teachers. The students, 
on a scale from 1 (“never”) to 6 (“always”), evaluate the frequency of the presence of 
stage anxiety with the assessment of 4.9 ± 1.4, meanwhile the teachers evaluate it with 
the assessment 3.3 ± 1.5 (p = 0.003). On the scale from 1 (“not present”) to 6 (“very 
strong”), the students evaluate the intensity of the stage anxiety with the assessment of 
4.4 ± 1.3, meanwhile the teachers assessed it lower 3.3 ± 1.5 (p = 0.02). Students are 
engaged in physical activity in an average of 2 ± 1.8 days a week, the teachers on the 
other hand in an average of 3.1 ± 2.8 days a week. Among all the participating musici-
ans, 26.7 % of them is not engaged in any kind of physical activity – 13 students and 3 
teachers. Figure 2 shows the most common forms of physical activity among students 
and teachers.



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Figure 2: Students´ and teachers´ engaging in physical activity or sport.

89.7 % of all the participating musicians feel musculoskeletal discomfort, among 
them 95.3 % of the students and 73.3 % of the teachers. The average time of reporting 
pain in the locomotor system after the starting point of playing on an instrument among 
the interviewed musicians is 64 ± 47 minutes, wherein the beginning of the occurren-
ce of problems with the students is on average 61 ± 41 minutes (onset between 5 and 
180 minutes), with the teachers on average of 75 ± 64 minutes (between 20 and 240 
minutes). There are no statistically typical differences in the time of occurrence of pain 
among the students and the teachers. The musicians cite the most common pain in the 
back, neck, shoulder girdle and wrists (Figure 3). Back pain occurs with mostly all 
instruments, flutists, violinists and pianists are the ones who most frequently feel neck 
pain and pain in the shoulder girdle, violinists and pianists also sense pain in the lower 
back, pianists can also feel pain in the upper arm, forearm and wrists, finger pain occurs 
with mostly keyboard instrument players, violinists and guitarists, lip pain with the 
players of wind instruments and finger skin pain with violinists and guitarists.



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Figure 3: Occurrence of pain or discomfort while playing the instrument.

When the pain occurs, 67.3 % of musicians immediately take measures, namely 61 % 
of the students and 90.9 % of the teachers (p = 0.001). Most often, the musicians take a 
break when the pain occurs; some of them stretch and take exercise, massage themsel-
ves or correct their posture. 36.2 % of musicians, among them 41.9 % of the students 
and 20 % of the teachers, report load and injuries, either of physical or psychological 
nature. The most common load reported by musicians is stress, followed by tendinitis 
and tendon sheath (Figure 4).

Figure 4: Loads and injuries reported by the participating musicians.



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Demands for excellence and the highest level of professionalism among both the 
young as well as older academic musicians are increasingly exceeding the limit of loads 
that men are capable of withstanding without negative effects on their body. In the last 
decade, this shows as a significant increase in injuries as a result of overloading due to 
playing the instruments and is reflected in the most demanding forms of chronic inju-
ries of world-class musicians (Črnivec, 2004; Elliott, 2012). An increasing number of 
typical injuries, particularly those of muscle-skeletal apparatus, which are typical for 
top musicians, could be detected already among the youngest musicians at the begin-
ning of their artistic career (Ranelli, 2012).

Both the students and the teachers evaluated the importance of preventive measures 
on a scale from 1 (“not important”) to 6 (“very important”). These are, according to 
both, the teachers and the students, arranged according to their importance, from the 
most important to the least important: optimal technique of playing, adjustment of the 
length of playing according to an individual’s abilities, adequate breaks, warming-up 
before playing, gradual increase in the amount of playing or avoidance of sudden in-
crease in the amount of playing, implementation of mobility exercises during breaks 
and the use of ergonomic devices (Figure 5). Statistically, there are no differences in the 
assessments of the teachers and the students.

Figure 5: Assessments of the importance of preventive measures, according to the stu-
dents and the teachers.

Regular physical exercise oriented either towards prevention or therapy helps im-
proving health conditions, general well-being and physical condition (Bejjani, Glenn, 
& Benham, 1996; Ackermann, 2013; World Health Organization, 2010). Physical exer-
cise also affects cognitive processes (Gasenzer & Parncutt, 2006), which are of great 
importance for creating and performing music. In her study, Ackerman (2013) demon-



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strated that if one engages in physical activity at least 2 times a week, this already has 
a positive effect when playing the instrument. Adequate physical activity and exercises 
is the first preventive measure, which should be taken into account by every musician 
(Norris, 2011). A special attention must be paid to the exercises of hands and fingers, 
which are distinctively strained while playing, but are usually the least taken care of 
(Ackermann, 2013). To prevent pain and injuries it is important to shift between the 
strain periods, i.e. playing the instrument, and suitably long and active breaks (Moha-
rić, 2014). Good mental fitness and stability are important for optimal musical perfor-
mance and keeping to the chosen strategy of practicing (Lockwood, 1989). 

Professional instrument playing causes a considerably increased heart rate (beats / 
min), which is also connected to body mass index, tempo of music and characteristi-
cs of the instrument (Vellers, Irwin, & Lightfoot, 2015). Iñesta, Terrados and Garcia 
(2008) report that while playing an instrument the heart rate rises on average up to 
72 % of the highest heart rate (the highest measured heart rate 85 %). The achieved 
heart rate depends on the playing characteristics, the complexity of the music and the 
psychophysical abilities of the musician. 

Injury prevention includes awareness and control over risk factors that cause pain 
and influence the emergence of injuries. Prevention also includes identifying and taking 
appropriate action when first symptoms and signs of injury occur (Robinson & Zander, 
2002; Zupan, 2007). It is very important that musicians know their psychophysical 
abilities and they do not exceed them to the disadvantage of their own health. To avoid 
illness and injuries they have to control and maintain their health, physical condition 
and appropriate diet (Bragge, Bialocerkowski, & McMeeken, 2006). The most impor-
tant preventive measures include maintaining good health and good physical condition, 
properly organised practicing and playing the instrument, the choice of appropriate 
ergonomic tools and instruments, proper lifting, holding and carrying the instrument 
and good awareness of the body (Robinson & Zander, 2002; Norris, 2011). Accor-
ding to Plevnik and Gerževič (2015), preventive actions also include implementing 
complementary tasks using a variety of training therapeutic devices while playing the 
instrument. 

One of the major causes of injuries is also a sudden increase of the amount of 
playing. When planning the instrument playing and practicing we need to take into ac-
count if a concert date is approaching in order to rearrange the quantity and the intensity 
of practice and preparation. It is very important that the amount of practice gradually 
increases before concerts and competitions and that we do not exaggerate with playing 
the instrument. A gradual change in the intensity of activity allows the body to adapt 
to it and enables musicians to recognise when their limits are exceeded and identify 
the signs and symptoms of injuries (Robinson & Zander, 2002; Roset-Llobet, Rosines-
-Cubells, & Salo-Orfila, 2000). In case of a sudden increase of the repertoire we divide 
practice into several shorter practice sessions; they will be more effective than one long 
practice. Fatigue is the indicator of excessive practise. We may also experience pain 
when fatigue occurs, therefore, we must be very attentive to posture, frequency and 
length of breaks and playing time. Nevertheless, the environment in which we play also 



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plays a significant role in successful instrument playing (temperature, brightness of the 
room etc.) as well as a quality of sleep, a healthy diet, a healthy lifestyle, avoiding stress 
and adequate hydration (Robinson & Zander, 2002).

Due to a high occurrence of injuries, it is very important that the musicians are awa-
re of the possibility of injuries or diseases that may arise as a result of playing (Parncutt, 
2007; Potter & Jones, 1995). It is also very important to know the preventive measures 
that can prevent injuries and to know how to take action when the pain already arises. 
Rising awareness about the consequences of playing the instrument should be carried 
out from the first contact with a musical instrument, as this would significantly contri-
bute to the acquisition of the optimal technique of playing a musical instrument in the 
early years and would, thereby, reduce the occurrence of injuries and health problems 
in the later years of the musical career.

CONCLUSION

The purpose of the study was to deter–ferences between approaches in the strate-
gies of practicing musical instruments of students and teachers of Music Department 
The Koper Art School. There is a statistical difference in the quantity of instrument 
playing time between the students who practice more and their teachers. (p = 0.04). No 
statistically significant differences in the duration and frequency of breaks between the 
students and the teachers were detected. An important finding in the study concerns the 
assessment of the importance of physical and mental preparation in relation to the de-
mands and needs of playing the music instrument. The teachers value the importance of 
physical and mental fitness higher (p = 0.013; p = 0.000), and at the same time they esti-
mate the level of their own physical and mental fitness to be higher as well. According 
to the surveyed musicians, the assessment of their own health condition is significantly 
associated with a greater degree of fatigue during and after the completion of playing 
(r = -537, p = 0.000). 89.7 % of all surveyed musicians feel pain or discomfort in their 
body, among them 95.3 % of students and 73.3 % of teachers. The musicians state 
that the most common pain occurs in the back, neck, shoulder and wrists. 36.2 % of 
musicians, among them 41.9 % of the students and 20 % of the teachers reported about 
strains and injuries, either of physical or psychological nature. However, the reported 
injuries were not confirmed by a medical doctor. The most common strain reported by 
the musicians is stress, followed by tendinitis and tendon sheaths inflammation. Stress 
is connected to the occurrence of stage anxiety, the musicians report. The students re-
ported a higher frequency and greater intensity of stage anxiety before performances 
compared to their teachers (p = 0.003; p = 0.02). As the most important preventive 
measures, musicians expose the acquired optimal technique of playing the instrument, 
adjusting the length of the individual playing abilities and adequate long breaks during 
practice. Regular physical exercise oriented either towards prevention or therapy helps 
improving medical health, general well-being and physical fitness (Bejjani, Glenn, & 
Benham, 1996; Ackermann, 2013; World Health Organization, 2010). Among all the 



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musicians involved in the study, 27.6 % of them engage in physical activity less than 
once a week. Based on the study results, we find significant differences between the 
strategies for instrument playing approaches between the students and their teachers. 
The teachers are more aware, not only of the technicality and specificity of the music, 
but also of the importance of and adequate physical and mental fitness. They are also 
more physically active and they express significantly lower frequency and intensity 
of stage anxiety of performances. Also, the teachers report a lower rate of pain and 
discomfort occurrences, as well as damage occurrences as a result of playing a musical 
instrument. Based on the mentioned study, we recommend that teachers include raising 
the awareness about risk factors of injuries in the learning process and that they teach 
students the basics of preventive action in the event of the occurrence of pain, discom-
fort and injury while playing.

Acknowledgement

The authors would like to thank the management of the Music Department of The 
Koper Art School for their support and help with study realisation, as well as all musi-
cians, students and teachers who participated in the study.

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