Personal Injury

I recently returned from two international conferences where I had the honor of learning from the preeminent researchers, doctors, teachers, and practitioners in the field of musicians’ health and wellness. As I listened, taught, and talked amongst them, I discovered almost all of us had one additional trait in common – we had suffered injury as musicians, and, most often injury that had ended a performance career, or at least the aspirations of one. 

My personal injury story starts with early symptoms of focal dystonia in my violin playing in my mid-thirties. Musicians’ focal dystonia is a neurological disorder involving loss of control, involuntary muscle contractions, and/or tremor that predominantly affects finger movements in string players, woodwind players, and pianists, and the muscles of the embouchure in brass players. Since I was equally passionate about teaching and performing, I delved into injury-prevention methods with my students almost as soon as I sought professional help for my injury. Wanting more answers for both me and my students led me to train to become a Feldenkrais practitioner. 

My article in the 2015 Feldenkrais Journal (Burrell, 2015), describes my difficulties in my training program – lessons exacerbated my dystonia to the point that I ended my performing career. Nevertheless, the Feldenkrais Method intrigued me for many reasons – it challenged my linear thinking, it was powerful enough to create neurological change in me almost overnight, and I found that I was becoming a more effective teacher with each class session.

Because I could not physically explore many lessons without provoking a negative response, I studied ATMs and tried them out in the laboratory of my teaching. I taught lessons in their original format; I compiled lessons that were built around similar themes; I applied different variations on themes with different students and groups, and I began to construct my own variations. As I found new ways to work specific ATMs I was studying into teaching, I started to build an ATM-style of pedagogy directly into teaching elements of string playing, from teaching mechanical strategies like moving the fingers of the left hand or controlling the direction of the bow on the strings, to concepts of musicianship like tuning, rhythm, tone production, and phrasing. As I developed more string-playing ATMs, I realized that through both structure and intent in the construction of his lessons, Feldenkrais created a pedagogy that could be applied to learning anything. 

Challenges in Tackling the MHW Problem 

Concurrent to my study of Feldenkrais as a pedagogical model, I have remained connected to the burgeoning field of research that is specific to musicians’ health, an area that deserves distinction from sports/dance/general health. The last two decades have been a period of rich scientific advancement, particularly in the neuroscience of musicians’ health, due to both the growing number of performing arts medicine programs embedded in university music schools and conservatories around the world, and new technology that allows scientists to study real-time function in performers. 

The troubling side of the data is that far too many professional musicians are struggling with pain and injury while engaging in regular performance responsibilities – an average of 86%, according to three comprehensive studies of full-time professional orchestras in Australia, Denmark, and the UK (Ackermann, 2014, Nelissen, 2012, Leaver, 2012). Longitudinal studies of pre-professional musicians also show that not much has changed when it comes to health in young performers from the 1980s and 90s (Zaza, 1997) to now, with one study showing that as many as 85% of musicians in a pre-college conservatory setting were experiencing playing-related pain (Gembris 2020). A big part of the problem is that most musicians do not seek out wellness opportunities until they become injured, and, generally, post-injury interventions have been found largely ineffective in reducing symptoms in the long-term (Jabusch et al, Warsaw 2023).

Researchers are in unanimous agreement that prevention is key. But what kind of prevention is most important? Professor Eckart Altenmüller who has run the neuroscience program at the Hochschule für Musik in Hannover, Germany, has spent the last fifteen years studying musicians’ injury from a learning perspective. His work shows that physiological factors are often less important than HOW we approach learning and practice, including how much rote repetition we do, AND how we limit our exploration by what we think is right and wrong. Even when injury appears to be orthopedic in nature, it contains neurological components (Altenmüller et al, Apollo’s Curse, 2015). Prevention, therefore, means changing traditions of practice and pedagogy that center on modelling, correction, rote-repetition, skill isolation honing, and looking for single solutions to complex problems. 

Feldenkrais as Injury-Preventative Pedagogy

I have been adapting Feldenkrais’s pedagogical model toward teaching musicians to learn and practice differently from the start so that wellness was integrated into every aspect of learning. Here are the main components of Feldenkrais’s pedagogy that I employ with musicians and educators:

  • Replace instruction with functional experiences. Instead of explaining how to do something, I try to think of the functional relationships involved in a particular technique – a relationship with gravity, with leverage, with perception of sound, etc. I remind myself that everyone will have a different relationship with the bow, the instrument, and the environment, and that if I impose my instruction on their experience, it will prevent them from developing the self-regulation and awareness they need to continue to adapt and evolve. 
  • Redefine posture and position with movement-based activity – rotating, moving side-to-side, flexing and extending in hips and knees in coordination with the movement of the bow, timing relationships by moving from sitting to standing or walking, adding developmental challenges like moving across the midline or contralateral movements.
  • Place the emphasis on adaptability – to new states of being, to growth, to new environments, to new applications of older techniques. Once you learn to do something one way, learn to do it another way.
  • Use variations to replace repetition. In addition to achieving the same result by new means, look for variations that require small modification to the outcome – playing the same bow stroke at different speeds, in different meters with different rhythmic emphasis, or on higher or lower strings with different degrees of tension and different relationships with gravity. 
  • Redirect attention to hidden places – the sound of the cellos on the other side of the room, your breathing, your stand partner’s left hand in your peripheral vision, or the relationship between your upper thighs and your chair.
  • Design activities that require adjustment to new sensory input – playing in a new system of tuning, standing versus sitting, rearranging the set-up of an ensemble, playing slower or faster than normal, or playing with balance challenges like sitting on one sit bone.

Ecological Dynamics as a Kindred Spirit – Practical Pedagogical Applications for Music Teachers

Working with students using these strategies has been more successful than I could have imagined. Students are gaining sensory awareness, learning to self-regulate, finding individualized solutions to problems, and becoming less fixed in their ideas of right and wrong in playing. They are also far more likely to share their concerns when discomfort/difficulty arises. The biggest challenge now is in providing teachers with the resources to make similar changes to their own pedagogy. Many teachers have commented that they would like to transition away from traditional models, but they feel that changing to an entirely new curriculum would be difficult due to time constraints, pre-set standards of learning, and high expectations within a rigorous pre-set concert and competition schedule.

In my own search for a framework that would help meet teachers’ needs, I discovered Ecological Dynamics (ED) in sports training (Davids, 2021), which includes the re-training of sports coaches away from traditional instruction-based teaching. ED is a product of Esther Thelen’s Dynamic Systems Theory, Ecological Psychology, Chaos Theory, and the work of Soviet neurophysiologist, Nikolai Bernstein, among other influences. ED opposes the post-World War II “information processing” view of the brain which continues to dominate learning models of educators, athletes, and musicians. 

Instead, ED embraces a learning theory based on brain-networking and plastic adaptation. It holds that learning can only happen when sensory information is taken in from the environment. Training, therefore, requires that individuals develop perceptual skills through experimentation rather than being inundated with concepts of how or what to do. Coaches set up training scenarios using constraints (similar to how we use constraints in a Feldenkrais lesson) to help athletes perceive new opportunities to act (affordances). This allows athletes not only to acquire new skills, but to be in the process of constantly adapting and evolving these skills.

Using ED tools for training coaches, I have been exploring ways to make Feldenkrais’s pedagogy more accessible to music teachers looking for alternative ways to train young instrumentalists. Teachers are learning to replace instruction with experiments that encourage individual distinctions and perceptual learning. They rearrange their classrooms to give students new experiences in listening and watching. They let the functional needs in front of them dictate the curriculum. We have also begun using ED coaching matrices to design mini-ATMs to “differentiate” and re-integrate challenging functions. 

Since its inception in the early 2000s, Ecological Dynamics has gained popularity in coaching at all levels from primary level physical education classes and beginning sports coaching through elite athletics, including Olympic coaching. Studies are now showing that young athletes who train using ED principles experience fewer injuries due to their ability to perceive problems at the outset and adapt their approach accordingly. This natural dexterity or ability to choose the optimal action in each individual performance situation is also what makes them excel in the competitive arena. I have high expectations that this work will have a similar impact on injury reduction among musicians. 

Concluding Thoughts

My Feldenkrais training’s educational directors, Paul Rubin and Julie Casson-Rubin, often reminded us that Feldenkrais did not set out to create a new profession, but rather, to teach a method of learning that trainees could bring into their own areas of interest and/or professions. When I began to experiment beyond Feldenkrais’s ATM lessons and directly apply his pedagogy to teaching students the functions of music making, I started to understand why Feldenkrais wanted these ideas to infiltrate other areas of learning.  Information-processing models have shaped traditions of teaching and practice to the detriment of our health and wellbeing. Musicians are taught to model ideals of function, to compulsively correct postures and actions, to build muscle-memory and automaticity, but rarely to vary behaviors, to change tactics, to trust in their senses, and to adapt to change. Yet, it is the latter kind of learning that we all require when difficulty arises. I am hopeful that in bringing Feldenkrais’s pedagogy to teachers, students, and performers, through methodology like ED, that I am contributing to a healthier future for the next generation of musicians.  

Bibliography

Ackermann, Bronwen J., Dianna T. Kenny, Ian O’Brien, and Tim R. Driscoll, “Sound Practice: improving occupational health and safety for professional orchestral musicians in Australia,” Frontiers in Psychology, Vol. 5 (2014), 973-990

Altenmüller, Eckart, with Christos Ioannou, Markus Raab, and Babett Lobinger, “Apollo’s Curse: Neurological Causes of Motor Impairments in Musicians,” Progress in Brain Research, Vol. 217, (2015), 89-116

Burrell, Lisa. “My Journey with Dystonia and the Feldenkrais Method: Beginning a Discussion on Contraindications for Aspects of Our Practice,” The Feldenkrais Journal, Vol. 28, (2015), 20-22 (Link)

Davids, Keith, Jia Yi Chow, Chris Button, and Ian Renshaw. (2021) Nonlinear Pedagogy in Skill Acquisition: An Introduction. Routledge, 2021.

Gembris H., Menze J., Heye A,. Bullerjahn C., “High-Performing Young Musicians’ Playing-Related Pain: Results of a Large-Scale Study,” Frontiers in Psychology, Dec 16;11:564736, (2020) doi: 10.3389/fpsyg.2020.564736

  1. Nelissen, “The Occurrence of Musculoskeletal Complaints Among Professional Musicians: A Systematic Review,” International Archives of Occupational and Environmental Health, Vol. 89 No. 3, (2015), 373-396 

Jabusch, H., Playing-related pain in musicians: Epidemiology, mechanisms, management, and prevention, International Symposium on Performance Science ISPS, Warsaw, Poland, August (2023)

Leaver, Richard, E. Clare Harris, and Keith T. Palmer, “Musculoskeletal Pain in Elite Professional Musicians from British Symphony Orchestras,” Occupational Medicine, Vol. 8 (2012), 549-555

Zaza C, Playing-related musculoskeletal disorders in musicians: a systematic review of incidence and prevalence, CMAJ, 1998 Apr 21;158(8):1019-25. 

About Lisa

Dr. Lisa Burrell is on the music faculty of Lone Star College in Houston, Texas. She is a violinist, violist, string clinician, and a Guild Certified Feldenkrais Practitioner. She teaches classes in the Feldenkrais Method® at Rice University, she is on the governing committee for the International Society for Music Education’s Musicians’ Health and Wellness SIG, and she is a active member of the Performing Arts Medicine Association. She teaches privately online and in the Houston area, working with both young musicians, professional musicians dealing with injury, and music educators. She is a regular clinician in the Houston public schools, college and university music programs, and teacher in-services, emphasizing pedagogy that promotes healthy playing through movement-based learning.

Dr. Burrell is a graduate of the University of Virginia (BA), Northern Illinois University (MM), and the University of Houston (DMA). She completed a four-year, 800-hour Feldenkrais training in 2013 through Institute for the Study of Somatic Education. As a practitioner, she sees professional musician clients and offers workshops to prevent and overcome injuries/difficulties associated with neurological issues, repetitive strain, and performance anxiety.

As an active writer and blogger, Dr. Burrell is interested in sharing her teaching experience and research with the wider community of educators, musicians, and practitioners working with musicians and injury. She has recently published in the Journal for the Feldenkrais Guild of North America (2015), and is a featured author in two books  The Feldenkrais Method in Creative Practice: Dance, Theatre, and Music, Bloomsbury Press, London 2021, and The Feldenkrais Method: Learning Through the Nervous System, Handspring Press, 2021.

Her website is: LisaBurrellViolin.com