“Wherever you are in your journey, it’s time to prioritise performance health”


BY STEPHANIE ESLAKE

You’d be hard-pressed to find a musician who hasn’t experienced injury. From a stiff neck to a painful finger, full-blown tendonitis to reduced range of motion, there’s a wide-ranging scale of things that can go wrong. And in this profession, it gets personal. Not only can an injury stop a musician from doing their work and enjoying their passion — it can also open the door to feelings and behaviours that can be negative at best and destructive at worst.

I’ll just push through the pain for now — this concert is too important.

I can’t tell the rest of my ensemble about this, or they won’t trust me to play at my best.

Everyone else can put up with it, so why can’t I?

What if it never gets better? I don’t have anything if I don’t have music.

Saxophonist Nikki Demandolx has experienced performance injury, with a wrist issue flaring up during her masters. She was practising up to six hours a day. Nikki wasn’t alone: she says her musician friends believed injury to be a normal part of daily life.

That’s why she decided to undertake research that would help bring relief to saxophonists and other musicians who are going through this, too. The Western Australian Academy of Performing Arts PhD candidate recently gave a performance while wearing a heart rate monitor and measuring her blood lactate levels to obtain data on the effect of fatigue on her body. It was a key event in her research into the way saxophonists can keep in peak mental and physical condition while practising and performing throughout their careers.

Nikki tells CutCommon how she is studying yoga and sport science to find valuable methods of injury prevention in the industry.

Nikki, thanks so much for the conversation. I’d first like to ask you how you got into this area of research. Did you have personal experience with performance and injury? Feel moved by what you saw in the musical community?

A bit of both, actually! I have had an overuse issue with my wrist for the past few years that flares up any time I do a lot of playing. During my masters — with a practice load of four to six hours a day; along with rehearsals, teaching, and a job that included some heavy lifting — my wrist injury came back with a vengeance, which made practising really painful.

Many of my colleagues and friends have had the same issues with their wrists, back, neck, embouchure, with mixed success in managing or eliminating the pain. Often in discussions, it just seemed that pain or injury was a natural consequence of being a musician, and sometimes even validation of our hard work.

As I got further into my postgraduate, it became more apparent that many of us were really suffering and in a lot of pain. I wanted to pursue this area so I could find ways that saxophonists could still maintain a professional standard with excellent technique and a high practice load, but without injuring themselves or needing to quit the profession early due to injury. 

Take us through what you understand to be some of the leading causes of injury among saxophonists — and if there are any injuries that are more prevalent among those who play this instrument, compared to others.

Most research has been looking at musicians as a general cohort, with leading causes of injury including stress, posture, instrument playing technique, insufficient rest and recovery, high or sudden increase in playing load, poor conditioning or physical strength, instrument weight and ergonomics, muscle tension, and repetition.

There haven’t been many studies investigating saxophone specifically, but from the few, it appears that saxophonists suffer mostly from upper-body injuries — specifically wrist, neck, face and jaw including embouchure, and upper and lower back. This commonly presents as pain, weakness, tendon or joint inflammation, muscle pain and tightness, or reduced range of motion.

Some saxophonists have experienced conditions like focal dystonia, temporomandibular joint dysfunction, soft palate issues like velopharyngeal insufficiency, carpal tunnel, and nerve entrapments and compression. Some of these are complicated medical issues and require professional intervention, others can be something the musician can alter in their practice habits or lifestyle to improve.

It’s also important to look at other factors that may contribute to what initially starts out as a playing-related injury, or a playing-related musculoskeletal disorder. For example, if you have an overuse injury in the wrist, and are doing a hobby in your spare time that’s highly repetitive or manual, that may be contributing to the overall load on your wrists.

There are also a few adjustments you can explore for saxophone: looking at your set-up, mouthpiece and reed combination, exploring different types of neck straps or harnesses used to hold the saxophone whilst playing, for neck or upper back pain. These can make a big difference to posture and weight distribution, especially for baritone.

In your recent live performance at ECU, which was also a bit of a case study for your research, you chose to wear a heart rate monitor to assess how your body would respond to the different aspects of the performance. What did this experience teach you about how you use your body in music — and also, about how you approach parts of the performance you may have thought felt healthy or ‘normal’ but perhaps are ‘taxing’ to your body?

Great question! It showed me that performing is more physically exerting than practice, and heart rate indicators show at least, in that measurement, it’s akin to an aerobic activity — an aerobic activity that requires high amounts of focus!

Taking blood lactate tests between pieces, and talking about the pieces was, in a way, distracting me from my performance, especially when I couldn’t get enough blood for the first few tests. And then your mind starts wandering about time limits, and audience attention. Endless distractions are available if you give into them, and this really affects perceptions of your own sound, audience reception, and the flow of the performance.

Since this study, I am interested in exploring more about body awareness and control over the stress response — and all the somatic factors such as elevated heart rate, sweaty palms, shallow breathing! — as well as the ability to improve mindset, even to get to ‘flow’ state, so that there is more harmony between the mind and body as a complete unit during performance. This is where I really think that yoga and sports science have many things that we can learn from and adapt for performance preparation.

Tell us a little more about those physical tests.

In regards to actual results and testing on the night, I wore a Polar H10 chest heart rate monitor, and used my Garmin to log the performance, and then tracked my heart rate over three different challenging pieces.

We also took RPE and blood lactate readings on the night in between each piece. For heart rate, the maximum was 168bpm, which is similar to aerobic activity heart rate levels, with the average being at about 141bpm — so this was a bit more taxing than I thought!

There was a piece which had a fair amount of circular breathing, which I thought would be more physically exerting. However, the max was also reached during a piece which didn’t have circular breathing, which surprised me.

I do think performance anxiety and nerves play a role, as the heart rate was a fair bit lower during a practice session of the same pieces, which was without an audience — and that was about a max of 130 with an average of 100. However, more testing on the interaction of performance anxiety and heart rate would need to be done.

They sound like pretty high heart rates!

This experience showed me that there is significant physical effort required to perform. Breath control is really important for saxophonists, and it’s the fundamental basis for our sound production. Being out of breath from an elevated heart rate could affect performance quality.

Depending on the length and intensity of a performance, fatigue just like in physical activity may also be a critical factor to consider, especially to avoid fatigue-induced errors.

I guess from the performance, there’s nothing that stands out as unhealthy, but that targeted training on instrument, and physically, may prove beneficial for performance conditions.

Other considerations include mental focus, and performance anxiety — training mindset as much as athletes do in order to truly give your best in the moment.

Obviously you’ve learnt a great deal from monitoring yourself while in performance. But at what point do you feel a musician should step in and take care of their health? For instance, is it about building strength in surrounding muscles; practising healthy instrument and posture techniques; addressing injuries after the fact?

Ideally, at this point now — wherever you are in your journey — it’s time to prioritise performance health.

Improving the strength and endurance in the muscles used for playing — for saxophonists, particularly upper body, and postural and core — using mobility exercises and stretches through yoga, practising your fundamentals and targeted exercises to improve technique, embouchure strength, and engaging in active recovery that matches the practice load, have all been key components of my research that I found really helpful.

Health is such a multi-faceted area already, but especially for musicians as our bodies are a key part of performing. We really are small muscle athletes. 

So what helped with your own health?

Personally, improving strength in the forearm flexors and extensors really helped eliminate my wrist pain, but I also had to be mindful of practice session length and intensity — keeping it between 45-60 minutes with breaks — making sure to combine enough recovery between sessions, and to include active recovery through stretching and mobility exercises, yoga, meditation, and breath work.

For me, it was the combination of factors that really allowed sustainable practice that was manageable and pain-free.

It is likely individual for each person, and you don’t need to do ‘all the things all the time’, but assessing your practice load and session length, looking at your technique and posture, improving conditioning, managing mental factors like workload, stress and anxiety — research shows that all of these factors play a role. 

Through pain, your body is telling you that something isn’t quite right. And maybe starting with some of the above factors, you may work out what is contributing to this pain and take steps to address the cause, not just the symptoms. Pain relief, braces, and aids — all of that can be useful. But without addressing the root cause, it is likely the symptoms will continue and could progress to a more serious overuse injury. Now is always the right time to for musicians to prioritise their health.

If a musician ignores their health, or “pushes through” pain, what do you feel are the risks to their career — or to their future physical or mental health?

Pushing through the pain can lead to physical and mental health issues, burnout, overexertion, overuse injuries — and that’s just a surface view. This could manifest through things like muscle tension and pain, joint inflammation, and nerve issues. Initially, symptoms might present like reduced range of motion, numbness, tingling, pain, or weakness but if ignored could quickly develop into issues that require professional, medical assistance like carpal tunnel or tendonitis.

It’s important to note that often performance-related musculoskeletal disorders can get so painful or debilitating that it has ended careers and affected other daily functioning, and this can have profound negative effects both on physical and mental health. Chronic pain and prolonged stress can have long-lasting negative effects on the nervous system. Pain, reduced functionality, occupational and financial stress that can arise from an injury are all considerations that carry across into the musician’s personal lives, too.

I tend to view performance health holistically, as we use physical and mental aspects of ourselves to perform, and targeting one area is unlikely to set you up for success in the long-run. 

Throughout current research, so many external factors are mentioned that often lead to poor health. These include things like erratic sleep schedules, periods of high intensity with lots of gigs and rehearsals, or no gigs — sudden load increase, economic and occupational stress, performance anxiety, perfectionist tendencies, and more. In many studies, musicians have mentioned how they often feel that being a musician is such a strong part of their identity and self-esteem that when encountering an injury and faced with total rest or even giving it up altogether, they’re often faced with mental health concerns, or notions that ‘Who am I, if not a musician?’.

You’ve chosen to focus on sports science and psychology as well as yoga when looking at the ways saxophonists can prevent injuries. Why do you feel these specific areas are useful?

I think this area has so much potential, and is under-studied in its application to music. These two areas appear to have a lot of crossover with music, particularly in injury prevention and peak performance. Sports science has been working with athletes for decades to maintain optimal performance and minimise injury risk, but they have also been looking into psychological aspects of performance — things like mindset and motivation; how to make years of training really count in the moment.

There are also many studies looking at the benefits of yoga for reducing stress and muscle tension, improving body awareness, physical conditioning, reducing trait and performance anxiety, and some of these things are linked really well to the injury risks that musicians face, and the occupational challenges such as a high training load, repetition, performance anxiety.

I enjoy running as a hobby, way to destress and keep healthy, and there’s so many resources out there, even for an amateur runner like me, about healthy mindset, training, alternating load, different types of training, how to prevent injury, even things like body awareness and minimising tension, and how to get into flow states. But as a musician, these areas are all important to maintain peak performance standard, but not as readily available.

To me, applying these concepts like periodisation, performance mindset, recovery, warm ups and cool downs, mobility exercises, meditation, and breath training can provide musicians with the tools to help us to shape the perfect practice and performance preparation that is individualised and matches performance demands.

With a holistic approach that addresses injury risk factors, and takes into account mental and physical wellbeing, the whole musician can be nurtured and hopefully lead a sustainable career.

What advice would you give to musicians of any instrument when it comes to the way they should be approaching injuries? It can’t be avoided that many will face this in their careers. So when it happens, how can they approach it without stress — and as something that needs correction and maintenance over the course of their lives?

​My best advice would be to start by being kind to yourself, and try to remove any negative self-talk. Research shows up to 93 per cent of musicians have experienced an injury, so you are most definitely not alone.

Then look at your practice as objectively as possible. How is your practice structured? Are you taking regular breaks with focused, efficient practice, or are you stress-practising for four hours straight? Do you have clear measurable goals, are you enjoying your practice? How is your posture, how is your body relating to your saxophone? Play in front of a mirror, and check your body for excess tension and inefficient playing technique. Is your set-up helping you, or do you need to go to a different mouthpiece and reed combo? Are you biting excessively? Some of these questions may help you to identify areas that could be improved.

Even [think about] things like time management, nutrition, and lifestyle. Are you burnt out? Do you have effective strategies for dealing with stress? Incorporate dynamic warm-ups and cool downs. Mobility exercises can help you address areas of pain and prioritise recovery, too.

In a nutshell, you’re right on — it’s usually something that can be corrected and maintained by balancing recovery and load.

Be kind to yourself, take care of your body. You can get through this. Don’t be afraid to seek help and reach out to those around you.

Learn more on the ECU website. If you’re a musician and you feel like you need help, contact your GP or call the Support Act Wellbeing Helpline 24/7 on 1800 959 500.


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