Health and Safety for the Musician


In a 1987 survey of members of the International Conference of Symphony and Opera Musicians (ICSOM), 76% reported having at least one medical problem severe enough to affect performance, and 36% reported four severe problems. When members of eight orchestras were interviewed and examined, 64% had painful overuse syndromes. The prevalence ranged from 75% among strings players to 32% among percussionists. Keyboard players were also at high risk. The reasons for instrument-specific variations in prevalence are complex. However, the total daily playing time, instrument size and weight, playing position, differences in the distribution of men and women in various orchestra sections, technical demands of the music, and personal drive all contribute. Student musicians also experience painful overuse syndromes at rates that have been reported to range between 9% and 49%. Approximately 5% to 11% of music majors at one university music school developed hand problems each year during a four-year period. The incidence of hand problems in women was about twice as high as that in men.

Voice problems

Musicians and actors are at risk for many disabling ailments. These include vocal abuse in singing or speech; vocal cord nodules, polyps, cysts, or swelling; and infectious or allergic laryngitis. In addition, the human voice is particularly sensitive to endocrinologic changes, systemic illnesses such as anemia or mononucleosis, and any inhaled or ingested substance. Symptoms of hoarseness, breathiness, loss of range, vocal fatigue, chronic cough, frequent throat-clearing or unusual sensations in the throat should be evaluated.

Muscular/Skeletal—Overuse Syndromes

The majority of patients suffer from overuse syndromes: symptom complexes defined as injuries caused by the cumulative effects on tissues of repetitive physical stress that exceeds physiologic limits. Women are more commonly affected than men. Immediately before the syndrome develops, increases in practice or work time, in the technical difficulties of the repertoire or equipment use, or in the levels of psychological stress are common. Use of new instruments or equipment, previous injury, or excessive joint mobility may be contributing factors.

Each instrument or piece of equipment has its own unique size and shape and utilization requirements that lead to overuse injuries. Because problems are exacerbated or frequently evident only while the musician or the artist/designer is working, they should be examined during and immediately after working.

Common locations for overuse syndromes include the fingers, wrist, elbow, shoulder, neck, and low back. Common symptoms include pain, weakness, and loss of fine motor control. Overuse syndromes can affect bones, ligaments, bursae, tendons and muscle, and can become serious problems if not appropriately treated.

(EXCERPTED) An Overview of Health Issues for Performing and Visual Arts Students
March 1991, Reprinted May 2009

Hearing Health

Noise Levels and Risk

  • Prolonged exposure to any noise or sound over 85 decibels can cause hearing loss. A decibel, defined by Merriam-Webster as “a unit for expressing the relative intensity of sounds on a scale from 0 for the average least perceptible sound to about 130 for the average pain level” is abbreviated “dB.”
  • The longer one’s exposure to a loud noise, the greater the potential for hearing loss.
  • The closer a person is to the source of a loud noise, the greater the risk for damage to the hearing mechanisms.
  • Consider these common sounds and their corresponding decibel levels:
  • 30 dB – A Whisper50 dB – Moderate Rain 60 dB – The Average Conversation70 dB – Passing Freeway Traffic 80 dB – Alarm Clock90 dB – Blender, Food Processer, Blow-Dryer; The Subway 100 dB - MP3 Players at Full Volume; Lawnmower, Snowblower 110 dB – Rock Concerts and Sporting Events; Power Tools120 dB – Jet Planes at Take Off 130 dB – Sirens; Race Cars; Jackhammers140 dB – Gun Shots; Fireworks
  • As a general rule, for every 3 dB above the 85 dB threshold, the intensity of a noise rises exponentially. For example, a 100 dB noise or sound has 32 times the destructive power of an 85dB sound or noise.
  • “Safe” exposure time is reduced by 1⁄2 for every 3 dB increase, a time/intensity relationship often referred to as the “exchange rate.” The 3 dB exchange rate is widely accepted as a means for developing scientific, evidence-based assessment of the potential for hearing impairment as a function of noise level and duration. The NIOSH chart in the next section shows the 3 dB exchange rate progression clearly.

Basic Protection for Musicians

  • On stage and in life, it is important for musicians to take steps to protect their hearing. Sometimes, however, it is not possible or preferable to completely avoid a loud sound or noisy environment. At these times, musicians and music faculty may wish to explore the following methods of hearing protection:
  • Earplugs – often made of foam or silicone; designed to be inserted into the wearer’s ear canal to protect against loud noise; some designed specifically for music applications.
  • Earmuffs – often consist of two protective foam pads connected by a headband or strap; designed to cover the wearer’s ears and protect against loud noise
  • Acoustical sound shields – generally made of clear plexi-glass or similar material; used to isolate and redirect the noise from a particular instrument or section of a band, orchestra, or ensemble; protects the hearing of musicians directly in front of the shielded instrument or section
  • Musicians often find that hearing protectors are not comfortable or that they create perceptual changes, even causing users to increase sound-intensity levels to compensate. One solution is to reduce the “average” sound-level exposure in rehearsals by making balanced repertory choices and giving greater attention to dynamic levels, especially in large or amplified ensembles. See Musicians and Risk of Noise-Induced Hearing Loss and Solo and Ensemble.
  • Protection also comes from regular behaviors such as:
    • Avoiding situations likely to pose a danger to hearing health.
    • Refraining from certain activities that can endanger hearing mechanisms.
    • Maintaining a safe distance from sources of loud noise.
    • At loud concerts, sitting or standing a “safe” distance from the stage and from speakers or other amplification devices.
    • Keeping MP3 players and other listening devices at “safe” volume levels. MP3 players need special attention. Normally, MP3 players generate about 85 dB at one-third of their maximum volume, 94 dB at half volume, and 100 dB or more at full volume. Translated into daily exposure time, according to NIOSH standards, 85 dB equals 8 hours; 94 dB, 1 hour; and 100 dB, 15 minutes. These numbers assume that an individual is not exposed to any other noise beyond 85 dB during the day.
    • Taking care with in-ear monitors, a device that has grown in popularity among musicians, especially in certain types of professional ensembles. These monitors can produce dangerously high sound levels. Musicians should see an audiologist or other qualified professional for a demonstration of safe practices before using an in-ear monitor for the first time and use the device in a manner that protects their hearing health.
    • Developing a sense of the extent to which daily exposure has exceeded safe volume levels and durations (see Noise Levels and Risk and Exposure Times and Risk.)
    • Taking breaks from exposure to elevated noise levels. (Enjoying quiet time.) See also Note 1 in the section Exposure Times and Risk.

(EXCERPTED) Basic Information on Hearing Health: Information and Recommendations for Administrators and Faculty in Schools of Music – NASM/PAMA: November 2011