By THIRSTY
Dr. Serap Bastepe-Gray,
along with Dr. Alexander Pantelyat and Sarah Hoover, D.M.A., are the leaders of
the Johns Hopkins Center for Music & Medicine. Using a multidisciplinary approach
that involves physicians, nurses, music therapists,
physical/occupational/speech therapists, somatic educators and practitioners of
complementary and integrative medicine, the Center’s goal is to promote research
and to help restore and preserve the proficiencies and talents of musicians all
over the world.
Dr. Bastepe-Gray, a
physician and a virtuoso guitarist, is the Director for Peabody Occupational
Health and Injury Prevention Program, serves on the Performing Arts Medicine
Committee of the Maryland State Medical Society, the Research and Education
Committees of the Performing Arts Medicine Association and the Musicians’
Health and Wellness Committee of the International Society for Music Education.
She holds joint appointments at the Johns Hopkins Department of Neurology and
the Peabody Conservatory. Her expertise comprises pain and playing related
musculoskeletal and neurological upper extremity disorders that affect musical
performers.
It was Stay Thirsty Magazine’s privilege to
visit with Dr. Bastepe-Gray in Baltimore for this Conversation and to learn
about the Center’s important work.
STAY
THIRSTY: Johns Hopkins recently established a Center for Music &
Medicine where you practice in the areas of performance health and wellness and
injury prevention and rehabilitation. How did this Center come about and what
is its mission?
DR.
BASTEPE-GRAY: During my student years at Peabody, I had
a first-hand encounter with a playing related musculoskeletal problem, from
which I was able to recover using my medical knowledge and the help of my
teachers in optimizing my biomechanics on the guitar. When the word got out, I
had become somewhat of an unofficial “healer”
for the Peabody students with similar issues. When I became a faculty member at
the Peabody Conservatory, students continued to knock on my door seeking help
with their pain and other symptoms that made it difficult for them to practice
and perform on their instruments.
In the two decades that
have passed, heightened interest in musicians’ occupational health resulted in a body of
epidemiological studies that indicated that about four out of five musicians deal
with at least one episode of playing related musculoskeletal problem sometime
during their careers. However, despite ongoing interest among health care
practitioners over these two decades, no trend in decreasing the percentage of
playing related musculoskeletal problems was happening. Clearly, we were
missing a few links in the knowledge chain that would prevent such problems and
that would help injured musicians return to play with long term relief.
As an individual with professional
training in both the medical and musical fields, and one with personal experience
with playing related injury who was able to come out on the other side with a
positive resolution, I realized that I had a responsibility to initiate change
that will lead to better understanding of the mechanisms of playing related
disorders in musicians so that we can design more effective preventive programs
and treatment protocols for musicians.
At the same time, my
colleague Dr. Alexander Pantelyat, a faculty member of the Johns Hopkins Department
of Neurology and an accomplished violinist, was very interested in researching the
healing power of music. Although the restorative and therapeutic properties of
music have been known to humans since the beginning of history, and the recent
body of research provided evidence, we have little knowledge of the mechanisms
behind all this.
In the fall semester of
2014, with unprecedented support from Peabody Dean Dr. Fred Bronstein and the
Chair of the Neurology Department Dr. Justin McArthur, Dr. Pantelyat and I began
collaborating to develop an initiative to bring together the expertise, wisdom
and resources that lay within the School of Medicine and the Peabody Institute
for the benefit of the musicians and non-musicians alike. On January 23, 2015, in
a meeting between the senior administrators and interested faculty members from
Department of Neurology and the Peabody Institute – and with an endorsement
from Leon Fleisher, piano icon and Andrew
W. Mellon Chair at the Peabody Conservatory – we officially co-founded
the Center for Music & Medicine to bring music and
medicine together with a dual vision:
1) Making music and
rhythm an integral part of treating neurological illness
2) Improving the health
of musicians worldwide.
Under the leadership of
Dr. Sarah Hoover, Peabody Associate Dean for Innovation, Interdisciplinary
Partnerships and Community Initiatives and co-director of the center, we have clarified
and developed our mission to leverage Johns Hopkins Medicine’s world-class expertise and excellence in
research and clinical care, and the Peabody Institute’s world-renowned
performance training for musicians in order to develop research, clinical care,
education and outreach projects that bring music, science and medicine together
to benefit patients, health care workers and musicians.
Our mission includes:
1) Discovery and treatment of the underlying causes of health issues
affecting musicians.
2) Exploration of neural mechanisms that underlie music perception
and kinesthetic learning for the development of prevention education and
evidence-based pedagogy for musicians.
3) Development of music and rhythm-based therapies that improve
patient quality of life and address symptoms of Alzheimer’s disease, Parkinson's
disease, stroke, autism and other conditions.
4) Creation of innovative roles for performers in clinical settings
to provide a direct benefit to patients and health care providers using musical
performance as medicine.
5) Educating physicians and others at Johns Hopkins Medicine on the
dynamics of musical performance and interventions.
STAY
THIRSTY: When a musician, such as yourself, experiences a
performance injury, what are the proper steps to seeking and obtaining
treatment? How does the new Peabody Clinic fit into the picture?
DR.
BASTEPE-GRAY: I think the most important step is to be
able to discriminate the symptoms of a disorder or injury from transient pain
or discomfort, which is temporary and does not interfere with practice and
performance. Musicians are notorious about waiting too long before seeking
treatment –
which suggests a bias among musicians to categorize discomfort as a transient
issue that will go away on its own.
Ongoing or repetitive
pain or other symptoms such as tingling and burning sensation or loss of motor
control are good reasons to seek help from a board-certified physician with an
interest in musicians’
playing related disorders. New pain during practice may be a “warning pain” – the tissues are
subjected to levels of stress that almost or slightly exceeded their
capacities. The best strategy is to stop and wait for about 20 minutes. If the
pain goes away, it may indeed be a warning pain. Analyzing the passage during
which the pain was perceived to correct mechanics, (for student musicians,
asking their teacher for help) and making sure the duration and intensity of
practice sessions are within the limits of the tissue capacities will usually
resolve the problem. New pain that does not go away with rest most likely indicates
the development of a new problem. I recommend temporary cessation of any
playing activity and seeking medical help immediately. Student musicians can consult
with their teachers and their institutions to identify the local physicians from
whom they can seek help. Additionally, the Performing Arts Medicine Association
has a referral web page that lists health care professionals who are interested
in treating musicians along with their location and contact information.
Our onsite clinic at
Peabody, established in collaboration with the Johns Hopkins Physical Medicine
and Rehabilitation Department, is one of the rare clinics for performing
artists that is housed within the grounds of a conservatory. It provides convenient access to hand
therapy, occupational therapy and physical therapy and presents opportunities
to develop innovative treatment approaches through collaboration between music
and health care professionals. Currently the clinic is open to Peabody
students, faculty and staff and we are planning to expand our services to our
alumni and musicians at large over the next few years.
STAY
THIRSTY: What are the key neurological and physiological
processes that the human body goes through in learning and in performing music?
DR.
BASTEPE-GRAY: Neuroscientists describe mastering a
musical instrument as one of the most significant achievements of the human
brain, requiring highly sophisticated skills including fast and coordinated
auditory, visual, perceptual, emotive and motor processing skills.
Practice provides multi-modal
stimuli to the brain. Due to the ability of the brain to reorganize itself,
referred to as “neuroplasticity,” a distinct multi-modal
network of highly connected perceptual-motor pathways develops in musicians’ brains through neurochemical
adaptation, circuitry formation and network enhancement processes. The changes
in the brain as a result of active engagement in instrument practice and
performance over years is so profound that musicians’ brains differ in
connectivity even at rest as compared to non-musicians.
Another consequence of
practice in a musicians’
mind is the formation of a multi-modal imagery of the performance of a given
repertoire: musicians, in their minds’ eye, can see, hear and feel themselves playing a
particular piece without actually physically performing that piece. This
multi-modal imagery not only serves as a basis for mental practice (or
visualization as musicians like to call it), but it also happens “online” during performance:
musicians, a split second before they actually move to produce a sound on their
instruments within the piece they are playing, experience the visual, auditory
and perceptual sensations of making that movement. This so-called online
imagery, which is for the most part unconscious, triggers motor anticipation,
thus optimizing and smoothing out the actual motor component of performance.
Practice also provides
stimuli to functionally condition and adapt the musculoskeletal system to the
demands of playing an instrument by inducing ultrastructural, biochemical and
metabolic changes in muscles and tendons. Just like a session of exercise, a session
of practicing results in disruption of myofibrils and cytoskeleton in muscle
cells, increased collagen breakdown in tendons and increased muscle metabolism
and metabolic waste production. This initiates an adaptive response in the
musculoskeletal system for structural and metabolic remodeling towards a better
contractile machinery, efficient neuromuscular junction, increased capillarity
and better oxygen utilization.
Most musicians believe
that they are improving during practice. In reality, most of the neurological
and physiological processes that lead to adaptation happen after the practice is
over, beginning during the recovery phase and continuing for several days. Sleep,
as we now know, is very important for memory consolidation as well as
decreasing muscle breakdown and facilitating remodeling. In a study conducted
at the Johns Hopkins Laboratory for Computational Motor Control and published
in Journal of Neurophysiology in 2015, Sarah Pekny and Reza Shadmer showed that
practice alone was not sufficient to result in increased efficiency of motor
output, but 6 to 24 hours spent away from practice was a required element for
optimization of effort. Similarly, studies indicate that after a session of
exercise, recovery of muscles and tendons can take as long as 24 to 48 hours,
while the remodeling process continues for 7 to 10 days or even longer. In
athletics, this improvement that happens 24 to 48 hours after the practice is
called “silent training.” I believe this is one of
the many useful concepts musicians can adapt from sports for training for better
practice outcomes.
STAY
THIRSTY: How important are the periods of rest between practice
sessions?
DR.
BASTEPE-GRAY: Short periods of rest, about 5 minutes
every half an hour of practice, are important both for giving the brain and
musculoskeletal structures time to clear some of the metabolic waste products
and replenish nutrients and energy, thus preparing them for the next session of
practice. Longer periods of rest and sleep are essential for allowing the
adaptive processes to happen in the brain and in the musculoskeletal system,
leading to motor learning and functional conditioning.
STAY
THIRSTY: What is the value of warming up and cooling down
before and after practice sessions and performances?
DR.
BASTEPE-GRAY: Warm up provides a bridge that moves the
mind and body of the musician from daily activities to focused practicing. Although
increasing tissue temperature and tissue flexibility by increasing blood flow
to those tissues that will work during practice and performance is one of the
objectives of warm up, the primary physiological objective of warm up is neural
activation in musicians and athletes alike. This activation facilitates
retrieval of motor and perceptual memory and optimizes motor output. Warm up
can also act as a psychological anchor: elite musicians and athletes have a
routine for warm up which becomes a cue (a trigger) for successful performance
by facilitating management of “nerves” and by triggering entry into peak
performance zone.
A good initial routine for musicians warms up the tissues that are
going to be used in performing the instrument and activates task specific motor
programs. Before picking up the instrument, about 5 minutes of gentle movements
of the body and arms that increase gradually in range, intensity and complexity
help initiate this process. Warming up on the instrument (about 10 minutes) involves
idiomatic previously mastered material. It begins with sequences of low
complexity such as scales and arpeggios at moderate tempos and in mid-range dynamic
levels and progresses towards more complex and high intensity material.
Cooling down is important after strenuous exercise to bring heart
rate gradually to normal levels and prevent pooling of blood in large muscles
of the lower limb. Although this aspect does not readily translate to musicians’
work, cooling down with gentle dynamic stretches (stretching like a baby
without pushing on or leaning into a prop) might facilitate relaxation of
muscles and restoration of resting state length-tension relationship of the
muscles.
 |
| Dr. Alexander Pantelyat, Sarah Hoover, D.M.A. and Dr. Serap Bastepe-Gray |
STAY
THIRSTY: What role do mental strategies play in a musician’s
overall physical and performance health?
DR.
BASTEPE-GRAY: Once in a conference, a physical therapist
colleague of mine who works with athletes, having watched a piano student
practice the same passage over and over again, was astonished with the need of
the student to do so many repetitions of a passage that sounded fine each and
every time. Although there is a certain amount of repetition that is necessary
to acquire a new motor skill or to explore different ways of phrasing a
passage, often musicians – especially student musicians – repeatedly play
already learned and mastered material because the execution of the material
does not “feel” reliable. We know from
research in the work force in other industries that repetitive movements,
especially if they involve high force production or upper limb positions that
require going out of the mid-range of motions in arm and finger joints, will
eventually lead to musculoskeletal disorders. This perception of low
reliability in the face of repeated successful performances is the product of
the mind and without training the mind, we cannot train the body to command an
instrument.
Mind and body are
interconnected in intricate and complex ways and separating one from the other can
lead to artificial distinction. In the field of athletics, this connection and
interdependency has been recognized long ago and mental skills training is an
important component in the development of skills for elite athletes. This type
of training has yet to become commonplace in music schools, and conversations
about mental training in musicians usually focus on performance anxiety
management and occasionally the benefits of mental practice or visualization. In reality, musicians, just like
athletes, require a variety of mental skills that precedes and supports
management of performance anxiety. Thanks to the field of sport psychology, a
large body of research has been done to identify mental skills necessary for successful
performance. These skills are often explained as a pyramid, categorized into levels,
beginning from basic skills such as attitude and motivation at level one at the
bottom of the pyramid and continuing with preparatory skills, where
visualization would be an area of focus.
Performance skills, which
includes performance anxiety management, are usually listed at the highest
level in the mental skills pyramid. These skills are believed to be learned and
can be improved with instruction and practice. These concepts can be translated
well to musicians’
work and with continued research will yield supporting evidence that can be successfully
integrated into the overall training of musicians. In the meantime, here are
some points to think about:
1. Clarify and develop mindsets. The basic
level 1 skills, such as attitude, motivation, commitment and goal setting
depend on one’s
mindset. Having the right mindset for the right circumstance aligns these
skills more clearly for that circumstance. For example, practicing to acquire
new repertoire or new motor skills requires conscious focus, problem solving
and learning – the musician is an explorer, teacher and student at the same
time. On stage, on the other hand, performance requires a flow-state with
subconscious intuition taking over, kept in-check only with short moments of
conscious attention – the musician is at the service of the music, bowing to
the audience having presented the gift of music in a shared journey of emotions
flowing with created sound. Clearly the attitudes, motivation, commitment and
goals of practice and performance have some significant differences. Student
musicians, who are usually more concerned about learning to play a particular
work of music or being able to successfully execute a difficult passage, spend much
time in the practice mindset. They would benefit from guided self-reflection to
identify their root motivations in wanting to become musicians and their
artistic philosophy as a first step towards building their performance mindsets
as a support to publicly displayed creativity.
2.
Build a “performer
button”. Having
identified the level 1 mental skills necessary for performance, the next task
is to identify and build triggers to switch to this mindset before the
performance. Olympic athletes, especially the ones that are alone in the arena
such as divers, swimmers, golfers, and ice skaters, receive training to build,
practice and use these performance triggers to get into their peak performance
zones. For musicians, these triggers can range from a warm up routine, an
imagery sequence with self-affirming statements (for example, seeing yourself in
your mind’s
eye stepping into a circle of golden light with your instrument and telling
yourself that within this circle of light you are the master of time), the
sound of the latch of an instrument case opening or the anticipatory silence of
the audience right before beginning performance on stage and more. Again, identifying
and practicing these triggers to switch to performer’s mode is the key for
successfully building and activating the performer button at will.
3.
Practice performing. Most often, performance practice is
understood as performing a mastered excerpt or an entire piece to an imagined
or real audience. This of course is an essential element of performance
preparation and performance experience cannot be substituted with anything
else. Most often, student musicians believe that in order to allow themselves
to play any material like a performer, they need to first master all musical
and technical aspects of the material at hand. This perpetuates practice mindset
does not allow for opportunities for frequent triggering of the “performer” and turns the
performance into a hard-to-attain reward for practice. In reality, a musician
can perform within the performance mindset a single note, a short motif, or a
phrase with temporal adjustments to fit the technical demands of that short
material to the current technical abilities. Interspersing performance of short
amounts of material in this way will not only inform the more deliberate
practice of that material to improve task specific technical and musical skills
but will also create opportunities to practice the performer mechanism.
4.
Learn to find your musical fingers now. Perceptual motor studies
demonstrate that there are both short term and day-to-day fluctuations in these
skills within the same person. This is not surprising because our perceptions
can be influenced by both internal and external factors. How much we have slept,
what time we woke up, our mood, the weather and many other factors like these
can cause small shifts in our interpretation of sensory information, the quality
of our attention, our reaction time and more. External factors such as the temperature,
humidity, may change the response of our instrument to touch. Have you ever
seen the occasional student that can sit in a masterclass for two hours with
their instrument nicely tucked in its case, and when their turn comes, they can
pick up their instrument, tune, and begin playing for the master without a
hitch? That student can sense where their perceptual and motor abilities currently
are right before they begin playing and can adjust their playing strategies
accordingly so that they can perform successfully. On the other end of the
spectrum, there is the student who would sit outside of the masterclass room
until it is their turn to play, repeatedly performing excerpts with the hope
that they can somehow find the fingers that they had the other day when they
performed the piece in the one ideal way that they think it should be performed
each and every time. Clearly, developing this perceptual-motor adaptability requires
not only learning to pay attention to our internal sensations, but also an understanding
that today’s
performance can only arise out of today’s abilities. One way to develop this mental skill of
on-demand perceptual motor ability gauging would be to pick up the instrument
at odd hours, under different conditions, and perform a selected piece as if on
stage, finding strategies during this performance to adjust the demands of the
piece to where the fingers are, followed by a reflection of internal sensations
and adjustment strategies.
5.
Commit to performance to minimize the impact of mistakes. The
recommendation during practice is to learn from mistakes – i.e. pay attention to
mistakes and solve the problem –
which is great advice but then the same person who spends hours conditioned to
pay attention to mistakes so that they can identify and solve the problems to
eliminate them is expected to not pay attention or be bothered by the mistakes
during performance. What is the solution for this conundrum? We are what we
practice –
if during practice we stop every time we make a mistake so that we can analyze
and solve the problem, this behavior will spill into the performance modality.
Similarly, if we do not balance the time spent on technical hygiene in practice
with exploration and refinement of musical expression on the same excerpt, the
mistake-catching thought processes will spill into the performance. And
further, if we do not spend time practicing the performing of that excerpt
within our performer mindset, the practice mindset will spill into performance.
One way to negotiate all this would be by committing to the performance of the
selected short material during practice, rain or shine, from beginning to the
end, with phrasing decisions, returning to mistake-solving process only after
the completion of the performance of the intended material. The selected
material can be as short as a motif or as long as the entire length of the work
depending on the goals of the practice. This mental skill of committed performance
in the face of mistakes until the performance of the intended material has been
completed will reduce the impact of mistakes on the overall performance quality
on stage.
6.
Build a strong memory chain with retrieval triggers. Although
we can encode large motor programs into our long-term memory, short term memory
is like the RAM of a computer, it has limited capacity to hold information. For
this reason, we retrieve motor programs in chunks, where these chunks can go
under automatic planning and optimization before execution. A musical work, as
we are performing it, is then retrieved in the form of a chain of small chunks.
In order to avoid hesitation or memory blocks, each chunk will need to trigger
the retrieval of the next chunk. It is common knowledge that practicing small
meaningful musical phrases or phraselets is an effective way of learning a new
piece since they allow focused work in small amount of material. This facilitates
encoding motor programs that are executed cleanly and eliminates the
distractive effects of the upcoming chunk on the learning of the chunk at hand.
Practicing in chunks also has the
advantage of tapping into our preferential memory: we tend to remember
beginnings and endings of an event better than the middle. By dividing the
piece into practicable areas with their own beginnings and endings, we are
creating more points within the piece for our preferential memory to latch onto.
However, if these musical
chunks are not hooked to each other from the earlier stages of encoding, the
triggering of them in a connected memory chain will be hampered. One way of
achieving this is to extend the practiced chunk to include the first note (or
chord) of the next chunk that comes in the piece. This overlap will serve as a
trigger for the next chunk. As the performance of each chunk becomes
comfortable, practicing these chunks in backwards order by beginning with the
last chunk of the piece and going backwards by chunk, increasing chunk size by “hooking
together” two or more chunks would reinforce the association of these areas
with each other within the scheme of the entire piece and will strengthen the
memory chain. Spending some time understanding the general architecture of the
piece, phrase structure, noticing patterns, repeated material, etc. would add
declarative memory into the memory process, adding to the associations between
the chunks and the entire work, creating another layer of strength to the memory
chain.
7.
Visualize. Mental practice, or visualization is a well-studied
mental skill in sports and in the field of motor rehabilitation of patients after
stroke. Although it requires more research in how to best integrate it into the
overall training regimen of musicians for increased motor learning efficiency,
it is nevertheless an important mental strategy among elite musicians. Research
in sports show that there are good visualizers and bad visualizers, and that
visualization skill can be improved by practicing visualization. As I mentioned
before, performance involves an unconscious online imagery of the performance
that activates and optimizes motor output a split second before the actual notes
are sounded. Visualization involves conscious access to this imagery to trigger
the performance in the mind’s
eye and ear and this ability to access this imagery becomes more fluent with
practice. Studies show that the practice of imagined performances activates
similar networks in the brain to those activated by the actual physical
performance, with the implication that the more times these networks are
activated the more they will strengthen. Research in the rehabilitation field
shows that sandwiching mental practice of a short motor action between two
actual physical performances of it has the most beneficial aspect in improving
the performance. Visualization can be used in chunk practice in this way. In addition
to facilitating motor learning and enhancing retrieval process, integrating
visualization into practice in this way reduces the number of physical
repetitions, and can decrease the exposure to playing-related biomechanical
loads in musicians.
In addition to its
benefits in motor learning and motor performance quality, visualization can be
used to increase overall performance success through visualization of the
preconcert routine, activating the performer button and the beginning and
ending of successful performance on stage.
8.
Trust silent training. Skill building takes time. In the
athletic world, there is a 3+3 week rule: it takes at least 3 weeks to acquire
a new skill and another 3 weeks for the skill to stabilize – to be consistently executed
on demand. Since musicians’
work often involves very high levels of cognitive demands in addition to motor
demands, it is logical to conclude that skill emergence and stabilization would
most likely take a somewhat longer amount of time. Additionally, some skills
take longer to develop as compared to others. For example, with good training,
it is possible to notice changes in flexibility in a few days but a noticeable
difference in reliable speed and agility may occur over the span of weeks and months.
Complex skills will take longer time to acquire than simple skills. Most of the
frustration in student musicians come from expecting improvement too quickly,
often over the span of a day of practice. When the expected goal has not been
reached, many people will respond to this goal blockage by increasing the
behavior to regain the goal accompanied by feelings of anger. Repeated goal
blockage will then result in decreased motivation to reach the goal often accompanied
with feelings of sadness. In the musicians’ case, this translates as increased repetitive
practice with increased risk for injury, followed by self-doubt.
It is important to
remember that most of the skill improvement will come during the recovery phase
after the cessation of the practice. Accepting this and trusting that your
training will result in the necessary changes in your brain and your musculoskeletal
system in the fullness of time will help decrease repetitive frustration, an
urge to engage in fruitless repetitive practicing and self-doubt.
9.
Embrace your butterflies. Performing in front of audience is exciting
as well as stressful Studies show that there is an inversed U-shaped
relationship between performance quality and nervousness: while too little or
too much nervousness can interfere with performance quality, a certain level of
nervousness is beneficial, helps sharpen the focus and fuels the energy
necessary to sustain this focus during a concert. However, nervousness also
changes the feel of the instrument-musician interface. Accepting that
nervousness comes with the territory and repeated exposure to on-stage
performance helps adapt to these changes. Not many musicians suffer from too
little nervousness, thankfully, however, excess amounts of nervousness before
or during performance seems to be an issue for a lot of musicians.
The first stage of
response to immediate threat has been described as the alarm stage in a stress
model developed by Dr. Hans Selye, a Hungarian endocrinologist. This stage begins
with a shock phase, where the body releases adrenaline which is the
neurochemical agent behind the symptoms of nervousness such as increased heart
rate and trembling. Shock phase is followed by the counter-shock phase where
the body reverses most of the physiological signs of the shock phase. These
phases can be as short as few minutes or can last up to 24 hours. Interviews with soldiers indicate that while
they feel very nervous the first day of combat, they usually feel less nervous
the second day. One of the strategies that musicians use is to begin getting
nervous early, for example in the morning hours of the day of an evening performance.
This strategy has the potential to allow completion of the shock phase to take
advantage of the temporary physiological recovery during the counter-shock
phase.
10.
Practice self-pep-talk. Much has been said about controlling
negative self-talk and replacing it with positive self-talk to maintain a happy
life and enhance mental toughness for better performance. Aside from the life
changing potentialities of these recommendations, research has shown that
motivational self-talk, such as “I got this,” and instructional self-talk, such as “shoulder up,” increases performance
success in athletes. Training in motivational and instructional self-talk is
one of the components of an overall mental training program in elite athletes
and can be easily translated to musicians’ work.
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| Wellness Immersion |
STAY
THIRSTY: How important is hydration and nutrition to a
musician?
DR.
BASTEPE-GRAY: Very important! Musicians, who are sometimes
referred to as “small
muscle athletes,”
need healthy and fit bodies and minds. Hydration, nutrition, sleep and exercise
are important factors in maintaining health. Studies show that dehydration
decreases endurance and performance quality in athletes. Sipping water
throughout the day rather than drinking large amounts of water infrequently is
recommended to maintain hydration. Sports nutrition, a complex science and art,
provides some insights for adapting nutritional strategies to support musicians’ practice and
performance. In general, protein intake is shown to facilitate recovery after a
hard work out session. Complex carbohydrate intake about 2 hours before a long
practice session or performance together with continued hydration provide fuel for
muscles. However, there are significant differences in the ways that musicians use their bodies as compared to athletes,
and more research is needed to help translate these strategies to musicians’ nutritional needs.
STAY
THIRSTY: Aside from the physical recovery from an injury, how
are the psychological implications of that injury addressed?
DR.
BASTEPE-GRAY: Most musicians, like athletes, begin
training in childhood and engage in practice and performance activities that
continue throughout their life-span. Due to the constant engagement of the
musician in musical tasks throughout their lives, and the not yet fully
understood effects of music making on cognitive reward systems, engagement in music
making has a high valence of meaning. Several qualitative studies reveal that disruption
or loss of participation in music making impacts musicians in a manner similar
to the loss of a close family member. For student musicians, there is the added
burden of falling behind in skill acquisition as compared to their peers. Strong
doubts of self-worth, guilt, and feelings of anxiety are magnified, especially in
the face of an unpredictable length of recovery in long term injury. Implemented
by a counselor, processes such as Socratic questioning, guided discovery, reframing
and journaling would be helpful in reorganizing thought processes. Training in stress
management techniques such as deep breathing, progressive muscle relaxation or
guided imagery helps in dealing with anxiety and stress. Preserving musician
identity by engaging in musical activities that do not require physical work on
the instrument, for example theoretical analysis of musical works, comparative
listening of performances of selected repertoire by various musicians, reading
and analyzing pedagogical texts will also be important. Education on the genesis
of injury, daily tissue capacity, injury first aid and pain management
techniques empowers the injured musician to be an active participant in their
recovery process. Appropriate therapy to promote tissue healing and a well-designed
gradual return-to-play program with biomechanical adjustments usually results
in an overall decrease in symptom levels and overall increase in practice and
performance tolerance over several weeks. However, recovery is not a smoothly linear
process and symptoms can often fluctuate from day to day, making it harder for
the injured musician to gauge their recovery. Keeping a pain log helps to demonstrate
overall benefits of the rehabilitation program in reducing discomfort and in
increasing capacity to play.
STAY
THIRSTY: What are the proper habits young musicians should employ
so that they are able to reduce time spent recovering from injuries in the
future?
DR.
BASTEPE-GRAY: Here are my recommendations to young
musicians for a healthy, long and successful career:
1. Keep your body and mind healthy, keep your
instrument user-friendly.
2. Control the daily wear and tear on your
upper limbs – understand that everything we do with our hands, not just playing,
has an impact on tissue capacities.
3. Make a habit of warming up and cooling
down.
4. Set clear goals and time limits for
practice and use a timer to remember to give breaks (~5 minutes every 30
minutes of practice).
5. Avoid sudden increases in daily practice
time.
6. Respond to fatigue and pain immediately.
7. Habituate fluent movement – strive for
biomechanical efficiency, ease of play; allow musical gestures to guide
physical gestures.
8. Use reduced-force techniques, such as
etouffee (muffled sound) or soft dynamic levels, for repetitive practice to
learn the choreography of a new piece.
9. Alternate mental practice with physical
practice.
10. Employ efficient motor learning strategies.
11. Practice and improve mental skills to
support performance success.
12. Be patient and trust your training.
13. Give yourself permission to be an artist.
14. Develop a plan to translate performance
success to career success.
15. Learn to deploy your strengths to work
around your limitations.
STAY
THIRSTY: What innovative treatments and strategies are being
developed to help professional musicians stay at their peak health?
 |
| Wellness Immersion |
DR.
BASTEPE-GRAY: Seeing that playing related injuries or disorders
are very common in musicians, rather than a traditional treatment model, an
integrated cycle of injury management is a more effective strategy to keep
professional musicians at their peak health. Similar to FEMA’s cycle of disaster
management, our injury management cycle includes preparedness, response,
recovery and mitigation phases. Our clinic at Peabody is part of a concerted
effort to change culture in order to increase capacities in managing our
students’ playing related health problems. The onsite
location of the clinic and various preventive programs provide opportunities
for meet and greet between the students and the rehabilitation staff,
supporting the preparedness phase of the management cycle. The response phase
is accomplished by providing students with walk-in advisement sessions in the
clinic where the staff can recommend adjustment of practice duration and
intensity, guide the students for setting appointments with a physician from our
Music & Medicine team or initiate the referral process for physical/occupational
therapy as needed. The recovery phase of our injury management cycle benefits
from the proximity of the clinic to our world-renowned music faculty. This
proximity facilitates our efforts to integrate the faculty’s experiential
wisdom and expertise on the instrument into the design of gradual
return-to-play programs to rebuild the playing capacity of the injured musicians.
Musculoskeletal screenings in the beginning of the academic year and prevention
programming such as Peak Performance Fundamentals serve the mitigation phase.
Despite progress in other industries, the field of musicians’
occupational health is still lagging behind in understanding and minimizing
exposures to work related biomechanical hazards. This knowledge gap is due to
lack of tools to quantify these exposures in musicians. In response to this, we
are currently developing a series of “smart” musical instruments that can
measure the forces the musicians apply onto the sound producing mechanisms of
instruments during practice and performance. Coupled with movement tracking
equipment, these smart instruments will provide us with a tool to conduct functional
performance assessments, similar to a runner’s assessment in a running clinic.
This will allow our rehabilitation staff to design interventions to correct
faulty biomechanics to facilitate recovery and to prevent re-injury.
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