Playing sports can lead to injuries…but so can playing an instrument. Just like athletes, musicians can suffer occupational pain, repetitive strain and overuse injuries. But unlike athletic injuries, there is a stigma around getting hurt while playing music, so some musicians don’t seek the help they need. 

The joy and pain of playing an instrument is a familiar experience for Serap Bastepe-Gray, a medical doctor who plays the guitar. She came to the United States from Turkey in the 1990s to do research on spinal cord regeneration. Instead, she became interested in music and studied guitar at the Peabody Conservatory in Baltimore, Maryland. 

“I started having aches and pain around my wrist,” she recalls. “Because of my background as a medical doctor, I was able to figure out stuff that helped me.”

She created a physical therapy routine. The word got out around Peabody. 

“Back then, musicians and music students didn’t want to let others know they were injured,” Bastepe-Gray says. “Because there was a connection between if you’re injured that means you have a bad technique, i.e. you’re not a good musician. So, I would be practicing and other students would knock on the door and say, ‘Can you look at me?’ All of a sudden, I became the underground healer for the students who didn’t want their teachers or anybody else to know that they were injured.”

Recognizing a need, Bastepe-Gray decided to pursue a career in healing musicians’ injuries. In 2015, she and neurologist Alex Pantelyat founded the Johns Hopkins Center for Music and Medicine. The goal is developing a holistic wellness model to better care for musicians. 

In the clinic

Eighteen-year-old Chelsea Strayer is a freshman at Peabody Conservatory. She plays the double bass, and usually practices for three hours every day. That can easily be doubled, if she has other rehearsals.

The long hours and intensity of the repetitive movements have enacted a physical toll. “I’ve had pain in my arm before, but it has never been in my wrist before,” Strayer says. “And I’ve gotten bruising in the same place in my hand. I never was like that before.”

Strayer tried to brush her pain aside, but it was too severe to ignore or endure. Her teacher told her to get the pain checked out.

Eventually, Strayer visited the Center for Music and Medicine, located on campus. Bastepe-Gray referred her to the center’s clinic and prescribed tissue therapy.

Bastepe-Gray explains that tissue therapy is basically “stretching, strengthening, soft tissue massage, (and) some physical agent modality like cold-heat and what that does is that helps promote tissue healing.” 

Musicians’ injuries are more common than most people realize, she says. “The injuries are either tendinitis, Tenos riotous, a nerve entrapment, or sprain. Four out of five musicians who play instruments will get injured during their career at least once. Out of these four, one will recover and get back to play an instrument. Out of the remaining three, two will continue playing, but will have chronic problems with acute episodes along the way. And unfortunately, one will discontinue their art because of the injury.”

Just as some sports cause more injuries than others, some instruments cause more pain than others.

“In 1988, Ralph Manchester, at the University of Rochester, published some findings from the Eastman School of Music,” Bastepe-Gray says. “He sort of figured out that some instruments did indeed cause more injuries and females had more injuries than males. In 1998, they did a follow-up study and (found that) harp, piano, guitar are among the top, also high strings (like) violin, viola. They are injurious. The least injurious instruments are brass (instruments), for the arm.” 

Fighting stigma with awareness

Peabody Associate Dean Sarah Hoover says raising awareness among students about the hazards of playing their instrument for a long time without taking breaks is important. So is having a clinic on campus, as it sends a message to their students and fellow musicians.

“There is a culture of shame and stigma associated with being injured as a musician,” Hoover says. “So, I think the establishment of our clinic here at Peabody, of the Center for Music and Medicine and a whole bunch of educational programs has been really to address this need. It’s a need for public awareness, for specialized health care, the need to create a model where we integrate training and teaching with medical care, so we get a full circle of care. ”

To create this circle, Hoover and her team have developed an online program that will soon become a valuable resource to help injured musicians beyond the Peabody Conservatory.

More attention is also being given to follow-up of the treated musicians, so that they don’t injure themselves again when they return to work.

“In order to be able to do that, one of the ideas is to create an instrument specialist position to work within an interdisciplinary team of doctors, (and) the therapists that can help the injured musicians in gradually going back to play,” says Bastepe-Gray.

Smart instruments

On the prevention side, Bastepe-Gray is now working with Johns Hopkins biomedical engineers and neurologists to develop a new “smart guitar.” 

“In order to come up with some quantified way of measuring how much a string player, a guitarist, a violinist a fiddle player, a cello player, how much finger force they apply, how quickly the force increases, we came up with the idea of the smart guitar and Peabody smart instrument series.”

Bastepe-Gray has been working on the smart guitar for three years. Her team is now developing a next generation of the smart guitar that will be able to measure the finger force on the entire neck of the instrument. It would also look more like the regular guitar so they can get more accurate data.

“This, I’m hoping, will inform us both in creating preventive programs, so that musicians don’t get injured,” she says. “I also think it would be valuable in training musicians so that they can develop certain motor skills more quickly without a lot of repetition, which is one of the occupational hazards.”

Bastepe-Gray says this approach can help performers enjoy doing what they like best – playing music – without suffering injuries.
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