Injury Reducing Ergonomic Guitar Prototype
Donation protected
As part of my PhD (https://www.kent.ac.uk/smfa/staff/staff-profiles/phdstudents/Bonner1.html) I’m trying to raise £2,500 to have an ergonomic classical guitar prototype built that reduces strains on the player’s body.
I have redesigned the classical guitar to reduce playing-related injuries and maybe even make it easier for novices to start playing by fitting the guitar to the body instead of the other way around. The design is drawn up and ready to go, all I need is the money to pay someone to make it.
In the first instance this project will help me complete my doctorate with tangible results that benefit the guitar community. My two long-term goals are: (1) to improve music education around the world so that players have access to the information they need to stay injury free; (2) to make ergonomically designed instruments more accessible to the general public by pressuring guitar manufacturers to improve their designs. Both of these are difficult and will take a long time, probably longer than my career if I’m realistic, but with a doctorate and the resources of a university behind me I may be able to have an impact.
Timeline
My PhD is due to finish sometime around the summer of 2021 and it could take about a year to make the prototype guitar so I plan to have it ready in the middle of 2020. This will leave enough time to take it to some professional classical guitarists in the UK who have expressed an interest in playing it (Richard Durrant, Gerald Garcia, John Mills) so that their evaluations can be part of my thesis.
Rewards
Any updates during the making process will be shared with investors before the general public has access. These may be in written form with photos, or video.
Background
I’ve been a classical guitarist for many years and I’m currently doing a PhD in the ergonomics (the efficiency of how body and the instrument work together) and physiology (how the body works) of playing this beautiful instrument. Over the years I’ve had pain problems in both wrists from playing, but I’ve got off far more lightly than many players.
‘…for those who perform professionally, music-making can bring pain, discomfort, and distress alongside pleasure. For a group of people who bring such relief to the masses, they seem to suffer disproportionately.’[1]
Music has long been used for its curative and therapeutic benefits, being part of shamanic medicine for more than 30,000 years and recorded in Egyptian frescoes dating back to the fourth millennium BCE.[2] However, it wasn’t until 1983 that Dr. Brandfonbrener started the Annual Medical Meeting on Performing Arts Medicine at the Aspen Music Festival[3] and Performing Arts Medicine was finally born[4] to help musicians.
Overuse Injuries can strike down a musician at any stage of their career, from the prepubescent student[5] to the seasoned professional. There are many studies that give us some idea of how common this problem is, and although they give different figures, they do show that performance related pain is far too common to be ignored. A survey carried out in the Spanish region of Andalusia revealed that more than 60% of professional classical guitarists and well over 80% of professional flamenco guitarists have an overuse injury.[6] Other surveys reveal that between 43% and 95% of music performance students suffer from problems that affect their ability to perform during their degree courses,[7] with the majority of elite 16-year-old string players reporting pain when playing.[8] In fact, musicians are more likely to begin their university studies with physical problems than students of sport.[9] Statistics are similar amongst professional performers, with between 50% and 75%[10] of professionals suffering from a medical condition related to their activity as performers.[11] Thus, despite some discrepancies in estimates of the affected population, pain has been shown to be a severe and widespread issue in musical performance and learning.
There are several factors that explain the differing numbers in these reports, but the most important is that musicians don’t want to talk about their injuries. One survey[12] of professional and conservatory musicians only got a 30% response rate, possibly due to concern that they would be seen as unreliable if word got out that they had an injury. The internationally renowned pianist Gary Graffman explains that ‘nobody wants a wounded musician. There is an oversupply of healthy ones. Admitting difficulties is like jumping, bleeding, into piranha-filled waters.‘[13] This means that there is a grey area of potentially unreported injuries, and that it’s likely that the number of reported injuries is much lower than the actual number.[14]
Surveys of instrument related injuries and articles by professionals such as physiotherapists or teachers of Alexander Technique always mention the importance of good posture[15]. These sources tell us that the limbs can’t function as freely when the torso is curled up, and that some of the most talented musicians would play even better if they used their bodies more naturally.[16] When instruments place us in asymmetrical postures they increase the risk of eventual postural pain[17] because asymmetrical postures load the spine at an angle to its axis, as well as causing muscle imbalances or nerve entrapment.[18] It’s not just that bad posture can eventually lead to pain, but it could actually lead to permanent developmental disorders because the skeleton is malleable up to the age of ten, so how a child plays will shape their bone structure. When bad posture is adopted during this time those traits will be forever ingrained in their body.[19] Thus, poor posture can lead to chronic pain conditions.
Although guitar supports like the A Frame enable guitarists to sit with healthy posture, the design of the acoustic guitar is not conducive to neutral postures for the joints between the shoulder blades and the hands, and this opens them up to possible Repetitive Strain Injuries (RSI). The high risk of RSI stems from the relatively small size of the muscles used to play. The demand for fast, repetitive movements for several hours every day means those small muscles are working harder than a runner’s larger leg muscles,[20] but because we don’t get out of breath we don’t realise how much strain they’re under. Additionally, the muscles at the periphery of the body receive less blood than those closer to the centre, making these small muscles still more vulnerable to injury.[21] Anything that can be done to reduce the strain upon them is very beneficial.
Muscles should generally be used in the middle of their Range Of Motion (ROM), and there are quite a few reasons for this:
- Muscles are strongest in the middle of their ROM;
- Tendons don’t have to move around such extreme corners. Tendons are lubricated by synovial fluids, which get thinner and less effective as we age. When we’re young, synovial fluid is slightly sticky or stringy,[22] somewhat like runny honey, but by the age of 80, it’s thinner than olive oil,[23] which can easily be used in spray bottles. Since there is no mechanism for increasing lubrication pressure, the ability of the synovial fluid to stay where it’s needed decreases considerably, allowing for more wear and tear in our later years.
- When joints are consistently used in a particular range the muscles become adapted to that region, either because the Central Nervous System has learned that this zone is safe and leaving it is unsafe, or (if given enough time) because the muscle has sacrificed some of itself to become shorter. To illustrate this, dentists suffer the same problems: they are often twisted to the left as they bend over their clients. Surveys have revealed that more than 64% of dental workers experience job-related pain during their career[24]. This is a warning for those of us that curl around our instruments for hours every day with a footstool.
- When muscles display ‘short’ behaviour they restrict ROM, causing unusual wear patterns within the joint.[25]
- The elastic resistance of opposing muscles usually holds joints in mid range, where muscles are at their strongest. When the muscles on one side of a joint are over developed or become shortened, their elastic resistance will pull the joint away from the centre when at rest. The weaker muscles will find it harder to do their job because they will have to overcome this excess resistance while being outside their optimal length for force production,[26] and this leads to their overuse and injury. Muscles of the wrist and fingers provide a vivid example of how the effectiveness of muscles changes when they are lengthened or shortened. It is harder to make a forceful fist when the wrist is flexed as in fig. 2 then when slightly extended as in fig. 3 because the finger flexor muscles are so short they produce insufficient force.[27]
- Just as deviating from the middle of ROM increases elastic resistance from opposing muscles, the increased elastic resistance from skin, joints, and ligaments compounds the problem.
- The standard guitar design makes it nearly impossible for the joints of the wrists and fingers to be used in their optimal positions.
My experiences as a teacher constantly remind me that there is very little that is natural about playing the guitar. When someone picks up a guitar and teaches themselves they consistently adopt postures and contortions that, from a physiological standpoint, are very unnatural. The guitar is one of the most popular instruments and players have a high incidence of pain injuries, yet the standard guitar design has not changed. Health issues experienced by musicians have affected people in other professions and received prioritised solutions: some decades ago the media highlighted typists suffering from RSI’s similar to those experienced by guitarists and various steps were taken to alleviate the problem. As the guitar is not designed to fit around the body it forces the player to adapt their body to fit the instrument. The idea of this project is to set aside predisposed ideas about posture and guitar design, to examine how the body should work according to anatomists, physiologists, and physical therapists, and design the instrument around that.
There are five problems that I would like to address with my guitar design:
1) The left wrist is often bent to enable the fingers to reach the strings, especially in barré chords. Some people naturally approach the neck with very bent wrists and it’s a difficult problem to overcome. Solution - twisted neck, so the low frets are pointing down;
2) The right wrist is also constantly bent, because straightening the wrist puts the thumb in a disadvantageous position. This puts both wrists in danger of developing Carpal Tunnel Syndrome and DeQuervain’s Tenosynovitis. Solution - a wedge-shaped bridge to raise the treble strings;
3) The right elbow is further forward than the left, placing constant stretch on postural muscles on one side of the body. This is known to cause dysfunction and pain in the muscles[28]. Additionally, problems with the shoulder on one side of the body are often paired with problems in the knee on the other side of the body[29]. This is due to the disruption in a Myofascial Continuity called the Anterior Spiral Line that joins the left ear, right shoulder blade, left hip, left knee, and left foot. Solution - wedge-shaped body that is thinner at the top;
4) The frets don’t match the natural movements of the fingers. Solution - fanned frets;
5) Due to the weight distribution of the instrument, stability is often a problem Solution - smaller headstock and thinner neck.
6) There are other problems that my design addresses, but I don't want to give all my information away yet!
As has been demonstrated, forcing our body around the instrument causes unnatural postures and angles that hinder the body from working at its full potential, or worse, cause damage. Instead, we should shape the instrument to better fit the body. Early performance practices such as elevating one foot are now known to be detrimental. For this reason various guitar supports have been created to allow people to use a neutral posture, but the instrument still tends to force the shoulder girdle, wrists, and fingers into bad positions. While it has been shown above that music-related injuries are startlingly common, it should be noted that there are people who are perfectly suited to playing the guitar[30] who will probably never suffer, but this project is for everyone else.
References
[1] Ginsberg et al. in MacDonald, R., Kreutz, G. and Mitchell L., (2012) Music, Health and Wellbeing. Oxford: OUP, p.362.
[2] MacDonald, R., Kreutz, G. and Mitchell L., (2012) Music, Health and Wellbeing. Oxford: OUP, p.257.
[3] National Library of Medicine (n.d.) MEET LOCAL LEGEND: Alice Brandfonbrener, M.D. [Online]. Available from: https://www.nlm.nih.gov/locallegends/Biographies/Brandfonbrener_Alice.html [Accessed 23rd November 2017].
[4] Manchester, R.A. (2012) Performing Arts Medicine--Past, Present and Future. Medical Problems of Performing Artists, 27(2), 55-56., p.55.
[5] Upjohn, S. (2013) Playing Related Injuries In Elite Young Musicians. Music Mark [Online]. British Association for Performing Arts Medicine. Available from: http://bapam.org.uk/news/wp-content/uploads/2014/02/Playing-Related-Injuries-in-Elite-Young-Musicians-by-Sarah-Upjohn_Music-Mark-Winter-2013-14_article.pdf [Accessed 26th May 2014], p.33.
[6] Marques, D.N., Rosset-Llobet, J., Fonseca Marques, M.F., Gurgel, I.G.D. and Augusto, L.G.S. (2003). Flamenco guitar as a risk factor for overuse syndrome. Medical Problems of Performing Artists. 18(1), p. 11.
[7] Ginsberg et al. in MacDonald, R., Kreutz, G. and Mitchell L., (2012) Music, Health and Wellbeing. Oxford: OUP, p.359.
[8] Robitaille J., Guay, M. and Tousignant-Laflamme, Y. (2015). Description of playing-related musculoskeletal pain in elite string students. International Musculoskeletal Medicine, 37(3), p.125.
[9] Ginsberg et al. in MacDonald, R., Kreutz, G. and Mitchell L., (2012) Music, Health and Wellbeing. Oxford: OUP, p.360.
[10] Ackermann, B.J., and Adams, R.D. (2004) Perceptions of causes of performance-related injuries by music health experts and injured violinists. Perceptual and Motor Skills, 99(2), p.669.
[11] Ginsberg et al. in MacDonald, R., Kreutz, G. and Mitchell L., (2012) Music, Health and Wellbeing. Oxford: OUP, p.357
[12] Caldron, P.H., Calabrese, L.H., Clough, J.D., Loderman, R.J., Williams, G. and Leatherman, J. (1986) A Survey of Musculoskeletal Problems Encountered in High-Level Musicians. Medical Problems of Performing Artists, 1(4), 136-139.
[13] Written by Gary Graffman, whose celebrated performance career was ended by a hand injury in the 70’s. Hickling, A. (2007) Pain Stopped Play [Online]. Available from: https://www.theguardian.com/music/2007/mar/09/classicalmusicandopera1 [Accessed 4th September 2017].
[14] Newmark, J. and Lederman, R.J. (1987) Practice doesn't necessarily make perfect: incidence of overuse syndromes in amateur instrumentalists. Medical Problems of Performing Artists, 2(4), p.142.
[15] Ackermann, B.J., and Adams, R.D. (2004) Perceptions of causes of performance-related injuries by music health experts and injured violinists. Perceptual and Motor Skills, 99(2), 669-678.
[16] Bruser, M. (1999) The Art of Practising: A Guide To Making Music From the Heart. New York: Bell Tower, p.73.
[17] [17] Upjohn, S. (2013) Playing Related Injuries In Elite Young Musicians. Music Mark [Online]. British Association for Performing Arts Medicine. Available from: http://bapam.org.uk/news/wp-content/uploads/2014/02/Playing-Related-Injuries-in-Elite-Young-Musicians-by-Sarah-Upjohn_Music-Mark-Winter-2013-14_article.pdf [Accessed 26th May 2014], p.34.
[18] Taylor, N. (2016) Teaching Healthy Musicianship – The Music Educator’s Guide to Injury Prevention and Wellness. Oxford: Oxford University Press, p.xvi.
[19] Dr. Fadi J. Bejjani in Bruser, M. (1999) The Art of Practising: A Guide To Making Music From the Heart. New York: Bell Tower, p.71.
[20] Bruser, M. (1999) The Art of Practising: A Guide To Making Music From the Heart. New York: Bell Tower, p.67.
[21] Bruser 1999, p.67
[22] Gabbey, A., (2015) Synovial Fluid Analysis [Onlline]. Health Line. Available from: http://www.healthline.com/health/synovial-fluid-analysis#Purpose2 [Accessed 20th January 2017].
[23] Jebens, E. H. and Monk-Jones, M. E. (1959) On The Viscosity and pH of Synovial Fluid and the pH of Blood. The Journal of Bone and Joint Surgery, 41b(2), p.390.
[24] Hayes, M.J., Cockrell, D. and Smith, D.R. (2009) A systematic review of musculoskeletal disorders among dental professionals. International Journal of Dental Hygiene, 7(3), p.159.
[25] Weppler, C.H. and Magnusson, S.P. (2010) Increasing Muscle Extensibility: A Matter of Increasing Length or Modifying Sensation? Physical Therapy, 90(3), p. 445.
[26] University of Bristol (1999) 2. The [sarcomere] length-tension relation {Online]. Available from: http://www.bristol.ac.uk/phys-pharm-neuro/media/plangton/ugteach/ugindex/m1_index/nm_tension/page2.htm [Accessed 3rd December 2016].
[27] Oatis, C.A. (2008) Kinesiology: The Mechanics and Pathomechanics of Human Movement. USA: Lippincott Williams & Wilkins, p.55.
I have redesigned the classical guitar to reduce playing-related injuries and maybe even make it easier for novices to start playing by fitting the guitar to the body instead of the other way around. The design is drawn up and ready to go, all I need is the money to pay someone to make it.
In the first instance this project will help me complete my doctorate with tangible results that benefit the guitar community. My two long-term goals are: (1) to improve music education around the world so that players have access to the information they need to stay injury free; (2) to make ergonomically designed instruments more accessible to the general public by pressuring guitar manufacturers to improve their designs. Both of these are difficult and will take a long time, probably longer than my career if I’m realistic, but with a doctorate and the resources of a university behind me I may be able to have an impact.
Timeline
My PhD is due to finish sometime around the summer of 2021 and it could take about a year to make the prototype guitar so I plan to have it ready in the middle of 2020. This will leave enough time to take it to some professional classical guitarists in the UK who have expressed an interest in playing it (Richard Durrant, Gerald Garcia, John Mills) so that their evaluations can be part of my thesis.
Rewards
Any updates during the making process will be shared with investors before the general public has access. These may be in written form with photos, or video.
Background
I’ve been a classical guitarist for many years and I’m currently doing a PhD in the ergonomics (the efficiency of how body and the instrument work together) and physiology (how the body works) of playing this beautiful instrument. Over the years I’ve had pain problems in both wrists from playing, but I’ve got off far more lightly than many players.
‘…for those who perform professionally, music-making can bring pain, discomfort, and distress alongside pleasure. For a group of people who bring such relief to the masses, they seem to suffer disproportionately.’[1]
Music has long been used for its curative and therapeutic benefits, being part of shamanic medicine for more than 30,000 years and recorded in Egyptian frescoes dating back to the fourth millennium BCE.[2] However, it wasn’t until 1983 that Dr. Brandfonbrener started the Annual Medical Meeting on Performing Arts Medicine at the Aspen Music Festival[3] and Performing Arts Medicine was finally born[4] to help musicians.
Overuse Injuries can strike down a musician at any stage of their career, from the prepubescent student[5] to the seasoned professional. There are many studies that give us some idea of how common this problem is, and although they give different figures, they do show that performance related pain is far too common to be ignored. A survey carried out in the Spanish region of Andalusia revealed that more than 60% of professional classical guitarists and well over 80% of professional flamenco guitarists have an overuse injury.[6] Other surveys reveal that between 43% and 95% of music performance students suffer from problems that affect their ability to perform during their degree courses,[7] with the majority of elite 16-year-old string players reporting pain when playing.[8] In fact, musicians are more likely to begin their university studies with physical problems than students of sport.[9] Statistics are similar amongst professional performers, with between 50% and 75%[10] of professionals suffering from a medical condition related to their activity as performers.[11] Thus, despite some discrepancies in estimates of the affected population, pain has been shown to be a severe and widespread issue in musical performance and learning.
There are several factors that explain the differing numbers in these reports, but the most important is that musicians don’t want to talk about their injuries. One survey[12] of professional and conservatory musicians only got a 30% response rate, possibly due to concern that they would be seen as unreliable if word got out that they had an injury. The internationally renowned pianist Gary Graffman explains that ‘nobody wants a wounded musician. There is an oversupply of healthy ones. Admitting difficulties is like jumping, bleeding, into piranha-filled waters.‘[13] This means that there is a grey area of potentially unreported injuries, and that it’s likely that the number of reported injuries is much lower than the actual number.[14]
Surveys of instrument related injuries and articles by professionals such as physiotherapists or teachers of Alexander Technique always mention the importance of good posture[15]. These sources tell us that the limbs can’t function as freely when the torso is curled up, and that some of the most talented musicians would play even better if they used their bodies more naturally.[16] When instruments place us in asymmetrical postures they increase the risk of eventual postural pain[17] because asymmetrical postures load the spine at an angle to its axis, as well as causing muscle imbalances or nerve entrapment.[18] It’s not just that bad posture can eventually lead to pain, but it could actually lead to permanent developmental disorders because the skeleton is malleable up to the age of ten, so how a child plays will shape their bone structure. When bad posture is adopted during this time those traits will be forever ingrained in their body.[19] Thus, poor posture can lead to chronic pain conditions.
Although guitar supports like the A Frame enable guitarists to sit with healthy posture, the design of the acoustic guitar is not conducive to neutral postures for the joints between the shoulder blades and the hands, and this opens them up to possible Repetitive Strain Injuries (RSI). The high risk of RSI stems from the relatively small size of the muscles used to play. The demand for fast, repetitive movements for several hours every day means those small muscles are working harder than a runner’s larger leg muscles,[20] but because we don’t get out of breath we don’t realise how much strain they’re under. Additionally, the muscles at the periphery of the body receive less blood than those closer to the centre, making these small muscles still more vulnerable to injury.[21] Anything that can be done to reduce the strain upon them is very beneficial.
Muscles should generally be used in the middle of their Range Of Motion (ROM), and there are quite a few reasons for this:
- Muscles are strongest in the middle of their ROM;
- Tendons don’t have to move around such extreme corners. Tendons are lubricated by synovial fluids, which get thinner and less effective as we age. When we’re young, synovial fluid is slightly sticky or stringy,[22] somewhat like runny honey, but by the age of 80, it’s thinner than olive oil,[23] which can easily be used in spray bottles. Since there is no mechanism for increasing lubrication pressure, the ability of the synovial fluid to stay where it’s needed decreases considerably, allowing for more wear and tear in our later years.
- When joints are consistently used in a particular range the muscles become adapted to that region, either because the Central Nervous System has learned that this zone is safe and leaving it is unsafe, or (if given enough time) because the muscle has sacrificed some of itself to become shorter. To illustrate this, dentists suffer the same problems: they are often twisted to the left as they bend over their clients. Surveys have revealed that more than 64% of dental workers experience job-related pain during their career[24]. This is a warning for those of us that curl around our instruments for hours every day with a footstool.
- When muscles display ‘short’ behaviour they restrict ROM, causing unusual wear patterns within the joint.[25]
- The elastic resistance of opposing muscles usually holds joints in mid range, where muscles are at their strongest. When the muscles on one side of a joint are over developed or become shortened, their elastic resistance will pull the joint away from the centre when at rest. The weaker muscles will find it harder to do their job because they will have to overcome this excess resistance while being outside their optimal length for force production,[26] and this leads to their overuse and injury. Muscles of the wrist and fingers provide a vivid example of how the effectiveness of muscles changes when they are lengthened or shortened. It is harder to make a forceful fist when the wrist is flexed as in fig. 2 then when slightly extended as in fig. 3 because the finger flexor muscles are so short they produce insufficient force.[27]
- Just as deviating from the middle of ROM increases elastic resistance from opposing muscles, the increased elastic resistance from skin, joints, and ligaments compounds the problem.
- The standard guitar design makes it nearly impossible for the joints of the wrists and fingers to be used in their optimal positions.
My experiences as a teacher constantly remind me that there is very little that is natural about playing the guitar. When someone picks up a guitar and teaches themselves they consistently adopt postures and contortions that, from a physiological standpoint, are very unnatural. The guitar is one of the most popular instruments and players have a high incidence of pain injuries, yet the standard guitar design has not changed. Health issues experienced by musicians have affected people in other professions and received prioritised solutions: some decades ago the media highlighted typists suffering from RSI’s similar to those experienced by guitarists and various steps were taken to alleviate the problem. As the guitar is not designed to fit around the body it forces the player to adapt their body to fit the instrument. The idea of this project is to set aside predisposed ideas about posture and guitar design, to examine how the body should work according to anatomists, physiologists, and physical therapists, and design the instrument around that.
There are five problems that I would like to address with my guitar design:
1) The left wrist is often bent to enable the fingers to reach the strings, especially in barré chords. Some people naturally approach the neck with very bent wrists and it’s a difficult problem to overcome. Solution - twisted neck, so the low frets are pointing down;
2) The right wrist is also constantly bent, because straightening the wrist puts the thumb in a disadvantageous position. This puts both wrists in danger of developing Carpal Tunnel Syndrome and DeQuervain’s Tenosynovitis. Solution - a wedge-shaped bridge to raise the treble strings;
3) The right elbow is further forward than the left, placing constant stretch on postural muscles on one side of the body. This is known to cause dysfunction and pain in the muscles[28]. Additionally, problems with the shoulder on one side of the body are often paired with problems in the knee on the other side of the body[29]. This is due to the disruption in a Myofascial Continuity called the Anterior Spiral Line that joins the left ear, right shoulder blade, left hip, left knee, and left foot. Solution - wedge-shaped body that is thinner at the top;
4) The frets don’t match the natural movements of the fingers. Solution - fanned frets;
5) Due to the weight distribution of the instrument, stability is often a problem Solution - smaller headstock and thinner neck.
6) There are other problems that my design addresses, but I don't want to give all my information away yet!
As has been demonstrated, forcing our body around the instrument causes unnatural postures and angles that hinder the body from working at its full potential, or worse, cause damage. Instead, we should shape the instrument to better fit the body. Early performance practices such as elevating one foot are now known to be detrimental. For this reason various guitar supports have been created to allow people to use a neutral posture, but the instrument still tends to force the shoulder girdle, wrists, and fingers into bad positions. While it has been shown above that music-related injuries are startlingly common, it should be noted that there are people who are perfectly suited to playing the guitar[30] who will probably never suffer, but this project is for everyone else.
References
[1] Ginsberg et al. in MacDonald, R., Kreutz, G. and Mitchell L., (2012) Music, Health and Wellbeing. Oxford: OUP, p.362.
[2] MacDonald, R., Kreutz, G. and Mitchell L., (2012) Music, Health and Wellbeing. Oxford: OUP, p.257.
[3] National Library of Medicine (n.d.) MEET LOCAL LEGEND: Alice Brandfonbrener, M.D. [Online]. Available from: https://www.nlm.nih.gov/locallegends/Biographies/Brandfonbrener_Alice.html [Accessed 23rd November 2017].
[4] Manchester, R.A. (2012) Performing Arts Medicine--Past, Present and Future. Medical Problems of Performing Artists, 27(2), 55-56., p.55.
[5] Upjohn, S. (2013) Playing Related Injuries In Elite Young Musicians. Music Mark [Online]. British Association for Performing Arts Medicine. Available from: http://bapam.org.uk/news/wp-content/uploads/2014/02/Playing-Related-Injuries-in-Elite-Young-Musicians-by-Sarah-Upjohn_Music-Mark-Winter-2013-14_article.pdf [Accessed 26th May 2014], p.33.
[6] Marques, D.N., Rosset-Llobet, J., Fonseca Marques, M.F., Gurgel, I.G.D. and Augusto, L.G.S. (2003). Flamenco guitar as a risk factor for overuse syndrome. Medical Problems of Performing Artists. 18(1), p. 11.
[7] Ginsberg et al. in MacDonald, R., Kreutz, G. and Mitchell L., (2012) Music, Health and Wellbeing. Oxford: OUP, p.359.
[8] Robitaille J., Guay, M. and Tousignant-Laflamme, Y. (2015). Description of playing-related musculoskeletal pain in elite string students. International Musculoskeletal Medicine, 37(3), p.125.
[9] Ginsberg et al. in MacDonald, R., Kreutz, G. and Mitchell L., (2012) Music, Health and Wellbeing. Oxford: OUP, p.360.
[10] Ackermann, B.J., and Adams, R.D. (2004) Perceptions of causes of performance-related injuries by music health experts and injured violinists. Perceptual and Motor Skills, 99(2), p.669.
[11] Ginsberg et al. in MacDonald, R., Kreutz, G. and Mitchell L., (2012) Music, Health and Wellbeing. Oxford: OUP, p.357
[12] Caldron, P.H., Calabrese, L.H., Clough, J.D., Loderman, R.J., Williams, G. and Leatherman, J. (1986) A Survey of Musculoskeletal Problems Encountered in High-Level Musicians. Medical Problems of Performing Artists, 1(4), 136-139.
[13] Written by Gary Graffman, whose celebrated performance career was ended by a hand injury in the 70’s. Hickling, A. (2007) Pain Stopped Play [Online]. Available from: https://www.theguardian.com/music/2007/mar/09/classicalmusicandopera1 [Accessed 4th September 2017].
[14] Newmark, J. and Lederman, R.J. (1987) Practice doesn't necessarily make perfect: incidence of overuse syndromes in amateur instrumentalists. Medical Problems of Performing Artists, 2(4), p.142.
[15] Ackermann, B.J., and Adams, R.D. (2004) Perceptions of causes of performance-related injuries by music health experts and injured violinists. Perceptual and Motor Skills, 99(2), 669-678.
[16] Bruser, M. (1999) The Art of Practising: A Guide To Making Music From the Heart. New York: Bell Tower, p.73.
[17] [17] Upjohn, S. (2013) Playing Related Injuries In Elite Young Musicians. Music Mark [Online]. British Association for Performing Arts Medicine. Available from: http://bapam.org.uk/news/wp-content/uploads/2014/02/Playing-Related-Injuries-in-Elite-Young-Musicians-by-Sarah-Upjohn_Music-Mark-Winter-2013-14_article.pdf [Accessed 26th May 2014], p.34.
[18] Taylor, N. (2016) Teaching Healthy Musicianship – The Music Educator’s Guide to Injury Prevention and Wellness. Oxford: Oxford University Press, p.xvi.
[19] Dr. Fadi J. Bejjani in Bruser, M. (1999) The Art of Practising: A Guide To Making Music From the Heart. New York: Bell Tower, p.71.
[20] Bruser, M. (1999) The Art of Practising: A Guide To Making Music From the Heart. New York: Bell Tower, p.67.
[21] Bruser 1999, p.67
[22] Gabbey, A., (2015) Synovial Fluid Analysis [Onlline]. Health Line. Available from: http://www.healthline.com/health/synovial-fluid-analysis#Purpose2 [Accessed 20th January 2017].
[23] Jebens, E. H. and Monk-Jones, M. E. (1959) On The Viscosity and pH of Synovial Fluid and the pH of Blood. The Journal of Bone and Joint Surgery, 41b(2), p.390.
[24] Hayes, M.J., Cockrell, D. and Smith, D.R. (2009) A systematic review of musculoskeletal disorders among dental professionals. International Journal of Dental Hygiene, 7(3), p.159.
[25] Weppler, C.H. and Magnusson, S.P. (2010) Increasing Muscle Extensibility: A Matter of Increasing Length or Modifying Sensation? Physical Therapy, 90(3), p. 445.
[26] University of Bristol (1999) 2. The [sarcomere] length-tension relation {Online]. Available from: http://www.bristol.ac.uk/phys-pharm-neuro/media/plangton/ugteach/ugindex/m1_index/nm_tension/page2.htm [Accessed 3rd December 2016].
[27] Oatis, C.A. (2008) Kinesiology: The Mechanics and Pathomechanics of Human Movement. USA: Lippincott Williams & Wilkins, p.55.
Organizer
Michael Bonner
Organizer