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Health, Resources

To Avoid Back Pain, Straighten Up

Sitting, standing, or taking a bow—which movement will trigger back pain for a musician? Sitting for prolonged periods of time, as many musicians do, can be linked to a number of health concerns, chief among them, back issues. Around 80%-90% of people in the US will have back pain at some point in their lives.

Postural loads are different, depending on the musical instrument. For example, violin and flute require elevation from both upper limbs; asymmetrical postures are common and instrument weight can be significant. Almost every instrument requires some repetitive motion and therefore can lead to injury over time. Even young players can injure themselves over the course of just a few months.

Keep a Level Head

Avoid slouching your shoulders and invest in a supportive work chair, if you are going to be sitting for long periods of time. Musicians with proper form keep their shoulders level while playing. You will notice, too, musicians sit forward in their chairs. How far forward is a matter of comfort and body type. Some musicians are poised right at the chair’s edge, but most have their weight centered a little farther back.

If you must stand for a prolonged period of time, keep one foot forward and your knees slightly bent. This takes pressure off your low back. Change position often to avoid strain and keep your circulation flowing. 

Sleep Posture Counts, Too

A firm mattress can improve your spine’s alignment and prevent back pain while you are sleeping. Depending on your preferred sleeping position, consider using a pillow to help further align your spine and release pressure from joints. Monitor your back position even when you are sleeping. Sleeping in a curled-up position or with too thick of a pillow can cause upper spine pain. Sleeping on your back puts 55 pounds of pressure on your back. If you must sleep on your back, try putting a couple pillows under your knees, which will cut the pressure in half.

Your footwear also plays a role. The best way to maintain proper posture is to wear comfortable, low-heeled, and supportive shoes.

Be sure to do a regular posture check. Check the height of your chair, the position of your music stand, and instrument. Your feet should be flat on the floor (unless using a guitar footrest) with your knees level to your hips. If your chair doesn’t support your low back, place a small pillow or rolled-up towel behind you. If you find yourself caught up in a long practice session, change your position occasionally. Plus, get up and stretch when you have a short break. 

The Core Is Key

When most people think about the core of the body they think of the abdominal or six-pack area just below the ribs. While the abdominal muscles are an important part of the core, we consider other areas important, too.

Your core includes:

  • Front abdominal muscles
  • Muscles along the side of your body—internal and external obliques.
  • A deep muscle that wraps around the front—the transverse abdominal.
  • Muscles in your back that are located between your spine bones and run along your spine—erector spinae and multifidi.

Your core also includes your diaphragm, muscles of the pelvic floor, hip flexors, and gluteal muscles.

Theoretically, if the muscles around the low back are weak, your body will rely more on passive structures for stability, including ligaments—the tissue that connects bone to bone—as well as the spinal bones or discs that lie between the spinal bones. This can cause pain.

Some studies have shown that specific core exercises are not any more beneficial than general exercise for low back pain. What we know is that exercise, in general, can help and focusing on core muscles may provide some additional benefit.

Play It Safe

Exercise strengthens the muscles that protect the spine. When combined with a healthy diet, it can prevent excess weight gain that puts additional strain on your back. The best way to prevent injury is to listen to body cues and note any sign of pain during, immediately after an exercise, and the following day. Make stretching a part of your daily routine. Stretching before, during, and after performance or rehearsal will make you feel more relaxed and avoid injury.

Lift with your legs. Musicians often carry heavy equipment, putting them at higher risk for back injury. If you are carrying an item by hand, put one knee down with the other foot flat on the floor, as near as possible to the item you are lifting. Lift with your legs, not your back, and tighten your core muscles. Hold the object close to your body and maintain your back’s natural curvature. If an item is excessively heavy or bulky, use a hand truck or a dolly.

Physical therapists trained as musculoskeletal experts are the most qualified, aside from an orthopedic doctor, to assess back problems. Since there are many factors that impact low back pain and many types of low back pain, it’s a good idea to visit a physical therapist at least once for an evaluation and subsequent tailored care plan so you can progress safely.

Health, Resources

Take the Long View on Eye Health

Musicians are susceptible to any number of performance-related injuries, including carpal tunnel syndrome and joint pain. But, let’s face it, the eyes and ears do the heavy lifting in performance. As a focus of health and wellness, vision is often taken for granted.

Focusing on small notes on a page for long periods of time, frequent reading with inadequate light, dry eyes, and playing loud and high-pitched notes on wind instruments—which can double eye pressure—all put a musician’s eyes at risk for strain and injury. The eyes are not meant to repeatedly scan small text, like musical notes, for an extended period of time. Doing so overworks the eye muscles to the point where they can spasm, causing vision to blur. Eye strain can sometimes lead to ocular migraines.

A simple way to relieve stress and to lubricate the eyes is to blink. On average, most people blink 15-20 times per minute. Blinking cleanses the eyes and keeps them moist and oxygenated. If you are prone to dry eyes, especially if you wear contact lenses, eyedrops add a layer of protection.

When you look up and try to refocus, everything at a distance is blurry because the muscles have temporarily lost the ability to focus. An easy way to relax your eye muscles throughout the day is to practice the 20-20-20 rule: For every 20 minutes of digital screen use or rehearsing look at an object about 20 feet away for at least 20 seconds.

If You Wear Contact Lenses

Wearing contact lenses can make vision sharper, but improper use can lead to potentially serious problems. Over time, contact lens wearers develop micro-abrasions on the surface of the eye that predispose them to infections. Over wearing lenses can cause inflammation of the cornea, known as keratitis, or giant papillary conjunctivitis, under the eyelid.

There are no blood vessels in the cornea, which is one of the reasons it’s clear. Contact lenses prevent the cornea from getting oxygen. The cornea is resilient and can typically heal from minor abrasions, but major corneal damage can result in a corneal scar. If this occurs, clear corneal tissue may be replaced by scar tissue or become occluded by new blood vessels (a problem called neovascularization). These corneal scars can impair vision. To avoid infection and corneal damage, first be sure you are properly fitted with the right lenses. Second and most important, limit wear time to eight to 10 hours per day. Consider wearing your glasses to gigs or when you rehearse.

Maintain Focus

One common cause of eye strain in musicians is the strenuous, uncomfortable positions musicians sometimes sit or stand in when playing. When practicing at home or rehearsing with the band or orchestra, make sure the room is well lit. Be sure the sheet music is placed so that you are not craning your neck to read the music.

Our eyes are designed to look downward when reading or doing closeup work. Looking straight ahead at a focal point, or worse, upward or sideways, will cause additional strain on the eye muscles.

If you practice with a music stand, adjust it to slightly below eye level and place it where you can comfortably see the notes, without contorting your neck and body. Maintaining a neutral head and neck position is key to reducing the occurrence of eye strain. If you share a music stand and tend to crane your neck, try switching places to create a better balance.

Get Regular Eye Examinations

Make an annual visit to your ophthalmologist to keep tabs on your eye health and to update prescriptions. For a more accurate assessment, take sheet music to your eye appointment to illustrate the exact distance of reading material.

According to recent data, if you are between 30 and 40 years old, there’s about a 42% chance that you need some sort of vision correction. The eye specialist may recommend an anti-reflective coating on your lenses, which will reduce the glare from digital devices. If you have sensitivity to light, ask about a blue light filter or a light amber tint.

Seeing Straight: Get the Facts

Myth: Reading in dim light will worsen your vision.

Fact: Dim lighting will not damage your eyesight or eye health, but it will tire your eyes more quickly. The best way to position a reading light is to have it shine directly onto the page, not over your shoulder. A desk lamp with an opaque shade pointing directly at the reading material is ideal.

Myth: Carrots are the best food for eye health.

Fact: Carrots contain vitamin A and are indeed good for the eyes. But fresh fruits and dark, green leafy vegetables, which contain more antioxidant vitamins such as C and E, are even better for eye health. Antioxidants may even help protect the eyes against cataracts and age-related macular degeneration. Just don’t expect them to prevent or correct basic vision problems such as nearsightedness or farsightedness.

Myth: It’s best not to wear glasses or contact lenses all the time. Taking a break from them allows your eyes to rest.

Fact: If you need corrective lenses, use them. Not wearing your glasses will strain your eyes and cause fatigue. You should, however, take a break from wearing your contact lenses, for instance, in the evenings or during rehearsals. Glasses should not be discarded because of the use of contacts.

Myth: Staring at a computer screen all day is bad for the eyes.

Fact: Using a computer does not damage your eye health. Staring at a computer screen all day can contribute to eyestrain or tired eyes. People who stare at a computer screen for long periods tend not to blink as often as usual, which can cause the eyes to feel dry and uncomfortable. To help prevent eyestrain, adjust the lighting so there is no glare or harsh reflection on the screen. Rest your eyes every 20 minutes. Look up at a distant object or outside. Blink regularly so that your eyes stay well lubricated.

Health, Resources

Scents, Smells, and Ventilation in the Workplace

It could be perfume, cleaning products, smoke, or exhaust, but aromas and air pollutants can trigger a litany of allergy-like symptoms for many people. For those with chemical sensitivities, the onslaught of environmental agents contributes to respiratory issues (and possible asthma attacks), sneezing, nausea, headaches, and eczema. Complaints of workplace allergens are common. For musicians, when the workplace comes with an entire audience, the problem is not an easy HR fix.

People who cannot tolerate even small concentrations of chemicals have multiple chemical sensitivity (MCS). Described as an idiopathic environmental intolerance (IEI), the mysterious phenomenon is largely invisible and hard to pin down. It presents as a cluster of symptoms that almost always occur together. There are potentially dozens of causes, from allergies to autoimmune disorders.

When we think of pollution, we think of outdoor air pollution. But most of our exposure to pollutants occurs indoors. For example, air fresheners may emit or cause the formation of numerous substances associated with harmful effects. Claims like “green” and “all natural” on packaging do not have legal or regulatory status.

A primary source of indoor air pollutants is fragranced consumer products. Scented products—perfumes, hair spray, and laundry detergent—may emit the same number of chemical vapors as petroleum from vehicles. Each spritz of perfume contains volatile organic compounds (VOCs).

Sonia Klimasko, a 45-year member of Local 149 (Toronto, ON) and violinist with the National Ballet Orchestra in Toronto, says that it’s debilitating when symptoms develop during a performance. “Violins are situated approximately seven feet from the front row of the audience and potential scent exposure.”

Years ago, she reached out to the HR department regarding the orchestra’s exposure to products, specifically fragrances in the audience. The company took it very seriously. She says, “They added notifications about scent to their website and programs, and even to their call center on-hold recording. Signs are posted at the box office and in the theater washrooms, and the company has a two-page health and safety scent policy.”

Despite all the proactive measures, many patrons continue to wear strong fragrances in the close confines of the concert hall. Klimasko says, “These exposures generate many ailments for our musicians, including migraines, nausea, coughing, and difficulty breathing and concentrating, which make performing difficult.”

When It’s an Underlying Problem

Overwhelming sensitivity to smells is called hyperosmia. Relatively rare, it may evolve from a certain condition, perhaps with the onset of pregnancy and hormonal changes, autoimmune disorders, Lyme disease, and some neurological conditions. Scientists speculate that there may be a genetic link. In most cases, doctors can only rely on the patient’s report of what they are experiencing. Because scent travels from the olfactory system into the throat, inhaling strong scents creates a taste in your throat that may cause nausea. The increased sense of smell may also make flavors more intense.

Post-COVID and Indoor Air Quality

As COVID restrictions ease and venues prepare for in-person events, more concert spaces are paying attention to air quality to handle possible virus-infused air. A dividend, of course, is that better ventilation can remove excess moisture and microbes, eliminate smells, and reduce volatile organic chemicals. 

The Four Season Centre in Toronto, where Klimasko and The National Ballet of Canada perform, has addressed airflow quality. They employed an indoor air security system for extensive testing of circulated air. DNA sequencing provided a high-resolution view of bio-aerosol movement. Results show that the center’s state-of-the-art ventilation systems support above average air quality and sanitization.

Other venues are fine-tuning their HVAC systems. Air handling systems at Symphony Hall in Boston have been upgraded to provide enhanced ventilation and filtration, including filtration with MERV13 or higher rated recirculated air systems and bringing in outdoor air at increased rates of ventilation.

The Bradley Symphony Center, home to the Milwaukee Symphony Orchestra, is equipped with a state-of-the-art HVAC plasma air bipolar ionization system to deactivate virus particles and improve indoor air quality. The system greatly reduces dust, mold, allergens, and viruses.

Walt Disney Concert Hall, where The Los Angeles Philharmonic performs, and the entire campus at the Music Center, has improved air circulation and filtration across all spaces. It is the first performing arts center to earn the UL Verified Healthy Buildings Mark for indoor air quality.

Results of recent scientific research point to new directions for reducing the effects of fragranced consumer products on air quality and health. Klimasko, who is thankful that there is increasing recognition of the hazards of everyday chemicals, has made it her mission to heighten awareness about MCS in the symphonic world. She notes, “I like to say that I want to leave an impactful and positive vapor trail when I retire.”

RESOURCES:

Health, Resources

Self-Help Strategies to Improve Mental Health

Long dimmed by the pandemic, lights are coming back on in symphony halls around the country. Clubs are reopening. Musicians are back on the road. But a complete industry recovery is likely more than a year away. The hardship of the last year and the uncertainty of the future are taking a toll on the mental well-being of musicians. Musicians who cannot work or who work sporadically—book an event only to have it canceled because of a COVID outbreak—not only suffer financially, they lose their creative support network.  

As we enter another tenuous season of pandemic life, it’s important to find ways to maintain contact with fellow musicians and friends. Take time to make a call to a colleague or video chat with family members daily. Reach out to other musicians who can identify with your situation. Most important, achieving a more regulated emotional state takes a holistic approach.

Exercise

Most forms of exercise trigger the release of “feel-good” chemicals in the brain. These mood-boosting chemicals include brain messengers such as dopamine, serotonin, and norepinephrine. Being physically active is a positive coping strategy for difficult times. Moderate exercise is a great way to refocus your energy while taking advantage of the mental and physical benefits.

Cortisol, a stress hormone released by the adrenal glands, helps your body deal with stressful situations—the “fight or flight” response. When levels of cortisol are too high for too long, it can cause a number of health issues, like weight gain and chronic disease. Exercise can help regulate cortisol levels, prompting greater resilience to acute stress.

Walk

These days we’re all looking for ways to improve our immunity, and walking seems to be a smart strategy. Research shows that moderate-intensity exercise—and walking in particular—ramps up our immune system. It increases the number of immune cells that attack pathogens in our body. Studies show substantial health benefits for people clocking between 7,000 and 10,000 steps a day.

A good walk can do wonders for your mental well-being. It’s a great stress reducer and improves mood and sleep quality. Walking is a great way to work out problems, reining in the anxiety that comes with intrusive and racing thoughts. One of the most cited studies on walking and health, published in The New England Journal of Medicine, found that those who walked enough to meet physical activity guidelines had a 30% lower risk of cardiovascular events. Pounding the pavement helps improve your range of motion and mobility because it increases blood flow to tense areas and strengthens the muscles surrounding your joints.

Tai Chi

Originally developed for self-defense, tai chi has evolved into a graceful form of exercise that’s used for stress reduction. Often described as “meditation in motion,” it’s an ideal way to help maintain strength, flexibility, and balance. There is growing evidence that this mind-body practice, which originated in China as a martial art, has value in treating or preventing many health problems. Each posture flows into the next without pause, ensuring that your body is in constant motion. The movements are usually circular and never forced. The low-impact nature of the exercises put minimal stress on muscles and joints, making it generally safe for all ages and fitness levels. It may be especially appropriate for older adults who otherwise may not exercise.

Yoga

Yoga is another mindful exercise that encompasses poses, breathing techniques, and meditation that calm and center the mind. Some yoga styles are intense and vigorous. Others are relaxing and meditative. No matter which type you choose, yoga is a great way to stretch and strengthen your body, focus your mind, and relax your spirit. According to the National Institutes of Health (NIH), scientific evidence shows that yoga support stress management, mental health, mindfulness, healthy eating, weight loss, and quality sleep. When you practice yoga in a group it can be a supportive social activity. In addition to reducing anxiety and depression, studies show that it actually makes your brain work better. When you practice yoga, your brain cells develop new connections, which strengthen memory, attention, awareness, thought, and language.

Breathe

Deep, controlled breathing, often used in mindfulness-based practices such yoga, tai chi, and qigong, is a simple technique for stress reduction, lowering the levels of cortisol. It also helps to stimulate the parasympathetic nervous system, known as the “rest and digest” system. Try this breathing exercise: Put one hand on your chest, the other hand on your lower belly, and close your eyes. Breathe in through your nose, hold for five counts, and breathe out through your mouth. Repeat as necessary. 

Meditate

Meditation is a way to clear away the information overload that clouds your thoughts. A 3,000-year-old practice, meditation began as a way to deepen an understanding of the sacred and mystical forces in life. Today, it’s commonly used for relaxation and stress reduction. Even a few minutes in meditation can restore a sense of peace and can take you calmly through your day.

Wellness & Mental Health Resources

Resources are available for many types of relief. Whether you are struggling to make ends meet or need to connect with a therapist, there are organizations that support artists in need. Connect with other musicians, learn about grants or financial assistance, access free wellness content, or simply tune in to a podcast.

Backline—Connects music industry professionals and their families with a trusted network of mental health and wellness providers. www.backline.care

Sweet Relief Musicians Fund—Provides financial assistance to all types of career musicians and music industry workers who are struggling to make ends meet
while facing illness, disability, or age-related problems. www.sweetrelief.org

Black Mental Health Alliance—Develops, promotes, and sponsors trusted culturally-relevant educational forums, trainings, and referral services that support the health and well-being of Black people and their communities.www.blackmentalhealth.com

MusiCares—Provides a safety net of critical health and welfare services to the music community in three key areas: mental health and addition recovery, health (including screening and financial help); and human services (basic needs support in times of hardship). Plus programs that address affordable housing, career development, legal issues, and senior services.  www.musicares.org

Check Your Head—A podcast where notable musicians share their mental health stories, experiences, and solutions, to encourage and support other musicians in finding the help that they need. Mental health experts also share their insight. The website offers free and affordable resources. www.checkyourheadpodcast.com

We Rise LA­—An ongoing project of the Los Angeles County Department of Mental Health, serving the 10 million people of LA County with education and prevention programs and providing mental health-related services, offering connection, hope, recovery, and well-being. www.whywerise.la

SIMS Foundation—Provides mental health and substance use recovery services and supports for musicians, music industry professionals, and their dependent family members—through education, community partnerships, and accessible managed care. www.simsfoundation.org

The Actors Fund—Fosters stability and resiliency and provides a safety net for performing arts and entertainment professionals over their lifespan.www.actorsfund.org

Books-Resources, Products

The Musician’s Hand: A Clinical Guide

The Musician’s Hand: A Clinical Guide was the first book to focus on the specialized topic of the upper limb and hand in musicians. This second edition, now available in paperback, has been revised to reflect the scientific and clinical progress made since the book’s 1998 publication. The book opens with chapters describing the principles of hand and arm pain as experienced by musicians. Subsequent chapters cover specific disorders in musicians, therapeutic solutions, and key prevention strategies.

The Musician’s Hand – A Clinical Guide, second edition,
by Ian Winspur, JP Medical Publishers, www.jpmedpub.com.

Horn Playing from the Inside Out
Books-Resources, Products

Horn Playing from the Inside Out: A Method for All Brass Musicians

Horn Playing from the Inside Out

This book by Eli Epstein, of Local 9-535 (Boston, MA), presents brass pedagogy informed by scientific evidence gleaned from real-time MRI films of the interior movement patterns of the world’s finest horn players. Epstein offers tried and true methods to learn and teach these exemplary biomechanics that promote not only beautiful and easeful playing, but also career health and sustainability. Available in print from poperepair.com and digital format from Apple Books.

Horn Playing from the Inside Out, A Method for All Brass Musicians,
Third Edition, by Eli Epstein, www.eliepstein.com.

Health

Wind Musicians’ Risk Assessment in the Time of COVID-19

by Adam T. Schwalje MD, DMA and Henry T. Hoffman MD

COVID-19 is a severe and dangerous disease. Its heart-wrenching infectivity and virulence hit home for many musicians, as we learned of the several choirs which were affected by superspreading events early in the pandemic. One was in Amsterdam, where 102 of 130 participants wound up with coronavirus infection; one in Washington state, where 52 of 60 participants were infected; and at least two others in Europe. Several choir members unfortunately died as a result. These were early hints that singing itself might be risky. The risks were strong enough that an alarm was raised by Dr. Lucinda Halstead and others in a National Association of Teachers of Singing (NATS) webinar, leading many—including the Metropolitan Opera—to forego their upcoming seasons.


Because of similarities to singing, there is concern that wind players might also be at additional risk for spread of COVID-19. It is vitally important to be clear about the current uncertainties in COVID-19 risk assessment for the wind instrumentalist.


Background
Novel coronavirus continues its rapid spread throughout the world. Infections with SARS-CoV-2 are increasing and number more than 12.2 million worldwide, with over 550,000 deaths reported as of July 10—and many more likely unreported due to well-publicized issues with testing and the high prevalence of asymptomatic infection.


The pandemic is serious and deadly. According to various medical studies, more than 1 in 3,000 Americans have died from the disease so far. Symptoms are gradual in onset and flu-like, however, many infected individuals are asymptomatic or pre-symptomatic and still infectious. It is likely that COVID-19 is several times more deadly than influenza, which itself is a dangerous disease. Most deaths from COVID-19 are in those who are elderly and/or have serious pre-existing conditions. However, over 15 percent of US deaths—numbering over 17,000—have been in people younger than 65 years.


The spread of SARS-CoV-2 is mostly by droplets or aerosol. The larger droplets can deposit on surfaces, while smaller droplets and aerosols can hang in the air and remain infectious. The smallest aerosols may lead to more serious disease, as they can be inhaled further into the lungs. The six-foot radius of safety is commonly mentioned as a distance over which larger droplets will not remain airborne, but, for example, if an infected individual is coughing in a small room, the air in the room can remain infectious for some time due to aerosols. An international group of 238 scientists recently authored a paper in Nature highlighting evidence for airborne spread of SARS-CoV-2 via microdroplets, leading the World Health Organization (WHO) to acknowledge an urgent need to further study the importance of aerosols in the spread of SARS-CoV-2.


Musicians and SARS-CoV-2
K-12 programs, collegiate programs, and orchestras are struggling to imagine how they might survive the tremendous challenges represented by COVID-19. Despite the ongoing pandemic, a few orchestras are already back to work, and many music programs and ensembles are making plans to resume operations.


It is understandable to wonder what the additional risks are for wind musicians, above the non-zero background risk of COVID-19 spread. How might we mitigate these risks for ourselves, our colleagues, audiences, students, and families? Some groups have put out detailed guidelines which purport to reduce risk of transmission of SARS-CoV-2. Others have put out blanket statements to the effect that any potential risk of infection or transmission of the virus from wind playing is essentially gone as long as proper social distancing and other precautions are being observed. The risks are unknown, but they are assuredly not zero.


Scientific and Ethical Underpinnings
It is more important than ever to read studies and guidelines with a critical eye and keep in mind the basics of scientific inquiry. A scientific study would cite sources and be peer reviewed, in the case of COVID-19, it would have the input of a physician or infectious disease specialist, and would be clear about who is producing the study and any conflicts of interest. The ability to replicate results is crucial. Musicians who do rely on the conclusions of non-reproducible studies might underestimate either the risks of their activities or the uncertainty involved in assessment of these risks. Unfortunately, there are several recent, widely circulated, pseudo-scientific assessments of risk and risk mitigation strategies for wind musicians. The good news is that there are several scientific studies on these questions also, most of which are still ongoing.


If we assume there’s no risk, or if we assert that unstudied risk mitigation procedures work, then people can’t make an informed decision about whether to put themselves in those potentially risky situations. Also, if there is at least an acknowledgement of risk, then those who are at greater personal risk from COVID-19 (the elderly, those with co-morbidities, etc.) may be able to seek accommodations for risk mitigation from their local governments. In the US, for example, this might be accomplished through the Americans with Disabilities Act.


Specific Risks of Wind Playing

The Issue of Aerosols
Much attention has been given to the risks of singing, largely because of early superspreading events. The mechanism of singing requires deep breathing, vibration of the vocal folds, active manipulation of the larynx, pharynx, tongue, and lips, and produces aerosols which can hang in the air for at least hours. Some individuals produce significantly more aerosol than others, for unknown reasons.


Risks of playing a wind instrument are probably different than those involved in singing, though there are similarities. The flute, for example, creates a strong airflow, though other instruments do not. But airflow does not tell the whole story. Playing a wind instrument involves deep breathing, sometimes forceful exhalation, and possible aerosolization of the mucus in the mouth and nose, along with secretions from deeper airway structures. The only peer-reviewed, published study on a wind “instrument” and aerosolization investigated the vuvuzela and found significant aerosol production. There is, therefore, at least a theoretical risk of droplet or aerosol transmission during wind performance, but more study needs to be done.


Two often-referenced recent studies, one from Vienna Philharmonic and one from Freiburg University, investigated airflow and wind instrument playing. Neither of these were peer-reviewed or published in a journal. Neither of these addressed aerosol generation, which is the main issue, as aerosols can hang in the air for extended periods of time and can be infectious. Dispersion of aerosols was hinted at in both studies, but dispersion is dependent on external factors like room airflow and mixing dynamics, which were not examined in either paper.


A lack of evidence about aerosol generation and elements of aerosol dispersion is explicitly noted in the Freiburg review. Even if there is minimal airflow from playing, if aerosols are produced especially in the context of deep breathing, there is a risk of spreading the aerosols around the environment. This risk is not quantifiable at the moment. Several centers in the US are investigating aerosol production from wind instrumentalists, these include University of Colorado at Boulder, Colorado State University, Rice University, and University of Maryland.


Other behaviors associated with wind playing might also be risky: Wind players buzz on their mouthpieces, blow out tone holes, blow out spit valves, clean their instruments with swabs and feathers, and might have leaking embouchures or nasal emissions during playing. How to mitigate these risks is not yet known, though many approaches have been suggested and are even being put into use.


One example is the use of disposable rags to blow out spit valves for brass musicians. This is intuitively cleaner and less likely to spread infection than, for example, emptying them onto the bare floor for everyone to track around—but the potential for aerosolization if any force is used to expel the contents, for example, is not known.


Another strategy is use of shields of plexiglass surrounding wind players. This strategy has not been studied for wind musicians, but is reminiscent of (though not entirely similar to) the idea of using polycarbonate face shields to protect healthcare workers from aerosol spread—effective in the short term to protect from an infected patient coughing in one’s face, but after 30 minutes during which aerosols mixed with surrounding air the face shield was found to be ineffective.


The risk of aerosol production posed by wind instrument performance is not known, though there are several indications that it might exceed background risk of COVID-19 transmission. Studies on this risk, and the effectiveness of risk mitigation strategies, have not yet been completed.

Reeds
Reedmaking is a large part of many people’s livelihoods. But, it is important to recognize that there are no guidelines, no US Centers for Disease Control (CDC) recommendations, no EPA or FDA recommendations, and very little science that specifically supports or instructs on how to make a reed safe from coronavirus. There is no validated method that will eliminate the risk of viral transmission from reeds. The safest approach would be to treat all reeds as if they are infectious: to not work on others’ reeds and not share reeds with others. This can be difficult, especially for double reed players.
CDC guidelines which have been referenced by some reedmakers, like the suggestion for a soak in 70% alcohol, are designed for disinfecting already clean surfaces. Unfortunately, reeds are not like other typically studied surfaces. Played-upon reeds include proteins, respiratory secretions, and dead skin, in addition to the structure of the reed itself—all of which would probably tend to stabilize the virus, according to multiple studies. The CDC has no recommendations on how long, or with what, to soak or process a reed to render it safe from coronavirus.


There is some timeframe, of unknown duration, during which virus particles deposited on and in a reed will lose their ability to infect a new host. Unfortunately, it is unclear how long coronavirus particles remain infectious on or in items like reeds. The closest available comparison is with cardboard, on which virus particles seem to remain infectious for a relatively short time (24 hours compared to 72 hours or more for solid surfaces). However, SARS-CoV-2 remained infectious on a wooden board for at least 96 hours. In any case, the materials tested to draw these conclusions are not soaked in someone’s mouth for hours on end, and these types of tests generally exclude presence of other substances like proteins.

Therefore, applicability to reeds in a real-world situation is unknown.
Another theoretical option for reed disinfection is a high-temperature soak (e.g., at 77 degrees C or 170 degrees F, for 30 min), which is more conservative than the 30 minutes at 65 degrees C used for heat inactivation of commercially available SARS-CoV-2. This might be a way to ensure that the entire reed is disinfected—though this method has yet to be validated.
For cleaning and disinfecting reedmaking equipment, a reedmaker might be able to use resources like the CDC’s Interim Recommendations for Cleaning and Disinfection for Households or the EPA’s list of disinfectants to use against COVID-19. Knives and other reed tools should be treated like food preparation equipment; potentially dangerous chemicals should be removed from their surfaces before use.


Putting one’s mouth on a reed which has been sucked on by another person is not without risk in the COVID-19 era. It is impossible to quantify this risk. It is likely that some procedure like heating in water or waiting for a specified time decreases this risk, but it is impossible to say how much the risk is reduced with this or any other method. To support those who choose to wait for some length of time before using a reed which has been played by others, reeds should be marked with their date of last play-testing. Using a “sanitizing procedure” could give a false sense of security but is probably better than doing nothing, if there is no alternative to sharing.

Music Education
Less-experienced players are more likely to have leakage of air around the embouchure, to have stress velopharyngeal incompetence or nasal emissions, and to work harder to produce sound—all of which may create more risk of aerosol production and subsequent COVID-19 spread.
Practice rooms are small spaces which might easily be filled with aerosol. These particles may take hours to settle and could still remain infectious on surfaces even when settled from the air. Appropriate ventilation and cleaning precautions should be used, with some minimum time required before cleaning and re-use.


In K-12 school music and collegiate methods courses, sharing and storage of instruments present another set of challenges. While brass instruments can probably be effectively cleaned using the CDC guidelines for surfaces, using an instrument brush/hot soapy water for cleaning followed by a disinfectant wash, it is unclear how other instruments, made of delicate woods, felts, and corks, can be cleaned or disinfected. Careful management of a full class of school-age recorder players, in this context, would be difficult. The instrument storage room presents additional possibilities for spread of potentially infectious droplets.


Unknown Risks
The risks of wind playing in the COVID-19 era are unknown. There is a possibility, currently being studied, that the risks of wind playing and associated behaviors are greater than baseline risk of spread of COVID-19. This has wide ramifications as programs are attempting to re-open. Acknowledging the risks and attempting to mitigate them is important—but should not lull musicians into a false sense of security. Unfortunately, the available scientific evidence is too scant to reliably inform decisions about risk mitigation strategies for wind musicians. Musicians should be empowered to make their own decisions based on their individual risk tolerance. Leaders should be cautious in their representations of risk and clear about uncertainty regarding the efficacy of risk mitigation strategies.


———


This article has not been peer reviewed. There is no external funding source. It represents the general opinions of Drs. Schwalje and Hoffman and is not intended to offer or replace specific medical advice. If you have questions about your medical situation or your specific risks regarding COVID-19, please contact your physician.

For a list of the references used in completing this article, see https://rb.gy/ack7vw

Dr. Adam Schwalje is a resident physician and National Institutes of Health T32 research fellow in the Department of Otolaryngology at the University of Iowa Hospitals and Clinics. He also holds the DMA in bassoon performance from the University of Cincinnati College – Conservatory of Music. He has played in professional orchestras and been a music educator, and is currently the medical liaison for the International Double Reed Society.

Dr. Henry Hoffman is Professor of Otolaryngology at the University of Iowa Hospitals and Clinics. He is director of the Voice Clinic and is involved in research addressing laryngeal pathophysiology. His bands, occasionally including bassoon, can be heard throughout southeast Iowa.

Orchestra News

Indianapolis Symphony Orchestra Cuts Off Health Coverage

The Indianapolis Symphony Orchestra (ISO) has furloughed its musicians without health coverage, making it the only major orchestra in the US to terminate musicians’ health care during the pandemic.

ISO musicians, members of Local 3 (Indianapolis, IN), were furloughed for a second time on June 7. The orchestra was first furloughed in March and then re-employed at a reduced salary for eight weeks beginning in April, when the organization received a Payroll Protection Program loan. 

The second furlough came with the removal of health benefits. In lieu of coverage, management offered a stipend of $1,800, the equivalent of approximately two weeks of COBRA coverage on a family plan. Talks to re-evaluate the situation were scheduled for July.

Since the furlough, musicians have continued to organize free, public concerts in open spaces such as church parking lots.

stress
Health

How Understanding Your Temperament Can Help You Cope With COVID-19 Stress

emily agnew

by Emily Agnew, Member of Local 66 (Rochester, NY)

In August 1987, the Honolulu Symphony went on strike. During our four months on the picket line, I experienced a level of stress like nothing I had ever felt before. Our union strike fund stipend of $100 a week was a lifeline. I pulled myself together and got a job waiting tables for the lunch shift at an upscale restaurant. But I suffered terrible stomach aches. I lived in a state of near-overwhelm all the time. Anything could push me over the edge: I still remember the sheer panic I felt when my Plymouth Valiant overheated in rush-hour traffic.

Stressful as that strike was, it was a minor event compared to the challenge thousands of musicians are dealing with now due to COVID-19. Back then, I could just buy a new water pump for my car; restaurants were open for business. I felt scared to death about money, but the word “death” was a figure of speech, not the literal danger we face now from this virus. And most importantly, I wasn’t homebound or isolated. I could see friends, and I met with my fellow HSO musicians every week to eat the Portuguese bean soup that union president Milton Carter cooked for us.

Stress has two elements: an external stimulus, and our response to that stimulus. I’d like to talk about the response part of that equation, and specifically, the way your temperament affects your response to stress. The information I’ll share here won’t pay the mortgage, make your roommate less irritating, or flatten the curve. But it will help you to meet those challenges in a calmer, more effective way as the world works to get COVID-19 under control.

Temperament: Understanding How 20% of Us are Different, and What That Means

In 1992, a psychologist in California, Dr. Elaine Aron, identified a temperament trait she had observed in many of her clients. She called it “Sensory Processing Sensitivity,” popularly referred to as “High Sensitivity.” I learned about the trait eight years later from a psychology magazine. Glancing at the bulleted list in the page sidebar, I read an eerily accurate description of myself. “Needs 8-10 hours of sleep to function well.” Check. “Sensitive to bright lights, loud sounds, harsh fabrics, or strong smells.” Check. “Needs to recharge alone in a quiet room.” Check. “Gets rattled when rushed or required to do multiple things at once.” Check. No doubt about it: I was one of these “highly sensitive” types the article described.

stress

In the years since Dr. Aron published The Highly Sensitive Person, her first book about the trait, dozens of studies have given us more information about it. High sensitivity is in fact an inherited trait, found inabout one in five men and women around the world. It is not a syndrome or a pathology. Rather, it is a functional evolutionary response to new situations, characterized by a “wait, watch, then act” approach. 

All highly sensitive people—HSPs for short—share the fundamental neurobiological characteristic of the trait: pronounced deep processing ability. HSPs are sensitive to subtlety, taking in more information from our environment. And we are keenly empathetic, feelingour own and others’ emotions more intensely than people who are not highly sensitive. In some ways, our trait makes us ideally suited for a music career, and many musicians are highly sensitive. However, all our noticing, feeling, and processing also contributes to HSPs’ biggest challenge: we get overaroused more easily than the other 80% of people.

Being Highly Sensitive During a Pandemic

Our vulnerability to overarousal is even more pronounced during an intensely stressful time like this one. Faced with the multiple complex implications of the pandemic and the overwhelming number of unknowns, our deep-processing minds can easily go into overwhelm. When a highly sensitive person gets exhausted or overaroused, or both, we lose connection with our natural empathy. At best, we feel miserably stressed. At worst, we shut down, act out, or even blow up.

If you are highly sensitive, you need to know how to take care of yourself to avoid overarousal. It takes skill to regulate your intense emotions. Ideally, you’d learn that skill as a child. But for those of us who didn’t, it’s never too late. (That’s the kind of work I do with sensitive clients using a process called Focusing.) And for those of you who aren’t highly sensitive, the odds are high that you live with, work with, or hang out with sensitive people. You can support the HSPs in your life by better understanding their trait.

Five Ways to Lower Stress and Overarousal

During this pandemic, each of us faces a unique configuration of challenges. Some people are in better shape financially than others, but no musician is unaffected by the pandemic. Highly sensitive or not, we all need practical, effective ways to keep our heads on straight in these extremely difficult conditions. These five steps can help anyone lower their stress, and are particularly important for sensitive people:

1. Learn more about the HSP trait. The better you understand it, the more effectively you can take care of yourself and/or support the HSPs in your life. Elaine Aron’s website (https://hsperson.com) has extensive research documentation and many articles about all aspects of sensitivity, and a self-test you can take to determine if you are highly sensitive.

2. Acknowledge your external stressors and calculate your stress level. If you need stronger motivation to take care of yourself, use the Holmes-Rahe Life Stress Inventory to compute the total point value of recent external events in your life. Holmes and Rahe demonstrated the dramatic effect of stress on health, finding that when your point total exceeds 150 on the inventory, your risk of a major health breakdown in the next two years increases 50%.This risk increases by a startling 80% if your score exceeds 300 points.

3. Identify the internal stressors contributing to your level of stress. Your internal stressors may range from chronic worrying to catastrophic thinking and harsh self-criticism. In addition, highly sensitive people tend to be so conscientious and solicitous of the needs of others that we may minimize or ignore our own needs, creating internal stress. Talking to a friend, family member, or therapist can help you become more aware of such patterns, so you can regain perspective and respond in healthier ways.

4. Take steps to keep your arousal level down. Highly sensitive people need solitude to process and recharge. If you can possibly find some time alone each day, do. If your stress level is chronically elevated, you can re-train your body to a calmer baseline by resting in a simple, enjoyable restorative yoga pose for 15 minutes a day (found on YouTube at https://youtu.be/BgGQJTGMNe0). I do it every day after lunch.

5. Trust your intuition as you make decisions. Highly sensitive people are gifted with particularly keen intuition. As your stress level decreases, your access to this sense of inner rightness increases—another motivation for taking care of yourself and skillfully managing your arousal levels. Meditation helps by lowering your arousal and is a powerful support to your intuition.

These five steps can benefit all of us during the COVID-19 pandemic, and they are indispensable if you are highly sensitive. I’m living proof: though my current Holmes-Rahe score is similar to my score during the 1987 Honolulu Symphony strike, I’m relatively calm. I’ve avoided the kind of stress tsunami I experienced back then. The difference? Greater knowledge of my sensitive trait, and hard-won arousal-management skills.

If you think you might be highly sensitive, take the self-test and begin learning. Managing your overarousal is a vital skill to help you stay well during this pandemic.

After 30 years of performing and teaching, including five years playing second oboe for the Honolulu Symphony, Emily Agnew now works with creative, sensitive people around the world in 1:1 sessions and courses. You can find more free stress-relieving resources on her website at https://sustainablysensitive.com.

hearing protection
Health

Hearing Protection Field Test 2020 – Some of the Best Gear For Your Ears

by Todd Hobin, Member of Local 78 (Syracuse, NY)

A musician should protect their hearing as if their career depended on it

NOTE: The pandemic has caused a pause in live performances, but performing is not the only risk to your hearing. Listen up.

hearing protection

If you sit at the back of the orchestra, right in front of the percussion section, you’re a victim. Play in a rock band, you’re a victim. Drummers? Duh. But, what about the happy homeowner mowing their lawn, doing small repairs or housework? Do you ride a motorcycle, go to parties, or enjoy music in your earbuds? You are all victims. Prolonged sound over 90 decibels (dB) will cause permanent hearing damage. How long? As little as three minutes of mowing the lawn.

The tiny hair cells inside your cochlea are very sensitive. Too much volume will make them bend over and fold. Unlike some cells in your body, they will not regenerate. Long-term exposure will cause irreversible damage including tinnitus. (Musicians are 57% more likely to develop tinnitus.)

First, do no harm. Control your environment. Damaging sounds are everywhere. For example, full volume on your earbuds delivers 112 decibels. Don’t do that. Protect your hearing off the job. 

May is Better Hearing Month, so what better time to think about the value of your ears? My completely unscientific field test starts in the field outside my house. I put these popular hearing protectors up against my tractor, my chainsaw, and the tools in my shop:

hearing protection

3M EAR Classic Earplugs. Proper insertion is essential to get their full 29dB Noise Reduction Rating (NRR). Roll them up between your thumb and forefinger into a tight little barrel. Then, using your opposite hand, reach over the top of your head and gently lift up on the top of your ear. This opens your ear canal to allow the earplug to slide in right up to the hilt. After insertion, press and hold the earplugs in your ears until they expand to fill the entire canal. This will take a little longer than you think. Be patient and make sure you have a good seal. 

The most offensive sound I can think of is a circular saw cutting through a pine board. I cut through a number of boards without so much as a flinch. The EAR Classics were equally successful blocking out the sound of my chainsaw, my drill, and the massive sawmill my neighbor brought in to cut up and plank a 70-foot ash that fell in our yard. Perfect. Hair follicles saved. 

The EAR Classics are reusable and you can wash them. A little soapy water does the trick. I don’t recommend them for gig use. They cut out too much sound. My rating: safe, comfortable, and inexpensive. Highly recommended. 

hearing protection

Uline Bullet Earplugs work well, but I noticed a couple of issues. They come in a variety of colors and Noise Reductions Ratings. I used the orange 33 NRR version for my test. Many manufacturers have similar products. They are a little firmer than the Classics. Insertion technique is critical, with the pointier end going in. The longer shaft goes in deeper and in my case caused a little ear pain from time to time. After a number of days testing, I noticed what sounded like water in my ear. My audiologist pulled a nasty chunk of hardened wax out of my ear. Could that have been caused by packing bullets in my ear canal?

Be careful. I don’t recommend washing them either. The foam doesn’t hold up. Rating: safe, a little uncomfortable at times, cheap. I purchased the 200-count box. I’ll use them up.

hearing protection

Professional Safety Ear Muffs by Decibel Defense have an impressive 37dB NRR. Riding the tractor was quiet and comfortable from the start. But on a hot day I had a problem. It got sweaty. I found myself adjusting them quite a bit. I also couldn’t wear a wide brimmed hat. I’m Irish. I burn. I rate them safe when in position, semi-comfortable, and very dorky. www.decibeldefense.com.

For the gig, I chose three consumer devices to rate:

hearing protection

Earasers—The clear plastic design is unique, making them all but invisible on the gig. With a -19 dB rating, they still allow enough sound in to be of use while saving you from the big hits and overall booming sound of a rock band in full swing. My field work over the last few years involved major concert venues, small clubs, and lots of band practices. After long gigs in hot environs, I was having trouble getting them out of my ears—eventually breaking off the little wire extraction thingy. No complaints though. They served me well. Rating: safe, comfortable, not so cheap.

hearing protection

EarPeace HD Musicians Earplugs—I carry them with me everywhere I go. It’s been a constant field test in every environment from a huge amphitheater to a tiny stage in the corner of Shifty’s bar. I could hear everything clearly. It was just quieter. Sometimes I forget that I have them in. Even band practice is perfect. Hear what you need to, nothing more. Rating: Perfect. www.earpeace.com.

hearing protection

Westone makes hearing protection for shooters. They were recommended to me by a drummer. Go figure. And indeed, they have a very impressive array of products. www.westone.com. Rating: Trust the drummer.

The Best

A good musician needs a good audiologist. If you don’t have one already, get one now. You’ll want to get a baseline reading to know how much hearing you are losing over time. Find a professional audiologist near you who can make a mold of your ear canal to properly fit you with the best hearing protection for musicians. Find one at Hearingtracker.com. Rating: Pricey, but by far the best way to go.

Todd Hobin is a singer/songwriter, recording artist, studio owner, and adjunct professor in the Music Department at Le Moyne College. He has toured with the Beach Boys and the Kinks, to name a few, and has written scores for film and TV.