Tag Archives: health

pain and strain

Muscles in Play: Avoiding Pain and Strain

Playing is all about repetition so overuse can be synonymous with a music career. Proper posture and holding an instrument correctly are key to avoiding strain. And, because certain muscles are used repeatedly when playing, musicians should take care not to overuse those muscles during other daily activities.

If possible, hold joints in a neutral position. For example, to prevent wrist tendonitis, keep your wrist in a straight position when not playing, instead of extremely bent or flexed. This will help alleviate the added stress placed on tendons during a performance. Also, as a preventative exercise, be sure to stretch regularly.

Early intervention means you should not play through the pain. Immediate treatment is essential to prevent long-term injury. Pay attention to your pain, noting changes or increases. Encourage students to tell parents or teachers when they experience pain. Teachers should also be alert to changes in a student’s technique or style.

Tendonitis vs. Tendonosis

Naming the pain is important. Tendonitis is inflammation (redness, swelling, heat, soreness) that occurs when the immune system detects an injury and responds. The body increases the flow of blood and infection-fighting substances to the injured tendon.

Tendonosis is a degenerative injury that does not prompt an immune response. It occurs when repetitive stress over time causes the breakdown of collagen, growth of abnormal blood vessels, and thickening of the tendon’s sheath. Research suggests that many injuries diagnosed as tendonitis are actually tendonosis.

Repeated or sustained muscular contraction associated with mastering virtually any musical instrument causes a decrease in blood flow to the working muscles and tendons. In the case of overuse injuries, the body is signaled to repair muscles that are not really damaged. The result is accumulation of scar tissue in otherwise healthy muscles and tendons, which increases stress on the tendons causing them to begin to degenerate.

Scar tissue prevents normal stretching and limits muscle contraction. This can cause decreased range of motion, decreased strength, fatigue, and pain. Physicians say pain is often the last symptom. The involved muscle is then weakened, requiring neighboring muscles to overwork. This cycle of increasing stress, buildup of scar tissue, and degeneration continues until the body can no longer compensate. The result is chronic pain.

Intermission—Take a Break!

If you have an audition, concert, or festival coming up, do not rehearse all night. Spread out practice sessions. Take a break after about 45 minutes, whenever possible. Researchers say the instance of injury goes up dramatically after 45 minutes of continuous activity. Adequate rest reduces muscle tension as do proper posture and body mechanics.

Also, do not dramatically increase playing time. As athletes can attest, this presents high injury risk. An average 5K runner would not suddenly run a marathon. In the off-season, athletes cross-train. So, when not at festivals, concerts, or auditions, take time to do other activities and exercises.

Strengthen to the Core

Cardiovascular exercise and moving in general are important, especially for musicians who spend a lot of time sitting. Critical to handling, moving, and supporting instruments is strengthening other muscles: the core, upper back, and shoulders all support areas of your body used when playing.

Back pain and pain of the upper extremities are common, whether it’s shoulder pain for high string and flute players or elbow strain for violinists. Bowing techniques put strain on the right shoulder and elbow. Brass players may have back pain, consistent with having to support heavy instruments. The list goes on.

For Good Measure

Watch a video of your performance or practice to critically review your stance and playing position. Ask yourself: Do I seem to have excessive tension? Where is that tension showing up? Is it one-sided? Does it appear in my shoulders, in my hands? Do I make any extraneous movements? Do I move too much or too little?

Remember, to avoid injuries and recover from minor pains: use proper posture and body mechanics, stretch often, build your muscle strength and endurance through exercise, ramp up your playing gradually, and take frequent breaks. Always consult a physician at the first indication of pain or injury.

mental hygiene hacks

10 Mental Hygiene Hacks for Creatives

What are mental hygiene hacks? Just a simple behavior that keeps your creative mind working at its very best. We list ten below.

1) Exercise 30 minutes per day to boost mood, reduce stress, sharpen your mind, and increase energy.

2) Get six to eight hours of sleep in every 24-hour period. Don’t stay in bed too long (10-plus hours dampens energy).

3) Eat healthy to boost your mood.

4) Limit substance use. Alcohol is a depressant. If you use recreational drugs or binge drink, ask yourself: Have you experienced negative consequences of your use? Are you using more drugs/alcohol or more frequently? Have you tried to stop and just keep using? Do you have cravings and withdrawal symptoms? Any positive answer is a sign you may need help.

5) Build a support system of live, face-to-face contact. Limit social media.

6) Challenge your negative thoughts. Negative bias can become a habit.

7) Self-soothe with a daily dose of sunlight. Take a walk; keep a routine.

8) Instead of listening to upsetting news, listen to music to soothe your mind. Create playlists of songs that make you happy.

9) Show compassion; practice generosity. Volunteer to help someone or care for a pet.

10) Know when and where to reach out for help. Create a core group of trusted supporters and develop a written safety plan to cope with stress.
The US National Suicide Prevention Lifeline is 1-800-273-TALK (8255). For Canada, visit the website: suicideprevention.ca/need-help/ for a list of crisis centers by province.


How to Talk About Depression

In the US, there are more deaths by suicide than homicide; someone takes their own life every 15 seconds. About 60% of suicides are linked to severe depression. Studies reveal that creatives, such as musicians, are more likely than the general population to suffer from depression and anxiety.

Suicide is preventable with early intervention, but those struggling with depression often withdraw. If you know someone who might be depressed, talk to them. Verbalize your concern and willingness to provide support, while encouraging them to seek professional help. Help them set up a proactive support system should they feel imminent risk of harming themselves.

How can you recognize if a friend or loved one needs help? Symptoms to look for include changes in sleep patterns or appetite, social withdrawal or alienation, mood swings, distorted self-perception, increased sensitivity, impulsivity or recklessness, and decreased coping and problem-solving skills.

Having meaningful human contact with a trusted friend can make a huge difference to someone suffering from depression. Reach out to them, making it clear that it is safe for them to tell you how they feel without fearing judgment, pity, or guilt.

What should you say:

“Hey, how are you? I mean, how are you, really?”
“I noticed you’ve been a little distant lately. Is there something you’d like to share? Would you be willing to talk about it with me?”
“I see you are hurting, and I’m here for you. I know there’s nothing I can say to fix your hurt, and I might not understand it, but I’m so grateful that you are allowing me to listen.”

What you should not say:

“If you try, you’ll feel better” or “You’re too focused on your (insert mental health ailment), you should focus on the future.”
“What’s the matter with you? Why haven’t you been (going out/calling/responding to texts/meeting up with friends)?”
“It could be worse,” and “At least you aren’t (insert bad situation)”

The New Orleans Musicians’ Clinic’s “You Got This” program provided much of the information found in this article.“You Got This” is funded by Broadway Cares.

acoustic shock

Too Loud, Too Close, Too Long: Musicians Suffer Career Ending Acoustic Shock

acoustic shockIn the symphonic world, a crescendo makes for a dramatic finale, but it can have serious consequences for musicians. Recently, in an unprecedented court ruling, British viola player Chris Goldscheider, 40, won a landmark High Court judgment against Royal Opera House when he suffered career ending hearing loss from a rehearsal of Wagner’s Die Walkure. Seated directly in front of the brass section, he suffered acoustic shock, the result of sound that exceeded 130 decibels.

It’s a story that cellist Janet Horvath knows too well. The former associate principal cello for the Minnesota Orchestra, sustained an acoustic-shock injury to her left ear in 2006 after a one-time concert.

That night, the drum set, piano, electric guitars, keyboard, and conductor were positioned directly in front of her for a pops concert that included Broadway singers. Horvath was wearing musician’s earplugs, but one speaker was no more than two feet from her left ear. Eight speakers blasted music back toward the musicians. She says, “I felt it instantly; it was excruciating. When the concert was over, I took out my earplugs and could not bear to hear anyone talking. It never subsided.” She took a few months off to heal, but she needed to wear her left earplug. She compensated, relying on her right ear, and continued to be exposed to high decibels.

By 2009, her right ear, like the left, could no longer tolerate normal sound. After several doctors, she was diagnosed with hyperacusis, an auditory injury caused by repeated exposure to high decibels or a single acoustic shock. In 2010, she had to leave the orchestra that was her home for nearly 34 years.

She says, “It was characterized by abnormal sensitivity—the total breakdown of tolerance to all sound. I couldn’t leave the house. There was pain in my ear, teeth, tongue, it radiated down my neck. You actually fear sound. Many people with hyperacusis become hermits.”

The problem is prevalent, especially among woodwind players, Horvath says. “There is more awareness of the condition and I was lucky to have found physicians who helped me retrain my brain. I was fitted with special hearing aids, which turned sound down.”

“It was painstaking training that took more than two years of slowly increasing sound. I am aware of limits and decibels,” she says. Today she is mostly cured, but avoids loud restaurants and sports events. She can finally attend concerts and plays chamber music.

Noise-induced hearing loss is a combination of exposure time, noise level, peak level, and proximity to the sound. Being aware of decibel levels is important. Horvath explains, “If you know you will be playing Mahler, it’s not a day to mow your lawn.” Horvath maintains that silence is as critical to musicians as making sound. “It would be smart to have rooms where musicians can go to have silence.”

Minnesota Orchestra has an audiologist come in to offer hearing tests and fit musicians for earplugs. According to Horvath, this could be precedent-setting. No one wants to get sued so they’re now willing to take further steps to protect their musicians’ hearing. She hopes, too, that conductors will begin to alternate the repertoire to give musicians a break.

OSHA limits the number of decibels one can be exposed to per day. The decibel level of an average two-hour concert generally exceeds OSHA’s recommendations. And there are no regulations for intermittent loud blasts. Horvath adds that OSHA only talks about hearing loss as a disability when you can no longer hear speech. 

In the hall where the Minnesota Orchestra regularly performs, they have made modifications. “Our orchestra has always been on the cutting edge, partly because of my work. Their stage manager was one of the first to build a Plexiglass shield,” she says.

Horvath has written a number of books, including Playing Less Hurt: An Injury Prevention Guide for Musicians. She is a recognized authority in the area of medical problems of musicians and a recipient of the Richard J. Lederman Lecture Award presented by the Performing Arts Medicine Association. She conducts seminars across the country and regularly appears on national radio and television.

The Mozart Effect on Epilepsy

The debate on the Mozart Effect — the notion that listening to classical music can boost brain power — remains open. Some claims from the ’90s media frenzy were debunked, yet other studies have shown evidence that Mozart’s music can improve cognition for young and old alike. Now, research from the University of Edinburgh has shown classical music benefits for children who suffer from epilepsy. A common test that detects electrical activity in the brain revealed: “there is an anti-epileptic effect of Mozart music.” Contemporary music did not have the same effect, but one 2015 study did show positive results from a classic jazz recording.

cleaning your wind instrument

Cleaning Your Wind Instrument Could Be Life or Death.

cleaning your wind instrumentCleaning your wind instrument isn’t just a matter of aesthetics, it could be a matter of life or death. According to an article published in the journal General Dentistry, many woodwind and brass instruments are heavily contaminated with bacteria and fungi. Through the act of merely blowing into an instrument, you are creating the perfect warm, moist environment for germs, mold, bacteria, and microscopic organisms.

Every time an infected instrument is played, contaminants enter the lungs. If they do not cause an infection, they can cause an immune system reaction that results in inflammation of the respiratory system, and eventually, hypersensitivity pneumonitis.

In one study published in The International Journal of Environmental Health Research, Tufts University scientists tested 20 instruments and found that all of them harbored living bacteria, mold, and yeast. Wooden reeds and mouthpieces had the most contamination. While that study was focused on student instruments, there have been many well-documented cases of instrument-caused illness in adults, even professionals.

The journal Chest reported on a 35-year-old trombone player whose 15-year cough went away after he began disinfecting his instrument with rubbing alcohol. The same journal reported on a 48-year-old saxophone player with lung disease. The molds ulocladium botrytis and phoma sp. were discovered in his saxophone. 

And there’s the well-known case of English bagpiper John Shone who suffered a near fatal infection caused by fungus growing in his bagpipes. “Failing to clean my pipes led to me becoming critically ill,” he reported in Piping Times. Shone, of Wiltshire, England, who has been playing since childhood, was hospitalized twice. Doctors were stumped until they learned he was a bagpiper. They tested his instrument and discovered deadly fungi, including rhodotorula and fusarium, which typically kill half the people they infect. 

One AFM member and trombone player suffered from asthma for 15 years, until he noticed that, when he was away from his instrument, his symptoms improved. “I had a horrible barking cough—especially when I played trombone,” he explained in a 2010 National Public Radio interview. 

When doctors at the University of Connecticut, where he was teaching at the time, took a culture from inside his trombone, they found the mold fusarium, as well as a type of bacteria called mycobacterium. He admitted he was once lax about cleaning his instrument, is now diligent about cleaning. “I use a rod with a cloth and I use alcohol—rubbing alcohol or isopropyl alcohol,” he says. 

All wind instruments should, at the minimum, be swabbed on the inside after each use. In most cases, mouthpieces can be safely washed in warm water and dish soap. Brass instruments should be disassembled and thoroughly cleaned according to manufacturer suggestions every couple months, depending on use.

Preventing and Managing Wrist Tendinitis

by Allison Shearer, MOT, OTR/L, CHT

Due to repetitive motions, instrumentalists are prone to overuse injuries of the wrist and hand. Among those most at risk are string players and percussionists. One problem is de Quervain’s tenosynovitis, a form of tendinitis particularly common in percussionists. This inflammatory condition affects the two tendons in the wrist that control the ability to pull the thumb out and away from the hand. The sheath containing the tendons swells and thickens, irritating the tendons and causing pain on the thumb side of the wrist that can extend into the thumb. Pain often worsens with thumb and wrist motion, gripping, and pinching. For professional musicians, ceasing performance usually isn’t an option. So how can you manage and prevent these symptoms?

Perform Dynamic Stretching

Regardless of whether you’re gearing up for practice or performance, always warm up. Musicians are similar to athletes. They repeatedly perform a high-level skill with extreme precision and focus. Like athletes, a five to 10-minute warm-up of dynamic stretching—stretching through motion—primes the body for playing. Moving your joints through their full available range of motion stimulates blood flow, lubricates joints, and improves flexibility, strength, and body awareness. It can also enhance performance and reduce the likelihood of injury. Try these movements to warm up your wrists and hands.

  • arm circles — Hold arms to the side of the body at shoulder height and slowly make smaller-to-larger circles clockwise, then reverse the circles to make larger-to-smaller circles counterclockwise.
  • wrist circles — Hold your fingers in a loose fist position and slowly move your wrist in a circular motion both clockwise and counterclockwise.
  • thumb opposition — Touch the tip of your thumb to the tip of each finger in an “O” shape and straight out for a stretch.
  • tendon gliding exercises for the fingers — See example images below.

Examples of tendon gliding exercises that help to warm up fingers.

Do not perform static stretching—manually stretching soft tissue and joints—prior to playing. This can actually decrease strength. This type of stretching should be saved for after you play to reduce excessive muscular tension.

Check Your Grip

Have an expert in your instrument or a clinician specializing in performing arts medicine check how you are holding and playing your instrument. For example, de Quervain’s in timpanists can be related to how you hold your mallets. Using a French style grip places extra stress on the thumb side of the wrist, irritating the tendons. With a German or American style grip, the forearm is in a more palm-down position and more force is absorbed by the palm and index finger. Modifying your grip—even temporarily—may allow you to continue playing.

Check Your Hearing

Choosing the correct type of hearing protection is essential. Too little protection can put you at risk for hearing loss. Too much protection (industrial-strength, foam-style earplugs) may cause you to “overplay.” Overplay occurs when too much high-frequency sound is filtered out and you compensate by playing louder, strumming or striking the instrument with excessive force. Specialized musicians’ earplugs provide even filtering of low, medium, and high frequency sounds.

Avoid Aggravating Motions

In de Quervain’s, the tendons are aggravated by moving your wrist side-to-side, so avoid pulling too far towards your thumb. Also avoid pulling your thumb far away from your hand—such as when stretching your hand over the top of a jar—and minimize pinching activities. This means changing the way you grasp and lift objects. For example, if you are lifting a frying pan, use a palm-up position to grasp and lift the pan to reduce stress. If you have small children, rather than picking them up by placing your hands underneath their armpits, try to “scoop” them up from underneath, again using the palm-up position.

Seek Medical Attention

If you are experiencing pain that occurs for more than four days, is unbearable, or worsening, seek medical attention. Do not let your pain become unmanageable, as early diagnosis and treatment yield better outcomes. Physicians specializing in performing arts medicine are best suited to assess your symptoms and intervene as appropriate. Participation in a hand therapy rehabilitation program with an occupational or physical therapist is often recommended.

Try Conservative Methods

After diagnosis, doctors typically recommend conservative management techniques to treat tendinitis. A recent onset (two weeks or less) of pain on the thumb side of your wrist likely means that you are experiencing acute inflammation of the tendons and sheaths. To reduced pain and inflammation during this time, apply ice for 10-15 minutes, one to three times per day or after playing. If you have significant or constant pain, you may be advised to use a thumb splint (thumb spica), which puts your wrist in a healthy position for healing.

—Allison Shearer, MOT, OTR/L, CHT, is an occupational therapist specializing in the treatment of musicians’ injuries. She is a member of the Performing Arts Medicine Association, and founder of Resonance Wellness.

Eating Healthy on the Fly: Don’t Let Fast Food Slow You Down

Eating HealthyFor musicians on the road, eating healthy food can be hard. Restaurants and mini-mart offerings can add unwanted calories quickly, but they are often the only option.

Choose beverages with no added sugar or with few calories. Most stores stock fat-free or low-fat yogurt, fruit packs, and trail mix. Keep in mind that some prepackaged foods look like single servings, but actually contain multiple servings. Avoid obvious bad choices: fried food, high-fat meat, and milk shakes. Instead, choose sandwiches with fewer toppings and no cheese. Opt for salads with low-fat or fat-free dressing, replace French fries with sliced fruit, and swap out fried meats for grilled options or fish.

The good news about health halos is a bit more complicated. Fast food chains use the symbol to indicate a healthier option. This claim, however, usually overestimates the healthfulness of an item. Researchers note that consumers frequently confuse low fat with low calorie, resulting in overconsumption. Some veggie dishes pack nearly 1,000 calories, while a burger may have as few as 250.

According to the Food and Brand lab at Cornell University, “Consumers chose beverages, side dishes, and desserts containing up to 131% more calories when the main dish was positioned as ‘healthy,’ even though the main dish contained more calories than the ‘unhealthy option.’” The rule of thumb is always read the nutrition facts before ordering. (Now that restaurants are adding calorie counts to menus, it’s becoming easier to riddle out how much you will be taking in.)

Other recent studies done by the Food and Brand Lab found that “low-fat” labels on snack foods encouraged people to eat up to 50% more than those who saw labels without the low-fat claim. “Simply seeing the words low-fat encouraged people in these studies to consume 84 extra calories! This happens because when consumers see the low-fat label on a product, they automatically assume it has fewer calories.”

Got a smart phone? Get an app to count calories. The Fast Food Calorie Counter app ($1, for iPhone or Android) lists more than 9,000 menu items. Also, eat small with pint-size portions. The kids’ menu can save you calories. If it’s unavoidable to eat unhealthy at one meal, make sure the next choice is a healthy one.

Dehydration can cause sweet and salty food cravings. Stay hydrated and you will be less likely to snack. Fruits can add to overall hydration: lettuce and some vegetables have high water content, as do watermelon, peaches, strawberries, oranges, pineapple, and blueberries.

Banana, beans, greens

Maximize protein and plant-based foods. Plant-based foods plus plenty of protein keep energy levels up. Generally, avoid refined grains, sugary snacks, and fried foods. Called a super fruit, bananas are high in B vitamins, calcium, and other minerals, such as magnesium and iron. Dark leafy greens, quinoa, nuts, seeds, and fruits, and foods high in probiotics (fermented foods) all boost energy. High-fiber and nutrient-heavy plant foods that will burn for hours. Low-fiber and nutrient-light foods—simple carbohydrates—burn quickly. When you’re eating plant-strong, you won’t have the energy highs and lows.

Kale, mustard greens, collard greens, cabbage, and broccoli are high in nutrients and contain glucosinolates, which inhibit the growth of certain cancers. Swiss chard and spinach have similar nutritional value. What’s more, they are available throughout the year, and both are rich in iron, which carries oxygen to the blood.

Egg, salmon, almonds

Nuts are satisfying proteins that fill you up, although try to find the “no salt” option. They have heart-healthy unsaturated fats and omega-3 fatty acids, vitamin E, and fiber. 

Eggs pack a punch, too. More than half the protein is found in the egg white, along with vitamin B2, and whites are lower in fat and cholesterol than the yolk. Egg whites are also rich sources of selenium, vitamin D, B6, B12, and minerals, like zinc, iron, and copper.

If you like it, fish is one of the healthiest foods you can eat. Like nuts, it is plentiful in omega-3 fatty acids and the vitamin D, a nutrient that most people are deficient in. It functions like a steroid hormone in the body. (Of the many unhealthy options at a McDonalds, the Filet-O-Fish contains a rather modest 380 calories.)

Health of Orchestra Musicians

OCSM Looks at the Health of Orchestra Musicians

by Robert Fraser, President Organization of Canadian Symphony Musicians

When I began my studies many years ago, I had no idea of the physical hazards of musical performance. Overuse injuries, hearing loss, unsafe performance environments—these were all very new to me and there was relatively little research or remedy in this area. I had never even heard of the drug Inderal and was astonished when my first-year music history teacher mentioned in class how many musicians took it.

Fast-forward to 2018 and there is still much work to be done. While we continually work to improve our physical safety in the workplace, dangers to our personal well-being in the form of harassment still abound, and the demands of our profession can take a toll on our psychological health. In this column, I want to draw your attention to two significant surveys, both conducted in the UK but very relevant to our position in North America.

Early last month, a few news outlets reported on survey results released by the Incorporated Society of Musicians (www.ism.org), a UK-based organization. The survey is ongoing and can still be accessed through their website. I would invite readers to look at both the survey and the report on the initial period of responses from last November. The most telling statistic, and the one that was shared in all the press articles, is that almost 60% of the respondents reported some form of sexual harassment in their musical workplace, and of those 60%, a large majority of respondents who revealed their gender were female. (The survey gives respondents the option to not reveal gender or to choose  transgender; 71.71% identified as female and 10.53% chose not to identify gender.)

The report states that there were more than 250 voluntary respondents to the survey during this period. While this is not a large sample, it is telling nevertheless. It makes me wonder what the responses would be if such a survey was conducted through AFM player conference orchestras.

Another survey, done in 2016 by Help Musicians UK, was entitled Music Minds Matter (www.musicmindsmatter.org.uk) and it presents itself as being “the world’s largest known study of musicians’ mental health.” Of the 2,211 respondents, 71.1% believed they had experienced panic attacks and/or high levels of anxiety and 68.5% reported they had experienced depression—making musicians three times more likely to experience depression and anxiety than the public at-large.

Respondents to the survey listed a number of reasons for ill mental heath.

To quote directly from the summary report:

  • Poor working conditions including: difficulty sustaining a living, anti-social working hours, exhaustion, and the inability to plan their time/future
  • A lack of recognition for one’s work and the welding of music and identity into one’s own idea of selfhood
  • The physical impacts of a musical career, such as musculoskeletal disorders
  • Issues related to being a woman in the industry—from balancing work and family commitments, to sexist attitudes, and even sexual harassment

In October 2017, a follow-up to the Music Minds Matter survey (Phase 2) included in-depth interviews with 26 of the survey’s respondents. Again, quoting from the report, three suggested areas for change were:

  • Education
  • A code of best practice
  • A mental health support service for those working in music

At the last OCSM Conference in August, the delegates adopted a resolution to address all three of these areas. We resolved to “encourage orchestra managers to become familiar with The National Standard of Canada for Psychological Health and Safety in the Workplace. This document can be found at the website of the Mental Health Commission of Canada. It is a daunting document (more than 70 pages), but I encourage all our members to find and download it. Point it out to your locals, your orchestra committees, and your human resources personnel. This is one area where union-management collaboration and cooperation is a must. Having research and well-documented plans for implementation will help, but the road to good mental health and safety in the workplace will not be easy.

On behalf of the 1,200 members of OCSM, I wish you all a prosperous and healthy 2018, and to my colleagues in the symphony world, an exciting second half of your season.

New Occupational Health and Safety Rules Protect Alberta Workers

For decades, Alberta has suffered higher worker injury rates than other jurisdictions in Canada. Bill 30 updated Alberta’s Occupational Health and Safety (OHS) Act for the first time since its introduction back in 1976.

“These long overdue Occupational Health and Safety changes will put workers at the center of the workplace health and safety equation by building an OHS system on three fundamental worker rights: the right to know about workplace hazards, the right to participate in workplace health and safety programs and policies, and the right to refuse unsafe work,” says Alberta Federation of Labour President Gil McGowan.

Other key changes in the new legislation include broader workers compensation coverage for workers who are either injured or killed on the job, as well as the continuation of pay and benefits when stop-work orders are issued.