Before, During and After – Prevention, Management and Recovery of Performance-Related Neuromuscular Health Issues in Musicians

In this keynote, perspectives will be presented on the ‘before’, ‘during’ and ‘after’ components of managing health in musicians. Several of the approaches and evidence emerging from the fields of sport and dance medicine will be presented to compare strategies that can be implemented to optimise performance health in musicians.

Attaining an elite level in human performance domains requires a long-term commitment to regular and repetitive training to achieve the desired level of skill mastery. A fine line is often walked between pushing the body hard enough to increase or maintain performance levels but not overextending to the point that an injury occurs. Increasingly in sport and dance, a wide range of interventions have been implemented in training to mitigate risk and prevent injuries wherever possible, including a focus on health education in improving training practices. Alongside domain-specific upskilling of health professionals, this has helped advance injury management and returns to performance approach in sport and dance domains, while music lags behind.

In the first part of this keynote, models used to identify and subsequently modify key risk factors related to overuse-related injuries in dancers and musicians will be presented, and some of the challenges in implementing these systems will be discussed. The cornerstone of preparing a musician for their craft involves specific health education aimed at increasing their performance capacity, including making informed and appropriate health decisions to practice and perform safely. However, recent research on musicians’ health literacy, the ability to access and understand reliable, specific health information and translate this knowledge into practical settings, may be a barrier that should be addressed to facilitate changes in health behaviours. This highlights how maintaining optimal performance and preventing injuries can be impacted by the availability and comprehensibility of domain-specific health information.

In the second part of this keynote, research relating to the assessment and management of performance-related neuromuscular health issues will be presented. This will highlight the range of variables that have been found to impact injuries and movement issues occurring in musicians, particularly with typical chronic overuse-related conditions. Research findings such as the relationship between altered playing movements and pain and physical characteristics of the instrument and performer will be discussed in relation to developing effective treatment strategies.

Finally, this presentation will discuss recovery and return to performance strategies which may facilitate the prevention of injury recurrence.

Bronwen Ackermann, PhD, is an Associate Professor in the School of Medical Sciences at the University of Sydney and an internationally renowned expert in performance optimisation through the application of performance science research. With over 50 peer-reviewed journal articles, five chapters in music textbooks, and numerous publications for non-academic journals on musicians’ health, she is the leading figure in musicians’ health research in Australia. She was Editor-in-Chief for five years (2016-2021) for the foremost international journal in Performing Arts Medicine, "Medical Problems of Performing Artists" (USA).

In addition, Ackermann has an extensive background in clinical work, applying her research in her practice as a physiotherapist with many high-profile musicians for more than 20 years. As a clinical physiotherapist, she has toured internationally with orchestras since the late 1990s and continues to provide highly specialised physiotherapy work with musicians globally.

For over three decades, Ackermann has been delivering health education to musicians, including students, professionals, and community organisations both nationally and internationally. She led the Musicians’ Health and Performance Wellbeing Program at the Australian National Academy of Music from 2013 – to 2019 and the first international Performing Arts Medicine Training Program in collaboration with the American College of Sports Medicine and the Performing Arts Medicine Association (USA). Bronwen headed a team in converting and modifying the program for online delivery in 2020.

In health promotion and injury prevention for musicians, Ackermann was a lead investigator for the internationally important Sound Practice Project, a collaborative research venture studying the health of Australia’s orchestral musicians (2009-2015). She led the content development of Sound Performers in collaboration with A/Prof Suzanne Wijsman and has overseen the content and research of this highly acclaimed project with Wijsman over the last ten years. They have since collaborated with an international team of musicians’ health researchers in studying musicians’ health literacy and developing international applications of Sound Performers as a member of the Musicians’ Health Literacy Consortium, supported by the Worldwide Universities Network Research Development Fund (2018– ).

From 2019 to 2021, Ackermann was sponsored by an Alexander von Humboldt Experienced Researcher Fellowship to collaborate with the world-renowned neurologist and musicians’ health researcher, Professor Eckart Altenmüller, in Germany. Using a program she developed, she retrained movements in musicians with severe movement control disorders (focal dystonia – hand and embouchure) to enable them to return to the stage.