The Suffering Artist: Not Something to Aspire To

A telling exchange between Beethoven and a pianist struggling with his Piano Sonata No. 32 ended with the composer offering this retort: “I don’t care about your fingers.” That exchange, however apocryphal, is illuminating. It sheds light on how some composers consider—or rather don’t consider—the effects that their works have on performers’ bodies.

Performance injury among musicians is an issue of no small matter. A recent study identified that as much as 65 percent of the music student population suffer from a performance injury. That study, a joint effort by the Texas Center for Music and Medicine and the Performing Arts Medical Association, also pegged the adult musician population suffering from a performance injury at 75 percent. The Texas Center for Music and Medicine, located on the campus of the University of North Texas, is the leading U.S. research institution on musician health and performance injuries.

Spreading awareness among composers of the potential effect that compositions may have on performers’ bodies is in its infancy. But it has been gaining momentum as of late. It’s a pertinent issue for Dr. Kris S. Chesky, co-founder and director of education and research for the Texas Center of Music and Medicine. The Center seeks to build a dialogue among schools and researchers about performance injuries and music curriculum standards for schools.

According to Chesky, “The idea that compositional practices and arranging practices should be influenced by some understanding of the risks in playing is permeating our disciplinary group. Now, people involved in teaching composition are thinking that maybe they should be bringing this up when teaching kids how to compose.” That discussion, Chesky says, may include how some modern or contemporary works, especially extremely repetitive ones found in minimalist music, impact players. From a composer’s point of view, that issue treads into sacrosanct territory.

“I certainly can say that if some music departments are throwing around the idea that living composers are responsible for performance injuries, the Eastman School is definitely not one of those institutions,” contends Carlos Sanchez-Gutierrez, who teaches composition at the Eastman School of Music. “The thought that modern music, as a whole, is to blame for performance injuries is ludicrous. While I have no hard data to support this assertion, I can base my observations on the many years of personal experiences and contact with musicians who have suffered from injuries related to musical practice.”

Sanchez-Gutierrez believes that, if anything, the cause for music performance injuries is due to the stress that surrounds traditional professional and pre-professional music practices. According to him, “Musicians do practice excessively, and under tremendous stress, the same musical passages, when preparing for auditions, competitions, master classes, and such opportunities.” And he’s fervent in his belief that the large majority of the music to blame is traditional classical music and not modern music. “We should look there for the cause of these injuries, and leave composers alone.”

Some composers agree, but see it as less of a black and white issue. “I really do feel that the basic premise of [Sanchez-Gutierrez's] comment is right,” posits composer Kurt Rohde, who teaches composition at the University of California at Davis. Rohde likened any movement to get composers to look at their compositions through a performance injury lens as “morality for musicians.” A violist, Rohde has not seen any example of a musician’s health being adversely impacted by his compositions, though he does think that there has to be a type of consideration for performers. Still, he believes the bigger issue is what is reasonable to expect from a performer in getting ready for a new work.

But some musicians who toil in orchestras and orchestra pits see things differently, like violist Anna Kruger, who plays with the Sacramento Ballet orchestra and also fills in with the Sacramento Opera orchestra when needed. Kruger believes that some music, like that of composer Philip Glass, gives her and others pause at the stand. “This music can be hazardous. Anytime you stay in the same place, where you’re doing the same thing with your left hand, that hand will get stressed and tired.”

Kruger claims that one of those works is a ballet with the music of Philip Glass called Glass Pieces. “One of the movements is just unrelenting. It’s four or five pages of the same thing. We have to take turns on the stand where I play eight bars and hang out for eight while my stand partner plays eight. We don’t want to hurt ourselves. I think there would be a lot more people calling in sick if we didn’t do that.”

But minimalist music isn’t the only kind that concerns players. Don Ehrlich, who recently retired as violist with the San Francisco Symphony, contends that he suffered a major injury due to the repeated bow “scrubbing” demanded by Beethoven’s works, mainly his Eroica.

“Beethoven does that to us violists, Bruckner as well,” says Ehrlich, who now teaches the violin at the San Francisco Conservatory of Music. “Some composers have seemed arrogant when placing demands on performers.” He cites Wagner and his use of the Viola Alta as a primary example. That instrument was designed by 19th-century German violist Herman Ritter, and Wagner was keen on the instrument’s bigger sound. Violists at the time complained that they couldn’t play the instrument because it was too big and they got injured. “Wagner, of course, couldn’t be bothered to change his mind, calling the violists complainers. He just didn’t care that he caused the ends of their careers.”

Ehrlich believes that the same potential for injury exists with contemporary, and particularly minimalist, music. He contends that his colleagues at the San Francisco Opera Orchestra all fear the new pieces of minimalist composers. “They all know that they’re at risk for injury, and a number of them go down when those pieces are played. They expect us to perform what the human body is not designed to do.”

“Contemporary music has come to include so many styles that no sweeping generalizations can be made,” counters Elinor Armer, who has been teaching composition at the San Francisco Conservatory for the last 39 years. “Highly repetitious stuff or brutal technical demands can cause injuries—like tendonitis, carpal tunnel, and sprains—in any style, from Baroque on up to the present.” But, she admits, there are aspects of new music that make things tough for players. “I think that the unfamiliarity of new music, even tonal new music, builds tension into the learning, and that has to be dealt with, and overcome. There are specialists in new music who tackle this very issue head-on, by learning the language of the piece before ‘speaking’ it.”

Armer points out such techniques require “sympathy” and “identification” with the composer. But she thinks that a larger issue is at play: “I believe performance injuries are more likely the result of poor teaching than of compositional demands.” And the recent efforts of schools around the country, many of which are taking the health issue seriously, confirms Armer’s contention.

Education is where the Texas Center for Music and Medicine has taken the lead. A team of musicians, educators, clinicians, and research scientists are working to address music performance injuries. The goal there is to help schools come up with the appropriate curriculum to steer students away from compositional techniques that may spur a performance injury. But bringing those efforts to bear in classrooms where composition is taught is years away. To date, the Center has worked with university music departments and conservatories including the University of Southern Maine, Michigan State University, and the Eastman School of Music, among others. At some of these schools the focus is on injury prevention wherein graduate students can enroll in music medicine classes, participate in ongoing research and outreach initiatives, or select an optional related field of study in music medicine.

Although, at first sight, the field of music medicine and the study of performance injuries seems like a new one, it is but a latter day offshoot of old school occupational medicine. That discipline began in earnest with the treatise Diseases of Tradesman published in 1700 by Bernardino Ramazzini, considered the father of industrial hygiene. Ramazzini’s treatise was the first to examine the effects of things like lead poising on potters and silicosis on stonemasons. While several tracts have been written about such injuries since the 18th century, it’s a medical specialty that really got started in the late 1970s and early 1980s.

The singular event that gave the discipline its greatest momentum in the music community was when pianist Gary Graffman went public in the early 1980s with his battle with focal dystonia, a neurological condition which causes undesirable muscular contraction or twisting. And the issue was further thrown into the spotlight once pianist Leon Fleisher went public with his dystonia a few years later. In one fell swoop thousands of musicians who had suffered in the dark realized that they were not alone. Many now credit Graffman and Fleisher going public as the beginning of the field of music medicine in the United States.

Today the issue is being addressed worldwide, and most aggressively at the college-age level. Through a collaborative effort called “Health Promotion in Schools of Music,” the Texas Center for Medicine and Music seeks to establish a minimum standard in music schools. That standard includes offering at least one introductory-level undergraduate course that covers relevant occupational health concerns. At present the National Association of Schools of Music, which accredits more than 500 music schools, only recommends providing such courses in the accreditation process.

However, it remains unclear how that initiative will impact the way composing is taught. At a school like the San Francisco Conservatory, classes are offered in Alexander Technique. The class is geared to all performers and not just for composers of new music. But Elinor Armer says that physical realities are acknowledged in composition classes. “We keep our composition students mindful of the practical capabilities and physical limitations of all the instruments, and the players they write for, including voice.”

For composer and composition teacher Sanchez-Gutierrez, communication may be the key in limiting potential for injuries. “I tell my composing students to push the envelope, if the piece so needs. But I make sure that they know what they’re doing, and I advise to always talk to your players. Eastman is special in that respect, as there is great synergy between composers and performers, so this sort of dialogue is constant and fruitful.”

“The hierarchical aspect of composition is a thorn in my side,” exclaims Dr. Robert Markison, a hand surgeon and associate clinical professor of surgery at the University of California at San Francisco. “There is still a great disconnect between composers and musicians. There is a lot of responsibility to look at the long haul of composing. Any modern composer, especially with access to fingering charts, should know what he or she is asking a performer to do. As a composer, I would do what Duke Ellington did. He knew every musician in his group, he knew their strong suits and he wrote music for them that’s as beautiful as what Mozart wrote for Anton Stadler.”

Markison is in a unique position to address the issue since he’s also a classical and jazz musician who has been playing the clarinet, trumpet, and flugelhorn for 40 years, but he also believes that there needs to be a deeper understanding in the medical profession of how performance injuries begin. To that end, he used a string quartet to shed light on the anatomy of musical strains when addressing this year’s incoming class at Stanford University’s Medical School. He claims he has treated more than a 1000 patients with music performance injuries since he saw his first music patient in 1975. Nowadays, he sees between 5 to 10 patients weekly, from the child prodigy to orchestral musicians approaching the end of their careers. To hear Markison tell it, the data that exists on performance injuries may just be tip-of-the iceberg numbers. The true number may never be accurately identified. “There are hidden numbers. The average person sitting in a line to audition does not want it known that they’ve had an injury.” And doctor-patient confidentiality means that many performance injuries go unreported statistically.

For composer Kurt Rohde, it is the evolution of musical form that is most important and will always trump any injury issue. He believes composers create the environment from which new performance practices are born. “The technique to play instruments has really changed. There are many people that are now playing music that was not playable before, and I think that is the progression. We all want to be the greatest composer, and to create something universal. And if that means that we have to write something that is almost impossible to play—then we do it.”

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Edward Ortiz

Edward Ortiz is the classical music and opera critic for the Sacramento Bee. Prior to joining the Bee he worked as staff reporter for the Boston Globe and the Providence Journal, and is a contributor to the website San Francisco Classical Voice.