Perceptions of Playing-related Discomfort/Pain Among Tertiary String Students: A Longitudinal Study

Abstract

Over the past 35 years a growing body of research has shown that many musicians suffer from playing-related discomfort/pain and injury throughout their lifetime. The vast majority of studies have collected cross-sectional quantitative data with the aim of establishing the incidence of injury in a specific population whether that be professional orchestral musicians, tertiary string students, adolescents, or children. Whilst beneficial, this type of research has been unable to provide much detail as to the unique experiences of these individuals, and how these change over an extended period of time. The purpose of this PhD thesis is to gain a better understanding of the perceived impact of personal circumstances, past and present learning environments, and musical culture on the development of playing-related pain and injury among tertiary string students. The study used a multi-phased mixed methods methodology utilising elements of both quantitative and qualitative research. Over a period of 5 years a total of 40 Bachelor of Music string students at an Australian tertiary institution (all the violin, viola, cello, and double bass majors who entered the Bachelor of Music program in 2007 and 2008) participated in twice-yearly questionnaire/interviews. These contained standard and established pain measurement tools namely Fry’s Overuse Injury Scale and the McGill Pain Questionnaire. Additional questions were added to both gather demographic data and also to allow the researcher to explore individual circumstances that may have impacted their playing and playing-related injury circumstances over the 5 year period. Data was also collected from three focus groups. There were only 5 instances in 181 questionnaire/interviews where a student reported they had not experienced any playing-related discomfort/pain since the previous round of data collection. Considering the participation rate remained extremely high at 96%, these results are striking. The perceived severity of student experiences varied greatly with some students suffering from only occasional mild discomfort whilst playing. Unfortunately, there were others who were experiencing severe pain and injury that impacted on their ability to not only play the instrument but also their ability to undertake some everyday activities. The thesis itself consists of 10 chapters and extensive appendices. Chapters 1-3 introduce the research questions, give a detailed review of the literature, and outline the methodology and preliminary data analysis. Chapters 4 to 8, the main discussion chapters, then go on to explore the 5 main areas of perceived influence on playing-related discomfort/pain and the emerging themes. Chapter 4 looks at the influence of past and present learning environments, with a particular emphasis on the Major Study course at the institution. Chapter 5 focuses on the perceived impact of the Orchestra course at the institution and examines factors such as rehearsal structure/scheduling, breaks, atmosphere, repertoire, stretching, ergonomics of the rehearsal spaces, and the Opera component of the course. Chapter 6 considers the relationship between their experiences of playing-related discomfort/pain and the number of hours per day spent playing their instrument and factors within practice such as consistency and content (warm-ups, practice breaks, and repertoire). Chapter 7 examines technique, posture, instrument set-up, and tension. Chapter 8 unpacks the multitude of other influencing factors, which ranged from exercise and diet, outside work, computer use, writing, and day-to-day activities to pre-existing medical conditions, psychological health, and personality. The data was analysed using a mixed-method approach using a variety of qualitative and quantitative methodologies best suited to the research question. Through this process summaries of the individual cases for each of the 40 participants were also generated. (These extensive documents are contained in the Appendix B.) The summaries document the individual journeys of each student and the perceived interaction within and between the 5 main areas of contributing factors to discomfort/pain. The summaries also reinforce the extent to which students had a variety of perceptions of the overlapping, interactive, and highly subjective contributing factors. From these summaries, six specific cases (two violin majors, two viola majors, and two cello majors) were selected for further in-depth analysis in Chapter 9 of the thesis. The final chapter of the thesis, Chapter 10, reviews and discusses the 5 main areas of influence and the relevant themes in relation to the broader literature. It concludes with a general discussion of limitations to the research, recommendations for the institution and other tertiary institutions, and recommendations for further research.