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Huge numbers of professional musicians and music students suffer from muscular problems and performance anxiety. Biomechanics specialist Professor Jean-Pierre Baeyens and his team go beneath the skin to explore potential prevention and treatment for an under-reported problem.

 

The smell of chlorine from the swimming pool below lingers in the corridors, while faint cries from the sports field drift in through the open windows. It’s perhaps not a place you’d expect to find an erstwhile art historian working on interventions to tackle performance anxiety among classical musicians. But here in the faculty of physical education and physiotherapy is indeed where you’ll find Professor Jean-Pierre Baeyens, whose research could change the lives of countless musicians who are currently suffering for their art.

 

“I got my master’s in biomedical sciences and my doctorate in rehabilitation sciences and physiotherapy, but I also have a master’s degree in art history and archaeology,” Baeyens says of his academic background. “So as an art historian, I’ve always had a strong connection with the arts.” Is he musical himself? “Not at all,” he says with a laugh. “I don’t play music; I play basketball.”

I got my master’s in biomedical sciences and my doctorate in rehabilitation sciences and physiotherapy, but I’ve always had a strong connection with the arts
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Jean-Pierre Baeyens

Despite his earlier artistic leanings, Baeyens now specialises in biomechanics, the field in which scientists use the principles of mechanics to tackle biological problems. At the crossroads of physics and biology, to outsiders it’s a discipline perhaps more readily associated with the world of athletics and post-trauma rehabilitation. But years ago, while working as an independent manual therapist, Baeyens found himself treating a number of opera singers who suffered from recurring neck pain. This practical experience as a therapist, combined with his existing interest in the arts, was the spark that inspired his research into the wider physical problems suffered by professional musicians during rehearsals and performance.

 

Vulnerable to injury
Playing a musical instrument professionally is a very demanding task, involving both physical and mental skills developed over a lifetime of learning and practice. Just like athletes, musicians frequently suffer from various mild to severe performance-related problems, or PRPs, including musculoskeletal disorders, peripheral nerve problems and a very specific neurological problem known as focal dystonia, or musician’s cramp. Performance stress only compounds these physical ailments. Baeyens and his team are busy studying the underlying processes in the hope of finding practical applications that can address the problem in individuals before it’s too late.

So far, research has been mainly limited to epidemiological studies, identifying reports of specific stressors. It’s been shown that such problems among music academy students and professional musicians are frequent, with reported prevalence ranging from 39 to 90%. On top of this, many musicians use beta blockers to cope with performance anxiety, an affliction that can cause a speeded-up heart rate, trembling voice, sweating, dizziness and shaky hands.

 

These previous studies also show that problems can emerge in tertiary, secondary and occasionally even earlier levels of education, with those affected vulnerable to developing further injuries as their academic and professional careers advance. Baeyens’s research project – known as motor learning and repetitive strain injury in musicians, or MOREMU – focuses initially on classical music students who are studying at conservatory level, and for this he works with the conservatories of Brussels, Maastricht and Lugano, as well as the Brussels Philharmonic.

 

Intense practice
The onset of performance-related problems coincides with the transition period as musicians enter a conservatory, and can be ascribed to the increase in rehearsal hours and competition as students’ careers progress to the next level. “It’s a very intense, high-pressure environment in the conservatories,” says Baeyens. “So often we find that musicians may be suffering from pain but they won’t tell their tutors or even their classmates about it, because there’s such a stigma attached to it.” This taboo is reflected by the fact that one in three of the affected students in a previous study admitted that they didn’t seek help for the problem at all.

The fact is, very simple ergonomic interventions can make a real difference to the problem
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Jean-Pierre Baeyens

MOREMU, set up three years ago, focuses on the musculoskeletal factors associated with these symptoms. The team work on site at the conservatories with subjects including pianists, violinists, cellists and flautists. During the investigation, the movement behaviour of the shoulder girdle, neck and spine is measured by means of 3D optoelectronic tracking using Vicon motion-capture technology. At the same time, surface electromyography (EMG) is applied to capture the electrical activity of the muscles. “In the first phase, we are looking at the muscle strain that musicians suffer during performances. We are also looking at the effects of long periods of rehearsal on the shoulder and neck region,” Baeyens explains. “Using all these monitoring devices, we can measure the extent of the physical stress as they are playing.”

 

In this initial phase, the project was focused on organising and developing appropriate data analysis algorithms, he says. “For instance, in order to properly analyse the surface EMG data we obtained while a subject was playing a very dynamic music score, we explored an approach using wavelets, based on the pioneering work of physicist Ingrid Daubechies, a VUB alumna. The results suggest adaptations to practice sessions that last for longer than an hour under particularly high muscular loadings.”

 

Apparent discrepancy
The team have also investigated performance anxiety in professional musicians playing with the Brussels Philharmonic. “To do this, we used questionnaires and physiological measurements such as skin conductance and heart rate variability, using ECG sensors,” he explains. “The results showed individual differences: for example, some professionals presented more stress during rehearsals with the conductor than they did during a public performance, while others displayed the opposite.” The musicians themselves may be unaware – or perhaps in denial – of these issues. Baeyens: “We also found that there was an apparent discrepancy between the measurements we took  – which demonstrated physiological indications of significant performance stress – and the psychological questionnaires our subjects filled in, which indicated only minor stress.”

Our aim is really to make people aware of the problems before it’s too late
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Jean-Pierre Baeyens

What frequently occurs next is a particularly vicious circle: certain factors cause stress, and efforts to alleviate the problem only exacerbate it. For instance, a physical complaint has an impact on a musician’s playing quality, leading to anxiety about performance, which may push them to use medication. They increase the duration and intensity of their practice in an attempt to compensate, but by overloading the muscles, this further decreases the quality of their playing. Emotional stress increases, and the cycle continues. The capacity for motor learning, by which the brain changes in response to practice, is also diminished.

 

And these problems increase with time if they are not addressed early on. “The more information and insight we have concerning the origin of these PRP syndromes in adolescence, the better we will be able to protect future musicians from unwanted physical impairments,” Baeyens says. “Our aim is really to make people aware of the problems before it’s too late. The conservatories themselves might call in physiotherapists to treat the symptoms, but that’s curative and we’re much more interested in prevention than in cure. Something we also find is that there might be a different attitude to therapy among the artistic community, and that they tend to opt for alternative methods of treatment.

 

“But the fact is, very simple ergonomic interventions can make a real difference to the problem: adding extra supports to a violin, for example, to ease the stress of holding it in place, or changing the seats that musicians sit in during performances and rehearsals to something more comfortable than the chairs they tend to use at the moment.”

The next step
The team’s first measurements and analyses are now finished. The next step is to communicate these findings to the musicians themselves, making them conscious of the problems and the vicious circles they are confronted with.

 

But Baeyens believes that further exploration of the problems suffered by music students still needs to be carried out. “Better understanding of the efficiency of various treatment interventions after the occurrence of PRPs, and a change in attitudes towards their application, will provide us with additional insights for prevention and treatment,” he says. There is work on the subject taking place around the world, and this team of researchers are part of a small but growing community. “I present at symposia, but often you find that there are not that many people there, maybe only thirty,” he says. “That really makes for a much more honest, open and supportive research community.”

 

And he has high hopes for this particular project. “The research will be furthered based on our first results. One day, I hope we might even be looking at an expertise centre here at VUB that specialises in repetitive strain injury and motor control in musicians,” he says. “A place where we can study this phenomenon and develop our research into applications for prevention and treatment – but right now, that’s really just a dream.”