October is National Arts and Humanities Month and ACSO contributes to its theme - “Stories Unite Us” - by sharing this blog written by ACSO Conference and Marketing Intern, Sairaksha Thirunavukkarasu. In it, she shares how attending an ACSO conference session helped her reflect on the intersection between music and health and recognize the importance of supporting the well-being and longevity of the musicians who bring orchestral music to life. 

Musicians are Athletes?

Imagine a professional athlete. Someone who trains for hours each day, performs in front of thousands of people every season, and keeps themselves in optimal condition since their body is their job. Chances are that you are thinking of a Wimbledon champion or Super Bowl player. 

Or perhaps, a musician may have sprung to mind. As someone not previously part of the orchestra world, I certainly wasn’t thinking of musicians. In fact, I was surprised to learn that professional musicians are considered “small-muscle athletes,” a term used by Dr. Jeremy Stanek of Stanford University during the Musician Injuries and How to Avoid Them session at the 2026 ACSO Annual Conference. At this wonderful session, I learned about the hidden physical and mental challenges musicians face, how performers can receive care, as well as how orchestra administrators can improve the culture around musician well-being.  

Thanks to this session, I now finally understand why my high school marching band sported varsity jackets alongside the football jocks. 

Playing Through the Pain

As a Communication student at USC, I spend a lot of time thinking about messaging. We interpret messages every day, all of which contribute to building the culture of our social environment. For example, if an individual works for a company where their colleagues rarely take sick days, work in lieu of taking vacations, and don’t speak up if they are struggling, these nonverbal messages produce a culture that prioritizes high-performance and a tireless work ethic over worker well-being. 

Sean Krissman, medical student and former Principal Clarinet of the San Francisco Ballet Orchestra, shared his firsthand knowledge about the demands of working in an orchestral environment. 

“Music performance culture promotes that availability is the best ability,” Krissman said. “The fear of failing...stops people from speaking out, but you know when something’s wrong with your body versus when you just have a difficult passage.” 

His perspective led me to think about popular contemporary representations of artists in film. It’s easy to notice a trope of the lone musician who sacrifices much of their mental and physical well-being in pursuit of their art. Films such as Whiplash, Black Swan, and Tick, Tick...Boom! reinforce these stereotypes. These media messages convey to audiences that musicians must be willing to overlook injuries or illness as part of the artistic pursuit of excellence. In other words, the artist’s pain helps demonstrate their skill. 

Common Musician Injuries

Unfortunately, these portrayals don’t seem too far from the truth. Dr. Stanek cited a study by Ackermann et. al which found that 84% of professional orchestral musicians in Australia reported playing-related medical issues (2012). 

One commonly overlooked musician injury is psychiatric or mental illness. This often manifests as performance anxiety, from which many performers suffer. 

Hearing loss is another injury that affects musicians due to their frequent exposure to loud music during rehearsals and performances. Along with hearing-related injuries, I did not consider that several dermatologic issues can arise as well, often with brass players whose skin comes into contact with instruments plated in nickel. 

The session also addressed the long-lasting effects of poor technique and posture taught during early childhood, and how these habits can increase the risk of developing an injury down the road. As a child taking piano lessons, I never understood why my instructor emphasized the importance of curved fingers and a straight back. Now that I’m older and trying to get back in touch with piano, I can attest to how muscle memory persists; it is difficult for me to maneuver my fingers any differently than what I had previously learned. 

Another factor that I was not familiar with previously is that performers also grapple with intense variations in strenuous activity depending on the time of year. The difference between the amount of time spent playing their instruments during the busiest parts of the season as opposed to slower periods increases the risk for injury as well. 

The issue that I related to most closely though was how college-level musicians may be forcing themselves to overlook injuries for the sake of their grades or keeping scholarships. As a college student, I have personally experienced sacrificing my well-being at times to meet academic expectations. I can only imagine that for my peers in music performance, the pressure may be more intense as they begin auditioning for professional orchestras, thus increasing the potential to perpetuate unhealthy habits. 

The situation isn’t entirely bleak, however. Once musicians recognize signs of injury, they can seek help from performing arts medical specialists, such as Dr. Stanek, at the Performing Arts Medicine Program at Stanford. These healthcare providers are trained to understand how music technique and repetitive performance can cause injuries, helping them offer a more comprehensive and specialized medical opinion and treatment compared to general practitioners. 

Creating a Culture of Caring

I was not aware of the existence of performing arts medical specialists until this session. And though I’m grateful to know that there is specialized care for musicians, part of creating inclusive access also involves encouraging musicians to utilize these resources. This is where orchestra administrators play a pivotal role. What messages can orchestra administrators send to musicians to make the culture surrounding music performance more focused on health and well-being? 

Andrew Tremblay, Director of Orchestra Personnel at the San Francisco Symphony, has an answer. He emphasized that orchestras should focus on “creating a culture of caring.” This includes making performers feel comfortable reaching out early with their concerns, so a minor issue doesn’t deteriorate into an unforgiving injury.

“Good culture [also] requires good systems,” said Tremblay. That means, administrators should inform their musicians of what the organization’s sick leave policies entail, have reliable substitute coverage in case of injuries, and provide knowledge on disability and workers’ compensation. The latter is essential since the rate of performers who file for workers’ compensation is lower than the injury rate. 

By providing examples of consistent messaging and safety policies that personnel staff can provide musicians, the speakers highlighted the importance of reducing the stigma that comes with help-seeking within the orchestra field. Instead of being seen as a sign of weakness, this session taught me that there are concrete steps that orchestra administrators can take to encourage support-seeking behavior. 

Healthy Musicians Make Thriving Orchestras

All of us within the orchestra field, from musicians to orchestra administrators (and interns!), are committed to enriching our communities through live music performance. But as much as our culture might have taught us that “the show must go on,” this should never come at the cost of performers’ health and well-being. 

Let us instead make it the norm for musicians to let their orchestras know at the early stages of pain and, whenever possible, encourage them to seek help from performing arts healthcare specialists. This way, we can cultivate a flourishing environment of healthy musicians who feel good and are ready to play! 

I had so much fun delving into a topic that was completely foreign to me prior to this session. Relating it to my own study afterwards also helped me recognize how these various fields are interconnected in ways I had not appreciated before. 

I believe my experience at this year’s ACSO Conference demonstrates that the orchestra has a place for everyone. We are bonded through our appreciation for classical music and desire to support the musicians who make it possible. Additionally, in honor of National Arts and Humanities Month, I encourage you to reflect on the orchestral community you support and discover ways in which you can involve more inclusive messaging and practices to promote musician health.  

Additional Information:  

Musician Injuries and How to Avoid Them, Session Slides

Stanford Performing Arts Medicine Program

Performing Arts Medicine Association