Outside your work as an occupational and environmental health and safety (OEHS) professional, you’re probably at least a little familiar with the world of music through the medium of popular culture. Almost everyone has at least a few styles or genres they enjoy, and many people also play an instrument or sing at the hobbyist, semi-professional, or professional levels. In this context, it can be surprising to learn how common occupational injury and illness are among those who create music.

Occupational Illness and Injury Among Musicians

Consider Julie Andrews, whose singing voice never completely recovered after she experienced vocal strain in the midst of a '90s Broadway production—and surgery intended to correct the issue caused permanent scarring of her vocal chords. Lady Gaga once received a concussion during a live show; the pop singer would later cancel the entire tour due to a cartilage tear in her hip caused by repetitive movements. Latin artist Enrique Iglesias severely injured his hand while attempting to catch a camera drone at a performance—a crowd-pleasing stunt that Iglesias had performed several times but only now resulted in permanent nerve damage. Rapper Killer Mike sustained a shoulder injury while defending a bandmate who had been attacked by a hostile audience member. Indie vocalist Florence Welch, rock musician Dave Grohl, and punk icon Patti Smith have all broken bones due to falls from high stages.

It might seem that the artists mentioned above comprise a small group of people who perform in uncommon circumstances outside the range of traditional OEHS practice. But the health and safety risks that affect celebrity musicians are shared by the more “ordinary” people who work in the industry—such as musicians who entertain at weddings, nightclubs, and restaurants or are employed by religious organizations, the education and university systems, orchestras, chamber music groups, operas, musical theater productions, ballets, and the military. Furthermore, the risks to musicians’ health and safety considerably overlap with risks OEHS professionals are accustomed to controlling in more familiar industries.

Foremost, performance-related musculoskeletal injuries (PRMDs) are very common among musicians. According to a 2014 study of 377 musicians from eight professional Australian orchestras, 84 percent of study participants reported having experienced a PRMD, while 50 percent of participants reported a current PRMD. Instrumentalists are particularly vulnerable to musculoskeletal disorders because playing almost any instrument requires repetitive movements and hours of practice per day. Additionally, some instruments are particularly heavy or are played while maintaining uncomfortable postures.

Exposure to hazardous levels of noise is another common concern. The researchers who conducted the study on PRMDs later issued another survey evaluating noise exposure, noise surveillance, use of hearing protection, and hearing loss symptoms among the same community of orchestra musicians. “For average reported practice durations,” the researchers found, “53 percent would exceed accepted permissible daily noise exposure in solitary practice, in addition to sound exposure during orchestral rehearsals and performances.” While the eight professional orchestras maintained hearing protection programs, only about 64 percent of survey participants reported regularly using adequate hearing protection. It is noteworthy that unlike the orchestra musicians, many professional musicians are not employed by a large organization. Freelance, self-employed, and part-time musicians generally lack access to hearing protection programs.

Moreover, both outside researchers and industry observers have identified work-related psychosocial risks that may negatively impact musicians’ mental health. For one thing, performing music at elite levels or as one’s primary source of income generates immense pressure to achieve perfection. For another, the nature of work for many musicians often requires frequent travel, lacks financial stability, or both. The United Kingdom Musicians’ Union identifies inconsistent work as one of many psychosocial risks that professional musicians are exposed to in its free publication A Young Freelancer’s Guide to Mental Health in the Music Industry. Musicians who attempt to medicate performance anxiety or financial stress with alcohol or illicit drug use may develop substance use disorders.

The U.K. Musicians’ Union website provides extensive resources available to non-union members on additional risks and hazards that can affect the health and safety of music industry professionals, including electrical hazards, fire safety, and improper ventilation at venues. Issues of harassment and discrimination toward musicians who are women, disabled, or part of the LGBT+ community are also covered.

Finally, the COVID-19 pandemic continues to impact the music industry. Concerns relate to virus transmission in crowded venues or in association with vocal, woodwind, or brass performances.

Protecting Musicians’ Health and Safety at Work

Musicians aren’t exposed to workplace hazards radically different from workers in other industries, but applying the hierarchy of controls to protect musicians during performances may require special considerations. Depending on the style or genre of music, the artistic experience of a performance may involve stage props, pyrotechnics, costumes that restrict performers’ movements, athletic dance moves, and exposures to bright lights and loud noises. OEHS services for musicians would need to account for musicians’ visions and audience members’ expectations for performances.

An additional challenge to protecting musicians’ health and safety is the pressure that many musicians feel to continue performing even after receiving an injury or while knowing they are at risk of injury. Some of this pressure comes from audience members’ expectations for an entertaining show, but much of it is rooted in the inconsistency of musicians’ work and frequent lack of employee benefits such as health insurance and disability pay. In reference to noise-induced hearing loss among musicians, the U.K. Musicians’ Union states that many do not admit to their symptoms out of fear of losing work, which “possibly leads to musicians struggling on and putting up with pain and discomfort on a regular basis, rather than taking sick leave or canceling gigs.”

However, there are potential ways forward: the World Health Organization (WHO) recommends an extensive set of controls for limiting noise exposures in venues where performances are held in the WHO Global Standard for Safe Listening Venues and Events. Some of these controls involve limiting and monitoring sound levels, while others focus on venue and sound system design, the adoption of “quiet zones” where audience members and performers can rest their hearing, and the provision of training and information. NIOSH has also published guidelines on reducing musicians’ risk of hearing disorders (PDF).

A 2006 pilot study (PDF) evaluated administrative controls for instrumentalists that included modifying the musicians’ playing environment and technique. For example, venue lighting could be adjusted to reduce glare and musicians could practice warm-up exercises or adopt postures less likely to cause joint or tendon injuries. The authors also discussed interventions such as the adoption of lighter-weight instruments that still produce quality sound and the use of personal protective equipment such as cushions and pads.

The Music Industry and the Evolving OEHS Profession

The standards of the National Association of Schools of Music require all accredited institutions to provide music program students, faculty, and staff with basic information about maintaining health and safety while practicing, performing, teaching, and listening to music. Nonetheless, all workers could benefit from access to an occupational health expert's advice.

The 2006 pilot study mentioned above also discussed a program in which educational sessions on health maintenance, ergonomics, and prevention of PRMDs for musicians were held at community events. Additionally, occupational health nurse practitioner students provided counseling, health evaluations, and specialist referrals to 10 musicians experiencing PRMD symptoms. While noting that "[m]usicians often do not have health insurance and therefore have limited access to health and safety education within the context of occupational health, physical or occupational therapy, or primary care services," the authors suggested that this program indicates directions for future outreach. "Health and safety prevention measures can be targeted to schools of music, musician unions, and organizations that hire large groups of musicians," they continued.

In the wake of the COVID-19 pandemic, the general question of how OEHS professionals can protect the health and safety of people outside traditional workplaces is becoming increasingly important. Do you have thoughts on how the OEHS profession could meet these challenges? Feel free to share them in the comments below.