Peabody Johns Hopkins University Magazine

Sound Bodies and Minds

Sound Bodies and Minds

By Julie Scharper 

An initiative to weave health awareness into all aspects of life at Peabody is rapidly gaining traction, challenging assumptions about musicians and pain and providing student artists with a plethora of resources to prevent and treat injuries. 

Headshot of Ilana Inselbuch
Ilana Inselbuch pushed through the pain of her injury before finally seaking treatment..

The pain radiated through Ilana Inselbuch’s arms as she lifted her clarinet to her lips. For the previous four weeks, Inselbuch had been playing for six or more hours a day at a summer music festival, driving herself to perfect her art among other dedicated musicians. But in the fifth week of the festival, a fiery ache set in. Inselbuch, a rising senior at the Peabody Conservatory, told herself to push through the discomfort. That’s just what musicians do, she thought. 

After the festival, she hurried back to Baltimore, further taxing her arms by lugging boxes of books and housewares into her new apartment. Then, in the final weeks before school started, she traveled to visit family. By that point, the pain had become so intense Inselbuch could no longer ignore it. Even holding a glass of water was agony. 

“It was really scary,” says Inselbuch, 22. “I didn’t realize it was possible to hurt yourself so badly when you are still young.” 

But as Inselbuch and many other young musicians have discovered, it is possible to develop a severe injury from the rigors of practice and performance. Such injuries are often devastating to performers, leading them to question their career trajectory, their place in their social group, and their very sense of self. For many musicians, serious injuries can be complicated by feelings of guilt, shame, and depression. They blame themselves for not taking better care of their bodies while simultaneously feeling anxiety for not practicing more. Like Inselbuch, many musicians have been coached since early childhood to believe that asking for help is a sign of weakness. 

What we are trying to do is promote an inclusive, holistic culture of health. We are ultimately trying to keep our students connected with the joy of making art with their bodies. They are investing in themselves as a vehicle for the movement or the sound.

— Sarah Hoover Associate Dean for Innovation, Interdisciplinary Partnerships, and Community Initiatives

It is this culture that Sarah Hoover (DMA ’08, Voice), Peabody’s associate dean for innovation, interdisciplinary partnerships, and community initiatives, is working to change. Hoover, the author of the new book Music as Care: Artistry in the Hospital Environment (see sidebar box), is working to integrate health awareness into all aspects of life at Peabody, to help prevent injuries, enable students to recognize problems sooner, and challenge assumptions about musicians and pain. She works closely with team members at the Johns Hopkins Rehabilitation Clinic for Performing Artists at Peabody, who help students heal from injuries — and prevent new ones — through exercises and treatments designed specifically for musicians. Beyond the clinic, Peabody has embraced a multifaceted vision of healthy performing artists to help students build lasting and sustainable careers. 

“What we are trying to do is promote an inclusive, holistic culture of health,” says Hoover. “Performing artists are athletes and musicians are athletes of the small muscles. We are ultimately trying to keep our students connected with the joy of making art with their bodies, an embodied sense of the joy of making sound or creating gesture in a way that is generative to them. They are investing in themselves as a vehicle for the movement or the sound.” 

It is this culture that Sarah Hoover (DMA ’08, Voice), Peabody’s associate dean for innovation, interdisciplinary partnerships, and community initiatives, is working to change. Hoover, the author of the new book Music as Care: Artistry in the Hospital Environment (see sidebar box), is working to integrate health awareness into all aspects of life at Peabody, to help prevent injuries, enable students to recognize problems sooner, and challenge assumptions about musicians and pain. She works closely with team members at the Johns Hopkins Rehabilitation Clinic for Performing Artists at Peabody, who help students heal from injuries — and prevent new ones — through exercises and treatments designed specifically for musicians. Beyond the clinic, Peabody has embraced a multifaceted vision of healthy performing artists to help students build lasting and sustainable careers. 

“What we are trying to do is promote an inclusive, holistic culture of health,” says Hoover. “Performing artists are athletes and musicians are athletes of the small muscles. We are ultimately trying to keep our students connected with the joy of making art with their bodies, an embodied sense of the joy of making sound or creating gesture in a way that is generative to them. They are investing in themselves as a vehicle for the movement or the sound.” 

Building Healthy Habits

From the moment Peabody students arrive on campus, they receive subtle and not-so-subtle reminders to care for their health. Incoming students can opt to undergo a muscular-skeletal screening to see if they would benefit from changes to their posture or physical therapy. An orientation seminar, Peak Performance Fundamentals, teaches students to view their health holistically. Students learn how their bodies work through classes such as somatic practice for dancers, vocal health for singers, and Pilates, which is taught in workshops tailored to specific instruments. The seminar delves into topics such as the Alexander Technique, healthy warm-ups, and auditory health. 

Throughout the year, the weekly student newsletter includes reminders to stay hydrated and get enough rest. Posters remind students to be attuned to cues from their body and take frequent breaks when practicing — something passionate young musicians often forget to do.

“The bulk of performance-related injuries are due to overuse, sometimes misuse, and more rarely abuse,” says Hoover. “There are many signs that one is nearing overuse — stiffness, soreness, pain. Often what instrumentalists notice is that the very refined coordination that they normally have is not available to them. Sometimes one ignores the signs and keeps going anyway, perhaps due to anxiety, perfectionism, or a need to achieve at a certain level. And sometimes you get so wrapped up in the thing you’re doing because it’s so beautiful that you just keep going.”

Physical injuries are often entwined with mental health challenges, Hoover says. “Physical injuries can be devastating for performing artists,” she says. “Their art stems from a deep, internal passion, and by the time they have reached conservatory, they have practiced for years and years. There is almost not a memory of life without that art form.”

To bolster Peabody’s wellness initiatives, institute leaders brought on Rawsam Alasmar, Johns Hopkins’ inaugural postdoctoral fellow in performing arts health, science, and education. The fellowship is jointly managed by the Johns Hopkins University School of Medicine and Peabody. Alasmar, who recently completed a doctorate in exercise science at Middle Tennessee State University, is an amateur dancer who has a deep appreciation for the arts. He will be analyzing data around the prevention and treatment of injuries in performing artists while helping to bolster Peabody’s curriculum and messaging around health.

“We need to go back to the basics and train and teach students what it is to take care of their health,” says Alasmar. “We can help students build habits that are good for their longevity and their performance.” 

(Left to right) Johns Hopkins Rehabilitation Network therapist Amanda Green, dance student Elle Krasner, and Peabody Clinic manager Andrea Lasner.
Headshot of Rawsam Alasmar
Rawsam Alasmar

We need to go back to the basics and train and teach students what it is to take care of their health. We can help students build habits that are good for their longevity and their performance.

— Rawsam Alasmar Johns Hopkins’ inaugural postdoctoral fellow in performing arts health, science, and education

Building Healthy Habits

From the moment Peabody students arrive on campus, they receive subtle and not-so-subtle reminders to care for their health. Incoming students can opt to undergo a muscular-skeletal screening to see if they would benefit from changes to their posture or physical therapy. An orientation seminar, Peak Performance Fundamentals, teaches students to view their health holistically. Students learn how their bodies work through classes such as somatic practice for dancers, vocal health for singers, and Pilates, which is taught in workshops tailored to specific instruments. The seminar delves into topics such as the Alexander Technique, healthy warm-ups, and auditory health. 

Throughout the year, the weekly student newsletter includes reminders to stay hydrated and get enough rest. Posters remind students to be attuned to cues from their body and take frequent breaks when practicing — something passionate young musicians often forget to do.

“The bulk of performance-related injuries are due to overuse, sometimes misuse, and more rarely abuse,” says Hoover. “There are many signs that one is nearing overuse — stiffness, soreness, pain. Often what instrumentalists notice is that the very refined coordination that they normally have is not available to them. Sometimes one ignores the signs and keeps going anyway, perhaps due to anxiety, perfectionism, or a need to achieve at a certain level. And sometimes you get so wrapped up in the thing you’re doing because it’s so beautiful that you just keep going.”

Physical injuries are often entwined with mental health challenges, Hoover says. “Physical injuries can be devastating for performing artists,” she says. “Their art stems from a deep, internal passion, and by the time they have reached conservatory, they have practiced for years and years. There is almost not a memory of life without that art form.”

To bolster Peabody’s wellness initiatives, institute leaders brought on Rawsam Alasmar, Johns Hopkins’ inaugural postdoctoral fellow in performing arts health, science, and education. The fellowship is jointly managed by the Johns Hopkins University School of Medicine and Peabody. Alasmar, who recently completed a doctorate in exercise science at Middle Tennessee State University, is an amateur dancer who has a deep appreciation for the arts. He will be analyzing data around the prevention and treatment of injuries in performing artists while helping to bolster Peabody’s curriculum and messaging around health.

“We need to go back to the basics and train and teach students what it is to take care of their health,” says Alasmar. “We can help students build habits that are good for their longevity and their performance.” 

(Left to right) Johns Hopkins Rehabilitation Network therapist Amanda Green, dance student Elle Krasner, and Peabody Clinic manager Andrea Lasner.
Headshot of Rawsam Alasmar
Rawsam Alasmar
Serap Bastepe-Gray sits at a piano with a student demonstrating proper hand placement
Faculty artist Serap Bastepe-Gray pursued an occupational therapy degree to diagnose and treat performance related injuries. Bastepe-Gray discusses proper hand posture with Huyuan Peng.
Serap Bastepe-Gray examines Wesley Hamilton's elbow recovery.

Eight out of 10 musicians are going to get injured at some point. What’s important is to recognize it early and treat it early. We can create an environment where artists can talk about it openly and with confidence.

—Serap Bastepe-Gray, assistant professor, guitarist, and physician

Recognizing and Treating Injuries

As a guitarist and physician, Assistant Professor Serap Bastepe-Gray (BM ’96, MM ’99, Guitar) is uniquely positioned to understand the health challenges musicians face. When she was a student at Peabody herself in the 1990s, she crafted a regimen of physical therapy to heal her strained arm. Soon word traveled around campus and students began furtively knocking on her door. “They had all this emotional baggage around their injuries. They wondered, ‘Am I going to lose my scholarship? Am I not good enough to be here?’” she recalls. “I realized there was a big hole in our understanding of this.”

So Bastepe-Gray decided to pursue yet another degree, this time in occupational therapy. Today, she sees patients at Peabody’s clinic, while also continuing to play professionally and teach guitar at the Conservatory. “I realize music students are really, really busy. If they are going to receive help for an injury early, it needs to be super convenient. They need to be able to roll out of their bed in their dorm and roll into the clinic,” she says.

When students visit the clinic, located in the “Cottage” building just off the Plaza, they receive an evaluation and a plan for treatment, which could range from taking more breaks to a program of weekly physical or occupational therapy sessions and at-home exercises. Most students bring their instruments with them and work with their therapist on posture and positioning while playing. Patients who are pianists head to a studio to do a posture check on the piano. More complex or severe injuries are referred to Johns Hopkins School of Medicine physicians who routinely work with musicians.

Common injuries for violinists and violists include tennis elbow and hand muscle strain, as well as shoulder and neck issues. Guitar players frequently develop tennis elbow on their left forearms and De Quervain’s tenosynovitis in their right hand; pianists are prone to problems of the wrist. However, Bastepe-Gray notes, these observations are anecdotal. “There are a lot of gaps in our knowledge of musicians and health,” she says. “The research is still developing in this area.” Indeed, studies show injury rates among musicians have not budged since the 1980s. 

Bastepe-Gray has also designed and teaches a suite of classes called Playing Well, to guide musicians to care for their bodies. The first class focuses on anatomy and movement for musicians, the second on health problems common to musicians, and the third on the prevention of injuries and retraining musicians to prevent future injuries. She hopes that such courses will help musicians better advocate for themselves in medical settings, providing them with the terms to describe their symptoms.

Peabody leaders are also examining best practices in wellness at conservatories around the world. Taylor Weetman, a doctoral candidate in occupational therapy at Drake University, is completing her capstone project at Peabody under Bastepe-Gray’s supervision. She is working on a study of wellness programs at 28 music schools in both this country and abroad. Weetman, a clarinetist, has also teamed with Alasmar and Jasmine Pigott, a Peabody doctoral candidate in tuba and a personal trainer, to create instrument-specific fitness programs to help students strengthen and stretch key muscles. 

Hoover is also working to increase awareness among faculty members about the importance of quickly recognizing and treating injuries. Professional development funding has been made available for faculty members who take Playing Well. Next fall, doctoral students will offer instrument-specific health information and resources for undergraduate students. In the broader community of musicians, there is a sense that attitudes about health are shifting, Hoover says. “There is increasingly broad awareness of holistic well-being and more awareness of injury,” says Hoover.

Both Hoover and Bastepe-Gray hope that Peabody faculty and students will not only learn to care for their own health but will educate musicians in the broader community about wellness and remove the stigma around performance-related injuries. 

“Eight out of 10 musicians are going to get injured at some point,” says Bastepe-Gray. “What’s important is to recognize it early and treat it early. We can create an environment where artists can talk about it openly and with confidence.” 

Recognizing and Treating Injuries

As a guitarist and physician, Assistant Professor Serap Bastepe-Gray (BM ’96, MM ’99, Guitar) is uniquely positioned to understand the health challenges musicians face. When she was a student at Peabody herself in the 1990s, she crafted a regimen of physical therapy to heal her strained arm. Soon word traveled around campus and students began furtively knocking on her door. “They had all this emotional baggage around their injuries. They wondered, ‘Am I going to lose my scholarship? Am I not good enough to be here?’” she recalls. “I realized there was a big hole in our understanding of this.”

So Bastepe-Gray decided to pursue yet another degree, this time in occupational therapy. Today, she sees patients at Peabody’s clinic, while also continuing to play professionally and teach guitar at the Conservatory. “I realize music students are really, really busy. If they are going to receive help for an injury early, it needs to be super convenient. They need to be able to roll out of their bed in their dorm and roll into the clinic,” she says.

When students visit the clinic, located in the “Cottage” building just off the Plaza, they receive an evaluation and a plan for treatment, which could range from taking more breaks to a program of weekly physical or occupational therapy sessions and at-home exercises. Most students bring their instruments with them and work with their therapist on posture and positioning while playing. Patients who are pianists head to a studio to do a posture check on the piano. More complex or severe injuries are referred to Johns Hopkins School of Medicine physicians who routinely work with musicians.

Common injuries for violinists and violists include tennis elbow and hand muscle strain, as well as shoulder and neck issues. Guitar players frequently develop tennis elbow on their left forearms and De Quervain’s tenosynovitis in their right hand; pianists are prone to problems of the wrist. However, Bastepe-Gray notes, these observations are anecdotal. “There are a lot of gaps in our knowledge of musicians and health,” she says. “The research is still developing in this area.” Indeed, studies show injury rates among musicians have not budged since the 1980s. 

Bastepe-Gray has also designed and teaches a suite of classes called Playing Well, to guide musicians to care for their bodies. The first class focuses on anatomy and movement for musicians, the second on health problems common to musicians, and the third on the prevention of injuries and retraining musicians to prevent future injuries. She hopes that such courses will help musicians better advocate for themselves in medical settings, providing them with the terms to describe their symptoms.

Peabody leaders are also examining best practices in wellness at conservatories around the world. Taylor Weetman, a doctoral candidate in occupational therapy at Drake University, is completing her capstone project at Peabody under Bastepe-Gray’s supervision. She is working on a study of wellness programs at 28 music schools in both this country and abroad. Weetman, a clarinetist, has also teamed with Alasmar and Jasmine Pigott, a Peabody doctoral candidate in tuba and a personal trainer, to create instrument-specific fitness programs to help students strengthen and stretch key muscles. 

Hoover is also working to increase awareness among faculty members about the importance of quickly recognizing and treating injuries. Professional development funding has been made available for faculty members who take Playing Well. Next fall, doctoral students will offer instrument-specific health information and resources for undergraduate students. In the broader community of musicians, there is a sense that attitudes about health are shifting, Hoover says. “There is increasingly broad awareness of holistic well-being and more awareness of injury,” says Hoover.

Both Hoover and Bastepe-Gray hope that Peabody faculty and students will not only learn to care for their own health but will educate musicians in the broader community about wellness and remove the stigma around performance-related injuries. 

“Eight out of 10 musicians are going to get injured at some point,” says Bastepe-Gray. “What’s important is to recognize it early and treat it early. We can create an environment where artists can talk about it openly and with confidence.” 

Serap Bastepe-Gray sits at a piano with a student demonstrating proper hand placement
Faculty artist Serap Bastepe-Gray pursued an occupational therapy degree to diagnose and treat performance related injuries. Bastepe-Gray discusses proper hand posture with Huyuan Peng.
Serap Bastepe-Gray examines Wesley Hamilton's elbow recovery.

Overcoming an 'Identity Crisis'

For Wesley Hamilton, too, the pain started at a music festival last summer. The University of Georgia graduate spent five weeks playing the viola at a festival before moving to Baltimore to start a master’s program at Peabody. She noticed an unpleasant feeling in the knuckles of her right hand, the one that pulls the bow across the strings of her viola. Hamilton wasn’t sure what it meant and neither was her teacher at the music festival. She iced her hand a bit, but largely ignored the injury until she started studying with Peabody viola professor Victoria Chiang.

“Some teachers I had had in the past might have said to push through the pain, but Vicky is very body conscious. She noticed right away that something was starting to inhibit my playing and told me to see Serap in the performing artists’ clinic,” says Hamilton. 

Bastepe-Gray diagnosed Hamilton with tennis elbow and hand muscle strain, which was manifesting in finger pain. Once a week, Hamilton visits Bastepe-Gray for occupational therapy. She keeps a list taped to her refrigerator of exercises Bastepe-Gray recommends and performs them each day. “The clinic has been a lifesaver,” says Hamilton. “If I’m having a tough week or part of my hand is kind of tender, she breaks out Roxanne, which is what she calls her ultrasound machine. [Serap] is a real hoot and keeps me laughing the whole time.” 

Hamilton has also learned to improve her posture while playing the viola, which has helped her back and neck. She is back to practicing and performing a normal schedule, with what she calls her “bionic arm” wrapped in physio tape. “Although it has been a longer journey than I expected, [getting treatment] has given me a way to prolong my career,” she says. “Taking the steps to correct my posture has made performing really sustainable. I feel like I’m using my body the way I was supposed to. I’m playing my regular amount now, but in a healthy way.”

For Hoover, Hamilton’s healing encapsulates the holistic approach she hopes to instill throughout Peabody: the idea that music can heal in many different settings. And if musicians want to be able to heal others, first they must be able to care for themselves. “In order for our artists to make an impact, they need to be healthy and they need to know their health matters,” she says. 

Inselbuch, the clarinetist, spent the fall of 2021 learning these lessons herself. In addition to receiving physical therapy at the clinic, she started counseling at the suggestion of her professor. “Being injured was a huge identity crisis,” she says. “When you are an artist, your art consumes you, controls you. I’ve learned that is a dangerous place to be. Now I have learned other ways to cope. I started learning Chinese again. I go on walks and try out new coffee shops. My therapist tells me to literally look at myself in the mirror and say, ‘I am Ilana. I am OK. I am more than my clarinet.’”

The experience of being injured and beginning to heal has led Inselbuch to broaden her plans for the future. While she continues to build a career as a performing musician, the skills she learned in negotiating her recovery have led her to contemplate working in arts management. Most importantly, she has changed the way she thinks about her well-being. 

“In the music world, there is a lot of pressure to be the best and practice the most. To push through. There is no need for that. We are artists, but we are also humans,” she says. “The number one thing is to always listen to your body. You have one body for your entire life and you need to care for it.” 

Healing Notes

During the early months of the COVID-19 pandemic, one of the few places musicians continued to perform was in hospital auditoriums. Weary doctors, nurses, and other health professionals sat masked and socially distanced as musicians provided a brief respite from the stress of caring for critically ill patients. 

The myriad benefits of music in health care settings is the subject of Peabody Associate Dean Sarah Hoover’s book, Music as Care: Artistry in the Hospital Environment, which was published last year. Hoover brings together the voices of experts in the field as well as musicians who perform in hospitals, hospices, and clinics. She examines the role of music in soothing patients and health care workers alike, bringing comfort to those facing death, and the transformative effect that these interactions can have on performers. 

“In the hospital, the musician’s artistry serves the aim of engendering well-being. Human connection and the listener’s self-transcendence are not happy coincidences but desired outcomes,” Hoover writes. “Artistry enables the listener either to transport himself out of his untenable present situation or feel affirmed exactly where and as he is. Both are healing.” 

Students perform in the Johns Hopkins Hospital lobby.