A tomb painting of the ancient Amarnian ruler Pa-Aton-Em-Heb (1350 BC, Eighteenth Dynasty) appears to indicate that harpists are susceptible to occupational illnesses. The harpist in question has slightly closed eyes with swollen eyelids, and he seems to stare into space; his shoulders are round and his face emaciated. His temple is heightened and hollowed by a broken line joining the end of the eyebrow with the corner of the eye. These clues suggest the harpist depicted was a victim of temporal arthritis associated with polymyalgia rheumatica.¹ Though not tracked by the Occupational Safety and Health Administration (OSHA), many occupational-related problems resulting from the playing of the harp are not limited to antiquity and continue to exist today.

While each medium of performance has its particular professional hazards, harpists are particularly prone to physical problems and mental stresses. The size and weight of the harp combined with the predominance of females among professional harpists, the arm stretches required, and the simultaneous use of both hands and feet can present particular overuse or fatigue problems. The injuries and disabilities caused by these problems affect both the ability of professional musicians to engage in their profession as well as the quality of their musical artistry. To help to avoid this particular situation, it is essential that healthy playing would be included in instrumental teaching from the first day of music lessons. How is it possible to achieve this?

SURVEY OF HARPISTS’ OCCUPATIONAL HAZARDS
In spite of the predictability and informal reports of harp-related problems, little had been done to determine the incidence of such injuries and stresses among harpists, and few systematic solutions had been proposed. In the summer of 1997, I began a study entitled Incidence of Occupational-Related Problems Among Harpists, whose purpose was first to examine, through the results of a survey, the incidence of physical and mental problems among professional harpists. A second purpose of this study was to identify and define the occurrence of occupational-related problems among harpists. A summary of the results of the research findings were published in the Summer 1998 issue of the American Harp Journal.²

As part of the research, a questionnaire was developed and mailed to 500 harpists residing in forty-seven countries. The participants ranged in ages twelve through sixty-three. A vast majority of the respondents (89 percent) were female. The questionnaire sought information about physical and mental fatigue, physical discomfort, practice habits, and physical wellness that are of special concern to harpists.

The relatively high response rate (38 percent) to a mailing of 500 questionnaires is evidence of the timeliness and interest in this subject among harpists. Findings suggest that the professional demands of harp playing—such as work conditions, harp moving, varied repertoire, and adapting to unfamiliar instruments—contribute to the high occurrence of physical and mental fatigue as well as potential injuries among harpists.

Briefly summarizing the questionnaire, harpists agreed that there are many challenges in playing the harp. Among them, harp moving was the most challenging according to the harpists who returned the questionnaire. They also indicated the areas of their body where they felt the most discomfort while playing the harp were the back, the shoulder, and the neck. While they indicated that they practice two hours in one sitting, physical and mental fatigue or physical discomfort develops already in the first thirty minutes and culminates before the second hour of practicing. The physical and mental fatigue, and the physical discomfort stay with them for at least an hour or more after practicing. In this situation, how do harpists try to regain body strength or to have mental relief? Resting and stopping playing are the most common methods for them. As for physical activity, walking is the most common method they employ. In addition, harpists use different therapies for physical and mental relief, but massage is the most common as most harpists indicated who returned the questionnaire.

Besides providing answers in the questionnaire, harpists also asked questions and expressed real concern regarding physical wellness connected to playing the harp. One harpist wrote, "In my injury prevention classes, I find about 95 percent of harpers and harpists have injuries from playing their instruments. About 40 percent also have injuries from other activities, which affect their harp playing." The most commonly mentioned physical injuries were tendonitis and carpal tunnel syndrome. Besides the physical condition, mental condition also plays a crucial role in harpists’ work. Harpists agreed that mental fatigue often results from having to visually jump between harp strings and the music stand. In addition, many harpists wrote about difficulties in harp playing that are connected with performance, such as performance anxiety that causes tension.

Difficulties encountered with the harp develop gradually over a period of time. Therefore, many harpists suggested exercise and relaxation techniques as methods of prevention. As one respondent wrote, "Training in physical and mental wellness is not just teaching music: it is teaching students to live fuller, happier lives." Another wrote, "If we have strong, fitted bodies, if we feel in control of our bodies, we would really improve and be able to show our full potential." Others noted that many of the activities outside of actual playing could be the source of problems. Over and over, however, respondents lamented that they did not know how or where to begin to incorporate a program of physical and mental wellness into their professional and every-day lives.³

THE KOVÁCS METHOD OF HEALTHY PLAYING
In researching musicians’ occupational-related problems in the 1950s, Hungarian professor and researcher Dr. Géza Kovács found a relationship between occupational problems and musicians’ work and lifestyles. He found that talent itself was not sufficient for developing the desired artistic level and that there also needed to be a balance among the intellect, spirit, and physical condition. Musicians spend only a part of their time in musical pursuits; the bigger part of their time is devoted to their worldly cares. That is why their problems cannot be solved in the limited time spent in practicing or concertizing. Musicians should extend their attention to that other part of their lives—learning how to relax, how to spend their free time effectively, how to gain energy, and so on.

The result of Dr. Kovács’s research led to the development of a program for the prevention of physical and mental problems related to musicians’ work. The Hungarian physical fitness program The Care of Musicians’ Work Capacity was created by Kovács, who was soon joined by pianist and professor Zsuzsa Pásztor. Their method is a pedagogical approach for improving physical, mental, and spiritual capacities of musicians as a balanced unit. In bringing these traits to their highest levels and keeping them in constant equilibrium, it enables musicians to achieve their utmost performance. Through their program, participants can learn to understand the true nature of musicians’ profession, to prevent occupational injuries, to relax, to have confidence, to use special exercises for stretching and strengthening, to learn proper breathing that is required by every instrument, the importance of maintaining a healthy auditory system, and the care of musicians’ hands.

In Budapest, Hungary, Dr. Kovács and Dr. Pásztor continued to develop their program of mental and physical health maintenance for musicians for more than forty years, and Pásztor is continuing after Professor Kovács’ death in 1999. This continuing work is seen in the increasing number of published research articles, a growing number of lectures in continuing education programs, and the expansion of their physical wellness program.

One of the basic purposes of the Kovács Method is to prepare musicians to achieve and maintain a work capacity level that meets the anticipated demands and specific tasks in the area of instrumental playing. This is realized through:
• Laying a foundation for a balanced posture and movements that are involved in playing an instrument
• Improving speed and strength needed in performing
•Improving proper breathing required by every instrument
• Building up stamina and endurance for practicing
• Increasing the musician’s performing ability and effectiveness in work

Another purpose of Kovács’s program is to prevent occupational-related injuries through:
• Preventing the overuse of the muscular system
• Relaxing strained muscles
• Correcting an asymmetrical body posture
• Balancing the physical inequities that are inherent with playing an instrument
• Overcoming tiredness from playing an instrument
• Protecting and relaxing the auditory system
• Preserving the stability of the autonomic nervous system
• Helping the synchronization of the visceral system

A third goal of the program is to help restore the work capacity and physical condition in cases of exhaustion, overexertion with a:
• Practice plan adjusted to individual needs
• Gradual progression in physical training
• Daily routine that helps to restore the normal work capacity

As being a professional harpist myself, I have participated in this program The Care of Musicians’ Work Capacity for more than ten years and have personally experienced tremendous results. While studying at the Franz Liszt Academy of Music, I first addressed existing overuse problems with the Kovács Method and then learned how to build and maintain my work capacity, with excellent results. During my doctoral work at Indiana University, I then researched the international literature on this subject of physical wellness of musicians, and I recommend the Kovács Method as an excellent comprehensive program for healthy playing.

IMPLEMENTING THE KOVÁCS METHOD IN INSTRUMENTAL TEACHING
After experiencing the many positive results of the use of the Kovács Method in my own work, I have adapted the philosophy and the purposes of the Kovács Method described above to harp teaching. The practical application of this comprehensive method throughout many years had produced and continues to produce wonderful results in my teaching. Some of these results in conjunction with my own research findings related to harpists’ physical wellness are documented in a DVD program entitled Harp Playing for Life, The Kovács Method in Harp Pedagogy. The DVD demonstrates how the Kovács Method can be implemented in instrumental teaching and performing, particularly for the harp. The seventy-minute long DVD program, released in 2002 in cooperation with Dr. Zsuzsa Pásztor, consists of five sections:
1. Introduction to the Kovács Method.

2. Preparation for and Correction of Movements Used in Playing the Harp: Physical movements used in harp playing can be prepared away from the instrument. Thus, harpists can save time and energy at the harp in establishing the correct procedure for physical movements used in harp playing. For example, to have a supple hand that produces beautiful harp sound, the Kovács Method recommends developing and improving the skill away from the instrument by using a balloon exercise. While bouncing a balloon, neuron connections are being made in the brain that will serve as a foundation for related musical movements used in harp playing. When it is necessary to use a supple hand in harp playing, it will be easier for the brain to decipher and direct the body to the correct corresponding technical solutions at any level. Not only beginners need preparatory help, but often professional players, too. Incorrect movements and bad habits, which hinder musical expression, are sometimes extremely difficult to remedy through the usual teaching means or practice. In such cases correction of the movement can be achieved away from the instrument.

3. Basic Physical Skills and Functions in Harp Playing: Basic physical skills and functions, such as the simultaneous use of both arms and legs, can be improved through specially developed exercises. For example, a continuous foot-tapping exercise is paramount not only as a preparation for efficient manipulation of the harp pedals, but also is at least equally important training the transmission center within the brain that effects the coordination of the hands and feet. A healthy or properly functioning tissue of the body has a pronounced effect upon our emotional state, our mental capacity to think, and our direct physical ability to approximate our very best at all times while performing.

4. Efficiency Maintenance While Practicing: The fourth section gives three series of physical exercises to be used in musicians’ daily routine in order to maintain the ability of sustaining music performance. For example, the customary finger warm-up on the instrument is not always sufficient. In some cases several hours of practice are needed to be adequately prepared for musical tasks. On the other hand by warming up with full body movements away from the instrument the same thing can be achieved in a fraction of the time. Furthermore, it is vital to follow a period of playing with a period of active rest alternating the two throughout an entire practice session or a lesson. With this method of work it is possible to delay the onset of tiredness as well as to keep tiredness itself at a lower level. In addition, by having short periods of active rest and relaxation students and professionals can regain concentration, physical strength and an optimal emotional level for further work. In turn, this work can result in a better quality of accomplishment in a shorter period of time and in using less effort while this caliber of performance will be better stabilized throughout a practice session, or a lesson, or a performance.

5. Short Exercise Procedure for the Development of Basic Conditioning for Instrumental Playing: This do-along series of exercises is designed to balance the instrumental activities that overburden certain parts of the body, while other areas are left doing nothing. The uneven provision of stimuli upsets the inner automatic regulating order and could result in some kind of occupational injury. Correct training rests an overtired constitution and revives it, as well as beneficially occupying and strengthening the inactive parts of the body. At the same time, this series of conditioning exercises can develop and maintain excellent work capacity, improve stability of nervous state and build growing strength as they can accomplish multiple purposes. These exercises are relevant to our professional and cultural needs and can bring wonderful results in terms of helping musicians to achieve and maintain their highest possible level of development.

This DVD can be used at any developmental level and at any age regardless of the instrumental technique musicians play. Although it emphasizes harpists’ special needs, other instrumentalists can recognize the similarities that exist between playing different instruments, therefore, they can use this program for their particular situations. To get the most out of the DVD program, it should be used in accordance for example with one of the pedagogical principals of the Kovács Method, namely, to adjust all information to the specific musical, spiritual and physical needs of each individual. The exercises are not strenuous; rather they enhance all of the body functions. The DVD program should prove to be a joyful and satisfactory experience. Moreover, the DVD program Harp Playing for Life can serve as an example of how healthy playing should be an integral part of music education from the very first lesson and carried out through an entire professional career.

REFERENCES
1. Appelboom and Van Eigem, 929-931.
2. American Harp Journal, Summer 1998.
3. D.M. Document, Indiana University, 2000.


Bibliography
Appelboom, T., and A. Van Eigem. "How Ancient Is Temporal Arteritis?" Journal of Rheumatology 17, no.7 (1990): 929-31.

Bishop, D. The Musician as Athlete: Alternative Approaches to Healthy Performance. Calgary, Canada: Kava Publications, 1991.

Cayea, D., and R. A. Manchester. "Instrument-Specific Rates of Upper Extremity Injuries in Music Students." Medical Problems of Performing Artists 13, no. 3 (1998): 19-25.

Critchley, M., and R. A. Henson. Music and the Brain: Studies in the Neurology of Music. London: Heinemann, 1977.

Fry, H. J. H. "The Treatment of Overuse Injury Syndrome." Maryland Medical Journal 42, no. 3 (1993): 277-82.

Gaál, E. Harp Playing for Life, The Kovács Method in Harp Pedagogy. DVD, Harpa Hungarica, 2002.
______. "Harpists’ Health and Fitness". American Harp Journal Vol. 16, N0. 3 (Summer 1998),
31-34.
______. "Incidence of Occupational-Related Problems Among Harpists." D.M. document, Indiana University, 2000.
______. "Medical Problems of Musicians: A Survey of the Research". The Recorder Education
Journal No. 7, (2001), 26-31.
_______. "Physical Fitness Program for Musicians." Harpa-Piano 1 (Spring 1997), 48-49.
_______. "The Care of Musicians’ Work Capacity". Harpa-Piano 3 (Winter 1997/1998), 22.
Harris, P. "Visual Conditions of Symphony Musicians." Journal of the American Optometric Association 59, no. 12 (1988): 952-59.

Kovács, G. "Zenemüvész növendékek és müvészek munkaképességéröl." [On student musicians’ and musicians’ capabilities]. Parlando 7 (1965 1, 2): 23-35, 13-18.
________. "A zenei munkaképesség fejlesztése és gondozása." [The development and care of musical capacity to work]. Parlando 18 (1976 3, 4, 6), 16-23, 6 12, 14-17.

Kovács, G. and Pásztor, Zs. "Munka- és munkásvédelem a zenei szakmában." [Work and workers’ protection among musicians]. Budapest: XX. ker. Tanács. (1980).
________. "Zeneórai munkaképességgondozás zeneiskolákban és zenemüvészeti szakközépiskolákban." [Care of ability to work during music lessons in music schools and musical high schools]. Budapest: XX. ker. Tanács. (1980).
________. "Zeneórai munkaképességgondozás zeneiskolákban." [Care of ability to work during music lessons in music schools]. Népszava 7 (1983): 5.
________. "A zeneoktatás problémáinak természetes okai a szervezet automatizmusában." [The natural causes of physicial difficulties in music instruction]. Budapest: Fövárosi Pedagógiai Intézet. (1985).
________. "A muzsikáló kéz." [The musical hand]. Budapest: Fövárosi Pedagógiai Intézet. (1985).
________. "A zene érzékelésének szervezeti rendje: Hallásgondozás a zeneiskolában." [Music perception’s physical structure: care of hearing in the music school]. Budapest: Fövárosi Pedagógiai Intézet. (1987).
________. "Az idegrendszer zenei foglalkozási ártalmai." [The harmful effects of the musical profession on the musculatory system]. Budapest: Fövárosi Pedagógiai Intézet. (1990).
________. Hand Strains from Instrumental Playing. Debrecen, Hungary: Muzsikáló Egészség Alapítvány, 1999.
________. Ten Short Sets of Exercises. Debrecen, Hungary: Muzsikáló Egészség Alapítvány, 1999.
________. Movement Preparation for Playing Instruments. Budapest, Hungary: Kovács Módszer Betéti Társaság, 2000.

Lassú, T. The Care of Human Work Capacity. Budapest. (1997).

Mark, T. What Every Pianist Needs To Know About The Body. Chicago, Illinois: GIA Publications, Inc., (2003).

Mischakoff, A. Sforzando! Music Medicine for String Players. USA: Tichenor Publishing Group, The American String Teachers Association, (1985).

Muller, H.K. Symposium "Medical and Sociological Aids To Performing Musicians". Netherlands: World Harp Congress, (1983).

Pásztor, Zs. "Az alsófokú hangszeres oktatás hatékonyságának fejlesztéséröl." [On the development of the effectiveness of elementary instrumental instruction]. Parlando 15 (1973 4, 5): 8-12, 21-28.
________. "Zenei munkaképességgondozás kisérlete a Fövárosi XX. ker. zeneiskolában." [An experiment regarding the care of musicians’ ability to work at the Capital state music school in the twentieth district]. Parlando 21 (1979 2, 3, 4, 5, 6, 7, 8, 9, 10, 12): 13-15, 22-25, 16-20, 21-23, 7-14, 48-53, 20-23, 23-27, 21-23.
________. "Hangszeres mozgások elökészítése a zongoratanításban." [Preparation for Physical Movements in Piano Teaching]. Parlando 31, 32 (1989, no. 6, 7, 8, 1990, no. 4, 5, 6, 12, 1991, no. 1), 11-16, 24-33, 31-39, 13-17.
_________. A lámpaláz legyözése. [Overcoming Stage Fright]. Debrecen, Hungary: Muzsikáló Egészség Alapítvány, 2000.

Riley, L. and M. MacBean. Preventing and Correcting Chronic Harp-Related Injury. Vashon Island, WA: Laurie Riley, 1994.

Royster, J. D., L. H. Royster, and M. C. Killion. "Sound Exposures and Hearing Tresholds of Symphony Orchestra Musicians." Journal of the Acoustical Society of America 89, no. 6 (1991): 2793-2803.

Sternbach, D. J. "Addressing Stress-Related Illness in Professional Musicians." Maryland Medical Journal 42, no. 3 (1993): 283-88.
_______. "Chronic Muscle Pain Syndrome." International Musician, 92, no. 4 (April 1994): 8-9.

Udvari, K.K. "Psalmus Humanus, Hagyomány és megújulás a kodályi zenepedagógiában." [Psalmus Humanus, Tradition and Renewal in the Music Pedagogy of Kodály.] Budapest, Hungary: Püski Kiadó, 2002.

Winberg, J. S., and M. F. Salus. Stretching for Strings. Fairfax, Va.: American String Teachers Association, 1990.


Copyright © 2003, American String Teachers Association
Printed originally in the August 2003 issue of the American String Teacher.
Used by permission.