Musician health

How I Practice: Texas DO gets in tune with musicians

Sajid Surve, DO, talks about the changing world of music education and why osteopathic physicians are uniquely qualified to treat musicians.


Musicians at the University of North Texas (UNT) College of Music recognize that when it comes to their health, the Texas Center for Performing Arts Health is a helpful instrument.

A musician himself, Sajid Surve, DO, co-director of the Texas Center for Performing Arts Health, a partnership between the UNT College of Music and the Texas College of Osteopathic Medicine in Fort Worth, discovered early on that music and medicine share a common goal: to heal. In this edited interview, he discusses the center’s efforts to help change music education and the reason DOs are uniquely qualified to treat musicians.

What is the Texas Center for Performing Arts Health?

The center, known as the Texas Center for Music & Medicine until two years ago, provides health care to performance artists and studies the performing arts population from a health perspective. It’s a lively research hub with a clinical presence. We have pianos with sensors built into the keys so we can measure the forces that pianists use, and we have sensors for trumpets to look at mouthpiece forces.

Is this research influencing music education?

Yes. Music education is changing right now. The UNT College of Music and the Texas College of Osteopathic Medicine worked together to build a body of evidence to show that musicians have pretty high injury rates. We then joined with other groups to recommend that the National Association of Schools of Music (NASM) create new standards requiring colleges to make students aware of the musculoskeletal, hearing, and vocal risks of making music. Because of our efforts, NASM issued the new standards a few years ago. The Texas Education Agency adopted similar standards for high school and middle school students.

What’s the most common condition you see in musicians?

In general, musicians suffer from repetitive stress injuries. Every instrument has unique demands and as a result, they have these unique injuries. Trombonists, for example, can develop shoulder problems from the weight of the trumpet. Pianists often have hand problems. Clarinetists and oboists develop right thumb problems.

What does treatment look like?

With an osteopathic approach, we have to consider the whole situation. My focus isn’t necessarily on the instrument. For example, posture is how your body rises up to meet the instrument. Any aberration in a musician’s posture can cause neck and back pain. Maybe we give the patient a strengthening program to improve their posture. Or maybe they need to take more breaks. Or we need to treat their shoulder with osteopathic manipulative treatment. I do a ton of OMT in the clinic.

Treating musicians’ injuries can be really tough if you don’t approach treatment with the mindset of considering the whole patient. This is why DOs are uniquely qualified to treat musicians. I’m so thankful to have my osteopathic background.

What is the most rewarding aspect of your job?

I had the fortune of helping a young singer who had been injured and was unable to sing. She came to me with paperwork to withdraw from the university, but over the course of six to seven months she was able to sing again. She invited me to her senior recital, and sitting in that audience watching her deliver stunningly beautiful arias, knowing that I had a part in making that happen, was one of the greatest moments ever.

What matters to me is that the musician is now better at playing music because of what I’ve done.


  1. Sweet Sue

    My daughter is an accomplished harpist. One of the most important parts of her pedagogy (Salzedo method) was to play without tension. Tension = injuries.

  2. Michael Flowers

    As a first year medical student at Lake Erie College of Osteopathic Medicine in Bradenton, Fl, I took up playing violin as a stress relieving activity. As a fledgling violinist and osteopathic student this article resonated with me.

    Osteopathic medicine relies heavily on diagnosing asymmetry of bones or asymmetric tension within muscle groups. In my most proper violinist stance, I am contracting my left sternocleidomastoid in my neck, straining my left fore arm supinators as well as my left opponens pollicis to hold the violin and pinch the strings. For bowing, I have my right arm abducted and extended at an uncomfortable angle and I am working my right deltoid, supraspinatus and infraspinatus as well as my right rhomboids which are working to retract my scapula, allowing the extra shoulder glide for long bow strokes. Because I never get an opportunity to switch hands, I preferentially work those muscle groups, asymmetrically, for 20-30 min every day (ideally).

    After an hour of practice, which would be one of my longest sessions. I have to stop. If not because I have something to study, because those muscle groups discussed above are done working for the day. When I skip practice for a few days, on coming back, a long session can feel like a gym workout.

    Luckily, I am always close to my fellow students, and I can ask them to give me their osteopathic work up. I find that muscle energy techniques and soft tissue of the neck and shoulders has been especially helpful in preventing the pains and strains that would otherwise keep me from practicing.

    And it is not just violin. As this article points out, each instrument has its problems. I also play piano, although I do not keep up with this currently. With piano I had some serious repetitive stress issues in my left hand from playing too many songs with octave stretches which were practice limiting as well as paraspinal lumbar tenderness as a teenager. Based on my experience with OMT as a new violinist, I am sure that OMT would have helped me at that time as well with piano.

    As Sweet Sue pointed out above, musical pedagogy frequently harps on proper technique to prevent stress injury. My piano teacher used to use the ruler; when she saw me stretching instead of moving my wrist to hit octaves she would swat my hand (gently). It would be interesting to see an osteopathic physician and music teacher come together to work on techniques with an individual to correct specific somatic dysfunctions caused by improper technique. This idea, with its focus on the individual, really embodies the whole person approach that osteopathic physicians so heavily emphasize.

  3. Lori Flores

    I’m a DO in Internal Medicine who was a Music Educator for 26 years prior to Medical School. In addition I am a vocalist and former dancer. I volunteer as a medical “officer” with the Phantom Regiment Drum and Bugle Corps as well as two local high school marching bands. I’m very interested in finding out more information about your work. Please contact me by email.

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