Looking back at all my years of school, from Pre-K through the end of grad school, I think the single most stressful period of my life was senior year of high school. Between AP classes and SAT’s, lessons, performances, competitions, and the whole college application and audition process, it felt pretty overwhelming at times.

Mostly, because for the first time ever, I felt a real need to play flawlessly. Playing perfectly was always the goal of course, but now there were some real stakes involved. In previous years, if I bombed a performance or totally choked in a competition, of course it would be embarrassing – but life would go on as normal. But I knew that I was only going to get one chance at college and conservatory auditions, and I worried that if the level of my playing fell short in those auditions, I wouldn’t get to go to the school my friends were at. And that my life would be ruined and derailed before it even really got started.

Which sounds overly dramatic now, I know, but this was high school after all. I blame the hormones.

Given all of this, perhaps it’s not so surprising that the only time in my life when I had any issues with tendonitis or such injuries was…senior year of high school.

What’s the connection?

Well, there are many reasons why we might get injured, but the research is beginning to suggest that personality factors also play a role in whether we are likely to get injured or not. And no, I don’t mean this in the sense that being an arrogant, condescending jerk is bad karma and makes you more likely to be the target of retaliation by the universe.

Specifically, it’s perfectionism that appears to predict injury. And a very particular kind of perfectionism at that.

How so?

Two dimensions of perfectionism

Before we get to the injury piece, let’s take a step back and take a quick look at perfectionism. Psychologists have conceptualized perfectionism in different ways, but one theory is the two-factor model, which proposes that there are two dimensions that comprise perfectionism.

One dimension is called perfectionistic strivings. This is characterized by having high personal standards, and a strong internal motivation to strive for perfection.

The other dimension is called perfectionistic concerns, which is characterized by worries about mistakes, fears of being evaluated negatively by others, and feeling angsty about the gap between what you expect of yourself and your current level of performance.

The two dimensions are not mutually exclusive, in that most of us have both to some degree, but they tend to pull us in different directions. Perfectionistic strivings are linked to desirable outcomes like greater intrinsic motivation, while perfectionistic concerns are associated with anxiety, depression, and other outcomes that are generally considered undesirable.

So how does this factor into the injury equation?

Tracking athletes’ injuries

A team of researchers recruited 80 elite junior athletes1 to participate in a study to see if there was any correlation between perfectionism and injury.

At the beginning of the study (September), all the athletes took two different sport-specific perfectionism assessments which included questions like “I have extremely high goals for myself in my sport” and “People will think less of me if I make mistakes in competition.”

Then, the athletes’ injuries were tracked and logged for the next 10 months, as they trained and competed as they normally would throughout the season. Injuries were defined as anything severe enough to require medical treatment and necessitate sitting out at least one practice or competition.

Was there a connection?

Of the 80 athletes, 38 managed to get through the season injury-free. However, more than half endured at least one injury, with 18 experiencing more than one injury.

As the researchers suspected, higher perfectionistic concerns scores were indeed significantly correlated with injury. In fact, for each standard deviation increase in an athlete’s perfectionistic concerns score, their odds of getting injured increased by over two times.

On the other hand, there was no significant relationship between perfectionistic strivings and injury.

So why is this? What is it about perfectionistic concerns that seems to predict injuries?

Two pathways to injury

The authors suggest that there are two ways to explain this connection.

One, is that folks who are high in perfectionistic concerns tend to experience a lot of stress. And this stress may not only keep individuals in a heightened fight-or-flight state, but disrupt their focus too, both of which could increase the likelihood of an injury. For instance, I remember my first summer playing in orchestra at a big music festival. As one of the youngest and least experienced members of the group, I was constantly worried about screwing up. I was so tense at every rehearsal, I’m surprised I got through the summer without hurting anything.

Another possibility is related to research which suggests there are differences in how athletes high or low in perfectionistic concerns approach training. It appears that those who are high in perfectionistic concerns are prone to “overtraining,” pushing themselves harder and longer in practice than those who are low in perfectionistic concerns. Training with high intensity and focus is one thing, but overtraining, especially over time, can lead to an increase in “training distress,” which can increase one’s susceptibility to injury.

Caveats and takeaways

It’s important to note that this study was done on a group of primarily male athletes with an average age of 17, so it’s not necessarily the case that these findings would generalize to musicians across a wider range of ages.

But it does seem reasonable that the same principles would be relevant across disciplines. And I was really struck by a passage in the NY Times article In Music as Well as Sports, Injuries Can End a Career, where a Yale University School of Medicine professor notes that whereas athletes understand “performance is about winning, not being perfect,” musicians are indoctrinated into an “early expectation of perfection,” despite perfection being an unattainable challenge.

And a somewhat misleading challenge too, since at some point in our development, we learn that technical perfection was never really the ultimate end-goal to begin with (as you can get a sense of from this interview with Yo-Yo Ma and this article by Norwegian violinist Henning Kraggerud).

I think the really tricky question has always been how to balance the pursuit of perfection with the expectation of perfection. And as much as I wish there were a simple answer, or one weird tip that you could click on in a Google ad, that could solve this overnight, I don’t think there is.

Although, in light of the prevalence of injuries amongst musicians, and the appearance of a link between perfectionism and injury susceptibility, I’m beginning to wonder if it’s an even more critical question than we might have thought. And one we must be vigilant about not only in our own approach to practice and performing, but in the messages we pass on to students in our teaching as well.

Additional reading

Musician, Heal Thyself @Peabody Magazine (which, with regards to overtraining, describes an interesting 5-rep-max-or-consult-with-teacher strategy about a third of the way down)

Footnotes

  1. (average age = 17.1 yrs)

About Noa Kageyama, Ph.D.

Performance psychologist and Juilliard alumnus & faculty member Noa Kageyama teaches musicians how to beat performance anxiety and play their best under pressure through live classes, coachings, and an online home-study course. Based in NYC, he is married to a terrific pianist, has two hilarious kids, and is a wee bit obsessed with technology and all things Apple.

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