A Common Personality Factor That Could Increase Your Risk of Injury

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)


  1. (average age = 17.1 yrs)

Ack! After Countless Hours of Practice...
Why Are Performances Still So Hit or Miss?

It’s not a talent issue. And that rush of adrenaline and emotional roller coaster you experience before performances is totally normal too.

Performing at the upper ranges of your ability under pressure is a unique skill – one that requires specific mental skills, and perhaps a few other tweaks in your approach to practicing too. Elite athletes have been learning these techniques for decades; if nerves and self-doubt have been recurring obstacles in your performances, I’d like to help you do the same.

Click below to learn more about Beyond Practicing – a home-study course where you’ll explore the 6 skills that are characteristic of top performers. And learn how you can develop these into strengths of your own. And begin to see tangible improvements in your playing that transfer to the stage.


7 Responses

  1. I definitely agree with the point about tension – I’ve found concerns-based perfectionism leads to excess muscle tension while playing, which in turn leads to tendonitis. One particularly illuminating experience was experiencing tendonitis pain following a day of 2 long performances with total playing time equal to the playing time of a typical practice day, whereas practice days that same week did not result in the same tendonitis pain. With the quantity of playing as the control variable, the incremental stress of performing was qualitatively the primary variable compared with a practice day, and my conclusion was that the tendonitis pain resulted from incremental tension driven by the incremental stress of performing.

  2. Not necessarily regarding injury, but in the world of classical guitar there tend to be a strong number of performers who went through their rock and/or jazz improv years, then crossed over to classical music. The level of classical guitar performance has progressed by light years over the past half-century, including the need to be “perfect.” However a fair number of crossover people bring a different mentality from their improv years. They tend to care about excellence, but with a less rigid psychology. It’s interesting to think from the perspective that the notes one plays are a choice, rather than a demand. In solo settings, if these folks have blank moments, they know how to get through them – perhaps by making something up briefly until the mental track can be resumed. Any of them would probably still describe some level of “nerves” in various situations, but I find this interesting. Obviously one can’t just make stuff up in a classical group (chamber, orchestra, etc). Still it’s an intriguing observation.

  3. I once observed a piano master class where, after the young woman performed a Chopin Sonata, the master critiqued that she was “too perfect!” What do you do when you attain virtual perfection and even that isn’t good enough? That’s too perfect! I hope the student didn’t freak out too much. Of course, I’ll never face that problem, but if I did, I imagine I’d go home and enjoy a good head-banging against the wall. Where do you go from virtual perfection — up, down, sideways?

    How does Taubman piano technique relate to perfectionist concern? I have only a very small understanding of Taubman/Golandsky, but it seems to me that she advocates the hands leaving the keys (more chance of missing) and using the pedal to connect (less anal ‘clarity’) as opposed to contorting to cling to the keys and connect with less pedalling (much more injury prone). I do feel less secure making a small leap of faith with the hands rather than that comforting but physically dangerous clinging — but Taubman feels so much better! Can perfectionist concern lead to a resistance to Taubman technique?

    Now, as a writer, I had, I think, a good exercise to put nitpicking and endless “perfecting” into perspective. I’d look at a masterwork of fiction, say ‘Giovanni’s Room’ by James Baldwin, and I’d go through word-by-word nitpicking just to let the pointlessness sink in. There can be no perfection, because the artwork only really exists in the eyes, ears, and mind of the audience, which you can influence but never control.

    1. Hi Canaan,

      Interesting question about Taubman technique. I have some familiarity with the basic concepts, as my wife studied it a bit in college, and my secondary piano teacher in grad school shared a little about it with me, but this is a bit beyond me I’m afraid!

    2. I’ve added your last sentence to my quote journal. Excellent. Thank you for taking the time to share your thoughts

  4. I’m a violinist but I had a session with a piano teacher at UCI who is very familiar with Taubman technique. Watching her play the piano was like watching waves of the ocean roll over the keys. Fascinating and beautiful! I can’t comment on playing technique of the piano but it seems the Taubman concepts relate to any instrument. At least it was very helpful to me.

Leave a Reply

Your email address will not be published.

Get the (Free) Practice Hacks Guide

Learn the #1 thing that top practicers do differently, plus 7 other strategies for practice that sticks.

Do you know your mental strengths and weaknesses?

If performances have been frustratingly inconsistent, try the 4-min Mental Skills Audit. It won't tell you what Harry Potter character you are, but it will point you in the direction of some new practice methods that could help you level up in the practice room and on stage.