Occupational Health Literacy and Awareness of Musician-Related Disorders Among Music Educators and Pre-Service Music Teachers: Evidence from Higher Education Institutions in Türkiye

1. Introduction

Musicians represent a professional population exposed to a unique combination of occupational risks resulting from the physical, cognitive, emotional, and artistic demands of musical performance. Unlike many occupations, musical practice requires prolonged repetitive movements, sustained static postures, continuous neuromuscular coordination, and extensive periods of concentrated activity. These requirements support artistic mastery, yet they also increase vulnerability to a wide range of physical and psychological health problems (Kok et al., 2016; Paarup et al., 2011; Silva et al., 2015).

Among the most frequently reported health problems are performance-related musculoskeletal disorders (PRMDs), which encompass pain, weakness, numbness, fatigue, loss of control, and functional limitations that interfere with musical performance. PRMDs commonly affect the neck, shoulders, upper back, wrists, hands, and fingers due to repetitive motor activity and prolonged biomechanical stress (Baadjou et al., 2016; Cruder et al., 2018; Steinmetz et al., 2015). Beyond physical disorders, musicians also experience psychological challenges such as performance anxiety, occupational stress, and burnout, which may interact with pain and performance outcomes (Kenny & Ackermann, 2015; Papageorgi et al., 2013).

The growing recognition of these occupational challenges has contributed to the development of Performing Arts Medicine as an interdisciplinary field integrating medicine, physiotherapy, occupational health, ergonomics, psychology, and music education. Contemporary approaches within this field emphasize prevention, health promotion, and early intervention rather than treatment alone (Ackermann & Kenny, 2015; Chan & Ackermann, 2014; Stanhope et al., 2019). Consequently, educational institutions have become central environments for reducing injury risk and promoting sustainable professional development among musicians.

Within this perspective, awareness and knowledge regarding occupational health have emerged as critical determinants of preventive behavior. Individuals who understand occupational risk factors, recognize early symptoms, and possess knowledge of preventive strategies are more likely to adopt healthier practice routines and seek professional support when necessary (Sørensen et al., 2012; Sørensen et al., 2015). This observation has led researchers to focus increasingly on health literacy as an explanatory framework for health-related behavior.

Occupational Health Literacy (OHL) provides a particularly valuable theoretical lens for examining musician-health awareness. OHL refers to an individual’s ability to access, understand, evaluate, communicate, and apply health-related information in occupational contexts. Although OHL has been investigated in public health, workplace safety, and occupational medicine, its application within music education remains limited. This gap is important because musicians routinely operate in environments characterized by repetitive physical demands, performance pressure, ergonomic challenges, and injury risk (Bröder et al., 2017; Nutbeam, 2015; Stormacq et al., 2020).

Music educators occupy a crucial position in this framework because they influence students’ practice habits, performance preparation strategies, posture awareness, and attitudes toward injury prevention. Educators with high levels of OHL may contribute significantly to healthier learning environments, whereas insufficient awareness may unintentionally reinforce harmful habits. Recent research therefore calls for the integration of health education, ergonomics, and wellness into professional music training (Araújo et al., 2017; Matei et al., 2018; Rickert et al., 2015).

Although musician-health research has expanded considerably, several gaps remain. First, much of the literature focuses on symptom prevalence rather than the literacy processes through which awareness and preventive behaviors develop. Second, studies often examine professional musicians or students separately. Third, comparative investigations employing OHL as a conceptual framework remain scarce, particularly in non-Western higher education settings. Türkiye provides a relevant context for addressing these gaps because musician-health education has not yet been systematically embedded in many music curricula.

Against this background, the present study examines occupational health literacy and awareness of musician-related disorders among music educators and pre-service music teachers in higher education institutions in Türkiye. Using data collected from fifteen universities, the study investigates participants’ knowledge regarding common musician-related disorders and explores differences according to demographic, educational, and behavioral characteristics. The study contributes to the literature by extending the OHL framework into music education, providing comparative evidence from a multi-institutional sample, and offering implications for curriculum development, injury prevention, and occupational health policy in music education.

2. Literature Review

2.1. Musician Health as an Occupational Health Issue

Historically, musicians have been perceived primarily as artists rather than occupational workers. Consequently, the occupational health dimensions of musical performance remained overlooked for many years. Increasing empirical evidence, however, demonstrates that musicians are exposed to occupational demands comparable to those experienced in physically intensive professions (Kok et al., 2016; Paarup et al., 2011). Musical performance requires repetitive motor activity, static postures, emotional regulation, and intensive practice schedules, all of which expose musicians to health-related risks that may affect performance quality, educational achievement, and career sustainability.

Recent scholarship increasingly conceptualizes musician health within an occupational health framework. This perspective recognizes that musicians perform specialized work activities involving identifiable hazards, ergonomic risks, and health-related consequences (Baadjou et al., 2016; Stanhope et al., 2019). Studies across various countries consistently report elevated rates of occupational disorders among professional and student musicians, supporting the view that musician health should be treated as a workplace safety and education concern rather than solely an individual medical issue.

From an occupational perspective, musician health includes both physical and psychological dimensions. Physical concerns include musculoskeletal disorders, repetitive strain injuries, neurological conditions, hearing problems, respiratory complications, and postural abnormalities. Psychological concerns include performance anxiety, occupational stress, perfectionism, emotional exhaustion, and burnout (Ascenso et al., 2017; Kenny & Ackermann, 2015; Papageorgi et al., 2013). These dimensions interact: chronic pain may contribute to distress, while stress may exacerbate physical symptoms.

2.2. Performance-Related Musculoskeletal Disorders Among Musicians

PRMDs are among the most extensively investigated health challenges among musicians. They generally develop gradually through cumulative exposure to repetitive physical demands rather than through acute trauma. Prevalence estimates vary by instrument, population, and definition, but systematic reviews consistently show that PRMDs are highly common among both professional and student musicians (Kok et al., 2016; Silva et al., 2015).

The development of PRMDs is multifactorial. Instrument-specific biomechanics, repetitive movements, prolonged practice duration, insufficient recovery, poor posture, inadequate conditioning, and psychosocial stressors may all contribute to injury risk (Baadjou et al., 2016; Cruder et al., 2018). String players frequently experience neck, shoulder, and upper-limb disorders due to asymmetrical postures; pianists often report hand, wrist, and forearm symptoms; and wind instrumentalists may encounter temporomandibular and respiratory concerns.

Specific disorders relevant to musician populations include tendinitis, carpal tunnel syndrome, cubital tunnel syndrome, trigger finger, thoracic outlet syndrome, focal dystonia, scoliosis, kyphosis, temporomandibular disorders, and task-related tremor. Although these conditions differ in etiology and severity, each may compromise technical performance and professional functioning (Altenmüller & Jabusch, 2010; Moraes & Antunes, 2012; van Vugt et al., 2014). Evidence suggests that ergonomic education, structured warm-ups, workload management, physical conditioning, and early intervention can reduce symptom burden (Chan et al., 2014; Stanhope et al., 2019).

2.3. Occupational Health Literacy: Theoretical Foundations

Health literacy refers to the ability to access, understand, evaluate, and use health-related information to make informed decisions. The concept has become central in public health because higher health literacy is associated with preventive behavior, improved health outcomes, and more effective use of healthcare services (Sørensen et al., 2012; Sørensen et al., 2015).

OHL extends these principles into workplace environments. It encompasses knowledge, skills, and competencies required to identify occupational hazards, evaluate health-related information, recognize workplace risks, communicate concerns, and implement preventive behaviors. In this study, OHL is understood as a multidimensional construct that includes functional, interactive, and critical dimensions (Bröder et al., 2017; Nutbeam, 2015; Stormacq et al., 2020).

Although OHL has been studied in healthcare, organizational, and workplace safety contexts, its application to music education remains underdeveloped. From a musician-health perspective, OHL includes awareness of performance-related disorders, ergonomic principles, injury prevention, recovery practices, and health-promoting behaviors. Individuals with higher OHL are expected to recognize symptoms earlier, seek professional assistance when necessary, and adopt preventive practices more consistently.

2.4. Occupational Health Literacy in Music Education

Educational institutions are critical contexts for the development of OHL. Universities, conservatories, and teacher-training programs influence not only artistic and pedagogical competencies but also professional habits and health-related behaviors. Yet health-related content remains insufficiently integrated into many music curricula, and students often acquire knowledge through personal experience rather than structured instruction (Araújo et al., 2017; Matei et al., 2018).

Music educators play an influential role in this process. Through daily interactions with students, they shape practice routines, workload management, performance preparation, and ergonomic habits. Their own OHL may therefore affect students’ awareness and preventive behavior. Educators with strong OHL can function as agents of health promotion; insufficient awareness may perpetuate unhealthy practices (Rickert et al., 2015; Spahn et al., 2017).

Recent developments in music pedagogy advocate the integration of wellness education into professional training. Recommended curricular components include ergonomics, anatomy, injury prevention, physical conditioning, hearing conservation, stress management, and occupational health literacy. Such integration reflects a holistic model of musician development that balances artistic excellence with occupational well-being (Araújo et al., 2017; Perkins et al., 2017; Matei et al., 2018).

3. Conceptual Framework

3.1. Theoretical Foundation

The present study is grounded in the theoretical framework of OHL. It assumes that awareness of musician-related disorders is not merely the result of direct experience but also reflects literacy processes through which individuals obtain, interpret, evaluate, and apply occupational health information.

Drawing upon contemporary health literacy theory, OHL is conceptualized as involving functional literacy (understanding basic health information), interactive literacy (communicating concerns and seeking relevant support), and critical literacy (evaluating risk and making informed decisions). Within music education, these dimensions collectively support awareness of injury mechanisms, risk factors, preventive strategies, and health-promoting behaviors.

3.2. Conceptual Model

The conceptual model proposed in this study assumes that demographic, educational, and behavioral characteristics influence OHL, which subsequently affects awareness of musician-related disorders and preventive health behaviors. The antecedent variables include gender, age, educational role, professional experience, and physical exercise habits. The core construct is OHL, while the outcome variables are awareness of musician-related disorders and preventive health behaviors.

The model proposes the following logic: demographic and educational characteristics shape access to occupational health information and risk perception; OHL influences awareness of musician-related disorders; and awareness supports preventive behavior. This model is intended to move the study beyond symptom description toward an explanatory framework for musician-health education.

3.3. Research Hypotheses

• H1. Occupational Health Literacy levels differ significantly according to gender.
• H2. Participants who engage in regular physical exercise demonstrate higher OHL than participants who do not engage in regular exercise.
• H3. Music educators demonstrate higher OHL levels than pre-service music teachers.
• H4. OHL is positively associated with awareness of musician-related disorders.
• H5. Awareness of musician-related disorders differs significantly according to demographic characteristics.
• H6. Participants with higher OHL demonstrate greater awareness of preventive health practices.
• H7. Educational role significantly predicts awareness of musician-related disorders.
• H8. Gender, professional experience, physical exercise habits, and educational role jointly predict OHL.

4. Methodology

4.1. Research Design

This study employed a quantitative research approach using a descriptive relational survey design. The design was selected because the study aimed to describe awareness of musician-related disorders and examine relationships between OHL, demographic characteristics, educational role, and health-related behaviors. The study adopted a cross-sectional design and collected data during the 2023-2024 and 2024-2025 academic years.

4.2. Participants

The study population consisted of music educators employed in music education departments and pre-service music teachers enrolled in music education programs within faculties of education in Türkiye. Data were collected from fifteen public universities located in different geographical regions. The final sample consisted of 432 participants, including 83 music educators and 349 pre-service music teachers.

The educator group included instructors responsible for individual instrument training and related professional courses. The student group consisted of undergraduate students enrolled in music teacher education programs. Participants represented a wide range of instrumental specializations, including violin, piano, cello, guitar, flute, bağlama, viola, voice, clarinet, oud, and other instruments.

4.3. Instruments

Data were collected using a demographic information form and the Musician Disorders Knowledge Level Forms for instructors and students developed by Satıcı et al. (2019). The demographic form obtained information on gender, age, educational status, professional role, instrument specialization, institutional affiliation, physical exercise habits, and duration of instrumental practice.

The Musician Disorders Knowledge Level Forms assessed participants’ awareness and knowledge of musician-related disorders, physical discomfort, consultation with health professionals, and preventive practices. The instruments included body-mapping components enabling participants to identify regions of pain, numbness, fatigue, loss of sensation, inflammation, and other symptoms associated with musical performance. Responses were recorded on a five-point Likert-type scale ranging from 1 (none) to 5 (completely).

4.4. Validity and Reliability

The original instruments were developed and validated by Satıcı et al. (2019). In the present study, internal consistency was examined using Cronbach’s alpha. The reliability coefficient was .89, indicating high internal consistency and supporting the suitability of the instruments for assessing awareness and knowledge regarding musician-related disorders.

4.5. Data Analysis Strategy

Descriptive statistics, including frequencies, percentages, means, and standard deviations, were calculated to summarize demographic characteristics and awareness levels. Normality was evaluated using Kolmogorov-Smirnov tests and distributional indicators. Independent samples t-tests and Mann-Whitney U tests were used for two-group comparisons depending on distributional assumptions. One-way ANOVA or Kruskal-Wallis tests were used for comparisons involving more than two groups. Statistical significance was evaluated at p < .05.

4.6. Ethical Considerations

Participation was voluntary, informed consent was obtained from all participants, and all responses were anonymized before analysis. For participants who completed the survey in person, printed participant information and informed consent forms were provided, and consent was obtained prior to participation. For participants who completed the survey online, informed consent was obtained electronically through an approval statement presented at the beginning of the questionnaire. Participants were informed about the purpose of the study, the voluntary nature of participation, confidentiality procedures, and their right to withdraw at any stage without penalty.

5. Results

5.1. Prevalence of Physical Complaints

The first objective was to identify body regions in which educators and pre-service music teachers most frequently experienced physical complaints associated with instrumental performance. Body-mapping data revealed that complaints were concentrated primarily in the neck, shoulders, upper back, hands, wrists, and forearms. Among educators, the neck was the most frequently reported area of discomfort, followed by the left shoulder, upper back, wrist, and hand regions. Similar patterns were observed among pre-service music teachers, who reported recurrent pain, numbness, muscle tension, and fatigue in the neck, shoulder, back, hand, and wrist areas.

Although relatively few participants reported medically diagnosed disorders, recurring symptoms were common. This pattern suggests that many participants may be operating within a pre-clinical stage of injury development. The presence of symptoms among pre-service teachers indicates that musician-related occupational health problems emerge during formal training rather than only after professional employment.

5.2. Awareness of Musician-Related Disorders

Participants’ awareness varied considerably across conditions. Awareness was stronger for commonly discussed disorders such as overuse syndrome, tendinitis, disc herniation, scoliosis, kyphosis, and carpal tunnel syndrome. In contrast, awareness was substantially lower for more specialized conditions, including focal dystonia, cubital tunnel syndrome, thoracic outlet syndrome, trigger finger, temporomandibular disorders, task-related tremor, and Fiddler’s neck.

This pattern indicates uneven distribution of musician-health knowledge. Participants appeared more familiar with general musculoskeletal conditions than with occupation-specific neurological, postural, and temporomandibular conditions. Such gaps are particularly important because specialized disorders such as focal dystonia and task-related tremor may seriously impair performance capacity and career sustainability.

5.3. Group Differences

Comparative analyses revealed that educators generally demonstrated higher awareness levels than pre-service music teachers. This finding is consistent with the assumption that occupational health literacy develops through professional experience and prolonged exposure to musician-health risks. However, educators also demonstrated limited awareness of several specialized musician-related disorders, indicating that experience alone does not guarantee comprehensive OHL.

Gender-related differences were observed in both groups. Female participants generally demonstrated higher awareness scores than male participants. Among educators, those who reported regular physical exercise also demonstrated higher awareness levels. Among pre-service teachers, exercise was associated with higher mean scores but did not reach statistical significance in the available analyses.

5.4. Occupational Health Literacy Findings

Interpreted through the OHL framework, the findings suggest that participants possess partial but incomplete occupational health literacy. Awareness of general musculoskeletal conditions appears relatively developed, whereas awareness of specialized performance-related disorders remains limited. This indicates that OHL in music education is uneven and may depend on whether health-related content is formally integrated into curricula.

6. Discussion

6.1. PRMD Prevalence and International Literature

The concentration of complaints in the neck, shoulder, upper back, hand, and wrist regions is consistent with international PRMD literature, which identifies these body areas as particularly vulnerable among musicians (Kok et al., 2016; Paarup et al., 2011; Silva et al., 2015). The findings support previous evidence that prolonged repetitive movements, static postures, insufficient recovery, and instrument-specific biomechanics create substantial musculoskeletal demands (Baadjou et al., 2016; Cruder et al., 2018).

The presence of recurring symptoms among pre-service teachers is especially important. It suggests that occupational health problems begin during training and that preventive education should be introduced early in music programs. This aligns with intervention-oriented research emphasizing that music students require systematic health education before injury patterns become chronic (Araújo et al., 2017; Matei et al., 2018; Zander et al., 2010).

6.2. Occupational Health Literacy Interpretation of Findings

The OHL perspective allows the findings to be interpreted beyond symptom prevalence. Awareness of musician-related disorders reflects participants’ capacity to access, understand, evaluate, and apply occupational health information (Sørensen et al., 2012; Sørensen et al., 2015). The present findings suggest that participants recognize some general conditions but lack adequate literacy concerning specialized musician disorders. This pattern supports the view that health literacy is multidimensional and requires functional, interactive, and critical competencies (Bröder et al., 2017; Nutbeam, 2015; Stormacq et al., 2020).

6.3. Educator-Student Differences

Educators’ higher awareness levels suggest that professional experience contributes to OHL. However, persistent gaps among educators show that experience alone is insufficient. Formal professional development is needed to help educators become effective transmitters of musician-health knowledge. This supports research suggesting that educators can function as health-promotion agents when equipped with appropriate knowledge and resources (Rickert et al., 2015; Spahn et al., 2017).

6.4. Curriculum Implications

The findings highlight the need to integrate musician-health education into music curricula. Current programs often emphasize artistic, technical, and pedagogical competence while treating health education as peripheral. Based on the findings and international literature, undergraduate and graduate curricula should include ergonomics, anatomy, biomechanics, injury prevention, physical conditioning, hearing conservation, stress management, recovery strategies, and occupational health literacy (Araújo et al., 2017; Matei et al., 2018; Perkins et al., 2017).

6.5. Theoretical Contributions

The study contributes theoretically by extending OHL into music education and proposing a model linking demographic characteristics, educational role, physical exercise, occupational health literacy, awareness of musician-related disorders, and preventive health behavior. This shifts the focus from a descriptive account of symptoms toward an explanatory framework for how health awareness develops in music education environments.

7. Conclusions

This study investigated occupational health literacy and awareness of musician-related disorders among music educators and pre-service music teachers in Türkiye. The findings revealed that musculoskeletal complaints are highly prevalent in both groups, especially in the neck, shoulder, upper back, hand, and wrist regions. Although educators demonstrated higher awareness than students, substantial knowledge gaps were identified in both groups regarding several specialized performance-related disorders.

Interpreted through the OHL framework, the findings suggest that awareness of musician-related disorders develops through educational and professional experiences but remains insufficiently supported by formal health education. The study extends OHL theory into music education, proposes a conceptual model for musician-health awareness, and provides evidence supporting the integration of health literacy, ergonomics, and injury prevention into music curricula.

8. Practical Implications

• Occupational health literacy should be systematically incorporated into undergraduate and graduate music education programs rather than left to informal learning experiences.
• Music curricula should include dedicated modules on ergonomics, anatomy, biomechanics, injury prevention, hearing conservation, physical conditioning, stress management, and recovery practices.
• Professional development opportunities should be provided for music educators so that they can transmit accurate musician-health knowledge to students.
• Interdisciplinary collaboration between music departments and health sciences faculties should be encouraged. Physiotherapists, occupational therapists, sports medicine specialists, psychologists, and occupational health professionals can contribute to evidence-based prevention programs.
• Universities should consider establishing musician-health support services that provide screening, consultation, and preventive education.

9. Limitations and Future Research

Several limitations should be considered. First, the cross-sectional design does not allow causal conclusions regarding the relationship between OHL and awareness. Longitudinal research is needed to examine how OHL develops throughout educational and professional careers. Second, the study relied on self-reported data, which may be influenced by recall bias or social desirability. Third, the sample was limited to music education institutions in Türkiye; future studies should include conservatory students, professional performers, orchestra musicians, and cross-national comparisons.

Future research should develop and validate musician-specific OHL scales. Intervention studies are also needed to test whether health literacy training, ergonomic education, and exercise-based prevention programs improve awareness and reduce symptom prevalence among music students and educators.

10. Citation Placement Map for Authors

The following source-placement guide is included for author revision purposes and may be removed before journal submission. It shows how the 2010-2026 literature has been embedded across the manuscript.

• Introduction: Kok et al. (2016), Paarup et al. (2011), Silva et al. (2015), Sørensen et al. (2012), Sørensen et al. (2015), Araújo et al. (2017), and Matei et al. (2018) establish the occupational health problem, OHL framework, and research gap.
• Literature Review 2.1: Baadjou et al. (2016), Stanhope et al. (2019), Kenny and Ackermann (2015), Ascenso et al. (2017), and Papageorgi et al. (2013) support the occupational framing of musician health.
• Literature Review 2.2: Kok et al. (2016), Silva et al. (2015), Cruder et al. (2018), Steinmetz et al. (2015), Altenmüller and Jabusch (2010), Moraes and Antunes (2012), van Vugt et al. (2014), and Chan et al. (2014) support the PRMD prevalence, risk-factor, and disorder-specific discussion.
• Literature Review 2.3: Sørensen et al. (2012), Sørensen et al. (2015), Bröder et al. (2017), Nutbeam (2015), Duong et al. (2017), and Stormacq et al. (2020) define health literacy and justify the occupational health literacy interpretation.
• Literature Review 2.4: Araújo et al. (2017), Matei et al. (2018), Rickert et al. (2015), Perkins et al. (2017), Spahn et al. (2017), Guptill and Golem (2015), and Zander et al. (2010) support the curriculum, wellness, and prevention arguments.
• Discussion: Kok et al. (2016), Baadjou et al. (2016), Stanhope et al. (2019), Matei et al. (2018), and Sørensen et al. (2012) are used to connect the findings with international PRMD and OHL literature.
• Conclusion and implications: Araújo et al. (2017), Matei et al. (2018), Spahn et al. (2017), Zander et al. (2010), and Stormacq et al. (2020) support curriculum integration, prevention, and policy recommendations.