How the correct hearing protection reduced wrist strain for a viola player

Marshall Chasin
June 14, 2016

Years ago I wrote an article called “My wrist sings the blues”. I think it may have been in the now defunct journal Hearing Instruments which was the predecessor of Hearing Review.  This was a long time ago when the alphabet only had 24 letters and pi only had 7 decimal places.

The idea behind the article is that non-hearing related injuries in musicians can occur as a result of improper monitoring. Too much hearing protection can be as bad (or maybe even worse) than too little hearing protection.  An incorrect level of monitoring can result in wrist or arm strain and result in long-term chronic injuries that may be career threatening.

I was reminded of this fact when I saw a musician this week for a re-evaluation.  She is an accomplished viola player and even though this wasn’t reported (or asked about) in the initial consultation, she had been having left arm and wrist pain.  (I won’t make that mistake again).  During the appointment we were in the process of making several adjustments and she reported that she no longer had any problems with her left arm.

While I cannot take any direct credit for this (and no EMG studies were performed) she was quite delighted and intuitively felt that she had a better sense of her viola playing and thought that she wasn’t “pushing things” as much as she normally does. She is a retired physician and plays about three times a week, so her music is very important to her.

I had a case like this many years ago where a drummer had read in the popular music magazines of the day that he should be wearing hearing protection. Being an intelligent soul who wanted to ensure that his musical career would last as long as possible, he started wearing his father’s industrial strength hearing protection.  Six months later he noted significant wrist and arm pain.

By the time I had seen this musician, he could barely hold his drum sticks and his EMG (muscular activity) was off the scale. You don’t have to be Mead Killion to figure this one out! The industrial strength hearing protection was sufficient enough to cause him to lose his monitoring ability of his high hat and rim shots; simply stated, this drummer was overplaying because of the loss of monitoring.




103 dB SPL


113 dB SPL


104 dB SPL


He was fitted with the proper form of hearing protection (namely the ER-25 musicians’ earplugs) which provided 10-15 LESS high frequency attenuation. With the improved (high frequency) monitoring, his playing level was reduced and EMG activity returned to normal.  The table shows the measured sound pressure level (SPL) generated while the musician was hitting a practice pad with an “average” playing level with no hearing protection and then with the properly fit ER25 musicians’ earplugs showing no measureable difference.  In contrast, when he was wearing the industrial strength hearing protection (i.e., deeply seated foam earplugs), the average playing level was about 10 dB greater.



  1. I observe that I sing much better since wearing hearing aids. While I could certainly hear my base frequency in spite of my high frequency loss, I missed much of my higher frequency overtones. This made me force things, and I got hoarse quite quickly.

    On the other hand I observed that while playing with hearing protection, I was able to hear details that others did not. I once played electric guitar in a big orchestra and wore my elacin 15 dB plugs. The guitarist sitting on my side said that he didn´t hear my guitar monitor at all and wondered how I was able to play, but I heard myself perfectly.

    I absolutely agree that the right amount of hearing protection will improve the performance!

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