Experiences of physical struggle in playing or singing are common in higher music education (HME), yet the nuances of these experiences, especially in terms of musicians’ health, often remain unexamined or subsumed under simplified narratives and presumptions about how skilful movement works, how injuries occur, and where the responsibilities of students’ health and wellbeing ultimately lie. To investigate, this project explores how performance struggles and abilities are conceptualised, problematised, and embodied at macro, meso, and micro levels in HME. Drawing on dynamic systems theory, motor learning, and health sociology, this project develops interdisciplinary models that examine the conceptual spectrum between physical ease and extreme struggles and injuries, particularly detailing the ambiguous ‘grey zones’ in between.At the macro level, a critical discourse analysis of health and wellbeing statements from nine HME institutions examined the underlying assumptions and health ideologies informing health narratives and action plans. At the meso level, four in-depth interviews and four focus groups with teachers and students were complemented by a longitudinal prospective cohort study of 1,577 students followed over two to three years. At the micro level, a subsample of 20 instrumental students from the cohort participated in a lab-based motion capture and electromyography study to characterise the variability in upper limb coordination solutions among students with differing experiences of playing-related struggle.In the cohort study, students’ perceived difficulties were explored using a 24-item performance struggle scale covering dimensions such as sense of control, effort, tension, confidence, discomfort, and performance anxiety during playing. Analyses revealed a broad spectrum of struggle experiences across students, with struggle scores correlating with upper-limb disability scores, pain, injuries, and historical physical activity. A pain-mapping tool developed specifically for this cohort study revealed detailed patterns of pain location associated with specific instruments and genres. Both the institutional website analyses and the teacher interviews mobilised a strongly psychologised discourse around struggles, framing students’ struggles predominantly in terms of individual psychological states and behavioural traits such as resilience and coping. The interpretative repertoires surrounding these statements were critically examined and problematised. The combined findings aim to support and encourage critical reflective engagement with assumptions underpinning performance struggles and injuries, and to inform sustainable pedagogical and structural strategies in music education.