Physical Therapy Haven

“Singers and musicians are some of the most driven, courageous people on the face of the Earth. They deal with more day-to-day rejection in one year than most people do in a lifetime. Every day, they face the financial challenge of living a freelance lifestyle, the disrespect of people who think they should get real jobs, and their own fear that they'll never work again. Every day, they have to ignore the possibility that the vision they have dedicated their lives to, is a pipe dream. With every note, they stretch themselves, emotionally and physically, risking criticism and judgment...Why? Because musicians and singers are willing to give their entire lives to a moment - to that melody, that lyric, that chord, or that interpretation that will stir the audience's soul. Singers and musicians are beings who have tasted life's nectar in that crystal moment when they poured out their creative spirit and touched another's heart. In that instant, they were as close to magic, God, and perfection as anyone could ever be. And in their own hearts, they know that to dedicate oneself to that moment is worth a thousand lifetimes."¹

 

Might I add dancers and every performing artist that ever lived to the subject of this quote. Everyday, when we hop into our cars and turn on the radio, pop in our headphones during a workout at the gym, or attend a live concert or dance performance, we enjoy the fruits of the labor that these performing artists put forth just to touch our hearts with their art. I have met people who do not like chocolate or ice cream (why, I do not understand), but in all of my experience, no matter with whom I have come into contact, I have never met someone who has disliked music, dance, or art in some form. Art in its various forms is an integral part of humanity and an expression of the human condition.

 

It is also an essential part of our educational system. In November of 2001, Dr. Terry Bergeson, Washington State’s Superintendent of Public Instruction, summed up the value and purpose of art beautifully: “The Arts are an essential part of public education. From dance and music to theatre and the visual arts, the arts give children a unique means of expression, capturing their passions and emotions, and allowing them to explore new ideas, subject matter, and cultures. They bring us joy in every aspect of our lives. Arts education not only enhances students' understanding of the world around them, but it also broadens their perspective on traditional academics. The arts give us the creativity to express ourselves, while challenging our intellect. The arts integrate life and learning for all students and are integral in the development of the whole person. The Arts communicate and speak to us in ways that teach literacy and enhance our lives. We must continue to find a place for arts programs and partnerships not only for what it teaches students about art, but for what it teaches us all about the world we live in.”² Art unifies humanity past any barriers of race, gender, or rank through means of expressing emotions and reflecting on the universal human condition.

 

When we think about the artists themselves, many people think of the clichés “the starving artist” or the artist “suffering for their art”. Little do most people know, this is not too far away from the truth. In a survey study performed in 1988 by Fishbein et al, 82% of American orchestral musicians experienced medical problems and 76% described problems serious enough to interfere with playing³. This percentage runs higher in dancers up to 97%⁴. From an occupational health standpoint, performing artists are at high risk for injuries that interfere with their livelihood.

 

Performing artists are often likened to athletes in terms of the hours of intense practice and physical exertion that they undergo in order to continually perform at peak capacity in front of critical audiences, yet they certainly do not receive as much financial support as do college or pro-athletes. Often times, musicians and dancers are known to play or dance through their pain in order to keep their position in an already competitive field. Musicians experience hearing loss, repetitive stress injuries, tendonitis, crippling focal dystonias, and nerve entrapment syndromes. Dancers are prone to stress fractures, severe ankle sprains, tendonitis, low back pain, and hip labral tears. Vocalists are susceptible to nodules, hemorrhaging, laryngitis, and deterioration of their vocal cords due to acid reflux. These are only a short list of medical problems that performing artists sustain. Most artists who are not fortunate enough to be millionaire pop stars, and who live from audition to audition or gig to gig for income, do not have the capacity to have decent health insurance or coverage to receive proper treatment for such debilitating ailments because of the transitory nature of their jobs. It is sad to see that those who give so many quality contributions to society and preserve much of the artistic history of humanity, get so little back from it in terms of proper healthcare and financial support.

 

The other side of the story is educational. Many of these musicians and dancers begin at very young ages (2-3 years old and up) practicing and taking private lessons. Often when young individuals are singled out to have exceptional talent, they are enrolled in a musical conservatory or dance school where they practice up to 8-9 hours a day to perfect their skills, not to mention the added rehearsals for multiple ensembles and private lessons one-on-one with their teachers. The question is whether or not these private teachers are certified to teach these young students in a manner that is safe and puts the student’s health and well-being above all especially at such a young age. Unlike physical education teachers, there is no single certification process for musical or dance instructors. Many do not focus on the manner in which these motions are performed, rather they focus on the end product. Poor posture, poor technique, lack of rest breaks, lack of nutrition or hydration, fatigue, and lack of knowledge of anatomy and physiology or proper health practices amongst musicians can be detrimental after years of uninhibited playing. Some of the most up-to-date research shows that the majority of physicians and therapists who are unfamiliar with the unique demands of the performing artist cannot give the highest quality care because they cannot speak the same language as the artist⁵ (Brandfonbrener  2006) or foster the level of trust required to establish a working relationship with the artist⁶ (Brandfonbrener  1998). In other words, you cannot treat a prima ballerina that same way as you treat a professional rugby player if you are an orthopedist or physiatrist or sports medicine physical therapist.

 

These are just some of the ideas that the members of PAMA, the Performing Arts Medical Association, discussed at its annual symposium in Aspen, Colorado from July 19-23, 2013.

 

PAMA’s objectives are to:

- Promote the highest quality of care to all performing artists and bring to that care an appreciation of the special needs of performing artists.

- Develop educational programs designed to enhance the understanding and prevention of medical   problems related to the performing arts.

- Promote communication among all those involved in the health care and well being of performing artists.

- Foster research into the etiology, prevention, treatment, and rehabilitation of medical problems of performing artists⁷

 

This international organization provides a strong platform and a forum for researchers, practitioners, and educators to share their ideas and insights and collaborate to further the common dream of achieving better standards of health for every performing artist in the world. 

 

Somehow, learning about the high percentage of debilitating injury amongst performing artists reminds me of the lyrics of Fort Minor’s song “Remember the Name”:

 

                                          “This is ten percent luck, twenty percent skill

Fifteen percent concentrated power of will

Five percent pleasure, fifty percent pain

And a hundred percent reason to remember the name!”

 

In my opinion, the percentages don’t have to be that skewed for performing artists. It is PAMA’s vision as well as mine to alter those percentages and change it to reflect 50% pleasure, 5% pain (or even less). If you are a health care professional interested in treating these artists or an educator involved in the foundational formation of these artists, why don’t you join us on this mission? 

 

 

Maria Arini is currently a physical therapist at Bethesda Physiocare in Maryland as well as a member of the Performing Arts Medical Association (PAMA) and the Performing Arts Special Interest Group (PASIG) of the American Physical Therapy Association (APTA) with a keen interest in treating performing artists.

 

1) Ackert, David. Opinion Section of LA Times. Jan 2013. Accessed via blog on July 23, 2013.  http://www.thornybleeder.com/index_files/singers_and_songwriters_by_david_ackert_from_la_times.html

 

2) Joseph, AnnRene. The Value of the Arts to the Community and Education. New Horizons for Learning. Sept 2002. Accessed July 23, 2013. http://education.jhu.edu/PD/newhorizons/strategies/topics/Arts%20in%20Education/joseph.htm

 

3) Fishbein, M.M., Middlestadt, S.E., Ottati, V., Straus, S., Ellis, A. Medical problems among ICSOM musicians: overview of a national survey. Med Probl Perform Art. 1988; 3:1-8.

 

4) Kerr, Gretchen, Krasnow, Donna, and Mainwaring, Lynda. The Nature of Dance Injuries.  Med Probl Perform Art. 1992; 7:25-29.

 

5) Brandfonbrener, A.G. The Etiologies of Medical Problems in Performing Artists. Performing Arts Medicine. Ed: Brandfonbrener, A.G., Lederman, R.J., Sataloff, R.T. Singuler Publishing Group, San Diego, 19-45.

 

6) Brandfonbrener, A.G. Special issues in the medical assessment of musicians. Phys Med Rehabil Clin N Am. 2006; 17 (4): 747-753. 

 

7) Performing Arts Medical Association. PAMA Mission Statement. Accessed July 23, 2013. http://www.artsmed.org/about.html