PAIN AND THE PERFORMING ARTS

Performers relentlessly pursue perfection in their craft and sometimes at the risk of putting their own well-being second.

They are constantly judged on their performances, and even the tiniest pain or injury can have a hugely detrimental effect on their ability to achieve their own very high standards.

BAPAM estimates that three quarters of musicians and dancers experience health problems that affect their work, and sometimes those health problems can be career-limiting or even career-ending, so the very best of care is needed.

• Musicians, dancers and other performers experience the same range of health issues as the rest of us, but the impact of their injury, pain or illness may be even greater when it comes to their work.
• Performers need to be able immerse themselves fully in every performance, and what might be a minor pain or strain for you and I, could be hugely distracting or impeding for the performer.
• Not only does the quality of performance suffer, but pain and illness can lead to huge loss of confidence and possibly the performer’s good reputation, and even their livelihood.
• And of course, the particular sphere in which they work in, can bring its own, particular ailments.
• Dancers are required to put their bodies under tremendous and sometimes ‘unnatural’ pressure, they may injure ankles when jumping, or experience back and hip problems.
• There is pressure to remain lean and light as a dancer, and some dancers are under nourished.
• Dancers participating in both in a matinee and an evening performance face additional physical demands and will use ice baths, stretching and massage to try to combat pain and muscle inflammation.
• Some performers may be even required to wear elaborate costumes, with heavy head pieces which can cause pain and vocal impairment through muscle tension in the neck.
• Instrumentalists can experience repetitive strain injuries, tendinopathies, and pain related to prolonged postures (such as playing the violin).
• Not being able to practice reliably, competently, and consistently can feel disastrous for a musician. Enforced restrictions on practice and performance can limit ability to work but also their self-expression.
• In addition, medications to combat pain may not always be suitable for them because side effects could may interfere with role-learning and performance.
• Some painful conditions are unique to particular musical spheres, such as embouchure dystonia, which cases involuntary spasm of the lips, jaw or tongue, making it difficult to for a musician to correctly form their mouth around the instrument’s mouthpiece, or to be able to sustain a note or play in a high range.
• This can induce anxiety in the player, and when they can’t produce a good sound, and even complicated feelings towards their instrument, which may further induce spasm.

 

• Performers work unusual hours. They may work late into the evening, and yet be required to be up early in the morning to teach or rehearse. They are often travelling, sometimes for weeks at a time, and they can suffer from sleep disturbance and jet lag.
• Dancers and performers who may be placing huge physical demands upon their bodies, must have adequate rest, and ideally more than 8 hours per night, but many performers struggle to achieve this.
• Performing in the evenings goes against the natural human biorhythm, when humans should be winding down, not ramping up.
• Sleep is essential for body restoration and for healing. During optimal sleep, growth hormone is released in pulses, which triggers a gene that then stimulates cell proliferation and tissue recovery. It also helps to strengthen the immune system.
• And if lifestyle effects were not enough, pain can also interfere with getting a good night’s sleep.

I am senior medical advisor and honorary Consultant in Pain Medicine to the Royal Society of Musicians for 14 years.

The society is an ancient charity, founded in 1728, and Handel was one of the 228 original members, and became the charity’s biggest benefactor. The society supports professional musicians who have been affected by illness or injury.

I’m also an assessing physician and member of the medical committee for BAPAM (British Association for Performing Arts Medicine). This wonderful organisation provides health and wellbeing services for performers and as well as providing wellness education.

Working with performers as a clinician requires a sensitive understanding of the emotional world of performance, and sometimes it can be very helpful to bring in additional support from psychologists, particularly if there may be performance anxiety issues, or if the emotional burden of pain is overwhelming.

So, when I work with performers who are in pain, I will often work alongside specialist physiotherapists, and psychologists, and our goal is always to try to find a way for the performer to continue their work, rather than to stop it completely. This may mean making temporary adaptations in their choreography or reducing their performances or rehearsal time. This can enable them to maintain their position in their company, and their reputation as a reliable performer.

Dr ANTHONY ORDMAN