Performing Arts Medicine:
Current Trends in Treating the String
Musician
Eric N. Bengtson, MA, LAT, ATC, PES, CPT
Coordinator of Performing Arts Medicine
Outline
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Introduction
Medical Needs
Performing Arts Medicine Overview
Injuries
– Anatomy
• Recommendations
• Performing Arts Medicine at App State
Demographics
• The audience
• The presenter
Introduction
• String oriented presentation
• The human body is consistent
“Most music-related injuries are the
result of soft tissue overuse
stemming from long hours of
practice, poor physical conditioning,
and stressful postural positioning”
Quarrier NF. Performing Arts Medicine: The Musical Athlete. J Orthop
Sports Phys Ther 17:90-95, 1993
Performing Artist and Traditional Athlete
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Strength
Flexibility
Endurance
Coordination
Talent / Ability
Physical skills determine
level of success
• Begin training at a young
age
• Competitive field
• Psychological endurance
• High stress in striving for
perfection
• Economic success is
dependent on level of
skill
• Prone to activityoriented, overuse injuries
Quarrier NF. Performing Arts Medicine: The Musical Athlete. J Orthop Sports
Phys Ther 17:90-95, 1993
Elbaum L: Musculoskeletal problems of instrumental musicians. J Orthop
Sports Phys Ther 8:285-287, 1986
Fatigue
Adaptive Patterns
Pain / Injury
Poor Technique
Quarrier NF. Performing Arts Medicine: The Musical Athlete. J Orthop
Sports Phys Ther 17:90-95, 1993
Pain is a symptom, not a diagnosis.
Not Seeking Medical Care
• Lack of knowledgeable medical professionals
• “no pain-no gain” principle
• The belief that performance related pain is
inevitable or will resolve itself
• Consciously or unconsciously ignoring pain
• Fear of temporary loss of income or employment
• Treatment itself may threaten their ability to
perform
Brandfonbrener A: Performing arts medicine: an evolving specialty. Music
Educators J 77:37-41, 1991
Lowest Success Rate:
1. General Practitioner (6%)
2. Neurologist (13%)
3. Orthopedist (20%)
Highest Success Rate:
1. Surgery (94%)
2. Rest – stop playing (84%)
3. Physical Therapy (82%)
Fishbein M, Middlestadt SE, Ottati V, Strauss S, Ellis A: Medical problems
among ICSOM musicians: Overview of a national survey. Med Probl
Performing Artists 3:1-8, 1988
Psychological Influence of Injury
• Performing artists have been shown to be
more attached to their craft than athletes are
to their sport.
– Being removed from their craft while injured can
negatively alter psychology
• Self-reported an increased physical health
status but decreased mental health status
compared to the general population
Bengtson E. The Correlation Between Time Loss Due to Injury and Perceived
Health Status in Female Collegiate Dance Students. Unpublished.
Voltmer E, Zander M, Fischer JE, Kudielka BM, Richter B, Spahn C. Physical
and Mental Health of Different Types of Orchestra Musicians Compared to
Other Professions. Med Probl Perform Art 2012; 27(1):9-14.
Performing Arts Medicine
• Emerged ~40 years ago from physicians and
therapists not understanding the strains and
stresses placed on the performer’s body
• Early research focused on musicians
– Dance research followed
Harman SE. Odyssey: the history of performing arts medicine. Md Med J.
42(3):251-3; 1993
• Performing Arts Medical Association
– Founded in 1989
– www.artsmed.org
• International Association of Dance Medicine &
Science
– Founded in 1990
– www.iadms.org
Performing Arts Medicine
• At Appalachian State University:
– College of Health Sciences
– Department of Theatre & Dance
– Athletics Department
– Hayes School of Music
• Staff with performing arts medicine education
– Program implementation
– Research
Supplementary Fitness
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General training principles
Fatigue
Muscular strength and endurance
Flexibility
Cardiovascular fitness
Supplementary Fitness
This is not simply a way for the artist to get in
shape
Studies suggest that it is not adequate to train
performers without proper physiologic
preparation
Laws H. Fit to Dance 2: Report of the Second National Inquiry into Dancers’
Health and Injury in the UK. London: Dance UK, 2005.
Wyon M, Redding E, Abt G, Head A, Sharp C. Development, reliability and
validity of a multi-stage dance specific aerobic fitness test (DAFT). J Dance Med
Sci. 2003; 7(3):80-4.
Krasnow DH, Chatfield SJ. Dance science and the technique class. Impulse.
1996;4:162-72.
General Training Principles
• “SAID” principle
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Specific
Adaptations to
Imposed
Demands
• The body must be challenged above a minimum
threshold for improvement to occur
– For example, if the demands of dance class are similar
day to day there will be insufficient overload for
desired improvement
Fatigue
• Supplemental exercise when done correctly
has the ability to slow fatigue
– Except after exercise
• Fatigue leads to more errors when playing
Drinkwater EJ, Klopper CJ. Quantifying the physical demands of a musical
performance and their effects on performance quality. Med Probl Perform Art
2010;25:66-71
Strength & Muscular Endurance
• Optimal strength training program should be specific to the
desired outcome.
• Muscular Strength
– 70-100% of maximum strength
– Low number of repetitions and sets
– 5-6 minute rest between sets
• Muscular Endurance
– 60-70% of maximum strength
– High number of repetitions and sets
– 2-4 minute rest between sets
Clark MA, Lucett SC, Corn RJ. National Academy of Sports
Medicine: Essentials of Personal Fitness Training. Baltimore:
Lippincott Williams & Wilkins, 2008. Print.
In a 2007 study, performers were asked to
complete one year of supplemental exercise in
addition to their classes. Compared to their
classmates the subjects experienced:
– Reduced fatigue
– Increased energy levels
– Increased capacity in their dance classes to sustain
technique and jumping ability
Rafferty S, Redding E, Irvine S, Quin E. The effects of a one-year
dance-specific fitness training program on undergraduate modern
dance students: an experimental study. Abstract. J Dance Med Sci.
2007; 11(1):16.
A 2012 study demonstrated that two one-hour
circuit training sessions per week for six weeks is
enough to increase (as compared to a control
group)
– muscular power by 11%
– muscular endurance by 22%
– aerobic fitness by 11%
– aesthetics (in the dancer) by 12%
Angioi M, Metsios G, Twitchett EA, Koutedakis Y, Wyon M. Effects of
Supplemental Training on Fitness and Aesthetic Competence Parameters in
Contemporary Dance: A Randomised Controlled Trial. Med Probl Perform Art
2012; 27(1):3-8.
Flexibility
• Important element of physical fitness. Is used for:
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Correcting muscle imbalances
Increasing range of motion
Decreasing excessive tension of muscles
Relieving joint stress
Improving musculotendinous junction extensibility
Maintaining normal functional length of muscles
Improving optimum neuromuscular efficiency
Improving function
Preventing injury
Alter MJ. Science of Flexibility, 2nd ed. Champaign, IL: Human Kinetics, 1996.
Chaitow L. Muscle Energy Techniques. New York: Chruchill Livingstone, 1997.
Koutedakis Y, Sharp NCC. The Fit and Healthy Dancer. Chichester: Wiley, 1999
Flexibility
Cardiovascular Conditioning
• Cardiac demands during performances is far
above what would be expected from a
supposedly sedentary activity
• Rehearsals:
• Concerts:
• Soloist:
74-124 beats per minute (bpm)
123-152 bpm
140-164 bpm
Inesta C, Terrados H, Garcia D, Perez JA: Heart rate in professional
musicians. J Occup Med Toxicol 2008;3:16.
Cardiovascular Conditioning
Aerobic Exercise
– Uses oxygen
– Rehearsal only elicits an improvement in aerobic
capacity in a very unfit group of people
• too intermittent in nature
• A rise in heart rate to 70-90% of maximum
heart rate will stress the aerobic system
• 20-40 minutes, 2-3 times a week
Koutedakis Y, Sharp NCC. The Fit and Healthy Dancer. Chichester:
Wiley, 1999