Transcription:
Avoiding Painful Performing Arts Injuries

Melanie Cole (Host):  Not every ache is an injury and some minor aches and pains are normal and usually lessen once the muscles are warm. However, when you’re in the performing arts, the injuries can be quite unique. My guest today is Dr. Paul Schaefer. He’s a Sports Medicine Physician with experience in the care of performing artists at the Performing Arts Medicine Clinic of the Courage Kenney Rehabilitation Institute. Welcome to the show, Dr. Schaefer. What are some of these kind of unique injuries that people in performing arts might be susceptible to?

Dr. Paul Schaefer (Guest):  Hi, Melanie. It’s really great to have a chance to talk about this with you. Thanks for this opportunity. When people ask me, “What are typical injuries in the performing arts?” I first like to explain that just like other athletes, people in the performing arts experience a range of injuries that are common to everyone who’s active. So, ankle sprains, wrist tendonitis, shoulder pain, back pain, these are all common things that we treat in a sports medicine practice but are also seen amongst our performing artists. I think what’s unique to the performing arts, however, is the tendency for performing artists to be spending hours and hours working their bodies in similar repetitive motions so that performing artists tend to be more susceptible to problems with overuse injury. A lot of times the overuse injuries present to us as a spectrum of problems. So, it isn’t someone coming into a sports medicine practice saying “I have elbow pain” and that turns out to be lateral epicondylitis, which is tennis elbow. Contrary to that it may be a cellist who comes in and says, “I have elbow pain but it really radiates into my wrist and, boy, my thumb hurts when I hold the bow” and “I’ve got a lot of shoulder pain”. So, when we look at overuse injuries we have to put all of this together and try to explain it in terms of the work that they do and the motions that they’re going through as part of their practice and performance.

Melanie:  We’re going to talk about possible prevention and treatment but tell us a little bit about your personal experience with performing artists and why you’re so committed as a physician to working with this unique group of patients.

Dr. Schaefer:  This is a population of patients who are very important to me and I self-identify with them. At a young age, I began piano lessons and was quite active with that. I spent a lot of time practicing and then performing as I got older and then moved into other areas, as many people do who are in the arts. I played trombone both in a classical setting but also in jazz ensembles. From there, I began to sing and ultimately became a choral conductor. So, I’ve had an opportunity to experience music in a variety of settings, both as an instrumental musician but also as a vocalist, and then, finally, as a conductor.

Melanie:  Because these artists, as you say, have to do these repetitive motion, with athletes we can recommend they take the season off or they change sports during off season or they cross train, we can’t really recommend the same for a performing artist as you said a cellist that has to do just that exact motion for their career. What do you tell them about this repetitive motion and how they can try to avoid some of these injuries?

Dr. Schaefer:  I think it’s such a great question. I would say, there is a lot of overlap in our care of athletes. Often we will see athletes who are mid-season and it’s important to them and it’s important to us to keep them active and participating in their sport. With an athlete, we make appropriate modifications whenever possible. Sometimes we can’t do that. If someone has a fracture, of course, they have to be pulled out and immobilized until we can heal the fracture and then we return them to the sport. That’s similar with our performing artists. Oftentimes, as you’ve well stated, a performing artist is committed to a number of engagements over the next several months. This happens even at the high school level. Oftentimes there are recitals and auditions and juries and concerts that they have to get ready to participate in. If they can’t play, it impacts them. It impacts maybe their potential for auditions down the road but it also impacts the ensembles that are counting on them to be ready and to perform at a high level. As musicians go further in the profession then it becomes even more critical that they stay healthy. So, with regard to the question of overuse injury, we look at ways to modify so that we can keep them participating even if it’s at a very reduced level of participation. Sometimes people come in and with so much pain that we really have to cut them down to maybe five minutes of practice maybe two or three times a day but it’s important to continue that playing in a safe way so that we can move them more quickly back to a higher level of participation. From there, it’s very important to get an accurate diagnosis. Oftentimes, symptoms present in ways that could be explained by a variety of different diagnoses. We really try to get to the heart of what we think is underlying from the symptoms that the patient is experiencing. Once we understand that, then we can really move forward in a targeted approach for therapy. Now at the Courage Kenney Rehabilitation Institute, we are really fortunate to be working with hand therapists and physical therapists who have a true love of performing artists. These are therapists who have done additional training in the care of instrumental athletes--and that’s the term I prefer to use with our musician--as well as with dancers and gymnasts and figure skaters – those who are using their body in a performing type of activity. They understand the particular stresses that are placed on the body as well as the unique instruments and tools that are used in their trade and the particular styles that they have to do to perform in the way that they’ve been trained to perform. An example would be a violinist who makes certain movements with the upper arm in terms of bowing or it could be a guitarist who’s having a lot of pain when she is trying to finger the strings on the guitar. Our therapists understand this. They have tremendous insight into what typically causes pain. We will guide from the diagnosis what that therapy should look like and get them to people who really understand our performing artist patients.

Melanie:  Well, it certainly is interesting that they’re like an athlete that’s involved in a year-round sport. They don’t get the season off as you say because they are auditioning and constantly performing and, not only individually, but with a group. So, there are other people depending on them. It can go on all year and all the time. Give us some of the tips that you like to offer some of these artists that can help just a little bit.

Dr. Schaefer:  That’s a really great question. I think number one, self-care is very important. Life can be very stressful for all of us and if other stresses are coming into play, either emotional stresses or physical stresses, that can really limit the activities that are important to us. In this case, I’m referring to practicing and participating in performing arts events, concerts or preparing for auditions. So, making sure that someone is getting adequate sleep, is receiving proper nutrition, and is dealing with outside stresses in a healthy way so that they can continue to function at a high level is important. These things are fundamental, I think, for everybody but especially when you’re trying to perform at a high level, anything that is becoming a stress from the outside can really drag down someone’s ability to continue to perform. Secondly, we are very conscious about how much practice is occurring without breaks. In general, we say that performing artists should not practice longer than about 45 minutes without taking a substantial break. By substantial, I mean at least 5 to 10 minutes to get up, walk around, take a drink of water, stretch a little bit, think about something else and then come back. Another tip would be not to overwork a particular skill or a particular passage of music. That can be a pitfall for people who are working on a difficult area. What you want to do is figure out, in terms of your practice, what is giving you trouble, work on that and address it for a short period of time but then move onto something else before it becomes a hindrance to you and can lead to the development of chronic pain.

Melanie:  So fascinating. These are such great tips. How about some tips about finding a good teacher that understands what you’re discussing and can help them to further their performing arts while hoping and helping them to prevent some of these injuries.

Dr. Schaefer:  I think that finding a teacher who is well-suited to a child in the performing arts is really absolutely crucial. In the first couple of years, you want to have a teacher who helps a child to experience the fun of whatever performing activity their involved in. So, finding teachers who are experienced with younger children, who offer a variety of styles with regard to the teaching, who get them into many different types of activities related to the particular instrument or activity, such as skating or gymnastics. Initially, you want children to have a lot of fun and to develop the basic skillset and then from there, as children express an interest in continuing and moving forward, then you’re starting to look for a teacher who has significant experience as a performer, who understands the skills and the requirements for the particular instrument or whatever other participation they’re involved in. There’s a trap that sometimes parents find themselves in and that’s trying to seek out a teacher who is most known as a performer. I often recommend to people to first look for someone who is well-known as a teacher. That’s really fundamental because the skills that make someone a top performer do not always translate well to making someone an excellent teacher. Oftentimes there is overlap but they are unique skillsets. So, you want to find someone who has a reputation as a teacher, who is patient with their students, whose students have done well in past events. It might be juries or auditions or other performing opportunities. It just takes time and sometimes it takes trial and error. A lot of discussion with other parents whose students are involved in the performing arts can be helpful. Attending performances from the students of particular teachers can be helpful. It really takes in investment of time and energy to get to the point of feeling comfortable with a student’s teacher.

Melanie:  What a great topic and you’re so well spoken. I applaud all the great work that you’re doing for these artists. Thank you so much for being with us Dr. Schaefer. You’re listening to The WELLcast with Allina Health. For more information you can go to allinahealth.org. That’s allinahealth.org. This is Melanie Cole. Thanks so much for listening.