Performing Arts Medicine: Current Trends in Treating the String Musician

1. Performing Arts Medicine: Current Trends in Treating the String Musician Eric N. Bengtson, MA, LAT, ATC, PES, CPT Coordinator of Performing Arts Medicine

2. Outline • Introduction • Medical Needs • Performing Arts MedicineOverview • Injuries • Anatomy • Recommendations • Performing Arts Medicine at App State

3. Demographics The audience The presenter

4. Introduction String oriented presentation The human body is consistent

5. “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 PhysTher 17:90-95, 1993

6. Performing Artist and Traditional Athlete • 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 activity-oriented, overuse injuries Quarrier NF. Performing Arts Medicine: The Musical Athlete. J Orthop Sports PhysTher 17:90-95, 1993 Elbaum L: Musculoskeletal problems of instrumental musicians. J Orthop Sports PhysTher 8:285-287, 1986

7. Fatigue Adaptive Patterns Pain / Injury Poor Technique Quarrier NF. Performing Arts Medicine: The Musical Athlete. J Orthop Sports PhysTher 17:90-95, 1993

8. Pain is a symptom, not a diagnosis.

9. Not Seeking Medical Care Brandfonbrener A: Performing arts medicine: an evolving specialty. Music Educators J 77:37-41, 1991 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

10. 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

11. Psychological Influence of Injury 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 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

12. 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

13. Performing Arts Medical Association • Founded in 1989 • www.artsmed.org • International Association of Dance Medicine & Science • Founded in 1990 • www.iadms.org

14. 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

15. Supplementary Fitness General training principles Fatigue Muscular strength and endurance Flexibility Cardiovascular fitness

16. Supplementary Fitness 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. KrasnowDH, Chatfield SJ. Dance science and the technique class. Impulse. 1996;4:162-72. 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

17. General Training Principles • “SAID” principle • 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

18. Fatigue 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 • Supplemental exercise when done correctly has the ability to slow fatigue • Except after exercise • Fatigue leads to more errors when playing

19. Strength & Muscular Endurance Clark MA, Lucett SC, Corn RJ. National Academy of Sports Medicine: Essentials of Personal Fitness Training. Baltimore: Lippincott Williams & Wilkins, 2008. Print. • 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

20. 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. 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

21. 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. 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%

23. Flexibility Alter MJ. Science of Flexibility, 2nd ed. Champaign, IL: Human Kinetics, 1996. Chaitow L. Muscle Energy Techniques. New York: Chruchill Livingstone, 1997. KoutedakisY, Sharp NCC. The Fit and Healthy Dancer. Chichester: Wiley, 1999 • Important element of physical fitness. Is used for: • 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

24. Flexibility

25. Cardiovascular Conditioning Inesta C, Terrados H, Garcia D, Perez JA: Heart rate in professional musicians. J Occup Med Toxicol 2008;3:16. Cardiac demands during performances is far above what would be expected from a supposedly sedentary activity Rehearsals: 74-124 beats per minute(bpm) Concerts: 123-152 bpm Soloist: 140-164 bpm

26. Cardiovascular Conditioning Koutedakis Y, Sharp NCC. The Fit and Healthy Dancer. Chichester: Wiley, 1999 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