Musicians might not be the most obvious candidates for work-related injuries, but they can suffer many pains and strains, writes MICHELLE McDONAGH
WHEN THE American classical pianist and former child prodigy Leon Fleisher lost the ability to use his right hand at the age of 37 in the mid-1960s, he refused to let his disability hold him back.
He continued to perform and record with his left hand while searching for a cure for his condition. He was eventually diagnosed with focal dystonia, a performance-related injury which caused the muscles of his hand to contract involuntarily.
After many years of rehab, including the use of botox injections and massage, Fleisher regained the ability to play with both hands. In 2004, he released his first album in more than 40 years performed with both hands to critical acclaim. It was aptly titled Two Hands.
By openly discussing their performance-related injuries, Fleisher and his friend and fellow classical pianist, Gary Graffman – who also suffered a neurological problem in his right hand – started a discussion about the physical demands of playing music.
This encouraged the medical community to expand treatment options to provide better care for musicians and the field of performing-arts medicine began to grow.
Galway consultant rheumatologist and musician Dr Ronan Kavanagh had been running an informal clinic for musicians with performance-related musculoskeletal problems for many years in the middle of his busy rheumatology practice without ever actually giving it a name.
“As part of any rheumatology practice, you get people with all sorts of aches and pains. I found myself wanting to spend more time with the musicians because they needed it and having played a bit myself, I have empathy with them, so earlier this year, I decided to set up a dedicated service, the Musicians’ Clinic.”
A keen amateur musician, Kavanagh played keyboards for a number of years with Galway band The Stunning. It is clearly his passion for music and empathy for those who play that motivates him to dedicate the time he does to this clinic every month. Although a private service, it is not a profit-making venture.
He and Dr Juliet Bressan, a medical specialist in performance-arts medicine and musicians’ dystonia at St Vincent’s Hospital in Dublin, recently formed Performing Arts Medicine Ireland, an organisation of healthcare professionals with an interest in the health of musicians.
They are also both members of the British Association of Performing Arts Medicine and the Performing Arts Medicine Association. Bressan has been running a musicians’ clinic at St Vincent’s for a number of years, treating performance-related health problems.
Kavanagh points to a 1988 study of orchestral musicians by Fishbein et al, which found that 76 per cent of musicians reported a medical problem severe enough to negatively affect their playing and force them to take time off. Although an old paper, he says there has probably been no better research done since in this area.
He says that “70 to 80 per cent of musicians will have some sort of musculoskeletal pain and for many, this will be serious enough for them to need to take time off playing which can be a problem as the majority are self-employed.
“This is a group of highly motivated people who have jobs that are physically demanding. Its such a competitive employment market that a lot of musicians tend to stay quiet and play through the pain. There can also be an attitude out there of no pain, no gain.”
Former Blondie drummer Clem Burke has allowed himself to become the guinea pig for research into the physiological demands of rock drumming. Through the Clem Burke Drumming Project in the UK, his live concert performances have been monitored, enabling researchers to map the extraordinary stamina required by professional drummers.
Dr Marcus Smith from the University of Chichester, who conducted the research, says: “Musicians need exceptional stamina to sustain optimum output, especially when on tour. Footballers can normally expect to play 40 to 50 games a year. In one 12-month period, Clem played 90-minute sets at 100 concerts. When you consider the implications of touring on top of the performance requirements for high-profile drummers, it is clear that their fitness levels need to be outstanding.”
While the performance of a cellist or guitarist might not be so obviously physically demanding as that of a drummer, Kavanagh points out that they are still performing highly repetitive tasks quite often in cramped conditions, for example in an orchestra pit.
In his musicians’ clinic, he sees a variety of professional and amateur musicians with a wide range of pain problems including carpal tunnel syndrome, shoulder and elbow pain, finger tendonitis, arthritis and repetitive-strain disorders.
“I see a mix of people. I have had a run of accordion players over the past couple of years for some reason. I have seen fiddlers, guitarists, piano players, a bazooka player, orchestral musicians.
“One of the reasons I hold the clinic outside my regular clinic time is that people can be quite private and, if somebody well known is coming in, they might not want people to know about it.”
Although he would not dream of naming any of his more well-known musician patients, Kavanagh says he treats a wide range “from people who might play in a local session in a pub once a month to musicians at the highest level possible”.
Being a musician himself gives him a unique insight into the mindset of this particular group of patients. He spends time watching his patients playing their instrument and often picks up problems with their posture or the way they are sitting or holding their head which may be contributing to their condition.
“A lot of musicians would not necessarily be aerobically fit and they really need to be in good physical shape to continue playing,” he says. “Awareness of posture is also really important no matter what instrument you play. The standard recommendation is that a musician should take a 10-minute break every hour during rehearsals.”
In terms of medical treatment for performance-related injury in musicians, prevention is the best cure, explains Kavanagh, but there is a lot that can be done. Depending on the problem, the treatment can be as simple as bed rest, icing an inflamed tendon, correcting posture or taking breaks during practice. Other patients may require physiotherapy or medication and, as a last resort, surgery may be recommended.
“The key thing about looking after musicians is that you have to understand that they are different to non-musicians with the same physical complaint. What you or I might be happy with in terms of a level of disease – perhaps a finger that does not bend as much as it used to or a stiff wrist – can be crucial to a musician. It can affect their ability to play to their highest standard or to play at all. The relationship with music goes right back to their childhood, its an integral part of them and how they express themselves. To ask them to give this up is like asking them not to see a member of their family or a loved one ever again.”
For more information, go to musicians clinic.ie, twitter.com/musiciansclinic or tel 091-720095
