Hitting the right medical notes


Performing arts medicine, although relatively new in Ireland, has been developing as a medical specialty in the US and UK for a number of decades

“It was absolutely desolate, desolate, since the age of four this was it for me and suddenly I couldn’t do it. The gods know where to hit you, when they want to hit you.”

THIS WAS how world-renowned pianist and conductor Leon Fleisher described the experience of developing focal dystonia, a neurological condition that in Fleisher’s case caused the fourth and fifth fingers of his right hand to curl under, rendering him unable to play the piano with two hands for more than 30 years.

Fleisher’s story, as told by the director Nathaniel Kahn in his moving documentary Two Hands, shows just how devastating a condition like dystonia can be for a musician.

Dystonia was one of a number of physical conditions that can significantly affect a musician’s health and their ability to perform that was discussed at Ireland’s first International Conference of Performing Arts Medicine.

The conference, which took place in Galway on Saturday, October 13th, also featured a special showing of Two Hands, with the kind permission of Kahn.

Entitled Musicians Health 2012 – Keeping the Show on the Road, the Galway event saw a packed programme of talks and presentations by international experts in performing arts medicine and professional musicians.

Dr Mike Shipley, consultant rheumatologist, with the British Association for Performing Arts Medicine (BAPAM), spoke on managing upper limb pain in musicians and Dr John Chong, president of the Performing Arts Medicine Association in the US, delivered the keynote address entitled: Tuning the mind and body of the musician for optimal health and performance.

Rather uniquely for a medical conference, the programme was interspersed with live musical performances and interludes with musician “patients” telling their stories of how physical injury has affected their ability to perform.

Enda Scahill, Banjo player with We Banjo 3, described his experience of repetitive strain injury, after which the audience was treated to a live performance by the banjo-playing trio.

Former drummer with the Sawdoctors, Johnny Donnelly, also addressed the conference and gave a drummer’s perspective on musician injury.

Much like sports medicine where doctors have developed special expertise in caring for athletes and treating sports-related injuries, doctors working in performing arts medicine are dedicated to caring for and treating musicians and other performers.

Although relatively new in Ireland, performing arts medicine has been developing as a medical specialty in the US and the UK for a number of decades. The British Association for Performing Arts Medicine (BAPAM) for example, delivers specialist health advice and support to professional and student performing artists and has also developed an MSc in the specialty at University College London.

Dr Ronan Kavanagh is a consultant rheumatologist who runs a musicians’ clinic in Galway. He provides medical care and advice to musicians with musculoskeletal problems that affect their ability to play their instruments to their true potential.

Together with Dublin GP Dr Juliet Bressan, Kavanagh established Performing Arts Medicine Ireland and both doctors were responsible for staging the Galway conference.

The event attracted up to 80 delegates from a wide range of medical specialties including general practice, neurology, oncology and gastroenterology. Other health professionals such as physiotherapists and psychologists were also in attendance.

According to Kavanagh, the multidisciplinarity of the event was testament to the fact that performing arts medicine spans a great number of different specialties. He said this was obvious from watching a musical performance, which in itself can involve a number of different parts of the brain and the body.

Jennie Morton, an osteopath with BAPAM, gave a workshop for doctors on how they should perform a physical assessment of a musician and Kavanagh said she encouraged doctors to think about the importance of the interface between the patient and their instrument, and to examine musicians while they were actually playing.

“So much of it is very fundamental and simple but you don’t actually think about it until you see them playing. Their standing posture, the height at which they hold their shoulder, the angle at which they might hold their wrist when they are playing the violin for example,” Kavanagh said.

According to Kavanagh, musicians can suffer from a range of different physical problems such as musculoskeletal difficulties as a result of bad posture. These can result in repetitive strain injuries, upper limb problems, carpal tunnel syndrome, shoulder and elbow pain, finger tendonitis, arthritis, repetitive strain disorders and other painful conditions. Some can be so serious that they can end a career.

He also said that in his clinic in Galway he has seen “a run of . . . older accordion players”.

“It is a big heavy instrument and you are bent over it . . . so it is an instrument that lends itself to problems with the neck, the low back and injuries to the tendons around the wrist and the elbows. It is a physically demanding process . . . you are doing something repetitively for long periods of time.

“If you were a professional athlete, you would have a whole team of people surrounding you or certainly you would be building up your aerobic fitness and preparing yourself in a very particular way to perform at a specific event. Whereas musicians don’t really have that background and they don’t have that support network,” he said.

Kavanagh said it was important for musicians to be fit and have a good awareness of their posture when playing as well as the importance of stretching and warming up.

“Anyone who is even a regular jogger would know the importance of these things to avoid injury . . . but it doesn’t dawn on a lot of musicians,” he added.

Like Kavanagh, Bressan is keen to further develop performing arts medicine in Ireland and said it would “be wonderful” if Irish universities or post graduate medical training bodies developed training or an academic programme in the specialty.

As well as caring for professional musicians, Bressan said she would also like to see such a programme support music students to look after their health and wellbeing.