BAPAM Presentations at the Performing Arts Medicine Association Symposium 2021

BAPAM was very well represented at the PAMA symposium this year with no less than 6 presentations by BAPAM Practitioners and staff.

Health Promotion

Claire Cordeaux (BAPAM CEO) and Dr Pippa Wheble (GP Assessor and Trainer/Facilitator of our online Community Drop In series) spoke separately about health promotion initiatives at BAPAM. With online sessions offering improved access to health promotion and a significant audience of locked down performing arts professionals with no work, BAPAM was able to deliver online training, mentoring and peer support to nearly 3500 people over the last year.

Claire focused on the development of health education interventions timed to correspond with touring (2019) and the pandemic (2020), using the literature of behaviour change which shows that significant events, or transition points, present an opportunity for individuals to review healthy behaviours. Using a “healthy practice checklist” which was transformed into a “healthy practice diary” during COVID, artists were encouraged to review their own health, and to set goals and access ongoing support and training to adopt healthy routines. Whilst qualitative feedback was positive, BAPAM was also able to measure the number of participants who subsequently accessed health services because they had identified a health problem which needed intervention. 25% of the touring cohort and 40% of the COVID cohort made an appointment with a health professional.

Pippa described her work with the Community Drop In as a means of embedding healthy practice through online peer support. She highlighted how, as mastery as an artist requires technical skills and resilience, the same is true in maintaining physical health and mental wellbeing. The Community Drop In consists of weekly online sessions, aimed at promoting physical and mental health practices to support performing artists during the covid-19 lockdown. The weekly sessions introduced new practices including meditation, stretching, anxiety management, mental skills, Pilates and much more. The sessions provided space for group discussion and peer support addressing physical and mental health and barriers to change. Many performers had lost motivation, hadn’t picked up their instrument, experienced a loss of creative space and many were experiencing high levels of stress.

Participants were encouraged to complete a Warwick-Edinburgh Mental Well-Being Score (WEMWBS) and the Music Quick Dash score which measures physical wellbeing, at the start and end of their participation in the group. The following scores were collected:

Qualitative responses show how participants valued this:

A Multidisciplinary Pianist’s Clinic 

Mark Phillips (BAPAM Clinician and Hand Surgeon) and Penelope Roskell (Professor of Piano) described their joint clinic for pianists who have a long standing health problem, highlighting some interesting case studies. Patients attend the clinic as a result of a referral from either Mark or Penelope. The clinic shifted to online over COVID which has made it cheaper and more accessible. Penelope advises educators interested in this approach to have some understanding of anatomy and to work within a clinical governance framework. It is a very different environment to a teaching environment, and BAPAM requires teachers to sign a BAPAM Code of Practice for Educators. Both parties described how mutual respect for each other and the pianist is important. There is a potential conflict with the regular teacher, and this has been overcome by inviting them into the session. Mark also described the risk of giving advice beyond your individual area of expertise. The success of the project has expanded into work with violinists, guitarists, cellists and other instruments using the same principles, and inviting other clinical practitioners (hand therapists for example). Penelope and Mark have also set up a group for pianists with focal dystonia.

Risk and Occupational Hazards

Dr Naomi Brecker (Consultant Occupational Physician) and Dr Finola Ryan (Occupational Medicine Specialist Registrar) ran a workshop which considered occupational hazards for performing arts workers including light, sound, temperature, make up, costume, stage fog, COVID, instrument & character postures, equipment use, touring, financial, antisocial hours, working at heights and young performers. The sessions also looked at risk assessment tools both for hearing conservation and for freelancers returning to work environments during COVID. A future post will explore these sessions further.

A Health Lesson from the Performing Arts: How Clinicians can Perform Better

BAPAM’s musculoskeletal clinicians Dr Hara Trouli and Mr Nikos Reissis, together with young surgical trainee Dr Markos Reissis, demonstrated how the results of their literature search have revealed common ground of training and performing between clinical practitioners and performing artists. These similarities can spark new educational and technical skill approaches with extended cultural and humanitarian benefits. At a time when the clinical professions as well as the performing arts are practised under social and health challenges, a mutual collaboration can have a long-lasting effect on the physical and mental health preservation for both professions.

Tuning up the Body: Warming Up and Cooling Down for Musicians

BAPAM Physiotherapist, Lucie Rayner‘s workshop explored practical examples of appropriate neuromusculoskeletal warm-up and cool-down protocols for instrumental musicians, examining the underlying theoretical principles behind them. Musicians would benefit from viewing themselves as ‘Musician Athletes’ and managing their physical health accordingly. This should include integrating appropriate physical preparation and post-playing regimes into their habitual practice.

There is some evidence that warm-up routines are an effective component of injury prevention and may help to optimise practice and performance. However, musicians often neglect to warm-up in preparation for playing, and prioritise tuning up their instrument rather than their own body. Musicians may also benefit from performing a cool-down routine following practice or performance. There is currently a lack of specific evidence regarding the role of a cool-down for instrumental musicians. However, we can apply knowledge gained from research in the fields of Sports and Occupational Medicine to guide this element of healthy practice. Some musicians may already recognise the importance of warming up and cooling down, but may need guidance on structure, duration, intensity, and type of exercises most appropriate to precede or conclude their playing.

Lucie’s workshop covered the proposed mechanisms and benefits of warming including:

• Increased blood flow and oxygen delivery
• Increased muscle temperature and metabolism
• Enhanced motor control and accuracy through pre-activation of neural pathways
• Increased muscle-tendon suppleness and joint range of movement
• Improved focus, attention, and awareness
• Supporting the transition to a creative mindset

The cool-down period is to promote recovery and allow the body to return to baseline function. In addition, it enables the musician to reduce muscle tension resulting from prolonged static loading, helps prevent muscle imbalances linked with asymmetrical playing positions, and supports healthy posture. It may also be an opportunity for self-reflection, evaluating practice, and consolidating learning.