Performing Arts Injuries
Professional and amateur musicians, dancers, and other performing artists often confront injuries and conditions related to the instrument they play, the dance performed or their chosen arts medium. These injuries and conditions include:
- Muscle strains
- Repetitive motion disorders, including carpal tunnel syndrome
- Myofascial, neck, and back pain
- Other musculoskeletal, orthopedic, and neurologic conditions
It is not uncommon for instrumental musicians to complain of with pain, numbness, tingling, or incoordination of the upper extremities, shoulders, or neck. Performers, such as dancers and actors, are more predisposed to serious injury due to overuse and repetition in their legs and back.
String musicians, pianists, and wind players often suffer from overuse injury (tendonitis, ligamentous sprains or muscle strains), nerve entrapment (ulnar nerve at the elbow, carpal tunnel syndrome), neck and shoulder pain, thoracic outlet syndrome, and focal dystonias. Dancers are in general very flexible. While this improves their lines for performance it also predisposes them to musculoskeletal and orthopedic conditions of the lower extremity (most commonly the foot and ankle, hip and knees).
Incorrect posture, non-ergonomic technique, excessive force, overuse, stress, and insufficient rest contribute to chronic injuries that can cause great pain, disability, and the end of careers. Because an injury represents more then just an ache or pain to the performing artist, they are notoriously hard to persuade to reduce or stop their playing to allow injuries to heal.
Worse yet, even if a rest period is tried, symptoms can promptly reappear upon restarting the activity. At the same time the “No Pain, No Gain” is a disastrous policy for a dancer or musician. If it hurts you should not perform through the pain. In general musicians often need to reduce force, find postures that keep joints in the middle of their range of motion, use larger muscle groups when possible, and reduce fixed, tensed positions.
There are plenty of self help techniques that can be tried. Examples include a warm up and cool down period before and after the performance, momentary breaks to stretch and relax, adjustments in playing or dance technique and modifications to foot gear, string tension or reed selection.
If symptoms do not resolve within a few weeks there is no point in performing past the pain. Receiving professional help early on can make a big difference. If getting well isn’t motivation enough then hoping to avoid dystonia, an uncontrollable firing of muscle groups, should be. This is a not uncommon, severe ailment that occurs in performing artists. It is very difficult to fix and can be disabling. Treatment for this almost always includes sedating medication and injection with botulinum (a weakened form of botulism).
In typical cases muscle re-education of what is inhibited, stretching what is tight, followed by strengthening what is weak can be quite helpful. In more involved cases formal testing for nerve entrapment (with EMG/NCV studies), tendonitis or ligamentous strain (with Diagnostic Musculoskeletal Ultrasound) is required. Other structural abnormalities (such as muscle belly hernias) may require the use of MRI. In special situations Thermography can be used to evaluate for abnormalities in blood flow associated with weather sensitivity.
Fortunately there are numerous treatment options. Special injections that regrow ligament (prolotherapy), procedures that reattach tendon without having to go the operating room (percutaneous tenotomy) and medications that both reduce inflammation and improve blood flow exist. Restorative therapies (PT and OT) are often quite helpful as well. Less commonly, more difficult cases may require surgery. New advances are always being made. With proper care the vast majority of performing artists continue to enjoy the passion of their life.