Break a leg: performing arts medicine

Helen Barratt takes a look at this undervalued emerging specialty

Playing a musical instrument or treading the boards may not seem hazardous activities, but the range of health problems encountered by performers is surprisingly extensive. Currently, performing arts medicine is not a recognised specialty in the United Kingdom, and, despite the large volume of work, no specialist training is available from either the Royal Colleges or the medical schools. Despite the high profile of similar medical specialties--such as sports medicine--performing arts medicine is only just emerging.

Practitioners working in performing arts medicine deal with any injuries or illnesses stopping performers from reaching or maintaining their potential. Problems can be physical, psychological, or emotional and encompass everything from focal dystonia and voice problems to performance anxiety. The most common injuries are probably musculoskeletal. Performing arts medicine treats all disciplines--musicians, dancers, actors, singers, and comedians.

Performing arts medicine encompasses the expertise of a broad range of practitioners, both conventional and complementary, who offer their services to treat artists. Around half of this register is made up of doctors, including specialists in a broad spectrum of fields, and the remainder includes physiotherapists, psychologists, counsellors, technique and adaptation experts, voice coaches, and a variety of treatment specialists.

Eileen Quilter Williams is the general administrator for the British Performing Arts Medicine Trust (see box). She says, "Dancers, whether in West End shows or the Royal Ballet; singers, whether Glynebourne or Top of the Pops; musicians, whether the City of Birmingham Symphony or the Electric Light Orchestra, all earn their living because of the fitness of their bodies. They provide entertainment and excitement, but only if their legs work, their voice is in good order, and their head, eyes, ears, and limbs are not just sound but at the peak of fitness, both physically and psychologically. Everybody in this country has a GP, but GPs cannot devote the time necessary to research and understand the implications of illness and injury on performance. Whether or not you have to be on stage giving a performance at 7 30 that evening is going to have a significant bearing on whether the instruction, 'Rest it.' really solves the problem or not."

Williams is keen to start working at the grass roots level towards preventing the conditions which commonly affect performing artists, by getting alongside students in teaching establishments such as performing arts schools and the conservatoires. She also feels that there is an urgent need to raise the profile of performing arts to doctors and medical students: "In the UK it is not really challenged that sports medicine is a very distinct field of expertise, yet there is still a reluctance to see that performing arts medicine has a real parallel. Performing arts is not seen as a needy profession and might even be considered as a luxury item."

Any doctor, at any career level with an interest in addressing the problems faced by performing artists should join the British Association of Performing Arts Medicine's register of practitioners. In addition to specialists in fields such as orthopaedics; rheumatology; and ear, nose, and throat medicine, generalists are always needed.

Britain traditionally has a reputation for producing some of the best performing artists in the world, but support for performers and their health still lags behind systems in other countries. The British Performing Arts Medicine Trust receives no state support and is entirely dependent on volunteers, supporters, and the funding it receives from artistic organisations. In an age when employers are bound to look after the health of their employees, hundreds of artists in the United Kingdom are forced to live with health problems that may even be career threatening; these problems are not tackled because of the lack of specialist care available. Maybe it's time the medical profession redressed this balance.

Some background on the trust

The only provider of specialist healthcare to performing artists in the United Kingdom is the British Performing Arts Medicine Trust. It is a recognised charity and was founded in 1987. The trust's aims are to help performers with health problems and to undertake research into the particular conditions affecting artists. Given the lack of formal training available, the trust also provides courses to enable those doctors who are interested in the performing arts to branch out from their normal work and gain the skills they need.

Based on Shaftesbury Avenue in the heart of London's theatre land, the British Performing Arts Medicine Trust also runs a telephone help line for performers, as well as a monthly clinic at the Manchester Royal Infirmary. Initial contact is made by the patient or their general practitioner and an appointment is arranged with a doctor experienced in working with performers at the trust's London clinic.

The clinic is staffed by doctors working for the public good and the initial assessment is free to the patient. This is to reach an accurate diagnosis of the problem then to help the performing artist obtain the most appropriate help. Patients are frequently referred to the trust for an expert second opinion; many are also able to receive expert opinions at a reduced rate negotiated by the trust. Many can then be referred back to their own general practitioner and the NHS, but some are referred on to one of the specialists on the trust's register.

In general, each consultant sees patients referred by the trust once a month, and the trust's general practitioners work in the clinic one day a month; some also make themselves available to see urgent cases. The only requirement to be seen by one of the doctors is that a person is a professional, semiprofessional, or student performer.

The trust is also responsible for administrating the Association for Medical Advisors to British Orchestras, a network of 20 doctors providing medical treatment to nearly all the leading orchestras in the United Kingdom. This scheme has been in operation for about 13 years and is run on a similar basis to the provision of medical care to professional sports teams. The doctors are all volunteers and work entirely for the players, having no responsibility to the orchestral management. Some travel with the orchestra, some attend rehearsals, and others are available when necessary for players to consult.

Registration with the trust is free for all clinicians; the only documentation required by the trust is a certificate of accreditation and proof of insurance status. The British Performing Arts Medicine Trust runs twice yearly training courses for its doctors covering topics, both general and specific, relating to performing arts medicine.

The trust also welcomes medical students, and, for those with an interest in the performing arts, this can provide a gateway to a wealth of medical knowledge which is not available elsewhere. Although the meetings are aimed at doctors, they are accessible to students. As well as being informative, the sessions help to provide a different perspective on health and well being. Interested students may be welcome to sit in on clinics and help with research and audit projects.

Helen Barratt, fourth year medical student, Imperial College of Science, Technology, and Medicine, London
Email: helen.barratt@ic.ac.uk


studentBMJ 2002;10:397-440 November ISSN 0966-6494