Performing Artists as Athletes: A New Perspective

1. Performing Artists as Athletes: A New Perspective • Evan D. Collins, M.D. • Center for Orthopedic surgery • The Methodist Hospital • Houston, Texas 1

2. Introduction • Musculoskeletal injuries were reported by greater than 50% of the 264,000 employed Musicians in 2006 • National survey of orchestral musicians 76% of the respondents had to take time off from performing because of injury during their career 2

3. Introduction • Common injuries reported: • Persistent pain in the extremity • Loss of facility • Loss of endurance • Loss of strength • Common diagnosis: • Overuse syndrome • Repetitive stress • Myofascial pain • Tendonitis 3

4. Introduction • Recent review of Playing-Related Musculoskeletal Disorders (PRMD) indicated a 35% prevalence of recurrent problems despite treatment • Approximately 1/3 of musicians require multiple visits to medical providers 4

5. Introduction • No consensus on effective treatment • No outcome data regarding treatment modalities • Patient satisfaction 5

6. Introduction • Questions: • Why is it so difficult to effectively treat? • What can we do differently to improve this problem for performing artists? 6

7. Approach • Traditional Medical dogma • People seek medical attention when something hurts • People seek medical attention when things don’t work • Medical treatment applies scientific approach • Assumes that identifying the change from normal, and then correcting it, will alleviate the problem 7

8. Introduction • Consider the type of problem the patient has • Categories • Mechanical - broken, torn or compressed • Biological - infections or disease 8

9. Mechanical • Examples • X-ray of broken humerus 9

10. Mechanical • Repair of torn biceps tendon 10

11. Mechanical • Ulnar nerve decompression surgery 11

12. Biological • Rheumatoid arthritis, cancer, bone cyst 12

13. Additional Category • Capacity problem: • All constructs have a defined “capacity” to perform work • When you exceed the ability for a construct to perform work - “exceed capacity” • Result is break down • The majority fall into this category • Repetitive stress • Over-use syndrome • Chronic Fatigue syndromes • Tendonitis • Bursitis 13

14. Science of Capacity • Musculoskeletal system principle material is collagen • Collagen cross linkage • Strength dependent on amount of cross-linkages 14

15. Science of Capacity • Stress increase cross linkage between collagen fibers decrease weakening the construct • Exceed capacity, failure occurs 15

16. Capacity • Lateral Epicondyltits (Tennis elbow) • Pathology - Tendon fails after repetitive use • Most people never played tennis • Occurs between ages adults 30-65 16

17. After Before Capacity • Treatments • Rest, injections, splinting, physical therapy • Surgery 17

18. Capacity • Considering these musculoskeletal problems as a lack of capacity, can we apply this in a more efficacious way for the performing artist? • How does this apply to athletes, and relate to the performingartist? 18

19. Capacity • A Football play lasts on average 3.5 - 5.5 sec for sixty minutes • Time from a pitch to completed out is less then 6 sec repeated until 27 outs have been recorded • Soccer match has two 45 min halves 19

20. Capacity • Opera – Some can last as long as 4 hours with one intermission • Ballet – Nutcracker • Symphony - Two hours with one intermission 20

21. Capacity • Athletes train to achieve peak performance • Athletes train to prevent injuries • Athletes train to increase their capacity to do work 21

22. Capacity • Performing artists • Musicians - PRACTICE • Ballet performers - REHEARSE 22

23. Capacity • Energy used during a performance • Violinist can burn over 700 calories per hour equivalent to 40 minutes on a treadmill with average heart rate of 140 bpm 23

24. Capacity • The athlete trains to increase his/her capacity • Why not a performing artist? 24

25. Treatment • Example: • Rule out biological and mechanical problems first • Identify capacity problems • Corrected with physical therapy, core strengthening, and training specific to that performer 25

26. Treatment • Therapy • Examples 26

27. Prevention • Easier to prevent then to treat • Artist and their environment may have to change 27

28. Conclusion • Performing artist rehearse to perform • Performing artists should also train to perform • Doing both may decrease injuries, enhance recovery and prolong careers 28

29. Thank You For more information contact: 713-441-3535 or www.drevancollinsm.com 29