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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:

o Tendinitis
o Sprains
o Muscle strains
o Repetitive motion disorders, including carpal tunnel syndrome
o Myofascial, neck, and back pain
o Dystonias
o 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 isnt
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.