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Overuse of muscles, knee and back strains and collisions: Why musicians and dancers need specialised treatment

Dancers, musicians and vocalists are at higher risk of certain injuries and require unique healthcare and management, explains Changi General Hospital’s Dr Mandy Zhang

Stretching is a good way for artists and athletes to prevent performance injuries. PHOTO: GETTY IMAGES

They look and sound good on stage and are able to wow audiences because of the long hours they’ve put into honing their craft. But all that intensive training can take a heavy toll on performers’ bodies, sometimes resulting in injuries requiring specific management. 

To cater to the unique healthcare needs of performing artists, Changi General Hospital (CGH) launched its Performing Arts Medicine initiative last December, with a Performing Arts Medicine Clinic at the Singapore Sport & Exercise Medicine Centre (SSMC) @ Novena.

The clinic is led by a multidisciplinary team of professionals to address the health and wellness needs of performing artists at all levels through comprehensive evaluation, injury prevention, treatment, rehabilitation, wellness and education on body mechanics and posture.

Dr Mandy Zhang, a consultant at Changi General Hospital’s Department of Sport and Exercise Medicine, explains how this field of healthcare is catered to performing artists. She will also be speaking at the Medicine + Sports Conference on Sept 1 at MEDICAL FAIR ASIA 2022, which runs from Aug 31 to Sept 2 at Marina Bay Sands, Singapore.

What is performing arts medicine?

Performing arts medicine caters to the unique health needs that are specific to performing artists such as dancers, instrumentalists and vocalists. 

These performing artists are exceptional individuals who have distinctive traits of both athletes and artists. 

Vocalists can prevent injuries to the vocal cords through proper warm ups and speech therapy. PHOTO: GETTY IMAGES

As they undergo intensive and extensive training for performances and competitions, they are at higher risk of sustaining injuries from overuse of the same muscles and joints through repetitive movements. 

What sort of sports or performance activities are considered more high-risk?

High-risk sports or performance activities are those that have a high cardiovascular load, and are performed at high intensity. 

They are also activities that pose significant risk to the person due to bodily collision, either between performers, or between the performer and the ground.

What are the injuries that performers are susceptible to?

Dancers experience high training loads due to repetitive movements, while musicians develop their complex psychomotor skills over the years. 

Both are prone to extreme bodily stress and strain, and face anxiety and mental health issues at times. 

Dancers are at higher risk of foot and ankle injuries. PHOTO: GETTY IMAGES

The prevalence of dance-related musculoskeletal injuries, usually due to overuse, is as high as 84 per cent in dancers, while lifetime prevalence of playing-related musculoskeletal disorder in musicians is reported to be between 62 and 93 per cent, according to international research studies.

Another study, which surveyed dancers in Singapore in 2017, found that about half out of the 365 dancers surveyed had dance-related injuries to the foot,ankle, knee and back. Of the injured, less than half sought medical attention.

On the other hand, musicians are prone to upper limb injuries relating to their shoulders, wrists and fingers.

Musicians have to watch out for overuse strains in their wrists and fingers. PHOTO: GETTY IMAGES

For vocalists, laryngitis, vocal cord hemorrhages and polyps are common acute injuries that may occur. Vocalists may also experience hoarseness and have poor vocal endurance that can interfere with the quality and clarity of their voice.

A performer can also be affected by a variety of ear, nose and throat disorders, which can include hearing loss, tinnitus, sinus disease and swallowing problems. 

What form of rehab is recommended for such injuries?

The type of rehabilitation prescribed will be specific to the patient’s needs. Physical therapy is useful in restoring joint movement, strength and stability, and pain is reduced via targeted exercise. 

Physical therapy and targeted exercise help reduce the strain from performance injuries. PHOTO: GETTY IMAGES

Hand occupational therapy works on improving fine motor skills in the upper extremities including the shoulder, elbow, forearm, wrist and hand. Rehabilitation aids include customised splints. 

Speech therapy provides education on preventive measures and direct voice treatment which may involve altering pitch, loudness, or breath support for good voicing quality. 

Voice-related computer programmes can also be used to provide feedback and help patients achieve their goals.

How can these injuries be prevented?

One of the best ways for performing artists to prevent injury is to increase self-awareness of their body’s posture in movement, sitting and standing. 

Other techniques include incorporating warm up and cool down exercises, taking momentary breaks to stretch and relax, ensuring good strength and conditioning, following a healthy diet with good hydration and adequate macronutrients like carbohydrates and protein, as well as being mindful of the body’s response to pain. 

Hydrating well and having a balanced diet help keep our bodies in optimum condition. PHOTO: GETTY IMAGES

Having the mentality of “no pain, no gain” is a misconception that increases the risk of injuries. Instead, embrace a “no pain, more gain” approach. 

Developing self-awareness and cultivating good habits like allowing your body time to rest will mean no pain from injury and no setback in your training, thus taking you further.

Dr Mandy Zhang will be speaking at the Medicine + Sports Conference on Sept 1 at MEDICAL FAIR ASIA 2022, which runs from Aug 31 to Sept 2 at Marina Bay Sands, Singapore. Visit www.medicalfair-asia.com for more information or register here.

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