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

2. 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

3. 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

4. 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

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

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

7. 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

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

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

10. 10 Mechanical  Repair of torn biceps tendon

11. 11 Mechanical  Ulnar nerve decompression surgery

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

13. 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

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

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

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

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

18. 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 performing artist? 

19. 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

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

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

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

23. 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

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

25. 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

26. 26 Treatment  Therapy  Examples

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

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

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