CHAPTER 83 - Performing arts rehabilitation: Harmonic performer orchestrations

Abstract

Performing Arts Medicine dates back to the 1713 treatise of Bemardino Ramazzini titled “Diseases of Tradesmen” summarizing the occupational diseases of musicians. Contemporary interdisciplinary practice includes occupational, rehabilitation, orthopedic, sports, podiatric and otolaryngology medical methods. They collaborate with specialized therapists, trainers and educators achieving performer centered wholistic care. For example, musicians should be examined while playing their instrument. Problems with embouchure (the position of the lips and mouth in playing a wind or brass instrument), focal dystonia, and ergonomic and other technical problems will be missed if the musician is not examined while playing. Videotaping in the office as well as during rehearsal and performance can be a helpful adjunct. Underlying medical problems may present earlier in musicians, who are more sensitive to the functional effects of minor impairment early in the course of disease. A careful search for contractures and tendon anomalies should be done, especially in string and wind instrument players. A common problem that can cause difficulties in the left hand of violin players and the right hand of clarinet players is the conjoined flexor sublimis tendons of the small and ring fingers. Other specific problems for which to examine include hypermobility, hand span, dyscoordination and uneven playing, muscle tension, and excessive gripping or pressure on the instrument. As with musicians, it is often necessary to see the dancer demonstrating basic movements such as the five basic foot positions, plie, pointe, and leg “extension” (actually forward flexion in turned out position). The pointe position, permits analysis of toe shoe and insert fit and function. Successful outcomes require a preventive, primary and rehabilitative practice that is informed with contemporary interventions customized to enhance artists’ performance and minimize complications.