Home | Musicians' Health | Anatomy/Biomechanics | Piano Teaching | Richard Beauchamp

Report on ISSTIP Course held at the London College of Music

25 March, 1998

The highlight of this course for me was the talk given by Dr C. B. Wynn Parry, consultant/advisor to ISSTIP (International Society for the Study of Tension In Performance) and founder member of BAPAM (British Association of Performing Arts Medicine).

He began with a brief history of performing arts medicine after saying that musicians tended to avoid coming to G. P’s with their problems, instead preferring to try alternative medicine or some sort of do-it-yourself cure, for the following reasons:

In 1986 the first issue of an American quarterly journal called “Medical Problems of Performing Artists” was printed. In it was an article by the pianist Gary Graffman entitled “Doctor, Can You Lend Me an Ear?” It described a serious hand problem which had forced him to give up his very successful performing career at the end of the 1970’s, and discussed the lack of understanding he had experienced from all the doctors he had visited. The article resulted in a deluge of letters to the press from musicians who were thankful that someone (especially someone as famous as Graffman) had finally come out of the closet and admitted to having a problem. As Graffman said “... instrumentalists’ hand problems — somewhat like social diseases — were unmentionable. Understandably so: If a performer is still performing, or hopes to get back on the road soon, he’d be crazy to advertise his disabilities. Nobody wants a wounded pianist. There is an oversupply of healthy ones. Admitting difficulties is like jumping, bleeding, into piranha-filled waters.” The medical community were at last alerted to the problem and there are now a number of Performing Arts Clinics in the USA.

BAPAM was started by Dr Ian James and is run jointly with Dr Wynn Parry. It has a number of clinics throughout the UK and a national helpline — (0171-840-5588). They will help musicians with anything from emotional problems and financial difficulties to physical pains and injuries.

ISSTIP was started by Carola Grindea in 1981 and runs a multidisciplinary Performing Arts Clinic which includes a muscle rehabilitation specialist, consultant physicians, orthopaedic and ophthalmic and ENT surgeons, psychology consultants, specialists in Alexander Technique, Feldenkrais and acupuncture, osteopathy consultants and chiropractors on its staff. They use specialist consultant musicians to advise on instrumental technique. The clinic is held at the London College of Music on the 1st and 3rd Wednesdays from 4 - 6 pm and is available for dancers, actors, sports people and public speakers as well as musicians. The ISSTIP appointments number is: 0171-373-7307.

Dr Wynn Parry emphasised that a musician’s life was an exceptionally tough one “especially in Britain” and statistics show that a high proportion of musicians suffer from performance related injury and/or psychological problems. The people we see on the concert platform smiling and bowing and dressed like penguins are all too frequently unhappy, stressed, suffering from stage fright, lonely or in pain, and are undergoing a nightly hell. In Germany, he said, a musician in an opera or ballet orchestra would be expected to work only three days a week in the pit and would be well paid for it, whereas, in Britain they may well have to work seven days in cramped and dirty conditions (stage smoke and bits of rubbish coming off the stage), straining their eyes and scarcely being able to see the conductor, and then have to rush home to teach to supplement their meagre income, gulp some food and rush off again to a recording session somewhere else. He said it was very important that management be made to see that conditions must be improved. At present musicians were told that if they didn’t like their job, then there were plenty of others who would be pleased to have it.

In order to cope with such a life, a musician had to be very fit. Teachers obviously had to spend a lot of time on technique, sound and repertoire etc., but they were not doing their job properly if they did not encourage their students to take up a sport and learn healthy warm up and practice habits. He spoke of the common traumas of working under an unpleasant conductor or with an incompatible desk partner. He also mentioned the stresses of the top line performers — the loneliness of living in hotels, the pressure of keeping up a standard of performance, the worry of watching younger (better?) artists coming up and winning competitions with the same repertoire. Wynn Parry deals with all these people and has had to persuade some artists that they didn’t really need to do e.g. yet another world tour with the 32 Beethoven Sonatas.

Ergonomics are important. In sport this aspect is taken seriously. If someone wants to learn to throw the javelin, a lot of thought goes into selecting a weapon of the right length and weight for the individual. Students should not be made to fit instruments of the wrong size and shape, violinists and viola players with long necks should have specially made neck rests/shoulder pads etc. Apparently experiments are being made with cut away violas. I brought up the subject of the ergonomics of the piano and it was agreed that pressure should be brought to bear on piano manufacturers to design instruments with different sized keyboards and adjustable legs and pedals, although it was thought that piano manufacturers were fairly well entrenched in their ways and had little financial incentive to change.

There was some discussion about choosing an instrument that suited the physique of the students, although it was admitted that several artists had succeeded in spite of physical limitations, Alicia de Larocha, Murray Perahia, Andras Schiff and Mozart having small hands, for example.

The importance of good posture was stressed as perhaps the most important ingredient in the avoidance of problems. Joan Dickson was mentioned as a great pioneer in this area as a teacher of the most efficient and ergonomic way to use the body in playing the cello. Stephen Isserlis was cited as a good example to follow — as someone who used the whole body to play the cello in an effortless way. Economical technique — maximum effect for minimum effort — was emphasised as vitally important for survival in a demanding profession.

Students should learn simple and effective warm up and warm down routines and not practice from cold. They shouldn’t practise for longer than half an hour — twenty minutes might be even better — and they should then exercise their muscles by doing the opposite movement to the position they have been held in, thus avoiding cramps or ‘dystonias’ (such as ‘writer’s cramp’). A greater proportion of mental practice as well as reading and thinking about other aspects of music — beyond the ‘dots’ — would help to give resting space between physical practice sessions and help to produce more rounded players. Students (and their teachers!) have been known to worry that they have done only six-and-a-half hours practice instead of seven.

Joints should be kept flexible. Mobility increases up to the age of 15 and then tends to decrease unless joints are exercised through their full range of movement. Movement is more healthy if the middle range of the joints are used — and the middle range tends to become more limited if the joints are not exercised regularly. Yoga was recommended, especially as a warm up for practice or performance, because it is relatively cheap to learn and maintain and you can do it by yourself. Alexander Technique takes a long time to assimilate and is expensive to learn because it requires a lot of hands on time from the teacher. It is regarded more as a preventative measure than as a cure and should certainly be available at music colleges as an important way of avoiding injuries in the future. Better from a financial point of view and from the immediate help gained was the so called ‘Grindea Technique’ which seems to me to be a boiled down version of Alexander’s method. It takes 10 minutes to show someone how to do it — and they don’t need to return to the teacher. (But let us not not be guilty of being too easily attracted to the short term view! — R.B.)

Hypermobility (double jointedness) was discussed and its incidence given as 15% of the population. Apparently most Asians and all Indians have it, but have correspondingly strong muscles to cope. (I didn’t ask whether Asians and Indians made up more or less than 15% of the population!) Hypermobility can be an advantage to an instrumentalist (apparently both Rachmaninoff and Paganini had the condition) but they need to build up their muscles to control the joints if they are not to suffer damage.

Stress and unhappiness were given as common causes of injury. When we are stressed or unhappy, muscles, particularly those around the neck and shoulders, tend to become tense and more liable to injury. The importance of looking at the whole person was emphasised. It is important to know if a bereavement has been suffered, if there is worry about exams or fear of an unpleasant conductor as well as to look at the posture and technique of the player.

Performance anxiety or ‘stage fright’ is a major problem and often leads to the termination of a career. We have to train students in the habit of confidence and enjoyment of the music. Worrying about the horn solo at the beginning of “Till Eulenspiegel” is almost certain to make it go wrong. Barry Green’s “Inner Game of Music” was recommended.

RSI (repetitive strain injury) is thought (by Dr W. P.) not to exist. The term originated in Australia and was popularly known as ‘kangaroo paw’. Typists and computer keyboard operators were the first to report it, and the scare rapidly caused an epidemic. The ‘disease’ has been effectively disproved by comparing keyboard operators elsewhere who had not heard of the problem and who failed to develop RSI. The currently acceptable term is ‘work related upper limb disorder’ which, while taking longer to type, doesn’t imply either overuse or misuse.

Dr Wynn Parry finds that all pains which have been diagnosed (usually self-diagnosed) as RSI have, in fact, some recognisable cause, e.g. muscle cramps, nerve entrapments, postural faults, faulty technique, practising for too long in one session, emotional stress or some other misuse of the body. I got the strong impression that Dr Wynn Parry preferred the word ‘misuse’ to ‘overuse’, although the distinction can be subtle — for example Dr W.P. would describe practising for six hours without a break as a ‘misuse’ of the body. It came to light though that the brain can play tricks with regard to pain and can learn to produce ‘expected pain’ (my term) with movements it has previously come to associate with pain. At the other end of the spectrum the brain can sometimes not produce pain if it is not expecting it or if is concentrating on something else, for example the scratch we don’t notice until later, the fire walkers, or, on a more dramatic level, the colleague of Lord Nelson’s who had his leg blown off. “B’Gad, sir!” (or some equivalent), said Lord Nelson, “You seem to have lost your leg!”. “B’Gad, sir!” exclaimed his colleague, looking down, “I believe you’re right!”.

We discussed at some length possible strategies for helping someone out of an ‘expected pain’ syndrome, and Dr W. P. said that the student would have to start again very slowly, thinking consciously about the new techniques and/or changes in posture until new habits had been formed (and, I suppose, the brain had accepted the new ways as painless).

Dr W. P. came out very strongly against rest cures and cited recent thinking in the treatment of back problems. Formerly rest was prescribed which resulted in wastage of the muscles and required months of painful work to build them up again. Now, patients are encouraged to use the back as soon as possible, to keep the muscles fit. “Muscles need exercise,” says Dr W. P. — “Not rest.”

A ‘Guru’ — someone to whom musicians could confide their problems was considered to be a great help. Another musician, though was not thought to be a good choice for a ‘Guru,’ as musicians were too likely to be worried by their own problems, and would perhaps pass these on.

Dr W. P. is confidant that, with good posture, a sensible practice routine and a way of keeping fit, all musicians should be able to play for a life time without problems.

The remainder of the course was a workshop given by Carola Grindea. She showed us (and made us all do) her ‘Grindea Technique’, which made me feel very light and floating, and after that worked at a number of pianists and string players who had problems (mostly pains in the shoulders). She said that most of the people who come to ISSTIP for help are pianists. With the pianists, she worked on their posture with special exercises away from the instrument and then at the piano. With the string players, she got them to stop — “like a statue” — while they were playing, then took the instrument away and asked them if they were comfortable. She then worked on their posture before giving the instrument back. Most of them had either twisted backs (the string players), shoulders pulled forward or stiff wrists, or combinations of these, and Carola was able to make considerable improvements with all of them.

©Copyright Richard Beauchamp, 1998
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