Arts health practitioners in focus: Massage Therapy

March 27th, 2018

Arts professionals and students are unlikely spend much time thinking about their health until something goes wrong. Yet they work in a tough industry and often push themselves to the limit. Problems can accumulate over days and years spent practising and performing. Taking care over physical and mental health is essential to sustainable performance practice and a successful career.

Sometimes things go wrong. A health problem or injury starts to affect your performance and you need help to beat it.

If you are a student or professional in the performing arts, a call to BAPAM’s Helpline can provide advice about where to get help for work-related health problems. You can arrange a free assessment at BAPAM with a doctor or clinician who will understand the demands of your career. You should always talk to your NHS GP as well – often excellent services are accessible by GP referral.

What if you are looking for independent expertise from a physical or psychological therapist? It is easy to be confused with the number of different therapies available. How do you go about finding a practitioner with the right experience and expertise?

BAPAM’s Directory of Practitioners lists information about high quality and accessible performing arts healthcare provided by skilled professionals working in a variety of modalities. In this series of posts, we’ll look at how these different kinds of practitioners can help you stay fit, overcome problems, and give your best performance. In this post, we look at a sometimes overlooked section of our Directory, Massage Therapy.

Massage Therapists work with the soft tissues – muscles, tendons & ligaments to apply pressure, manipulate and stretch them. Often these clinicians are termed Sports Massage, Holistic Massage or Sports and Remedial Massage practitioners.

You should check Massage Therapists are properly registered with the regulatory body, the Complementary & Natural Healthcare Council, which means they are highly qualified. ITEC level 3 certificates are a good entry point into massage but for detailed knowledge of anatomy & physiology and more advanced methods of working, it is important that the therapist is qualified to diploma level or above.

We asked four BAPAM Registered Practitioners for their opinions on how arts specialist Massage Therapists can help you stay fit and give your best performance.

Rebekah Gilbert:

Rebekah Gilbert trained as a singer at the Royal Academy of Music and has sung as a concert soloist, recorded for EMI, BBC Radio, Classic FM and at Abbey Road Studios. She trained at the London School of Sports Massage and ITEC. She has a doctorate in coaching and is an Associate of Canterbury Christ Church University, working with Professor Stephen Clift on worldwide publications relating to singing and wellbeing.

“A good Massage Therapist will do a lot more than just ‘pummel’ you! First they will take a history of the issues you are consulting them on, your artistic practice and the time you put into it, lifestyle, exercise, the environments in which you work, and your medical history. If they discover anything that may need referral to another medical professional they will know when not to treat you.

Secondly, they will assess your posture as you stand and sit, the way a musician plays their instrument, and look at your walking gait. Is anything out of alignment? What are your posture habits and why? Might you need orthotics to improve how you stand and walk or just more supportive shoes?

Thirdly, they understand the difference between palpating well toned muscles and tense ones. Massage Therapists are good detectives, examining how you may have formed adhesions (knots), and can recommend changes necessary to reduce them in the future. The muscular skeletal system has an integral deep & superficial layer of facia running through it, which connects to every part of the body down to cellular level. Because of this, a Massage Therapist will know that a pain in one location may be triggered by problems in another and, within their toolkit of techniques, which will be most beneficial to apply.

Fourthly, they will have a long list of stretching exercises to give you as ‘homework’. However well a Massage Therapist can work in one hour, the time until your next appointment needs your input to make a difference. They may suggest other local practitioners such as Pilates, Feldenkrais, Yoga or Physical Training instructors to help you improve core strength and posture awareness. As a singer, I also know how beneficial optimal breathing techniques are in performance.”

Felicity Vincent:

Felicity Vincent is a professional cellist and a Pilates Instructor and Massage Therapist specialising in exercise for cellists. Felicity is an experienced active performing cellist and teacher with a deep understanding of how a player’s body might accumulate problems and how these might be solved. She has gone on to study Fascial Release with Anatomy Trains. Please check the BAPAM Directory for contact details. 

“Every string player knows their body isn’t just made up of levers (bones) and pulleys (muscles) but a controlled flow of circular and rotational movement. This is made possible by your fascia, the soft tissue of the body which is now known to be a strong, bouncy, stretchy, highly intelligent and trainable cell matrix which is everywhere, joining muscles to bones, allowing muscles to glide over each other, and through and over organs. But the fascial system is the site of countless numbers and types of nerve endings. These can respond to overuse and misuse which may be caused by imbalanced body use or holding onto emotions. Some degree of hypermobility can be an advantage in playing but is a double edged sword because stretchy tissue is particularly vulnerable to injury when overworked. On the massage couch your therapist will coax adhesions to dissolve and encourage held patterns to let go.

I see regular exercise as the principal key to health and wellbeing for every string player. I enjoy Pilates because it can be challenging and, particularly using the equipment, is a sophisticated way to balance the body and strengthen it. There are many schools of cello playing; the most important thing is that playing shouldn’t be destructive.”

Zoltan Zavody

As a musician (and martial artist) himself, Zoltan Zavody understands the range of injuries, impediments to joyful playing, and pain that can result from muscular imbalances.

“Anyone who trains their body intensively is more prone to soft tissue injuries – musicians sit in the same position for hours, make countless repetitive motions at speed, and then lug their instrument or box of scores to their next session. They are perfectionists who put themselves under intense scrutiny and thus stress. In the course of their careers, many musicians are likely to experience an injury requiring time off from performing.

The conditions sustained through the playing of music vary. Some seem relatively innocent, for example tightness and soreness in the left shoulder of a violin player. Others are more insidious, like the burning pain in the wrist of a guitarist. Still others are structural, like a lower back torsion in a pianist. Massage Therapy can generally help with all of these. And they can be interconnected.

Interestingly, through years of practise, it is not only the muscles that are habituated to playing. The connective tissue, the fascia that surround the muscles, also adapt. Research shows that this connective tissue morphs, slides, and grips according to habitual movements. So a musician may end up with managing to relax their ‘playing muscles’, but unless it is released, the tissue enveloping these muscles continues to pull their body and limbs into a specific posture, like a skewed bodysuit. The person is relaxed, yet they still feel a tightness, a pull, a misalignment. This is where a Massage Therapist can help with a range of myofascial techniques; softening, stretching, and pulling the connective tissues, the bodysuit, into comfortable alignment.

Myofascial work is not all about injury and problems! All of us inevitably have muscles and tissues that are a little stuck, whether from old injuries or emotional holding or underuse, and we don’t even notice. Take a singer for example, who has no complaints but wishes to improve the smoothness of their sound. By working fascially through the diaphragm and along the ribs, a Massage Therapist can help release these areas, leading to greater lung capacity and breath control, and an easier, more joyful singing experience. We have essentially freed up the bellows – and who wouldn’t want that?

If musicians were sportspeople, they would have ‘pitch-side’ Massage Therapists and coaches to help them fulfil their potential and make life a little bit easier.”

James Wellington

James Wellington is a specialist musculoskeletal physiotherapist and Sports Massage Therapist who works extensively with circus performers and other artists. He Lectures nationally and internationally in the fields of physiotherapy, injury prevention & performance enhancement and conducts research in evidence based practice.

“Using sports massage within clinical practice is hugely beneficial, as evidenced by the hundreds of satisfied performers that receive and rave about it. However, there are few well controlled studies into its clinical efficacy.

The speculated effects are biomechanical (improved joint range of motion, reduced stiffness and tissue adherence), physiological (reduced stress hormones, improved blood flow and parasympathetic activity), neurological (less pain and muscle tension), and psychological (reduced anxiety and improved relaxation).

Let’s be honest. It does feel therapeutic getting a sports massage (depending on the pressure being applied of course). It’s my conviction, however, that its benefits rely most heavily on therapist experience and their choice of technique.

If you’re lucky enough to find a sports massage therapist that has a broad set of massage skills, the ability to clinically reason and be able to justify every technique they use – you’re way more likely to see positive results. Personally, I find it hugely beneficial in improving joint range, reducing muscle tension, decreasing pain and decreasing injury-potential factors.

My top tips for performing artists thinking about getting a Sports Massage:

1. Think about the reason(s) you want to book a Sports Massage (post-training soreness / poor flexibility / repetitive strain injury / accumulated muscle tension / a pampering treat?) and communicate this to the therapist (this will assist in selecting appropriate depth of pressure and duration of treatment).

2. Tell the therapist if you specifically intend for the Sports Massage to improve your performance and/or recovery as this may also determine the type of techniques they use.

3. Timing of the massage is important. If in doubt, ask the therapist before booking what is the most appropriate.”

Freeing the Dancers Voice, March 2018

March 1st, 2018

Are you a dancer increasingly called upon to sing during performance? A singer increasingly called upon to dance? In London on Sunday 18th March the British Voice Association is running a multidisciplinary workshop, Freeing the Dancer’s Voice, in how to successfully face the challenges of combining talents in the same performance. It boasts a panel of esteemed therapists, tutors and other specialists, including specialist performance physiotherapist, Ed Blake, and osteopath and UCL Performing Arts Medicine MSc graduate, Tommi Sliiden.

Sunday 18th March 10:30am-5pm

Arts Educational School, Chiswick, London W4 1LY

For further details and to book your place contact administrator[at]britishvoiceassociation.org.uk or visit www.britishvoiceassociation.org.uk

BAPAM Director Appointed

December 7th, 2017

We are delighted to welcome our new Director, Claire Cordeaux

Having started her career as a youth and community worker over 30 years ago, Claire Cordeaux has worked in the private and voluntary sectors, social care and the NHS, covering early years and children’s services, workforce development, health strategy, research and innovation at international, regional and local levels. In addition to a language degree, Claire holds a Masters in Research and Postgraduate Diplomas in Public Sector Management and Youth and Community work. Prior to her current role, Claire was Healthcare Director of SIMUL8 Corporation, working globally to improve healthcare using computer modelling and simulation. Claire is an active musician in a Celtic folk fusion band, and has supported a number of arts initiatives and festivals from youth music projects to running a boat stage to connect performers in coastal areas.  Now Director of the British Association for Performing Arts Medicine, Claire counts herself as very lucky to have a role which combines her two passions of health improvement and performing arts.

Psychosocial Practitioners Peer Supervision Group

December 5th, 2017

BAPAM is pleased to support the establishment of a new Peer Supervision Group for psychosocial practitioners who work with performing arts clients.

The group, whose inaugural meetings took place earlier this year, hope to open up the conversation between performing arts and psychological practice. The aim is to foster a network for counselling, coaching and psychology practitioners working frontline with performance artists for interactive exploration, mutual consultation and support on professional practice issues, and for reflection on what constitutes best practice in working with performers, as well as to share specialist expertise, guidance and information according to a professional framework of rigorous evidence-based practice and practice-based evidence in the field.

The next meeting is scheduled to take place on December 9th, and thereafter every two months on Saturdays from 12 to 1:30 pm at the London Natural Health Centre, 46 Theobalds Road, NW1 8NW.

Practitioners interested in finding out more or joining the group are invited to contact Dr Jane Oakland by email: jane.oakland@btinternet.com

Research: The Wellbeing of Musicians Across the Lifespan

October 5th, 2017

Musicians sometimes spend a lot of time looking at what is wrong, which can give more energy to challenges and create a downward spiral. Positive psychology is influenced by the idea that in spending more time focusing on what’s right, we allow ourselves to consider what it looks like to do well, which can in turn lead to a more positive physical/mental/emotional outworking.

Marie El-Khazen is a researcher inviting musicians aged 60+ to take part in interviews which will help develop knowledge and understanding of musicians’ perception of wellbeing as a performer, throughout a lifelong professional career.

If you’d like to help with this study you need to be aged 60+, having earned the majority of your full time income from employment as a performing musician. Interviews lasting 60 – 90 minutes will be conducted face to face, or via Skype, and will be recorded (on a dictaphone). Participants will remain anonymous. To take part or to find out more, please contact Marie directly by emailing U1620023@uel.ac.uk. You can also find here a detailed participant invitation letter.

This research has been approved by the School of Psychology Research Ethics Committee, and follows the standard of research ethics set by the British Psychological Society.

Psychiatrist Recruitment

September 28th, 2017

Mental health in the arts has become an increasingly high profile issue in recent years. In partnership with performer support organisations such as Help Musicians UK and Equity, BAPAM is uniquely well placed to provide mental health advisory services to arts workers. We are looking for psychiatrists with an interest in performing arts clients to assess and advise clients with psychosocial concerns in our clinics. This is will include making recommendations for appropriate treatment and therapy, including to specific individual practitioners and services, both private and NHS, and working with the BAPAM team to ensure accessible options are explored for people in a wide variety of employment and financial circumstances. We benefit from a fascinating and highly motivated client group, excellent peer support and networking, plus access to unique training and clinical experience. Flexible working arrangements can be agreed on a voluntary basis, with an honorarium of £50 per hour available for clinical work.

If you’re a psychiatrist interested in getting involved with charity work in the performing arts, or can help us spread the word please contact us by email or phone.

Tel: 020 7404 8444
E: info@bapam.org.uk

Healthy Performance Workshops at The Actors Centre

September 28th, 2017

We’re pleased to announce a new series of healthy performance workshops in partnership with The Actors Centre, with funding support from Equity.

Members of The Actors Centre can book their place for the first two sessions now.

Look out for more workshops as the series continues through 2018.

Friday 10th November: Finding a Work-Life Balance in Changing Times 

Dr Carol Chapman
Counselling Psychologist and Performance Coach

This 3 hour interactive workshop looks at ways of establishing a viable work-life balance and managing time effectively in the context of irregular jobs and irregular working patterns. These can affect health and well-being and impact on family and social life. The workshop illustrates ways of managing the stress reactions these unpredictable patterns can bring, and shows how to facilitate resilience. Participants will be able to raise appropriate issues that affect them personally and options for coping will be described and discussed. Suggestions for taking ideas further will be made. Book here

Friday 8th December: Healthy Voice

Dr Jenevora Williams
Singing Teacher and Vocal Health Expert

All voice users suffer from ill health at some time. Find out how to minimise the vocal fatigue suffered as a result of overuse or misuse. You can also learn

about the effects of medications, environmental factors, hormones, ageing, and of course – stress.

Dr Jenevora Williams will begin with a brief summary of how the voice works, followed by a practical guide to understanding and managing your own voice use. Book here

International Symposium in Performance Science, Reykjavik

September 28th, 2017

The MSc in Performing Arts Medicine and BAPAM were well represented this month at the International Symposium in Performance Science (ISPS) in Reykjavik, Iceland, with research papers by Dr Trish Halliwell, Dr Philippa Whebble, Dr Farrah Jawad, Dr Hara Trouli, osteopath Tommi Sliiden and physiotherapists Kari Arnason, Lindsay Wallace and Krzystoff Dabrowski. Projects on flautists’ injuries, breathing relaxation for singers, vitamin D levels in dancers, health issues of popular musicians, lung function when singing and dancing, muscle injuries in string players, footwear and dancers’ injuries, and palmaris longus in pianists were received with great interest by the conference delegates. It is important to see such a group on the international arena of Performing Arts Medicine and we hope this will encourage more researchers to bring their work to this level. Congratulations to all involved!

Chartered Society of Physiotherapy on Rehabilitation for Musicians

September 13th, 2017

The Chartered Society of Physiotherapy have published an informative article on Rehabilitation for Musicians in their Frontline magazine. Sarah Upjohn – a key clinician in our physiotherapy team in London – and BAPAM registered physiotherapist, Patrice Berque, share their expertise, with contributions from BAPAM and the Musicians’ Union.

Read the article here.

OPACA Study Day: Osteopathic Approach to the “Singing Voice”

September 4th, 2017

The Osteopathic Performing Arts Care Association (OPACA) present their second study day in Manchester on Sunday 15 October, focusing on Voice, and led by osteopath, singer and teacher, Ashley Staffiord.

To book online please visit: www.opaca.co.uk

OPACA aims to foster a uniquely Osteopathic perspective of treating performing artists, to encourage new ideas and offer mutual support. New members are welcome.

“A practical and experiential workshop for osteopaths with a special interest in the power of the voice. This full day’s programme will include practical work with bodybreath-voice relationship: exploration of the diaphragms and the relationship between primary and thoracic respiration and the many influences upon the functionality of the voice from head to toe. It will include a review of the anatomy and neurology of the vocal apparatus and demonstrations with singers. Participants will leave with a clear view of how to approach the voice of the patient osteopathically and with minimum trauma in the interventions”.