Archive for the ‘Clinicians and Practitioners’ Category

NHS Specialist Voice Clinics Vocal Rehabilitation Coach Pilot

Friday, May 10th, 2019

BAPAM is excited to announce the start of a new pilot project, in which we are funding a Vocal Rehabilitation Coach (VRC) to work alongside clinicians in NHS Professional Voice User Clinics.

Vocal health problems in singers and actors are often multifactorial, requiring a specialised multi-disciplinary approach to diagnosis, in order to get patients onto the right pathways of treatment and rehabilitation and back to performing as quickly as possible. Over the last two years, we have been working with a group of clinical experts in this area, including Laryngologists and Voice-specialist Speech and Language Therapists, who have advised us that adding a Vocal Coach into this team – an experienced singing teacher with understanding of the clinical processes in vocal health – would further help the diagnosis and rehabilitation of performer patients. Lewisham and Greenwich NHS Trust already employ a Vocal Rehabilitation Coach and BAPAM has agreed to fund a VRC post across up to three NHS hospitals for a pilot year, with funding support from PPL, Help Musicians UK, Musicians’ Union and Equity, following which the pilot will be independently evaluated to assess the requirements for the VRC role and the effectiveness of this model in the care of performers. Dane Chalfin, an experienced VRC and singing teacher, is taking on the role for the initial 12 months’ pilot. The first of these BAPAM-funded clinics has just started at Wythenshawe Hospital, part of Manchester University NHS Foundation Trust. Guy’s and St. Thomas’ NHS Foundation Trust is expecting to start to offer this additional service from September, and a third NHS Trust is expected to be confirmed soon.

BAPAM undertook a survey across existing specialist Voice Clinics in order to develop the competencies required to work in this new role and these were reviewed and approved by our Vocal Health clinical experts and adopted by the BAPAM Medical Committee. There is currently no professional body able to provide formal registration of VRCs and BAPAM hopes that by facilitating a process whereby experienced vocal coaches can demonstrate that they meet a set of competencies, we can help provide a level of confidence in this role both to the NHS and to performers themselves, and reassure our funders that we are investing in the best services. Four practitioners who meet these competencies have so far been approved to join a new section of the BAPAM Directory of Practitioners as VRCs, and we are hoping to expand this number in the near future. We can provide guidance to practitioners interested in this field towards appropriate training that may be required to meet our competences.

We hope that this pilot will provide some initial evidence to support the involvement of practitioners with an educational background in the rehabilitation of performers and, specifically, the wider adoption of this practice to improve patient care in vocal health. If the pilot is successful, we hope to be able to secure funding to support substantive VRC appointments going forward via an open appointments process. This work takes place against a backdrop of developing education and science in vocal health, with practitioners at the UCL Performing Arts Medicine MSc and the MA in Vocal Pedagogy at the University of Wales undertaking exciting new studies which are increasing our understanding in this area of performing arts health. BAPAM is pleased to be able to make this small contribution to continuing improvement in vocal health for performers.

Further enquiries are welcome via info@bapam.org.uk

Related information:

BAPAM VRC Competencies

Hand Surgeon and Professor of Piano joint BAPAM clinic

Wednesday, May 1st, 2019

There are intrinsic relationships between health and performance excellence, and educational and clinical expertise in the performing arts. In overcoming medical problems, specialist diagnostic and medical expertise can be complemented by performance technique and lifestyle and health-related guidance. In a new joint clinic at BAPAM, Mr Mark Phillips, Hand Surgeon, and Penelope Roskell, Professor of Piano at Trinity Laban, are exploring this opportunity for clinicians and educators to provide each other with unique insight and feedback. We asked them to tell us more about this innovative approach.

Could you explain the idea behind the joint clinic and why you decided to do it?

Mark Phillips: In my experience when treating musicians I found quite an overlap between the physician’s knowledge and the specialist physiotherapist/hand therapist’s knowledge, who’s an expert in musicians. But I soon realised there was a huge gap for the third element which is filled by the expert tutor on that instrument. I happen to be a trumpet player so as a musician I have some insight into the patient but that’s not enough when it comes to some of the issues they face. I can relate to some of the psychological performance issues, but the expectation patients have is of someone that can really understand how the technical demands of the instrument interface with the physiological problems they’re having and anatomical problems they may have and the outcome of the clinical assessment.

Penelope Roskell: The knowledge we have between us is enormous. My students have included musicians with injuries for 40 years, and so we fill in the gaps. Seeing musicians together in a joint clinic is very important because you can then see the whole picture and then decide on the best way forward. Sometimes it may be steroid injection and sometimes it may be surgery. But sometimes it may be that a tweak or a change of technique will solve that problem and reduce the need for further intervention. So, seeing them together we can get to the root cause, which we can’t always do if seeing them independently.

How do you decide if a patient would benefit from this dual approach? What can a patient expect at a typical joint session? How do you each approach the patient?

How do you prepare for a joint clinic session?

Mark Philips: Normally I will contact Penelope to say I’ve got a patient or she may say she has a student. We will both select patients for this clinic.

Penelope Roskell: Sometimes Mark will send me over a video of that person playing, so I’ll have a chance to look at it and pick out the obvious problems about what I think may be causing it. I’ll also have a clinic letter which will give some sort of background.

Mr Phillips: We then meet up for a coffee and chat about the patient. So then the patient comes in, and if it’s my patient I present it to Penelope and on one occasion Penelope presented the patient. And then we do the history in the normal way, present findings and run through it all. I then suggest what may be the anatomical or physiological problem and how that relates to this person’s technique. The technique may have worked well for a long time but now there’s a problem which is unique to them. Looking at the technique can help if I’m referring to Penelope. Or similarly if Penelope is referring to me is there a way that some of my interventions such as hand therapy or injections or my approach to examination would throw some light on the matter. It’s that overlap which is invaluable really.

Penelope Roskell: So for instance one of my students came to the last clinic and she had problems for the last year and had come to me for that reason. And Mark gave her quite a different diagnosis to what she had been given in the past, which then informed me. So now we are working slightly differently in the lessons that I have with her privately, having now had this intervention from Mark and he also suggested a steroid injection which we are waiting to see the results to. We can then see the whole picture about the ways forward, because there isn’t always one solution. A patient may need a steroid injection or piano playing adjustments to the technique.

Mark Phillips: It’s multi-faceted, there may be Alexander Technique, hand therapy and it may be someone looking at their posture. I learn so much by looking at Penelope tutoring at the piano in terms of elbow position, shoulder position and what impact that has in terms of the way the fingers lie on the key for example. Each presentation has its own unique cocktail of remedies really.

There are complex multi-faceted problems by the time they come here and it comes down to how we triage these patients essentially. I don’t bring every pianist to this clinic.

Penelope Roskell: It’s inevitably going to be someone with a piano related injury. If they’ve broken their wrist by falling down the stairs then they should go straight Mark. Whereas it’s different when it’s something like accumulated stress from years of playing with a technique which is a tiny bit off balance. They may be very experienced players and their technique has lasted them well, but there’s something that just tips it over.

Mark Phillips: What I see in my patients is that half of them have the same problem as everybody else and that may affect how they use their instrument. And the other half have instrument related problems and it may be a combination of the two. And say if someone broke their wrist a year ago and it may be throwing out their elbow, their shoulder or their posture and it may well be a good way down the line that it’ll come to me that a session with Penelope would be helpful. Because it may be to do with their elbow and shoulder which may be making some notes inaccessible and we can work around. They’re so unique each of these cases an each of them would have their own relative roles for the two of us sitting together and discussing the case. It would be good to extend this to guitar, violin and cello and get tutors to do a similar thing. And it’s pretty unique, I don’t think there’s anyone else out there in the world doing it.

What do you feel are the benefits of having an educator in a clinical setting?

Penelope Roskell: It is a very formal environment which is a positive thing and it focusses everything which is very important.

It is a sort of pilot, it’s the first of its kind and I think it is very valuable and let’s hope that other clinics may take the idea from this and develop that further.

What are the direct benefits for patients of having the educator and clinician in the same room in a clinical setting?

Mark Phillips: We often find that patients are often reticent about coming to these clinics. They really don’t want to look at their own techniques and I suppose they remember back to days when they were being tutored and they feel self-conscious. They have to want to come to this clinic and to be looked at. It isn’t like going for a piano lesson or being taught. We are looking to see whether there’s anything about their technique that may be in anyway connected to the clinical problem they have. So we’re not trying to look at the way they play from any other perspective than that. People play in lots of different ways. Also videos are really useful, anyone with a smartphone can record themselves. When we look at them we can slow them down, go back over a sequence, look at it carefully, look at it together and see how that relates to their clinical problem.

Penelope Roskell: There is something different about the joint clinics, because I’m there involved in the consultation I’m able to ask them questions from my own point of view so that I’m well informed as to how best to help them in the future. Because a piano teacher is not qualified to diagnose and that is absolutely number one and nor am I qualified to answer questions that students sometimes ask me, like should I have that steroid injection or that operation and it’s not for me to advise on that but in this situation between the three of us we can discuss the best way forward viewing it from all the different angles.

Any challenges you are finding with the joint approach?

Mark Phillips: It’s 30 minutes long, which is short. We are just getting into our flow by half an hour.

We haven’t had a chance to find out what patients think, especially how they feel about the added value of seeing us both together.

The four patients we have seen in this format have individually expressed to us they thought it was a good session and it stimulated a lot of discussion and ideas. It would be great in the future to include a hand therapist and do a proper multi-disciplinary clinic. Hand surgeons always work very closely with hand therapists. Because there are so many different joints in the hand and different diagnoses. In the hand you’ve got unique problems to one finger or there will be a combination of problems. So your hand therapy is always bespoke, it’s all tailor made to that patient so you have to discuss each patient individually and with musicians it’s even more so.

Certainly with the three most commonest instruments this is going to be a major area of growth in the next ten years and it’s very exciting.

During the half an hour the patients sense the trust we have with each other (Penelope: we work very well as a team, we both have a lot of respect for each other’s knowledge. So I think they go away feeling they’re whole picture has been seen and assessed and we are seeing them as an individual with a problem that can be resolved.)

All patients have been bought over by the end of the 30 minute sessions. You can see the reticence and slight nervousness at the start of the half an hour turning into trust and outpouring of confidence and sharing of the problem and by half an hour we are in to the nitty gritty aren’t we. The output of that is usually I will see them again or Penelope will see them again.

What they can do is continue seeing Penelope for a while and see me in the clinic two months later and see how things have been going on in the meantime. And because we know each other well we can send secure emails back and forth and stay in touch.

Psychosocial Practitioner Peer Supervision Group

Wednesday, March 27th, 2019

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

This group, whose inaugural meetings took place in 2018, opens up the conversation between performing arts and psychological practice. It is developing a growing professional network for counselling, coaching and psychology practitioners who work with performing artists of all kinds. The group meets regularly, roughly every 8 weeks, in central London.

As well as discussing clinical cases and case issues, there is interactive exploration, mutual consultation and support on more general professional practice issues, including ethical issues, boundary and confidentiality areas. Such exchanges of expertise and experience enable members to reflect on and refine best practice in working with performers. The Group offers members the chance to share specialist expertise of particular problem areas and to provide interventions, guidance, information and professional support within a rigorous evidence-based practice and practice-based evidence framework in this developing field. The Group acts as a forum not only for encouraging and developing the highest standards of practice but also for identifying, promoting and supporting new research in the field.

Members of the group use a variety of approaches and come from a range of career backgrounds. Some members bring specialist expertise within the field, for example, working with people in particular arts professions or with certain types of problem. The Group is sensitive to BAME, LGBT+ and other dimensions of difference.

It is hoped that specialised supervision of this type will become available and accessible to many more practitioners on the BAPAM Directory and the Group is keen to encourage this in whatever ways it can. Members are happy to offer advice and suggestions to practitioners wanting to start their own peer supervision group and to find ways of welcoming practitioners new to the Directory to join.

Practitioners interested in finding out more, joining the London group or starting a group of their own are invited to contact Dr Carol Chapman by email at carol@carolchapman.co.uk

Bournemouth Symphony Orchestra are recruiting an Orchestra Doctor

Monday, July 9th, 2018

The Bournemouth Symphony Orchestra is looking for a local GP to become one of the Orchestra’s Doctors. The GP will ideally be interested in music. This is an interesting voluntary role which will consist of giving a few hours each month in return for concert tickets where possible.

The successful Doctor will become a member of AMABO (Association of Medical Advisors to British Orchestras) and BAPAM (British Association of Performing Arts Medicine) which will involve one or two training days per year.

As one of the Orchestra’s Doctors you will be expected to come into rehearsals every couple of months or more frequently if desired, to meet with orchestra members who wish to discuss any health problems especial those which are performance-related. An interest in Rheumatology and MSK type disorders would be an advantage.

For further information please contact Natalie Wright at the BSO directly:

T: 01202 644704
E: nwright@bsorchestra.co.uk

You can also apply with CV and covering letter to the BSO.

Closing date for application is Monday 23rd July 2018 with interviews being held in Poole towards the end of the summer. Start date will be beginning of October.

The BSO is an equal opportunities employer.

Setting and Delivering Standards in Vocal Health

Tuesday, May 8th, 2018

The singing industry is completely unregulated, meaning anyone can call themselves a singing teacher, vocal coach or even vocal rehabilitation coach regardless of training, experience or lack of clinical supervision. At BAPAM, we have many calls from actors and singers with voice problems and we have been aware of an inconsistent approach to care.

Working with a group of vocal health specialists established by our Medical Committee, comprising Ear Nose and Throat specialist doctors, speech and language therapists, physiotherapists and vocal rehabilitation coaches from across the country, we have set standards for our vocal health advice, and competencies for Vocal Rehabilitation Coaches. We are also funding sessions for specialist clinics to have a Vocal Rehabilitation Coach for a pilot period so we can evaluate the impact.

We hope this will be a major step forward improving the quality of care for vocalists who present with problems in healthcare. It will enable them to get a rapid assessment by the right professionals to accelerate the right treatment. It will also provide a set of standards for singing practitioners in the UK who wish to work with a Voice Clinic and provides an improved level of protection and quality assurance for organisations supporting arts professionals accessing specialist health care.

The literature on dysphonia demonstrates that singers presenting with voice disorders are most likely to have Muscle Tension Imbalance (MTI). General ENT Surgeons tend to look for organic pathology or structural abnormality and do not always diagnose MTI.  Diagnosis of MTI in speech is usually made by a Speech and Language Therapist with experience and training in assessing the muscular function of the whole larynx and vocal tract via nasendoscopy.  MTI in singing is being assessed in a few leading clinics by a Vocal Rehabilitation Coach with experience and training in the assessment of the larynx and vocal tract in a wide range of singing styles, also diagnosed via nasendoscopy.  Only specialist Voice Clinics have access to equipment and personnel qualified to deal with this type of problem in professional singers.  Treatment of MTI in singers is carried out by Speech and Language Therapists and Vocal Rehabilitation Coaches, jointly or in succession.

The BAPAM Vocal Health Working Group recommends multidisciplinary clinics with a surgeon and specialist speech therapist using high definition cameras with stroboscopic or high speed videos to analyse the vocal folds as standard of care. BAPAM has adopted this standard for the advice we give to patients.

BAPAM’s advice for GPs is to refer to a specialist Voice Clinic when patients with the following characteristics present with a voice problem:

Patient population

  1. Elite Performers (professional singers, actors, broadcasters, etc)
  2. Studying Performers (FE, Undergraduate and Postgraduate singers and actors)
  3. Quality of Life Performers (singers whose singing is their primary means of socialising like older local choir members)

Presenting Voice Problems

  1. Loss of range, power, flexibility
  2. Pain, fatigue, hoarseness
  3. Gaps in range, delayed onset of phonation
  4. Increased recovery or warm-up time
  5. Chronic throat-clearing, sensation of lump in throat (globus)

Referrals

A referral to a specialist Voice Clinics should be made for:

  1. Any vocal symptom lasting more than 2-3 weeks
  2. Any vocal symptom lasting more than 2 weeks following resolution of a bacterial/viral infection

Advantages of a Specialist Voice Clinic

  1. Stroboscopy to view vocal fold vibration is only available in these clinics
  2. EGG and other specialist equipment for accurate measurements
  3. Expertise in muscular function and dysfunction of the vocal tract
  4. More accurate diagnosis, improving management and decreasing patient recovery time (P.S. Phillips 2005)

The large clinic team enables a multidisciplinary assessment because performance voice problems are likely to be multifactorial and more likely to be muscular with musculoskeletal and/or psychogenic causes. Staffing includes:

  1. Voice Specialist Laryngologist*
  2. Voice Specialist Speech and Language Therapist
  3. Vocal Rehabilitation Coach (Singing Voice Specialist)
  4. Performance Specialist Osteopath/Physiotherapist (in some clinics)

*Some Specialist Clinics are SLT-led with Laryngologist review

Accurate diagnosis and specialist treatments speed up recovery times and save money in the long run.

(see British Voice Association leaflet on Multidisciplinary Voice Clinics)

Patient Outcomes

  1. If organic lesions are present they may be listed for surgery immediately or referred for Speech Therapy then reviewed
  2. Functional disorders will be referred for Speech and Language Therapy and/or Vocal Rehabilitation
  3. Musculoskeletal disorder will be referred for Osteopathy/Physiotherapy
  4. Psychogenic disorders will be referred to Speech and Language Therapy and onwards to access Psychology/Talking therapies as appropriate (for Psychotherapy and/or Speech Therapy)
  5. Most patients will be referred to more than one of the above

Vocal Advice

BAPAM offers 90 minute small group vocal health advice workshops to performers who have concerns about their vocal health once they have received a referral to a Specialist Voice Clinic and been put on the waiting list.

The sessions will be run by a Vocal Rehabilitation Coach with experience working with performers in Specialist Voice Clinics. Participants will receive general advice on how to look after their voice, gentle stretching to release vocal tract tension, exercises to release tension in the breathing mechanism, and information on what to expect in their Specialist Voice Clinic appointment.

These sessions are educational, not diagnostic, and are not a replacement for an appointment in a Specialist Voice Clinic.

To find our more or book a place at a BAPAM vocal health advice workshop please call us on 020 7404 8444.

The Vocal Rehabilitation Coach

In late 2017, BAPAM’s Vocal Health Working Group approved competencies for Vocal Rehabilitation Coaches to set a standard of practice in this important area. Vocal Rehabilitation Coaches on the BAPAM Directory of Practitioners must meet the following competency criteria:

  1. Hold or have previously held a contract with an NHS specialist Voice Clinic including a job description. Verified by contract document. Where an informal but significant relationship with a Voice Clinic exists or has existed in the absence of a contract, a letter from the Voice Clinic may be accepted.
  2. Have spent at least 10 years practicing as a singing teacher/vocal coach within an educational institution or in private practice. Verified by contract document or evidence of proven track record.
  3. Work under supervision from both voice specialist laryngologist and speech therapist (as appropriate) as part of a clinic team with all clients.
  4. Undertake at least 10 hours of Voice Clinic observation per year. Verified by letter from Voice Clinic.
  5. Have completed relevant anatomy/physiology training formally or in-house. Verified by attendance certificate or letter from Voice Clinic.
  6. Have completed endoscopic interpretation of singing physiology training. Verified by attendance certificate or letter from Voice Clinic.
  7. Have both basic counselling and palpation training, formal or in-house. Verified by attendance certificate or letter from Voice Clinic.
  8. Adhere to data protection standards when keeping client records.
  9. Have current appropriate liability and indemnity insurance policies. Verified by documents.
  10. Provide at least two references, one from a specialist Voice Clinic, one from a reputable professional performance-related company (ex: university or production company).
  11. Adhere to all BAPAM professional practice standards at all times.

Applicants will be included on the directory for a term of three years before needing to revalidate their application.

Information about applying to join the Directory can be found here.

We look forward to reviewing and reporting on our pilot project to support specialist Voice Clinics by funding a Vocal Rehabilitation Coach.

Vocal rehabilitation is a truly multidisciplinary endeavour, with crucial contributions from laryngologists and speech therapists.  A central member of this team is the Vocal Rehabilitation Coach who is uniquely placed between the medical clinicians and the performers to carry the scientific aspects of vocal treatment into the performance practice.  It is critical that these coaches are well schooled in vocal anatomy, physiology, pathology and rehabilitation; this schooling should be assessed with a series of measurable competencies to ensure that they are providing the best possible care. Mr. Declan Costello – Consultant Laryngologist

Following treatment for any vocal problem, like any injury one might sustain during physical exercise, a patient must rehabilitate appropriately with the aim of getting back to their pre-morbid state; to allow them to sing and speak again. In the same way you must learn to walk before you can run, one must set up the larynx correctly before trying to push its limits. Speech therapy achieves this but translating this laryngeal work into the singing voice requires a vocal rehabilitation expert. The expert vocal rehabilitation practitioner will help the performer take their correct setup into their performing voice before returning to their genre specific vocal coach. It can be seen that this is an essential part of the recovery process and having trained, competent and expert help is a comfort to patients.To this end, having the appropriate knowledge and having been assessed as reaching a standard level of expertise means that you know your patient will be in good hands.  Mr Nicholas Gibbins – Consultant Laryngologist

BAPAM Vocal Health Working Group

Mr. Nicholas Gibbins ENT

Mr. Declan Costello ENT

Ms. Tori Burnay SLT

Dr. Ron Morris SLT

Ms. Linda Hutchison VRC

Mr. Dane Chalfin VRC

Mr. Ed Blake Phys.

Arts health practitioners in focus: Massage Therapy

Tuesday, 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.”

Psychosocial Practitioners Peer Supervision Group

Tuesday, 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

Chartered Society of Physiotherapy on Rehabilitation for Musicians

Wednesday, 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.

BAPAM Physiotherapist Supports Team GB at World Games

Wednesday, July 19th, 2017

The 2017 World Games commence in Wroclaw, Poland on July 20th, and we wish the very best of luck to the Team GB athletes and BAPAM physiotherapist, Louise Curley who returns to her role supporting gymnasts, acrobats and tumblers as the British Gymnastics Delegation Physiotherapist.

Here at BAPAM, Louise gives expert help to musicians, actors, dancers, circus and physical performers, providing free physiotherapy assessments and subsidised, affordable follow up sessions at our London clinic. She also runs her own practice Rejuven8 Physiotherapy in Warwickshire.

Osteopathic Performing Arts Care Association Study Day

Wednesday, March 29th, 2017

The Osteopathic Performing Arts Care Association (OPACA) are a group of osteopaths who have a special interest in the care of performers. Members include BAPAM registered osteopaths Michael Mehta, Karolin Krell, Nikki Ellis, David Propert, Alison Judah, Toby Pollard-Smith and Lazarus Nono.

Presented by dancer and choreographer, Russel Maliphant, and Osteopath, Andrew ferguson, the first OPACA Symposium and study day, The Dancer’s Body: Integrity and Fluidity, will be held on Saturday May 6th at the General Osteopathic Council in London.

Find out more here.