Archive for the ‘MSc/Diploma in Performing Arts Medicine’ Category

Research Investigates Dance Shoes

Tuesday, June 2nd, 2015

Lindsay Wallace, a dancer, physiotherapist and Performing Arts Medicine MSc researcher at University College London, is looking for female dancers (minimum 4 hours dance activity per week) to take part in her project investigating dance footwear. The project aims to help reduce dance injuries and protect dancers.

Female dancers, please fill in this survey.

Event Report: ASPAH 2014 Symposium

Friday, March 6th, 2015

Tommi Sliiden, osteopath and a graduate of UCL’s MSc in Performing Arts Medicine, attended the November 2014 Symposium of the Australian Society for Performing Arts Healthcare, to present research into breathing in musical theatre performers. We were pleased to help facilitate this through a BAPAM Research and Education Bursary.

Tommi’s report follows: 

ASPAH 2014 Symposium

Tommi Sliiden M.Sc PAM, B.Ost

The theme of this years ASPAH symposium was The complete performer: Turning evidence into practice, with the focus on research and knowledge that could immediately be integrated and translated into clinical, studio or organisational practice. Participants and speakers included performers, teachers, practitioners and researchers from Australia, Malaysia, Canada, and UK.


Dr Cliffton Chan and Dr Paul Duff welcomed all participants and officially thanked the indigenous Australians for allowing the borrowing of their land, upon which the University had been built. They were further delighted with the range of this years speakers and the increasing development of research into and practice of Performing Arts Medicine specifically – rather than just “adapted sports medicine”.

Keynote speech

The Central Nervous System as a limiting factor to performance and recovery from injury, by Victor Popov, one of Australia’s leading Sports Physiotherapists with a long experience of and interest in Performing Arts medicine. He pointed out the importance of considering the complex and non-linear role of the CNS in order to achieve successful training or treatments, rather than just focusing on mechanical repair and symptomatic relief.

The performance is an expression of skill that is in turn a highly refined motor pattern.  If proprioception is dysfunctional, the execution will be dysfunctional. Poorly co-ordinated contraction and muscle tone pattern easily leads to overuse injury. It is therefore important to appropriately engage CNS in training and treatment – sometimes musculoskeletal injury is related to CNS ‘overload’. By modulating the input to CNS, the output will be changed.

Presentation, 20 min

The Vocal athlete: An introduction to the Estill Method, by Gerald Marko, an Austrian born, Melbourne based singer, musician, lecturer, researcher and Certified Master Teacher of the Estill Method and Course Instructor with testing privileges (the highest of their teaching qualifications). His interest in Estill voice training grew early in his singing career, while performing in musicals in Europe, often expected to sing in a vast range of styles, and through his frustration of his own limited level of knowledge but more so, the lack of helpful coaching and teaching. Coaching rarely included clear, objective instructions with reference to various anatomical structures and muscular activity but often focused on achieving subjective feelings and sensations through, many times vague or nonsensical instructions and imagery that was difficult to interpret, such as the advice he once had been given: “Think yellow!”.

The Estill Method uses research based knowledge of anatomy and vocal physiology and focuses on the ability to safely produce various types of sounds and voice qualities by learning to control the specific structures in the vocal mechanism. It includes a series of exercises specifically designed to individually move any of the thirteen identified involved structures, is used to enable reproduction of any of the six arbitrary voice qualities (speech, falsetto, sob, twang, belting, opera) and variations of them.

Care is taken to develop kinaesthetic feedback and to recognise, locate and control the level of effort to enable safe work.

Though the so called “power, source, filter model” for voice production is used (airflow creating power; vibrating vocal folds as the source of sound waves; vocal tract (area from vocal folds to lips) as filter for further shaping and colouring of the tiny sound produced by vocal folds), more focus is put on the control of vocal folds and vocal tract and their interaction, with less focus on breathing.

The Estill Method puts more emphasis on the craft of control of vocal mechanism, rather than “artistry and performance magic”, and makes no subjective judgments such what voice is “pretty” etc. The method is used to help to reproduce any required sound safely and thus useful for any style of music, and can be useful for both singing and voice therapy.

This short presentation acted as an introduction to the afternoon workshop.

Free papers, 10 min each

(I chose to attend the first four)

The relationship between dancer perceptions of dance floor properties, dance floor force reduction and in situ vertical deformation, by Dr Luke Hopper at the Western Australian Academy of Performing Arts, a Sports scientist specialising in clinical biomechanics including 3D motion capture. This study included comparisons of 15 dancers’ perception of how “sprung” four different floor samples were, compared to the vertical deformation carefully measured by specialised cameras. Their study showed that the dancers, as a group, demonstrated the ability to differentiate small variations in floor mechanical properties (0.5-1.5 mm), something that could be used as an assessment method of dance floors, rather than expensive testing equipment. However; an individual dancer’s perception would on its own not provide a statistically relevant accurate representation.

Comments from the dancers also included that some floors could be perceived as “too soft” and working on a harder floor could be seen, by them, as “safer”, as they would know what to expect, and could better rely on their own skilled dance technique to adapt.

Feeling the sound: Finger proprioception in violin pedagogy, by Dr Marina Robinson, a violinist and lecturer in violin at the Sydney Conservatorium of Music, with added personal experience within this field from having to rehabilitate and retrain following an earlier, serious injury. Her ongoing studies in this field investigate how proprioceptive training and cross-disciplinary learning can enhance violin pedagogy. Testing 24 elite violinists’ proprioceptive acuity showed that there were no overall differences between either hand for their chosen specific tests, indicating that, in spite of the difference in tasks, there are significant proprioceptive demands for both left and right hands. She also talked about how proprioception responds to specific training, is correlated with performance acuity and improves with increased age and experience.

Behind ten equally strong fingers, by Dr Therese Milanovic, a Brisbane based pianist and educator with 11 years experience of learning and teaching the Taubman Approach. She gave insight into causes behind the experience of weak fingers, and the importance of considering the synchronisation between fingers, hand, arm, and even the posture of the rest of the body. She talked about how she uses demonstrations, video examples and step-by-step checklists, to address problems rather than, as often happens in teaching, merely pointing out what not to do, or using independent exercises and monotonous drills in repetitive patterns.

The benefits of ergonomically scaled piano keyboard for smaller handed pianists: Leveling the playing field, by Erica Booker, a Sydney pianist and Suzuki piano teacher trainer, presented her ongoing research in muscular effort and functional load (and the risk of performance injuries). So far, ten pianists, aged up to 14 years, have had their forearm flexor and extensor muscles tested using electromyography whilst playing on a ergonomically scaled piano keyboard (5.5 inch octave) and again on regular full sized model (6.5 inch octave).

The current piano keyboard was standardised in the 1880s, based on what suited male virtuosos at the time, such as Liszt, and research has shown that a small hand span is a risk factor for injuries and that it is affecting females, with often smaller hands than men, disproportionately.

A case of facial peripheral neuropathy in a flautist, by David Peterson, physiotherapist for, among others, Sydney Symphony Orchestra. David discussed a recent case study of a single flautist and the specific patient-centered management approach and outcome.

Health promotion in a sample of elite tertiary student-musicians, by Michael Ingle, a Sydney physiotherapist and trombonist. A study that evaluated the effectiveness of a web-based health promotion course (Sound Performers), in a group of elite musicians at the Australian National Academy of Music.

Findings from the Student Musician Health Survey at Universiti Pendidikan Sultan Idris, Malaysia, by Dr Dr Karen Lonsdale, a music graduate with a doctorate involving research in injury prevention and management of flautists. The results of their online, self-reporting survey that attracted 98 full-time undergraduates and post graduates, were consistent with previous studies on musicians health; 29% were currently suffering from playing-related pain, 47% had experienced it at some time, and 57% felt they had not received enough information or advice on playing-related health during their current studies.

Playing-related pain in bowed string students: Preliminary results, by Judith Robitaille, a violinist and Occupational therapist in Québec. Judith presented results from their prospective cohort study of 152 young string students at three different summer camps.  Using questionnaires distributed few week before the camp and again one week into the camp, they inquired about playing habits, playing-related pain and its impact, and found that playing time had increased from 16 hours/week before the camp, to 33 hours/week during the camp, and found the prevalence of playing related musculoskeletal pain being as high as 96%.

Paper Streams, 25 min

Actors health and wellbeing in Australia: Further analysis of 2013 Actors Survey, by Prof Ian Maxwell, Dr Marianna Szab and Dr Mark Seton, all from University of Sydney. Presentation of results from the Equity (Australia) on-line survey 2013, with 782 respondents, that had gathered information of actors’ professional experiences including training, and income from both acting and non-acting sources as well as aspects of health and wellbeing using validated instruments measuring depression, anxiety, eating disorders, alcohol and drug use.

Elite Australian singer – Career stories, by Kathleen Connell, Sydney-based vocal coach, researcher and singer.  Using questionnaires and interviews of a cross section of singers with active careers between 1985-2005 and using established career theoretical concepts from other fields of work, she had investigated singers’ career maintenance and planning, especially in the latter stages of a career with their transition into other areas and potential changes to identity. Further study looked at how entrepreneurial methods, and the identification of a variety of capabilities, can help plan and sustain a career as well as a transition into other fields or professions.

An evaluation of the breathing strategies and maximum phonation time in musical theatre performer during controlled performance tasks, by Tommi Sliiden. The first research of it’s kind, testing 20 professional West End musical performers’ ability to sing long, sustained notes and how that ability is affected by the increased heart rate and effort of dancing; measuring changes to breathing pattern and heart rates whilst repeating (at a performance-like intensity) a chosen 3 minute extract from a musical number taken from their respective show in three different ways: singing only (standing still); dancing only (in silence); and combined, simultaneous singing and dancing (as in show).

Results showed that maximum phonation time was on average reduced to a third, and heart rate nearly doubled, immediately after fully singing and dancing the number. Lung volume per breath remained the same during dancing only, as during singing only (only breathing rate was increased – to the double). Singing restricted the spontaneous breathing used during dancing only, resulting in a reduction of air usage per minute (by 16%) when combining the two.

A questionnaire showed that only 45% of our performers had felt able to combine these two tasks, to their full potential, by opening night.

Workshops, 1h 40 min each

(I chose to attend the last one)

Posture, balance, symmetry and flow, with Victor Popov. With reference to his earlier speech, he elaborated on practical techniques for improvement of the Central Nervous System parameters of posture, balance symmetry and flow, functional posture training, awareness exercises, pain management and how ‘flow’ can be taught to enhance both expression and rehabilitation.

Optimising music performance: a systematic approach to dynamic postural analysis, with Dr Bronwen Ackermann, physiotherapist, researcher and educator. By using a template previously tested and clinically applied successfully to the Australian Youth Orchestra, a framework was provided to evaluate the posture of musicians with their instruments, in a more static position as well as during performance.

Introduction to muscular voice training – Pushing breath is what’s hurting you, with Gerald Marko. Following the presentation earlier in the day, Gerald demonstrated with great enthusiasm and knowledge the different voice qualities used within the Estill Method (speech, falsetto, sob, twang, belting, opera). He used his own impressive vocal skills to illustrate the various sounds and how they can be varied with subtle, controlled changes to various structures and muscles involved in voice production. Video laryngoscopic images of the larynx and vocal folds highlighted some differences seen when producing different voice qualities. We had a demonstration of Voiceprint™ software, a real-time spectral analysis program that records, analyses, and plays back the voice, giving audiovisual feedback about pitch and voice quality, used to enhance the learning and rehabilitation process.

He further explained the basic mechanics of breathing, the involvement of both active and more passive structures – including muscular control and elastic rib recoil, and how the different voice qualities naturally utilise different amounts of air and produce different levels of loudness, pointing out that production of loud volume is not necessarily a result of increased air volume or pressure, and furthermore, how excessive use of abdominal and other respiratory muscles to increase pressure can even be damaging to the larynx, depending on what voice quality and larynx position is used.

Breathing, especially when no sound production is used, often comes naturally, involving various automatic processes, and the Estill method focuses more on the ability to control the larynx and vocal tract, rather than breath control, something that is often emphasised rather more within other types of vocal training. Gerald used the analogue of sailing to explain – breath does indeed provides the power of voice production, like the wind does for sailing, but it is the ability to control the boat and sails to successfully and safely adapt to the wind that is important, not trying to change the wind – “Thus, it’s called sailing – not winding ”.


Dr Cliffton Chan and Dr Paul Duff thanked all participants and speakers for a successful and interesting day, and presented ASPAHs Career Development Award as well as the award for the winning contribution to this years online competition to create a YouTube clip promoting this year’s symposium!


The Symposium was highly inspiring, with a lot of varied speakers within different fields and interesting participants from different backgrounds to discuss the topics and other work related matters; comparing similarities and differences.

During the week that followed the symposium, I had the opportunity to get in contact with some of the other participants and speakers, including Dr Cliffton Chan, 2014 Symposium Chair, and his colleague, the Principal Physiotherapist at Potts Point Physiotherapy, David Peterson, who invited me to the Sydney Opera House to learn more about treating members of the Australian Opera and Ballet Orchestra.

As a final treat, I managed to get a ticket for the Sydney Symphony Orchestra’s concert, “Symphonic Firsts”, performing Brahms’ Piano Concerto No.1 and Mahler’s Symphony No.1 in the magnificent main hall of the Opera House, with the final piece performed by over 120 musicians in the orchestra! A spectacular evening finished off outside on the terrace overlooking the Harbour Bridge, enjoying a glass of Australian wine in the balmy summer evening.

BAPAM Journal Relaunch

Monday, June 24th, 2013

After nearly eight years, we are happy to announce the re-introduction of The Journal of The British Association for Performing Arts Medicine, covering a broad spectrum of topics related to clinical research, education and healthy practice within performing arts medicine.

The new Journal is a free online publication. You can download it in pdf format here: The BAPAM Journal Issue 1 June 2013. We recommend right-clicking and saving the file to your computer.

We encourage our readers to assist us by contributing articles, letters and email responses. Our contact details and further information can be found on the contents page of the Journal. We know that there are many of you working in, studying or fascinated by this specialism, and we hope to open a new channel of communication.

The State of Play 2013 – Musical Instrument Day

Thursday, February 14th, 2013

Saturday 23rd March

(Registration from 09:30)
Saturday 23rd March

The Old Refectory, Wilkins Building, Main Quadrangle, University College London WC1E 6BT

A study day for performers, healthcare practitioners, music teachers, manufacturers and modifiers of musical instruments

Enhancing performance and facilitating healthier practice

Bespoke instrument modifications and manufacturing technology

Investigating tools for musicians’ rehabilitation from injury

Configuring the musical interface for healthy performance

Musical instrument ergonomics 

Sessions focusing on brass, strings and guitar

Full Day £75 Half Day £40

BAPAM Practitioner £65

Students £50

To reserve your place please email and we’ll send you a booking form. 

More information: State of Play Instrument Day Programme

Photo: MFHiatt

Performing Arts Medicine MSc Research

Tuesday, October 16th, 2012

Performing Arts Medicine MSc research student, Michael Durtnall, is undertaking a project to evaluate a safe ultrasound and laser system for measuring the impact of playing activity on bone health.

If you are over 18 and have been involved in music training from a young age, the project requires attending a 10 minute appointment involving leg measurements. Appointments will take place on Saturday 27th October 2012 from  9.30 am to 5.30 pm at BAPAM in London.

If you would like to participate, please contact Michael by emailing or call 020 7937 8978.

Project supervised by Research Fellow, Ian MacDonald.

Note: This project is part of an MSc research thesis at UCL (University College London), has official ethics approval and is covered by UCL’s data protection protocol. The research is not being conducted by BAPAM.

Musical Instrument Appeal

Monday, September 24th, 2012

Photo: Paul J S

BAPAM needs new (old) toys! We’re putting out a request for donations of unwanted musical instruments – of any kind (though we don’t have room for a Wurlitzer) – Brass, Woodwind, Strings, Percussion. Even parts of instruments and broken instruments:

Chin rest without the instrument
Without mouthpieces
Damaged pads

We help musicians with medical problems caused by or affecting their playing. Our doctors need to see how musicians’ bodies work with their instruments, honing our expertise in instrument ergonomics, and our understanding of their composition and construction.

BAPAM has a key role in training medical practitioners through the Performing Arts Medicine MSc qualification at University College London.  Getting to grips with these occasionally obscure implements is an integral part of the MSc learning experience. We need Performing Arts Medicine specialists to know their autoharp from their euphonium.

Photo: Kaensu

So can you help us? Do you have old, unloved musical instruments taking up space in your life? Email and we’ll gratefully give them a new home.

Violinists and Viola Players Research

Thursday, May 10th, 2012

Violinists and viola players – would you like to find out more about how to optimise your playing?

Photo: Mel B.

Postgraduate student and violinist, Dr Alison Loram, is looking for student, professional and amateur violinists and viola players for her study.

The study, in collaboration with University College London and Manchester Metropolitan University, aims to understand more about the neuromuscular aspects of playing the violin/viola, and the effects that these may have upon musculoskeletal and other playing-related problems.

Alison believes that violinists and viola players taking part will benefit from the insights gained: “You will have the opportunity to see how your neck and shoulder muscles are involved in holding and playing your instrument, the bodily movements you make, and how these may be optimised to enhance your playing and reduce/prevent muscular tension”.

The study is open to any student, professional or experienced amateur (regardless of whether or not you have playing-related problems), and will involve attending one individual 2-hour session during May, July/August or September.  The confidential session (to be held at Manchester Metropolitan University in Manchester City Centre near to the Royal Northern College of Music), will involve standing and playing your instrument for very short periods whilst your muscular activity and movements are recorded and analysed using ultrasound scanning and movement analysis equipment.  No preparation is required.

Participation is voluntary and you can leave the research at any time. If you agree to participate in the study, you will be given a detailed information sheet and a consent form.

For further details or to sign up for the study, please contact Dr Alison Loram directly by emailing

Please share this article amongst any family, friends or colleagues you think may be interested in participating.

Note: This research project is not being conducted by BAPAM. The project has official ethics approval from UCL (University College of London) and is covered by UCL’s data protection protocol.

Pianists Research

Wednesday, April 25th, 2012

Pianists, are you interested in taking part in research into arm tension and other painful conditions? 

Medical doctor and pianist, Dr Hara Trouli, is looking for advanced students and professional pianists to take part in this project. Dr Trouli explains:

I am a medical doctor and a pianist, currently also a student of the first Masters Degree on Performing Arts Medicine at University College London that was developed by BAPAM (British Association of Performing Arts Medicine) in collaboration with the Royal College of Music and Trinity Laban.  I am conducting research on pianists’ arm tension and other painful conditions under the supervision of Professor Howard Bird who is a UK specialist in performers’ health.

We need to see advanced students or professional pianists who have suffered at some point a medical or painful condition (either diagnosed or not) of the upper limb or the cervical spine (hands, wrist, arms or neck) and analyse their piano playing through a triple method of video/ MIDI/ Electromyography.

The idea is to see whether these conditions show signs on the graphs of muscle tension in the arms and neck (electromyography), velocity, force and articulation of piano playing (MIDI) and on postural images of the hand and arm (video). We are aiming to bridge the technical pianistic accomplishment with the clinical history and to measure parameters that would be reproducible and available to both the pianists and the doctors for evaluation. We are also trying to see whether these parameters can be used in monitoring the progress of the pianist during recovery from a painful condition or an injury, and to also enable the pianist to use this method as biofeedback when they re-train.

The assessment of each pianist lasts 2 hours, it takes place in a studio in North London and travel expenses are covered up to £10.00.   Full information and consent sheets will be given to you before your assessment. We would need to see you in April or May and appointments can be made for any weekday or the weekends. We will also be pleased to share the results of your assessment with you and send you a full report of the recorded images. All information that we will receive from you is kept strictly confidential.

Please contact Dr Trouli directly if you’d like to get involved:  

Photo by David Denicolò

BAPAM Newsletter April 2012

Thursday, April 12th, 2012

Our April 2012 Newsletter is now available to download in pdf format here:

BAPAM Newsletter April 2012


Guitarists Research

Tuesday, February 21st, 2012

Guitarists, are you interested in taking part in research into guitar support tools and the curvature of your spine while playing?

Postgraduate UCL student, Efthalia Paleokastriti, is looking for classical and acoustic guitarists for her study.

Efthalia believes that guitarists taking part will benefit from the insights gained: “You will have the opportunity to test your guitar playing using different support tools and you may decide which is better for you. Moreover, you may be more informed about the “right” posture of the body while holding the guitar and about ergonomic playing”.

Efthalia explains the project and how you can get involved:

Dear Guitarist,

I am investigating functional scoliosis in guitarists using different guitar support tools.

This involves a temporary change of spinal curvature caused by a provocative factor – in this case, playing the guitar.

I am looking for guitarists to participate in the research project. Specifically, classical or acoustic guitarists (who use a footstool or ergo play guitar support equipment) and who are professionals or experienced guitar players (3 years or more).

The research includes:

  1. answering an anonymous questionnaire (questions about guitar playing habits/pain occurrence/use of guitar support tools).
  2. arrangement of a meeting in which we will take photos of your back while you hold the guitar and use guitar tools.

Participating in this research will be beneficial for you because you will learn more about ergonomic playing and you will try different guitar support equipment.

Participation is voluntary and you can leave the research at any time. If you agree to participate in the study, you will be given a detailed information sheet and a consent form. If you have any queries about our project do not hesitate to contact me.

We are looking forward to hearing from you.

Please read the Information Sheet which includes a detailed description of the project.

And please complete and return the Anonymous Questionnaire – you can answer it even if you decide not to participate in the measurement part of the research.

Contact details: EFTHALIA PALAIOKASTRITI. Email:

Note: This research project is not being conducted by BAPAM. The project has official ethics approval from UCL (University College of London) and is covered by UCL’s  data protection protocol.