The global pandemic has brought unprecedented disruption to our lives over the last year. To protect public health and reduce disease transmission, we have endured stay-at-home orders and strict quarantines. Those who work in the Performing arts industry have been disproportionally affected by these restrictions, with the majority of performance venues forced to close. In a recent study, 96% of performing artists reported a reduction in working time. Many of us have experienced physical, psychological and financial challenges. As we begin to emerge from lockdown and plan to return to work and performance environments, it is important to build fitness to perform physically and psychologically, to make a return to live performance as successful as possible.
At BAPAM our clinical assessments and health education focus on returning to performance, and this is the first in a series of blogs providing advice to performers and anyone involved in putting on a performance.
Read more in this series here:
Returning to work in the performing arts after having COVID-19 | BAPAM
When the curtain goes up again: Injury prevention for dancers | BAPAM
In this blog, BAPAM physiotherapist, Lucie Rayner, considers how we can avoid health problems as we return to our performance environments and schedules.
How could the lockdown contribute to injury risk? Research shows that during the period of COVID restrictions, our physical activity levels decreased by up to 38% and have involved lower intensity activities. It is well established that periods of low physical activity result in a loss of muscle mass and general de-conditioning. Returning to performing after time off, or a sudden increase in a physical activity without allowing sufficient time for the body to adapt are known risk factors for injury. Therefore, if performers jump straight into pre-pandemic levels of workload without adequate preparation and planning, they will significantly increase the risk of injury.
There are positive steps all performers can take to reduce injury risk
So how can performing artists reduce injury risk as we are released from lockdown? The good news is that there is much we can do both during the current restrictions and as we transition back to work to mitigate the negative impact of lockdown. This series of articles aims to help guide performers from all sectors of the industry as theatres, concert halls and other venues start to re-open over the next few months. This first article concentrates on instrumental musicians, with a future post focusing on dancers and physical performers.
Instrumental musicians
Instrument playing is a highly complex, physically and mentally exacting skill. Research has shown that there is a significant, physical demand placed on the body during playing. Musicians therefore benefit from viewing themselves as ‘artistic athletes’ and paying attention to their physical status, preparation and recovery. It is likely that many musicians will have some level of general deconditioning over the last few months. In a similar way that deconditioning affects athletic performance, it may also affect instrument playing performance and contribute to increased risk of injury.
What you can do now
Exercise more
Note: If you have been ill with COVID 19 or are experiencing symptoms of Long COVID, rest is vital, and any increase in physical and mental activity should be cautious and gradual.
There is plenty of evidence that a combination of aerobic and resistive strengthening exercises can protect musculoskeletal integrity. A recent study on preserving muscle health reminds us that “exercise is music for your muscles – don’t stop playing as they are still listening!” The authors recommend regular exercise which should include resistance training (consisting of slow, low/medium intensity, high volume repetitions) and aerobic exercise workouts involving large muscle groups (e.g., jogging or cycling). This type of regular exercise will help increase the resilience and flexibility of the soft tissues (muscles, tendons and ligaments etc.) along with strengthening and cardiovascular fitness. In addition, exercising is known to have a positive impact on mental health. A survey completed during lockdown showed that exercise was associated with higher wellbeing scores for Performing Arts professionals.
Resources
Infographic on staying active during COVID: bjsm.bmj.com/content/early/2020/11/11/bjsports-2020-103282
NHS Fitness Studio – aerobic exercise and strength training videos
Sleep well
When we sleep, our bodies are busy carrying out small repairs to the everyday ‘micro-injuries’ we sustain from normal life living. The repetitive movements and prolonged postures experienced when playing an instrument may add to this list. These micro-injuries are so insignificant that we are not aware of them. In order to complete these repair jobs, we need sufficient, good quality sleep. The body can cope with some disrupted sleep, but if we are chronically sleep deprived, a repair backlog can turn into a noticeable injury. Practicing good sleep hygiene will help ensure musicians get the sleep quality and quantity they need for rest and recovery.
Resources
The Sleep Charity offers independent, expert advice and support on getting a good night’s sleep
Improve diet
The body’s overnight repair team also need the necessary building materials, which come from the proteins, carbohydrates, fats, vitamins and minerals that we consume in our diet. If we lack a healthy balanced diet, we could be missing some key ingredients, again contributing to a repair backlog and potential for injury. Research done during COVID restrictions has indicated a shift towards unhealthy eating. Try to maintain a healthy diet with plenty of fresh vegetables, good quality protein and moderate amounts of seeds, nuts and monounsaturated fats.
Resources
The British Nutrition Foundation provides impartial, evidence-based information and resources on food and nutrition
BAPAM Factsheet: Sensible Eating for Performers
Manage stress
As well as the physical load of normal life living, ‘psychological loads’ such as stress and anxiety can impact the capacity of the soft tissues. There are physiological responses to stress within the body which can reduce our physical resilience. It is not surprising that during the pandemic, studies have observed a significant decline in mental health. In a recent survey, a large number of performing arts professionals reported an increase in feelings of loneliness (63%) and anxiety (83%) during the lockdown. Support available for creative practitioners includes BAPAM’s weekly Community Drop Ins via Zoom, which aim to support performers’ mental health. These free sessions are facilitated by Dr Pippa Wheble, a GP who specialises in the physical, vocal and mental health issues for performing artists.
Resources
BAPAM Community Drop ins and healthy practice events: BAPAM Events
BAPAM Factsheet Psychological Self Care – Enhancing Mental Health & Wellbeing
Tonic Rider – a new programme providing music industry-specific mental health support, including free resources and a virtual peer support group run by Adam Ficek, professional musician and BAPAM-registered psychotherapist
Practice better
A large number of musicians seen in the BAPAM Clinics do not sufficiently prepare their bodies before instrument playing and this has significantly contributed to their injury. A proper physical warm up away from the instrument as well as ‘cooling down’ exercises to rebalance the body and promote recovery should be part of a musician’s normal routine. BAPAM run regular Physical Health and Injury Prevention workshops with further information on this topic.
In addition, the BAPAM Community Drops Ins aim to help support the development of healthy practice habits. If you prioritise building good practice habits during this time it will pay dividends as you return to performance.
Resources
BAPAM Physical Health and Injury Prevention workshops take place regularly. Sign up to free events here: BAPAM Events
BAPAM Factsheet: Don’t Cramp Your Style: Warm Up Exercises for Musicians
BAPAM Factsheet: Fit To Play: Health, Performance, and the Instrumentalist
Refine technique
Some performers have used the lockdown period as an opportunity to fine tune their technique. If this is done with the guidance of an experienced tutor it could be a perfect time address minor flaws or improve certain aspects of technical ability. However, BAPAM clinicians have seen some musicians who have sustained injuries from pushing their technique without proper guidance or without allowing enough time for the body to adapt. If you are working on technique, seek help from an experienced teacher, progress slowly and plan plenty of recovery time.
Resources
Article: Effective Practice: Lessons from Neuroscience and Psychology by Gregg Goodhart
Monitor activities
Be mindful of other activities which use similar muscle patterns to instrument playing such as computer use, gaming and DIY. All these activities have increased during the lockdown, potentially adding to the workload of the muscles and tendons in the forearm, wrist and hand. Monitor and pace how much time you spend doing activities with your upper limbs, as this can quickly accumulate and significantly contribute to overall load. If you are using a computer or laptop, check that you have your equipment set up to allow healthy posture and ease of movement. Take regular breaks during computer use or gaming to stand up, move and stretch.
Resources
The National Back Pain Association provides some useful advice on setting up your desk for computer use
The Chartered Society of Physiotherapists (CSP) offers some simple exercises for desk users
What you can do after lockdown
The government has now revealed a roadmap out of lockdown which will give musicians some indication of when they might return to work and performance so they can adequately prepare.
COVID Risk Assessment
Performing artists will need to be aware of the risk of exposure to COVID-19 going forward. Public Health England (PHE) will provide further guidance for working safely. Freelance performers can complete their own risk assessment before returning to performing. BAPAM have developed a comprehensive risk assessment guidance document which allows performers to assess their own individual level of risk and how to mitigate risks within the work environment.
Resources
BAPAM Return to Work Risk Assessment for Freelance Performers
Phased return
In a recent survey, over 30% of performing arts professionals have engaged less in skill maintenance activities such as learning, practice and reflecting; and a further 33% had not engaged at all. This reduction in practice combined with general deconditioning from reduced lockdown activity needs to be considered. Instrument practice should be carefully planned to reflect current levels of playing fitness. Increases to practice length and intensity should be phased in gradually and progressively to allow the body to adapt. Consider your current practice workload and compare it to where it needs to be in order to represent your playing times once work or normal schedules resume. As a guide, musicians can increase their playing time by about 10% every 2-4 days until they reach their target levels. However, this will vary between individuals depending on age, experience, instrument, general fitness and repertoire played. Each time you increase your playing time, monitor how your body responds and only increase to the next level if your body is comfortable with the current workload.
Rest and recovery
It will be vital to plan plenty of recovery time as you transition to regular schedules. In this ‘re-conditioning’ phase, an optimal work-to-rest ratio will be important. Plan your practice and breaks carefully. Consider splitting your practice time into 2 or 3 sessions over the day with at least an hour break in between. Use mental rehearsal or visualisation techniques to reduce the physical workload. During your scheduled breaks, restrict other upper limb activities such as computer use to allow the soft tissues a complete rest. Be mindful of committing to social events or other activities that could interfere with rest time.
Resources
BAPAM article on Mental Practice Skills by Applied Performance Psychologist Dr Ellis Pecen
Maintain good practice hygiene
For some musicians, the lockdown period has provided an opportunity to ingrain some healthy practice habits. As you become busier and have less spare time, it may be tempting to miss out breaks and skip your regular warm up or cool down. However, continuing healthy practice habits will be more important than ever during this period so keep prioritizing your physical health in order to keep the soft tissues strong and resilient.
Maintain health foundations
As the workload increases, maintaining a balanced diet, staying hydrated, protecting sleep quantity, managing stress and keeping up with general fitness will still be crucial. These factors remain the foundation for good health and injury prevention.
Don’t ignore pain
If you do experience pain or discomfort – don’t ignore it. There are various reasons why musicians are reluctant to seek help from a healthcare professional when they become injured and unfortunately this can lead to poorer outcomes. Seeking help early can help reduce the impact of an injury, speed up recovery and lead to more positive outcomes. BAPAM provide free, confidential assessment clinics run by Performing Arts Medicine specialist healthcare professionals: BAPAM Clinics
References
Spiro N, Perkins R, Kaye S, Tymoszuk U, Mason-Bertrand A, et al. The Effects of COVID-19 Lockdown 1.0 on Working Patterns, Income, and Wellbeing Among Performing Arts Professionals in the United Kingdom (April-June 2020). Front. Psychol. 2021 11:594086. doi: 10.3389/fpsyg.2020.594086
Naricia M, De Vitoa G, Franchib M, Paolic A, Moroc T et al. Impact of Sedentarism due to the COVID-19 Home Confinement on Neuromuscular, Cardiovascular and Metabolic Health: Physiological and Pathophysiological Implications and Recommendations for Physical and Nutritional Countermeasures. Eur J Sport Sci. 2020;1-22.
Flanagan EW, Beyl RA, Fearnbach N, Altazan, AD, Martin CK & Redman LM. The Impact of COVID-19 Stay-at-Home orders on Health Behaviours in Adults. Obesity (Silver Spring). 2021;29(2):438-445. doi: 10.1002/oby.23066. Epub 2020 Dec 18. PMID: 33043562; PMCID: PMC7675243.