In a dimly lit room at the Recording Academy headquarters in Santa Monica, author and repetitive strain injuries expert Jill Gambaro gives a presentation to a small audience of musicians and industry professionals. The title of her talk is “Musicians in Pain: Get Help and Keep Your Gig.”
According to one recent study, as many as four in five working musicians will experience “pain severe enough to interfere with their performance” at some point during their career, most commonly caused by any of 100-plus different types of repetitive strain injuries (RSIs), from tendonitis to more severe conditions such as carpal tunnel syndrome and focal dystonia. Another half at any given time struggle with performance anxiety, and 32 percent report suffering from depression or depressionlike symptoms.
But despite these epidemic numbers, musicians' health remains a seldom-discussed issue, especially among the musicians themselves, who tend to power through injuries for fear of losing work. “It's a culture of silence,” says Jennie Morton, an osteopath, educator and founder of the Healthy Performers website.
In her talk, Gambaro, author of The Truth About Carpal Tunnel Syndrome, tries to address this. “With repetitive strain injuries, the more you do something, the worse it gets,” she says. “It’s so easy to ignore and I’m asking you please, don’t do that, because your body’s trying to tell you something.” Behind her, a PowerPoint slide reads: “Three Keys to Keeping Your Gig: Posture, Body Awareness, Movement.”
After her talk, both Gambaro and Morton, who is in attendance, are surrounded by musicians seeking guidance for their various ailments: a young violinist with a frozen shoulder, an older guy who's “got the dystonia” and wants to know if myotherapy is “just more voodoo, or is it worth looking at?” Their frustration and fear is palpable. Music is these people's passion, and often their livelihood, and although the healthcare industry offers a bewildering array of treatment options for their various injuries, Gambaro says the overall approach still resembles “throwing spaghetti against a wall.”
Fortunately, more resources are emerging for musicians dealing with RSIs and other health issues. One of them is the Recording Academy's own MusiCares, which has long served as a charity for musicians in need of financial, medical or emergency assistance. Another, the Performing Arts Medicine Association (PAMA), has been serving the classical music community since the '80s but in recent years has expanded its mission to include research on health issues for all musicians, and to provide referrals via its website to medical professionals who specialize in working with musicians and other performing artists.
Morton, who has a background in dance and musical theater and serves on PAMA's board of directors, says that performing arts medicine was not a well-recognized field until just a few years ago and is still unknown to many musicians. Before relocating to Los Angeles from her native England, she helped create the curriculum for the world's first graduate degree in the field, a master's of science at University College London, established in 2011. Since joining PAMA, she's worked with the National Association of Schools of Music to ensure that all 644 accredited music schools in the United States now offer musculoskeletal, hearing and voice health classes to all of their students. She runs the wellness program at the Colburn School in downtown Los Angeles and is working to develop another master's program for performing arts medicine at Chapman University in Orange County.
For Morton, the next frontier for performing arts medicine is mental health, a topic she addresses in her book The Authentic Performer: Wearing a Mask and the Effect on Health. Among her own patients, “The people I see with so-called 'physical injuries,' there’s always a huge emotional component to that. Anxiety drives muscle tension, which then makes their playing more risky. It’s all intertwined. You can’t really separate the two.” She and some of her PAMA colleagues are advising the National Association of Schools of Music on how to add psychological health to their member schools' curricula.
Dr. John Chong, director of the Musicians' Clinics of Canada and an active member of PAMA since day one, agrees. “The effect of [physical] impairment is just so bloody devastating,” he says. “I think the key thing is that the artist is so self-identified with the art … you turn that around [and it becomes] a risk factor, an Achilles' heel to the strongest. That’s very different than other occupations.”
He cites prog-rock keyboardist Keith Emerson, who took his own life earlier this year after a long struggle with focal dystonia, as an example. “You’re not gonna tell Keith, ‘Well, just lighten up and do something else.’ So everything is geared to getting Keith functional again.” But too often, Chong says, those efforts are too focused on masking pain and other symptoms, or fail to take into account the psychological component of the musician's suffering. He believes that's what happened in the case of Prince, who died from an overdose of fentanyl, a powerful opioid painkiller.
Chong himself gave up a promising career as a classical pianist at an early age due to repetitive strain injuries. Before going into medicine, he studied engineering, and used that skill set to develop a system that uses wireless sensors and software to measure a musician's muscle activity during performance. Chong uses the system with his patients to identify areas of muscle tension that contribute to RSIs and other chronic injuries.
“I have found it invaluable in the way I assess an injury and formulate a treatment plan,” he says of his system, which he hopes to eventually make available to other medical professionals. “It does work. [My patients] do get back to work and they live a very transformed, healthy life and are healthy performing.”
Chong, Morton and Gambaro have all done invaluable work in pushing issues of musicians' health out of the shadows, and their efforts will no doubt continue to help destigmatize RSIs, chronic pain, performance anxiety and depression in ways that will make those conditions more treatable and less devastating to the performers who experience them. Depression, in particular — which Morton says creative people of all sorts are more susceptible to — has already become a greater part of the conversation throughout the music industry. Rapper Kid Cudi recently announced he was entering rehab to seek treatment for depression, and Bruce Springsteen openly discussed his own mental health struggles in his recent memoir, Born to Run.
But there is much progress still to be made — especially since, as Chong notes, we still have a tendency to “blame the victim” when a prominent musician such as Prince or Scott Weiland dies of a drug overdose while struggling with physical and/or mental health issues. He hopes that organizations like PAMA and MusiCares can help shift the conversation around such deaths from judgmental discussions of the “rock-star lifestyle” to something more sympathetic to the incredible stresses many musicians face in order to perform and practice their art.
“The medical things I see every day are unbelievable. The horrendous arthritises. The addictions,” Chong says. “These people are amazing to persevere. They want to get better; they want to keep it going.”