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Suffering for Their Art

Young dancers and musicians can fall victim to certain injuries

SATURDAY, Oct. 20, 2001 (HealthDayNews) -- Parents who worry about sports injuries may breathe a sigh of relief when their children show interest in the arts instead. But whether it's fine arts or performing arts, injuries can still be part of the game.

Although such impact injuries as broken arms are reserved for sports like football and gymnastics, students who engage in more subdued activities -- from ballet dancing to piano playing, even to such fine arts as painting or sculpting -- face an array of potential injuries.

Injuries common to ballet dancers, for instance, include foot and ankle problems ranging from tendinitis to stress fractures. Such injuries are more common in children older than 10 or 11, explains Dr. William G. Hamilton, the attending orthopaedic surgeon for the School of American Ballet in New York City.

"As children get into their teens, the practicing intensifies, and that's when you might start seeing such problems as a sprained ankle," he says.

Most good ballet instructors know the correct exercises, stretches and dancing limitations that prevent injury in children, Hamilton adds. And while kids are typically anxious to begin dancing on their toes, or "on point," most instructors will hold off until the children's feet are fully grown, at about age 12.

"Parents are best advised to consult with the instructor as to when to allow them to go 'on point,' " Hamilton says.

Although ballerinas may be battling achy ankles and feet, student-musicians performing that piece from "Swan Lake" may be experiencing their own unique aches and pains.

The source of many of these problems is repetitive stress, or the wear-and-tear muscles and joints sustain when exposed to repeated motion.

"Musicians and other performing artists are exposed to tremendous amounts of stress in the upper extremities during practices and recitals," says Dr. Barry P. Simmons, a professor of orthopaedic surgery at Harvard Medical School in Boston.

"Even the less aggressive music of the composers like Bach presents many of the same potentials for strain and injury," he adds.

Simmons and Hamilton discussed issues related to injuries in the arts at a recent American Academy of Orthopaedic Surgeons meeting in New York City.

Simmons says the adage "No Pain, No Gain" couldn't be less appropriate when it comes to pain that arises from playing an instrument.

"You shouldn't, at any cost, play through pain," he says. "Take a step back and examine the practice and performance habits. Take frequent breaks and rest when you get sore."

Dr. Michael Charness, director of the Performing Arts Clinic at Brigham and Women's Hospital in Boston, sees his share of music- and arts-related injuries. A common culprit is a sudden increase in the time spent practicing and performing.

"We'll see [it] when kids are sent away to summer music camp where they're playing much more than during the school year, when they'll maybe practice one or two hours a day. But they get to these camps, and suddenly they're playing six or seven hours a day," he notes.

Problems can range from tendinitis and carpel tunnel syndrome, which is caused by pressure exerted on the median nerve of the wrist, to cubital tunnel syndrome, caused by repeated injury or pressure on the ulnar nerve in the elbow.

Charness says treatment can involve everything from physical therapy and anti-inflammatory drugs to surgery for more severe cases. Essential to proper treatment, however, is understanding the practices that caused the problems in the first place.

"We want to look at the circumstance that led to the injury, and that means looking at both the intensity and the duration of the playing, as well as how they're holding their instrument, how they're holding their bodies," he says.

Depending on the instrument being played, various types of stretching exercises are recommended, in addition to frequent breaks.

To prevent further injury and ease strain, many instruments can be adjusted or fit to accommodate growing bodies, Charness adds.

"For instance, clarinet players put the weight of the instrument on their right thumb. But there are posts that can be attached to the clarinet to allow the weight of the instrument to be transferred to the chair," he says.

"In addition, as kids who play the violin or viola grow, they can find themselves squeezing their shoulder or neck to hold the instruments because their neck is growing. But we can refit the instruments with shoulder pads or chin rests to eliminate unnecessary muscle contraction," he adds.

What To Do

The University of Nebraska/Lincoln has a Web site with plenty of helpful information about musicians and injuries.

A common injury specific to children, whether they're artists or athletes, occurs to the growth plate. Read more about the signs and treatments at the American Academy of Orthopaedic Surgeons' Fact Sheet on Growth Plate Fractures.

SOURCES: Interviews with William G. Hamilton, M.D., clinical professor of orthopaedic surgery, Columbia University, and attending orthopaedic surgeon, School of American Ballet, New York City; Barry P. Simmons, M.D., professor of orthopaedic surgery, Harvard Medical School, Boston; Michael Charness, M.D., director, Performing Arts Clinic at Brigham and Women's Hospital, and associate professor of neurology, Harvard Medical School, Boston; American Academy of Orthopedic Surgeons press releases
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