Athletes and the Arts – The Role of Sports Medicine in the Performing Arts

“Athletes and the Arts – The Role of Sports Medicine in the Performing Arts”

Dick, Randall W. MS, FACSM; Berning, Jacqueline R. PhD, RD, CSSD; Dawson, William MD, BS, FAAOS; Ginsburg, Richard D. PhD; Miller, Clay MD, MFA, PMR; Shybut, George T. MD

Published in Current Sports Medicine Reports, November/December 2013, Volume 12, Issue 6, p. 397-403.


Performing artists are athletes. Like athletes, performing artists practice and/or perform most days with little off season, play through pain, “compete” in challenging environments, and risk career-threatening injury. Athletes and the Arts is a multiorganizational initiative linking the sport athlete and musician/performing artist communities. Performing artists of all ages and genre are an underserved population related to medical coverage, care, injury prevention, performance enhancement, and wellness. Sports medicine professionals are a valuable resource for filling this gap by applying existing knowledge of treating sport athletes (nutrition, injury prevention) while gaining a better understanding of performers’ unique needs (hearing loss, focal dystonia) and environment. These applications can occur in the clinical setting and through developing organizational policies. By better understanding the needs of the performing arts population and applying existing concepts and knowledge, sports medicine professionals can expand their impact to a new patient base that desperately needs support.

Read full article – Athletes and the Arts – The Role of Sports Medicine in the Performing Arts

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Preventing dance injuries: current perspectives

From the abstract “Preventing dance injuries: current perspectives” by Dr. Jeffrey A. Russell of Ohio University:

“Dancers are clearly athletes in the degree to which sophisticated physical capacities are required to perform at a high level. The standard complement of athletic attributes – muscular strength and endurance, anaerobic and aerobic energy utilization, speed, agility, coordination, motor control, and psychological readiness – all are essential to dance performance. In dance, as in any athletic activity, injuries are prevalent. This paper presents the research background of dance injuries, characteristics that distinguish dance and dancers from traditional sports and athletes, and research-based perspectives into how dance injuries can be reduced or prevented….”

Watch the video abstract and read the full paper here (look for “Download article PDF”).

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Performance Anxiety – One Page Fact Sheet

Performance anxiety, commonly referred to as “stage fright” in performing arts contexts, is a distressing and disabling condition that affects performers of all ages. At least half of all performing artists, regardless of age, gender, and talent or experience level, report problems associated with performance anxiety.


Download a one-page fact sheet (PDF) on Performance Anxiety.

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Focal Dystonia – One Page Fact Sheet

Focal dystonia is an abnormal movement disorder that develops when a person is attempting to perform a specific task such as playing a musical instrument. It shows in the loss of voluntary muscle control while playing an instrument. Focal dystonia can affect any group of muscles in the body including the face, lips, tongue, neck, arms or legs.


Download the Focal Dystonia (PDF) one-page fact sheet.

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Eating Before Performing – One Page Fact Sheet

The day of a performance, I often feel nervous and sometimes skip lunch, only to feel hungry later. Performances are usually in the evening so I know I need to eat something beforehand. Playing extended sets, I rarely get a break. What foods can I eat and at what times to supply me with enough energy to perform well the entire time?


Download the Eating Before Exercise (PDF)



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Athletes and the Arts: An Amazing Representation

Amazing imagery demonstrating athletes and the arts!

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The Affordable Care Act: What it means for artists of all disciplines


The national health care reform law known as the Affordable Care Act, has several nicknames such as the ACA and ObamaCare. The law used Massachusetts’ landmark 2006 health care reform law as one of its key templates*. This is a three part blog post focusing on the ACA. The first two parts share important information and web links about the ACA as it pertains to individuals and families. The focus of the third part is to highlight how important it is for artists of all disciplines to become involved in health care reform policy. Artists of all disciplines are a population that has one of the highest rates of uninisurance in our country and it is usually double the rate of the general public. Our population needs to be highly visible on all levels of the health care policy  arena (local, state, federal) to best ensure that reform is successful for our community.

One key tip we can not stress enough for artists of all disciplines: Find a local community health center and/or a health care advocacy organization in your region that can act as a resource and hopefully as an advocate for you. This is especially important if you are self employed, have some self employment income, are a seasonal employee, have multiple employers, have fluctuating, and/or hard to determine income. Do not go it alone when enrolling or navigating the new ACA programs. Trust us on this. Two on-line resources to help you find a community health center:

*’s home state is Massachusetts.


Part One- Some of the Key Basics on the ACA 

1) Pre-Existing Conditions and Dropped Coverage

The artist community has sadly experienced the horrible results of wide scale discrimination from health insurance companies. In the 80’s and early 90’s, during the first wave of the HIV/AIDS crisis in our country, those living with the disease often lost their coverage either from losing their jobs that provided their insurance* or losing their jobs from being too sick to work. The insurance companies also dropped coverage when it  learned of someone’s “condition” or if  they  decided the person belonged to what was deemed a high risk group more susceptible to contracting the disease. If the person was able to obtain health coverage from another job or tried to obtain it on their own, they were usually denied coverage due to their “pre-existing condition” and/or if they were thought to belong to a “high risk group” .

Massachusetts in the early 1990’s banned insurance companies from using pre-existing conditions as a means to deny coverage. It also banned them from dropping coverage when ever they felt like it. The ACA has followed suit. By 2014, everyone in this country will have these same needed protections.

* At that time people living with HIV/AIDS had no legal protection from discrimination.

2) No life time caps, annual limits on coverage, waivers or riders.

The ACA will also bar insurance companies from placing life time caps or annual limits on coverage. In other words, they won’t be able to deny financial coverage to any one who needs expensive health care such as cancer treatment, heart transplants and other types of care that have a high price tag.

Please be aware that the only exceptions from this rule are the health insurance plans offered to students by colleges/universities or if the employer’s plan is self-insured. In those cases, check with your insurance company, not the employer/college/university for clarification.

* Many large companies, unions, or other large organizations often self insure their health plans- ask your HR department if your employer sponsored health plan is self insured.

3) Children can stay on their parent’s health insurance plan up to the age of 26.

Parents should check to see if their employer sponsored health plan offers this as an option. Again it is best to check with the insurer. Self-insured health plans are exempt from this requirement. Some self-insured plans, however, may decide to offer this benefit to remain competitive in the “job market”.

4) Insurance companies won’t be able to charge women more than men for their health plans. 

No more discrimination based on gender. Enough said.

5) The ACA now requires insurers to be transparent with how they spend the money they collect from premiums. 

Starting in 2011 insurers are now required by the ACA “to spend between 80 and 85 percent of every premium dollar they collect on medical care (as opposed to administration, advertising, etc.). If insurers exceed this threshold, they have to rebate the excess to their customers.” This is called the Minimum Medical Loss Ratio for Insurers.

Above quote from:

 6) Many individual and families will qualify for health care tax subsidies. 

Many individual and families who are earning 400 percent or less of the Federal Poverty Line (FPL) will more than likely qualify for tax subsidies to help them pay for their health insurance. The tax subsidies are on a sliding scale and are based on income levels. Basically premiums are capped for those 400 or less of the FPL. Worth noting from the Kaiser Family Foundation online calculator: “All individuals and families with incomes at or below 133% of the federal poverty level will be eligible for Medicaid. Others with higher incomes may also be eligible, depending on rules that vary by state.” 

These subsidies are only for those who are purchasing coverage on their own through the Exchange and there are certain exceptions (The Exchange and the exceptions will be discussed in Part Two). For example, those who have income between 300 to 400 percent of FPL, who have or are offered employer sponsored insurance health insurance that requires a premium payment that is 9.5 percent or less of their annual gross pay/income, will not be eligible for the subsidy. From the Kaiser Family Foundation online calculator: “In general, full-time employees with employer coverage available that meets specified requirements are not eligible for premium subsidies, unless the employee would have to pay more than 9.5% of income for the employer-provided coverage.”

The Kaiser Family Foundation has created an online calculator to show the subsidies and the caps for different families and individuals at different income levels:

 7) Some links worth reading:

 11 Facts about the Affordable Care Act

FACT SHEET: The Affordable Care Act: Secure Health Coverage for the Middle Class

Kaiser Family Foundation Summary of the New Health Reform Law

Kaiser Family Foundation Health Care Reform Source website:


Next Up- Part Two- The Exchanges, The Individual Mandate, and Income Eligibility

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What can the performing arts learn from sports?

In recent years, a number of novel initiatives have emerged that stand to impact upon the way performing artists are trained and carry out their professional activities. It is now not uncommon for sports medicine physicians to weigh in on the treatment of performing artists. The contributions of sports medicine to the diagnosis and treatment of performing artists’ injuries are becoming increasingly acknowledged and valued. Furthermore, a growing number of science-based research disciplines within the performing arts (i.e. dance science, performance science) are adding to the discussion too.

Admittedly, this has resulted in some concern being raised from pedagogues within the performing arts. I have had a number of such discussions (and at times debates) with pedagogues who doubt that sport and science have much to offer to the performing arts. “Sport is concerned with dynamic movement in a competitive, open environment”. “Applying scientific inquiries to the performing arts would strip away the artistry from what performing artists do and reduce it to quantitative numbers”.  Indeed, it would be easy to draw up a list of distinctions between sport, science, and the performing arts.

However, just as sports medicine can help artists receive appropriate treatment for their injuries and allow them to keep performing, the application of principles from sport and science can actually help reduce barriers and better equip artists with skills that allow them to focus more clearly on the artistic aspects of their craft. Indeed, there is considerable merit in the notion of treating (or considering) artists as athletes.  By no means is this to suggest that we reduce what artists do down to a string of analyzable numbers, but if we consider everything that goes into making their craft look effortless while on stage we could allow them to look effortless more easily.

So in addition to treating the injured performing artist and keeping them on stage, what can sport and science contribute to research and training for performing artists?

Educators do an excellent job of teaching young performing artists the craft of their area of performance. Young musicians, for instance, have no challenge learning the technique required to play their instrument and how to stylistically interpret standard repertoire. In addition to this now, educators, aided by researchers, are coming to consider and recognize the physicality and psychology of performance. It is recognized that learning to play an instrument and interpret standard repertoire is not all that is required to achieve and sustain a successful career as a performer. Once we develop a better understanding of the physical and psychological demands associated with learning and performing, we will be in a position to train our developing artists more effectively. This will ultimately createartists who are more successful,as well as artists who are healthier.

While we are developing a clearer understanding of how to treat performing artists’ injuries, we still don’t have a good understanding of how these injuries occur and what can be done to minimize their occurrence.Just as the physicality and psychology of performance are of growing interest to researchers and educators, so too are the physicality and psychology of injury occurrence and recovery.

Sport and science are currently informing a variety of lines of inquiry within the performing arts. For example, the role and relevance of fitness and strength for artists isnow being interrogated. We often hear now that “fitter dancers and musicians are better dancers and musicians”, but what aspects of fitness are most relevant? Should musicians aspire to be marathon runners, or should male dancers be concerned with how much they can bench press? Not necessarily. In dance, for instance, research has found that lower-body muscular power and aerobic fitness are associated with increased severity of injuries and increased length of time off due to injury, respectively. We also know that poor levels of aerobic capacity can induce fatigue which increases the chance of musculoskeletal injury; although the precise mechanism by which this happens is not yet fully understood. Researchers in sport have investigated similar questions and as such are well positioned to advise on methodological approaches for arts-based investigations.

While there is still much to learn within dance, very little is understood about the relevance of fitness for musicians. However, for anyone inclined to suggest that sitting at a piano all day moving their fingers can’t possibly be physically taxing, I would urge them to take a look at the attached video. The top number is a real-time display of the pianist’s heart rate as she performs the final section of Ligetti’s L’escalier du diable. This is of a graduate piano performance student who regularly practices between 10 and 12 hours a day. While all of her practice obviously isn’t at this intensity, it does demonstrate how demanding playing an instrument can be! Again, here is an example of how methodologies from sport can inform our understanding of the performing arts.

Ongoing research is producing a growing body of evidence-based knowledge about healthy and effective dance- and music-making. However, this knowledge won’t do much good if it isn’t passed along to educators and students. Doing so will allow us to shift some of our energies from treating artists’ injuries to preventing them.Again, sport has much to offer in terms of models for effectively disseminating this knowledge to performing artists, as well as recommendations for the training of artistsmore generally.

In order to assist athletes to attain their performance goals, and ensure healthy and sustained involvement, professional sporting bodies throughout the world are adapting long-term athlete development (LTAD) models. LTAD models emphasize the intellectual, emotional, and social development of the athlete, encourage long-term participation in physical activities, and enable participants to improve their overall health and well-being and increase their life-long participation in physical activity. This is achieved through the early and focused introduction of non-specific gross and fine motor skills, activity-specific technical skills, physical fitness, mental training and psychological skills, training and tactical/competition-specific skills, and interpersonal and social skills. Broadening the focus of young artists’ training to incorporate such aspects could help equip them with the skills to facilitate lengthy, health careers.

As mentioned above, as we come to understand the physicality and psychology of the performing arts, we will be better positioned to understand the necessary components of artists’ training. Considering the debilitating and injurious impact of fatigue, as well as burn out, introducing principles of periodization into dancers’ training has been recommended. Again, a made-in-sport training model.Sport also has much to offer in terms of how we might provide supplemental training to artists in fitness, strength, motor control, and psychological skills.

No doubt due in part to the money that can be associated with professional sport, those involved in sports medicine and research have made considerable progress in understanding how to treat and train their athletes. It is readily agreed that performing artists have little desire, and certainly no need, to have themselves or their artistry reduced to a string of quantifiable numbers. However, collaborations with sport stand to offer considerable benefits for aspiring and professional artists.

Equally, there is no reason that this conversation only proceed one way. It is highly plausible that these conversations could also foster mutually beneficial research activity applicable to high performance endeavours in both the performing arts and sport. For instance, the performing arts offer a unique venue within which to examine questions relating to the effects of intense, early engagement in an activity as well as the acquisition and development of fine motor control. No doubt such conversations and collaborations will prove fruitful for all involved!

Terry Clark

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