Performing Artists as Athletes: A New Perspective

Evan D. Collins, M.D.
Center for Orthopedic surgery
Houston Methodist Hospital
Houston, Texas


1. Musculoskeletal injuries were reported by greater than 50% of the 264,000 employed Musicians in 2006

2. National survey of orchestral musicians 76% of the respondents had to take time off from performing because of injury during their career

3. Common injuries reported:

  • Persistent pain in the extremity
  • Loss of facility
  • Loss of endurance
  • Loss of strength

4. Common diagnosis:

  • Overuse syndrome
  • Repetitive stress
  • Myofascial pain
  • Tendonitis

5. Recent review of Playing-Related Musculoskeletal Disorders (PRMD) indicated a 35% prevalence of recurrent problems despite treatment

6. Approximately 1/3 of musicians require multiple visits to medical providers

7. No consensus on effective treatment

8. No outcome data regarding treatment modalities

9. Patient satisfaction

10. Questions:
Why is it so difficult to effectively treat?
What can we do differently to improve this problem for performing artists?


Traditional Medical dogma

  • People seek medical attention when something hurts
  • People seek medical attention when things don't work
  • Medical treatment applies scientific approach

    Assumes that identifying the change from normal, and then correcting it, will alleviate the problem


1. Consider the type of problem the patient has


  • Mechanical - broken, torn or compressed
  • Biological - infections or disease


Examples: X-ray of broken humerus

Repair of torn biceps tendon


Rheumatoid arthritis, cancer, bone cyst

Additional Category

Capacity problem:

  • All constructs have a defined "capacity" to perform work
  • When you exceed the ability for a construct to perform work - "exceed capacity"
  • Result is break down

The majority fall into this category:

  • Repetitive stress
  • Over-use syndrome
  • Chronic Fatigue syndromes
  • Tendonitis
  • Bursitis

Science of Capacity

  • Musculoskeletal system principle material is collagen
  • Collagen cross linkage
  • Strength dependent on amount of cross-linkages
  • Stress increase cross linkage between collagen fibers decrease weakening the construct
  • Exceed capacity, failure occurs


Lateral Epicondyltits (Tennis elbow)

  • Pathology - Tendon fails after repetitive use
  • Most people never played tennis
  • Occurs between ages adults 30-65


  • Rest, injections, splinting, physical therapy
  • Surgery

Considering these musculoskeletal problems as a lack of capacity, can we apply this in a more efficacious way for the performing artist?

How does this apply to athletes, and relate to the performing artist?

  • A Football play lasts on average 3.5 - 5.5 sec for sixty minutes
  • Time from a pitch to completed out is less then 6 sec repeated until 27 outs have been recorded
  • Soccer match has two 45 min halves
  • Opera - Some can last as long as 4 hours with one intermission
  • Ballet - Nutcracker
  • Symphony - Two hours with one intermission
  • Athletes train to achieve peak performance
  • Athletes train to prevent injuries
  • Athletes train to increase their capacity to do work

Performing artists

  • Musicians - PRACTICE
  • Ballet performers - REHEARSE

Energy used during a performance

  • Violinist can burn over 700 calories per hour equivalent to 40 minutes on a treadmill with average heart rate of 140 bpm
  • The athlete trains to increase his/her capacity
  • Why not a performing artist?



  • Rule out biological and mechanical problems first
  • Identify capacity problems - Corrected with physical therapy, core strengthening, and training specific to that performer

Therapy Examples:


  • Easier to prevent then to treat
  • Artist and their environment may have to change


  • Performing artist rehearse to perform
  • Performing artists should also train to perform
  • Doing both may decrease injuries, enhance recovery and prolong careers

Thank You

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