Music can seriously damage your health

Embouchure droop, the `pearlies', conductor's itch and Paganini's kiss - just some of the complaints endured by over-worked British classical musicians. By Victoria McKee

Drums beat, cymbals clash and trumpets blare shrilly out from behind the doors of Dr Ian James's performing arts clinic at the Royal Free Hospital in Hampstead and at the British Performing Arts Medicine Trust's headquarters in Ogle Street. Eventually, after half an hour or so, a musician will emerge, clutching his or her instrument and a prescription which is as likely to be for coaching with a new teacher as for physiotherapy or anti-depressants.

"Many teachers are very poorly trained," observes a violinist (from a major provincial orchestra) who has been seen by Dr James because, after playing for 30 years with no trouble, he has suddenly started getting spasms in his left shoulder. "I can't imagine there's something wrong with my technique after 30 years, but the violin's an asymmetric instrument, and it's very easy to do things in an off-balance way. It can affect the hearing in one ear, and you have to move your legs out of the way so that they don't catch on the bow, which can be uncomfortable." New instrument- stands, chin and shoulder rests, seat-straps and perspex sound-shields to protect against trumpet or timpani blasts may also be prescribed in this clinic, which is intended to pick up problems that conventional clinics miss.

Certainly, the average, overworked GP would have little patience with some of the syndromes that performing arts clinics take so seriously. Nor with a plea for special consideration for British musicians who, according to Alex Scott, the BPAMT's administrator, "have to work longer hours than professional musicians in other countries because of low pay". Scott disputed an article in Classical Music magazine which implied that musicians were "whingeing hypochondriacs" grasping at alternative therapies, from Alexander technique to Zero-balancing.

But, Dr James admits, "Today's viewing of psychological and physical illness as separate things is very unfortunate. It's neither all in the mind or not, and the psychosomatic area is something we really have to take seriously, particularly with sensitive, creative people like performers."

The embouchure, for example, is a part of the anatomy that, like the lap, does not exist until created. It is the way of pursing the mouth into the correct position required to play anything from a flute to a French horn, and sometimes - "often during a mid-life crisis", according to Dr James - the ability to create the necessary embouchure will simply disappear. That state, which causes players to despair, can be likened, Dr James says, to sexual impotence, and is equally fraught with performance anxiety and adversely affected by worries about the sufferer's ability to rise to the occasion. As with erections, the more the embouchure becomes a source of concern, the less likely it is to form.

The trombonist who followed the violinist in for a consultation on the day I visited hadn't been able to work for six months because his mouth muscles would no longer hold the requisite position. He was now, understandably, in a serious state of depression. Whether the depression had preceded the embouchure problems or resulted from them was something Dr James had to fathom.

"A lot of performers' problems are multi-disciplinary in their solution, and you can't look at them with blinkered, medical eyes," says Dr James, who himself plays the viola and is married to a violinist (Jane Faulkner of the English Piano Trio). "The commonest are overuse or misuse problems - some people call them RSI [Repetitive Strain Injury] but I'd like to change that to Muscle Tension Syndrome. It can stem from a combination of three things - bad technique, bad posture and emotional tension."

The trombonist says his friends, mostly fellow trombonists, have rallied round and been supportive, all thinking "There but for the grace of God..."

"You tend to hang out with other trombonists, because you find similar sorts of temperaments in each section of the orchestra," he theorises. "Trombonists are more intellectual than trumpeters, and string players tend to be very fussy and health-conscious - they come with their wholemeal sandwiches and herbal teas, while brass players will go out for a curry and a beer."

Trumpeters and string players might, of course, dispute such generalisations - or provide contrary ones - but there are others that are fairly widely acknowledged among the profession. Brass players drink more, it seems, partly because they're usually quite a macho section and need to wet their whistles in order to play. Although alcohol abuse is a big problem among orchestral musicians, brass players are not necessarily the biggest problem drinkers, Dr James says, "because they tend to drink beer rather than spirits".

Second violinists, predictably, come in for considerable ribbing. "There is the sense of literally playing second fiddle when you're playing second violin," says Dr James, "which can lead to crises of confidence." Second violinists are also more prone than first violinists to occupationally induced deafness because they sit closer to the brass section. The brass players themselves don't tend to have hearing problems - they're usually deafening other people.

Percussionists are most likely to suffer hearing loss, Dr James says. But then, of course, they have Evelyn Glennie as a role model: she proves that it is possible to perform even when profoundly deaf.

String players generally are susceptible to neck and upper limb problems. "Violists particularly, because of the size of the instrument," says Dr James. "It's much larger and heavier than a violin, and tends to be associated with neck problems such as cervical spondilosis. Luckily, the larger violas are now less in vogue." Cellists must beware of "cellist's twist", which results from twisting to look at their fingering when they start to play, Dr James warns.

Non-upper limb problems that plague string players include "the pearlies", as an attack of stage fright is called, and "Paganini's kiss" - or "the Devil's kiss", as Dr James prefers to name it. This is a brown mark on the neck that can be the bane of vain violinists. "It's really a kind of contact dermatitis," says Dr James, "and can usually be avoided if the instrument is held in the correct way."

The average GP certainly would not be able to offer this type of advice, and might simply prescribe a steroid cream - yet, as Dr James stresses, unless the underlying cause of the condition is worked out, it will recur. Hence his impressive register of therapists and teachers, so that when he asks Alex Scott, "Do we have a violin teacher in the Chiswick area who is also familiar with Alexander technique?" - one will be found.

The BPAMT, founded in 1984 for research into and treatment of performers' problems, is a registered charity, supported by the Musicians' Union and the Musicians' Benevolent Fund and other performing arts bodies including Actors' Equity. BPAMT will pay for treatment for performers who can't afford it, but will expect contributions or full payment from those who can. Singers benefit from the expertise of the BPAMT's chairman, David Garfield Davies, a laryngologist.

According to a survey done by physiotherapist Gabrielle Rankin into upper limb disorders in string musicians, 96 per cent of sufferers felt that their symptoms were caused at least partly by their work, even if they didn't stem directly from the act of playing. Double-bass players and cellists often suffer from having to hump their heavy carrying cases around. When they're on tour, string players seldom dare leave their valuable instruments lying about, so have to carry them everywhere.

Although most orchestras now have doctors attached to them, players are often afraid to consult someone who is seen as in the employ of the management for fear of jeopardising their careers. Most of the doctors, though, are independent honorary advisers giving freely of their time, and are appointed in association with the Trust, which also runs a 24-hour national helpline (0171-636 6960). "The doctors are attached to the players, and no reports go to the management," Alex Scott assures me.

Although the likelihood of injury increases with age, the BPAMT reports an increasing number of young string players coming in as a result of musculo-skeletal problems caused by over-practising, usually because of a parent urging them on.

But Dr James says young people should not be put off instruments in which they are interested simply because they seem too large or heavy. "You can always use a spike or chair strap for larger instruments like a bassoon," he notes, "and even flautists can get aches and pains from muscle tension, embouchure problems, dystonia in their fingers - where the little fingers curve in - and performance anxiety."

Playing a short harp solo or waiting for your two-second trill on the triangle can be more stressful than constantly playing, Dr James suspects. Being a percussionist can be a stressful job partly because you have few or no companions with whom to share your complaints. "One timpanist suffered because he was so hated by the brasses in front of him for the loud noises he made - until some perspex screens were put up to shield them from the worst excesses," Alex Scott remembers.

Conductors are not immune, and even if they don't succumb to "conductor's itch" (probably a heat rash occasioned by sweating profusely during their energetic gyrations) or "baton-wielder's bursitis" (an inflammation of the joints with which Toscanini and Zubin Mehta, among others, are said to have been afflicted), "they tend," notes Dr James, "to be the most unpopular people in the orchestra, towards whom most of the anger and frustration is directed. In the surveys we did, they were blamed for everything under the sun." (Many musicians would argue that they have the arrogant temperaments to cope with that.)

Yet the symphony of symptoms that can cause disharmony among Britain's "overworked" and overstressed classical musicians is nothing, apparently, to the cacophony of complaints experienced by self-trained jazz musicians - and the rock music industry is where the mega hearing problems really lurk, because of the levels of amplification used. Sting is, reportedly, learning to lip read and Pete Townsend of The Who long ago admitted that his hearing was shot.

But that's another story ...