Is there a doctor in the house, please?

PERFORMING ON the London stage has its downs as well as its ups for actors and dancers who tread the boards. A study of 20 West End productions found almost half the performers had suffered injuries and over 40 per cent of actors had been forced to miss at least one performance as a result.

The riskiest London show, it concludes, is Starlight Express, the Andrew Lloyd Webber musical performed on roller skates at breakneck speed.

The 21 performers reported an average of almost three injuries apiece. However, the production was also rated as the most physically demanding of the 12 plays and eight musicals surveyed.

The study, conducted in February 1996, rated Tommy Steele the next most risky show but it caused fewer injuries than other less physically demanding productions such as Les Miserables and Blood Brothers.

The Mousetrap, rated as among the least physically demanding shows, also had one of the lowest injury rates despite the fact that one cast member is murdered nightly on stage.

The survey of 269 cast members found women were at greater risk than men, probably because they wore high heels. Sprains and strains were the most common type of injury followed by neck and back injuries, with those playing the most physically demanding roles at three times the risk. Almost one in 20 consulted an Ear Nose and Throat specialist for a strained voice.

The findings, published in Occupational and Environmental Medicine, closely mirror those from a similar study of the risks of performing on Broadway in the US carried out in 1996. Dr Randolph Evans and colleagues from the University of Texas, who conducted both studies, say 60 per cent of the performers believed their most recent injury was preventable.

They say that raked stages, which slope towards the audience to give them a better view, increase the risks to the performers. One in five injuries was attributable to a raked stage used by nine of the 20 London productions. They ranged in gradient from 4 per cent for Les Miserables to 10 per cent for Starlight Express.

Raked stages increase the risk of injury because performers have to accommodate a shift backwards in their centre of gravity. In the US, the Actors Equity Association has recommended a maximum slope of 7.5 per cent and has also started a physiotherapy programme.

In Britain, the actors' union Equity has specified that theatre companies must hire a "rake specialist" - usually a physiotherapist - to show actors how to work on sloping surface safely.

The authors say that the West End boasts some of the world's outstanding performers and offers "witty dialogue", "enthralling music" and "dazzling dancing".

But it comes at a cost. "Behind the glamour and glitz is a highly stressful workplace," they say. More attention should be paid to the health needs of performers and how to protect them from injury.

A spokeswoman for the Really Useful Group, producers of Starlight Express, said performers had to attend skate school before being admitted to the cast.

The show, which has been running since 1984, requires the actors to sing while skating at up to 35mph.

"The cast do very strenuous warm-ups every night starting with singing and then skating. Everyone has to do that," she said.