Changing Industry Standards in Performing Arts Medicine

Gracie Bailey is a senior at the University of Georgia majoring in dance. She has seen a doctor for two injuries although she's had at least four significant injuries a year. "We don't have access to trainers. The football team has access to trainers who can catch overuse. A ballerina doesn't have anyone to reference, so they just don't," she said.

“Who the hell am I?” Dancers, actors, singers ask in the instance they get injured and have to take time off or hang up the pointe shoes.

Professional performers perfect their craft much differently than other forms of artists. Their body is their art and if injuries and re-injuries occur, they may be out of a job. A lot of companies provide in-house physical therapists and psychotherapists, however if they were never trained as a dancer, “they don’t speak the same language” of a performer, Jennie Morton, clinical osteopath and performing arts medicine specialist in Los Angeles said.

The situation

“Leading roles reported significantly more missed days due to their voice when compared with ensemble performers. These findings would suggest that increased exposure to the high vocal demands of the Broadway stage make veterans and leading roles an increasingly high-risk subgroup,” the study found.

A study by the New York University School of Medicine surveyed 135 Broadway performers during seven running shows to find that over 25 percent of performers had a vocal injury, yet only missed an average of 1.7- 4.7 days out of the year.

Taking time off for an injury can cause financial and career instability for performers, and durability would appear to be a key asset to appeal to directors, the study reports. However, the study found as many as 29.9 percent of the population reported vocal complaints but only 5.9 percent sought professional help.

This leaves the question "why are they not being treated?" Perhaps finances, or fear of being told to take a break or retire.

“It can be a combination of those things,” Morton said.

More nuanced options

Worker’s compensation covers just about everything except vocal injuries so broadway performers are not entitled to paid time off if they're injured. This law needs to be tailored to logically work for broadway singers. On Broadway, workers compensation doesn't help because the law only covers musculoskeletal injuries, not a vocal injury, according to Morton.

“A lot of companies do a good job of providing finances and medical help, but often it's in- house with a physical therapist and the lines of confidentiality can get blurred. You may be on a table next to six other people and if you’re getting your groin treated that could be uncomfortable,” Morton explained, founder of Healthy Performers.

She also said in-house help will actually discourage performers from going to physical therapy. "It becomes a head game for the dancer if they start thinking ‘If the casting director sees a dancer there he may think she’s not fit to perform and may not be cast in a particular role'," said Morton.

Morton is on the board of the Performing Arts Medicine Association (PAMA), where that question is raised often and one solution they have considered is providing performers financial support but allowing the dancer to choose where he or she wants to get help.

Janet Robertson echoed, explaining her dance students will forgo treatment in fear they will get a bad grade or be unable to perform. Or, if they do seek help the health center nor a private practice in the Athens area have performance arts medicine knowledge.

“‘Just rest’ is what they tell you at physical therapy and for determined dancers that just cannot work,” said Robertson, senior lecturer emerita at the UGA.

Rounded approach

Morton is working in two ways to keep healthy performers on stage. Her developed methodology targets dancers’ and musicians’ training so an injury is less likely to happen. One client she saw was a Broadway performer who had a role created on her with a particular sound developed just for that character for artistic nuance. The sound was unnatural to the performer and weeks of rehearsal put her through relapses of injury until the directors told her to forget about the sound and sing without straining, losing the artistic integrity of the character and still putting her vocals under stress.

Morton wants to combat this problem with a voice specialist on hand.

“If you want someone to sound a particular way then you need to cast someone for that,” she said. It could be helpful in dance, as well, she said, so that when pieces are choreographed on dancers, their bodies can work with the piece instead of against it.

On the other side of the injury, performing arts medicine specialists are needed.

Jennie Morton, former professional dancer, theatre performer, musician and trained osteopath asks her clients to bring their instrument to a session so she can understand their posture and technique. If the architecture of their body needs to change, and consequently produces a new sound, she looks at it as artistic expression and producing a sound natural to their body. (photo courtesy of Jennie Morton)

“They can look at a dancer’s body and know based on similar injuries and technique what the issue is. You have to be able to speak their language,” said Robertson.

A life in the audience

Whether performers suffer severe injuries or have a natural retirement, when the career ends, the identity can be confusing. Rehearsal, training, studying and performing has been their whole life since a young age in most cases.Just like a lawyer or doctor studies and plans to have a career in their respective field, a performer dedicates years of mental and physical exhaustion expecting their career will naturally follow.

Morton asks her students at The Colburn School to write papers about who they are related to their art and outside of their art. In many cases, there is no separation.

Robertson similarly talks with her students about alternatives to a career in dance in fields like dance therapy, performing arts medicine, or how to transition to being a spouse and mother.

“When you stop it’s like the world is ending,” said Robertson.

For dancers deciding the next step within the field, Morton encourages them to look specifically where they will find the best support for their body and to see who they are as a person outside of their art.

"As far as choosing somewhere (to dance,) I want to go somewhere that has an understanding of overall well-being. I'm going to look for somewhere that has someone to reference or offer certain classes or offer you the option to say 'I'm not okay today. I need to do this for my body.'That's going to be a major factor for what I decide to do in the future," said Bailey.

Morton is also working to make that transition more fluid. She encourages her students to consider other art forms related to their focus as a way to not feel restricted to just one art form, though it may be what they know better than anything else.