As a companion to ourÌýHealthy Practice Webinar Series, here are collected BAPAM resources to plan and sustain healthy creative practice:

Healthy Practice Diary
Knowing what you should do to keep healthy is one thing, this diary is aimed at helping you to adopt healthy practice as routine in your life.

Don’t Cramp Your Style: Warm-up Exercises for Musicians
All skilled physical activity, including music performance, should be preceded by a warm up to increase the blood flow to muscles, free up motion and prepare the body for effective activity. Here are some useful exercises to help you warm up before you play.

Fit to play
Top tips for instrumental musicians

Fit to sing
Vocal health is about mind and body as well as voice

Sensible eating for performers
Finding a healthy balance with the food you eat

Psychological Self-Care
Keep mentally healthy, enhance your well-being and achieve your goals

The drinks are on me
How do you manage stress, and how can you spot the signs of a drink problem?

I can’t go on
Managing performance anxiety (stage fright)

Choosing a Psychotherapist or Counsellor

Risky business
Situations that put the musician at risk

Don’t lose the music
Hearing loss and tinnitus

The acoustic guitar
Playing technique and ergonomics

The Healthy Pianist
Essential advice for piano and keyboard players

Musician’s Focal Dystonia
Guidance on symptoms, possible risk factors and management

Healthy Touring Checklist and Rider
Planning for a healthy tour

Sources ofÌýfinancial and practical support
Organisations who may fund Ä¢¹½tv health care and provide other support

Resources produced with the support of our partners:

Current Scientific Research and Models for the Alexander Technique

A free online symposium outlining current scientific research and models for the Alexander Technique is taking place on Monday 18th May.

The event has been shared byÌýBAPAM Registered Alexander Technique teacher, Dr Alison Loram and will feature research she did with her husband Professor Ian Loram, who will be presenting at the online event. It is for Alexander teachers, those who may be training and students. It’s been organised byÌýÌýan online platformÌýdevoted to improving scientific understanding of the Alexander Technique.

This is a free online symposium featuring presentations, Q&A, and discussion from

This symposium addresses an urgent need for specific, up-to-date, science-based models to help AT practitioners to

• Better understand what we are learning and teaching physiologically
• Better communicate with scientists, medical professionals, and AT colleagues
• Broaden the base of respect and understanding for our profession

 

Date:ÌýMay 18th (a video version will be available after for anyone who cannot join live)
Time:Ìý5 pm (UK time)

BAPAM is continuing to offerÌýclinicalÌýservices during the outbreak by telephone and video consultation. We regret thatÌýfor reasons of patientÌýand staffÌýsafety,ÌýandÌýin line with otherÌýhealthÌýservices,Ìýwe are unable to offer face to face consultations. We are very mindful that performersÌýmay be having difficulty accessing the normal range of healthcare provisionÌýwhilst healthÌýserviceÌýresources are focusing on patients with COVID-19, so we are expanding ourÌýservicesÌýto provide interim supportÌýin the following areasÌýand are very grateful to our practitioners for offering theseÌýservicesÌýat a discounted rate for BAPAM patients.Ìý

The BAPAMÌýHelpline 0207 404 8444Ìýcontinues to operate as normal and is staffed remotely by our admin team.Ìý

 

Vocal HealthÌý

For patients with vocal health problems, we would generallyÌýadvise a referral to an NHSÌýProfessional Voice User Clinic. These are currently closed and we are very pleased that our Vocal Rehabilitation Coaches have agreed to offer aÌýtelephone/video adviceÌýsession to singers unable to be seenÌýby the NHS,Ìýto provide some support meanwhile.ÌýPlease phone the Helpline to arrange a session.ÌýActors with vocal health problems should be seen by a Speech and Language Therapist andÌýare welcome to contact the SLTs listed inÌýour DirectoryÌýofÌýpractitioners.Ìý

 

Mental HealthÌý

We are still bookingÌýfreeÌýassessmentÌýsessions with ourÌýdoctors andÌýclinicalÌýpsychologists,Ìýand counsellors and psychotherapistsÌýon our DirectoryÌýareÌýavailable for online therapiesÌýif funding is available.ÌýEquity’s counselling scheme is still alive,ÌýandÌýHelp Musicians and the Royal Society of Musicians, as well as other charities, are still able to provide funding for therapies ifÌýapplicants meet the criteria.Ìý

In addition, BAPAM will be offering group therapy forÌýpatientsÌýwhere the assessment suggests that this would be helpful.Ìý

 

Musculoskeletal HealthÌý

OurÌýhandÌýandÌýorthopaedicÌýsurgeons andÌýour rheumatologists are still available forÌýtelephone or video consultations,Ìýas well as our physiotherapists and osteopaths. We are also able to offer follow upÌýappointmentsÌýduring this time.ÌýHands-on treatment/procedures, and physical examinations,ÌýareÌýnot available but clinicians will be able to provideÌýsupport andÌýadvice on what to do in this interim period.ÌýClinicians will also be offering jointÌýconsultationsÌýwith educators so thatÌýperformers canÌýdevelop new ways of performingÌýwhich do not exacerbate an injury but allow you to continue to practise.

There are intrinsic relationships between health and performance excellence, and educational and clinical expertise in the performing arts. In overcoming medical problems, Ä¢¹½tv diagnostic and medical expertise can be complemented by performance technique and lifestyle and health-related guidance. In a new joint clinic at BAPAM,ÌýMr Mark Phillips, Hand Surgeon, and Penelope Roskell, Professor of Piano at Trinity Laban, are exploring this opportunity for clinicians and educators to provide each other with unique insight and feedback. We asked them to tell us more about this innovative approach.

Could you explain the idea behind the joint clinic and why you decided to do it?

Mark Phillips: In my experience when treating musicians I found quite an overlap between the physician’s knowledge and the Ä¢¹½tv physiotherapist/hand therapist’s knowledge, who’s an expert in musicians. But I soon realised there was a huge gap for the third element which is filled by the expert tutor on that instrument. I happen to be a trumpet player so as a musician I have some insight into the patient but that’s not enough when it comes to some of the issues they face. I can relate to some of the psychological performance issues, but the expectation patients have is of someone that can really understand how the technical demands of the instrument interface with the physiological problems they’re having and anatomical problems they may have and the outcome of the clinical assessment.

Penelope Roskell: The knowledge we have between us is enormous. My students have included musicians with injuries for 40 years, and so we fill in the gaps. Seeing musicians together in a joint clinic is very important because you can then see the whole picture and then decide on the best way forward. Sometimes it may be steroid injection and sometimes it may be surgery. But sometimes it may be that a tweak or a change of technique will solve that problem and reduce the need for further intervention. So, seeing them together we can get to the root cause, which we can’t always do if seeing them independently.

How do you decide if a patient would benefit from this dual approach? What can a patient expect at a typical joint session? How do you each approach the patient?

How do you prepare for a joint clinic session?

MarkÌýPhilips: Normally I will contact Penelope to say I’ve got a patient or she may say she has a student. We will both select patients for this clinic.

Penelope Roskell: Sometimes Mark will send me over a video of that person playing, so I’ll have a chance to look at it and pick out the obvious problems about what I think may be causing it. I’ll also have a clinic letter which will give some sort of background.

Mr Phillips: We then meet up for a coffee and chat about the patient. So then the patient comes in, and if it’s my patient I present it to Penelope and on one occasion Penelope presented the patient. And then we do the history in the normal way, present findings and run through it all. I then suggest what may be the anatomical or physiological problem and how that relates to this person’s technique. The technique may have worked well for a long time but now there’s a problem which is unique to them. Looking at the technique can help if I’m referring to Penelope. Or similarly if Penelope is referring to me is there a way that some of my interventions such as hand therapy or injections or my approach to examination would throw some light on the matter. It’s that overlap which is invaluable really.

Penelope Roskell: So for instance one of my students came to the last clinic and she had problems for the last year and had come to me for that reason. And Mark gave her quite a different diagnosis to what she had been given in the past, which then informed me. So now we are working slightly differently in the lessons that I have with her privately, having now had this intervention from Mark and he also suggested a steroid injection which we are waiting to see the results to. We can then see the whole picture about the ways forward, because there isn’t always one solution. A patient may need a steroid injection or piano playing adjustments to the technique.

MarkÌýPhillips: It’s multi-faceted, there may be Alexander Technique, hand therapy and it may be someone looking at their posture. I learn so much by looking at Penelope tutoring at the piano in terms of elbow position, shoulder position and what impact that has in terms of the way the fingers lie on the key for example. Each presentation has its own unique cocktail of remedies really.

There are complex multi-faceted problems by the time they come here and it comes down to how we triage these patients essentially. I don’t bring every pianist to this clinic.

Penelope Roskell: It’s inevitably going to be someone with a piano related injury. If they’ve broken their wrist by falling down the stairs then they should go straight Mark. Whereas it’s different when it’s something like accumulated stress from years of playing with a technique which is a tiny bit off balance. They may be very experienced players and their technique has lasted them well, but there’s something that just tips it over.

MarkÌýPhillips: What I see in my patients is that half of them have the same problem as everybody else and that may affect how they use their instrument. And the other half have instrument related problems and it may be a combination of the two. And say if someone broke their wrist a year ago and it may be throwing out their elbow, their shoulder or their posture and it may well be a good way down the line that it’ll come to me that a session with Penelope would be helpful. Because it may be to do with their elbow and shoulder which may be making some notes inaccessible and we can work around. They’re so unique each of these cases an each of them would have their own relative roles for the two of us sitting together and discussing the case. It would be good to extend this to guitar, violin and cello and get tutors to do a similar thing. And it’s pretty unique, I don’t think there’s anyone else out there in the world doing it.

What do you feel are the benefits of having an educator in a clinical setting?

Penelope Roskell: It is a very formal environment which is a positive thing and it focusses everything which is very important.

It is a sort of pilot, it’s the first of its kind and I think it is very valuable and let’s hope that other clinics may take the idea from this and develop that further.

What are the direct benefits for patients of having the educator and clinician in the same room in a clinical setting?

Mark Phillips: We often find that patients are often reticent about coming to these clinics. They really don’t want to look at their own techniques and I suppose they remember back to days when they were being tutored and they feel self-conscious. They have to want to come to this clinic and to be looked at. It isn’t like going for a piano lesson or being taught. We are looking to see whether there’s anything about their technique that may be in anyway connected to the clinical problem they have. So we’re not trying to look at the way they play from any other perspective than that. People play in lots of different ways. Also videos are really useful, anyone with a smartphone can record themselves. When we look at them we can slow them down, go back over a sequence, look at it carefully, look at it together and see how that relates to their clinical problem.

Penelope Roskell: There is something different about the joint clinics, because I’m there involved in the consultation I’m able to ask them questions from my own point of view so that I’m well informed as to how best to help them in the future. Because a piano teacher is not qualified to diagnose and that is absolutely number one and nor am I qualified to answer questions that students sometimes ask me, like should I have that steroid injection or that operation and it’s not for me to advise on that but in this situation between the three of us we can discuss the best way forward viewing it from all the different angles.

Any challenges you are finding with the joint approach?

Mark Phillips: It’s 30 minutes long, which is short. We are just getting into our flow by half an hour.

We haven’t had a chance to find out what patients think, especially how they feel about the added value of seeing us both together.

The four patients we have seen in this format have individually expressed to us they thought it was a good session and it stimulated a lot of discussion and ideas. It would be great in the future to include a hand therapist and do a proper multi-disciplinary clinic. Hand surgeons always work very closely with hand therapists. Because there are so many different joints in the hand and different diagnoses. In the hand you’ve got unique problems to one finger or there will be a combination of problems. So your hand therapy is always bespoke, it’s all tailor made to that patient so you have to discuss each patient individually and with musicians it’s even more so.

Certainly with the three most commonest instruments this is going to be a major area of growth in the next ten years and it’s very exciting.

During the half an hour the patients sense the trust we have with each other (Penelope: we work very well as a team, we both have a lot of respect for each other’s knowledge. So I think they go away feeling they’re whole picture has been seen and assessed and we are seeing them as an individual with a problem that can be resolved.)

All patients have been bought over by the end of the 30 minute sessions. You can see the reticence and slight nervousness at the start of the half an hour turning into trust and outpouring of confidence and sharing of the problem and by half an hour we are in to the nitty gritty aren’t we. The output of that is usually I will see them again or Penelope will see them again.

What they can do is continue seeing Penelope for a while and see me in the clinic two months later and see how things have been going on in the meantime. And because we know each other well we can send secure emails back and forth and stay in touch.