On 18 July, we were delighted to celebrate BAPAM’s 40th anniversary with a special event at the . Friends and partners from across the performing arts, academic and medical community came together to celebrate four decades of providing performers with the clinical help necessary to maintain and thrive in their careers.

Speeches from our Chair Peter Leathem OBE, our CEO Claire Cordeaux, Ģ��tv Trustee Dr Penny Wright, and the RCM’s Professor Aaron Williamon, took us through the history of BAPAM, our impact now and our mission for the future.

Dr Penny Wright spoke movingly about BAPAM’s history and described BAPAM’s founding in 1984 by Ian James. Ian was a Consultant Physician and clinical pharmacologist at the Royal Free hospital, and an accomplished viola player. His experience of treating his own performance nerves led to a special interest in the medical problems of musicians and performing artists, and he started to collect around him colleagues with a similar interest. Their vision from the beginning was for doctors and other clinicians to work with educators, researchers, and performers themselves, to build a comprehensive clinical service for performers of all types.����

Penny reminded us of the hours of unpaid, dedicated work to establish and grow the organisation. We thank the many people whose expertise and dedication has enabled BAPAM to become what it is today, including Penny herself, whose 35 years of service with BAPAM are an extraordinary commitment. We wish her well as she takes a well-earned rest! We remembered those no longer with us, among them Kit Wynn-Parry, Ian James, Mike Shipley, Ian Winspur and Carol Chapman.

We are also hugely grateful to all our funders, large and small. Our work is only possible thanks to Help Musicians, Music Minds Matter, the Musicians’ Union, Equity, PRS Members Fund, the Royal Society of Musicians, Equity Charitable Trust, the Dance Professionals Fund, PPL and to all those who have donated funding over the years. Many of our partner organisations have been there from the early days and we wouldn’t have been able to build the service we provide today without them.����

Since BAPAM was founded, we have grown to serve the whole performing arts sector, from music to theatre, from frontline performers to backstage staff.��

We were proud to be co-chairing the at UCL, held this year for the first time outside the USA, and we welcomed delegates��who joined our celebration, which coincided with the first day of the conference.��Building��on��years of clinical practice, BAPAM developed our first Performing Arts Medicine syllabus in the early 2000s, which was used to plan the training days for clinicians that we organised twice a year, and which eventually fed into the development of the Masters’ degree in PAM at UCL, still the only qualification of its kind in the world. Co-chairing a major international medical conference in our landmark 40th anniversary year felt like an important milestone in our ongoing work training health professionals and��establishing��clinical standards in performing arts medicine.

Speeches concluded, , joined by Francesca Gilbert on the viola and Alexander Rolton on the cello, treated us to performances of Brahms and Mozart to remind us of the power of music and why it is so important to help performers continue to pursue their passion as their livelihood.����

A great deal has been achieved in the last 40 years, and BAPAM CEO, Claire Cordeaux, had spoken earlier about our hopes for the next 40 years. Our goal is to ensure every performing arts worker in the UK has access to a clinical health service tailored to their unique needs. By building on the collective dedication in evidence at our anniversary��event, and working together, we can achieve this. ��

To this collaboration, BAPAM brings clinical expertise and standards of best practice, our community of Ģ��tv practitioners, high quality training for performance and��health professionals, a wealth of clinical data that can contribute to the research and evidence base, and 40 years’ experience helping thousands of people overcome health problems to achieve and sustain creative excellence. ��

Feedback from the event has been warm and positive and��it is wonderful to see BAPAM’s clinical expertise and unique services recognised throughout the creative sector.����

Many thanks to PPL, Penny Wright and the Centre of Performance Science who sponsored the event which also raised nearly £3000 in donations.��

If you would like to support BAPAM and help sustain a healthy performing arts community, you can give a donation here: . Thank you to all of our supporters!

��When was the last time you joined an online event? Never? Don’t worry if online workshops are a foreign concept to you. You’re not the only one!

Today, we’re looking at the many advantages of online events and what to do if you’re anxious about joining. We’re also highlighting exciting upcoming BAPAM sessions, so don’t forget to scroll to the bottom. Let’s get started!

Why Should You Attend Online Events?

From training sessions to workshops, BAPAM’s online events bring evidence informed practice, the latest research and performing arts health experts to your home.

If you’re unfamiliar with online sessions, you might not understand why they’re so popular — or relevant to your career. Online events are a great way to learn about new topics, nurture your skills, meet new people, and access support.

You don’t have to leave the house to tune into these digital sessions, meaning you tune in at the click of a button. Perfect.

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What if You’re Nervous?

Attending online sessions can be intimidating, so you’re not alone if you feel nervous. However, with BAPAM’s online events, you can join in the conversation as much or as little as you want. Whether you want to share your thoughts in the chat box or simply want to watch with your camera off, we’re happy as long as you’re comfortable.

Can you join from anywhere?

Yes! We welcome international audience members to all our education sessions but please note that BAPAM can only provide clinical services to people who are based in the UK. ��

5 Benefits of Online Sessions for Performing Arts Professionals

Wondering how online events can benefit you? Here are some quick pros of joining digital workshops.

• Accessibility — You can join from anywhere in the world if you have a Wi-Fi connection, and a live transcript is available for participants.
• Advice from professionals — BAPAM’s online workshops are hosted by experts in healthy creative practice, ensuring you receive high-quality, evidence informed information and trustworthy advice.
• Connect with peers and share knowledge — Online events connect you to a diverse creative community — but only if you want! There’s no pressure to chat, but hearing others share experiences of challenges and successes, problems and the solutions that worked for them, can be reassuring and inspiring.
• Affordable — Online events save you money on travel costs, accommodation, and other expenses associated with networking events.
• Develop your professional & personal skills — We host events for everyone working in the performing arts – on stage, backstage, on set, in the studio, teaching, on tour, at college – we focus on practical advice and skills for healthy and sustainable creative careers, and help you maintain your best physical, vocal, hearing and mental health.

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Upcoming BAPAM Sessions

BAPAM delivers expert health and well-being services to performing arts professionals. We work with professional researchers, artists, educators, clinicians, and creators to deliver empowering content.

Here are some of our upcoming online events:

31 Jan 1-2pm Stress & Burnout. Psychoeducation self-care session with Help Musicians.

Suitable for musicians who are feeling stressed or are/have experienced burnout. Lots of information on what stress is, how it can lead to burnout, what burnout looks like, how to avoid burnout and what to do if you are burnt out.

How to Prioritise Self-Care When Working in Music: Stress and Burnout – BAPAM

7 Feb 11am-1pm Mental Health with the Royal Society of Musicians.

Also suitable for musicians, this is a deep dive into mental health – what mental health is, why you might become mentally unwell, what to do and where to go and lots of advice for staying mentally well. There will also be a section on performance anxiety and breathwork for anxiety.

RSM and BAPAM Present: Healthy Minds – BAPAM

14 Feb 10:30-11:30 Career Transitions: It’s OK To Grieve.��

The first session in a brand new series of three workshops for performing artists who have had a diagnosis of an illness which will prevent them from performing. This series is there to provide support for their change in career with their mental health and some practical guidance on what transferable skills they have and employment support.

Career Transitions: Change, Loss and Playing To Your Strengths – BAPAM

The Bottom Line

Online sessions are an excellent tool for performing artists. Whether you want to learn from experts or connect with others, there’s always an upcoming event to sign up for. Remember, there’s no pressure to turn your camera on or speak. You can take online events at your own pace — and we’re always glad to have you!

See all upcoming BAPAM events now

To register, please email hara.trouli@ucl.ac.uk�� �� ��

The MHPC22 will be a national, Nordic and international forum for physicians, therapists, educators, artistic directors/employers, athletic trainers, musicians/performing artists and music/performing arts students and other performing arts and health care professionals who seek to improve the performance, health and well-being of musicians and performing artists within all genres.

The conference aims to combine scientific knowledge and practical experience through a range of keynote speakers, panel debates, paper presentations, demonstration or performance presentations, workshops, poster presentations, round table/symposiums as well planned networking.

“My first contact with BAPAM was through the mentoring programme with Help Musicians. At the time I was experiencing significant difficulties from a wrist injury which affected my ability to play guitar. BAPAM arranged for a consultation which led to multiple sessions with a dedicated music physiotherapist who showed me how to strengthen, and resolve my problems. The mentoring itself has completely changed the way I look after my health as a musician. Key mentoring sessions were about maintaining physical health for performing, including vocal warm-ups, and general emotional and physical self-care around touring and playing live. I’d considered many of the self-care things to be for ‘proper singers’, but making them part of my routine has strengthened my voice and keeps me in better shape for that short-notice live show. It’s reassuring to know that BAPAM are there to provide help or guidance should a health challenge arise in the future.”

BAPAM is very proud to be hosting a wonderful panel of experts in vocal health this week at the British Voice Association . The theme of the conference is ‘Crossing Boundaries in Voice’, with an emphasis on multidisciplinary approaches to health, performance, and research in the field of voice. Key areas for discussion include; physical and mental wellbeing for voice users, voice and the workplace, and crossing genre boundaries in pedagogy and performance.

Over 40 hours of lectures, workshops and masterclasses, from the world’s top practitioners in the field of voice, include keynotes and masterclasses from Markus Hess MD, Steven Zeitels MD, Prof. Janice Chapman, Prof. Kenneth Bozeman, and Christina Shewell.

BAPAM’s panel has been put together by Sarah Wright-Owens, one of our Vocal Rehabilitation Coaches who is also facilitating the Q&A, and BAPAM CEO Claire Cordeaux. The session will explore our Vocal Health Care Pathway, the importance of expert clinical assessment in the Voice Clinic and the multidisciplinary team.

Up to 20% of our callers present with a vocal health problem and our message to any professional voice user in this position is that they should always seek a diagnostic assessment in a Ģ��tv voice clinic run by a laryngologist or speech and language therapist.

There are so many potential causes of voice problems, that a clinical diagnosis with a scope of the vocal folds is the only way to fully understand what is going on, rule out any surgical options and guide effective treatment to resolve the problem. Once this has taken place, with a multidisciplinary team involved in the assessment, the right rehabilitation can take place.

Our panel includes presentations from key members of the multidisciplinary team:

• Declan Costello, consultant laryngologist, will talk about his role in the diagnostic process
• Tori Burnay will describe how she works as a speech and language therapist, including how she has established an SLT-led Ģ��tv voice user clinic at Guys and St Thomas’ NHS Foundation Trust with support from BAPAM
• Dr Anna Colton, clinical psychologist, will discuss how she works with performers where there is a psychological cause for their vocal problems
• Michael Mehta, osteopath, will talk about his approach particularly in relation to muscular tension
• Pippa Anderson, Vocal Rehabilitation Coach will outline how she uses her skills as a singing coach in the clinical setting

We are so grateful to the clinicians who bring their combined skills to work with BAPAM to resolve vocal health problems, and we thank the BVA for allowing us to bring together this stellar group of Ģ��tvs to talk about their work.

Health Promotion

Claire Cordeaux (BAPAM CEO) and Dr Pippa Wheble (GP Assessor and Trainer/Facilitator of our online Community Drop In series) spoke separately about health promotion initiatives at BAPAM. With online sessions offering improved access to health promotion and a significant audience of locked down performing arts professionals with no work, BAPAM was able to deliver online training, mentoring and peer support to nearly 3500 people over the last year.

Claire focused on the development of health education interventions timed to correspond with touring (2019) and the pandemic (2020), using the literature of behaviour change which shows that significant events, or transition points, present an opportunity for individuals to review healthy behaviours. Using a “healthy practice checklist” which was transformed into a “healthy practice diary” during COVID, artists were encouraged to review their own health, and to set goals and access ongoing support and training to adopt healthy routines. Whilst qualitative feedback was positive, BAPAM was also able to measure the number of participants who subsequently accessed health services because they had identified a health problem which needed intervention. 25% of the touring cohort and 40% of the COVID cohort made an appointment with a health professional.

Pippa described her work with the Community Drop In as a means of embedding healthy practice through online peer support. She highlighted how, as mastery as an artist requires technical skills and resilience, the same is true in maintaining physical health and mental wellbeing. The Community Drop In consists of weekly online sessions, aimed at promoting physical and mental health practices to support performing artists during the covid-19 lockdown. The weekly sessions introduced new practices including meditation, stretching, anxiety management, mental skills, Pilates and much more. The sessions provided space for group discussion and peer support addressing physical and mental health and barriers to change. Many performers had lost motivation, hadn’t picked up their instrument, experienced a loss of creative space and many were experiencing high levels of stress.

Participants were encouraged to complete a Warwick-Edinburgh Mental Well-Being Score (WEMWBS) and the Music Quick Dash score which measures physical wellbeing, at the start and end of their participation in the group. The following scores were collected:

Qualitative responses show how participants valued this:

A Multidisciplinary Pianist’s Clinic��

(BAPAM Clinician and Hand Surgeon) and (Professor of Piano) described their joint clinic for pianists who have a long standing health problem, highlighting some interesting case studies. Patients attend the clinic as a result of a referral from either Mark or Penelope. The clinic shifted to online over COVID which has made it cheaper and more accessible. Penelope advises educators interested in this approach to have some understanding of anatomy and to work within a clinical governance framework. It is a very different environment to a teaching environment, and BAPAM requires teachers to sign a BAPAM Code of Practice for Educators. Both parties described how mutual respect for each other and the pianist is important. There is a potential conflict with the regular teacher, and this has been overcome by inviting them into the session. Mark also described the risk of giving advice beyond your individual area of expertise. The success of the project has expanded into work with violinists, guitarists, cellists and other instruments using the same principles, and inviting other clinical practitioners (hand therapists for example). Penelope and Mark have also set up a group for pianists with focal dystonia.

Risk and Occupational Hazards

Dr Naomi Brecker (Consultant Occupational Physician) and Dr Finola Ryan (Occupational Medicine Specialist Registrar) ran a workshop which considered occupational hazards for performing arts workers including light, sound, temperature, make up, costume, stage fog, COVID, instrument & character postures, equipment use, touring, financial, antisocial hours, working at heights and young performers. The sessions also looked at risk assessment tools both for hearing conservation and for freelancers returning to work environments during COVID. A future post will explore these sessions further.

A Health Lesson from the Performing Arts: How Clinicians can Perform Better

BAPAM’s musculoskeletal clinicians Dr Hara Trouli and Mr Nikos Reissis, together with young surgical trainee Dr Markos Reissis, demonstrated how the results of their literature search have revealed common ground of training and performing between clinical practitioners and performing artists. These similarities can spark new educational and technical skill approaches with extended cultural and humanitarian benefits. At a time when the clinical professions as well as the performing arts are practised under social and health challenges, a mutual collaboration can have a long-lasting effect on the physical and mental health preservation for both professions.

Tuning up the Body: Warming Up and Cooling Down for Musicians

BAPAM Physiotherapist, Lucie Rayner‘s workshop explored practical examples of appropriate neuromusculoskeletal warm-up and cool-down protocols for instrumental musicians, examining the underlying theoretical principles behind them. Musicians would benefit from viewing themselves as ‘Musician Athletes’ and managing their physical health accordingly. This should include integrating appropriate physical preparation and post-playing regimes into their habitual practice.

There is some evidence that warm-up routines are an effective component of injury prevention and may help to optimise practice and performance. However, musicians often neglect to warm-up in preparation for playing, and prioritise tuning up their instrument rather than their own body. Musicians may also benefit from performing a cool-down routine following practice or performance. There is currently a lack of specific evidence regarding the role of a cool-down for instrumental musicians. However, we can apply knowledge gained from research in the fields of Sports and Occupational Medicine to guide this element of healthy practice. Some musicians may already recognise the importance of warming up and cooling down, but may need guidance on structure, duration, intensity, and type of exercises most appropriate to precede or conclude their playing.

Lucie’s workshop covered the proposed mechanisms and benefits of warming including:

• Increased blood flow and oxygen delivery
• Increased muscle temperature and metabolism
• Enhanced motor control and accuracy through pre-activation of neural pathways
• Increased muscle-tendon suppleness and joint range of movement
• Improved focus, attention, and awareness
• Supporting the transition to a creative mindset

The cool-down period is to promote recovery and allow the body to return to baseline function. In addition, it enables the musician to reduce muscle tension resulting from prolonged static loading, helps prevent muscle imbalances linked with asymmetrical playing positions, and supports healthy posture. It may also be an opportunity for self-reflection, evaluating practice, and consolidating learning.

Every year BAPAM helps with hundreds of inquiries about health problems related to working in the performing arts. These include musculoskeletal problems caused by strain and intensive use of parts of the body, vocal health issues which need Ģ��tv diagnosis and treatment, psychosocial problems including performance anxiety, stress related to the uncertain nature of the work (82% of the workforce are freelance) and more complex and enduring mental health conditions as well as hearing health problems. Performers, in common with other freelancers, tend to ignore health problems and seek help at a very late stage.�� The research shows that, at any one time, 75% of performers will have a health problem.

We were delighted when the Royal Society of Medicine chose to partner with BAPAM on a professional development event held on March 27, 2019 to consider occupational health in the performing arts sector and its relationship to the wider ‘gig economy’. We were lucky to have a stellar line up of speakers from the arts, academic and clinical worlds to provide a range of perspectives on this question.

Kicking off the conference, Jane Dyball, former CEO of the����outlined the complexity of the industry and the relationship of an artist to industry bodies at different times of their career. In the early stages, the artist may be very dependent on promoters, venues, managers, but that relationship changes when they are successful so that those bodies are dependent on the artist for their own success.

Dr. Colin Thomas, Chief Ģ��tv Officer of the BBC, added to the picture as he described the plethora of jobs undertaken by freelancers in broadcasting and the difficult balance between their tax status as self-employed workers and the duty of care issues that organisations owe to both employees and freelancers.

, BBC Radio 4 broadcaster and BAPAM Patron, described the moment when he suffered paralysis of one of his vocal cords and his journey back to full health and employment. He spoke with courage of the isolation and anxiety of losing your identity and the difficulties of accessing the right care in this very Ģ��tv area.

��of the Royal College of Music’s Centre for Performance Science, described results from recent research which demonstrated the lack of general fitness, particularly amongst student musicians.

In the afternoon we heard examples of good practice from Peter Garden of the Royal Liverpool Philharmonic and��, Head of Dance Science at Trinity Laban. Peter outlined Liverpool Philharmonic’s approach to developing and supporting performance excellence through providing health and wellbeing services to orchestra musicians. He and the Board have seen the impact of this investment on enhanced performance, improved employee satisfaction and engagement, and positive signs of reduced reliance on freelancers to cover sickness absence due to playing-related musculoskeletal injuries. Professor Redding outlined the advances in healthy practice in dance education and how a Ģ��tv health insurance scheme is helping to provide access to occupational health services.

Dr Rob Hampton, RCGP representative at Public Health England and a practising GP, described his own caseload and the difficulties for freelancers in accessing support with work-related health problems, the impact on the NHS and the evidence that working itself improves health. Dr John Etherington, NHS lead for rehabilitation, drew on research on performance enhancement in the military and in sport to demonstrate that effective training for the physical and vocation-related psychological demands as well as good rehabilitation after an injury can significantly improve health.

In this conference, the problems were clearly laid out and examples of solutions are available, but whose responsibility is it to drive the improvements? With over £5bn in UK annual revenue coming from the performing arts, it doesn’t seem sensible NOT to look after the health of the workforce, and leaving this role to charities on their own is not a sustainable solution.

Here are some thoughts from the BAPAM team on how the current position might be improved. First of all, to answer the question, who is responsible for improving performing arts health?

1. Employers and Education Providers. These bodies do have a duty of care to employees and students. Liverpool Philharmonic has demonstrated the economic and artistic case for employers investing in healthcare. Many employers can and do support occupational health for performers. A consistent approach here would improve the health of 18% of the workforce. There are 50,000 students in performing arts education and Professor Williamon’s research, the practice in Dance Education and the work of the Healthy Conservatoires Network demonstrate what can and should be done to develop healthy behaviours in students and ready them for the realities of working life.
2. The Freelance Performer. The performer is responsible for their own health (however, see point 3 below), including seeking help at an early stage and following the health behaviours which are evidenced to reduce the likelihood of health problems. Freelance performers who have learned these behaviours in education should be equipped for the working environment, but many performers have not had access to performance education. The provision of educational sessions and written and online materials together with peer support networks is crucial for this group. The Musicians’ Union, ISM, Equity, Help Musicians, Music Support as well as BAPAM and many other individual coaches and writers are currently offering support in this area.
3. The Performance Environment.��Research evidence tells us that good self-care is best achieved within organisational structures that support individual wellbeing. While other organisations in the industry may not have a��direct��responsibility for performers, they do have a responsibility for ensuring that the environment enables the performer to carry out their personal health responsibility. In addition to statutory health and safety duties, a culture and environment that encourages and supports healthy practice will help performers. As a very basic example, hydration is vital for performers – if there is no water available in a venue, it becomes difficult for the performer to practise this behaviour. What if the acoustics are so bad in a venue that the only way performers can hear themselves is turning the amps up excessively? What if there is a culture in your organisation that discriminates against certain groups or individuals, contributing to negative social relationships and mental health problems? What if the people you depend on don’t know where to go for help when they need it?

If this is a structure we can organise around, then��what would a Health Manifesto for the Performing Arts look like?

1. Everyone in the performing arts world needs to understand what healthy practice means, from the educator to the employer, individual performance professionals and any organisation or individual working in the business (managers, promoters, agents, labels etc).
2. Everyone needs to know where and how to get clinical help when they need it.
3. All funding options should be explored to develop a system-wide approach to providing for the health needs of performers, combining charitable funding sources with other sources of support including industry-specific insurance schemes, access to work funding etc.

We welcome responses by email at��info@bapam.org.uk