Last month, PhysioFirst’s , a clinical journal for physiotherapists working in private practice, published a special issue dedicated to performing arts medicine. It featured articles on how physiotherapy can help dancers, musicians, circus artists, and actors maintain health and remain injury-free. The issue also included an article authored by BAPAM assessing clinicians Lucie Rayner and Genevieve Tawiah, highlighting the role of physiotherapy in supporting voice performers.

Singers and actors are elite professional voice users or ‘vocal athletes’ as they need to consistently produce high-quality and technically demanding speech or song, often under difficult environmental conditions. Unfortunately, research shows that a high percentage of voice performers will experience a voice problem during their career. Vocal rehabilitation aims to restore voice function and often requires a multi-disciplinary team led by a laryngologist or speech & language therapist. The team may also include a singing teacher, a psychologist, and, increasingly, a physiotherapist. Vocal physiotherapy is an emerging speciality within the profession, and research has highlighted its effectiveness when supporting professional voice users with their vocal health or recovery from a voice injury.

What is Vocal Physiotherapy?

Voice production relies on several interconnecting systems to function effectively. Physiotherapists specialise in optimising physical function and can use their skills and knowledge in the following areas when supporting a voice performer:

• Manual therapy: to help reduce tension, pain, and restriction in key areas. This can include direct manipulation of the larynx and other more global structures and regions throughout the body.
• Exercise therapy: to help address muscle imbalance, postural problems, and strength or stability issues by providing tailored exercises and guidance.
• Respiratory support: to help promote optimal breathing for voice by supporting ease of movement in the spine/rib cage, healthy posture and efficient abdominal muscle support.
• Health promotion: to support the performer with healthy lifestyle practices integral to voice health, such as physical warm-ups, nutrition, hydration, sleep, stress management, and general fitness.

Physiotherapists can also help facilitate referral to a Ģ��tv voice clinic or other health professionals where appropriate. They are regulated by the Health and Care Professions Council (HCPC), ensuring standards for education, training and practice.

 

You can read BAPAM Physiotherapists, Genevieve Tawiah and Lucie Rayner’s article in full here: InTouch: Vocal Physiotherapy.

We are grateful to PhysioFirst In Touch Journal for their kind permission to reproduce the article, which was first published in InTouch191, Spring 2026.

Find a Vocal Physiotherapist or Osteopath on the BAPAM Directory����

The BAPAM Practitioner Directory includes physiotherapists with expertise in performing arts medicine. If they are trained in vocal physiotherapy, this will be indicated in the practitioner’s biography. In addition, there are Osteopaths with expertise in voice on the Directory who work in a similarly holistic way and are regulated by the General Osteopathic Council.

If you are experiencing any vocal symptom lasting more than 2-3 weeks or persisting for more than two weeks after the resolution of an upper respiratory tract infection, you should seek professional help. Contact the BAPAM helpline to arrange a clinical assessment with one of our voice Ģ��tv assessing clinicians.

References:

Tawiah, G., & Rayner, L. (2026). Getting the word out: vocal physiotherapy. InTouch: Spring Edition: 191. p: 14-19.

Tawiah, G., & Rayner, L. (2025). The role of physiotherapy as part of a multidisciplinary team approach to vocal rehabilitation and care of the professional voice. Physiotherapy, 126, Article 101497. https://doi.org/10.1016/j.physio.2025.101497.

For September 2024, the magazine of the British Psychological Society, The Psychologist, turned their focus to Science Communication. For this edition, the article Joined in Dance by BAPAM’s Monia Brizzi (Counselling Psychologist), and Dr Anthony Ordman (Specialist in Pain Medicine) was selected. Based on their work with BAPAM, Joined in Dance explores the link between mind and body in performers with career-threatening physical presentations.

We are grateful to the BPS for allowing us to reproduce the article which you can read or download here: JoinedInDance

 

---

As we come to the end of Mental Health Awareness Week, BAPAM’s Mental Health Ambassador, Anushka Tanna, highlights The Colour of Madness, an anthology of reflections on race and mental health that has been inspiring her work with BAPAM and our partner organisations in the performing arts.

is a revolutionary collection of work edited by Dr Rianna Walcott and Dr Samara Linton. The third edition (paperback) was published in May 2024. I was fortunate enough to come across this book a few months ago have chosen to share it to round off Mental Health Awareness Week. I’ve been deeply moved and inspired by the stories and insights collected here, which highlight a range of perspectives relevant to our collaborative effort to improve mental health for all in the performing arts.

Through a collection of stories, essays, poetry, short fiction and artwork shared by 65 voices, many of whom work in healthcare and/or creative professions themselves, the Colour of Madness provides an important and much-needed space for the voices of People of Colour, and their experiences with mental health to be heard.

As many of the contributors talk about very challenging experiences in their lives, I�� would encourage you to look at the content warning, especially if reading about sensitive content may be upsetting or triggering.

This is a collection that will undoubtedly resonate with those who have shared similar experiences, as well as being an important read for individuals and mental health professionals looking to further understand and combat systemic injustice.

As stated within the first pages of this anthology, The Colour of Madness is:

For those past and present who were not able to tell their stories. For those who told their stories but were not heard. For those who are steeling themselves waiting for their moment to speak.

It felt all the more important to share and disseminate this book following the key findings within , a collaborative report and podcast between Black Lives in Music and Attitude is Everything, as well as the insights provided by the . Both reports convey clearly how inequality and discrimination create barriers to sustainable creative careers and adversely impact health in our community.

A collaborative approach is vital in tackling inequality. BAPAM brings clinical expertise to a consortium of organisations committed to providing accessible health support for all in the performing arts. We are grateful for essential support from our funders and partners which enables us to deliver these Ģ��tv services.

As a reminder of how you can access support through BAPAM, provided with Music Minds Matter for musicians, with Equity for creative practitioners and with Dance Professionals Fund for dancers and choreographers, please follow this link: Mental Health Support at BAPAM

Likewise, here you can find out more about BAPAM’s healthy practice and mental health workshops

Published in , BAPAM Counselling Psychologist, Monia Brizzi’s article Bridging Mind and Body describes how a complex systems approach helped a musician identify and understand the emotional roots of his physical symptoms. Thank you to Therapy Today for allowing us to share the article which you can read here: Bridging Mind and Body.

Working as a psychologist and psychotherapist at the Ģ��tv, I often see performers with career-threatening physical presentations that may defy medical understanding.

© This article was first published in��Therapy Today, the journal of the British Association for Counselling and Psychotherapy (BACP)

Touring and Mental Health: The Music Industry Manual is to be published by Omnibus Press on 23 March 2023 in paperback and eBook.

The paperback edition is available to pre-order now at , Omnibus Press have kindly offered discounts to readers of this blog. Simply enter one of the following discount codes when pre-ordering online: S0EZC7YDJ969 (20%) / CC1Y4EP81BQK (25% – min quantity 5 copies).

‘Like having a therapist in your back pocket. It helped deepen my understanding of myself as a performer and how the demands of the music business can take a toll’ Siobhan Donaghy, Sugababes.

The manual is edited by psychotherapist, Tamsin Embleton (MA, MBACP), and is aimed at helping musicians and those working in live music to identify and cope with the various physical anad psychological difficulties that can occur during, or as a result of, touring.

Covering topics including: emotional intelligence, depression, trauma, crisis management, anger and conflict, stress, addiction (substance & process; sex & porn), eating disorders, anxiety (performance; flight; general), group dynamics, mindset, exercise, physical health (hearing; vocal; sexual; general), optimal performance, dealing with the media, diversity and inclusion, romantic relationships, nutrition, sleep science, breathwork, meditation, duty of care, mental capacity, psychological safety and post-tour recovery, Touring and Mental Health – The Music Industry Manual is written by health and performing arts medicine professionals to provide robust clinical advice, cutting edge research, practical strategies and valuable resources.

Each chapter is also underpinned with personal recollections from artists and professionals including Nile Rodgers, Justin Hawkins, Philip Selway, Charles Thompson, Katie Melua, Kieran Hebden, Jake Berry, Tina Farris, Taylor Hanson, Trevor Williams, Lauren Mayberry, Pharoahe Monch, Jim Digby, Will Young, Angie Warner and Dale ‘Opie’ Skjerseth, among others.

Editor Tamsin Embleton is a psychoanalytic psychotherapist and ex-music industry booker based in London, UK, and working internationally online. She is the founder of the .

“Artists and crews spend their lives on the road, bringing shows to life for fans around the world. But that dedication can come with sacrifice. It’s critical that we provide support to ensure that everyone can maintain sound mind and body while on the road. Live Nation is proud to join the Music Industry Therapist Collective in providing new resources for mental health and wellness for the behind-the-scenes heroes who make it all happen.”��Michael Rapino, CEO & President, Live Nation

‘This book can add decades to a career, give wisdom to the most exhausted mind, and offer encouragement to every burdened heart.’��James Ainscough, CEO Help Musicians UK

‘The perfect book at the perfect time.’��Marty Hom, Tour Manager Fleetwood Mac, Shakira, Beyoncé

‘A remarkable encyclopaedia of wisdom…�� This impressive book needs to be read by every single artist and every single psychological worker as well.’��Professor Brett Kahr,��Senior Fellow, Tavistock Institute of Ģ��tv Psychology

Touring and Mental Health��is designed to be picked up, put down, read at length and passed around the tour bus.

BAPAM-registered chartered physiotherapist Dominique Royle sent us her recent article which explores the management of playing-related musculoskeletal disorders (PRMD) in musicians. First published in , which focused on occupational health, we are grateful to Physio First for their permission to share the article here: Playing-Related Musculoskeletal Disorders in Musicians (pdf)

Dominique’s article helps us gain a better understanding of the incidence of PRMD in musicians, and appropriate physiotherapy management strategies to facilitate musicians’ recovery and return to optimal performance. She describes the problems that musicians face with seating. Seating provided by practise and performance venues often does not cater for the various body shapes and sizes, causing difficulties for those who spend a considerable amount of time sitting while playing. Dominique also examines the importance of the ratios of work:rest and acute:chronic workload when considering the length of practise sessions.

Managing musicians’ problems is a dynamic and reflexive process which requires a deep understanding of the demands placed on the musician. Dominique stresses the need for physiotherapists to adjust their hands-on education and exercise techniques to mirror the experiences, thought processes and language used by musicians, especially when considering self-management strategies such as adjustments to lifestyle and practice routines.

By Dr Charlie Easmon

Performers may be perfectionists and perfectionists are more prone to mental health problems and included in this are eating disorders. In at least 50% of people with eating disorders there is an existing mental health disorder of depression or anxiety. In many cases the individual has been dealing with issues of low self-esteem and/or past traumas.

I rephrase ‘eating disorders’ as ‘disorders of thinking about eating’ and in this way the mental disruption is always kept to the forefront.

Eating disorders are never easy to treat or manage and are deep psychological problems.

Examples of problems caused may be the performer with ‘chalk like’ bones’ who breaks them after a simple fall. The singer who has to use mints to hide the vomit smell on their breath. The locked hotel room as the performer binge eats having ‘maxxed out’ room service food and/or drink.

Dr Marianna Kapsetaki (a student on the UCL course initiated by BAPAM in Performing Arts Medicine) and I in 2017 wrote a paper on Eating disorders in Musicians. This showed that 18% (almost 1 in 5) of those who replied had a current eating disorder and 1 in 3 had a history of eating disorder.

Florence Welch acknowledged her eating disorders in the song “Hunger’. Taylor Swift and Janet Jackson have talked openly about the pressures of unreasonable ‘figure expectation’ in female artists.

A performer wanting to look good in costume and dieting to achieve that is not an eating disorder.

Touring (once it restarts) makes healthy eating and nutrition difficult for everyone.

I think of the 3 main types of eating disorders as a horror movie playground. The scary slide is the anorexic descent to a declining weight by variations of cutting calories and exercising. The bulimic see-saw is the binge/purge cycle of eating vast amounts of food followed by various combinations of vomiting and laxatives. The binge eaters are on a ‘not so merry go round’ as their weight balloons.

If you think that someone has an eating disorder try to understand that they need careful management. Some people will need hospital or residential care, and some people will need to stop touring, as Ed Sheeran famously took a year off. Now is a good time to have systems in advance of touring or at least have a ‘resource’ handbook available to the key managers concerned with the performer’s welfare.

The UK Eating disorder charity is an excellent resource. Performing arts Ģ��tv counsellors and therapists can be found using the BAPAM Directory. Online counselling is available and both the and also list registered professionals.

References and links

Self-Harm and Eating Disorders in Schools by

 

Whatever your style of singing and whatever your repertoire, you should take a holistic approach to your practising and performing. Our Fit to Sing! factsheet covers 12 tried and tested tips for healthy singing and has been updated for 2020.

We are grateful to Millie Packer and Sarah Kelsey who have redesigned this resource for us as part of their Graphic Design HND project exploring the concept and practicalities of art and design in relation to the subject of wellbeing.

If you have any concerns about your voice, or about any other aspect of your performance related health, contact BAPAM on 020 7404 8444 for advice about Ģ��tv clinical support for creative practitioners. Remember – the sooner you address any problems, the less damage you will do.

More Resources

Master healthy practice, prevent injury and enhance performance. BAPAM’s full range of essential resources for artists, creative practitioners, teachers and industry organisations can be downloaded here: Factsheets and Resources

Healthy Practice Training Sessions

You can also book your place at a BAPAM healthy performance training session. All our events are currently being delivered as free webinars: Training and Events

 

It was a great privilege to be invited to Sydney to speak at the����(ASPAH) conference at the end of 2019, and inspiring to hear about the great practice happening in Australia. The conference��Lasting the Distance: a Lifetime in the Performing Arts��considered physical and psychological approaches to support career longevity. Dr. Sue Mayes, the Australian Ballet’s principal physiotherapist and keynote speaker outlined how their approach to healthcare had minimised injuries over the years, measured by insurance claims – a compelling argument for the value of investing in performance health.

There were some really interesting presentations on dance, from child education to��foot adaptation of wearable technology and athlete management systems used by athletes, and developing a career in health after dance. On mental health, identification and intervention in eating disorders and management of music performance anxiety were explored, and Ben Steel, former Ģ��tv and Away star, movingly discussed his documentary on depression in the performing arts. I presented on our experience of��Developing Evidence-Based Policy and Practice in Psychosocial Health in the Performing Arts.

There is a thriving performing arts medicine community in Australia and we were honoured to be part of the discussions, and look forward to a continued relationship. ASPAH has produced a great set of healthcare guides which they have kindly allowed us to share with you:��