Performers have lives that are spiritually healthy and physically disastrous. The price for plumbing the depths of the greatest composers’ music, integrating it, sharing it publicly via an adrenalin-filled performance and receiving instant appreciation (and a fee), is considerable. Endless travelling, hours of sedentary practising, intense nervous strain, the isolation of the glass box syndrome, the self-imposed discipline that is inclined to crumble around the late night and possibly bibulous post-concert meal – none of this lives happily with staying healthy and fit. For the pianist, every whiff of holiday must have a decent piano included, so that the return to performance fitness should not be delayed. This is restrictive, to say the least.
Within this regime, I suspect that each pianist has a slightly different relationship to their hands. Common sense dictates care around sharp knives, and an instinct to avoid bags and luggage that cannot be wheeled or strapped on one's back. But otherwise within a life that sometimes seems robbed of normality, there is paradoxically a need not to be paranoiac about these workman's tools, no more than an awareness of tools actually vital to every aspect of functioning normally. There is far greater paranoia around viruses and contagious bugs, the catching of which will more often entail the cancellation of a concert and loss of income than will an injury.
But it is at the hint of an injury that the antennae start undulating. Why does a certain movement hurt? Why does a certain passage not function so well? Is it excess practising? Is it a technical difficulty that is forcing an unnatural compromise? Should I play through the pain? Is it tension in the upper back or neck that is blocking a flowing movement? Or worse – the gloomy realisation that that innocent tumble has had a consequence, a pulled muscle … or a strained ligament or tendon. The dread of the soft tissue injury! Maybe fractures are easier to live with – the prospect of straight cancellations, time out, no secrecy possible, the instantly recognisable status of war-wounded given by a cast, sympathy – whereas it is the uncertainty and hidden element of the soft tissue injury that makes it so corrosive to live with.
So, at the onset, it is vital to remain calm, and keep a balance between awareness and panic, above all between ignorance and knowledge. Sometimes with common sense, by avoiding the harmful passage, doing relaxing and stretching exercises, gentle massage, ice or heat, things right themselves. But it can take time to be sure. This leads to the difficulty of planning forward, the conundrum as to whether to practise, and possibly harm oneself further, for the next concerts, or not to practise – and not to be match fit to perform. This aspect can be paralysing, and may be stop one seeking professional help. In my younger years, I certainly lost time through strenuously avoiding the acquisition of knowledge; since an injury named instantly effects a switch of perception: I must not play, my management must be told, I shall lose income (how many of us insure against loss of earnings? not many, I suspect). Then comes fear: how long will it last, will it niggle forever?
These last questions are in part answered by how one then chooses to move forward, if choice there is. Nowadays I would be more inclined to decide straight out to give my body a break and allow it to heal itself, even if that means some cancellations. Note that I say ‘more inclined’ as the decision is nevertheless fiendishly difficult, if a really interesting level of concert is involved. This is also because I have observed over the years that sometimes injuries happen for a reason. If one is carrying a long-accumulated tiredness – une vieille fatigue, as the French so poetically say – this may be an accident waiting to happen. This has to be heeded. Our performers’ lives have no weekends, no bank holidays, 2indeed no holidays unless we create them – and many of us don't, sufficiently.
An injury can be a clear sign to get out the bucket and spade, or at least to re-assess. One can almost see an injury as a message from home.
Vital in the acquisition of knowledge is which expert one chooses to go and see. Those who specialise in musicians are known to us all, and I would never go elsewhere. The complex psychology of the musician/performer must be well understood (see earlier), and the manner of imparting knowledge is also vital – spirits can be lifted if, simultaneously to hearing bad news, hope is given, and as clear as possible a prognosis. Even a little brutality can be refreshing – I know of a colleague who had a fracture, and, asking what the prognosis was, was told brusquely, 10 weeks until you play again, no problem. It was true, to the day (and entailed the loss of 13 concerts, without insurance).
I would be inclined towards as little intervention as possible, although it is only fair to say that if one puts one's trust in a specialist, one should be prepared to do what is suggested. A choice of actions, with consequences explained, is the best. In my younger years, I have the impression that cortisone injections were offered more liberally – I had but one, and it was not only painful but not very helpful either. I was told that if poorly administered they can cause damage. I have not been a fan since, possibly mistakenly.
I think that vital too, or at least an area for caution, is the place of the therapist in all of this. I have twice in my life shirked seeing a rheumatologist or orthopaedic surgeon at the outset of a niggle, and opted instead straightaway to see a physiotherapist. In both cases – many moons ago, and the practitioners should remain safely anonymous – I got a slightly false diagnosis, which simply delayed the cure. This is of course not a given, rather an exception, but it can happen. Best to get a firm diagnosis first. I would however choose to see a good physio initially, particularly one who knows my body well, to check out correct alignments, muscle knots, upper back tension, and to make sure that all is in good order, without necessarily treating the injury if too early to so do. Good physios perform a vital role.
The speciality of hand therapy has been a wonderful development for pianists. What a positive addition it is to know the role of the smallest muscles in the hand, and what can be done to strengthen and stabilise them; for me it has been revolutionary, as have been the exercises and aids given (putty, strong elastic bands), useful in times of inactivity as well as post injury.
Of course the avoidance of performance-related injury, as opposed to one generated by exterior circumstances, should start as soon as an instrumentalist starts to learn his or her instrument. Scales, and exercises – yes there are some fun ones! – should be part of regular practice from the start, to strengthen fingers. If there is a solid foundation there, injury is more easily avoided. How often have I seen weak hands not sustaining the music given them, with inevitable contortion and tension following, which if not corrected can become chronic? The ethic of believing in the power of communicating music above all else is a dangerous one – we are to a certain degree athletes too and must train accordingly. Teachers should not be shy of insisting on pure technical work, intelligently supervised, with plenty of praise for achievement and progress made, and plenty of understanding if the going is hard. It reaps its own rewards.
We are incredibly lucky as musicians that in the last 25 years, groups of doctors and medical professionals, recognising the special nature of musicians’ physical problems and medical needs, have formed national organisations to meet our needs.
Here, in Britain, we are lucky to have the British Association for Performing Arts Medicine (BAPAM) as a discreet guardian angel/knight in shining armour. I know few musicians, myself included, who have not at some stage of their career rung BAPAM, and benefited greatly from a free confidential health assessment and expert advice at the top level. Undoubtedly the fact that they specialise in the complex problems inherent in a performing artist's life means that they can provide an extra dimension of understanding, and compassion, which is precisely what is needed when the hidden beast of injury strikes. Long may they thrive.