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Dr Mike ShipleyConsultant Rheumatologist
University College Hospital, London
Trustee BAPAM
Introduction to BAPAM services
• Information about BAPAM
• How can performers get the most out of BAPAM?
• What can you do for BAPAM?
• BAPAM staff
BAPAM
Mission:
‘To develop an independent nationwide occupational health provision for professional, semi-professional and student performing artists, including clinical advice for performance-related health problems, health promotion and education.’
BAPAM
• Objectives:– Profile – to give information about our and other
services to performers and their teachers and representatives
– Access to independent health support through telephone advice and seeing clinicians
– Education of students, teachers & performers– Research – Income generation
BAPAM PAID STAFF
• Naomi Wayne - Chief Executive
• Sanchita Farruque - Health Promotion in Music Development Officer
• Dan Hayhurst - Clinics and Administrative Officer
• Clare Hicks - Office and Clinics Manager
BAPAM
• Clinical governance:– Medical Committee– Risk assessment– For the benefit of the patients– To protect the Directory members
What does BAPAM offer for Performers?
• Free assessment clinics• Referrals to the most appropriate specialist or
practitioner (most of whom provide their services free)
• Directory of interested practitioners• Advice on getting & staying healthy• AMABO: special service for orchestral players• Training in performing arts medicine
BAPAM Assessment Clinics• We run free health-assessment clinics for full or part
time professional and student performing artists and production crews in– London– Bath & Bristol– Birmingham– Cambridge– Cardiff– Dublin– Glasgow– Leeds– Manchester– Newcastle– Portsmouth
BAPAM Assessment Clinics
• Usually delivered by a GP (occasionally a specialist physiotherapist or rheumatologist)
• Route to further specialist help (advice or treatment, again usually free of charge)
• Information and advice normally sent to the performer’s NHS GP
BAPAM Assessment Clinics
• The clinicians are often musicians or performers themselves
• Awareness of the pressures and demands placed on performers and teachers
• Understanding of problems with technique and access to advice
• Major role of reassurance and
helping people to cope
BAPAM Assessment Clinics
• Whom do we see?– 1200 visits (750 new) per year – 70% instrumentalists– 15% singers– 8% actors– 5% dancers
BAPAM Assessment Clinics
• What do we see?– 75% Musculoskeletal– 9% Voice– 3% Hearing– 5% Psychosocial
BAPAM Assessment Clinics
• Pressure points– Over-practicing and not taking breaks– Lack of general fitness– Going from top of class to middle of
conservatoire– Change of instrument– Learning new techniques– Unwilling to accept there is a problem
BAPAM Assessment Clinics• Effects of pain
– A slight increase can have a major impact when under pressure
– Wind-up is a common feature – a vicious circle of pain, muscle tension and poor posture
– Fear of the dreaded ‘RSI’ or ‘teno’ and ending a career - catastrophising
– Pain acts as a block between brain
and performance
BAPAM Specialist Referrals
• Performer-friendly clinical specialists or healthcare practitioners
• Specialists usually NHS and provide their services free
• Practitioners are mostly private but offer care free or at a reduced price to BAPAM patients
• Advice on sources of funding for treatment is given
BAPAM Directory• Comprises around 250 practitioners
– Doctors (33%)– Physiotherapists (10%)– Counsellors & psychotherapists (10%)– Complementary therapies (40%)
• Requirements for listing – qualifications, insurance, attendance at twice yearly BAPAM updates
BAPAM Directory
• Performers can access directory via the web www.bapam.org.uk/
• Searchable by area of expertise & locality
• Additional information is available by phone from BAPAM
• Practitioners’ website address is published if appropriate
BAPAM Health Promotion
• Prevention is the key but difficult to do• Health Promotion Officer gives talks to
students and teachers• Resources area on the website
www.bapam.org.uk/• Covers: musculoskeletal, voice, ENT and
psycho-social and lifestyle issues• Hard-copy resources (concertina cards and
posters are available)
Association of Medical Advisors to British Orchestras (AMABO)
• Free confidential medical advice to orchestra players
• Long-term relationships with players, independent of orchestra management
• Clinics, telephone access for advice plus ‘on call’ by some
AMABO doctors
BBC Concert Orchestra - Dr Frances Carter
Bournemouth Symphony Orchestra - Dr Elizabeth Nodder
City of Birmingham Symphony Orchestra - Dr Jonathan White Chair
English Chamber Orchestra - Dr Jennifer R Lisle
English National Opera - Dr Michael Shipley
Hallé Orchestra - Dr Margaret Garner & Dr Bill Tamkin
London Philharmonic Orchestra - Dr Louise Miller
Philharmonia Orchestra - Dr E Chonon Lewis
Royal Liverpool Philharmonic Orchestra - Dr Christopher Mimnagh
Royal Philharmonic Orchestra - Dr Frances Carter & Dr Peter Warren
Ulster Orchestra - Dr Christine Hunter
BAPAM Training in Performing Arts Medicine for Practitioners
• Induction days (2 annually)
• Training days (following a syllabus)
• Attendance is required to remain in the Directory
• Diploma in Performing Arts Medicine jointly with University College London from September 2011.
MSc & Diploma in Performing Arts Medicine
• Being run jointly with– University College London– The Ear Institute, UCL (Vocalists)– The Royal College of Music (Musicians)– Trinity Laban Conservatoire of Music and
Dance (Dancers)– BAPAM– Generous start up funding from PPL
MSc & Diploma in Performing Arts Medicine
• The diploma will run over one year (two days per week) or two years (one day per week) with an optional research module leading to an MSc.
• Costs will be of the order of £6500 for a full timer, £3300 per year for part timers and £15,000 pro rata for overseas students.
MSc & Diploma in Performing Arts Medicine
• Aimed at– Physiotherapists– Doctors– Osteopaths– Alexander technique teachers– Counsellors– ?Performers
DIPLOMA AND MSc in Performing Arts Medicine - Syllabus
• Musculoskeletal & Neuromuscular Injury in Performing Arts Medicine
• Performance Psychology
• Research Methods – shared with Sports Medicine
• Drugs and Disability in the Performing Arts Medicine world
DIPLOMA AND MSc in Performing Arts Medicine - Syllabus
• Environmental Issues, Travelling & Touring, Governance & the Law
• Practical assessment & wellness of Performance Artist
• Rehabilitation of Performance Related Injury’s - shared module with Sports Medicine
DIPLOMA AND MSc in Performing Arts Medicine - Syllabus
• One of the following:– Clinical Voice Management (Voice Institute
UCL)– Medical Problems in Dancers (Trinity
Laban)– Medical Problems of Instrumentalist (RCM)
• Research Module for MSc
www.bapam.org.uk
BAPAM
• A charity generously supported by– The Musicians Benevolent Fund– Musicians Union– Equity– Incorporated Society of Musicians– PPL (MSc & Diploma start up funding)– Fund raising and private donations
How you can help us
• Spread the word to performers & teachers
• Encourage people to join the Directory
• Write fact sheets
• Help us to collect stories
• Donations! or fundraise for us
A Typical Problem
• A second year violin student
• Had done well at school and in the first year but was under pressure
• Responded by working and practicing over 12 hours a day
• She was sleeping badly and had developed neck pain.
A Typical Problem
• She had been advised to take time off and not play at all
• She feared for her career
• Neck pain was muscular & related to poor posture
• Sleep disturbance is well recognized
to worsen chronic pain
A Typical Problem• Advised to play a little intermittently &
gradually increase – she immediately looked less anxious
• Take regular paracetamol for a while to break the cycle of pain – not wait until at ‘screaming pitch’
• See a physio about posture & relaxation
• Get advice about violin technique
A Typical Problem
• She took up exercise & yoga and got fitter• Sleep improved• Pain levels reduced & she no longer needed
paracetamol• Felt happier with her technique• Came to terms that she would never be a
superstar• Graduated and now plays in a professional
orchestra
KEY POINTS
• Educate the teachers and the performers
• Prevention is better than cure• Early recognition can often reduce long
term disability• We need to reduce the stigma –
intolerance from colleagues not yet affected
