Mental health and well-being in the arts sector has been a big topic of discussion, especially during the pandemic’s periods of isolation, when many experienced depression, anxiety and a sense of hopelessness.
But it’s still rare to think of the physical injuries that performers, including musicians and dancers, can sustain and how this also adds to such mental health issues as self-doubt, stress, panic and depression.
Dr Margaret Osborne, Senior Lecturer in Psychology and Music at the University of Melbourne (Australia), was chair of the ‘Artists’ Well-Being’ panel presentation at the Performing Creativity, Culture and Well-being conference last week in Melbourne (16 February 2023), during which she pointed out that physical pain ranks extraordinarily highly for musicians, and not only professional ones, but university-aged and school-aged musicians too.
Up to 90% of performance-related problems for musicians are musculoskeletal issues, up to 75% relate to anxiety, panic or stress attacks, and up to 69% stem from depression.
The panel speakers shared evidence-based research to outline the common issues that performers face in the sector, as well as what is being and could be done to improve the overall well-being of the sector.
How treating dancers like athletes could help prevent injury
Physical injury is a common occurrence for dancers. Professor Emma Redding, Director of Victorian College of the Arts (VCA), said that we need to start seeing dancers as artist-athletes, who should work on their body as much as their craft.
‘There’s the assumption that because art is good for health, artists must be healthy, and that’s not necessarily the case,’ said Redding.
‘Anyone interested in dance should be interested in both the art and the science of dance… Dancers can be injured more than many other athletes, and scientific research can help us understand why that may be.’
The high rate of injury can be a result of how dance has traditionally been taught, with dancers often specialising in one specific choreographic style. Today, however, dancers work across a range of styles and this requires them to move in different ways to how they may have been trained.
As a dance educator herself, Redding’s awareness of this trend led to her completing a PdH in Applied Biological Sciences and an MSc in Sports Science, in order to better inform herself and her students. She is a founding partner of the UK’s National Institute of Dance Medicine and Science.
During the panel presentation Redding explained: ‘Two national studies in the UK showed that up to 83% of dancers are injured in any 12-month period.’
Similar to musicians, this high injury rate is consistent throughout professional practice, as well as in younger dancers and those in private dance schools.
Further, music and dance training are often handed down through generations, which means ‘the way in which dancers are taught is based primarily on anecdotal evidence, teacher wisdom and experience’, said Redding.
As part of her research and to better understand how dance training prepares performers for the stage, Redding collected data on the heartbeat and oxygen uptake of a dancer from Studio Wayne McGregor Company, comparing the physical demands of a technical dance class versus a performance.
The result showed that there is a gap between the level of intensity that dancers are put under in classes and on stage in performances, where for the latter, they are often dancing for longer with a different work-to-rest ratio.
Redding said: ‘We know sports athletes are often trained in a competition environment, yet the training in dance doesn’t seem to be matching the demands of performance.’
While there are now more resources available than a few decades ago – including textbooks in dance science, journals and research findings – it really boils down to a commitment from all stakeholders, including dancers, educators, dance companies and their boards, to implement profession-wide change.
Setting an example
The Australian Ballet is among the companies internationally, that are leading the way in this by introducing injury prevention and well-being programs for its dancers, with significant results.
Dr Sue Mayes AM is Director of Artistic Health at The Australian Ballet and has been the organisation’s Principal Physiotherapist since 1997. Also sitting on the Artists’ Well-being panel, she said: ‘On average, 60% of our dancers come to us reporting some kind of musculoskeletal complaint every single week and most of them actually are able to maintain full dance capacity, but we are not afraid to modify someone [to prevent it from developing into something major].’
This accommodation in training means that ‘very few dancers have to go off practising completely, because we’ve been able to prevent those minor niggles turning into major ones,’ said Mayes.
This approach has major benefits for the company as well as for the individual dances. Since implementing injury prevention programs in 2013 the company has been able to reduce its workers’ compensation premium from 342,755 Pounds (AU$600,000 to $100,000). There has also been a 78% reduction in surgery from pre- to post-2010.
Mayes continued: ‘We use injury data from the previous year to examine what are the risk factors and identify the key injuries that we’ve had in the previous 12 months, and then we put a program into place. We focus on one program [at a time] and do it really effectively to not overwhelm the dancers with a lot of information, and this is supported by a lot of education.’
One strategy introduced by The Australian Ballet, which has now been adopted by dance companies around the world, is performing calf raises in classes – known as the ‘Aussies’ overseas.
‘Within three years, we saw a dramatic reduction in ankle pain,‘ said Mayes. Other strategies include analysing the risks of a repertoire beforehand and coming up with adjustments. In one instance, where dancers were required to do 39 arabesques, the piece was adjusted so that they could alternate their legs and reduce the chance of overexertion.
Mayers said: ‘One thing that’s really important is: how do we get the dancers to buy into all of this? They have to have shared decision-making and be represented in any policy implementation.’
A focus on health and well-being needs to become part of a company’s legacy, added Mayers, ‘which not only gives the supporters more enthusiasm to invest … but also gives confidence to the dancers that they’ve got the best team they could possibly have’.
She concluded, ‘Change takes time [but] we need to make sure that clinically relevant, evidence-based information is translated into dancers’ daily lives in a timely manner.
‘We need to have a very multi-model, multidisciplinary approach, and we need to engage as many stakeholders as we can. Success really does breed success.’
Health as a pathway towards artistic freedom
Associate Professor Bronwen Ackerman, University of Sydney, sits across physiotherapy and sports medicine, and has spent over 30 years touring with orchestras to assist in keeping musicians on the stage. She told conference attendees that not enough musicians know how to use the body to their advantage, but what many of them would like to achieve is intrinsically linked to good health.
‘There is this one soloist who said that the perfect music technique is: “the complete freedom to express yourself in any way you want in any kind of situation”. That is the definition of health – complete optimisation of the mental and physical health in social and work environments, so that performers can express themselves without impediment.
‘Performers shouldn’t just be thinking about health as whether [or not] they have an injury. It’s about empowering [them] to have the freedom and flexibility to [perform],’ she explained.
Ackerman added that if performer well-being isn’t introduced at an early stage, ‘it could be really difficult to shift some of those habits later, when you realise it’s not ideal’.
Having the toolkit to maintain optimal health can also prolong the careers of performing artists. It’s all about increasing health literacy in the arts overall, she stressed.
‘What that refers to is the motivation and ability for individuals to access, understand and use the information that promotes good health,’ said Ackerman.
This can range from adopting the right breathing patterns when playing an instrument to knowing how to better use facial muscles to avoid cramps. (An example was raised of someone who ripped their lip muscle playing the trombone; the medical term is embouchure collapse – they didn’t think it was possible either.)
Better health literacy in the sector can also help assess the effectiveness of certain interventions, and identify areas of improvement for the sector. Furthermore, what performers need is advice from those who actually understand the demands and experiences of their industry.
Understanding what contributes to good mental health for performers
Performers can be very self-critical, and this perfectionism often leads to performance anxiety.
Dr Rebecca Zarate, Professor of Music Therapy at Lesley University, Cambridge, Massachusetts in the US, said stress and anxiety in performers is not just psychological or theoretical, but cultural and collective dynamics are at play too.
‘Think about how the arts are stacked up against each other, the kinds of perceptions and projections that we put on artists… That is where we have to locate ourselves as researchers and apply this to our research and education,’ Zarate told conference attendees.
Drawing on a quote by US psychologist Rollo May from The Meaning of Anxiety (1950), Zarate said that if we think about anxiety as the need to create, then it means that ‘we need to start reframing and de-stigmatising what anxiety really is and what this means for performing artists’.
Her approach is to get to the ‘roots of anxiety’ and help performers develop techniques and methods from an integrated perspective of both clinical and cultural factors.
Read: Am I depressed, or just over it?
Performers often feel nervous about a performance and can envision disastrous outcomes such as forgetting the piece or making a significant error. In more serious cases, this can lead to musicians choosing a repertoire below their performance standard, feigning illness or finding themselves unable to practise. (Conversely, over-practising can be equally detrimental).
In the chair, Osborne said performers also need to be mindful of the symptoms of emotional distress, accept them and then commit to a new behaviour – a method called ‘Acceptance and Commitment Therapy (ACT)’.
‘We need to develop an ability to sustain attention and diffuse potential negative thoughts – criticisms that can come in and hijack in the act of performance. We learn to observe symptoms that are just to be observed, and not interpreted as oneself,’ she said.
The strong link that performers feel between their performance and their sense of identity can sometimes have negative impacts on well-being, added Mayers.
She noted that one thing COVID-19 made clear for The Australian Ballet was the immediate need to address dancers’ mental health struggles, especially during the time when they didn’t have access to performances, rehearsals and their dance communities.
During this period, the organisation employed a full-time Welfare and Development Coordinator, who not only ensured that dancers were provided with access to psychologists or doctors, but were also able to work on career development.
Mayers explained: ‘It’s really important to help dancers develop their identity, other than being a dancer. In the very first year of being in the company, they start making a plan for the future, working on different aspects beyond ballet and just developing them as really healthy, flexible and well-rounded people.’
The way forward
Increasing numbers of national studies are being conducted around educating performers on a range of health topics, implementing injury prevention for dancers and also utilising new technologies to model different performance settings. For example, led by Osborne, the University of Melbourne is developing VR (virtual reality) environments to help musicians manage performance anxiety.
But all of the speakers stressed that, in order for such programs to reach their full potential and help performers in practice, all stakeholders need to support these initiatives – from performers, educators and researchers to companies, leaders and donors.
Osborne concluded: ‘We need to look at the individual performer within the broader system. It’s [about] capacities to change with education, with policy and with guidelines – it needs to be multifaceted.’
Artist’s Well-being was presented as part of Performing Creativity, Culture and Wellbeing at the Ian Potter Southbank Centre (Melbourne, Australia) on 16 February. ArtsHub attended as a guest of the University of Melbourne.
