Tag Archives: music health


When Vertigo Rocks Your World


Vertigo is a tilting, spinning sensation of being off-balance. You may feel like the world is spinning around you even when you are standing perfectly still. Vertigo symptoms are caused by a disturbance to equilibrium, and may be accompanied by nausea and headache. More than 2 million people visit their doctors each year complaining of dizziness or vertigo, and while it’s generally a harmless symptom, you can imagine how it could be debilitating and stop a performer in her tracks.

To better understand the cause of vertigo you need to look at the anatomy and function of the ear. Sound waves travel through the outer ear canal until they reach the eardrum. There, sound is turned into vibrations, which are transmitted through the inner ear via three small bones (the incus, malleus, and stapes) to the cochlea, and finally to the vestibular nerve, which carries the signal to the brain. A collection of semicircular canals (canalis) positioned at right angles to each other inside the inner ear act like a gyroscope for the body. These canals, combined with sensitive hair cells within the canals, provide us feedback regarding our position in space. When there is a disturbance in this system, it can cause vertigo.

Common Types and Causes of Vertigo

  • Benign paroxysmal positional vertigo (BPPV): This type of vertigo is caused by tiny calcium particles (canaliths) that clump in the canals of the inner ear, which sends signals to the brain about movements relative to gravity to keep your balance. This type of vertigo is most commonly felt when tilting the head or climbing in and out of bed.
  • Meniere’s disease: This inner ear disorder is thought to be caused by a buildup of fluid, which alters the pressure in the ear. Along with vertigo, symptoms can include ringing in the ear (tinnitus) and hearing loss.
  • Vestibular neuritis or labyrinthitis: This inner ear problem is caused by an infection (usually viral). The infection inflames the inner ear around the nerves that are important for helping the body sense its balance.

Less frequent causes of vertigo include head or neck injury, brain problems (stroke or tumor), certain medications, and migraine headaches. In many cases vertigo will go away with no treatment. When necessary, what treatment is used depends on the cause of the vertigo.

Common Treatments

  • Canalith repositioning maneuvers: Performing a series of specific head and body movements can relieve the symptoms of BPPV by shifting the calcium deposits out of the ear canal and into an inner ear chamber where they can be absorbed by the body. While the movements are safe and effective, you may need a doctor or physical therapist to teach you the techniques. Also, if you are uncertain which ear is affected your doctor can let you know.

Epley maneuver is the most common, and provides relief to 90% of BPPV sufferers.

1) Sit on the side of your bed. Turn your head 45 degrees to the side of the affected ear (not as far as your shoulder).

2) Quickly lie down on your back, with your head on the bed (still at a 45-degree angle). Place a pillow under you so it rests between your shoulders rather than under your head. Wait 30 seconds.

3) Turn your head halfway 90 degrees in the opposite direction without raising it. Wait 30 seconds.

4) Turn your head and body on its side in the same direction, so you are looking at the floor. Wait 30 seconds.

5) Sit up slowly but remain on the bed for a few minutes.

6) Repeat before going to bed each night until you’ve gone 24 hours without dizziness.

     Half somersault or Foster maneuver

1) Kneel down and look up at the ceiling for a few seconds.

2) Touch the floor with your head, tucking your chin so your head goes toward your knees. Wait about 30 seconds or until any vertigo stops.

3) Turn your head toward the affected ear. Wait 30 seconds.

4) Quickly raise your head so it’s level with your back while you’re on all fours. Keep your head at that 45-degree angle. Wait 30 seconds.

5) Quickly raise your head so its fully upright, but keep your head turned to the shoulder of the side you’re working on. Then slowly stand up.

6) Repeat this a few times for relief, resting for 15 minutes in between.

  • Vestibular rehabilitation: This physical therapy may be recommended by your physician if you have recurring vertigo. It is aimed at helping to strengthen the vestibular system and its function in sending signals to the brain about head and body movements relative to gravity.
  • Medication: In cases where vertigo is caused by an infection or inflammation, antibiotics or steroids may reduce swelling and cure the infection. For Meniere’s disease, diuretics may be prescribed to reduce fluid build-up pressure. In some cases, medications are taken to relieve the nausea associated with vertigo.

Occasionally vertigo can be a symptom of a more serious problem. It’s always advisable to visit your physician when you are experiencing any medical condition.

Dry Eyes

In the Spotlight: Help for Dry Eyes

Dry EyesDuring allergy season many people experience dry eyes. With age, it becomes more common and can be chronic. Whether you’re staring at a computer screen all day or reading music under stage lights, your eyes may begin to feel gritty and dry. The problem develops when the eye cannot maintain a healthy coating of tears.

There may be any number of causes: dry environment or workplace (wind or air conditioning); sun exposure, smoking or secondhand smoke exposure; cold or allergy medicines; or hormonal changes brought on by menopause.

People who work long hours staring at a computer screen are likely to blink less often and are more susceptible to dry eye. (Optimally, people should blink about 15 times a minute or every four seconds.) Those who have had Lasik or other refractive surgery, where their corneas have reduced sensation due to incisions or tissue removal, may also experience dry eye. Long-term contact lens wearers are also at risk.

More serious conditions—auto-immune diseases, such as lupus, rheumatoid arthritis, or thyroid disease—can contribute to the problem. Dry eyes can also be a symptom of Sjögren’s Syndrome, an autoimmune disorder associated with rheumatoid arthritis and other auto-immune diseases.

Any number of over-the-counter and prescription medications can reduce tear secretion.

While there is no cure for dry eye syndrome, you can find relief.

Here are some tips to help relieve dryness:

  • First, be sure to have regular eye exams. The American Optometric Association recommends that people aged 18-60 get eye exams every two years, as long as they are symptom-free. At-risk and symptomatic patients should have their eyes examined at least once a year and whenever they are experiencing problems.
  • Apply warm compresses on the eyes. Wet a clean cloth with warm water. Hold the cloth over your eyes for five minutes. Rewet the cloth with warm water when it cools. 
  • Control inflammation by cleaning lids with mild soap. (Ophthalmologists often recommend baby shampoo.) Apply cleanser on clean fingertips and gently massage your closed eyes near the base of your eyelashes. Rinse thoroughly.
  • Massage your eyelids to activate secretions.
  • Only use recommended eyelid cleaners.
  • Use artificial tear ointment or thick eye drops just before you go to bed.
  • Avoid using a hair dryer.
  • Run a humidifier to add moisture to the air.
  • Protect your eyes from sun and wind with sunglasses.
  • Consider adding more omega-3 oils to your diet (salmon, sardines, tuna, trout, anchovies, and flaxseeds). In studies omega oils appear to improve the eye’s Meibomian glands, which produce the oily part of tears. Fish oil may also reduce inflammation.
  • Try to avoid medications that deplete body fluids.
  • Ask your doctor about punctal plugs, which are placed in the tear ducts to retain lubrication.

If you have chronic dry eyes contact an ophthalmologist for evaluation. Left untreated, dry eye (keratoconjunctivitis) can lead to pain and more serious conditions such as ulcers, scars on the cornea, and partial impairment of vision. Permanent vision loss, however, is uncommon.

Trigger Points: A Pain in the Neck

by Dr. Marc Brodsky and Ron “Bumblefoot” Thal

Trigger Points, or knots, in the neck and shoulder muscles from repetitive use are common in musicians. In addition, chronic muscle-related pain of the head and neck may be exacerbated, or caused, by other conditions such as whiplash, migraine and tension headaches, temporomandibular joint (TMJ) disorders, fibromyalgia, and even cancer. This article explores how integrative medicine can be used to ease neck and upper back pain.

Case Study

A guitarist in his 40s continued to have neck and upper back pain following a car accident two years prior where he was rear-ended at a stop. An MRI revealed a herniated disc in his neck. He described the pain as a splinter that was permanently in his body, irritating him every day. His pain intensified while moving around stage playing his guitar, as well as during travel for touring. The pain persisted despite steroid injections and pills, physical therapy, and a trial of self-medication with alcohol. The guitar player finally found relief with a self-care program that included acupressure—pressing strategic points to release muscle knots in his neck and upper back. He also ate an anti-inflammatory diet and exercised with an arm bike and did push-ups. He specially designed a guitar case to take off some of the load from moving gear.

Highlights of Integrative Medicine Approach

If you are experiencing neck and upper back pain, a hands-on physical exam may find neck and upper back pressure points. They are most commonly found in two muscles: the trapezius (below, left) and splenius capitis (below, right):

A medical professional may use trigger point injections (TPI) to treat painful areas of muscles that contain muscle knots. In the TPI procedure, a small needle is inserted into the trigger point. The injection contains a local anesthetic or saline, which inactivates the trigger point to alleviate pain. Several sites may be injected in one visit. A brief course of treatment often results in sustained relief. Acupuncture and massage by licensed professionals may relieve muscle knot pain as well.

You may take an active role in relieving your own neck and upper back pain by pressing the acupressure points on your arms, neck, and upper back. Try these three techniques: 

1) Press on a point two inches down from the crease of the elbow.

2) Interlock the fingers and press the thumbs into the tender points below the base of the skull.

3) Place two tennis balls in a stocking and press them against a wall with your back using the weight of the body to access the pressure points below.

The recommended self-care routine for muscle knots in the neck and upper back is to press each of the acupressure points for the duration of three relaxing breaths (about 15 seconds) one to three times each day. This is a natural muscle relaxant and stress reliever.

For persistent neck and upper back pain always seek treatment from a medical professional.

Marc Brodsky, MD, is a 2017 member in good standing of the Performing Arts Medicine Association (PAMA). Ron ‘Bumblefoot’ Thal is a solo artist and producer. Images courtesy of Katrina Franzen, Junghwa Choe, and World Health Organization.

Avoid the Flu

Avoid the Flu this Season: What You Need to Know

Avoid the FluIn North America, millions of people are sickened, hundreds of thousands are hospitalized, and more than 100 million workdays are lost, due to the flu each year. It’s important to take every precaution to not have to cancel gigs. Don’t risk sidelining your career due to illness. Do your best to avoid the flu this season. 

Your best defense may be to get vaccinated. Flu vaccine effectiveness depends on how well the vaccine matches the dominant strain of influenza circulating in a particular year. This year’s shot will offer protection against the H1N1 flu virus and two other flu viruses expected this season. A vaccine that protects against four strains of the virus will be available, as will a high-dose flu vaccine for adults age 65 years and older. According to the Centers for Disease Control and Prevention (CDC), when the vaccine is well-matched, it can reduce the risk of flu by about 50%.

It takes up to two weeks to build immunity after receiving a flu shot, but you can benefit from the vaccine even after flu season is underway. Typically, the flu hits in October, peaks in January or February, and can run well into spring. Experts say that for some populations, like the elderly, the vaccine may wear off faster. But because it’s unknown when the flu will strike, it’s best for people to get their flu shots sooner rather than later.      

Who should not get a flu shot?

Check with your doctor if you have had a serious reaction to a previous flu vaccine. Generally, it’s inadvisable for these individuals.  

Most types of flu vaccines contain a small amount of egg protein. A mild egg allergy is not cause for alarm, but if you have a severe egg allergy, you should be vaccinated in a setting with medical personnel who can respond to a severe allergic reaction. There are flu vaccines approved for use in people age 18 years and older that do not contain egg proteins. Consult your doctor about your options.

What are the flu vaccine delivery options?

This year the vaccine is recommended as an injection only. The CDC no longer recommends nasal spray flu vaccinations because in the last three flu seasons, the spray has been ineffective.

The injection is usually given in a muscle in the arm. The FDA has also approved an alternative for adults aged 18-64. The intradermal flu vaccine is injected into the skin, instead of the muscle, and requires 40% less antigen than the regular flu shot.

Can the vaccine give me the flu?

The vaccine’s killed (inactivated) viruses enable the body to develop the antibodies necessary to ward off influenza viruses, but cannot give you the flu. However, you may develop flu-like symptoms—muscle aches and a fever—for a day or two after receiving a flu shot. This may be a side effect of your body’s production of protective antibodies.

It takes about two weeks for the flu shot to take full effect. If you are exposed to the influenza virus shortly before or during that time period, you may catch the flu.

What other illnesses mimic the flu?

Flu symptoms include fever, chills, malaise, dry cough, loss of appetite, and body aches. Because this is the body’s natural response to fighting infection, other illnesses mimic flu symptoms. Some of the more well-known conditions include meningitis, tuberculosis, food poisoning, hepatitis, Hodgkin’s disease, and Lyme disease.

What kind of protection does the flu vaccine offer?

The flu vaccine is generally more effective among healthy children two years old and older and adults age 64 and younger. The elderly and people with particular medical conditions may develop less immunity after receiving a flu shot.

According to the CDC, when the match between the flu vaccine and circulating strains is more precise, a flu shot is 71% effective in reducing flu-related hospitalizations among adults. The flu shot may reduce a child’s risk by 74%.

What are other ways I can avoid the flu?

Most flu viruses are not spread directly by airborne particles, like coughs and sneezes, but by direct contact. Hand washing is the first line of defense. Wash your hands often and avoid touching your face, especially your nose and eyes. Carry hand sanitizer and use it throughout the day.

Bar soap can be a breeding ground for many viruses and bacteria. When possible, use liquid soap. Hand towels should be changed frequently for the same reason. Wipe down surfaces such as stair rails, telephones, countertops, desks, music stands, doorknobs, and grocery carts. Clean your mouthpiece each time you handle it and avoid touching any part that will make contact with your lips.

Germs survive in stagnant air so open the windows and air out your home or practice room. Avoid breathing in smoke. Smoke can increase your susceptibility to viruses. If you have no choice but to play in a smoke-filled room, step outdoors for fresh air during breaks.

Rest, exercise regularly, stay hydrated, eat a nutritious diet, and try to manage your stress.

How do I determine if I have a cold or the flu?

Cold symptoms include runny nose, sneezing, and coughing. Influenza symptoms are more acute, accompanied by fever, extreme fatigue, sore throat, headache, and muscle aches.

Prescription medications, such as Tamiflu, may reduce the length of the illness, but  must be taken within the first 48 hours of showing symptoms. You can sometimes get a prescription before showing symptoms, if a family member has been diagnosed with the flu.

Although there is no cure for the flu (or the common cold), you will recover more quickly by following some simple advice. First, stay at home and rest. Try to avoid spreading the illness to colleagues and other musicians with whom you are in close contact. Physicians recommend drinking plenty of fluids and avoid alcoholic beverages, which are dehydrating.

On average, the duration of the flu is about a week. Seek medical advice immediately if you experience high or prolonged fever; difficulty breathing or shortness of breath; pain or pressure in the chest; dizziness or fainting; confusion; or vomiting.

Where can I get vaccinated?

Flu vaccines are offered at doctor’s offices. If you do not have a regular doctor or health care practitioner, you may be able to get a flu vaccine at a pharmacy, urgent care clinic, or a university  or public health center. To find a flu vaccine location near you, go to the flu shot map (http://flushot.healthmap.org/).

Staying Healthy as a Musician

Athletes and the Arts: Staying Healthy as a Musician

by Randall W. Dick, M.S., FACSM 

Staying Healthy as a Musician

Lessons from the Sports World

Performing artists are athletes. Just like “sport” athletes they:

• Practice or perform almost every day

• Play through pain

• Compete in challenging environments

• Experience little “off season”

• Face extreme competition

• Face real risk of career-threatening injury

Yet, performing artists rarely have access to the injury prevention, nutrition, and practice and competition guidelines afforded most sports athletes, even at the youth level. Performing artists—musicians, dancers, singers, conductors, actors, and marching band members—of all ages and their instructors need this information, along with education and research associated with optimizing  performance and unique performance related problems.

Why the Concern?

Consider these factors:

In one year, 64% of world-class drum corps had members who developed stress fractures.

• 50% of all musicians have some form of noise-induced hearing loss (NIHL).

• 75% of orchestra instrumentalists will develop at least one musculoskeletal disorder from playing during their lifetimes.

Initiated in 2008 and formally launched in 2013, Athletes and the Arts (www.athletesandthearts.com) is a multi-organizational initiative that recognized that athletes exist throughout the performing arts community and that established performance, wellness, and injury prevention research for sport athletes is also applicable to performing artists. Health and wellness are generally foreign concepts in the performing arts community.

Athletes and the Arts (AATA) believes sports medicine physicians have the skill set to expand their practices to an entirely new and underserved population once they understand the needs and key risk factors of performing artists. Music instructors can address wellness, hearing, and cross-training, similarly to the way sports coaches introduce injury prevention initiatives.

Put Practice and Performance
in Perspective

At some point the number of practice hours may hurt rather than help. Consider focused practice segments with different goals in each session. Rote repetition for extended periods of time has not proven successful.

Large increases in the time spent practicing increases the risk of injury. If the volume or intensity of practice must increase, do it gradually.

Cross-train: employ a mental or physical activity that allows the body to focus on something different. Emphasize both mental and physical rest and recovery.

How to Put These Findings
into Practice

Select appropriate repertoire for yourself and your students. Select repertoire that challenges growth but does not overwhelm  physically or musically.

Learn and teach healthy practice strategies. Seek a problem-solving strategy
to avoid mindless practice. Break up
practice sessions to enhance concentration and avoid overuse.

Observe, record, and review the strength and posture needed during practice. Don’t underestimate the value of core strength when it comes to posture and being strong enough to hold their posture (or instrument) for long stretches.

Promote the joy of performance. Open yourself and your students up to a range of different performance opportunities in order to feel comfortable in any performance setting.

Avoid Overuse/Burnout

Consider repetitive motion, a major source of injury in the sport world.

• About 150 pitches per team are thrown in a professional baseball game.

• Around 8,000 steps are taken by each field player during a soccer match.

• Approximately 50,000 steps are taken in a marathon.

• About 3 million musical notes are played in a full-length Broadway performance.

Youth in today’s culture are driven to train early and extensively. Early specialization and extensive training creates documented risks of overuse injury, burnout, stress, and less enjoyment in youth sports.

The performing artist faces many of these same challenges, but specific research for this population is scarce. Minimize the risk of physical and mental overuse by monitoring how often and intensely you perform.

Noise-Induced Hearing Loss

Be aware of exposure to both the intensity of the sound (measured in decibels or dB) and its duration. Government standards for occupations with high noise exposure have
a foundation exposure value of no more than 85 dB for an eight-hour period. For every three dB increase, time exposure should
be halved:

88 dB for four hours per day

91 dB for two hours per day

94 dB for one hour per day

The dynamic range of music, live or recorded, can peak at or above 95 dB. Normal piano practice ranges from 60 dB to 90 dB, more intense, 70 dB to 105 dB. Hearing damage can occur when exposed to 94 dB for 60 minutes or less daily. Protect your hearing by limiting your exposure to loud noise when not performing, using musicians’ ear plugs on stage, and getting an annual hearing test with an audiologist.

Find a Health Professional
and Wellness Coach

Establish a relationship with a health professional before an injury occurs. Let your physician know you are a performing artist, demonstrate your craft, and explain how often/intensely you perform. Keep a performance diary to document a “typical” week of practice, performance, and other related activity. Insist on regular hearing checks. Your healthcare provider needs to understand how you play your instrument in order to counsel on injury prevention.


The Athletes and the Arts (AATA) website, www.athletesandthearts.com, is a resource  for artist health information through its own content and links to the 13 collaborating organization websites. There are one-pagers on subjects ranging from hearing loss to performance anxiety to nutrition. Use the website to educate yourself, your colleagues, and your students to enhance their long-term wellness and performance.


Performing artists are an underserved population related to medical coverage, care, injury prevention and wellness. Your short-term and long-term health will benefit from a knowledgeable medical team that understands what you do (including the volume and intensity of your activities). Your body is an extension of your instrument. Be as proactive about protecting your health as you are your instrument.

—Randall Dick, M.S., FACSM, is a member of the American College of Sports Medicine. He worked for 20 years with the National Collegiate Athletic Association, managing its sports medicine and injury prevention programs. He has authored more than 50 peer-reviewed publications and serves on the US Lacrosse Sports Science Committee and as a consultant for Major League Baseball injury surveillance. He began developing the Athletes and the Arts initiative after a conversation with the New Orleans-based Preservation Hall Jazz Band.

exercise as medicine

Exercise as Medicine for Your Music

by: Patrick Gannon, PhD

We all know that exercise is good for you. But you may not know all that exercise is good for.

Besides promoting general fitness, musicians need exercise to strengthen their legs, core, and upper body to meet the physical demands of daily practice and performance. This is particularly important because musicians are vulnerable to performance-related injuries. Exercise promotes muscle balance that offsets the physical asymmetries that commonly occur among instrumentalists. And it offers the added benefit of reducing stress.

Now, a broader recognition of how exercise impacts the mind and body is emerging. The American College of Sports Medicine, in concert with the American Medical Association, promote the idea that “exercise is medicine” to reduce risk factors for aging, diabetes, dementia, mood disorders, and sleep. Think of it as a longevity pill that is free, readily available, and has no side effects. 

Beyond being a medicine, exercise can also be a tool. The trick is to prescribe exercise purposefully to activate certain brain functions. For example, by varying the type of exercise (cardio/aerobic or weight training), as well as the intensity level (high/moderate), frequency, and timing of exercise (before practicing or performing), you can prime the brain to help with anxiety, learning, memory, mood—even creativity.

Anxiety Management

Cardio exercise may be the best natural treatment for performance anxiety, including state (situational) and trait (dispositional) anxiety. Exercise reduces anxiety by discharging muscle tension, increasing cardiovascular capacity, and disrupting negative thoughts. Physiologically, cardio stimulates the production of calming neurotransmitters such as serotonin, dopamine, and gamma-Aminobutyric acid (GABA), which dampen anxiety.

Two ways to use exercise to reduce anxiety:

1) Thirty minutes of vigorous cardio exercise will immediately reduce anxiety. Although musicians are often discouraged from exercising before performing, it can be helpful. However, the exercise must be completed at least three hours before stepping on stage, allowing sufficient time for rest.

2) For trait anxiety, ongoing exercise several times per week, for 30-45 minutes, will lower the resting heart rate.


Who would have thought that exercise could also be a learning tool? Several studies have shown that exercise improves working memory, attention, and processing speed. Exercise stimulates neurogenesis—the creation of new neurons in the hippocampus that builds capacity for learning. It also stimulates long-term potentiation (LTP) by binding neural cells together that encode learning.

Two ways to apply exercise to learning:

1) High intensity exercise (at 60% to 80% of maximum heart rate) redirects blood flow away from the prefrontal cortex (PFC), thereby inhibiting learning (recall how hard it is to think straight when pushing your physical limit). But blood flow to the PFC is gradually restored, which then optimizes brain functions for several hours afterwards. This is why exercising before practicing makes sense.

2) Combine moderate exercise (at a 120-130 bpm heart rate) with mental rehearsal of the material that you want to learn. Because exercise stimulates the brain-derived neurotrophic factor (BDNF), new neural circuits are created that encode learning. This is essentially self-directed neuroplasticity in action.

Try these exercises to promote learning and memory:

• Do 30 minutes of moderate cardio exercise while listening to the music that you want to learn or 30 minutes of high intensity exercise an hour before practicing that music.

• Divide the music up into sections and create associations to each section with your own memories, feelings, and images. These narrative links will serve as cues for memory retrieval.

• Follow up with moderate exercise while mentally rehearsing the music with the narrative imagery included. Repeat this process on alternating days until fully memorized.


Studies show that creativity is stimulated by the interplay between the hippocampus, amygdala, and PFC. Creativity happens by holding diverse concepts in mind through working memory, using cognitive flexibility (and tolerance for uncertainty) to play with these concepts, and then focusing attention on the generation of new ideas.

Because exercise lowers the activation of the dorsolateral part of the PFC, old ideas are held back somewhat, allowing new ideas to emerge. But you must keep your mind open—and be patient with the process—until a new idea streams into consciousness.

Here’s how to exercise to stimulate creativity:

• Do 20-30 minutes of moderate cardio exercise on an elliptical trainer or stationary bike while mentally rehearsing the music you plan to practice that day. Allow new ideas to pop into awareness and then track the ideas as they unfold.

• The same technique can be applied to problem solving, procrastination, and planning. By holding the question or issue in mind while exercising, new ideas will emerge. Remember, listening to your intuition and “going with the flow” are what generates creativity.

Patrick Gannon, PhD is a clinical and performance psychologist working in San Francisco and nationally via Skype. He is a member of the Performing Arts Medicine Association and a national presenter on performance psychology. He welcomes comments and inquiries on this article. Visit his website (PeakPerformance101.com) or email him (drpatrickgannon@gmail.com).

Don’t Call It Stage Fright! New Ideas About Treating Music Performance Anxiety

by Patrick Gannon, PhD

Stage fright, or more accurately, music performance anxiety (MPA), is one of the most commonly cited problems for professional musicians.

Surveys show that upwards of half of all musicians, regardless of instrument, genre, and expertise, suffer some degree of MPA. It may be comforting to know that famous sufferers include Frederic Chopin, Maria Callas, Vladimir Horowitz, Arthur Rubenstein, Sergei Rachmaninoff, Carly Simon, Barbra Streisand, George Harrison, Janis Joplin, and even Jimi Hendrix.

How did these expert musicians treat their MPA? Not very well. In fact, standard treatments for performance anxiety—cognitive behavioral therapy (CBT) and relaxation techniques that were borrowed from sport psychology over the last 50 years—have had mixed results when applied to musicians.

For this reason, many performers, such as New York Philharmonic Orchestra violist, Kenneth Mirkin of Local 802 (New York City), have relied on beta-blocker medications such as Inderal. Mirkin, who wrote an essay in Psychology Today about his lifelong struggles with MPA, says he experimented with all types of therapies, but only beta-blockers gave him the symptom relief he needed. While this medication is generally effective at reducing physiological activation of the heart, it does not eliminate the other categories of MPA symptoms—emotional, cognitive, psychological, and behavioral—that can also impair performance.

Recent findings in neuroscience and clinical psychology have given us a better understanding of what causes MPA and how we might improve treatment effectiveness. Neuroscientist Joseph LeDoux’s work at NYU shows that the body’s threat detection system unleashes a barrage of symptoms that go far beyond the simple activation of the sympathetic nervous system. MPA can trigger upwards of 50 symptoms of varying intensity and duration.

The somatic nervous system, the neuroendocrine system, the limbic system and amygdala, as well as the vagus nerve are hardwired to activate a “defensive response” that impacts many aspects of mental functioning essential for playing music. For this reason, treatment needs to target the physiological symptoms first because it appears they drive symptom formation across the other categories. The primacy of the physiological response to threat is why beta-blockers work—and why standard techniques are less effective.

Psychologist Dianna Kenny, who has done extensive research with Australian orchestral musicians, has reconceptualized MPA as a more multifaceted condition. MPA can occur days or weeks prior to performance, aggregate over the long term, and carry forward in an escalating cycle before the musician ever steps on stage. Kenny has identified three sub-types, each emanating from a different biological and/or psychological source that require different treatment plans.

Exposure-based treatments, coupled with “brain-based” techniques, including the time-limited use of beta-blockers, offer the quickest path to symptom reduction. Musicians must learn how to self-regulate their anxiety down to manageable levels, on demand. Mastering this skill, while being exposed to increasingly challenging performance situations, will degrade symptom intensities. While not as simple as taking a pill, this comprehensive treatment strategy offers significant, long-term relief from anxiety—without reliance on beta-blockers.

One overlooked source of MPA is early performance anxiety. Negative performance experiences are often encoded in the brain as trauma. One new “brain-based” treatment is Eye Movement Desensitization & Reprocessing (EMDR). EMDR accesses the implicit memory system in the hippocampus that stores emotional learning, desensitizes traumatic reactions to old performance, and then “installs” new mental scripts that model optimal performance.

The most eagerly awaited treatment for MPA is virtual reality (VR). VR involves using a headset that provides realistic 360-degree visual immersion into a given performance situation. Combining simple CBT and relaxation techniques, while experiencing a virtual performance (without the stress of an audience), desensitizes the psycho-physiological activation that produces the MPA symptoms.

The take-away message is that MPA is treatable—with or without beta-blockers—but you have to have the right plan. Musicians with severe and persistent MPA need to be aggressive in their treatment strategies. One cautionary finding is that, if MPA symptoms are not sufficiently managed, it is difficult to deploy peak performance techniques that can take your performance to the next level. And if MPA is allowed to persist, it may get worse. Like any multisystem mind-body condition, it needs to be adequately treated in order to offer any realistic expectation of sustained relief.

—Patrick Gannon, PhD is a clinical and performance psychologist in San Francisco and a former musician and tennis coach. He is an active member of the Performing Arts Medicine Association (www.artsmed.org). His website is PeakPerformance101.com and his email is drpatrickgannon@ gmail.com. He welcomes questions and comments about this article.

Making Music Improves Behavior in Children

A study led by Canadian psychologist E. Glenn Schellenberg of the University of Toronto-Mississauga confirmed that making music improves behavior in children. The study included 84 third and fourth graders from a wide range of socioeconomic backgrounds who were enrolled in public school. Half of the participants took a weekly 40-minute group ukulele class that included singing, playing, improvisation, ear training, and sight reading. During the class children were encouraged to interact.

At the beginning and end of the school year the students took a series of tests to measure vocabulary, pro-social skills, ability to read emotions, and sympathy with others. Students who initially scored low on sympathy and helpfulness developed those qualities at above-average rates after taking group music lessons for a full school year. The changes in the students who took a group ukulele class occurred whether or not they attended the class voluntarily. The researchers say that the results, which were reported in the online journal PLOS One, showed that music  “fosters social cohesion, cooperation, and a pro-social orientation.”

Work Those Fingers

All athletes have a common goal to develop and maintain strength, control, endurance, coordination, and dexterity to ensure their competitive edge. Musicians are no different. Professional sports trainers, athletes, and therapists use Gripmaster because of its unique ability to provide an effective isolated resistance workout. Gripmaster conditions the fingers, hand, wrist, and forearm with a unit you can carry in your pocket.

Your hands are the direct link between your brain and your instrument. But your hand is really five separate systems–the fingers—which work in seamless unity. The only way to develop superior hand strength, endurance, and coordination is to challenge and develop each finger. Work those fingers. The patented Gripmaster hand exerciser can isolate and strengthen each finger individually.

The pocket-sized, durable device isolates each finger, supplying it with its own spring loaded button. Small size means you can practice anytime, anywhere. Gripmaster is available in three different tensions: blue (light, five pounds per finger), red (medium, seven pounds per finger), and black (heavy, nine pounds per finger).

-visit www.gripmaster.net for dealer information and exercise program suggestions.

9 Tips for Healthy Outdoor Summer Gigs

After a long winter of indoor gigs and stuffy practice rooms, you’d jump on any chance to finally play outdoors. But, before you head outside to enjoy these fun opportunities, take a little time to consider how to stay healthy in the heat and sun. Here are nine things to consider:

1) Venue review. Be sure to check out your stage ahead of time. Considering the time of day of your performance, will you be playing in direct sunlight, partial shade, or completely protected? Check what type of power supply is available at the venue and what precautions have been taken to protect the gear (and yourself from shock) in the event of sudden storms. Also, will there be electrical fans provided, or could you bring your own?

2) Gear check. To reduce the possibility of electrical shock when playing in an outdoor environment, always check your equipment beforehand. Replace any cables, particularly mains, that have nicks or look tattered.

3) Great covers. Ideal clothes for an outdoor gig are sun protective, light in weight and color, loose-fitting, comfortable, and can wick away the sweat. If your fabric offers little sun protection, consider using an additive like Sun Guard, which increases the ultraviolet protection factor (UPF) of any clothing for several (up to 30) washes. Wear layers if the temperature is likely to change. If you will be in direct sunlight, wear a hat—preferable one that will shade your head and the back of your neck.

4) Lather up. Apply sunscreen before you arrive to all skin not covered by UV protective clothing. The US Food and Drug Administration recommends Broad Spectrum sunscreens with SPF values of 15 or higher. It should be applied 20 minutes before you head outside and reapplied at least every two hours, more often if you’re sweating. Use a “sports” sunscreen that is waterproof so it doesn’t run off your skin and into your eyes. Don’t be fooled into believing that your facial makeup’s SPF protection is enough to protect your face. You would need seven times the normal amount of foundation to get the SPF factor on the label.

5) The right shades. Don’t forget your sunglasses. Time spent in the sun without eye protection can lead to eyestrain, as well as long-term eye diseases such as cataracts. Be sure to read the labels when purchasing sunglasses. They should state that they block at least 99% UVA and UVB radiation, or look for the phrases “UV 400 protection” (block light rays with wavelengths up to 400 nanometers) or “meets ANSI Z80.3 blocking requirements” (standards set by the American National Standards Institute). Polarized lenses cut down on glare, but can actually make it more difficult to read iPads or other screened devices. Wraparound glasses offer the best protection, but at least look for a pair with lenses large enough to go down to your cheek bone and wide temples to protect side exposure.

6) Hydration, hydration, hydration. The human body is 66% water, while the muscles are up to 75% water and lungs are 90% water. If you are sweating on stage, you are probably losing between 0.8 to 1.4 liters (roughly 27.4 to 47.3 oz.) per hour. So pack a small cooler of water bottles and keep one within reach at all times. Avoid alcohol, sugary, or caffeinated drinks. For prolonged or heavy sweating, you should also keep a sports drink handy to also replace electrolytes.

7) Plan ahead. If possible, plan your performance so that you limit your time in the sun, especially between the hours of 10 a.m. and 2 p.m., when the sun’s rays are most intense. If you want to wander around the festival or watch other performers, try to stay in the shade before your set. Also, don’t overdo it. Make sure you have adequate breaks in your set, and scope out a cool, shaded place to take them.

8) Healthy eats. Eat a healthy meal at least one hour before your performance is to start. Include plenty of fresh fruit and vegetables, and avoid the salty, high-fat junk food found at most concerts and festivals.

9) Listen to your body. If you feel thirsty, you are not drinking enough water. A headache is also a warning sign that you are becoming dehydrated. Light-headedness, confusion, nausea, cramps, rapid heart rate, and profuse sweating are symptoms of severe dehydration. Get out of the sun and seek medical care immediately, if they do not go away.