The Oh-So-Not-So-Prime Players

By Anastasia Toufexis

In theaters across the country each night, audiences are captivated by scintillating music, soaring voices and dazzling footwork. When the show ends, spectators mark their appreciation with thunderous ovations and tossed bouquets. As often as not, the actors, singers and dancers taking their bows ( onstage are in turn quietly applauding those who keep them fit to earn accolades: the practitioners of a fast-growing field called performing-arts medicine. Within the past decade some dozen programs and clinics have sprung up in the U.S. devoted to diagnosing, treating and preventing the physical and emotional ills that can hamper artistic careers. Staffed by medical specialists, dentists, nurses, psychologists, physical therapists and social workers -- many of whom are amateur performers themselves -- the centers offer artists the same sort of sophisticated care routinely provided for star athletes.

Onstage physical stresses can be as fierce as any endured on the football field or basketball court. Actor Mark Frawley, late of Broadway's Starlight Express, had to barrel-jump over five people in the show's opening number. "You're wearing two 4-lb. skates and a costume weighing 25 lbs.," he notes. "In order to clear the people, I had to get my speed up to 35 m.p.h. It was a knee killer." Musicians face peril as well. Pinched nerves and muscle cramps caused by repetitive hand motions are common. Violinists suffer everything from fiddler's neck rash to complete jaw displacements. Trumpeters get neck hernias and muscle tears around their mouths. Bagpipers are prone to lung infections from fungus that grows inside the bag. Clarinetists develop thumb problems, because the 28-oz. horn is supported only by a hook on the finger. "It's a vicious instrument," declares one physician.

Most vulnerable of all are ballet dancers. "They are like Thoroughbred racehorses," says Dr. William Hamilton, who is affiliated with New York's Miller Institute, one of the most comprehensive of the new clinics. Falls and poor landings from jumps can cause sudden injuries, including sprained backs and snapped foot bones. "The fifth metatarsal breaks like a chicken bone," says Hamilton, orthopedic surgeon for the New York City Ballet and American Ballet Theater. "You can hear it in the audience when it happens." Overuse and chronic trauma produce inflammations of tendons and stress fractures of foot and leg bones. Many of the syndromes that plague dancers and musicians are so subtle that they go unrecognized. Observes Dr. Alan Lockwood, who started the University of Texas clinic in Houston: "Many physicians who don't see performing artists regularly just don't understand the demands placed on their bodies."

Even the specialists have difficulty. "Frequently you can't tell that anything is wrong until you see them play," explains Dr. Alice Brandfonbrener, director of Northwestern University's program. Some clinics boast practice rooms and videotaping equipment. Solutions can be as simple as recommending a reduced performance schedule, muscle-strengthening exercises or changes in diet. Actors and singers with voice difficulties are often told to avoid mucus-producing foods like milk and cheese. Technique may also be modified. Eric Jensen, a jazz guitarist in San Francisco with persistent pain in his left arm, was advised to shorten the scale lengths on the neck of the instrument and use lighter strings.

Doctors also rely on medication, though cortisone, a mainstay of less experienced physicians, is frowned upon by specialists because it relieves symptoms without correcting the basic problem. Surgery is generally a last resort because it may leave scar tissue that can interfere with agility. Rock Drummer Max Weinberg, who underwent seven operations on his fingers to keep his hands from clenching, had no such damage. Currently on tour with Bruce Springsteen and the E Street Band, he downs six aspirins a day and does hand warm-up exercises for 45 minutes before a show. Afterward he chills his hands in ice for ten minutes and wears elastic gloves to reduce swelling.

Often the best remedy, but the one artists dread most, is to stop performing for a while. "Rest is a four-letter word for the ballet dancer," declares Hamilton. "For the musician," says Dr. Michael Charness, a member of the University of California clinic in San Francisco, "playing is more than their job. It's an emotional outlet." Are artists more vulnerable to psychological problems than most? "Performing is a very exhilarating and draining experience," says Dr. Richard Lederman, who heads a program at the Cleveland Clinic. Others observe that because training usually demands immersion at an early age, many performers may be emotionally and intellectually ill equipped to cope with intense competition and career setbacks.

The centers treat a wide array of psychological ailments, from eating disorders and drug abuse to depression and, most often, stage fright. Those who take care of the performers admit to having some jitters of their own as well. Last fall Dr. Michael Saviano was roused from his sickbed by the San Francisco Opera to tend a singer whose voice was giving out. His verdict: finish the performance but sing at half power. His backstage visit concluded, a feverish and bleary Saviano headed for the hospital to await his patient -- and a reassuring once-over of those valuable vocal cords.

With reporting by Janice M. Horowitz/New York and Dennis Wyss/San Francisco