Illness and Injury in the Drum Corps Activity:
A query to provide a challenge and a focus for the concerned assembly
Dr. R. Craig Bales
Contents.
1. Introduction
2. Are there common illnesses or injuries associated with the drum corps activity?
3. Does the need for research exist?
4. Locating interested parties
5. Drum corps medicine for the future
6. Conclusion
1. Introduction.
Due to time constraints this presenter has acknowledged certain literature written on the
subject of Performing Arts Medicine, but has not actually reviewed them. That process is for
future investigation. It is quite interesting and exciting to me, however, that there are symposia,
books, and journals concerning the subject. Heretofore unknown to me there is even a medical
specialty in Performing Arts Medicine:
Kella JJ. Symposium on musicians' medical problems: performing arts medical specialty
continues to grow. International Musician 1987 Oct;86:7, 19.
Lederman RJ. The coming of age of performing arts medicine. [Editorial] Western
Journal of Medicine 1994 Jan;160(1):73-4.
Arts medicine directions. International Journal of Arts Medicine 1992 Spring;1(2):30.
Pascarelli EF; Bishop CJ. Performing arts medicine: the status of the specialty within the
evolving health care system. Medical Problems of Performing Artists 1994 Sep;(3):63-6.
Textbook of performing arts medicine. Arts Hazards News 1990;13(10):2.
Knox R. Music medicine in the 1990s. Music Magazine 1990 Apr-May;13(2):13-16.
At this point I must credit one of our very own RAMD contributors, Susan E. Harman,
M.S.L.S., M.Ed., from the Music Medicine Clearinghouse, Medical Chirurgical Faculty of
Maryland. She presented a paper, Medical Problems of Marching Musicians, at the Tenth
Annual Symposium on Medical Problems of Musicians and Dancers, Aspen, Colorado in July
1992. Susan provided me with several great sources for the bibliographical citations here
presented.
Other presentations by Ms. Harman include:
Harman SE. Occupational diseases of instrumental musicians, a review. Maryland State
Medical Journal 1982 Jun;31(6):39-42.
Harman SE. Bibliography for occupational diseases of instrumental musicians--update.
Medical Problems of Performing Artists 1988 Dec;3(4):163-5.
Harman SE. Medical problems of marching musicians. Medical Problems of Performing
Artists 1993 Dec;8(4):132-5.
Thanks, Susan for all your help! You helped me get started but we shall finish together.
As you read this presentation, it will be apparent that I have few preconceived opinions
on this topic. The presentation intends, therefore, to challenge inquiring minds and focus their
attention on numerous questions regarding illnesses and injuries that performing artists,
specifically drum corps (DC), might or does experience. Only having been involved in the
activity for five or six years I have little knowledge of what DCI or individual corps have done to
address these problems. Keep in mind this topics' questions concern ALL corps members both
marching members (younger) and staff (older). Many of the topics mentioned may be more of
academic interest than of practical interest.
There is very little written in the literature on the subject of marching bands and only one
that I could find on drum corps (DC):
Bischof R.O., Drum and bugle corps: medical problems and issues. Medical Problems of
Performing Artists 1994.
Thus, as I begin this presentation, there is scanty support for my suspicion that certain
medical problems have and do exist in the Activity. If there are medical problems, they appear
to be addressed by individual corps members or their staff.
This questioner does feel that corps staff and marching members who are healthy will
gain the most benefit from their adventures in the activity. As a youth oriented activity, I hope
we all desire the best of health for all concerned.
Thus the main thrust of this presentation is to inquire from current and past corps staff
and members, as to their recognition and solution of their respective medical problems perceived
or real relative to DC. Others are also encouraged to participate fully:
Goode DJ; Knight SP. Identification, retrieval, and analysis of arts medicine literature.
Medical Problems of Performing Artists 1991 Mar;6(1):3-7.
2. Are there common illnesses or injuries associated with the drum corps activity?
A. What are the common illnesses and injuries experienced by DC?
B. What illnesses or injuries demand professional attention?
C. What illnesses or injuries which occur during a competitive season currently prohibit
a member from continued participation? Should they prohibit continued participation?
D. What preventive measures and/or rehabilitation should and/or could be provided to
the member to allow continued participation?
E. A list of illnesses and injuries to consider.
First, are there any medical issues that are or should be a concern of the activity? I am
positive each of us can cite a long list to answer that question. THAT IS PRECISELY THE
POINT OF THIS PRESENTATION!
There does appear to be some concern in the literature for this issue in general.
Following is the << short >> list of a review of the Occupational Diseases Of Performing Artists
Bibliography found at http://sailor.lib.md.us/topics/.musicians. Some citations may or may not
be relevant to DC, but I now have data that supports the premise that MEDICAL PROBLEMS
DO EXIST in DC:
Lockwood AH. Medical problems in secondary school-aged musicians. Medical
Problems of Performing Artists 1988 Dec;3(4):129-32.
Stanley N. Medical considerations for marching bands. Instrumentalist 1985 Aug;40(1):
76-9.
Steele G. Physical stresses from percussion equipment loading. Percussive Notes 1993
Feb;31(3):14-16.
Sternbach DJ. Staying healthy on the road. International Musician 1992 Apr 90(10):10.
Sternbach DJ. Taking care of yourself on tour. International Musician 1994
Jun;92(12):13.
Newmark J; Lederman RJ. Practice doesn't necessarily make perfect: incidence of
overuse syndromes in amateur instrumentalists. Medical Problems of Performing Artists
1987 Dec;2(4):142-4.
Newmark J; Hochberg FH. "Doctor, it hurts when I play": painful disorders among
instrumental musicians. Medical Problems of Performing Artists 1987 Sep;2(3):93-7.
Newmark J; Salmon P. Playing-related complaints in nonclassical instrumentalists: a
pilot questionnaire survey. Medical Problems of Performing Artists 1990 Sep;5(3):106-8.
Pollack R. Occupational diseases of musicians: physical ailments. Hygeia
1935;13(2):132-5.
Luongo EP. "Hornblower's" disease. [letter] Archives of Environmental Health 1966
Mar;12(3):410.
Medical care of musicians. Emergency Medicine 1989 Jun 15;21(11):125, 128-30.
Musicians, just like ball players can suffer professional injuries. Daily Mail
(Hagerstown, Md.) 1982 Jun 10.
Roach KE; Martinez MA; Anderson N. Musculoskeletal pain in student instrumentalists:
a comparison with the general student population. Medical Problems of Performing
Artists 1994 Dec;9(4):125-30.
Rosen NB. Myofascial pain: the great mimicker and potentiator of other diseases in the
performing artist. Maryland Medical Journal 1993 Mar;42(3):261-66.
Smith DWE. Medical problems of orchestral musicians according to age and stage of
career. Medical Problems of Performing Artists 1992 Dec;7(4):132-4.
Wallace H. Performance-related injuries--a dark continent? Strad 1991 May:396-404.
Hall T. A musician's view of music medicine. Medical Problems of Performing Artists
1986 Mar;1(1):2.
Kella JJ. A musician's guide to performing arts medicine: musculoskeletal, neurological
and dermal ailments of musicians. International Musician 1988 Jul;87(1):7, 18-19.
Kagen SH. Diseases of the musical profession. Maine Medical Journal 1934
Sep;25(9):181-7.
Stanley N. Medical considerations for marching bands. Instrumentalist 1985 Aug;40(1):
76-9.
Second, as a medical professional, sometimes it is very difficult to decide which illnesses
or injuries require professional assessment. Well, to be honest they all require professional
assessment; professional being used in its broadest sense. They require the professional
expertise of the corps instructor, the corps "mom", the corps nurse or trainer, the individual
corps member, as well as a multitude of medical specialties.
How do those involved in the Activity decide which professional to use? THAT IS A
QUESTION FOR THIS AUDIENCE TO HELP ANSWER.
Mastroianni T; Norris R. Performers, teachers & medical practitioners: working together
to promote wellness. American Music Teacher 1993 Apr-May;42(5):26-9.
Medical concerns for music educators. [insert] Teaching Music 1993;Dec;1(3).
Pratt RR. Music education and medicine: a renewed partnership. Mutional Journal of
Arts Medicine 1992 Spring;1(2):7-20.
Green R. Treating performers takes talent. Medical World News 1988 Dec
12;29(23):42-3.
Hinz, CA. Musicians' health needs call for a medical team approach. American Medical
News 1984 Aug 17;27(31):26-8.
Ver Berkmoes R. How some MDs help the band play on. American Medical News 1989
Mar 24-31;32(12):31-2.
Third, which medical problems occurring subsequent to DC involvement should prohibit
an individual from participation? Surely there are some ailments that fall in this category. YET
ANOTHER QUESTION FOR THE SYMPOSIUM HERE GATHERED.
Saxton SE. Rap session on disabled/handicapped hornists and how they cope. Horn Call
1987 Oct;18:31-7.
What medical entities occurring during the rehearsal and competitive season should
prohibit an individual from continued participation? There must be some in this category, but
which ones must be included? Experience in sports medicine tells me that there is little
difference in the psyche of the coach versus the corps staff and the "athlete" versus the marching
member. They are all very competitive, dedicated, and driven to continue at all cost. How do
we temper their drive to continue with GOOD, REASONED judgment?
Roehmann FL. Making the connection: music and medicine. Music Educators Journal
1991 Jan;77(5):21-5.
Howse J. The importance of good teaching in injury prevention. Medical Problems of
Performing Artists 1994 Jun;9(2):32-34.
Fourth, what preventive or rehabilitative methods can and should be employed to allow
an ailing individual to continue participation in the activity? Well, the sky is the limit. Varying
modalities can provide prevention, cure or safe palliative treatment. Some are even cost
efficient:
Saxon J. Cost constraints on health care access to some performing artists. Medical
Problems of Performing Artists 1989 Sep;4(3):105-7.
Solomon R; Micheli L; Solomon J; Kelley T. The "cost" of injuries in a company
professional ballet company: anatomy of a season. Medical Problems of Performing
Artists 1995 Mar;10(1):3-10.
Howse J. The importance of good teaching in injury prevention. Medical Problems of
Performing Artists 1994 Jun;9(2):32-34.
Norris R. The Musician's Survival Manual: A Guide to Preventing and Treating Injuries
in Instrumentalists. ed. D. Torch. San Antonio, Tx.: International Conference of
Symphony and Opera Musicians; distributor St. Louis, MMB Music, 1993.
Poole W. Curing musicians' ills: a new health program to meet the special needs of
performing artists. Image 1986 Aug 17:9-10.
Press JM; Wiesner SL. Prevention: conditioning and orthotics. Hand Clinics 1990
Aug;6(3):383-92.
Prokop LL. Upper-extremity rehabilitation: conditioning and orthotics for the athlete and
performing artist. Hand Clinics 1990 Aug;6(3):517-24.
Kella JJ. Prevention is the best medicine for musicians' occupational problems.
International Musician 1992 Sep;91(3):8- 9.
Prudden B. Myotherapy: Bonnie Prudden's Complete Guide to Pain-Free Living. New
York: Ballantine, 1984. Injury prevention in percussion. Percussive Notes 1994
Apr;32(2):73-5.
Finally, a list of possible illnesses and injuries to consider. Citations follow each general
category:
ILLNESSES
Upper Respiratory
Allergies
Infections (viral vs. bacterial)
Sinusitis vs. rhinitis
Tonsillitis
Pharyngitis
Bronchitis
Fever blisters
Walter WG; Chaffey D. Bacteriological and cleaning studies on the
mouthpieces of musical instruments. Applied Microbiology 1959
Mar;7(2):126-30.
Bryan AH. Band instruments harbor germs. Music Educators Journal 1960
Apr-May;46(5):84-5.
Gastrointestinal Dental hygiene (brushing, flossing, braces, cavities) Train
J. Dentistry and the wind musician. International Musician 1992
Jun;90(12):12.
Hills EM. Medicine and dentistry for brass players; a selected survey of
recent research in the journal literature. ITA Journal 1987 Fall;15(4):32-7.
Porter MM. Dental problems in wind instrument playing. 1. Dental
aspects of embouchure. British Dental Journal 1967 Oct 17;123:393-96.
Porter MM. Dental problems in wind instrument playing. 8. Brass
instruments. British Dental Journal 1968 Feb 6;124:129- 32.
Taddey JJ. Musicians and temporomandibular disorders: prevalence and
occupational etiologic considerations. Journal of Craniomandibular
Practice 1992 Jul;10(3):241-4.
Dyspepsia (heart burn)
Ulcers
Food Intolerances vs. Food Allergies (special diets)
Hepatitis
Appendicitis
Diarrhea (common vs. infectious)
Constipation
Hemorrhoids
Climate Related
Heat
Babin A. Heat stress. [data sheet] New York: Center for Safety in the Arts,
1989.
Cold
Sexually Transmitted Diseases
Hepatitis
HIV
Syphilis
Gonorrhea
Crabs and Scabies
Schnitt D. AIDS deaths among professional dancers. Medical Problems of
Performing Artists 1990 Dec;5(4):128-30.
Cardiovascular vs. Hematologic
Dizziness
Congenital Heart Defects
Benign Heart Murmurs
Sickle Cell Disease
"Adolescent" Anemia
Varicose Veins
Hypertension
Lewis LW. How to avoid that dizzy feeling. School Musician 1946
Feb;17(5):12-13, 34.
Tucker A.; Faulkner ME.; Horvath S.M. Electrocardiography and lung
function in brass instrument players. Archives of Environmental Health
1971 Nov;23(5):327-34.
Hunsaker LA. Heart rate and rhythm responses during trumpet playing.
Medical Problems of Performing Artists 1994 Sep;9(3):69-72.
Calif. Univ. medicos claim horn playing makes coronaries. Music Trades
1972 Mar;120:20-1.
Endocrinopathy
Diabetes
Hypoglycemia
Thyroid
Central Nervous System
Seizure Disorders
Head Aches
Encephalitis
Meningitis
Dermatological
Tick Born Illness
Scabies vs. Crabs
Fungal
Bacterial
Warts
Herpes Simplex
Lamb J. Herpes simplex. Journal of the Oklahoma State Medical
Association 1946 Apr;39:150-2.
Mills OH; Kligman A; Acne mechanica. Archives of Dermatology 1975
Apr;111(4):481-3.
Nethercott JR; Holness DL. Dermatologic problems of musicians. [letter]
Journal of the American Academy of Dermatology 1990
Apr;22(4):657-63.
Signore RJ. Dermatologic problems of musicians. [letter] Journal of the
American Academy of Dermatology 1991 Feb;24(2 pt. 1):321.
Harvell J; Maibach HI. Skin disease among musicians. Medical Problems
of Performing Artists 1992 Dec;7(4):114-20.
Gynecological
Menses
Painful
Irregular
Heavy Flow
Birth Control Pills -- used for their hormonal regulation of menses
Pregnancy
Psychological
Social Adjustment Disorders
Performance Anxiety
Burn Out
Lehrer PM; Goldman NS; Strommen EF. A principal components
assessment of performance anxiety among musicians. Medical Problems
of Performing Artists 1990 Mar;5(1):12-18.
Sternbach D. A self-test on performance anxiety. International Musician
1988 June;87:?.
Salmon PG. A psychological perspective on musical performance anxiety:
a review of the literature. Medical Problems of Performing Artists 1990
Mar;5(1):2-11.
Sternbach D. Addressing stress-related illness in professional musicians.
Maryland Medical Journal 1993 Mar;42(3):283- 8.
Montello L; Coons EE; Kantor J. The use of group music therapy as a
treatment for musical performance stress. Medical Problems of
Performing Artists 1990 Mar;5(1):49-57.
Miller DK; Kupersmith JRF. "Louisville-PACH": psychiatric problems of
performing artists. Medical Problems of Performing Artists 1990
Mar;5(1):19-22.
Pollack R. Occupational diseases of musicians: psychic ailments. Hygeia
1935;13(1):46-9.
Mittleman KD; Keegan M; Collins CL. Physiological, nutritional, and
training profile of university modern dancers. Medical Problems of
Performing Artists 1992 Sep;7(3):92-96.
Stern A; Cox J. Teacher burnout: the dull reality. Music Educators Journal
1993 Nov;80(3):33-36, 49.
Hamann DL. Burnout: how to spot it, how to avoid it. Music Educators
Journal 1990 Oct:30-3.
Over-the-counter, prescription and 'street/recreational' drug concerns
INJURIES
Hearing Impairment
Marching band hearing loss. Instrumentalist 1982 Dec;37:8.
May;20(4):271-4.
Barry JP; Thomas IB. A clinical study to evaluate rock music, symphonic
music and noise as sources of acoustic trauma. Journal of the Audio
Engineering Society 1972.
Santucci M. Musicians can protect their hearing. Medical Problems of
Performing Artists 1990 Dec;5(4):136-8.
Cohen P. Drumming: how risky is it to your hearing? Modern Drummer
1990 Oct:24-9,95-101.
Spinal or back injuries
Hip, knee, ankle, and foot injuries
McNeal AP; Watkins A; Clarkson PM; Tremblay I. Lower extremity
alignment and injury in young, preprofessional, college and professional
ballet dancers: dancer-reported injuries (second of two parts). Medical
Problems of Performing Artists 1990 Jun;5(2):83-88.
Quirk R. Knee injuries in classical dancers. Medical Problems of
Performing Artists 1988 Jun;3(2):52-9.
Sammarco GJ. The hip in dancers. Medical Problems of Performing
Artists 1987 Mar;2(1):5-14.
Schon LC. Foot and ankle problems in dancers. Maryland Medical Journal
1993 Mar;42(3):267-70.
Andersson S; Nilsson B; Hessel T; Saraste M; Noren A;
Stevens-Andersson A; Rydholm D. Degenerative joint disease in ballet
dancers. Clinical Orthopaedics and Related Research 1989 Jan;238:233-6.
Hardaker WT; Vander Woude LM; Dance medicine: an orthopaedist's
view. North Carolina Medical Journal 1993 Feb;54(2):67-72.
Schon LC; Biddinger KR; Greenwood P. Dance screen programs and
development of dance clinics. Clinics in Sports Medicine 1994
Oct;13(4):865-82.
Shoulder, elbow, wrist, and hand injuries
Manchester RA. The short-term outcome of hand problems in music
students. Medical Problems of Performing Artists 1989 Jun;4(2):95-6.
Manchester RA; Fleider D. Further observations on the epidemiology of
hand injuries in music students. Medical Problems of Performing Artists
1991 Mar;6(1):11-14.
Markison RE. Tendinitis and related inflammatory conditions seen in
musicians. Journal of Hand Therapy 1992 Apr-Jun;5(2):80-3.
Markison RE. Treatment of musical hands: redesign of the interface. Hand
Clinics 1990 Aug;6(3):525-44. May DW.
Rozmaryn L. Upper extremity disorders in performing artists. Maryland
Medical Journal 1993 Mar;42(3):255-60.
Huddleston CB; Pratt SM. Cymbal-player's shoulder. [letter] New England
Journal of Medicine 1983 Dec 8;309(23):1462.
Owen ER. Instrumental musicians and repetition strain injuries. Journal of
Occupational Health and Safety--Australia and New Zealand
1985;1(2):135-9.
Phillips P. Musicians' myths and the pain they perpetuate or how to
prevent instrument related injuries. Soundboard 1985 Spring;12(1):43-5.
Judkins J. The impact of impact: the percussionist's shoulder. Medical
Problems of Performing Artists 1991 Jun;6(2):69- 70.
Ryniker DH. Dealing with the aches and pains of drumming. Modern
Drummer 1981;5:29-30, 86.
Dental Injuries
Pre-Existing Injuries
Vascular and/or Neuronal Compression Syndromes
Trauma vs. Congenital vs. Body Habitus)
Lederman RJ. Thoracic outlet syndromes: review of the controversies and
a report of 17 instrumental musicians. Medical Problems of Performing
Artists 1987 Sep;2(3):87-91.
3. Does need for research exist?
Certainly, knowing the numbers of individuals involved in the activity and the
bibliographical data so far presented there should be little doubt that investigation in this arena is
sorely needed. If it seems important to US what how do we proceed from here.
First, we need documentation regarding the activity's collective knowledge of its illnesses
and injuries. I have not seen any concerted effort by DC to supply that data. Only after we have
collected as much historical data as possible can we begin to understand what the problem is or
is not and what we might propose as a solution.
To that end I propose a committee be assembled to develop objectives for the collection
and tabulation of such data. It could be a standing committee for the FUTURE OF DC. It would
develop a questionnaire to be sent to all concerned parties.
That questionnaire must:
A. Be developed by knowledgeable and concerned individuals.
B. Be comprehensive (what ever that means). It should not be so complex as to scare
respondents.
C. Be simple in language so all can understand it and thus give meaningful answers.
D. Satisfy respondents need for confidentiality.
Further, that committee could address such concerns as:
Develop a team of professionals that could be made available to ALL corps at the
various cities traveled through each year.
Hinz, CA. Musicians' health needs call for a medical team approach.
American Medical News 1984 Aug 17;27(31):26-8.
Medical concerns for music educators. [insert] Teaching Music
1993;Dec;1(3).
Pratt RR. Music education and medicine: a renewed partnership. Mutional
Journal of Arts Medicine 1992 Spring;1(2):7-20.
Lederman RJ. The coming of age of performing arts medicine. [editorial]
Western Journal of Medicine 1994 Jan;160(1):73-4.
Lederman RJ. An overview of performing arts medicine. American Music
Teacher 1991 Feb-Mar;40(4):12-15, 70-1.
Leopold W. Backstage doctors. Northwestern Perspective 1990
Spring;3(3):13-15, 38-9.
Possibly develop the standards-of-care for a "DC Medical Program" Address the medical
concerns of the parents or guardians of corps members, corps members themselves, and corps
staff.
Medical insurance issues
What corps have pre-season physical exams?
How do they accomplish the exam
Who does the exam
How appropriate are the exams
For defining existing problems
For preventing problems
Do corps have difficulty finding medical care for members during?
Home Base Rehearsals
Traveling
Winter and Spring Clinics
Is anyone concerned about actual or perceived injuries or illnesses?
Are corps staff concerned?
Are marching members concerned?
Are corps sponsors concerned?
Are marching members' parents or family concerned?
Are fans concerned?
Are show organizers concerned?
Are former corps staff or marching members concerned?
What are the liabilities of this endeavor?
What are the confidentiality questions that need to be addressed?
Who can best address those questions of confidentiality?
This venture could be funded at least in part by educational grants. There is a plethora of
educational grant money each year that is untapped.
4. Who are the knowledgeable and interested parties?
DC directors
DC Staff
DC Marching Members
DC Marching Members' Families
DC Former Staff Or Marching Members
DCI Administration
Music Educators
Nurses
Athletic Trainers
Aerobic Instructors
Strength Trainers
Librarians
Grant Writers
Statisticians
Physicists
Physicians
Attorneys
Fans of DC
5. Drum corps medicine for the future.
Well, that is a topic in which we should ALL participate. There are many unanswered
questions. It could be very interesting though.
6. Conclusion.
There is a fair amount of literature devoted to the subject of performing art medicine, but
very little devoted strictly to the drum corps activity. Let us gather our own data so this is no
longer the case.
With my experience in DC over the past five years, I see a need to prevent as many
medical ailments as possible -- for the sake of the "kids", if for no other reason. Many of those
preventive measures are already in place at least by some corps. Some corps do one thing and
some another. Let us get together and provide all of our ideas to ALL the corps.
Treatment of various ailments can require money and medical professionals, but let us
attempt to gather enough meaningful information to keep treatments simple and cost effective --
use a common sense approach, if you will. Maybe a nationally recognized team of medical
professionals in the DC activity could and should be a reality.
Finally, I am positive that I am not the first person to address this topic. I simply have
not been around DC long enough to learn who else was here before me. I do not want to leave
the impression that I am the only person interested in this topic or that I have all the answer. I
am not and do not. The foregoing is just some food for thoughtful people.
Thanks to Susan Harman and Stuart Rice.