Ralph Manchester

As I think back over my 30-plus years as a physician and researcher in performing arts healthcare and try to imagine what might happen in the next 30 years, I sometimes fantasize about having three wishes that some supernatural force would grant. While waiting for something like that to happen is not likely to be an effective strategy for improving...

I was honored and privileged to join Dr. Robert Sataloff in delivering a tribute to Dr. Alice Brandfonbrener at the 2015 Symposium on the Medical Problems of Performing Artists in Snowmass, Colorado. As virtually everyone who reads this journal knows, Dr. Brandfonbrener organized the first symposium (then focused on the medical problems of musician...

The article by Cliffton Chan et al. in this issue of Medical Problems of Performing Artists is the written version of his presentation at the PAMA Symposium that won the 2014 Alice G. Brandfonbrener Young Investigator Award. In it, Chan and his colleagues describe a controlled trial of an exercise program for professional symphony orchestra musicia...

Two articles in this issue of Medical Problems of Performing Artists use specific technologies to advance our understanding of particular aspects of performance health. Clemente et al. used three-dimensional accelerometers to measure the motion of the head, jaw, and neck in pianists. Saito et al. used electromyography (EMG) in the soleus muscles of...

Now that the field of performing arts medicine has been in existence for over three decades, we are approaching a key point: we should start to see more articles that bring together the data that have been collected from several studies in order to draw more robust conclusions. Review articles and their more structured relative, the meta-analysis,...

When I was growing up, it seemed like posture was a big deal--to my parents, other (older) relatives, teachers, and other authority figures. Hardly a day passed (as I recall) without an adult telling me to stand up taller or sit up straighter. An informal survey of my peers suggests that I was not alone in this regard. Whatever effect those posture...

The two articles on the health of marching band musicians and the one on Irish traditional musicians in this issue of the journal are the most recent examples of research on the health of performing artists who participate in non-classical art forms. While it may not be easy for everyone to agree on the definitions of classical (or, more broadly, "...

The idea of specialty certification in performing arts medicine (or performing arts healthcare) has been discussed for a long time among professionals in the field. An article by Pascarelli and Bishop published nearly 20 years ago mentioned the perceived need for certification and some of the obstacles to creating it. The Performing Arts Medicine A...

The Letter to the Editor from Matthew Arthur in this issue of Medical Problems of Performing Artists asks an important question for performing arts medicine professionals: why haven't we used the scientific method to determine optimal piano technique? More broadly framed, why is technique in most of the performing arts based much more on tradition...

Performing arts medicine has made significant progress over the last three decades, and not infrequently we have looked to the field of sports medicine for inspiration and strategies. It seems that we have looked to occupational medicine less often as a model to emulate, but that may be worth reconsidering. The article by Chimenti et al. in this is...

Performing artists are used to dealing with uncertainty--how will the next performance go, what will the new conductor expect, will my current combination of jobs and gigs be enough to pay the bills? Likewise, health care professionals have to deal with uncertainty on a regular basis--is the patient's chest pain due to myocardial ischemia or someth...

The article by Haben in this issue of Medical Problems of Performing Artists describes one expert clinician's approach to the use of rest in treating voice problems in singers. In the absence of well-designed randomized controlled trials of voice rest for various vocal problems (and little in the way of other research on the topic), expert opinion...

As I hope everyone who has an interest in the health of performing artists already knows, the 30th annual "Aspen" symposium will be held in July. I am using the theme of this year's conference as the title of this issue's editorial. We have a lot to be proud of as we look back on the last three decades, as we look around at what is happening in the...

The article by Lamontagne and Bélanger in this issue of the journal describes the development of a questionnaire concerning performance-related musculoskeletal disorders (PRMDs) in musicians. It is well designed and deserves careful reading by clinicians and researchers alike. The authors are very clear in stating that their focus was strictly on m...

Two papers in this issue of Medical Problems of Performing Artists examine energy expenditure while playing a wind instrument and dancing. Measurement of the amount of energy required to play an instrument, dance, or sing has been done in the past, but these two papers advance our understanding of how performing artists carry out their professional...

The article by Schneider and Chesky in this issue of MPPA presents an interesting look at how social support affects performance anxiety. Performance anxiety is one of the most discussed topics in performing arts medicine, in part because it is a multifaceted phenomenon with medical, psychological, and academic/financial aspects. This has led to co...

The article by Guptill in this issue of MPPA presents the results of a type of research that has not been published to a great extent in the performing arts healthcare literature to date. Only a few articles that are based on qualitative research have been published in this journal. The vast majority of original research published in this and other...

The article by Guptill in this issue of MPPA presents the results of a type of research that has not been published to a great extent in the performing arts healthcare literature to date. Only a few articles that are based on qualitative research have been published in this journal. The vast majority of original research published in this and other...

Several articles in this issue touch on some of the more athletic components of the performing arts. The article by Twitchett et al. describes fitness aspects of ballet, Gabrilo et al. discuss lung function in synchronized swimmers, and we also learn about how one flutist prepared for a very difficult piece by exercising (and practicing) in the let...

As the body of knowledge that comprises the field of performing arts medicine has grown, it has simultaneously become more important and more difficult for everyone who is concerned about the health of performing artists to stay current with the state of the art. In this regard, performing arts medicine is no different from any other field, but we...

The announcement last month that Medical Problems of Performing Artists will now be indexed in Medline/PubMed is truly an important development for the field of performing arts medicine. While many of us wish that this had happened sooner, we should all be proud of our combined efforts that made it possible. In addition to the publisher Mike Bokuli...

Almost by definition, the performance of dance, music, or any other performing art involves physical exertion of some type and some degree. In most performances, the amount of energy expended appears to be substantially higher than the resting state but significantly lower than many athletic events that last about the same amount of time. Performin...

While there are many causes of hearing loss, many of which have nothing to do with exposure to loud noises, noise (or music)-induced hearing loss is theoretically preventable 100% of the time. Loss of hearing is typically a major problem if it happens to dancers and actors, but it is catastrophic for musicians. Thus, it is not surprising that this...

Health care in the United States is beset by three critical problems: cost, quality, and coverage. We have by far the most expensive health care in the world, spending about 17% of our Gross Domestic Product, or over $7,000/person; most other developed countries spend about 8 to 10% of their GDP on health care. ¹ Despite spending that much money, t...

As the Performing Arts Medicine Association (PAMA) celebrates its 20th anniversary this year, it seems to be a good time to discuss a definition of what the field includes—and, by extension, what it doesn't include. Some may think that this might not be the best use of our time, since we have done pretty well so far without a written definition of...

This month's editorial is based on a presentation that I did at the International Congress on Music Physiology and Musicians Medicine, which was held in Freiburg, Germany, in late March. Stimulated by some recent articles published in MPPA, I attempted to review what we know about the pattern of performance-related musculoskeletal disorders (PRMDs)...

Clinical research, like aging, is not for sissies. As everyone who has tried to do studies involving real, free-living human beings knows, it is an endless quest to get just one simple conclusion out of a morass of data that has been collected despite countless obstacles and complications. Whenever a study actually produces clinically significant r...

All of us who are concerned about the health of performing artists hope that, through our combined efforts, we will see improvements in the health status of musicians, dancers, actors, and other performers in the coming years. Ideally, this will mean the betterment of all aspects of performing artists' health, including the physical, psychological,...

In my first editorial, from September 2005, I made an analogy between the duties of a conductor and those of an editor. Both roles require an individual to produce something worthwhile through the efforts of others: composers, arrangers, and musicians or authors, reviewers, and publishers. A similar analogy probably could be made with the choreogra...

Performing arts medicine has had a global reach since the early days of the field, but there are ample indicators that we are increasing our impact around the world. In this editorial, I take a brief look at the formative years of our specialty and then jump ahead 25 years to assess the progress to date.

As the field of performing arts medicine continues to advance, it is essential that we maintain the trust that has been built over the last quarter century with the dancers, musicians, and other performing artists we serve. Trust is a precious commodity that is built over time, largely between individual health care professionals and the patients f...

Epistemology is the branch of philosophy that studies the nature of knowledge, its presuppositions and foundations, and its extent and validity. It is as relevant to performing arts medicine as it is to any other area of human inquiry, and the article by Wu in this issue is a new brick in the foundation of what we know about risk factors for muscul...

David Nabb's interview of Maarten Visser on page 159 of this issue and Brenda Wristen's article on the 7/8ths keyboard from the March issue are two recent examples of articles on musical instrument ergonomics. Ergonomics, literally the study of work, is defined as "the applied science of equipment design intended to maximize productivity by reducin...

The Special Article in this issue of Medical Problems of Performing Artists has the potential to usher in a new era in improving the lives of musicians (and potentially other performing artists) around the world. The Health Promotion in Schools of Music conference that was held in Texas in the fall of 2004 brought together a rich mixture of music a...

HPSM recognizes fundamental challenges in responding to the health risks associated with learning and performing music. In addition to current research showing that young musicians enter college with existing problems, the underlying physiological and psychological mechanisms for performance injuries are multidimensional and involve both individual...

Purpose: Performing arts medicine has traditionally focused on the medical problems of classical musicians. Unfortunately, there is a paucity of data regarding differential incidence or prevalence of injury in nonclassical musicians. The present study analyzed the baseline prevalence, new onset of injury following a substantial increase in playing...

As the diverse populations of the planet interact on a more frequent and intense basis, it becomes increasingly important for every individual and organization to examine its own approach to this vital issue. The field of performing arts medicine should pay particular attention to diversity for a number of reasons, some of which will help to advanc...

To paraphrase the old saying, a sixteenth note of prevention is worth a whole note of cure. Unfortunately, in 2006 we have very few sixteenth notes of proven prevention to offer performing artists. Therefore, practitioners of performing arts medicine are mostly limited to offering injured artists whole notes of treatment, assuming that the artist i...

I am humbled and deeply honored to become the second editor of MPPA . To pick up the task that Alice Brandfonbrener took on 20 years ago is a huge responsibility, and time will tell if I am up to it. Jimmy Carter once commented that the most crucial election in a new democracy is not the first but the second, as it represents the orderly transition...

A randomized, controlled trial was conducted at a private university to determine whether students who received an informational letter (n = 366) would be more likely to receive a hepatitis B vaccination than students in a control group (n = 366). Surveys were conducted to determine the students' reasons for deciding to be vaccinated. Rates of hepa...

The instrument-specific injury rates of students at a university-level music school were calculated from data collected over 14 academic years, 1982-83 through 1995-96. During this period, 513 performance majors presented to their university's health service with performance-related upper-extremity injuries. The overall injury rate (number of injur...

In this article, the authors explore three research designs common to college health investigations: survey, epidemiologic, and experimental. They identify the varieties of research questions addressed by these designs and note examples from clinical nursing/medicine, menial health, and health education topics. In addition, the authors summarize th...

The final article in this series on research in college health deals with the analysis and communication of research data. The authors introduce descriptive and inferential statistics and summarize the applicability of different types of statistical analysis to college health research. Two major means of conveying results, conference presentations...

Building upon an initial article, which described the processes of literature review and hypothesis development, the authors summarize issues of research design. General issues encountered by researchers in college health settings include the establishment of a clear research focus, selection of a representative and adequate study sample, use of re...

College health professionals are often intimidated by the research process and thus miss opportunities to develop and communicate their ideas. The present article, the first in a series on college health research, describes the basics of the research process, including the purpose and nature of research and the ways in which ideas are developed int...

In an effort to better understand the factors that lead to performance-related hand problems in instrumental music students, the authors sent questionnaires to university-level music students who had sought medical treatment for performance-related hand problems (cases) and to similar students who had not sought treatment for such problems (control...

The final article in this series on research in college health deals with the analysis and communication of research data. The authors introduce descriptive and inferential statistics and summarize the applicability of different types of statistical analysis to college health research. Two major means of conveying results, conference presentations...

This article explores three research designs common to college health investigations: survey, epidemiologic, and experimental. It identifies the varieties of research questions addressed by these designs and notes examples from clinical nursing/medicine, mental health, and health education topics. In addition, it summarizes the unique challenges en...

Building upon an initial article, which described the processes of literature review and hypothesis development, the authors summarize issues of research design. General issues encountered by researchers in college health settings include the establishment of a clear research focus, selection of a representative and adequate study sample, use of re...

Recommended doses of bile-acid binding resins have an established hypocholesterolemic effect, but data on responses to low doses, especially in women and subjects with moderate hypercholesterolemia, are sparse. A double-blind, placebo-controlled, randomized trial of 3 low doses of colestipol hydrochloride was conducted in women and men with moderat...

The publication of Textbook of Performing Arts Medicine marks another milestone in the growth of this new multidisciplinary specialty, complementing the recent arrivals of annual conferences, peer-reviewed journals, and professional societies. The editors of this concise volume are among the leaders in the field, Lederman being one of the leading n...

College health professionals are often intimidated by the research process and thus miss opportunities to develop and communicate their ideas. The present article, the first in a series on college health research, describes the basics of the research process, including the purpose and nature of research and the ways in which ideas are developed int...

Two national panels have recommended similar, specific strategies for detecting hypercholesterolemia: selective screening for children aged 2 to 19, and mass screening for individuals aged 20 and over. It is, however, unclear how best to apply these recommendations to a college student population. In order to determine which strategy is more effici...

Physicians may choose one of several strategies when initially uncertain about making a specific therapeutic recommendation. The authors investigated how patients' satisfaction is affected by disclosure of uncertainty and its attempted resolution during a clinical encounter. Three hundred and four patients awaiting appointments at a university hosp...

Discusses music development in terms of the interaction of mental and physical processes of the nervous system, musculoskeletal system, respiratory apparatus, and sensory organs. Other organ systems play a supportive role. Health problems affecting any of these components can interfere with music development. Common problems in the various organ sy...

Coronary artery disease is a major public health problem in the adult years. Substantial evidence supports a hypothesis that atherosclerosis begins in childhood or adolescence and that the behavioral risk factors for atherosclerosis become entrenched in adolescence or young adulthood. While there have been recommendations that preventive efforts sh...

We conducted a voluntary cholesterol screening in a medical/occupational setting using the Eastman Kodak Ektachem (desk top) blood analyzer. In 10 hours, five technicians performed a finger-stick puncture on 1,081 screenees, 17.7 per cent of whom were classified as moderate-to-high risk. The cost per screenee was under $3; cost per moderate-to-high...

A study of the visiting patterns of a general hospital psychiatric unit was undertaken to determine what difference could be detected between visited and unvisited patients. The physical rehabilitation floor at the same hospital was used as a "control." The results indicate that no significant differences could be found between the two groups of ps...