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It’s well known that sports-related injuries can devastate athletes’ careers as well as their bodies. When a famous athlete is felled by an injury, the story is likely to receive considerable publicity. But less publicized are the equally grave struggles faced by performers to maintain their health and rehabilitate their bodies following performance-related injuries. Performing artists dance, sing, and make music with a grace and ease that belies the strain that such activities can place on the body. In reality, performers are constantly engaged in a battle against injuries and pain that could separate them from what they love: their art.

Fortunately, artists do not have to engage in this struggle on their own. In the industry of performance-related rehabilitation, specialists work not only to help heal artists but also to prevent injury in the first place. Student performers at Harvard who treat their craft as seriously as athletes treat their sports have had to cope with a wide variety of injuries and learn how to treat their bodies in order to protect against future damage. Meanwhile, doctors at the nearby Harvard-affiliated Spaulding Rehabilitation Hospital are working to revolutionize performance-related injury rehab. While the specifics of different performers’ stories vary widely, the stress on knowing the right way to practice your craft is consistent. For those seeking a life-long career in performance, proper form and technical foundation are imperative to staying healthy. How to realize this imperative is far from obvious.

A DANGEROUS DANCE

Ileana C. Riveron ’17 never planned on applying to college. A member of the Royal Dance Company in London from 2008 to 2011 and of the Boston Ballet from 2011 to 2013, Riveron had an established career as a dancer.  However, 17 years of dancing (12 of them en pointe) had a devastating effect on the young dancer’s feet. The thought of rehearsal began to bring tears to Riveron’s eyes; even walking caused her considerable pain. Riveron’s story is not a unique one in the ballet community. Recalling her days as a member of a professional dance company, Riveron describes an environment where pain was the norm. “Everyone is in quite a bit of pain at all times,” Riveron says. “The [physical therapy] room is always jam-packed full of dancers.”

When her feet did not recover after two months off from dancing for a broken wrist, Riveron was diagnosed with degenerative joint disease. Her doctors told her that she would likely never be able to dance again and that she should told start looking for a new career. “It was heartbreaking,” she says.

Riveron did not take the news lying down. Even before the doctors’ devastating prognosis, she had begun an intensive rehabilitation program that incorporated a spate of treatments. “I started getting ultrasounds done on my feet every day, [and] stem treatments, which is like electroshock therapy for your feet,” Riveron says. “I got injections a couple of months later…for two years I was on hardcore painkillers.”

It was while Riveron was engaged in her rehabilitation regimen that she made the decision to apply to Harvard. Because it led her to pursuing an undergraduate education as opposed to embarking on a professional career straight out of high school, Riveron has come to view her injuries as a blessing in disguise. “I will always love dance, but I’m so happy I’m here,” she says.

Though Riveron will never dance professionally again, rehabilitative treatments have enabled her to recover enough to dance in a non-professional context. After matriculating at Harvard, Riveron joined the Harvard Ballet Company. Since returning to dancing, she has adopted habits that combat the possibility of future injury. “I know now that I could’ve prevented how bad my feet got,” she says. “[Now] I tape them a special way, and they don’t bother me unless I push too hard and do things I shouldn’t.”

INSTRUMENTAL STRESS

Whereas a ballet dancer’s struggle may stem from too many hours en pointe, instrumentalists are a class of performers instructed to keep their feet planted firmly on the ground. But this difference in podiatric orientation does not exempt musicians from doing battle with performance-related injuries. Gabriela D.M. Ruiz-Colon ’16 didn’t start playing cello until high school. Determined to catch up to the level of her peers, she spent two hours every morning practicing her instrument.  “It was a very intense regimen and very physically demanding,” Ruiz-Colon says. “I developed tendonitis on my right and left hand…just from playing too much…. It was one of the sharpest pains [I’ve] ever [experienced].”

Ruiz-Colon’s condition forced her to cut back in her practice time and ultimately take a break from cello. It also led her to work with a teacher to develop recovery strategies, including many elaborate hand stretches. “As a musician, I wasn’t really aware that [stretching] was a thing you had to do because at orchestra concerts you see this virtuoso that plays so gracefully,” she says. “But you don’t really see all the stuff that happens behind the scenes. It’s not just the practicing, but making sure that your hand muscles are well.”

By pacing her practices and maintaining her stretching regimen, Ruiz-Colon regained the ability to play cello. Like Riveron, her experiences with injury taught her to be mindful of her body in her approach to musicianship. “It’s like how you can’t become a runner and just start running a marathon,” she says. “I had to build up stamina.” Although she is currently taking a semester off due to a busy schedule, Ruiz-Colon has continued playing cello at Harvard with the River Charles Ensemble and in pit orchestras.

Had Ruiz-Colon continued to play as often as she did without adapting her playing habits, it is possible her condition would eventually have led to far steeper consequences for her body. As a pianist at Berklee College of Music, Erik Hanson practiced his instrument for four to six hours a day. After months of this intensive schedule, Erik developed an extreme case of tendonitis. Eventually, he was forced not merely to cease playing, but to stop using of his right hand altogether. He got out of his performance requirements at Berklee and spent the last year and a half of college writing with his left hand.

Hanson’s debilitating pain continued to plague him long after he graduated from college.  “I’d play for 30 minutes and then hurt for three days,” he says. “I had to minimize the use of my right hand for 25 years.” After giving physical therapy and acupuncture another shot, Hanson decided to reevaluate the foundation of his technique. Although he had taken lessons for years as a child, Hanson’s problems came from the very basics of his performance process. Realizing this led him to discover the Golandsky Institute, an organization dedicated to educating and rehabilitating musicians that uses the Taubman Approach: a corrective process based on close analysis of piano virtuosos that trains pianists to keep their muscles in natural alignment.

This approach worked wonders for Hanson, who can now play piano for up to eight hours at a time. After searching 25 years for a way to painlessly do his passion, Hanson is astounded by what the simple changes in technique have done for his playing. “It’s amazing!” he says. “I never thought I’d be able to play fast again. I just wanted to not hurt, and to my surprise after about 18 months of this new training, my speed had doubled and now I can do things that I never thought I could do.”

VOCAL AWARENESS

Vocalists are one class of performers that seems to be acutely aware of the importance of preventing injuries through consistent practice of proper habits. The voice is an incredibly fragile instrument, and the need to maintain one’s vocal health has a considerable influence on the lifestyles of serious singers. Camille L. Crossot ’16, who plans on pursuing a career as an opera singer (she recently performed the role of Despina in the Dunster House Opera Society’s production of “Così fan tutte”), knows what it means to always be alert about the impact of daily choices on one’s voice. Such surveillance is particularly important when one is in the rehearsal process for a show, or in the middle of a show’s run. “I know a lot of people’s voices really suffer here, just because it’s so much,” she says. Crossot is careful to rest her voice whenever she can, refraining from singing outside of rehearsal. She also carries a water bottle with her constantly, as even a simple dry throat can mean missing rehearsals.

Allison A. Ray ’14, who also hopes to become an opera singer in the future, performed as Dorabella alongside Crossot in “Così fan tutte.” Ray also played the female lead in the Harvard-Radcliffe Gilbert & Sullivan Player’s fall production of “The Pirates of Penzance.” Ray says, “The biggest issue with vocal performance that most people have is usually too much strain or overuse of the vocal chords.” Opera and musical theater are especially wearying; performers tend to push themselves to sing louder and belt higher. “They’re trying to create a certain measure of volume or a certain amount of sound,” she explains. Often, this can cause calluses to develop on the vocal chords.

Protecting the voice against this does not only involve utilizing proper singing techniques but also modifying one’s everyday speech. “People have to go to speech therapists…because they’re speaking really low in their register, where their voice sounds like its cracking, which puts a lot of pressure on the vocal folds.” Ray says. “The goal of vocal rehabilitation is to teach people to speak and to sing without putting too much pressure on the vocal folds…which involves placing the voice higher in their register.”

AT THE FOREFRONT OF PREVENTION

When it comes to preventing further injury, the development of healthful performance habits is of paramount importance. Performance-related rehabilitation specialists work not only to help heal injured artists but also to prevent injury in the first place by helping them to develop the proper habits that are instrumental in safeguarding one’s ability to perform. This prevention-focused philosophy is a fitting response to the innocent lack of awareness that was at the root of the performance-related injuries incurred by Ruiz-Colon and Riveron.

At the forefront of this field, and heralding this philosophy, is the Spaulding Rehabilitation Hospital. The teaching partner of the Harvard Medical School Department of Physical Medicine and Rehabilitation, Spaulding is one of the nation’s leaders in performance rehabilitation. The Spaulding Hospital for Continuing Medical Care, an affiliate of the Spaulding Rehabilitation Hospital Network, is located in Cambridge.

When one first enters this acute-care center, it feels like a standard hospital, sterile and quiet, but upon taking a right, left, and another right, a more unconventional wing of Spaulding is revealed: a music rehabilitation center. This wing of Spaulding boasts a grand piano, gym equipment, and “Easy Street,” a mock neighborhood complete with a bumpy terrain that prepares clients to navigate the cobblestone and uneven roads of Boston and a grocery store where stroke victims can regain their ability to grasp and reach.

Each of these fixtures is integral to the Healthy Performing Artists Program. Launched five years ago, the program  has provided aid to numerous local musicians. The goal of the program is simple: to help ensure that a musician’s body never interferes with his or her passion.

“We developed it to be a two-tiered program,” says Catherine Wee, an occupational therapist and certified hand therapist at the center. “Number one, for people who are musicians who are already insured and need to recover from that injury…and go back to playing again—The second part is about prevention.”

To prevent injury, Wee takes her patients through an ergonomic assessment, observing clients as they play their instrument in order to monitor movement. Once Wee has determined what harmful habits a musician has developed, she works with them over several sessions to modify their movements. Modifications are normally small—adjustments to grip or placement of the instrument—but tiny changes such as these have a huge impact over time. “Musicians often develop some bad habits, which contribute to this ongoing pain, which musicians ignore a lot of times because they think they’re supposed to have it,” Wee says. “Everyone has the pain, so they just live with it, but they are not realizing that they can do something to change that.”

The program also aims to make musicians more mindful about the need to take care of their bodies. Unlike professional athletes with teams of personal trainers and coaches, musicians are often not trained to be mindful of their bodies. But the strain placed on professional musicians’ bodies is comparable to that placed on those of professional athletes. “These guys are playing above and beyond just practicing,” says the manager of the Spaulding Cambridge Outpatient Center Melanie Deveikas. “They’re athletes of music.”

In order to combat this lack of awareness, the Healthy Performance Artist Program has collaborated with the New England Conservatory and is currently working with Berklee School of Music to start injury prevention early into in budding musicians’ careers. At individual 30-minute appointments with students, representatives from the program attempt to instill the importance of healthful musicianship. “It’s not a treatment session. It’s an educational session,” Wee says. “We point them in the right direction before they develop bad habits.”

Wee and Deveikas have more than Spaulding in common—both are artists themselves. Wee played piano, and Deveikas played violin and flute. The doctors agree that having a background as an artist is an important asset for a performance rehabilitation specialist. When an artist is faced with the prospect of having to give up the activity that is at once their passion and their career, the emotional toll can be considerable. “It helps to have an understanding of what music really means to them—how passionate they are,” Wee says. “Because they love their art so much, they are very tied to that craft…. So we need to be able to empathize.”

Timothy Sullivan, head of communications at Spaulding, hopes that through prevention-focused programs more artists will be taught to prevent injury from a young age, and will consequently be able to avoid ever having to cope with injuries that can cause mental as well as physical trauma—heartbreak like Riveron’s. “The ideal is to work with our patients to develop the right habits to avoid injuries…to help people know how to live and perform well enough so that they don’t have to come see us.”

Clearly, the kind of awareness Sullivan hopes for is not unreasonable. Performers educated about how to avoid practicing their craft in potentially dangerous ways seem dedicated to maintaining salutary habits. Modern rehabilitation programs aim to offer increased opportunities for education that will allow more artists to learn this information at the outset of their careers, rather than as the result of painful experiences.

--Crimson staff writer Haley A. Rue can be reached at rue@college.harvard.edu.