Dancers' and musicians' injuries.

This overview is based on the over 30 years of performing arts medicine experience of the author, an orthopaedic surgeon who devoted his professional life entirely to the prevention, diagnostics, and treatment of dancers' and musicians' injuries. After a short introduction on the specific demands of professional dance and music making, it describes some general principles of orthopaedic dance medicine and causes of injuries in dancers. The relation of dance injuries with compensatory mechanisms for insufficient external rotation in the hips is explained, as well as hypermobility and the importance of 'core-stability'. As a general principle of treatment, the physician must respect the 'passion' of the dancer and never give an injured dancer the advice to stop dancing. Mental practice helps to maintain dance technical capabilities. The specific orthopaedic dance-medicine section deals with some common injuries of the back and lower extremities in dancers. An important group of common dance injuries form the causes of limited and painful 'relevé' in dancers, like 'dancer's heel' (posterior ankle impingement syndrome), 'dancer's tendinitis' (tenovaginitis of the m.flexor hallucis longus) and hallux rigidus. The second half of the overview deals with the general principles of orthopaedic musicians' medicine and causes of injuries in musicians, like a sudden change in the 'musical load' or a faulty playing posture. Hypermobility in musicians is both an asset and a risk factor. As a general principle of treatment, early specialized medical assessment is essential to rule out specific injuries. Making the diagnosis in musicians is greatly facilitated by examining the patient during playing the musical instrument. The playing posture, stabilisation of the trunk and shoulder girdle and practising habits should always be checked. Musicians in general are intelligent and the time spent on extensive explanation and advice is well spent. In overuse injuries, relative rest supported by 'mental practice' is effective. The specific orthopaedic musicians' medicine section deals with some common injuries of the neck and upper extremities, like (posture related) cervicobrachialgia, and thoracic outlet syndrome. An important group of causes of musicians' injuries form the entrapment neuropathies (especially ulnaropathy), osteoarthritis of the hands and hypermobility.