Kit Wynn Parry

'I flew in all kinds of planes, assessing problems arising from how airmen were forced to sit or position themselves. For example, those who flew in one plane were reporting terrible back pains because they were locked tight in a very cramped seat for 12 to15 hours on end. We designed special individually-moulded seats to offer more support.'

From early days, Wynn Parry was a keen amateur musician, playing the trombone at school and singing in choirs at Oxford, eventually going on to join the Bach Choir. Small choir singing remains a hobby. The interest fed into his connection with the Air Force - which, like all the armed services, has a distinguished record of producing top-quality performers, most obviously via a multiplicity of military bands of international renown. 'I started a clinic for RAF musicians at the Royal National Orthopaedic Hospital...it was soon clear they had a particular range of problems as performers.'

For decades since, Wynn Parry has continued to devote a significant corner of his career to the medical welfare of professional musicians, becoming a trusted confidante of both rank-and-file and internationally-famous performers - confidentiality being a key guarantee he must give in this most sensitive of areas. 'None of them want to admit to being in trouble of some kind. Even in the big orchestras you're not necessarily given long to recover from injury or illness before your place is threatened - competition is so great. So instead of owning up, you just keep going, saying nothing. It's not so bad in countries like Germany and Austria where if you're no longer able to play you're more likely to be offered another job, maybe looking after the orchestra library.

'Athletes don't have the same problem with secrecy! If you're an injured sportsman, all the details are in the Daily Express with quotes not just from the star but from his coach and doctor. It's not the same in music, even though musicians are athletes too, in a way.

'In this country culture isn't widely seen as important - we're philistines, really, more interested in building football stadia than promoting serious music. If you complain about work conditions as a musician you may very well be thought of as a trouble-maker or a wimp. So there you are in a tiny, cramped orchestra pit, playing in a musical with barely any room around you, and yet you daren't say anything.....if you do, you may be told to be grateful because twenty other people are after your job. Things have to change, though.

'Players can be reluctant to see a doctor simply in case they hear what they don't want to hear. It's easier to go to an osteopath or chiropractor, perhaps - which is fine, except that a doctor will be able to look at possible underlying medical problems. I had a patient just recently who turned out to have a general medical condition which had to be sorted out before the symptoms she presented with could be treated.'

'Ian James was a clinical pharmacologist at the Royal Free Hospital who also played the viola. He developed bow tremor, which was treated quite successfully with beta-blockers. That inspired him to carry out a study of the effects of beta-blockers at the Wigmore Hall with a group of violinists, using placebos as well as the real thing. This showed various interesting results - for example, that beta-blockers reduced anxiety, but on the other hand may have inhibited zest and zing in playing.'

Ian James's continuing studies, aided not least by a special clinic set up at the Royal Free Hospital, investigated such areas as the relationship between anxiety and physical symptoms, and the general reaction of doctors to musicians' problems. In the latter case his findings suggested a lack of understanding and expertise - for example, treating certain injuries simply by suggesting six months off work, a measure that could be hugely damaging to a musical career.

BAPAM was founded by Ian James in 1984, since when its services and research activities (for the benefit of actors and dancers as well as musicians) have gradually expanded, aided by funds provided by the MU, Equity and the Musicians' Benevolent Fund. Among its current patrons are the likes of Eveleyn Glennie, Sir Simon Rattle and Nigel Kennedy.

The simple aim is to make available, either free or where possible at reduced rates, specialist health care to those earning a living or partial living from music, as well as to student performers. The need is clear enough, says Wynn Parry. 'Statistics suggest that between 50% and 60% of orchestral musicians worldwide regularly suffer discomfort as a result of playing. With between 12% and 20% of cases, the pain is great enough for the person involved to have to stop playing for a time.

'The most obvious damage we see presented by musicians at BAPAM is musculo-skeletal, but we'll handle anything - of course including hearing problems, anxiety and emotional difficulties - especially stress. Whatever their actual symptoms, I regularly ask people who come to me about stage-fright. So many suffer from it. A hell of a lot can be done to help - BAPAM has three psychologists readily available, for example. In some 40% of cases of physical discomfort there isn't a specific medical condition involved. It's to do with stress or emotional disturbance. Musicians use their bodies to express emotion and this can in certain circumstances produce pain. In many cases the solution comes down to common sense - and the success rate of dealing with problems is good.'

Among the available BAPAM services are free confidential clinics in London, Manchester and Glasgow (with more to come across the UK). These provide medical assessments by practitioners in a whole range of fields, from specially-trained GPs and rheumatologists to physiotherapists, counsellors and those working in complementary medicine. Some physiotherapy comes free of charge. A BAPAM helpline offers instant first-port-of-call advice. The same line provides access to BAPAM's Directory of Practitioners - a source of contact details for professionals working in both conventional and complementary medicine who have experience in the special needs of performing artists. Often their charges are at a reduced rate if the referral comes from BAPAM. In addition, injury prevention and health awareness training is available for performers and students.

BAPAM also administers the Association of Medical Advisors to British Orchestras scheme, which exists to provide independent medical advice to orchestral musicians - if you wish to know whether a band you're working with has an AMABO advisor, call the BAPAM helpline. While he believes there's still a fair way to go before BAPAM's services are fully appreciated and utilised, Wynn Parry is encouraged by the increasing number of salaried members of orchestras who are finding their needs better understood and catered for. 'We've trained doctors who now have relationships with particular orchestras, attending rehearsals and making themselves available to the players in total confidence: management aren't told anything at all without the express permission of the orchestra member. Often the root problem is that they're working too hard.'

However, Wynn Parry emphasises that freelance players are almost by definition particularly vulnerable, not least when you consider that one calculation suggests 66% of MU members earn less than £7,500 pa. 'You advise them to take out their own health insurance, but it can be so expensive. What we try and do at BAPAM is provide an immediate service offering advice on what's wrong and then arrange for swift treatment - for example, we'll write to musicians' GPs to explain individual cases. The confidentiality of what we do is vital - musicians can be sure of that. Because of the financial constraints we inevitably work under, we remain heavily dependent on the NHS. It's been a matter of finding doctors and therapists with an interest in performing artists, and offering them training. Taking a problem for assessment early is so important.'

However, BAPAM's message, as you would expect, embraces prevention as well as treatment. OK, there's no avoiding the fact that many of the potentially harmful things musicians do to their bodies while playing are difficult to avoid, but measures can be taken to mitigate the effects, says Wynn Parry. 'The problem is that there are so many different ways to play...and you can't radically change the way people do things. Sviatoslav Richter played almost standing up....Glenn Gould was practically sitting on the floor. You can't rebuild a personal technique from scratch. All we at BAPAM can say is that if difficulties arise, help is at hand.

'But there are things that can help keep problems at bay - warming-up before playing, for example: exercises to loosen the body - back stretches, rolling the neck, and so on. This really should be a normal part of orchestra life - although it became an issue with one United States orchestra when it had to be decided just how the 15 minutes involved was to be paid for!

'Ideally, there should be no longer than thirty minutes of work before a break - the guitarist John Williams only does twenty minutes! Make sure that chin rests and shoulder rests fit properly. Maybe seek advice on adapting the way an instrument is held. And however obvious it may seem, get the right amount of sleep if you possibly can, eat the right things at the right times and keep yourself reasonably emotionally stable. But in this profession things will never be a bed of roses - you're so often going to be exhausted from travelling, for example. But you can adopt measures to keep yourself physically fit, taking exercise regularly.'

Among the targets for a recently appointed BAPAM Health Promotion Officer are conservatoires. Getting messages about health and wellbeing across in the early years is vital - indeed, Wynn Parry is concerned that many students arrive at music college with problems their teachers haven't spotted or tackled. 'There still seems to be a lack of awareness of the importance of warm-ups and things like good posture.

'However, colleges need to teach students that in their careers they're bound to get aches and pains, and as a result they should learn to take responsibility for themselves...learning how their body works and so on. Thanks to Aaron Williamson, head of the Centre for the Study of Music Performance at the Royal College of Music, all students there have to attend six one-hour seminars on different aspects of health. It's important that students at all the conservatoires and indeed at school level are properly instructed.'

British Association of Performing Arts Medicine, 4th Floor, Totara Park House, 34 - 36 Grays Inn Road, London WC1X 8HR

Helpline (including advice about clinics, Association of Medical Advisors to British Orchestras etc): London: 0207 404 8444; elsewhere: 0845 602 0235

BAPAM website
bapam General Enquiries
bapam Clinic

BAPAM Directory of Practitioners, embracing GPs, physiotherapists, osteopaths, homeopaths, neurologists, chiropractors, rheumatologists, counsellors, psychiatrists, Alexander Technique, yoga, aromatherapists, etc: phone the helpline on 0207 404 8444 or 0845 602 0235 or email

BAPAM Musicians leaflet: Together we can make music (aka 'The Red Leaflet') available from the address/email address above

by Andrew Green

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