Lata Mangeshkar at the Deenanath Mangeshkar Purashkar function in Mumbai, April 2017. Photo: PTI
- Health hazards to performing artists are well-known in the Indian film/music industry.
- Instrumental musicians suffer from a variety of disorders such as nerve entrapments, repetitive strain injuries and muscle and tendon injuries. Dancers sustain injuries to the foot, ankle, knee, hip or back.
- Occupational health nurses, almost non-existent in India, are needed to help dancers in their battle against injury, pain, disability and psychological distress.
- The branch of medicine dealing with performing artists is known as performance medicine.
Lata Mangeshkar, who passed away on February 6, 2022, aged 92, sang professionally well into her 70s, and is credited with more than 50,000 songs. Notwithstanding her natural ability, her training in classical music combined with vocal hygiene and conservation surely protected her from the ill effects of rigourous rehearsal and performance.
The career of singer Julie Andrews, famous for such hits as ‘The Sound of Music’ and ‘Mary Poppins’, crashed after a botched surgery on her vocal cords. She underwent this procedure after her voice became hoarse. Her doctors first told her that she had non-cancerous nodules on her cords that would have to be removed, but the actual cause was later found to be a muscle problem (scarring due to overuse). Andrews emerged from the surgery with her singing voice permanently damaged.
Many other well-known singers, including Freddie Mercury, Elton John, Celine Dion and Whitney Houston, have suffered similar problems.
Dr Kamal Parsram is an ENT specialist in Mumbai who treats many singers. He said that voice abuse is the primary cause of damage that impacts a person’s voice. Participants in popular singing contests in India and overseas have had careers that ended quickly because the increased vocal strain and muscle tension from singing while rehearsing and competing resulted in voice-abuse patterns.
Our vocal cords are folds in the throat made of tissue and muscle that produce sound when air is forcibly exhaled through them. This sound resonates through the mouth and nose, resulting in speech, song and music. Minor inflections of pitch, tone and intensity in these sounds enable speech-making and artistic expression. Damage to vocal cords results in various problems, such as hoarseness, inflammation, scarring, paralysis, formation of nodules and cancerous growths. Each of these pathologies leaves a unique mark on the cords. The cords are also susceptible to infections, trauma, damage by smoking, environmental pollution and thyroid dysfunction. A person’s voice quality also declines with age.
For singers, avoiding voice abuse is the primary goal. Voice therapy, in the form of vocal and physical exercises, along with behavioural therapy are taught by singing coaches as part of vocal hygiene. Techniques like breathing control and exercises are a part of classical music training and are now being used by singers who can afford to hire coaches.
In India, awareness of the problem has increased in the last decade or so, and a few voice therapy centres have been established in some major cities. In addition to voice therapy, medical causes of dysfunction are treated, and a technique called laryngeal manipulation is performed to reduce muscle tension and improve voice quality. Advanced techniques like botulinum toxin injection to relieve spasm, vocal fold injection for paralysis and laser surgery to remove lesions help the voice to return to near normal quality. Jeannie Gagné’s 2015 book Belting: A Guide to Healthy, Powerful Singing is a good resource on how to sing with healthy vocal techniques.
Health hazards to other performing artists are known in the Indian film-music industry. Instrumental musicians suffer from a variety of disorders such as nerve entrapments, repetitive strain injuries, and muscle and tendon injuries. Dancers sustain injuries to the foot, ankle, knee, hip or back. The constant fear of injuries is universal among dancers because injuries can lead to permanent disability and the end of their careers.
Anita Vallabh, a Bharatanatyam dance teacher-trainer, notes that dance positions create abnormal forces on the body and an awareness of anatomy combined with core muscle strengthening and yoga can help mitigate trauma. Prompt treatment of injuries is critical but there are multiple barriers to receiving treatment. These include misunderstanding from the healthcare community, cost of treatment, time constraints, fear of unemployment and dancers’ viewing injuries and pain as a way of life.
Occupational health nurses, almost non-existent in India, are needed to help dancers in their battle against injury, pain, disability and psychological distress. The branch of medicine dealing with performing artists is known as performance medicine, which provides comprehensive healthcare for artists, with services tailored to individuals with voice, hearing, and neuromuscular disorders. Its goal is protecting artists’ most valuable tool: their bodies.
Demand for content across television, cinema and OTT platforms is exploding and experts estimate India’s media and entertainment sector may employ as many as eight million people by 2025. That is twice the four million currently making a direct or indirect living from the $24 billion industry. Many of these workers are likely to be contracted labour with no or little provision for general and work-related health care. If we add the number of workers in the sports industry, this number will increase manifold.
There are no current reliable estimates of the number of work-related injuries and illnesses occurring in the total entertainment and sports industry in India. However, judging by the number of accidents in other industries (also undercounted), it is safe to say that the burden of ill health in the entertainment industry is likely to be huge.
Successful artists have access to finances, good training and healthcare. However, they are the privileged few and many workers will fall by the wayside without awareness and access to appropriate health care. Even the legendary Lata Mangeshkar took a break at the peak of her career for vocal cord problems. After a period of silence, she returned, healed, to continue her musical journey. The message here is that protecting the body and prompt treatment are vital for long-term success – a principle applicable to many aspects of life.
V. Ramana Dhara is an occupational and environmental medicine specialist and a former member of the International Medical Commission on Bhopal.