Alice Brandfonbrener M.D.  

"Things Are Seldom What They Seem"

Alice Brandfonbrener M.D.
April 10, 2019

Alternative Care

A discussion of the wheres and whyfores of what is referred to as “alternative care” cannot be adequately examined in a brief article. There are many different types of such care out there, and even that which has the same label, e.g., “chiropractic,” can mean entirely different approaches, one from the other. There are two givens here.

  • The first is that many people, perhaps artists in particular, gravitate with a sense of trust towards alternative care. I think this comes both as the result of some successful encounters, and from the aforementioned distrust of traditional medicine. There is also what is often a mis-perception – that such care is less costly.

  • The second given is that the training and understanding of the cause of illness and injury is often poles apart, due to the differences in training and philosophy regarding the explanation of disease between traditional and alternative care practitioners. The issue that those of us in the traditional camp have with alternative care is that much of it has not been subjected to rigorous, scientific inquiry and measurement, as has traditional medicine.

Those things said, I will say that all of us do some things right and succeed, but all are fully capable of errors of commission or omission, or just bad luck. The concern is that when the diagnostic criteria are not specific to a particular problem, then the treatment may not only be inappropriate but may be injurious, and that delay in more specific and traditional therapy may even result in an increased level of pathology and disability.

Instrumentalists can find help from a variety of sources that (and again I admit to some bias) is increasingly informed and understanding of what can happen to you, even in the absence of characteristic textbook-type presentations. Rarely is anything that happens a true emergency, so multiple opinions are frequently the way to go – certainly if anything invasive is suggested, such as injections or surgery.

In many cities in the US and in Europe, there are people who have made it their business to provide excellent care to musicians. However, that does not always mean that a definitive diagnosis can be made, and usually means that there is more than one way of treating medical problems.

The organization founded in 1989 in Aspen, the Performing Arts Medicine Association (PAMA) has a web site,, that provides names of practitioners geographically closest to you. (These are names of people without any specific accreditation but who belong to the group, and at least have a demonstrated interest and hopefully expertise). Some clinics advertise on the web, and some orchestras keep the names of physicians who have served their members well in the past.

One practical issue is financial. HMOs and PPOs may or may not understand that a musician really does have special problems, and that sports medicine physicians, rheumatologists, or neurologists, absent some experience with playing instruments themselves or informing themselves, do not automatically fill the bill. Currently the delivery of all medical care tends to be something of a nightmare. All I can promise you is that there are people available for you, and that your medical musical health is of supreme importance.

Don’t allow your anxiety, impatience, or frustration in accessing care to compromise your ability to play at your top level. Do remember that most of the things that happen to musicians are more nuisance than threat, but neither should they be ignored or mistreated, by you or your caretakers.

Alice Brandfonbrener holds an M.D. from Columbia College of Physicians and Surgeons. She is on the faculty of the Medicine and Physical Medicine and Rehabilitation Departments at Northwestern University Medical School in Chicago. She is the founder of the Medical Program for Performing Artists at the Rehabilitation Institute of Chicago, and for 20 years served as the editor-in-chief of the journal, Medical Problems of Performing Artists. She was co-editor of the text, Performing Arts Medicine, has written chapters for many books, contributes articles to medical and musical journals, and is a frequent lecturer.

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