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Piano Injuries-First Aid

We have all read posts over the last several months from people asking for advice who have experienced repetitive strain injuries (RSI) of one kind or another while playing the piano. I am posting this information because many people have asked or PMd for information about First Aid for pianists’ injuries. Piano World seems to be the ideal place to put this out there.

RSIs are very common among musicians, and they strike students as well as working professionals with equal regularity (1), (2). They strike the high and low, the famous and the not-so-famous. For instance, we have all read or heard about what happened to Leon Fleischer and Gary Graffman in the 1960s and 70s, where RSI severely hampered or curtailed their celebrated careers while they were still young and healthy.(3) RSI also affects the amateur playing piano in their home.(4) Musicians don’t generally like to talk about their injuries, which is why I think there is so little information about them available to musicians. And if you’re a professional who performs regularly, there can be internal and external pressures to hide an injury no matter how severe it is.

The nature and cause of RSI are very well understood. Pianists get RSI for several of the same reasons professional athletes get injured (5):

1- Unvarying repetitive movement patterns
2- Excessive force
3- Awkward postures, poor form or technique
4- Adverse environmental factors e.g. extreme cold, poor condition of equipment, etc.

Both athletes and pianists experience soft tissue injuries such as tendinitis, tenosynovitis, stenosis, bursitis, and others because of these reasons. Sport injuries have a very specific protocol for their treatment that requires immediate First Aid when an injury occurs. This same protocol can be helpful to musicians with recent, sudden-onset injuries. The first round of treatment sports coaches or trainers administer most often follows the RICE protocol (6):

R- rest
I- ice
C- compression
E- elevation

REST eliminates further trauma to the site of injury.
ICE or COLD causes arterioles and capillaries to constrict, limiting the spread of edema.
COMPRESSION stabilizes any joints that are affected, and can help further limit edema.
ELEVATION of the injury above the heart helps speed the flow of oxygen- and nutrient-starved veinous blood and other fluids back to the trunk, further helping to reduce swelling at the injury site.

Over-the-counter pain medication can also be very helpful in speeding recovery. Not only do aspirin, ibuprofen and Tylenol help with pain and discomfort, they also have anti-inflammatory properties that help with swelling. If you use them, follow the instructions on the packaging.

It’s very clear why this protocol works well. The initial stage of injury causes, among other things, the breaking of mast cells that release histamine into the surrounding tissues and fluids. This causes edema, drawing more fluids to the injury site that bring antibodies, nutrients and oxygen to the site of injury. That’s good, because those things speed healing and help prevent infection. But the swelling can progress to surrounding tissues, ultimately impairing circulation. If circulation is compromised, the blood fluids can become exhausted of oxygen and nutrients at the injury site, and also limit the transit of carbon dioxide and waste products out of the affected area. The edema also makes the cells water-logged, affecting their structural integrity and making them more prone to re-injury.

The comparison between pianists and athletes is not perfect. Sports injuries are often multi-joint injuries caused by excessive force and blunt trauma that can be quite severe. Also, athletes most often injure groups of large muscles and the related tissues, whereas musicians injure the small ones. Since that’s the case, compression is probably not necessary for most RSIs of the upper extremity. But the other three are very helpful and can significantly reduce the recovery period.

Additionally, pianists don’t often experience sudden onset, blunt trauma while they play. Rather, they undergo microscopic trauma at a cellular level that their bodies cannot heal completely in a 24-hour period. Since they go back the next day to do the same thing that brought on the micro-trauma, the damage gets worse over time. Finally, it becomes pronounced enough to cause discomfort, pain, swelling, impaired mobility or function. Suddenly, you’ve got tendinitis, or something like it. It may seem like it just “happened” suddenly but, in fact, the injury was building over a long time period.

Here’s another key difference. Posture, form and technique are things that athletes at every level look at and improve regularly, especially after an injury. Coaches and trainers work technical remediation and retraining into recovery programs with every injured athlete, once recovery has progressed sufficiently to do so safely. Pianists almost never do this, and it’s a serious omission. One of the reasons pianists get and stay injured is that they go back to the same movement patterns that injured them in the first place. They don’t change them, so they start playing again and re-injure themselves in the very same way.(7)

If an injury is relatively recent and not severe, then home care can be the option of choice. A home care program should look something like this:

1- Rest. Stay away from playing until the acute symptoms (pain, swelling, loss of mobility) subside.

2- Cold. Use an ice or cold gel pack on the affected area to reduce swelling. Keep it on only long enough to cool the skin to the touch. Repeat as often as two or three times an hour. Don’t put ice directly on the skin as it can cause frostbite.

3- Elevate. If swelling is pronounced, hold the injury slightly above the level of the heart.

4- Retrain. Once you’ve recovered, work with a teacher who can help change your technique so you don’t injure yourself again.

How do you know you’re recovered? Simple: it won’t hurt to play. If it just plain hurts to play, at all, then you are probably not recovered enough to start yet. If the acute symptoms have subsided but it still hurts to play a particular passage, then avoid that passage or texture until you’ve worked with a teacher to retrain the technique. Playing through the pain is always a bad idea.

Lifestyle habits can make healing prolonged or difficult, as well as making you prone to injury. These include:

1- Smoking.
2- High stress
3- Sleep deprivation
4- Poor diet
5- Dehydration, particularly that brought on by excessive alcohol consumption and certain recreational drugs
6- Certain health conditions and drug interactions.

The RICE protocol is intended for recent, sudden-onset pain or injury. You will need to see a doctor if your symptoms don’t improve in a few days, or a week at the outside.

I’m very interested in hearing what your experiences have been. If it’s of interest, we can discuss further on what can be done about more advanced problems of RSI.


---Notes---

1- Zaza, Christine. 1992. "Playing-related health problems at a Canadian music school," Medical Problems of Performing Artists, 7: 48-51.

2- Numerous studies support this view e.g.:
-Driscoll T, Ackermann B, Kenney D, “Sound practice: Injury occurrence and surveillance in orchestral musicians”, [abst.] 28th Annual Symposium on Medical Problems of Performing Artists Proceedings, Denver, CO: PAMA/Rocky Mt. Health Plans (Thu).
-Yeung E, Chan W, Pan F, Sau P, Tsui M, Yu B, Zasa C., “A survey of playing-related musculoskeletal problems among professional orchestral musicians in Hong Kong”, Med Probl Perform Art, 1999: 14(1):43-47.
-Ackermann B, Driscoll T, Kenny DT., “Musculoskeletal pain and injury in professional orchestral musicians in Australia”, Med Probl Perform Art., 2012: 27(4):181-187.

3- Dawson, W.J., “The dedicated amateur instrumentalist with upper extremity difficulties [abst.]”, 19th Annual Symposium on Medical Problems of Musicians and Dancers Procedeings: Education Design (Thu) (Denver, CO, 2001).

4- For those of you who may have missed that, here are a couple of articles: http://en.wikipedia.org/wiki/Leon_Fleischer, and http://en.wikipedia.org/wiki/Gary_Graffman .

5- http://www.mayoclinic.com/health/tendinitis/DS00153/METHOD=print. Accessed 4Aug13.

6- Ibid.

7- Taubman D., “A teacher's perspective on musicians' injuries”, in Roehmann F. L., Wilson F.R., editors, “The Biology of Music Making”,: MMB Music, pp. 144-153, (St. Louis, 1988).

Hi all,

I expect this thread to end up in the Pianists' Corner FAQ. Because of this, I'll be moderating it fairly tightly to keep it on topic.

Please feel free to weigh in with any advice or information you might think helpful to others. When things have settled, I'll add it to the FAQ section.

Thanks!

K

This is a very well-written article already. I doubt I'll have much to add, but I did see one idea on which I'd like to expand:


Consider adding paying attention to aches/pain you feel after performing the exercise, with particular attention late at night before going to bed. Minor inflammation can take time to swell to the point that it's noticeable, and the symptoms may not occur until hours later -- sometimes during a completely different activity (certainly a lesser problem than what Greg described above, but potentially an early indicator of being on the road to a more severe injury).

One example I use, because it's one I had to deal with, is for salespeople who hold a phone for hours a day. The stress of holding that phone at an awkward angle for several hours each day can add up over time, and you may not feel any aching or pain until hours later. You might notice the symptoms while typing on your computer that night, playing the piano, or even sitting around doing nothing.

Computer programmers, gamers, and any professionals who use their computer keyboards/mice for hours a day might feel similar symptoms. Especially because most people do not type or mouse "correctly". (They plant their elbows/wrists on a flat surface, and twist and extend/stretch fingers and joints to hit the keys they need, or manipulate the mouse to click on something. All bad motions.)

Like I said, obviously this is a much lesser issue than Greg posted about, but I felt it important for inclusion, because these types of aches and pains can (and probably will) lead to the more serious problems Greg listed above. If you can nip it in the bud before it becomes a serious problem, the road to recovery is often much shorter.

Hi Derulux,

You bring up an excellent point. I was focusing initially on First Aid measures, not necessarily the after-care. But it is nevertheless very important to consider how activities of daily living (ADLs) affect your condition. It's exactly the direction that the conversation should go.

If you have an acute injury, I tell people that you should baby the limb that's affected. Don't do things outside of playing the piano that make the condition worse. That includes all the things Derulux said plus others such as:

- house cleaning,
- driving,
- general computer use (a consideration here),
- playing video games (a bigger consideration here),
- carrying groceries (the bag boy/girl is there for a reason - let them help you out with your groceries)
- ...and all the other things you do in your life, including holding drinks at parties. Can't you get your date to do it for you? I'm not joking...

And then there's the telephone. Holding a telephone handset to one's head puts the cervico-brachial area into such a poor posture that I don't suggest anyone do it even if they are perfectly healthy. I never do it. A few years ago, I invested in headsets for every phone in my house, and a wireless one in my office so I can hunt for files or even go to the piano in the next room while I'm talking on the phone. The latter instance is really a lot of fun.

That goes double for a cell phone. The smaller the handset you are working with, the more likely it is that that you will violate the basic biomechanics of the body if you hold it to your head, or even dial a number on that teensy, tiny keypad that no adult human hand could possibly use properly even if they knew how (curse the designers). I use a corded headset with my BlackBerry, and voice-activated hands-free dialing. So should everybody.

If you suddenly find yourself with an injury, don't do things to make it worse, or keep it hurting. The body has the most amazing recuperative powers if we allow it to heal, and create conditions that support the healing. Really, for a sudden-onset injury, we are only talking about a few days.

The color and bold is mine. I trashed both my hands by typing WAY too much, and the wrong way. I had to sleep with wrist supports on both wrists, and at one point I could barely press a single key with RH.

I got about 99% of it back. I never had one tiny bit of a problem coming from playing the piano, and once I found out what was going wrong with the typing I actually was able to rebuild while playing piano.

And I want to also support something else you said elsewhere. Those exercises requiring certain fingers to be held, which we talked about in the Teachers Forum, is also a total no-no for me. I never like them before I had problems with my hands. The did not feel well, so I stayed away from them. But even famous pieces that require special movements, like the Chopin A Minor Eture (chromatic) or the Etude in Thirds, are things I have to approach very carefully, with absolute correct movements.

I haven't read the rest of the thread but wanted to mention these two things.

For me typing is necessary. I like to communicate. But learning to take rests and do it correctly was a huge thing in my life. I was starting to use the use of both my hands.

On the subject of sleep, I experienced recovery setbacks related to sleeping on my right side where I suffered my injury. I would wake up slightly numb in parts of my right hand and up the arm to the shoulder from falling asleep on top of my hand. Even if I went to sleep on the left side sometimes I would wake up on the right again. I had to take additional steps to make sure I slept on the correct side throughout the night.

My injury must have been pretty severe for this to happen but it's just an example of another thing to think about. In my case I also played video games and worked at a desk job with probably poor posture. I eventually quit video games (for other reasons) and learned to use the mouse with my left hand.

Since a large part of my injury was poor practice routine in addition to excessive tension, I returned to the piano with greater discipline in practice and playing pieces that were more appropriate for my level and less likely to cause pain or injury. I still have to be careful to this day so my practice sessions are brief. As I stated in another thread, I never practice for more than 30-60 minutes at a time. This had the added benefit of INCREASING my rate of progress because I realize I was actually wasting a lot of time by not taking breaks.

The Advancing Injury

RSI is a cyclic injury that follows a pattern over the long-term. What starts as a localized, comparatively minor injury can advance into a more complex and obscure series of problems because each step of the cycle contributes to the next, as in the following:





Poor posture or incorrect technique play a complex and prevailing role in these injuries. In a healthy movement pattern, there is a contraction and relaxation phase to each movement. Antagonist muscle groups contract to pull a limb in one direction while opposing agonists relax, and vice versa. Blood is pushed out of the tissues during the contraction phase, and flows back in when the muscle relaxes. Such a movement pattern is easily sustainable over long periods provided other conditions are met. It also promotes mobility in the limbs performing work.

This cycle changes when posture or technique are poor. In that circumstance, antagonists and agonists begin to contract while the opposing muscle group has not yet relaxed. The dynamic, contraction/relaxation pattern in the muscles then becomes static and isometric in nature, where neither muscle group undergoes a relaxation phase so long as the posture or movement pattern is maintained. The prolonged contractions stress the tissues bearing the static load, leading to microscopic damage at the cellular level. Soft tissues are affected initially, and edema becomes a problem as mentioned earlier. So do other adverse physiological conditions. The prolonged isometric contractions induce ischemia, or a lack of blood in the tissues, so long as they are maintained. This contributes to hypoxia, or a lack of oxygen, in the remaining blood fluids and tissues. In the absence of oxygen, damaged tissues are replaced with fibrotic scar tissue. At this level, the body is unable to heal itself from such damage in a 24-hour period. So the cycle repeats as the executant starts work again the following day, the damage building on the scars and detritus from the previous day. As irritation and discomfort increase, technique and posture deteriorate further, exacerbating the conditions that brought on the injury in the first place.

The damage from RSI accumulates over time. In general, the syndrome goes through three stages of progression:

Primary: Initially, damage occurs at a cellular level and is microscopic. This provokes a complex chain of physiological events that prevent damaged tissue from healing completely. RSI usually begins as a localized tendinitis, and can affect any part of the upper extremity from the shoulder girdle to the fingertips. Irritation can also lead to localized edema, or swelling. Irritation of the membranes that surround the muscles and tendons can lead to tenosynovitis.

Secondary: The previous conditions become more pronounced and generalized. Localized fibrotic scar tissue can spread to other surrounding tissues and literally “glue” them together, further hampering mobility. Edema can not only spread but also become more severe. When these issues encroach on neighboring structures, the most common events that occur are various conditions that involve mechanical compression of the nerves that pass through the upper extremity. These can include carpal tunnel syndrome at the wrist, compression of the ulnar nerve at Guyon's canal also at the wrist, cubital tunnel syndrome at the elbow, and compression of the brachial nerve plexus at the thoracic outlet, compression at or near the cervical foramena at the neck, and others. It can also lead to stenosis or the narrowing of the passages of the synovial sheathes around the tendons, commonly referred to as trigger finger.

Tertiary: A number of syndromes can appear at the end-stage of RSI, and these include several chronic pain syndromes such as Reflex Sympathetic Dystrophy and Fibromyalgia, as well as permanent damage to the nerves under compression. Physical degeneration can also be implicated in end-stage RSI in the form of muscular atrophy, degenerative joint disease or osteo-arthritis and the like. Lastly, and most poorly understood, is Focal Dystonia, a neurological disorder resulting in involuntary muscle contractions associated with certain movements patterns.

Towards the end of 2008 I began to experience painless, involuntary movements and cramps in the index finger of my left hand. By association, the dynamic balance of the rest of the hand became unreliable, with conscious correction of one thing leading to a new spasm somewhere else. Sometimes, conscious effort to correct it did result in soreness, which complicated things still further. Moreover, the issue appeared only during piano playing, and its distribution over various types of movement, different ways of playing, was uncorrelated and unpredictable. Slow playing did not ameliorate it, neither did rest. It was a complete puzzle. It was neither visible nor audible to observers but while playing I was in a constant internal battle for breath. It did not help that musicians laughed at my concern and said they wished they could play as well.

To cut a long story short, it is all but gone now, and I play much better than ever. But getting rid of it was one of the hardest things I have ever had to do. It was so personal, so specific to my whole playing philosophy, highly individual at the best of times, that I doubt an expert would have been any use. No way was I going to compromise my music without a fight, so I turned every playing session into a sort of laboratory, kept diaries about what appeared to work and what did not. Eventually, through innumerable relapses, I found the answers. I shan't post details, as most of them would just seem peculiar and silly, and worse, what was right for me might damage somebody else.

I think I can say, however, that the root cause, as the original post suggests, lay in habituated, automatised, forceful playing of a rather restricted type, over a long period, albeit toward a thoroughly worthy musical end.

Hi All,

This is a subject near and dear to my heart. I'll spare you the details of my personal experiences but I encourage anyone dealing with these issues to check this out.


www.musiciansclinics.com
Toronto Star 2012/07/10
Video Interview: Dr. John Chong

905-574-5444

This man is brilliant. He has saved my life, my art and my career several times and in several ways over the past 15 years.
He operates a private clinic near Hamilton Ontario and is now a consultant at the Faculty of Music, University of Toronto.

Whether your issues are physical, emotional, professional or psychological, this man can bring you back. Using state-of-the-art technology,combined with ancient wholistic techniques, he can find what needs to be "fixed" and how to do it. He takes the time to learn about each patient as an individual and from a musicians perspective. His credentials, experience, training and results speak for themselves.

I am not advertising or endorsing anyone. I DO encourage musicians, dancers, performance artists, atheletes or anyone dealing with injuries on any level to simply take a moment and do some research. You will not be disappointed.

Good luck and good health to you all.

Best,

Concertdeck
Aug 9, 2013

A small point- according to what I've read, Tylenol (acetaminophen), unlike aspirin and ibuprofen, is not anti-inflammatory.

For the inflammation, anyone care to confirm that these are helpful?
Drink lots of water
Drink green tea and/or coffee
Drink red wine

The coffee and red wine are just nice either way!

Hi T,

Yes, it is important to stay hydrated if you have an injury. However, anything containing caffeine and/or alcohol is actually dehydrating. If you do drink a lot of tea or any alcohol during recovery, you need to offset the hydrostatic loss by drinking water. But I agree, they are quite nice!

The diet generally needs to be very good during recovery, including increased amounts of anti-oxidants such as vitamin C, vitamin E, et cetera, and abundant protein.

Hi Jo,

It's always good to check these things, so I looked up acetaminophen in my Materia Medica. And apparently it does have anti-inflammatory properties as it seems to inhibit the production of prostoglandins that contribute to edema.

I think its popularity has fallen off in recent years because it's very hard on the liver and kidneys and especially in the presence of alcohol. Aspirin and ibuprofen are much less so.

Hi Concert,

Is this clinic part of the National Health Service, or is it a cash-only place?

It would be very nice if we could get a list going of music medicine clinics wherever we find them. When people have serious problems that I can't help them with, I usually refer them to university teaching hospitals that have a music medicine department on campus.

Excellent thread/posts.

In a nutshell, be kind to your hands, arms, wrists, etc - your body. As piano players, we all know that the brain has to learn stuff slowly and must be done accurately.

When it comes to injuries - injuries take a very, very, very long time to heal.

So there is an incentive to be kind to your hands because they will last a lifetime of painfree use.

If you are not kind to your hands - and you start getting pain - it can easily take 2 to 5 years of being extra kind to your hands before the hands are painfree again.

So, you see, that you will pay in spades if you
abuse your hands!

Because 2 to 5 years is a long time to suffer not being able to use your hands.

I can speak to the phone-to-the-ear syndrome. I did it on a job for about 13 years and it was still as many years later when it took its toll. My chiro said this is not unusual, as the body ages, old bad habits exact their price.

Also - gals out there: Nix the heavy shoulder bags. If you can't lighten the cargo, at least get into the habit of switching shoulders on a daily basis. When you notice that the bag wants to slide off one shoulder, then you KNOW you've been running around lop-sided.

Yes -- on both counts.
It's a relatively small point, but it's also right and it was worth noting. The reason I'm chiming in is that there was a rebuttal, and I thought it would be good to help keep the medical details accurate, since this thread has been given a "sticky" and apparently the site wants it to be considered a reference.

While it's possible that one could find mentions of some effects that have a theoretical anti-inflammatory aspect, acetaminophen is not in any significant or clinical manner anti-inflammatory and it's simply misleading to say that it is.

By the way, the rest of what I'm seeing on here seems quite good, although I can't help bristling a bit at the general way in which some of the material is being presented, including the physiological aspects of what happens with such injuries as well as the treatment approaches. I do believe that the principles and approaches apply to many situations, perhaps most, but they don't apply as generally as seems to be stated.

P.S. Smaller point: "Prostaglandins" has an 'a' in the middle, not an 'o.'

Hey, Mark_C: You took my head off for supposed inaccuracies in my original thread. So, hows about you doing the same thing here.

First, Laguana Greg lists the website to his "business" at the bottom of every post. If you did that while giving psychiatric advice on this website, the New York State Board of Medical Examiners would have your license on a platter!

So, Kreisler, this man, who practices physical therapy in the State of California is giving medical advice on this website. Now, I realize that being from San Antonio, unlike Brendan from McAllen, this is not yet "tedious."

However, it is blatantly unethical. Arbitrarily giving it a "reference" designation does not take the lipstick off of the pig.

If Neal Peres Da Costa, Kenneth Hamilton, of Clive Brown tried to do the same thing regarding historic performance practice, they would be thrown out on their ears.

PW, you cannot have it both ways!

Louis:
A couple of things....

First of all I continue to be surprised at the seeming tension between you and Greg, because I'd had the impression that you and he were essentially allies. Sure, there are differences in the details of how you see these things, but it's an interest that the two of you share, and I really think that broadly speaking, the two of you are on a similar page. (I'm aware that you may not see it this way at all.)

That said, I agree with you that this thread has no business being viewed as a reference and I was quite shocked that it was "stickied," but I figured it is what it is, and as long as this is what it is, I'll at least help avoid gross inaccuracies and try to temper the flat-out-ness of what Greg posted.

Music Medicine

RSIs have long been documented in the medical literature. In 1700, the Italian physician Bernardino Ramazzini first described RSI in more than 20 categories of industrial workers in Italy, including musicians and clerks. Yet despite this history, the diagnosis and treatment of musician's injuries is a relatively recent occurrence.

I got involved in this field because I myself was injured practicing for auditions in high school. When I first started started studying the subject at the Taubman Institute in the early 80s, the climate was very different than it is now. RSI was not yet a recognized occupational injury in the US, or anywhere. Computers had not yet made their major penetration into either the workplace or the home, so RSI had not yet become the epidemic problem it did in the 90s. Major musicians were still keeping the great secret about their own injuries very much to themselves. The idea that musicians even got injured was highly controversial. Music medicine was not yet even thought of as a medical sub-specialty. So musicians of any kind had no place to go, and no resources available to them, when they experienced problems.

Emil Pascarelli was the first doctor I remember coming across who did research about musician's injuries. He co-founded the Miller Institute for Performing Arts Medicine at St. Joseph's Hospital in New York about the time I got involved with the Taubman Institute. He and his team published some of the first clinical research available about this subject. In the 90s, he and his team also began applying the same clinical methodology to injured computer users. He and early researchers such as Alyson Brandfonbrenner, Christina Zaza and a few others developed the initial body of research that became the basis of music medicine.

When I first began to work with injured pianists in 1991, there were very few doctors who understood the medical problems of musicians. I used to refer anybody who needed more orthodox treatment to doctors at a select few university teaching hospitals. Those were the only places you could find providers versed in music medicine.

Luckily, that has all changed. Today, there are enough specialist providers that professional societies have formed to support this perspective in medical treatment. Here are a few contacts you might use if you are looking for a doctor. This list is not meant to be exhaustive. Rather, it's a point of departure, a place to start your search for someone to work with if you are seriously injured:

In the United States:

The Performing Arts Medicine Association
http://artsmed.org/

This group is a professional association for providers and researchers in North America. Their website has a searchable database of their journal articles, which might very well be the most exhaustive resource on the subject available. Their journal, "Medical Problems of Performing Artists" is the first scientific medical journal devoted to the etiology, diagnosis, treatment, and prevention of medical and psychological disorders related to the performing arts. Original peer-reviewed research papers cover topics including neurologic disorders, musculoskeletal conditions, voice and hearing disorders, anxieties, stress, substance abuse, disorders of aging, and other health issues related to dancers, singers, musicians, and other performing artists. (this last from their web site)

In Great Britain:

The British Association for Performing Arts Medicine
http://www.bapam.org.uk/

This is a privately funded charitable organization that does some of the same things as PAMA in the US for a little over 25 years. They also provide referrals to medical providers vetted by their selection committee, publish a journal, and promote public awareness about performing arts medicine, and several other functions.

In France:

La médecine des arts
http://www.medecine-des-arts.com/

This appears to be a professional association similar to PAMA in North America. They publish a journal, "Médecine des Arts", provide referrals, hold symposia, support research, and so forth.

I haven't yet found other resources on the continent, or in Asia. If anybody has more information, please add to the list.