The role of rest.

T he article by Haben 1 in this issue of Medical Problems of Performing Artists describes one expert clinician's approach to the use of rest in treating voice problems in singers. In the absence of well-designed randomized controlled trials of voice rest for various vocal problems (and little in the way of other research on the topic), expert opinion is the best guidance available. Performing artists of all types have to make decisions on a daily basis about how to balance practicing and performing versus resting and recovering from those activities. Likewise, both teachers and health care professionals who work with performing artists are in a position to advise musicians, dancers and others about when to rest and when to engage in specific types of practice and performance. For all involved, these questions apply to both the prevention of performance-related injuries and for their treatment. Dr. Brandfonbrener wrote an editorial 2 on this very subject 21 years ago. Titled " 'R' is for Rest, " it raised critical questions about the use of rest to treat and prevent performance-related injuries in musicians and called for scientific guidelines. Unfortunately, we don't have much more evidence on which to base scientific guidelines in 2012 than we did in 1991. Mamie Air and Boni Rietveld wrote some guidelines for the use of rehabilitation of injured dancers that was published in MPPA in 2008, 3 but these too are the recommendations of expert clinicians. The following paragraphs will attempt to provide a brief overview of these issues as they relate to performing arts healthcare based on what we have learned over the last two decades. W hat do we know about the use of rest to treat acute muscu-loskeletal injuries in the 21st century? A review article published in 2004 4 in the Journal of Family Practice concluded that rest is not beneficial in the treatment of acute upper or lower extremity injuries, including both fractures and soft-tissue injuries. In fact, many of the 49 randomized controlled studies that met the inclusion criteria for this systematic review showed that early mobilization results in improved outcomes. For ankle sprains, immobilization in a cast did not improve outcomes. However , it's not clear from the way the article was written how patients with non-fracture upper extremity injuries fared with rest/immobilization versus early mobilization. But what about subacute and chronic injuries, which are more typical in the …