Occupational Therapy
Research Briefs
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Behind the scenes at the Broadway show "The Lion King" at the New Amsterdam Theater lies a drama the audience knows nothing about. It's a story about makeup artists who suffer from physical injuries due to the strenuous nature of their work and the help that came to them unexpectedly from a group of occupational therapy students at Columbia.

Working on Broadway isn't all glitz and glamour. There's also pain, something Elizabeth Cohen, supervisor of "The Lion King" makeup crew, can attest to. Ms. Cohen has suffered with a severely irritated thumb joint on her right hand and has experienced chronic shoulder and back pain for several years. Other makeup artists also complain about joint and muscle pain.

Ms. Cohen developed tendonitis five years ago from contorting her body while applying actors' makeup. A seemingly benign switch from using water-based paint to grease paint precipitated the damage – grease paint requires the use of tools with small handles that must be gripped tightly as opposed to the tools for water-based paint, which have thicker handles and are easier to manipulate. The tension of using the new tools aggravated her thumb joint. In December 2003, Ms. Cohen's condition forced her to take a leave of absence.

This is where a student in Columbia's program in occupational therapy enters – stage left – and the plot thickens. The student, Ali Lesch, and her classmates, were assigned a project in a class called "Occupations," taught by Danielle Butin, instructor in occupational therapy. They had to find people with interesting occupations, analyze the physical and psychological requirements needed to perform their jobs, and contribute recommendations and perspectives on ways to reduce repetitive work-related injuries and improve function. Students were required to present the person interviewed with a set of recommendations specifically targeted to the individual's environment.

Ms. Lesch and her classmates, Alexia Lantzounis and Donna Lick, visited the "Lion King" production at the theater to watch the makeup artists at work. They observed that the artists engaged in repetitive hand movements requiring the use of a great deal of arm strength. They noted the way the artists moved, sat and stood. They realized that the way they opened makeup jars could lead to joint inflammation in the wrist and fingers, causing pain, stiffness and fatigue and that the way they grasped paintbrushes could cause tightening of muscles in the wrist and fingers. They saw that the artists' shoulders were often in an outstretched position while reaching to paint a performer's face, which can cause stiffness in the neck and shoulder.

In addition, the cramped space the artists work in prevents proper movement. The way products are set up and the manner in which artists move around as they apply makeup to the actors aggravate lower back and shoulder pain.

This past January, the students presented their report and recommendations. Those included a good deal of avoidance – of placing sustained pressure on the back of fingers and thumb, of remaining in one position and bending the back for long periods, and of reaching and gripping with an outstretched elbow and a bent and twisted wrist. The students also recommended the use of aids such as a foam grip that builds up tool handles to protect hand and finger joints. Other recommendations included using a tall stool on wheels so the artists can sit or stand while applying makeup and a small step stool so the artists can raise their legs eight inches off the floor to alleviate back strain.

As the curtain comes down, Ms. Cohen says she is going to closely follow the students' recommendations and pass them on to her crew.