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Drummer Lars Ulrich of Metallica plays at the Opera House in Toronto, on Tuesday.Mark Blinch/The Canadian Press

At the Metallica show this week at the small-venue Opera House in Toronto, the singer-guitarist James Hetfield addressed an audience. "Do you want it heavy?" he bellowed.

The crowd, a sausage party of dads, record-label personnel and other refugees from the nineties, replied affirmatively, with gusto and the requisite devil-horn-hand-gesture exclamation. Hetfield responded with a roar and a promise: "Toronto, Metallica gives you heavy!"

Which they did, for a while. Shortly after Hetfield's rally call, an older fan was brought back into the lobby where he was put on oxygen by paramedics. Some of the concert was marked by what could charitably be called "loose" performances. The band played For Whom the Bell Tolls, an ominous metal-rock classic about war, wounds that test pride and time that marches on. Metallica, superstar thrashers now middle-aged, plow forward, but not as easily as they once did.

The next day, the band's chatty drummer, Lars Ulrich, talked about the struggle of the night before. "During the last half of the show the air got really thick in there," says Ulrich, who was in town to promote Metallica's latest album, Hardwired…to Self-Destruct. "For a bunch of guys in their early 50s, fighting winter colds and sinus issues, it was a little challenging."

Earlier this year, Ulrich attended this year's Desert Trip, a three-day festival in the California desert featuring Bob Dylan, the Rolling Stones, Neil Young, Paul McCartney, the Who and Roger Waters. "Did you notice the drummers?" Ulrich asks. "Only one of them was still an original."

I hadn't thought of it, but it's true. Charlie Watts from the Stones is still keeping time at the age of 75, but the Who's drummer, for example, is Zak Starkey, the second-generation son of drummer Ringo Starr. "If every singer at Desert Trip was 70 and change," Ulrich says, "only one drummer was in his 70s."

The attrition of drummers, Ulrich continues, "It is a real thing."

The issue of drummers and health has bubbled up of late. Phil Collins's new memoir comes with a cheeky title (Not Dead Yet) that refers, in part, to debilitating health caused by 50 years of hitting things with sticks. After a Genesis reunion tour in 2007, an MRI revealed that Collins had crumbling neck vertebrae. "If I don't have an operation forthwith, paralysis and a wheelchair are in the cards," he wrote.

Collins's case isn't an isolated one. The recent rocumentary Time Stand Still follows what was likely the final large-scale tour by the Canadian rock trio Rush. The band's retirement from the road has happened, in large part, because of drummer Neil Peart's tendonitis and diminishing physical abilities. "My style of drumming is largely an athletic undertaking," Peart wrote in a farewell piece published in Drumhead Magazine. "Like all athletes, there comes a time to … take yourself out of the game."

Peart's analogy to sports is spot on, according to Dinah Hampson, a physiotherapist and owner of Toronto's Pivot Sport Medicine Clinic. "I have drummers who can't feel their hands, who can't hold their sticks," she says. "And the first thing I ask them is, 'Have you been to the gym today, have you done any push-ups this week, have you prepared your body for the physical tasks that you are now demanding that it does?'"

Common problems include frayed tendons from overuse and repetitive strain damage to the small muscles of the hands and forearms. Unless the injuries are treated – usually through strengthening and physiotherapy that involves finding muscles to compensate for the damaged ones – the problems only get worse as the drummer ages.

Drummer Mike Belitsky, 50, is a member of Toronto's Sadies, the favourite psychedelic-country band of Gord Downie, Margaret Atwood and Neko Case. When he was younger he played through any physical issues, figuring they'd dissipate. "But all of sudden you hit 45," he says, "and it becomes something that won't go away."

Belitsky has battled tears in his common extensor tendon. He's endured cortisone injections and had to wear a brace after shows during tours. Even mundane activities are affected. "Brushing your teeth becomes a choreographic routine," he says.

Along with quality-of-life issues, Belitsky's health has him concerned about the Sadies. "That's my biggest fear," he says. "That my injury will change the way I play and change the way the band sounds."

As for Ulrich, he's avoided anything severe when it comes to drummers' maladies. In the 1980s, he began having issues with his hearing. "I would get up from my bed in a hotel room to go turn the television off," he says. "But the television wasn't on. The sound was in my head."

Since then he's issued ear-protection devices to guard against the clash of cymbals and the snap of snare drums. As well, Metallica employs a staff of physical therapists, trainers and massage specialists on the road. Ulrich runs, stretches and does torso-strengthening exercises as a matter of course. "I work out rigorously," he says. "More than I practice the drums."

Still, the bell tolls. "I understand what Neil is saying," Ulrich says, referring to the Rush drummer's reluctance to perform at a less-than-peak level. "It's the same for me."

Jazz drummers such as Max Roach and Elvin Jones played into their 70s. Ulrich's not sure his more punishing style will allow for such graceful aging. "I don't know if I, or the band, can bring the weight and the energy to what Metallica music requires physically," he says. "That's something we'll have to find out as we get further down the road."

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