Performing artists need specialized rehab care
Musicians and dancers seek specialized care
The Rehabilitation Institute of Michigan in Detroit provides area musicians, ice skaters, and dancers with rehabilitation care that is designed specifically to help them heal while continuing to pursue their art.
"The types of injuries your performing artists are going to have are somewhat different from your average sedentary type of individual," says Kim Dunleavy, PT, MS, OCS, assistant professor at Wayne State University and a clinical associate at the institute.
"What any performing artist does is very repetitive," Dunleavy explains. "So for both musicians and dancers, the amount of practice and performance they put into doing these same activities means they are very susceptible to building up forces in the body that are unique to their particular professions."
For example, a violinist must keep the head tilted at a certain angle for a long period of time, and the wrists also are in an angulated position for hours at a time, Dunleavy says.
"This means the muscles and tendons going around the wrists are going to be stretched and taking a lot of force," she says.
Likewise, dancers will work in extreme positions of hip turnout and rotations, putting pressure on their ankles to hold unusual positions and to absorb the forces of jumps.
"So the differences in the types of injuries performing artists sustain means that if you do traditional rehab where you just address recovery from acute inflammation and strengthening and making sure their ranges of motions are adequate, that’s not enough for this clientele," Dunleavy maintains.
"There needs to be a detailed analysis of biomechanics of the type of movement that they’re doing," she adds. "And there needs to be re-education of the most efficient position and movement technique."
For example, suppose the rehab patient is a ballet dancer who has knee problems. The way the dancer turns out her hip is using more turnout from the knee rather than from the hip. So the therapist will need to take the dancer through his or her daily ballet positions and make sure the knee is not turning out, Dunleavy explains.
"When you get into treatment techniques, the exercises should be adapted for the positions that the performing artist is going to be creating on a daily basis," Dunleavy says. "In a way, it’s like sports, where you need to recreate the sporting activity and strengthen the body for those activities."
The difference is that with performing artists, there is a creative component, which means the performer needs to focus on more information.
We problem-solve with them’
At the Rehabilitation Institute of Michigan, therapists working with performing artists teach them how to adjust their practice schedules and how to adapt their positions and movements while they are practicing and performing, Dunleavy says.
"We try to work with them and their coaches, teachers, or mentors on their skill or craft in order to find the most efficient way of producing their music or their dance."
The institute has a wooden floor with a spring to it, so dancers and therapists can work on the dancer’s jump. There also is a ballet bar and a room that is mirrored on all walls to permit the therapist and performer to see all angles, which makes it easier to correct a movement.
Musicians are asked to bring in their instruments and demonstrate their practice and performing positions.
"We problem-solve with them," Dunleavy says. "We don’t profess to be experts in every type of performing art, and we get different types of people: cellists, ballet dancers, Irish dancers, modern dancers, and each type is different and has different methods."
So therapists learn to improvise and rely on the clients to bring their skills to the process of deciding, through mechanical analysis, how to spread out the forces that are injuring their joints and limbs.
The performing arts team includes two physiatrists, physical therapists at both the downtown Detroit and suburban rehab facilities, and occupational therapists who work primarily with the musicians.
Physical therapists generally become performing arts specialists because of their own special interest in the field. Most have been involved in some performing art, such as dancing or skating, Dunleavy says.
"We developed the techniques ourselves, and we have hobbies that have benefited us personally, and these benefit our knowledge in terms of rehab," Dunleavy says.
Also, the performing arts therapists will share with other staff what they know through inservices.
Most of the reimbursement for the service is handled the same as traditional rehab, but there are some differences in how this needs to be documented, Dunleavy says.
Whether the clients are professional or amateur performing artists, they have expectations that their recovery should include their continued ability to perform their craft. Therefore, therapists should not use standard muscle strength and conditioning rating systems to determine when the patient has achieved optimal recovery, Dunleavy says.
Standard criteria not sufficient
For example, a dancer has to be stronger than the normal population, so when a therapist is judging an injured dancer’s muscle strength, the therapist should not grade the achievements according to what a normal, non-athletic patient might achieve. A grade 5 for a sedentary 50-year-old would not be the same grade 5 for a strong 20-year-old dancer, Dunleavy says.
The institute has treated a variety of performing artists from across the Detroit metropolitan area, including traveling ballet troupes, professional ice skaters, singers, actors, and symphony musicians, Dunleavy says.
"Except in the major areas of the country, you won’t have an entire patient clientele base that consists of performing artists, but there is a need for rehab facilities to at least have some therapists with specialty knowledge about the performing arts," Dunleavy says.
You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
- Award-winning Medical Content
- Latest Advances & Development in Medicine
- Unbiased Content