Performing arts medicine

[dancerMD]

I am a third year medical student planning on going into PM&R. I am interested in performing arts medicine, and I am wondering if anyone knows of programs that offer performing arts medicine. Thanks!

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[axm397]

Dr. Brandfonbrener at RIC does performing arts medicine. We also cover the Ravinia festival, which is a big music/performing arts festival in Chicago. (We as residents can cover events and get 2 free tickets when we cover.)

 

[mehul_25]

Dr. Scott Brown the chair at Sinai in B'More has a special interest in this field. In fact I was at a spine conference today in Richmond where he presented on that very topic.

 

[stretch210]

Dr. Scott Brown the chair at Sinai in B'More has a special interest in this field. In fact I was at a spine conference today in Richmond where he presented on that very topic.

mehul_25...I believe Dr. John Toerge at Georgetown/NRH (where you are at) is a specialist in that as well.

 

[bbbmd]

I am a third year medical student planning on going into PM&R. I am interested in performing arts medicine, and I am wondering if anyone knows of programs that offer performing arts medicine. Thanks!

Rebecca Clearman, MD in Houston (was previously faculty at Baylor/UT, now in private practice) wrote the chapter in Delisa's text. A few of the residents interested in it here spend time with her in her free clinic and we had a very interesting lecture on it --> she brought a cellist and a dancer in. This is a VERY interesting component of musculoskeletal medicine!!! Unfortunately, there's not much money in it since a lot of the performing artists do not have good insurance plans (if they have insurance at all), unless of course they are professionals. The performing arts clinic at TIRR closed several years ago and I hear it was because of this reason--> It could not support itself. That's why Dr. Clearman runs a free clinic once a month. She provides an excellent service for the artists in Houston.

How are the performing arts programs run in the other centers across the country??? I found this topic an awesome application of our basic MSK training and would also like to learn more about it through the experiences of other centers.

B

 

[fozzy40]

What exactly falls under "performance arts?"

 

[mehul_25]

Actually Dr. Toerge and Dr. Kathleen Fink both of whom are at NRH see a considerable amount of patients whose backgrounds are in the performing arts. Dr. Fink sees a lot of musicians and dancers and Dr. Toerge sees more of the dancers.

 

[melancholy]

My impression as a medical student is that many physicians who have a medical interest in performing arts medicine do it on the "side" rather than have it as their primary focus of practice (although there may be exceptions). They tend to practice in more urban settings as this is where you find a greater concentration of possible clients who work in orchestras, dance companies, bands, theatre, etc.

From my limited exposure, it seems like many get interested due to previous involvement with playing musical instruments, singing, dancing, etc. It definitely is an interesting part of the PM&R spectrum that I would like to get involved in in the future.

It seems like PAMA (The Performing Arts Medicine Association) is one of the main organizations dealing with performing arts medicine. The website is http://www.artsmed.org.

Has anyone ever checked out their Aspen Symposium they hold annually?

 

[Hemisphere]

agreed... i found most people don't only do performing arts medicine, still as one doc told me if you want to be a specialist in an area just see those patients and do research in that area. simple and sound advice.

then to treat performing artists it really helps to be a performing artist at some level to earn their trust
some areas are
brass musician performing arts - the PD at alb. einstein/montefiori does this, draws on pulmonary rehab, also tendinitis, etc.
string musician performing arts
voice/vocals - learning to do endoscopy/laryngoscopy and assess the needs of singers, and actors
dancers, gymnasts, and other athletic performing artists

also you need to be where the performing artists are!
there is the Miller Institute of performing arts medicine in NYC, which is affiliated with columbia.

 

[PMnRDancer]

Another good resource for dance medicine is IADMS (the International Association of Dance Medicine and Science). They even publish articles in this field in their quarterly peer reviewed journal (just got my newest copy today). I also know that there is the Harkness Center for Dance Injury (part of NYU), but I think that is more the ortho side of things.

Just a little background: I am a third year medical student also applying for a PM&R Residency very soon. I appreciate the discussion we had in the past on this thread, and am wondering if anyone has had any additional experiences or interactions at their institutions, specifically working with dancers.

As an undergraduate, I created many works with artists who were wheelchair bound, mostly from spinal cord injuries. For more information on professional artists who have inspired much of my work, just google Victoria Marks or the Candoco company in Canada for a piece entitled "Outside In". (Side note: Although I wasn't involved in that piece, I did have a chance to work with "Vic" when she was doing a residency at my school [residency = visiting artist]... and have helped choreograph several dance pieces that were less about the wheelchair and more about the movement.)

Anyway, my whole reason for entering PM&R is because I am intimately aware of how important movement is in shaping our sense of identity [insert more mushy stuff that I will most likely incorporate into my residency application... to be written very soon.. ack!], so if anyone has any additional information on doctors who work with dancers --- I would greatly appreciate it. I kind of like the idea of offering a monthly clinic for artists who are generally unable to afford insurance.

Thanks in advance for the info!

 

[Disciple]

A little off topic, but I'm wondering why when we, as Physiatrists, speak of Performing Arts Medicine, Dance Medicine (and this goes for all the lectures I've heard on the topic), etc., without explicitly saying so, it always refers to Ballet, classical music, etc.

How about hip hop? Break dancing?

Pole injuries?

Just kidding.

In all seriousness, I have a couple friends with chronic lumbar radics from breakdancing.

I also have a rock drummer in my practice with chronic wrist synovitis and medial/lateral epicondylitis, and a bass guitar player with cervical spondylosis and weak scapular stabilizers.

I liked classical music as a kid, and still do, but think that we could spice things up a bit, especially in PM&R.

Anybody else feel this way?

It's kind of like sports med.

I've covered plenty of big races, but would have liked to have been on the sidelines for some high-level football games, maybe ringside for boxing or MMA. When I was resident, the attending team docs and fellows all got box seats to the ALCS. Not enough tickets left for me unfortunately.

Anybody here done hockey? Power lifting?

 

[caedmon]

I recently worked sideline for Randy Jackson's "America's Best Dance Crew"...


Kidding of course. Those guys do some crazy stuff though.

 

[PMR 4 MSK]

Anybody here done hockey? Power lifting?

We cover an AHL team. We see some interesting injuries. I love going to those games. Hockey crowds are ruthless. I've triaged a lot of fractures, diagnosed and treated a lot of MSK injuries, sewed up a lot of guys during the games - many don't want any local. IMO hockey players are some of the toughest mofo's around. Worst injury besides guys getting knocked out that I've seen was a fratured jaw from a puck combined with a laceration.

We used to have a non-NBA basketball team, might be getting another, that we covered. Also have a Frontier League Baseball team that we are the docs for. We've been asked to cover our arena football team, but we're already stretched pretty thin. We also cover local high school and college sports.

 

[ostensibly]

Harkness is run by a couple of ortho docs, but a huge majority of their cases are treated non surgically. I think most of the operations they do are hip replacements in older dancers. They use the outpatient PT/OT gyms at HJD where we also rotate. NYU/Rusk PM&R residents don't formally rotate through Harkness but the ortho docs are very welcoming, we have plenty of opportunities to drop in and we have lots of elective time (3 months).

check out this link for their conference this July.
http://www.med.nyu.edu/hjd/harkness/edu_programs/cme_08.html#

 

[drusso]

Pole injuries?

Exotic Dance Medicine (EDM)....this *is* the next frontier for physiatry...I imagine you see some pretty refractory cases of gluteal tendinitis in that sub-specialty!

 

[medicineman1]

what a great specialty- move to Vegas - and open up a flourishing business! Im in!

 

[Disciple]

I imagine you see some pretty refractory cases of gluteal tendinitis in that sub-specialty!

Gotta work hard for the money!


Anyway, I'm sure it's happened before. Someone falling off the pole. Cracked vertebrae.



Think there are any of them out there with fusions?

 

[PMR 4 MSK]

Gotta work hard for the money!


Anyway, I'm sure it's happened before. Someone falling off the pole. Cracked vertebrae.



Think there are any of them out there with fusions?

I had a chronic pain pt s/p L4-S1 fusion from MVA, who was also an exotic dancer. Bipolar too. And on Medicare with Medicaid (I'd love to see that disability case in court). Her career was ended at age 26 with a second MVA (passenger) when she wasn't wearing her seatbelt and hit the windshield. Even plastics and makeup couldn't hide the scars on her face.

 

[PMRMD2B]

I had a chronic pain pt s/p L4-S1 fusion from MVA, who was also an exotic dancer. Bipolar too. And on Medicare with Medicaid (I'd love to see that disability case in court). Her career was ended at age 26 with a second MVA (passenger) when she wasn't wearing her seatbelt and hit the windshield. Even plastics and makeup couldn't hide the scars on her face.

It is always tragic when a promising career is put to a hault so early. And some say seat belts are worthless...

Doc.. that patient seems like a mess...I have noticed a lot of "exotic dancers" being bipolar..and most of them have a drug problem too. They alway wonder why bad stuff always happens to them..

I am with you.. I could see an attorney questioning her disability in a court room. I bet she was on medicare/caid, but still drove a nice car, had a nice place to live and nice clothes.

Did she have any significant perm. impairment as defined in the AMA Guides from her fusion?

 

[drvlad2004]

I am a third year medical student planning on going into PM&R. I am interested in performing arts medicine, and I am wondering if anyone knows of programs that offer performing arts medicine. Thanks!

I did an elective/interview at the Wash U in St. Louis sports & spine program. I know that Drs. Heidi Prather and Devyani Hunt both treat and work with dancers in performing arts and not the exotic dancing kind

 

[PMR 4 MSK]

It is always tragic when a promising career is put to a hault so early. And some say seat belts are worthless...

Doc.. that patient seems like a mess...I have noticed a lot of "exotic dancers" being bipolar..and most of them have a drug problem too. They alway wonder why bad stuff always happens to them..

I am with you.. I could see an attorney questioning her disability in a court room. I bet she was on medicare/caid, but still drove a nice car, had a nice place to live and nice clothes.

Did she have any significant perm. impairment as defined in the AMA Guides from her fusion?

She lived with whichever boyfriend wasn't beating her at the time. Don't know what she drove. I figure if she could still dance, she shouldn't be on disability, but probably got it for the bipolar, Dx'ed as a teenager. I doubt she ever worked a different job. Pot smoker too. Go figure.

 

[Disciple]

It is always tragic when a promising career is put to a hault so early.

I can't tell if you're joking.

The medicaid/nice car thing, I think that's a problem with our society in general, not just the stripper (I don't see a need to be PC here) population.

I've never seen one on disability through a work-comp claim though. Maybe they're not covered.

Independent contractors?

 

[PMRMD2B]

I was teasing about the career thing. I had a dancer as a patient once that was on medicaid, but as we talked about her "career", she said she made over 200K a year dancing.... All cash, no taxes. Of course she had a nice mercedes, nice jewelry (she wore a $10K rolex) and lived in a really nice neighborhood in our area.

It just goes to show no one goes to medical school for the money.lol

Not really related to the post.. but I also had a patient who was a hair stylist.. she made $150K a year, cutting hair.. never went to school for it! She had her shop out of her house, so no overhead. What were we all thinking?...haha

 

[Disciple]

I was teasing about the career thing. I had a dancer as a patient once that was on medicaid, but as we talked about her "career", she said she made over 200K a year dancing.... All cash, no taxes. Of course she had a nice mercedes, nice jewelry (she wore a $10K rolex) and lived in a really nice neighborhood in our area.

It just goes to show no one goes to medical school for the money.lol

The societal issues I was talking about. How many physicans do you know who wear $10K Rolexes?

Even the ones making $500K/year.

I have a work comp patient on permanent disability. Walks with a cane, hunched over greater than 45 degrees. Parks in our handicap spots and always needs a medical assistant to help him get into his $100K sports car on the way out.

The thing is, I don't think he's a malingerer. Functional overlay up the butt, but not a malingerer.

Anybody have a link to that study showing a lower rate of disability after cervical whiplash, in which European country?

 

[drusso]

Anybody have a link to that study showing a lower rate of disability after cervical whiplash, in which European country?

I think that it was one of the former Czeck Republics or something like that. Fascinating paper...someone should dig it up.

To your point, I think that Americans just don't "suffer" well. At least those born after 1927. Now, I believe in managing pain aggressively. I've written for mega-tons of opioids in my short career. I'm not opiophobic. And I'm sure there's some DEA agent out there licking his chops every time my pen clicks, but...

Case in point: I saw an 84 y.o. guy in clinic the other day (typical "greatest generation" guy) with metastatic lung CA and supraclavicular mass eroding through his neck. He's status post XRT and chemo. Oh, and he's immunosuppressed and has shingles too...

Me: "How bad is your pain?"

Pt: "It's pretty bad."

Me: "Well you know that scale---0 to 10. Ten is the worst pain you can imagine."

Pt: "Well, we were gassed by the Germans in war and that was pretty bad. I felt like my insides were burning up."

Me: "Okay, then let's go with that. Compared to being gassed by the Germans, let's just make that a 10, how bad is this pain?"

Pt: "I don't think that's worst pain I ever had.

Me: "Really?"

Pt: "Yeah, after The War, I came home and went back to running the old man's Orchards and fell from a tree and impaled my leg on a pitch-fork. That was awful. Broke my back too."

Me: "Okay. Let's say *that* was a 10. How bad is *this* pain?"

Pt: Oh, you know, I don't like to complain about it...thinking about just makes it worse...

You get my point? This guy is using APAP to manage is metastatic CA pain and doesn't want anything "stronger" because he needs to be alert to drive the wife to *her* doctor appointments!

I'm well aware of the IASP definition of pain. I know we can't "judge" the nociceptive mechansims of others, but how come the typical WC patient with an industrial injury and an open claim is 7/10 on oxycontin 40mg TID and this gentleman with metastatic lung CA, shingles, and XRT burns is getting by on APAP, capable of doing a mod-assist car transfer for his disabled wife, and still "driving the tractor" on the farm?

...flame away!

 

[ampaphb]

The societal issues I was talking about. How many physicans do you know who wear $10K Rolexes?

Even the ones making $500K/year.

I have a work comp patient on permanent disability. Walks with a cane, hunched over greater than 45 degrees. Parks in our handicap spots and always needs a medical assistant to help him get into his $100K sports car on the way out.

The thing is, I don't think he's a malingerer. Functional overlay up the butt, but not a malingerer.

Anybody have a link to that study showing a lower rate of disability after cervical whiplash, in which European country?

A cross-cultural comparison between Canada and Germany of symptom expectation for whiplash injury.
J Spinal Disord Tech. 2005 Feb;18(1):92-7.
Ferrari R, Lang C.

OBJECTIVE: Symptom expectation for whiplash injury has been shown to be low in countries with low rates of chronic whiplash when compared with countries like Canada, where chronic whiplash is common. The objective of the current study is to compare the frequency and nature of expected "whiplash" symptoms in Germany with that in Canada.

METHODS: A symptom checklist was administered to two subject groups selected from local companies in Germany and Canada. Subjects were asked to imagine having suffered a neck sprain (whiplash injury) with no loss of consciousness in a motor vehicle collision and to check which, of a variety of symptoms, they would expect might arise from the injury. For symptoms they anticipated, they were asked to select the period of time they expected those symptoms to persist.

RESULTS: In both groups, the pattern of acute symptoms anticipated closely resembled the symptoms of acute whiplash victims, but 50% of Canadians also anticipated symptoms to last months or years, whereas few German subjects selected any symptoms as likely to persist.

CONCLUSIONS: In Germany, despite the documented occurrence of neck sprain symptoms in individuals following motor vehicle collisions, there is a very low rate of expectation of any sequelae from this injury. The current or previous aspects of society that underlie this remain uncertain. This lack of expectation of chronicity in Germany may, in part, determine the low prevalence of the chronic whiplash syndrome there. Further studies of symptom expectation as an etiologic factor in the chronic whiplash syndrome are needed.


Laypersons' expectation of the sequelae of whiplash injury: a cross-cultural comparative study between Canada and Greece.
Med Sci Monit. 2003 Mar;9(3):CR120-4.
Ferrari R, Constantoyannis C, Papadakis N.

BACKGROUND: The objective of the present study is to compare the frequency and nature of expected 'whiplash' symptoms in Greece [a country where the chronic whiplash syndrome is rare or unknown] with that in Canada.

MATERIAL/METHODS: A symptom checklist was administered to 2 subject groups selected from local companies in Patras Greece, and Edmonton, Canada, respectively. Subjects were asked to imagine having suffered a neck sprain [whiplash injury] with no loss of consciousness in a motor vehicle collision, and to check which, of a variety of symptoms, they would expect might arise from the injury. For symptoms they anticipated, they were asked to select the period of time they expected those symptoms to persist.

RESULTS: In both the Greek and Edmontonian groups, the pattern of symptoms anticipated closely resembled the acute symptoms commonly reported by accident victims with acute neck sprain, but while up to 50% of Edmontonians also anticipated symptoms to last months or years, very few Greek subjects selected any symptoms as likely to persist.

CONCLUSIONS: In Greece, despite the documented occurrence of neck sprain symptoms in individuals following motor vehicle collisions, there is a very low rate of expectation of any sequelae from this injury. What current or previous aspects of society that underlie this remain uncertain. This lack of expectation of chronicity in Greece may, in part, determine the low prevalence of the chronic whiplash syndrome there. Further studies of symptom expectation as an etiologic factor in the chronic whiplash syndrome are needed.


Laypersons' expectation of the sequelae of whiplash injury. A cross-cultural comparative study between Canada and Lithuania.
Med Sci Monit. 2002 Nov;8(11):CR728-34.
Ferrari R, Obelieniene D, Russell A, Darlington P, Gervais R, Green P.

BACKGROUND: The objective of the present study is to compare the frequency and nature of expected 'whiplash' symptoms in Lithuania (a country where the late whiplash syndrome is rare or unknown) with that in Canada.

MATERIAL/METHODS: A symptom checklist was administered to 2 subject groups selected from local companies in Kaunas, Lithuania, and Edmonton, Canada, respectively. Subjects were asked to imagine having suffered a neck sprain (whiplash injury) with no loss of consciousness in a motor vehicle accident, and to check which, of a variety of symptoms, they would expect might arise from the injury. For symptoms they anticipated, they were asked to select the period of time they expected those symptoms to persist.

RESULTS: In both the Lithuanian and Edmontonian groups, the pattern of symptoms anticipated closely resembled the acute symptoms commonly reported by accident victims with acute neck sprain, but while up to 50% of Edmontonians also anticipated symptoms to last months or years, very few Lithuanian subjects selected any symptoms as likely to persist.

CONCLUSIONS: In Lithuania, despite the documented occurrence of neck sprain symptoms in some 50% of individuals following motor vehicle accidents, there is a very low rate of expectation of any sequelae from this injury. What current or previous aspects of society that underlie this remain uncertain. This lack of expectation of chronicity in Lithuania may, in part, determine the low prevalence of the late whiplash syndrome there. Further studies of symptom expectation as an etiologic factor in the late whiplash syndrome are needed.

 

[rehab_sports_dr]

drusso,

I think your example about the vet is probably the best I've ever heard. Nothing really to add- just letting you know it is appreciated

 

[dancin]

A little off topic, but I'm wondering why when we, as Physiatrists, speak of Performing Arts Medicine, Dance Medicine (and this goes for all the lectures I've heard on the topic), etc., without explicitly saying so, it always refers to Ballet, classical music, etc.

How about hip hop? Break dancing?

Pole injuries?

Just kidding.

In all seriousness, I have a couple friends with chronic lumbar radics from breakdancing.

I also have a rock drummer in my practice with chronic wrist synovitis and medial/lateral epicondylitis, and a bass guitar player with cervical spondylosis and weak scapular stabilizers.

_______


The main reason why all the literature is on ballet and modern is that the "dance" departments at universities, where most of the research occurs, usually focus on ballet and modern. Also these forms are known to be more "structured" than others.

You are right- there are a whole lot of dance injuries and mechanisms that are being overlooked. I'm currently doing an epidemiological study on tap injuries... for now. I hope to move on to some of the other forms also. Especially in the dance studio "factories" that turn out teeny-bopper dancers.

check out the International Association for Dance Medicine and Scientce
www.iadms.org

 

[Disciple]

That's what I'm getting at.

For the community practicioner who has an interest in treating performing artists, a broad scope may be more practical.

I'm not sure a base of specialized research would be necessary to practice effectively.

The same biomechanical principles apply whether it is performing arts or sports.