When Healing Arts Enhance the Arts

Outlook magazine January 2014

This year Devyani Hunt had an epiphany. During Dancing in the Streets, a St. Louis outdoor dance festival featuring more than 60 dance companies and 1,000 dancers, Hunt saw many dancers who might not have been on a stage without her help. In one instance, Hunt had treated 10 of a company’s 18 dancers.

“It was great to see that,” said Hunt, a physiatrist and associate professor in the Department of Orthopedic Surgery. “It was a real ‘aha moment’ for me that I am really making a difference.”  

Along with physical therapist Lynnette Khoo-Summers, PT, DPT, Hunt co-directs Washington University’s Medical Program for Performing Artists (MPPA). This program helps a variety of arts professionals — musicians, dancers, circus acrobats, ice skaters, painters, and singers — return to their beloved stage, abiding passion and, in many cases, their livelihood. Frequently, without the help of the MPPA team, these unique people would have to give up the very things that animate their lives.

MPPA clinicans primarily treat local artists but also see performers from many different tours — “So You Think You Can Dance,” Disney on Ice and Cirque du Soleil, for example — performing locally at The Fabulous Fox Theatre, the Blanche M. Touhill Performing Arts Center or other venues.

Last year, during the St. Louis production of “The Lion King,” one of the lead actors, outfitted with a heavy headpiece, suffered acute neck pain. The role was physically demanding, Hunt explains, and the actor could no longer perform in costume. In the clinic, Hunt diagnosed him with a pinched nerve and treated him to decrease inflammation and muscle spasms. Khoo-Summers also addressed the muscle spasms, and taped his shoulder girdle to provide more support. Within a few days, he rejoined the “Lion King” cast.

Hunt once treated a physical comedian from Branson who hurt himself after doing the splits nightly for 15 years. “He wasn’t one to be told not to do the splits anymore!” Hunt said.

Performing artists use their bodies more intensively and repetitively than most people. Musicians might do the same movement with their bow arm hundreds of thousands of times in learning a piece of music. Dancers and circus performers repeat precision movements day after day.  Strain injuries are common.

Functioning within “normal” limits simply is not good enough. Alvin McCall, a cellist for the St. Louis Symphony cellist Alvin McCall found he could not exert enough force on the end of his bow. Because of damage to his ulnar nerve his fingers were sluggish.  Initially, McCall’s doctor told him that the strength in his left hand was “within the normal range.”

““Diagnosticians and therapists have to understand the demands you make on your body,” says McCall’s wife, Anna Lackschewitz, who is also a professional musician. “Lots of doctors just shrugged off his concerns about needing a higher level of performance.” Another doctor told him ‘wait and see.’ They have no idea that this is our livelihood.”

Not so with the MPPA, where McCall found support and help to strengthen weak muscles and adapt his playing style. Lackschewitz and McCall were so happy with how McCall was treated that they referred all four of their children, two who now dance professionally. Recently Lackschewitz, principal violist of the Fox Theatre Orchestra, underwent therapy for a pinched nerve in her neck.

The MPPA was established in 1988 by the late Jerome Gilden, an orthopedic specialist in the School of Medicine and Barnes-Jewish Hospital. He retired in 1998, but in 2004, the program was revived by Hunt, Khoo-Summers and Heidi Prather, DO, orthopedic surgery professor and chief of the section of physical medicine and rehabilitation. Prather and Hunt are physiatrists — specialists in physical medicine and rehabilitation who focus on non-surgical musculoskeletal care. They excel at linking symptoms to root causes and, unlike orthopedic surgeons, are not body-part specific.

Two years ago Aaron Chamberlain, an elbow and shoulder surgeon, joined the group.

Because of their experience as performing artists, they bring zeal and understanding to their clinical work: Hunt and Khoo-Summers as dancers, Prather on trumpet and Chamberlain on violin.

“We understand where they (the artists) are coming from,” says Khoo-Summers, danced professionally in Chicago before injuring both her knees. Now an assistant professor in the Program in Physical Therapy and the Department of Orthopedic Surgery, she found her niche in rehabilitating performing artists.

“We understand that need to perform, to make your body do things it is not built for. Most often if you go to someone who doesn’t understand that need to perform, they’ll say, ‘if it hurts to dance, don’t dance.’”

Together, Hunt and Khoo-Summers, diagnose problems by observing patients in motion. In addition to traditional exercise equipment, such as treadmills, an elliptical, bikes and a universal gym, the physical therapy clinic boasts a ballet barre and special flooring for dancers.

“If you test performing artists in the office in standard fashion to see if they have good muscle strength, their strength will be fine,” she said. “But if they can’t maintain the posture they need because of fatigue then you have to develop a training program to work more toward endurance and posture retraining.”

While the MPPA physicians’ efforts help decrease symptoms, Khoo-Summers corrects the movement impairments that are causing the symptoms. This is done by attaining better alignment, correcting muscle imbalances, building stamina and developing adaptive strategies.

“The MPPA is cutting edge — designed to maintain high levels of performance in those who push the limit of what is physically possible on a sustained basis,” said Richard Gelberman, MD, the Fred C. Reynolds Professor and chair of the Department of Orthopedic Surgery. “The clinicians are to be congratulated for bringing exceptional care for this ultra-committed population to St. Louis and to our region.”

Not surprisingly, the field of performing arts medicine is a small and tight-knit community. There are fewer than 50 such programs nationwide, and many  have sprung up in cities with major performing arts centers. Harkness Center for Dance Injuries, for example, was founded in 1989 in response to the New York dance community’s critical need for specialized and affordable health care. Washington University’s program, while not one of the nation’s largest, is well known and well respected.  

“Washington University’s program in performing arts is a wonderfully integrated and multidisciplinary program,” says Dr. Monica Rho, assistant professor of physical medicine and rehabilitation at Northwestern University’s Feinberg School of Medicine. “Dr. Hunt worked hard to develop a clinic where both she and Lynnette co-evaluate and co-treat the patient. The coordination of these services places the performing artist’s needs first and makes Washington University’s program a model to emulate.”

Such coordination may sound simple, but most programs cannot coordinate evaluations, says Rho, who also sees performing artists in her practice. Because it’s critical for these artists to maintain their performance schedules, the MPPA team offers same-day appointments whenever possible.

Besides working in the clinic, often Hunt or Khoo-Summers often are on-call or backstage at performances. Recently Khoo-Summers accompanied Dance St. Louis pro bono on a three-city tour.  

Because most patients have chronic overuse injuries, it’s important that artists adopt preventive strategies early in their careers. The MPPA holds outreach programs with young dancers, musicians and circus performers, recently leading a symposium for Webster University’s Department of Music and Community Music School.

But no matter how much prevention they preach, injuries will occur. With proper intervention, however, injuries don’t have to result in a sidelined career; performing artists can get back on the road and back to following their passion.