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Keep Your Head Straight w/ Dr Kristen Schuyten (sponsored by OnCall.AI)
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Yasi and Steven chat with Dr. Kristen Schuyten, physical therapist and faculty at the University of Michighan School of Music Theater and Dance. She's also a PT for US Figure Skating and works in the U of M Concussion Center. She Is a go-to person for performing artists, but she also is researching concussions in dance. We talk about changing trends in dance medicine, differences in skaters and dancers, creating a career in performing arts medicine, the rise of GLP-1 medications in the arts, and lessons learned over 2 decades of experience.
Dr. Schuyten's instagram: @theperformingartspt
Bio: Dr. Kristen Schuyten, PT, DPT, MS, SCS, CSCS is a Physical Therapy Clinical Specialist with MedSport at Michigan Medicine, faculty with the University of Michigan Department of Dance and Physical Therapist with the Wellness Initiative with the University of Michigan School of Music, Theatre and Dance (U-M SMTD). She holds her Board Certification in Sports through the American Board of Physical Therapy Specialties and is a Certified Strength and Conditioning Specialist through the National Strength and Conditioning Association. She performs faculty and staff training in concussion and emergency management of the performer, screening, and treatment of performing arts patients and coordinates and performs on-site triaging, backstage treatment services for U-M SMTD. She has developed a post-operative protocol for returning to dance, a post-concussion return plan for university performers, and injury risk assessments for figure skaters, gymnasts, and instrumentalists. For over 15 years, she has coordinated musculoskeletal injury risk screening and neurological baseline testing for the U-M SMTD including analysis of individual screenings and customized exercise prescription. Dr. Schuyten has been a volunteer physiotherapist for the US Figure Skating national medical team since 2013, coordinating care for local, regional, and national figure skating championships, as well as providing support for the team during Olympic and World Championship events. Dr. Schuyten has delivered presentations at both national and international conferences focusing on concussion, injury risk assessment, and wellness related to the performing arts. Additionally, she provides lectures and workshops on these topics at other colleges and universities, dance studios, skating rinks, and online educational modules regarding Performing Arts Rehabilitation. She is a member of the Faculty Council at the University of Michigan Concussion Center and has collaborated on several papers that highlight research regarding post-concussive return to learn and return to performance progressions for university students in the performing arts.
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Transcript
Introduction and Sponsor
00:00:06
Speaker
Welcome to the Athletes in the Arts podcast, hosted by Steven Karaginas and Yasi Ansari. Hi there, everyone.
00:00:23
Speaker
Hi there, everyone, and welcome to the Athletes and the Arts podcast. Along with Yassi Ansari, I'm Stephen Karaginus, and we thank you for listening in today. We are sponsored by On-Call AI, a tool that helps medical professionals make money off office visits, phone calls, and keep track of medical records. You can find the On-Call AI app in the App Store or go to getoncall.ai.
00:00:46
Speaker
Also, if you're looking for more information on performing arts medicine, go to athletesandthearts.com.
Guest Introduction: Dr. Kristen Scheiten
00:00:52
Speaker
With that housekeeping out of the way, let's get to our guest, Dr. Kristen Scheiten, a physical therapist from the University of Michigan.
00:00:59
Speaker
Her bio is rather lengthy and full of wonderful accomplishments, so I'll just go through a few things here first. Kristen, thank you so much for coming to our school today. How are you doing? It's great. Thank you. A physical therapist from the U.S. Fingerskating National Team. And I'm very glad to have you the show. I've been talking for a long time about all the various things you do because... Top of working for the University of Michigan, U.S. Figure Skating, giving lectures all across the world. She's also spending time doing research concussions in performing arts.
00:01:26
Speaker
So she's here today to talk more about what she's doing. pathway here Because it's not that easy just to like go to school and say, I want to do performing arts. True. So I had past of also being a performer and i didn't even realize that this was an avenue that I could pursue in physical therapy. And i actually was a physical therapy patient when I was in high school. And it was more so from a track and field related hamstring tendonitis type of injury. But even back then it was challenging because the providers, I had still danced at the time and it was
00:02:00
Speaker
tough to have them kind of know what I had to be able to get back to
Dr. Scheiten's Journey and Career Path
00:02:04
Speaker
as a dancer. I wasn't doing it a super high level. It was more of a studio level dance. But then as I continued throughout my undergrad and I was doing drop-in classes, i went to school at University of Michigan and would go to drop-in classes, would take classes within the dance department just as a hundred level ballet. ah But being able to still participate was great. But as I was getting older, I also noticed I was starting to have injuries. And seeing different providers that didn't know how not only I was supposed to get back, but weren't able to speak the same language. I remember I was going to a competition and I had right before that had a ah partial Achilles tear. Oh, my God. Wasn't in PT school, so I didn't really know. i was like, I can't point my foot and I can't go up on a releve. This doesn't sound good for me. And then I went to the competition and there was an athletic trainer that was there. And they taped my ankle like I had an ankle sprain. And I'm like, that's not really going to help me point my foot or do what I need to in the 16th foot combination. And again, that that was kind of the the first realization that maybe these health care providers don't really know what dancers and performers have to do in all aspects.
00:03:15
Speaker
And when I went into PT school, it was nice because we were able to still do some projects that were to our areas of of interest. And I was able to have some of biomechanics and anatomy physiology and being able to kind of go into this performing arts still type of world. And when I started off as a physical therapist, just I worked over in Grand Rapids area in Michigan, had seen some general ortho sports types of patients, got a couple of dancers on my schedule. And I'm like, I really like this. I was being able to speak with them. I was being able to have those conversations and then coming into University of Michigan and being able to then have more
00:03:55
Speaker
possibilities of working with performers in and the Ann Arbor area and with the university community. It was amazing because i was able to have some faculty, some students, some local skaters come in and be able to have those conversations and not only realize the fact that I had past experience in this as a performer, but now even as a mom of a competitive dancer and my son to start playing the French horn and trying to navigate those waters as a mom that then is also having kiddos that are in the performing arts. It's it's been really cool, but it has all been, I guess, from self-realization that I'm seeing that there's this need that's out there. I realized it myself as being a performer that was injured and not being able to navigate that as easily. But then to in the faces and experiences of my own patients, and then everything is just kind snowballed from there.
00:04:49
Speaker
So to go back a moment, so you chose to go into physical therapy. So a lot of folks sometimes get caught in this idea. I want to go into medicine. I want to do yeah something. how do you How did you choose your path versus like, I'm sure you could like went to like be a doctor or PA. You could have been an athletic trainer. What made you choose but physical therapy and and what's that path like?
00:05:08
Speaker
Yeah. ah So my my thoughts were that I actually had no clue that I wanted to be a PT at all. And I started out at Michigan in the engineering and the College of Engineering because I wanted to work for NASA and I wanted to be an aeronautical engineer. And after the first year yeah
00:05:31
Speaker
I loved math, I loved science, and I'm like, okay, this is this is my thing. I love space. This is this so what I'm going to do. And then it ended up being that i went through that first year and realized my brain does not work for computer programming and technical writing. And I didn't want to sit behind a desk and not be able to be social and with people. And as I was going through undergrad, I realized I really liked psychology and I loved being able to have...
00:05:57
Speaker
This ah just kind of dive a little bit deeper into the science, the brain and how we work, which was which was even then kind of having a little bit of a little bit of a, ah I guess, ah a foresight into what my then future was going to
Unique Challenges for Performers
00:06:11
Speaker
be in working with concussions a bit. But i was set into a practicum in sociology class that I was doing volunteer work. at the hospital with the PT gym. And I was able to get credit and still get volunteer hours. But then going through that process, speaking with the patients, speaking with their families, speaking with other rehabilitation professionals in that setting, i'm like, this is actually really cool. I really, really like this. And then I tied it back to my past as a physical therapy patient. said, okay, not now I'm seeing there's all these different settings. And then the next semester I did do volunteering with pediatric neurorehab. which was amazing be able to work with the kids that had, a played Twister with the PTs that were there said, okay, keep but keep a journal, see if you're seeing the changes, see if you're seeing what they can do better through the time that you're here as a volunteer. And I actually felt like even though I wasn't there in a paid position, i was still involved in their care, which was really, really amazing. And then again, that kind of sold sold me on physical therapy. It's been something.
00:07:18
Speaker
Now that I've been a PT now for 20 years and looking back at other things that I could potentially do, I think I've kind of worked into these little niches of being able to do strength conditioning, personal training, looking into some research side of things. I know back in the day, we didn't have it available to have training. the combination degree of PT and PhD. If I went back and did anything, i may explore that just because now I'm getting more into research, but I'm also in a good place to be able to pass that baton to some of our amazing researchers and help them along the process and be part of their team.
00:07:54
Speaker
It sounds like engineering too. I mean, you went into the school for engineering and there's no better form of engineering than the human engineering, right? You know, angles and yeah velocity and force and strength and all that type of stuff.
00:08:05
Speaker
um All my engineering patients are always like fascinated by everything that talk about. They're like, tell me more, show me anatomy map. I love that. So. Yes. Yeah. And there's there's been quite a few through the through the years of biomedical engineering students and professors that we've been able to collaborate on projects with. And I i any engineer patient that I have, I I tell them, especially if they're computer engineering, i say, bless your hearts. I wish my brain worked like that. And y'all are amazing. I
Research and Insights on Concussions
00:08:32
Speaker
i love what your brains can do. It helps my life. but But I don't function like that. So I'm very happy that you do. and so it' That's awesome.
00:08:42
Speaker
What unique challenges, Kristen, do you feel that performing artists face compared to traditional athletes? And how do those differences shape your approach to care? Especially because...
00:08:54
Speaker
You know, you did mention I liked that. I like the interaction piece as well. i don't know if any of what you're noticing that's a little bit different is that interaction piece as well between the different athletes, but also your experience as a performer yourself.
00:09:12
Speaker
I would say the that one of the biggest challenges, and this is something that I'm still consistently seeing across the board for the performers, is being feeling like they're being taken seriously. And especially, I would say, our younger performers, the ones that are doing this as a profession, if they say that I am a professional dancer, I am a professional musician, they're Then when you have a healthcare provider, especially one that may not know as much about performing arts, they tend to still get taken, I guess, a bit more seriously because it's their career. But when you have someone that may be a studio level or recreational level even, i think that tends to be the challenge. And I still hear it from patients, especially ones that may say that I only want to see you or I only want to see your team because they've been with sports specific types of per providers that may not have had that experience or that background or taken them as seriously as a performer and looked at it more as a hobby versus it being something that is really wrapped into their identity and that they're doing, that they're investing a lot of their time and their money into being able to achieve at a very high level. And again, now that I'm on the mom's side of things, it
00:10:25
Speaker
takes a whole other spin because then I'm seeing as a parent, and how I would want my kids to be treated. And there's a lot of still disconnect with such emphasis placed on sports and sports medicine, and then not also having them this added facet of how performers are different. Still a lot of similarities, but how they're different, even more so what we're seeing in the research and what's available out there for trends or patterns that we're seeing in our performers, because there is so much still that's placed into sports with what's out there in new studies for research.
00:10:57
Speaker
You mentioned being on the other side of things now with being a parent of a dancer. So um I know I had this issue with my daughter when she was dancing a studio and me being there and and all that stuff and how involved they get. So how do you handle that? ah Do they call on you for a lot of things? you sometimes see things you're like, got to say something here. I don't like that too much.
00:11:16
Speaker
there there's been There's definitely been some challenges. I would say one of the one of the most evident things that I've seen, and I see this pretty ah regularly when I attend even some of my patients,
00:11:27
Speaker
i I'll go to their, this time of year is not cracker season. Right. And so I will go to their, go to their performances. And I love supporting my patients. I would say there's not many better feelings than having worked with somebody and helping them feel better, get better, get to that level of, of competition or performance where you're just like I'm, you're able to kind of see almost the fruits of your labor, but also all their hard work and watch them perform. ah But I've also seen sometimes where i'm like,
00:11:55
Speaker
we should get you in for a screening or we should get some of these students some education or or something. And you're you're seeing that evidently on stage. I would say within, because my daughter's been dancing at the same studio or since she was three years old. And- It's been a great conversation to be but able but to be able to have with the studio owner and with even other studio owners and concerns that there may be on common injuries.
00:12:20
Speaker
There will be some times where they'll ask me, but then I think they also see most times when I'm there in the studio that my face is buried in a computer and I'm trying to respond to as many emails as I can. But it's been nice to be able to have that conversation, even get to know some of the other parents of the older girls, the ones that have questions or if they have concerns. And I've seen some of them in the clinic seeing our providers from the physician standpoint and being able to touch base with them. It's been kind of a full circle thing. haven't been bombarded as much quite yet. I would love to be personally, but it's also one of those things that I think it's great just having the open and blind communication and that they know that there is somebody that's there that is more easily accessible if they were to have any questions.
Physical Therapy in the Performing Arts
00:13:02
Speaker
Is that common these days for person he a physical trainer to be around at studios? Like, are studio owners starting to reach out more to physical therapists? Yeah, I would say between athletic trainers and physical therapists ah that they're having a little bit more involvement, but more so if you have a relationship that's already developed. I know that there's multiple studios around Ann Arbor just because I've gotten to know Again, with being here for a couple of decades, I've gotten to know the owners, some the instructors, and just reaching out and asking them, would you guys like me to come in for a workshop? Would you guys, like do you have any questions? Is there any concerns that you have? Even one of the Synchro teams that I had, that I have a connection with that's in the Detroit area, been able to reach out to them. And one of their coaches got to hold them and said, and There's a specific maneuver called the Beelman, which is where the figure skaters like put their hands over their head and they spin like a little teardrop. And they have one leg up over their head and you'll have younger skaters that will start to learn this, but then they may start to have spine issues or shoulder issues or whatever, because they're trying to force some of this range of motion and just asking, okay, what is an easier progression for exercise? What makes sense for the younger skaters?
00:14:23
Speaker
girls, younger kids to be able to then start with something and then progress. And having a strength conditioning background, I'm able to also see it from that lens as a personal trainer, as someone who has then looked at that developmentally as um exercise progressions too.
00:14:38
Speaker
So I think it's becoming more of more of a commonality. think there's two that we saw during COVID is that we had a lot of students, we had a lot of performers that were relying on online influencers who may not always have the um the the most, I would say, and looking at health and looking at overall wellness and then also natural body progression developmentally as as the performers are getting older from young up to older or
00:15:09
Speaker
ah that you may have someone who's a professional level ballerina who can do all these amazing things things or had, you know, 25 years of yoga and can contort their body in all different ways. But then the kiddos that may not have as much experience with that don't know how to get to that point safely. And so I think the studio owners are seeing that then there's concerns, there's injuries coming up and then maybe wanting to bring in a professional and that can then be able to help them out with doing so in a safe and um again, developmental type of manner.
00:15:41
Speaker
So how is your set setup arranged at University of Michigan? You work with the School of Music, Theater and Dance, and you are obviously one of the therapists. but like So how does the program work as far as getting care to your performers?
00:15:54
Speaker
Yes. ah So I have, I split my time between Mesport, Michigan Medicine. and They're about 25 hours a week treating patients within the clinic setting. It's a sports medicine facility, but I primarily work with the performers that come in through any which way that they may be referred. And then with the school setting, I have 15 hours a week that is then allocated with the School of Music, Theater, and Dance. And I'm the only health care provider that is working in that capacity within the school. And for that, I go through and I have triage appointments that are available for any injuries, concerns, questions that then that um that any of the students or even faculty and staff may have. I do have instructors and professors that cover admins that come in if they have questions. And then I also do screenings of all the incoming freshmen. So we do musculoskeletal screenings and neurological baseline screenings, the concussion baseline. for the students. And if there's any concussions that end up happening too, then I will be able to see them, try to do it within 24 to 48 hours of diagnosis that we get in have them go through a baseline assessment, kind of see where they're at then compared to their their previous assessment, but then also assist them with communication to disabilities office if they need accommodations communication to their professors, if they were to then have any concerns coming up like quizzes or a big performance that they may then be limited on. But then even paratransit, I had one performer that was injured on the bus that she got a concussion on the bus. And so she did not want to then take bus transportation. So then we were trying to figure out paratransit for her so that she had someone that could pick her up and drop her off more easily. Or if there's an emergency situation on campus trying to help out With that, too, we've had some mental health emergencies. We've had concussions. We've had things that have happened at performances. And then trying to make those calls to campus police is needed, too.
00:17:51
Speaker
Got it.
Concussion Education Gap
00:17:52
Speaker
Well, the concussion ah issue in performing arts now is just starting to get some traction in research, publications, a few other things out there. And then you have been involved in research, too. So what issues are you seeing that need to be researched more heavily in performing arts to help performers get back more safely?
00:18:10
Speaker
Yeah, I i think of the biggest things, and again, this is across the board, they're starting to come out with, there was an article that was just published for high level skaters and that hadn't but existed before. So now we have a stepwise progression. I know there's stuff coming out with some good content with circus performers, with stunt performers. ah What we haven't seen as much in, there there are there is a bit on dance too, We haven't seen as much with gymnastics. And so I would say gymnastics and cheer, that would be a great area to be able to to look a little bit more into. And then even our theater and drama and our musical theater, that's something that we're trying to do from the university level. But again, it' look at professional, there's a whole other level of added layers for it being their profession, touring. I mean, all of that that we're not going to be seeing at the university level.
00:18:59
Speaker
But one of the concerns I would say we see very consistently is that in performing arts, this content, this education, this responsibility to report and then also withhold from participation or practice at least for 24 hours, which is mandated with sports, at least in our youth athletes across the U.S., that that is not in place for our performers. And so we don't have any legal legislation that's helping to back this when we do recommend that they stay out at least for 24 hours to see if any concussion symptoms were to present themselves. Number one. Number two, concussion education is not also mandatory with our performers where it is for sports, for coaches and parents and then NCAA, the athletes. Yeah. Yeah. So they they don't know unless they're going and seeking this information out themselves. So, for example, I teach mostly freshmen, but with the dance department at University of Michigan, I teach an anatomy and physiology class every fall. I have a lecture that's dedicated to concussion. And i go through and I go through what our protocol is, what the signs and symptoms are, what the red flags are that need to get you to the emergency room. If you were to have it not only for their own information, but also for any of their classmates that then if they see something happen, that they'll say something that they'll help them and be able to make sure that they're then going to hopefully have expedited care to hopefully expedite their recovery at the same time. But everything that I'm seeing really does try to still follow the concussion and sport group six step type of protocol, which is helpful because if you have a performer that's following a very similar protocol as sports, they can see really interesting.
00:20:40
Speaker
any type of provider, as long as they know specifically what that performing art has to get back to from a class setting, technical setting, professional setting. If there's still some commonalities there, they know that the stepwise progression is going to be very similar, which can be helpful to kind of reach the masses. And that's what we're trying to really go through and promote. What we also see A little aside is our musicians, bless their hearts, ah they don't tend to get concussed while they are practicing or while they are performing unless you're like in a marching band or drum court, then sure all ah all holes are out. There's nothing to throw that ah But what we look at for our musicians, for our vocalists, is that if they have a concussion because of a slip and fall they bump their head on a patio door or something like that, then they're trying to get back to their performances. They still have auditory, visual, ah you know,
00:21:37
Speaker
cognitive types of concerns with trying to sight read music that any other performing art would have. But it's not, I would say, taken as seriously sometimes by the instructors because we're like, how are you going to get a concussion in music? So they may not invest the time to learn more about it, even if their students may have it happen outside and be affected within what their practice and performance schedule may look like.
00:22:00
Speaker
But the audio and visual stimulation is a big part of this because that's, I mean, football players and other athletes, you know, it's not as much of like strobing and music and having memorize choreography. So obviously it's got to be a little bit different challenge to get a performer back from a concussion versus normal athlete because got to be some specialized ways of handling that, right?
00:22:21
Speaker
Yes, yes. And trying to get to that level of stimulation, especially when you look at, okay, you you can ask them, just put sunglasses on. So you're not getting as much of the visual. Well, what happens if they're also a student and they have to try to do work through a computer or they have to do things in a university setting where there might be only fluorescent lights available? Or if you say, okay let's...
00:22:41
Speaker
Have you just put a pair of earplugs in so that you don't hear things as much, but you can still practice and perform? Yes, it will take it down a certain dusk level, but it also may turn what they're trying to produce vocally or what they're trying to produce through their it instrument. It may actually change the pitch. And so what we look at with that, it gets to it gets to be challenging to try to make some of those accommodations, those ah those adjustments to their practice and performance, because it really does alter quite a bit for what they have to do down the road.
00:23:10
Speaker
Well, then the biggest issue also is that you're taking care of athletes or sorry, you're taking care of students that are, you know, their studies are the performing art. So like your final exam is playing. Their final exam is yeah dancing so as opposed to a football player who's got to just take a econ exam something like that. So that puts even more pressure on you to help them out because juggling all of that with the teachers and faculty, it's be really difficult.
00:23:34
Speaker
it's It's a lot. I would say the biggest sticking point that we have right now is more so, yes, we can get them through the stepwise. um I'm not there all the time. And so to try to lead them through, I've had some dancers that are also on the dance team and dance team has access to athletics and athletics has people there all the time. And so I've been able to touch base with athletic trainers that work with the dance team, give them our protocol, try to communicate with whatever academic concerns that may come up, but they're able to do a lot more one-on-one with them, which I'm absolutely grateful for, but then also being able to learn, okay, these are things that then we need to try to just have multiple touch points with the students and making sure that they're good to go through the stepwise progression. But also if you have any performer that's dance, musical theater, theater, and drama that specifically of those students, that they get a clearance that they can be re returned ah to full practice, to full performance, because that is something that is required with athletics. And we want to make sure that if a student has a potential of doing partner work or doing performances that involve other students, that we don't not only increase their risk of inflicting more musculoskeletal or another concussion, but that they don't possibly increase the risk of injury to someone else.
Backstage Medical Support
00:24:50
Speaker
What does treating some of the injuries look like backstage like on a show day? How, you know, I mean, just share ah a little bit about your. yeah It's it's it's a little different between i comparing kind of the the two worlds of the new university settings or like dance companies.
00:25:12
Speaker
And skating. Skating is mostly lacerations, people cutting themselves with their skate blade. And so, you know, a lot of Band-Aids, like there's a lot of Band-Aids that get thrown out. So lots of gloves, Band-Aids, and then just trying to help out any of that just because they'll have to catch. So If you ever look the thicker gloves that skaters wear that's part of their costumes, it almost kind of looks like a Kevlar thickness type of thing to it. And it's so that they don't cut their fingers. Oh, wow. didn't know that. it's part of so that they're not cutting their fingers when they're doing it. So a lot of skaters are moving to that because they are having a lot of lacerations with trying to grab their skate blades or their partner's skate blade for choreography. Wow. learn something new. So there's that. And then that's the biggest thing that we see with skating coverage. There's other things too that could actually come up with any type of acute injury. With what we see backstage for our performers, there'll be cramping. There'll be different things that happen with soft tissue work. And most times it's an overuse that then kind of comes to an head as an acute type of a thing. And so there's a lot of taping that ends up happening backstage. I do. One of the tips that I like as as as a little trick is there's this stuff called tough skin that you can use this by Kramer and the sticky tacky type of thing. And so when we look at Kinesio tape or other tapes that may if you're really sweaty or your body's just actually really oily.
00:26:36
Speaker
you can put that down to allow for a little bit more grip on the kinesio tape. So it allows for them then still does it be able to have some of that same support or feedback from from the tape application, but then it stays on a little bit longer, which a lot of the lot of the dancers like. So I tend to see more soft tissue, more taping types of ah techniques needed. injuries, if they've had to overuse thing, that's just then kind of come and started to get a little bit more angry. But with the skaters, definitely lacerations and lots of things to the fingers.
00:27:08
Speaker
A lot of similarities with dancers and and skaters, of course, there's even ice dancing specifically. What are kind of was some of the things that are very similar that you deal with with both them? And what are some of the pitfalls that each group has that you're always trying to stay ahead of?
00:27:26
Speaker
they i I'll answer the last part of the question first. they're ah Both of them, and I see this throughout performing arts, um especially our movement-based disciplines, ah they're always trying to stay ahead and push the envelope of athleticism for what they can do. And they keep trying to push or try new things or wrap in other techniques from other disciplines to push themselves forward. And we'll have changes that happen to the rules, to competitions, to all that, to really kind of push that as well. And we're now. And so we're going to see that even more with people really trying to push. So that is challenging because if you're doing things your body has never done before, And then the motor plans aren't 100% there in your brain yet. And that's an increased risk for injury right out the gate. So that's one thing that we see, I think, across across all those disciplines. As far as things that from an injury perspective, the the boot that's with the figure skate can lock down the foot and ankle quite a bit, which can decrease the ability of the foot muscles to be able to function as well when they get out of the skating boot because the boot gives so much support ah that then if we try to do off-ice training with them, they might have more risk of like ankle sprains because they got used to the boot giving them so much help. And then they got out of the boot and then they got these floppy floppy ankles and shoes that may not be super supportive.
00:28:47
Speaker
which is crazy because this is also one of the areas that we see a lot of dance injuries is ankle sprains, but for a completely different reason because they're all the way up here. And then you have a dead point shoe and a dead point shoe isn't going to give a whole bunch of support and help. A dead figure skate boots, going to give a whole bunch of help either. And so you have a lot of body breakdown, tissue breakdown that albeit the the surface that they're on is different. The base of support that they're on is different. but because of the artistic demands and body positions, there's a lot of similarities
Health Advice for Performers
00:29:18
Speaker
there. So carry over to when it comes to injury.
00:29:21
Speaker
And I would say maybe a little bit more on the acute side for figure skating, but more so if you're doing synchronized skating where you have lots of people on the ice or if you're doing pairs or ice dance, just because if there's another person that's in close proximity with you.
00:29:35
Speaker
Excellent.
00:29:39
Speaker
I see anything. Yeah, i'm looking I'm looking through my questions I put together. um
00:29:47
Speaker
So I'll step into the next question, I have it here. um So one of the things that we're dealing with with dancers and skaters for a long time has been with nutrition, eating disorders and such. And one of the things that's been coming up now is ah the use of GLP-1 drugs that they're injecting to help with their, trying to keep fat um off their bodies and trying to get a leaner body. And one of the things that people are our root now realizing about using these drugs is the muscle loss that comes with it. So when you have people who are obese, they are inactive for a long time, they wanna try to lose weight, it's a great drug, and sometimes they can take the muscle loss with that. When you start having athletes using this, it becomes really scary when you're losing muscle mass as well. So um first of all, how often are you seeing this and what kind of issues are you seeing with these performers and skaters who are using these drugs?
00:30:35
Speaker
I would say the ah amount that I'm seeing it within our performers right now, it's it's just starting to at least ah come to come to us as wellness within the university setting. I haven't heard it as much within the figure skating community. i'm not saying that it isn't. happening or that things are at least depending on the level of skater that that's you're at, that there may be discussions around this.
00:31:01
Speaker
ah There's always been discussions around weight, especially in anything where the male has to lift the female and depending on the traditional versus the modern type of style of coaching. But what we have heard within the university setting, which has been challenging, is that we'll have from, again, not just the performing arts side, but just the general student population as a whole, that maybe during the summer that they have explored this, that they have done things like Vagovia or Ozempic, and then they've enjoyed the fact that they were able to lose that weight and how can they keep with this. And so they've had discussions with their RDNs, they've had discussions with the
00:31:41
Speaker
with some other general providers, but maybe not also discuss their concerns and some of these underlying issues with psychological, mental health types of providers. And where is this then where is their motivation coming from? Is there anything that there that might be concerning, especially in some of the performers that may not have of ah that may not be overweight, but maybe still wanting to lose weight and reach a certain goal that they may have? Then again, where is that mental health side of things and making sure that all facets of this process are being addressed by the performers? And so I would say that that's what we're seeing the most is, yes, that
00:32:23
Speaker
It's starting to pick up a bit in our college age community with looking at a muscle mass loss That's a big concern to me as a physical therapist and strength conditioning that I want to make sure that they have the energy because we know that fatigue is one of the biggest risk factors for injury. And if they don't have the strength and they don't have the capability of performing their choreography or their hours upon hours of classes and rehearsals, they don't have the strength or the stamina to do so, we know injury risk is gonna go up. And then we also know that their recovery from said injuries is not going to be as fast. because they're not going to have the muscle mass there to be able to then do the exercises or the corrective things that we could then be able to give them as something immediately a following any type of an injury. so yeah, i I see this, I think it's starting to pick up. I think it's going to continue to progress. And I think the biggest thing that we can do is just try to educate as much as possible for our performers, but not just the performing artists themselves based on their age, but also their support team, our faculty, administration, looking at anybody that has a touch point with them to be able to make sure everyone at least knows more about it to get on the same page. And of course, make sure they feel comfortable talking about it too with you.
00:33:40
Speaker
Exactly. Right. Exactly. It sounds like the the loss of muscle mass, the fatigue, there's a lot of concern about return to performance, but do you also feel like it's just been an increase of injuries when someone is on this medication? Because i can I feel like if someone is fatigued and they're not getting their nutrition needs, are are are you just seeing more people in the office? And perhaps that's a question that's being asked in your one-on-one assessment with them.
00:34:11
Speaker
I think that's, it's''s it's starting to, now that we're a bit more aware that there is this added challenge, ah it is something that is part of the conversation, especially right when we know that an injury has happened, is when did the injury happen? We do ask for their incoming screenings. We do ask what medications that they're currently on, what their allergies are, different subjective questions like that. But also the student, the performer has to be willing to share that information at the same time. And we know that there may be some that omit that, and then it makes it much more challenging for us to see, okay, what exactly may have contributed to the injury in the first place. So I i think it's it's tough because we want to be able to have, we want to support them. We want to have them feel comfortable with making sure that they can kind of tell us everything, but with something that
00:35:05
Speaker
Jill is in this in this area of being somewhat taboo. They may or may not feel comfortable quite yet with that. Now, in your career, you're also working with people across many different age groups, both within the figure skating world and the dance world.
00:35:21
Speaker
Are there tips that you provide to your athletes about long-term health and the sustainability of the of being a performer and what that looks like throughout the lifespan?
00:35:36
Speaker
Yes, i i I like to, and it's it it's tough because I can say I i'd like to give advice and sometimes as healthcare provider, we may not always be the ones that take our advice. So when it comes to sleep, I don't get as much sleep as what I should, but I usually, I'm trying to recommend that. I'm trying to recommend things like good nutrition and especially making sure that you're listening to your body when you are having those aches and pains before they turn into something big.
00:36:02
Speaker
With one of my biggest soapboxes, and i do this, i've I've been on a soapbox for years now, is the importance of warming up and cooling down. And it is one of the biggest things that we can do as people as active people, let alone if you're a performer or an athlete, that if you can give yourself the time to be able to warm your body up properly before you ask something of it and then give some time at the end of that activity to cool it down and get the tissues back to their resting length,
00:36:35
Speaker
Again, these are modifiable factors, risk factors that we directly have access to helping ourselves out with. And the frequency about how many people do a cool down, I can tell you is is few and far between, especially when I look at my patients and I see their flexibility. And even in some of our skaters that I saw earlier today that I saw in triage, I'm like, how many of you do a cool down? Like when you're done skating, do you just stretch a little bit?
00:37:05
Speaker
But also i i look back at when I was a teenager and I was active in dance and sports and and I'd get in the car and go right home and try to get something to eat and do homework. So it's tough. But if it is something, especially our performers that are also students that have to sit for a while after, or we know that their schedules are grueling. If you can try to carve out that little bit of time pre and post, it can really make a difference, especially for things progressing into more tightness or or overuse areas of more concern as they pursue this profession or if it's something that they're training for now and then they want to keep up with even recreationally later, it can allow them to
Traits for Success in Performing Arts
00:37:48
Speaker
continue to do it. Even some of my, I have 67 year old cellists that I give them ah a warm-up program that's just a little bit more than them doing scales. I just give them like, here, do like six, seven minutes of something before you start playing. And it's been consistent that they've told me when I do the physical warm-up, it cuts down on how much I actually have to play as a warm-up because I feel like I'm more ready to go. And then the aches and pains tend to subside as well because they feel like, okay, blood flow, tissue is a little bit more available for them to be able to utilize for their practice and their performance. So that for sure.
00:38:27
Speaker
So is there something that you've seen over the years now? I spent a couple of decades now doing this work and you've been with the University of Michigan for a long time. And the University of Michigan's program is one of the most outstanding programs in the country as far as people who go on to be professionals.
00:38:40
Speaker
So have you been able to notice traits or ah things that, so outside of obviously natural talent, that kind of stuff, but as far as like attitudes or behaviors they pick up from school, some of the traits that have led most led people to become better professionals?
00:38:57
Speaker
Yeah, i I think in probably of all the departments, the one that I've been able to work the most closely with has been dance. And I'm still in awe whenever I'm able to watch the students go from being incoming freshmen and to then graduating seniors and you follow out that path with them. One of the biggest things that I think that our students have working for them is they're very hard workers, 100%, but the creativity and what they're able to do and across all facets that In my class, when I teach anatomy and physiology, I'm having them go through an eight count movement and asking them to break it down by muscles that they're using, planes that they're moving in, axes of rotation, and being able to see their minds work in how their bodies put together and that type of mechanics, and then watch them and what they're able to put together for an amazing production for their thesis as they're graduating and seeing the creativity, seeing the hard work, And then just watching how their brains are working to be able to accomplish something that's very academically focused, but still with tweaks of their performance to these just amazing types of performances that are so multifaceted with lighting design and choreography and, um you know, even their own solos. So I think the fact yeah that they're hard workers, 100 percent, and and that they are just amazingly creative. I think part of that is
00:40:18
Speaker
that that They'll come in with it for sure, but then that is just um further assisted by the faculty and development that ends up coming through the the the course of the curriculum. And the ones that tend to... i had one um freshman who's rocking it out on Broadway right now, but she...
00:40:38
Speaker
asked me, she had had a concussion when she was a freshman and got her through the process even before we had a concussion protocol and went through everything with the assessment with her She was just there with it, really wanted to work hard, making sure that she got herself all the way back. And then when she was a senior, she was the only senior that asked asked for another screening. So she had a screening, an injury risk screening when she was a freshman. She got ahold of me and she said, can I have another one before I leave Michigan? I wanna see where I'm at.
00:41:08
Speaker
And i did the same as exact tests on her, every single thing. And it was amazing to see how much she progressed and how, you know, any deficit that she had, any asymmetry. She was, again, just so amazing. And and now I look and see what she's doing on Broadway. I'm like, OK, this makes sense. like She was taking care of herself. She wanted to make sure that she was in a good place. And boom, now she's just the
Advice for Aspiring Clinicians
00:41:31
Speaker
star on Broadway. So fabulous. And so I would say,
00:41:34
Speaker
That making sure you're taking care of your body along with all of those other, all those other attributes. Amazing. So Kristen, what advice would you give young clinicians who want to specialize in performing arts medicine?
00:41:50
Speaker
I get this one a lot. how I will have, whether it be PT students, athletic training students, PTA students, I mean, anybody in the in rehab, I've had PAs and physicians, also multiple residents that I have helped to shadow. I i think the...
00:42:07
Speaker
the The biggest thing with this is that um trying to get into areas where you can shadow other people that that do this. If this is something that you want to do, i just presented at a University of Michigan Flint at their PT program on Wednesday this past week. And one of the students came up, she's a dancer. She's like, this is why I got into PT. I wanted to know about performing arts. I wanted to do this. And it was awesome. And I'm like, this is so cool.
00:42:31
Speaker
It's like, yay, 20 years later. and But then she asked me the same question, what do I do? And I think a part of it is surrounding yourself with these networks of ah providers that work in performing arts. You can learn what they do, kind of see ah see the the patients that they see, but then also aligning yourself with different organizations like Athletes in the Arts, like International Association of Dance Medicine Science, Performing Arts Medical Association, ah for PTs and PTAs, the American Physical Therapy Association with their performing arts special interest group that all have
00:43:04
Speaker
pretty good deals for students and trying to see, okay, what can we do then as a student discount? Can you attend a conference or can you go to a free webinar to learn more about it? And if you have the availability of doing something like a residency in sports or orthopedics or Or you have the availability of doing a performing arts fellowship, depending on what your time and feasibility is for your schedule, then that is just even more icing on the cake to try to learn more about working with performers in these specific types of environments. But first off, trying to shadow and then trying to follow it up with aligning yourself with the professional organization.
00:43:40
Speaker
that is able to then help to mentor you from kind of a top down level too. And there are, especially if you want to do something like skating or like gymnastics, because those are national governing bodies within the US that they have their athletics associations, you could try to get involved with one of them too, whether you're a past gymnast or a past figure skater, to be able to do different things like coverage. uh, a local skating event or be able to align yourself with another coach or something to be able to get kind of dive into working with their athletes. So there's, there's lots of options that are out there. I think it just depends on which ones are most workable for you.
00:44:22
Speaker
And one of the best, um, pieces of advice that I got was from Mariko Molnar's niece, Mariko Baxter, who Mariko Monar is West Side Dance, New York, like rock star, like one of the biggest and best PTs of New York. And her niece, I did some shadowing with her actually at Ohio State University, the Ohio State University, whenever we were going through building our program at Michigan.
00:44:50
Speaker
And her niece had noted, basically, like, say um say yes until you can afford to say no. And that was one of the things that just stuck with me, that any opportunity that came my way, i just kept saying yes to, yes to, yes to. And then it finally I'm at a point now where with having a family, with having the the job and all of the responsibilities, I can start saying no a little bit or trying to prioritize. But for a long time, i would just say yes to everything that came my way. And that's exactly how I was able to have the opportunities come my way.
Dr. Scheiten's Future and Podcast Conclusion
00:45:23
Speaker
So then where do you go from here? Because you've got the all these different interests and there's only so many time oh so many hours in a day. um yeah But you're doing research now and you got figure skating and dance. So where do you want to go in the future where as far as like your focus?
00:45:38
Speaker
ah I, that's a really good question. i think one that I haven't a hundred percent figured out yet. ah the The, the, the biggest thing i i think that there's a lot that we can do in concussion. There's a lot that we can do in research. And i think I'm just starting kind of wet my feet in that, which is, which has been great and have a really good team that is amazing at what they do and trying to surround myself with as many of those people as possible. ah I would say probably more towards education and mentoring because I really enjoy that as well. ah But I love being there. I love treating. And so I think as much as I can still be able to be involved and invested within our performers lives at a direct level, i
00:46:22
Speaker
and I don't know. i I love what I'm doing, so it's still hard to say no. So I think it's just kind of more bringing a team in to be able to help out with a lot of this, which we're starting to do, to be able to hopefully help offload a little bit and ah be able to go down some of these rabbit holes.
00:46:39
Speaker
Amazing. Well, Dr. Kristen Scheiten, thank you so much for your time. i think we packed four hours of show into 55 minutes here. So we are so appreciative of having you on. Wanted to have you on for long time. Thank you guys so much. Yeah. but Great to see you both. We'll talk to you soon.
00:46:54
Speaker
Thank you. Sounds good. Thank you. And so we come to the end of our show. I'd like to thank Dr. Kristen Scheiten for spending time with us today. i'd like to thank On Call AI for a sponsoring our show and AthletesAndTheArts.com for all their support.
00:47:09
Speaker
For Yossi Ansari, this is Stephen Karaginas, and this has been the Athletes and the Arts Podcast.