Dr. Eduardo Pereira talks to us about this new program sponsored by the MSM Student Affairs department and tells us why it’s important. Students may take part in the program after a referral from the student nurse.
After reading our interview with Dr. Pereira, meet two MSM students and how they were helped by MSM’s PT program: MSM viola student Ariana Mascari, and MSM Jazz Arts student Mikkel Blaesild Vuust (drums).
Photos by Jeffrey Langford
Group physical therapy sessions at MSM
Dr. Pereira: The physical therapy program at MSM – MSM PT – was put in place by the Student Affairs Office in the 2019–2020 school year as a pilot project to provide treatment for musculoskeletal [MSK] pain and injuries related to instrumental and musical theatre students.
Data shows that musculoskeletal complaints are one of the main reasons students visit the campus health office; they also produce a significant number of visits to different types of physical therapy services which in turn results in a significant number of claims from MSM to the MSM health insurance plan.
This illustrates the need for treatment services at the school as well as the value of education and injury prevention to help with the overall well-being of our student community.
Dr. Pereira: We essentially run a small out-patient orthopedic facility open on Wednesday and Friday during the academic year in the MSM gym, located in the basement of Andersen Hall. The student referred to us – by the campus health and other Healthcare providers outside MSM – receives a personally structured complete wellness package of services that could include:
Our goal is to help students to continue prioritizing their musical practice while treating their injuries and improving their health and wellness. We share highly engaging content relevant to all fitness and wellness levels.
MSM PT is a high-quality care physical therapy intervention with in-person, one-on-one, remote, and group interventions. We must not forget that the same injury manifests itself differently in each person due to psychosomatic aspects. Our approach, therefore, takes into account the individuality of each person.
“The most rewarding part of the physical therapy sessions is the practical and instantly applicable exercises and information Eduardo provides.” Mikkel Blaesild Vuust MSM jazz drumset student
“The most rewarding part of the physical therapy sessions is the practical and instantly applicable exercises and information Eduardo provides.”
Mikkel Blaesild Vuust
MSM jazz drumset student
Dr. Pereira works with students such as jazz drummer Mikkel Blaesild Vuust to assess musculoskeletal complaints and determine solutions focusing on well-being for the whole musician.
Dr. Pereira: We have individual, one-on-one sessions, as well as group sessions.
As for the Physical Therapy individual, one-on-one interventions, we offer these services as an educational opportunity for performing artists to gain the skills and awareness needed to create healthy patterns early on in their careers for overall well-being, both personally and professionally.
And the Physical Therapy Group sessions: to enhance the efforts on health promotion activities, students are organized by injury type: either by upper extremities, which we call the “neck, shoulder, and arms group,” or lower extremities – the “back, hip and legs group.” Students join these groups after an individual assessment by us, or after completing four consecutive one-on-one interventions.
[ The criteria for the groups sessions are:
Dr. Pereira: While the life of a musician may seem glamorous, behind the scenes of a performance it involves long hours of repetitive practice, prolonged or sustained postures, performance anxiety, and exposure to environmental hazards such as dim lighting and loud noises.
For students, practice and performances mean hours of sitting, holding challenging body positions, and hours upon hours of rehearsals and practice. Added to this are the difficulties and stress generated by the experience of living far from home, maintaining a social life, and having a schedule filled with school assignments that often translates into a sedentary lifestyle.
With this program, MSM aspires to help our students become healthier performers. We are also particularly interested in incorporating the teaching about how to prevent those types of injuries into the students’ overall learning experience, to help them have a better professional future in the music and arts field.
MSM viola student Ariana Mascari works with Dr. Pereira in one-on-one or in group sessions.
What is important to highlight is that performance injuries are preventable. A holistic approach that encourages wellness and personal responsibility is necessary for prevention. In our opinion, it is very important for music schools to focus on prevention education in addition to supporting efforts to treat diseases once they have occurred.
There are a few basic concepts that are indispensable for Musicians to understand:
I like to explain to students that musicians are athletes. As athletes, they need to increase their body capacity to meet the high demand of their activities, otherwise they will have injuries. This decree is applied to all of us and especially to individuals who are subjected to high demand activities, as musicians are.
Thus, musicians need a lot of resources and training (read here: workouts and better yet, cross-training!) required for them to be successful athletes. Furthermore, as musicians, they actually need more of these efforts because:
This knowledge comes from the literature of a profession that is specialized in the human movement system: the physical therapy profession.
Physical therapy is a health care profession concerned with the habilitation and rehabilitation of individuals having limitations resulting from movement impairments, pathological, surgical, or traumatic conditions. The profession is also concerned with health, wellness, and prevention of disability in an effort to promote maximal use of an individual’s capacities, to reduce and prevent their risk of illness.
Another important concept to understand is pain science. Pain is an alarm, a highly effective mechanism of protection. Pain is not a reflection of body tissue damage. Although pain is real and personal, it is dependent on context, and the system can learn to be in pain after tissues have healed.
This being said, once the system is “irritated,” the dosage of the exercises are fundamentally important. Exercise is medicine. As an analogy, if you take a very high dose of a medication, you will most likely have side effects, correct? It is no different in my field. I am the doctor who will prescribe, not advise, the exact amount of exercise for my patients in order to have an immediate positive response reducing pain and improving movement. All this without the risks of medication.
Hope. Autonomy. Reassurance. Self-efficacy. Healthy Lifestyle.
I also help people to reframe their beliefs (based on evidence).
Which beliefs?
On day one working with me, the students realize that they are not fragile or in harm.
Here at MSM, we are doing what is right: helping change healthcare one patient at a time. I transfer my knowledge teaching the students how they can treat themselves. This way, they effectively learn how to prevent further injuries as well.
Our focus is the root of the problem. Focusing on diagnosing the disease for which little can be done, may lead to ignoring signs and symptoms of which much can be done.
Rehabilitation is to show a patient what they can do for themselves. Our approach is based entirely on this idea, and our ultimate goal is to create a positive experience, a positive environment building capacity to decrease under preparation for the unexpected, developing resilience, promoting reassurance and reactivation and thus, decreasing over protection.
Resistance training is just one piece of the overall recipe for success. Despite plenty of evidence about how strength and force generation can have a great positive impact on injury prevention (strength is currently seen as more important than motor control), it is still less important than bio-psychosocial factors (it would be less helpful if you do not sleep enough, do not monitor nutrition and are constantly stressed out). We can not forget that our capacity to perform is dictated by a multitude of factors and doing our best to address them all is key.
In this respect, besides PT intervention, the students are introduced to meditation and mindfulness (highly important and very correlated to optimal mental skills and performance) and strategies to reduce anxiety.
I also apply in my treatments at MSM a combination of exceptional manual therapy techniques, the prescription of precise corrective exercises and joint stabilization through muscle activation, and motor control to address the demands of each individual. The patient’s education in physical therapy techniques, fitness, general wellness, and ergonomics is key. I work one-on-one with each student to ensure that their treatment goals are met.
Therapy programs are continually reassessed to monitor changes and improvements in a patient’s condition. My knowledge is strongly grounded on research, and my treatment philosophy is permeated by an array of theories that are all integrated in a model to compose joint alignment and function, stability control and optimal human performance.
I will give you two. The first one is prevention. The second is linked to prevention: remain active, whenever possible.
It takes patience and persistence to overcome an injury. So, the best way is to prevent the occurrence of any injury, learning how to listen to the signs and signals that your body is sending to you. The body “tells you” that an injury will occur before the occurrence of an injury. 100% of the time. And, the best way to “listen to it” is having awareness.
We are at MSM to provide support and to teach the students what they haven’t learned yet in their careers: how to treat themselves. This way you will learn the most effective way to also have an active lifestyle. Then, the positive outcomes will be a mere consequence.
Basically I can over-simplify it into three big clusters of concepts: mobility, strength, and integration of both. Everything else comes from these three things (flexibility, stability, etc…).
We first do a thorough individual Assessment (Initial Evaluation) to create a Plan of Care, letting value-based goals direct care. The causes and consequences of an injury can extend beyond those observed in the affected tissue, and for this reason, I consider of paramount importance a comprehensive movement analysis assessment of each individual. During this process we create rapport, make shared decisions, define readiness to change. Then, we deliver our treatment. In this phase, we help the students make sense of symptoms, we teach problem-solving skills, we set the students up for successful experiences, and we provide tools to manage pain and emotions. These first two phases can take roughly from two to four weeks on average depending on each individual case. Later, we re-evaluate with adjustments of goals, action planning, and making sure that the students have a better understanding of pain.
After this re-evaluation, the students are placed in groups of treatment with other students with similar injuries and level of knowledge and fitness. All this is surrounded by lots of compassion and respect. We are all about people!
It is very important to highlight the positive outcomes and positive feedback from the students that have participated in this project so far. There is still a lot to be done, but we can assure that we have accomplished a lot in these past years.
Qualitatively, students at MSM were classified as having a sedentary lifestyle, deprived of sleep, and poor body awareness prior to the interventions. Their impaired aerobic and physical conditioning are risk factors for multiple diseases and an important factor for their complaints. It is important to consider that injury will be more prone to occur when our bodies are not prepared for a load or activity.
On the other hand, all these are modifiable factors through education. The students demonstrated compliance and the outstanding results of our interventions are linked to their increased motivation to change their behaviors and the attitude towards their conditions.
A great part of the success of the project was also due to our approach: the patient needs to take charge in order to improve their condition.
To say that music has played a major part in any MSM student life would be an epic understatement. Most music students overcome several obstacles to follow passion for performance. It’s incredible how our students persevere to find their place in New York City through music. It’s motivational to anyone who has the slightest notion of how hard and stressful their life routine is. Now, if you add to this depiction a history of persistent pain, symptoms of peripheral nerve irritation that are often disabling, worries and assumptions related to an injury… then you have a recipe for a vicious cycle leading to chaos.
I like to provide very important contributions to the lives of my patients, and I have an endless desire for getting these patients pain-free and functioning again. I am grateful to help people, to collaborate effectively with colleagues, and there is no greater feeling for me than helping a person get back to activities that are important to their lives or even enabling them to perform simple things with no difficulty.
I am super-passionate about sharing and teaching what I know and do with others. And to see that spark – to ignite what I preach in others – is exciting and priceless.
Music schools do influence student behaviors through factors such as collective values, beliefs, and actions. These factors need to be considered and modified as crucial first steps toward reducing the rate and severity of performance injuries. A health-promotion framework offers a common philosophical and practical basis for such efforts and would allow for effective and sustainable prevention-oriented educational efforts.
In my daily clinical practice, I have noticed the eyes can see only what the mind already knows. As I am in a constant learning process, I feel as if I have “new eyes” every single day. These “new eyes” have guided me in my approach, and my philosophy is applying the host of my skills to improve someone’s overall mobility and movement.
At MSM, we are introducing a new culture. With our passion to help musicians, we are also getting better, growing, constantly improving. It is great to see so many people engaged in this project now. The difficulties have always existed. All sorts of them. I don’t want to be cliché, but all obstacles just make us much better.
We would never be where we are if not for all the hard work done in the background. Over the weekends, at night, during the holidays, we have a perfect team! And I am sure that the reason is because music has the power to bring us together! All this would not be possible without all the efforts from Monica Christensen, Kai Santiago, Antongiulio Foti, and so many others, including, of course, all the students that have already participated in this project since 2019.
I am an enthusiastic Doctor of Physical Therapy [DPT], with a solid background and knowledge in health promotion and wellness, and expertise in Orthopedics, Sports Rehab, and musician’s injuries. My studies and experience encompass two continents and several cultures. I have obtained extensive experience with musculoskeletal injuries working with professional athletes, musicians, and dancers. Born in the US and raised in Brazil, I earned my first physical therapy degree in 2005. Since then, I received my Doctor of Physical Therapy degree from the University of Montana, among other titles in the orthopedic field and in the healthcare administration. I am a mindful practitioner combining comprehensive movement analysis, exceptional manual therapy, and the prescription of precise corrective exercises to address the demands of each individual. Physical therapy and music are my greatest passions.
In addition to pursuing new challenges and honing this knowledge, in my spare time I enjoy running, hiking, cycling, and yoga. I also appreciate the arts, soccer, playing musical instruments, and traveling.
Finally, finding work you love is essential to living a healthy, balanced life. I am fortunate that I have found work where I can help people have better lives.
130 Claremont Avenue New York, New York 10027 212-749-2802
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