Musicians' Health Collective

Musicians' Health Collective: Supporting the health of musicians (and normal people)

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From Violinist to Physical Therapist: Talking With Arlyn Thobaben, D.P.T.

Arlyn Thobaben is a professional musician turned physical therapist working in the San Antonio area.  We have a number of mutual acquaintances from her time at Community Musicworks in Rhode Island, and as a body nerd, I truly appreciate the amount of work and dedication needed to transition from performing artist to healthcare professional. 

Kayleigh: What is your background in music and performance?

Image by Marc Arevalo.

Image by Marc Arevalo.

Arlyn: I have been involved in music as long as I can remember. My two older sisters played the violin (and later, my younger sister) so it was inevitable that I would too!  In high school, I took as many music classes as possible! I was in Orchestra, Chamber Orchestra, Show Choir and Cantorum, and even played the lead role in my high school musical. I began as a Music Education major at Baldwin Wallace University Conservatory of Music, but soon shifted my focus to Violin Performance with Dr. Julian Ross. I have always wanted to be a teacher, and my goal was to be the BEST teacher I could be! 

I completed my graduate studies at the Longy School of Music, where I studied violin and viola with Laura Bossert. Laura is one of the most incredible, life-changing teachers I have ever worked with. I believe that she planted the seed for my curiosity and fascination of the human body and how people learn to learn about the human body. She helped me transform my left hand technique to function with less pain and energy in a totally unorthodox, but truly effective way!  Upon graduating from Longy, I started my musical career as a Fellow with Community MusicWorks. My work with CMW combined my interests in teaching, performance, and community involvement and was the perfect environment for me to cultivate my ultimate professional interests (see below).

K: How did you first get interested in physical therapy?  Did that interest come from being injured?

Arlyn at Community Musicworks, circa 2008/2009.

Arlyn at Community Musicworks, circa 2008/2009.

A: My first experience with physical therapy came through my own injury that hindered my ability to function as a musician. I woke up one morning and couldn’t move my neck. My left arm was tingling! I couldn’t teach or play. Luckily, one of my colleagues at CMW suggested that I call her physical therapist’s office. In Rhode Island, where clients have direct access to physical therapy (without the need for physician referral), I was scheduled and seen that same day. My physical therapists worked with me for a few months, until I was back to 100%. I learned so much about myself, and was touched by what I saw around me in that outpatient clinic. I witnessed people struggling with pain and  rehabilitating from major surgeries, working through to reach their personal goals and get back to their lives with the help of a mentor who knew so much about the human body and how it moves. Soon after, I volunteered at the University of Rhode Island school of physical therapy and had my first exposure to a Parkinson’s exercise group. I watched a professor/therapist work with a woman in the later stages of Multiple Sclerosis, where the focus of problem solving around her functional activities transcended her grim diagnosis. After witnessing that particular interaction, I knew for sure that I wanted to use my talent and the strengths I developed as a musician to become a different kind of teacher—a physical therapist.

K: How has your understanding of the body changed in your studies?  How has your own relationship with your body evolved?

A: I immediately became more reverent and awestruck by the human body through my work in cadaver lab (first semester of PT school, when the going gets tough and you have to learn how to use a scalpel and bone saw with ease). In working to help improve real problems with live bodies (clients), it helps to remind myself of that respect that I developed that first semester.  I remember how everything works together and try to maintain a positive outlook, no matter how difficult the case. In other words, I think, “how is this spine, as is, trying to help my client get through their day? How can I create a window of opportunity to improve how it works?” vs. “my patient has severe lumbar spondylosis and it is causing a lot of pain. X-rays say it’s bone on bone. My exam says so too. What can I do to help fix this mess of a spine?"

In looking at my relationship with my own body, I am hardly ever deeply bothered by an injury or pain. I try to approach my physical impairments with the same sense of curiosity and respect that I use with my clients. My training has taught me to think about the problem, reason through what is most likely to help, make a plan and then take action. 

K: What has been the biggest epiphany with your studies and work so far?  

A: The one idea that has changed my outlook on practicing physical therapy is this: the more complicated the client presents, the simpler it is to discover the appropriate treatment for that client. This provides hope for both clients and their physical therapists! I won’t go into great detail here, but just know this: as a client struggling with complex, severe or elusive injury or pain, you are more likely to find the right treatment with the help of a skilled therapist. 

K: What's one thing you wish musicians knew about health/wellness/the body?

A: I believe that musicians who play an instrument should know that first and foremost, your own body is still your primary instrument! Take care of it as you would your violin (or insert your instrument here). Would you leave your violin in the car when it’s 0 degrees outside? Forget to rosin your bow for 3 months because you don’t have time? Taking care of your body with intention is just as important as practicing with intention. 

K: How do you plan on combining music and PT in your life?

A: I hope to one day play a large role in facilitating access to physical therapy for student and professional musicians of all ages.

K: How can people connect with you and your work?

A: I am currently practicing as an Orthopedic Resident with Texas Physical Therapy Specialists in Selma. (San Antonio, TX area)  Andrew Bennett  is my clinical mentor.  Dr. Bennett is an expert clinician and teacher, and I am so excited to develop my practice and prepare for the Orthopedic Specialty with him!  We are available to clients through physician referral OR for free screenings / consultations (no referral required.)   You can also e-mail me directly at arlyn@texpts.com!



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What is Pain?

Guest Post from Arlyn Thobaben, PT, DPT

Pain can be difficult and confusing. I spent much of my musical career trying (and often failing) to understand and manage my recurrent struggles with a stiff neck, a tingly left arm, and a sore upper back. When these symptoms became too much for me to continue playing and teaching,I was referred to a physical therapist , for the first time. Not only did my physical therapist help me along and get me back to my violin, he inspired me to turn my curiosity and interest in human anatomy into a new career path. After much contemplation, I packed up my violin to purse a doctorate in physical therapy. I was on a mission to help other people understand and begin to manage their pain!

Now that I have become a physical therapist, my primary role is to collaborate with each patient in creating and implementing an individual plan for pain management. This can include hands-on treatment in the clinic, home exercises, movement strategies, and activity/behavior modification, but the first step often involves increasing understanding pain and its physiology.  If you have been struggling with pain as a musician, you are not alone! In this 3-part series, I aim to help musicians like you understand pain a bit better, shed some light on the role of physical therapy, and provide some battle tactics for those who have been struggling with nerve entrapment issues and / or chronic (long-term) pain.

First, what is pain? It is a multifaceted experience that we may describe as a sting, ache, burn, twinge, pinch, stab, throb, stiffness or other unpleasant term. It can be annoying, worrying, even debilitating. It can make a brief appearance, or hang out for a while. Pain is highly individual and personal, so much that there is no way for an outsider (for example, your doctor or therapist) to objectively measure your pain. In other words, you are the only person who can experience your pain. Pain is a normal body process, involving many body systems, that is experienced when the brain concludes that somewhere, somehow, you are being threatened. Pain is often a motivating force to change: your body position, your situation, your behavior. Pain is meant to keep you safe.

So why don’t we say “yay, thanks!” to our pain and embrace it for its important, life-preserving role? Acute pain caused by a sudden injury (a slip and fall on an outstretched right arm, for instance) can prevent a violinist from holding and manipulating her bow, thus forcing her to sit out of her orchestra job, perhaps even for the next several months. Chronic pain (which will bediscussed in greater detail in part 3) can affect a musician profoundly for months or years. No wonder why we can hate and fear our pain, wanting it to just go away! However, I believe that when we soften our stance by working with our pain, rather than fighting against it, that we can be happier and more productive. We just have to dig a little deeper to find out its message.

Here are some of the most common pain messages:

Call an ambulance / seek medical attention immediately. Maybe you were involved in a traumatic accident, or the pain is intense and sudden, unusual / disturbing, or accompanied by excessive bleeding, broken bones, or any other gruesome scene you could dream up. This time, the body is telling you to get help quickly.

Time to rest and recover. Following an acute injury, this type of pain usually requires time off for the bones, muscles, ligaments, and tendons involved. Although it can be difficult, this type of pain usually means the marathon runner should cease training, and the cellist should stop playing the cello. This time off can also be mandated by a surgeon, physician, therapist or other professional. The body’s healing functions can be more efficient with adequate rest, nutrition, sleep, and smoking cessation (if applicable)

Time to retrain the body / gradually return to function. This type of pain hasaffected most musicians at some time in their career. Overuse injuries such as tendinitis or nerve entrapments are often involved, and acute injuries often transition into this type of pain after several weeks once initial healing has taken place. Recovering from this type of pain requires patience, persistence and artistry.  It can be facilitated by someone like a physical therapist, Feldenkrais Alexander technique,  instructor, yoga teacher, your private instrument teacher, or other professional. The body is telling us that yes, we can return to our activities gradually, but we may need to examine and change our posture, technique, or rehearsal load.  It is telling us to plan and schedule our practice very systematically to allow the  body adequate recovery time. You do not want to play or practice through this type of pain.

• Time to retrain the brain.  When pain has continued for a long time (e.g. 3 months or longer), it may be necessary to retrain the brain through visualization, movement strategies, and carefully graded exposure to activities involved. You may have been searching for a definitive diagnosis for a long time, your pain may be becoming more widespread, or you may be noticing that you have been able to move and function less and less over time. This type of pain can be the most difficult to deal with, and requires a strategic approach (which we will discuss in part 3, stay tuned.)

How does your brain respond to pain?  And why does everyone's experience differ?  Watch this Ted-Ed video on pain thresholds and how pain causes different reactions in different people.

If you are a musician with pain, remember- you are in good company, and there are many resources available to facilitate your recovery! In the next post, we will discuss in more detail the physiology behind pain and nerve entrapment issues. Knowledge can be one of your best allies in managing your pain.


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