Five Questions With: Dr. Amity Rubeor

Dr. Amity Rubeor, a board-certified sports medicine physician, practices at Care New England Medical Group Sports Medicine East Greenwich, formerly Affinity Sports Medicine. Rubeor is the only physician in Rhode Island to have completed a proficiency exam in performance medicine, focusing on the specialized array of neuro-musculoskeletal and musculoskeletal conditions and injuries in musicians, dancers and other performers. The Performing Arts Medicine Association in conjunction with the American College of Sports Medicine offer that proficiency exam. She spoke with Providence Business News about her practice and what’s different about treating actors, dancers and musicians.

PBN: Explain the performance medicine certificate, and what was involved in getting that certificate?

RUBEOR: The certificate in performance medicine is relatively new in the American College of Sports Medicine. With the help of the American College of Sports Medicine, clinicians skilled in performance medicine have been educating other individuals in this field. It has become a joint venture between the Performing Arts Medicine Association and the American College of Sports Medicine. I attended a two-day course this summer in New York City where the basics of performance medicine were covered. I completed a standardized test at the end of the course, which tested me on the material. It was also helpful that I had previously completed courses in performance medicine.

PBN: You have said that treating patients with concussions inspired you to treat performance artists; do performance artists experience concussions at a higher rate than does the general population?

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RUBEOR: Currently, there are no statistics documenting a higher incidence of concussions in performers than the general population. To my knowledge, there have been no studies on this topic. As a sports medicine physician, I was seeing athletes who also played musical instruments or were involved in the school play. When prescribing physical or cognitive rest for these athletes, I also needed to take into account their practice of their art. I needed to incorporate a return to play that involved their art, as well as their sport and their schooling.

PBN: Do you have an affinity for acting, dancing or singing, or watching such performers; if so, does that inform your practice in some way?

RUBEOR: I have always been an athlete and was not particularly adept at the arts. I played the piano briefly and worked on our high school plays as part of the stage crew. But, I have always had an appreciation for the arts. Growing up in Maine, I would attend the Portland Symphony Orchestra performances, and here in Rhode Island, my family and I love to attend performances at the PPAC [Providence Performing Arts Center], Festival Ballet Providence and the Island Moving Co. in Newport. I enjoy caring for dancers and musicians in my office and would love to grow that portion of my practice.

PBN: Injuries to a patient’s vocal cords are nothing like injuries to a patient’s knees; what are some of the specific medical issues that dancers, singers and actors each face, and how do you treat them?

RUBEOR: Just like there are a constellation of musculoskeletal injuries that are associated with football and soccer, there are injuries that are common to dancers like hip and foot pain. Some medical illnesses, such as relative energy deficiency in sports, can be seen in athletes such as runners and gymnasts, as well as performers, like dancers and actors. Accountants and truck drivers sit for long periods of time, as do some musicians. If that prolonged sitting also involves rotating one’s body in one direction and keeping it like that, one can develop pain from overuse in that position. This could be seen in sharing a music stand with a fellow violinist or driving cross-country in a truck repetitively using the clutch and brake and gas pedals. Vocalists can develop vocal strain if they are not optimizing their posture. No matter who I am seeing, I often educate my patients on their posture and how to optimize it to their performance.

PBN: Singing, dancing and acting all tax the body in ways that other general exercise might not; how can you help your patients minimize the wear and tear and protect their vocal cords, hearing, muscles, tendons and bones?

RUBEOR: Through my courses on performance medicine, I have learned about ear plugs that can reduce intensity of noise without affecting an artist’s ability to perform. I have learned of straps and stands that may help a musician hold his or her instrument without straining his or her body. I have learned the difference between a raised stage and a flat stage at performing arts centers. But, what I learned more than anything else is that my treatment and recommendations should never be done in a vacuum. As much as I involve a certified athletic trainer and coach in an athlete’s return to play or recovery, I need to involve a performer’s coach or instructor. I learned the importance of recognizing an instructor’s pedagogy and incorporating that with my medical recommendations.

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