“Artists are Athletes”
An interview with Physical Therapist Karen Litzy
Few things are as terrifying to the performing artist as injury. When your livelihood is based on performing a range of super-specialized actions you’ve spent years honing, the notion that your bodies might “break” can feel like a truly existential threat.
With this interview, Creatives Care is launching a short series on the intersections between physical injury and mental health. How do the two impact each other? How might they be related? And how can learning about one help us improve the other? To kick off this series, Ariana Sidman, Kamala Schelling, and Catherine Hancock sat down with physical therapist Karen Litzy.
About our guest: Dr. Karen Litzy is a renowned physical therapist who practices in NYC. As the founder of Karen Litzy Physical Therapy, PLLC, she has developed a business model based on the acronym EPIC: Empathy, Punctuality, Integrity, and Compassion. The result is a world-class physical therapy practice based on the "concierge" model, catering each session to an individual's needs to help patients find health and wellness in the home, in the office, or on the playing field.
Dr. Litzy is also an internationally acclaimed speaker and the host of the podcast Healthy Wealthy & Smart, where she interviews influencers in the worlds of health, medicine, and entrepreneurship and also shares how she has prevailed with her own experience of chronic pain.
Creatives Care: Dr. Litzy, you have significant experience working with athletes, which is why we invited you to join us today. But have you ever worked with artists?
Karen Litzy: Absolutely! I used to work on The Lion King on Broadway, where I treated everyone from the musicians, dancers, and actors to the stage management, dressers, and makeup artists.
CC: What are some of the differences between treating a person who specializes in the performing arts and treating an athlete?
KL: When it comes down to it, performing artists are basically professional athletes. The pressures are the same; the need to perform at an incredibly high level is the same. So even if the injury itself might be different, from a therapy standpoint, you go through a similar process of mapping out treatment: You strategize with the athlete or the performer, and you also talk to the stage management or sports coach. Performers never want to be pulled out of a game or off the stage, but continuing on with the show can put an individual at higher risk for a greater injury.
CC: In the performing arts, where repetitive stress injuries are common, there seems to be a notion that if you get injured it's because you did something wrong. In your experience, is that necessarily the case? And what would you say to somebody who feels like their injury reflects poorly on their abilities as an artist?
KL: I think it really depends on what stage you are at in your journey as a performer. Usually, the people that I'm working with have been in their craft for many, many years, so the odds that their technique is what caused the injury are actually quite low.
If someone has pain while running, we don't necessarily want to change their gait pattern; in fact, studies show that that doesn't end up decreasing pain. So instead of changing a patient’s form, I like to think of my job as optimizing their form, whether that patient is a runner, an athlete, or an artist. How can I increase their strength, flexibility, and stamina? Are there little external tweaks, like raising a seat height, that might help?
When repetitive strain injuries are associated with tendinopathy (what we used to call “tendonitis”), laying off the activity is the first step. Then you slowly increase the load on the tendon, so it can become familiar with accepting the weight you’re placing on it. But this kind of intervention takes time, and what I find with a lot of performers is that by the time they go to a physical therapist, they've been feeling pain for months, they have an upcoming performance, and they need to feel good ASAP. Overuse injuries need time to fully heal, so my advice as a physical therapist is: while confronting an injury can feel daunting, being proactive and seeking help at those first signs of pain can make the recovery much simpler in the long run.
CC: One thing we've heard from artists is that injury can be a lonely experience. Have you heard something similar from your patients? And why might injury feel so isolating?
KL: I think injury can feel incredibly lonely because we—both artists and athletes—identify so closely with what we're doing. It becomes not only our profession but also who we are, and our sense of value is so intrinsically linked to our craft. So as a physical therapist, it’s important to remember that this activity is about more than just the sport or the art. This activity is where your peer group is. It's where, perhaps, your friends are. It's where you're spending your free time.
An injury doesn’t just take you away from what you do for a living, it also takes you away from your friends and your social life, as well. So when you’re injured, it’s not just your body that is hurt. Your whole sense of self is suddenly vulnerable, and that’s a frightening place to be.
CC: What about if you have a patient whose injury might end their career? How do you support them through this experience, not only physically but also emotionally?
KL: I think that the most effective physical therapy often involves a team approach, taking into account not just the patient but also the physical therapist, the physician, and (if they are young) a parent or guardian. If they are older, perhaps it's a friend, a spouse, a coach, and/or a teacher. If it's sports related, I always try to bring in some sort of sports psychologist or other mental-health specialist. Because an injury is a bummer.
When these people can really come together as a team, they can engage the various implications of the injury—physical, emotional, social, etc.—and figure out how to help the patient move forward in a holistic way.
CC: When placed in a vulnerable position, artists often mask their discomfort. Is this something you run into a lot in your work?
KL: I would say patients almost always mask their discomfort, regardless of their age or their injury or their job title. I think some people see it as a badge of honor: “Look at how much I can do, even though I have all this pain! Look how good and strong I am!”
This stoicism is definitely something we’ve learned from the world at large. Think of the movies and TV shows we watch, how often we see people get injured. The response is typically “It's okay, it's just a flesh wound!” All of that goes into our brain, and then we think that's what we have to do.
But what if we started asking: “Wait a second, why do I need to have all of this pain?” It’s my job to work with patients to reduce the pain while still completing an activity to its fullest potential. And sometimes when you remove the pain, people can even perform much better.
CC: On that note, what do you tell people who claim pain is “all in your head”? What about people who say “no pain, no gain”?
I hear the “pain is all in your head” statement a lot. The answer is: yes, pain is all in your head but not in the way this phrase suggests. Pain is a sensation that is an output of your brain, because your brain is telling you that you’re in danger. But that doesn’t mean that pain isn’t real. Pain is real, it has a profound impact on our bodies.
The International Association for the Study of Pain recently modified their definition of pain. Now it's “an unpleasant sensory and emotional experience associated with or resembling that associated with actual or potential tissue damage.” It's important that they specified both sensory and emotional aspects. We know that pain affects the amygdala, which is the emotional center of our brain, so we can't disconnect pain from our emotions. We also know that pain is biological, psychological, and social. So more and more practitioners are treating pain through a bio-psycho-social lens.
As for “no pain, no gain,” I like to substitute “know pain, know gain.” We need to listen to the message our body is giving us through pain, and patients in pain need to be believed.
CC: Imagine I suffered a serious injury and have just finished the recovery process. From a physical standpoint, I’m ready to return to my activity, but mentally, I’m not prepared. What would be your advice?
KL: If that's what you felt, I’d say you’re not ready to return to your activity. The mental element of feeling healed is so important—it’s just as significant as being physically prepared. Kevin Durant, who plays for the Brooklyn Nets, tore his Achilles tendon, and it took him a very long time to get back into the game. He has talked openly about how he was very nervous about re-tearing his tendon. That mental barrier is real, and it needs to be taken into account.
That may be where a sports psychologist—or any mental-health provider—comes in handy. I would even argue that a sports psychologist can work very well with performers, because athletics is a kind of performance.
CC: Creatives Care is about educating providers as well as patients. Is there anything you would like to share with a mental health provider about physical injury?
KL: Mental health providers: refer your clients to a physical therapist if they're not already seeing one. Reach out to local physical therapists in your area and form a partnership. Physical therapists: reach out to local psychologists or coaches in your area, so that you can form a relationship and consult one another in areas outside your expertise.
As a physical therapist, I also take the time to ask questions. “Hey, do you need someone to talk to about what's going on and the difficulties you’re facing? Would that be helpful?” And that's where the team we talked about at the beginning of this conversation comes into play. When we can offer treatment that addresses both the physical and emotional components of an injury, we can maximize the outcome.
