Dancing through the pain: physician executive launches new business to treat patients with chronic pain.

Wilhelmina Korevaar, MD, MMM glides across the hardwood floor in her elegant floral print dress as dramatic Latin-flavored music blares from a small stereo system, filling the narrow room and spilling out open doorways to the cobblestone streets of Philadelphia's historic district.

Brona Vrtalova, an award-winning dancer and instructor from the Czech Republic, wiry and energetic, leads Korevaar in her graceful moves, as each keep one eye on the dance studio's mirrored walls. Vrtalova is gentle but firm, pushing up Korevaar's shoulder muscle in an effort to keep her posture straight as she moves.

The dance teacher is constantly gesturing, showing Korevaar how to keep her head upright. "If my back is just a little bit back," he says in his thick European accent, "then all my energy is separated."

Korevaar isn't just taking a routine dance lesson on this late summer evening. This is how the physician--with a specialty in pain management--was getting ready for the opening of her new clinic last fall, located right next door to the Society Hill Dance Academy.

Her facility is called MDance, and Korevaar believes that it's the very first of its kind--using dance therapy as a technique to reduce chronic pain and restore patients to a more active lifestyle.

"Sometimes, working out in the water or on a bike is not adequate" for patients with overwhelming chronic pain, Korevaar says. "And sometimes it's hard to get women out walking. But this is something that people would do in the course of their day-to-day life--hearing music and dancing."

As she works out with Vrtalova, she's not only learning salsa and tango steps but what moves might alleviate back pain, for example, or which ones help a patient with sore arms.

In one way, Korevaar's clinic and her bold approach to pain management is the culmination of a calculated career move some five years ago, when she went back to school and earned her master's degree in medical management at Carnegie Mellon University through the American College of Physician Executives.

Accidents happen

But Korevaar's career has also been driven by accidents--and not just the kind that cause patients to seek out this pioneer in the treatment of pain. Only a twist of fate caused her to switch career paths from art to medical school. Then, she started out on a program to become a surgeon--and shifted gears once again.

No accident had a greater impact on Korevaar's current career than a huge misunderstanding she had several years ago with her future husband.

"I actually started doing this because I had tremendous anxiety about social dance--and when I met my current husband, he made a small comment to me that I misunderstood," Korevaar recalls, laughing. "He said that being able to dance together was really important to him. Well. I panicked." Korevaar was a child of Southern California in the 1960s and 1970s, "so all I really know how to do is jump around."

But nothing spurs Korevaar on more than a challenge, and she never does anything halfway. After the remark, she signed up for what she jokingly calls "hundreds of dance lessons," covering everything from the tango to salsa. It was only after she'd paid up for the instruction that she found out she'd totally misconstrued what her future groom had said.

"It turned out my husband didn't know how to dance either. All he knew was how to jump around." The couple did learn enough to do a tango at their wedding, but in the meantime Korevaar realized that dancing was also making her feel better physically and mentally as she reached middle age.

"I was starting to get 60-year-old aches and pains," says Korevaar, who is now just 51. "I would wake up in the morning and my fingers were numb. I was starting to feel old." But those things changed dramatically with her dance lessons.

Korevaar lost 40 pounds and she never felt better. The improvement was dramatic when she moved to the Society Hill Dance Academy and started working with two Czech-born and trained dancers, Rene Ostarek and Vrtalova. "In just one or two months of working with them, my entire posture changed," she says.

"It was then," Korevaar adds, "that the light bulb clicked." Korevaar says that bad posture, often compounded by poor eating habits, placed pressure on the spinal chord that in turn leads to problems with the way that nerves fire.

Over the last couple of years, Korevaar worked closely with Ostarek and Vrtalova to learn how specific dance movements and posture improvements can help different types of medical problems. She says that shoulder pain, for example, "is probably a neck problem, and you need to support your torso and your neck more from below."

Korevaar's ideas eventually led to the creation of MDance. She now spends afternoons working with patients and the two instructors in the studio, after evaluating their pain problems inside her medical office.

Not the first time

This is far from the first time that Korevaar struck out in a bold new direction. The habit may come from her father, who moved her family from the Netherlands to America shortly after Korevaar was born because he saw a lot more opportunities to teach in his field of mathematics in U.S. universities.

The quest took the young Korevaar to Ann Arbor, Mich., and then Madison, Wis., before she ended up in San Diego for her teen years. In the late 1960s, she enrolled at the University of California-San Diego with a proposed major of Spanish literature and with every intention of becoming a full-time artist.

[ILLUSTRATION OMITTED]

But the drudgery of the table-waiting jobs that were putting her through college made her aware she wasn't cut out for the life of a starving artist. That's when she discovered medical illustration.

But to become an illustrator, Korevaar would have to do something else she's never been especially good at--taking orders. She recalls that "a friend told me, 'you don't want to be a medical illustrator--you'll go nuts with dumb doctors telling you what to do. You should go to medical school.'"

Korevaar did just that, winning admission to the prestigious Yale Medical School in 1973. She did, in fact, draw illustrations for the school paper and her class show, but that dream faded as she got deeper into her medical training on the Ivy League campus.

Now, Korevaar was looking toward a career in a specialty that was heavily dominated by men: surgery. She sought to become the first ever woman to complete a prestigious residency in surgery at the University of North Carolina at Chapel Hill, but found she was clashing with male students.

"I would be there for 36 straight hours," she recalls, "and the guys would come back in and make their rounds and start calling me names like 'K & K,' for 'Kleenex and Kotex.'"

She switched over into anesthesiology, where there seemed to be less sexism and where she was dealing with many of the same patients. She finished her residency in 1977 and found herself increasingly drawn to the field of pain management--a concept that was just getting off the ground.

"They would give a patient 50 milligrams of Demerol, and if that didn't take care of the pain the doctor would say, 'But it says right here in my handbook that that's what you get. It's supposed to last four hours.'"

Korevaar won a federal fellowship to study pain management in Chapel Hill, and then came to Philadelphia for more training. She never left the City of Brotherly Love--getting married and raising two children who are now teen-agers.

Treating pain

She had some novel ideas about pain management, including some that were way ahead of their time. Indeed, some doctors scoffed when she proposed studying pain management in children, because the conventional wisdom--since undercut--was that the brains of infants and toddlers were not developed enough to experience pain.

"When I explained my interest, some doctors were appalled," she recalls. "They looked at treating pain in a 2-year-old as odd. It wasn't traditional."

She did some early work in that area at Philadelphia's St. Christopher's Hospital, but by the mid-1980s she was doing more traditional work in pain management through the University of Pennsylvania Hospital as well as her own clinic in a suburb just west of the city.

She learned that nerve blocks--a common procedure for treating pain--didn't work in the long run and that only two things were successful: Neuromuscular rehabilitation and cognitive behavioral therapy.

"What studies show is that treatment isn't working unless the patient can get back to a normal working lifestyle," she says. She explains that chronic pain is often the result of nerves learning to send the wrong signals over time. That means it's necessary to essentially re-educate the nerves to perform their original purpose, which often also means changing the habits of patients who've learned to avoid certain muscles and motions.

But just as Korevaar's philosophy of treating pain began to come together, she began to suffer a mid-career crisis. Her new dean at Penn was less supportive, but more importantly she was frustrated--as were many of her colleagues--with the changes resulting from the rise of managed care in the mid-1990s.

She found her methods of evaluating pain patients didn't always jibe with the insurance providers' ideas and she feared for her financial future. "In my mind," she says, "I thought maybe I could become a high school science teacher, that that would be more financially rewarding."

But she also looked into a job that would mark another change in direction for her--studying pain treatment for the local Independence Blue Cross to come up with better ideas of what works and what doesn't. That information could be used to control costs by avoiding unnecessary treatments.

The job Korevaar was looking at was for a "medical director," and Korevaar jokes that she didn't know what exactly a medical director was. Then somebody sent her a book from ACPE called: Medical Directors--What, Why, How?

She ultimately decided to seek a degree in medical management and says it was a career altering experience. "I met people from all over who were similar in age and who had a similar professional quandary, noting that things were changing and wanting to embrace the change rather than hang around."

Working with worker compensation

After earning her master's degree, Korevaar took on a very different career challenge, as medical director for employee liability for the city of Philadelphia. Much of her city job involves the evaluation of worker compensation claims. She said her experience with the municipal job also helped keep up her interest in alleviating pain, because "by and large most employees want to go back to work."

Korevaar believes that her work with MDance Clinic will allow her to help pain patients return to their jobs and the other activities that they once enjoyed. In addition to working with the Philadelphia employees, Korevaar says a lot of the motivation for opening the new clinic came from her own life.

"People are different in their 40s and 50s--they go through a fragile time," she says. "People put weight on and more people are going through their life cycle. They aren't biologically depressed but they aren't feeling good."

She says that as she focused on her posture through her dance lessons, "it made a huge difference in what foods I chose to eat and how happy I felt about it."

Korevaar says the two dancers, Ostarek and Vrtalova, are instrumental to the clinic and helping her to understand the interconnections between the different muscles, pain, and particular dance steps. "They are playing a key role in terms of educating me," she says, adding that they are preparing a book of "homework" for patients so they can continue their therapy at home.

Her plan for the new clinic calls for an extensive, initial medical evaluation, to be followed by three weekly sessions that include exercise and re-evaluation as well as 40 minutes of one-on-one dance instruction.

It may or may not be ironic, but now that Korevaar has recharged her own career, she's anxious to help others get back to work. "When people are in pain and not working," she says, "that flies in the face of everything we know."

IN THIS ARTICLE ...

Wilhelmina Korevaar's career path as a physician executive has taken many twists and turns. Early on, she didn't even want to be a doctor. Now, she's foxtrotting down yet another path, trying to use dance to help patients relieve their pain.

Will Bunch is a journalist for the Philadelphia Daily News in Philadelphia, Pa.