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Not “IF” but “WHEN”: Rehearsing for medical emergencies in dance

Posted By Carina M. Nasrallah, MSAT, ATC, CISSN, Thursday, April 13, 2017

He was only 18 years old - healthy, strong and a beautiful performer. It was just a typical day of class and rehearsals. Everything seemed normal.  No one knew that he had a congenital heart condition that would cause his heart to stop unexpectedly in the middle of rehearsal.  He simply collapsed.

 

 

Catastrophic injuries and life-threatening medical emergencies are not common in the dance studio or theater.  Ankle sprains, bruised toenails and sore backs are more the “bread and butter” of dancers’ woes, and as a result it is easy to develop a false sense of security - the mentality that “it would never happen to us”.  But it is critical to remember that dancers are elite athletes and not immune to catastrophic injury.  Therefore, having a plan for handling emergency situations is not a recommendation - it is necessity.

 

What is an emergency action plan (EAP)?

An emergency action plan (EAP) is a written document that outlines how medical emergencies will be managed within a dance institution or performance venue.  The plan should be clear, comprehensive, and adaptable to a variety of scenarios.  Many facilities may already have a barebones EAP - a paragraph or two discussing what to do in the case of fire, flood, medical emergency, etc.  But a detailed and comprehensive EAP should read more like the choreography notes for a Balanchine ballet.  The reader should be able to visualize how the scene would unfold, which characters will emerge from the wings, the sequence of steps, and the location of props.

 

 

 

Who should be involved?

In the case of an emergency roles need to be delegated and the parties should know their responsibilities in advance. Instructors, staff, administrators, any on-site or off-site medical personnel (i.e. athletic trainers, physical therapists, attending physicians), and the local EMS team should be familiar with the venue-specific EAP.  The plan should answer the following: Who will call EMS? Perform the initial evaluation? Retrieve the emergency contact card? Fetch emergency equipment? Escort EMS into the facility? Keep in mind qualifications, location, and availability. When working with minors a staff member needs to be designated to accompany the child to the emergency department and/or make treatment decisions if a guardian is not present.  A list of key administrative and medical personnel along with contact information should be included in the EAP. Clear lines of communication should be established along with any special instructions (i.e. dialing “9” first from a landline, information to given to EMS, name/address of the receiving emergency facility, etc).

 

 

Plan, prepare, and plot it out

Often a qualified medical professional may not be available to perform the initial evaluation in a medical emergency.  Therefore the EAP should outline scenarios in which EMS needs to be activated and when it is unsafe to move an injured dancer depending on level of consciousness, type and location of injury, etc. A healthcare professional trained in emergency care services should assist with developing these guidelines using easily understood language and terminology.  Additionally all instructors and staff should be trained in automatic external defibrillation (AED) use, cardiopulmonary resuscitation (CPR), and first aid. Emergency contact cards for each dancer should always include a “consent to treat” signed by the dancer or parent/guardian (if a minor).

  

 

Locating and setting up emergency equipment can cost precious minutes in situations when seconds can mean the difference of life or death.  Automated external defibrillators are a life-saving investment that all companies and studios should consider making.  They can be easily mounted on a wall in a studio or carried on tour without even requiring a “per diem”! The EAP should include a detailed description of the location of automated external defibrillators (AEDs) and first aid kits. Someone not familiar with the facility’s layout should be able to locate any emergency equipment by following the EAP.  Similarly, the plan should establish an entry and route for emergency care personnel to approach the venue and access the injured person quickly. Floor plans or diagrams may be beneficial for clearly designating routes and locations of emergency equipment. These should be specific to each venue.

 

The performance should never be a rehearsal

As any dance patron knows, seeing a show that has never been rehearsed is not worth paying for.  Similarly, implementing the action plan in an emergency situation should never be the first time it is rehearsed.  This only invites disaster. An EAP should be reviewed and revised as needed at least once a year with staff, administrators, and medical personnel.  Practicing scenarios to drill the EAP is the best way to reinforce the action steps. Then when the unthinkable happens and the adrenaline kicks in chaos does not ensue. A well-designed and rehearsed EAP will reduce time-costly errors and ensures that communication and order are maintained in an emergency situation.  Being unprepared could cost everything.

 

So returning to the young dancer above - what was the end of his story?
That is for you to determine. What is your plan?

 

 

 

Additional Resources

1. Andersen J, Courson RW, Kleiner DM, McLoda TA. National Athletic Trainers' Association Position Statement: Emergency Planning in Athletics. J Athl Train. 2002 Mar;37(1):99-104. PubMed PMID: 12937447; PubMed Central PMCID: PMC164314.

 

2. Emergency action plan (template). National Institute for Occupational Safety & Health. October 2003.

 

3. Casa DJ, Guskiewicz KM, Anderson SA, Courson RW, Heck JF, Jimenez CC, McDermott BP,
Miller MG, Stearns RL, Swartz EE, Walsh KM. National Athletic Trainers' Association Position Statement:
Preventing Sudden Death in Sports.
 J Athl Train 2012Jan-Feb 47(1):96-118.

 

4. Gates R. Be Prepared for Disaster. Occupational Health & Safety. May 

Tags:  dancers  emergency  injury  teachers 

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Are You Warm Enough to Start Dancing?

Posted By Brenton Surgenor and Andrea Kozai on behalf of the IADMS Dance Educators’ Committee, Monday, April 3, 2017

 

Warming up is essential before taking part in any type of dance activity, but it’s not always clear how to warm up effectively.  This blog post sets out the what, why and some of the how-to’s of an effective dance-specific warm-up.  This prefaces our new, upcoming Resource Paper on effective warm-up for dancers, which has much more information and advice on how to prepare the body for dancing.

 

Firstly, an effective warm-up will prepare you (or your dancers) mentally and physically to meet the challenges and physical requirements of a class, rehearsal, or performance.  As the name suggests, a warm-up should increase your core body temperature, which prepares your muscles and joints to function effectively during dancing as well as reduces injury risk.

 

During the warm-up there is an increase in the amount of energy required by your working muscles.  This means your body needs to consume more oxygen and fuel (glucose) to generate energy to power your muscles.  A byproduct of all this extra energy production is the increase in body temperature that gives the warm-up its name, so the cardiovascular section of a warm up is vital in ensuring your body is ready to go.  Therefore, sitting in the sun enjoying a hot coffee will not have the same benefits as a physical warm-up, as a warm-up ensures that your cardiovascular system, breathing rate, and energy-producing systems gradually increase to meet the higher demand for energy when you begin dancing.

 

A warm-up will have a number of other beneficial effects. These include: increasing the flow of synovial fluid (the lubricant in the joints), which allow your bones to slide more freely; improving the elasticity of your muscles, joints and ligaments for increased range of movement; and increasing the speed that signals travel through your nerves, which improves your overall balance, coordination and proprioception (your body’s ability to understand its orientation). For more information about proprioception see IADMS Resource Paper “Proprioception”. 

 

 

Whilst it’s good to include some stretching as part of your warm-up, not all types of stretching are beneficial before dancing.  The role of stretching during a warm-up is to mobilize muscles and prepare them safely to carry out the range of motion required of dance activities, not to increase flexibility. Stretching should happen after the activation of the cardiovascular system and when core body temperature is raised.  Dynamic stretching (taking the joint through a full range of motion in a slow and controlled way) is the best form of stretching in a warm-up.  This is because research suggests static stretching (stretches held in one position for longer than 15 seconds) can have a negative effect on balance, proprioception (knowing where your body is in space) and the muscles’ ability to produce powerful quick movements like jumps (Morrin and Redding, 2013). While static stretching can be an important part of flexibility training it is not an appropriate method of warming up; on the contrary, the purpose of dynamic stretching is to ready the body for full range, dynamic motion (Quin, Rafferty and Tomlinson, 2015).  For more about stretching, see IADMS Resource Paper “Stretching for Dancers”.

 

 

Warming up your mind is just as important as warming up your body.  A good warm-up will give you an opportunity to check how you are feeling, to notice your posture and any unnecessary physical tension or pain.  It can also help you concentrate and focus, which should contribute to technically better dancing and reduced risk of injury (Laws, 2005; Malliou et al., 2007).

 

Although a thorough and effective warm-up should take about 20 minutes, the time required is dependent on a number of factors including, but not limited to: whether the dancer has participated in any physical activity that day (is it the first class of the day or has the dancer recently completed another class); how warm or cold the environment is; and how much space and time is available for the warm-up. This should include a general physiological warm-up that prepares the core body temperature for physical activity.  Importantly too, the warm-up should include specific activities that relate to the style of the dance to follow (Quin, Rafferty and Tomlinson, 2015).

 

A warm-up generally consists of three or four sections: a gentle pulse-raising section, a joint mobilizing section, a muscle lengthening section, and sometimes a second pulse-raising section (Quin, Rafferty and Tomlinson, 2015). The pulse-raising sections aim to increase cardiorespiratory and metabolic rates; these are the prerequisite to all further activity. The joint mobilizing section consists of gently moving the various joints through their ranges of motion, and the purpose of the muscle lengthening section is to prepare the muscles for the demands to come through the use of dynamic stretching (Wilmerding and Krasnow, 2017). It is also appropriate to include remedial exercises for injury prevention purposes at the end of the warm-up (Volianitis et al, 2001), and mental skills and preparation can be included at any stage.

 

Remember the benefits of a warm-up will be reduced or even lost once the body returns to its resting states of heart rate, respiration, and body temperature, so try to keep the time between the end of the warm-up and the dancing a minimum. Warm clothing and continued movement (but not static stretching) will help keep the body’s core temperature elevated. However, this is dependent on what happens after the warm-up (does the dancer keep moving or do they sit down and rest) and environmental elements such the ambient temperature. Cooler temperatures and the lack of movement may cause the effects of the warm-up to dissipate more rapidly.

 

Unfortunately, there is no magic recipe for warming up and the most important thing to remember is that the warm-up should be specific to the type of dance activity to follow (in other words a ballet warm-up will be different from a jazz warm-up). However, with an understanding of a few basic principles, it should be safe and easy for you to design a warm-up that works for you. 

 

 

Here are some suggestions to help you design your perfect dance warm-up.

1.      Involve your mind and take a moment to center yourself.  Check in with how you are feeling; notice any areas where you need to give special attention. 

2.      Make your warm-up dance (and type of dance) specific.

3.      Introduce an activity to gradually increase your heart rate.

4.      Keep the movement simple to begin then progress to more complex and challenging movement patterns.

5.      Mobilize all the joints in your body and don’t forget about your spine and upper body, especially if your dance style includes upper-body weight bearing or/and partnering work.

6.      Give yourself a goal or try some positive self-talk.

7.      Use dynamic stretching and take your body carefully through full ranges of motion saving the static stretching for the cool-down or the end of the day.

8.      Wake up your nervous system by incorporating quick changes in direction and stopping to balance on one leg – this will engage your proprioceptors. 

9.      Once you are feeling warm and just a little bit sweaty, introduce some power movements like small jumps followed by some bigger ones.

10.  Towards the end of the warm-up, pick the pace and progress your movement to speeds nearer the pace of the following dance activity.

 

Whatever you choose to include, by the end of the warm-up you should feel ready to meet the mental and physical challenges of dancing. For more detailed information, check out the new IADMS resource paper on warming up for dancers.

 

 

For more information about warming up see the following resources.

1.      Harris J, Elbourn J. Warming up and cooling down. Champaign, IL: Human Kinetics, 2002.

2.      Laws, H., & Apps, J. (2005). Fit to Dance 2: Report of the second national Inquiry into dancers' health and injury in the UK. Dance UK.

3.      Malliou, P., Rokka, S., Beneka, A., Mavridis, G., & Godolias, G. (2007). Reducing risk of injury due to warm up and cool down in dance aerobic instructors. Journal of Back and Musculoskeletal Rehabilitation, 20(1), 29-35.

4.      Morrin, N., & Redding, E. (2013). Acute effects of warm-up stretch protocols on balance, vertical jump height, and range of motion in dancers. Journal of Dance Medicine & Science, 17(1), 34-40.

5.      Quin E, Rafferty S, Tomlinson C. Safe Dance Practice. Champaign, IL: Human Kinetics, 2015.

6.      Volianitis S, Koutedakis Y, Carson R. Warm Up: A Brief Review. Journal of Dance Medicine and Science 2001; 5(3): 75-79.

7.      Wilmerding MV, Krasnow DH (eds). Dancer Wellness. Champaign, IL: Human Kinetics, 2017.

 

 

Written by Brenton Surgenor (BPhEd, MA, MSc), Hong Kong Academy for Performing Arts and Andrea Kozai (MSc, CSCS), Virtuoso Fitness

Tags:  dancers  teachers  warmup  warm-up  wellness 

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2017 Regional Meetings - All the info!

Posted By Elsa Urmston on behalf of the IADMS Dance Educators’ Committee, Monday, March 27, 2017

This year we are working hard to reach new audiences through a range of international regional meetings, arranged by key members of the IADMS Dance Educators’ Committee.  The aim of these events is always to widen our reach and ensure that information about dance medicine and science is broadly disseminated, especially amongst artists, practitioners, teachers, educators, clinicians, students and parents for whom these ideas are relatively new.  This year we have events lined up in Australia, the USA and the UK, which seek to present ways in which dance medicine and science principles can be transferred to the classroom and applied in practice.

 

REGIONAL MEETING #1 - iadms.org/melbourne

 

 

FRIDAY APRIL 7, 2017

 

8.15 – 9.00      Registration; Tea and Coffee  FOYER

 

9.00 – 9.10      Opening Performance

 

Maggie Lorraine, Tim Storey

Welcome Address and Acknowledgement of Country

 

9.10 – 9.15      David McAllister, Artistic Director, The Australian Ballet (video)

Welcome

 

9.15 – 11.15    Susan Mayes, Paula Baird-Colt, Megan Connelly     

Posterior ankle impingement syndrome

 

11.15 – 11.45  Refreshment Break                FOYER

 

11.45 – 1.15    Dana Rader and Debbi Fretus

Mobilizing and conditioning the upper body using GYROTONIC® Methodology

 

1:15-2:00         Lunch                                      FOYER

 

2:00-2:30         Janet Karin

Variability and the stability myth

 

2.30-3.00         Chris Swain and Sela Kiek

Research and teaching perspectives on spine health in adolescent dancers

 

3.00-3.45         Fiona Sutherland

Body Positive Nutrition for Dancers

 

3.45 -4.15        Afternoon Tea                                   FOYER

 

4.15- 5.15 app.Performance   Details to follow         

 

 

SATURDAY APRIL 8, 2017

 

8:30-9:00         Tea and Coffee                       FOYER

 

9.00 – 9.05      Maggie Lorraine/Tim Storey

            Welcome to day two and Information session

 

9.05 – 9.45      Jill Cook

Jumping your way to knee injuries: Tendon problems in young dancers

 

9.45 – 10.15    Melanie Fuller

Understanding changes in training load related to injuries in dance

 

10.15 – 10.45  Refreshment Break    FOYER

 

10:45- 11:25    Gene Moyle

The curse of being highly gifted: The ethical intricacies of injury rehabilitation in an elite ballet setting

 

11.25 – 12.00  Janet Karin

The curse of being highly gifted: Restoring the body, restoring the dancer

 

12.00 -12.45    Susan Mayes

Healthy ballet hips

 

12.45 – 1.30    Lunch                          FOYER

 

1:30-2:30         Maggie Lorraine

Enhancing and strengthening the range of movement in young dancers’ hips through the GYROTONIC® Hamstring Series.

 

2.30 – 3.15      Paula Baird-Colt

Intrinsic foot muscle activation and strengthening exercises with the assistance of real time ultrasound imaging

 

3.15 – 3.45      Liz Hewett

Beyond Dance: Is dance alone enough to develop the young dancer?

 

3.45– 4.15       Q & A and conclusion

 


Location: Victorian College of the Arts Secondary School, 57 Miles Street, Southbank, Victoria, Australia 3006
Click for map of location

Contact: Maggie Lorraine mlorraine@internode.on.net

Booking can be found here

 

 

 

REGIONAL MEETING #2 - iadms.org/texas

 

 

SATURDAY MAY 6, 2017

 

8:00 – 8:45am             Welcome: Registration and Breakfast

 

8:45 – 8:55pm             Opening remarks

 

8:55 – 9:40am             Dancer as Athlete

Vanessa Muncrief, PT; Ballet Austin

9:40 - 9:50am              Q & A

 

9:55 – 10:40am           Using Rotator Discs to Increase Strength and Endurance in External Rotation in Dancer

 Carisa Armstrong, MFA and Christine Bergeron, MFA; Texas A&M University

10:40-10:50am            Q & A

 

10:55-11:40am            Motor Control Training for the Dancer’s Hip

Sally Donaubauer, PT, DPT, OCS; Pittsburgh, PA

11:40am-11:50am      Q & A

 

11:50 – 1:15pm           LUNCH BREAK

 

1:15 – 1:45pm             Research in Dance

                                    Amanda Clark Tanruther, MFA; Cleveland, OH

Margaret Wilson, PhD; University of Wyoming

 

1:50-2:30pm                Warming Up in Technique Class

Amanda Clark Tanruther, MFA; Cleveland, OH

2:30-2:40pm                Q&A

 

2:45 – 3:30pm             Movement Session

Margaret Wilson, PhD; University of Wyoming

3:30 – 3:40pm Q & A

 

3:45 – 4:30pm             Using a Roller for Myofascial Release

                                    Melissa Hausman, MS, ATC, LAT; Texas A&M University

4:30 – 4:40pm             Q & A

 

4:40-5:00pm                Closing Remarks

 

Date: May 6, 2017
Location: Texas A&M University, PEAP Building, College Station, Texas 77843-425, USA

Contact: Christine Bergeron; cbergeron@tamu.edu; 979-845-5025

Booking can be found here

 

 

 

REGIONAL MEETING #3 - iadms.org/ipswich

 

 

FRIDAY 26TH MAY 2017

 

10.00 – 10.30am:        Arrival and Coffee

 

10.30 – 11.00am:         Keynote Presentation - Speaker to be confirmed

 

 11.00 – 12.00noon:     Training the Adolescent Dancer: Physiological and Psychological Perspectives

                                         Siobhan Mitchell, University of Bath

 

12.00 – 12.30pm:         Coffee

 

12.30 – 1.30pm:           Parallel Sessions:  

                                   Pointework Readiness

                                              Katy Chambers, Royal Academy of Dance  

                                   OR 

                                   Resilience and Mental Health

                                               Stella Howard, Trinity Laban Conservatoire of Music and Dance

 

1.30 – 2.15pm:                                   Lunch

 

2.15 – 2.30pm:              Creating a safe environment for dance

                                                Mark Rasmussen, Harlequin Floors

 

 2.30 – 3.30pm:              Panel Discussion – How Do We Support Adolescent Dancers to Dance

                                                Chair:  Rachel Rist, Tring Park School for Performing Arts

Panellists:  Sujata Banerjee (Classical Indian Dance Artist); Hakeem Onibudo (Impact Dance and Changemaker at The Place);

Sarah Lewis (Glass House Dance and DanceEast Centre for Advanced Training);

Tracy Witney (Head of Learning and Participation, Northern School of Contemporary Dance)

 

3.30 – 4.30pm:                Parallel Sessions:  

                                      Nutrition for the Young Dancer 

Zerlina Mastin, Dance Dietitian and Author of Nutrition for the Dancer

                                      OR 

                                      The Widening Role of the Dance Teacher

Tom Hobden, UNIT and DanceEast Centre for Advanced Training

 

4.30 – 5.00pm:                                   Tea

 

5.00 – 6.00pm:                Children and Young People Dance Performance


Location: DanceEast, Jerwood Dancehouse, Foundry Lane, Ipswich IP4 3DW, United Kingdom
Click for map of location or Click for DanceEast's info page

Contact: Elsa Urmston elsa.urmston@gmail.com
Booking: 01473 295230 or via DanceEast website

 

 

Elsa Urmston is Chair of the the IADMS Dance Educators’ Committee and a Member of the One Dance UK Expert Panel for Children and Young People.  She is a freelance Dance Educator, based in the UK.

Tags:  regional conference  regional meeting 

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IADMS Seeks Nominations for the 2017 Dance Educators Award

Posted By IADMS Education Committee, Thursday, March 2, 2017

The Educators Committee of IADMS promotes communication and education for dance teachers, dance students, parents, dancers, and the medical and other health practitioners who provide their care.

The Committee also seeks to recognize teachers who integrate principles of dance science in their teaching and is seeking nominations for the 2017 IADMS Dance Educators Award from around the world

The recipient of this recognition shows evidence of substantial impact through teaching dance and has influenced future dance teachers. Additional evidence for the award comes from service to the field of dance medicine and science as well as mentoring students participating in dance medicine and science events and conferences. 

 

 

The 2016 IADMS Education Committee Dance Educator Award is presented to Dr. Tom Welsh, Professor at Florida State University. Tom joins Dr. Janice Plastino, recipient of the 1st IADMS Dance Educator Award and Janet Karin, recipient of the award in 2015 in receiving this honor from the IADMS Education committee.

 

 An initial letter of nomination will be used to address the candidate’s eligibility, and additional letters of support will be solicited from parents, school directors, and/or former students. Nomination submissions will be due May 1, 2017. The candidate will be selected by the Educators Committee and will be recognized at the Annual Meeting in October.

 

The criteria for the award describe a dance educator who:

 

· Demonstrates long standing support for the integration and implementation of dance science in the classroom and technique studio;

 

· Has developed a system of training based on sound knowledge of human anatomy, physiology, and/or psychology;

 

· Understands and effectively communicates the biomechanical components of movement and dance training principles, both intuitively and based on research, to augment artistic performance;

 

· Can address artistic and pedagogical priorities within a scientific context to help researchers understand the art of dance and dance teaching;

 

· Demonstrates innovative thinking in teaching, is not afraid to challenge myths and historical methods;

 

· Demonstrates attention to physical development and emotional welfare of the student, working to train and educate independent artists fully able in mind, body, and spirit;

 

· Has students who embody and practice the principles that underpin the teacher’s philosophy;

 

· Demonstrates an ongoing commitment to furthering the field of dance and dance science and IADMS as an organization.

 

Please send in your nominations to Education@iadms.org.

 

 

 

Tags:  IADMS Dance Educator Award 

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Bunions in Ballerinas: it’s not really the shoes!

Posted By Megan Maddocks, Monday, February 27, 2017

I have bunions, two in fact. They were never a problem while I danced, but they got worse when I stopped. As a podiatrist, this made me curious about the relationship between pointe shoes and bunions (more accurately called hallux valgus). Below is a brief summary of a literature review I presented at the 2016 annual IADMS conference in Hong Kong, outlining some extrinsic risk factors unique to female ballet dancers.

 

Hallux valgus (HV) is a common1 and complex deformity2. Being particularly common to dancers 3–9, it is believed that dancing plays a role in the cause and development of HV 10–12, however much research suggests that dancing is not a likely cause of HV 11–13.

 

COMMON MISCONCEPTIONS

It has been shown that the average number of dancing hours per week 3,14, hours of pointe work per week 3,14, total years of doing pointe work3 and the age of starting pointe3 are not significantly associated with HV in the dancer 3. Also, the intensity of practice (professional vs recreational) is not predicting variable for HV 3 and an increased Beighton (hypermobility) score, which most dancers have, has not been associated with HV10.

 

HV is mostly related to anatomical hereditary factors and to incorrect technical execution, rather than to the amount of dancing hours, with or without pointe shoes. 3,14

 

TRAUMA

Apart from rupture of the medial ligament of the big toe joint (first metatarsophalangeal joint – 1st MTPJ)3,14 from an incorrect landing or unexpected accident, there is substantial microtrauma to the joint from the hard pointe shoe box15.

 

FOOTWEAR

Constrictive Footwear

There is currently not enough evidence to implicate footwear in the development of HV 1,16. HV has been reported in populations that don’t wear shoes 1,17.         

 

Dance Footwear:

Ballet Flats

Ballet pumps are chosen to fit tighter and tighter as girls get older, eventually fitting more like a glove than a shoe18. They are fitted, like pointe shoes, when the foot is non-weight bearing and pointed 18, ignoring the fact that the foot expands on weight bearing, resulting in the toes being squished together and increasing the tension on the inside of the big toe joint (1st MTPJ).

 

The Pointe Shoe

The bottom end of the box (block), on which the dancers bear weight, is flat, whereas the pointed toes do not form a straight line, resulting in the longest toe, usually the big toe (hallux), supporting the majority of the body’s weight when en pointe19.

                                                                                                              

Inappropriate pointe shoe fit could exacerbate HV formation1,19: an overly narrow, short or soft toe box, results in the toes being squashed, increased tension on the big toe joint (1st MTPJ) and a general lack of support of the foot, (Fig.1). Proper pointe shoe fit is recommended to prevent or delay HV deformity, especially in the predisposed dancer1.

Fig. 1 – Foot structure change in a pointe shoe that is too narrow, created by M Maddocks

 

DANCE TECHNIQUE

All turnout must be from the hip 6,18, however, it may be augmented at the knee, ankle, and foot 1,6,15,20. These forced turn out positions may result in pronation of the foot, with abduction of the big toe (points toward 2nd toe) and an increase valgus force on the joint 1,3,6,7,13–15,20, (Fig. 2). When the foot is frequently forced into exaggerated “turnout”, the supporting ligaments and tendons on the bottom and medial side of the foot and ankle may be lengthened and cause them to lose their ability to support the ankle joint and the arch of the foot 3,14,15,21

Fig.2 – Hyperpronation / Rolling in : foot compensation for poor turnout at the hip, From Davenport1

 

It has been show that ankle plantarflexion is associated with HV3, and the average ankle plantarflexion (pointed foot) in professional female ballet dancers is 113°, which is more than twice the normal value of 50° 22. The combination of maximal ankle plantar flexion and an “over-pointed” foot may accelerate the progression of hallux valgus and exacerbate the symptoms 3.

 

 A small degree of ‘‘winging’’ (Fig. 3) can add to the aesthetic alignment of the line of the leg, however, an excess of pressure is applied through the first toe, particularly in a pronated foot 1,13. Hyperpronation or excessive “winging” of the foot while en pointe or demi-pointe may also result in microtrauma of the big toe joint (1st MTPJ)1.

 

 Proper technique may prevent excessive loads on the big toe joint (1st MTPJ), which in turn may reduce the incidence of bunions.13

 

Fig. 3 – Winging: a technique fault in which the feet are forced outward or abducted at the ankles (Photographer: Darian Volkova)

 

Teacher Influence

Teachers should constantly strive to see that the leg and foot turn out as a unit from the hip18,21. Every effort should be made to control or avoid compensatory foot hyperpronation, as well as excessive winging, as it may increase the risk of hallux valgus development 1,6,18,21.

 

CONCLUSIONS

The unique positions and postures used in classical ballet are all potentially dangerous for the foot and leg6,18, with unique and increased forces through the big toe joint (1st MTPJ) and the foot while in extreme positions 1,3,5.

If that isn’t bad enough, the pointe shoe is the antithesis of everything that we, as podiatrists, know about footwear 18. Shoes for ballet dancers are not made for health 18, yet “dancer’s feet are the instruments on which their art depends”13.

Pointe shoes are definitely not protective of HV development 1, and it is almost impossible to prevent HV formation in an individual who is genetically predisposed18, but the evidence is not sufficient to conclude that pointe work causes HV1.

Dancers, like the rest of the population, are either prone to developing bunions or not 10,13,20. However, dancers are at high risk of developing hallux valgus as they have increased exposure to risk factors. Dancer’s at risk of developing HV need to be identified as early as possible and need to be managed conservatively with focus on good technique to reduce dance and non-dance biomechanical risk factors 3,6,13,23.

 

Megan Maddocks – Promotions Committee

Podiatrist – South Africa

 

 

REFERENCES

1.        Davenport KL, Simmel L, Kadel N. Hallux Valgus in Dancers: a closer look at dance technique and its impact on dancers’ feet. J Danc Med Sci. 2014;18(2):86-93.

2.        Dayton P, Feilmeier M, Kauwe M, Hirschi J. Relationship of frontal plane rotation of first metatarsal to proximal articular set angle and hallux alignment in patients undergoing tarsometatarsal arthrodesis for hallux abducto valgus: a case series and critical review of the literature. J Foot Ankle Surg. 2013;52(3):348-54. doi:10.1053/j.jfas.2013.01.006.

3.        Steinberg N, Zeev A, Dar G, et al. The Association between Hallux Valgus and Proximal Joint Alignment in Young Female Dancers. Int J Sports Med. 2015;36:67-74.

4.        Clippinger K. Dance Anatomy and Kinesiology.; 2007.

5.        Miller H, Schneider HJ, Bronson JL, McLain D. A New Consideration in Athletic Injuries: THe Classical Ballet Dancer. Clin Orthop Relat Res. 1975;(111):181-191.

6.        Kravitz SR, Huber S, Murgia C, Fink KL, Shaffer M, Varela L. Biomechanical Study of Bunion Development and Stress Produced in Classical Ballet. 1Journal Am Podiatr Med Assoc. 1985;75(7):338-345.

7.        Howse J. Disorders of the Great Toe in Dancers. Clin Sports Med. 1983;2(3):499-505.

8.        Baxter DE. Treatment of Bunion Deformity in the Athlete. Orthop Clin North Am. 1994;25(1):33-39.

9.        Schneider HJ, King AY, Bronson JL, Miller EH. Stress Injuries and Developmental Change of Lower Extremities in Ballet Dancers. Radiology. 1974;(113):627-632.

10.      Prisk VR, Loughlin PF, Kennedy JG. Forefoot Injuries in Dancers. Clin Sports Med. 2008;27:305-320. doi:10.1016/j.csm.2007.12.005.

11.      Einarsdottir H, Treoll S, Wykman A. Hallux Valgus in Ballet Dancers: A Myth? Foot Ankle Int. 1995;16(2):92-94.

12.      Kennedy JG, Hodgkins CW, Colombier J, Guyette S, Hamilton WG. Foot and ankle injuries in dancers. Int Sport J. 2007;8(3):141-165.

13.      Kennedy JG, Collumbier JA. Bunions in Dancers. Clin Sports Med. 2008;27:321-328. doi:10.1016/j.csm.2007.12.004.

14.      Biz C, Favero L, Stecco C, Aldegheri R. Hypermobility of the first ray in ballet dancer. Muscles Ligaments Tendons J. 2012;2(4):282-288.

15.      van Dijk C, Lim L, Poortman A, Al. E. Degenerative joint disease in female ballet dancers. Am J Sport Med. 1995;23(3):295-300.

16.      Nix SE, Vicenzino BT, Collins NJ, Smith MD. Characteristics of foot structure and footwear associated with hallux valgus: A systematic review. Osteoarthr Cartil. 2012;20(10):1059-1074. doi:10.1016/j.joca.2012.06.007.

17.      Zipfel B, Berger LR. Shod versus unshod: The emergence of forefoot pathology in modern humans? Foot. 2007;17:205-213. doi:10.1016/j.foot.2007.06.002.

18.      Tax H. Ballet. In: Podopaediatrics. 2nd ed. Baltimore: Williams & Wilkins; 1985:401-419.

19.      Colucci LA, Klein DE. Development of an Innovative Pointe Shoe. Ergon Des. 2008.

20.      Shrader KE. Biomechanical evaluation of the Dancer. Orthop Phys Ther Clin North Am. 1996;5(4):455-475.

21.      Ahonen J. Biomechanics ofthe Foot in Dance: A Literature Review. 2Journal Danc Med Sci. 2008;12(3):99-108.

22.      Russell J a, Shave RM, Kruse DW, Koutedakis Y, Wyon M a. Ankle and foot contributions to extreme plantar- and dorsiflexion in female ballet dancers. Foot ankle Int / Am Orthop Foot Ankle Soc [and] Swiss Foot Ankle Soc. 2011;32(2):183-188. doi:10.3113/FAI.2011.0183.

23.      Weiss DS, Rist RA, Grossman G, Ed M. When Can I Start Pointe Work? Guidelines for Initiating Pointe Training. J Danc Med Sci. 2009;133:90-92.

Tags:  bunions  dancers  foot 

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5 Questions With…Gabriel Gonzales

Posted By IADMS Student Committee, Monday, February 13, 2017

This month’s featured member is our newest Student Committee member, Gabriel Gonzales of University of New Mexico. Gabriel is a pre-med student with an interest in dance medicine. His areas of interest include biochemistry, exercise science and dance (ballet).

-How did you first get interested in dance science/medicine?

My high school dance teacher doubled as my ballet teacher and my inspiration to pursue a career in dance medicine. Her knowledge of the human body astonished me, sparking my interest in learning about the human body and the ability it possesses in dance.


-
If you were not studying dance medicine/science, what would you be doing or what would your career be?

My alternative career would be a professional dancer, I love and respect the art immensely; but to study it with a scientific approach is my true goal.


-What are your plans after graduation?

After graduation, I plan on applying to medical schools with a focus in sports medicine, I also have plans to audition for ballet and modern dance companies.


-What would you say to a student thinking of joining IADMS?

Jump in! I would encourage students considering a career in sports wellness, dance, and dance science/medicine as students are exposed and continually kept up to date with the latest of dance research provided by well-established and respected members of the community.

 

-What made you apply to join the student committee?

My decision to apply to the IADMS student committee was clear when considering what I aspire to become in my future. Being a part of this committee grants the opportunity of sharing thoughts and gaining knowledge from professionals in the two fields I am interested in, dance and science. 

 

 If you’d like to share your experiences, email us at student@iadms.org.

Tags:  5 Questions With 

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Developing a Personal Dancer Wellness Plan

Posted By Donna Krasnow and Ginny Wilmerding on behalf of the IADMS Education Committee, Monday, January 30, 2017

Our focus for this blog post is on a new IADMS and Human Kinetics publication, edited by renowned dance educators and IADMS members, Ginny Wilmerding and Donna Krasnow.  Dancer Wellness is a useful, one-stop resource for all dance teachers interested in embedding dance medicine and science principles into their practice and ensuring the long-term health and wellbeing of the dancers with whom they work.  Here, Ginny and Donna give us a taste of how to design a personal dancer wellness plan as a foundation for long and effective dance practice.

 

Photo by Jake Pett, image reproduced with permission by Human Kinetics:
http://www.humankinetics.com/products/all-products/Dancer-Wellness-With-Web-Resource

 

As a dancer, you will face many challenges to your health and wellness. Every aspect of your training, from the environment and what you eat to your technical work and possible injuries affect your health. You can design your own personal dancer wellness plan and continue to develop it for many years. You can seek the assistance of teachers, health care professionals, and others in your support network to help you create your personalized plan.

 

Let’s start with the basic foundations of the dancer’s life. You can learn about your dance studio floors and other environmental aspects such as temperature, ventilation, lighting and sound, and make sure that you are working in a studio that meets certain requirements. You can speak to the school director and your teachers if you find problems in these areas. You may feel more confident if you have others such as parents or other dancers join you in these discussions. Next, you can study anatomy and physics. You can make sure that you are dancing in the best possible alignment, and that you understand scientific principles of movement. You can pair up with a friend from class and do partner assessments. You can also examine your learning strategies so that you have multiple ways to learn new technical skills in class. Finally, think about ways to supplement your class work with outside conditioning, and consider what areas of conditioning need the most focus, whether that is muscular strength, flexibility, or cardio-respiratory endurance. Conditioning can decrease fatigue and improve your confidence.

 

Next, let’s look at the mental components of dancer wellness. In terms of your mental training, you can consider how reliant you are on the mirror, and shift your emphasis to physical sensation and developing your kinesthetic sense of movement. You can use your teachers’ images and create your own images to enhance your dancing, especially in areas where you need improvement. Dance psychology can provide important tools for motivation, and help you deal with a wide range of views about yourself, including self-concept, self-awareness, self-esteem, self-confidence, and self-compassion. Rest and recovery are crucial for your health, and may be the most overlooked aspects of wellness. Consider your sleep habits, and also look at ways to cope with stress and anxiety, especially near performances. Finally, you can find alternate ways to rest, such as mentally practicing choreography.

 

Last, let’s consider the physical components of the dancer’s health. Make sure you are getting all the nutrients you need, such as carbohydrates, protein, fats, vitamins and minerals, and water. See if there are ways to eat fewer foods that have little nutrition, and add foods such as fruits and vegetables. If you smoke, design a plan to stop, and make sure you are physically active during periods of time that you are not dancing. For bone health, it is important to include weight-bearing exercise in your activities. Through your conditioning work, make sure you understand how methods of gaining strength, flexibility, and core support can give you knowledge you need to prevent injuries and sustain long hours of dancing and rehearsing. If you add a new technique to your training, you may need to add different conditioning exercises that prepare for those demands.

 

By developing your personal dancer wellness plan, you can improve your health and have many years of rewarding dancing. Good health contributes to dance injury prevention, less fatigue, better nutrition to fuel your energy needs, and enhanced self-esteem. You can find out much more about the principles discussed here in the new Dancer Wellness book.  You can purchase a copy with accompanying e-resources here. Happy reading!

Tags:  Dancer Wellness  dancers  teachers  wellness 

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Presenters at Australia's IADMS Regional Meeting April 2017

Posted By Maggie Lorraine, Thursday, January 26, 2017

 

The topics presented at the meeting will convey anatomical and medical information to the attendees. Presenters and practitioners will share anatomical and medical information as well as demonstrate potential methods of working with and helping students.

 

The Regional Meeting will be tailored toward the dance teaching community but it is envisaged that it will also stimulate interest with medical practitioners. The event will be hosted at the Victorian College of the Arts Secondary School (VCASS) which is the education provider to the Australian Ballet School.

 

Both of these schools attract dance students nationally and internationally.

 

Confirmed Presenters:

 

The Australian Ballet Health Team

Sue Mayes      Principal Physiotherapist.   

Susan Mayes has been the Principal Physiotherapist of The Australian Ballet since 1997. She manages the medical department of The Australian Ballet and treats the diverse injuries of the professional ballet dancer, as well as musicians of Orchestra Victoria. Susan graduated from La Trobe University in 1990 with a Bachelor of Science (Physiotherapy) and completed a Graduate Diploma in Sports Physiotherapy in 1996. She has been a collaborator or co-investigator in several ballet-related research projects and published the findings from her research on the hip in ballet dancers as part of her PhD

 

Paula Baird-Colt        Body Conditioning Specialist.         

Paula Baird-Colt graduated from the Victorian College of the Arts Secondary School, beginning her professional dance career with the West Australian Ballet before joining The Australian Ballet in 1987. After retiring in 2000, Paula retrained in the Pilates Method. From 2001 – 2007 she taught a dance-specific conditioning program at The Australian Ballet School. She is the co-author of the book Body wise: Discover a new connection with your ballet. A member of The Australian Ballet’s medical team since 2007, she works with dancers to help them understand and improve their body management and has developed an innovative approach to conditioning.

 

Megan Connolly        Ballet Mistress and Rehabilitation Specialist.        

Megan Connelly joined The Australian Ballet in 1991, performing in works such as The Sleeping Beauty, Don Quixote, Giselle and Symphony in C. She later followed her passion for teaching and was appointed Assistant to the Ballet Staff. In 1995 Megan left the Australian Ballet but returned to the Company in 2001 as Assistant to Artistic Director and Ballet Coach. In 2009 she was appointed Ballet Technique & Rehabilitation Specialist. Since 2010 Megan has been on the teaching faculty of The Australian Ballet School, and has completed a Vocational Graduate Certificate in Elite Dance Instruction.

                        _______________________________________________________________________

Janet Karin              

A former Principal Dancer of The Australian Ballet, Janet Karin established her teaching career in Canberra, devising her own teaching system and training many outstanding dancers, choreographers and teachers. Ms. Karin’s publications include a variety of papers and studies in dance training, dance education and cultural development. She has received awards for direction, teaching and services to dance, including the Medal of the Order of Australia. Dance science research is an important aspect of Ms Karin’s work as Kinetic Educator at The Australian Ballet School. In 2010 she was awarded a Centre of Clinical Research Excellence grant to carry out a study into imagery and dynamic pelvic stability with Professor Paul Hodges, international expert in spine health. This year she is investigating the neuroscience and management of pain, and also the development of movement efficiency in adolescents.

 

 

Liz Hewett    Absolute Health & Performance

Strength and Conditioning Coordinator/Exercise Physiologist

Imbalance Massage and Pilates, Pilates Teacher / Exercise Physiologist, Exercise Therapy Consulting Australia, Exercise Physiologist

 

Fiona Sutherland    Director, Body Positive Australia & The Mindful Dietitian

Fiona Sutherland is an Accredited Practising Dietitian & Nutritionist with a diverse working background including international clinical work, private practice, sports nutrition, corporate consultancy, research & working extensively in dietetic training. Fiona is also an Accredited Sports Dietitian, working with elite athletes, including the young dancers at the Australian Ballet School in Melbourne.

 

Gene Moyle  Head of Dance QUT, Associate Professor

Creative Industries Faculty, School of Media, Entertainment and Creative Arts, Dance

Gene Moyle graduated from the Australian Ballet School and QUT Dance. After having danced with the Australian Ballet Dancers Company and Queensland Ballet, Gene completed a Masters and Doctorate in Sport and Exercise Psychology.

 

Dana Rader GYROTONIC® Melbourne,             

Grad Dip Exercise Science (Rehab), Accredited Exercise Physiologist (ESSA), GYROTONIC® and GYROKINESIS® Specialized International Master Trainer, Diploma of Contemporary Pilates and Teaching Methodology,

 

Debbi Fretus                        Innovative Physio,

Advanced Diploma of Myotherapy (MIMT) (AAMT), Level 4 Pilates Practitioner (APMA), Diploma of Contemporary Pilates and Teaching Methodology. GYROTONIC® and GYROKINESIS® Level 1 Certified Instructor.

Debbi has a vast and varied dance background, from Ballet, Contemporary Jazz, Tap and Character. She has been employed as a professional dancer, teacher, adjudicator and choreographer nationally and internationally having danced with Sydney Festival Ballet, Athens City Ballet, Greece, and CH Tanzteater Zurich, Switzerland. Debbi has taught as a freelance ballet/dance teacher as well as having run her own ballet/dance school in Queensland. 

 

Professor Jill Cook

Professor in musculoskeletal health in the La Trobe Sport and Exercise Medicine Research Centre at La Trobe University in Melbourne Australia. PhD, Grad Cert Higher Ed, PG Dip Manips, BAppSci (Phty)

Professor, Deputy Director Australian Centre for Research in Injury in Sport and its Prevention

Jill’s research areas include sports medicine and tendon injury. After completing her PhD in 2000, she has investigated tendon pathology, treatment options and risk factors for tendon injury. Jill currently supplements her research by conducting a specialist tendon practice and by lecturing and presenting workshops both in Australia and overseas. 

 

Chris Swain, Australian Catholic University. Current research: Lower Back Pain in Adolescents

Chris Swain is a graduate of Trinity Laban and has presented at IADMS International Conferences, most recently at the IADMS Conference in Hong Kong.

 

Dr Sela Kiek-Callan     Contemporary Studies, VCE DANCE, Victorian College of the Arts Secondary School (VCASS)

Sela completed a Master of Philosophy researching site specific performance in 2003 through Coventry and Middlesex Universities in England. Sela is also a sessional lecturer on the dance degree programs at The Victorian College of the Arts and Deakin University. She completed a practice based PhD in Dance in 2011 through Deakin University and remains passionate about her area of research, architecture, the body and dance.

 

Maggie Lorraine

Vice Chair of the IADMS Dance Educators Committee. Leading Teacher in Ballet, Victorian College of the Arts Secondary School (VCASS). Certified Trainer of GYROTONIC® Level 2, and GYROKINESIS® Maggie joined the Ballet Rambert aged 16 years. Later she danced with The Royal Ballet Company, working with the Covent Garden Company and Touring Companies, London Festival Ballet, P.A.C.T. Ballet (South Africa), New Zealand Ballet and West Australian Ballet Company. On retiring as a dancer Maggie moved smoothly into a full time teaching position at Ecole Classique in Sydney, then later joining the faculty at the Victorian College of the Arts (VCA) and the Victorian College of the Arts Secondary School (VCASS) in Melbourne. Maggie has been involved in the accreditation and course review of numerous tertiary institutions both nationally and internationally. In 2007 the Hong Kong Council appointed her as a Subject Specialist for Accreditation of Academic and Vocational Qualifications. Maggie is passionate in her position on the IADMS Dance Educators Committee, with the aspiration of bring the research and knowledge provided by IADMS to the dance community.

 

For further information please contact: mlorraine@internode.on.net

Tags:  Australia Regional Meeting 2017  regional conference 

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Wayne McGregor on John Travolta, technology and why everyone can dance

Posted By Maggie Lorraine, Monday, January 23, 2017

“Everyone has a personal physical signature”   Wayne McGregor

 

This interview with Wayne McGregor is not the usual dance medicine and science post, however McGregor makes some interesting comments which refer to science and which imply how strongly science relates to art. McGregor makes reference to neuroscience (3:05) and specifically how he works with neuroscientists (3:32). He uses sound to shape action in his choreography (5:54) There are other choreographers who also use their voices to create sounds to achieve a movement quality from their dancers and dance teachers sometimes use verbal sounds to trigger a particular movement dynamic when teaching.

 

He also makes observations on personal habits and neuroplasticity (23:05), suggesting that we challenge ourselves to break our own movement patterns.

 

This is an inspiring interview for dancers and creators of dance.

 

Tags:  choreography  dancers  neuroscience 

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Adding Fitness to your Dance Agenda: Where to start?

Posted By Clara Fischer Gam on behalf of the IADMS Promotion Committee, Wednesday, January 18, 2017
So you came to the understanding that it is not all about dancing: in order to nourish your body for greater freedom of artistic expression, other elements have to be added to the equation. You have already done the reading about reducing the risk of injuries and enhancing performance. Then you came across supplementary fitness training and its role in supporting your career goals and longevityFeeling more responsible for your body and empowered to take care of yourself, you are now craving for putting it into practice – what then?

 

Signing up at the local gym? Trying yoga? Going for a run? – Practically speaking, where do you start?

 

 

 

To be responsible for your body means not only to get informed and up to date but also to know when to look for professional support. Having a certified health and fitness professional to guide you through supplementary fitness training is imperative. As Dance Medicine and Science is an emerging field, many of these professionals, however may not be familiar with the needs and aims of dancers, neither with the demands of the art form. Whilst it is always best to look for specialists from the field, we know that is not often feasible. It might be the case that you cannot find one locally, however it is much more likely that there will be good certified professionals working in your neighbourhood. This is when “being responsible for your body” comes into play again: Work together with your health/fitness professional as a team for your health by sharing with him the information you now hold and including  dancers’ health resourcesSupport him to support you.

 

Where to start?

 

  • Learn about the demands of your dance career: Are you a ballet dancer? Or are you training in Breaking? Kathak? Contemporary? Dance styles have their particularities; therefore, physical demands may likely vary. Besides, career level may also result in different requirements to your body. All of that has to be taken into account when preparing to perform. There is a lot of discussion and interesting findings concerning dance physical demands and to what extent styles and levels would differ in terms of elements of fitness being stressed. Find a well-rounded summary and good resources to start here.
  • Identify your own needs: At the moment, what are you aiming for in your career? Where can you spot that there is room for improvement? Have you got any injuries currently? Getting a screening session is the starting point for building up a fitness programme that supports your dance goals truly from inside out.
  • Understand your dance calendar: What are you preparing for? When? Keep track of your dance routine, daily schedules and performance calendar. Have you got a packed day of classes in school? If you are dancing in a company, when are you touring? Or will you be performing mostly one-offs? We know that in the dance world it can be very hard to predict in advance your dance curriculum or performances, specially if you are a freelance dancer. Likewise, you might not be in control of your rehearsals and classes schedules to adapt them to a better fitHowever, by estimating your workload, your fitness professional will be able to design a more suitable programme for you.

Image: Clara Fischer Gam

 

By having access to information about your needs, routine and dance demands, a fitness professional can more readily apply their expertise of training principles and methodologies to support you in your career journey.

 

Clara Fischer Gam, MS

MSc Dance Science | BEd Dance Education

Rio de Janeiro – Brazil

Dance Science Brasil Group

Corpos Aptos, Gestos Livres Project

 

Tags:  cross-training  dancers  fitness 

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