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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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Book Review: Dancer Wellness Textbook

Posted By K. Michael Rowley on behalf of IADMS Promotion Committee, Wednesday, January 11, 2017

This phenomenal Dancer Wellness textbook is like a who’s who of the dance medicine and science world. A quick scan of the Table of Contents will toss up well-known names in the community like Luke Hopper of Australia, Emma Redding of the UK, Derrick Brown of the Netherlands, and Margaret Wilson of the US among many many more. This textbook embodies what I personally have wanted from IADMS for the entire time I’ve been aware of the organization – a reference textbook combining the best of the best in contributors, scientifically and clinically rigorous information, and accessibility to multiple audiences.

 

 

Editors M. Virginia Wilmerding and Donna H. Krasnow have done a superb job compiling everything a dancer, dance teacher, or dance practitioner needs to know about dancer health and wellness. These two have even included chapters on Psychological Wellness (authored by Lynda Mainwaring of Toronto, Canada, and Imogen Aujla of the UK) and Optimal Nutrition for Dancers (authored by Derrick Brown of the Netherlands and Jasmine Challis of the UK). These two topics are frequently cited as overlooked or under-acknowledged. Well, not for these two star editors who clearly made every effort to give readers this important information.

 

A highlight of the textbook design is the Application Activity found at the end of each chapter. This takes information from the chapter and helps readers incorporate the main points into their practice or their wellness plan. In addition, the supplemental resources found on Human Kinetics webpage would be quite useful for students and teachers. Here, readers can find sample syllabi, slides, tests and quizzes, as well as learning activities for inside and outside the classroom.

 

I’ll end this short review by highly recommending this textbook. Whether you’re already plugged in to IADMS and the dance medicine and science community or not, this textbook is a great up-to-date summary of where the field stands. It delivers only the best to students, teachers, and practitioners who take advantage of it. You can order the textbook at Human Kinetics, here.

 

Editors M. Virginia Wilmerding (left) and Donna H. Krasnow (right)

Tags:  dancers  review  teachers  wellness 

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IADMS Dance Educator Award Update

Posted By IADMS Education Committee, Tuesday, January 3, 2017

 

The 2016 IADMS Education Committee Dance Educator Award is presented to Dr. Tom Welsh, Professor at Florida State University.  Tom’s direct and indirect influence on dance pedagogy and training has been profound.  He carefully thinks about how research informs practice and how research needs to reflect practice.  The many colleagues and students he works with are challenged and invigorated by his thoughtful questions, carefully worded concerns and unique solutions to difficult problems.  The students and colleagues he mentors are directly impacting the field of dance, from the smallest studio to college programs.  He has written several papers for the Journal of Dance Medicine and Science, Journal of Dance Education and his book, Conditioning for Dancers, is a foundational text in many dance programs and studios around the country. A founding members of the Dance Kinesiology Teacher’s group (now the Dance Science and Somatic Educators Group), Tom also served on the IADMS board of directors and was the President of IADMS from 2009-2011.  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.  More information on the Dance Educator Award can be found at Education@IADMS.org.

Tags:  IADMS Dance Educator Award 

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Introducing the knee: Anatomy and biomechanics

Posted By Elsa Urmston and Jonathan George on behalf of the IADMS Education Committee, Monday, November 28, 2016

As dancers, educators and clinicians, we know that knees cope with a lot!  Over the last decade or so, the demands placed on the dancer’s body has increased exponentially and ever more complexly.  Acrobatic movement is becoming evident and the effect to the joints of the limbs can often mean greater incidence of injury.  As Liane Simmel points out “pirouettes on the knees, knee drops, and even a plié in fourth position require particular leg stability and optimal mobility in the knee.”1  In reviewing the literature, Russell2 identifies the lower extremity to repeatedly be the most commonly injured region of the body amongst dancers.

 

 

The knee joint is hugely complex and as Teitz (in Solomon et al, 2005)3 explain there is no bony stability in its structure.  A modified hinge joint, the knee comprises articulations between the femur and tibia, and the patella and femur, held together by a fibrous capsule and connected via a network of ligaments.  It’s this lack of potential stability which makes the knee prone to injury, often through misalignment and poor mechanics, although as well through sudden trauma or overuse.  Over the next couple of weeks we have a series of posts which focus on the knee; today we zone in on the structure, anatomy and mechanics of the knee itself.  Part 2 provides an overview of common knee injuries amongst dancing populations, and in Part 3 we focus on two case studies of young men who have experienced knee issues during their training and have been successfully rehabilitated to class and performance via a joined-up clinical and educative rehab programme.

 

 

The tibio-femoral joint is a hinge joint, capable of flexion (bending) and extension (straightening).  The screw-home mechanism allows the knee to slightly internally and externally rotate too.  During the last 30° of knee extension, the tibia (open-chain movement such as rond de jambe en l’air) or femur (closed-chain movements such as ascending from a demi-plié) must externally or internally rotate respectively by about 10°.  This determines the knee as a modified hinge joint.  You can see Rosalie O’Connor from American Ballet Theater demonstrating the screw-home mechanism in a rond de jambe action here!

 

The patellar-femoral joint serves to heighten stability in the joint.  The patella (knee cap) is a sesamoid bone which sits in the quadriceps muscle, and during flexion and extension undergoes complex gliding movements. The fairly unanimous consensus as to the function of the patella is to effectively increase the movement arm of the patella tendon about the tibio-femoral joint, thereby magnifying the movement and force of the quadriceps muscle group about the knee.4

 

 

The stability offered by the joint capsule is complemented by numerous, strong ligaments and more than any other joint in the body, these ligaments are vital in guiding the aligned movements of the bones as they come together to form the joint.  Yet, they are arranged in such a way that the stability is not always constant; some remain taut to ensure stability when the knee is extended and others slacken to ensure mobility when the knee is flexed5.

 

The medial and lateral collateral ligaments

The collateral ligaments are located on either side of the knee joint (collateral means side by side).  The medial collateral ligament – the one on the inside of the knee – is taut in knee extension and external rotation.  It controls the knee if the knee rotates inwards and in fact when the knee bends in a demi-plie, it controls approximately 80% of the medial stress on the knee (Besier et al, 2001)6.  The lateral collateral ligament – located on the outside of the knee – becomes taut with knee extension and provides lateral stability to the knee.  It controls approximately 70% of the lateral stress of the knee for example when the knees bow out on flexion and cause the feet to roll outwards (Besier et al).

 

The cruciate ligaments

The cruciate ligaments join the tibia and femur to one another within the internal structure of the knee.  The cruciate ligaments prevent any forward/ backward motion of the femur and tibia in relation to one another.  The anterior cruciate ligament also has another role in aiding rotation of the knee and controlling hyperextension in the joint.  It also plays a role when deceleration from jumping, floor work and quick changes of direction are required. It is now also widely accepted that the anterior cruciate ligament provides up to 40% of medial knee stability7.

 

The menisci

The medial and lateral meniscus are two cartilaginous discs which sit on the tibia and deepen the articular surface of the knee joint – they provide a kind of collar in which the bony ends of the femur sit, thereby improving the congruency and stability of the knee joint.  They assist with shock absorption and help to friction thus aiding smooth knee movement. The menisci are critical in the production of synovial fluid-‘the oil’- around the knee joint.

 

Bursae

The knee has the most extensive distribution of bursae in the body. More than 20 bursae are thought to be within the knee joint, with the primary role of reducing friction amongst the structures of the knee joint.  Many are located around the patella to aid its gliding function within the muscle and over the top of the joint itself.

 

Iliotibial Band

The iliotibial band is an adaptation of erect posture and provides key lateral support to the knee and hip; it runs down the side of the upper leg from the rim of the pelvis, to the outer edge of the femur and tibia.

 

This super video really provides a great introduction to the anatomy and ligament structure of the knee joint – take a look!

 

 

The musculature

As with the skeletal anatomy of the knee, the muscles which act on the knee are complex!  Because the muscles of the thigh also act on the hips, they often have a dual purpose –hip movement is included in brackets for ease of understanding here!  We have provided a simple table of the main muscles which act on the knee to produce movement.

 

Muscle

Action

Anterior/ front of the thigh

Rectus femoris

Knee extension (hip flexion)

Vastus medialis

Knee extension

Vastus intermedius

Knee extension

Vastus lateralis

Knee extension

Sartorius

Knee flexion (hip flexion, hip abduction and hip external rotation)

Posterior/ back of the thigh

Biceps femoris

Knee flexion and external rotation (hip extension and hip external rotation)

Semitendinosus

Knee flexion and internal rotation (hip extension and hip internal rotation)

Semimembranosus

Knee flexion and internal rotation (hip extension and hip internal rotation)

Popliteus

External rotation of femur when foot fixed; internal rotation of tibia when foot free

Medial surface of thigh

Gracilis

Knee flexion (hip adduction and hip flexion)

Posterior/ back of calf

Gastrocnemius

Knee flexion (ankle plantarflexion (pointing))

 

 

As you can see muscles often have more than one role in creating the movement of the limbs – we separate them out to learn about them, but of course they should be seen in their entirety to understand the complexity of the muscular system.  This video really helps us to see the wholeness of this system but understand each individual muscle’s location in relation to each other – take a look.

 

 

 

 

1.    Simmel, L.Alignment of the leg and its impact on the dancer's knee: Clips from the 2014 Annual Meeting
2.    Russell, J. Preventing dance injuries: Current perspectives, Journal of Sports Medicine, 4, 199-210.
3.    Solomon, R., Solomon, J. & Cerny Minton, S. Preventing Dance Injuries.  Champaign, IL: Human Kinetics, 2005.

4.      DeFrate LE, Nha KW, Papannagari R, Moses JM, Gill TJ, et al. The biomechanical function of the patellar tendon during in-vivo weight-bearing flexion. Journal of Biomechanics 40:1716–1722, 2007.

5.      Clippinger, K. Dance anatomy and kinesiology.  Champaign, IL: Human Kinetics, 2016.

6.      Besier, TF., Lloyd, DG.,  Cochrane, JL. and Ackland. TR. External loading of the knee joint during running and cutting maneuvers. Medicine and science in sports and exercise33, no. 7:1168-1175, 2001.

7.      Quatman CE, Kiapour AM, Demetropoulos CK, et al. Preferential loading of the ACL compared with the MCL during landing: a novel in sim approach yields the multiplanar mechanism of dynamic valgus during ACL injuries. American Journal of Sports Medicine, 42:177–186, 2014.

 

More information about the knee’s structure can be found in a variety of dance specific dance anatomy, kinesiology and safe practice books.

 

Elsa Urmston is the Centre for Advanced Training Manager at DanceEast, Ipswich, UK as well as Chair of the IADMS Education Committee and a member of the One Dance UK Expert Panel for Children and Young People.  Jonathan George is a Chartered Physiotherapist at the DanceEast Centre for Advanced Training.

Tags:  anatomy  biomechanics  dancers  knee  teachers 

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Snapping Hip Syndrome

Posted By Janine Bryant on behalf of the IADMS Education Committee, Wednesday, October 5, 2016

Do your dancers ever say, ‘My hip snaps or pops when I do grand battement or developpe´ devant or a´ la seconde’?

 

The snap sometimes presents with pain but sometimes not, and happens either on the up phase or down phase of the movement. Dancers might also notice decreased range of motion through multiple planes of movement. .

Snapping or clicking hip is common in dancers and athletes who regularly move through range of motion extremes, experience some degree of tendinitis, and repeat abduction of the legs above waist level.  With proper diagnosis and care, the condition can be addressed in a timely way so that the dancer does not lose too much rehearsal and class time.

 

Usually painless and harmless, a snapping hip can happen as a result of a tendon or muscle passing over a bony structure. It can occur frequently in dancers in three ways:

 

·         Lateral Snapping Hip (Iliotibial band syndrome), which is more common, involves movement of the iliotibial (IT) band moving over the greater trochanter (large bony structure on the head of the thigh bone) and is also referred to as external snapping hip syndrome. A clue to diagnosis of this condition may be the inability to adduct past anatomic neutral, an anatomical position where the two bones that form a joint are parallel to one another, - with the bones parallel and joint space uniform, this creates ‘anatomical neutral’. A more likely indicator, however, is the location of the pain along with palpable tenderness.  Pain to the lateral (outside) side of the knee as well as pain at the lateral hip can occur simultaneously and could be symptomatic of lateral snapping hip. Initially, there may be a sensation of stinging or needle-like pricks that are often ignored. This can gradually progress to pain every time the heel strikes the ground and finally can become disabling with pain when walking or when climbing up or down steps. (1,2,3)

 

 

      

 

 

·         Anterior Snapping Hip presents as a kind of clicking or snapping, as the iliopsoas tendon passes over the iliopectineal eminence on the front of the pelvis or pelvic brim. This can be caused by inflammation of the bursa that lies between the front of the hip joint and the iliopsoas muscle. A cartilage tear or bits of broken cartilage or bone in the joint space can cause snapping, or a loose piece of cartilage can cause the hip to ‘lock up’. (2)

 

 

·         Intra-Articular Snapping Hip (intra-articular meaning inside the joint) results from capsular instability caused by muscular imbalance, skeletal inconsistencies, such as a leg length discrepancy or bony deformity, or previous injury to the hip joint or from a labral tear. Dancers with this condition may experience decreased range of motion in the hip and a painful click directly inside the joint caused by bony instability resulting from hip dysplasia or excessive congruency resulting from Femoral Acetabular Impingement (FAI). (2)

 

Treatment:   Dancers could benefit from physical therapy to strengthen the surrounding musculature, improve flexibility, restore function, and prevent re-injury.  Movement reeducation and progressive resistance training might also prove effective. (6) Dancers may need to temporarily reduce rehearsal/class regimen as part of recovery/management of the syndrome.

 

Please refer to the examples below.

 

 

 

 

Resources for further reading:

1.       Keene S, Coxa saltans: iliopsoas snapping and tendinitis. Hip Arthroscopy and Hip Joint Preservation Surgery.2014; 64(1):1-16.

 

2.       Lewis CL. Extra articular snapping hip: A literature review. Sports Health.2010; 2(3):186-90.

 

3.       Grumet RC, Frank R, Slabaugh M, Verkus W, Bush-Joseph C, Nho S. Lateral hip pain in an athletic population: differential diagnosis and treatment options. Sports Health. 2010;2(3):191–196.

 

4.       Battaglia M, Guaraldi F, Monti C, Vanel D, Vaninni F. An unusual cause of external snapping hip. J Radiol Case Rep, 2011; 5(10)1–6.

 

5.       Reiman, M P, Thorborg K. Clinical examination and physical assessment of hip jointrelated pain in athletes. International J Sports Phys Ther.2014; 9(6): 737–755.

 

6.       Laible C, Swanson D, Garofolo G, Rose DJ. Iliopsoas syndrome in dancers. Ortho J Sports Med.2013; 1-3.

 

7.       Weber A E.The hyperflexible hip: Managing hip pain in the dancer and gymnast. Sports Health 2015:7(4); 346–358.

 

8.       Frank RM, Slaubaugh M, Grumet RC, Verkus W, Bush-Joseph C, Nho S. Posterior hip pain in an athletic population: Differential diagnosis and treatment options, Sports Health.2010; 2(3): 237–246.

 

9.       Lee S, Kim I, Lee SM, Lee J. “Ischiofemoral impingement syndrome.Ann Rehabil Med. 2013; 37(1): 143–146.

 

10.    Sobrino, F J, Crótida C,  Guillén P.Overuse injuries in professional ballet: Injury-based differences among ballet disciplines.Orthopaedic J Sports Med, 2015; 3(6).

 

11.    Smith PJ, Gerrie BJ, Varner KE, McCulloch PC, Linter DM, Harris JD. Incidence and prevalence of musculoskeletal injury in ballet: A systematic review.Orthop J Sports Medicine, 2015; 3(7).

 

12.    Domb BG, Shindle MK, McArthur B, Voos JE, Magennis EM, Kelly BT. Iliopsoas impingement: A newly identified cause of labral pathology in the hip. HSS J.2011; 7(2): 145–150.

 

13.    Pun  S, Kumar D, Lane NE. Femoroacetabular impingement,  Arthritis Rheumatol, 2015; 67(1): 17–27.

 

14.    Sajko S, Stuber K. Psoas major: A case report and review of its anatomy, biomechanics, and clinical implications. The J Canadian Chiro Assoc. 2009; 53(4): 311–318.

 

 

Janine Bryant, BFA, PhD (ABD) is Senior Lecturer at the School of Arts at The University of Wolverhampton in the UK.  She is also a Registered Safe in Dance International Certificate Provider and member of the IADMS Education Committee.

 

Tags:  dancers  hips  injury  pain  teachers 

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Student Events at the 2016 Conference in Hong Kong

Posted By IADMS Student Committee, Tuesday, October 4, 2016

Our Annual Conference is fast approaching and there are some exciting student events this year!

 

Our student social is a great way to meet new faces before the conference begins and to network with Dance Science students from across the globe! This years’ student social will take place the Wednesday before the conference begins to give you a chance to meet up in person before attending the conference.

Other student events and sessions include our student and young professionals networking event, the student roundtable and presentations on The future of dance medicine & science: An IADMS student survey, and Building your career: how to establish and foster a mentor-mentee partnership in your interest area – see details below!

 

Student Social

Our student social is a great way to meet new faces before the meeting begins and to network with Dance Science students from across the globe!

What?

Networking and drinks with IADMS student members

When?

Wednesday 19th October, 7pm

Where?

Meeting on the steps in front of the Jockey Club Amphitheatre at the Hong Kong Academy for the Performing Arts. 

 

Student Roundtable

What?

An opportunity to gain insights from an international group of students on a range of topics and issues affecting students of dance medicine and science.

When?

Friday 21st October, 2pm – 3.30pm

Where?

Atrium Lounge 1st Floor

 

Building your career: how to establish and foster a mentor-mentee partnership in your interest area

What?

For many aspiring dancers, clinicians, educators, and researchers, locating a mentor or an advisor in fields of interest as specific as those in dance medicine and science can be a daunting task. This talk will provide information for students and recent graduates about the value of having a career mentor and will discuss the process of finding, pursuing, and building a mentorship relationship. Topics will include: how to utilize peers and school resources to make connections with potential mentors, suggestions for contacting and pursuing potential mentors, ways to develop and maintain an ongoing mentor - mentee relationship, and tips for being an excellent mentee candidate.

When?

Saturday October 22, 4.45pm – 5pm

Where?

Recital Hall

 

The future of dance medicine & science: An IADMS student survey

What?

The IADMS Student Committee will present a retrospective snapshot of student membership and Educational Opportunities to illustrate a clear picture of the future of Dance Medicine & Science within the IADMS community to answer a question of “where is this field headed based on the current student interest?”

When?

Saturday October 22, 5pm – 5.15pm

Where?

Recital Hall

 

Student and Young Professional Networking Workshop

What?

An opportunity for students to connect with professionals and to build networks in their area of interest.

When?

Saturday October 22, 5.30pm – 6.30pm

Where?

Studio 8

 

Tags:  Annual Conference  Annual Meeting  students 

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Stretching the Point: Part 2

Posted By Gabrielle Davidson and Maggie Lorraine on behalf of the IADMS Education Committee, Wednesday, August 24, 2016

In Part 1 of “Stretching the Pointe” we discussed some issues that may arise as a result of incorrect use of the foot and faulty foot alignment in training.

 

Anatomical information about the foot is available in previous blog posts here.

 

In discussing the foot and the dancer, there are a few specific injuries and conditions that need to be taken into account to further strengthen the argument for ensuring correct alignment and muscle activation when teaching young dancers how to pointe their feet.

    


One of the most common of these injuries is posterior impingement of the ankle. This is when tissues at the back of the ankle are inflamed and prevent full ankle range into plantarflexion (pointing, demi pointe or pointe). This can either be due to compression of the soft tissues between the posterior edge of the tibia, the talus bone and the superior calcaneus [1] or irritation of the tendon sheath of the FHL (flexor hallucis longus- the muscle that controls the big toe into plantar flexion- full pointe)[4]. Posterior impingement and FHL tenosynovitis can go hand in hand and are often caused by the repetitive nature of dancers rising to demi pointe and pointe, and also pointing their feet [5]. It is thought that poor coordination of the lower leg and intrinsic foot muscles can exacerbate this condition. The condition can also arise after a sprained ankle and forced plantar flexion injuries, and in some cases has also been attributed to the presence of an os trigonum, a small bone that sometimes develops behind the ankle bone (talus bone). The os trigonum is a normal part of the ankle anatomy but sometimes fails to fuse with the talus therefore creating a small ‘extra’ bone in the ankle, and this can sometimes increase the effect of posterior impingement [1,3].

 

FHL tenosynovitis is frequently seen in female ballet dancers. It has been called “dancer’s tendinitis” but research has found that the condition is rarely a pathology of the tendon itself but of the sheath surrounding the tendon [1,2,3]. As mentioned above it can be part of the posterior impingement syndrome. The flexor hallucis longus muscle originates from the back of the fibula (outer lower leg bone/ lateral lower leg bone), then travels down along the inside of the lower leg and ankle where it inserts into the base of the big toe via the tendon. Its primary role is to flex the big toe assisting to pointe the foot (into plantar flexion), stabilise the foot and ankle as the dancer rises to demi pointe, and assist the foot to rise to full pointe [4].

 

The repetitive change in foot position from full plantar flexion (on pointe position) to full dorsiflexion (plié position) can cause this FHL tendon sheath to become inflamed [5], especially if it is not being supported by the other ankle and intrinsic foot muscles.


  


The repetitive loading of bones, especially in the feet, in activities such as fouettés (repetitive plantar flexion action of one foot on and off pointe) or landing from a series of repetitive jumps may cause bony stress. This is when loading of the bone outweighs its ability to recover and remodel, therefore leading to weakening of the bone structure itself and the resulting stress reactions or fractures [6,9].

 

Dancers are susceptible to a unique fracture at the base of the second metatarsal called the “dancer’s fracture” that is rare in other athletes and possibly as a result of the demi pointe and pointe work they carry out whilst dancing [5,7]. Controlling the amount of load a dancer is undertaking and controlling the rate at which this is increased, as well as making sure they have sufficient muscle support in both their feet and ankles will always help to reduce the risk of these overuse injuries.

 

Injuries to the mid foot in dancers while rare, can be debilitating [5]. The mid foot comprises the navicular, cuboid and three cuneiform bones. It stabilises the arch and transfers the forces generated by the calf, to the front of the foot during the stance phase of gait, so in dance terms this is whenever the dancer moves through their feet either rising or jumping. Acute cuboid subluxation may occur with ankle sprains, overuse of the peroneal muscles during repetitive movements such as rising up and down from pointe and excessive pronation of the foot, although the precise mechanism has not been proven [8]. Stress fractures and fractures of the navicular bone can be a career ending injury for a dancer.

 

  


Lisfranc injuries are injuries that occur to any part of the articulations of the 5 long metatarsal bones with the tarsal bones. These bones are connected by thick plantar ligaments (found on the underside of the bones) and strengthened by the tendons of tibialis posterior, peroneal tendons as they wrap under the foot and tibialis anterior tendon over the top of the arch. The Lisfranc ligament is the only ligament that binds the first and second metatarsal bones [8]. The mechanism of injury to this area in dancers may result from trauma to the foot of the female dancer when performing advanced pas de deux choreography where the edge of the pointe shoe sticks against an irregular floor surface when being slid along the foot by her partner. It can also occur from missed jump landings, during pirouettes/spins or during take-off for a jump [5].

 

Of course there are many more injuries that can occur in the course of a young dancer’s life but these are just a few of the main ones seen in the feet and ankles, some of which can be reduced with particular technique training and attention given to the development of specific muscle activity in the calves and intrinsic muscles of the feet, as mentioned in the previous blog post from the Education Committee.

 

The biggest message for young dancers, is to not allow pain to continue for too long. Seek treatment earlier rather than later to prevent too much time out of the studio and take heed of exercises and advice given by health professionals as their aim will always be to get you back dancing as soon as possible and for as long as possible.

 

Gabrielle Davidson and Maggie Lorraine

B.PHTY(HONS)              Leading teacher at the Victorian College of the Arts Secondary School

 

 

 

 

References:

[1] Russell J.A., Kruse D.W., Koutedakis Y., McEwan I.M., Wyon M. Pathoanatomy of posterior ankle impingement in ballet dancers. Clin Anat. 2010;23:613–621.

 

[2] Hamilton WG, Geppert MJ, Thompson FM. Pain in the posterior aspect of the ankle in dancers. J Bone Joint Surg Am 1996; 78 (10): 1491-1500.

 

[3] Peace,KA., Hillier, JC., Hulme,A., Healy, JC. MRI features of Posterior Ankle Impingement Syndrome in Ballet Dancers: A Review of 25 Cases. Clinical Radiol 2004: 59:1024-1033

 

[4] Kirane,YM., Michelson,JD., Sharkey, NA. Contribution of the Flexor Hallucis Longus to Loading of the First Metatarsal and  First Metatarsaophalangeal joint. Foot Ankle Int 2008; 29(4):367-377

 

[5] Kadel,N MD. Foot and Ankle Problems in Dancers.Phys Med Rehabil Clin N Am 2014; 25: 829-844

 

[6] Davidson, G., Pizzari,T., & Mayes, S. The Influence of Second Toe and Metatarsal Length on Stress Fractures at the Base of the Second Metatarsal in Classical Dancers. Foot and Ankle International  2007;28: 1082-1086

 

[7] Micheli, L. J., Sohn, R. S., & Solomon, R. Stress fractures of the second metatarsal involving Lisfranc's joint in ballet dancers. A new overuse injury of the foot. J Bone Joint Surg Am, 1985; 67(9), 1372-1375.

 

[8] emdedicine.medscape.com. Lisfranc Fracture Dislocation

Trevino, SG., Early, JS., Wade, AM., Vallurupalli, S., Flood, DL

 

[9] Mayer, SW MD., Joyner, PW MD., Almekinders, LC MD., Parekh, SG MD MBA. Stress Fractures of the Foot and Ankle in Athletes. Sports Health 2015: 6(6), 481-557.  

 

Kadel, N. J. Foot and ankle injuries in dance. Physical medicine and rehabilitation clinics of North America 2006; 17(4), 813-826.

 

O'Malley, M. J., Hamilton, W. G., Munyak, J., & DeFranco, M. J. Stress fractures at the base of the second metatarsal in ballet dancers. Foot & ankle international 1996; 17(2), 89-94.

 

An interesting videowhich highlights the horror for a dancer of a career threatening injury:

Portrait of a Dancer: Lauren Cuthbertson

 

 

Tags:  dancers  foot  injury  teachers 

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