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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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Stretching the Point

Posted By Maggie Lorraine on behalf of the IADMS Education Committee, Monday, August 15, 2016

Learning how to bend the knees and point the feet may be the first movements that dance students learn. It is sobering to consider that both of these movements are potentially harmful if not executed correctly and practiced in perfect alignment.  Experienced teachers of children and young people often notice that by encouraging students to “stretch” their feet rather than “point”, they are less likely to crunch their toes. Crunching results in a “shortened” line of the foot. On the other hand, “stretching” encourages the students to lengthen the leg through to the ankle and arch of the foot.  Anatomically speaking we are talking here about plantarflexion of the ankle of course, although this actual term is seldom used in a teaching context.


 

The pointed or stretched foot is the image that we so closely identify with classical ballet and arguably the control of the stretched foot whilst dancing is one of the skills that may take the longest to master.  It requires repetition throughout the dancers’ training to ensure sound alignment.  When teaching young children to dance it is important to consider the bone development of the body, which is called ossification. The completion of growth in a tubular (long) bone is indicated by the fusion or closure of the epiphyses (growth plates), located at each end of the long bone.  The long bones of the feet are the metatarsals – full anatomical information about the foot is available in previous blog posts hereThe final epiphysis to close does so at an average age of 16 years in boys and 14 years in girls (1). Of course, dancing can place added stress on growing bones and negligent dance training may also affect the development of the bony structures - repetitive trauma in training and increased impact due to poor biomechanical alignment can cause the epiphyseal plate to widen, rather than close (2).

 

It is acknowledged that foot and ankle injuries are the most prevalent injuries in classical ballet in both the student and professional population (3). The extreme position of the foot and ankle when dancing on demi pointe, (see illustration b) where the ankle is in full plantarflexion, the body weight is distributed on the ball of the foot, or en pointe, where the dancer is on the tips of her toes (see illustration c), the weight of the body is carried through the ankle joint, and the longitudinal axis of the foot may put the dancer at risk of injury.  Poor training, alignment, and faulty technique are all contributing factors to injury. Dancers, like athletes, are prone to common overuse injuries but they are also vulnerable to unique injuries, due to the extreme demands of ballet.

 

 

Teaching students how to align their feet and ankles, avoiding the urge to sickle (invert) or fish or wing (evert) when stretching their feet, and also ensuring that they do not crunch their toes (in an attempt to achieve the illusion of a high arch) will hopefully assist the student in avoiding serious foot problems. These issues will be exacerbated when the dancer rises on demi or full pointe. The control of the ankle when rising in an aligned position is a strengthening action.  However, when the ankle and foot is not aligned the action of weight bearing is potentially injurious.

 

 

Frequently students crunch their toes in an attempt to point their feet harder and consequently this action contracts the muscles of the foot causing the joints of the foot and ankle to compress.  Unfortunately, due to the students wearing shoes, the teacher does not always notice this problem, and the repetitive action possibly results in weakness in the intrinsic foot muscles and overuse of the extrinsic foot muscles, though this reasoning needs to be investigated scientifically. The issue sets up a pattern in the use of the foot that results in the toes crunching both when rising on demi pointe.  Strengthening the intrinsic foot muscles could potentially enable the middle joint of the toes to remain lengthened while stretching the foot. Research groups around the world are currently investigating just such possibilities and continually present their progress at annual IADMS conferences.


As teachers, we know that the habits that are developed in early training always affect the student in later years when greater complexity of training is introduced. Setting up the pattern amongst our students that they should strive to hold their feet evenly on the floor and keep their toes stretched out along the surface of the floor will help. While the feet are bearing the body’s weight they should be holding the ground at three points - one behind the back of the heel, and two in front of the heads of the first and fifth metatarsals. This triangle forms a base from which the muscles and soles of the feet can work to support the arch and align the feet. Potentially this will assist in the recruitment of the intrinsic foot muscles.

           

The intrinsic muscles are like the “core” muscles of the foot.  Because they are deep and don’t cross over too many joints, they can work well in stabilizing and protecting the arch and structures within the foot.  If the foot intrinsic muscles are weak, the foot structures are more prone to increased stress and injury.  Strengthening the intrinsic muscles of the foot is good for people with foot injuries and for those looking to prevent injury”(4).

 

Supporting the arches whilst standing all helps in ensuring strong, adaptable feet for dancing.

 

 

The extreme positions created when dancing on pointe are particularly hazardous if the body and foot are not physically ready to deal with the weight of the body on pointe. IADMS has produced a really useful guide to point readiness available here.

 

In conclusion movement habits practiced in early training can have a profound effect on the young dancer’s development and their potential for injury.  By laying the foundation of sound alignment the teacher will empower the student to achieve their goals with reduced potential for injury.  Celia Sparger describes it well: 

           

"It cannot be too strongly stressed that pointe work is the end result of slow and gradual training of the whole body, back, hips, thighs, legs, feet, co-ordination of movement and the 'placing' of the body, so that the weight is lifted upwards off the feet, with straight knees, perfect balance, with a perfect demi-pointe, and without any tendency on the part of the feet to sickle either in or out or the toes to curl or crunch. “

 

The IADMS Education Committee will post a follow up article describing possible foot and ankle conditions and injuries that may impact on the dancer written by Gabrielle Davidson who is the Physiotherapist of the Dance Department at the Victorian College of the Arts Secondary School.

 

Maggie Lorraine

Leading Teacher in Ballet at the Victorian College of the Arts Secondary School. Australia.

Member of the IADMS Education Committee

 

References

(1) Weiss, D., Rist, R. and Grossman, G. Guidelines for initiating pointe training.  IADMS Resource Paper, 2009.  Available here.

 

(2) Laor T, Wall EJ, Vu LP. Physeal widening in the knee due to stress injury in child athletes. AJR Am J Roentgenol. 2006; 186(5): 1260–1264.

 

(3) Foot and Ankle Injuries in Dance.  Physical Medicine and Rehabilitation Clinics of North America December 2006.  

 

(4) Amy McDowell, P.T From ARC Physical Therapy Blog

 

Further resources

Common Foot and Ankle Ballet Injuries

Dancing Child: Foot Development and Proper Technique

 

Micheli, L. J., Sohn, R. S., & Solomon, R. (1985). 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, 67(9), 1372-1375.

 

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

 

Wiesler, E. R., Hunter, D. M., Martin, D. F., Curl, W. W., & Hoen, H. (1996). Ankle flexibility and injury patterns in dancers. The American journal of sports medicine, 24(6), 754-757.

 

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

 

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

Tags:  dancers  foot  teachers  toes 

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Putting on a Conference: An Interview with IADMS Day for Teachers organizer Brenton Surgenor

Posted By IADMS Program Committee, Monday, August 8, 2016

A Day for Teachers is an important part of the annual IADMS programme. This popular event evolves year by year depending on where it is and who is organizing it. To find out exactly how the programme is developed I sat down with this year’s organizer, Brenton Surgenor, to find out what makes A Day for Teacher Hong Kong unique.


  


(1) How do you go about producing a Special Interest Day that is both educational and appealing?

 

Well that’s easy. I’ve been to going to IADMS conferences since 2010 and always attend A Day for Teachers (ADFT).  This experience has given me a good idea of who attends and what sort of content dance educators are looking for.  Firstly, I thought it was important to incorporate some practical session - which in Hong Kong will be Franklin Method for Dancers presented by Morten Dithmer. Then I felt it important to include a “hot topic” which this year is Nutrition for Dancerspresented by Frankie Siu from the Hong Kong Sports institute (which just happens to coincide with the IADMS Education Committees new resource paper on nutrition).  Finally, I wanted to include a panel discussion so dance educators could ask their burning dance science questions and get advice and support from our panel of experts.

 

(2) Who is involved in putting together A Day for Teachers?

 

Like so many advocates for the wonderful work of IADMS, I’m a bit of a Dance Science one-man band here in Hong Kong.  So the first thing I did was consult with local dance teachers to see what they thought was important to include.  Once I had an outline and some initial ideas I then sort the guidance and advice from my international colleagues (Edel Quin, Erin Sanchez and Margaret Wilson) who were instrumental in finalizing the programme and presenters. So I would say this has definitely been a team effort.

 

(3) Every Special Interest Day is different so what do you think is different or special about this year’s?

 

A Day for Teachers Hong Kong is unique because this year it’s nested within the main IADMS conference.  In the morning ADFT delegates have specially designed programme and then in the afternoon ADFT delegates are invited to attend any of the presentations or movement session offered as part of the main IADMS conference.  This is exciting as it means that our ADFT delegates will have the opportunity to be a part of the main IADMS conference and to meet and share ideas with delegates from across the world.  In this way it fully reflects IADMS commitment to inclusivity and introduces new delegates to the wonderful world of Dance Medicine and Science.

 

(4) What do you think you are most looking forward to about A Day for Teachers or conference as a whole? 

 

For me it’s all about learning.  And by this I mean knowing what is current in the field of dance medicine and science.  Dance medicine and science is evolving very quickly and there is always something new being discovered. By utilizing the knowledge I learn by attending an IADMS conference, it ensures that my students at the Hong Kong Academy for Performing Arts have the best opportunity to be happy, healthy and performing at their very best.



 

Tags:  conference 

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Putting on a Conference: An Interview with the IADMS Program Committee Chair Alexander McKinven

Posted By IADMS Program Committee, Monday, August 1, 2016
Alexander McKinven is the IADMS Program Committee Chair and works year-round to prepare for the IADMS Conference. Here are his answers to a few questions we had about what goes into planning a conference.

 

1)       How do you go about producing a conference that is both educational and appealing?

 

As a multi-profession organisation, it is so important that the conference is relevant to all members. We are relatively guided by the abstracts submitted each year but do balance this with clinical symposia choices.

The program committee has continued to develop our selection process to ensure the highest quality of presenters are selected for conference and want to ensure that the association is at the forefront of dance medicine and dance science development.

As this is our second time in Asia, we have tried to harness the expertise from Australasia and the Indian subcontinent.

 

2)       Who is involved in putting together the conference program?

 

It truly is a combined effort from SO many people. The program committee are responsible for the scientific content of the program but behind the scenes we have the blinded reviewers for the abstract selection, the IADMS IT personnel, the local host committee and the education committee of IADMS who specifically help develop the special interest group day. This year, the work of IADMS member Brenton Surgenor and Hong Kong Doctor Jason Brockwell have been instrumental in these SIG days.

 

3)       What timeline do you have to work to leading up to the conference?

 

The conference work is ongoing throughout the year.

After each conference we review the delegates’ feedback and see how we can implement the members’ views to improve the next conference.

At the start of the year we ensure that all the systems are in place for when the call for abstracts goes out. Once all the abstracts are submitted the program committee work exceptionally hard to review and select the very best for conference. I am excited for our members to see the Hong Kong schedule once it is released and am so proud and thankful to the team that I have lead this year.

 

4)       Every annual meeting is different so what do you think is different or special about this year’s?

 

The IADMS conference is three and half days long this year, with the special interest group days called A day for Teachers and A day for Medics, running concurrently within the main program. This decision was taken in line with IADMS mission statement, to raise the standard of the SIG days and to work with the local community where the conference is taking place. China is such a vibrant country and the opportunity to learn and work with the local community of Hong Kong is exciting. I am very much looking forward to seeing some of the performances that have been lined up and exploring the wonderful culture of the East.

 

5)       What do you think you are most looking forward to about the conference?

 

There are some fantastic presentations this year. What I look forward to most is attending a talk or movement session on a topic I know relatively little about. I really believe that this cross collaboration is what makes the IADMS conferences unique and would urge delegates to expand their knowledge and challenge their benefits by trying something beyond their professional norms.

Tags:  Conference 

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Getting ready for the conference: Students and Young Professionals

Posted By the IADMS Student Committee, Thursday, July 14, 2016

The annual conference is fast approaching and it’s time to start making plans. This year the exciting city of Wanchai, Hong Kong will be on the map as the second Asian location for the meeting to be held. Here are a few things we’ve been thinking about in preparation for heading to the tropical paradise in a cosmopolitan city, which happens to have the highest density of 7-Eleven shops in the world AND the world’s largest collection of skyscrapers…

 

Accommodation

If you’re looking to meet up with other student members AND cut some costs why not find a roommate on our student forum. Don’t forget that you need a current membership to access the forums! This can be a great way to get to know other members and will mean you have company finding your way to/from the conference. If you’re in the UK and are looking for a roommate, you might also want to join the Dance Science Study UK Facebook group and share a post there, we’ve met loads of great new people this way!

 

Travel

Getting between the airport and the city…

You might want to start thinking about your travel plans for when you arrive in Hong Kong. This way, instead of feeling flustered when you arrive you can take in the sights and sounds of Hong Kong!

The airport express is the fastest way to get between the airport and the city, reaching Hong Kong Island in around 24 minutes. Airport Express allows free in-town check-in services for major airlines; passengers are also able to take a free shuttle bus from Kowloon and Hong Kong stations to major hotels. More information on the free shuttle bus here.

 

Getting to the conference venue…

Planning your route between where you’re staying and the conference venue ahead of time will also help you to make the most of your time in Hong Kong. If you’re presenting or hoping to make it to the conference for a particular session or workshop, you don’t want to be worrying about how to get there.

The quickest and most efficient way to get around Hong Kong is traveling via the Mass Transit Railway (MTR) system. It covers major districts in Hong Kong, which includes stops at the boundary with Mainland China (Lok Ma Chau Station and Lo Wu Station). 

The Academy is located roughly mid-way between the Admiralty and Wanchai MTR stations, although it is slightly closer to Admiralty (take exit D signposted to the Hong Kong Academy for Performing Arts).

Another option is to use the bus. Buses in Hong Kong are comfortable, plentiful and mostly air-conditioned. They are popular for watching the great views from the top deck of the double-deckers.

Bus route guide for the conference venue:

A) A12, 18, 18P, 18X, 40M, 590, 720, 720A, 722, 780, 788

B) 2, A12, 18, 18P, 18X, 70, 104, 260, 307, 309, 590, 720, 720A, 720P, 722, 780, 788, 930A, 930X, 967X, 969X


Connecting with other students

The IADMS annual conference offers a unique opportunity to connect with peers and professionals who specialise in dance medicine and science. Here’s our top tips on how to make the most of this opportunity…

Top tips

·         Attend the student social – this is a great way to meet other students before the conference even begins!

·         Attend a roundtable – this can be a great way to meet other students and professionals in your area. There is also the student roundtable, an opportunity to discuss key issues with students in dance medicine and science

·         Check out the student networking session – this session brings together professionals from a wide range of dance medicine and science disciplines and gives you an opportunity to meet peers in your research area and to get to know the professionals in your area too.

·         Networking – put yourself out there and try to talk to as many new faces as possible. The IADMS conference is a great place to make new connections and to talk to professionals who are as passionate about dance science as you are!

·         Introduce yourself to the Student Committee - we’re really friendly and love getting to know other young people who share our passions J

 

Getting the most out of the conference

In addition to connecting with other students and professionals you want to make sure that you get the most out of what’s on offer at the conference and in the city of Hong Kong.

Top tips

·         Attend a variety of sessions not just your main area and try to sit down with the conference schedule before you go and plan out the sessions you want to check out

·         Be brave – ask questions during the sessions and get involved!

·         If you don’t fancy asking questions during the formal sessions, attend a roundtable. The roundtable is a great opportunity to engage in discussion with a smaller group of people on a more specific topic.

·         Make the most of your breaks – use this time to try to get to know new faces at the conference and to talk to new people.

·         Make the most of any free time to explore the city – this is one of the perks of being a part of an international association!

 

Student Events

Getting involved with student events can really help you to make the most out of your time at the conference and the events we have on offer mean that you can get to know some new faces before the conference even begins!

Student social

Our student social is a great way to meet other students before the meeting begins and to network with Dance Medicine and 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

 

Little things…

Something as small as having the right travel charger can be the key to making your trip a success.

Travel chargers – The electric power is 220 Volt, 50 Hertz. A power converter is necessary to avoid damage to computers designed specifically for 120 V. Hong Kong uses a Type G electrical plug that has three rectangular blades in a triangular pattern and has an incorporated fuse (usually a 3 amps fuse for smaller appliances such as a computer and a 13 amps one for heavy duty appliances such as heaters). Check out this website for info on what type of adapter you will need.

 

Watch this space! More details to come on our student events in our upcoming blog posts :)

Tags:  Annual Meeting  Conference  students 

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