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Foot Injuries in Dancers. Are they preventable?

Posted By Maggie Lorraine on behalf of the IADMS Education Committee, Wednesday, July 6, 2016

Perfecting the art of dance requires long hours of intensive training over many years with constant repetitions of exercises to refine and perfect the execution of sequences and movements. Dance places high demands on the body and for this reason professional dance training institutions often include physique testing, conducted by the resident physiotherapist as part of the audition process. Subsequently even the physiques that are deemed “ideal” for training at a pre professional level are at risk of injury as a result of faulty alignment and technique.  In recent years the quest for greater virtuosity in performance has added an extra layer of risk to the aspiring young dancer who is hoping to achieve a career in dance. Issues such as more intrusive stretching techniques to achieve higher extensions of the leg, bigger and higher jumps with added complexity, more virtuosic turns and particularly greater engagement of the spine in movement. These trends have all added to the necessity for dance teachers to have a comprehensive knowledge of human anatomy, physiology and kinesiology. This knowledge will give teachers the information to guide their students to reach their full potential and to avoid sustaining injuries.

 

No dancer is immune to the possibility of injury, however the young dancer who is experiencing a growth spurt is at the greatest risk. Whilst growing, a child’s bones are more susceptible to issues, since as the bones lengthen the growth places stress on the muscle tendon unit and consequently the young dancer at a higher risk for stress fractures and fractures.

 

Building from our previous posts on the foot’s skeletal and muscular structure, this article focuses on the foot and issues that arise from faulty biomechanics, technique and resulting from over pronation of the feet.



Incorrect turn out of the legs and feet often results in over pronation or “rolling “of the foot and ankle. To make up for inadequate mobility at the hip, dancers often rely on the rotation of the knee, and ankle to achieve the desired 180-degree turn out of the feet. This problematic mode of movement compromises the control of the rotation of the leg in the hip socket and the efficient recruitment of the deep rotator (turn out) muscles which assist in the stabilizing muscles of the legs and pelvis.  Maintaining alignment, stability, strength and control is difficult to achieve whilst dancing with torsion of the knee, and pronated foot. When the foot is pronated the weight of the body falls through the unaligned joints of the knee and ankle creating an increased torque of the medial (inner) arch and ankle and poor intrinsic foot muscle control  (see photograph above).


When there is poor intrinsic muscle strength in the arch of the foot, foot pain may occur. The intrinsic foot muscles are the tiny muscles, which contribute to control a ballet dancer's arch. If the muscles are not working effectively, larger muscles known as the extrinsic foot muscles, which originate on the leg and cross over the ankle joint, become overused.


Over-pronation of the feet can lead to a number of problematic conditions, which contribute to foot pain and may cause conditions such as bunions, hallux rigidus, plantar fasciitis, and sesamoiditis.

 


Unfortunately bunions can be common in dancers. They begin to develop in young dancers who do not have the muscle recruitment in place to support the growing bones. Both male and female dancers are at risk from the increased stress on the medial column of the foot as a dancer attempts to achieve greater turnout from the knee and ankle. Some bunions (or hallux valgus) are hereditary, however dancers may develop them as a result of forcing turn out with little to no intrinsic muscle control. Tight fitting shoes and pointe shoes may also contribute to bunions as the shoes narrow to the pointe and the foot is broadest across the metatarsals. Squeezing the toes into narrow pointe shoes put pressure onto the big toe joint which is exacerbated by carrying the weight of the body on the tiny surface of the shoe en pointe.

 

Repeated strain on the big toe joint may result in hallux rigidus or stiffness of the big toe. Dancers with bunions are more prone to hallux limitus. The shock and forces from dancing can lead to inflammation of the big toe joint, and over time cause stiffness and a lack of range of motion. Because of the pain and stiffness, dancers will shift their weight to the outside of the foot during demi-pointe. 

  

Metatarsalgia is an overuse injury and the term describes pain in the ball of the foot, which usually develops over months. High impact activities such as jumping without sound foot control and abnormal weight distribution on the foot can result in this injury. Although this injury is not solely a result of hyperpronation, the reduced foot control resulting from poor intrinsic strength will be a contributing factor.

 

Sesamoiditis is another condition where pain is often felt in the ball of the foot and is a result of excessive pressure on the forefoot. The sesamiod bones are two tiny bones within the flexor hallucis longus (FHL) that run to the big toe and when a person has sesamoiditis the tendon become inflamed. Dancers, who alternate between extreme plantar flexion and dorsiflexion rely on the flexor hallucis longus (FHL) for dynamic stability of the foot during these movements and they may be particularly susceptible to this condition. Other causes can be an increase in activity, having a foot with a high arch or a bony foot (with insufficient fat to protect the tiny bones) and also stress fractures. Most frequently dancers with sesamoiditis have an imbalance of FHL vs. gastrocnemius/soleus {calf muscles} and FHL vs. intrinsics.

 

The plantar fascia is a dense band of fibrous tissue that originates at the heel and connects to the base of the toes. It stretches each time the foot is used, and is prone to overloading especially if the arch is not supported by proper footwear. Dancers experience pain and swelling at the inside base of the heel and arch area and it is known as plantar fascilitis.

This article has focused on foot injuries, which may result from faulty biomechanics of the foot in dancers.

Forcing turn out from the foot and ankle instead of at the top of the leg at the hip joint results in faulty alignment and poor muscle recruitment. Dancers require strong intrinsic muscles of the feet, which are imperative for aligned foot control against the ground in repetitive movements of the foot, pointe work and jumping.  Without this control of the foot the dancer is at risk of injury.

The next article in this series will examine issues resulting from incorrect stretching of the foot and faulty

biomechanics of rising to demi pointe and pointe.

 

Maggie Lorraine

 

The following IADMS link provides an excellent training program for dancers:

 

         Turnout for Dancers: Supplemental Training

         Feet: Skeletal and Muscular Structure

         Resource Paper: The challenge of the Adolescent Dancer

Follow these links for more information:

YouTube - 1

YouTube - 2

 

 

Further reading:


Grossman G, Krasnow D and Welsh TM. Effective use of turnout: biomechanical, neuromuscular, and behavioral considerations. Journal of Dance Education 2005; 5(1): 15-27.

 

Jeffrey A. Russell, PhD, ATC. Breaking pointe: Foot and ankle injuries in dance.

 

 

Maggie Lorraine is the Leading Teacher in Ballet at the Victorian College of the Arts Secondary School and is a member of the IADMS Education Committee.

Tags:  dancers  feet  foot  injury  prevention  teachers 

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Caring for bony injury demystified!

Posted By Meredith Butulis, DPT, ACSM HFS, Monday, June 27, 2016

Welcome to Part Three of our three part series on muscle, ligament, and bone injuries. We will explore some common myths and how you can use current evidence to efficiently return to optimal performance. This month we will explore bony injuries.

 

“It’s just a stress fracture; I can keep going.”

 “I only take the boot/orthopedic shoe off to dance, other than that I wear it all the time. Is that OK?”

“I can prevent shin splints by stretching my calves more.”

 

As dancers, teachers, or allied health professionals, we’ve likely experienced situations like these.

 

What are some essential pearls that dancers, teachers, and allied health providers need to know when it comes to preventing and caring for bony injuries?

 

What are the most common bony injuries in dancers?

At this time, research does not clearly differentiate dancers versus other athletes with regard to bony injury; however, common bony injury sites for athletic youth and adults including dancers will be discussed here.

 

Common sites for bony injury, particularly stress fractures, include metatarsals, tibia, fibula, navicular, talus, calcaneus, and pars interarticularis.1,2,3,4 Teens and youth are also susceptible to injuries involving epiphyseal (growth) plates. See Fig 1. for an illustration of these common locations.



Clinically, I also find that many dancers think that they have a chronic muscle strain as opposed to a bony injury, especially when fractures are located in the back, pelvis, hip, shins, or feet (Fig 2). For example, dancers often enter the clinic with a self-diagnosis of “hamstring strain,” “hip flexor strain,” “back strain,” “plantar fasciitis,” or “ shin splints.” Once medically evaluated, many of these are found to be fractures. 



Now that we’ve taken a look at common sites of bony injury, let’s get into some common myths and alternative views surrounding these bony injuries! We will delve into management tips, and foundations for designing your own injury prevention programs.

 

Myth # 1: It is OK to dance on a stress fracture.

 

Fact: Dancing on any fracture is not recommended. A stress fracture indicates excessive loading to the involved bone, typically over a period of time; this is different than an acute fracture, which occurs in a single episode.3 Continuing to dance on any fracture can lead to a non-union where the bone terminates its healing process; this is an undesirable outcome as it can lead to needing to permanently modify activity choices. High-risk locations are much more susceptible to delayed or non-union injuries.3,5,6

 


Myth #2: All ankle and foot injuries should be treated with PRICE (protect, rest, ice, compress, elevate) for 2-3 days followed by gradual return to activity as long as they don’t show excessive swelling and bruising at first.

 

Fact: Many bony ankle injuries actually do not swell and bruise extensively immediately. Many can also take more than two weeks to show on an X-ray image.3,7 There are a few indicators that should lead a dancer to see a medical provider initially, as opposed to trying self-treatment for a few days. These indicators are known as the Ottawa ankle rules, and further medical evaluation should be performed. If there is bony tenderness to the distal 6 cm of the medial or lateral malleolus, posterior edge or tip of either malleolus, talar neck, navicular, or base of the 5th metatarsal, medical evaluation is indicated (Fig 4).8 Additionally, if there is inability to weight bear to walk at least four steps either at the time of injury or subsequent time, medical evaluation is indicated. 8  



Myth #3: Once a fracture has healed, the dancer can return to his/her previous level of dance immediately.

 

Fact: Return to activity is guided by the high versus low risk classification of the fracture, the extent of the injury, and the typical training or competitive schedule for the individual.9 Generally, stress fractures take 6-8 weeks to heal with proper rest and rehabilitation; 7 the high risk sites can take quite a bit longer to heal.2,3 Low back fractures typically have a minimal healing time of 3 months.6

 

Proper management of a stress fracture goes beyond bone healing. Ligamentous laxity, leg length differences, areas of joint hyper or hypomobility, and neuromuscular imbalances can all play a role in minimizing improper loading forces through the body.3 Rehabilitation professionals also often use functional test batteries to determine the neuromuscular control of the involved body part prior to returning a dancer to activity.

 

Additionally, comprehensive management of a stress fracture is not limited to physical rehabilitation. Training schedules, adequate recovery strategies, fatigue management, nutrition, medications, menstrual cycle patterns, and footwear should also be evaluated.3

 

 

Myth #4: Stretching the calves regularly will prevent shin, ankle, and foot bony injury.

 

Fact: Injury prevention requires a comprehensive approach in managing multiple risk factors. Risk factors are commonly divided into intrinsic (a property of the individual human body), and extrinsic (the environment surrounding the individual).  Intrinsic risk factors include bone density, skeletal alignment, flexibility, muscular endurance, bone turnover rate, hormonal balance, and nutrition.10  Extrinsic factors include dance surfaces, footwear, training schedules, and load.10 All of these factors need to be considered with regard to the individual performer (Fig 5). 

 


Concluding thoughts:

Now that we’ve explored bony injury myths, and samples of current recommendations in prevention & treatment, how will you utilize this information in your practice?  

 

References:

 

1. Brunker PD, et al. Stress fractures: a review of 180 cases. Clin J Sports Med. 1996; 6(2): 85-9.

 

2. Bennell KL, Brunker PD. Epidemiology and site specificity of stress fractures. Clin Sports Med. 1997. 16(2): 179-96.

 

3. Mayer SW, Joyner PW, Almekinders LC, Parekh SG. Stress Fractures of the Foot and Ankle in Athletes. Sports Health. 2014;6(6):481-491.

 

4. Smith PJ, Gerrie BJ, Varner KE, McCulloch PC, Lintner DM, Harris JD. Incidence and Prevalence of Musculoskeletal Injury in Ballet: A Systematic Review. Orthopaedic Journal of Sports Medicine. 2015;3(7)

 

5. Behrens SB, Deren ME, Matson A, Fadale PD, Monchik KO. Stress Fractures of the Pelvis and Legs in Athletes: A Review. Sports Health. 2013;5(2):165-174.

 

6. Standaert CJ, Herring SA (2007). Expert Opinion and Controversies in Sports and Musculoskeletal Medicine: The Diagnosis and Treatment of Spondylolysis in Adolescent Athletes. Archives of Physical Medicine and Rehabilitation. 88(4): 537-40.

7. Verma RB, Sherman O. Athletic stress fractures: part I. History, epidemiology, physiology, risk factors, radiography, diagnosis, and treatment. Am J Orthop. 2001; 30(11): 798-806.

8. Bachmann LM, Kolb E, Koller MT, Steurer J, ter Riet G. Accuracy of Ottawa ankle rules to exclude fractures of the ankle and mid-foot: systematic review. BMJ. 2003;326(7386):417.

9. Deihl JJ, Best TM, Kaeding CC. Classification and return-to-play considerations for stress fractures. Clin Sports Med. 2006 Jan;25(1):17-28, vii.

10. Bennell K, et al. Risk factors for stress fractures. Sports Med. 1999 Aug;28(2):91-122.

 

Further Reading:

1. Robson B, Chertoff A. Bone health and female dancers: Physical and Nutritional Guidelines

Resource Paper. International Association of Dance Medicine and Science. 2010. Available at: http://c.ymcdn.com/sites/www.iadms.org/resource/resmgr/resource_papers/bone_health_female_dancers.pdf

 

About the Author: Meredith Butulis, DPT, MSPT, OCS, CIMT, ACSM HFS, NASM CPT, CES, PES, BB Pilates is a dance-specialized Physical Therapist, Personal Trainer, Pilates Instructor, and dance performer. With over 15 years of experience, she is based in Minneapolis, MN at Twin Cities Orthopedics and the Minnesota Dance Medicine Foundation.

Tags:  bone  dancers  injury  teachers 

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Maybe you should stop dancing… a little

Posted By Luke Hopper and Peta Blevins, Wednesday, June 15, 2016

We all know how super hard dancers work. Dance is a passion, a lifestyle and an identity for millions of people around the world. And you only get to the top with hard work and grit right? But can you have too much of a good thing?


Most dancers know the stories of dance legends like Nureyev and Cunxin dancing through adversity night and day, spending more time in the studio than any other dancer on their way to greatness. And we have all heard stories of dancers pushing their bodies through performance because the show must go on. These are inspirational stories of motivation and determination, but the fact is while dancers are super humans they certainly aren’t superhuman, and injury caused by over working in dance is a worldwide problem. A dancer who has not experienced some form of injury that has forced them to stop or modify their training is a rarity. This is really no surprise because dancers love what they do. They want to be the best they can be and put a huge number of hours into the studio pursuing their dreams. But all this training can come at a cost. No-one can work as hard as dancers do without running the risk of experiencing injury or illness that is going to stop them dancing in some way. So, could dancers actually train less, reducing the risk of injury or illness, and still progress in their training, perhaps even faster?


 


The majority of dance injuries are referred to as overuse injuries. The term overuse means just what it says - injury occurring as a result of the body being overused. The tissues in the body become fatigued and susceptible to injury when a dancer is overusing them. This is the risk dancers take in dedicating so much time training. Nobody wants to get injured and one of the hardest parts about injury for a dancer is having to take the time out of dance to recover and rehab the injury. But let’s step back and look at the injury from a different perspective. Maybe the injury is a way in which your body is showing that you are working too hard and the injury has actually just forced you into a period of recovery time? Think all of the days or weeks in the past years that you may have spent not dancing as a result of injury or illness. This is time that your body has spent recovering from training. Wouldn’t it be a better option to dedicate time for recovery as part of your regular practice so that you don’t become too injured or ill to dance in the first place?


Colleagues who work in sports are often amazed when they hear how much time dancers actually train. It is way above the training time of elite or professional athletes. This is partly because of two fundamental principles of physical training used in sport, progressive overload and recovery. Progressive overload refers to the concept that training should stress, fatigue and challenge the body beyond a comfortable limit. As a result, after the training, the body responds by adapting with strength or fitness gains, or whatever physical capacity the training challenged. But it is only after training that the body adapts; it is only when the body is recovering that we improve. Making sure you get enough sleep is just as important as working really hard in the studio. We do some of our best work at night when we are asleep in bed.


These principles go beyond the physical and apply just as strongly to psychological factors. There is a huge amount of psychological pressure that goes hand in hand with being a dancer. Dancers may feel pressure to look a certain way, they may be worried about gaining employment, and more and more there is increasing demand for dancers to have versatility in their performance skills. It’s not always possible to leave our worries at the studio door and often we find they creep into the studio behind us and start affecting our performance. Often the first reaction we have when we notice performance dropping off is to increase our training efforts, but maybe training smarter is a better option than just training harder.


A first step in becoming a smarter dancer is looking at yourself as a whole person, not just a dancing body but also a dancing mind. It’s important to acknowledge that pressures from within and outside the dance world, as well as a combination of physical and psychological factors, can have an impact on your performance. Finding a balance between pushing hard and backing off training when you need to recover is a bit like walking a tightrope; it’s very easy to lose your balance and only you can feel where your center of gravity is. There can be a bit of a stigma attached to taking it easy; no one wants to be seen a quitter or a ‘lazy dancer’. But it’s so important to be aware of your own recovery needs and to know when you can push your training and when you need to spend more time focusing on recovering from the hard work you’ve put in.


 


So let’s think about recovery in the context of injury or illness again. You push a little hard through training, ignoring the niggle in your foot or tickle in your throat and all too soon you are too sick to get out of bed or you’re watching class from the side waiting for your foot to recover. Can you frame this series of events as your body forcing you to recover after you have been forcing your body to train? If you can accept that recovery in dance is inevitable (and indeed, essential), then you have the choice of taking the recovery pill the easy way or the hard way. There is nothing like coming home from a hard day’s training, feeling you have accomplished something and are on your way to being a brilliant dancer. So reward yourself, take some downtime, even half a day coupled with an easy afternoon’s training. You are much better spending the day recovering and doing some light training than pushing your body with another hard session risking injury or a week in bed.


So how much training is enough and how much rest is too much? Ultimately, this is your choice, nobody knows your body’s limits better than you. A good place to start is to plan your training over the next few months. In sports this is called periodization and IADMS President Prof Matt Wyon’s articles are a great guide to get you on the way here. By scheduling rest periods it means that you may be able to train differently on your work days and Glenna Batson’s article on distributed practice in dance can help you through that. You will also need to think about your existing schedule, when do you have high intensity classes, days or weeks and how can you schedule your recovery time around these periods.


Finally, recovery does not mean being a couch potato. Elite athletes don’t spend nearly as much time in physical training as dancers but they certainly train full time. This means that when athletes aren’t training in the gym or on the field they will often be reviewing games, looking at game strategy or doing mental skills training. This is referred to as active recovery. So why not schedule half a day a week or so to study dance history or even better catch up on your journal of dance medicine and science articles or IADMS blogs! There are heaps of activities you can do that aren’t dancing that will let your mind and body rest and recover and make you a better dancer.

  

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Luke Hopper (Post-doctoral Research Fellow) and Peta Blevins (PhD Candidate) are based at the Western Australian Academy of Performing Arts. Peta Blevins’ PhD advisory team include Luke Hopper, Associate Professor Gene Moyle (Queensland University of Technology) and Dr Shona Erskine (Western Australian Academy of Performing Arts). Peta will present her research investigating recovery in dance at the IADMS conference this year at the Hong Kong Academy for Performing Arts.

Tags:  dancers  teachers 

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TaMed Dance Medicine Conference Report

Posted By Richard Gilmore, Wednesday, June 1, 2016

How to begin to capture my impressions of the weekend? The essence of the 13th Congress for Dance Medicine held by the Dance Medicine Organization in Dresden on this past Mother’s Day weekend requires a mental review of the subjects, ideas and movement classes. The fact that so many people were sufficiently captivated to stay indoors while the sun gave Germany a first preview of summer speaks for the event and for the inventiveness of our presenters and organizers. There are always new approaches and new aspects of dance medicine worth lending our ears, but also our bodies and souls.



 

We got started not with our ears but with our stomachs, as three lectures addressed various aspects of nutrition for dancers. Among other things, we learned that classical dancers have more eating issues than Latin-American formation dancers, that depression can be one of the major predictors of eating disorders, and that we should have more than just a cappuccino for breakfast. While digesting these lectures we also heard that there are different methods of coping with injuries depending upon obsessive versus harmonious passion for dancing and we were introduced to a tool for fascia work to complete the first segment of the Congress.


Since dancers are not known for being especially awake at early hours, it was advantageous to begin the Saturday morning with Andrew Greenwood, who gave us information packed together with a movement “cappuccino”. He transmitted inspiration to get us all involved in a block of lectures mostly on dance with older or disabled people, but also touching on occupational diseases and skin problems. The wide variety of workshops on all three days allowed for individual selections which could give every participant the chance to find desired information on yoga or emotions, on eurythmy or holistic physiotherapy, fascia work or ballet for seniors, just to mention a few possibilities. The only frustration was from not being able to experience all of them.



Fascial therapy seems to have become established as a standard approach for therapy of dancer’s chronic problems. A lecture on its application to the foot, which followed an examination of factors leading to hallux valgus, the pathological bunion joint, addressed the need and possibilities for prevention.

 

The final segment of the congress began with holistic methods for treating dancers’ injuries, including a method called Wingwave®, which can root out the potentially emotional causes of barriers to performance. The final two lectures headed in a critical direction. While dance medicine attempts to find methods to relieve the pains and to avoid wear and tear from dancing, the world seems to just keep pushing dancers in a direction that is ever more demanding. It could not be determined from where these pressures originate, but the feeling seems to be that dancers are less appreciated as artists and have become more interchangeable, thus can be discarded when broken. While this was not a happy ending, it was cause for all to do some serious thinking.



Tags:  regional conference  TaMed 

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Caring for ligament sprains demystified!

Posted By Meredith Butulis, DPT, ACSM HFS, Wednesday, May 25, 2016

Welcome to Part Two of our three part series on muscle, ligament, and bone injuries. We will explore some common myths and how you can use current evidence to efficiently return to optimal performance. This month we will explore ligamentous injuries.

 

“It’s just an ankle sprain; can I perform this weekend?”

 “My hip flexors are always tight, so my friend taught me the frog stretch; is this a good stretch?”

 

As dancers, teachers, or allied health professionals, we’ve likely experienced questions like these.

 

What are some essential pearls that dancers, teachers, and allied health providers need to know when it comes to preventing and caring for ligamentous injuries?

 

What is a ligament and what does it do?

A ligament is a connective tissue in the body that connects a bone to another bone.  Ligaments serve to create stability in the joint structure. Injury to a ligament is called a sprain, which is different than a muscle or tendon injury.

 

Myth # 1: After resting a new sprain for a few days, the dancer will be ready to return to the stage.

 

Fact: Ligament healing depends on the grade of the sprain, location, and overall health of the dancer.


 


However, the most common sprain, that involving the ATFL (anterior talofibular ligament) in the ankle, notably takes 6 weeks to 3 months to achieve mechanical stability4, with 30% of these sprains continuing into a state of chronic instability.5

 


Dancers may wonder if they should see a medical provider if they suspect a sprain. A correct diagnosis will help lead to the most efficient route of correct treatment. There are a few indicators that should lead a dancer to see a medical provider initially, as opposed to trying self-treatment for a few days. These indicators are known as the Ottawa and/or clinical prediction rules, and further medical evaluation should be performed. Since these findings indicate possible fracture, we will discuss them in next month’s blog post on bony injury.

 

Myth #2: New ligament injuries should be treated with PRICE (protect, rest, ice, compress, elevate) for 2-3 days followed by gradual return to activity.

 

Fact: Rehabilitation strategies depend on the type of injury and its phase of healing. Current evidence supports matching rehabilitation strategies to healing phases.

 


Within this decade, sports medicine has also revealed that ligament sprains are more than a localized injury; they affect the entire kinetic chain and sensorimotor system of the body. 7, 8 Therefore, rehabilitation needs to include these elements. Details on proprioceptive training can be found in the International Association of Dance Medicine & Science’s resource paper, Proprioception.9 Details on progressions of functional training can be found in General Considerations for Guiding Dance Injury Rehabilitation in The Journal of Dance Medicine and Science. 10

 

Myth #3: Stretching is the best strategy to prevent sprains.

 

Fact: Stretching can be part of an injury prevention program, as it can help to improve joint alignment and neuromuscular efficiency; however, stretching by itself has not been proven to prevent injury. 11 Currently, there is not a consensus on best prevention, as injury prevention involves addressing the individual within the context of his/her abilities, movement tasks, and environment. 7, 8, 10

 


Generally, stretches should be reserved for muscles, not ligaments. One should not attempt to stretch his or her ligaments, as they may excessively elongate and fail to stabilize the joints that they protect. 12

 

Here is an example of a popular dance “frog” stretch targeted at the ligaments and capsule in the front of the hip. Since the stretch targets ligaments and the joint capsule, it is not recommended.

 


Instead, alternatives like stretching the hip adductors or hip flexors would provide safer and more muscularly targeted stretches. 

 


Clinically, I have found that when dancers are instructed in how to stretch muscles instead of ligaments and joint capsules, their pain often decreases; their functional pain free range of motion often improves within a couple of weeks.

 

Concluding thoughts:

Now that we’ve explored ligament sprains, myths, and samples of current recommendations in prevention & treatment, how will you utilize this information in your practice?  

 

 

 

References:

1. Manske RC. Postsurgical Orthopedic Sports Rehabilitation: Knee & Shoulder. Philadelphia, PA: Mosby. 2006.

 

2. Axe MJ, Snyder-Mackler L. In: Current Concepts of Orthopedic Physical Therapy, Independent study course 21.2.11, 3rd Ed.  Manal TJ, Hoffman SA, Sturgill L. American Physical Therapy Association. 2005.

 

3. Haddad SL. Sprained ankle. OrthoInfo. American Academy of Orthopedic Surgeons. 2016. Available here.

 

4. Hubbard TJ, Hicks-Little CA. Ankle ligament healing after an acute ankle sprain: an evidence-based approach. J Athl Train. 2008; 43(5): 523-529.

 

5. Wilkstrom EA, Hubbard-Turner T, McKeon PO. Understanding and treating lateral ankle sprains and their consequences: a constraints-based approach. Sports Med. 2013; 43(6): 385-93.

 

6.  Phuc L. Human Anatomy System: Skeletal System (Free App for iPhone)

 

7. Petersen W, Rembitzki IV, Koppenburg AG, et al. Treatment of acute ankle ligament injuries: a systematic review. Archives of Orthopaedic and Trauma Surgery. 2013;133(8):1129-1141.

 

8. Fulton J, Wright K, Kelly M, et al. Injury risk is altered by previous injury: a systematic review of the literature and presentation of causative neuromuscular factors. International Journal of Sports Physical Therapy. 2014;9(5):583-595.

 

9. Batson G. Proprioception. International Association of Dance Medicine and Science. Resource paper. 2008. Available here.

 

10. Liederbach MJ. General considerations for guiding dance injury rehabilitation. JDMS. 2000; 4(2): 54-64.

 

11. Clark MA, Lucett SC, Sutton BG, Eds. NASM Essentials of Personal Fitness Training, 4th Ed. Baltimore, MD: Wolters Kluwer; 2012

 

12. Norkin CC, Levangie PK. Joint Structure & Function, 2nd Ed. Philadelphia, PA: FA Davis; 1992.

 

Further Reading:

1. Critchfield B. Stretching for dancers. Resource Paper. International Association of Dance Medicine and Science. 2011. Available here.

 

2. Sefcovic N. First aid for dancers. Resource paper. International Association of Dance Medicine and Science. 2010. Available here.

 

 

About the Author: Meredith Butulis, DPT, MSPT, CIMT, ACSM HFS, NASM CPT, CES, PES, BB Pilates is a dance-specialized Physical Therapist, Personal Trainer, Pilates Instructor, and dance performer. With over 15 years of experience, she is based in Minneapolis, MN at Twin Cities Orthopedics and the Minnesota Dance Medicine Foundation.


Tags:  dancers  injury  ligament  sprain  teachers 

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Bridging Dance and Health in Brazil V – Towards a Brazilian framework for dancers’ health and wellbeing

Posted By Clara Fischer Gam, Tuesday, May 17, 2016

Welcome to the last installation of the series about the opportunities and challenges of Dance and Health in Brazil! Since January, we have been delving into the Brazilian dance sector through the eyes of our local IADMS members. Along this post series, we have been exploring information accessibility issues and public policies impasses, meeting inspiring initiatives, and familiarizing with the dance career pathways in the country. Today, as we get to the end of a journey, another one begins: this time towards a Brazilian framework for dancers’ health and wellbeing.


 

 

“Dance sector’s problems are still of a very elementary level”, states IADMS member Dr. Adriano Bittar. As we investigated in the 4th installation, Brazilian dancers’ every-day challenges concern employability, low remuneration rates, and lack of recognition in the field. Besides regulations for professional careers, educational development and retirement planning in dance are still proceeding towards approval, mentioned in a previous post. “There are so many unmet needs that inquiry on dancers’ health was left out”, says Dr. Bittar.

 

 Over the years, we have been observing that there are changes taking place, however there is still a long way to go. “In Brazil, dancers are overexposed to health risks during their careers. There is a considerable disparity between the knowledge produced internationally in dancers’ health and the present scenario”, points out rheumatologist Dr. Izabela Gavioli, another IADMS member. Whilst discussions about dance and health are in an early stage, raising awareness of such topics could be in itself a strategy to empower the community, promote the sector, speed up the development of public policies and achieve professional recognition. At the moment, both the dance sector and the broader community are still in the process of understanding the potentials of the dance profession, questioning the nature of the occupation and the further application of dance.

 

Embedded in this context, there is an emerging movement for putting dance medicine and science into practice. Across the country, there are people taking action to bridge that gap. As we have previously explored in depth, there is a growing number of initiatives for dance and health in Brazil. Being part of this community of dancers, researchers and educators that are fostering an emerging field, my peers and I have all been individually working to understand: What does Dance Medicine and Science looks like from a Brazilian perspective? How does it apply to the Brazilian context? 

 

 

 

Since I founded “Dance Science Brasil”, a group on Facebook to connect IADMS members in Brazil, firstly located through IADMS members directory, and other professionals interested in this area of knowledge, a lively space has been opened up for change-makers and leaders of the field to communicate and take this shared inquiry forward.

 

In a few months, the opportunities for sharing and integration to occur will be expanded due to another initiative, proposed by IADMS members Dr. Adriano Bittar from Brazil and Dr. Matthew Wyon from the UK. The project will establish a collaboration network for dance medicine and science between Brazil and the UK, representing a giant leap for the field in my country. As this innovative partnership unfolds, members of IADMS from both nations are getting together in two research workshops to strengthen the bonds and facilitate exchange.  

 

Having arrived back in Brazil less than a year ago, it is very exciting to be in the source of an emerging field in this country. Specially, to have the opportunity to share it with you through this post series! It was a pleasure to bring to you an overview of the challenges and opportunities for dance and health down the Tropics, and with your help I really hope we can keep nourishing this field together!

 

The Brazilian members of IADMS are:

 

- Adriano J. Bittar Sr

- Aline N. Haas

- Bárbara P. Marques

- Clara Fischer Gam

- Claudia Daronch

- Daisy M. Machado

- Flora M. Pitta

- Izabela L. Gavioli

- Kaanda N. Gontijo

- Marcia Leite

- Mariana G. Bahlis

 

Join us on the Facebook group “Dance Science Brasil”!

 

Clara Fischer Gam, MS

“Dance Science Brasil” Group Admin

MSc Dance Science | BEd Dance Education | Pilates Instructor

Rio de Janeiro – Brazil

clara.figa@gmail.com

www.clarafischergam.com

www.gestoslivres.com

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Integrando Dança e Saúde no Brasil, Parte V:  por uma perspectiva brasileira para a saúde e bem-estar do bailarino

 

Bem-vindo à última postagem da série sobre as oportunidades e desafios de Dança e saúde no Brasil! Desde Janeiro de 2016, estamos investigando o setor da Dança no país, através da perspectiva dos nossos membros locais da IADMS. Ao longo desta série de postagens, viemos explorando questões relativas à acessibilidade de informação e políticas públicas, conhecendo iniciativas inspiradoras, e nos aproximando dos desafios da carreira de bailarino no Brasil. Hoje, ao passo que alcançamos o fim dessa jornada, uma outra se inicia: dessa vez em busca de uma perspectiva brasileira para a saúde e bem-estar do bailarino.

 

"As dificuldades do setor da Dança ainda são de um nível bastante elementar...", afirma o membro da IADMS Dr. Adriano Bittar. Como nós investigamos na  quarta postagem dessa série, os desafios diários dos bailarinos brasileiros incluem empregabilidade, baixa remuneração e falta de reconhecimento no campo. A regulamentação da carreira profissional, além de outras questões quanto ao desenvolvimento educacional e o planejamento da aposentadoria na Dança, ainda estão sendo discutidas ou em processo de aprovação legal, como mencionado em uma postagem anterior. "Há tantas necessidades não atendidas que a discussão sobre a saúde dos bailarinos foi deixado de fora.", diz o Dr. Bittar.    

 

Ao passar dos anos, têm ocorrido mudanças nesse sentido. No entanto, existe um longo caminho pela frente: "No Brasil, bailarinos estão sendo super expostos a riscos de saúde durante suas carreiras. Existe uma disparidade considerável entre o conhecimento produzido internacionalmente em saúde na Dança e o cenário atual no país.", destaca a Reumatologista Dra. Izabela Gavioli, outro membro da IADMS. Enquanto as discussões sobre Dança e saúde encontram-se em um estágio inicial, a conscientização de tais temas poderia ser em si mesma uma estratégia para empoderar a comunidade, promover o setor, acelerar o desenvolvimento de políticas públicas e alcançar o reconhecimento profissional. No momento, tanto no setor da Dança, como em outras camadas da sociedade brasileira, parece haver um interesse nas potencialidades da Dança, no sentido de explorar a natureza da profissão e sua possível aplicabilidade em outras áreas do conhecimento.  

 

Neste contexto, há um movimento crescente para levar a Medicina e Ciência da Dança para a prática. Em diferentes regiões do país, algumas pessoas têm trabalhado para dar conta dessa lacuna. Como já descrito em profundidade  em um texto anterior, um número crescente de iniciativas tem sido criada pela Dança e saúde no Brasil. Como parte dessa comunidade de bailarinos, pesquisadores e educadores que estão promovendo um campo emergente, eu e meus colegas temos trabalhado individualmente para entender: quais são as particularidades da Medicina e Ciência da Dança na perspectiva brasileira? como este campo de estudo aplica-se ao contexto deste país?

 

Desde que fundei o "Dance Science Brasil", um grupo no Facebook criado para conectar os membros brasileiros da IADMS  (localizados através do diretório dessa associação), além de outros profissionais interessados ​​e atuantes nessa área de conhecimento no país, surgiu um espaço dedicado à comunicação e partilha para facilitar que agentes e líderes do campo pudessem levar esses questionamentos compartilhados adiante.  

 

Muito em breve, as oportunidades para a integração do campo serão ampliadas devido a uma outra iniciativa, proposta por dois membros da IADMS: Dr. Adriano Bittar, do Brasil, e Dr. Matthew Wyon, do Reino Unido. O projeto pensado por eles vai estabelecer uma rede de colaboração para a Medicina e Ciência da Dança entre Brasil e Reino Unido, representando um salto gigante para esse campo de conhecimento no país. Ao passo que essa parceria inovadora desenvolve-se, membros da IADMS de ambas as nações irão reunir-e inicialmente  em dois workshops de pesquisa para fortalecer os vínculos e facilitar o intercâmbio.  

 

Tendo retornado ao Brasil menos de um ano atrás, posso afirmar que tem sido fascinante participar do desenvolvimento de um campo em ascenção neste país. E ainda mais especial foi ter tido a oportunidade de compartilhar algumas impressões com você através desta série de postagens! Foi realmente um prazer ter podido apresentar uma visão geral dos desafios e oportunidades de Dança e saúde nos trópicos, e com a sua ajuda eu espero que possamos continuar nutrindo este campo juntos!

 

- Junte-se a nós no Grupo “Dance Science Brasil”!

 

- São membros brasileiros da IADMS:

 

Adriano J. Bittar            

Aline N. Haas            

Bárbara P. Marques            

Clara Fischer Gam  

Cláudia Daronch         

Daisy M. Machado            

Flora M. Pitta            

Izabela L. Gavioli            

Kaanda N. Gontijo            

Marcia Leite            

Mariana G. Bahlis    

 

Clara Fischer Gam, Mestre Ciência da Dança

Licenciada em Dança

Administradora do grupo Dance Science Brasil

Co-fundadora do Corpos Aptos, Gestos Livres

Rio de Janeiro – Brazil

clara.figa@gmail.com

www.clarafischergam.com

 


Tags:  Brazil  translation 

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5 Questions With Carina Nasrallah, Stephanie Alimena and Lucie Clements

Posted By IADMS Student Committee, Wednesday, May 4, 2016

Our next featured members in the “5 Questions With…” column are Student Committee Members, Carina Nasrallah, Stephanie Alimena and Lucie Clements. Carina is an athletic trainer at Physical Therapy Solutions, Mechanicsville, Virginia - the official provider of physical therapy services and onsite care for the Richmond Ballet. Stephanie is a medical student at University of Connecticut School of Medicine, Farmington, CT and Lucie is a PhD student at Trinity Laban Conservatoire for Music and Dance, London UK.


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


Carina - I began my training as a dancer at a young age, continued pre-professionally through high school, and then pursued dance as my major in undergraduate studies.  In high school, I witnessed one of my fellow dancers rupture her anterior cruciate ligament (ACL) during jumps in center.  I remember hearing about her experience with the doctors, surgery, etc. – she was often frustrated with how the doctors compared her injury to that of an athlete or football player and how little they knew about the demands of dance.  This piqued my interest and I found myself wanting to learn more about dance-related injuries, anatomy, and health.


Lucie - During my undergraduate degree studies, I was required to do a year-long work placement. I had pursued a BSc in Psychology rather than a dance career due to unresolved problems with bilateral labral tears, but I always had a determination to combine my studies with my lifelong love of dance. I could not believe my luck when I found a placement working in the cognitive neuroscience of dance, investigating kinaesthetic empathy and the mirror neuron system. During my research that year I came across some of the big names in dance psychology and realised that a career in the field was possible. I am grateful to my placement supervisor, Corinne Jola, for the encouragement and support she gave me in my first steps into dance science. When I discovered the MSc in Dance Science at Trinity Laban, there was no going back for me. I’ve been determined to pave my way in dance science as a specialist in dance psychology ever since.

 

Stephanie I've been dancing since the age of three and have wanted to be a doctor for just as long. Then when I was living in France for 2 years after college, I obtained a second Bachelor's degree in Dance in Paris, and learned just how underserved dancers are as a population. It became clear to me that I am passionate about learning how we can improve their access to health care and educating dancers about proper health maintenance strategies while training. While I've ultimately decided that I want to pursue a career in Women's Health, my passion for helping dancers will be something I take with me throughout my career.

 

 

-Are you currently participating in research? Can you give us your elevator pitch about your research area?

 

Carina - I am currently conducting a nationwide survey-study in the U.S. on the availability of healthcare services to student-dancers in university programs. Student-dancers in university programs are largely underserved with adequate healthcare.  Compared to traditional student-athletes, student-dancers in universities have limited access to specialized medical services, but the current availability of healthcare services is not well documented.  By identifying successful models for providing services and addressing potential limitations the dance medicine community can better advocate for accessible medical services as a feasible and necessary option for dance programs. I presented a poster summary of my research at the IADMS Annual Meeting in Pittsburgh.

 

Stephanie - I am currently involved in research looking at health seeking behaviors in dancers. Last summer I travelled to France and administered a questionnaire to members of two major ballet companies and two major ballet schools. Overall we found that dancers in France, like dancers in the U.S., tend to avoid going to the doctor when injured. We found that most dancers did not first seek help from a physician when injured. However, most dancers ultimately did receive care from a physician from their injury (86%), on average within 2.5 weeks of sustaining it. We also found differing rates of health seeking behaviours towards physicians among professional dancers vs. student dancers, with students being more likely to first access care from a dance teacher, whereas professionals were more likely to go directly to a physician specialist. We hope to further examine the cause of these differences in health seeking among dancers of varying professional status, to help improve access to care for younger dancers.


Lucie - I’m extremely fortunate to be receiving funding from the Leverhulme Trust to undertake PhD research within a project entitled ‘In the Dancer’s Mind; Creativity, Novelty and Imagination’. Working with Emma Redding at Trinity Laban, alongside UK dance and psychology colleagues from Coventry University and Plymouth University, we are investigating the impact of systematic imagery training in developing our students’ creativity and creative abilities. It’s been an amazing opportunity to work with choreography staff, embedding dance science research into the contemporary dance curriculum. Our research is a little different to the health-based focus we usually see at IADMS, but Dr. Redding and I are excited to share our work with IADMS over the coming years – watch this space!

 

 

-Which annual meeting has been your favourite so far and why?

 

Carina - I truly enjoyed the meeting in Basel, Switzerland.  I loved getting to travel internationally and visit to such a beautiful country and culture (not to mention the amazing chocolate and cheese fondu!).  It was also neat to reconnect with many of the colleagues I had met at my first annual meeting.  There are more familiar faces at every meeting you attend!

 

 Lucie – My favourite annual meeting was the one just gone, the 25th Annual Meeting in Pittsburgh. Not only was it my first experience of visiting the USA but the first time I had presented at IADMS. Being able to share my work with esteemed IADMS colleagues will always be a very special memory. I was also lucky enough to meet and receive advice from two of IADMS’ longest serving dance psychologists – Lynda Mainwaring and Paula Thomson. To speak to these people, whose work had opened my eyes to IADMS and dance psychology, was truly inspiring and their words of encouragement will stay with me for a very long time. It was also IADMS’ 25th anniversary celebration, and I turned 25 a couple of weeks after – I love that IADMS and I were born at the same time!

 

-In which ways has IADMS helped you grow in your field of study?

 

Carina - I have truly enjoyed getting to know the people behind the expanding and growing field of dance medicine and science.  Through their journal articles, online educational resources, and then getting to meet them in person at the annual meetings, I have continually been inspired and challenged to never stop asking questions -- and seeking out the answers.  My involvement with the IADMS community has made me more aware of how critical dance medicine and science is to the advancement of dance as an art form and the nurturing of body-wise, artist-athletes.

 

StephanieBefore IADMS, I had no idea that dance medicine and science existed. IADMS has helped me find mentors for my research, network with other people with similar research interests, and help me learn about my career options.

 

-What is the best thing about being a student member of IADMS?

 

Carina - The people and the resources.  Attending the annual meetings has been the best opportunity for me to meet like-minded individuals who are similarly passionate about improving dancer wellness and performance.  Of the researchers, students, and healthcare professionals that I have met at conferences, there have been a number who I have continued to collaborate and network with professionally.  Also, the resources that IADMS publish have raised the bar for dance medicine and science research; I have learned so much about expanding my knowledge and experience as an artist, researcher, and healthcare professional.

 

Stephanie - Hanging out with other students with similar interests! I was so impressed with the calibre of the student presentations at the last IADMS meeting. All the students are bright individuals with really interesting research projects. Everyone is also super nice and easy to get along with, and happy to help put you in touch with their connections as well. It really is an awesome student network.

Lucie - It’s great meeting other young, like-minded individuals. There is a large community of young dance scientists in London, but it’s exciting to establish connections with other people from around the world. I also love that now I’ve completed my MSc in Dance Science and I’m progressing with my PhD, I can share my experiences and enthusiasm with undergraduate students who are thinking of pursuing further study in the field.


-What has been your favourite IADMS experience?

 

Carina - At the 2013 Annual Meeting in Seattle, WAI had the opportunity to go on the kayaking trip around Lake Union in the centre of the City.  In the group were Matthew Wyon a Professor at Wolverhampton University and a handful of fellow students and educators.  Along with the amazing scenery and seeing the houseboat from Sleepless in Seattle, the trip was filled with laughter and so many unforgettable moments shared with amazing people!

 

Stephanie - I really enjoyed the Movement Session on KT Taping at the Annual Meeting in Pittsburgh. I learned a lot of information that has proven valuable to me time and time again this year in treating musculoskeletal injuries at the clinic where I work during medical school.

 

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


Carina - Do not miss out!  The access to online resources such as the Journal of Dance Medicine & Science that you receive as a student member are essential to exploring any type of dance medicine/science topic -- for research, artistic development, or education.  The discount on registration for the Annual Meeting is another huge plus!  View it as a professional investment in your career as a research, educator, or artist rather than just an annual fee.

 


Lucie – I would highly encourage it. IADMS is a hugely supportive, welcoming network of individuals. When you’re undertaking research like I am, it’s easy to become really focused on that area and forget to listen out for what else is going on in dance science. For me, IADMS is the best way to stay up to date with current research in the dance science world. As students we look up to the founders and long serving members of IADMS, but we should also recognize that students are the future of the organisation. So, don’t be afraid to get involved!

 

If you are interested in the Student Committee and its initiatives, contact us at student@iadms.org.

 

Special thanks to the “5 Questions With...” sub-committee, Andrea Alvarez and Siobhan Mitchell.





Tags:  5 Questions With 

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Caring for muscle strains demystified!

Posted By Meredith Butulis, DPT, ACSM HFS, Tuesday, April 26, 2016

Welcome to our three part series on muscle, ligament, and bone injuries. We will explore some common myths, and how you can use current evidence to efficiently return to performance. This month, we will begin with muscular injuries.

 

“I strained my hamstring three months ago!”

“Why does it take so long to heal?”

“I’ve done everything from stretching to massage and I keep losing flexibility!”

 

As dancers, teachers, or allied health professionals, we’ve likely experienced or witnessed these self-diagnosed and self-treated muscle strains.

 

What are some essential pearls that the dancer, teacher, and allied health provider need to know when it comes to caring for muscular injuries?

 

Myth # 1: A muscle strain is the cause of the motion loss.

 

Fact: Muscle strains are quite prevalent in dance and sport injury. 1,2 In addition to muscle spasm and tension that can follow a strain, structures that can limit range of motion include the joint capsule, ligamentous or myofascial adhesion, joint swelling, bone structure, neural tension, and dysfunction in how segments of the body work together. 3,4 It is common to have multiple structures limiting range of motion, even if there was a specific incident that seemed to cause the limitation. 1,3 Resolving the range of motion loss depends on a correct assessment of the entire kinetic chain.1,4,5,6, 7

 

Example: A dancer presents to an allied health provider; over the past month, she notes pain at the top of her left hamstring and progressive motion loss with stretching into left leg forward splits. She has received several sessions of hamstring soft tissue work without improvement. She has been working on back walkovers and back bends, but you find that she does not have the thoracic and shoulder motion for proper alignment of the shoulders over the wrists. You find that this has led to segmental dysfunction of the entire thoracolumbar spine. The solution to restoring this dancer’s left splits lies in restoring proper mobility of the spine and proper alignment of the shoulders over wrists in performing her bridge and back walkover skills.

 

This case illustrates the importance of assessing the performer’s skill specific alignment throughout the kinetic chain when formulating a treatment plan. It also illustrates that range of motion loss may present as muscular pain, but the cause may not be a muscular strain.


 




Myth #2: Muscle strains should typically be treated by self-prescribed stretches and fascia release.

 

Fact: All tissues progress through healing phases. Current evidence supports matching rehabilitation strategies to healing phases. 1,5,6


 




Myth #3: After a muscle strain, a dancer should be back to full performance ability within 1-2 weeks.

 

Fact: There are different types of muscle strains. Correct identification and proper early treatment can help manage time frame expectations. 


 

 

Dancers, however, often do not rest or seek medical care.6 They also often take up to 32-50 weeks to return to premorbid dance levels after hamstring muscle strains.6 This prolonged recovery period is possibly due to lack of early proper treatment and premature return to activity.6  Additionally, re-injury rates can be quite high; the hamstring re-injury rate within one year is 34%1

 

As we can see, seeking medical evaluation (even for a minor strain) could help dancers develop a proper plan of care to help with efficient return to performance.

 

Concluding thoughts:

Now that we’ve explored muscle strains, myths, and current recommendations in treatment, what will your actions be next time you suspect a muscle strain?

 

References:

1. Foglia A, Bitocchi M, Gervasi M, Secchiari G, Cacchio A. Conservative Treatment of Muscle Injuries: From Scientific Evidence to Clinical Practice. In: Bisciotti GN (Eds) Muscle Injuries in Sport Medicine, InTech, 2013. Available here.

 

2. Roberts KJ, Nelson NG, McKenzie L. Dance-related injuries in children and adolescents treated in US emergency departments in 1991-2007. J Phys Act Health. 2013; 10(2): 143–150.

 

3. Konin JG, Harrelson GL, Leaver-Dunn D. Range of motion and flexibility. In: Andrews, Harrison, Wilk (Eds) Physical Rehabilitation of the Injured Athlete, 3rd Ed, Philadelphia, PA: Saunders, 2004, pp. 129-156.

 

4. Lee D, Lee LJ. The role of the pelvis in hamstring injuries and posterior thigh pain. In Touch. 2009; 127.

 

5. Page P. Pathophysiology of acute exercise-induced muscular injury: clinical implications. Journal of Athletic Training. 1995; 30(1): 29-34

 

6. Deleget A. Overview of thigh injuries in dance. Journal of Dance Medicine & Science. 2010; 14(3): 97-102.

 

7. Tiidus PM, Ed. Skeletal muscle damage and repair. Champaign, IL: Human Kinetics. 2010.

 

 

 

About the Author: Meredith Butulis, DPT, MSPT, CIMT, ACSM HFS, NASM CPT, CES, PES, BB Pilates is a dance-specialized Physical Therapist, Personal Trainer, Pilates Instructor, and dance performer. With over 15 years of experience, she is based in Minneapolis, MN at Twin Cities Orthopedics and the Minnesota Dance Medicine Foundation.


 

Tags:  dancers  myths  teachers  tips 

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Bridging Dance and Health in Brazil IV – Dancing against the odds

Posted By Clara Fischer Gam, MS, Tuesday, April 19, 2016

This is the 4th installation of a series about the opportunities and challenges of Dance and Health in Brazil. Over the last few months we have been exploring together the potentialities of this emerging field – as experienced by our Brazilian IADMS members! As we start heading to the end of this post series, today, in the second-to-last installation, I will be sharing with you some perceptions and lived experiences of Brazilian IADMS members when it comes to building up a dance career in Brazil.


   

 

Considering our country’s particular context, the central question arises: What is exactly the greatest challenge of a dancer’s career in Brazil?

 

 

“To dance.” Simply states Dr. Adriano Bittar, a Brazilian IADMS member. “Just to get to the point of building up a career is fairly challenging in this country”, states Dr. Izabela Lucchese Gavioli, another IADMS member. As most of my Brazilian peers have agreed, it seems that the greatest challenge dancers face today is to find the most elementary conditions for nourishing their professional development.

 

Since the early years as a student there are high rates for education, maintenance of dance shoes or specific dancewear as well as additional costs for supplementary training, medical, and psychological care. Although it is widely known that proficiency can only be achieved by a certain cost, in the Brazilian context those are high-stakes investments. “There are not enough dance companies to accommodate the amount of professional dancers in the sector”, attests IADMS member Barbara Pessali-Marques. Consequently, “there are not many chances to experience auditioning, which is routine for young dancers around the globe”, as Dr. Gavioli explains. Auditions play an important role in the early artistic development because “dancers can learn to cope with the stresses involved in performing. It is also a chance to attain more self-knowledge”. Not being able to experience dance or find work in the field, it is no surprise that “a considerable amount of dancers will leave the country on the search of an opportunity to start a career in dance”, attests by Dr. Aline Haas, also part of the IADMS community. Among the dancers that go abroad for experiencing dance, a portion of them can afford the costs of living abroad whilst the other portion were able to attain financial support through dance competition results. For the dancers that build up their careers in Brazil, starting either by joining a dance company or by taking part in a particular dance project, it is very likely that remuneration will be low. For dancers that pursue individual initiatives such as founding their own companies or developing solo performances, the scenario remains the same; “frequently, dance projects will end up in financial loss”, affirms Barbara Pessali-Marques.

 

As we delve into the dancer’s situation in the Brazilian context, it becomes clear that the greatest challenges of a career in dance are way beyond the sphere of individual striving; they are part of a bigger picture. “I believe that the lack of support for arts and culture is the main challenge, as the dance occupation is unappreciated; it is a vicious cycle”, Barbara Pessali-Marques states. As we have mentioned back in the second installation of this series, the issues involving recognition of the dance professional are reinforced by the lack of national policies, legislation or regulation of the dance career. “Getting proper health care assistance, planning the season and the volume of classes and rehearsals is hard work when support and sponsorship are scarce”, states Dr. Gavioli, who speaks from the perspective of both a physician and a choreographer.

 

Taking these conditions into account, I wonder what would be the impact on dancers’ behavior towards health and well-being. Ultimately, how does that affect the relationship with their own bodies?

 

“Based on my own experience as a classical dancer, where self-competition is very present, I see that crossing our boundaries becomes part of the routine in such environment”, says Kaanda Gontijo, a physical therapist and IADMS member that is still dancing on stage, and “as a result, we see the high rates of injury in this population”. Worldwide, dancers are known for having the habit of dancing through injury. Still nowadays that seems to be part of dancers’ culture. As suggested by Flora Pitta, another IADMS member that shares the occupation of being a professional dancer and a physiotherapist, “I believe that this behavior is related to dancers’ fear of unemployment”.

 

Interestingly, at the same time that the culture of pain remains present these days, some members of the Brazilian IADMS community pointed out to a shift in dancers’ behavior towards health and wellbeing. Over the last few years they have been noticing that dancers are arriving to their clinic of practice, classroom or studio with a broader awareness of the physical dancer and engagement in listening to their body needs than before – a trend I observe to be common to the Global North countries. Brazilians have come to understand  that a higher number of the injured dancers that go through the rehabilitation process become hard wired for a deeper understanding of the injury pattern as well as for taking care of their own bodies.

 

 

Later in the career, the dancer’s body will eventually exceed its peak performance years. As we have formerly discussed in a previous post, many dancers will have to retire in what would be considered a young age, as often dance involves a short career on stage. Although their bodies are not as available as before, the creative capacity is still ascending. But what happens next?

 

“The lack of career transitioning programs tailored for dancers in Brazil results in dancers transitioning to different occupations, mostly unrelated to dance. I believe that the lack of appreciation for the dance occupation diminishes the chances of keeping this professional in his original field of knowledge after dancing years have passed”, states Dr. Bittar, “I can clearly see that these artists have a lot to contribute to the dance sector after retirement, assuming roles that are still to be explored”.

 

Being a dancer in Brazil seems to go against the odds; from the early ages of professional development, through dancing years to life after retirement, the challenges of building up a successful career are constant. When working for dancer’s health, it is important to consider that this process goes together with empowering the dance occupation. As an educator and researcher, I continuously ask myself,   “How can Dance Science contribute to the recognition of our dancers?”

 

 

The Brazilian members of IADMS are:

- Adriano J. Bittar Sr

- Aline N. Haas

- Bárbara P. Marques

- Clara Fischer Gam

- Claudia Daronch

- Daisy M. Machado

- Flora M. Pitta

- Izabela L. Gavioli

- Kaanda N. Gontijo

- Marcia Leite

- Mariana G. Bahlis

 

Join us on the Facebook group “Dance Science Brasil”!

 

Clara Fischer Gam, MS.

“Dance Science Brasil” Group Admin

MSc Dance Science | BEd Dance Education | Pilates Instructor

Rio de Janeiro – Brazil

clara.figa@gmail.com

www.clarafischergam.com

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Integrando Dança e Saúde no Brasil, Parte IV: dançando contra a corrente

 

 

Esta é a quarta parte de uma série de postagens sobre as oportunidades e desafios da Dança e saúde no Brasil. Nos últimos meses, viemos explorando as potencialidades deste crescente campo, através da experiência dos membros brasileiros da IADMS! À medida que começamos a aproximarmo-nos do fim dessa série, hoje, na penúltima postagem, vou compartilhar com vocês algumas das nossas percepções e vivências sobre a carreira de bailarino no Brasil.

 

Considerando o contexto específico desse país, surge o questionamento: qual é exatamente o maior desafio da carreira em Dança no Brasil?

 

"Dançar." Afirma sucintamente Dr. Adriano Bittar, membro brasileiro da IADMS. "Só para se chegar ao ponto de iniciar a construção de uma carreira já é bastante desafiador nesse país", afirma Dra. Izabela Lucchese Gavioli, outro membro. Como a maioria dos meus colegas brasileiros concordam, parece que o grande desafio que o bailarino enfrenta atualmente é encontrar as condições mais elementares para nutrir seu desenvolvimento profissional.

 

Desde os primeiros anos estudando Dança, é necessário arcar com o custo alto de aulas técnicas, manutenção de sapatilhas ou trajes específicos do estilo, bem como despesas adicionais com a preparação física, atendimentos médicos ou psicoterapêuticos. Sem dúvida, sabe-se que a proficiência apenas pode ser alcançada a um certo preço - porém, no contexto brasileiro, esses são investimentos de risco. "Não há companhias de dança suficientes para acomodar a quantidade de bailarinos profissionais no setor.", atesta o membro da IADMS Bárbara Pessali-Marques. Consequentemente, "...poucas são as oportunidades de passar pela vivência da audição, que é rotina para jovens bailarinos de todo o mundo.", explica a Dra. Gavioli. As audições desempenham um papel fundamental nos primeiros anos do desenvolvimento artístico, pois nesse ambiente "...bailarinos aprendem a lidar com o estresse da performance. É também uma chance de alcançar maior auto-conhecimento.".

 

Por não conseguirem vivenciar a Dança, nem encontrar trabalho no campo, não é de se surpreender que "...uma quantidade considerável de bailarinos vai deixar o país em busca de uma oportunidade de iniciar a carreira em Dança", observa Dra. Aline Haas, também parte da comunidade IADMS no Brasil. Entre os bailarinos que vão para o exterior em busca de experiência em Dança, apenas uma parte deles pode arcar com os custos de viver no exterior, enquanto a outra porção é composta por vencedores de premiações competitivas, recebendo apoio financeiro para os estudos. Quanto aos bailarinos que seguem a carreira no Brasil em companhias de Dança, é muito provável que a remuneração será baixa. No caso dos bailarinos que apostam em iniciativas autorais, tais como a criação de suas próprias companhias ou o desenvolvimento de performances solo, o cenário permanece o mesmo; "Frequentemente, os projetos de Dança resultam em perdas financeiras.", afirma Bárbara Pessali-Marques.

 

Enquanto mergulhamos na situação do bailarino no contexto brasileiro, torna-se evidente que os maiores desafios de uma carreira na Dança estão muito além da esfera do esforço individual; eles são parte de um quadro geral: "Eu acredito que a falta de apoio para as artes e cultura é o principal desafio. Como resultado, a profissão em Dança é desvalorizada. No fim das contas, isso se torna um ciclo vicioso.", Bárbara Pessali-Marques afirma. Como já mencionado na segunda postagem dessa série, as questões em torno do reconhecimento do profissional Dança são reforçadas pela falta de políticas públicas, legislação ou regulamentação da carreira de bailarino: "Obter assistência de saúde adequada, planejamento da temporada e organização do volume de aulas e ensaios é um trabalho árduo num cenário onde há escassez de apoio e patrocínio.", afirma a Dra. Gavioli, que observa essa situação pelo olhar médico e também da coreógrafa, já que ocupa ambas funções.

 

Levando em conta essas condições, eu me pergunto como elas impactam o comportamento dos bailarinos quanto ao tema saúde e bem-estar. Em última análise, como isso afeta o relacionamento com seus próprios corpos?

 

"Com base na minha própria experiência como bailarina clássica, onde a auto-competição é muito presente, eu vejo que ultrapassar nossos limites torna-se parte da rotina nesse ambiente.", diz Kaanda Gontijo, fisioterapeuta e membro da IADMS, que continua dançando na palco. Completa Kaanda: "Sabemos que como resultado, vemos elevadas taxas de lesões nessa população.". Mundialmente, bailarinos são conhecidos por terem o hábito de desconsiderar suas lesões. Ainda hoje, isso parece ser parte da cultura da Dança. Como sugerido por Flora Pitta, outro membro da IADMS, que divide seu tempo entre a profissão de bailarina e fisioterapeuta, "Eu acredito que esse comportamento está relacionado com o medo permanente que os bailarinos cultivam do desemprego.".

 

Curiosamente, ao mesmo tempo que a cultura da dor continua presente nos dias de hoje, alguns membros da comunidade brasileira da IADMS apontam para uma mudança no comportamento dos bailarinos em relação à saúde e bem-estar. Ao longo dos últimos anos, eles têm percebido que os bailarinos estão chegando nos consultórios, salas de aula ou estúdios com uma consciência mais ampla das demandas físicas da profissão e maior interesse em perceber as necessidades do corpo - uma tendência que observamos ser comum aos países da Europa e Estados Unidos. Nossos membros têm identificado que muitos bailarinos lesionados, que passam pelo processo de reabilitação, tornam-se mais atentos a uma escuta profunda do padrão das lesões recorrentes, bem como mais cuidadosos com seus próprios corpos.

 

Em algum momento mais adiante na carreira de bailarino, o corpo irá ter que encarar, e ultrapassar, os seus anos de alto desempenho no palco. Como já anteriormente discutido em outra postagem, muitos bailarinos terão de aposentar-se em uma idade jovem, já que na maioria dos casos a carreira de performer tem curta duração. Embora seus corpos não estejam mais tão disponíveis como antes, a capacidade criativa ainda é ascendente. Mas o que acontece a seguir?

 

"Como no Brasil não existem programas de transição de carreira adaptados para bailarinos, muitos não têm opção, se não buscar diferentes ocupações, em geral não relacionadas com a Dança. Eu acredito que a falta de reconhecimento do setor da Dança diminui as chances de manter esse profissional em seu campo original de conhecimento, depois que os anos de palco terminam.", afirma o Dr. Bittar. Completa, ainda: "Na minha opinião, é bastante claro que esses artistas têm muito a contribuir para o setor da Dança após a aposentadoria, assumindo papéis que ainda precisam ser explorados."

 

Parece que ser bailarino no Brasil é ter que nadar sempre contra a corrente. Desde os primeiros anos de desenvolvimento profissional, passando pelos tempos no palco, até o período após a aposentadoria, os desafios da construção de uma carreira de sucesso são constantes. Enquanto promovemos a saúde do bailarino, é importante considerar que esse trabalho precisa caminhar junto com o empoderamento da profissão Dança. Como educadora e pesquisadora, eu me pergunto continuamente: como a Ciência da Dança pode contribuir para o reconhecimento de nossos bailarinos?

 

Fique ligado, em breve estará no ar a última edição do “Integrando Dança e Saúde no Brasil”! 

 

- Junte-se a nós no Grupo “Dance Science Brasil”!

 

- São membros brasileiros da IADMS:

 

Adriano J. Bittar           

Aline N. Haas            

Bárbara P. Marques            

Clara Fischer Gam  

Cláudia Daronch         

Daisy M. Machado            

Flora M. Pitta            

Izabela L. Gavioli            

Kaanda N. Gontijo            

Marcia Leite            

Mariana G. Bahlis    

 

Clara Fischer Gam, Mestre Ciência da Dança

Licenciada em Dança

Administradora do grupo Dance Science Brasil

Co-fundadora do Corpos Aptos, Gestos Livres

Rio de Janeiro – Brazil

clara.figa@gmail.com

www.clarafischergam.com

 


Tags:  Brazil  translation 

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Feet: Skeletal and Muscular Structure

Posted By Elsa Urmston on behalf of the IADMS Education Committee, Tuesday, April 5, 2016

Over the next few months the Education Committee bloggers shine a light on the importance of the feet.  In June, Maggie Lorraine will write a two-part blog which focuses on potential foot injuries, structural issues, and working with them in dance.  We look forward to her insight.  By means of introduction to this topic, this short blog provides an introduction to the foot’s skeletal and muscular structure.



We all know that tired feeling in our feet at the end of a busy dancing day, don’t we?  They ache, they click, and let’s face it, dancers’ feet aren’t always the prettiest of things!  We look down at our bruised feet and hard skin, massage our insteps, and slather on moisturizer in an attempt to keep them as pliable as possible.  And no wonder, they work hard and we ask a lot of them!!

 

But what do you know about the structure of the foot?  It’s a hugely complex skeletal structure, comprising 26 bones, 34 joints and more than 100 muscles1, tendons and ligaments, all arranged to be weight-bearing in all sorts of different contexts from pointe to heeled shoes, from sliding across the floor in bare feet to taking off and landing on all surfaces of the foot.  And of course, the foot contributes to that sought-after, beautiful line from the toes and arch of the foot and into the rest of the lower leg in an arabesque.  Most importantly the foot is designed to create resilience and acts as a shock-absorber to the rest of the body. As Russell2 explains, “the foot’s structure, with its many bones intricately fitting together, provides a dynamic platform on which to support the body. The foot’s adaptability to the floor or ground, regardless of whether or not it is encased in a shoe, is what starts the process of pushing off the floor, absorbing shock when landing from a jump, changing direction in turns, and providing a surface on which to spin, to name a few of the foot’s functions important to dance.”

 

There are many super resources online which can help you learn the various bones and joints of the foot for example here and here, plus this interactive tutorial: Foot Anatomy Tutorial.

 

We provide a simple diagram here.



The foot can be divided into the posterior and anterior sections.  The ankle joint itself (a synovial hinge joint) is formed between the distal ends of the tibia and fibula and the talus where plantarflexion (pointing) and dorsiflexion (flexed foot) occurs.  The seven tarsal bones including the talus then make up the posterior portion of the foot, nearest to the heel, or calcaneus.  Each tarsal bone is roughly square in shape with flat articular surfaces and together the surfaces glide past each other to provide lateral stability just below the ankle joint itself; they contribute hugely to subtle changes in balance and it is here that inversion (sickling) and eversion (winging) can occur.  The five metatarsals and fourteen phalanges comprise the anterior section of the foot, extending away from the ankle joint itself down towards the toes.  These bones act as levers, alongside the muscular system of the lower legs and feet to allow the dancer to come up onto demi-pointe and ultimately to jump and locomote.

 

The skeletal structure of the foot also creates the longitudinal and transverse arches of the foot which are vital to spread the dancer’s weight across the whole foot.  The arches absorb shock from the ground in landing from a jump which is why it is so important for dancers to maintain strong, articulate feet.  The arches are reinforced by the ligament system and power is achieved by the muscles working on the joints to create motion through the foot’s resilient dome-like structure.

 

As you’d expect, the muscular system of the foot is also complex! They can be divided into two groups; extrinsic and intrinsic muscles.  The extrinsic muscles arise from the anterior, posterior and lateral areas of the lower leg and are mainly responsible for actions such as plantarflexion, dorsiflexion, inversion, and eversion.  The intrinsic muscles are responsible for more fine motor control actions such as the adaptation of the foot to the body’s weight and balance and the movement of individual toes.  These intrinsic muscles are layered through the foot to achieve the precision and intricate demands that dancers place on their feet – no wonder our feet and ankles fatigue!  These two great tutorials are a great interactive introduction to the musculature of the feet.

 

Intrinsic Muscles of the Foot: Dorsal Muscles

 

Intrinsic Muscles of Foot:  Plantar Muscles

 

 

So, the balance between strength and flexibility is of paramount importance in the dancer’s foot.  When it is achieved we are able to power through space, travelling with height, speed, and dexterity.  The simple directive of ‘using the floor’ is familiar to many of us.  Building strength and articulation can be achieved through emphasising the stroking of the sole of the foot on the floor in tendu and degagé, leaving the heel until last as the foot extends away from the body, and lowering it first as the foot closes back in.  This pressing of the foot into the ground strengthens the intrinsic muscles of the foot whilst also rehearsing the action of pushing into the ground to propel the body in a specific direction - fabulous conditioning exercise and a cornerstone of many dance techniques.  For more inspiration see The Royal Ballet’s class broadcast in 2014, a series of tendu exercises feature from about 6 minutes from the start of the video.

 

But what if strength and flexibility of the foot structure is compromised either through poor posture or dynamics in alignment of the body, or indeed due to an acute injury sustained whilst dancing? Our forthcoming posts will tackle these issues in June 2016.

 

 

References

 

1.  Clippinger, K.  The ankle and foot, Dance anatomy and kinesiology. Human Kinetics, 2007, 297-371.

 

2.  Russell, J.  Insights into the Position of the Ankle and Foot in Female Ballet Dancers En Pointe.  The IADMS Bulletin for Dancers and Teachers, 6(1), 2015, 10-12.  Available here.

 

 

Elsa Urmston, MSc, PGCAP, AFHEA, is the DanceEast Centre for Advanced Training Manager, Ipswich, UK and a member of the IADMS Education Committee.  She also sits on the One Dance UK Expert Panel for Children and Young People.
Email: elsa.urmston@danceeast.co.uk

 

Tags:  anatomy  feet  foot 

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