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Injury Prevention: Screening as a tool for education

Posted By Posted by Stephanie De’Ath on behalf of the IADMS Education Committee, Tuesday, July 7, 2015

What is screening?

Screening is often used for pre-entry to a school or company to highlight any concerns with regards to health, injury risk or mental and physical capabilities. Although research suggests that protocols should, where possible, be carried out by a physiotherapist or dance science professional there are some protocols that can be adopted by schools or companies with limited resources to at least complete some of the tests for educative purposes.  Although not widely used as an educative tool, screening provides a great opportunity for dancers to learn more about their bodies, optimise performance and identify injury risk1. By addressing the weaknesses or concerns which arise as a result of the screen, a programme of activity can be developed to compliment training and reduce the likelihood of injury. As a member of Trinity Laban's screening team for the past four years, in this post I will explore how screening can contribute to injury prevention from an educational perspective.

 

What is involved in screening?

As highlighted by Liederbach et al2, screening often involves collating information on many components including medical history, skeletal structure, alignment, range of motion, strength, cardio-respiratory response, motor skills, stability and mobility, self esteem, motivation and nutrition amongst others.  From personal experience, the benefits for using screening as an educative tool, rather than pre-entry or for research, is that the methods can be adaptive to reflect the student needs, the current staff's knowledge/experience and developments in research. This can however make it somewhat difficult to use the data for research, which is why changes in protocols should be considered carefully

 

In the UK National Institute of Dance Medicine and Science (NIDMS) screening program, we explore a number of different areas which include: health and injury history, current training exposure, anthropometrics, hypermobility/flexibility, strength, a functional musculoskeletal screen and an aerobic fitness test. Once the assessments have been completed, individuals are invited for feedback to go through each test result: looking at comparable means and discussing how their results can impact their training.

 

How can screening contribute to injury reduction?

There are many benefits and outcomes of screening, however the following are the five testing protocols that I typically find to be most helpful in educating dancers on injury reduction. These protocols can easily be adopted by individuals, especially those with limited resources.

 

1.  Health and injury history

As we already know, results from injury history, menstrual status and nutritional status can be combined to “red flag” symptoms of Female Athlete Triad3. A red flag for each area would be:

- Frequent bone related injuries (more than 2) in the last 12 months e.g. Fractures, bone bruising, etc and/or already diagnosed osteoporosis and/or a known low bone mineral density.

              - Amenorrhea, or no menstrual cycle, for more than three months.

              - And disclosure of, or indicators of, an eating disorder or disordered eating.

There are of course many other areas which may arise as a concern from completing the health and injury questionnaire. For example a low BMI or sleep disturbances, however what is important in this instance is that any red flags for Female Athlete Triad or any other issues are dealt with appropriately. Therefore, if you do not have the provision in your school/ company to provide nutritional advice, have a reliable contact who you can refer your dancers to.

2.  Single jump height

Single jump height measures how high an individual can jump. This result is important information for dancers, however what I find more interesting as an observer of the test is the biomechanics of an individual's jump technique. By looking out for the following we can use the screen itself to optimise the performance of the jump and reduce injury:

             - Are they rolling in or out of the ankles during take-off/landing?

             - Turning in/out of the feet, looking to see if one is more turned out than the other.

             - Are they able to maintain the 90 degree angle at the knees during take-off and
             landing, as specified in the test protocol.

             - If/when fatigued, are they able to maintain technique e.g. feet pointed during
             jump, land in parallel, maintain height, maintain speed, etc

By breaking the jump down and giving this feedback to the dancers I find this to be more helpful than informing them how high/powerful their jump is (of course they will still be interested in this!) as you may point something out to them that hasn’t been identified before.


3. Turnout/turn in

There are a number of different ways to test turnout/ turn in, however I find active standing turnout to be one of the most useful for educative screening, as it is most representational of the dancer in the studio. The dancer will stand on two rotational discs (therefore removing the friction from the floor) and starting in parallel they will turnout or in. The distance of each measurement will be recorded in degrees and repeated three times for accuracy, as they can be rather wobbly if you haven't used them before! In literature it is suggested that dancers should be achieving 70 degrees of turnout4, which may be true for ballet dancers, however for other dance genres this requirement may not be as necessary. What I find that we are actually looking for here is bilateral balance between the right and left side, with no more than 10 degrees difference between the right and left score. An inability to achieve bilateral balance may be an indicator of muscle weakness or tightness in the internal or external rotators or simply a lack of proprioception. I particularly like this test because the dancers are unable to "cheat" due to there being no resistance from the floor - but make sure their knees stay over the toes to ensure no cheating!

                      USEFUL VIDEO HERE.

4. Plank

Like all of the other tests, the plank is more than just achieving a number, it can be indicative of a number of different physical aspects. However from past experiences we usually see dancers achieving roughly around the 2-3min mark.

Whilst the dancer is completing the plank (feet hip width apart and resting on forearm) you can also look out for the following:

              - Feet: are they rolling in/ out or can they maintain a true parallel?

              - Hips: are they even? Or does one side dip more than the other?

              - Alignment: can they ensure that the head, hips and feet sit in one straight line.

              - Shoulder blades: do they "wing" off the back?

5. Dance Aerobic Fitness Test (DAFT)

Over the past 10 years schools and companies have been able to use Dance Specific Fitness Tests (DSFT)5,6,7. One of the most frequently used DSFT by schools and companies is the contemporary Dance Aerobic Fitness Test (DAFT). This fitness test has a number of advantages beyond the data produced i.e. heart rate and rate of perceived exertion (RPE). Observers can also make notes on the individual’s technique over the five stages, each of which is four minutes and progressively increases in intensity. An observer might look out for: arm placement, landing from the jumps, extension of movements, focus, musicality, coordination, etc. The DAFT stage three is representative of the effort levels required for a technique class and stage five is representative of performance intensity. Therefore, the individual can track the changes in their heart rate and RPE over a time period, to see if their training is providing any positive adaptation in their aerobic fitness levels and resistance to fatigue, which allow them to perform set movement at a lower relative intensity. There is currently no published data available on the norms or averages for each stage of the DAFT, however Redding et al will be presenting this information for the first time at the 25th Annual meeting in Pittsburgh…so watch this space!

 

So…what do we do with all this information?

Well, as you can see from the above information, the outcomes are primarily indicators of an area of weakness. To allow this information to contribute to injury reduction we need to ensure that we apply these findings back into training. Therefore, I would recommend that your feedback time is highlighted as one of the most important features of your educative screening session. These indicators cannot be actioned if dancers do not understand the importance and relevance of the results, and furthermore, how to implement this into their training. Ensure you are confident with the official protocols for each test and most importantly, develop a network of dance specialist professionals who you trust for onward referral.

 

References/ recommended resources

1.       Wilson, M., & Deckert, J. L. (2009). A screening program for dancers administered by dancers. Journal of Dance Medicine & Science, 13(3), 67-72.

2.       Liederbach, M., Hagins, M., Gamboa, J. M., & Welsh, T. M. (2012). Assessing and reporting dancer capacities, risk factors, and injuries: recommendations from the IADMS standard measures consensus initiative. Journal of Dance Medicine & Science, 16(4).

3.       Torstveit, M. K., & Sundgot-Borgen, J. (2005). The female athlete triad: are elite athletes at increased risk?. Medicine & Science in Sports & Exercise, 37(2), 184-193.

4.       Howse, J., & McCormack, M. (2009). Anatomy, Dance Technique and Injury Prevention. A&C Black.

5.       Wyon, M., Redding, E., Abt, G., Head, A., & Sharp, N. C. C. (2003). Development, reliability, and validity of a multistage dance specific aerobic fitness test (DAFT). Journal of Dance Medicine & Science, 7(3), 80-84.

6.       Redding, E., Weller, P., Ehrenberg, S., Irvine, S., Quin, E., Rafferty, S., Wyon, M. & Cox, C. (2009). The development of a high intensity dance performance fitness test. Journal of Dance Medicine & Science, 13(1), 3-9.

7.       Twitchett, E., Nevill, A., Angioi, M., Koutedakis, Y., & Wyon, M. (2011). Development, validity, and reliability of a ballet-specific aerobic fitness test. Journal of Dance Medicine & Science, 15(3), 123-127.

 

Stephanie De’Ath, MSc, SRMT, is a Lecturer in Dance Science at UK Higher Education Institutions and is a Sports and Remedial Massage Therapist at London Contemporary Dance School and Central School of Ballet.

Email: stephaniedeath1@gmail.com

 

Tags:  dancers  injury  screening  teachers 

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An Introduction to Dance Injury

Posted By Elsa Urmston on behalf of the IADMS Education Committee, Thursday, June 4, 2015

 

Well, it’s the moment that all dancers and their teachers dread.  Sustaining an injury in dance can be at best, a ‘momentary’ interruption to dance training and performance, at worst a career-ending catastrophe.  Thankfully, dance medicine and science colleagues have produced a vast range of conditioning and injury prevention strategies to enable dancers to be stronger and ever more versatile, as well as take ownership over injury if, as and when it might occur.  Yet of course, by just looking at the repertoire of our modern dance and ballet companies, we can see that choreographers and audiences have increased their expectations of what the human body can achieve.  Injury remains a very real possibility. 

Improving awareness of dance injury, in terms of how and when it might occur, and ensuring dancers know about injury care, can play a large part in the successful rehabilitation and timely return to dancing.  This blog post is one in a series which introduces dance injury.  Subsequent posts will focus on how we might be able to prevent dance injury in the first place, through screening for dancer health and wellness, and by ensuring dance educators’ practice is safe and effective for all involved.

Research suggests that the most commonly perceived causes of injury were cited as ‘fatigue’ and ‘overwork’, along with repetitive movements amongst dancers and managers alike.  Organisations such as IADMS, Dance UK and Harkness Center for Dance Injury amongst many other dancer wellness initiatives, all advocate for optimising dancers’ training and performance through supporting dancer fitness and conditioning, ensuring sound biomechanical function in dancing and promoting an autonomy supportive environment for dancers to flourish.  New research from ArtEZ Institute for the Arts in Arnhem, Holland has sought to reconceptualise how the undergraduate dance curriculum is shaped to maximise performance through the principles of periodisation.  The programme year is designed as a series of macro- and micro-cycles in which the training intensity alternately increases and decreases, ensuring that the dancer develops and recovers without causing staleness or overtraining.  The approach has seen a significant reduction in injuries and less course dropout since the instigation of this system.  Take a look at this easy-read overview of the project at ArtEZ here.

 

So what actually happens when I sprain my ankle or strain a muscle?   

Essentially, if cells become damaged, the body releases a number of chemicals that create an inflammatory response, usually resulting in swelling, redness, heat, pain and loss of function.  Inflammation is the body’s natural response in promoting new cell growth, and is a necessary stage of the healing process.  The injury process can be conceptualised like this:


How can we help our dancers manage injury in the short-term?

Try and help your dancers remember the acronym PRICED – it’s an invaluable first aid guide to immediate treatment which can be self-administered, and when used in the first minutes and hours after injury can help in controlling pain and inflammation and assist in the safe return to dancing.

  • PROTECTION: Remove additional danger or risk from injured area.
  • REST: Stop dancing and stop moving the injured area.
  • ICE: Apply ice to the injured area for 20 minutes every two hours.
  • COMPRESSION: Apply an elastic compression bandage to the injured area.
  • ELEVATION: Raise the injured area above the heart.
  • DIAGNOSIS: Acute injuries should be evaluated by a health-care professional.

And in the first few days after injury, help them to avoid HARM too.

 

  • HEAT: Any kind of heat will speed up the circulation, resulting in more swelling and a longer recovery.
  • ALCOHOL: Alcohol can increase swelling, causing a longer recovery.
  • RUNNING OR OTHER EXCESSIVE EXERCISE: Exercising too early can cause further damage to the injured part. Exercise also increases the blood-flow, resulting in more swelling.
  • MASSAGE: Massage increases swelling and bleeding into the tissue, prolonging recovery time.

 

And what about managing injury more long-term?

Drawing on some of the most recent research findings about injury, such as the periodisation work at ArtEZ, the growing body of research-informed practice around screening dancers and the importance of safe dance practice, we should be seeking ways to embed these examples of best practice in our work to minimise the likelihood of injury first and foremost.  But in managing injury more long-term, we should aim to reduce swelling, restore proprioception (awareness of where the body is in space without relying on the visual system), maintain cardiovascular health and ensure a healthy, balanced and varied diet to facilitate healing.  IADMS have a very accessible resource paper full of practical ideas about First Aid for Dancers here.

 

Local provision

In the UK the establishment of the National Institute of Dance Medicine and Science means that through shared expertise and a network of multidisciplinary partners, better and more affordable, high quality, evidence-based, dance specific health care and dance science support services are being offered to dancers across the sector.  Please check out their website.

In the USA the Harkness Center for Dance Injury is dedicated to providing the dance community with the highest quality injury care and preventative resources. Harkness offers many subsidized and free services including orthopaedic and sports medicine clinics, physical therapy and athletic training services, and injury prevention lectures and workshops.  Please check out their website.

If there are other support services in your locality not listed here, please do add them in the comments box below.

 

For information about dance injury and treatment have a look at the following recommendations:

Laws, Helen. Fit to Dance 2-Report of the second national inquiry into dancers’ health and injury in the UK, 2005.

Solomon, Ruth L., John Solomon, and Sandra Cerny Minton, eds. Preventing dance injuries. Elsevier, 2005.

 

For more information about optimising dancers’ fitness have a look at these texts too:

Welsh, Tom. Conditioning for dancers. University Press of Florida, 2009.

Krasnow, Donna and Jordana Deveau.  Conditioning with imagery for dancers.  Thompson Educational Publishing, 2010.  Additionally there are some useful introductory videos on Krasnow and Deveau’s approach here.

 

Don’t forget to watch out for our forthcoming posts continuing this series about preventing dance injury.

 

Elsa Urmston MSc PGCAP AFHEA is the DanceEast Centre for Advanced Training Manager, Ipswich, UK and a member of the IADMS Education Committee.

Email: elsa.urmston@danceeast.co.uk

Tags:  dancers  injury 

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Maintaining Correct Alignment When Training Positions Retiré or Passé - (to withdraw or to pass)

Posted By Maggie Lorraine on behalf of the IADMS Education Committee, Wednesday, May 13, 2015

 

In the last post from the IADMS Education Committee “Dancing with the pelvis” the authors focused on pelvic alignment and its relevance to movement execution in the studio. When reading this post on the retiré position, it would be useful to refer back to information posted on previous IADMS posts, as each new post now reinforces the anatomical truths that guide us as teachers. To quote Clara Fischer and Elsa Urmston,“We have all learned from experience: proper alignment is one of the basic building blocks for achieving the aesthetic line and form required for dance technique.”

Dancers and teachers cannot underestimate the importance of achieving correct pelvic alignment when practising or performing the retiré position, as it is a key position for the successful performance of many dance movements. Pirouettes and developpé are clearly affected by the placement of this position and the retiré influences the execution of many steps of virtuosity.


Pictured: Rebecca Blenkinsop
Photo by: Maggie Lorraine 

In this photograph (above) Rebecca is demonstrating a well aligned retire position en pointe. Note that her head is centred over her foot en pointe.

Points to remember when practising retiré:

Commencing in 5th position

The Supporting Leg.

  • Full transference of weight over the center of the supporting foot as the gesture leg leaves the floor. The dancer should be ready to rise to demi pointe without further adjustment of weight by ensuring the foot is controlled against the floor. Check that there is no pronation of the supporting foot.
  • Lengthen through the supporting hip maintaining pelvic alignment and the control of turnout of the supporting leg.

The Gesture Leg

  • The foot and ankle of the gesture leg retain alignment, no sickling or winging of the foot.
  • The thighbone or femur inserts into the hip socket or acetabulum from the front of the pelvis and the rotation of the thigh should occur from the turnout in the acetabulum, which is initiated by the deep rotator muscles.
  • The continued control of the deep rotator muscles and core muscles as the gesture leg passes through petit retiré to full retiré.
  • Maintain control of the femur extending from the acetabulum and maintain the knee, ankle and foot alignment. The appearance of the position will vary from student to student depending on their personal pelvic structure, however students should be encouraged to work with their respective physiques rather than meeting a “prescribed” position.
  • Remember “turnout is a verb” and the turnout muscles should continue to be active throughout.

          Thus the retiré position should demonstrate pelvic, shoulder, and head alignment.

Points to consider:

  • On the point of transference of weight from two feet to one foot it must be emphasized not to sink into the supporting hip as this action will result in loss of rotation and control in the supporting side.
  • The hip of the gesture leg must not be raised by lifting the thigh higher than can be controlled by the dancer. This will result in the weight moving off the supporting leg and pelvic alignment will be lost. The deep rotators cannot recruit efficiently when pelvic alignment has been sacrificed
  • Placing the foot too high at the side of the supporting knee can be problematic for some, as not all dancers possess the range of movement in the hip to accommodate this position of the foot and retain pelvic alignment. Many will anteriorly tilt their pelvis, which will result in loss of turnout, and the gluteal muscles will overwork to accommodate the position of the thigh.

When viewing this photograph (below, left) of Rebecca practising retiré it would appear that her retiré is turned out. Observing the same retiré from the side (below, right) we can see that Rebecca is far from turned out, her thigh is in reality inwardly rotating. 

   

 

Please follow this link to see how perfect alignment can work in steps of virtuosity - enjoy!
In this video Isabela Rodriques has an unfortunate slip when performing the coda of the Diana & Acteon pas de deux but later goes on to repeat the whole coda.  You will see that in both of these dancers the gesture leg in retiré is placed in front of the bodyline.

 

 

Maggie Lorraine

IADMS Dance Education Network Subcommittee

Leading Teacher in Ballet

The Victorian College of the Arts Secondary School 

 

Tags:  alignment  dancers  passe  pelvis  retire  teachers 

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Dancing with the pelvis: Alignment, deviations, and mobility

Posted By Clara Fischer Gam and Elsa Urmston on behalf of the IADMS Education Committee, Thursday, April 30, 2015

In the latest post from the IADMS Education Committee we started a two-post discussion on pelvic structure and alignment. We looked at pelvic anatomy, motion and came up with ideas for putting these concepts into practice in class. This second post will focus on pelvic alignment and its relevance to movement execution in the studio.


Source: Getty Images

We have all learned from experience: proper alignment is one of the basic building blocks for achieving the aesthetic line and form required for dance technique. We know that many are the contributors for good skeletal alignment, but one area that plays a special role is the pelvis.

Practitioners and researchers comment on the importance of pelvic alignment. As mentioned in the previous post, when in a natural position in relation to the rest of the body, the pelvis assumes neutral alignment because the surrounding joints and muscles are balanced. Neutral pelvic alignment can help us to achieve efficient execution of dynamic movements and static positions and therefore more effective muscle recruitment. Not only might neutral pelvis facilitate body movements in general but it also seems to improve specific action at hip and lumbar spine.

How to find your neutral pelvis?

As well as the image below, have a look at this handy youtube film which helps you find neutral pelvis.  Place the tip of your index fingers on the symphysis pubis, resting each of your wrists on the tips of your front hip bones (right on those bony projections, called anterior superior iliac spines) and let your thumbs extend, nearly touching in the middle. Can you notice that your hands are now forming a triangle shape on the centre of your pelvis?  For a neutral pelvis, the triangle lines should be on the same plane, aligning these three bony landmarks.

When working with students, it’s good to keep in mind though that anatomical differences may occur from dancer to dancer, therefore the triangle alignment should be a reference for finding an individual neutral pelvis.

Pelvic deviations generally imply any alteration in posture from neutral but when it comes to dancers, anterior pelvic tilt (that is allowing the tailbone to flare backwards) appears to be more common.

Why is that?

Misalignment of the pelvis could be related to imbalanced use of muscles that control the pelvis, the lower portion of the trunk and hip, or to structural conditions.  Particularly, anterior pelvic tilt could be linked to lack of action of the deep rotators of the hip for turning out (we’ve mentioned before the key role that these muscles play, recap here. The misuse of the inner thigh muscles or poor core control to stabilize the turnout may increase this deviation still more (for more about the core check this post).

Dancers with anterior pelvic tilt might get tight hip flexors and possibly lower back pain, as it increases the angle of lumbar lordosis. Posterior pelvic tilt (tucking the tail under) is typified by a flat back-like deviation and commonly associated with tight hamstrings and gluteal muscles and weak quadriceps, hip flexors and spinal erectors. Generally, dancers with a misaligned pelvis either anteriorly or posteriorly can more easily develop vertebral stresses and knee, foot, and ankle injuries due to compensatory movements and excess of muscle tension during training.

Despite all the information available on pelvic alignment, there is still a question to be answered: Is there an ideal degree of pelvic tilt that should be maintained through our dance movements?  Pelvic mobility in dance seems to be a hot topic of discussion among dance practitioners, teachers and scientists. Undoubtedly, there are many steps that intentionally involve the pelvis (either as initiator of the action as observed in Graham Technique for example, or as a consequence of another movement). However, we know that some techniques  require  that some specific movements should be performed with neutral (or even immobile) pelvis. I wonder though to what extent the pelvis really is immobile in such movements?

In relation to this, Wilson and colleagues looked at a grande rond de jambe en l’air. In our training, most of us learned that the pelvis should be still for the whole time during grande rond de jambe en l’air both at and past 90°. Yet these researchers observed that amongst experienced dancers the pelvis itself is deeply involved in gesture leg range of motion, especially when the leg is raised past 90°. In order to move the leg fully at highly vertical angles, the pelvis seems to follow the leg - even though we aim for creating an illusion of an immobile pelvis.  In a follow-up study the role of the pelvis was examined in facilitating gesture leg motion, and the related “cost” of the muscles involved. For skilled dancers the effort in the gesture leg is smaller than in the standing leg. This was reversed in less skilled dancers. So we might conclude that the skilled dancers worked more efficiently in their standing leg to support the pelvis and gesture leg, whereas the less skilled dancers are mostly using the muscles in the gesturing leg.  A recommendation to the teacher might be to appreciate that when working on movements where one leg is moving fully, a strategy to focus on the standing leg will help balance the necessary movement in the pelvis and spine. Not allowing the pelvis to move commensurately with the gesturing leg will decrease the potential range of motion and place unnecessary stress on the hip joint and lumbar spine.


Source: Getty Images

But what about other movements where the pelvis should be neutral? Deckert suggests that the answer is multifaceted and individualized to each dancer. Introducing exercises for dancers which focus on increasing awareness through individualized anatomical education, motor control and promoting alignment habits may help dancers locate the neutral pelvis.

Integrating the following exercises into a dancer’s daily routine may also help:

• Increase abdominal strength; strong abdominals provide support for finding and maintaining a neutral pelvis.

• Stretch hip flexors, if they have become excessively tight from years of anterior pelvic tilt. Stretching them on a daily basis will allow the pelvis to settle into a more neutral position.

• “Pelvic clock” provides a first step toward improvement by increasing awareness of pelvic alignment: Lying on your back with knees bent and feet on the floor, tip the pelvis through full range of motion, starting at 12 o’clock with the navel and lower back pressed to the floor and moving through to 6 o’clock as the waist rises off the floor and the tailbone is the only part of the spine contacting the floor. Make certain not to miss any point of the clock, and repeat in a counterclockwise circle. This exercise forces you to explore the full range of motion available in the pelvis and find a neutral pelvic alignment.

What I enjoy the most about the quest for finding movement efficiency in dance, is that it always awakens further inquiry; which movements involve pelvic motion? Which should hold a neutral pelvis? Which body part is leading, following or supporting movement?

 

Keep Exploring:

IADMS Resources here and here.

 

Clara Fischer Gam, MSc.

Dance Science

Dance Education

Pilates Method

Rio de Janeiro – Brazil

Email: clara.figa@gmail.com

 

Elsa Urmston MSc PGCAP AFHEA is the DanceEast Centre for Advanced Training Manager, Ipswich, UK and a member of the IADMS Education Committee.

Email: elsa.urmston@danceeast.co.uk

Tags:  anatomy  dancers  pelvis  teachers 

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The Pelvis: The Meeting Point of the Body

Posted By Clara Fischer Gam on behalf of the IADMS Education Committee, Monday, April 27, 2015

We will get the week started with a post from the IADMS Education Committee. This is part 1 of a two-post discussion on pelvic structure and alignment. Today we will take a closer look at anatomy of the pelvis and share ideas for embodying these concepts in the studio.

 
Source: Getty Images

The pelvis as the “meeting point” of the body is a really clear analogy, as it is this structure that offers attachment for the legs and supports the spine and upper limbs. It plays a key part in bearing and transferring weight, it allows us to travel with dynamism as well as find balance and stability in the body.  Experiential anatomy allows us to really develop a sound working knowledge of the anatomical structure; linking theoretical knowledge and practical exercises in class can be really useful for developing movement strategies, enhancing quality and intention for dance technique.

So, how is the pelvis structured?

The pelvis is made up of two halves, the innominate bones (or simply, hip bones). Each one is formed from the fusion of three bones: ilium, pubis and ischium. Together, these three bones contribute to the hip socket that connects the pelvis to the femur (more about the hip joint in a previous post). 



Diagrams by Jake and Stuart Pett for IADMS

Anteriorly, the hip bones are connected by the symphysis pubis, a cartilaginous joint. Posteriorly, they connect to the sacrum through the sacroiliac joint. The upper part of the sacrum connects with the 5th vertebra of the lumbar spine (lumbosacral joint). For a more comprehensive anatomy of the pelvis, check out this great video.  

To bring about a more embodied knowledge of pelvic bones, I often encourage students to make use of touch as we go through anatomy concepts. Bone palpation activities can be easily applied to class when exploring anatomy of the pelvis. The author Andrea Olsen offers us a good suggestion:

Starting at a supine position, knees bent: trace the bones of the pelvis with the finger tips.

Firstly at the iliac crest, find the anterior superior iliac spines (ASIS), those bony projections at the front part of each hip bone. Then walk the fingers forward until the pubic symphysis.

Roll on your side: starting again at the iliac crest, trace the ilium back to the sacrum, feel the sacroiliac joint. Continue down the back of the pelvis and locate the ischial tuberosities (the "sitz" bones).

Flex the hip, and trace from the ischium to the pubic bone between the legs. Roll to the other side and repeat. You can find more experiential anatomy exercises on Olsen’s book, referred below.

 

Mainly, the pelvis moves as a whole: articulation occurs at the lumbosacral joint and at the heads of the femurs. It tilts anteriorly (allowing the tail bone to flare backward) posteriorly (tucking the tail bone under), laterally (lifting one side of the waist) and it also rotates (turn) for both sides. When watching students dancing, we may notice that ease of movement as well as restrictions for specific directions vary from dancer to dancer.

At a natural position in relation to the rest of the body, the pelvis is in the so-called neutral position: known for being the most stable and shock-absorbing for our structure, as surrounding joints and muscles are balanced.  Watch out for our next post, where we will discuss the importance of pelvic alignment for optimal performance! 

Something I really like to do to explore pelvic articulation and positioning is to practice the pelvic clock exercise as a warm-up in class (typical routine of Feldenkrais and Pilates sessions). That way, dancers can experiment with pelvic movements, discovering their own range of motion, restrictions and ultimately find their neutral pelvis. Watch a tutorial here.

 

Keep Exploring:

Olsen, A. Bodystories: A Guide to Experiential Anatomy. Lebanon: University Press of New England, 1991.

Calais-Germain, B. Anatomy of Movement. Seatle: Eastland Press, 2007.

Fitt, S. Dance Kinesiology. New York: Schirmer Books, Second Edition, 1996.

Salk, J. Teaching modern technique through experiential anatomy. Journal of Dance Education. 2005;3(3): 97-102.

Batson, G. Somatic studies and  dance. International Association for Dance Medicine and Science, 2009. Available here.

 


Clara Fischer Gam, MS.

Dance Science

Dance Education

Pilates Method

Rio de Janeiro – Brazil

 

Email: clara.figa@gmail.com

 

 

Tags:  anatomy  dancers  pelvis  teachers 

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Dance Medicine and Science at Dance UK’s ‘The Future: New Ideas, New Inspirations’ Conference

Posted By Sarah Beck, Monday, April 13, 2015

This past weekend, from April 9th to 12th, Dance UK hosted their first ever Industry Wide Conference titled The Future: New Ideas, New Inspirations. With the future of the dance sector at the heart of this conference, it seemed only right that dance medicine and science featured within discussions.

The program on Saturday 11th included 12 ‘healthier dancer’ sessions on a wide range of dance medicine and science topics including: ‘Protein for dancers’ from Professor Kevin Tipton, ‘The hypermobile student in dance class’ from Nicky Ellis, and ‘Psychology of injury: the impact of what we say and do’ from Dr Natalie Walker. Dance UK were also extremely honoured to be able to feature four presentations that were previously presented during the IADMS 24th Annual Meeting in Basel and extend thanks to IADMS for their partnership in this. IADMS also had a promotional stand at the conference, which delegates engaged with. Sessions were filled to capacity and attended by dancers, teachers, choreographers, and directors of schools and companies, as well as medical doctors, students, physiotherapists and dance scientists. This mixture led to interesting discussion on the application of principles discussed into practice, something I know we all strive for in this field. Many of the sessions were filmed and video clips will be available over the next few weeks.

The final day of the conference focused on education and training the dance artists of the future and although no specific dance medicine and science content was scheduled in this day, it certainly featured in discussion in a way that any dance medicine and science enthusiast would be proud of. One topic in particular kept resurfacing: periodization. It seems imaginations had been sparked by the presentation on the previous day from Professor Matthew Wyon and Joost Van Megan on the work in periodization currently underway at ArtEz in the Netherlands (also presented at the IADMS 24th Annual Meeting). I urge you all to follow the link and watch Dr Christopher Bannerman’s keynote speech, in particular from around 36 minutes 30 seconds in, to hear him enthusiastically discussing this presentation. 

This conference provided fabulous exposure of dance medicine and science into the wider dance sector in the UK, which we hope continues to inspire debate, collaboration, and practical implementation of and around ideas presented.


[The IADMS blog would like to feature further write ups of events and conferences so please do let us know about those happening in your local area so that they can be included.]

Tags:  conference  dancers  UK 

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The Spine: The impact of head position

Posted By Elsa Urmston on behalf of the IADMS Education Committee, Monday, April 6, 2015

This blog post from the IADMS Education Committee brings focus to the importance of spinal alignment and its role in aiding the efficient and effective mobilization of the body in dance.  Specifically this week, we will look at the cervical spine and the all too common problem of the forward head posture.


In recent weeks I’ve been aware of the images on social media about the impact of smartphone and tablet use on the alignment of the upper body in everyday life, bringing about the forward head posture which drops the shoulder girdle down and forwards, bringing with it the cervical spine and skull.  The middle back or thoracic spine area has a tendency to drift backwards and, to accommodate the upper back shift, the hips tip forwards, creating a domino effect of increased force on the central line of the body.  Herein lies muscular and skeletal imbalance as the center of gravity is pulled anteriorly and posteriorly off the midline – the result – pain, discomfort and inhibited movement range.  Here we see the resulting force placed on the spinal column, relative to degrees of anterior cervical spine flexion.

 



In my own classes I often see this forward head posture - whether it is a result of increased screen use is up for debate!  I’d like to think it is the students’ eagerness to learn but this forward head posture may come about because of students looking down, lack of confidence, concentration or any multitude of reasons.  But balancing the skull on the spine is critical in helping young dancers to find efficiency in their whole body movement, and tackling it early on in the training journey seems a prudent step in finding fluency of movement and avoiding injury risk. 


Ideal spinal alignment requires the skull to be balanced on the occiput, creating a central line through the spine which minimizes stress on the body.  And once the skull is balanced on the spine we can ensure that the natural curves of the spine are supported for maximum shock absorbancy in jumping and support for the dancing body in motion.  As soon as the head moves off this central line, forces impact on the joints of the body; of course sometimes we want that to happen as this initiates movement, or balances movement in other parts of the body.  But equally, we need to ensure the efficient balance of the skull on the spine to enable safe and effective practice.  Any distortion in the spine because of head position can impact balance and how we move – pirouetting with a forward head stance is nigh on impossible!  


The impact of the forward head posture on the spine is varied, but as I mentioned earlier there is always a domino effect on the spine and indeed the joints of the lower limbs.  This image below really illustrates this clearly – with the arrows indicating the stress points rippling down the body from poor head position.



So what can educators do to enable efficient head position amongst our youngsters and avoid the impacts on the spine we see above.  We have probably all experienced the image of the string coming from the top of the head, to ‘lighten’ the skull on the spine and allow length in the spinal column.  This can be helpful but I think can sometimes result in the chin being pulled inwards towards the throat, the head falling slightly back and in turn, creating the flat back posture, also often associated with young dancers as they try to find that length we all seek.  Those vital spinal curves disappear. 


Multidimensional images of the head-spine relationship seem to create a better balance amongst the students I work with.  For example, whilst standing we consider the string from the crown of the head, alongside marionette strings which cluster above the ears and draw upwards to help students understand the volume of the skull balanced on the spine.  Often I will have students working in trios, one partner clustering their fingertips firmly on the sides of the skull just above the ears.  They press gently on the flesh for 30 seconds or so, so that the dancer can feel the touch of their partner, the partner then draws the fingertips up to the crown of the head to unite and lengthen up into the space above, often drawing the hair with the fingers.  The other partner lightly cups one hand on the forehead and the other on the posterior curve of the skull and remains there whilst the marionette strings are drawn upwards.  Students’ reactions to this tactile task are always positive and they observe in their partners the lengthened spine and ideal head placement we seek but also the spinal curves remain intact.  They are able to recall the tactile memories of the hands-on work in their dancing as a reminder. 


For me, I have learnt a lot from Alexander Technique (AT).  The verbal directions, “to let the neck be free, to allow the head to go forward and up, so that the back can lengthen and widen”, alongside hands-on work in class as shown below, reiterate the balance of the head whilst dancing.  Examples of AT in practice are widely available on the web; these short films are a great visual introduction to the basic principles of AT, and their specific application in dance. 
Video 1
Video 2

I have also found these dance-specific AT podcasts helpful in developing my own understanding and taking these ideas into the classroom to help my students.  I strongly recommend a listen!
BodyLearningCast

IMAGE WILL RETURN SOON


At the DanceEast Centre for Advanced Training we spend a lot of time team-teaching in technique classes – a luxury I know.  I will work within ballet and contemporary classes, the class teacher leading the class in the normal way, whilst I circulate to work with students individually, reminding them quietly of teaching points covered in dance health classes, using tactile feedback from the examples above as well as many others, to try to support the transfer of learning of principles from our health classes to their application in technique and performance.  So in fact we are trying to overcome habitual movement patterns such as the forward head posture through re-education.  We find a sustained deepening of the students’ understanding when we work in this way, which enables an enquiring learning approach from the students in which they ask questions and interrogate their own practice.


There are numerous videos including stretches for forward head posture available on the web.  In my experience some people, sometimes find these useful, but the focus is on treating the pain caused by poor alignment rather than tackling the root cause.


For further resources, take a look at the following:


A great collection of Alexander’s writings:
Alexander, F. M.
The Alexander Technique: The Essential Writings of F. Matthias Alexander. Lyle Stuart. 1990.


Batson, G. Somatics Studies and Dance.  IADMS Resource Paper. 2009.


The Complete Guide to the Alexander Technique

  


Elsa Urmston MSc PGCAP AFHEA is the DanceEast Centre for Advanced Training Manager, Ipswich, UK and a member of the IADMS Education Committee.

Email: elsa.urmston@danceeast.co.uk

 

Tags:  dancers  ergonomics  neck  spine  teachers 

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What do ballet dancers, bar tenders and paramedics have in common?

Posted By Luke Hopper, PhD, Friday, April 3, 2015

Lifting is an important technique across dance styles. With diverse modern choreography, lifting is an increasingly common technique not only for males but for female dancers as well. The act of lifting is often described as giving the partner grace and the impression weightlessness as they float through the air. But what about the lifter below? What about their technique? And more importantly what about their health?

In industry, lifting is the focus of a wealth of attention in the interests of occupational safety and health. This is because so many workers injure themselves performing lifting tasks. And the injuries they experience are commonly to the lower back

Dancers experience lots of leg injuries, but backs, particularly lower back injuries are also way too common in dance. A serious back injury can be a disastrous career ending experience for a dancer. Therefore should lifting in dance be considered from an occupational safety and health perspective and how could it prevent injury? In the US, the National Institute for Occupational Safety and Health (NIOSH) have released a safe lifting equation which lists six key variables (in addition to the weight being lifted) that affect risk of injury to the back:

  1. Horizontal location of the object relative to the body
  2. Vertical location of the object relative to the floor/li>
  3. Distance the object is moved vertically
  4. Asymmetry angle or twisting requirement
  5. Frequency and duration of lifting activity
  6. Coupling or quality of the workers grip on the object

Swap the term ‘object’ in the list for ‘partner’ and I’m sure that you can think of a whole lot of examples where dance breaks most if not all of the rules. But should lifting be banned from all choreography? Certainly not. Should dancers question their partner’s weight? Definitely not. Should dancers be aware of the risks of lifting so they can perform safe dance practices? Absolutely.

Alderson et al. (2009) estimated the lumbar forces in male dancers performing two lifts:

  1. Arabesque or presage: where the female stands in arabesque and is lifted in the arabesque posture by the male above his head into straight arms
  2. Full press: where the female stands in front of the male, jumps into the lift and is lifted above the male’s head

Surprisingly, every male dancer, for every lift examined, experienced the largest forces in the back before his partner had even left the ground in the posture shown below (Figure 1). The forces are likely the highest at is point because the male is generating momentum into the lift which requires more force. Think of pushing a piano across the studio, it requires a more effort at the first push compared to after the piano is moving.


                Figure 1: The position of greatest force in the lift.

In addition, despite the female jumping into the lift and ‘helping’ the male, the maximum back forces in the full press lift (Figure 2) were larger than in the arabesque (Figure 3). The full press was likely to have higher forces because of the dynamic jumping like movements of the lift. The explosive movement at the start of the lift may make the lift feel easier but it is because of the increased forces at the start of the lift.

 
           Figure 2: Full press lift.                                 Figure 3: Arabesque Lift.

Dancers should be careful of their posture right at the start of the lift as the discs of the spine are particularly susceptible to injury during these kind of intense movements and flexed body positions. Maintaining good posture throughout the whole lift is really important but male dancers should be particularly aware of the posture they start the lift with considering the high forces they experience at that point.

The forces measured in Alderson et al. were above the NIOSH recommended safe limits. To add a bit of perspective, the forces measured were more than a paramedic lifting a stretchered patient, but less than a bar tender lifting a beer keg. Lifting remains an important component of modern day choreography, but so do the risks to the dancer. Technique is of course important, but approaching lifting in dance from an occupational safety and health perspective can only serve to make dancers more aware of their bodies, closely consider their lifting technique and the forces they put through their bodies.

Recommended reading and images sourced from:

Alderson J, Hopper L, Elliott B, Ackland T. Risk factors for lower back injury in male dancers performing ballet lifts. J Dance Med Sci. 2009;13(3):83-89.

Full text articles from the Journal of Dance Medicine and Science are available to IADMS members!

Luke Hopper, PhD, is a Postdoctoral Research Fellow at the Western Australian Academy of Performing Arts, Edith Cowan University.
Email: l.hopper@ecu.edu.au

Tags:  biomechanics  dancers  lifting 

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Core Control: “Not just abdominals”

Posted By Clara Fischer Gam on behalf of the IADMS Education Committee, Monday, March 16, 2015

 

In previous Education Committee posts we’ve spent time talking about turnout, and mentioned the importance of core control and neutral alignment in maximizing rotation of the legs.  Here, we spend a bit more time focusing on core control and what that might mean.

Everyone is talking about the importance of core control and the topic is becoming commonplace among dancers and teachers. We keep hearing that dancers got to have “core awareness,” “strong abdominals,” and “movement control.” Before we start “drawing our belly buttons in” we might well ask ourselves: 

What does core control actually mean?

The term core usually refers to the structures (including bones, muscles and ligaments) of the shoulder girdle, trunk, pelvis and hip. As the human spine is in essence an unstable structure, further stabilization is provided by the musculature.

There is still some debate within research about the muscles that constitute the core and their precise contribution to movement control, but here we will meet muscle groups that are often considered by researchers to be involved in the dynamics of core control:

Superficial muscles of the trunk: They produce trunk motion and act as prime movers during dynamic activities and provide multi-segmental stiffness over a wide range of motion (e.g.: rectus abdominis, external and internal obliques, iliocostalis thoracis).

Deep muscles of the trunk: These local muscles are better suited for segmental stability (e.g.: transversus abdominis, multifidus, interspinalis).


Transfer Muscles of the Shoulder Girdle and Pelvic Girdle: These muscle groups connect the upper or the lower limbs to the trunk thereby transferring the forces through the system during movement (e.g.: hip flexors, scapular stabilizers)


Above: Serratus anterior, example of transfer muscle of the shoulder girdle

 

Above: Psoas major and iliacus, examples of transfer muscles of the pelvic girdle

Pelvic Floor Muscles: These muscles are part of the compound structure that closes the bony pelvic outlet, offering support to the pelvic organs (e.g.: urogenital sphincter, levator ani)

As superficial muscles can be easily accessed, we tend to rely on them maybe more frequently than we should (e.g.: feeling only the “six pack” rectus abdominis activation without regard for the deep abdominals when “contracting” in Graham Technique class). Although deep muscles are not as easy to feel and recruit as superficial muscles, they’ve got an important function. Teachers can encourage students’ awareness for these deeper muscles (e.g.: they can be reminded of the action of transversus abdominis as well as of superficial muscles involved while reaching a penchée).

What then?

These diverse muscle groups act together to maintain control of positioning and movement of the trunk over the upper and lower extremities: and that’s especially relevant when it comes to dance. Core control seems to provide spine support and to back up pelvic alignment, which could be important factors to ensure movement control of legs and arms as well as to facilitate turnout in dancers.  You can find some ideas for core support training directed to turnout on this International Association for Dance Medicine & Science (IADMS) Resource Paper HERE.  Also check out our previous blog posts for bite-size information HERE.

Lack of core control seems to increase strain on the surrounding joints, bones and ligaments and has been related to injury risk on lower extremities and the lower back. As we know that dancers quite often acquire injuries on these parts of the body, bringing core control activities into studio practice could also play a key role on injury prevention and in turn enhance movement efficiency.

When cueing dance students to navigate through the core concept, it’s important to keep in mind that as postural adjustments and external loads entail constant changes to the body, core stability is considered a dynamic concept. That means that the contributions of each muscle on maintaining trunk stability may vary moment to moment throughout movement. For this reason, it’s hard to say that there is such a thing as a single core muscle we should always focus on while dancing. The core control muscles appear to work synchronously with one another.

Instead, it could be really useful (and fun) to explore the strategies used to achieve a desired movement you are working on and observe the muscle activation patterns it causes, whilst keeping in mind the anatomical references as well as research findings and discussions about core control. Why not help young dancers themselves to feel their core throughout movement and to identify their personal patterns during class? Kitty Daniels talks about strategies to help students to understand the role of core control in practice as well as to find a system of their own to work on individual challenges and artistic goals. Find out more about this teaching approach at this IADMS Bulletin for Teachers article HERE, click on Bulletin Volume 1, Number 1, pages 8-10.

As we’ve mentioned before providing images and online applications which allow dancers to locate these muscles really seems to aid understanding and importantly, the efficient execution of movement. Check out these short animated videos: they are great resources in locating those deep control muscles, which are often so difficult for dancers to feel.

Keep exploring:

Ambegaonkar JP, Rickman AM, Cortes N. Core stability: implications for dance injuries. Medical Problems of Performing Artists. 2012;17(3):143-148.

Cholewieki J & McGill SM. Mechanical stability of the in vivo lumbar spine: implications for injury and chronic low back pain. Clinical Biomechanics. 1996; ll(l):l-15.

Hodges PW & Richardson CA. Contraction of the abdominal muscles associated with movement of the lower limb. Physical Therapy.1997; 77(2):132-142.

Kline JB, Krauss JR, Maher SE, Quo X. Core strength training using a combination of home exercises and a dynamic sling system for the management of low back pain in pre-professional ballet dancers. A case series. Journal of Dance Medicine & Science. 2013; 17(1):24-33.

Panjabi M. The stabilizing system of the spine. Part II. Neutral zone and instability hypothesis. Journal of Spinal Disorders. 1992; 5(4):390-397.

Clara Fischer Gam, MS.
Dance Educator, Pilates Instructor
Rio de Janeiro, Brazil
Email: clara.figa@gmail.com

Tags:  anatomy  dancers  teachers  turnout 

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An intervention to improve turnout - Research Study

Posted By K. Michael Rowley, Tuesday, March 3, 2015

Many posts on the IADMS Blog from the Education Committee have been focused on the anatomy and control of turnout. But does awareness of where turnout comes from and exercise targeting hip external rotators actually make a difference in turnout a dancer can achieve? According to research from Florida State University published in the Journal of Dance Medicine and Science, the answer is yes.

Researchers developed a 45-minutes daily 10-day training intervention focused on turnout. This included education and awareness practices as well as exercises like the clam, a passé press will side-lying, side lunge, attitude on a rotating disc, stretches, and tennis ball massage. What made this study unique was that outcome measures were not only turnout ability, but also the rating of dancers performing an adagio by graduate students and faculty before and after the intervention.

Five of the six dancers tested increased their total turnout, measured by the angle of the feet on low-friction rotating discs (figure above), by 9° to 22°. A faculty rater with expertise in body sciences reported all post-intervention performance videos as showing greater turnout control than pre-intervention. The report states that, “Her comments included: ‘The pelvis looked more stable’; ‘the torso looked more lengthened’; ‘the chest was more open’; ‘I saw a greater level of confidence’; ‘much less hip hiking’; and ‘the initiation of the rotation is coming from the back of the legs.’”

Pata D, Welsh T, Bailey J, and Range V. (2014) Improving turnout in university dancers. Journal of Dance Medicine and Science, 18 (4), 169-177.

Full text articles from the Journal of Dance Medicine and Science are available to IADMS members!


 Photo Credit: Dan Dunlap, SarahKim Vennard

Tags:  dancers  research  teachers  turnout 

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