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Dancers - More Power To You!: Video from the 2014 Annual Meeting

Posted By Jatin P. Ambegaonkar PhD, ATC, Monday, August 31, 2015

IADMS Ambegaonkar from Steven Karageanes on Vimeo.

Watching a dancer perform can be breathtaking and fun. Being a dancer is hard! This is because dancer’s movements often involve jumping and landing. To safely perform these explosive movements, dancers need good power in their lower body (Lower Body Power - LBP). Understandably, 70% of all dance-related injuries are to the lower body. Dancers are also supposed to have better balance than non-dancers. In athletics, sprinters with better strength and power and balance have better performance. In modern dance, aesthetic performance and jump ability are positively correlated to each other. However, research investigating potential interrelationships between LB power and balance among dancers is lacking.

We examined (a) the relationships between LBP measures and balance in dancers, and (b) the relative contributions of LBP to predict balance in 61 female collegiate dancers (18.3 + 0.7 years, 164.7 + 7.3 cm, 61.7 + 9.5 kg and with 11.3 + 4.8 years of dance experience). The dancers performed three vertical jumps on the Just Jump Mat (Probiotics, Huntsville, Alabama USA) and we calculated Peak and Average Power. Dancers also performed the Single leg hop for distance, which examines horizontal LBP. We measured balance using the Star Excursion Balance Test, a commonly used valid and reliable test of balance, which has been found to predict the risk of injury.

Our primary findings were that all balance and LBP measures were positively correlated to each other. We found that the more powerful dancers also had generally better balance.  Our findings thus challenge the often-pervasive myth among that being more powerful equates to being more muscular, which then can worsen dance performance. In fact, our evidence supports the opposite view that for dancers, being more ‘powerful’ also translates as being more ‘balanced’ - a MUCH desirable quality!

We are excited with this finding as, to our knowledge, our results are among the first times in the dance medicine and science that we can say to dance teachers and healthcare professionals that dancers balance and power are positively related to each other. In fact, our data suggest that the three LBP measures collectively combined to predict almost 50% of the change in balance scores. Overall, for dancers being powerful is really a good thing!  Furthermore, prior researchers have noted that training can improve power, strength, and dancer performance. Combining these prior reports with our findings, we can recommend that dance medicine and science professionals need to encourage dancers to incorporate strength and power training outside of dance practice in their training regimens to improve balance and overall dance performance.

 

Reference:
Ambegaonkar, J. P., Caswell, S. V., & Cortes, N. (2014). Relationships among lower body power measures and balance in female collegiate dancers. Paper presented at the 24th Annual Meeting of the International Association for Dance Medicine & Science, Basel, Switzerland.

Tags:  biomechanics  dancers  presentation 

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The female athlete triad in college dance students: Video from the 2014 Annual Meeting

Posted By Amy Avery, BFA, MS, and Jane Baas, MA, MFA, Monday, August 24, 2015

IADMS Avery Baas from Steven Karageanes on Vimeo.

Diet and exercise is an important factor in addressing the health related problems of the estimated sixty seven percent of American adults who are overweight or obese.However, diet and exercise can also become a potential problem when mixed with a strong desire to become or maintain a very thin physique.  Eating disorders can result from these desires, where harmful behaviors are used to lose weight or maintain a thin appearance.2 When taken to the extreme, the practice of excessive calorie restriction and expenditure can have severe health implications.3

            The Female Athlete Triad (Triad) can result from disordered eating patterns and can have severe health consequences.4 The Triad is an interrelated problem and includes three syndromes: 

     1.      abnormal dieting behaviors include restrictive eating, fasting, using diet pills,
                   diuretics, enemas, overeating, binging and purging,5 
     2.      amenorrhea, is characterized as the loss of menstruation, and 6
     3.      osteopenia or osteoporosis, is known as a decrease of bone mineral density. 

The Triad can affect the entire body and mind in ways such as:

·         a reduction in speed, endurance and strength.7
·         fluid and electrolyte imbalances, with depleted muscle glycogen stores and blood
               glucose which can increase risk of injury.
8
·         a higher incidence of  infection, anemia, and electrolyte disturbances; impaired healing,
               cardiovascular differences, osteoporosis and endocrine conditions. 8 Without the
               production of estrogen, bone health can be compromised leading to increased
               occurrence of injuries and osteoporosis. 

Without the proper intervention, the consequences of the Triad can be as simple as the loss of participation in physical activity or as severe as emaciation or death. 2,3 What may begin as a simple diet can lead to a psychological disorder, with eating disorders having the highest mortality rate of all mental illnesses.9

            The occurrence of the Triad is a growing concern among populations, such as athletics, who focus on body image and body weight . 4 This population includes dancers.  Research has indicated the figure to be as high as 60% or greater for athletes in particular sporting events. 10 Historically, having a thin physique has been essential for consideration in the dance world.  Unfortunately, this can encourage eating disorders that are associated with the Triad. 11  The prevalence is unknown in college dancers. However, it is known to be higher in the dancer population due to collective pressures to maintain a thin body. 12 It is a common occurrence for dancers to limit their food intake to meet the demands of professional expectations of body image.  Weight control is influenced by aesthetic considerations and body image.8 Much has been written concerning eating disorders in dancers. 5,8,12-15 However, few studies have been conducted regarding the Female Athlete Triad and the premature occurrence of osteoporosis.16,17

            The purpose of this pilot study was to discover the prevalence of the Female Athlete Triad in college dance majors and minors. An anonymous survey was used to collect data from the current female dancers at an American university to determine if a relationship existed between injuries and eating disorders. Sixty female dancers participated in the survey that included a combination of questions extracted from the Eating Attitudes Test-26 (EAT-26) and the Pre-Participation Evaluation from the Female Athlete Triad Coalition. Findings indicated that 25% of participants could be classified as being in the symptomatic range for disordered eating patterns and behaviors; 48% stated the absence of a monthly menstrual cycle; and 16.67% had sustained stress fractures. 

  

 


            Dancers with a higher eating disorder attitude tended to have more injuries. Further, the sample population had disordered eating patterns and that a relationship existed among the Female Athlete Triad symptoms. In addition, more educational resources should be implemented in dance courses, along with an increase in seminars, town meetings, and counseling services addressing the consequences of eating disorders.

 

A Need for Education

In 1998, the American College of Sports Medicine advised detailed approaches be established to identify, prevent and treat this syndrome. These strategies included education about the Triad for a wide range of individuals including teachers, choreographers, directors, coaches, trainers, administrators, health care providers, parents and the dancers/athletes themselves.  Identifying individuals who may be at risk is especially difficult in the dance population.  In a field where a preoccupation with weight and disordered eating is considered "normal," how can we determine when “normal” becomes excessive? Becoming familiar with the signs and symptoms may help increase the prevention of a full blown eating disorder. It is recommended by the NCAA that those who work with dancers and the students themselves need to be aware of the risk factors and symptoms. Being aware of the situation is the first step in changing behavior. A teacher or a coach can be influential in providing students and staff with the education they need to decrease the risk of Disordered Eating and the Triad. Instructors must promote intelligent knowledge to their students and be healthy role models for their students.

Promoting healthy choices is crucial to the wellness of their dancers. Robson and Chertoff 18 make the following recommendations:

• Encourage positive attitudes and healthy bodies;

• Provide information regarding calorie consumption and energy expenditure;

• Raise awareness regarding adequate nutrition and bone health;

• Be mindful of early signs of the female athlete triad;

• Advise vulnerable dancers to seek proper assistance;

• Insist on regular medical check-ups;

• Create strategies to develop ideal health and wellness resources for dancers.

Current research indicates a need for additional resources, education and information for dancers of all ages. This was especially true for dancers in a serious training facility.

 

References

1.  Center for Disease Control/National Center for Health Statistics. (2009). Fast stats:      Overweight prevalence. Retrieved from http://www.cdc.gov/nchs/fastats/overwt.htm.

2.  American College of Sports Medicine. (1998). Position stand, the female athlete triad. Journal of Dance Medicine & Science, 2(1).

3.  Hobart, A. & Smucker, D. (2000). The female athlete triad. American Family Physician. Retrieved from http://www.aafp.org/afp/2000/0601/p3357.html

4.  Reinking, M., & Alexander, L. (2005). Prevalence of disordered-eating behaviors in     undergraduate female collegiate athletes and nonathletes.  Journal of Athletic Training,      40(1), 47-51. Retrieved from    http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1088345/.

5. Sonnenberg, J. (1998). Etiology, diagnosis, and early intervention for eating disorders. Journal of Dance Medicine & Science, 2(1).

6. Sherman, R. & Thompson, R. (n.d.) Managing the female athlete triad. NCAA Coaches Handbook. Retrieved from htttp://www.princeton.edu/uhs/pdfs/NCAA%20     Managing%20the%20Female%20Athlete%20Triad.pdf

7. Williams, N. (1998). Reproductive function and low energy availability in exercising     females, a review of clinical and hormonal effects. Journal of Dance Medicine &             Science, 2(1).

8.  Culnane, C., & Deutsch, D. (1998). Dancer disordered eating: Comparison of disordered eating behavior and nutritional status among female dancers. Journal of Dance Medicine & Science, 2(3), 95-100.

9.  Sullivan, P.F. (1995). Mortality of anorexia nervosa. American Journal of Psychiatry. 152(7), 1073-1074.

10.  Kenney, W., Wilmore, J., Costill, D. (2012). Physiology of Sport and Exercise. Champaign, IL. Human Kinetics, (5th ed). 

11.  The challenge of the adolescent dancer. (2000) International Association for Dance Medicine & Science. http://www.iadms.org/?1

12.  Vincent, L. (1998). Disordered eating, confronting the dance aesthetic. Journal of Dance Medicine & Science, 2(1), 4-5.

13.  Glace, B. (2004). Recognizing eating disorders. Journal of Dance Medicine & Science, 8(1), 19-25.

14.  Ringham, R., Klump, K., Kaye, W., Libman, S., Stowe, S. & Marcus, M. (2006). Eating disorder symptomatology among ballet dancers. International Journal of Eating       Disorders, 39(6), 503-8. DOI: 10.1002/eat20299.

15.  Robson, B. (2002). Disordered eating in high school dance students: Some practical   considerations. Journal of Dance Medicine & Science, 6(1).

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

17.  Myszkewcyz, L. & Koutekakis, Y. (1998). Injuries, amenorrhea and osteoporosis in active females. Journal Dance Medicine & Science, 2(3) 88-94.

18. Bone health and female dancers; physical and nutritional guidelines. (2008) International Association for Dance Medicine & Science.  http://www.iadms.org/?212

Tags:  nutrition  presentation 

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Do Dance Professionals think about their health? : Video from the 2014 Annual Meeting

Posted By Derrick D Brown, Tuesday, August 4, 2015
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Nutrition Research should drive advice and practice: which nutrients should the dancer be updated on and why: Video from the 2014 Annual Meeting

Posted By Jasmine Challis, BSc, RD, Monday, August 3, 2015

This blog looks at the information I presented at the 2013 IADMS conference in Seattle. It looks at an area where there is a lot of controversy and tries to steer a research based path to advise the dancer on current best practice considering the current evidence.

Introduction

Dancers interested in making sure their food and fluid intake optimises their performance are faced with a huge amount of nutrition information in magazines, newspapers, the internet, blogs(!), TV and radio programmes, Twitter and other social media, plus that from  teachers/colleagues/ peers/family and friends. It can take determination not to be drawn into believing the latest trend as to what is best. It is probably useful to remember that nutrition research changes knowledge slowly in almost every case, so if a claim sounds dramatic, it has probably been exaggerated or the actual information twisted to try and make a story.

When we think about nutrition we tend to think about energy, measured in either kcals (USA) or kjoules (Europe and Australia), which can come from carbohydrates and fats (and alcohol- though not relevant for training/performance), - and technically from protein. Although protein can be used as an energy source, it can’t then be used for its main roles in growth and repair so it’s not a viable option for most dancers. It is also the most expensive component of most meal plans so most dancers will have more of a challenge to take in enough protein to meet their needs than to have surplus to burn as a source of energy.

Moving on from energy we then need to consider the vast range of vitamins and minerals that humans, including and particularly dancers, need. There is ongoing research identifying new roles for established nutrients, such as Vitamin D having a role for a healthy immune system, as well as clarifying the roles of nutrients such as Vitamin E which we still don’t fully understand.

The tables below show the vitamins and minerals that are perhaps of most relevance to the dancer, and the body systems that are most important in dance and whether the nutrient may or may not be involved. Nutrition research is very challenging for a number of reasons. It is difficult to persuade people to keep to a fixed diet so that an experiment can be done to change just one food or nutrient; people do not all react the same; it may take a long time to see a difference, and all of this makes research very expensive and time consuming. Also, when trying to change a nutrient, unless it can be added to an existing part of your diet, for example adding folate to bread, then introducing more of one nutrient, means another typically must be reduced and this can impact your total energy intake which may in itself affect the results. Another problem is that large amounts of any nutrient is likely to do harm, and at extremely high intakes the body may process these nutrients differently compared to when taken in moderate amounts. 

  

There is also a problem that anyone can call themselves a nutritionist – though the title ‘Dietitian’ or ‘Dietician’ is legally protected – so there are many ‘experts’ who are taking some evidence (at best), and advising people without having the depth of knowledge to give the best advice. Always remember that if it sounds too good to be true, it probably is. And that nutrition is almost never black and white, because of the simple reason that if you make a change you are most likely taking something out of your meal plan to put something else in. If you take out sweets and put in fruit, your energy level as well as your intake of vitamins and minerals may well be better overall, but if you were eating a lot of sweets you will need to put in a large amount of fruit which may upset your digestive system at least initially (you may adjust in time) and also be acidic for your teeth and result in some damage over time. So what sounds like a very good change may bring a less welcome effect.

Small gradual changes you can sustain are best – avoid making huge changes that take a lot of time and effort unless your starting meal plan really needs a complete overhaul and is causing you problems at the moment.

So, think about your food plan, be honest with yourself; if changes would be helpful introduce them gradually and make sure you can keep up the new plan, along with the benefits it will bring, before making further changes. If you can find foods that you enjoy and that help you achieve your nutrition goals that is going to make keeping to a meal plan easier!

Jasmine Challis, BSc, RD

Tags:  dancers  nutrition  presentation  teachers 

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Alignment of the leg and its impact on the dancer's knee: Clips from the 2014 Annual Meeting

Posted By Liane Simmel, Tuesday, June 9, 2015

IADMS Simmel from Steven Karageanes on Vimeo.

This presentation gives an insight into the functional anatomy of the dancer’s knee, its biomechanical prerequisites and its economic use as base for a high resilience to dance injuries.

 

Over the last decade as more and more acrobatic movements invaded the various dance styles, the strain on the dancer’s knees has largely increased. Training on hard, inappropriate floors or dancing choreographies in high heels can add even more problems. Pirouettes on the knees, knee drops, and even a plié in fourth position require particular leg stability and optimal mobility in the knee. But dancers often pay little attention to their knees. They are seldom specifically warmed up, directly trained or used consciously in everyday life. Nonetheless, their functionality is a top priority if dancers’ knees are to be kept fit and healthy.

Being the largest joint of the body, the knee works as an important coordination centre to the leg. Located between the hip joint above and the foot below, it reacts to all movements and positions of these, its two functional partners. With its high number of daily repetitions, even seemingly small dance technical pitfalls like rolling onto the inner side of the foot in the turned out position or losing the alignment of the leg in demi plié  can lead to overuse problems and even acute injuries in the knee area.

As dancers are accustomed to work precisely on their coordination and alignment they do have a big supply of tools for improving leg alignment, be it in the dance class or in everyday life. They just have to be made aware of this potential...

When analyzing leg alignment and knee load in a dancer, there is more to consider than just screening the bony and functional anatomy of the lower extremity itself. When it comes to assessing the stress and load on the dancer’s knee, the form and mobility of the foot, the bony and muscular situation of the hip joint, the position and mobility of the pelvis as well as the torsion of the tibia play an important role. Thus, to get an impression about the dancer’s anatomical prerequisites, screening should start by analysing the anatomy of the whole functional chain: the foot, the torsion of the tibia, the antetorsion angle in the hip joint and the position and mobility of the pelvic girdle. To detect the keystones by which the dancer can influence, change and improve his or her individual biomechanics the next step in line is to assess the flexibility, function and muscular strength of all functional partners – foot, hip joint, pelvis and last but not least the knee itself.  

Being the most common challenges in many of the different dance styles, turnout, plié and hyperextended legs have been chosen to explain the approach of biomechanical awareness training in dance. Dancers spend a great deal of their days in the studio, but there is still a life outside the ballet room, and movements and biomechanics outside the studio seem to have potential for improvement in many dancers. Therefore the habits in the dancer’s everyday life movement should thoroughly be analysed and searched for negative influence on body functionality by imprinting unhealthy movement patterns in the dancer’s neurological motor program. If not detected and changed these often unconscious habits will be trained on a regular daily basis, imprinting into the dancers motion cortex. To break them up, specific exercises should be performed, with the focus on (1) mobilization (to allow new movement possibilities), (2) awareness (to make unhealthy movement patterns conscious and consider possible changes), (3) strengthening (to enable the muscles and the neurological system to perform unfamiliar movements) and (4) relaxation (to reduce unnecessary muscles tension and soft tissue restrictions). With “one second exercises” performed numerous times per day, the reset of the neurological motor program gets started.

Finally, what seems for the majority of the dancers the most challenging step, the new movement potential have to be transferred back from everyday life to the studio, to the individual dance technique. Easily understandable anatomical and biomechanical images and movement cues can support this tricky step. And last but not least: patience.

Liane Simmel, MD, DO, tamed, Tanzmedizin Deutschland e.V., Fit for Dance, Munich, Germany

Tags:  alignment  anatomy  presentation 

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