Each year dancetrain asks the leading group of performing arts healthcare professionals across Australia to talk about their expertise and experiences plus any new technological developments in the management & treatment of injuries.
This years Bodywise articles are a must read for any dancers who want a psychological and physical edge when the pressure is on.
The importance of seeing a healthcare professional that has experience and an understands the psychology of a performing artist, the pressure to keep performing and pushing yourself, even with injury, has a unique set of parameters that must be navigated and understood.
The Port De Bras by Gabrielle Davidson and Bradley Smith
Over Stretching by Susan Bond
The Benefits of Cross-Training for Dancers by Natalie Orola
Living with a Dream with Uncertain Job Prospects by Jocelyn Penna
OVERLOAD Understanding the Trigger by Charissa Fermelis
Body Talk- Pain Train Your Brain by Louise Drysdale
Reduce injury and Promote Performance by Melanie Fuller
Garuda by Anna Tetlow
It Takes Two by Michael Bellantonio
The Benefits of Private Coaching by Natalie Orola
Dance screening & injuries on the rise by Holly McPaul
Are injuries preventable? by Louisa McGinness
Dentist or Dance Physiotherapist? BOTH! by Susie Bond
Weight watching and your identity by Jocelyn Penna
Happy Hips by Deborah Chen
Turnout – what is it? by Samantha Jakelic
Remedial Coaching by Suzanne Way
The importance of dance-specific assessments by Shannon Trotter
Growth plates and pointe work by Louise Drysdal
Injectables by Andrew Cobb
Tips for exam and comp time by Charissa Fermelis
The Importance of intrinsic feet muscles by Gabrielle Davidson & Joanne Maskrey
by Katie Godwin
kineticaphysiotherapy.com.au | [email protected] | 02 9948 6188
There has often been discussion in the media regarding how much is too much when considering the level of exercise that young people engage in. Extreme examples of overtraining tend to make headlines, and can unnecessarily worry parents and teachers. No one wants to put any child or adolescent at risk of injury; that’s a given.
It is important, however, to put the idea of overtraining into perspective. Australia’s physical activity and Sedentary Behaviours Guidelines recommend that children aged 5 – 17 years should engage in at least 60 mins of moderate to vigorous physical activity daily. Furthermore: ‘To achieve additional health benefits, children should engage in more activity – several hours per day’. And: ‘on at least 3 days per week, children should engage in activities that strengthen muscle and bone’1. So this is to say that at least 7 hours of physical activity per week is recommended as a minimum. For most young people, the dangers of inactivity have far more serious long term health implications than the perceived dangers of dancing at a high workload.
The other extreme: how much is too much?
In some instances however overtraining does exist, to the detriment of the dancer. This is where parents in particular find it difficult to know when they need to step in and advise ‘enough is enough’. No parent wants to stand in the way of their child’s dreams by setting arbitrary limits, but no parent wants to allow their child to burn out either.
While every case is different, there are generally a couple of things all young dancers should be aware of when considering appropriate dance load.
The adolescent growth spurt:
Right about the time when dancers are often being encouraged to dance harder and longer, they will often commence their adolescent growth spurt. For girls this is usually between the ages of 11 and 13, and for boys 13-15. During this spurt bones grow quickly, muscles tighten, and coordination suffers. Building hours or dance intensity during this time may lead to frustration as the dancer’s body isn’t able to respond as well as normal. Because of the rapid bone growth during this time, bones are also more susceptible to injury. Repetitive overload of rapidly growing bones can cause bone stress or fracture which needs to be taken seriously to ensure the long term health of the dancer. Recognising times of rapid growth and communicating these with the dance teacher, should result in an easing off on dance workload rather than pushing forward. Such easing of load will not cause a dancer to fall behind as is feared, instead they are likely to perform better as their muscles and bones are given the space they need to develop optimally.
The adolescent body needs sleep:
More so than adults, adolescents need sleep. And in large quantities. Studies recommend ≥9 hours per night for adolescents; a hard ask in the current climate of homework, smart phones and extra-curricular activities. If dancing is taking place of sleep, this should be a consideration when asking yourself whether the load is too high.
The female menstrual cycle
While this is often irregular (or absent) in the healthiest of young females, it can be an early warning sign of overtraining. A dancer’s body needs to have lots of energy available for high levels of dancing. It also requires energy for optimal hormonal function and menstruation. When energy availability is low (either through low caloric intake or high levels of exercise) there may not be enough energy left over to maintain normal menstruation2. A dancer may experience delayed menarche, irregular menstrual cycles, or cessation of menstruation as a result. The hormone oestrogen which is produced during menstruation is also essential to build and protect healthy bones. Therefore low levels of oestrogen can cause bones to become more brittle, and that can be a problem. In all likelihood, your abnormal period may be completely ok for you. But it doesn’t hurt to discuss any change in menstrual status with your GP to ensure that it is not an early sign of overtraining.
Tendons, bones, and muscles need time to adapt to increasing load
More so than total dance load, large fluctuations in load lead to injuries. Any increase in dancing hours or intensity needs to be introduced gradually so that a dancer’s body has time to adapt. It is recommended, for example, that a dancer needs at least 4 years of dance training after the age of 8 to develop enough strength and control to start pointe work (along with other considerations)3. Jumping suddenly from 5 hours to 10 hours of dancing in a week is likely to put a dancer at high injury risk. If however the same dancer had increased that load gradually over a term, their risk of injury is much lower.
So where can parents find that magic number of hours that is appropriate for a dancer’s age?
The formula that is required to make a successful adult dancer is not easily pinned down. Certainly competitive dancing requires a combination of physical fitness and artistry that cannot be achieved without much hard work, hours at the barre, and no small degree of natural talent. But it also requires maturity. Towards the end of high school, many dancers who go on to dance professionally are participating in pre-professional training and full time loads without apparent detriment to their long term health. The potential benefits and risks of allowing 12 or 13 year old dancers (who are still growing rapidly) to do full-time loads are more uncertain. While there are exceptions in every case, there is the risk that high loads during these years may allow dancers to shine in the short term at the later cost of burnout or injury.
Signs of overtraining may include:
– Ongoing fatigue that is not easily improved with a night’s rest
– Deterioration in dance performance
– Lowered concentration
– Loss of menstrual cycle
– Multiple injuries over a relatively short time period
If you are concerned that you are not dancing at your best and you are considering whether you are doing too much, talk to your GP or Dance Physiotherapist. Having a good support team around you is a great way to ensure that you are achieving a balance that is right for you.
Keep dancing safely.
Katie Godwin and the team at Kinetica Physiotherapy
1. Australia’s physical activity and Sedentary Behaviours Guidelines. www.health.gov.au 2. IADMS Resource paper: Bone Health and Female Dancers: Physical and Nutritional Guidelines. J Dance Med Sci 3. IADMS Resource paper: When can I start pointe work? Guidelines for initiating pointe training. J Dance Med Sci Katie Godwin is an experienced physiotherapist, having spent more than 10 years working with clients from a variety of backgrounds, including The Australian Ballet Company. Katie is the current Chairperson for the NSW Dance Network, and lectures regularly to school students and full-time dance students on safe dance practices. kineticaphysiotherapy.com.au | [email protected] | 02 9948 6188 | 410 Sydney Rd, Balgowlah & 87 Chandos St, St Leonards
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by Gabrielle Davidson and Bradley Smith
insyncphysiopilates.com.au | [email protected] | 03 9813 2188
Understanding how your body is put together can help you understand and access the right muscles, joints and bones to allow you to perform with greater strength and artistry.
Whilst watching dance it is the legs and feet that appear to carry out the majority of athleticism and it is the port de bras that displays artistry and intention with fine, controlled movements paramount to helping an artist tell a story.
The whole upper body inclusive of the head, upper back, chest, shoulders, arms, fingers and even the eyes contribute to the creation of a beautiful port de bras. Shoulder and upper limb stability and strength are imperative for both line creation and the execution of dynamic movement and pas de deux.
The spine has 3 healthy curves, the neck, thoracic and lower back. The thoracic spine, also known as the mid-back is where the the ribs, shoulder girdle and arms attach. A healthy thoracic spine allows you to arch, curve and bend from side to side.
The upper limbs attach to the central skeleton in just two places, one for each side, at the base of the neck, by a joint known as the sternoclavicular joint, made up of the collar bone and breast bone. The arm and shoulder blade both connect to the clavicle to allow force from the arm to be transferred and distributed by the axial skeleton. An example of this would be when you are holding your partners hand for support. As the shoulder blade has no direct attachment to the central skeleton, it essentially rests on the back of the ribcage with all the support and control coming from the muscles attached to it.
The shoulder blade is an important part of shoulder and upper arm movements. The shoulder blade can rise with the upper trapezius muscle, lower using gravity and the pecs, move away and in from the midline using the serratus anterior muscle and middle traps and rhomboids respectively, rotate upwards using upper traps and serratus anterior and rotate downwards using the latissimus dorsi. A weakness in the serratus anterior muscle can often lead to winging scapula (chicken wings). A sense of width through the front and back of the chest can help to activate the serratus and prevent this. Mastering and controlling these movements are the key to strengthening your port de bras and preventing shoulder injury and instability.
Attaching to the shoulder blade is the humerus (upper arm), with the ball and socket joint known as the gleno-humeral joint (shoulder joint) allowing multiple movements in many different planes. These movements include lifting arms to a fifth, reaching arms behind the back, lifting arms to second, returning arms from second to bra bras, rotation of the shoulder so that palms face the front, rotation of the shoulder so palms face the back and combination movement. The stability of this joint is provided by the rotator cuff complex. The rotator cuff is referred to as a dynamic stabiliser due to its muscular nature, made up of the muscles and a tough sheath of tendons and ligaments that support the arm at the shoulder joint. The rotator cuff muscles play an important stabilising role in all shoulder movements by holding the humerus into the socket of the shoulder blade to prevent dislocation. The supraspinatus, infraspinatus and subscapularis muscles also contribute directly to the movements of shoulder abduction, external rotation and internal rotation respectively. The deltoid and latissimus dorsi play the prime role in flexion, extension, abduction, adduction.
The shoulder blade must be free to complete all movements to help position the shoulder girdle perfectly to allow the rotator cuff to work well and dissipate the arm forces through the clavicle to the central skeleton. The rotator cuff muscles must be strong enough to support the gleno-humeral joint as well as contribute to the smooth execution of movements. The strength required of the deltoid, latissimus dorsi and rotator cuff muscles increases tremendously in dancers who are partnering as the arms are usually the point of contact between the two dancers.
So now you get an idea of how all of these joints, muscles and bones need to work so you can tell a beautiful story with your arms or be supported in a lift or execute a dynamic dance routine.
Dancers can benefit by incorporating thoracic mobility, rotator cuff exercises as well as shoulder strengthening into their regular strength and conditioning program to help get the most out of their ballet training, improve the artistry of performance and protect shoulders from unnecessary injury. Your local physiotherapist can help to determine the best exercises to target these muscles.
“When the arms accompany each movement of the body with exactitude, they may be compared to the frame that sets off a picture. But if the frame is so constructed as not to suit the painting, however well executed the latter may be, its whole effect is unquestionably destroyed. So it is with the dancer; for his steps, unless his arms be lithesome and in strict harmony with his legs, his dance can have no spirit or liveliness, and he presents the same insipid appearance as a painting out of its frame or in one not at all adapted to it.” Carlo Blasis (1797-1878 Italian dance, choreographer and dance theoretician, trainer of Enrico Cecchetti’s teachers.
Gabrielle Davidson and Bradley Smith are Dance physiotherapists at InSync. Their team is at the forefront of a new wave of practitioners applying modern sports medicine principles in a dance specific environment. Their elite, pre-professional and professional dance backgrounds, give them first-hand knowledge and understanding of the stresses dancers place on their bodies. They understand “the show must go on”, liaising with dance teachers and other health professionals so the client may continue to dance through the rehabilitation period by applying the correct treatments and training practices. insyncphysiopilates.com.au | [email protected] | 03 9813 2188 | Level 1, 505 Riversdale Rd, Camberwell VIC 3124
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by Susan Bond
evolutionpilates.com.au | [email protected] | 02 9518 5009
Over stretching is where you stretch the muscle or hold a position for over 30 seconds at end of joint range limit.
Recently physiotherapists from The Australian Ballet medical team, have said they favour strengthening exercises rather than prolonged stretching on muscles. This has led to some confusion, as dancers cannot imagine going into class or performance without some sort of flexibility warm-up or back ground stretch training.
Dancers may have experienced the negative effects of going straight into high kick movements without warm-up, sustaining a muscle strain/tear as a result. However some dancers have felt the effect too much prolonged stretching has had on their allegro ability during class. They feel wobbly and lack coordination needed for ballistic jumping motion.
Your warm-up needs to be active movement to increase body temperature, increase blood supply to muscles, warm-up joints and other connective tissue. It is preferable to do dynamic range of movement exercises rather than sitting into stretches for a long time (eg. over 30 seconds) A 10 second stretch is adequate to give your body an idea of the movements and range you are about to embark on. A light walk then jog around the studio and leg swings with bent, then straight leg will help achieve this benefit.
Sustained stretches can ‘switch off’ protective nerve reflexes and the natural tightening of muscles that occurs around joints, leaving joints and tendons vulnerable to injury.
An example of stretching, that can be detrimental in the long term, is sitting on the floor with the legs out wide in 2nd position and holding this position while doing homework. It is especially detrimental to roll the pelvis forward and back over the hip joints in this extreme position. Many dance physios feel this could damage the hip labral cartilage and over stretch ligaments and joint capsule. The normal joint structures are designed to keep the joint stable and limit an unnatural compression, sheering and slip forces between bones. It is unlikely muscles are the main structure being stretched in this position. Bone/cartilage on bone pressure is potentially detrimental to the joint in the long term, as the majority of people’s hip joints are not anatomically designed for this position.
Stretching for Rehabilitation and Body Balance Exercise
I give dancers stretches to do for therapeutic purposes. There are times when muscles and connective tissues get tight because they are spasming in protection over injured areas, or following over exercising with poor postural or limb alignment. Some muscles need to relax a bit to allow a healed area to move more easily. I never give prolonged sustained stretches to dancers that require the spine or limbs to hang unprotected in ‘end of range’ positions.
The key is to do some detective work, to ask why an area of the body is getting tight and sore. I have clients who get relief from pain and tightness by doing specific stretches carefully. The tightness will return however in many cases, an underlying issue is the cause. That is when we need to do some detective work. For example if a dancer presents with regular feelings of tight calf muscles, I ask.. what is their pelvic dynamic muscle stability like? How is the dancer using all the muscles in their feet/ leg? Are each of the muscles sharing the load ? How many hours and what style of dance is the dancer doing a lot of? What type of floor surface are they dancing on? What specific strengthening exercises are needed to correct muscle ‘imbalance’? And the list goes on in our detective work.
• Dynamic stretches involving whole body movement are preferable in warm-up times
• Ballistic uncontrolled stretches into end joint ranges are not advised
• Careful 15-30 second static stretches are OK once the body is warm
• Combining controlled range of movement and strengthening exercises is a beneficial way of increasing dancer flexibility and functional control
• Sustained or prolonged static stretches are thought to be detrimental for dancers, especially just before class or performance requiring strength, agility and balance (eg. Allegro)
• Over stretching repeatedly, can cause long term joint instability issues
Balancing flexibility with strength is key. Before you attempt stretches seen on Social Media you need to consider more facts than the ones you can see. How old is the dancer? What is their Flexibilty:Strength ratio? And the most important one, are they performing the stretch/move safely to achieve the desired goal? A professional dancer has the necessary strength and flexibility ratio to extend themselves far more than a student who is still learning to understand and develop this balance.
If you are very flexible you will need to ensure the muscles around your joints have the necessary strength to support your movement. You do not want your joints to pay the price in years to come. If you are not so flexible but very strong then increasing flexibility is achievable as long a you are always considering joint health, not putting too much pressure on your joints. Visiting with a dance specialist physio will help you achieve either of these goals.
Susan is the Director of Evolution Pilates and MG Pilates, she is a Dance Physiotherapist, Pilates Instructor and has been dancing since she was 5. Susie has run lectures to dance schools and Dance degree courses in Australia and UK. She is a founding member of the special Dance Network, in the Sports Australia group of the Australian Physiotherapy Association and a member of the Australian Pilates Method Association and the International Assoc. for Dance Medicine and Science. evolutionpilates.com.au | [email protected] | 02 9518 5009 | 3/63 Johnston Street, Annandale NSW 2038
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by Natalie Orola
thebalanceddancer.com | [email protected] | 0415 715 080
Traditionally, a dancer’s training has been restricted to building their technique and performance levels during a dance class. Whilst we can all appreciate the demanding impact that dance has on our bodies, the dance industry has been relatively slow on the uptake of exploring cross-training pursuits for dancers. For many, it is the fear of injury or the appearance of looking ‘too bulky’.
As we progress into the 21st century there has recently been a significant shift in the training undertaken by dancers across the globe. With the rise of innovative and holistic solutions for dancers, there has never been a better time for dancers to access a wide range of services to take their dancing to the next level.
I am a firm believer that there is never too much variety in a dancer’s training. Whether this is through vigorous cardio-exercise, weight-training, yoga, swimming or acrobatics, a dancer is spoilt for choice when it comes to exploring innovative ways to enhance their dancing outside the scope of the dance studio.
What Types of Cross-Training Assists Dancers?
One of the most effective cross-training practices for dancers is yoga. Many of us can relate to the evident relaxing and calming qualities of yoga: the stillness of the positions, the meditative style of practice, the calm surrounding you while you fluidly move through the practice. What many dancers might not appreciate is the versatility which yoga can add to their skill set. In addition to the mental focus and joint stability which yoga can provide, it also improves posture, increases strength and flexibility. These are all benefits which can be incorporated into a variety of dance genres and progress a dancer’s skill set almost immediately.
Another example of a beneficial cross-training field for dancers is acrobatics. Whilst acrobatics is an especially challenging style for dancers to master as training in both dance and acrobatic elements is required, it can improve a dancer’s skill across a number of areas including balance, particularly in core control, flexibility and overall body strength. What’s more, a dancer with acrobatic skill holds a significant ‘triple threat’ competitive advantage at audition and eisteddfod time as they can incorporate more variety in their dance pieces and showcase more unique movement in their work than their counterparts.
How Does Cross-Training Assist Dancers?
On a physical level, with adequate training, supervision and moderation, a dancer in the current industry will significantly benefit from cross-training across their whole discipline. Expectations from dancers across the world are continuously rising and are at an all time high. Simply review the progression of traditional classical ballet poses, such as Penché’s and Grand Jeté’s, over a 40 year period, and you will appreciate the greater lengths that dancers need to go in order to keep ‘up to date’ with their skill set, especially if they have their hearts set on dancing professionally.
I have witnessed this for myself during private coaching sessions with my clients. One of my private dance clients who regularly participates in swimming lessons with a personalised coach possesses an enviable level of stamina and agility during our intensive 1 to 2 hour dance coaching sessions. A level which we have not consistently witnessed across our entire client base. Another one of my clients regularly participates and competes in gymnastics. His core strength is so highly developed, it allows him to execute explosive elevation work including dynamic Grand Jeté’s and larger barrel turns, with such poise and confidence that many of his peers cannot achieve.
On a mental level, cross-training provides even more advantages to a dancer. It adds balance to the day-to-day schedule and promotes positive health and wellbeing. Cross-training also helps those dancers rehabilitating from an injury maintain strength and stamina. Speak to your doctor or rehabilitation physician to understand the wide range of benefits. Cross-training assists in maintaining levels of motivation with an additional set of goals to strive towards within their cross-training program. This enhances a positive state of mind when they approach goal-setting in the dance context.
The benefits of cross-training are endless. My take-home message is that as long as dancers strike a balance between maintaining safe dance technique, practice cross-training in moderation, and ensure they are adequately fuelled for the mission (through nutrition), cross-training should be incorporated in every serious dancer’s timetable.
Natalie is the Founder of The Balanced Dancer, a holistic dance coaching and mentoring platform for dancers around Australia. Natalie is an Associate of the Australasian Dance Association (ADA) (formerly the Federal Association of Teachers of Dancing), an Affiliate Member with The Commonwealth Society of Teachers of Dancing (CSTD) and trained in the Royal Academy of Dance (ballet) syllabus, holding over 15 years of dance teaching experience at various dance schools throughout Sydney, Gold Coast and Brisbane, Australia. A true advocate of balance - Natalie offers her dance coaching and mentoring services to dancers while practising as a full-time lawyer and hopes to inspire young dancers all around the world to reach their potential through balance. thebalanceddancer.com | [email protected] | 0415 715 080
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by Jocelyn Penna
performancepsychology.com.au | [email protected] | 02 8011 4435
Most people feel more secure when they know what is around the bend, but unfortunately life is full of uncertainties. Dancers in pre-performance years usually have an idea of their desired career path, however each company, school and director have their own criteria and preferences. Performance is subjective so even if a dancer met the required criteria their selection is still uncertain. They must also deal with uncontrollable factors including health, puberty and injury.
Developing a resilient sense of confidence, planning and providing coping strategies is the most effective way to help pre-professional dancers prepare for an uncertain future. It is possible to feel secure when the future is unclear if one knows they will be okay regardless of the outcome.
Are there tell-tale signs of when this type of uncertainty is getting ‘too much’?
Uncertainty may become difficult to handle when
• it is present for extended periods.
• several things are indefinite at the same time.
• there are several unknowns one after the other.
• personality traits and life experiences have triggered a desire for feeling in control.
For many people uncertainty causes a little stress. If insecurity is perceived as threat however, the body will attempt to protect itself with an anxiety type physiological response including heightened alertness, and increased breath and heart rate. Whilst harmless in the short term, if prolonged this response can result in physical and mental exhaustion. Insecurity can also lead to changes in mood with more sadness, frustration, anger and worry. People who feel insecure might appear inflexible as they attempt to create as much structure and control in as many life domains as possible to compensate for whatever is making them feel “out of control”. They might also experience self-doubt or self-sabotage to help dreaded outcomes seem more bearable.
Dancers often describe themselves as perfectionistic. Sometimes people strive for perfection assuming they have ultimate control. Whilst the trait can help dancers refine technique, perfection is unobtainable, and the future is unpredictable, so if unmonitored it’s relentlessness can lead to burnout.
Does everyone feel this stress?
Whilst uncertainty is part of life, insecurity does not need to be. People with a resilient sense of self confidence know they will be okay regardless of the outcome of their circumstances.
• They see possibilities and opportunities instead of necessities.
• Their self-worth and perceived value to family, friends and society is not related to decisions, desires or career path.
• Subjective judgements of performance don’t influence their self-worth.
• All feedback is transformed into constructive criticism and used for development.
• They realise that some opportunities will be desirable, and others will be stepping stones.
Are their tips for discovering your own coping mechanisms?
If you feel like uncertainty is becoming too much,
1. Acknowledge your dream goals, even if they seem unobtainable! Pretending they don’t exist will increase your uncertainty.
2. List your limitations and strengths, so you can realistically consider your dream goals.
3. Revisit your dream goals and see how you can adjust them to be obtainable. Come up with as many variations as possible, to increase the certainty that you will achieve one of them.
4. View them as opportunities and possibilities, as uncertainty can be motivating if any of the consequences are welcome.
5. Maximise your chances of achieving your goals and decrease uncertainty by setting out a step by step action plan. Make sure these steps are controllable, for example to “stretch nightly for 20 minutes”, rather than “place first in the eisteddfod”.
6. Know your physiological and cognitive responses to uncertainty and deal with them proactively. Explore unhelpful thoughts, manage anxious feelings with abdominal breathing and grounding, talk to a trusted friend or family member and ask for help to cope with stress.
7. Forge security in other areas of life by maintaining family and friend relationships, making a secure home base and keeping other interests.
8. Seek support if you think an unobtained dream goal may change how you feel about yourself.
Look into meeting with a qualified performance psychologist, familiar with the world of dance if
• you would like specific strategies to manage physiological and cognitive responses to uncertainty,
• you are becoming inflexible or uncertainty is leading you to feel “out of control”
• you are not sure that you will be secure in uncertainty.
Remember that life is highly unpredictable, so numerous pathways to a dream goal are essential and there are many ways to experience the joys that performance brings.
Jocelyn Penna from Focus Performance has 18 years experience working with professional and developing performing artists. She enjoyed a background in dance and now studies the psychological challenges and rewards of being involved in the field. Working from clinics at Turramurra and Homebush. Skype and phone consultations are also available. performancepsychology.com.au | [email protected] | 02 8011 4435
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Understanding the Triggers
by Charissa Fermelis
charissafermelis.com | 0438 020 167 | [email protected]
Understanding when you are at risk of injury will help you better take care of yourself. Charissa offers some great advice on how to better understand you and gain a greater understanding of when you might be overloading.
‘Load’ refers to the overall physical force being placed on the body. Managing load appropriately is vital in dance conditioning as it reduces the risk of injury and guides rehabilitation. When the amount of load outweighs the body’s ability to cope, an overload injury can occur. The difference in the younger population is that throughout growth spurts and physical changes during puberty, the body is undergoing constant change in size, shape, weight and hormones. Finding the balance between participating in enough class work to continue progressing a dancer’s skill, without overtraining, can be quite the juggling act.
Sports physiotherapists and dance medicine experts look at the influence of external and internal load, and ratio between the cumulative training load over a 4 week average and the load in the current week.
External Load is the number of hours of physical activity. For example, a typical client of mine is a 13 year-old aspiring ballerina, whose weekly timetable involves 15 hours of dance, 3 hours of netball, and 2 hours of school sport – 20 hours per week on a regular basis; over the course of a school term, her body adapts and is now capable of managing this workload. During the holidays she participates in a ballet intensive, involving an additional 6 hours of dance per day over 5 days (extra 30 hours); her body has not prepared for this sudden spike in volume, so is now more susceptible to injury.
Internal load can be measured as the rate of perceived exertion (RPE) on a numerical scale from 1 to 10; 1 being minimal and 10 being maximal exertion. Both the dancer and the teacher can report RPE and note any discrepancies. For example, a teacher may report that a student had a fairly light class and rated the RPE as 4, yet the dancer rates her RPE significantly higher at 9. This discrepancy could be a warning sign that the dancer perceives a higher intensity of class, which could lead to an overuse injury. Professional sporting teams connect to an online database where players upload specific data, which is analyzed to calculate optimal loads for individual athletes. Recreational dancers can monitor their internal load/RPE on a daily basis in their diary, calendar or on smart phone apps.
As well as the dancer keeping track of their RPE, other signs for dance teachers and parents to watch out for are:
• Reduced tolerance of current activity schedule – they are just not able to keep up in class
• Sudden deterioration of performance – both physical and mental function, at dance or school
• Washed out feeling, fatigue, lack of energy – they used to voluntarily practise their class work at home but have ceased
• Body aches and pains which do not subside with rest
• Reduced immunity – they are experiencing frequent colds or sore throats
• Altered sleep patterns – the National Sleep Foundation recommends a teenager aim for between 8 and 11 hours of sleep per night, as during sleep, the brain triggers a release in hormones that instigates tissue growth and repair
• Withdrawal from friends and activities which usually bring joy
The World Health Organization suggests that kids aged between 5 and 17 should accumulate 60 minutes of vigorous physical activity daily. Many dancers will be doing in excess of this and their bodies are able to cope just fine…to a point. Any number or combination of factors can contribute to the development of an overload injury, such as:
• a rapid growth spurt – more than 1cm per month over a few months is considered significant
• a sudden spike in physical activity volume – might not even be dance-related, such as cross country running at school
• a sudden change in type of current class work – unexpected extra attention on allegro
• a recent injury to another body part which has lead to a technique modification or biomechanical substitution
• an unsustainable/unreasonable chronic load
• a recent illness
• emotional stress caused by school work, friends, family concerns
Nobody knows a dancer’s body better than the dancer themself, and most understand that mild muscle soreness is inevitable when learning a new technique, after a holiday/break or after a particularly demanding class. The challenge with young people is that thankfully most have never experienced adverse pain; the challenge is helping them to differentiate between an acceptable post-exercise soreness, a ‘warning pain’ and a ‘must stop pain’.
Charissa is a physiotherapist and Pilates practitioner with particular expertise in dance medicine. Charissa has a passion for dance injury rehabilitation and technique optimisation in the adolescent dancer, intertwining scientific-based clinical medicine with a grounded and wholistic approach to wellbeing. Charissa has worked alongside renowned physiotherapists from the Victorian Institute of Sport, the Victorian College of the Arts and the Australian Ballet Company, and managed a team of dance physios at one of Melbourne’s leading studios. Charissa currently consults on-site at dance schools across Melbourne and regional Victoria. charissafermelis.com | 0438 020 167 | [email protected]
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by Louise Drysdale
pondera.com.au | 07 3846 1488 | [email protected]
As dancers, our bodies are the most important tools we have. We need them to be in peak physical condition. When an injury occurs, we panic. Firstly, we start to wonder what is wrong, then pour back over the past few days, hours or seconds to find the point in time when it started hurting. Why is this new pain here? Will it go away and be better tomorrow? Will it come back? Will it ever get better? Will I still be able to dance?
Pain science is a huge area of scientific research. It is such a difficult thing to study because no two individuals experience pain in exactly the same manner. Here are some nifty things that pain science has taught us.
1. Pain is really useful. It’s a survival tactic. Listen to your pain and have conversations with it, your body is trying to tell you something.
2. Being stressed, anxious, fatigued or nervous can make pain feel worse. The difficult part about this is deciding how much of the pain is a mental manifestation and how much is physical. It will always be a bit of both.
3.Sometimes we find things on scans like MRIs and X-Rays and they don’t hurt.
4.Sometimes we can scan a painful body part expecting to find something to make sense of the pain, but we don’t find anything.
5.Pain is an experience shaped on past experiences with similar pain in similar situations. For example, if you rolled your ankle at an eisteddfod last year, you will likely associate competing in this years eisteddfod in the same theatre with having a sprained ankle. It doesn’t mean it will happen again, but your body will prepare itself in case it does.
6.People can lose limbs and still feel pain coming from them. This is a fascinating phenomenon that suggests perhaps there is a small area of the brain that represents each body part. The good news is that this will change over time. This phenomenon is called “neuroplasticity”. By the same token, bone, ligament, muscle and other body tissues re grow and heal. This is called “bioplasticity”. You are your own best way to heal.
Signs you might need to seek some help in better managing your pain:
1. You can’t work out how to change your pain, for example, you aren’t sure what makes it better or worse and you are having trouble modifying your dancing around it. Does your pain feel weird (not normal) or is it stopping you from dancing?
2. Your pain has lasted longer than three months. This is termed chronic pain or longstanding pain. This sort of pain requires a different treatment approach. If you have been seeing a health professional already for this length of time and you haven’t seen a change, it might be time to ask for a change (you can do this, we don’t mind) or try seeing a different health professional. We don’t always get it right and sometimes it takes a few health professionals working together to get it right.
3. You are relying on medication to get you through your dancing.
4. If your pain comes with swelling, redness, pins and needles, clicking, locking, numbness or weakness.
5. Someone has told you you won’t be able to dance anymore because of your injury or pain.
A dance physiotherapist is a good place to start, because we treat pain all the time and we understand where you’re coming from and what you’re trying to return to. Physiotherapists also recognise situations where a general practitioner, pain specialist or psychologist might also be useful in helping you to manage pain.
Where else to get help and find information? - Explain Pain- book by Lorimer and Mosley - TED Talk Lorimer Mosley https://youtu.be/gwd-wLdIHjs “Why things hurt” - http://www.painaustralia.org.au/about-pain Where I got my information - Moseley, L., Baranoff, J., Rio, E., Stewart, M., Derman, W., Hainline, B. (2018). Nonpharmacological Management of Persistent Pain in Elite Athletes: Rationale and Recommendations, Clinical Journal of Sports Medicine, July (published ahead of print) - Mayes, S., Ferris, A.R., Smith, P., Garnham, A., Cook, J. (2016). Professional ballet dancers have a similar prevalence of articular cartilage defects compared to age- and sex-matched non-dancing athletes, Clinical Rheumatology - Hainline, B (et al.) (2017). International Olympic Committee consensus statement on pain management in elite athletes, British Journal of Sports Medicine, September.
Louise Drysdale (B.Phty, Grad Cert Msk Phty) is a physiotherapist at Pondera Physiotherapy and Pilates in Brisbane. She has a keen interest in dance injury management and prevention - from budding students to seasoned professionals. She is currently Assistant Physiotherapist to Queensland Ballet and Queensland Ballet Academy. pondera.com.au | 07 3846 1488 | [email protected] | Level 1, 162 Boundary Street, West End, Brisbane Qld
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by Melanie Fuller
pondera.com.au | 07 3846 1488 | [email protected]
Dance classes work on neuromuscular coordination, this relates to your technique and balance1. Training in other areas can have a positive impact on our performance and overall health, and may reduce injuries. But how can we use our time most efficiently to achieve these results?
Research shows us that injury prevention exercise programs can reduce injuries, and enhance athletes abilities2. It has also shown us that strength training can reduce injuries by almost half3. While strength training can reduce injury, stretching has not been shown to be effective to prevent injury3.
An injury prevention training program may be affected by how often you can incorporate this training into your weekly schedule. A short program may be performed two to three times per week2. Developing muscle endurance can be a useful place to start, training certain muscle groups such as your calves, with higher repetitions, and low loads1.
Aerobic training that can be achieved by swimming, running, or cycling may also complement your dance classes. Other sports that increase your heart rate and maintains it at that level for 20-40 minutes on a regular basis could also be used1.
It’s also important to remember to schedule recovery activities, which might include getting enough sleep. Diet and hydration are also other important aspects to consider to ensure your body is adapting appropriately to the demands of your training.
The message is to start early in your dance career, train your strength and aerobic fitness appropriately with a consistent exercise program, and consider utilising recovery strategies to help your body adapt well to the demands of your training.
References: 1. Irvine, S., Redding, E., & Rafferty, S. (2011). Dance fitness. Retrieved from https://www.iadms.org/page/303. 2. Ardern, C., Ekås, G., Grindem, H., Moksnes, H., Anderson, A., Chotel, F., Cohen, M., et al. (2018). 2018 International Olympic Committee consensus statement on prevention, diagnosis and management of paediatric anterior cruciate ligament (ACL) injuries. British Journal of Sports Medicine, 52(7), 422-438. 3. Lauersen, J., Bertelsen, D., & Andersen, L. (2014). The effectiveness of exercise interventions to prevent sports injuries: A systematic review and meta-analysis of randomised controlled trials. British Journal of Sports Medicine, 48(11), 871-877.
Melanie Fuller - APA Titled Sports & Musculoskeletal Physiotherapist, M Sp & Msk Phty, M Phty, B Ex Sci, Adv Dip PA (Dance) Melanie is Physiotherapy consultant to QUT Dance. She has provided physiotherapy to Queensland Ballet, Expressions Dance Company, The Australian Ballet, Sydney Dance Company, Bangarra Dance Theatre, Royal New Zealand Ballet and Paris Opera Ballet. As well as musicals: Legally Blonde, Mary Poppins, Grease and other touring shows for their Brisbane seasons.
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by Anna Tetlow
annatetlowpilates.com.au | 0438 595 792 | [email protected]
When we think of techniques that work specifically well alongside dance and in particular classical ballet, we think of Joesph Pilates and The GYROTONIC® methods. I have a new technique to add to your repertoire and it is called Garuda. Creator of The Garuda Pilates Method, The Garuda Apparatus and founder of The Garuda Studio, James D’Silva was born and raised in Goa, India, before moving to England to become a professional dancer. I have worked with James for over 17 years and am the master trainer of Garuda in Australia. I am very excited to be be able to teach this wonderful method and to make it available ad a part of a dancers training as well being responsible for training Garuda teachers in Australia in the future.
Garuda is a perfect accompaniment to a preprofessional and professionals repertoire, it can assist and support dance teachers teach correct anatomy, is a remarkable method with proven results in injury rehabilitation and is a natural side step for professional dancers
wanting to retrain in a field that has a close synergy with dance.
Garuda combines the spirituality, pranayama and asana practice of yoga, the core strength and focus of pilates and the balletic grace of dance increasing strength, flexibility and body tone. It has all the benefits of a robust cardiovascular workout, while stretching the mind as well as the body. Garuda is a test of mental strength as well as physical, demanding total concentration during the exercises.
Using the specially designed Garuda apparatus, mat or other complementary equipment you’ll learn to control your body through precise stretches and actions, placing an emphasis on smooth, seamless movements without any stress on the joints. Through routines carefully choreographed you will work every area of your body.
Because of the choreographic, fluid nature of the technique dancers greatly enjoy and benefit from classes wether it be for strength, stretch, rehab or overall fitness. Garuda makes for a perfect cross training activity to complement your dance practice.
Developing Garuda training alongside dance training helps to strengthen and safeguard against injury. Programs can be developed for the touring dancer to support their schedule. Sessions are tailored to the individual need of the dancer, focusing on turn-out, pelvic stability, optimum hip extension, foot strength, alignment, correct thoracic placement for ports de bras, pointe work strength and muscle efficiency. Anna has developed a technique that is transferrable to the ballet class, and works to ensure dancers are firstly aware of any imbalances, and then able to take responsibility for the advancement of their own technique. This technique and anatomical knowledge of their own personal architecture empowers dancers to understand their own bodies, its strengths and frailties.
Anna Tetlow trained at the Royal Ballet School and went on to perform internationally with numerous prestigious ballet companies, culminating in over 30 years of experience in the elite ballet industry. As a Pilates teacher with 20 years of experience working with remedial professionals in rehabilitation she also continues to work closely with James D'Silva giving and as his master trainer for Garuda Australia she is responsible for all teachers trainings in Australia. A ballet examiner and educator of young dance students in injury management and correct muscle use to achieve optimum classical technique, she continues to work alongside ballet teachers, ballet companies and medical professionals to achieve the best results for dancers refining technique and rehabilitation from injury. Anna is passionate about mentoring dancers during both their major transitions, student to professional and life after stage. annatetlowpilates.com.au | 0438 595 792 | [email protected] | 165 Miller Street, North Fitzroy, Melbourne Victoria
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by Michael Bellantonio
southsidephysio.com.au | 02 6282 5010 | [email protected]
In the immortal words of Tina Turner and Rod Stewart: two can really ease the pain, like a perfect remedy.
As a male physiotherapist with a special interest in treating dancers, developing a good rapport with them is paramount. Most of my dance clients are young females, so they need to feel comfortable with me treating them. The importance of a good professional relationship and communication cannot be underestimated. It is as important as the interventions I provide to the dancer.
Over my fifteen years of clinical experience, I have come to appreciate that injuries to dancers can leave them devastated. Frequently I hear “will I dance again?”, ”when can I dance again?”, “I have an eisteddfod this weekend, will I be fit to dance?” And when you look at dance specific blogs, this type of thinking and questioning is a common theme. You can’t blame dancers for being upset at the thought of possibly not being able to do something they love and have worked so hard at. I would be no different. This is where providing clear education to the dancer can affect both their attitudes and behaviour. I work together with the dancer to set realistic goals and functional targets as part of their rehabilitation, being mindful that rushing back to dance too soon could potentially see an aggravation of their current issue, or the development of another. The dancer should feel like they have control over their injury and take ownership of their recovery. This can be extremely empowering for them in a time when they feel somewhat hopeless. You can feel their mood lift and the tears stop, replaced by a sense of optimism and excitement about the challenges ahead and returning safely to dance, not only with a lower risk of injury, but with improved aesthetics. I get a real buzz hearing my dance clients tell me that since they started doing the exercises I have given them, they receive fewer corrections in class and they feel stronger and have more control.
It is only through a good rapport that I get to appreciate the different personalities and eccentricities of my dancers. Personality makes a huge difference in the language I will use with them. Some are prone to catastrophising and irrational fears about their injury and they require a higher level of empathy, especially when there is a hard to diagnose problem or a diagnosis that potentially carries with it a long term recovery. Others will shrug their shoulders and get straight into the rehab – these dancers I can be more direct with. One of the best pieces of information I received at a dance therapy course was from Paula Baird-Colt about being mindful of the language you use to dancers, as it can have a negative impact on their psyche. As such, I have changed the words I use in describing deficiencies that I would like to change. “You’re weak!” or “you’re doing that wrongly!” all carry a negative tone. It is much nicer for the dancer to hear “you use this strategy, which is fine, but I’m going to show you a different strategy to try and we’ll see if that helps things.” Research shows that using language that makes a client feel incompetent leads to poor exercise adherence. Using language that gives them some autonomy and control over change greatly improves exercise adherence.
I have also come to appreciate the dancer’s perspective in the therapist-client relationship. They need to have clear communication from me. They need to have confidence that as their therapist, I possess the knowledge to help them, and will be humble enough to re-evaluate any diagnostic hypothesis should things not be progressing as anticipated. They need me to understand and appreciate the demands – both physical and psychological – of their craft. Finally, I should listen to and enquire about their goals of the treatment, and have enthusiasm for the treatment.
I now have a lovely list of dance clients, some of whom I have treated for almost ten years, and they are happy to confide in me any small niggle they have without fear I’ll simply pull them from dance for two weeks. This has only been made possible by developing a strong professional relationship with the dancer, their parents and their dance school, all of whom are assured that I will do my utmost to manage any injuries to the best of my ability. I reciprocate by having trust in the dancer that they will adhere to the treatment plan we have developed together, to ensure optimal recovery, safe return to dance and future prevention.
It takes two.
Michael is a Senior Physiotherapist at Southside Physio, Woden in Canberra. A Titled APA Sports Physiotherapist with over fifteen years of experience, he has worked with elite level male and female rugby players and lectured on APA Sports Physiotherapy courses. Over the years he has developed a passion for treating dancers, undertaking multiple courses and workshops from some of the best minds in Dance Medicine to ensure his knowledge and skills for managing dance related injuries are of the highest quality possible. southsidephysio.com.au | 02 6282 5010 | [email protected] | Level 1, Canberra Healthpoint Building, 16 Wilbow Street, Woden ACT 2606
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thebalanceddancer.com | [email protected] | 0415 715 080 The importance of a regular dance class builds socialisation skills, develops 'team spirit', allows for easier pathways to group performances and concerts, and provides students with clear, real-time benchmarks at their level within the class environment. So, where does private coaching fit in?
"tailored coaching plans can be developed to harness a dancer's strengths and rectify and overcome any limitations."
Natalie Orola is the Founder of The Balanced Dancer. Natalie is an Associate of the Australasian Dance Association (ADA) (formerly the Federal Association of Teachers of Dancing), an Affiliate Member with The Commonwealth Society of Teachers of Dancing (CSTD) and trained in the Royal Academy of Dance (ballet) syllabus, holding over 10 years of dance teaching experience at various dance schools throughout Sydney, Gold Coast and Brisbane, Australia. thebalanceddancer.com | [email protected] | 0415 715 080
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by Holly McPaul
baimed.com.au | 02 4227 1990 | [email protected]
What is a Dance Screen?
A dance screen is comparable to the appointments you make with your dentist or optometrist, except for the dancers body. We look at movement patterns, technique and dance movement control. Sometimes it is a simple thing that throws off the rest of the body or movement pattern and is easily corrected with exercises (that we call correctives). Your dance screen will be part of your dancer profile, allowing us to compare previous screens, and we can track changes to make sure that students continue to perform at their very best.
The screen is also very beneficial for the students parents and teachers and supports the teaching of safe and correct technique ensuring the activities done in youth do not hurt the adults body later in life.
How often should you be screened?
Ideally 3 times per year. We must consider that the body is always growing and changing and physical work load and demand are usually increasing as well.
Why have a dance screen?
The screen helps to determine any areas of a dancers’ body that could be prone to injury and highlights any areas, like their strength or flexibility, that can be improved on, from an aesthetic or performance perspective. Exercises are often simple but highly effective. Seeing a dance physiotherapist like myself, once every three to six months, decreases the likelihood of load related injuries. Every dancer is a changing athlete that needs reassessing and managing to assure that their physical capacity and their physical demand remain equal.
We are able to direct dancers to the the BaiMed Performance Centre to work under our highly skilled sports science team. Here they receive further objective testing and strength programming specific to the needs of the dancer identified in the screen.
The biggest goal is to keep people injury free so that they're in the studio doing what they love doing. That's my number one goal.
Are you seeing an increase in any types of dance injuries?
I am seeing more load related injuries, such as stress fractures and tendonopathies (chronic inflammation of tendons). These occur for a number of different reasons. Sometimes it is when training or performing volume increases rapidly and there’s not enough recovery time between classes or performances. Sometimes they occur when difficult skills or movements are performed incorrectly. A lot of the time they can occur because of a strength or range of motion deficit that’s causing a particular body part to become overloaded beyond its physical capacity.
There is a lot of focus in the world of elite sports around capacity versus load and the idea is that to minimise injury, we have to ensure that workload doesn’t exceed physical capacity. It’s the same with dancers who are essentially training as elite athletes. When load (the amount and types of dancing you are doing) and capacity (how strong and flexible you are) are out of balance we see load related injury starting to occur.
With the aid of Social Media there is a lot of pressure on young girls and boys to be able to do skills that are perhaps above and beyond their skill level. Some students are also not being taught by professional or skilled or experienced dance teachers. Seeing a dance specialist physiotherapist will help those parents without an extensive knowledge of dance understand how incorrect technique can cause injury.
Holly McPaul from BaiMed is a Physiotherapist and Exercise Physiologist with a Bachelor of Exercise Science and Rehabilitation UOW, Master of Physiotherapy USYD. Holly has danced since she was 3 as well as taught dance for many years. Holly is an advocate for specific programs for dancers – including a Dance Specific Screen, designed to highlight strengths and weaknesses in order to structure programs to suit the individual.
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by Katelyn Boshell
thedancetank.com.au | 0415 839 030
Maintaining a dancing body at peak performance level can be a struggle for dance students rehearsing for an eisteddfod, exams or even for their final NSW Higher School Certificate (H.S.C) practical examinations.
"Students often hear that they need to prepare their bodies both mentally and physically, but what does this really mean?"
Students undertaking the NSW 2 Unit H.S.C Dance Course through their secondary school/college or externally study the essential components required for body maintenance. The course teaches the core principals of the Safe Dance Practice pedagogy to ensure bodies are prepared for examination at peak fitness level, as well as safeguard against injury.
Students develop their physical dance technique through a series of contemporary dance exercises that concentrate on correct alignment to dance efficiently without the threat of injury.
Exercises begin on the floor focusing on Graham Technique through static stretching and spinal alignment curves and extensions. Moving to the barre, exercises such as tondues and balances assist the student to find their core stability. Centre-work follows, such as adage/shape exercises allowing a better understanding of engaging the required muscles to ensure correct quality of line. Lastly, a range of travelling/locomotor sequences explore kinaesthetic awareness as well as improve stamina and endurance for performance examination pieces.
Mental preparation for these final examinations is as crucial as training the physical body. The H.S.C Dance Course provides students with the knowledge of beneficial body maintenance tools consisting of healthy nutrition and hydration, good sleeping patterns and alternative lifestyle physical activities such as walking, swimming, Pilates, Yoga etc. to maintain a healthy and fit body. A healthy body provides a dancer with the ability to maintain a positive and confident attitude which will enhance their performance quality and portrayal of their work.
Undertaking the H.S.C. Dance Course is an excellent foundation for an individual’s future career in dance. Obtaining knowledge and understanding of the anatomical mechanics of the body; injury prevention practices; and mental preparation skills; are integral elements for establishing a well-rounded dancer and increasing the longevity of their professional dancing career.
Katelyn Boshell has over 20 years of experience in the field of Dance. Experience includes but not limited to; NSW Department of Education trained Primary and Secondary teacher (B. Arts/B. Education Honours UNSW) specialising in Dance and Schools Spectacular choreographer for the past 6 years.
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by Louisa McGinness
easternsuburbssportsmed.com.au | [email protected] | 02 9389 2766
"Up to 75% of dance injuries are preventable – so how can I reduce the risk of getting injured?"
Research has estimated that up to 75% of all dancers’ injuries are due to overuse1, regardless of the age, gender or training level of the dancer2.
Overuse injuries develop over time and are a result of repetitive pulling, twisting or compression. A key to avoiding injury as a dancer can be as simple as avoiding significant changes in overall dance training – a concept referred to as ‘load management’ in sports medicine. The long hours involved in dance training do not cause injury – it’s how you build up to long training periods that is important3 in injury prevention.
Situations which commonly involve significant change in training load for dancers include: commencing fulltime training, starting a new contract after a period of time off, returning to dance training after holidays, starting new choreography, or an increase in classes or rehearsals prior to exams or performances.
It is important to anticipate upcoming changes in load, and to plan ahead. Preventing injuries can be as simple as maintaining some level of training or physical activity during holidays, or slowly increasing your training in anticipation of an increase in your load after commencing fulltime training.
A common tool used by elite athletes to monitor training load change is called the ‘acute: chronic workload ratio’. An example for dance students may involve calculating the average of the hours spent in classes or rehearsals over 4 weeks. If a dancer increases their hours of training by more than 1.5 times the average of the previous 4 weeks, they may be 2–4 times more likely to sustain an injury in the subsequent 7 days3.
The longer you are involved in fulltime training, the less likely you are to be injured4. Overload injuries may also be more common in periods of rapid growth – it may be worth tracking your growth on the wall during your teenage years.
‘Acute’ and ‘Overuse’ injuries – how do I manage them?
An acute injury is a sudden onset of pain associated with a particular movement or incident, such as a sprained ankle, strained muscle or an injury due to direct impact. Rest, ice, compression and elevation are the essential first steps to reduce the tissue damage that occurs from swelling and bruising.
Ice can also be effective in the short-term management of overuse-type injuries, providing relief from swelling and inflammation, which can often accompany pain.
With both acute and overuse injuries, it is important to have the injury promptly diagnosed and managed by a health professional who understands the demands of dance training. Health professionals with experience working with dancers are able to help you resume your training in a modified capacity as soon as possible, minimising loss of fitness and strength associated with injury. Acute and overuse injuries can worsen if dancers delay seeking appropriate advice and treatment. Prompt injury diagnosis and correct management, as early as possible, can significantly reduce the recovery time associated with injury.
If you are suffering an overuse-type injury following an increase in training, see your physiotherapist or doctor as soon as possible to facilitate a speedy recovery.
Louisa McGinness is a Sports Physiotherapist at Eastern Suburbs Sports Medicine Centre. She was the full-time physiotherapist for Matilda the Musical through their Sydney and Melbourne seasons and the physiotherapist for the Top 20 of So you Think You Can Dance Australia in 2014. Verity Wright, Sports Podiatrist, is also able to provide treatment and advice tailored to dancers. Louisa and Verity have extensive dance training and are available for consultation at Eastern Suburbs Sports Medicine Centre.
Podiatry for Dancers – Verity Wright
Our feet are the foundation of our dance.
Barefoot and shod dancing can both elicit abnormal stresses on our feet and toes.
Excessive pain and discomfort in the feet and toes tolerated over a period of time can lead to chronic and degenerative concerns.
Having your feet assessed by a Podiatrist will allow your foot health to be assessed and management options explored. Treatment can include; mobilisation to the joints, taping techniques to offload inflammation, special toe devices to unload pressure, special dancing inserts to redistribute pressure areas.
Additionally our skin and nail health can be severely disrupted by our dance practice. Skin and nail issues can be best treated by your Podiatrist.
1. Smith, P. J., Gerrie, B. J., Varner, K. E., McCulloch, P. C., Lintner, D. M., & Harris, J. D. (2015). Incidence and prevalence of musculoskeletal injury in ballet: a systematic review. Orthopaedic journal of sports medicine, 3(7), 2325967115592621. 2. Yau, R. K., Golightly, Y. M., Richardson, D. B., Runfola, C. D., Waller, A. E., & Marshall, S. W. (2017). Potential Predictors of Injury Among Pre-Professional Ballet and Contemporary Dancers. Journal of Dance Medicine & Science, 21(2), 53-63. 3. Hulin BT, Gabbett TJ, Blanch P, et al. Spikes in acute workload are associated with increased injury risk in elite cricket fast bowlers. Br J Sports Med 2014;48:708–12 4. Caine, D., Bergeron, G., Goodwin, B. J., Thomas, J., Caine, C. G., Steinfeld, S., ... & André, S. (2016). A survey of injuries affecting pre-professional ballet dancers. Journal of Dance Medicine & Science, 20(3), 115-126.
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By Susie Bond
evolutionpilates.com.au | [email protected] | 02 9518 5009
Would just two visits a year to a specialist dance physiotherapist make a significant impact to injury prevention?
Dance physiotherapists love to assist dancers achieve their top goals in dance. Everyone visits the dentist regularly to prevent dental problems. Regular visits to a specialist dance physio should be made, in the case for dancers going through rapid growth spurts. Simple core stability, joint strengthening and leg alignment exercises can make all the difference for injury prevention.
"When I give a specific strengthening exercise to a dancer, I often say “this is like a ‘cleaning the teeth’ exercise”, that is something you would do every day."
Research shows that dancers are more prone to injury (e.g. Knee), as a teenager, when number of hours of dance load increase per week. It is good to a see a specialist dance physiotherapist to manage an injury and do a Pre pointe assessment. It is also important to check out physical niggles and limb and trunk alignment issues, before a big problem arises. A regular visit to the dance physiotherapist at least 1-2 times each year, will help guide the dancer, their parents and teachers through the many changes during the adolescent growth time.
Susie Bond is the Director of Evolution Pilates and MG Pilates, she is a Physiotherapist, Pilates Instructor, Dancer Physiotherapist and commenced dance training when she was 5. Susie runs regular lectures to Pilates teachers, dance schools and post Dance degree courses in Australia and UK. She is a founding committee member of the special Dance Network, in the Sports Australia group of the Australian Physiotherapy Association, which organised lectures to teach physios how best to treat dancers. She is a member of the Australian Pilates Method Association and of the International Assoc. for Dance Medicine and Science. Her passion is for dance, performance enhancement, healing physio treatment and injury prevention.
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by Jocelyn Penna
performancepsychology.com.au | [email protected]
People drawn to dance possess many amazing traits, beliefs and values that enable them to excel such as determination, emotional connection and focus. Yet, these same characteristics can place dancers at risk of suffering from stress and high pressure. Developing awareness of your strengths and vulnerabilities can help you keep a healthy, productive and enjoyable balance.
When Weight Watching is turning into something harmful.
Dancers bodies are their instrument, and not only are they required to keep it in good working order, but they can also feel the pressure to keep it looking a certain way. Being externally judged means that dancers often watch and scrutinise their own bodies more closely than other people may. This scrutiny can become problematic.
Weight watching may be turning into something harmful if you are significantly restricting food intake, feeling overly tired, thinking or talking about appearance often, comparing what you eat to other people, fear gaining weight, making excuses about what you are eating or are eating in private.
All people benefit from a healthy diet. We all need differing amounts of nutrients and energy for our body to perform optimally. Unhealthy weight management habits can quickly result in you being unable to perform, hinder your future in dance, and lead to permanent detrimental changes in body and brain functioning. More information about disordered eating can be found on the Butterfly Foundation website- thebutterflyfoundation.org.au.
You cannot perform your best if you are not physically and mentally healthy. If you’re not sure if your nutrition is meeting your needs, consult a sport dietitian who works with dancers. If your mind is stuck on thoughts about body image, or you don’t feel good about yourself for any reason, then talk to someone you know who cares about you, or consult a sport psychologist familiar with the demands of dance.
Dancers often become passionate about their craft at a young age. They can identify strongly with dance and become personally and emotional involved in their roles. Identifying strongly with something is great, it means you are passionate, committed and have great potential to be an expressive and animated performer.
"Dancing is what you do and what you love, but you are much more."
You could be a loyal friend, caring daughter or son, committed activist, passionate thinker, strong leader, and many other things.
Performances face external judgement, which despite being subjective, can be taken personally. So those with a narrow identity may struggle when faced with the challenges of being a performer. If your worth is being pushed around by nerves, performance results, body image or injury, it’s valuable to explore why. When you appreciate seeing yourself as you really are, you allow your performance and enjoyment to grow enormously.
Jocelyn Penna from Focus Performance has 15 years experience working with professional and developing performing artists. She enjoyed background in dance and now studies the psychological challenges and rewards of being involved in the field.
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by Deborah Chen
inspiredphysio.com.au | [email protected]
As dancers continue to push their body right to the extent of their flexibility I’m seeing an increase in hip pain complaints – particularly a pinching in the front of their hip when doing front kicks or developping leg to devant. Sometimes the pinch is only there with those particular activities and other times the pinch turns into a deep, dull ache that can last for a few hours and can eventually become constant.
This pain could be caused by a couple of different things – it could be something as simple as adjusting technique because of an overactive hip flexor muscle and as complex as torn hip cartilage (also known as a labral tear). Having been someone who has ‘faked’ her turnout for most of my dancing life, experienced labral tears in both my hips and had two hip arthroscopy surgeries to repair them I am a big advocate for learning about your true turnout muscles or deep hip rotators and stabilisers.
There are six muscles that work to exclusively rotate your thigh bone or femur outwards – they are your piriformis, quadratus femoris, obturator internus, obturator externus, superior gemilli and inferior gemilli. These muscles work to give you standing leg turnout as well as active turnout for things like demi plie or maintaining turnout when your leg is en lair in a developpe. If you’re looking for whether you’re working the turnout muscles correctly you should feel them contract around your lower bottom around the bottom of your leotard. Try this by standing with your feet together in parallel and rotate your thigh bones outwards – you may notice your knee caps now face directly forwards and feel your lower bottom muscles contracting.
Activating your turnout muscles should take some pressure of the hip flexors doing all the work but you also need to stabilize your thigh bone in its socket. To do this we need to activate the illiacus. The illiacus is a bit of a secret muscle – it sits inside the front of your pelvis and combines with the psoas to become the iliopsoas. The hip joint is a ball and socket joint and the illiacus is there to help hold the ball centrally in the socket. If you’ve loosened up your hip flexors and are still getting a pinch or blocked feeling in the front of your hip you could be experiencing anterior hip instability as a result of an underactive illiacus. This could potentially be reducing the height of your kicks and developpes in devant.
"Many dancers are also told that they are ‘hypermobile’ or ‘lax’ in their ligaments – which is fun when you want to be flexy but less fun if you’re experiencing pain due to lack of muscle/ligament control."
Something as simple as learning to activate your illiacus muscle may help to reduce laxity pain you experience in your hips and may even reduce clicking of the hips.
I can’t stress enough, the importance of acting on pain or restriction as soon as you notice them. It doesn’t always mean you’ll need to stop dancing – it may mean an adjustment in your technique and learning to activate the correct muscles to rehab and prevent further injury. Don’t be scared to speak up and let your teachers know if you’re struggling – it could very well be what prevents long term injuries in the future.
Deborah Chen Registered Physiotherapist B.App.Sc. (MRS-RT), Master of Physiotherapy from Inspired Physiotherapy Deborah studied dance as a child completing her Major 3 level in Ballet (Australian Dance Assessment Program). She has also taught ballet and lyrical in the Hills area of Sydney.
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by Samantha Jakelic
kineticaphysiotherapy.com.au | [email protected] | 02 9948 6188
Dance teachers and students are constantly talking about and working on making the most of turnout. It is what makes Ballet fundamentally unique. Turnout is the ability to outwardly rotate the leg so that the knees and toes turn away from the midline. The “perfect” 180o turnout is often desired amongst dancers and choreographers because of its aesthetic appeal. However, did you know that turnout has also been shown to allow more efficient weight transfer, better control of extensions and reduce the risk of injury?1
What does turnout really mean?
The vast majority of turnout is achieved by external rotation of the hips within their sockets and is often referred to as pure turnout. This pure rotation from the hip joints when combined with a small amount of outward rotation of the knees and ankles this is called your functional turnout. Pure hip rotation is the key area for working your turnout – it should contribute 80-90% to the standing in 1st position functional turnout. Using too little from the hip and too much from the knee, shin and foot can increase the risk of injury. Turnout can be influenced by the strength and flexibility of the surrounding muscles, bony architecture of the joints and laxity of the ligaments. As a result, we think about turnout in two different ways – how much can the hip joint give you (in the joint, ligaments and tissues) and how much strength do you have in your turnout muscles (actively).
Passive turnout (Your turnout potential!):
Passive turnout is the maximal possible amount of movement at the joints. It is achieved without the use of any muscles and is largely dependent upon the orientation and shape of the bones, laxity of the ligaments and joint capsules. Subtle differences in pelvis and hip joint development influence the passive hip turnout potential. The depth of the hip socket, the direction of the hip socket and many other factors all affect the potential turnout. When we measure turnout, we examine the relaxed amount in the hip joint with the leg in neutral – this represents what we traditionally consider our hip turnout - the passive amount in 1st position. Passive turnout is achieved when a therapist or teacher turns a dancer’s legs into turnout while the dancer is lying relaxed on a bed. However there are other places where turnout is important and limited by the bones and joint structure. We also need to consider:
turnout capacity elevated at the front (attitude and arabesque)
turnout capacity while elevating into 2nd
turnout capacity while elevating behind you
Active turnout (Your strength):
Active turnout is achieved when a dancer moves into turnout on their own such as when standing in 1st position. It relies on the activation of the muscles that move the leg into turnout and the relaxation of the muscles that oppose this movement.
Literature2 has shown that passive turnout range in the hip joint unfortunately does not improve across childhood or adolescence. Gains in turnout range is to do with strengthening our hip rotators and stretching the opposition muscles. So in order to improve our turnout we should be focused on exercising the muscles that help us move into turnout. It is important to work safely within your joint capacity! Strengthen but work safely and smartly with your physiotherapist and teacher to maximise your strength.
Does dancing help or hinder my turnout?
By repetitively practising the precise movements that are specific to the artistry of ballet will actually help you improve your turnout. Research3 has shown that strength in the muscles of the hip improved with training and continues to build through the first year of a full time program to a greater extent in dancers than in non-dancers. So it is more likely that dancing will help rather than hinder your turnout.
What can I do to improve my turnout?
1. Strengthen the deep hip external rotators: The deep muscles that sit closest to the hip joint (quadratus femoris being the main one) are responsible for actively moving our hip into external rotation. These are the muscles we want to target to improve our active turnout range.
2. Improve core activation to ensure neutral lumbo-pelvic-hip alignment: A neutral line through low back, pelvis and hip will ensure efficient activation of our deep hip rotators and help to optimise movement.
3. Ensure adequate flexibility of the hip internal rotators: A lack of flexibility of the hip internal rotators (adductors, tensor fascia latae, iliopsoas and pectineus) will restrict active hip outward rotation. Releasing these muscles will help to maximise turnout range.
We strongly advise arranging a consultation with your friendly dance physiotherapist for an assessment to determine the specific exercises that will help you improve your turnout.
Does not having “perfect” 180o turnout mean I will never become a professional dancer?
The “perfect” turnout is measured in first position and is described as 180o of leg external rotation. Experts agree that this is rarely attainable due to the structure of our hip bones. Overcompensating and attempting to maintain rotation beyond the strength and joint capacity can place the dancer at risk of pelvic and hip pain, shin splint and knee injury. Ideally, we want almost all of our turnout to come from hip external rotation rather than forcing it from our knees and ankles. This means that for most people 180o of turnout is not physically possible.
Many professional dancers with successful careers do not have the “perfect” turnout with the most recent research showing company level classical dancers averaged 60o of passive external rotation (from each hip), 35o of active hip external rotation and 133o of functional turnout when standing in first position. At the enthusiast level, dance physiotherapists see normal range at 45o of passive rotation potential but this number varies enormously.
"Dance encompasses a whole lot more than just perfect turnout – artistry, grace and musicality. Maximising your strength and learning to use it by keeping knees in alignment with toes, there is every possibility that less than perfect turnout will still permit you to have a successful dance career."
1 Pata, D., Welsh, T., Bailey, J., & Range, V. (2014). Improving turnout in university dancers. Journal of Dance Medicine & Science, 18(4), 169-177. 2 Steinberg, N., Hershkovitz, I., Peleg, S., Dar, G., Masharawi, Y., Heim, M., & Siev-Ner, I. (2006). Range of joint movement in female dancers and nondancers aged 8 to 16 years. The American journal of sports medicine, 34(5), 814-823. 3 Bennell, K. L., Khan, K. M., Matthews, B. L., & Singleton, C. (2001). Changes in hip and ankle range of motion and hip muscle strength in 8–11 year old novice female ballet dancers and controls: a 12 month follow up study. British journal of sports medicine, 35(1), 54-59. 4 Washington, I., Mayes, S., Ganderton, C., & Pizzari, T. (2016). Differentials in Turnout Among Professional Classical Ballet Dancers. Medical problems of performing artists, 31(3), 160.
Samantha Jakelic Physiotherapist APAM. Samantha was a former dance student herself, she understands the importance of preventing injuries, chronic injury management and fixing those niggles fast. Sam understands that providing alternative activities to maintain fitness, strength, and flexibility when an injury occurs is the cornerstone to a dancer’s recovery through every part of their lifespan.
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by Suzanne Way
professionalballetcoaching.com | [email protected] | 0407 010 286
What is something dancers really struggle with when they get injured?
In my experience I have found dancers struggle with the time frame of their injury. How long will I be out of class and rehearsal? What opportunities will be missed? These questions immediately set up a stress reaction in the body and must be dealt with carefully.
Why should dancers continue to do class whilst recovering from an injury?
The prime function of remedial coaching is to work with the injured dancer privately at their own pace to restore strength and integrity to the area and most importantly to correct the posture and technical weakness which created the injury in the first place. To join class is to work at the pace of the other dancers and would not be recommended until I felt confident the dancer could cope with the demands of class without compromising the results already achieved. By all accounts the first experience rejoining class must be positive, essential to restoring confidence and self esteem.
What advice do you offer dancers during this very trying time?
Mentoring is paramount, psychologically the expectation of pain either continuing or returning is always present. Will the injury hold up under normal class/rehearsal conditions?
Questions the dancers ask themselves, Will my injury support multiple pirouettes? Will my injury sustain working en pointe? Will my injury support my body through allegro work without cause of re injury?
Strengthening the mind, trust, encouraging the belief system to remove the mental blocks associated with the healing process can not only benefit but encourage a very positive recovery with a stronger disposition and less risk of self sabotaging in the future.
What should dancer and parent do?
As an experienced remedial coach I feel both the dancer and the parents must trust and be invested in the structured plan suggested and the time involved for recovery. To date this has been highly successful with outstanding results, the dancer is proactive armed with the knowledge and resources to prevent and overcome further injuries. Students do return from overseas to be coached privately, they trust me implicitly and know they have my best interests and confidentiality at heart.
Suzanne Way A.R.A.D. director of Professional Ballet Coaching Australia is now specialising in remedial coaching. A life member of the Royal Academy of Dance she trained at both The Australian Ballet School and The Royal Ballet School in London. She has an extensive career in classical ballet including The Royal Ballet and The Australian Ballet. Suzanne has created successful curriculum for full time students in both the U.S.A and Australia and now due to success devoting her time to remedial coaching.
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by Shannon Trotter
ssphysio.com.au | [email protected] | 02 9527 4099
A dance assessment carried out by a physiotherapist who specialises in treating dancers can be used to identify a dancers' strengths and weaknesses which in turn may decrease their risk of injury. It is also used to assess readiness for pointe work and for general improvement in technique and performance. Often, dancers will present to our clinic with injuries that could have been avoided with prior assessment and appropriate management programs. The long term benefits are immense with reduced risk of injury, less time off dancing and improved performance.
A study posted in the Journal of Athletic Training shows that 42% of dancers before the age of 8 had previously sustained an injury. The physical demands of repetitive practice puts a large amount of strain on a young dancers growing body. Growth spurts usually occur from ages 8-12 (girls) and 10-14 (boys). During this time, extra stress placed on the body through dance can cause stress fractures, tendinopathies, torn ligaments and various other injuries.
A typical dance assessment may include;
- A thorough dance history and injury history
- Postural assessment
- Assessment of range of motion of joints - particularly those in the lower limbs and feet
- Assessment of turnout range of motion as well as strength of deep hip rotators
- Pelvis and trunk stability - this is the ability to activate the deep core muscles dynamically to control movement and protect the spine
- Intrinsic foot muscle strength as well as ankle and foot stability
- A range of dance specific skills
- Growth - physical and mental development and readiness
Other than biomechanical risk factors assessed by the physiotherapist, another key to preventing dance injuries is being aware of young dancers growing bodies and educating dance teachers, adjudicators and parents on the dangers of pushing young dancers beyond their physical limits. Dancers have an amazing sense of body awareness; however often struggle to understand the difference between muscle fatigue from exercise and "bad" pain from an injury.
Tips for safe dance practice;
- Don’t keep dancing on an old injury. If you have had an injury for more than a few weeks and are hoping it will "just go away by itself" - chances are it won't, and you are more likely to make it worse with more dancing. As a rough guide, any pain that lasts more than 3 days should be assessed.
- Full rehabilitation of an injury is essential. The absence of pain does not necessarily mean your injury has recovered. It is imperative that you recover full range of motion, strength and dance specific skills so that you are able to dance to your full potential without becoming injured again.
- Know the difference between "good" and "bad" pain. Listen to your body. Dancers will often push through pain with the fear that they won't be able to dance at all.
- If you're injured, you can't keep doing the same thing." If you don’t change what you're doing- then expect the same results". If you have an injury and keep aggravating it, it will never improve. It is important to listen to your physiotherapists instructions on what you can and can't do. It is highly unlikely that your physio will ever prescribe total rest for an injury. It is likely they will send you back to dancing as soon as possible with a modified dance program.
- See a physiotherapist who specialises in dance. We all know dancers are not your average humans. They are expected to be able to achieve so much more in regards to flexibility and strength. Physiotherapists with dance experience will have the knowledge of what you are likely to do in each class and therefore can more easily fine tune a modified dance program for you. Their knowledge is also essential in the end stage of rehabilitation where dance specific training and exercises are necessary for an injury-free return to full dancing.
Whether you have an injury or you just would like to improve your technique, undergoing a dance-specific musculoskeletal assessment will put you in a strong position to enjoy injury-free dancing and enhance your performance.
Shannon is a Physiotherapist at Southside Physiotherapy & Sports Injury Centre. Her love of dance began when she started ballet at 3 years old. Shannon is able to bring together the knowledge and skills she has as both a dance teacher and physiotherapist to successfully treat dancers in her clinic.
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by Louise Drysdale
pondera.com.au | [email protected] | 07 3846 1488
Do growth plates in the foot affect the ability for the dancer to commence pointe work and can commencing pointe work too early create long term negative side effects?
These are difficult questions to answer because there is a lack of research explicitly investigating this. Growth plates are a bit like elastic in pregnancy pants - in young dancers, they are not yet comprised of fully calcified bone, in fact they are cartilaginous and ready to expand and grow as a dancer gets taller. Growth plates (around the ankle) generally fuse at age 14 for girls and age 16 for boys. Most girls I see progress to pointe are 11.5- 16 years of age. The International Association of Dance Medicine and Science recommends age 12 as an appropriate age to start or start preparing for pointe work.
Commonly, the injuries we see that are usually aggravated or occur during pointe work include ankle sprains, foot bone stress reactions, posterior ankle impingement and tendon pain, most of which can be resolved with good movement analysis, treatment and management. A comprehensive pre -pointe assessment allows the opportunity to educate dancers about their bodies to minimise the risk of these occurring.
Perhaps the real question (which we also don’t know the answer to) is - what would happen if a dancer were to start pointe at 15 years instead of 10 years? Would their chances as a professional dancer be hindered? Would they be stronger and have had more time to work on developing technical proficiency?
There are many factors to the dancer being ready for pointe work but what are you looking at in the foot for pointe shoe readiness?
To align yourself en pointe, you need to be able to achieve 180 degrees (a straight line) through your shin, ankle joint and metatarsals. Sometimes, even with exercises and physiotherapy help, a dancer cannot achieve 180 degrees. It is then that the student, teacher and physiotherapist should consider the safety of the dancer in making the decision to go ahead with pointe work.
A hypermobile (flexible) foot can be problematic. Dancers who have no trouble achieving 180 degrees (and more) often find it difficult not to sink into the pointe shoe or balance on one leg on a flat foot in a pointe shoe because their muscles aren’t strong enough to control the ankle or small joints through the midfoot. I always test simple toe co-ordination foot lumbrical muscle exercises and make this part of an everyday routine.
"If you are a dance teacher and have students preparing for pointe, ask them to take barre in bare feet occasionally - it will reveal many secrets hidden beneath the canvas flat!"
Sickling and over fishing are equally undesirable habits, so care should be taken to correct these in everyday rises, tendus, jumps etc.
What are some of the more common issue that prevent dancers going on pointe that can be assisted with physio and Pilates exercises?
1. Old or current injuries! This is a familiar scenario- a dancer will present for a pre-pointe assessment, although with questioning they reveal back, knee or hip pain that currently affects their dancing and hasn't been addressed. It’s very hard to develop competency en pointe when you are already compensating for pain somewhere else.
2. Optimal use of turn out from the hip. It is absolutely possible to dance professionally without having "flat" turn out. However, activation of the deep external rotators of the hip during basic ballet movements is often lacking.
3. I will ask a dancer to do "as many calf rises as they can" on a single leg in parallel, with good foot (controlling sickling and fishing), knee, hip and trunk alignment. Depending on the age and experience level of the dancer, 25-35+ calf rises is a good target.
4. Whole body trunk and pelvic co- ordination in ballet and non- ballet context. The "Airplane Test" is (according to research) viewed by therapists and dance teachers alike as a good indicator of pointe readiness. There is a handy YouTube video of this test in cyberspace.
When starting pointe work, you should be making a commitment to yourself to really look after your body and dedicate time and energy to ballet and conditioning exercises beyond that of “just a hobby”. Chronological age and skeletal maturity are only part of the puzzle. All clients who visit for a pre-pointe assessment leave with homework, even if the answer is "yes" to pointe shoes. Such is the life of a dancer!
Louise is a physiotherapist at Pondera Physiotherapy and Pilates in Brisbane. She has a keen interest in dance injury management and prevention- from budding students to seasoned professionals. She is currently Assistant Physiotherapist to Queensland Ballet and Queensland Ballet Academy.
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by Andrew Cobb
sports-spinal.com.au | [email protected] | 03 9878 8088
Osteoarthritis (OA) of the knee is quite common as you age but can develop much earlier when someone has suffered a significant knee injury. A classic example of this is when an athlete ruptures their anterior cruciate ligament (ACL), regardless of the treatment sought you can expect to see OA changes in the knee within 20 years. Quite often these athletes are still young and having major surgery like a partial knee replacement is best to be avoided for as long as possible. In these circumstances, there is a growing demand for injectables to delay the need for surgery. For all of these injections you need to discuss the appropriateness of them with your GP, sports physician or orthopaedic surgeon.
Corticosteroid (Cortisone) injections have been used in OA joints for years to help settle down pain and swelling. They give relatively quick relief and they aren’t cost prohibitive like some of the newer injectables. One of the bigger issues with corticosteroid injections is they can cause cartilage break down which would eventually make the OA worse. These injections should be used sparingly, they appear to be a quick fix but can’t be used long term.
Platelet Rich Plasma (PRP) injections have become more common in the last 5 years for management of OA knees. PRP is usually derived from a blood sample from the patient that is spun in a centrifuge to separate the blood into different layers. Once spun the Platelet layer is collected and used for the injection. The reported benefits of a PRP injection are reduced pain, stiffness and potentially slowing down cartilage degeneration. In theory, this delays the need for surgery however it doesn’t work for everyone. Given the promising early results more research is being done about the make-up of the PRP injection and which conditions and patients respond well.
Hyaluronic Acid (HA) Injections are an option as the knee becomes more painful and normal anti- inflammatory drugs aren’t helping control the pain or swelling. HA is normally found inside the synovial fluid that lubricates the knee joint however in a joint that is suffering from OA the HA starts to break down making the synovial fluid less effective and the joint painful and stiff. You normally would have 3-5 injections spaced 1-2 weeks apart. There is now limited evidence that shows that some people get relief from HA injections and it can help people delay more invasive operations. It takes some months before the benefit of an HA injection is seen.
Mesenchymal Stem Cell injections are getting a lot of media attention at the moment, but despite the excitement and huge cost there is currently no substantial evidence that supports the use of these injections in a OA knee. The Australian College of Sports Physicians recent position statement was updated saying they have “specific concerns about patient safety” and that further “rigorous clinical research” needs to be done.
Andrew Cobb is an APA Sports Physiotherapist and Director of Bellbird Sports & Spinal. He has over 15 years clinical experience and treats a large number of dancers and gymnasts. Andrew is also a qualified Clinical Pilates instructor and draws on his 15 years as a ballet dancer when treating and rehabilitating performers.
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by Charissa Fermelis
charissafermelis.com | [email protected] | 0438 020 167
The winter dance competition season has come and gone, and fast approaching is the spring exam timetable and soon enough, we will be in the midst of concert preparation. The yearly dance calendar can be quite a confronting routine, punctuated with extra rehearsals and private lessons; there are few opportunities for ‘down time’ or an ‘off season’ where rest and recuperation are allowed.
Add to a dance student’s busy diary their high intrinsic expectation and perceived external pressure from teachers and parents – the result can be a physically exhausted and emotionally drained young person.
I remember this all too well. In amongst all this dancing, I somehow needed to find time to stay abreast of school study, engage with my non-dancing peers and also just chill out!
Outlined below are some methods to assist with physical recovery during those heavy dance periods, to reduce muscle soreness, begin the tissue repair process and restore function in order to maximise performance potential and help minimise the risk of injury.
- Stretch following activity – long indulgent stretches, working through all the major muscle groups, holding the stretch for 30 seconds but repeating each 3 to 5 times
- Ice pack – utilise an ice pack at home (or a bag of trusty frozen peas!) on any acute injuries to help reduce pain, swelling, bruising and inflammation
- Soak feet in cold water – to soothe tired feet, especially helpful after dancing en pointe
- Injury management – have any new niggles assessed by a dance physiotherapist to establish a treatment plan, or implement your self-management regime at home to stabilise ongoing or chronic issues
- Massage – either by making an appointment with a myotherapist or massage therapist, or by self-massaging on a foam roller or spikey massage ball at home
- Compression garments – wearing compression leggings or compression socks on long car trips home after dancing will help prevent swelling pooling in the feet and assist with blood circulation
- Postural drainage – resting with the feet elevated up the wall or on the edge of the couch helps with venous return
- Adequate sleep - the National Sleep Foundation recommends a teenager aim for between 8 and 11 hours of sleep per night
- Optimal nutrition – replenish glycogen and protein, water rehydration
"Add to a dance student’s busy diary their high intrinsic expectation and perceived external pressure from teachers and parents – the result can be a physically exhausted and emotionally drained young person."
Charissa Fermelis is a physiotherapist and Pilates practitioner with a Bachelor of Physiotherapy degree and Pilates teaching qualification through the Australian Pilates Method Association. Charissa has a passion for dance injury rehabilitation and technique integration in the adolescent dancer, intertwining scientific-based clinical medicine with a holistic and grounded approach to wellbeing. Charissa has worked alongside renowned physiotherapists of the Victorian College of the Arts and dance community to develop highly regarded dance physiotherapy assessment procedures. She currently consults in Melbourne and the Gold Coast, and at regional dance schools around Victoria.
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by Gabrielle Davidson & Joanne Maskrey
insyncphysiopilates.com.au | [email protected] | 03 9813 2188
The humble foot is a highly mobile collection of joints, ligament and muscles that allow for flexibility of the ankle in demi-plies, the beautiful arc of the pointed foot, the explosive push off, and the light, quiet landing of allegro. Dancers are able to execute these movements precisely with the activation and control of highly trained intrinsic muscles of their feet.
The intrinsic foot muscles are a vital part of the technique for every dancer, male and female. The strength of these relatively small but essential muscles govern how far the foot can arch, which creates the aesthetically pleasing line all dancers desire. Long toes when jumping are the springs at the end of your feet, as the longer levers of lengthened toes give your jump more power.
When the concept of pointing the foot is first introduced to little ballet dancers they will naturally curl their toes. This is because the intrinsic muscles don’t switch on automatically. Watching how the foot works without shoes lets dancers see what their toes are doing.
As young dancers get older they become more able to select the muscles they use to execute movements. Students can then spend time learning how to activate and work their intrinsic foot muscles.
Class work becomes harder and more complex with the introduction of larger jumps, pirouettes, balancing on demi-pointe and full pointe. This puts much greater stress on the bones of the feet.
The intrinsic muscles of the feet, by their attachment to the bones, offer columns of muscular support to maintain the health of the bones and joints. Common dance injuries such as posterior ankle impingement and stress fractures of the metatarsals can often be traced back to weakness of these little muscles.
The Australian Ballet’s medical team is at the forefront of dance medicine research. It has discovered that intrinsic muscles help prevent posterior ankle impingement by acting as a counterbalance to the strong pull of the calf muscles that can compress the back of the ankle joint as the dancer pointes their feet.
Another role of these important little muscles is to support the arches of the feet. Rolling the feet (when the arches drop and are no longer visible when standing in first position) sends twisting forces through the knees and subsequently makes turnout more difficult at the hips. This can then affect the back and limit the biomechanical efficiency of the dancer’s entire lower limb.
There are many exercises available to help dancers activate and strengthen their feet. A dance physiotherapist or experienced dance teacher can provide individual assessments and targeted strength programs to suit specific needs.
Ultimately, the dancer must be able to integrate the new technique into their everyday dance classes. This can take a little while, because the dancer might need to change how they point their feet and habitual motor patterns take time to change, such as the way the dancer points their feet, so it is important to keep working with focus and concentration.
The tendu is the best way to engage and strengthen the foot intrinsic muscles in class. Done at the beginning of the class, dancers can warm up their feet and achieve greater articulation to prepare for more complex choreography.
Rising to demi pointe is also an important way to keep working and strengthening intrinsics. Toes should be able to remain lengthened and not shorten or curl. This will give the foot the long lever in the take off for a jump or to keep rising to pointe.
It is just as important to release the intrinsic muscles after class. Using a spikey ball and self-massaging can help keep your feet supple.
Remember, as tempting as it is to use passive joint stretches to increase the arch, these only add strain and stress to the ligaments and joints without creating muscular support. So put in time to develop good use of your muscles around the foot and ankle, particularly your intrinsic muscles. It will stand you in good stead for stronger and healthier feet, and a better pointe. Happy doming!
Gabrielle Davidson ( B.PHTY (HONS) and Joanne Maskrey (B.PHTY) are both Dance Physiotherapists at InSync Physiotherapy & Pilates with an extensive knowledge and history of treating dancers.