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Bodywise Dance health professionals

Welcome to Bodywise!

Your guide to some of the country’s most experienced health professionals who know dancers, treat dancers and some of them even were dancers!

Advice includes Injury Prevention, Hyperextension, Periods, Bone Density, Fractures, Common Injuries, Overstretching, Growing Bodies, Pain Management, Nutrition, and much more!

Find a dance specific health professional to help keep you dancing!
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Endeavour College of Natural Health
Diva Dance Australia
En Pointe Orthotics


Canberra Spine Centre
02 6257 9400 | spinecentre.com.au
Stacey Leong from Canberra Spine Centre
Why is it so important for dancers to have an injury prevention plan?
Injuries are very common amongst dancers due to repetition and many hours of practising. We also place high demands on our bodies doing movements that many other people without training are unable to perform. An injury can be very upsetting, slow down progress or even stop you from dancing all together. Visiting a chiropractor can be a very effective part of your injury prevention plan. Chiropractic care, via its effect on the nervous system, helps to optimise performance for many dancers and athletes. Dancers who receive chiropractic care tell me they are more robust, suffer fewer injuries and recover quicker. When the spine and nervous system are functioning well, dancers tend to cope better with training and performance loads.

How can seeing a chiropractor assist with alignment issues?
Chiropractors have a focus on alignment and posture. A chiropractor will often spot if you have a curvature in the spine, uneven leg length or a higher hip or shoulder. Poor posture is a reflection of underlying issues and chiropractors are experts at finding the cause of these problems.

Chiropractors apply techniques and provide rehabilitation advice to restore normal spine and nerve function. After chiropractic care, many dancers tell me they find certain steps easier to perform. For example, with a pirouette, a dancer uses a spotting action with their head. If the spine is not working well, spotting is really difficult. If your neck movement is restricted and your alignment isn’t good, attempting to spot can throw you off balance and make you quite dizzy. When the spine and nerves are functioning well, it is easier to perform a quick head movement while staying balanced and pulling off a perfect turn.

How can working with a chiropractor assist in increasing range of motion and therefore increase flexibility?
Misalignments of the spine and extremity joints (e.g. knee, ankle) cause a range of effects. In the spine, altered joint motion can irritate nerves, causing muscle tightness and poor coordination leading to injury. Poor alignment of extremity joints leads to the same changes, but more locally. Chiropractors use ‘adjustments’ to restore proper motion and function of the spine and the nervous system it protects. The chiropractor may use their hands or a variety of instruments to perform these techniques. When spine, nervous system and extremity joint function are improved, flexibility naturally gets better.

Muscle tone (the right amount of tension required to keep you stable, but mobile) is controlled by your nervous system. Nerve irritation resulting from spinal misalignment can result in low, or too much muscle tone. At Canberra Spine Centre, I often see dancers with one hamstring that is tighter than the other, no matter how much they stretch. In most cases, after correction of the spine or pelvis misalignment, hamstring tone returns to normal, leaving the dancer less prone to injury.

Stacey Leong: As a teenager Stacey did years of intensive ballet training. She is a graduate of Murdoch University in Western Australia and has a Bachelor of Science in Chiropractic and a Bachelor of Chiropractic with First Class Merit Honours.

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NSW-ATAlternative Therapies Today
02 4943 9023
Dianne Drelincourt from Alternative Therapies Today
Why should dancers in particular have a regular massage?
Dancers are used to physical pain and may be unaware of when they need relief. Muscle pain, joint stiffness, and ankle and feet injuries (amongst others) are part of normal life for a dancer. It is for these reasons that a regular massage should be part of any dancers regime.

Benefits of Massage include:
> Decreases pain intensity by eliminating the lactic acid. This in turns helps the body to recover.
> Assists in injury recovery by assisting in the elimination of toxins from the muscle.
> Elongates tight muscles, which frees joints from becoming compressed.
> Improves circulation, which transports oxygen to the injured tissue/s which helps heal that injured tissue.
> Can allow for the release of emotions, which helps de-stress the body and aids in recovery.
> Improved immune system function by increasing the number of white blood cells in the body.

Dancing is extremely physical and affects every system in the body, so it needs an eclectic therapy for support. Massage is that therapy.

What is one thing you would like all dance teachers to understand about massage and dancers?
Dancers look to their teachers for guidance and help particularly during an injury. A well-informed teacher will be able to help guide the young dancer to a much faster recovery. A dancer requires ‘a team of professionals approach’ for their health, to which a massage therapist is one part. As the saying goes “It takes a village to raise a child” so it takes a village to raise a dancer – the teacher, the doctor, the costumier etc. and of course, the massage therapist.

How difficult is it to pinpoint the area where the injury stems from when sometimes the pain occurs is another location and how do we help dancers understand this about their own bodies?
To an experienced therapist it is not difficult to pinpoint the area in which the injury occurs however sometimes dancers are unaware that where they are feeling the pain is not the actual cause of the injury. Helping the dancer understand how the body works and allowing the dancer to develop a sense of when assistance is needed is important. The dancer is the expert of their body but they can also be apprehensive about seeking treatment. It is my hope that this article moves that negative way of thinking!

Dianne Drelincourt: With 25 years experience in the dance industry, as well as having a dancing daughter and a soccer player for a son, Dianne knows first hand the physical demands required of our young athletes.

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Body Fusion Nutrition & Dietetics
bodyfusion.com.au | 0426 500 251 | 0410 533 213
Ashleigh Brunner and Katrina Mills from Body Fusion
Can you talk to us about the cycle that many dancers go through with their food choices?
Dancers have specific nutrient requirements because they need to stay lean, maintain strength and stamina, as well as fuel for adequate recovery and to prevent injury. Some of our dancers biggest challenges are understanding the foods that are right for their personal needs and body types and how these choices fit in within their lives, especially when eating with friends and family.

Often dancers are putting immense pressure on themselves to perform and this can cause stress. It addition to this they are burning through a lot of energy and frequently hungry! As a result many go through cycles of becoming too strict about certain foods or create rules about when and what types of foods they can eat. We have seen this lead to unhealthy behaviours like skipping meals, bingeing on sugar, overeating when going out or becoming anxious around food.

It is important that dancers:
> Find the right balance of foods to give them sustained energy and will keep them feeling full.
> Learn which foods give them the nutrients they need to maintain muscle mass and keep them in good health.
> Understand how to time their food to ensure optimal performance.
> Maintain a relaxed and open relationship with food and reflecting upon how it makes the body feel.

It is not a diet; it’s a lifestyle to achieving your dancing dreams.

How does the nutritional intake of a dancer vary to that of a non-athlete?
Dancers get hungry – very hungry, they often need to consume more energy than non-athletes because of the physical demands of their training. For instance, carbohydrates and protein are required in higher intakes for fuel burning and recovery. These requirements will also vary from individual to individual based on lean body mass, height, weight and the frequency and intensity of dancing performed. Dancers will also require more water to stay hydrated than the non-athlete and potentially higher amounts of iron depending upon their volume of practice.

If a dancer wants to lean out a little for a performance, their nutrition requirements will change. If a dancer has time off, these nutrient requirements will change! That is why it is important to be constantly reviewing nutrition intake and adjusting it accordingly with a professional such as a Sports Dietitian.

What would you like all parents of full-time dancers to know about their dancing child’s nutritional intake?
It’s really important for parents, teachers, a dietitian and their child to work together as a team to achieve goals and provide a consistent message. The more you can get your child to connect with food, such as learning to cook, understanding WHY they are eating what they are eating and how it impacts upon their performance, the better the outcome. As well as being a dancer, your child is also a child or a teenager. This means that you/we need to manage eating out, parties and food related situations realistically so that they can still enjoy food without feeling too restricted. Learn to look for the red flags: aversion or cutting out of whole food groups, not wanting to eat with the family, anxiety around food, substantial weightloss or bingeing. If you are concerned, check in with a professional and get some help.

Ashleigh Brunner and Katrina Mills: Ashleigh and Katrina work with many dance schools in Sydney including Tanya Pearson Classical Coaching Academy, The McDonald College, ED5international and Classical Ballet 121. She has a Bachelor of Science, Nutrition (Honours) and a Bachelor of Applied Science, Sports Science, University of Sydney.

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Evolutions Pilates
evolutionpilates.com.au | 02 9518 5009
Susie Bond from Evolutions Pilates
What are the benefits for a student dancer to continue with a physiotherapist Pilates program during times when the dancer is not injured?
Our Safe Dance research has shown that many dancers go into professional careers with injuries sustained in the junior years of their dance training, especially teenage years when dance training hours and intensity increase. Debilitating flare up of these weakened areas, such as foot and ankle, knee and low back, can cause time off from full-time training. Prevention of injury is better! It is good to iron out the physical problems before they become an injury.

When we are young and flexible it is easy to flop into excessive joint range in stretches, however where is the muscle control to support the dancer’s joints and connective tissues? Repeated injury can occur to unprotected joints.

Uneven pressure through joints due to poor alignment and muscle control can lead to excessive strain on bone growth plates and joints, leading to uneven bone growth, deformity and cartilage damage, especially in the toes, under the knee cap and spine.
Pilates instructors focus specific exercises from a detailed individual assessment of each dancer’s physique. These exercises strengthen control and awareness of foot and ankle, knee, hip alignment, especially in parallel and turned out positions. Lower abdominal muscle and other deep trunk muscle control helps protect your developing spine.

Pilates has long been used by dancers to augment and support their dance careers, not just rehab injury. Pilates helps dancers to:
> Find deep ‘core’ trunk muscles. This means you learn to correctly draw up in the pelvic ‘pull up’ muscles dancers use for central balance and trunk control.
> Lengthen spinal and limb alignment, rather than build brute strength that bulks muscles up.
> Find postural awareness: research shows Pilates based exercises can help dancer’s awareness of ideal pelvic alignment and centre.
> Practice ideal lower limb alignment. Have you tried the ‘jump board’ on the reformer? FUN.
> Learn relaxed breath control through movement.
> Balance strength and weaknesses in muscles.
> Improve connective tissue flexibility and joint mobility.

Dancers in professional companies prepare for new choreography with their exercise trainers, like Paula Baird Colt at The Australian Ballet. Each time you start a new technique or dance routine you want your body to be ready with a background of strength, flexibility and muscle endurance to take the new loads. Let your Pilates instructor know about your specific aims when you go in to your session and they will focus your hour workout to achieve these goals, and maybe give your homework exercises to do too!

Susie Bond: Director Evolution Pilates and MG Pilates, Physiotherapist, Pilates Instructor, Dancer – Physiotherapist since 1987, Pilates Instructor since 1996 and dancer since 5 years (Ballet, Jazz, Tap, Contemporary).

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Fit 4 Dance
fit4dance.com.au | 0431 534 127
Talia Clow from Fit 4 Dance
Do younger dancers need a longer comprehension time to learn self-correction and why is this so important?
Learning to self-correct and apply your teacher’s instructions throughout the class is a vital skill that ensures continuous improvement. Self-correction is working out what needs to change in your dancing to make the necessary improvements without a teacher continually needing to tell you. It is about learning to apply and perfect corrections you are given. It is having awareness of how the body feels in correct placement, and being able to make the necessary adjustments in your movements to correct any incorrect placement. Learning to self-correct is a skill that takes time to learn and tends to come with both age and experience. Younger dancers haven’t had the exposure to learning but as they gain this they learn to perform steps correctly and find self-correction much easier.

How can students be assisted to develop self-correction skills?
When teaching students to self-correct, I initially ask them to focus on a correction they have just been given. If the teacher focused on stretching the knees, the student needs to focus just on this, even when not dancing. Once students master self-correcting from one particular class, they are then asked to practice applying other corrections they have received. Once they master self-correction using the teacher’s corrections, I then show photographs/videos of them dancing asking what they could improve. This is the start of learning true self-correction. Using photographs and videos trains them to use mirrors effectively to self-correct. (e.g. when waiting for their turn/before class/after class). Learning to self-correct is an invaluable skill for the aspiring young dancer to master.

Why be mindful of the in-between steps and down time between exercises?
Learning how to make the most of your downtime in class shows that you are serious about learning and improving. Instead of chatting with your friends, think and work on corrections your teachers have given you during class. Focusing in this way enables you to master corrections quicker and progress faster.

Resist practicing the big flashy tricks and instead, practice the in-between steps. It’s the in-between steps that show a difference between a student and a professional. Learning how to perform the in-between steps is vital to giving any performance a flowing, graceful and professional look.

Talia Clow: Talia has completed all her Royal Academy of Dance examinations up to Advanced Two with Distinction. She has a Diploma in Dance, Bachelor in Dance majoring in Dance Teaching, Cert III and Cert IV in Personal Training as well as Master Trainer in Personal Training.

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Inspired Physiotherapy
inspiredphysio.com.au | 02 9674 5596 | [email protected]
Deborah Chen from Inspired Physiotherapy
When would you ideally see a student who wants to begin pointe work and why is this time period so important?
It’s most ideal to begin the pre pointe assessment process up to 12 months in advance. An assessment by a dance physio will give you a bench mark of where you’re at with your technique but also gives you enough time to mentally and physically prepare yourself for pointe work.

We don’t learn our concert dances in one lesson – it can take minimum one term and sometimes up to 3 terms to learn and it’s the same with preparing for pointe. It takes time to develop strength and control so it’s best to give yourself enough time to avoid disappointment.

How important is it for you to also have a connection with the dance studio owner?
It’s really important to have a connection with the dance studio owner. It makes the process a lot easier if the school understands what’s required to help their students understand how long it will take and the effort required to progress en pointe.
Communication can sometimes get lost between the student, the parent, the dance physio and the school and can turn into a game of Chinese whispers so ideally being able to communicate directly with the studio owner or ballet teacher ensures that the correct messages are getting to the right people for the safety of the dance student.

What do you think is one of the biggest misconceptions for dancers and their parents who are beginning pointe work?
One of the biggest misconceptions for dancers and their parents in regards to starting pointe work is that it takes one dance physio assessment and they’ll receive a yes or no answer.

Preparing for pointe work is a process that takes time – I would rather help a student progress through exercises to improve their technique than say ‘No you’re not ready’ and leave it at that. If you have the passion we’ll find a way – there are lots of different ways to do one exercise and it just takes someone to stop and listen to find which way will work for you.

Deborah Chen Registered Physiotherapist B.App.Sc. (MRS-RT), Master of Physiotherapy: Deborah who has also taught dance studied dance as a child and went on to complete her Major 3 level in Ballet (Australian Dance Assessment Program).

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Kellyville Chiro
kellyvillechiro.com.au | 02 9899 2937 | 02 9629 1717
John Cice from Kellyville Chiro
Why do dancers visit you before a competition or concert?
At times dancers come in with acute injuries affecting the ankles, knees, hips or lower back, particularly so before a competition where there is a lot of repetition at rehearsal as well as the apprehension in doing their best.

With continued repetition young bones, muscles and tendons, although considerably strong, can become inflamed from overuse causing irritation, pain and disability. At this point if they continue to rehearse they may alter the way they do certain moves and this change can lead to an incorrect technique. Dancers want to perform at their best and will strive to achieve just that.

What are the common injuries you are seeing in the recreational dancer?
Many of our younger patients are athletic and determined dancers who are always striving for perfection in their lines, balance and timing. However, when injury occurs we commonly see strains and sprains to the ankles, knees, hamstrings and hips. An important thing to keep in mind with injuries to these areas is the impact that one joint can have on the others. For example, when practising a specific dance move it is common for the repetitive movements to cause an overuse injury of a joint such as the ankle. This dysfunction in the ankle may cause rippling repercussions up the chain through the knee and hip joints. In some cases an x-ray may be required to rule out a stress fracture of one of the small bones of the foot or ankle.

What advice would you like to share with all dance teachers?
Teachers have the responsibility to impart their knowledge both in theory and especially the practise of dance moves and somewhat choreography. They need to keep a sharp eye on each student as he or she begins an exercise on the path to learning to express their art through dance. I believe that a good basic technique in dance at the start will help them on that path.

Once poor technique is noted in the student, individual attention by the teacher or assistant to correct their posture, the way they plié or the holding of the arms, will go a great way in helping that child. If injury occurs, technique will suffer.

The injured dancer should seek attention for any injury or harm. The pain from dance or sport injury usually is felt some time after the injury has occurred.

Teachers would be aware that the dancers on returning to class after injury will need to do some rehabilitation exercises to get back to normal. An important thing to keep in mind as a dance teacher is that in younger people (6-14 years old) it is uncommon for an injury to linger for longer than a few days. In the case of a prolonged limp, recurring pain or inability to perform certain dance moves the dance teacher should make sure that the parents aware of this so that a health professional may be contacted.

The recovering dancer should go back to basics in their exercises to relearn the right way to do it. In ballet we go back to the basic pliés, tendus, frappés, relevés etc. This way the right muscles will relearn the proper way to do more complex moves and the dancer will have the potential to reach greater heights and great appreciation of their role models, their teachers.

John Cice: John has danced professionally with the Queensland Ballet Company. Chiropractic treatment was instrumental in keeping him on stage and inspiring him to study and this led John to study Chiropractic and Osteopathy. He has been supporting dancers for over 20 years.

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Kinetica Physiotherapy
kineticaphysiotherapy.com.au | 02 9948 6188
Katie Godwin from Kinetica Physiotherapy
If a dancer continues to dance through pain they are putting themselves at risk of further injury. Pain is our body’s way of signalling to us that something is not quite right, and paying attention to these signals early almost always pays dividends in the long run.

In saying that, some pains are more serious than others. Pain from muscles that have been worked hard in the day or two before is generally safe to push through. This pain is called Delayed Onset Muscle Soreness, or DOMS, and feels like aching and stiffness through a muscle that has recently been subject to an intense workout. This pain usually warms up with exercise, and settles over 3-5 days, often peaking 48 hours following the workout.

Pain that doesn’t ease during a dance class, lasts longer than 3-5 days, or gets progressively worse during class should never be ignored.

Do dancers often push through pain in order to continue dancing?
I think it is only natural that dancers who love dancing will be reluctant to take time off. Knowing when to stop dancing is a skill that comes with time and maturity, and it is often difficult for young dancers to master early in their careers. Unfortunately this sometimes means that minor niggles can become major injuries before dancers are aware that they’re pushing themselves too hard. Talking to your teacher about how you’re feeling is usually the first step in figuring out whether you need to pull back. Your teachers are really good at knowing how your body should feel when you dance.

Why do you think dancers struggle taking time off?
There is a perception that when a dancer takes time off she/he will fall behind their peers in class, miss out on sought-after roles in concerts or eisteddfods, or let the team down if they are rehearsing for a group performance. The reality is that it is unusual for a dancer who has picked up a niggle early, to have to sit out of dancing completely. Usually a dance class can be modified, or choreography altered to allow an injury to heal while the dancer keeps dancing.

What are the benefits of taking time off?
Beyond the obvious benefits of allowing an injury time to heal, there are several other benefits to taking time off, or modifying a dance class due to injury.
1. Core strength and conditioning: Often if a dancer needs to avoid allegro, for example, they can still mark through these sections of class by doing the exercises lying on their backs and marking with their legs. This is extremely good for core strength, and dancers often return to class stronger after this period of enforced core work
2. Focus on other areas of repertoire: A dancer with a knee injury can mark exercises using arms only. This time exclusively focusing on upper body can be a huge difference to the overall strength and aesthetic of your dancing.
3. Mental rehearsal: Evidence shows that visualising yourself performing choreography well makes a large difference to overall performance
4. Learning to manage your body: No dancer reaches a high level of dance without having to learn how to respond to pain, and manage recovery from injury at some point. Each injury teaches us to manage our bodies better. Whether this be correcting an element of our technique to avoid further injury, or learning how to react to our bodies when they’re telling us they’ve had enough. This knowledge is essential for a successful dance career.
The take-home message is to listen to your body, and if in doubt, talk to your dance teacher, parents, or dance physiotherapist for advice. Early response to injury saves recovery time in the long run, and teaches you to understand your body and its limitations. Time off dance is rarely complete time off, and during these periods of recovery we are presented with opportunities to focus on difference aspects of our dancing, so that we return to class both stronger and smarter.
Katie Godwin: Is dancetrain’s in-house physiotherapist columnist. Having spent more than 10 years working with clients from a variety of backgrounds, including the Australian Ballet Company she is the current Chairperson for the NSW Dance Network, and lectures regularly to school students and full time dance students on safe dance practices.

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MG Pilates
mgpilates.com | 0410 581 466
Roula Kantarzoglou, Pilates Practitioner, Wellness Advocate from MG Pilates
Can you talk to us about your journey with Pilates, when it began and why and how you came to where you are now?
As a professional dancer training in 1986 I discovered a Pilates studio upstairs and stood amazed at how quickly my technique, strength, endurance and flexibility improved. I knew then Pilates would be a major part of my life. In 1999 I became certified in The Pilates Method when Romana Krysanowska, a protégé of Joseph Pilates first came to Sydney. Romana always stated “Pilates is good for the whole body darling“. Throughout the years I studied Yoga, Kinesiology, Alchemy, Chiropractic, EFT, Franklin Method and continue to research the latest science based information on all things alternative/energy medicine. This knowledge and what seemed like a full circle in 2011 when I completed my Professional Diploma in Polestar Pilates, I came to fully understand Romana’s statement in terms of the holistic philosophy of Pilates.

Why do you think dancers have such an affinity for Pilates?
Pilates is all about a holistic approach to movement and quality of life. An injured client can maintain a high level of fitness and most importantly the positive MIND/ BODY – SPIRIT connection and a pain free movement experience that is paramount with any healing journey. We have non-programmed hormones and glands that are waiting for our instruction to affect our bodies with our thoughts and feelings. Mental and physical rehearsals prepare cells everywhere, poised to work together on demand. People finish a Pilates session feeling refreshed, motivated, with changed perceptions and goals achieved. To witness their transformation is inspiring and gratifying.

Are you able to give us some data in early detection of injury and how this affects the rehabilitation and full recovery process?
Pilates unveils faulty movement patterns. All of these patterns are recorded in the nervous system, as it is the central highway of the body, regulating all muscular movement and communication to multiple systems of the body. It absorbs positive and negative information on an emotional, chemical and physical level from our time in the womb, throughout our lives, to our present day. The nerves originate in the spine and all pass through the solar plexus (core). When the body can no longer compensate for these faulty movement patterns, injuries may occur. The injury or imbalance may present in a part of the body but originates in another. No one part can be strained without affecting other parts of the body. This is the creative, intuitive process the Pilates Practitioner, together with the client, undergoes on the road toward full recovery and healing.

A key principle of Pilates is alignment and joint congruency, also breathing, spinal articulation, axial elongation, all of which stimulate the nervous system to fire up correct muscle and fascia movement and bone rhythms. Imagery is another wonderful tool used in Pilates as it is highly efficient in accessing the nervous system where change occurs.

In this environment a Dancer gains a greater awareness of body in space (proprioception) and ways to move pain free in full range that is not always possible due to gravity. There can be a focus on controlled movements slow and fast using different spring tensions, reaching goals of balance, core and overall strength, stability, injury prevention and healing.

Over the last ten years there is a massive increase in Physiotherapists recommending Pilates to their clients. It is now the norm with science and research upholding the benefits. There is continuing communication between Instructor and Physio for the common goal of their client. Many Physios integrate Pilates equipment in their clinics and some are trained as Pilates instructors. It’s all about the “strategy of healing” as Dr Brent Anderson states (one of the founders of Polestar Pilates).

Pilates has a history in rehab. During WW1 Joseph Pilates attached springs and levers to hospital beds which are now the Reformer and Trapeze (cadillac) to rehabilitate injured soldiers. He held mat classes and those who attended did not suffer the outbreak of influenza that hit the camp. When Jo and his wife Clara arrived in New York they opened their studio and the relationship between Dancers and Pilates began. It was frequented by many dancers and Pilates Elders Carola Trier, Romana Krysanowska, Ron Fletcher, Eve Gentry, were among the dancers who attended for rehab. In my mind Dance and Pilates are the perfect match and an essential element to support the quality and life span of a professional dancer for as long as they dance and beyond.

Roula Kantarzoglou: As a dancer, Roula performed on television, in musical theatre and on stage, as well as training and working with choreographers Ronne Arnold, Jane Beckett, Sue-Ellen Chester, Stephen Page among many.

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Nineways Chiropractic
ninewayschiropractic.com.au | 02 4961 6200
Inger Villadsen from Nineways Chiropractic
Cool Down: why should I engage in a cool down protocol?
Cool down routines have been recommended for decades but do most dancers routinely use a cool down routine? Do you?
The return of the body to a pre-performance state as a concept is widely accepted in the world of performing arts however it appears to be the undervalued bookend to the compulsory warm up. The cool down routine assists you in returning the whole body to an optimal state of breathing, oxygenating your tissues and relaxing the muscular fascia components bringing relaxation to the global body systems. The average human breathes 25,000 times per day, making breath control a very important tool in our exercise protocol.

The muscular skeletal system functions at optimal capacity when there is adequate glide between all tissue layers, muscles, tendons, fascia, blood vessels and the peripheral nerves travelling through these tissues. Breathing relaxation allows the large surface muscles to relax and facilitate the intrinsic stabilising system of the spine and body.

Relaxation, focus and constructive use of breathing to achieve the desired integration of the spinal stabilizing system can be learnt.

When should you use a cool down routine?
The ideal time is immediately following your session, whether this is a class or a performance. Never sit after a strenuous workout always proceed to your cool down. Sitting tightens hip flexors.
> Hydrate adequately, water being the most effective fluid, this will improve your recovery significantly.
> Eat sensible snacks, bananas, blueberries, cherries, pears, walnuts.
> Wear comfortable loose warm clothing.

How should you go about it?
After a performance or workout your heart and respiration rate will be increased and your muscles will have tightened to some degree. This is a normal response. The cool down sequence will return your heart and respiratory rate to your normal body requirements.

Commonly used is a reduced intensity version of your warm up program with a focus on breathing, lengthening of your body in space combined with broadening of your chest. Returning the muscles to their eccentric capacity during an activity. Include the use of smiling, as a smile is the fastest way to relax your muscles.

I would recommend a specifically designed routine for each individual dancer who takes their dancing seriously, as this will assist in optimising the body’s capacity to improve agility, effortlessness, endurance and expression in the dance performance. Speak with your dance instructor or health care professional and develop a program suitable for your body and level of training. The exercises must be specific to your needs.

The brain is perfectly capable of improving movements, if we understand how to tap into that resource. To do so you must understand, what you want to change, be willing to work with your body and focus 100% during your training, warm up, class/performance and cool down. Only then can you reach your optimal potential.

Commit to your cool down routine, use it with every training session. Become familiar with your body and know where to focus your attention. Great performance is the reward from doing the right thing on a daily basis, perfect practice creates perfect movement and fluidity on stage.

How long do I need to spend?
The time required depends on the individual, how long does it take to reach a zone of relaxation? How quickly can you train your brain to let go of everything around you? Then, once you have settled in the zone you should spend 30 minutes going through your routine.

How do Cool Downs play a part in injury prevention?
Injury prevention training is a buzz word and we would all love to be able to say we practice an injury prevention style of training. The key to injury prevention is to understand the performer, know all of the functional weaknesses and to build a program that addresses these functional insufficiencies. This is the key to help build a dancer who has the capacity to go the full distance in their chosen discipline.

In my experience the warm up, the technical part of dancing, the physical and emotional components, and the cool down all play equal parts.

However in reality very few place the same importance on the cool down as the warm up even though this part of the whole training protocol is so important in preparing your body for sleep and rest.

The function of the cool down is to return your body and mind to a relaxed optimal state of being. Your muscles should be at ease and there should be no tension in any of your large muscles.

Implementing a cool down routine ensures you have assisted your body in returning to normal muscle tone.

Having committed 100% to the session preparing your body through a warm up, completed the training session, and focused on the cool down, you have given your body the very best opportunity to excel.

All too often a story of a dancer that has been sidelined through injury is told. Often minor injuries are ignored and they later on escalate into major problems.

Accidents do occur and are unfortunately part of dancing. The important issues here are, we can minimise these injuries by being better prepared and by seeking to implement optimal daily routines.

The way forward is to habilitate the body to the best of our ability and prevent injuries that are avoidable. Should you experience an injury deal with it swiftly and always ask for guidance from a qualified professional who understands the needs of a dancer.

How does sleep impact on the dancer’s well being?
The human body requires sleep just as much as we need eating, drinking and breathing. We spend a third of our life sleeping. Sleeps offers an opportunity for the body to restore and rejuvenate. New research has shown the brain needs sleep. The brain accounts for only 2% of our body mass and uses approximately 25% of our energy supply to control all the complex electrical activity that drives body functions. The brain only rejuvenates during sleep and all of the waste products from the brain cells are flushed out via the interaction between the CSF (Cerebral Spinal Fluid) and the vascular systems. In the sleep phase the brain cells are able to increase supplies of ATP (Adenosine Triphosphate), which resides in the mitochondrial cells, our cellular batteries. This may explain why we wake up feeling refreshed, more alert and ready to take on a new day.

On the other side if we are sleep deprived it has a tendency impact on our ability to learn and perform a task. Secondly prolonged sleep deprivation can lower our immune system. The moral of the story is to ensure adequate sleep to allow you to be able to learn and improve your dancing techniques.

Inger Villadsen: DC, MSc., PG dip. NMS rehab: Inger has over 30 years experience in her field and is a leader in rehabilitation.

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North Sydney Sports Medicine Centre
nssmc.com.au | 02 9966 4700
Dr. James Lawrence from North Sydney Sports Medicine Centre
Does denying the body of adequate nutrients (either by unawareness or intentional) affect how the dancers body grows during adolescence?
Appropriate availability of energy (calories) and nutrition is essential for normal growth and development. The more active somebody is the more energy is required to maintain the normal physiological processes. If the brain detects that insufficient energy is available then it changes the chemical messages that it releases. This includes the hormones that stimulate and control menstruation, fertility, metabolic rate, growth, bone development and recovery from exercise. If energy availability subsequently increases then many of these functions recover, however bone health can remain compromised. Bone density increases up to the age of about 20 years, followed by a slow decline, which speeds up after menopause. Therefore if a girl does not reach an appropriate level of bone density through her teenage years then this can impact on her longer-term bone health and particularly her risk of osteoporosis later in life, after menopause.

In the shorter term inadequate nutrition can lead to increased risk of stress fractures, fatigue, susceptibility to infection, and possibly failing to meet the growth potential of that child.

These are some of the reasons why an appropriate and adequate diet is so important for individuals involved in high volumes of dance and sport. There can sometimes be a conflict between looking right/staying thin and staying healthy. It is important to recognize that ideal body weight is a very individual thing, and restricting the diet to prevent gaining weight in young active people can lead to the issues mentioned above.

Dr. James Lawrence B.Med.Sci. BMBS FACSP, with the assistance Dr. Louise Tulloh, Sports and Exercise Medicine Physician, from North Sydney Sports Medicine Centre
Dr. James is Sports and Exercise Medicine Physician to Sydney Dance Company and Bangarra Dance Company, having developed an interest in dance medicine under the guidance and mentorship of Dr. Ken Crichton. Dr. Louise has particular interest in medical concerns of the female athlete (hormonal changes, nutritional deficiency, absent periods and stress fractures).

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Pilates Pointe
Innovation, Passion & Supreme Quality.
pilatespointe.com.au | 0405 826 272
Tamara Rogelja from Pilates Pointe
What are the benefits of coming to you to prepare for an upcoming performance?
Whether a dancer is commencing a new show, is competing in an up coming competition or preparing for an exam, the new demands they place on their physical bodies are significant. Taking the time (in advance) to prepare the body for theses events can make an incredible difference in body awareness, strength, stamina and endurance, as well as reduce the likelihood of injury. This is what we do, write specific programs based on the dancers goals and abilities to help them get to where they want to be – safely and with confidence.

Ideally what sort of time would you prefer in order to assist an artist reach optimal fitness for their required role?
For an upcoming role or exam, ideally, 3 – 4 classes per week, 1 hour is most beneficial. This can be a mix of private and group Reformer sessions. Dancers’ movements can be modified accordingly within the class, this enables them time to put into practice what they have learnt in their private lessons. Ongoing, 1 class per week is recommended to continue developing core stability and functional movement.

How does this work help towards avoiding or being aware of potential injuries?
Pilates allows the dancer time away from class to learn how to manage their own body, reprogram old habits, and increase strength and flexibility. Dancers can often place too much focus on stretching, which causes muscle/tendon imbalances. On a Reformer they can plié, tendu, devéloppé, grand battement, port de bra and jump (using a jump board) with correct technique. Perfecting a higher jump, softer well-placed landing, using correct muscles, stretched feet, endurance, all with an easy carriage of the upper body.

Tamara Rogelja, Conditioning for DANCErs Module 1 – Focus 2016, Elixr Reformer 2012, Elixr Mat 2013, Diploma of Dance, Australian Ballet School 1988
Tamara has been practicing Pilates since she was a young ballet dancer at The Australian Ballet School. Tamara began instructing Pilates at the age of 21 and has continued to instruct throughout the years whilst teaching ballet.

Gretel Scarlett plays Kathy Selden in hit musical Singin’ In The Rain. She worked with Tamara prior to commencing rehearsals.
Why did you feel you needed to do extra work prior to rehearsals to prepare you for this role and is this normally the case for the shows you work in?

Every show is different. Some have minimal dance and others have a lot of dance, so depending on your track in the show, you may or may not have to do too much physical preparation. However, Singin’ In The Rain is one of the most iconic Triple Threat (singing, dancing, acting) shows in theatrical history, so I was very aware of what I was getting myself into. I also knew that my role had to dance Ballet, Tap and Broadway Jazz, along with a huge amount of Pas De Deux work and also dancing in the rain (literally, 12000 litres of it). I’ve been in heavy dance shows like Mamma Mia and Wicked, but my time as Sandy in Grease hardly saw me move! She was a singing role. So I was well aware that I needed to get myself back into dance mode!

I met Tamara back in 2013 when my brother was regaining ballet strength post surgery. About 6 months prior to rehearsals for Singin’ In The Rain, I called on Tamara to help me regain the strength that I needed to get through this show, 8 shows a week, as well as taking ballet classes full-time over a few weeks with Suzanne Way at Professional Ballet Coaching Academy Australia. As we get older, our turn out starts to fade, our core weakens and overall body strength slowly dissipates; and knowing that I was needing to pirouette, devéloppé, hold arabesques, have boys lift me and jump over benches, I certainly needed to get my body into gear. I am very thankful for the immense core work that Tamara tailored for my needs (being an ex-ballerina herself, she understands what dancers need), because when we arrived to stage on set, I saw how dangerous the stage was with all the water tracks and the slipperiness. If you have no core, you cannot save yourself from immense injury in this show!

Do you feel this extra work has assisted in injury management?
Absolutely. We have to rely so much on the props, set, costumes, partnering of others etc, so you need to have your body switched on and ready for any situation. In case something does occur, injury wise, you have to be on your A game – and a lot of the time it revolves around switching on your core and having your muscles engage to compensate. Tamara’s work with me on the reformer was seeing my abdominal strength go through the roof. I incorporate this work into my own personal warm up that I do for almost 45 minutes prior to the hour call.

Tamara’s knowledge in dance, injury rehabilitation and the dancer’s body allows her to personalise programs for all clients across the board. Being a part of her classes, I have witnessed people of all ages go from strength to strength through her training programs. She has rebuilt clients post injury and I truly believe that her classes have enabled me to rebuild my strength to cope with the demands of my performing schedule.

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Regent Street Physiotherapy
regentstphysio.com.au | 02 4950 9805
Erin Cuskelly from Regent Street Physiotherapy
How do you think we can make newcomers to the industry more aware of the importance of injury management?
Injury management starts with injury prevention! An injury does not only mean lost time in rehearsal and training but also a reduced likelihood of achieving a goal whether it be making the transition to a professional career or performing during the season. I think stressing this information to young and pre-professional dancers can help to instil discipline and motivation to be consistent with recovery and conditioning sessions.

Regular contact with health professionals with dance experience including doctors, physiotherapists and dietitians can provide newcomers with a wealth of information regarding injury management. We can liaise with dance teachers to provide an understanding of a dancer’s stage of growth and advise on appropriate and timely progression. A musculoskeletal screening such as the pre-pointe or pre-professional assessment is an essential tool for new and experienced dancers to identify deficits in strength, range of motion and technique that can be addressed and subsequently avoid injury.

Do you see a difference between seasoned performers and newcomers to the industry in relation to this topic?
There is a distinct association between dance experience and injury in professional dancers. This trend is demonstrated in multiple research studies looking to identify risk factors of injury in professional dancers.

Newcomers often push their body into positions, extensions and alignments before appropriate strength and control has been developed. A stronger push in young dancers towards acro style tricks and contortion, often self-taught, has meant an increased risk of injury to underdeveloped bodies. In my experience pre-professional and adolescent dancers rarely train their physical fitness outside of dance classes.

Physiotherapists know that a reduction in aerobic capacity and muscle strength are predictors of injury in all athletes. A clinical trial in 2014 proved that in the dancer specifically an intervention program targeting aerobic fitness and explosive strength resulted in significantly less lower back injuries and reports of pain.

Perhaps a lack of resistance training in young dancers can be explained by fear of injury to the immature skeleton or the misconception that weight training may have an undesirable effect on aesthetic appearance and lead to ‘bulking up’? Both these fears can be addressed through education. It is known that resistance training is particularly important for bone health and reducing the risk of overuse injury including the dreaded stress fracture. Resistance training may incorporate a clinical Pilates program which, guided by an experienced professional, can provided a strong foundation for all movement with core strengthening. Pilates may also be an option for rehabilitation of injuries requiring non-weight bearing period.

Often newcomers to the industry will under manage an injury due to perceived pressure to perform. This is an issue that needs to be addressed as an industry, ensuring all dance studios and schools are aware of the impact poor injury management will have on the long term career of a dancer. Young students fear losing form, fitness and possibly their place in a performance and rush back to rehearsals. Being guided by an experienced teacher and physio rehabilitation will focus on as much functional training as appropriate for the injury and when explained to the dancer this can be quite reassuring and allow a staged transition to full dance. At the professional level we are seeing these rehabilitation guidelines work very well.

What do you see the company dancer struggle with most when it comes to injuries and injury management?
The research shows that professional dancers experience at least one injury per season, most commonly affecting the foot, ankle and lumbar spine with 75% being overuse injuries.

Overuse injuries can commonly include patellofemoral pain, various tendinopathies, lower back pain, posterior ankle impingement and boney stress. The huge prevalence of overuse injuries can be explained by the duration of time spent dancing. With professional dancers spending up to 12 hours a day in training and rehearsals with a relatively short ‘off season’ compared to other sports for recovery. This overload means conditioning, recovery and liaison with professionals such as a Physio, Nutritionist or Dietitian essential to prevent breakdown of the musculoskeletal system.

Physically even an experienced dancer can struggle with restricting their body to within the limit of their injury. This may mean lowering extensions, staying off pointe and not performing any grande allegro. The mental challenges of an injury are also immense. A professional and amateur dancer may experience anxiety related to pressure to perform with injury, losing form, the impact on their future and career longevity, and the social stress of being outside normal class routine. This can have an impact on the dancers recovery and need to be addressed as part of the rehabilitation.

Erin Cuskelly, B. Physio Newcastle Uni: Erin has 7 years sports experience and a special interest in dance having trained with Australian Ballet principal physio Susan Mayes.

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RJ Chiro
rjchiro.com.au | 0418 697 099
Rebecca Player from RJ Chiro
Why are dancers more susceptible to injury when their workload increases – say when they start full-time?
Dancers in pre-professional training (full-time) are likely to sustain up to 4.6 injuries per 1000 hours of dancing and the greatest risk associated with injury in the same cohort is previous injury (1). When full-time courses average approximately 1600 hours of dance per year, you can see how this is becoming an ongoing issue and of paramount importance among dance medicine to allow for the longevity of dancers. Key factors, which contribute to such a high statistic of injuries in our youth, are usually in relation to overuse. “Overuse injuries are thought to result from exposure to repeated submaximal load without adequate recovery time”(2). These dancers have exceeded their biological capacity to adapt to a high load of training due to minimal training hours previously danced, and because they are less likely to address an injury when it occurs due to fear of missing out and competition with other dancers in the course. A dancer also tends to return to their practice before professional advice supports them to or before full healing of an injury has occurred. They also tend to overtrain particular skills in order to attain perfection, or to keep up with the latest dance trends. Furthermore dancers also exhibit functional and anatomical limitations including potential scoliosis, turn out range discrepancies, decreased ankle mobility improper landing technique from jumps and technique issues as well as many others which correlate with increase injury rates (1, 3). Overuse injuries in dancers constituted 72% of total injuries, this is in contrast to elite adolescents in other sports, where lower percentages of overuse injuries (15–63%) have been reported(2).

Rebecca Player – Chiropractor: Rebecca has been a member of the dance community since she was 4 and has competed in various competitions representing the state in dance companies. Rebecca is a fully qualified ballet and tap teacher and currently teaches dance at numerous studios around Sydney and the Central Coast.
1. Kenny SJ, Whittaker JL, Emery CA. Risk factors for musculoskeletal injury in preprofessional dancers: a systematic review. British journal of sports medicine. 2015:bjsports-2015-095121.
2. Ekegren CL, Quested R, Brodrick A. Injuries in pre-professional ballet dancers: Incidence, characteristics and consequences. Journal of Science and Medicine in Sport. 2014;17(3):271-5.
3. Caine D, Goodwin BJ, Caine CG, Bergeron G. Epidemiological Review of Injury in Pre-Professional Ballet Dancers. Journal of Dance Medicine & Science. 2015;19(4):140-8.

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Southwest Wellness Centre
Be Inspired. Be Challenged. Reach your potential
southwestwellness.com.au | 02 4647 1134
Arron Caller from Southwest Wellness Centre
Can you talk to us specifically about the dancer who studies Irish dancing and which types of injuries they are prone to?
One of my long-term patients is a young Irish dancer who has recently travelled to Glasgow for the Irish Dancing World Championships. As per most genres of dance, Irish dancers’ are prone to stress reactive and repetitive strain type injuries. Due to the pose of having the hips turned outwards and the majority of routines being performed on the forefoot region, the body experiences stress and movements that it is not naturally designed for. We’ve worked together on everything from stress fractures of the metatarsals (bones in the foot) to ligament tears in the knee and severe muscle strains in the hip. Despite all the ups and downs of injuries, we still manage to push on and prepare for the next competition, which is important for all dancers.

Are you able to give dancers some strategies and or injury management techniques to cope with ongoing stresses?
I work with the dancers’ to create a pain management plan that allows them to train and work on their chorey while allowing the body rest and recover seamlessly in preparation for competitions. This may include participating in step-through classes to minimise joint damage or train with slight modifications in order to prevent re-occurrence of injuries prior to performances. More specifically we can analyse the landing/weight distribution of the foot, ankle, knee and hip during a particular movement using video and visual feedback techniques. With this information we can alter practice and rehearsal sessions to eliminate pain, whilst not impacting performance when it comes to the big day.

In terms of immediate pain management, I find immediate success with myofascial releasing (basically a fancy manual therapy technique), shockwave therapy, dry needling, joint mobilisations, taping and bracing. Acute pain management will always be based on the dancers’ presentation and evidence. These treatment techniques have all been proven to reduce pain levels based on research-based evidence and clinical experience.

Do you also find there is a relationship between Irish and tap dancing?
No two dancers even within the same troop should be treated the same in regards to their injuries. The beauty of dancing is that it is so diverse. Even in group routines, the individual I’m working with is always going to perform slightly differently to the one standing next to them. Dancers of all genres have increased risk of injuries to lower limb joints, in particular the midfoot, inside of the knee and hip. These injuries can typically present due to alignment and loading abnormalities. There are more differences then similarities in regards to injuries between Irish and tappers. It’s important to note the mechanism of injury and gain a clear understanding of the biomechanics of each movement that the dancers have to perform. The only thing similar between Irish and tap dancers are their competiveness, which is something I embrace and use as motivation to get them back to dancing, pain free.

Arron Caller APAM, B. HSc/M. Physiotherapy, Dip. Rem Massage: Has extensive experience and knowledge working with dancers.

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Sydney Spine & Pelvis Physiotherapy Centre
sspphysio.com.au | 02 9719 9114
Michelle Wong from Sydney Spine & Pelvis Physiotherapy Centre
Can you talk to us about the effects extreme movements are having on our young dancers bodies?
Over recent years there has been an increased trend for dance students to work into extreme ranges of movement, for example the “oversplits”. As health professionals we have concerns about both the short and long term effects of these postures on growing bodies. Between the ages of 8-15, the body is continuously changing, laying the foundations for physical structure of bones, joints, muscles, movement patterns and strategies.
Generally the children that can achieve these positions are already hypermobile and therefore they are already at an increased risk of tendon and joint related injuries due to the innate nature of their body. Of course, flexibility is imperative for the dancer, as it enables them to achieve postures necessary for many different types of choreography. However, movements such as the “oversplit” tend to be more of a ‘trick’ and really don’t contribute significantly to a dancer’s ability to perform. While flexibility is important, dancers also need the strength and the control required to complete a piece of choreography over and over without injury. Additionally, teachers and choreographers have a great responsibility to help preserve and protect dancer’s bodies and must also consider the implications of these tricks when asking young dancers to perform such movements.

Take home messages:
> Over stretching in growing bodies can cause pain and dysfunction both short and long term.
> A trick such as the “oversplit” is not often essential to choreography and if it is required, needs to be balanced with a specific strengthening to ensure control of the relevant joints.
> The signs and symptoms of bone and joint problems may not be detected right away but will likely lead to pain and dysfunction either at the hip or in other regions of the body.

Michelle Wong M. Physiotherapy, M. Ex. Sports Sci, B.Sc (Pyschology) and Vanessa Barnes B.App Sci (Physiotherapy): Michelle is a keen dancer and therefore has a particular interest in Dance related injuries and assessment of young dancers requiring assessment or assistance to improve their movement strategies.
Vanessa has a keen interest in Ballet and treatment of Ballet related injuries, including hip, knee and ankle injuries.

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Pacific Orthopaedic
dr-andrew-letchford.com.au | 07 5527 1818
Dr Andrew Letchford from Pacific Orthopaedic
What types of injuries do you see in dancers?
There are not that many injuries in dancers that require surgery. The majority of injuries tend to be overuse injuries, versus trauma. Overuse injuries tend to respond better to rest and to retraining methods versus requiring surgery. Those that we see that require surgery would tend to be more traumatic injuries, and that would be in the knee.

The knee has complex arrangement of ligaments to maintain the tracking of the kneecap. The kneecap is really important in the overall function of the knee, in terms of achieving and maximising the power of the quadriceps muscle. Under stress and under load and under load in flexion, it puts a lot of pressure on the tracking mechanism and it can pop out laterally, or out to the side of the knee. If this becomes a recurrent issue then we need to try and either realign the rotation or use restraints to hold the kneecap and make it track more neutrally.

Traumatic injuries can occur in the presence of fatigue. So you want to try and avoid fatigue. You want to maintain good hydration to help with that. Proper warming up and cooling down type exercises are useful and obviously appropriate technique in dancing and appropriate rest.

I think the physios are pretty good in trying to initiate safety precautions and preventative management, right from the start, and I think that’s really important.

Something underappreciated, I think, is the stress and anxiety, of someone transitioning to full-time dancing, and trying to achieve a performance. Some sort of support in stress and anxiety levels helps someone maintain their peak and avoid the fatigue that might lead to a traumatic injury. I think, also, from my perspective, there are significant benefits in cross training. Cross training helps with maintaining balance and core strength and body control and helping people maintain the integrity of the whole musculoskeletal system, so that they can avoid an injury.

Dr. Andrew Letchford Orthopaedic Surgeon, F. A. Orth. A., FRACS (Ortho), MBBS (Sydney – Hons 1st), B.Sc. (QLD – hons 1st), Dip. Ed: Dr. Andrew Letchford is a specialist in hip and knee orthopaedic surgery, with a particular interest in arthroplasty (joint replacement), knee reconstructions, sports injuries and acute orthopaedic trauma. He also has a dancing daughter.

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Fine Lines Pilates & Movement
finelinespilates.com.au | 07 3161 0434
Sophie Pantges from Fine Lines Pilates & Movement
Why is it so valuable for a dancer to see a Pilates trainer who has an extensive dance background?
A qualified Pilates instructor with an extensive dance background will not only have a wealth of knowledge to help create a program to assist your body to work efficiently and effectively but they also understand the tendus and développés that you want to improve. They can also look at the whole picture and go as far as assisting with injury prevention.

They have been where you are so they can put themselves in your shoes to really work out and help you achieve your goals. They would also be able to communicate easily with dance teachers to really achieve the best out of you.

They “get” that performing is one of the best parts of dancing and if your instrument (body) is working for you efficiently you get to enjoy the performing your part with a magical ease, and you don’t have to worry about whether your body is going to be there for you.

Can you talk to us about the benefits of including a cross training injury management plan into a dancers schedule?
Cross training is very important as it helps with endurance, specific strengthening and control work (that often there isn’t time to focus on in normal class work), injury prevention and relaxation. It is important to find a balance and not over load your body, so you are helping not hindering. Speaking with your health professional and dance teacher as to what would be most beneficial to you is the first step.

Some specific benefits of including cross training into a dancers schedule include:
Cardiovascular fitness – Anaerobic Exercise and Aerobic Exercise – running/walking, elliptical, cycling & deep watering running
Improved memory – Pilates, yoga and barre classes focusing on the “how” in pilates and yoga, barre classes are often fast paced which means picking up things which challenges the brain.
Relaxation – focusing on breath in Pilates and yoga
Improved strength, flexibility and control – Pilates whether it’s improving ankle range and strengthening your intrinsic muscles for pointe work to working on being able to développé higher and have the strength to hold it!

At what age do you recommend student dancers commence Pilates work?
I would recommend starting as early as 10 or before. It is a great cross training program that strengthens and improves flexibility for dancing. It has some obvious and also many underlying benefits. It is a technique-based movement training method so when starting out it is important that there is supervision to make sure the movement is being performed correctly and efficiently. What is so wonderful is that as the awareness starts to grow, home programs can be given. It is a great tool for conditioning, warming up for classes and performances that you can take with you anywhere.

Some underlying benefits are awareness of good posture and the subtle control of postural muscles that will not only help with dance but with activities to help navigate through day-to-day life. Because let’s face it sometimes posture is forgotten as soon as we walk out of the dance studio. I always say to my clients an hour or two a week in the Pilates studio is great! But not nearly as effective if, as soon as they walk out that door they forget the awareness that they have been working on for the last hour!

Sophie Pantges: Sophie began her career as a professional ballet dancer, performing featured roles with companies in New York and Germany. Incorporating Pilates in her training throughout this time made the transition into Pilates Practitioner a natural one in 2006.

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Mind & Body Chiropractic
mindandbodychiro.com.au | 07 5559 1998
Dr Kate Hayter from Mind & Body Chiropractic
Can you tell us about the most common complaints dancers come to you with?
We commonly see dancers with injuries of the lower limb. Most commonly, we see injuries of the ankles and hips. This has also been identified in dancers who have been researched, whereby, approximately 75% of injuries occurred in the lower limb (Rietveld, 2000). In respect to ankle injuries, most are due to instability of the ligamentous structures surrounding the ankle. The laxity of these ligaments often cause pain when the foot is pointed and can often result in instability when en pointe. Furthermore, the dancer will be more likely to “sickle” the foot or overuse other muscles of the lower limb to compensate for the ligament laxity. This can then lead to further injuries of the knee or hip. Hip injuries are also very common in dancers. The major complaint is pain in the front of the hip and generally associated with an uncomfortable click. This type of injury is usually then identified as a tear of the labrum in the hip or a femoroacetabular impingement. Pain may also be felt into the groin and made worse with movements such as a jeté or grand plié.

Are there common causes for Ankle and Hips injuries?
The dancers we see most commonly present with these injuries when their training load has increased, for example, when rehearsing more for an upcoming competition, or after extensive recital rehearsals. Dancers also come in after re-injury or the occurrence of additional injuries. For example, research states that contralateral ankle injuries are more common in dancers who have previously had a lateral ankle sprain (Jacobs, Hincapié et al. 2012). A lateral ankle sprain will commonly occur in dancers who are uncontrolled or weak en pointe or when falling while attempting harder moves like multiple pirouettes. Injuries of the ankles are also common in other dancers such as tap dancers. Injuries in tap dancers are usually due to overuse of the muscles of the foot without adequate control of the leg from the knee and hip. The common cause for hip injuries such as femoroacetabular impingement and labral tears are overuse and hypercompression of the femur into the hip socket. Hypercompression can occur in excessive hip ranges of motion, for example, when practising an oversplit or continual landing from jumps. It is important for dancers to seek the assistance of a professional such as a chiropractor or physiotherapist prior to going en pointe, to ensure ankle stability is optimal for the prevention of injuries or following an injury to ensure correct rehabilitation exercises are being undertaken. It is also important that when a dancer return to rehearsals, that they limit the training intensity or load. Your physical therapist will help you determine when a safe time to return to full training load and intensity is in order to prevent further injury.

How does trigger point therapy work and why is it so beneficial for dancers?
Trigger point therapy is a form of specific and localised soft tissue therapy which involves placing pressure on small areas of muscle to remove “knots”. Trigger points are defined as “palpable nodules in a taut band of muscle’. The muscle may be taut or tight from overuse, muscle strain or generalised muscle tightness. These nodules can be hypersensitive and irritable and cause pain or weakness. Placing pressure on these nodules can help release or relax them and aid in promoting blood flow to the muscle in order to relax them. It is important for dancers to have these treated because they can lead to a muscle that is more susceptible to injury or imbalance. We administer trigger point therapy in combination with other very important treatments for dancers such as joint mobilisation, joint manipulation and joint rehabilitation. A multi-treatment approach is very important for both the prevention of injury and in the rehabilitation of current injuries.

Dr Kate Hayter BSc, Masters. Med. Research, Masters Chiro: Dr Kate Hayter has a Degree in Exercise Science, a Masters Degree in Medical Research and a Masters Degree in Chiropractic.

Jacobs, C. L., et al. (2012). “Musculoskeletal Injuries and Pain in Dancers: A Systematic Review Update.” Journal of Dance Medicine & Science 16(2): 74-84.
Rietveld, B. (2000). “Dance Injuries in the Older Dancer Comparison with Younger Dancers.” Journal of Dance Medicine & Science 4(1): 16-19.

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Revive Ashgrove
revivestudio.com.au | 07 3366 0500
Melissa Tattam from Revive Ashgrove
Why do you think it is imperative that an injured dancer seek the assistance of a physiotherapist who has a background in dance?
If I were to give an example, it would be like a physio with a professional background in football treating a ballet dancer, or a physio with a professional background in dance treating a football player. Clinically the structure of assessment and treatment are the same and guided by the patients signs and symptoms. But the terminology used to describe the symptoms; for example, “my back hurts in arabesque,” is quite specific and foreign to many. Also some dance injuries can appear a little ‘out of text book’. A dance physio will relate personally to many of the niggles presented or they will have had friends in a similar circumstance. This can be very reassuring for a patient. Sometimes just being able to modify the dance step rather than eliminate it completely is all it takes for the niggle or injury to improve.

Why do you think we see so many ankle injuries in dancers?
Studies show the most commonly injured area of the body in dance is the foot and ankle. All of the body’s weight is transferred onto the most distal and smallest joints of the body. If a dancer has poor proprioception, balance, co-ordination and strength of the core and lower limb, this will most certainly cause injury. For example: a pre-requisite for pointe work should include 25 single leg calf raises, performed with correct alignment of the foot.

If you could instil one point about injuries in the dancers psyche, what would it be and why?
Firstly: if you feel a niggle that lasts longer than a week or two, have it addressed straight away before it turns chronic. Chronic pain (pain that lasts longer than 3 months) can be very debilitating and discouraging for a young dancer. The longer you leave a small niggle the longer time it will take to rehabilitate. Secondly: compliance is the key to every injury, be motivated, and stay strong and positive. Don’t allow negative words, thoughts or emotions get in the way of your love for dance. There’s always a way around an injury if you have the right mindset. Ballet and dance is a wonderful world of its own, and in my opinion like no other.

Melissa Tattam Physiotherapist: Prior to becoming a physio Melissa had a ballet career spanning 15 years including soloist with the Queensland Ballet Company and principal with the Tasmanian Ballet Company.

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physiotec.com.au | 07 3342 4284
Louise Horrocks from PhysioTec
What are the benefits of having an ultrasound during a consultation/therapy?
Using real time ultrasound to look at muscle activation the dancer can see their muscles working, which helps with understanding correct muscle timing and patterns.

Ultrasound is particularly helpful to activate deep ‘stabilising’ muscles in the body which we can’t feel working as well as we can feel our surface ‘movement’ muscles. These muscles are really important, for example, the deep hip external rotators (at the back of the hip joint) can assist ‘turnout’; ankle and mid-foot movements need to occur before flexing the toes to help prevent some lower leg overuse injuries; and the deep hip flexors (at the front on the hip joint) and deep low back muscles need to be working well to eliminate an anterior ‘snapping’ hip.

With the help of ultrasound, muscle patterns can be assessed, retrained, and optimised, which can be useful in improving performance, preventing overuse issues, and assisting recovery from injury.

Why is it so important for a dancer to understand how the injury occurred in the first place?
It is vital for a dancer to understand why an injury has occurred. This allows the dancer to assist in recovering more quickly by understanding what movements and loads are harmful to their condition, and what movements and loads are helpful.

When a dancer is taught the correct way to perform a movement, with correct muscle patterning and timing, this empowers the dancer. The way the dancer moves their spine and limbs, or holds their spine while they move their limbs, can make a difference to their recovery from an injury, and help prevent an injury from recurring. Injury can be turned into a positive when performance is improved by greater knowledge of optimal movement patterns.

Why would you suggest to a dance teacher to take a class where the students don’t wear their shoes?
The shoes can hide how the intricate foot muscles and joints are moving, and when a dancer performs thousands of repetitions of a movement, it is important the movement is being performed correctly.

It may be helpful for the teacher to occasionally have the dancers remove their shoes so they can look for suboptimal foot and ankle patterns, which may become problematic over time. For example, it is important to assess that the dancer is not toe ‘clawing’, as this can cause muscles to overwork and become painful.

Louise Horrocks Musculoskeletal and Sports Physiotherapist: Having spent many of her early years dancing, Louise has a special interest in dance injury prevention and management.

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Pondera Physiotherapy & Pilates
pondera.com.au | 07 3846 1488
Melanie Fuller from Pondera Physiotherapy & Pilates
Why are the injuries of the student dancer so important to diagnose and treat in order to facilitate a sustainable career?
One risk factor to injury is having had a previous injury (Wiesler et al., 1996; Wong et al., 2008; Hiller et al., 2008). Therefore, it is important to have injuries diagnosed, assessed for why the injury has occurred, and managed appropriately by a health care professional. This helps to ensure a full return to pain free dance, in a timely manner, aiming to reduce the chance of recurrence. Some contributing factors to why an injury has occurred may be a sudden change in the intensity or duration of training, technique, strength or poor fitness. A potential added bonus to having injuries assessed in a timely manner might be to reduce the time to recovery, and in sports research, less time off due to injury relates to better performance (Raysmith and Drew, 2016).

Is there anything a student dancer can do now in order to have better resilience to injuries in the future?
I believe it is important to aim to reduce the risk of getting injured, due to the risk of recurrence mentioned before. Research has shown in 8-16 year old female dancers that the highest incidence of injuries occurs in the 11 year old age group (Steinberg et al., 2011). I feel this is an important age group to consider when aiming to prevent injury, for this is when many ‘changes’ occur. Around this age is when growth spurts occur, hours and intensity of training may increase, girls soon progress to pointe work, there may be a potential increase in frequency of performing or competing, along with other developmental changes and competing demands of school work. We can’t influence changes such as growth and development. We can monitor growth changes though so we are informed when they occur, as well as monitor slow and steady increases in training hours and intensity, number of performances and competition, and number of skills practiced – for example how many arabesques, jumps, new choreographic moves are being practiced each week compared to the week or month before. I believe reducing the number of ‘changes’ occurring at once could optimise developing resilience to injury. I think other key areas to consider are developing neuromuscular coordination, strength and aerobic fitness, and seeking the right balance of recovery via sleep and diet for instance.

What do you think is the biggest misconception student dancers have towards injuries?
‘I will get better when I have a chance to rest it’. I don’t think that young dancers should dance in pain. The International Olympic Committee (Bergeron et al., 2015) recommend that “No youth athlete should compete – or train or practice in a way that loads the affected injured area, interfering with or delaying recovery – when in pain or not completely rehabilitated and recovered from an illness or injury” (p. 9 of 14). Waiting for holidays to rest an injury could leave you at risk of making an injury worse, increasing the time needed to recover and rest alone will not address the contributing factors of why the injury has occurred and therefore could reoccur.

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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Xtend Barre Broadwater
xtendbarre.com | 07 5500 6002
Stacey Chew from Xtend Barre Broadwater
What is Xtend Barre?
Xtend Barre is Pilates and dance amplified. It brings in elements of dance, ballet and Pilates to create an adrenaline-fueled workout that strengthens, lengthens and chisels the body. Each class features an elegant yet energetic combination of movements which enhance flexibility, improve balance and challenge the core.

What are the benefits for dancers to include at least one Xtend Barre class in their routines per week?
The classes allow dancers of all levels to focus on particular movements in the body, paying in particular attention on alignment all whilst increasing strength from head to toe. The classes are filled with energising bursts of cardio which every dancer loves but we always come back to technique, posture and engaging the core. Dancers will feel the amazing effects in dance and performance but most importantly later on in life.

Do you need to have done ballet to do Xtend Barre?
Ballet experience is not necessary as the classes are easy to follow and extremely fun. Dancers come for many reasons, flexibility and posture, some to tone and sculpt and some to gain strength and control. The most exciting thing is all of these things are achieved and we sculpt the whole body proportionally and evenly!

Stacey Chew: Embracing dance from a young age, Stacey has operated her own dance school, toured and performed internationally with live children’s shows and, as a dancer and performer for many years, in live Action & Entertainment shows.

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Posture Podiatry
posturepodiatry.com | 08 8362 5900
Daniel Gibbs from Posture Podiatry
What are some tell-tale signs that a dancer should be aware of that require your help?
If you’re experiencing foot pain that doesn’t go away, or if you’re always re-injuring yourself, it could be a sign that your body is struggling to compensate effectively and you’re at risk of a bigger injury.

Good alignment of the musculoskeletal structures in your body prevents injury. It’s important to read those signs correctly, and that’s what we do as podiatrists for dancers. It’s not dancing that causes bad feet, but bad dancing that causes bad feet.

What most dancers don’t realise is that a dancer’s body is constantly trying to find the easiest way to do things. If there’s restriction in your joints or if your muscles are too busy protecting other areas, you may not be able to perform a particular technique correctly, and that leaves you open to injury.

As podiatrists, we carefully watch how you move to determine the true origin of pain in your toes, arches, heels, ankles, shins, calves, knees and the rest – and it’s often not where you might think!

What are some of the most common feet problems dancers encounter and is there often a common cause?
The majority of treatment for professional dancers is aimed at freeing up the joints and muscles of the feet and legs after they’ve been pummelled, tumbled, pounded and tripped on the rehearsal floor. The relief they experience from forefoot pain, weak ankles, tired and aching feet is immediate and shows how important it is to maintain good joint mobility and muscle conditioning.

The best approach is to help the body help itself, rather than rely on external aids, paddings or supports that can let you get away with poor technique.

It’s always fascinating to watch how the bodies of the dancers change according to the piece they’re rehearsing or the footwear they use. It’s changes like this that require careful attention, because if the body is unable to compensate effectively, injuries will be more likely to occur.

Never underestimate something as trivial as an ingrown toenail or skin split which has the potential to bench you for weeks – make sure you read the signs!

How often would you ideally like to see a dancer to assess potential problems?
Ideally, dancers should be seen at least once a month during the term, and immediately if there are any injuries or concerns with technique. It’s common for us to see dancers weekly leading up to a performance or examination to maintain good function and prevent injuries.

A good relationship with your podiatrist – including regular visits for foot mobilisation, skin and nail care, shoe modifications, taping plus exercises to help with your technique – will mean you can address potential problems before they threaten your future.

Daniel Gibbs, B.Pod, Member of Australian Podiatry Association, Accredited Podiatrist: Daniel works with dancers from the Australian Dance Theatre amongst many others.

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Anna Tetlow Pilates
annatetlowpilates.com.au | 0438 595 792
Anna Tetlow from Anna Tetlow Pilates
How can working with you help to improve a dancer’s technique?
Pilates, Garuda and Gyrotonic® play an important role in ensuring the health and well-being of young dancers, who are continuously exposed to the risk of injury and muscular stress related activities. Using these techniques help dancers understand correct muscle use, retrain unhelpful technical habits, and teach them to apply the work done in the studio to their own class work. Working in this way helps the dancers focus on strengthening the relevant muscles needed for dance to not only prevent and rehabilitate injury, but to improve dance technique overall.

What are the benefits of collaborating with teachers and other health professionals whilst working with dancers?
It is essential to have teachers, physiotherapists and other health professionals on the same page and working towards the same goals for the individual dancer. By collaborating on a treatment plan, you are able to set specific goals to increase muscle efficiency and achieve optimum technique and complete rehabilitation. Each professional should add to the dancer’s support network and knowledge of their body so they work intelligently in injury prevention and management. Together the support team helps the dancer strengthen their bodies and minds.

Can you talk to us about how you use Pilates, Garuda and Gyrotonic to facilitate dancers rehabilitation?
The combined benefits of Pilates, Gyrotonic and Garuda help to manage injuries, teach self-sufficiency and ultimately achieve rehabilitation. It is important for a dancer to work with teachers with a wealth of knowledge and experience in the art of movement and dance.

Anna Tetlow: Anna trained with The Royal Ballet School and toured professionally with The Birmingham Royal Ballet, The Royal Ballet, Scottish National and London City Ballet. She has been working with dancers for over 15 years.

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Bellbird Sports & Spinal
A boutique performance studio
sports-spinal.com.au | 03 9878 8088
Andrew Cobb from Bellbird Sports & Spinal
What are your thoughts on dancers stretching in second split with one foot raised on a block or both feet raised on a block?
Is this extreme hip range actually required by this dancer? Is this type of stretching and flexibility likely to improve their dancing (considering they can already do splits in second)? Is this type of stretching likely to increase their risk of injury?

As you can imagine there isn’t one answer to this question that suits all dancers, much like there isn’t one pointe shoe for all dancers. Also the training techniques used by professional dancers should be different to those adopted by young dancers due to the extra years of conditioning.

If a dancer can easily get down into second split without any sensation of stretching in their hip or associated muscles they are probably suitable to place a foot up on a block. Some dancers with hypermobile hips will also safely be able to perform this type of stretch without risking injury but there are many that are already pushing the boundaries set by their own anatomical hip joint shapes and pushing further into this range will undoubtedly cause an injury.

If the extra flexibility gained by doing this stretch isn’t supplemented with extra strength in that exact hip range of movement then the extra hip range is likely to increase their risk of injury.

Please be careful when attempting this type of stretch, as one size doesn’t fit all.

Can you talk to us about some of the more common problems dancers sustain in their lumbar spines and pelvis region?
Hypermobility versus Instability – Hypermobility is an attribute all dancers need a certain degree of. Hypermobility means that a joint can move further into range than is considered normal in the general population. For example if a dancer didn’t have some hypermobility they wouldn’t be able to do the splits. Hypermobility is very different to instability. Instability relates to a loss of control or stability of a joint or multiple joints. The joints stability is the combination of both passive and active components. The passive stability of the joint comes from the structure and shape of the bones and the tension of the ligaments, whereas the active stability comes from the strength of the surrounding muscles and the neural and proprioceptive control of the joint. A hypermobile dance may possess less passive stability, i.e. a joint shape that allows more movement, but they compensate for this with increased active stability, i.e. better strength and proprioceptive control.

When a patient presents with both hypermobility and instability this is a more difficult presentation to rehabilitate. Hypermobility increases your risk of injury and length of recovery but isn’t the cause of the injury, ultimately a lack of strength or endurance is usually what results in the injury of the hypermobile joint.

When a dancer presents with lumbar or pelvic instability, the important thing to remember is that the injury isn’t the instability. The pain is quite often the cause of the instability and is most likely coming from injuries to the zygapophyseal (facet) joints, the intervertebral discs or other local structures.

The fundamental solution to prevent a hypermobile dancer from injury but also rehabilitate one with an instability related injury is quite simple, the dancer needs to build stronger muscles with better proprioception and this will reduce their symptoms and ultimately allow them to return to dancing.

Scoliosis is another common complaint in female dancers. Scoliosis is defined as a sideways bend and rotation of the spine off its usual axis. It is much more common in females and the angle of bend needs to be greater than 10o to be called a scoliosis. Scoliosis can change overtime and is not considered an injury but still needs to be monitored.

Zygapophyseal (Facet) joints are another commonly treated spinal injury in dancers. The purpose of the facet joint is to control the direction and degree of movement at each vertebral level. The alignment of the lumbar facets joints allow flexion and extension but limit rotation, whereas the ones in the thoracic spine allow rotation but limit flexion and extension.

A facet joint can be strained when the joint is stretched further than designed resulting in ligament damage, similar to an ankle sprain. The other common facet joints injury is impingement, when a joint is jammed up excessively under force.

The last common lumbar spine injury in dancers is an intervertebral disc injury, the most common being a disc bulge, however disc tears and disc herniation’s can occur in older dancers. The disc sits between two vertebrae and is a made up of two parts, the outer fibrocartilage and the inner nucleus. The disc is a strong flexible joint which is what allows our spine to move. In a disc bulge the disc pushes backwards towards the spinal cord or exiting nerves and can potentially touch these nerves. If the nerves touch the disc bulge there is usually referred pain down the leg commonly called sciatica.

Common hip complaints in dancers:
Femoroacetabular Impingement (FAI) occurs when the femur (thigh bone) hits or rubs up on the acetabulum (hip socket) causing damage and inflammation of the hip joint. There is usually a boney anomaly of the femur or the acetabulum (sometimes both) that result in the condition. The dancer would usually experience pain with high hip movements forwards or to the side.

Labral tears often occur as a result of FAI but can occur due to an injury, especially in dancers. The labrum is a rim of fibrocartilage that sits on the edge of the acetabulum, which deepens the socket and acts like a suction cup to hold the femur in the socket. Once the labrum is torn the hip quite often becomes “clicky” and sometimes painful. This loss of suction results in extra-unwanted movement in the hip joint. If the labral tear is small most dancers can compensate for this loss of passive stability by strengthening their hip muscles, allowing them to successfully return to dancing despite the labrum never truly healing due to its poor blood supply. In large labral tears the current recommendation is to have arthroscopic surgery to reattach the torn labrum and restore the joints stability.

Muscular strains and tears around the hip joint are also quite common in dancers. The three most common muscles injured around the hip are the hamstrings, iliopsoas (hip flexors) and rectus femoris (center part of the quadriceps). These injuries almost always fully recover with appropriate treatment however there is a high reoccurrence rate if the strength and flexibility aren’t returned to a level at or above the pre injury level.

Are you able to say if these injuries have a common cause?
All sports have similar underlying causes that result in injuries; the obvious and easily managed things are often overlooked when trying to find the cause. The causes of most injuries are:

Fatigue – with many amateur dancers training over 10 hours per week and professionals easily over 30 hours, fatigue has a huge role to play. When people are tired they don’t concentrate as much, stumble more and make more mistakes increasing their risk of injury. There are a few simple solutions here, identify the signs of fatigue, get more rest/sleep, spend more time preparing your endurance for upcoming performances, eat snacks and drink water throughout long rehearsal days.

Overuse – dancers are prone to overuse related injuries, be it practicing the same move over and over and over or just the number of hours en pointe. This repetition of the same move loads the bones, joints and muscles in the exact same way and eventually leads to structural fatigue and injury.

Previous Injury – once a dancer has injured a joint or muscle this increases their likelihood of further injury not only to that area but the structures above and below the injury. The easiest way to prevent this from reoccurring is to continue working on rehabilitation months if not years after the injury to ensure you have regained your full strength, stability, proprioception and function.

Joint Stiffness – the majority of dancing requires extremes in joint range of motion. If a joint is asked to go beyond its available range of movement it will very quickly become injured. Knowing your own joint limitations is essential but also regularly working to improve your flexibility can actually let you achieve these ranges.

Decreased Stability, Balance & Proprioception – when a joint loses stability through injury the balance feedback sensors in the joint are quite often also injured. If these sensors aren’t sending information back to the brain telling it where the joint is, the brain cannot adequately protect and control the joint.

Muscular Weakness – when a muscle is weak it struggles to absorb force as efficiently as a stronger muscle would but it also fatigues quicker. If the force applied to a muscle is greater than what it can stand the muscle will tear. If you think of all the brilliant dancers you’ve ever seen, they all have one thing in common, their strength. Strong dancers hurt themselves less often as they can produce and absorb more force ultimately protecting their joints for longer.

Poor Technique – when a skill is performed incorrectly it is more likely to injure a dancer, a perfect example is a pirouette. If the pirouette technique is performed poorly the dancer is more likely to fall out of the turn and land awkwardly spraining an ankle.

Anatomical Factors – some people have anatomical changes that make them more prone to certain injuries, i.e. internally rotated hips and flat feet mean you are more likely to get knee pain. Having someone identify these anatomical differences and advise you on stretches or exercises to account for them can help prevent injuries.

Please remember that it is extremely rare for an injury to stop a dancer from all aspects or training and maintaining fitness. Please ask your health professionals what you can do while you are recovering. Apart from the obvious rehabilitation exercises to overcome the injury, ask if you can you also do:
– Clinical Pilates
– Floor barre
– Swimming
– Exercise bike
– Upper body strength exercises
– Core exercises
– Mark class at the back, either standing or seated

Andrew Cobb: Andrew is an APA Sports Physiotherapist and Clinical Pilates instructor with over 15 years clinical experience. He is an active member of the Australian Physiotherapy Association and Sports Medicine Australia.

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Highett Podiatry
highettpodiatry.com.au | 03 9555 3044
Kirstine Mann from Highett Podiatry
Can you talk us through exactly what you are looking for in the foot itself for pointe work readiness?
I am a podiatrist who has a special interest in dance medicine. I perform pre pointe assessments covering all aspects of the body including strength, alignment and structure. A full dance and medical history is taken prior to a physical examination. The physical examination includes strength and flexibility testing, turnout, ballet technique, joint range of motion particularly point position at the ankle and mid foot. Foot shape and pointe shoe recommendations are also made.

Have you ever had a case where a student should not pursue pointe work?
If a ballet student does not meet all the requirements to start pointe work an exercise program is issued to them. This usually consists of strengthening exercises and exercises to increase joint range of motion. I have only had two students who have not gone onto pointe, one being unable to achieve adequate pointe position as her ankle range of motion was blocked with a structural equinis and the other had moderate hallux limitis that restricted dorsi flexion at the 1st metatarsophalangeal joint. Many students who pursue pointe work after their initial assessment may not continue with pointe due to physical limitations that are exacerbated with pointe work and this is usually found in the first six months of pointe training.

Non-dancers are often taken aback at the state of a full-time or professional dancers foot. Can you talk you us about why the feet end up looking like this?
Dancers’ feet are their tools and are worked very hard. Due to unnatural forces they are placed under en pointe, dancers develop arthritis causing bunions and crooked toes. They also suffer with blisters, corns and callouses due to friction from the pointe shoe box as well as ingrown toenails. I treat dancers for these injuries and many more that affect the feet including stress fractures, tendonitis, muscle and ligament strains and neural injuries. Some of the most common dance injuries I see in the clinic are sesamoiditis, stress fracture of the metatarsals, plantar fasciitis, tendonitis of the Achilles and tibialis posterior tendon, posterior ankle impingement and intermetarsal bursitis.

Kirstine Mann B.Pod (LaTrobe University): Kirstine has over 20 years clinical experience in podiatry and is also a ballet teacher of the Cecchetti syllabus.

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InSync Physiotherapy & Pilates
insyncphysiopilates.com.au | 03 9813 2188
Joanne Maskrey from InSync Physiotherapy & Pilates
What advice would you offer to the dancer who is potentially facing a lengthy journey in rehabilitation?
The lengthy rehabilitation process and time away from full class can be challenging for any dancer. Injuries are never fun. But you can use them to your advantage. The key is to focus on your future as a dancer and get back to full strength as soon as possible.

The dancer should maintain elements of their regular practice that they can manage with their injury. Doing what they can in class will always be an advantage, physically and mentally.

Above all, be positive. Focus on aspects of the body that can be improved and remember that negative emotions can sometimes be a hindrance.

Pilates, hydrotherapy and gym work can really help with this, and are essential to an ongoing strength and exercise regime. To ensure correct diagnosis and the right rehabilitation processes, is it vital to see a practitioner who is experienced in dance.

What are the qualities in a dancer that make them more likely to succeed during long- term rehabilitation?
Dancers have patience and determination. These traits will come to the fore during rehabilitation. Setting short, medium and long-term goals will encourage a greater sense of achievement as each is reached.

At the end of the day, the rehabilitation period is a time to improve technique. While the injured dancer may not be experiencing the exhilaration of dancing on stage or flying through the air in grand jetés, they will be heartened by their improving technique. They will also be encouraged by their newly acquired strength and body understanding, which will ultimately elevate their ability.

Without lows a dancer can never fully appreciate the highs. Given time, injury can actually transform you into a better dancer.

Joanne Maskrey B.Phty: Joanne trained in the Royal Academy of Dance syllabus up until Advanced. She studied Pilates at the Australian Physiotherapy and Pilates Institute in London and Physiotherapy at the University of Melbourne. To this day she still attends ballet class.

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My Podiatrist
mypodiatrist.com.au | 1800 733 444
Elizabeth Kiriakidis from My Podiatrist
Can you tell us about the most common complaints you receive from dancers?
Most of the chronic injuries relate to the impact loading on the dancer’s foot, the floor and/or the shoe. This primarily is due to the absorption and impact forces. 15-20% of all dance injuries will include the foot. The most common problems I see is the inability to pointe correctly (not reaching full range of pointe) or over pointe, which leads to poor balance in the foot and ankle causing further alignment problems or further still injuries.

Inability to pointe issues include…
> Ankle joint having limitation, otherwise known as an Equinus.
> Achilles thickening and restriction, or inflammation (sometimes known as Tarsal Tunnel Syndrome).
> Tibialis postier muscles and peroneals (muscles position on front of shin and outside of the calf). This is when the muscles are not balanced and too tight, and some are working harder than others. Thus leading to “overuse” or repetitive use of the same muscle, which in time fatigues and begins to tire.
> Over pivoting – rolling in of feet (sickling) and compensating to pointe through rotation of the ankle and/or hyperextending of the knee.

Over pointe issues include…
> Tight calf and not balanced together with the peroneals. With constant calf raises you find the calf/gastrocniumes muscle builds up so much that range of motion is restricted.
> Hyperflexible foot- hypermobile ligaments can cause osteophytic lipping of cuneiform/bones in midfoot. This is when the spur or “bumps” on the top of the foot occurs, and the bone joints slip over each other.
> Twisting of the foot – over pronating, low arches and rolling in of the foot.
> Knee internal rotation leads to ankle and foot rotation.
> Foot type and shoe not correct in toe box of shoe.
> Restricted hip movement – the goal is to have 90 degrees hip rotation (internal/external). If you can’t reach full range then you begin to compensate through your thigh, knee and ankle.

How do we reach the perfect pointe or demi-pointe?
It is essential to identify which muscles imbalanced the foot. Is it the ankle, the foot only or coming from further up, e.g. hip flexors? Then a specific program needs to be targeted to tighten muscles with eccentric stretching and strengthen the weaker ones. If the balance of the muscles is not right, then this will show when on pointe or demi-pointe. The posture alignment will be wrong.

The newest and latest therapy that is achieving wonderful and very quick results is “shockwave therapy”. This treatment is relatively new, however I have been using it on my dancers for the last 2 years with outstanding results. They have been able to achieve ranges of motion, muscle strength and posture alignments that you would never achieve alone through daily stretching.

High-energy soundwaves from a machine transmit from the probe held against the skin and pass through spreading outwards into the underlying muscles tissues. It increases blood flow and metabolic activity around the site of pain accelerating the healing process. It breaks down any scar and connective tissue that is tight. It effectively reduces pain from this area. An immediate effect is that it loosens the muscle and allows us to reset the length of the muscle memory to a new length via stretching straight after the treatment. There is no pain and the dancers feel the result immediately. The treatment plan will require a few treatments depending on which and how many muscles are targeted as part of the dancers’ program. With continual stretching the dancer is able to maintain their new positions and range, and this is the magic and satisfaction lots of dancers are now achieving.

Elizabeth Kiriakidis: Elizabeth has worked with dancers who are currently performing with The Australian Ballet, Houston Ballet and The Royal Ballet.

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Performance Medicine
performancemedphysio.com.au | 03 9686 2373
Annie Strauch from Performance Medicine
When were you brought in to work with the dancers from the hit musical Strictly Ballroom and why?
Strictly Ballroom the Musical arrived in Melbourne after their opening season in Sydney and this was when we became involved. There were performers who were carrying injuries into the Melbourne season and the show had undergone some creative changes at the end of the Sydney season.

How did you assess the dancers?
The dancers were assessed during their physiotherapy sessions in the clinic or theatre. Their assessment reviewed each performer’s strength versus flexibility and muscular control and their endurance to perform. These aspects were then considered with the performers demands in the show and the specific show choreography.

What sort of injury management plans did you incorporate into their routines to minimise the injuries they were sustaining?
The programs focused on the ballroom genre and therefore included upper limb and partner work with exercise bands. The areas included were upper limb nerve mobility, shoulder girdle control, neck and thoracic mobility and pelvic control.

Did you encounter much surprise from the dancers in regards to how successful your program was in terms of injury prevention?
The cast were a fantastic group of performers who were motivated to incorporate exercises to improve the strength and endurance of their show. They found that the exercises provided them direction to manage the issues that were occurring to and decrease the repetitive overload in their bodies. Some were surprised but most were enthusiastic about being proactive about injury prevention.

Annie Strauch APA Sports & Musculoskeletal Physiotherapist B. Phty (Hons) M. Phty (Sports) M. Phty (Musc): Annie’s passion for performance physiotherapy developed on London’s West End where she managed performers in over 30 productions.

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True Potential Physiotherapy
truepotentialphysio.com.au | 0481 840 480
Haydee Ferguson from True Potential Physiotherapy
What is hypermobility?
Many people have flexible or loose joints, however in order to discuss the injuries that can occur we need to make sure that we know what hypermobility is and how it differs to flexibility. The term flexibility refers to the range of movement available from the muscles while the term hypermobility relates to ligaments. Many dancers, gymnasts, contortionists and yogis have some degree of hypermobility as that is one of the things that help them excel at their chosen art. Their joints move further and more easily than most. Sometimes, these people are called “double-jointed” and some may even have dislocated or popped their joints out of the socket at some stage in their lives. It is estimated that up to 10% of the general population have some degree of hypermobility, with women being affected about three times more often than men. Most hypermobile people do not develop any problems from their loose joints, but some can suffer chronic pain and other symptoms such as: pain and stiffness in the joints and muscles, clicking joints, joints that dislocate easily, fatigue (extreme tiredness), recurrent injuries e.g. sprains, digestive problems e.g. irritable bowel syndrome, dizziness, fainting and/or thin or stretchy skin.

Muscles and ligaments are made of two distinct types of tissues that perform very different functions in the body. Muscles are contractile tissues that cross over one or more joint in your body. When a muscle contracts, it causes movement of the joint it crosses. Ligaments, on the other hand, are short bands of fibrous connective tissue that connect bone-to-bone and effectively “fasten” our joints together. Ligaments do not contract or create movement in the body. Instead, ligaments serve as the “seat belts” of our joints. They are our back-up system to stabilise our joints if our body moves in a way that would otherwise take a joint beyond its normal range of motion.

An easy way to scan yourself to see if you may have hypermobility is to look at a few joints – can you straighten your knees past 180 degrees? Do your elbows appear to bend backwards? Can you bend your thumbs down to touch your wrists? Do your pinky fingers bend backwards past 90 degrees? Can you easily get your hands flat on the floor, even when you haven’t warmed up? Check with other members of your family as well – hypermobility is genetic and you may just find that your parents are hypermobile too! Although this test doesn’t diagnose you as having hypermobility, it may be an indicator that you should chat with your physiotherapist and teacher about ways to manage your extreme available movement.

Does a dancer with hypermobility need to work their body in a different way?
Dancers with hypermobility need to work a lot harder on their core, shoulder girdle and hip girdle stability, strength, joint control and proprioception (knowledge of where your joints/body is in space) than dancers who are not hypermobile. They do not need to spend as much time on stretching and increasing their range as this is likely to just increase their joint instability and create more problems if done incorrectly. Including modalities such as Pilates, some styles of yoga, dance specific conditioning programs and/or swimming into their dance-training regime can assist with managing the symptoms of hypermobility. Pilates and yoga can also teach dancers to control their joints but still achieve the aesthetic lines required. Even hypermobile dancers can have “tight” muscles as these muscles tend to overwork in order to control the joints when the ligaments are no longer doing their job, however it is important that their stretching program is monitored by a health professional in order to ensure they are stretching muscles, and not ligaments, and that they are combining enough stability. Often flexibility will improve naturally once a joint is better controlled.

Haydee Ferguson Physiotherapist: Haydee has a dance history spanning more than 25 years. In her capacity as physiotherapist she has worked with many elite contemporary and ballet dancers.

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Xtend Barre Bayside, Essendon, Hawthorn
Jacquie Larkins from Xtend Barre Bayside, Essendon, Hawthorn
Why does Xtend Barre class make for the optimal holiday workout?
Xtend Barre offers a great workout for dancers who are wanting to keep their bodies on point during times of rest, holidays or breaks in rehearsal schedules. The classes are an equal combination of strength training, cardio and flexibility, not unlike your familiar dance classes.

What are some of the key areas the dancer will work on during any given class?
The classes are designed to engage all the small, stabilising muscles of your body, using tiny and precise movements to challenge your core and create a strong body. The focus is not just on one area, instead dancers work on every aspect of the body, creating balance, and lengthening and strengthening from head to toe.

Can Xtend Barre substitute for a ballet class for a performing arts student who may be intimidated by ballet?
The basic ballet moves and choreography can actually be a great way to ease into the terms and form used in ballet without getting your ballet tights on. Dancers will be challenged however the highly trained instructors are there to help each individual meet their personal goals using modifications and progressions when needed. If dancers have injuries, they should always first seek advice from a medical professional and when they are ready to start we provide alternate exercises for anyone working with specific instructions from their doctor or physio.

Jacquie Larkins Diploma in Dance, DFTA Certificate, Pilates Mat and Reformer Certificates: Jacquie worked professionally as a dancer for many commercial and corporate events in Melbourne and overseas, spending 5 years at Tokyo Disney as a Character Actress and Aerialist. She also taught ballet, jazz and cheerleading at various dance schools.

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APS Physiotherapy
A university for the real world
apsphysio.com.au | 08 9227 7117
Danica Hendry from APS Physiotherapy
Why do dancers sometimes have the same injury reoccur?
In adolescent dancers the majority of injuries that occur are called overuse injuries. These can commonly reoccur if the dancers are unaware of what originally caused them. To prevent a reoccurrence of an injury the dancer needs to understand the cause, take the necessary time to heal and/or adapt to the new load. These overuse injuries usually occur due to multiple factors. Some examples include:
> A change in the training load – more classes, first pointe shoes, new jumps or a change in dance school.
> Underlying technique faults or biomechanical (the way a person moves) issues such as forcing turnout, rolling or pronating at the feet, curling or gripping of the toes and poor control of hyperextension.
> Inadequate nutritional intake to support the amount of physical activity.
> Attempting steps beyond the dancers capability and age.
> The adolescent growth spurt – the time when muscles and bones grow at different rates, and as a result there are inherent imbalances within the body. This is when many dancers feel that they are really uncoordinated.
> Poor recovery strategies.

Often dancers also have injuries reoccur if they are fearful of re-injury, or if the original injury had a large emotional impact on them. The way a dancer copes with an injury and their thought processes surrounding an injury and pain can play a huge role in the response of the injured tissue and also on the brain’s control of pain. Often when a dancer is scared of re-injuring themselves they become very cautious surrounding movement and what they can and can’t do. This mental side of things needs to be addressed so that the dancer is confident in his or her body and is able to move forwards beyond an injury.

Many dancers do not seek medical help for fear of bad news, how would you assist them with this mindset?
The most challenging part of being a physio for me is that I don’t like giving young dancers bad news. I like to help someone understand more about their body, why they might be injured, and what they can do while their injury heals. Growing up, and through my life as a professional dancer (prior to becoming a physio) I used to say, “I am going to be the physio who doesn’t make people take a break when they are injured”- I then became a physiotherapist and discovered that I couldn’t actually always do this because often tissue needs time to heal. So I adapted my thought process and work, using the idea that an injury is an opportunity to learn more about you, not only the dancer, but also the person. Rather than seeing it as a big red stop sign, think of it as a speed bump in the road. Just because you have an injury does not mean you have to step completely away from dancing, instead it is the time to focus in on other components of yourself. For example, if a dancer has sustained a bone stress injury in their foot, the rest of their body can still do a lot of work.

This is the perfect opportunity to sit down and write down different goals that you would like to achieve with the rest of your body and focus on them. The things you have recognized with your physiotherapist that may have been causative factors of the injury, or it may be other areas that your teacher has picked up in class – for example focus in on strengthening your turn out muscles or controlling your arms and upper back. While some of this can be done at home, I almost always recommend that dancers continue to go to class throughout an injury.

Danica Hendry: Before treating dancers at her practice Danica was a professional dancer and understands the anxiety dancers suffer when faced with an injury.

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Body Wise
bodywise.net.au | 08 9384 1555
Douglas Joyce from Body Wise
Can you talk to us about the lower back injuries that you are seeing in dancers?
Primarily dancers are hypermobile and whilst this is a most advantageous attribute, it can be a leading reason for the development of injuries. The most common of these complaints comes from excessive hypermobility that arises from the Arabesque position or the back bend we see in a layback position, where the spine is extended in the very low back. A tendency toward hypermobility, plus excessive and repetitive local movement at a particular joint, equals injury development. That’s why a lot of these injuries occur at the end of a series of rehearsals just in time for Opening Night.

It is the overuse at the level of L5 in the vertebra (just above the pelvis) that develops even more movement. There comes a time when this movement is untoward, unwanted and harmful as well as visible from the naked eye. The line is lost and most of the movement can be seen at L5. What does this mean? It means you’ve lost ‘the look’. ‘The look’ matters when going for an audition. This can be avoided by stretching. The movement most commonly lost from students is the hip extension. Stretches that take the pressure off the lower lumber area will reflect in more stretch going into the anterior, front, hip structures and a beautiful arabesque results. An even back bend that looks unstressed and easy occurs because these deep, strong anterior hip ligaments and deep groin muscles have been lengthened.

Douglas Joyce: Douglas has been a practicing physiotherapist for 33 years, was the physiotherapist for the West Australian Ballet for 5 years and opened in the first Pilates studio in Perth in 1991 primarily for WAB and dancers. He has a B.App.Sc. (Physio), Grad. Diploma Manip. Therapy and Advanced Certificate in Headache – Dean Watson and for a number of years was the go to physiotherapist for many touring musicals and companies including Cats and Riverdance.

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Endeavour College of Natural Health
Emrys Goldsworthy from Endeavour College of Natural Health
What is Myotherapy?
Myotherapy is a branch of manual medicine that focuses on the treatment and management of musculoskeletal pain and dysfunction. Myotherapy involves an extensive physical evaluation and an integrated therapeutic approach in the treatment of affected muscles, joints and nerves.

How do dancers benefit from Myotherapy?
Some of the benefits of having a Myotherapy session can include:
> Decrease muscle tightness and pain
> Increase joint mobility
> Correct spinal alignment
> Improve nerve mobility and function
> Improve movement patterns
> Improve technical requirements of dance with targeted treatment.

What are the most common reasons dancers visit you?
Dancer’s come to see me for 3 main reasons: pre-pointe assessments, dance
technique assessments and injury management. Pre-pointe assessments is an examination to determine if the dancer is ready to go en pointe and graduates of the Bachelor of Health Science (Myotherapy) will require further training to be able to do these assessments. Dancers come to me for injuries ranging from Achilles tendinopathy to back pain due to them having a scoliosis. My background in dance has assisted me in understanding the technical requirements of the art and in conjunction with Myotherapy it has allowed me to specialise in the treatment and assessment of dancers.

Emrys Goldsworthy MSC, BHSc (Musculoskeletal Therapy): Teachers at Endeavour College of Natural Health as well as running his own practice. Emrys also has a Masters Degree in Sports Coaching (focusing on classical ballet coaching) at Griffith University. He was a professional classical ballet and contemporary dancer and a graduate of the Australian Conservatoire of Ballet, which led to a career in the Royal New Zealand Ballet.

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Diva Dance Australia
divadanceaustralia.com | 0433 134 837
Savo Stankovich from Diva Dance Australia
“Since using the Spin Spot™ in my pirouette training, I have been able to find my centre. This then makes my turns a lot better and I can also hold a better posture and spot faster, but if I don’t do everything right, I fall off which makes my body work harder. It took a long time and a lot of patience, but it was worth it in the end”.
Isabella Stankovich 11 years

Which dance exercises does the Spin Spot™ help with?
The Spin Spot™, now made in Australia, is purpose designed for helping dancers with improving all basic and technical aspects of performing pirouettes, especially on relevé. It is also an invaluable tool for training in proper turnout as it builds muscle strength along with correct positioning. The Spin Spot™ improves spotting, increases core strength making it easier for the dancer to find his or her centre thus allowing them to perform more turns at a higher technical standard.
It’s about quality not quantity when it comes to turns and pirouettes.

How often should the Spin Spot™ be used?
The Spin Spot™ can be used daily as a part of any dancers normal training routine. It must be used under adult supervision at all times and in conjunction with regular turning classes. Using a Spin Spot™ requires the user to start out slowly and progress to the higher levels of training. The Spin Spot™ is a product that will, with time and using a progression style of training, bring you to a level of professional mastery when it comes to your pirouettes; and turn out. It is a challenge, but a challenge well worth the effort, time and rewards.

Which age bracket is best suited to use the Spin Spot™?
The Spin Spot™ is suitable for all ages above the age of 5. However, users aged 5 to 8 should NEVER use this product unless being supervised by their dance-training instructor to guide them in the correct way to turn. For older dancers, the Spin Spot™ is a fantastic tool to upgrade to, to further enhance core control.

Savo Stankovich: Entrepreneur Savo is the father of a very dedicated young dancer who is currently training with Joanne Williamson Dance Academy (JWDA).

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En Pointe Orthotics
Myfanwy Fish from En Pointe Orthotics
“I find I don’t get any blisters, my awareness for balancing has improved, my toes are in better alignment. Also I don’t get any more bruised toe nails because the pressure on my feet is relieved.“
Paige Rochester from Queensland Ballet Academy

What are En Pointe Orthotics (EPOs)?
EPOs are custom made silicone pointe pouches which are moulded onto the toes of the individual dancer and then into the pointe shoe. This Pouch is made to fit the unique shape of each dancers toes and improve the health of the dancer’s feet.

Why do some dancers need EPOs?
EPOs can benefit ALL dancers working in pointe shoes, however those dancers that have uneven toes (such as a long 2nd toe etc), space between the big and 2nd toe, or feel pain when dancing in pointe shoes can benefit greatly. EPOs help to distribute the weight more evenly, making being en pointe more comfortable whilst supporting correct alignment without hindering the feel of the floor. Many dancers experience ongoing problems whilst working in pointe shoes including: bunions, bone spurs, bruising of the nails, blisters etc. By wearing EPOs, our trials have proved that these are no longer issues the dancer will have to experience.

How often do the orthotics need to be reassessed and or replaced for the student dancer?
The En Pointe Orthotics will fit into any pointe shoe brand, size or style and can fit for up to 3 years even after an increase in pointe shoe size. Your EPO fitter will want to assess them regularly (or be in touch with you at least 6-12 monthly) and if there are any concerns, we always encourage the dancer to have them checked. In the event that they are worn in an area, they would be patched over at no cost.

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