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Bodywise – Dance Specialist Health Professionals


In this issue dancetrain talks with 11 leading dance specialists about the dancers body. Topics include: surgery, stress, strength training, in-toeing, out-toeing, long-term physical health, pointe work, warming up, one-on-one coaching, vitamin supplements and physiotherapy tips for improving technique. Below is an excerpt from each specialist, see dancetrain Sep/Oct issue for full editorials.



STRENGTH TRAINING
Why is it so important?
By Tamara Freeman
Agile, willowy, flexible, wraith-like… adjectives used to commonly describe a dancer’s physique but words like strong, dynamic, powerful, commanding and explosive also describe some of the world’s greatest dancers, such as the rising dance idol Misty Copeland. Strength training is the underlying key element that enables a dancer to reduce injury, correct muscle imbalances, and improve strength and technique; ultimately enabling a dancer to perform at their peak. When your body is strong, correctly aligned and you are fully aware of your body, you are able to dance with ease, true artistry and expression.
See dancetrain Sep/Oct issue for full editorial.
Dancing Through Strength
dancingthroughstrength.com

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IN-TOEING AND OUT-TOEING
When is it a problem?
By Gavin Johnston, B.App.Sci (Physio)
The foot is the foundation of good posture and myofascial (soft tissue) balance extending way beyond the knee and pelvis. What is often overlooked in kids’ posture is the tibia (bone). Excessive outward rotation of the tibial bone makes achieving first position in ballet relatively easy. Being an out-toer generally creates excessive torsion at the knee in activities that require parallel feet, such as running. Long term there is a lot of medial pressure on the arch and the pelvis will often tilt forward. In-toers generally will compensate by externally rotating their hip joints creating weak glute (bum) muscles and tight hamstrings (gripping). Correcting this tibial alignment issue is easier to treat in children with growing bones. This work is extremely satisfying to me as a lifetime of problems can be sorted with low amounts of fuss and is totally pain free.
See dancetrain Sep/Oct issue for full editorial.
EastWest Physiotherapy
eastwestphysio.com.au

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DANCING FOR THE LONG-TERM
How can we optimise development?
By Melanie Fuller – APA Musculoskeletal Physiotherapist Grad Cert MSk Phty, M Phty, B Ex Sci, Adv Dip PA (Dance)
More and more dancers are starting to increase the intensity, hours and advanced skills of their training at a young age. Research has shown that decreased fitness may be related to injury in dance1 and supplemental training has been shown to improve the aesthetic quality of dance performance2. In suggesting other physical activities we need to be mindful of also not adding in too much to already very busy schedules and accommodate for sufficient rest. Increased hours of training at a young age has been related to injury in dance research3 as have growth changes4. Some examples of foundational elements I believe young dancers could benefit working on are:
1. Tendus to develop articulation through the foot to prepare for good foot control for jumping and travelling steps
2. Demi pointe to develop strength for pointe work
3. Retiré to develop strength & control for en l’air work
With further development of strength and maturity, these are essential to later build more skilful dance movements and choreography with the added benefit of not developing bad habits, which can be difficult to change once they are ingrained.
See dancetrain Sep/Oct issue for full editorial.
Pondera Physiotherapy & Pilates
pondera.com.au

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PRE-POINTE ASSESSMENTS
What is involved?
By Emrys Goldworthy MSportsCoach, BHSc (MST)
A pre-pointe assessment is a comprehensive evaluation of the dancer from many aspects. The examination includes a full structural and movement analysis of the spine, hips, knees, ankles and feet with particular interest in ankle and foot motion. Assessing core stability is a vital part of the examination. A stable spine and pelvis gives the dancer efficiency of movement in their hips, drastically improving their technique and is particularly seen in adage and grand allegro. Additional strength testing is conducted on muscles associated with the hip, knee and ankle joints. The final part of the examination is the technique analysis. Some of the main barriers include a lack ankle and foot mobility, core stability, and calf and gluteal strength. An early pre-pointe assessment is critical to determine whether the foot and ankle range can be improved functionally, or whether the foot bones are causing a structural restriction in motion. Most dancers are able to achieve the ankle motion required, as the cause is often functional.
See dancetrain Sep/Oct issue for full editorial.
Red Hill Musculoskeletal
redhillmst.com.au

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WARMING UP
Why is it important?
By Gabrielle Davidson B.Phty (Hons)
As dancers, your bodies are your instruments. Every class you do is aimed at improving your technique and strength. Therefore it is extremely important to warm up, allowing you to work at your best in every class. It is accepted that warming up is associated with positive effects on the body’s systems, benefiting flexibility, muscular power and strength.
The proven benefits of warming up include:
1. Increased blood flow and oxygen delivery to muscles
2. Enhanced cellular metabolism
3. Increased speed of nerve impulses and sensitivity of nerve receptors – improving how we make our muscles work
4. Reduced number of injuries
5. Increased range of motion in joints and decreased stiffness of connective tissues
6. Improved relaxation and concentration

There has been a growing concern amongst health professionals working with dancers in Australia that more serious and chronic injuries in younger dancers are on the rise. The belief is that increased hours and expectations on growing bodies are part of the problem. There is no simple answer to this emerging problem but doing an effective warm up can help to decrease the risk of injury.
See dancetrain Sep/Oct issue for full editorial.
InSync Physiotherapy & Pilates
insyncphysiopilates.com.au


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COACHING
What are the benefits of personalised sessions?
By Talia Clow
In today’s competitive world everyone needs an edge. Expectations upon a dancer’s body are ever more demanding so to achieve success in the world of dance the body needs all the support it can get. Personalised dance coaching sessions are a fantastic way to focus on technique, build strength and fitness, and understand your true potential. Regular one-on-one sessions are ideal as coaches and students are able to monitor and adapt the individualised program as they progress, building their strengths, reducing negative habits, and giving the student the best opportunity to maximise their potential.
See dancetrain Sep/Oct issue for full editorial.
Fit 4 Dance
fit4dance.com.au

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VITAMIN D
Why should it be on our radar?
By Melissa Lee
A 2013 study conducted on a group of dancers at Birmingham Royal Ballet concluded that Vitamin D oral supplementation for ballet dancers has beneficial effects on muscular performance and reduces the rate of injury occurrence. The study showed significant increases in isometric strength and vertical jumps, as well as considerably fewer injuries sustained, particularly during the winter months, when exposure to the sun is reduced.
Signs of Vitamin D deficiency may include:
• Feeling sad or blue
• Aching bones
• Gut troubles
• Increased injuries
• Unexplained tiredness
A regular multivitamin may not meet all of a dancer’s needs therefore a supplement designed specifically for dancers would deliver the best results.
One that has a unique proprietary blend of vitamins, minerals and essential nutrients, crafted to have optimum nutritional benefit for dancers.
See dancetrain Sep/Oct issue for full editorial.
Dance Essential
danceessential.net

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POST INJURY
Getting back to class
By April-Rose Ferris
Dance related injuries occur for a number of reasons, and even for the most elite dancers, this can sometimes be technique related. Due to the repetitive nature of dance, injuries can develop because of subtle muscle imbalances that can be tricky to pick up on. A dance physiotherapist can help in diagnosing injuries and work with a dancer to better identify what may have contributed to the injury and proactively plan a treatment that effectively manages the issue and takes into consideration upcoming goals and commitments. Physiotherapist, dance teacher, and dancer working together towards the same goal is important when the dancer is returning to the studio. Injuries can happen to even the best dancers and if handled right, quite often you may return to the dance studio stronger and better than you were pre-injury.
If seeing a physiotherapist for a dance related injury, clarify the following things with them:
1. What is contributing to the injury?
2. How do I manage my workload in the studio to enable my recovery?
3. What can I do to prevent an injury like this happening again in the future?
See dancetrain Sep/Oct issue for full editorial.
Dance Physiotherapy Sydney
dancephysiotherapysydney.com.au

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IMPROVING TECHNIQUE
How long does it take?
By Lauren Campbell B. Hlt Sci/ M. Physio Prac & Annie Strauch B. Phty (Hons), M. Phty (Sports), M. Phty (Musc)
Learning a new technique is all about neuromuscular re-education, put simply, learning a new motor pattern. Dance physiotherapy research explains there are four stages to learning a new technique.
Stage 1: Observation
Stage 2: Trial – each element of the movement sequence
Stage 3: Feedback – from your teachers, mirrors and body awareness
Stage 4: Practice, practice, practice
Final goal: To execute a technique without thinking so hard.
Research has demonstrated that during a 6-week learning period, the series of precise movements and coordination of muscles for the technique are being committed to long-term muscular memory. However, it may take longer than 6 weeks to improve a technique depending on what type of dancer you are and how complex the technique is. Solid technique is the foundation to ongoing improvement and the stepping-stone to achieving more complex techniques whilst remaining injury-free in your dancing.
See dancetrain Sep/Oct issue for full editorial.
Performance Medicine
performancemedphysio.com.au

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BIG DECISION STRESS
By Dr. Kate Fennessy
When it comes to making decisions about dance schools or auditions, the pressure can really ramp up. Stress can influence decision making in some unexpected ways, such as causing people to pay more attention to the upsides of the choices under consideration, and less attention to the downsides. Some people respond to stress by rushing a decision, whereas others may slow down and become more risk averse, or procrastinate about the decision altogether.

Why are we better able to cope with stress at some times but worse off at other times? Models of stress incorporate the idea that there are many different sources, and that while some stress is positive, your body responds to the cumulative effect of all factors. Sleep, diet, hormones, time of day, and the quality of interactions with other people can make all the difference in determining how resilient or are to the effects of stress at any given time. You might be more sensitive to stress when you are more dehydrated, for example, or if there is another problem that you are actively avoiding, or if someone wasn’t nice to you on the bus that morning. It may also be the way that you are thinking about the decision that can help or hinder your coping with it. For instance, if you think that the stakes of this decision are life-altering and final, it is more stressful than if you focused on the fact that while it wouldn’t be ideal, you can change your mind later on if you need to. It is important to stick to the facts when thinking about the problem. At the end of the day, you will deal with any challenges or consequences as they come to you, as best you can.
See dancetrain Sep/Oct issue for full editorial.
Dr Bywater
drbywater.com.au


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RECOVERY FROM SURGERY
By Katie Goodwin
Fortunately, surgery is not often indicated for dancers. Most dance injuries respond well to a combination of modifying activity, physiotherapy treatment, and a graded program of activity. This type of approach is called conservative management and should be the first step in managing any injury.

Of course there are always exceptions to this, and in certain cases surgery is necessary to ensure the best possible outcome. As a general guide, surgery is only considered when a course of good physiotherapy management has already been trialled, or where there is risk of further damage should surgery not take place. If a dancer has been struggling with an injury for a while, an appointment with a Sports Physician or Orthopaedic Specialist will help clarify whether surgery is an option.

No dancer jete’s off the surgical bed and straight back onto the ballet barre! Following surgery a dancer will need to work hard to regain the normal function. Physiotherapy following surgery is critical in guiding a comprehensive rehabilitation strategy.
Your physiotherapist will focus on:
1. Reducing swelling
2. Restoring movement and preventing excessive scar tissue formation
3. Regaining strength
4. Maintaining function of the entire lower limb

Often following surgery a dancer will need to re-learn how to coordinate muscles, or to activate muscles that led to the need for surgery in the first place. Dancers need their joints to remain flexible, so it is essential to get things moving quickly and safely following surgery. Your physiotherapist will often gently mobilise joints to regain maximum range without stiffening.

Like no other sport, dance requires all of our muscles to coordinate and function optimally, and very occasionally there is a role for surgery in ensuring that this can occur. Never hesitate to seek the opinion of a Specialist if you are concerned that you are not recovering from your injury as you would like, and if you do progress to surgery, always complete a comprehensive rehabilitation program with your physiotherapist.
See dancetrain Sep/Oct issue for full editorial.
Kinetica Physiotherapy
kineticaphysio.com.au


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