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Blurred Lines: Aerial Dance & Aerial Circus

Blurred Lines: Aerial Dance & Aerial Circus

  1. Similarities and differences between aerial dance and aerial circus. 
  2. Brief history of aerial dance and aerial circus
  3. “Blurring” of aerial form

The table below identifies the differences between aerial dance and aerial circus. The primary differences are use of an apparatus, movement quality, gender roles, intent and location of the performance.  The main divergence is the intent of the performer and participation (or non-participation) from the audience. 

Movement vocabulary of aerial dance focuses almost exclusively on constantly flowing transitions. The choreographers craft and intention in creating dance was to focus attention on the process of movement exploration to capture aerial dance aesthetic. Stephanie Evanitsy and Terry Sendgraff pioneered aerial dance with their company Multigravitational Aerodance Group  in the late 1960s in New York City under the guidance of Alwin Nikolai. The duo investigated the human element in relation to changes in time, space and light. They used bungee cords, ropes and the inner tube of tractors to create the vertical environment they desired. Trisha Brown had also explored the use of props and suspension equipment at the Judson Dance Theater with “Man Walking Down the Side of a Building” in 1970. The next year Brown had left pursuing aerial work, having “plumbed the possibilities of control imposed by equipment”. Sendgraff continued to teach and explore with Motivity trapezes, stilts and bungee cords. This determination coined her as the “mother of aerial dance”. Sendgraff, a vocal feminist, celebrates women’s connectedness with the use of stilts and clashing cymbals at the 1992 Women Walking Tall festival in Michigan. The downplay of specific “tricks” and the emphasis on transitional movement from floor to air is paramount to the craft and intention of creating an aerial dance. 

Aerial circus is differentiated from aerial dance in that the structure and sequence of tricks build in intensity and virtuosity. This engages the audience, evoking a response such as an applause. The allure of aerial circus is predicated on engaging the audience with dangerous and provocative acts. 

 

Blurring of form between aerial circus and dance can be seen through shows such as Cirque du Soleil, Circo Zero, and “Woman in the Moon”. The blurred elements include a building up of theatrical tension in addition to inclusion of a narrative, transitional movements from the floor to the air that expand from “tricking”, use of make-up, costumes and various apparatus’ as well as the interaction of traditional male-female roles on stage. 

Conclusion:

A recent “blurring of form” between aerial circus and aerial dance has occurred within the recent contemporary performance world. The use of various apparatus’, narratives, costumes and intent has created a unique environment for the performing artist to develop professionally. 

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Important Considerations in the Care of Young Dancers

Important Considerations in the Care of Young Dancers

  1. Various dance styles and their differences
  2. Dance injuries
  3. Challenges present in youth specialization in dance
  4. Injury prevention in the dance population

1

Ballet emphasizes the technical aspects of body alignment, flexibility and strength in an effort to appear weightless and free from restrictions. Ballet slippers provide a mechanism with which the dancer can present en pointe with the use of special box to encompass the toes.

Tap dancing applies rhythm and percussion through the use of a metal plate on the forefoot. The drumming of the feet were a reflection of the ability to communicate during the American slave era. Several styles developed such as classical, hoofing, and clogging. Steps include the brush, flap, shuffle and ball change.

Jazz developed out of the African dances in the early 20th century and incorporates some elements of ballet. Jazz steps include the jazz square, walk and layout. Shoes can have thin or thick soles, are often flexible and close fitting.

Modern dance encompasses a wide variety of new styles that attempted to eschew the rigid formality of ballet. Notable figures include Wigman, Graham, Hortan and Cunningham.

Contemporary and lyrical dance incorporates ball, jazz and modern techniques. Footwear can be non-existent or specific to a show.

Hip-hop developed in New York as a form of street-dancing and includes Old school and New school. Breaking, popping, locking are elements of the old school whereas krumping, jooking, and street jazz are elements of the new school. A cornerstone of both is the use of improvisation.

Irish step dancing can be described as holding a stiff upper body while the legs perform rapid and precise movements. Footwear includes soft shoes, or ghillies, that are black lace-up soft slippers. Hard shoes are similar to tap shoes without metal plates.

Ballroom dancing includes the waltz, tango, foxtrot, samba, cha-cha, rumba, jive, swing and mambo. The emphasis is on poise, posture, alignment, emotional expression, foot action and steps. Costume and footwear vary depending on the style.

Competitive dance can include any style of dance, may be performed as a solo or in groups. Shoes are usually choreographed and are unique to the competition structure. 

2

Dance injuries are on the rise, with an increase of 37.2% from 1991 to 2007. Female teenagers are more likely to be injured. The lower extremities are the most frequently injured body part. Falls and non-contact injuries accounted for nearly 70% of the type of injury. Thirty to seventy percent of preprofessional dancers sustain an injury within one year. The variability reported is due to a difference in how an injury is defined. Overuse injuries account for 55-88% of all injuries. Ballet students often report foot/ankle and lower leg injuries whereas multidisciplinary dancers more frequently sustained knee injuries. Break dancers experience a higher proportion of upper extremity injuries due to the use of the floor to produce movement. 

 

Lower extremity injuries specific to the dance population include ankle inversion sprains, metatarsalgia, Achilles tendinopathy, stress fractures of the second and third metatarsals, cuboid syndrome, posterior ankle impingement syndrome (os trigonum), flexor hallucis longus tendinopathy, sesamoiditis, sesamoid stress fracture, Feiberg necrosis, peroneal tendon subluxation and posterior talus osteochondritis dissecans. 

3

Youth sports specialization, wherein young athletes participate in a single sport, such as dance, at an early age and the exclusion of other types of sport, may predispose athletes to overuse injuries. The prevention of injuries requires attention to early warning signs and specific knowledge about the intrinsic and extrinsic factors that lead to injuries. The developing body requires a different approach to technical training, strength training, rest and coaching. Growth spurts can affect aesthetics and performance. This includes an increase in muscle tension (flexibility, strength), alteration in the center of gravity (balance) and kinesthetic awareness (coordination). Dance rehabilitation should consider the elements of the dance style, the dancers goals, and communication with the dance teacher and care takers. Activity modification, progressive return to sport and complimentary strength training programs will facilitate a safe and confident return to dance. The use of a mirror, recording and feedback from a professional (coach, therapist) will allow the dancer the opportunity to progress with qualitative bench marks. Cross-training may incorporate pool exercises, barre to deload the body. The choreographer and therapist can develop a plan to limit exposure to aggravating movements such as battement when experiencing hip pain or jumping when experiencing knee pain.  Another important element to consider is relearning proper movement patterns. Injuries can be precipitated by poor alignment, muscle imbalance, flexibility and coaching strategies. Relearning how to move after an injury can provide an advantageous atmosphere in regards to internal feedback and building of confidence. Compensatory movement strategies should be addressed and normal movement restored prior to a full return to sport. 

Other considerations include the female athlete triad or “relative energy deficiency in sport”. This includes a cluster of symptoms such menstrual irregularity and impaired bone health due to energy deficiency, or poor nutrition. By the age of 18 year, 90% of a woman’s bone mass is accrued. Poor dietary habits can lead to future complications including osteopenia, osteonecrosis and increased fracture risk. Dancers are often at higher risk due to the aesthetic nature of the sport. One study found that nearly one-third of dancers had disordered eating. This requires a multi-disciplinary approach of a primary care physician, sports medicine physician, physical therapist, sports dietician and psychologist. Disordered eating also limits a dancers ability to rebound from an injury due to lack of proper nutritional intake. Additional psychological stress may occur due to the time-based nature of preparing for a show on a specific date. Activity modification may seem catastrophic to a dancer.

4

Injury prevention program can include a pre-season or pre-competition screen that may help identify movement disorders, flexibility limitations and strength deficits. Cardiovascular health is important as well. Studies of dancers have discovered that rehearsals may not provide a great enough stress to adequately prepare a dancer for the demands of a competition or a show. Cross-training may provide a a stimulus strong enough to prepare a dancer for an event. 

Conclusion:

Primary prevention, in the form of preseason screenings, may help identify areas that require attention prior to an injury occuring. Secondary prevention requires a comprehensive approach to injury rehabilitation, understanding the unique demands of the different types of dance and the specific types of injuries sustained within the dance community. 

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Cardio Considerations in Dance Class and Performance

Cardio Considerations in Dance Class and Performance

Cardiovascular capacity varies based on a dancers level of experience, style, gender, technical capability and status within a dance company. Research demonstrates a difference between the level of fitness expressed in rehearsals compared to that experienced during a show or competition. 

This article will cover the following topics:

  1. Dance as a physical exercise
  2. Dancers aerobic capacity
  3. Cardiorespiratory demands of dance classes and performances
  4. Supplementary fitness training for dancers
  5. Fitness testing and assessment for dancers

1

Dance style and technique has evolved over the past millennia, with changes in partner interaction, the use of the floor, apparatus’, footwear, and choreography style. This presents a unique challenge within the dance community, creating a stress that requires dancers to not only be highly technically developed, but also well-conditioned. Conditioning comprises the domains of strength, flexibility, cardiovascular capacity and balance/coordination. Programs aimed at addressing these systems will help reduce injury occurrence as well as performance quality. 

Weakness of the quadriceps appears to increase the risk of lower extremity injuries and exercise-induced fatigue seems to impair lower limb alignment with jumps and floor work. Activity modifications that are made due to injury often cause a decline in poor body composition. This cardiovascular and muscular atrophy can be attenuated with a prescribed aerobic and strength training program.

Dance is a highly physical and technical skill that requires short bursts of energy expenditure followed by lower intensity adagio-type movements. This alters the dominant energy system input throughout the course of a show, increasing the rate of perceived exertion (you feel like you’re working very hard). The type of dance, level of expertise and dance choreography all play a role in how fit the dancer is. Dance fitness requires mastery of several domains. Muscle power reserve, for the execution of high leaps and floor work; muscular endurance, to perform multiple movements in a short sequence; and cardiorespiratory endurance, to allow the heart to provide adequate oxygen to working muscles. A proper warm up provides an optimal aerobic pathway for oxygen saturation in muscle tissue, possibly delaying onset of muscle fatigue. 

2

Dance types and gender influence aerobic capacity, or the ability of the body to utilize oxygen to fuel muscles when exercising. Modern dancers seem to have higher aerobic capacity compared to ballet dancers. Male dancers tend to have higher aerobic capacity compared to female dancers. Within ballet, corp dancers often perform continuous, low to moderate intensity choreography whereas soloist tend to perform intermittent, high intensity movements. The difference in duration and intensity will determine which is the predominant energy system. Upon measurement, it was apparent that corp dancers had greater peak oxygen consumption compared to soloists, and soloist had greater jump height compared to corp dancers. Researchers demonstrated that anaerobic threshold was highly correlated to technical ability. Anaerobic threshold is the point at which lactate cannot be cleared from the muscle and contributes to exercise-induced fatigue. This muscle fatigue affects a dancers performance. A work to rest ratio of 1:3 is recommended to allow recovery of the energy systems. For example, if you performed center-floor jump sequences for 30 seconds, a rest period of 1 minute and 30 seconds should follow. Proper nutrition allows storage of muscle glycogen to buffer onset of fatigue and susceptibility to injury. 

3

It is well reported in the literature that energy demands in dance classes are less than those experienced during a performance. This seems to be the case for modern, jazz, highland and folk dance. Additional research demonstrates that classes themselves may not provide a strong enough stress to improve cardiovascular fitness. This is true for advanced students and professional athletes. The warm up and center-floor work often remain in the aerobic energy system despite performing high intensity activity. This may be due to the longer rest periods in between learning new sections of a show. 

Rehearsals, after the creation and learning process, often place a higher cardiovascular demand on the dancer. This adaptations to this demand, however, may be too late in order to prepare the dancer for a specific performance. In addition, the total amount of time spent in this higher intensity zone is often limited. In professional ballet dancers, this was about 10% of total time in rehearsals. 

4

Dancers, therefore, should train to optimize the contributions of the proper energy systems to improve their performance. This includes engaging in an exercise program that complements a dancers style, experience level and type of dance. Dance class and rehearsals often emphasizes technique and skill acquisition as opposed to strength and cardiovascular adaptations. Complementary fitness training should identify the strengths and weaknesses of the individual performer and develop a program that considers dance type, style and choreography of the show being rehearsed. Variables such as intensity, volume and frequency should be managed to avoid overtraining. Additional considerations should include total accumulation of classes, rehearsals and alternative body therapies. Researchers suggest that fitness training should not interfere with dancers’ technical work, thus, periodization strategies should be implemented. 

One frequently visited concern for performers is a loss of an aesthetically pleasing body due to muscle hypertrophy, loss of joint flexibility and overall fatigue when rehearsing. There have been a number of studies that show this is not true. A study of 12 weeks of aerobic and strength training exercise improved dancers aerobic capacity, muscle strength and flexibility in addition to positive changes in dancers body composition. Another study demonstrated that one hour of circuit training and vibratory training twice a week improved muscle power, aerobic capacity and dance aesthetics more efficiently than adding one additional hour of extra dance class per day. Other programs that varied intensity and work to rest ratios in training a ballet performance improved fitness levels. High intensity interval training (HIIT) appears to be the proper mode of exercise for improving dancers aerobic power. Intermittent exercise bouts with a work to rest ratio of 1:1, exercise time 3-6 minutes, 90-95% of VO2 max, RPE 16-17 and active recovery at low aerobic intensity is the recommended approach. For dancers that have limited time to add supplementary training, it is suggested that one five minute session performed three days per week of HIIT 3×20 program can induce changes in the cardiovascular system. For example, three sets of 20 seconds of high intensity activity followed by a 2 minute active recovery at low intensity. The active recovery process maintains blood flow to the muscles and assists in removing metabolites from lactic-acidosis pathways. The authors of this study suggest moving through a Grand adage for dancers with high technical ability. 

5

Several dance-specific tests exist to assess cardiovascular fitness. However, there is no standardized method for the different styles of dance. A standardized approach will match test-specific movements to style-specific techniques (i.e. there should be a standardized test for tap, which will be different than the standardized test for jazz, etc…). 

Conclusion: Dance is a mixture of aerobic and anaerobic metabolic exercise. This mixture varies between styles of dance, age, gender, level of experience. There are also differences between energy expenditure in class, rehearsals or performance. Cross training with high intensity interval training may help develop a dancers aerobic capacity and muscular strength and will not interfere with the aesthetics of the human body.  Fitness testing can measure aerobic and muscular strength which will help plan efficient exercise programs to supplement technical training. Strength training will help reduce the risk of injuries and enhance dance performance. 

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Communication Between Medical Practitioners and Dancers

Communication Between Medical Practitioners and Dancers

The intent of this article is to illustrate communication patterns between dancers and medical practitioners. The main findings include:

  1. Medical practitioners rarely communicated amongst each other concerning a dance patient
  2. There was limited communication between medical practitioners and a dancers’ teachers, choreographers, and directors
  3. Injured dancers were not bothered by this lack of communication
  4. Dancers lacked education regarding their dance-related injury when seeking treatment
  5. Dancers did not request additional information although they did not understand their injury
  6. Both dancers and practitioners believed that dancers would benefit from learning more about human anatomy

Note that this study was performed in a single Canadian city and the findings may not extrapolate to the world at large. This study was also conducted in 2009 and some of these barriers may have been addressed. 

Pain is also the precipitating event that causes a dancer to seek medical treatment. However, the experience of pain is highly individualized and the severity of the injury has little to no correlation with the intensity of pain experienced. Fear of loss of time from training or performing often prevents dancers from seeking medical treatment. They may seek alternative treatment due to the perception that medical practitioners do not understand their vocabulary and demands of dance and may lack dance-specific psychological training. The cost of medical care may also present as a barrier to treatment. 

What did medical practitioners report?

The majority of respondents from the questionnaire regarding communication were female (30 out of 48 responders), physical therapists (36%) or chiropractors (34%), between the ages of 30-39 (44%), mostly participated in some form of dance (70%), and often attend seminars related to dance medicine (54% had attended at least one sports medicine conference). While the majority (>50%) considered dancers understanding of anatomy “essential” and 24% thought it “moderately important”, one considered it “detrimental”. Practitioners that inquired about a dancers technique had a higher perception of improvement rates. While previous dance experience seemed to catalyze communication amongst health care practitioners, it was not the same with communication with dance teachers or directors. The better the communication between medical care and directors, the better the chance of a dancer modifying harmful activities. 

What did the dancers report?

The majority of the dancers that responded to this questionnaire were between the ages of 18-20 years (53%), and 21-24 years (39%); averaged more than 10 years of dance; were undergraduate students (65%), professional students (32%), and dance teachers (15%), and mostly female (92%); most had training in ballet (50%)  and one other type of dance including modern, jazz and musical theatre; a great majority believed that basic human anatomy was essential to dance training (68%); 13% had experienced one injury, 45% 2-3 injuries and 3% more than 10 times due to dance; 67% reported at least one injury sustained outside of dance; less than 1/3 of dancers sought medical care within 3 days of their injury. 

When asked about the quality of advice given from health care practitioners, dancers reported the following, where a “1” represents “significant deterioration” and “10” represented “significant improvement”. Family physicians scored a 4.43, sports medicine physicians scored a 7.03 and physical therapists scored a 7.62.

Dancers stated that they are willing to learn basic human anatomy and were willing to adjust dance techniques in the short term in order to follow prescribed treatment protocols. However, they would not do so in the long term. Dancers were more willing to reduce dance participation intensity more so than dance participation frequency. 

The single greatest variable of importance to dancers was the frequency with which practitioners observed dance. 

Conclusion:

The lack of compliance with dancers and treatment programs is multifactorial. Financial, psychological, social or aesthetic concerns may create barriers to effective resolution of dance related injuries. A dancers body is part of their identity, and as such, the culture of dance often demands a type of stoicism towards the pain experience. Thus, avoidance of treatment seems to ameliorate their concerns with missing training (attending medical appointments), development of poor aesthetics (due to exercise) and ostracized from the community (not being able to “handle the pain” associated with dance). The fear of losing an aesthetically-pleasing body is another barrier due to a health care practitioners instructions to modify dance activity or rest until recovered. However, collegiate dancers that pursued physical therapy treatment reported greater levels of energy and a more positive outlook.

It seems that education in basic human anatomy, communication between health care practitioners as well as directors or choreographers, and a plan of care that the athlete and therapist can mutually agree on may significantly improve reinjury rates, given that some 45% of dancers report at least 2-3 dance related injuries.

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Developing a Dancer Wellness Program

Developing a Dancer Wellness Program

This purpose of this article is to discuss the development a wellness program for professional ballet dancers. Over the course of 2 years a team of ballet dancers, management and artistic staff, as well as healthcare providers implemented and studied a dancer screen and wellness program. Continual feedback was utilized to address current issues and provide immediate alterations to the program to better serve the dancers. 

The article includes the following topics:

  1. Introduction to and evaluation of performing artist wellness programs 
  2. Materials and methods of research
  3. Results of the program

1. Introduction

There is limited evidence that quadriceps flexibility is a risk factor for hamstring injury.

Dancer wellness comprises two specific categories: physical and mental demands of performance. Studies demonstrate that for every 1000 hours of dance, up to 4.4 injuries may occur in the dance population. Anxiety and perfectionism in dance culture may influence the likelihood of physical and psychological injury. Additionally, body image dysmorphia and disordered eating are behaviors that are significantly higher in ballet dancers than other sports. Due to time-related constraints of learning a performance, dancers often forego seeking medical treatment for their injuries, resulting in poor rehabilitation outcomes. The current medical model is attempting to qualify and quantify the complexity of dance culture and ways in which more effective treatment can be implemented. 

One of the difficulties in addressing cultural perceptions within the dance community is the variability between dance types. For example, ballet dancers perception of an injury may be different than that of a hip-hop dancer. This is challenging as a health care provider because a different approach may be required to gain a mutually agreed upon plan of care. This article will attempt to address how the situational constraints particular to each organization needs to be considered for an effective implementation of an injury prevention program. 

Performing artists wellness programs

Wellness programs implement injury screenings that may help identify individual intrinsic patterns that predispose the dancer to injury. On the medical side, it helps clinicians better understand the physical and mental demands of training and performing over a longer period of time. Additionally, injury prevention programs can be periodically reassessed to determine their effectiveness. 

Programs designed to address dancers’ wellness face several challenges. Lack of clearly defined policies or strategies on how to utilize on-site services may limit a dancers exposure to said services. 

 

Evaluating wellness program development and efficacy

The goal of wellness programs is to track and hopefully reduce the injury rates. Frequent communication amongst health care providers, choreographers, directors and dancers may facilitate improved “buy-in” from all members. The content and effectiveness of the program can be determined by a team approach. The developmental evaluation allows for the adjustment of parameters based on the go-between of problem and solution. 

Three features of the developmental evaluation include:

  1. Framing: developing clarity of a particular problem via communication
  2. Testing: trying new things to improve outcomes
  3. Tracking: coming to a better understanding of the cause and effect relationship of a particular part of a program

Developmental evaluation allows a rigid goal but flexible framework to achieve that goal. Participation amongst all involved is paramount for the implementation and development of effective wellness program. 

Research aims

The purpose of this study were to identify how a unique 2-year developmental evaluation altered a wellness program in a school of professional ballet performers.

2. Materials & Methods

Who:

The ballet company of study included 32 professional baller dancers giving 61 performances over a two year period. Dancers were exposed to 30 hours of dance per week, including both rehearsals and performances. Collaboration was obtained with the University of Calgary’s Division of Physical Medicine and Rehabilitation. 

How:

This is a longitudinal study (2 years of research) with a developmental evaluation approach to guide the maturation of the program. A Framing, Testing and Tracking approach was employed to achieve this end. 

Meetings with the management and artistic staff were held for 10 months to ascertain the wants and needs of the ballet company. A medical team was made available to conduct annual screens. Screening included the following: medical and orthopedic history, mental health, body composition, aerobic fitness, postural assessment, mobility, range of motion, strength, balance and functional movement analysis. 

Feedback from the dancers and assessors was attained as far as the perceived enjoyment, usefulness, applicability and appropriateness of the screen. The team then convened and discussed possible modifications to the current model. A second round was performed to further clarify efficacy of the screen. 

3. Results

Three domains of information were reported on.

  1. Continued development of the screening protocol
  2. Continued development of the wellness program
  3. Continued development of the ballet company’s approach to rehearsal

Let’s take a look at each of the specifically.

1. Continued development of the screening protocol

Strengths and benefits of the process were reported as a change in perception of dancers’ movements that would not have otherwise been assessed. This seems to allow the opportunity for health care professionals to better understand dance-specific performance. 

Limitations from a dancers perspective seem to be limited understanding of the results and diagnoses found upon assessment. The limitations reported by the assessors include an inability to receive the test results in order to link deficiencies with injuries in order to create a proper plan of care for the dancer. A lack of dance-specific cardiovascular fitness was not implemented within the first round. 

The second round of screens addressed the above mentioned limitations and included a meeting with the company physician to explain the results and make recommendations for the dancer. 

Additional recommendations were made by the dancers to include psychological and nutritional counseling as well as advice on smoking cessation. These suggestions allowed for additional communication between dancers and health care professionals. Other concerns that were addressed include past and current injury history. In the year prior to the screen, nearly half (14 out of 30) of all dancers sustained an injury and 21 of 30 had a current injury. One challenge with injury prevention programs speaks to providing either specific, individual plan of care or a general, group-based treatment option. There are financial as well as time-related constraints. 

In this particular study, the ballet company performed two different shows, for one year each. The first show was more technically and physically demanding whereas the second show required less technical and physical roles. Of note is that the artistic staff reported more injuries in the second season than the first. This may be attributed to poorer physical fitness levels with the start of the second season compared with the start of the first season. It has been well documented in the literature that dance rehearsals do not provide a stimulus great enough to improve cardiovascular fitness to a level that is demonstrated while performing.  In other words, the energy expenditure when performing is significantly greater than that during rehearsals. This “gap” in cardiovascular endurance may be a causal factor in experiencing an injury. These findings shed light on the fact that performance and injury prevention programs may benefit ballet dancers. The implementation of a program requires an adjustment in ballet rehearsal schedule to accommodate for perceived levels of fatigue and time-related issues with concomitant training (technique/performance and strength/cardiovascular exercise). 

2. Continued development of the wellness program

The second and third rounds of reassessment demonstrated that dancers were interested in psychological and nutritional counseling as well as smoking cessation. Other areas that were identified by the researchers was the necessity of a balance program after nearly half of the dancers demonstrated poor balance with assessment. Cardiovascular and muscular weaknesses were also identified, allowing the wellness program to address this issue. 

The continued screening throughout the program helped the researchers better understand the perspective of the dancers as well as the areas within the program that required attention. Individual and group remedial work was implemented.

3. Continued development of the ballet company’s approach to rehearsal

It is well known in dance literature that rehearsals does not adequately prepare dancers for performance in the domains of cardiovascular and muscular strength. The researchers noted that  the order of learning multiple shows can alter the injury rates. Less demanding shows may not expose dancers to enough “good stress”, making them more susceptible to injury for subsequent performances. Thus, it is recommended that the intensity and volume of dance rehearsals be taken into consideration when developing a dancer wellness program. If the dancers frequently engage in start-stops throughout the rehearsal process, they may be losing out on their cardiovascular health.

Conclusion: The benefits of a developmental process employed by a team of health care practitioners, dancers and artistic directors allows for an opportunity to open discussion in how best to identify and address dance-specific problems. Communication amongst team members provides the catalyst to provide effective screens and treatment plans to prevent and treat injuries in the dance community. While the model described above “worked” for a single ballet company for 2 years in Canada, a different approach may be required for a different style of dance in a different part of the world. 

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Injuries in Ballroom Dancers (Polish Edition)

Injuries in Ballroom Dancers (Polish Edition)

The purpose of this article is to assess the influence of physical therapy in ballroom dancers in Poland. Of the 63 athletes questioned, 47 sought professional care from a physical therapist and 16 self-treated. It was found that those seeking professional help tended to have greater improvements in a shorter period of time.

The topics in this article are:

  1. What is an injury?
  2. Injury statistics in ballroom dancers
  3. Conclusion

1. What is an Injury?

Injuries are a consequence of trauma to a bodily structure. In the athletic population, this includes ligaments, tendons, muscles or bones. The trauma can be acute or chronic and can affect more than one body structure (if you have a primary shoulder injury, you may start to hold your head in an abnormal position, or perhaps rely on the opposite arm more so than you usually do). The injury causes changes at the micro and macro levels of the individual athlete. Torn ligaments can cause swelling and pain at the site of injury (micro), instability of the leg and fear of movement (macro).

The healing process should be taken into consideration. It is typically divided into three phases: inflammatory (~2 days), proliferative (48 hours – 4 weeks), and regenerative (4-6 weeks). Each phase typically lasts for a specific amount of time. However, there may be some overlap between phases and it is possible to regress if a structured program is not followed or early return to sport is adopted. 

Injuries can limit participation in dance- this can be self-limiting such as pain, weakness or fear of movement. Or it can be at the request of a choreographer or director- they may choose to modify certain dance moves or parts of a show. 

If acute injuries are not properly cared for, they may linger on and effect how you move. If you become accustomed to avoiding a particular move due to weakness or instability, you may adjust your dance style to avoid this pain. 

This article will speak to ballroom dancers in Poland and how they address injuries. 

2. Injury Statistics in Polish Ballroom dancers 

Table 2 shows two groups: in green are those who were injured and sought professional help from a physical therapist, and in red are those who were injured and chose to try to recover without professional help. 

Table 3 (above) and Figure 1 (below) shows that the majority (68%) of injuries were sustained during training.

The table and graph below show which is the most frequently injured body part in this group of ballroom dancers. The lower limbs are the most injured body part at 47% and the spine a close second with 37%. The questionnaire did not specify which parts of the lower body was injured.

Power

The next question asked of the ballroom dancers were which body part was injured. The muscles were the most frequently injured with the bones the second most reported with tendons and ligaments at a tie for third. 

Now lets take a look at the average time it took to rehabilitate a specific type of injury and compare the two groups, those who sought treatment and those who self-treated. You can see from the two groups that there is a considerable difference!  

So now we can look at the two groups and can see that all of those seeking professional help successfully returned to ballroom dancing whereas three of those who sought self-treatment did not return to ballroom dancing.  

3. Conclusion

Ballroom dancers who sought help from professional therapists experienced a quicker recovery and all of them returned to dancing. Those who self-treated had nearly twice as long of a recovery and some of them did not return to ballroom dancing. While this was a small group of dancers, and a very specific type of dance, the professional community that serves to assist dancers to return to their passion was able to do so. 

The bottom line:

If your goal is to become the best possible dancer- seek the best possible dance teacher. 

If you are dancer that is injured- seek the best possible healer. 

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Preventing Dance Injuries

Preventing Dance Injuries

The purpose of this article is to discuss what we know about injury prevention in dancers, help you understand how to receive the best care from health care professionals and to motivate you to take care of yourself as a dancer. 

Section 1: Dance injury research

Section 2: Injury prevention factors

Section 3: Access to health care for dancers

Section 4: Conclusion

Section 1: Dance injury research

One of the things we need to establish is the definition of a “dancer”. It appears that dance can encompass a wide variety of styles (ballet, jazz, modern, break), avenues for performing (theatre, stage, cruises, or the street) and groups (university students, professional artists). Very often dancers engage in multiple forms of dance. This often makes dance research difficult to study. Ballet has been the most researched genre, with break dancing coming in second. 

Different groups also have different definitions of what constitutes an “injury”. Does it mean you experience pain? Is it having to take time off and resting completely? Is it modifying all or part of a dance routine? Injuries can be influenced by a dancers prior experience of pain; communication with a choreographer, director, peers or family; current circumstances within the dance community such as employment or a scholarship at university. 

Across genres, a range of 42-97% of dancers were “injured”. This suggests that nearly all dancers will experience at least one injury in their career. The lower extremities (hips, knees and foot/ankle) were the most commonly reported to be injured. This is not surprising, given that dancers are required to perform leaps, floor work and wear different footwear. Footwear plays a greater role if multiple genres are required for a single contract (as is the case with performers on cruise ships). 

For every 1000 hours of dance, 4.4 injuries occurred. Overuse injuries were the most commonly reported. Females lost an average of 4 days, males an average of 9 days. 

In conclusion, due to high injury rates and the near certainty that most, if not all, dancers will experience at least one injury in their career, an injury prevention program is warranted.

Dancers are a unique domain of athletes in that the pursuit of perfection in technique is multifaceted. Technique training and rehearsals comprise a large portion of a dancers time. This places a high volume of work on the athlete and creates a deep emotional connection to the performance itself. This means that dancers are often very emotionally invested. Understandably, suffering from an injury can invoke both physical and emotional pain. 

Several studies demonstrate that dancers exhibit a higher pain threshold and higher pain tolerance. This means that they typically acknowledge pain when it is very high and tend to disregard the pain in order to continue to participate in dance. Ballet dancers have a difficult time distinguishing between “customary” dance pain and “pathological” pain. Coping skills (perception and reaction to pain) also tend to be poor in ballet dancers. 

Several factors may contribute to dance injuries (see Table). Some of these factors are modifiable, meaning you have control over them. Communication with health care professionals also plays a role in a dancers understanding of their injury. A provider that understands the nature of dance, rehearsals and performing can provide the psychological support necessary for a dancer to feel comfortable sharing their pain experience. This often results in improved outcomes for the dancer. 

Studies demonstrate that female dancers are more disciplined than male counterparts. Their more resilient outlook on dance performance often results in more success but consequentially greater risk of injury. 

Poor training technique or coaching, especially with a skillset such as turnout, may increase the likelihood of a dancer suffering from back, hip, knee and/or foot and ankle pain. Younger dancers are more susceptible because dance technique is a requisite for an aesthetically pleasing performance. 

 

Section 2: Injury prevention factors in dance

So now that we spoke about dance injury research, lets see what we can do to prevent injuries from happening in the first place. 

Several authors identify a proper warm up, strength training, knowledge on footwear and self-care as the cornerstone for injury prevention. We know that dance rehearsals alone does not adequately prepare a dancer for performance. This “gap” needs to be addressed in order to reduce the risk of injury while performing a show. 

Strength training:

Other authors demonstrate that implementing a strength training program to dance rehearsals cut injury rates in half (from 4.76 per 1,000 hours to 2.2 per 1,000 hours in males and 4.14 per 1,000 hours to 1.81 per 1,000 hours in females). 

Back pain in particular can lead to upper and lower extremity injuries due to its ability to control movement while moving across the stage. Ballet dancers in particular demonstrate smaller muscle size of the back muscles after suffering from a low back pain injury. This may increase the risk for further back injuries as well as of the extremities due to poor timing mechanics. 

Poor leg strength, as measured by jump height, is a predictor for taking more time off from dance as a result of an injury. In other words, weak legs = less dancing. Luckily, one study was able to demonstrate that a 6 week training program could significantly increase muscle strength, power and endurance in addition to improved aesthetics (you look better). 

Nutrition & Rest

Disordered eating is a common problem in the dance population. Maintaining a certain “look”, by managing food, and thus weight, is a practically obligation of dancers. Unfortunately, dancers often receive poor counseling on effective strategies to supply their bodies with the necessary nutrients. Thus, it is very important for dancers, especially young dancers, to seek nutrition counseling if they feel the need to do so. 

Fatigue, due to overtraining form multiple classes, rehearsals and performances (or even holding down a job to make ends meet), is a common occurrence within the dance community. Scheduling of “down-time” where dancers take a physical & psychological break is warranted to allow the body to rest and digest. This provides adequate “space” for dancers to solidify their performance. 

Flooring

Due to the variety of dance genres, many floor types may be used. Modern and ballet dancers often train on “sprung” floors whereas break dancers may perform on a piece of cardboard thrown on the concrete sidewalk. Schools that cannot afford material that is more agreeable to dancers feet might see an increase in lower extremity dance injuries. 

Jumping and landing mechanics change on “marley floors” compared to concrete or wood that is unsprung. One study suggests that some 12.7% of accidents may be attributed to faulty flooring. 

Footwear

As mentioned above, the variety of dance genres require different footwear. A jazz shoe is different than a ballet slipper which is worlds away from a tap dancing shoe. Poorly fitting footwear, or inadequate support may result in foot and ankle injuries. 

Lack of training, a wearing schedule (breaking in the shoe) or premature adoption of footwear also plays a role. In young dancers learning pointe, this is especially important. 

Section 3: Access to health care for dancers

Dancers often receive sub-par care due to a lack of understanding on the health care practitioners part. An inability to conceive dance schedules, requirements for aesthetics, and other psychosocial factors limits a provides ability to provide proper care. Some 80% of dancers at one university felt their doctors did not understand dancers and 43% believed they gave unhelpful advice. 

I can personally attest to this with patients I have treated at Royal Caribbean and Celebrity studios over the past years. Performers have told me the medical doctors said “just google it”. Thats definitely NOT helpful…

Many medical doctors tell dancers to just “stop dancing”, which is often not an effective strategy and may alienate a dancer from continuing care under their guidance. Many dancers do not have the opportunity to “just stop dancing” due to career or academic pressure. 

Research performed by Bronner et al demonstrated a substantial decrease in time-loss from injury and decrease in medical expenditures after implementation of a health care program. Across the implementation time, workers compensation injury rates declined 80% across the first 3 years of study to 24% in the fourth year and 17% in the fifth year. 

A follow up study of the same dance company showed a 34% decrease in injury incidence, 66% fewer workers compensation claims, and 56% decline in days lost from dance. 

Section 4: Conclusion

1. Screening of dancers’ physical and psychological attri- butes, prior injuries, and current and planned dance activity can identify areas that should be addressed to minimize the likelihood of injury. 

2. Physical training of dancers, apart from their technical training in dance, should be encouraged, with special attention to the core and to the musculature specific to the demands of their genre(s). 

3. Proper nutrition and rest (reduction of fatigue) are essential factors in maintaining a dancer’s body that is as resistant to injury as possible. 

4. The provision of specialized health care services to danc- ers is important to risk assessment, injury management, and injury reduction. 

5. Health care practitioners not conversant with dance or the psyche of performing artists will become more appreciative of dance’s physically rigorous nature, be better equipped to care for dance injuries, and gain favor with dancers by observing different varieties of dance and interacting with dancers about their art form. 

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Breakdancing: Physiological demands and effect of endurance training

Breakdancing: Physiological demands and effect of endurance training

The purpose of this article is to discuss the cardiovascular and metabolic (energy) demands of break dancing and demonstrate the effect of endurance training on performance. Nine female dancers performed three running sessions per week on a treadmill for 30 minutes at high intensity for 8 weeks. The training program improved cardiovascular endurance in break dancers. 

Part 1: Introduction to demands of break dancing

Part 2: Endurance testing, training program and results

Part 3: Conclusion

Part 1: Introduction to the demands of break dancing

Break dancing requires a high level of total body muscular strength & cardiovascular endurance. Breaking combines high intensity movements with relatively little rest. Some routines may be choreographed, whereas others may be spontaneous. Dances may be 20 seconds to 6 minutes in length. 

Training sessions last about an hour and are often divided into a prepatory (warming up), main (technique or rehearsing) and a cool down.  Warming up includes increasing blood flow to the muscles and stretching to improve tendon and muscle elasticity. The main portion of training  aims to improve technical skill. The cool down includes relaxation movements and additional stretching.

Part 2: Endurance testing, training program and results

Samples of lactate threshold (a blood marker for metabolic demand) of nine female  dancers with 2 years of training were obtained after performing a 6 minute break routine. The samples showed a significant increase in blood lactate levels and heart rate. This demonstrates that the dancers performed a very rigorous amount of exercise during the 6 minutes of breaking.

The researchers then had the nine breakers walk on a treadmill that increased in intensity until the dancers were exhausted. The same lactate threshold and heart rate were measured as in the break dancing routine. 

Both of the tests (the 6 minutes of dancing and the treadmill test) were performed before and after the 8 weeks of endurance training to see how much the dancers improved. 

The running program had a 10 minute warm up, 30 minutes of running and 10 minutes to cool down. There were three sessions per week for 8 weeks. The dancers ran at 90-100% of their pre-determined lactate threshold (a measure of exercise intensity). This training was probably pretty difficult to perform.

What were the results?

All of the dancers significantly improved their cardiovascular endurance by measurements of heart rate response (how well the heart was able to handle delivery blood to the muscles). This means that they were able to perform higher intensity movements for a greater length of time. 

Part 3: Conclusion

So it seems that treadmill running at a high intensity can improve dance capacity. This may be due to several mechanisms. For one, the heart is able to pump a greater volume of blood to working muscles. Secondly, it is able to clear metabolites (toxins) from the blood, which allows the muscle to continue their work. 

It can be speculated that treadmill running is not very break-dance specific, since many movements require a great deal of upper body input. It is possible that a training program that combined both upper and lower body aerobic exercise can provide even greater benefit to break dancers. 

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Professional Ballet: Injuries & Return to Dance

Professional Ballet: Injuries & Return to Dance

This article discusses injury occurrence in 99 professional ballet dancers. The article looks at several factors including age, education level, experience, ballet status, cigarette smoking, alcohol consumption and drug use and its effects on injury occurrence and time-off due to injury. 

Part 1: Introduction

Part 2: Results 

Part 3: Conclusion

Part 1: Introduction

Professional ballet dancers undergo a great deal of stress. This can be attributed to training demands, scheduling, employment and other extraneous factors (family or social life). Injuries are quite common in ballet and are often categorized into acute (traumatic, like an ankle sprain) or overuse (too much work too soon). 

Training for a performance can consume up to 40 hours of rehearsing. The repetitive nature of the movements contribute to early wear and tear with progressive degeneration over time. Ankles were the most commonly injured body part whereas knee injuries resulted in the greatest time off from training. Studies demonstrate that on average, females take 3 days off and males take 9 days off. Functionally, several factors contribute to injuries in ballet dancers: poor movement control; weak abdominal muscles, lower body strength; and poor aerobic endurance.

Coping mechanisms for managing stress associated with being a professional dancer were lacking in the ballet community. More than two thirds of men state they binge-drank more than once per week and more than 30% of women smoked cigarettes. 

The below table demonstrates that smokers sustained higher rates of injury and less experienced dancers were more likely to be absent from dance class compared to more experienced dancers.  

Part 2: Results- What affects professional ballet dancers injury rate?

This study received responses from 99 professional ballet dancers (41 males, 58 females) in Croatia and Slovenia. The dancers engaged in an additional 25-30 dance hours per week, in addition to their rehearsals. 

Forms were filled out to identify the dancers age, education level, experience and position within the ballet company and number of training hours per week of each dancer. Additional information was gathered on the use of cigarette smoking, alcohol drinking and drug use. Injury status was also obtained- including body part and number of days they took off from dance.

Table 1 demonstrates that the majority of injuries in male dancers occurred in the lower back (20%), ankle (14%) and knee (11%). Female dancers sustained the most from the ankle (36.5%), then the calf (14.6%) and the knee (12.5%). 

Part 3: Conclusion 

Smoking cigarettes and drinking alcohol negatively affected the rate of injury and the amount of time off due to injury in these professional ballet companies. Smoking increases chronic inflammation, causes vascular damage, increases oxidative stress and affects bone mineral content. This results in a higher injury risk and longer recovery times.

More experienced female dancers tend to take less time off due to injury. This may be attributed to a difference in perspective about what may constitute an “injury” and what may be likened to normal, dance-related “aches”. 

Binge drinking alcohol negatively effects training recovery, disturbs sleep, and acts as an immunosuppressant. It also interferes with anabolic (muscle building) hormones and increases total system inflammation. 

Injury rate and time-off due to injury are influenced by several factors, some of them modifiable. The modifiable factors include alcohol consumption, cigarette smoking and illicit drug use. It may be prudent for companies to invest in substance abuse education to improve the quality and longevity of professional ballet dancers careers. 

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How dancers can test their cardiovascular endurance to improve their performance

How dancers can test their cardiovascular endurance to improve their performance

This article will help the reader determine how to test their cardiovascular fitness using a submaximal testing procedure. It is accurate and may assist dancers in determining if they require additional cardio exercise to improve their performance and reduce their risk of injury. 

Part 1: Introduction

Part 2: Different types of tests to use

Part 3: How to interpret the tests

Part 4: Discussion

Part 1: Introduction

Dancers undergo rigorous training in rehearsals and technique classes in preparation for performing.  There have been multiple studies that demonstrate that despite the high volume (work) done by performers, rehearsals and class does not prepare them for the day of performance. In fact, studies show they have aerobic fitness levels similar to that of healthy sedentary people!

To perform better dancers need to supplement their dance training with cardio training. 

But how do you know if your cardio is improving? Are there tests we can use to measure a dancers fitness so we can better design a cardio training program to enhance their performance?

Using a submaximal, or low to mid-intensity, testing protocol, a dancer or a dance team can measure their cardiovascular fitness. It is generally easy to perform and can provide useful information to the dancers, their teachers, physical therapists and medical doctors. 

The test results can then be used to design a cardiovascular program to improve their performance.

Part 2: Different types of tests used to predict cardiovascular fitness

Several testing methods can predict your cardiovascular fitness.

The tests require a heart rate monitor, a scale (to measure weight), stopwatch & some type of exercise equipment (treadmill, stationary bicycle, track). Once the test is performed, the results are calculated to predict what the maximal workload is. 

The tests described below are submaximal, meaning they do require effort, but not to exhaustion. In this way, they are all predictive of your cardiovascular capacity. 

Here are a few of the tests and the specific equipment they require. 

Part 3: Interpretation

The “gold standard” for testing your maximum cardiovascular fitness is with the use of expensive equipment and experienced testers. The use of the above mentioned sub maximal tests do not require much equipment and can be administered by most health care professionals (physical therapist, athletic trainer, personal trainer) if they are familiar with the equipment, protocol and how to interpret the results. 

However, the tests, because they do not achieve maximal exertion, can only predict what your maximal exertion is, and therefore your true cardiovascular fitness. Rather, these tests estimate what your maximum is by finding a “line of best fit” based on your heart rate response to a given intensity of exercise. In athletes in particular, this may undervalue you true maximum.

Not all is lost though, as these tests can be very useful at determining your improvements in fitness over time. After engaging in a well-designed training program, your heart rate should have a better response to working at the previously tested levels. In effect, your heart does not have to work as hard (lower heart rate). The heart can pump more blood and the muscles use the oxygen in the blood more efficiently.

Part 4: Discussion

Because of the unique nature of performing and the rigorous training schedules that dancers undergo, exercise testing is an important part of any dancers career. These tests can be used to measure a baseline of a dancers fitness level as well as how well they have improved with a given exercise program. 

It is well known in the research that rehearsals do not provide a strong enough stimulus to adequately prepare a dancer for their performance. In other words, the level of intensity of a performance is greater than that experienced during rehearsing. This is unfortunate as it can place a great deal of stress on the performer- they may fatigue earlier and thus appear less aesthetically pleasing during a performance despite working for months on a particular show. 

The aerobic testing can be a very useful tool if a performer wishes to take their career to the next level. If used appropriately, an aerobic training program can model the specific type of performance they are rehearsing for. This will provide a unique advantage for the dancer and their team as their movements will appear effortless and their breathing easy.

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