Injuries

Dance Injury Prevention in Breaking

March 5, 2019 by 4dancers

I’m so pleased to be able to bring you an article on a topic we don’t hear too much about in the dance medicine world – Breaking – or “Breakdancing” as it is often referred to in the media – and how it affects the dancer. Nefeli Tsiouti Is a young IADMS (International Association for Dance Medicine and Science) member from Cyprus, who has brought the art form forward, bringing knowledge and understanding to the injuries suffered in this field. She graduated from Trinity Laban Conservatoire of Music and Dance (London) with her Master’s in Dance Science less than 3 years ago, and already has done much to further her passion about Breaking and concern about the dancers’ wellbeing. She is the founder and Director of Project Breakalign, drawing attention to this topic worldwide. She is also a researcher for the Cyprus Musculoskeletal and Sports Trauma Research Center, and is currently pursuing her Physiotherapy degree at European University, Cyprus. Nefefi won the Sports Therapist of the Year award from the international Federation of Holistic Therapists. She has an impressive resume already, and we will be hearing much more from her in the future. Please pass this on to all of your dancers / teaching colleagues, but especially those who work in this particular dance form.

– Jan Dunn, MS, Dance Wellness Editor

by Nefeli Tsiouti, MA, MSc

I will not stop writing articles until I can get all hip-hop dancers away from injury!

Psychologists say that if you have experienced a situation yourself, you are more equipped to relate better and help others who will go through similar situations. So here I am, after overcoming severe chronic injuries, some of which have not yet decided to fully go away, and some surgical experiences, I have decided to dedicate my life to helping others prevent injuries.

Dance gave me wings, as it does to everyone. But one day, when I met ‘Breaking’ (or Breakdance as known by the media), I was amazed! A very intriguing, social, upside-down, flipping around, creative dance style that offers creativity beyond the roof. It is literally one of the most uplifting and open-to-options dance forms that one can get involved with.

However, as positively unique as Breaking may be, because of the extreme physicality that is required to be able to perform it, if it is not taught progressively, and without the appropriate body conditioning, it may cause injuries to the body.

Breakdancer — Nefeli Tsiouti, photo by Anna Motou.

A big part of the mentality of a Bboy/Bgirl (Break-boy /Break-girl, the male or female who dances to the ‘break’ of a song – otherwise known as Breaker / breakdancer) is the constant fight to achieve. Bboys and bgirls set very high goals when practising their art form, and with that also comes managing an injury and dancing through it. They prefer to dance with an injury and keep developing, than to stop practising in order to rest and heal–and then return to dance.

This preference to continue while injured, was one of the answers dancers gave on the 1^st global Breaking survey I conducted with Dr. Matt Wyon (University of Wolverhampton – UK), on injury occurrence in Breaking. They stated that it was preferable to ‘continue dancing with the injury, but carefully’. From my perspective, this hunger and drive to become better than yourself every single day, and to always develop, is one of the most beautiful and rewarding elements of Breaking. The hard work that Breakers put in their craft, and the reward they feel when achieving their goal, when winning the battle, when completing their move, when spinning on that head, when landing properly on that elbow – all the crazy things that once looked supernatural, become systematic in their practice.

Generally, in Breaking the most common injuries occur on the upper body. The axis of the body is very often vertical in Breaking, therefore the impact on the joints and the demands for the upper body to generate the movement, is very high – but also unnatural, in terms of principles of functional movement as well as ‘typical’ ways of moving. A study that we conducted at the Institute of Sport, Exercise & Health at UCL (2015), showed that not only does fatigue have a significant negative impact on the stability of specific foundational breaking movements, but it can also reduce the force which breakers use to get into certain movements. This finding suggests that fatigue may lead to injuries – in relation to pressure and weight distribution. However, the more fit and in better condition the breaker is, the less likely it is that they will get injured ^[1].

It is essential to not put obstacles into this positive community of people who have built great skills out of nothing. In 2013, when I realised how broken I had become from dancing (18 years of dancing at the time), I decided to act on it and contribute to the hip-hop culture in a way that others hadn’t had the chance to do at that point.

Therefore, in 2013 I started a research project on the prevention of injuries in the breaking field – Project Breakalign. What we have concluded is that there is something missing for the breakers, and generally for many dancers in other forms as well. That missing ingredient is a tool…..A tool for dancers to educate themselves and embody in their body – i.e, the necessary information for prevention of injuries. My research team of 15 international researchers/dancers, and myself, conducted a 1.5 year-long project where we created the Breakalign Method. This is a conditioning program, based on the analysis of the biomechanical (meaning the mechanics of movement) and physiological demands of Breaking. More information on the Method and the project can be found at: www.projectbreakalign.com . The creation of the methodology was funded by the Centre National de la Danse, in France.

But, a moment of honesty is necessary here. Preventing injury in such a physical group of dancers may be done up to a certain point. From that point onwards, as dance scientists and researchers of the genre, we can reduce the risk of injury by implementing certain principles in the practice of Breaking – but the risk will always be there, depending on the spontaneity of the dancer, their fitness level, the flooring, their shoes, and many more elements…..that I could talk about for hours!

So this concludes this first introduction to Break Dancers and Dance Medicine / Wellness –stay tuned for #2 article, coming soon on 4dancers.org.

References: ^[1] Tsiouti, N., Constantinou T., Philip, K., Sanchez, E., Paton, B. (2016). Evaluating the relationship between fatigue, pressure and weight distribution on the upper limb in breakers. Revista Movimenta. 9(4): 659-664. (http://www.revista.ueg.br/index.php/movimenta/article/view/5622/3840)

Nefeli Tsiouti completed her MSc in Dance Science, supported by 3 scholarships from Trinity Laban Conservatoire of Music and Dance in London. She has been dancing for 21 years, having as her main dance training classical ballet in Cyprus and Greece. She has obtained a Bachelors Degree in French Language and Literature from the University of Athens in 2009 and a Masters in Choreography from Middlesex University in 2011. She has been a Lecturer in Dance in Colleges and Universities across London since 2011. She is also the Artistic Director of Scope Dance Theatre since 2010, making hip-hop dance theatre using the artistic elements of the hip-hop culture.

Nefeli initially began training Breaking in 2007 and unfortunately obtained a very serious injury on her shoulder, which meant she had to stop any physical activity and have a medical operation in 2008. Several years after no dance activity, she moved to UK for her studies and began Breaking again and has been competing nationally and internationally ever since. Since 2013 she has been the Founder and director of ‘Project Breakalign’, a prevention of injuries research project for breakers. The aim of the project is to bridge the gap between dance medicine and science, and dancers, and to make the knowledge of research become as applicable as possible to the hip-hop dancers, and not only.

Nefeli won the Lisa Ullmann Travelling Scholarship Fund in 2014, choosing New York as her research destination. She was also awarded the Bogliasco Foundation Fellowship in 2015 in Genoa Italy for further research on injuries in breakers. She has also been awarded the Gill Clarke Resource Fund, the ‘Centre National de la Danse’ Funding in 2015 to develop the ‘Breakalign Method’ for Project Breakalign, the ‘Dance UK’s Dancers’ Mentoring Programme’, being mentored by Matthew Wyon, as well as being a finalist for the ‘Change Maker Award’ by London Inspires Awards.

Nefeli’s work over the past few years has focused on developing a new area of dance medicine and science research, which focuses on hip-hop dancer and specifically breakers. Project Breakalign has been at the forefront of bringing new information to academic research and translating it to reach the communities with the dancers who need it. Nefeli has devoted her work to the mission of reducing the risk of injuries and promoting a healthier dancer for longer, with Project Breakalign’s research, lectures, workshops and her active participation in international breaking competitions.

International speaking engagements include Brazil-UK Network in Dance Medicine & Science 2016 in Brazil, Performing Arts Medicine Association’s Annual Conference 2016 in L.A., Healthy Dancer Canada 9th Annual Conference 2016 in Saskatoon, International Association for Dance Medicine & Science Annual Conference 2016 in Hong Kong, Serendipity’s Blurring Boundaries: Urban street meets contemporary dance 2015 in De Montfort University UK, Kingston University’s PoP Moves Emerging Scholars Symposium 2012 in UK and Goldsmith’s University’ Conference of Contemporary Music & Dance 2012 in UK. In 2017, she will present the creation process of the ‘Breakalign Method’ at the Centre National de la Danse in France. For more info, watch the following trailer: https://youtu.be/zJjSoo6WAic

Nefeli’s professional performance and/or choreographic credits include London Olympics Opening Ceremony 2012, RIOT Offspring/Sadler’s Wells 2014, Open Art Surgery/Breakin’ Convention, Dance Umbrella/Barbican, B.Supreme UK Tour, Faraday’s Cage film/Company Bricolage, Barcelona International Dance Exchange, The Place, ELLE-Adidas MyGirl Global campaign 2014, Folk Dance

Remixed UK Tour (2014-15), Opera in Revolution 2015 in Cyprus, and more.

Published articles include a piece of research in Blurring Boundaries: Urban street meets contemporary dance by Serendipity (2016) and also an article about health in dance in Dance Today. Dancing Times (2014). More publications are expected from 2017.

Tsiouti, N., Constantinou, T., Philip K., Sanchez, E. & Paton, B. (2016). Evaluating the relationship between fatigue, pressure and weight distribution on the upper limb in breakers. Revista Movimenta. 9(4): 659-664

Sidelined?

March 17, 2017 by Rachel Hellwig

By Samantha Hope Galler

Louise in Kenneth MacMillan’s “Carousel” with Miami City Ballet. Daniel Azoulay.

Understanding Injuries

Since I began my career nearly 10 years ago, I have discovered that professional ballet dancers are among the strongest human beings. When I was 5 years in to my professional career, I met with a sports medicine doctor. During our conversation he said to me, “Well, it’s not like you are playing tackle football.” I could not believe it. His comment opened my eyes to how little people understood the dance world and the risks that come with it. Dancers put their careers on the line every day. We must deal with disappointments, but, most of all, we must deal with injuries. Discovering mental stamina while sidelined is the biggest challenge.

The Worst News

The worst news a dancer can receive is that she or he must hold off on what they live and breathe. Dance injuries come when you least expect them. Performing and rehearsing is going along so well and then all of a sudden things come to a screeching halt. It is a complete shock. Many injuries will take weeks, months, or even years to come back from. Emotional attitudes are compromised and difficulties arise from being sidelined. Fortunately, dancers today have access to advanced dance and sports medicine doctors who will answer any questions they have regarding their path to recovery. Depending on the severity of an injury, movement may be limited. This can force a dancer to be away from the studio for quite some time. Other injuries may allow a dancer to continue some normal activity like watching rehearsals or marking in the back of the studio. It is common to find a young dancer joining a company and sidelined early on from an overuse injury. A professional dancer’s schedule can be drastically different from that of a student and they may not be used to it. I have learned that a dancer’s first injury is a crucial learning experience. It was for me. It is the first time a dancer is forced to sit out, cross train, and build back mental and physical strength. There is a significant amount of time to reflect on yourself and any recent experiences. Reflection can be a positive experience, especially when the person is in their most vulnerable state. Reflecting can build a dancer’s confidence while they discover new ways to approach goals. This is when a dancer finds their deepest strength to pull through.

Learning to Cope

Mental stamina and mental clarity are two crucial elements dancers require to tackle their careers. Interestingly enough, our training prepares us for injuries in more ways than one. It is a matter of finding the patience we need to keep our head in the game. Most professional dancers are accustomed to spending 7-8 hours a day rehearsing. It can be quite a shock when all of a sudden you do not have that schedule anymore. Time seems to go by more slowly because the schedule is quieter. It is important to fill that schedule with activities that keep the mind and body alert. A portion of time can be spent working with a sports psychologist to learn how to compartmentalize, gain focus, and grasp the situation. Feeding the mind with positive thoughts and meditating has helped me find trust and confidence. I really have to believe there is a master plan behind it all.

Back to Work

Visualization plays a key role in my return. As I approach the weeks before returning to the studio, I begin to visualize my pirouettes and jumps. Sometimes I watch rehearsals just to become accustomed to the sounds of the pointe shoe hitting the floor. In addition, I find time to research and study ballet videos. Even though injuries stop us from being able to physically practice, we can still keep our minds going. Watching these videos reminds the mind what the movements feel like without actually doing them. All of these practices guide us in the right direction. When the chance comes to finally step back into the studio, it is important to feel ready. I find comfort in knowing what muscles I can and cannot move. This helps me narrow down a productive workout routine to stay into shape. Although it is not easy to work out equivalently to a daily rehearsal schedule, two or three hours in the gym can make a huge difference. The more I do while recovering the more I can focus on the main issue once I am given the ok to move on. My workouts typically include reformer sessions, gyrotonics, biking, and swimming as permitted. My advice for those coming back from an injury is to try all different forms of cross training. If you do Pilates all the time, make sure to throw in a few sessions of swimming to build stamina in a different way. This career is first and foremost visual so it is important to understand how to make an appropriate comeback so that you can feel confident with your progress once you are in the studio or on stage. Be ready to face anything that comes your way.

Safe Dance Practice: What Is It And Why Do We Need It?

April 4, 2016 by Rachel Hellwig

Kai Downham photography: Instep Dance Company — Kai Downham Photography: Instep Dance Company

Aloha All 🙂

New dance medicine book to share! “Safe Dance Practice” is written by three British colleagues of mine in the dance medicine world, Edel Quin / Sonia Rafferty / Charlotte Tomlinson. All three are involved with IADMS (International Association for Dance Medicine and Science), Safe in Dance International (SIDI), and are all MSc graduates of the Dance Science program at Trinity Laban Conservatoire of Music and Dance (London UK). They have been long-involved in dance medicine and science, aka Dance Wellness, aka Safe Dance Practice (a British term), and have put together their invaluable knowledge and experience in writing this book – giving teachers and dancers a solid grounding for training healthy dancers who will be better equipped to dance many long years, in the best possible condition. The book is a great addition to your dance medicine and science library – Please pass it on!
Aloha
Jan

by Sonia Rafferty, Charlotte Tomlinson and Edel Quin

What It Isn’t!

The term “safe dance practice” often conjures up the vision of a checklist of boring, restrictive, and often unnecessary health and safety regulations. As dancers, choreographers, and teachers, we certainly don’t want to be held back in our artistic endeavours by recommendations that we think will limit our creative risk-taking capacity.

Fortunately, the upsurge of interest and increasing knowledge in safe dance practice will help us to do exactly the opposite. We can support artistic challenge by helping dancers to train and work at their best, but also heed the potential reasons for the high injury rate that has been observed in a wide variety of different dance styles.

Who Is It For?

Safe dance practice is important for dancers of any age and any ability. It is not simply for the elite “racehorse” of a dancer, at risk because of high-level demands, or the dancer who perhaps could be seen to be more prone to injury because of lack of technicality or physical ability.

Knowing how to work safely and effectively is relevant for everyone – for dancers themselves who can take responsibility for protecting and maintaining their readiness to dance, and for teachers who are trusted with instructing the dancing bodies. Add to that list the choreographers who use the expertise and abilities of dancers to create innovative and challenging works, and the artistic directors and managers who rehearse those dancers and organise their schedules.

[Read more…]

Dance Injuries – About That Ice Pack…

December 6, 2015 by 4dancers

The web and social media can be wonderful places to get information – facts and news are able to be shared shared quickly and easily. Unfortunately, the same things that make these areas great for spreading information can also have a drawback. Too often something can get passed along without context, which can change the entire meaning…or information can be widely shared that may not have a solid foundation underneath it.

In the coming months our Dance Wellness team will be putting together some solid guidelines for readers on how to go about evaluating dance medicine and dance wellness information on the Internet. They will share specifics on what to look for when searching for, and reading dance wellness info on the web.

We’ll also be compiling and sharing a list of reputable sites that you can go to for information in this field.

In the meantime, our Dance Wellness editor, Jan Dunn, wanted to address some recent information that has been circulating around on social media about the use of ice for dance injuries to make sure that dancers know that indeed, the ice pack is still a useful tool!

by Jan Dunn, MS

This post is in response to discussions I recently became aware of online (primarily on Facebook) regarding the use of ice in treating injuries. Respected dance educators were advocating throwing away the ice pack, despite the many years where RICE (Rest / Ice / Compression / Elevation) has been advised, or more recently PRICE (Protection / Rest / Ice / Compression / Elevation).

I was not aware of any discussions, presentations, or articles on this topic in the dance wellness field – and so was cautious / skeptical, since some of what is seen or posted online is not necessarily true – or is not in line with current scientific / medical protocols. I started doing some research, and checking with various experts in dance medicine – including members of the 4dancers.org Dance Wellness Panel: James Garrick, MD; Moira McCormack, PT; Selina Shah, MD; Matt Wyon, PhD; Janice Plastino, PhD; Robin Kish, MA; Gigi Berardi, PhD; Emma Redding, PhD; Erin Sanchez, MS; and Nancy Wozny.

And what I learned is — well, please don’t jump on this particular bandwagon and throw away your ice packs!

Some basics

Ice can clearly be overused, and when it is, it’s not good. It can damage the tissue it’s meant to be helping if it’s kept on too long. It is usually advised the first 48-72 hours after an acute injury (like an ankle sprain). Some of the sites online are advising not using ice at all are saying that because inflammation is the body’s way of healing, and they imply that to use ice is to stop inflammation. But ice treats the symptoms of inflammation, it doesn’t get rid of it. Ice and compression (more on that in a moment) can reduce the amount of initial swelling –which speeds the healing process– and this is the whole point of post-injury care.

Why Ice Can Be Helpful

Ice is also very useful for helping decrease pain levels –another major symptom of inflammation. So another good reason not to throw away that ice pack.

There is also the issue of “secondary hypoxic injury” – this refers to tissue not damaged by the primary injury (such as the ligaments directly affected by an ankle sprain), but nearby, which can become damaged as a direct consequence of the physiologic response to the primary injury. Ice can slow down these metabolic processes and therefore save some tissue.

How to Use Ice

When you do use ice, go for at least 10 – 15 min. on a new injury (or until the area is numb, which vary slightly depending on how muscular or bony the area is), allowing at least 20 min. before re-applying. Try to go for at least 5 min. minimum on not-so-new areas, if you can’t do the full 10-15.* You have to also always be sure you have something between you and the ice itself – most icepacks come with a fabric covering, and that works fine. You just don’t want to put ice directly on the skin, without something to protect it (think “freezer burn”!). Never use heat on a new injury.

Compression

Now, let’s briefly go over Compression. Most people interpret this as (for example) wrapping an Ace bandage around a sprained ankle. Yes, all well and good – but, as Dr. James Garrick, MD (one of the founders of both the sports medicine and dance medicine fields) points out:

“The ‘hollowed out’ areas posterior (behind) the malleoli (ankle bones, on both inside and outside of the joint) and anterior (in front of) will have NO compression at all (with an Ace bandage), and those structures (the ligaments that were actually injured) will actually be encouraged to swell more.”

What is needed instead is focal compression (directly on those “hollowed out” areas)—which moves the bleeding away from the areas injured. Dr. Garrick gave the example of a dancer whose sprained ankle was treated with this protocol, and “the ankle actually looks like an ankle, not the polish sausage one sees if just an elastic wrap is used.” He noted that this dancer was able to walk with nearly full ankle motion 24 hours after the injury.

Some of the dance medicine medical and scientific colleagues (and non-dance as well) whom I contacted on this Ice / No Ice question, gave some pertinent thoughts that are worth passing on:

“There is no research that counters the practice of using ice to reduce swelling. On the contrary, there are studies that do show the benefits of ice as well as NSAIDS. Not using ice is not standard of care in sports medicine, and I don’t know of any research in dance medicine.” (orthopedic MD who specializes in sports and dance medicine).

“The articles being referenced (in some online sites advocating no ice) need to be referenced to determine their quality – most research in this area is pretty poor. I am also a great believer in using our years of clinical experience (on the beneficial aspects of using ice)”. ( PhD researcher in Sports Physiotherapy).

“Until I see some really solid physiological studies, over time, that ice is detrimental and actually damages the tissues, I will continue to use it as part of my treatment protocols.” (long-time sports medicine physical therapist).

So in conclusion – I hope this article / advice from dance (and sports) medicine experts (who keep up with the latest research) will help clarify this for you, and as I said at beginning – please don’t throw away your ice packs!

Happy Nutcracker and Holiday Season! – Jan Dunn, MS, Dance Wellness Editor

*Please note that this time has been adjusted from the recommendation of 5 minutes, along with a clarification to make it more applicable to a variety of injuries

Editor Jan Dunn is a dance medicine specialist currently based on the island of Kauai, Hawaii, where she is owner of Pilates Plus Kauai Wellness Center and co-founder of Kauai Dance Medicine. She is also a Pilates rehabilitation specialist and Franklin Educator. A lifelong dancer / choreographer, she spent many years as university dance faculty, most recently as Adjunct Faculty, University of Colorado Dept. of Theatre and Dance. Her 28 year background in dance medicine includes 23 years with the International Association of Dance Medicine and Science (IADMS) – as Board member / President / Executive Director – founding Denver Dance Medicine Associates, and establishing two university Dance Wellness Programs

Jan served as organizer and Co-Chair, International Dance Medicine Conference, Taiwan 2004, and was founding chair of the National Dance Association’s (USA) Committee on Dance Science and Medicine, 1989-1993. She originated The Dance Medicine/Science Resource Guide; and was co-founder of the Journal of Dance Medicine & Science. She has taught dance medicine, Pilates, and Franklin workshops for medical / dance and academic institutions in the USA / Europe / Middle East / and Asia, authored numerous articles in the field, and presented at many national and international conferences.

Ms. Dunn writes about dance wellness for 4dancers and also brings in voices from the dance wellness/dance medicine field to share their expertise with readers.

On The Marley Floor…

October 1, 2015 by 4dancers

Maria Chapman of Pacific Northwest Ballet. Photo by Angela Sterling Photography.

by Jessika Anspach McEliece

Her deafening scream reverberated through the studio.

Remembering it and my stomach still curdles. One moment she was doing petit allegro, the next writhing on the Marley floor in animalistic agony.

There are just some moments you never forget.

Moments you wish you could.

And yet these terrifying incidents are ones rarely thought of, let alone mentioned. It must be human nature to sweep the scary under the rug. Like those cheesy ceramic monkeys I often see in vintage shops, we choose to “see no evil, hear no evil, speak no evil,” superstitiously (and aren’t we dancers the worst?) believing that if we don’t speak it, acknowledge it, then it doesn’t exist. Injury won’t happen to us. We keep the lights on and those monsters “safely” under the bed.

But sometimes, no matter our diligence – how often we ice, how much we stretch or see the P.T., no matter how many “Zzz’s” we get, the monsters rear their frightening faces. And sometimes we end up on the Marley floor.

My “Marley moment” came May 15^th, 2015. And I actually was on the floor. [Read more…]