dance wellness

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…]

Healthy Bones For Dancers

February 11, 2016 by 4dancers

by Selina Shah, MD, FACP

Our bones are important because they serve as the foundation on which we are built. Bone is living tissue that contains blood vessels; proteins, including collagen; and cells that are actively maintaining healthy bone. Bone also contains many minerals, the most important of which is calcium.

Building Strong Bones

We have the best chance of building our strongest bones when we are young — because the rate at which we form bone is higher than that of losing bone up until about the age of 30, when peak bone mass is reached. After peak bone mass is reached, we starting losing bone at a higher rate than we form it. The majority of the mass of our bones forms between the ages of 11 – 14 in girls and 13 – 17 in boys. The more bone mass you have by the time you reach peak bone mass, the less of a chance of you have of breaking your bones, especially later in life as bone loss occurs.

Bone Health And Your Diet

As dancers, we place a lot of stress on our bones. This stress can lead to damage of bone tissue. However, luckily our body is designed to repair itself, so bones maintain their healthy structure by containing cells that remove damaged bone and replace it with healthy bone, also known as bone turnover.

In order to achieve the highest bone mass possible and to ensure healthy bone turnover, it is important for our bones to have the right ingredients. Dancers need have enough nutritional intake based on activity level, adequate calcium, and adequate Vitamin D. Without these, a decrease in bone density can occur, making a dancer susceptible to fractures and stress fractures.

Dance is a form of exercise which uses energy. This energy needs to be replaced by consuming enough healthy carbohydrates and fats so that your body can continue to function normally. Having adequate fuel is especially important for girls to ensure normal, regular menstruation. The hormones that regulate menstruation directly affect bone mass. If a dancer does not consume enough calories and fats to adequately re-fuel the body, then the hormone balance gets thrown off – which can result in a decrease in bone density.

It is not unusual to experience irregular periods (meaning periods that do not come monthly) during the first year of menstruation. However, missing your periods for months at a time or getting your period too late, may also be a sign that you are not consuming enough calories. Genetics and other medical issues could also be playing a role in abnormal menstrual cycles or later onset of menstruation. It is best to consult a physician if you do miss your period for more than 2 months, especially if this occurs on a regular basis, or if you are 15 years old and have not gotten your period. Males are also susceptible to bone loss due to inadequate energy consumption. All dancers need to consume enough calories to re-fuel the body.

Bone Density

The human body is designed to always have normal calcium levels – so if you do not consume enough calcium, it will take it from bone which again will lead to decreased bone density. The Institute of Medicine currently recommends consuming the amount of calcium based on age shown in Table 1 below. It is best not to exceed the amount of calcium shown at the upper limit column because this can increase the risk of forming kidney stones. It is best to get calcium from dietary sources such as dairy, almonds, broccoli, Brussels sprouts, and dark leafy greens, to name a few. Check your food labels and calculate how much calcium you get in a day. If you do not reach the level recommended in Table 1, then buy a supplement. Do not take more than 500mg at a time to maximize effective absorption.

Table 1: Institute of Medicine Daily Adequate Intake of Calcium

Age	Calcium (mg/day)	Calcium (mg/day) Upper Level Intake
4 – 8	1000	2500
9 – 18	1300	3000
19 – 50	1000	2500
51 – 70	1200	2000
> 70	1200	2000
Osteoporosis	1500	2500

Bone Health And Vitamin D

In order for your body to absorb dietary calcium, you need to have an adequate amount of Vitamin D. The best source for Vitamin D is from the sun. Vitamin D is formed by cells in the skin layer. Sun exposure to form Vitamin D in the skin is inhibited by sunblock and decreased by clouds and pollution. Additionally, the darker the skin color, the longer daily exposure time to sun is needed for the cells in your skin layers to form adequate vitamin D. Generally speaking safe sun exposure (no sunblock for the time allotted as long as there is no risk of skin cancer by family or personal history of skin cancer) is best obtained between the hours of 10am – 3pm on the arms and legs for a minimum of 20 minutes per day depending on skin color and the latitude in which you live.

The further you are from the equator, the less Vitamin D is formed during winter months. It is difficult to adequately consume Vitamin D from foods fortified with Vitamin D. A few foods such as Cod Liver Oil, egg yolks, salmon, sardines, mackerel, and canned Tuna are natural sources of Vitamin D. One study found that more than 95% of dancers are deficient in Vitamin D. If you cannot get enough sun exposure, the Institute of Medicine recommends the supplementing Vitamin D at the levels based on age shown in Table 2 below. Your doctor may check a blood level and recommend a higher dosage of Vitamin D to boost your levels quickly. It is difficult to become toxic with Vitamin D supplementation. Follow your doctor’s advice.

Table 2: 2010 Institute of Medicine Daily Adequate Intake of Vitamin D

Age	Vitamin D (IU)
0 – 1	600
1 – 70	600
> 70	800
Pregnancy	600

In summary, it is best to ensure adequate Vitamin D levels, calcium intake, and food intake to develop and maintain strong bones. The younger you begin, the better off you will be in the future.

Selina Shah, MD, FACP is a board certified sports medicine and internal medicine physician and the Director of Dance Medicine at the Center for Sports Medicine in San Francisco, CA and Walnut Creek, CA. She has lectured nationally and internationally on various dance medicine topics and has published papers in medical journals and books including her original research on dance injuries in contemporary professional dancers. She is the dance company physician for the San Francisco Ballet School, Liss Fain Dance Company and Diablo Ballet. She is a physician for Berkeley Repertory Theater, Mill’s College, St. Mary’s College, and Northgate High School. She takes care of the performers for Cirque du Soleil and various Broadway productions when they come to the San Francisco Bay Area. She has taken care of several Broadway performers (i.e. American Idiot, South Pacific, Lion King, Book of Mormon, MoTown, and Billy Elliot). She is a team physician for USA Synchronized Swimming, USA Weightlifting, USA Figure Skating and travels with the athletes internationally and nationally. She is also a member of the USA Gymnastics Referral Network. As a former professional Bollywood and salsa dancer,

Dr. Shah is passionate about caring for dancers. She continues taking ballet classes weekly and also enjoys running, yoga, Pilates, weightlifting, and plyometric exercise.

Dance Wellness Links And More…

January 9, 2016 by 4dancers

Aloha and Happy New Year !

I hope everyone had a wonderful holiday season, and you are back in full swing with your dance life. This month marks 4 years that I have been associated with 4dancers.org, and so I felt it was an appropriate time to comment – and to encourage you to keep “spreading the word” about dance medicine and science / aka Dance Wellness!

So, how did the Dance Wellness segment of 4dancers.org get here?

In the fall of 2011, Catherine Tully, editor of the site, approached me about writing an article about Dance Medicine and Science, to introduce that topic to the readership. She and I had never met, or communicated, before that –i.e., it was a “cold contact”. I said “of course” and wrote that first post–which was supposed to be a one-time thing. But–the readership response was so positive that Catherine asked me to keep going…..and so our Dance Wellness segment became official.

Over time I started asking other colleagues in the field to also contribute, and things just kept growing. This past year, we added our Dance Wellness Panel of experts–all long-time experienced professionals, each focusing on different aspects of dance medicine and science.

From a personal perspective, 4dancers.org has been one of the most fulfilling things that has ever happened in my professional dance life–and I say that coming from many years of very fulfilling experiences! Since the beginning of my work in the dance medicine field, 35 years ago, my #1 goal has always been to reach out to the thousands of dancers and teachers who don’t normally have a chance to access this kind of information. I was given different opportunities, in that respect, over the years–such as helping to form IADMS (International Association for Dance Medicine and Science), and starting Dance Wellness programs in university settings. And all of that was wonderful–but it still didn’t reach out on the “grassroots” level, which was my original goal.

4dancers.org, and Catherine Tully, changed all of that, and I will be eternally grateful both to her, and to you, the readership, for the opportunity I was given, and for the way you have embraced the information we have put out there for you, and “passed it on”!

Some of you reading this probably have been with 4dancers for a long time, maybe all of the past 4 years, but many of you may have not. So with this post, I am sharing our full list of dance wellness articles, so that if you missed any, you can read and catch up–and maybe learn one or two new things you didn’t know before…..and that’s the whole point, isn’t it?

Mahalo Nui Loa (thank you from the heart), and–
Pass it on!

Jan

Jan Dunn, MS
Dance Wellness Editor – 4dancers.org

4dancers.org – Dance Wellness posts 1/1/12 to present

2012

1/2/12 – Keeping Dancers Dancing: An Introduction to Dance Wellness in 2012 – Jan Dunn, MS

1/19/12 – “The Perfect Arch” – Frank Sinkoe, DPM

1/26/12 – Blisters And Corns Between The Toes (Interdigital Lesions) – Frank Sinkoe, DPM

2/1/12 – Dance Wellness: Causes of Injuries (Risk Factors) – Part 1 – Jan Dunn, MS

2/9/12 – Treatment Of Warts In The Dancer – Frank Sinkoe, DPM

2/12/12 – Dance Wellness: Causes of Injuries (Risk Factors)- Part II – Jan Dunn, MS

2/14/12 – Nutrition for the Dancer: Emily’s Apples and Pumpkin Oatcakes – Emily Harrison, MS

2/16/12 – Toenail Injuries in the Dancer: Bruised Nail – Frank Sinkoe, DPM

2/18/12 – Dancers and Hydration – Emily Harrison, MS

2/23/12 – Toenail Injuries of the Dancer: Ingrown Toenail / Infection – Frank Sinkoe, DPM

3/8/12 – Keeping Dancers Dancing: “Help! – I have an Injury- What Do I Do?” – Jan Dunn, MS

4/3/12 – Keeping Dancers Dancing: Conditioning – Jan Dunn, MS

5/4/12 – Keeping Dancers Dancing: Conditioning – Pilates – Jan Dunn, MS

5/13/12 – Keeping Dancers Dancing: Conditioning Gyrotonics and Gyrokinesis – Jan Dunn, MS

6/14/12 – Keeping Dancers Dancing: Conditioning – The Franklin Method, Part I – Jan Dunn, MS

6/15/12 – Keeping Dancers Dancing: Conditioning – The Franklin Method, Part II – Jan Dunn, MS

7/12/12 – Staying on Your Toes with a Physical Therapist – Sarah Graham, PT

8/9/12 – Competition Dance: Maximizing Peak Performance, Part I – Robin Kish, MA

8/21/12 – Competition Dance: Maximizing Peak Performance, Part II – Robin Kish, MS

9/6/12 – Dance Wellness Update – Jan Dunn, MS

10/25/12 – Nutrition for Your Dancer Body: Understanding the Fundamentals of Making Good Food Choices – Diana Clanin, MS

11/29/12 – Dance Wellness: Phases of Healing – Marika Baxter, PT

2013

1/10/13 – Motor Learning in Dance – Donna Krasnow, PhD

1/24/13 – Dance Wellness: Preparing for the Summer Intensive – Jan Dunn, MS

3/21/13 – Dancing Through the Adolescent Growth Spurt – Jan Dunn, MS

5/7/13 – Ballet: How Hard Should It Be? – Janet Karin, OAM

5/9/13 – “Older Dancers” – Gigi Berardi, PhD

8/23/13 – Dance: The Importance of a Good Warm-Up – Jan Dunn, MS

10/2/13 – Book Review: Dance Medicine Head To Toe: A Dancer’s Guide To Health – Emily Kate Long

11/10/13 – Healthy Dance Practice Certification Course – Jan Dunn, MS

12/2/13 – Supplemental Fitness Training Can Improve the Artistic Element of Dance Performance – Matthew Wyon, PhD

12/26/13 – Dancing in the Dark: Dancers Need Vitamin D – Matthew Wyon, PhD

2014

1/22/14 – The Healthy Dance Practice Certificate – Jan Dunn, MS

2/14/14 – Stretching Healthy: A Primer for Dancers – Jan Dunn, MS

2/27/14 – Mirror Use in the Classroom: How Much is Too Much? – Sally Radell, MFA

3/10/14 – Mirror Mirror on the Wall: A Dance Teacher’s Perspective – Sally Radel, MFA

5/27/14 – Thoughts on Starting a Dance Screening Program – Jan Dunn, MS

6/9/14 – Integrating Best Practices From Dance Medicine And Science To The Faculty Of A Professional Dance Conservatorie – Rachel Rist, MA

7/4/14 – The Hypermobile Dancer – Moira McCormack, MSc

8/7/14 – A Somatic Update for Dancers – Nancy Wozny

11/19/14 – Turn-out and the Dancer: A Closer Look – Jan Dunn, MS

2015

1/2/15 – Dancers and Stretching: How Hard Should You Push? – Matthew Wyon, PhD

1/22/15 – Are You Ready For Pointe? – Selina Shah, MD

3/11/15 – A Franklin Method Foot Warm-Up for Dancers – Jan Dunn, MS

5/13/15 – Introducing Our Dance Wellness Panel – Catherine L. Tully

5/20/15 – Franklin Method Foot Warm-Up: Part II – Jan Dunn, MS

6/25/15 – An Easy Guide to Portion Sizes – Catherine L. Tully

8/5/15 – Let’s Talk “Core Control” – Jan Dunn, MS

8/31/15 – Let’s Talk “Core Control” II – Jan Dunn, MS

9/1/15 – Let’s Talk “Core Control” III – Jan Dunn, MS

10/1/15 – On the Marley Floor – Jessica Anspach McEliece

10/24/15 – IADMS 25^th Annual Meeting – Catherine Tully

10/29/15 – Flash Feldenkrais for the Busy Dancer: Part I – Nancy Wozny

11/10/15 – Book: Anatomy, Movement Analysis, Conditioning – Gayanne Grossman, PT

12/6/15 – About That Ice Pack…… – Jan Dunn, MS

Dance Medicine: IADMS 25th Annual Meeting

October 24, 2015 by 4dancers

by Catherine L. Tully

The International Association for Dance Medicine and Science held their 25th annual meeting in October at the Marriott City Center in downtown Pittsburgh, PA. Starting off with a day for teachers, the gathering spanned a four-day period that offered networking opportunities, information-sharing, and an overall sense of purpose that was clear and heartfelt.

As a first-time attendee, I thought I’d share some thoughts on the meeting with those who may be interested, and those who might want to consider going in the future. After all, next year’s meeting is in Hong Kong, which would make a lovely trip!

I have to say that I really enjoyed my time with this unique group of professionals, and felt the experience was definitely worthwhile. As most of you are already aware, I’m very passionate about the topic of dance wellness, and I’d love nothing more than to see IADMS continue to grow and connect with dancers and dance teachers everywhere.

So…here are some thoughts on the experience from my perspective, along with a few photos that should give a little context to my narrative.

Networking

Without question the single largest benefit to attending this meeting is the networking. The IADMS gathering brings professionals together from all over the world, giving them a chance to compare notes, talk dance medicine, and, perhaps most importantly, get to know one another.

Even with the magic of connecting via the web, there is just no substitute for face-to-face interaction. To that end, I enjoyed having the chance to meet the members of our own Dance Wellness Panel in person for the first time, and I couldn’t have been more pleased with the planning time we had to solidify topics we’ll share with readers throughout the year (stay tuned!).

Although IADMS is smaller gathering of professionals than conferences such as Dance USA and the Dance Teacher Summit, it actually works to the advantage of the organization in this case. It simply felt much easier to connect with people here. Faces became familiar after a day or two, and because of that, it made approaching people less intimidating–even for a somewhat introverted person, such as myself.

Several events were incorporated into the meeting’s overall framework that allowed participants the chance to just relax and mingle a bit. Among these were the welcome reception Friday evening, and the “dance party” on Saturday night.

Information

The information presented at the IADMS meeting fell into three primary formats: lectures, movement sessions, and poster presentations. There were also a number of tables on-hand from various supporters and exhibitors. To try and summarize everything offered is quite an impossibility, so an overview of the main categories is offered here instead…each with a few examples…

Lectures

Throughout the event there were numerous lectures available for attendees to take in — from “Nutritional concerns in vegetarian and vegan dancers“ to “The science of motor learning: creating a model for dance training” to “Anterior hip pain in a dancer – an alternative diagnosis.”

Injury prevention/treatment, teaching strategies, metabolism, and dancer fitness were just some of the topics addressed by professionals from the podium. Lecture sessions were typically brief and specific, with accompanying slides. Following each lecture there was an opportunity for questions/comments.

Poster Presentations

Poster presentations offered another approach in terms of information sharing and engagement. Posters were displayed in a room where attendees could peruse them and discuss ideas with one another at a leisurely pace. These sessions were lively, and many people took advantage of the opportunity to join in the conversation.

There were two poster presentation slots during the span of the meeting, and a wide range of topics were covered, such as, “Differences in sway area observed in ballerinas en demi pointe and en pointe,” “Can textured insoles improve ankle proprioception and performance in dancers?” and “Building a safe environment for private dance sectors: a business model to provide healthcare for dancers.”

Movement sessions

In addition to the posters and lectures, the IADMS meeting also provides numerous “movement sessions” where participants have the chance to explore thoughts and ideas in a more “hands-on,” active environment.

Some of the movement sessions included: “Using technology for movement analysis in the dance studio,” “Incorporating conditioning into a modern dance technique class,” and “Gaga, Ohad Naharin’s movement language,” among many others.

Unlike the lecture sessions which are generally rather short in length, the movement sessions typically run about 50 minutes, giving attendees the chance to dig in a bit and try some things out for themselves.

Camaraderie

In my time at the meeting I met a wide range of educators, students and dance medicine professionals — from seasoned, founding members of the field — to brand new faces just joining the ranks after graduation.

It was wonderful to see such a large span of ages and experience levels in attendance, and exciting to think about the possibilities that bringing this group of people together offers to the dance community throughout the world.

For more information on IADMS, please visit their website, and be sure to keep an eye on their blog. Those hoping to attend the 26th annual meeting in Hong Kong can keep an eye out for details on the site, and membership information is there as well.

Disclosure: 4dancers attended the 25th annual meeting on a press pass granted by IADMS, but no monetary compensation was received for coverage of the event. All transportation, lodging, and meals were paid for by 4dancers.

Dancers: Let’s Talk “Core Control” – Part III

September 1, 2015 by 4dancers

by Jan Dunn, MS

Welcome to part three of our “core control series”! If you’ve missed the others, you’ll find part one here, and part two here. Enjoy!

Core Exercises

Now we are ready to actually do some “core” exercises! This one actively involves the TA (transverse abdominal) that we discussed in Part 1 – but remember that “core” really means back stabilization, and these kinds of exercises utilize all of the muscles we discussed in Part 1, even if we’re consciously focusing on only one of them, as in this next exercise.

Lying on your back, in NP, place your hands on your lower belly, as in the photo here:

As you inhale (remembering all your cues above for a nice full breath), feel your belly rise slightly. Now, as you exhale, let your belly fall inwards, away from your hands. Don’t lose your NP as you do this–the whole point of the exercise is to use the TA in a NP position, where it is working to best help stabilize your back. Many dancers (and non-dancers) want to flatten their back / lose NP when they first try this – so watch out for that!

It’s also important not to “suck your belly to your spine”. The TA doesn’t need to work on 100% contraction (which that cue tends to do) to be effective (in a healthy back, it’s working at only about 30% of it’s full capacity).

This simple exercise is just initial awareness / training for how to activate the TA in a neutral position. If it’s easy for you, great. If not, and you find yourself wanting to “tuck” / flatten your back, then this would be a good one to practice daily, until that habit of “tucking” is no longer there.

Now we’re going to do some back stabilization exercises that may be more challenging (or maybe not!):

But before we do, a few words on the breathing pattern that will best help you with these:

Generally speaking, we stabilize our back best when we exhale with exertion –in other words, the hard part of the exercise. So for example, on the first exercise below, you exhale as you lift your leg.

Another thing to realize about breath use is that a forced exhale actually overuses the oblique abdominals, and does not allow the TA to fully engage. I’ve actually seen this on diagnostic ultrasound, and it was fascinating–when the dancer forcibly exhaled, you could actually see, on the screen, how the TA was not working, but the oblique abdominals were working way too hard (“hypertrophying” in scientific language). So just taking a normal inhale / exhale will serve you best.

Leg Lift Core Exercise