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“Mr. Fix It” – Meet PNB’s Director of Physical Therapy, Boyd Bender

April 30, 2018 by 4dancers

PNB Forsythe
Pacific Northwest Ballet dances Forsythe’s “One Flat Thing, reproduced”. Photo by Angela Sterling.

by Emma Love Suddarth

“My ankle is jammed.”

If you ask Boyd Bender, the Pacific Northwest Ballet’s Director of Physical Therapy Services (and physical therapist), how many times over his years with the company he has heard that sentence, his answer would be in the thousands. He’s a wizard when it comes to mending those ankles that suddenly feel stuck, restricted, or “out of place” from a hard landing or a sudden torque. However, Bender didn’t acquire 30 years of thankful dancers based solely on ankle pulls.

If you walked into the PNB studios on an average Tuesday and felt the need to address that acute back pain that came on yesterday, or that chronic tendonitis that has intensified over a long rehearsal period, you would head straight for the sign-up sheet on the PT board. Bender and his fellow PTs’ hours vary depending on the day of the week, and any dancer can sign up for a 15-minute slot within that period.

The system at the theater during performance time is different; it consists of a dry erase board and markers (which festively turn red and green over Nutcracker season) and a first-come-first-serve type of sign up. The schedule fills up fast in both settings—and the battles over the pen or marker to get your name down first are frequent. While the session time allotment may seem brief, it is only a part of ongoing, continual care. While Bender’s treatment begins at the onset, sudden or not, of the problem, it is rarely a “one-visit” fix and requires regular visits to his table for repeated care. He even acts as frequent liaison between dancers and the sports medicine doctor, massage therapists, or outside PTs (to name a few). The time spent with the company PT is both extremely necessary and immeasurably valuable—one of the most essential elements in a dancer’s career.

Boyd Bender Director of Physical Therapy Services & Physical Therapist at Pacific Northwest Ballet
Director of Physical Therapy Services and Physical Therapist Boyd Bender at work at PNB. Photo by Emma Love Suddarth

In PNB’s case, there are numerous generations of dancers who swear by Boyd Bender’s care. His breadth of knowledge is not just incredibly vast, but also constantly expanding. Not only must his know-how encompass the entirety of the human body, but it also must address the variety of situations that a dance career might require that body to end up in. The physical issues that arise from Kent Stowell’s Swan Lake are very different than those from William Forsythe’s One Flat Thing, reproduced; and, when the transition time between the reps spans only two days, Bender must be immediately ready to address the new problems that the dancers bring in to him.

Bender, his fellow PTs, the company sports medicine doctor, the massage therapists, the company manager, and the artistic director—Peter Boal, who also offers a dancer’s perspective on each work— routinely meet in order to discuss the physical requirements of the specific reps, as well as to keep track of the overall health of the company. On top of that, Bender sometimes watches videos of the pieces prior to the rep as to get a feel for issues that might arise. He compares this practice to a similar one in football—where PTs will also study videos of upcoming competitors to see how and where they hit, in order to prepare as best they can to address the players’ physical needs. However, most of all he prefers to rely heavily on the information the dancers bring to him in the beginning of the process in order to gauge what to expect. While each dancer’s body is different, and predisposed to varying pains and problems, specific trends oftentimes surface over the course of a single rep.

PNB Swan Lake
Pacific Northwest Ballet dancing Kent Stowell’s Swan Lake. Photo by Angela Sterling

During Swan Lake, his table was occupied by a never-ending stream of swans with any number of lower leg problems—a common one being a bad calf. The audience might likely never think of it, but those swans encircling the stage, standing motionless on one leg for the entirety of the 2nd and 4th act pas de deux, are aching and sweating more than if they were dancing. By the end of the run almost every swan had a bad right or left calf, depending on which side of the stage she stood. However, three days later, one of those same swans is back on Bender’s table at the studios, attempting to put words to the intense neck pain she is experiencing due to a certain motion of One Flat Thing, which she then gingerly, very cautiously demonstrates. Boyd is ready for all of it.

Thirty seconds after a horrific ankle sprain, Bender is in the room ready to help. Ten years of on-and-off Achilles tendonitis, Bender is still finding new ways of caring for it. His arsenal of tools and skills is immeasurable; whether he is adjusting, lasering, ultra-sounding, taping, massaging, scraping, or even exercising (that’s right, it’s not all passive!) the problematic area, he’s thoroughly monitoring, addressing, and protecting the entirety of the dancer’s physical well-being. I, and numerous others, can easily name more than one instance that I likely wouldn’t have been back on stage that evening if it wasn’t for Bender’s care. You might never realize that one vertebra on your back being out of place is the reason for the shooting nerve pain in the back of your knee—but Bender knows.

And he’ll fix it too.


Pacific Northwest Ballet’s season resumes in June with their “Love & Ballet” program. Get more details by visiting the PNB website.


Emma Love Suddarth
Pacific Northwest Ballet’s Emma Love Suddarth. photo by Lindsay Thomas.

Contributor Emma Love Suddarth is from Wichita, Kansas. She studied with Sharon Rogers and on scholarship at Pacific Northwest Ballet School, and attended summer courses at Central Pennsylvania Youth Ballet, Ballet Academy East, and Pacific Northwest Ballet School. She was first recipient of the Flemming Halby Exchange with the Royal Danish Ballet School and was also a 2004 and 2005 recipient of a Kansas Cultural Trust Grant. She joined Pacific Northwest Ballet as an apprentice in 2008 and was promoted to corps de ballet in 2009.

While at PNB, she has performed featured roles in works by George Balanchine, Peter Boal, David Dawson, Ulysses Dove, William Forsythe, Jiri Kylian, Mark Morris, Margaret Mullin, Crystal Pite, Alexei Ratmansky, Kent Stowell, Susan Stroman, and Price Suddarth. Some of her favorites include the Siren in Balanchine’s The Prodigal Son, Jiri Kylian’s Petit Mort, David Dawson’s A Million Kisses to My Skin, William Forsythe’s New Suite, and Price Suddarth’s Signature.

She is a contributor to Pacific Northwest Ballet’s blog. She is married to fellow PNB dancer Price Suddarth.

Filed Under: 4dancers Tagged With: boyd bender, dancer injury, Forsythe, Kent Stowell, massage therapists, One Flat Thing, pacific northwest ballet, Peter Boal, physical therapist, physical therapy, PNB, reproduced, swan lake

Need A Dance Healthcare Specialist? There’s An App For That!

August 30, 2017 by 4dancers

Aloha! I hope everyone is getting back “intro the swing of things” as the new dance / academic year starts up!

Today we are pleased to offer you another piece of exciting information from the UK — we last posted Erin Sanchez’s article on One Dance UK / NIDMS (National Institute for Dance Medicine and Science), and all the good work going on in that country.

This post is from Claire Farmer, another one of the younger generation of dance medicine & science leaders in the UK. Claire is a dancer / Associate Lecturer at Roehampton University, and is also affiliated with One Dance UK. She initiated the website Dance Longer Dance Stronger, and in 2016 launched the Performers Health Hub mobile app, to allow those in the UK dance community to connect more easily with dance medicine healthcare and resources. She now working on eventually launching a USA version of the app.

Enjoy reading about all her good work, and pass it on!

Aloha,
Jan

Jan Dunn, MS, Dance Wellness Editor


by Claire Farmer, MSc

Have you ever felt a twinge, or something that didn’t feel quite right but you’ve also got a class in 10 minutes, followed by a rehearsal and then a million other things to do, so you’ll work out what to do later?

BUT WAIT – STOP!! Shouldn’t our body be our first priority, as our main tool for our work? We know that dancers are busy, but that they also need to be able to quickly access specialist healthcare and to find reliable information on how to care for their body. Luckily, there is a wealth of information available from experts in dancers’ health – but unfortunately this information often doesn’t always make its way to the dancer.

That’s where the Performers Health Hub App comes in. Launched in the UK in November 2016, the app is now expanding to the US. The aim of the app is to quickly connect dancers with reliable, evidence based information on a range of topics including warming up and cooling down, fitness, stretching, hypermobility and nutrition. The app has been developed in response to the high injury rate among dancers and the lack of time available due to the nature of their work, to conduct thorough research in locating top quality healthcare.

If you do experience an injury, the app will also help you to search for a dance medicine specialist near you – either private treatment, practitioners who accept your insurance, or one of the few specialized dance medicine centres scattered across the US – or if you’re in the UK, one of the few free ones. Making sure you receive the best care to ensure you reach your optimal potential as a dancer, and receive the best rehabilitation as a performer, is our top priority.

A study into injury rates in professional modern dancers concluded that a total of 82% of dancers experienced between 1 and 7 injuries within the previous 12 months(1). Of those that sought medical attention 47% were to physicians, 41% to physical therapists and 34% to chiropractors(1). Similar research in the UK reported that 80% of all dancers (professional and student) will suffer an injury each year through training, rehearsal of performance(2) or as a result of fatigue and overwork, insufficient warming-up or cooling-down, recurring injury or not being able to respond to the early warning signs of injury(3).

This highlights the need for dancers to quickly, and easily find the specialist care that will enable them to return to dance training and performance as soon as possible. Resources on the Performers Health Hub are drawn from a consortium of UK organisations at the forefront of dance medicine and science research and advocacy – including: National Institute of Dance Medicine and Science (NIDMS), One Dance UK, Safe in Dance International, British Association for Performing Arts Medicine (BAPAM), and also the International Association for Dance Medicine and Science (IADMS). It will now expand to include resources and clinics in the United States and Canada.

Experiencing an injury can be a very lonely and challenging time for a dancer, and it is hoped that the app will not only help the dancer seek specialist care and information, but to also reduce that feeling of isolation. There are many things we can do to support each other as a dance community internationally and the Performers Health Hub app aims to draw these connections closer, providing support for dancers wherever they are in the world and connecting them with others who have gone through similar experiences.

The app will continue to grow as resources expand and through feedback from dancers, with regular updates taking place to ensure the most up to date information is in the palm of your hand.

The Performers Health Hub is available to download for iOS and Android. For more information visit Dance Longer Dance Stronger, or download from the Google and Apple stores.


Dance Longer Dance Stronger

Dance Longer Dance Stronger was established in 2014, growing out of a need to encourage dancers to be more open about injuries and training, the struggles they face and the training methods they use. Dance Longer Dance Stronger aims to open communication between dancers, and between health professionals so there is a two-way dialogue and so that should a dancer face an injury, they don’t feel alone in dealing with it.

Dance Longer Dance Stronger aims to connect dancers with other dancers who have faced similar health related issues and help dancers find specialist healthcare and easy-to-digest, reliable resources as quickly and easily as possible.


(1)Shah, S,. Weiss, D,. & Burchette, R. (2012) Injuries in professional modern dancers: incidence, risk factors, and management

(2)Laws, H (2005) Fit to Dance 2, Dance UK, Newgate Press, UK: London

(3)Brinson, P & Dick, F (1996) Fit to Dance, Calouste Gulbenkian Foundation, UK: London

Filed Under: Uncategorized Tagged With: BAPAM, Canadian Centre of Performance Psychology, Claire Farmer, Dance Healthcare Specialist, Dance Longer Dance Stronger, dance medicine, dance wellness, dancer injury, iadms, NIDMS, Once Dance UK, Performers Health Hub App, quality healthcare, Safe In Dance International

Battling Injury As A Dancer…

February 14, 2017 by 4dancers

Joffrey dancers
Cara Marie Gary with partners Fernando Duarte and Edson Barbosa. Photo credit: Cheryl Mann.

by Cara Marie Gary

My career as a professional dancer has been an incredible journey–and it has taught me many life lessons about discipline, commitment, sacrifice, and patience. Dance has always been my outlet for creativity and expression. I’ve gathered a variety of special moments throughout the years. For example, I still remember the exhilarating feeling I had after nailing my first challenging sequence of fouettes on stage. I’ve been blessed to travel and perform in incredible theaters all over the world, one of my favorite moments was performing at the Kennedy Center as Clara in Robert Joffrey’s The Nutcracker. I’ve also had stressful hair situations; in Christopher Wheeldon’s rendition of Swan Lake it was choreographed for me to entered the stage with my hair completely down and in a few seconds style it into a french twist that had to last throughout Four Little Swans and the entire ballet! I’ve had crazy things happen at gala performances like music stopping in the middle of a pas de deux and having to exit the stage and start completely over. As a dancer, you learn to be “ready for anything” and to be able to improvise if something doesn’t go exactly the way you rehearsed it.

However, what I wasn’t prepared for was an injury. [Read more…]

Filed Under: 4dancers Tagged With: cara marie gary, dance injury, dancer injury, joffrey, physical therapist, physical therapy, physical therapy exercises, professional dancer, rehabilitation, the joffrey, the joffrey ballet

Dance Wellness: Phases Of Healing

November 29, 2012 by 4dancers

We are pleased to have Marika Baxter, PT, as our guest contributor this month.  Marika has extensive experience working with dancers, and her article on the “Phases of Healing” is great information to share regarding what happens in your body when you have an injury, and how to integrate that with returning to happy, healthy dancing.

After Marika’s article, you’ll find a few additional words from me, on something we’ve mentioned before in our Wellness column, but which bear mentioning again — keeping the rest of your body in shape while you’re recovering from an injury.

The Holidays are here, so enjoy — happy “Nutcracker”, if that’s a part of your dance life, and “talk” to you again soon!

Jan

Jan Dunn, MS

___________________________________________________________________

Phases of Healing

by Marika Baxter, PT, MSPT, OCS

ballet dancer striking poseIf you’ve ever had an injury that’s sidelined you from dancing, the most pressing question you may have is “How long will it take to recover and when will I be dancing again?”  Though every injury and dancer is different, the way our body heals does follow the same pattern.  Understanding the phases of healing and how they relate to getting back in the studio can help you in the journey back to health.   The important thing to remember is that healing is a process, not an event!

Phase I – The Inflammatory Phase

The first phase of healing is called the inflammatory phase.  You’re in the studio rehearsing for a performance and as you step into a turn your concentration lapses and your ankle rolls.  You feel pain on the outside of your ankle and when you try to continue dancing your ankle feels weak and is too painful to put weight on.  Luckily you put ice on it right away but by the end of the night your ankle is swollen and bruised.

Whether the injury is major, like this story of an ankle sprain, or just a small cut or bruise, the first thing the body will experience is inflammation.  You can think of the inflammatory phase as the clean up phase.  In the first 24-48 hours, the body will send cells to the area to help remove injured tissue.  The body will also begin laying down new cells to form a blood clot, almost like an internal scab.  This helps keep the injury protected as it begins to heal.

During the inflammatory phase, there are a number of things you may be feeling.  It’s common to have pain, swelling and possibly warmth and redness in the area.  Depending on the severity of the injury, you may have difficulty dancing, walking or moving the body part.  In this first phase of healing, you may need to modify what you’re doing in class or rehearsals to allow for healing to begin.  In some cases you may need to take a break from dancing so the body can start the healing process.

In these first few days after an injury, the best thing to do is PRICED: Protect, Rest, Ice, Compress, Elevate, Diagnose.  You can see the previous dance wellness article on 4dancers.org entitled “Keeping Dancers Dancing: “Help I Have An Injury – What Do I Do?” for more information on PRICED.

Phase II – The Repair Phase [Read more…]

Filed Under: 4dancers, Dance Wellness, Injuries Tagged With: dance wellness, dancer, dancer injury, iadms, Marika Baxter, new york city ballet, phases of healing, school of american ballet

Dance Wellness: Causes Of Injuries (Risk Factors) Part II

February 2, 2012 by 4dancers

Yesterday Jan Dunn talked about causes of injury in dance–listing five risk factors of ten. Today she’s back to cover the remaining five. If you missed the first post, read it here.

by Jan Dunn

Jan Dunn, MS

5)  Muscular imbalance:

To avoid injury, the muscles surrounding a given joint should be relatively equal in strength and flexibility (“balanced”), so that one side of the joint is not being stressed more than the other.  Different dance forms affect the body differently in this respect, depending on how it is being used. In ballet, for example, there are three common muscles imbalances:

-Quadriceps (front of the thigh) vs. hamstrings (back of the thigh):  the hamstrings are usually weaker, and are one of the most frequently injured muscle groups in dance.  One reason for this imbalance is often the emphasis on forward motion through space, which is powered by the quadriceps.  One way to address this particular concern, besides actual hamstring strengthening exercises, is to create class sequences which move into the back space  — for example running backwards in combination with a turn into a forward leap, then turning again into the backwards run.

-Gastroc-soleus (calf muscles) vs. anterior tibialis (front of the shin):  In ballet, because of the constant pointing of the foot, the calf muscles are usually the stronger of this muscle pair.  This imbalance can be one of the possible causes of “shinsplint” pain.  Using motions / exercises which flex the ankle often in dance training can help to address this imbalance, as well as specific strengthening exercises for these muscles.

-External hip rotators (turn-out muscles) vs. internal hip rotators (turn-in muscles):  This imbalance frequently exists because of the excessive amount of turn-out used in ballet, as opposed to parallel or turn-in movements.  The muscles which control internal rotation are usually weaker and more frequently injured because of that imbalance.  Creating parallel and internal rotation movements to add to the ballet barre is one way to address this situation, as well as strengthening exercises for the weaker muscle groups.

Many research studies have proven the importance of outside (of class) conditioning for dancers.  By addressing their imbalances with a specific conditioning program, such as Pilates / Gyrotonics / Franklin Method / cross training, they are able to more fully prepare for the demands of dance, and to decrease their injury risk.

6) Lack of warm-up:

Going into a class / rehearsal / performance without being adequately warmed-up first is almost like asking for an injury to happen.  Some dance medicine physicians even suggest that teachers lock the studio doors when class starts, so no one can enter late ! –that’s how important it is.

Some things to keep in mind regarding warm-up:

-Every dancer’s body is different, and has different needs in terms of what best warms up their muscles. No teacher, no matter how brilliant, can give a class warm-up that fits every individual person in that class.  The smart dancer learns what his / her own body needs, and designs his / her own brief warm-up to do BEFORE going into the studio.

-Many factors affect your warm-up, and how much    you personally need:

-Age: the older you are, the more time you need

-Injury: an injured area will need more time

-Weather: the colder it is, the longer you may

need, and vice versa with warm weather

-Physiologically a warm-up means that you have raised your internal body temperature by several degrees. This accomplishes several things:

-increases blood flow / oxygen intake

-increases joint lubrication

-increase the speed of neural transmission-

i.e, the message gets from your brain to your

muscles faster !

For most dancers in their teens or 20’s, it usually takes 15-20 minutes to reach the warmed-up state, depending on weather and other factors mentioned above.

-Once your body is warm and ready to dance full out, it can quickly lose that wonderful warm-up by standing still / not moving – for example, in a rehearsal, when you’re waiting to be shown the next section.  If you have to stand and wait in a class / rehearsal, keep moving in place !  Doing small movements will help to keep your body in it’s warmed-up state.

7) Psychological Factors:

Stress plays havoc with the body, in many ways. It can cause your Central Nervous System (CNS) to function at less-than-peak efficiency, slowing down the transmission of signals from your brain to your muscles, and makes it harder to concentrate.   Dance is a high-stress profession, and dancers who take good care of themselves learn stress reduction techniques, such as meditation.  This kind of self-care will do much to lesson your risk of injury in terms of psychological factors.  We’ve all heard the phrase “leave your ‘stuff’ (emotional baggage) at the studio door” – and it’s good advice – but hard to do. That’s why it’s important to incorporate stress relieving practices into your daily and dance life.

8) Premature Point Work:

This is something most dancers and teachers are aware of, but it’s still an important aspect of injury prevention. There are many factors that should be considered before putting a child on pointe. Chronological age (such as automatically at 12, an age where many students start pointe work) is not the most important factor.  It is very important to consider factors such as core stability, leg alignment, foot / ankle flexibility and strength, frequency and length of dance training.  The website of IADMS (The International Association for Dance Medicine and Science) has an excellent Resource Paper on this topic, available to all dancers / teachers / parents (www.iadms.org).

9) Adolescent Growth Spurt (AGS) concerns:

This is the age when rapid growth takes place, and the young dancer is at higher risk for injury.  It is also the age when students on a career path begin to train very intensively.  It is vital that teachers, parents, and students are aware of the many changes the growing body is undergoing at this point, and how to best adapt dance training to avoid injury.

The AGS usually happens between 11-14 (often later for boys), and lasts from 18-24 months.  Dancers may lose:

–          flexibility

–          -strength

–          coordination

–          technical control and skill

A dancer who could do triple pirouettes easily at age 10 may suddenly find her / himself having difficulty doing even one.  Loss of self-esteem is common, especially if you, the dancer, and your teacher / parents, do not understand the changes that are happening in your body, and how it is affecting your dance life.  As with the Resource Paper in Pointe Work, IADMS has a Resource Paper available on “The Challenge of The Adolescent Dancer”.  We will talk about the AGS in greater detail in a future article on 4dancers, but for now, be aware that it can have an impact on injuries happening to young dancers.

10) Poor  Nutrition:

Dancers frequently worry about their weight, and in consequence don’t eat the foods (or fluids) that they really need to dance in a healthy manner.  Our bodies need fuel, it’s as simple as that, and especially in a profession that demands peak physical performance.  Learning about nutrition is so important — and again, IADMS has an excellent resource paper on this topic, “Fueling the Dancer” !

One important point to make regarding nutrition is on calcium intake, and how it’s SO important, especially to the young dancer still in his / her teens.  This is when we are building our “bone bank” – laying down the bone that will last us for a lifetime.  If we don’t do this during these teen years, it may be too late to make up the loss.  Some studies have shown professional dancers in their late 20’s / early 30’s who have the bone density of 70-year olds, because they did not have adequate calcium intake when they were young.

Poor nutrition can also affect a young woman’s menstrual cycle, leading to ammenorhea (lack of regular periods). This hormonal imbalance can wreck havoc with the body, and also lead to the low bone density mentioned above.

So bottom line —learn about good nutrition and eat healthy foods / fluids !

So now we have our list of risk factors for dance injuries.  I mentioned at the beginning that most often an injury is caused by a combination of these factors.  Here’s an example:

-You haven’t been eating well for several months, trying to lose weight and not going about it in a healthy, knowledgeable manner.

-Your long time boyfriend / girlfriend broke up with you two days ago, and you are very stressed not only about that, but about a big audition coming up.

-You also have, unknown to you, some major muscle imbalances around the hip joint (you’ve had some pain / clicking in your hip joint, but you have chosen to mostly ignore it).

-You go into the studio without adequately warming-up, along with all these other factors coming into play, and during class you sustain a significant injury to the muscles around that hip.

So – now you’ve been injured – what do you do about it???  That’s the topic for next month’s 4dancers Wellness blog!  “Talk” to you then !!

BIO: Jan Dunn is a dance medicine / Pilates / Franklin Method specialist  based in Denver / Boulder, CO, and Los Angeles, CA.  She is Co-Director of Denver Dance Medicine Associates, and Adjunct Professor, University of Colorado – Boulder, Dept. of Theatre and Dance.  She has been active in Dance Medicine since 1984. Previously she was Coordinator of The Dance Wellness Lab, Dept. of Theater & Dance, Loyola Marymount University, Los Angeles, CA , and has held dance faculty positions at Connecticut College, Florida State University, Hartford Ballet, Washington Ballet, and Colorado Ballet.  She has been active with the International Association of Dance Medicine and Science (IADMS) for 22 years, serving as Board member, President, and Executive Director. Jan was Associate Dean / Workshop Coordinator at the American Dance Festival 1983 – 1991,  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 worldwide, has published numerous articles, and presented at many US / international conferences.

Filed Under: 4dancers, Dance Wellness, Injuries Tagged With: ballet injury, dance wellness, dancer injury, jan dunn, risk factors for injury in dancers

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