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Healthy Bones For Dancers

February 11, 2016 by 4dancers

Human skeleton with left arm extended; front and back views. Wellcome V0008012
See page for author [CC BY 4.0 (http://creativecommons.org/licenses/by/4.0)], via Wikimedia Commons

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

fuel-2741_640As 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

broccoli-952532_640The 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

pill-316601_640In 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
Selina Shah, MD, FACP

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.

Filed Under: Dance Wellness, Nutrition Tagged With: bone health for dancers, calcium for dancers, dance nutrition, dance wellness, selina shah, strong bones for dancers, vitamin d, vitamin d for dancers

Introducing Our Dance Wellness Panel

May 13, 2015 by 4dancers

Jan Dunn
Jan Dunn

Aloha to all!

This is a very special post regarding the Dance Wellness segment of 4dancers.org:

In the fall of 2011, Catherine Tully (whom I had never met) contacted me and asked me if I would like to write an article about Dance Medicine and Science – aka Dance Wellness – for her online site, just to introduce readers to that aspect of information in the dance world. I was pleased to do so, and so in January of 2012, we posted that first article. Your response, as readers, was so overwhelmingly positive that Catherine asked me to start a new on-going segment of 4dancers, entitled “Dance Wellness”.  I did, and the rest is history. Over the last 3+ years we have posted, 36 articles, written not only by myself but by guest contributors whom I have brought in.

Your eagerness to learn more about this important field has prompted us to take the next step, to continue “spreading the word” online about the many aspects of Dance Wellness, and how all of this information can help dancers to “dance longer, dance stronger”.  We are so pleased to announce the 4dancers.org Dance Wellness Panel–a distinguished group of people from the Dance Medicine and Science field, who have agreed to join us in this new endeavor.   

Below you will find each of our panel members, along with information about their backgrounds, associations and areas of specialty. We are thrilled to have them on board, and we look forward to sharing more dance wellness information with you in the coming months!

My best to everyone-
Jan

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


 

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James Garrick, MD

James Garrick, MD., is an orthopedic surgeon and the founder and Medical Director of the Center for Sports Medicine, at St. Francis Memorial Hospital in San Francisco, California. When founded 35 years ago, the Center had the first Dance Medicine department on the West Coast, and had one of only two West Coast Pilates facilities. For forty years he has been one of the leading figures in the dance medicine field, with particular research interests in the epidemiology of dance and sports injuries. His research includes a cost analysis of dancers’ workman’s comp injuries, insurance coverage of independent dance companies in San Francisco Bay area, and injury patterns in young dancers.

Dr. Garrick was physician for San Francisco Ballet Company, founded the clinic for dancers at San Francisco School for the Arts, and is currently on  the physician panel for the San Francisco Ballet School. He also founded the Sports Medicine Division at the University of Washington, and is a founding and former board member of the American Orthopedic Society for Sports Medicine. He is a clinical professor in the Department of Pediatrics at the University of California, San Francisco School of Medicine, and serves on the editorial board of several journals. He has authored / co-authored five books, including Ski Conditioning (1978), Peak Condition (1986), and Sports Injuries – Diagnosis and Management (1990), as well as numerous articles for medical journals and book chapters.

Dr. Garrick is a member of American College of Sport Medicine, American Orthopedic Surgeons, American Academy of Orthopedic Surgeons, Performing Arts Medicine Association (PAMA), and International Association for Dance Medicine and Science (IADMS).

Gigi Berardi, PhD
Gigi Berardi, PhD

Gigi Berardi, PhD has an academic background and performing experience that allow her to combine her interests in the natural and social sciences with her passion for dance, as both critic and writer. Over 300 articles and reviews by Dr. Berardi have appeared in broadcast and print media, including Dance Magazine, Dance International, the Los Angeles Times, the Anchorage Daily News, The Olympian, The Bellingham Herald, LA Style, IDEA Today, LA Reader, LA Weekly, and scientific journals such as Journal of Dance Medicine & Science, Kinesiology and Medicine for Dance, Dance Research Journal, Your Patient and Fitness, and Impulse: The International Journal of Dance Science, Education, and Medicine. She has written as a national advocacy columnist for the Dance Critics Association Newsletter and has served on performing arts panels for the Alaska State Council on the Arts. She currently serves as a contributing editor and writer for and a correspondent for Dance Magazine. She is a founding co-editor of Kinesiology and Medicine for Dance and currently serves as Book Review Editor for Journal of Dance Medicine & Science. Her public radio features (for KSKA, Anchorage) have been recognized by the Society of Professional Journalists. She has served on the Board of Directors of the Dance Critics Association, and is a member of the American Society of Journalists and Authors.

A professor at Western Washington University, she received the university’s Diversity Achievement Award in 2004. Finding Balance: Fitness and Training for a Lifetime in Dance is her fifth book. The completely revised edition appeared in 2005, a seminar on the earlier edition was noted in The New Yorker; both editions had second printings. Her technical training, residencies, and seminars are listed in her resume. In winter, 2000, she was a Fairhaven College Distinguished Teaching Colleague for dance.

Robin Kish, Dance Wellness
Robin Kish, MS, MFA

Robin Kish, MS, MFA, is an Assistant Professor in the Department of Dance at Chapman University. Robin blends her background in dance and science to creative innovative educational programs supporting the development of safe and effective dance training programs.

She has presented research and developed education lectures for the Performing Arts Medicine Association (PAMA) and the International Association of Dance Medicine and Science (IADMS). In 2013 she developed the first online dance kinesiology class for the National Dance Education Organization (NDEO). As a product of the private studio / competition environment she is passionate about bringing dancer wellness and safe teaching practices to the industry.

Moira McCormack
Moira McCormack, MS

Moira McCormack, MS, is Head of Physiotherapy at The Royal Ballet Company in London, UK.

After a professional dance career in classical ballet she trained as a dance teacher and then as a Physical Therapist and has worked with dancers for the last 20 years. She teaches anatomy, dance technique and injury prevention internationally, with a main interest in the management of the hypermobile dancer.

Janice Plastino, Dance Wellness
Janice G. Plastino, PhD

Janice G. Plastino, PhD is Emerita Professor from the University of California Irvine (USA) in the Department of Dance. Her book with James Penrod, The Dancer Prepares: Modern Dance for Beginners has been in continual print with revisions since 1970. She has published extensively with papers, journal articles, and several book chapters. She has danced professionally on television, stage, and in dance companies for national and international venues.

Dr. Plastino’s choreography of over 50 works includes 15 years as co-director of Penrod Plastino Movement Theatre, directing opera at Lincoln Center, New York, and creating works at NBC and the BBC television. She is regarded as the founder of the field of Dance Science, and established the first dancer screening / wellness program in an educational setting at UCI in 1982. She introduced the Pilates Method in the UCI Dept. Of Dance in 1983, the first such program in higher education.

She was instrumental in the formation of the National Dance Education Association (NDEO), and a leader during the organization’s early years. She has been a member of Performing Arts Medicine Association (PAMA) since 1989, served on the BOD for four years, and in 2013 was awarded the Dawson Service Award. In 2015, she became the first recipient of the International Association for Dance Medicine’s (IADMS) Dance Educator Award.

Dr. Plastino has reported her findings in dance science to scientific societies and medical associations throughout the United States and abroad. She was an invited guest of the USSR government in 1988 (before détente), observing the Bolshoi and Kirov ballet companies while consulting and lecturing about dance injuries. The Olympic Committee invited her to lecture on dance injuries at the 1984 Olympic Scientific Congress held in Eugene, Oregon and in Seoul, South Korea in 1988. Her pioneering and continuing work in the pre-participation screening of dancers has been lauded by the medical, research and dance communities. Many of her students have established wellness programs at their colleges, universities, private studios, and private practices.

Dr. Plastino is currently adapting her movement theories for use in for the private dance studio. She is most passionate about the private studios having easy access to new research in training methods of the young dancer. Currently she consults on dancer wellness, evaluation of public and private dance programs, gives dancer wellness workshops, and continues to present papers at conferences.

Emma Redding
Emma Redding, PhD

Emma Redding, PhD is Head of Dance Science at Trinity Laban Conservatoire of Music and Dance.

Emma originally trained as a dancer and performed with the company Tranz Danz, Hungary and for Rosalind Newman, Hong Kong. She teaches contemporary dance technique at Trinity Laban and lectures in physiology alongside her management and research work. She has been Principal Investigator for several large-scale research projects including a 3-year government funded study into dance talent identification and development as well as studies into the physical and mental demands of music playing and the role of mental imagery within creative practice.

She has published her work in academic journals and is a member of the Board of Directors and a Past President of the International Association for Dance Medicine and Science (IADMS). She is also founding Partner of the UK National Institute for Dance Medicine and Science (NIDMS).

Erin Sanchez
Erin Sanchez, MS

Erin Sanchez, MS is the Healthier Dancer Programme Manager (job share) at Dance UK in London, administrates the Rudolf Nureyev Foundation’s Medical Website for healthcare professionals and dancers and manages the Dance Psychology Network.

Erin pursued vocational dance training with American Ballet Theatre, Boston Ballet School and the Alvin Ailey School. She also holds a BA (Hons) in Dance and Sociology from the University of New Mexico and an MSc in Dance Science from Trinity Laban Conservatoire of Music and Dance in London.

Erin is a registered provider for Safe in Dance International, a member of the International Association for Dance Medicine and Science and holds the qualification in Safe and Effective Dance Practice. She has lectured in dance science and taught dance technique in the United States, UK, Egypt and Malta.

Selina Shah, MD, FACP
Selina Shah, MD, FACP

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.

Nany Wozny
Nancy Wozny

Nancy Wozny is editor in chief of Arts + Culture Texas, reviews editor at Dance Source Houston and a contributor to Pointe Magazine, Dance Teacher and Dance Magazine, where she is also a contributing editor. She has taught and written about Feldenkrais and somatics in dance for two decades.

 

Dance Wellness Contributor Matt Wyon
Matt Wyon, PhD

 

Matthew Wyon, PhD, is a Professor in Dance Science at the University of Wolverhampton, UK and a Visiting Professor at the ArtEZ, Institute of the Arts, The Netherlands.

At Wolverhampton he is the course leader for the MSc in Dance Science and Director of Studies for a number of dance science and medicine doctoral candidates. He is a founding partner of the National Institute of Dance Medicine and Science, UK.

Prof. Wyon is Vice President of the International Association for Dance Medicine & Science and a past chair of the Research Committee. He has worked with numerous dancers and companies within the UK and Europe as an applied physiologist and strength and conditioning coach.

Filed Under: Dance Wellness Tagged With: dance medicine, dance wellness, dance wellness panel, Emma Redding, Erin Sanchez, gigi berardi, iadms, James Garrick, jan dunn, Janice G. Plastino, matthew wyon, moira mccormack, nancy wozny, NIDMS, pama, robin kish, selina shah

Are You Ready For Pointe?

January 22, 2015 by 4dancers

Photo courtesy of Mararie on Flickr, Creative Commons 2.0
Photo courtesy of Mararie on Flickr, Creative Commons 2.0

 

I’m so pleased to introduce this month’s guest contributor, Selina Shah, MD, a dance and sports medicine physician based in San Francisco, where she is Director of Dance Medicine at the Center for Sports Medicine. A dancer herself, Dr. Shah is the company physician for the San Francisco Ballet School, Liss Fain Dance Company, and Diablo Ballet, among others.  Her article discusses the different factors that determine when a student dancer should begin pointe work. 

We are grateful to her for sharing her expertise on this topic —pass it on! 

– Jan Dunn MS, Editor, Dance Wellness


by Selina Shah, MD, FACP

If you are anything like me, you are captivated by ballet. You love its grace and its gravity-defying, gentle power. You dream of performing as a prima ballerina. In the years of work it will require to get there, perhaps the single most important milestone you will face is when to go en pointe.

Dancing en pointe is an advanced stage of ballet that requires unique skills. The challenge is to place almost all of your weight on the extreme tips of your toes, yet appear as light as a feather. In fact, no matter how long all of your toes are, research has shown that most of your body weight is carried on the tip of your big toe. It may sound very hard, but in truth, it’s even harder!

How Will I Know When I Can Get Pointe Shoes?

Teaching TipMost likely, your teacher will decide when you are ready to go en pointe. Many factors are involved in this decision. One common myth is that there is a mandatory age requirement of 11 or 12. In actuality, having adequate training rather than age is what matters. Usually, this means at least several years of consistent, high-quality training. Often girls are around age 11 or 12 before this happens, but some girls may be ready sooner, some later, and some not at all. Keep in mind the quality of work is more important than quantity.

You need enough flexibility in your foot to rise fully to pointe. One way to test this is to point your foot while sitting down with your legs extended in front of you. Next, place a pencil on top of the ankle and it should be able to lay flat from the tibia to the foot across the ankle joint.

You need physical and technical skills, such as strength, balance, alignment and control. For example, you should be able to hold passé on each leg with arms in high fifth for at least a few seconds. You should also be able to perform a clean pirouette with a smooth landing.

You also need to be able to continuously accept and apply teacher feedback.

Last but not least, you must consistently maintain your discipline and focus to keep your skills sharp and reduce the likelihood of injury.

Barre is where you form the crucial foundational skills on which pointe, and all other ballet movements are built. Listen to your teachers when they give you corrections and apply them until they become second nature. For instance, “working the floor with your feet” in tendus helps build your foot strength, which is essential for pointe. Working diligently on your turnout (and not cheating!) results in proper alignment. Use your core strength (ask your teacher how to do this correctly) to help you with balance and control. Apply these skills in the center and across the floor.

Various Foot Types

261936797_761833106a_z
Photo courtesy of mmarchin on Flickr, Creative Commons 2.0

Knowing your foot type is important when you look for pointe shoes. Most people fall into one of three categories.

  1. The “Giselle” or peasant foot shape is one where the first three toes are of equal length, making this ideal for pointe because the big toe gets assistance from the other two toes in carrying the weight.
  2. The “Morton’s” or “Grecian” foot, in which the second toe is the longest, is more prone to developing callouses, pain, and stiffness in the big toe. Most of the body weight is still carried by the big toe in the Morton’s foot.
  3. A narrow “Egyptian” foot, in which the toes taper in length from the big toe which is the longest, usually requires a cap on the second toe so that it can assist the big toe with weight bearing.

Finding The Right Pointe Shoe

Pointe shoe fitting is complicated because of the variability in shape, size, strength, and flexibility of each dancer’s feet. Most dance stores will have specialized pointe shoe fitters on staff. Your first visit to the store will take some time as you try on a number of shoes until you find the one that feels good and fits properly. As you gain experience in pointe, you will likely change shoes.

With hard work and dedication, one day you may be fortunate enough to hear the words “You are ready for pointe!”


Selina Shah
Selina Shah, MD, FACP

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.

Filed Under: Dance Wellness, Foot Care, Pointe Shoes Tagged With: Ballet, egyptian foot, en pointe, foot types in ballet, grecian foot, morton's foot, peasant foot, pointe readiness, pointe shoe fitter, pointe shoe fitters, pointe shoes, pointe work, selina shah, toe shoes

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