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10 Questions With…William G. Hamilton, MD

June 23, 2010 by 4dancers

Today I have the pleasure of introducing a very special guest on 4dancers. I’m sure readers will find the interview with Dr. William G. Hamilton enlightening. He has worked with dancers at some of the leading companies and schools in the United States…

1. Can you tell readers a bit about your medical background and how you came to work with dancers?

I graduated from Princeton University with a degree in Engineering. Eventually I went to Medical School at Columbia University, College of Physicians & Surgeons. This was followed by a General Surgery internship and residency in Orthopedic Surgery, at the Columbia-Presbyterian Medical Center in New York City, NY. Then a post-graduate fellowship in children’s orthopedics.

Dr. William G. Hamilton

In 1972 I was a young orthopedic surgeon practicing near Lincoln Center, treating young athletes and a few dancers. By a chance encounter, George Balanchine asked me to become the doctor for his company,  New York City Ballet. I gladly accepted but knew that if I was going to treat these fascinating professionals I had a lot to learn about classical ballet, so I went to Lincoln Center regularly on the weekends to watch Balanchine’s Company classes and to learn the vocabulary of dance. This helped me to understand the source and mechanism of their injuries.

In 1975 Lincoln Kirstein asked me to be the consulting orthopedist for the School of American Ballet; the training academy for NYCB.

In the late 70’s Baryshnikov joined NYCB to work with Balanchine but shortly afterwards Mr. B’s health began to decline and this never really came to fruition. So, in 1980 Baryshnikov left “City Ballet” to become the director of American Ballet Theatre and asked me to become their doctor too. Currently, I also care for their school, the Jacqueline Kennedy Onassis School of Ballet at ABT.

Because most of the injuries to dancers occur in the foot and ankle, I developed a sub-specialty in this area of orthopedic surgery and in 1993 became the President of the American Orthopedic Foot and Ankle Society (AOFAS). I also belong to the International Association of Dance Medicine & Science (IADMS) plus numerous medical boards, associations and societies.

2010 marks my 38th year with NYCB and the 30th with ABT. I have enjoyed every minute of it!

2. Would you talk a little about what you are currently doing with dancers and for what organizations?

I currently diagnose and treat both acute and chronic injuries to dancers and athletes as well as non-performers and do various surgeries when they are indicated. This can be a challenge because dancers often have obscure problems related to their dance techniques that are not seen in athletes.

Another big challenge I’m involved with today is promoting wellness, screening, and injury prevention along with proper rehabilitation following an injury at NYCB and, to a lesser extent, ABT. This is a win-win approach both for the dancers and the dance companies.

I also consult for The Ailey School, as well as various Broadway shows and sports teams, such as the NY Yankees and the Knicks.

3. Are there any orthopedic injuries that you see repeatedly in dancers?

Dancers have two types of injuries: acute (sudden) and chronic (ongoing). The most common acute injury is the sprained ankle, which is also the most common injury in all sports that involve running and jumping. The most common chronic problem is tendonitis, which is a form of overuse injury. It is important that these injuries be diagnosed, treated, and properly rehabilitated to prevent recurrence or permanent disability. Unfortunately, most doctors don’t see enough dancers to understand the technical demands or their “weird” injuries. Many patients who come to see me for injuries that are not getting better have been misdiagnosed and the treatment regimen is not right for their problem.

4. What are some things that dancers can do to help prevent injury?

The key to injury prevention is to be in shape for what you are trying to do. This sounds simple but it is not always so straightforward. Each generation of athletes is running faster, jumping higher, and breaking old records and this is true for dancers as well. A double fouetté used to be a rare thing, but now it is seen all the time. So dancers can no longer get by with “class” only. Like athletes, they must cross-train in a gym—but not in mid-season—in offseason or in preparing for re-entry after a lay-off or injury. In mid-season cross-training can cause overuse injuries and burnout. Of course, proper nutrition, healthy weight control, and rest (sleep) are very important.

Linda Hamilton’s book: The Dancer’s Way.  The New York City Ballet Guide to Mind, Body, and Nutrition. St. Martin’s Griffin, New York, 2009 is an excellent reference for all types of dancers.

5. Is it worthwhile to get an orthopedic screening, and if so, how often should you have it repeated?

An orthopedic screening is an invaluable tool because the body changes over time. Dancers need to know how to work with their unique “instrument.” This is especially important for professional-level dancers or those who are having chronic problems or recurrent injuries.

Ideally, it should be done on a yearly basis.

6. Do you have any recommendations for dancers who are looking for a good orthopedic doctor?

As noted above, orthopedists with experience in dance medicine are rare. The 1st place to start is to call up your local or regional ballet company and ask them who takes care of their dancers. Next would be to check the International Association of Dance Medicine & Science website at iadms.org. The next best thing would be to see a sports medicine doctor who takes care of the local soccer or football team.

7. Turnout is one of the ballet “buzzwords”…can you comment on how to approach improving turnout in a healthy way?

Turnout is complicated. The more you look into it, the more complicated it gets. It is the sum of the turnout in the hips + the knees + the foot & ankle; the hips being the most important. People are born with 3 types of hips:

  1. Normal, with equal turn in/turnout (normal “version” in medical parlance).
  2. Pigeon toed or turned in, ¯ turnout (“anteverted”).
  3. Duck footed—turned out with ¯ turn-in (“retroverted”). These people are born to be ballet dancers.

The orthopedic literature indicates that turnout of the hip is pretty much formed by age ten and it is doubtful that it can be improved by early ballet training. So it’s mainly a matter of making the most out of what you have naturally.

Learning to work with what you have is very important because forcing your turnout or getting it from below the knee is the most common technique fault in ballet and can lead to many injuries of the knee, foot and ankle. An orthopedic screening and working with a dance-oriented physical therapist can help you be sure that you are working properly.

8. What is the most satisfying thing about working with dancers?

Dancers are terrific patients and are great to work with. They just want to get better and get back to what they love to do. For me, the most rewarding moments have been seeing a dancer get back to performing after having had a serious injury that might have ended their career. Fortunately, these types of injuries are quite rare, but when they occur they are devastating and the recovery can be one year or longer.

9. Can you talk a bit about the NYCB Wellness Program?

The New York City Ballet wellness program began with a study over two seasons at the company in 2000. The purpose was to try to identify and treat weaknesses or imperfections so they could be corrected before they led to an injury. It was led by Clinical Psychologist, Dr. Linda Hamilton, with the help of the rest of the Company’s medical team: Orthopedic Surgeon Dr. William Hamilton; Chiropractor Dr. Lawrence DeMann, Jr. ; and physical therapist Marika Molnar. Later, we included registered dietician Joy Bauer after discovering nutritional problems. In addition to educational seminars, the wellness program includes screenings for orthopedic problems that may require physical therapy, fitness screenings that encompasses flexibility, strength, and endurance with a specialized program at the gym, and dietetic evaluations and counseling for healthy weight control. Psychological counseling is available for dancers who are struggling with problems, such as a serious injury. We also offer educational seminars. This has resulted in a 46% decrease in weeks lost to disability, so it’s been beneficial for both the health of the dancer and a savings for the company.

10. If you could communicate one thing to dancers as a group—what would it be?

Injury prevention and survival in dance depends to a great degree upon knowing your own body’s limitations and working within your natural abilities. A perfect body in dance is a dream not a reality. All dancers, including principals and stars have their physical strengths and weaknesses.

In the end, the most important thing in dance is talent and this can make up for many physical deficiencies because it’s the illusion in art that makes it so exciting.

Bio: William G. Hamilton, MD is an orthopedic surgeon who practices in New York City. He specializes in injuries to dancers and athletes. He graduated from Princeton University and the Columbia University College of Physicians and Surgeons. He is the orthopedic surgeon for The New York City Ballet, American Ballet Theatre, The School of American Ballet and the Jacqueline Kennedy Onassis School of Ballet at ABT. He consults for The Ailey School, the New York Knicks and the New York Yankees. He has written numerous chapters and articles regarding injuries to dancers and lectured around the world. For appointments contact  his secretary “Mary” at maryvelazco@covad.

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Filed Under: 10 Questions With..., 4dancers, 4teachers, Studios Tagged With: Baryshnikov, dr. william g. hamilton, george balanchine, International Association of Dance Medicine & Science, lincoln kirstein, Linda Hamliton, md, nycb, nycb wellness program, school of american ballet, the ailey school, The Dancer’s Way, turnout, william g. hamilton

10 Questions With…Dr. Linda Hamilton

May 18, 2010 by 4dancers

When I was a young dancer I can remember getting my first subscription to Dance Magazine. In it was a column that I absolutely loved–one that answered some of the burning questions I had–but that I was afraid to ask. I always flipped to it first and eagerly read the advice…

That column was written by Dr. Linda Hamilton–who was kind enough to spend some time sharing her insights here with us on 4dancers today. I’m honored to share them with you now…

1. You have had a long, successful career helping dancers. What is one thing about them that stands out to you after working with them all these years?  

There are many things that make dancers stand out from the crowd. However, if I have to narrow it down to one factor then I’d say it’s their extraordinary passion for dance. While most performers love what they do, serious dancers love it almost to excess. This can be a double-edged sword. It helps them to excel in dance because they are so eager to make progress. However, this same drive can also sabotage their best efforts if they ignore pain and fatigue. 

 
Linda Hamilton (c) Paul Kolnik

2. What are the primary injuries and issues you have seen over the years in the dance world, and have they changed with time or do they remain largely the same?

Overall, the most common concerns in dance include overuse injuries, burnout, mental stress, and eating problems. The good news is that today’s dancers are better informed about a variety of health issues. The problem is that the training and choreography are much more intense. As a result, it takes more than dance class to survive. You also need to consider good work habits, cross-training, nutrition, weight control, and stress management. We’ve integrated these elements in our wellness program at New York City Ballet, and the weeks lost to disability have dropped almost in half. 

3. You have done a good deal of research during the course of your career…what was the most surprising thing you found? 

The biggest surprise was how similar dancers are around the world. We compared dancers from Western Europe, China, Russia and the United States and found that they were all experiencing the same mental and physical stresses. Isn’t that amazing? The main factor that separates dancers, regardless of the country, is how pro-active their schools and companies are in terms of preventing these problems. Fortunately, the International Association for Dance Medicine & Science is a wonderful resource that can help you get up to speed. I highly recommend becoming a member (www.iadms.org). 

4. How did you begin writing for Dance Magazine? 

Writing for Dance Magazine coincided with my becoming a licensed clinical psychologist. I wanted to focus on the entertainment industry after working with different performers at a clinic that specialized in the area. However, I knew that dancers can have a hard time discussing problems because the training rewards you for being stoic. So the idea of an advice column where dancers could write to me and ask for help without using their real names held great appeal. I proposed the column to Dance Magazine and it’s been running ever since. It’s been highly rewarding for me on a personal level. More important, I hope it’s shown dancers that reaching out when you have a problem can be empowering.

5. What is it like to work with New York City Ballet? 

It’s like going home! I grew up at City Ballet and performed with them for almost two decades. Helping to develop and implement the wellness program is like a dream come true. It allows me to bring everything I know about dance medicine to the Company. Now every young dancer receives an annual orthopedic, fitness, and nutritional screening to identify potential problems before they become serious. We also offer seminars when time permits, where I may discuss ways to prevent burnout. I’m also available for dancers who need more personalized help, such as recovering from an injury. It’s an honor to give back to the dance community that has brought so much joy and meaning to my life. To do this at City Ballet is a gift.  

6. In your mission statement it says, “you no longer have to suffer for your art form to excel”. Can you explain what you mean by that? 

It means that a lot of the suffering that occurred in the performing arts was due to lack of knowledge and resources. Dancers need to be thin but they can lose weight safely by knowing what to eat and how to cross-train. The same is true for working with your unique body type without getting injured, using mental skills to reduce performance anxiety and increase self-confidence, and knowing when to seek medical help to take advantage of that one-month magic healing period. 

7. Are there any psychological issues that dancers tend to be more prone to? 

I’d have to say perfectionism! Obviously, you need a hefty dose in order to practice the same dance steps over and over again. This trait is inborn and common in gifted individuals. The healthy aspects include high standards and the organizational skills to meet your goals. The less adaptive parts that can trip you up are never accepting anything less than perfection (which is unattainable) and looking at mistakes as a sign of failure rather than an opportunity to learn something useful. Perfection is an ideal, not a reality.   

8. You have recently written a book called The Dancer’s Way. Who should read this book and why? 

I think everyone in the dance community can benefit from the book, including dancers, teachers, directors, and healthcare specialists. I wrote it to help reduce occupational stress and achieve peak performance in any dance technique, not just ballet. It shows you how to develop a wellness program tailored to meet your unique needs, and includes New York City Ballet’s screening protocol and the resources to duplicate it. I just heard that The Royal Ballet is considering adopting it after reading the book. I also know that Jerry Mitchell, who’s choreographed numerous Broadway hits, wants to make it mandatory reading for his gypsies. It’s also being used by a number of dance schools and BFA programs. Frankly, it’s the book I wish I’d had when I was a performer. 

9. Can you share a particularly meaningful moment from your career? 

Actually, that question is easy to answer because it just happened. I was invited to speak at the first dance medicine conference in Monte Carlo, which happens to be the first city where I performed on tour as a 16 year-old dancer with New York City Ballet. I felt like my life had come full-circle. As a young dancer I had the honor of being introduced to Princess Grace. This time her daughter, Princess Caroline, was in the audience. It was a very special moment that brought two careers together in a highly meaningful way. 

10. What is next on the horizon for you? 

Well, it seems like I always have another project on the table. This time it’s focusing on my new website for all types of performers. I have monthly wellness tips on topics like self-esteem and dieting, surveys that target constant concerns such as technique, photos on different sources of occupational stress, and a daily discussion forum. It’s meant to provide both information and support. I invite everyone to visit, check out the tips and resources, and join me in the forum at www.wellness4performers.com. This is for YOU! 

Biography:  

Former New York City Ballet dancer Linda Hamilton is a clinical psychologist specializing in the performing arts. In addition to her private practice in Manhattan, Dr. Hamilton is the wellness consultant for New York City Ballet and The Ailey School. She writes a monthly advice column in Dance Magazine, and has three books that deal with occupational stresses in the entertainment industry. Dr. Hamilton’s website provides the community with useful tips and resources, as well as daily support in her discussion forum (www.wellness4performers.com). 

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Filed Under: 10 Questions With..., 4dancers, 4teachers, Online Dance Resources, Studios Tagged With: city ballet, dance magazine, dr. linda hamilton, linda hamilton, new york city ballet, the ailey school

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