Healthy Bones For Dancers

Human skeleton with left arm extended; front and back views. Wellcome V0008012

See page for author [CC 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.


Preview: The Joffrey Ballet: Bold Moves

Joffrey Ballet in RAkU

                         The Joffrey Ballet in RAkU. Photo by Cheryl Mann

by Catherine L. Tully

The Joffrey Ballet opens its Bold Moves program Wednesday, February 10th at Chicago’s Auditorium Theatre with one world premiere and two audience favorites. The evening will feature live music from The Chicago Philharmonic, with Joffrey Music Director Scott Speck at the helm.

Joffrey Ballet in Forgotten Land

Christine Rocas and Rory Hohenstein in Forgotten Land. Photo by Herbert Migdoll

Jirí Kylián’s Forgotten Land is the opening piece, set for 12 dancers, with music by English composer Benjamin Britten. Last performed by the company in 2012, this well-received ballet was inspired by an Edvard Munch painting of women staring at the sea from the beach. The choreography does indeed evoke water, its many lifts and swirling motions resembling the ebb and flow of waves.

Preview of world premiere:

Another work for 12 dancers, Ashley Page’s world premiere, Tipping Point, is the next item on the program. This piece is centered around the music, Thomas Adès’ violin concerto Concentric Paths. An award-winning choreographer, Page has a strong background in ballet, but this abstract piece focuses on highlighting human behaviors that are illuminated by the shifting tensions of the score. Take a closer look at how Page came to work with Joffrey in this post on Art Intercepts.

Joffrey dances RAkU

Fabrice Calmels and Victoria Jaiani in RAkU. Photo by Cheryl Mann

RAkU is the final piece in the Bold Moves program, and it is a truly unique offering. First created for San Francisco Ballet in 2011, Yuri Possokhov’s contemporary story ballet is based on the burning of Kyoto’s Golden Pavilion. The choreographer commissioned a score by composer Shinji Eshima, and the music illuminates the love story beautifully. A stunning visual piece as well, RAkU fits nicely with the program’s theme, as it leaves quite an impression.

Bold Moves runs from February 10th through the 21st at Chicago’s Auditorium Theatre.

Take a quick peek at the three program pieces here:


Dance Students: The Importance Of Good Character

by Lucy Vurusic Riner

There is a lot of talk that typically surrounds the plight of the millennial. Did their parents raise them to be self-sufficient? What sort of work ethic do they have? How do their values and morals play out in today’s workforce?

And, for me as a teacher, how do I impart my “Gen X wisdom” on them in dance class?

I wonder about this each day as I watch my students come into class. They really do toggle back and forth from being complete perfectionists and go-getters to being completely entitled and lazy. As a parent I wonder when their character will begin to take shape and how much influence their own parents have over the kinds of humans that are walking into my dance class each day. As an executive director of a dance company I wonder if I would hire more than a fraction of them upon graduating from college.

Attitude matters these days.

Teaching high school dancers (and I believe this extends well into college as well) is challenging in that most of our students are setting goals that are superficial; or what I like to call surface level. They read the syllabus or the rubric to see what they need to do to get the A or get cast in the role and then they simply do the bare minimum to make that happen. There is a preconceived notion that if you’ve done all the work, you now deserve the job. Period. The problem is that a lot of them can do the work. A lot of them can even do the work well; but there aren’t enough jobs for the amount of dancers we’re cranking out these days.

We need to teach them that doing the work is standard. It’s status quo. It’s the bare minimum expectation. It’s what happens after you’ve done part one that leaves an impression. It’s more than just bringing your skills and talents. Attitude, character and work ethic matter.

Read more


BDancewear Clothing Review


Cotton Shrug

by Catherine L. Tully

The staff over at BDancewear asked if I would like to check out some of their merchandise and write something up for our readers.* When I agreed, they shipped me a nice box of goodies to try out, and I’d like to share some of my favorites with you. But first, I wanted to mention a little bit about the company itself, as I think some background is always nice…

One thing I found fascinating about this business is that they offer items in 200+ different colors. The ability to get a piece you like in a shade you love it pretty impressive. And the pieces are all made in the USA, which to me is another selling point. Add to that the fact that you are supporting a small business when purchasing from them, and it stacks up to be a pretty good deal overall. Especially since the items I sampled were very well made.

High-Waist Pants

High-Waist Pants

By far my favorite item in the package was the pair of high-waisted pants. I got the cotton ones, and they are excellent quality, lasting a very long time. I washed and dried them repeatedly, and since they are a bit on the long side (which I love, because I have long legs and my pants always shrink too much), they stood up to it just fine.

I’ve had many types of pants like this – all name brands – and these held up better than any other one to the wear/tear and wash cycle of a dancer. No splitting seams, no see-through spots, no loose elastic. I’m still wearing them, many months later. The only caveat is they are long, so shorter people may have an issue with the fit. They also make a high-waisted brief that is very comfortable.

I love shrugs, and the ones offered by BDancewear are no exception. Besides keeping my arms warm in a tank top or sleeveless leotard, they look pretty. I find these are one of those “optional” pieces, like a dance skirt, that makes you feel more like a dancer. Decorative/fun pieces. And again, the ability to dial in the fabric and color is a nice touch.

High-Low Skirt

High-Low Skirt

The company sells a full compliment of skirts as well, which can be a good choice for dance school students, or possibly instructor attire. I find the high-low skirts appealing, but there are a variety of choices, including angle skirts, circle skirts and longer skirts. To me these were better suited for the casual student, not as much geared toward the pre-professional or professional dancer. Studios with a color-coded system will find they can get any shade they need here.

In addition to the different colors available, BDancewear also offers a number of fabric choices, including lycra, velvet, cotton, mesh and more. They also stock sports bras, gloves, tank tops, briefs, leotards and other items.

To learn more about the company and take a look at their full range of offerings, visit them on the web at BDancewear.

For additional information on the company and more clothing reviews, visit our friends at Dance Advantage for their take on BDancewear.

*BDancewear has purchased ad space with 4dancers in the past. Review items were sent at no charge. This is not an advertorial.



Paris, Passion, And Pointe Shoes: Atlanta Ballet Presents Moulin Rouge®

Atlanta Ballet in Moulin Rouge®. Photograph by Charlie McCullers.

Atlanta Ballet in Moulin Rouge®–The Ballet. Photograph by Charlie McCullers.

By Rachel Hellwig

A tragic love triangle, the City of Lights, and the bohemian nightlife of the late nineteenth century—Atlanta Ballet brings Jorden Morris’ Moulin Rouge® – The Ballet back to the Cobb Energy Performing Arts Centre from February 5-13.

Created in 2009 for the 70th anniversary of Canada’s Royal Winnipeg Ballet, the production has since toured internationally, been adapted into a ballet film, and was re-staged on Atlanta Ballet in 2010.

Inspired by the iconic French nightclub depicted in the art of Henri de Toulouse-Lautrec, Moulin Rouge® blends ballet, Cancan, and tango to the music of composers such as Debussy, Offenbach, Shostakovich, Ravel, Johann Strauss Jr. and Astor Piazzolla, among others.

"At the Moulin Rouge" by Henri de Toulouse-Lautrec. Wikimedia Commons Public domain image.

At the Moulin Rouge by Henri de Toulouse-Lautrec. Wikimedia Commons public domain image.

A fantasia of history and imagination, the ballet follows the stories of Nathalie–a laundress turned cabaret dancer, Charles Zidler–the sinister proprietor of the Moulin Rouge (“The Red Mill”),  Matthew–an aspiring painter, and, of course, Henri de Toulouse-Lautrec.

Atlanta Ballet veteran John Welker, now in his 21st season with the company, will portray Zidler and Toulouse-Lautrec. “What I really enjoy about these roles is that they are both based on real people,” he says. “They are not just a figment of the choreographer’s imagination. I love that, in some strange way, it makes you feel connected to that time period in Paris.”

The original Moulin Rouge circa 1914. Wikimedia Commons public domain image.

The original Moulin Rouge circa 1914. Wikimedia Commons public domain image.

Interestingly, the historic Toulouse-Lautrec would not likely have been able to dance. After breaking his legs as a youth, the bones did not heal properly and stopped growing. As a result, he was disproportionately short and struggled to walk, even with a cane.

Nonetheless, Morris wanted to bring him to life through dance. In an interview for Pittsburgh Ballet Theatre, he explained, “When choreographing the dance for Toulouse, I wanted the audience to see the amazing and beautiful things going on in his mind – which is translated through dance. It would have been easy to make his choreography twisted and deformed, but then we would never see the beauty behind what was in his mind.”

John Welker and Christine Winkler as Matthew and Nathalie in Moulin Rouge®. Photograph by Charlie McCullers.

John Welker and Christine Winkler as Matthew and Nathalie in Moulin Rouge®–The Ballet. Photograph by Charlie McCullers.

As Nathalie, the rags-to-riches Moulin Rouge star whose life is fatefully intertwined with Matthew, Nadia Mara returns to a role she first visited in Atlanta Ballet’s 2010 production. She delights in the character’s creative and dramatic possibilities. “Nathalie goes through so many emotions and transformations during the story,” she says. “It allows me to explore and work on my acting, which I always love. I can’t wait to show the audience this beautiful ballet!”

If you would like to be in the audience of Moulin Rouge®–The Ballet, tickets starting at $25 may be purchased here.


Prix Rewind–Women’s Classical Variations

by Rachel Hellwig

Prix de Lausanne is tough competition. Inevitably, many wonderful dancers aren’t counted among the prize winners.  Here are some lovely non-winning performances from past competitions by dancers who are now in companies…

Tyler Donatelli – 2014. Now with Houston Ballet.


Thamires Chuvas – 2012. Now with San Francisco Ballet.


Mai Miyazaki – 2012. Now with Tokyo City Ballet.


Natsuki Yamada – 2014. Now with Semperoper Dresden.


Ayaka Fujii – 2012. Now with Stuttgart Ballet.


Anisa Sinteral Scott- 2011. Now with Ballet West.


Dance Wellness Links And More…

Jan Dunn

Jan Dunn, MS, Dance Wellness Editor

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, 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 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, 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., 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 Dunn, MS
Dance Wellness Editor – – Dance Wellness posts 1/1/12 to present


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


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


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


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 25th 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


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