Dance Wellness
Toenail Injuries in the Dancer by Dr. Sinkoe – Bruised Nail
Toenail problems become a source of concern and agony for the dancer, particularly the ballerina on pointe. Toenails function to improve our tactile (pressure) sensation and to act as a support structure for the toe. This can be helpful for the dancer on pointe. However, because there is a lot of pressure on the nail while on pointe, bruising of the nail can result.
The underlying nail bed is highly vascularized. The nail plate is adhered to the nail bed via small ligaments. Repetitive microtrauma to the nail plate can injure the ligaments resulting in shear stress to the nail bed. A small amount of bleeding occurs under the nail. As the bleeding continues, the nail plate can elevate, producing calloused tissue and making the nail appear thick. A portion of or the entire nail plate can be lost.
This cycle usually repeats itself over a period of time. Many ballerinas accept the fact that they have chronically bruised nails. Long term consequences of a chronically bruised nail can be chronic ingrown nail borders, a deformed nail or a fungal infection of the nail.
Causes of a bruised nail:
Treatment of Warts in the Dancer By Dr. Sinkoe
Warts are a virus which infects the outer layer of the skin. They are considered opportunistic and will enter the skin via a small wound or under a callous or blister. Thick calloused tissue grows over the developing wart and is painful. The surrounding area may also feel swollen due to the immunological response of the skin, reacting to a “foreign body”. Warts may occur as a single lesion or may be clustered forming several warts.
Causes in dancers:
Dance Wellness: Causes Of Injuries (Risk Factors) Part II
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.
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.
2Dance Wellness: Causes of Dance Injuries (Risk Factors) Part I
KEEPING DANCERS DANCING
by Jan Dunn, MS
Jan Dunn, MS
This month’s topic in our ongoing Dance Wellness series is “Causes of Dance Injuries” (also called “risk factors” in the dance medicine world). We all know that dance is a risky business – injuries do happen. But learning what causes them can go a long way in helping to reduce that risk, and keep you “Dancing Longer / Dancing Stronger” (actually the title of an excellent dance medicine books for dancers!). All of the information in this article is supported by dance medicine research over the last thirty years.
The risk factors discussed below are NOT listed in any order of importance! In many dance injury situations, more often it is a combination of “causes” that may result in injury (I will explain what I mean by at the end !). We’ll cover five today, and five tomorrow:
1) Poor alignment and faulty technique:
While it is true that many injuries result from a combination of factors, this one is usually agreed to be one of the most important. Dr. Justin Howse, longtime physician to The Royal Ballet in England (now retired) and one of the early pioneers in Dance Medicine, went so far as to say that all injuries were the result of faulty technique. Most current experts would agree that while faulty technique is a major component of injuries, they would not necessarily concur that it is the only factor.
By “Alignment problems” we mean such postural patterns as:
-forward head (the head not in good alignment with the spine and torso)
-forward shoulders (rounded shoulders)
-lumbar lordosis (“swayback”)
-thoracic hyperextension (protruding ribcage)
-hyperextended knees (knees straightened beyond 180)
- foot pronation or supination (rolling in or out)
A dancer who has good alignment is more likely to have “efficient movement” (using only the muscles and amount of energy necessary to accomplish the movement), and is less likely to be putting strain and tension on soft tissue (ligaments / tendons / muscles) around the joint, thus resulting in less possibility of injury.
An example:
A young dancer complains of knee pain. The dance medicine physical therapist or physician gives a diagnosis of patellofemoral syndrome, which frequently involves the patella (kneecap) not tracking properly in the patellar femoral groove (the groove in the femur through which the patella glides, on knee flexion and extension). Looking at the dancer’s plie in first, the medical specialist and the dance trainer note that the dancer’s feet are turned out to 65 degrees, and the knees are not aligning over the toes, but falling instead in front of the great toe. Foot pronation (rolling in) and lumbar lordosis (“swayback”) is also noted. The dancer’s external rotation (turn-out) in the hip joint is then tested lying prone (on the stomach), and is found to be 48 degrees – so she is “forcing her turn-out”, which can cause knee pain (and possibly other problems). Recommendations are given for medical treatment for the knee pain, and she is also given cueing for proper plie technique, using her natural turn-out of 48 degrees, and not forcing at the knee and ankle.
The crucial point here is that ALL injuries in dance need to be evaluated for technique concerns, to see if this may have played a causative part. If the dancer rehabs the injury without knowing if faulty technique is involved, the injury is more likely to re-occur when returning to full dance activity.
2). Anatomical limitations:
0“The Perfect Arch” by Dr. Sinkoe
Today we bring you the first in a series of articles for 4dancers by Dr. Sinkoe, a podiatrist from Georgia who works with the Atlanta Ballet. He was kind enough to share some thoughts on the best ways to help strengthen and improve your arch. Look for additional information from Dr. Sinkoe this month and next month on subjects such as warts and bruised toenails...
Dancers are always looking for ways to obtain that “perfect arch”. Every foot is genetically designed differently and not everybody will be able to achieve that “perfect arch”. Stretching and flexibility exercises are always helpful. However, I caution those that are attempting to achieve this position with the use of spring-loaded devices or placing their foot under the couch or other furniture to try to stretch the ligaments at the top of the foot. The midfoot joints are supported by strong ligaments and will allow the bones of the midfoot to only glide up and down. Attempting to make the midfoot joints act as hinge joints will injure the ligaments. If the ligaments are overstressed they can become weakened which can result in a sprained ligament or a subluxed joint.
The most effective method to strengthen the arch is to strengthen the foot muscles which stabilize the toes. These muscles are located on the bottom of the foot. Exercises to contract these muscles will flex the arch, giving you a dome appearance, thus the name “doming exercises”. Strong foot muscles will also reduce the incidence of tendonitis and metatarsal stress fractures. Experienced dancers will learn to use these muscles to stabilize themselves on pointe rather than depending on the pointe shoe to do the work.
Exercises for foot strength:
0Keeping Dancers Dancing: An Introduction to Dance Wellness in 2012
Join me in welcoming Jan Dunn who is going to be with us this year writing about Dance Wellness. Ms. Dunn has an extremely impressive background in the field and I’m really excited that she will be sharing her insights with us here at 4dancers…
by Jan Dunn, MS
Jan Dunn, MS
Welcome to the world of Dance Wellness! (also sometimes called “Dance Medicine and Science”). Dance Wellness is a fairly recent branch on the dance family tree; thirty-five years ago, the field did not exist at all. But the last three decades have witnessed tremendous growth in our knowledge of how to keep dancers dancing, longer and stronger than ever before. This is the first in a series of on-going articles about dance wellness, integrating recently learned information to help teachers, dancers, choreographers, and directors.
What IS “dance wellness”, or “dance medicine and science”? The “dance medicine” part is comparable to sports medicine – the care and prevention of dance injuries – just as sports medicine serves the same function for its participants. “Dance science” draws on research in the last thirty years (most of it in dance itself, as opposed to sports or other fields) from such areas as:
- kinesiology and anatomy
- biomechanics
- exercise physiology
- motor learning
- nutrition
- psychology
Both areas are concerned primarily with how dance injuries can be prevented / minimized, and how to integrate these findings into dance training. “Dance wellness” incorporates all of these concepts — i.e., keeping dancers healthy, to be able to have long, viable careers with decreased risk of injury.
2