Dancer Health

Are You Teaching Your Dancers to Work Through Pain?

Mary Six Rupert (center) is spokeswoman for the American Association of Physical Activity and Recreation's "Get a Kick Out of Life" knee-health campaign. Photo courtesy of Rupert

Mary Six Rupert remembers the exact day when demonstrating pullbacks in her tap class didn't quite feel right. The former Rockette then noticed that walking up the subway stairs caused sharp pain in her knees. In the beginning the pain only occurred during activity, but it soon became so constant that she needed a demonstrator for class. “Six shows a day seven days a week with high heels and high kicking will take a toll on anyone's knees," says Rupert, referring to her 13-year stint in the famous Radio City kick line. In her 50s, she was diagnosed with osteoarthritis in both knees—an arthritic condition common among dancers where the protective cartilage at the ends of bones gradually deteriorates and the knee loses shock absorption. In extreme cases, bones can rub against each other.


“Think of the treads on a tire—eventually they just wear out. And all the jumping and landing dancers do puts them at greater risk for knee injuries," says Patrick McCulloch, an orthopedic surgeon at Houston's Methodist Center for Sports Medicine and consultant for the Center for Performing Arts Medicine. But good news: Proper training and awareness can help your students protect their knees.

Preventive Measures

Marijeanne Liederbach, director of research and education at the Harkness Center for Dance Injuries in New York, advises teachers to educate dancers on knee-health maintenance. “This means good solid nutrition, taking part in some form of supplemental training, having a strong core and taking care of the neighboring joints, like the hip and ankle," she says. “Pay attention to fatigue as well, as we know from research that most knee injuries occur during extreme fatigue." Basic bone health also includes encouraging students not to smoke and to intake enough calories for proper hormone balance.

Photo courtesy of Mary Six Rupert

Your job as a dance teacher is to build and strengthen students' stamina to endure tough physical technique, says Liederbach, who recently studied the number of jumps dancers do in a typical class—about 200. She also encourages training dancers to see the knee in a broader sense. “From a biomechanical point of view, the knee is the largest joint in the body, located between two of the largest bones," she says. “Because of this, the knee can fall victim to ankle and hip problems."

The first step to knee protection, according to Houston-based physical therapist and former dancer Jennifer Romanek, is making sure students execute proper turnout (which involves the ankle and hip). “When you force a turnout from the feet, it puts a tremendous torque on the knees, which can wear down cartilage," she says. “Don't push a turnout past the external range of motion that the hip allows."

Cross-training can help build knee-supporting muscles—as important for teachers as for their students. “Go to the gym and do other types of movement besides dance classes," Romanek says. “Even if you are just teaching, you need to remember that you are demonstrating all day, which can take a toll on your knees." She recommends Pilates exercises on the reformer to loosen the iliotibial (IT) band—thick fibrous tissue that runs from the pelvis to the lower leg bone—and quadriceps, which are crucial for knee stability. “A tight IT band and quads will pull excessively on the knee," she says. “Dancers need long and lean muscles."

Early Warning

Knee pain that feels completely different from the average ache and pain is often the first sign of trouble, says Rupert. Tell students to be on the lookout for joint swelling or catching, and grinding sensations as well. McCulloch, who has diagnosed and treated many Houston Ballet dancers, recommends that dancers (when experiencing unusual, lingering knee pain) first see a doctor to check for any damage. “With an X-ray we can see the spaces between the bones," he says. “Although cartilage will not show up on an X-ray, we can see the narrowing of that space. An MRI will show the condition and possible loss of the cartilage."

While Rupert managed to finish her professional performance career relatively injury-free before developing osteoarthritis after age 50, McCullough says he has seen the condition in dancers as young as 20 and 30. If injuries aren't taken care of at a young age, further damage can occur that might ultimately lead to knee replacement. As Rupert says, “Dancers need to get over working through the pain. The sooner you find out what's going on, the more options you have."

Dance Buzz
PC Break the Floor

Two competition routines are equal in technical proficiency, artistry and choreography. One consists of all girls, the other includes a boy. Guess which takes home first prize?

If you guessed the one with the boy, you may be privy to an unspoken and much-debated phenomenon in the competition dance world: The Boy Factor. According to The Boy Factor, a competitive piece is more likely to win if there's a boy in it.

"If it's all technically equal and one group is all girls and the other group has a boy, the one with the boy will win," says Rysa Childress, owner of All Star Studios in Forest Hills, New York. "Boy soloists are sometimes scored higher than more technically proficient girls because if a boy has good stage presence, we let him slide," says an anonymous competition judge. "And most of the feedback will be for the boy."



The Boy Factor doesn't just have to do with competition scores: It's how we treat boys throughout their dance education. "We idolize the boys," says Ashley Harnish, a teacher at a competition studio. "We build entire dances around one boy, and we teach them that we need them more than we need the girls."

On the surface, The Boy Factor is flagrant sexism. But what's really behind the phenomenon? "So often, young male dancers are bullied because our culture says that dance is for girls," says a second national competition adjudicator. "This stigma pushes some judges to reward boys by scoring them higher than their female competitors." The Boy Factor also stems from a simple fact: There are far more girls than boys in the dance world.

"Judges see boys as valuable commodities," says Marissa Jean, a staff member at Broadway Dance Center's new building for children and teens and a teacher at several competition studios. "To encourage their career in dance, judges will throw a little extra their way. It could be placing them in the top ten or giving them a special award. They nurture them a bit more than the girls."



But by trying to retain more male talent, are we suggesting to girls that they are less valuable to the dance world than boys? "There's so much about this getting into these kids' psyches," says Childress. "Like, 'Oh the boy will beat me no matter what.' How do we teach self-worth knowing that you're going up against a boy, so what's the point?"

The Boy Factor is a product of and a contributor to the culture that sends the few men in dance up the glass escalator: "Many boys growing up in the dance world are not told the word 'no' often, so they tend to climb the professional ranks more quickly than the women," says Jean. We often bemoan the absence of female leadership in dance, but the damage is already done if we've taught young women that their gender determines their value to our community.

So what can be done about The Boy Factor? First, we could change how we encourage boys to continue dancing. Instead of empowering young men by devaluing young women, we could work as a community to dispel the culture of toxic masculinity that discourages boys from pursuing dance in the first place.

But it also falls in the hands of judges and teachers. "We need to increase awareness," says the second adjudicator. "A lot of us judges don't realize what we are promoting and the messages we send through our scoring and awards. If enough of us band together, I think we can make a difference so that this part of our field is less toxic."

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