Injury Prevention

WOU students Kaitlin Bauld (standing) and Samantha Cunningham have benefited from the program's focus on wellness.

Senior dance major Nastassia Zacarias is used to the particular brand of feedback given by her dance professors at Western Oregon University. “I continuously hear professors say, ‘I’d rather have good alignment than a high kick,’ or ‘Beautiful dancing, but where’s your pelvis?’” says Zacarias. Indeed, a concern for dancer health is woven throughout the WOU dance program, thanks in part to Marita Cardinal, a health and physical education professor who championed a curricular model for wellness that the dance department has embraced.

Instead of just offering a kinesiology course or a semester of bodywork, WOU’s wellness program is comprised of a cohesive group of courses taught mostly by Cardinal that address a breadth of personal well-being issues. In addition, dance faculty integrate wellness ideas into their classes, and the program partners with local health professionals, who provide additional expertise. Cardinal, who received the 2009 National Dance Association Scholar/Artist award, believes that this comprehensive approach and community involvement are keys to higher education dancer wellness, so she couldn’t be happier with WOU’s program, now in its second year.

Cardinal danced in college and after (her professional gigs include a Department of Defense Southeast Asia tour of Godspell). Like many dancers, she experienced injuries, dietary challenges and psychological stress during her university years and, though she took courses in anatomy, physiology, kinesiology and athletic training as an undergraduate, felt that dance-specific guidance on preventing and treating health problems was missing from her education.

She went on to earn her doctorate in education from Temple University in 1993 with a dissertation that focused on dancer wellness in American colleges. Five years later, she joined WOU’s Division of Health and Physical Education, where she continues to teach numerous courses, including Teaching Dance in Physical Education and Teaching Aerobic Fitness.

She began working with WOU’s Department of Theatre and Dance in 2007 after her division head, inspired by a university goal to expand interdisciplinary relationships, made the dance faculty aware of Cardinal’s dance science background. Backed by a supportive administration and enthusiastic dance faculty, Cardinal produced a group of wellness courses that were approved and implemented by the following academic year.

To create WOU’s wellness curriculum Cardinal drew from many sources, including Case Western Reserve University’s comprehensive dancer wellness screening/assessment program, which includes a database for longitudinal research on dancer wellness programs. She also credits the International Association for Dance Medicine and Science and information available from the Dance Kinesiology Teachers Group.

Marita Cardinal teaching in Hong Kong

Using these materials and others, she created a curriculum that addresses dancer health on many levels. In her Wellness for Dancers course, for example, Cardinal asks students to complete a “dancer wellness survey” and share their stories, issues and fears about being a college dance student. She also has students assess their current alignment, body image and conditioning and do a health history/injury profile and a diet analysis. Then they set goals and create their own wellness program, which might include personalized exercises to prevent injuries, resolve muscular imbalances and improve alignment; somatic practices to improve technique; an individualized nutritional plan; and relaxation techniques to reduce stress.

Classes also include advice from a variety of health experts. Cardinal brings in WOU dietician Sarah Weber, a registered clinician and former ballerina with Oakland Ballet, who meets with dance students to analyze their nutritional behaviors and needs and assists them in making healthy food choices. Regional psychologists and therapists also serve as guest presenters.

Though currently not mandatory, WOU’s wellness classes can be used to fulfill 13 dance degree credit hours. Cardinal’s conditioning course, for example, fulfills an elective technique requirement and Wellness for Dancers counts toward the required 19 hours of general dance electives.

But even outside of Cardinal’s classes, students think about what’s best for their bodies. In pointe classes taught by WOU professor Sharon Oberst (formerly of Houston Ballet and Eugene Ballet), students learn how to assess their readiness for pointe work, which includes measuring ankle-foot range of motion with a tractograph/goniometer. In Oberst’s technique class, students are taught to integrate resistance bands and rotation/Pilates discs with barre work to increase muscle strength and endurance. In addition, all dance faculty videotape their technique classes and do student evaluations at midterm and finals.

Oberst is enthusiastic about Cardinal’s work in the program. “Dr. Cardinal is able to explain the material with much greater depth and specificity to individual dancers than can be covered in other courses,” she says, adding that this greatly supports the program’s holistic approach to helping students develop their full creative, technical, pedagogical and performance potential.

WOU students attest to how the wellness classes have helped their dance careers. Senior dance major Allie Boyden says, “Before coming to WOU, I was always having dance injuries, but not now. And as a teacher, being able to explain which muscles are working and how they are connected has also helped me.”

“Teachers have a wonderful job—they have the opportunity to influence positive changes in students’ lives,” says Cardinal. “What could be more meaningful than educating students on how to take care of their bodies and their health?” DT

Gigi Berardi is an assistant editor for the Journal of Dance Medicine & Science, a contributing editor and writer for Dance Magazine and the author of Finding Balance: Fitness, Training, and Health for a Lifetime in Dance (Routledge Press).

Photos from top: by Cliff Coles, courtesy Western Oregon University; by Paulette Cote, courtesy Marita Cardinal

Dancer Health

Gigi Berardi is an assistant editor of the Journal of Dance Medicine & Science. Parts of this article have been adapted from her recent book, Finding Balance: Fitness, Training, and Health for a Lifetime in Dance.

Some injuries happen unexpectedly: An off-balance landing, a poorly timed lift or a slippery floor can cause a strain or sprain in a split second. Most often, however, injuries develop slowly over a period of time and are caused by overuse or continual, low-level stress.

Therefore, it’s essential for teachers to be on the lookout for destructive movement patterns and signs of pain among students. Is a dancer favoring one side? Is she constantly rubbing her calf muscle? Learning what to look for will enable you to intervene before a condition becomes chronic.

Some risk factors to watch out for include excessive pronation (feet rolling in), excessive eversion (feet rolling out, or “sickling”), muscular imbalance, forced turnout and structural anomalies (e.g., differences in leg length). Other factors include inadequate warmup and training overload, as well as poor nutrition, disordered eating and menstrual dysfunction or irregularity. Here, we take a look at seven common dance injuries, as well as risk factors and methods of treatment.

Ailments: Achilles Tendonitis and Shin Splints 

Risk Factors: Poor technique, anatomical limitations (a high instep), environmental factors (hard floors). Dancers who land with their “heels up” (i.e., with the heels of the feet not making contact with the floor) are also at risk. Those with a shallow plié or weak thigh muscles will have problems rolling through the entire foot during fast-tempo ballets.

Treatment: At early onset, rest and ice (and, for tendonitis, compression and elevation) are recommended. An evaluation by health professionals may indicate the need for corrective devices such as orthotics. An orthotic shoe insert limits excessive rolling in and out of the foot and repositions joints to alleviate pressure put on muscles and tendons. Alternatively, dancers may follow a course of extensive manual and physical therapy practices. In the studio, teachers should advise quadriceps conditioning, as strong thigh muscles help to stabilize the knee joint and control the plié.

Ailment: Ankle Sprain 

Risk Factors: Poor technique, fatigue, weak ankle and lower-leg muscles, history of ankle sprains.

Treatment: For immediate treatment, application of ice, compression and elevation is recommended. Ice should be applied about three times per day for 10 to 20 minutes each time. Ice has an analgesic effect, and allows for exercises that move the joint through full range of motion. Strengthening work should include resistance exercises in pointing and flexing the foot, as well as with lateral ankle movements.

Ailment: Stress Fracture

Risk Factors: A pronated foot and genu valgum (knees rotated to the outside). Repetitive loading with demanding movements, predisposition to amenorrhea (absence of menstruation) and restricted caloric intake may also contribute.

Treatment: Rest and ice, until a diagnosis can be made.

Ailment: Patellofemoral Syndrome

Risk Factors: Patellofemoral syndrome is caused by poor patellar (kneecap) tracking or excessive loading of the patella, which generally results from the outside hip and thigh muscles (the vastus lateralis) being stronger than the inside thigh (vastus medialis), pulling the kneecap to the outside. When jumping or practicing lunges, many students contract their quadriceps tightly throughout their plié, producing constantly high patellofemoral compression forces. The situation can be aggravated by a pronated foot, anterior pelvic tilt (swayback) and decreased external hip rotation.

Treatment: Rest and ice can be effective until a diagnosis is made. Rehabilitation of patellofemoral syndrome involves conditioning for strength and flexibility of the quadriceps, hamstrings, gastrocnemius and soleus (calf muscles), as well as stretching of the iliotibial band (outside leg). Giving feedback in technique class also helps—emphasizing that the dancer’s knees should be over her feet in lunges, and that external hip rotation should be used to initiate plié.

Ailment: Low Back Disorders

Risk Factors: Lifting and jumping with poor alignment, muscle imbalance (which may involve a tight psoas, or hip flexor) and training overload. Environmental factors, such as non-resilient floors, tight costumes or lifting a partner mismatched in height or weight, or with improper timing, may also contribute.

Treatment: Rest and ice are recommended for immediate treatment. Following a diagnosis and treatment, core strengthening and stretching exercises, including those for tight hip flexors, are recommended. Conditioning programs that focus on abdominal and back extensor strengthening, hip flexor stretching and exercises to release tension in the low back area can help to relieve pain. Rehabilitation also could include Pilates work. Any number of soft tissue (manual mobilization) treatments will ease spasms and release the tissue. Physical therapy adjuncts may include massage, electrical stimulation and ice.

Ailment: Anterior Shoulder Impingement

Risk Factor: This occurs when the many tendons that envelop the head of the shoulder bone are “pinched against” the roof of the shoulder joint, as with improper overhead lifting.

Treatment: Rest, ice, compression and elevation, as well as gentle shoulder mobilization, manipulation and massage of tight shoulder girdle muscles, stretching and strengthening exercises. DT 

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