Out of Harm's Way

Help students prevent painful foot and lower-leg stress fractures.

Stress fractures in the shinbone or ball of the foot are the most common dancer injuries.

If one of your dancers points to a spot on her foot or leg and says it hurts, pay close attention. She may have the start of a stress fracture, an incomplete break in the bone caused by repetitive trauma or an abrupt twist or torque. “When a dancer complains of pinpointed pain, don’t ignore it, especially when it is near a joint surface, like the side of the leg, the dome of the foot or under a toe,” says Glenna Batson, associate professor of physical therapy at Winston-Salem State University.

According to a study published in the January 2010 issue of International Orthopaedics, 50 percent of all activity-related injuries are due to overuse, and the most common overuse issues are stress fractures and soft-tissue problems in the feet. For dancers, stress fractures often involve the shinbone or the ball of the foot—specifically the second or third metatarsal, which are among the five long foot bones located between the toes and ankle.

One of the biggest problems for dancers, however, is recognizing the warning signs before the injury escalates. “Dancers, like athletes, operate at higher pain thresholds and tend to wait longer than they should,” says podiatrist James Ludden. “They should be evaluated if they have a sudden onset of pain, or within a day or two if they complain of the symptoms. If you leave it unattended, you can get a through-and-through fracture.”

Unfortunately, diagnosis is often delayed because there is minimal swelling and physical examinations and X-rays are often inconclusive, according to the study, which examined 150 pre-professional ballet dancers for two years and followed 19 students with stress fractures. A bone scan or MRI may be necessary if X-rays fail to illuminate the cause of discomfort. The study found that “initially, the pain occurred only during activity and resolved with rest. Continuation of activity is associated with a progression of pain that becomes constant. This usually occurs 7 to 20 days after the first onset of pain.”

So what actions should you take to help students recover from and prevent stress fractures? Read on for tips on properly guiding injured students back into class and ways to help them prevent these fractures from the start.

Patience During Healing

Those most at-risk for developing stress fractures are girls ages 15 and older, and boys ages 18 and older, because their bones have matured. Depending on the student’s age, it can take four to five weeks of healing before the dancer can be (carefully) active again. Expect 8 to 10 weeks for full bone healing. If the fracture is severe, a physician may ban the dancer from any weight-bearing activity for eight weeks.

But this doesn’t mean that a dancer has to stay away from the studio. “They can come to class to learn the combinations from a static position, use their arms and backs and visualize performing the exercises,” says Batson. Ludden agrees: “They can work on their upper-body motions to keep themselves intact. For five or six weeks, I recommend light, weight-bearing activity before they are back to full swing.” This includes swimming, yoga, bicycling or limited class participation with no rélevés or jumps.

It’s also important for teachers to acknowledge the emotional impact an injury like this can cause, says Kathryn Daniels, dance department chair at Cornish College of the Arts in Seattle. “Injured dancers, particularly those experiencing their first injury, often don’t realize that the fear, anger and sadness they experience are normal,” she says. “I try to provide an empathetic ear so that they have an opportunity to talk about their emotions at this time of stress. I remind them that this is a temporary situation, and I encourage them to make it a time for learning and growing.”

When a dancer does get the OK to return to regular training, Daniels recommends conditioning and somatic classes to aid in recovery, as well as starting students at a lower-level class because it “serves the dual goal of diminishing physical demands while facilitating attention to good mechanics.” Batson adds that injured students should be under the guidance of a physical therapist throughout the course of healing, because “once you’ve had one stress fracture, your risk goes up for getting another one.”

Preventing the Injury

So, how do you make sure students safeguard themselves from stress fractures? First, consider whether there are sprung floors, which help absorb the shock and impact of jump landings. How many hours a week does the dancer train? Does the dancer have extremely high arches? If so, her risk for stress fractures increases, since high-arched dancers experience an unusual amount of stress on the ball of the foot, instep and heel, especially when landing from jumps.

“From a training standpoint, there is an amazing amount of high-impact repetition, especially from landing a jump over and over again,” Batson says. “A dancer should land to bring the heels down as close to the floor as possible, otherwise she is more likely to be injured.” Daniels agrees and says that it’s important to emphasize good mechanics to minimize the stress on any part of the body.

Reduce overuse by giving students an appropriate rest-to-activity ratio—for example, a 30-second rest between jump combinations—and alternate exercises, like going from a petite allegro to turns to jumps.

Teachers should also give students exercises that stretch the back of the leg and strengthen the front. “Most studios should have some sort of stretching board, where the dancer stands on an incline with the heel lower than the toes, feeling the stretch in the back of the legs,” says Batson. Thera-Bands can aid in strengthening the fronts of legs—loop the band around a sturdy object, put the band around the top of the foot and pull the foot and toes toward the body in a flexed position. (Place a bag of rice on top of the foot for added resistance.)

Poor nutrition also plays a role in stress fracture risk, as does a lack of dance-shoe support. Custom-made, sports-friendly, prescription orthotic inserts can help support the foot—even in the thinnest dance shoes. Another way to ensure dancers stay healthy is to encourage annual orthopedic screenings, writes Linda H. Hamilton in her book, The Dancer’s Way: The New York City Ballet Guide to Mind, Body, and Nutrition. With routine screenings, doctors can identify problem areas—before an injury occurs. DT

Hannah Maria Hayes is a freelance writer with an MA in dance education from New York University.

Photo copyright iStockphoto.com/carlo dapino

Music
Mary Malleney, courtesy Osato

In most classes, dancers are encouraged to count the music, and dance with it—emphasizing accents and letting the rhythm of a song guide them.

But Marissa Osato likes to give her students an unexpected challenge: to resist hitting the beats.

In her contemporary class at EDGE Performing Arts Center in Los Angeles (which is now closed, until they find a new space), she would often play heavy trap music. She'd encourage her students to find the contrast by moving in slow, fluid, circular patterns, daring them to explore the unobvious interpretation of the steady rhythms.


"I like to give dancers a phrase of music and choreography and have them reinterpret it," she says, "to be thinkers and creators and not just replicators."

Osato learned this approach—avoiding the natural temptation of the music always being the leader—while earning her MFA in choreography at California Institute of the Arts. "When I was collaborating with a composer for my thesis, he mentioned, 'You always count in eights. Why?'"

This forced Osato out of her creative comfort zone. "The choices I made, my use of music, and its correlation to the movement were put under a microscope," she says. "I learned to not always make the music the driving motive of my work," a habit she attributes to her competition studio training as a young dancer.

While an undergraduate at the University of California, Irvine, Osato first encountered modern dance. That discovery, along with her experience dancing in Boogiezone Inc.'s off-campus hip-hop company, BREED, co-founded by Elm Pizarro, inspired her own, blended style, combining modern and hip hop with jazz. While still in college, she began working with fellow UCI student Will Johnston, and co-founded the Boogiezone Contemporary Class with Pizarro, an affordable series of classes that brought top choreographers from Los Angeles to Orange County.

"We were trying to bring the hip-hop and contemporary communities together and keep creating work for our friends," says Osato, who has taught for West Coast Dance Explosion and choreographed for studios across the country.

In 2009, Osato, Johnston and Pizarro launched Entity Contemporary Dance, which she and Johnston direct. The company, now based in Los Angeles, won the 2017 Capezio A.C.E. Awards, and, in 2019, Osato was chosen for two choreographic residencies (Joffrey Ballet's Winning Works and the USC Kaufman New Movement Residency), and became a full-time associate professor of dance at Santa Monica College.

At SMC, Osato challenges her students—and herself—by incorporating a live percussionist, a luxury that's been on pause during the pandemic. She finds that live music brings a heightened sense of awareness to the room. "I didn't realize what I didn't have until I had it," Osato says. "Live music helps dancers embody weight and heaviness, being grounded into the floor." Instead of the music dictating the movement, they're a part of it.

Osato uses the musician as a collaborator who helps stir her creativity, in real time. "I'll say 'Give me something that's airy and ambient,' and the sounds inspire me," says Osato. She loves playing with tension and release dynamics, fall and recovery, and how those can enhance and digress from the sound.

"I can't wait to get back to the studio and have that again," she says.

Osato made Dance Teacher a Spotify playlist with some of her favorite songs for class—and told us about why she loves some of them.

"Get It Together," by India.Arie

"Her voice and lyrics hit my soul and ground me every time. Dream artist. My go-to recorded music in class is soul R&B. There's simplicity about it that I really connect with."

"Turn Your Lights Down Low," by Bob Marley + The Wailers, Lauryn Hill

"A classic. This song embodies that all-encompassing love and gets the whole room groovin'."

"Diamonds," by Johnnyswim

"This song's uplifting energy and drive is infectious! So much vulnerability, honesty and joy in their voices and instrumentation."

"There Will Be Time," by Mumford & Sons, Baaba Maal

"Mumford & Sons' music has always struck a deep chord within me. Their songs are simultaneously stripped-down and complex and feel transcendent."

"With The Love In My Heart," by Jacob Collier, Metropole Orkest, Jules Buckley

"Other than it being insanely energizing and cinematic, I love how challenging the irregular meter is!"

For Parents

Darrell Grand Moultrie teaches at a past Jacob's Pillow summer intensive. Photo Christopher Duggan, courtesy Jacob's Pillow

In the past 10 months, we've grown accustomed to helping our dancers navigate virtual school, classes and performances. And while brighter, more in-person days may be around the corner—or at least on the horizon—parents may be facing yet another hurdle to help our dancers through: virtual summer-intensive auditions.

In 2020, we learned that there are some unique advantages of virtual summer programs: the lack of travel (and therefore the reduced cost) and the increased access to classes led by top artists and teachers among them. And while summer 2021 may end up looking more familiar with in-person intensives, audition season will likely remain remote and over Zoom.

Of course, summer 2021 may not be back to in-person, and that uncertainty can be a hard pill to swallow. Here, Kate Linsley, a mom and academy principal of Nashville Ballet, as well as "J.R." Glover, The Dan & Carole Burack Director of The School at Jacob's Pillow, share their advice for this complicated process.

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Teachers Trending

From left: Anthony Crickmay, Courtesy Dance Theatre of Harlem Archives; Courtesy Ballethnic

It is the urgency of going in a week or two before opening night that Lydia Abarca Mitchell loves most about coaching. But in her role as Ballethnic Dance Company's rehearsal director, she's not just getting the troupe ready for the stage. Abarca Mitchell—no relation to Arthur Mitchell—was Mitchell's first prima ballerina when he founded Dance Theatre of Harlem with Karel Shook; through her coaching, Abarca Mitchell works to pass her mentor's legacy to the next generation.

"She has the same sensibility" as Arthur Mitchell, says Ballethnic co-artistic director Nena Gilreath. "She's very direct, all about the mission and the excellence, but very caring."

Ballethnic is based in East Point, a suburban city bordering Atlanta. In a metropolitan area with a history of racism and where funding is hard-won, it is crucial for the Black-led ballet company to present polished, professional productions. "Ms. Lydia" provides the "hard last eye" before the curtain opens in front of an audience.

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