Pain, Pain, Go Away

Help your students understand the risks of NSAIDS

If you look inside the dance bag of most of your teenaged students, among the shoes, bobby pins and warm-ups, you will likely find a bottle of over-the-counter painkillers. Many young dancers pop an Advil, Motrin or Aleve—types of nonsteroidal anti-inflammatory drugs (NSAIDs)—as a preventive measure before class, to relieve cramps or soreness after a day of rehearsing, or to mask symptoms of what could be a serious injury.

Dancers tend to take medicines like this because they reduce inflammation and pain. They will do anything to keep moving, says Lori von Alten, a physical therapist for Carolina Ballet and owner of Progress Physical Therapy, both in Raleigh, North Carolina. “Dancers are often afraid to go to the doctor because they don’t want to be told they have to rest or take a break.”

It’s crucial that students know that they can go to their teachers to seek advice when they are hurting, because they often don’t realize the importance of proper dosage or the risks of taking this kind of medication. While teachers should never prescribe medication, they can play the role of trusted advisor in helping dancers understand how to best deal with injuries and when turning to painkillers may not be wise.

WHAT ARE NSAIDS?

NSAIDs are a class of medications that includes ibuprofen (Advil, Motrin, Midol Liquid Gels), naproxen (Aleve, Midol Extended Relief) and salicylates (aspirin). These over-the-counter medicines work by stopping the body’s production of substances that cause pain, fever and inflammation, and they are used for reducing fever and relieving mild pain from headaches, muscle aches, arthritis, menstrual periods, the common cold, toothaches and backaches. NSAIDs are often the go-to pain reliever for dancers, who may not be aware of the potentially serious side effects, says Dr. Judith R. Peterson, clinical associate professor at Sanford School of Medicine at the University of South Dakota and author of Dance Medicine: Head to Toe: A Dancer’s Guide to Health.

“They may be over-the-counter, but that doesn’t mean they should be taken all the time,” Peterson says. “The reason they work is because they are powerful.”

 

WHAT ARE THE RISKS?

Some of the less serious side effects of ibuprofen and naproxen include constipation, diarrhea, gas, bloating, dizziness or ringing in the ears, according to PubMed, a National Institute of Health consumer website. And serious side effects include ulcers, bleeding or holes in the stomach or intestine, and a higher risk of having a heart attack or stroke. Taking the medicine on an empty stomach increases the risk of gastric effects.

Salicylates act slightly differently than ibuprofen and naproxen and carry less risk for adults. However, they can cause Reye’s syndrome (a serious condition where the liver and brain are injured) in children and teenagers, especially if they have a virus such as chicken pox or the flu.

“Any dancer taking NSAIDs [especially for more than two consecutive days] should let their pediatrician or general doctor know, and if a dancer is taking any other type of medication, there can be serious interactions,” Peterson says. Side effects may occur when combined with blood thinners, oral steroids or other NSAIDs, according to PubMed, and may include stomach pain, heartburn, vomit that is bloody or looks like coffee grounds, or black and tarry stools.

One of the most dangerous effects for a dancer who takes NSAIDs regularly is that they may make her unaware that an injury is getting worse, since she is continuously masking the symptoms. “If you’re taking these medications chronically to deal with or to mask pain, you likely have a serious injury that your doctor can help you get to the bottom of,” Peterson says. “Taking painkillers is not going to correct the issue. Just treating the symptom will make your underlying condition worse because you’re not really dealing with the cause of the problem.”

 

WHEN TO USE THEM

NSAIDs can be used to help with temporary pain such as muscle soreness, headaches or menstrual cramps. But overall, dancers should use them “as little as possible” because of the risks involved, Peterson says. While side effects can occur during short-term ingestion, daily long-term NSAIDs use greatly increases the risk. This is why it’s so important to follow the dosage instructions on the bottle. If a dancer feels that she needs a higher dose to effectively get the job done, she should always see a doctor for a prescription, as opposed to just taking more pills. And if a student needs them for more than two days in a row, it’s also an indication she should make an appointment to see her doctor.

Both Peterson and von Alten encourage using alternatives to NSAIDs whenever possible. If von Alten sees a dancer with a chronic injury that has flared up, she may suggest using NSAIDs for a few days to help reduce the inflammation. But for an acute injury, such as a sprain or strain, she recommends ice and rest. Acupuncture can be effective for pain management and reducing inflammation as well, von Alten says. “I will also suggest physical therapy with soft tissue work that might be impacting the area of injury, and I might recommend chiropractic treatment, too.”

Peterson is also “a fan of ice, stretching, solid attention to technique and making sure the student is talking to their teacher. Sometimes we underuse the simple things,” she says. DT

 

Hannah Maria Hayes is a freelance writer with an MA in dance education with an emphasis in American Ballet Theatre pedagogy from New York University.

 

photo ©iStockphoto/Michal Kowalski

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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