Dancer Health

Pelvic Floor Dysfunction: This Major Muscle System Doesn't Get Enough Respect

"We think as dancers, 'Oh my gosh, if this thing isn't working hard enough, I have to work it harder.' In order for these muscles to work, they have to have a chance to relax, too." –Kathryn Maykish

As deeply familiar as dancers are with their bodies, there's one muscle group that can remain mysterious. You can't see it, and it can be tough to access, but the pelvic floor serves a major role in your posture and body function. Dancers and other athletes are more prone than the general population to dysfunction of the pelvic floor, and this can have major ramifications in dance and life.


The Anatomy

The pelvic floor is an interconnected series of about two dozen muscles that form a horizontal hammock (or sling) inside the pelvis. It anchors to the pubic bone in the front and the coccyx in back, as well as several points around the inside of the pelvis. The urethra, the opening of the rectum and the vagina pass through the pelvic floor. The bladder, colon, uterus, digestive organs and even the lungs and heart are supported from below by this sheet of muscle. Its contracting and relaxing control important functions, like going to the bathroom or holding it in, giving birth and enjoying sex.

Potential Problems

When dancers repeat high-intensity activities like jumping, the impact of landing stresses the muscles of the pelvic floor over and over again. Improper technique can make this worse. Dancers can ease the impact by rolling through the feet, ankles and legs into a plié.

Dancers can be dysfunctional breathers, says dancer, yoga instructor and doctor of physical therapy Kathryn Maykish. They overly tense their abs and fill the upper chest with air when they breathe, rather than allowing the stomach to expand on an inhale. As the chest pulls up, the pelvic floor comes up with it, keeping the muscles from fully releasing.

It's also common for dancers to compensate for overworked or weak abs, back, hips and inner thighs by squeezing or tightening the pelvic floor without even realizing it. Interestingly, because of the close connection between these muscles, pelvic floor dysfunction can sometimes play a role in lower-back pain, anterior hip pain and other issues or injuries in the groin and pelvis area.

Tight vs. Weak

There are two main kinds of pelvic floor dysfunction. One involves muscles that are too weak, which can cause incontinence: bladder or bowel leakage. Incontinence can show up as a sudden urge to use the bathroom that you just can't control in time. Or, you might experience a little leakage when you cough, laugh or land from a jump. Maykish says dancers may not realize that it's a health concern if they leak a little during petit allégro. "If you have a student who's always running to the bathroom before jumping," she says, "it's worth having a conversation."

The other type of dysfunction is when muscles are too tight. (And yes, it's possible to experience both types at once—tension doesn't necessarily mean the muscles are strong.) Dancers may feel the frequent extreme urge to pee—as much as 10 times a day or more—but only a little comes out. Tension in the pelvic floor can also make it difficult to use a tampon and cause pain during gynecological exams or sex. Or a dancer may feel a pain deep inside their pelvis that seems like hip pain, but they can't quite point to it.

Solutions

If you're seeing early signs of muscle weakness, practice gently engaging your pelvic floor when you land jumps. "It's not all about a squeeze," Maykish says. "It should be a gentle lifting sensation, like tightening up the ends of that hammock."

Practice Kegels, too, if incontinence is a concern. Don't overdo it, though, or you can wind up with the other problem—tension. "The common thing we think as dancers is, 'Oh my gosh, if this thing isn't working hard enough, I have to go work it harder,'" Maykish says. "In order for these muscles to work, they have to have a chance to relax, too." Engaging the muscles continuously won't make them stronger. Stretching with hip openers is helpful for both weakness and tightness. Consider seeing a professional, especially if symptoms change or worsen.

What to Expect With Treatment

A licensed PT with certifications in pelvic floor therapies can help you identify what exercises you need. The clinician should have a private room for pelvic floor therapy, and allow an adult to accompany a minor inside. They should always ask for permission before they do an internal exam and wear gloves for it. People can be a little apprehensive about pelvic floor therapy, Maykish says, but a good clinician will prioritize the patient's comfort. "Always my patient is in charge and can direct the exam," she says. An internal exam by a PT does not involve stirrups or speculum; just one gloved finger inserted into the vagina to feel for the muscles of the pelvic floor. "The therapist will go systematically to test the strength and range of motion of the muscles." They should be looking for the patient's feedback, and back off if something feels too uncomfortable. "I think most patients find their fear or anxiety about the exam is bigger than how it actually goes."

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My high school dance teacher was smart. Knowing that she did not have the time to mold us into technically proficient dancers, she introduced us to the craft and skill of making dances. I spent four years opening the door to my creative voice, becoming a confident choreographer. As a dance major in college, however, I quickly realized I was lacking something very important: actual dance training. So I began an intense regimen of studying, analyzing, copying, stealing and emulating every movement language, quality and nuance with which I could connect. Later, I completed a master's degree in choreography and choreological studies, formed a small dance company and set out to fund my artist's life with teaching.

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Valentina Bagala and Rafael Savino held their studio's very first registration at a Subway. "We didn't even have an office," says Bagala, who heads the artistic side of Ascendance Studio in Doral, Florida. "This lady called us over the phone, and we said, 'OK, we can take your registration. Would you mind meeting us at the Subway that's downstairs from our studio?'"

Now, five years later, Ascendance is thriving, with a growing competitive team, a 5,000-square-foot space and 300 students—one of whom is the same dancer who was registered in that Subway. Today, registration mostly happens online, as do many of Ascendance's processes—attendance, billing, e-mail marketing campaigns—thanks to Savino, who heads the studio's marketing, finances and administration. To what do Bagala and Savino credit their impressive growth? Digital advertising. Despite working in an industry where many still rely on old-school methods of operation—manual registration, tuition paid in person by cash or check, fliers handed out in parking lots—they took the plunge to modernize their advertising strategy and found it a game changer for their studio.

Slow, but consistent

Bagala and Savino admit Ascendance got off to a rocky start. They rented space from a fitness studio for three months. "We didn't get the best schedule," says Bagala, who could only rent the space by the hour when it wasn't being used. Still, she managed to amass 25 students. Eventually, she found a small, 550-square-foot space of her own in a shopping center. "I remember for our first classes, we would have people who were supposed to show up but didn't," says Savino. "If we had one student in class, we had to teach to that student. That happened multiple times."

When two more spaces became available in the same shopping center, the couple grabbed them, despite the inconvenience of the units not being connected. "You had to step outside," says Bagala. "It wasn't very comfortable."

"The fliers weren't working."

With more space came more responsibility—to increase enrollment. They had been passing out fliers at nearby schools, but that approach, Savino says, "became unscalable. That's when I started looking at digital advertising." He didn't have much money to spend on it—his budget was $5/day—but he began looking into advertising on Google. He also enrolled in a local digital marketing course at nearby Miami-Dade College. "That gave me strategy," he says.

His most successful venture has been with Google's AdWords. With this advertising strategy, business owners create a search ad. (Search ads appear above Google search results when people look for local services the business offers.) The Ascendance search ad, for example, includes the studio website and phone number, plus: "Dance classes for kids. All ages and styles. Try a free class today." Then, you choose keywords—the words or phrases potential customers might type into their browser—and set a daily budget for how much you'd like to "bid" on each keyword. You're charged only if users click your link. During his first AdWords campaign, Savino often bid less than $1 on keywords like "ballet classes," "hip-hop classes," "jazz" and "dance studio."

How much you bid affects in what order your search ad appears among other businesses. But a business with more money to spend on keywords won't automatically see their ad pop up first. Multiple factors—keyword bidding price, how long a user stays on your website, your click-through rate—determine what's called your quality score. And it's your quality score, ultimately, that decides in what order your ad appears on Google.

"For example, let's say there's a huge competitor who's bidding $10 a keyword, while I'm only bidding $1," says Savino. "Google is tracking everything. If users stay on my website for a while and don't click the back button to get back to the search page, Google knows my website is relevant and a good experience." That increases his quality score and gives his search ad odds a boost.

Experimenting, wisely

Savino ran his initial AdWords campaign for about a month in 2013, starting in mid-September—prime back-to-school time. Each week, he wound up getting 10-plus interested customers. He offered each a free trial class. Of that weekly number, more than 80 percent enrolled in classes. By the time the campaign was over, Ascendance had 45 new students. And it all cost him less than $150. Though he risked spending more than his daily allotted $5, he knew it would pay off in increased enrollment.

As they became more comfortable with AdWords, the couple experimented. Bagala asked her mom what words she would use to search if, for example, she were looking for ballet classes for a 5-year-old. Her responses became part of their strategy: "ballet classes in Doral," "dance classes in Doral," "dance studio in Doral." They also interviewed parents of new students, asking 'How did you hear about us?' "If they said, 'Google,'" says Savino, "we'd ask if they remembered what they typed."

Now his daily budget is $20, though he's careful to time campaigns with high-enrollment periods. "During back-to-school season, August and September, I know a lot of people are going to be looking for classes," he says. "But I also know that January is another high-enrollment period—that's when we see an uptick in our baby program. Those moms are operating on a calendar year, not a studio year."

When Google came to town

Last spring, Google itself took an interest in Ascendance, and it featured Savino and Bagala in a national video campaign as a small-business case study. Of particular interest was the studio's dual advertising campaigns: one in English and one in Spanish. Savino and Bagala are bilingual, and their community is largely Spanish-speaking—so they capitalized on that. "Since we were advertising in Spanish," says Savino, "those people were sure that they were going to come through our door and someone would be here who would speak their language."

Of course, digital advertising can only take a studio so far. You have to follow through with a great product—and that, Savino says, is Valentina's greatest contribution to the business. "At the end of the day, if the product isn't good, people are simply going to leave," he says. "She's the heartbeat of the studio."

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