Dancer Health
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It's time to talk seriously about safety in dance education. As the physical and psychological demands put on student dancers escalates—thanks to competitions, social media and ever-evolving choreography—there is a pressing need to consider how we can successfully safeguard young dancers.

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Dancer Health
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Q: Two years ago, one of my dancers fractured her ankle and was out for six months. Upon her return, I cautiously allowed her to take pointe class, but treated her as if she was a beginner, because she was rolling out into supination, and I was fearful she would reinjure her ankle. Her mother feels I have held her back and changed to another studio. Did I make the right choice?

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Is chiropractic a long-term solution or just a quick fix?

When Richmond Ballet dancer Cecile Tuzii was a student, she repeatedly injured the same ankle and couldn’t find a solution. A friend suggested she see a chiropractor, who discovered that her lower back and sacrum were misaligned, putting stress on her ankle joints. After regular treatments, she finally found relief. Now, she regularly sees a chiropractor to maintain her body and identify causes of inflammation. “I probably owe my long career to chiropractic, because it’s taken care of me and prevented injury,” says Tuzii. “I prefer going to the chiropractor over taking pills.”

Dancers often favor holistic treatments to prevent and heal injuries. Chiropractic is a drug-free, hands-on option that could potentially help avoid more drastic measures, like surgery. While some medical professionals question its effectiveness (the practice was invented in the late 1800s by magnetic, metaphysical healer Daniel David Palmer), many dancers find it helps correct their alignment issues and identifies sources of pain.

Treatment

Chiropractors are specialists in how the bones and muscles connect and relate to each other. The goal is to balance the body’s alignment, evening out the weight put on joints. Much of this is done to resolve small issues before they become a bigger problem. “When a dancer comes in, they may have pain on the outside of their left knee,” says chiropractor Joshua Cohen, who works with Pittsburgh Ballet Theatre dancers. But the discomfort, for instance, may be coming from a strained muscle in the hip. “Just because the knee is where they feel the pain, it doesn’t mean that’s where it’s coming from,” he adds.

Chiropractors will perform a series of manual adjustments to increase range of motion and release the affected muscles and joints. Most will use multiple methods of care within the same visit. Diversified Technique is one of the more common adjustment methods. During treatment, the chiropractor applies sudden pressure to the joints to help restore proper movement and alignment. (Sometimes, this manipulation releases gasses in the joint, creating the cracking often associated with the practice.) Other methods include Thompson Technique, which uses a special table that increases the force of the adjustments to a specific area, and Directional Non-Force Technique, in which the practitioner applies a softer touch that does not cause joints to crack.

Chiropractic helped Richmond Ballet dancer Cecile
Tuzii’s ankle.

Cohen practices Nimmo, or trigger point therapy, which can help treat injuries like tendinitis, arthritis and strained, sprained or pulled muscles. “Trigger points are localized areas of muscle spasm. When a muscle gets overused, it gets tighter and tighter until it tears on a microscopic level,” he says. By applying pressure to these points, blood flow is temporarily stopped, and when he releases pressure, Cohen says, “It allows fresh blood to rush in and wash away a lot of the inflammation.”

A Controversial Craft

Critics of chiropractic argue that the method is not a solution for injury. “Chiropractic is a temporary fix. Nothing is permanent,” says Cohen. Overuse injuries like arthritis can’t be cured, but a chiropractor may help manage them. Jennifer Green, a physical therapist at PhysioArts in New York City, is most concerned that dancers regularly seeing any kind of practitioner are trying to find a quick fix for their pain, instead of looking for the root of their problem, which is often tied to their technique. She concedes that chiropractic care may help some dancers. “Preventive care would likely include manual treatments, but also active treatments such as strengthening, stretching, technique modification, etc.,” she says. “Some respond better to massage, some to PT, some to chiropractic and some to acupuncture.” Ultimately, the dancer is the best judge. For Tuzii, working with a chiropractor helped her realize how her body parts worked together to achieve proper alignment. “I learned much more about my body,” she says. “It taught me that my work at the barre and in the center had to change.” DT

Kathleen McGuire is a former dancer. She also writes for Dance Magazine and Pointe.

Know Before You Go

Finding a doctor: Chiropractor Joshua Cohen says, to find a trusted practitioner, ask peers or your regular doctor for a referral and look at patient reviews online. To find someone in your area, he suggests chirodirectory.com.
Cost: Most major insurance carriers cover at least a portion of the fee. If uninsured, treatment often costs $50–$150 per visit.
Scheduling: Chiropractic treatment usually takes 15–20 minutes. With active patients like dancers, Cohen suggests going once or twice every week. Tuzii visits hers about once a month on her day off from dance. Chiropractic care is often an ongoing process requiring regular appointments.
What to wear: Cohen suggests wearing loose-fitting, thin clothing, so your chiropractor can feel the muscles.

Photos from top: ©iStockphoto.com; photo by Sarah Ferguson, courtesy of Richmond Ballet

Understanding which to use for injury

Heating pads, cold baths, ice packs. With all the options for treating injuries, it can be difficult to decide which will lead to the quickest recovery. You know that using one or the other can help the body heal faster, but in a moment of panic, which should you reach for?

The moments immediately following an injury are crucial, because recovery will be faster if the area is properly treated within the first 24 hours. Acute injuries, or single-event injuries that occur suddenly, call for immediate icing, while smaller aches and pains, like muscle soreness, can benefit from alternating treatments. “Ice can be used to reduce inflammation or help prevent soreness,” says physical therapist Trina Bellendir, who has worked with Ballet West. “But if the muscle actually feels strained or is in spasm, heat can get it moving better before you start dancing.”

It can be dangerous, though, if you’re not sure which and when to apply. For instance, if heat, not ice, is used immediately after an ankle sprain, it will actually send blood to the area, increasing the swelling. “When in doubt,” says Broadway physical therapist Sarah Bigham, “always use ice.” In the chart, she and Bellendir outline when and how to use ice or heat on an injury. DT

Below are basic guidelines for using heat and ice. Note that heat should only be used in alternating treatment with ice—it is not a standalone option.

ICE HEAT
What it does: After injury, the body sends blood to the area, causing it to swell. Ice reduces inflammation by slowing the blood flow. It also reduces pain, numbing the area. Increases the blood flow to increase mobility and help the bloodstream deliver nutrients during recovery.
What it’s for: Acute injuries, like sprains and dislocations, and chronic injuries, like tendonitis. It also helps prevent inflammation or soreness from overuse, as well as bruising. Pulled muscles or muscles that are stiff, strained or in spasm, and tight tendons. It can also be used on joint problems, like arthritis.
When to apply it: For an acute injury, “the first 24 to 72 hours is the most important time to use ice, because it’s your best anti-inflammatory,” says Bigham. If used to prevent soreness, wait until after your body has cooled down. Do not ice within an hour of dancing. For muscle or tendon strain, use before dancing to increase circulation. “It is not something to use immediately after injury,” says Bigham. If you’re using heat for recovery, wait at least 48 hours after the injury occurred.
Frequency and duration: Ice for 10 minutes, once every hour until the swelling reduces. The body part should return to its normal temperature between treatments. For 10 minutes or until the area feels warm. Heat should not be left on for more than 20 minutes at a time.

Common mistakes: “Leaving ice on longer than 20 minutes will actually send more blood to the area,” says Bigham. Also make sure you put something between the skin and ice pack to prevent frostbite. “A heating pad doesn’t substitute for a proper warm-up,” says Bigham. “I’ve had dancers sit on them and think they’re ready for performance.”

The Goods

Ice is a must-have. “We use crushed ice,” says physical therapist Trina Bellendir. “It’s my favorite because it distributes the cooling evenly.” A pack of frozen peas works similarly.

Activate instant ice packs by squeezing them—they don’t require a freezer.

Cervical ice packs “can be molded to fit around joints, like the ankle or knee,” says physical therapist Sarah Bigham, who treats Broadway dancers.

Freeze water in Dixie cups for a great ice massage. Bigham warns to “keep the ice moving so that it doesn’t cause a skin burn.”

Pillowcases are “great to wrap around the ice pack, because they’re not as thick as towels,” says Bigham.

With heating pads, you control the temperature. Do not use them at night when sleeping. “I’ve had patients actually fall asleep with them on. That can cause a burn,” says Bigham.

Hot packs come in disposable versions for germ-free first aid.

Washcloths can absorb heat and act as a buffer. “Throw a moist towel in the microwave, and then wrap it in a dry towel before applying, to keep students from burning themselves,” says Bellendir.

 

 

 

 

Photos ©iStockphoto.com

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