In the lead-up to competition season, "Again! From the top!!" can be overheard in studios across the nation. As students rehearse their routines ad nauseam in the final push to get ready, longer hours can sometimes mean that warm-ups get lost and increased repetition can create overuse injuries. Plus the extreme tricks and greater demands for flexibility can put stress on the joints and tendons of growing and adolescent bodies.
"In the dance industry, we are very used to releasing and stretching," says Dr. Alexis Sams, physical therapist and owner of AZ Dance Medicine Specialists. "But the key to injury prevention is matching mobility with stability. You are not going to get the results you want without doing the stabilizing work." While Dr. Sams does not recommend that students self-diagnose an injury and believes in the necessity of a professional assessment when a student reports pain, she has found that many overuse injuries can be prevented by strengthening the core and glute muscles, and sticking to a proper warm-up. Here are three common places where students report pain, what may be causing it, and the best exercises to address and prevent the injury.
Dancers are trained to think often about the range of motion, stability and power of their extended lines: the point of the foot, the reach of the penché, the explosion of the sauté in the air. But finding that same mix of flexibility and strength in the flexed foot is just as integral to technique and injury prevention. Without adequate dorsiflexion mobility, it is nearly impossible to find the kind of supple demi-plié needed to bound into the air and land safely.
Working as the physical therapist for the Atlanta Ballet, Amanda Blackmon often sees dancers who report hip pain, high hamstring strain or sacroiliac sensitivity and soreness. And while there are a host of reasons for such pains, including the often discussed gripped glute and hip flexor muscles, there is one overlooked culprit: dysfunction in the pelvic floor muscles. Though pelvic floor health has become a hot topic for women postpartum who often need to strengthen weakened and compromised muscles, there is a different set of concerns when it comes to athletes and dancers. "I often see a hypertonic pelvic floor," says Blackmon, "meaning the muscles are overactive or gripped and tight. Also, the obturator internus muscle is an external rotator that is also part of the pelvic floor. When that is gripped (particularly in turnout), it can refer pain to several places around the hip and high hamstring."
Dance students at Arts Umbrella in Vancouver, British Columbia, spend their first week at a remote camp overlooking the Pacific Ocean. The retreat, led by artistic director Artemis Gordon, prepares them to make the most of the next two years of this residential program that is intended to be a bridge between high school and a professional dance career.
Gordon facilitates the week with a boundless curiosity and a tendency to follow every big question with another, even bigger, question. Instead of starting right into their physical practice, Gordon prompts the group of 28 who've come from all over the world to think about such questions as: What is technique? How does artistry interface with technique and are they different or the same thing? Discussions tend to go deep and broad: What is the zeitgeist right now? Culturally speaking, what countries are doing/promoting what? How do economics and politics affect our daily conditions as artists?
In essence, Gordon's organizing principle for her program is to embody the answer to one very poignant question about the future of the art and profession of dance: "What world do we think we are going into and what skills do we need to prepare for that world?"
When ballet star David Hallberg sought out the medical team at The Australian Ballet to help him recover from his ankle surgeries, one of the things rehabilitation specialist Megan Connelly had him learn was to jump from his hips. By doing so, he learned to put less stress on his lower legs and feet and access the powerhouse group of muscles surrounding the hips, most commonly referred to as the glutes. While many parts of his rehab were particular to him, understanding how to properly engage the glutes is something many professional and pre-professional dancers can stand to gain from.
The human head weighs somewhere between 8 and 12 pounds. For many of us, our youngest students included, that comparatively large weight spends on average at least a couple hours a day hunched over a screen. While you may not consider your students as average, there is no denying we spend more hours than ever looking down at handheld mobile devices. "I think of it as 'tech posture,'" says Blossom Leilani Crawford of Bridge Pilates, "when the head is forward and the shoulders are forward. People don't know where their heads are anymore, and you certainly can't turn well with the weight of your head forward."
Forward head posture seems to be the very antithesis of the open chest, lifted spine and presentational sensibility of most classical dance training. But beyond the aesthetics, this misalignment can affect balance and coordination in developing dancers and, at the extreme end, can be associated with nerve damage and pain down the arm.
According to Dr. Marshall Hagins, physical therapist for the Mark Morris Dance Group, there are really two things going on when you see forward head posture. First, the skull is projected forward in front of the body (as in when we look down at a phone). But then, because we are social creatures who want to see and interact with the world in front of us, the head rotates backward on the spine, thrusting the chin up and out. "The muscles in the front of the neck are short and relaxed," he explains, "while the muscles in the back, which are keeping the head from falling further, are lengthened and overworking." The neck muscles have a very high density of proprioceptors and the nervous system feedback is working to fight gravity all of the time, all of which can result in a levator scapulae that is overused and painful.
Hagins offers a tent analogy for balancing the head in three dimensions without simply resorting to a military posture. "All the surrounding neck muscles need to have just the right amount of tension to keep a heavy object, such as the head, balanced atop the tent pole of your spine," he says. "When it leans one way, the corresponding wire becomes loose and the other wires have to pull harder." He notes that it can still be possible for dancers to move in and out of the proper positions even if the resting posture is slouched. However, assuming such a posture for most of the day can lead to injury.
The phenomenon has caused Crawford to modify the abdominal exercises in her mat class. "I sometimes ask for the head to stay on the floor for the single-leg stretch or double-leg stretch," she says. "I call it 'angry turtle' when you work to draw the back of your head into the floor. Once that is understood, it is easier to transfer into lifting the head off the ground properly."
However, both Hagins and Crawford caution that dancers are often hypermobile and prone to overcorrecting, so it is important to focus on good postural habits and incremental changes so they don't move from one misalignment of the head and neck to another. Here are three simple exercises Crawford uses to help students find and feel where proper head alignment is in different planes of movement. They are great on their own, in any warm-up, or can be easily sprinkled into a Pilates mat routine.
Supine Head Float
Elena Prisco, age 17, student at Lake Tahoe Dance Collective. Photos courtesy of Thompson
1. Lie on your back, knees bent and feet planted, with a yoga block, or prop of similar height, under the shoulder blades. Let your head rest back into this big, chest-opening stretch, with your fingers interlaced, hands behind your neck so that your pinky fingers are against the base of your skull.
2. Float your head up to spine level, chin tucked in, hands helping to
traction your neck long. Use exhales to activate the abdominals and keep ribs heavy and soft while your head is up. Hold for a few counts and then rest back into the stretch.
3. Repeat several times, being careful not to let the chin jut forward.
*If you are ready for more, float the pelvis up to spine level along with the head. Keep the pelvis in a neutral, untucked position.
For Colette Krogol and Matt Reeves, artistic directors of Orange Grove Dance and adjunct professors at George Washington University, cooking dinner each night is an extension of their collaborative, creative partnership. While the married couple uses this time to unwind from their busy lives, the conversation often returns to their work together, whether it be their newest project, most recent class or simply items left lingering on the to-do list. "Matt anchors it by cooking main courses, and I'm swirling around figuring out side dishes, condiments, drinks and feeding the dog," says Krogol. "Come to think of it, this anchor and swirling connects to many points in our lives in regards to our dancing, creative process, administrative tasks, chores…even our social life."
DT caught Xiomara Reyes in early October, just a few weeks into her new job as head of The Washington School of Ballet in Washington, DC. The former American Ballet Theatre principal dancer had recently relocated from New York City with her husband Rinat Imaev, and immediately begun working long days and nights in an effort to get to know the institution better.
Asked about her future plans, she graciously admitted that she had yet to see how the budget might allow for certain changes and was still a few days away from the first meeting of the board. She was already formulating plans, though, likening the experience of learning on the job to getting comfortable with a new ballet. "Right now, I see a problem, and I just try to solve it," she says. "But I look forward to the moment when I can begin to walk through it, and maybe a year from now, when I have learned more, I will eventually have more control over all of the steps."