Health & Body
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Dance is an art form that requires the whole self. You've likely witnessed a talented, hardworking student inexplicably hit a block or fail to perform their best when the stakes are high. No matter how hard they work physically, getting to the next level will be an inefficient struggle until the mind becomes a more active and effective partner.

The practice of mindfulness can help. "There is a concept called 'participating' or 'flow,' in which a person is able to throw themselves completely into an activity with awareness and control but without actively focusing their attention on themselves or analyzing the details of what they are doing," says Catherine Drury, a psychotherapist and licensed clinical social worker who specializes in working with dancers. "That ability to enter wholly into movement without judgment or self-consciousness is what allows dancers to perform at their peak."

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Health & Body
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Just when young dancers need oxygen the most—during a challenging balance or speedy petit allégro—it often seems they instinctively hold their breaths. Sometimes this happens as a reaction to stress; other times it might simply result from a constant sucking in of the waistline. No matter, it is an important habit for dance teachers to break.

"Dancers do not want their bellies sticking out, so most of them never breathe deeply enough and only take very shallow breaths into their upper rib cage," explains Marika Molnar, founder of Westside Dance Physical Therapy. "This reduces the amount of oxygen that gets into the blood to nourish the working muscles." Limiting the breath can also bring aesthetic and functional issues, from appearing stiff or uncoordinated to experiencing fatigue and exhaustion from not getting enough oxygen to your working muscles. In order to start coaching a deeper breath or diaphragmatic breath, it is necessary to help students understand the muscles at work with every inhale and exhale. While much time is spent having dancers work on their core, most often the abdominals are the focus and the topmost muscle is ignored: the diaphragm. The diaphragm is best described as a thin, dome-like muscle that acts as a partition separating the thoracic cavity, or chest, from the abdomen.

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Health & Body
Photo courtesy of Schaeffer

Picture the knee joint as a crowded intersection in a busy city, with people and cars moving through it: up and down, from side to side. When this junction is flowing smoothly, traffic is a breeze and it is easy to get to where you need to be. But when there is an accident or stalled vehicle anywhere linked to the crossing, your route is derailed.

"The knee doesn't work in isolation," says Marissa Schaeffer, a physical therapist at Alvin Ailey American Dance Theater in New York City. "It is constantly affected by forces above and below."

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Teaching Tips
Physical therapist Meredith Butulis in action. Photo courtesy of Twin Cities Orthopedics

After a long tennis match or a basketball game, elite athletes often head straight to the locker room and hit the exercise bike. On first thought, this might seem to be overtraining, but in fact, they are pedaling as a way to cool down properly.

"All of our blood vessels get dilated and blood goes out to muscles when we are doing cardiovascular work," says Meredith Butulis, a physical therapist specializing in dance medicine. "The blood goes mostly to the leg muscles, and blood pooling there is a real phenomenon. If your blood doesn't get back to the heart and brain, you can pass out."

She goes on to explain there are two ways to recover from an intense workout: actively, using a low-intensity movement to gradually bring the heart rate down, or passively, with no activity at all. The latter requires little explanation—how many times have you seen a dancer do a run-through and follow it up by sitting down on the side of the studio in a static stretch? But for many reasons, including the real possibility of blood pooling that Butulis describes, a passive recovery is not the best choice for dancers.

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Photo by Scott Shaw, courtesy of Williams

Have you ever looked at a student's posture and said: "Close your ribs" or "Don't grip your glutes" or "Use your abdominals more"? While that pinpointed correction may or may not have achieved the desired results in the moment, such phrases naturally raise a bigger question: "But how?"

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Health & Body
Tension in the legs is related to core weakness. Photo courtesy of AZ Dance Medicine Specialists

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.

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Health & Body
Adequate dorsiflexion mobility is needed to find a supple demi-plié needed to bound into the air and land safely. Getty Images

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.

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Health & Body
Ashley Wegman, Atlanta Ballet; courtesy of the author

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."

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