The Female Athlete Triad is a condition that includes three components:
– Low bone density (risk for stress fractures and osteoporosis)
– Disordered eating
– Amenorrhea (no menstrual cycle for three months or more)
(Matzkin et al., 2015).
The consequences of the Female Athlete Triad can be long-term and irreversible, and include stunting of growth, reproductive dysfunction, and osteoporosis. Any female athlete is at risk for this syndrome, but women who participate in dance are more susceptible because of the desired lean aesthetic and rigorous training schedule (Barrack et al., 2014). Peak bone density is achieved between ages 18 to 25 years. Poor nutrition (i.e., insufficient calories, calcium and vitamin D), stress, and intense training lead to hormonal disruption during the peak-forming period. Reduced estrogen production leads to bone resorption, and this can occur despite the fact that load-bearing physical activity such as dance usually improves bone-mineral density. Some female athletes have bone density similar to older postmenopausal women, which is dangerously low. One study reported that 80% of female dancers diagnosed with stress fractures of the second metatarsal started their menstrual period late (O’Malley, 1996). This type of bony injury requires at least 6-8 weeks to heal and even longer to rehab.
The remedy for Female Athlete Triad requires that energy needs be met consistently, either by modifying diet or reducing exercise. If body fat is inadequate, restoring body weight to a healthy level is the best strategy for normalizing menstrual periods and improving bone health.
Stress fractures occur in up to 46% of dancers during their career (Delegete, A). Over 60% of these fractures occur during puberty. Decreased strength, proprioception, and balance control, as well as poor technique can lead to increased stress to the bones and thus increased risk for stress fracture. Females are twice as likely than males to have a stress fracture secondary to caloric restriction, reduced bone mineral density, and menstrual irregularities (Delegete, A).
Rehabbing a stress fracture can involve complete rest for 6 to 10 weeks. It is important to recognize possible signs and risk factors to avoid bone damage.
1) Delegete, A. Health Considerations for the Adolescent Dancer. A webinar through the Harkness Center for Dance Injuries. Accessed September 23, 2018.
2)Weiss, David S. Stress Fractures in Dancers: Evaluation and Treatment. A webinar through the Harkness Center for Dance Injuries. Accessed November 11, 2018.
Looking and performing your best for auditions should not involve suffering or engaging in crash diets. Obtaining ideal body composition may require you to be more aware of the quality and quantity of your food choices as well as the intensity of your training regimen.
Some simple suggestions for staying lean include:
Remember, don’t be intimidated by other dancers or their bodies - focus on doing your best and shining in areas you excel at! Allow nutrition to help fuel you during the audition season - you need adequate food fuel to provide energy, build strength, and maintain a healthy immune system.
Strength, precision, and artistry set you apart at an audition. Optimal nourishment and rest is important. Audition at your best by staying in peak shape with these helpful tips.
Before audition day:
Skills to focus on during your audition:
Koutedakis, Y. (2000). " Burnout” in Dance: the physiological viewpoint.
Koutedakis, Y., & Jamurtas, A. (2004). The dancer as a performing athlete. Sports Medicine, 34(10), 651-661.
Homemade chicken noodle soup made in the crock pot for a set-it-and-forget-it easy dinner. You can evan prep all the ingredients ahead of time and store them in the freezer to pull out on a day where you forgot to plan dinner. Just make sure you thaw the ingredients before adding it to the slow cooker to prevent it from staying at an unsafe temperature for too long.
8 ounces whole-wheat egg noodles or other whole-wheat noodles
3 pounds bone-in chicken breast, skin removed
2 cups chopped onion
1 cup chopped carrot
1 cup chopped celery
2 sprigs thyme
8 cups low-sodium chicken broth
2 teaspoons kosher salt
2 cups frozen peas
¼ cup chopped fresh dill, plus more for garnish
2 tablespoons lemon juice
The adolescent dancer faces unique challenges due to physical and emotional changes that occur during pubertal development. Rapid growth periods can lead to reduced strength, impaired balance, and decreased flexibility, which can alter technical ability and increase the risk of injury.
Growth spurts in dancers usually occur between the ages 11-15 in girls and 13-17 in boys, and can last up to two years (IADMS 2000). As height increases, weight gain also occurs. A girl’s menstrual cycle begins during these growth phases and is essential for formation of bone. The pressure to stay thin during periods of weight gain in addition to being unaware of/ignoring nutritional needs results in an energy deficit and increases the likelihood of irregular periods (Delegate 2018). Bones grow at a faster rate than muscles and tendons, and limbs grow at a faster rate than the trunk. This affects strength, flexibility, and balance control in dancers. These changes can make movement feel awkward and may affect your ability to perform at the level that you are used to. Don’t be discouraged, these changes are temporary!
The injury rate increases by 35% as dancers reach ages 14-16. Body regions most commonly affected are the foot/ankle, lumbar spine, hips, and knees (Steinberg 2012, Delegate 2018).
Common injury types in adolescents:
REDUCING INJURY RISK DURING GROWTH CHANGES:
1)Education Committee (Kathryn Daniels, Chair). International Association for Dance Medicine & Science. November 2000 https://www.iadms.org/page/1
2) Delegete, A. Health Considerations for the Adolescent Dancer. A webinar through the Harkness Center for Dance Injuries. Accessed September 23, 2018.
3) Steinberg, N., Siev-Ner, I., Peleg, S., Dar, G., Masharawi, Y., Zeev, A., & Hershkovitz, I. (2012). Extrinsic and intrinsic risk factors associated with injuries in young dancers aged 8–16 years. Journal of sports sciences, 30(5), 485-495.
4) Steinberg, N., Siev-Ner, I., Peleg, S., Dar, G., Masharawi, Y., Zeev, A., & Hershkovitz, I. (2013). Injuries in female dancers aged 8 to 16 years. Journal of athletic training, 48(1), 118-123.
The immune system provides protection from seasonal illness such as the common cold as well as other health problems including arthritis, allergies, abnormal cell development and cancers. Dancers are exposed to physical stress from training, which increases susceptibility to illness. Additionally, working in close proximity with other dancers increases exposure to infection. Nutrition plays an important role in maintaining immune function to protect against infection. Learn how to boost your immunity by including these nutrients in your eating plan.
Proteins form many immune cells and transporters. Try to consume a variety of protein foods including seafood, lean meat, poultry, eggs, beans and peas, soy products and unsalted nuts and seeds.
Vitamin A helps regulate immune function and protects from infections by maintaining healthy tissues in skin, mouth, stomach, intestines and respiratory system. Vitamin A is found in foods such as sweet potatoes, carrots, kale, spinach, red bell peppers, apricots, eggs or foods labeled "vitamin A fortified," such as cereal or dairy foods.
Vitamin E works as an antioxidant to neutralize free radicals. Include vitamin E in your diet with fortified cereals, sunflower seeds, almonds, vegetable oils (such as sunflower or safflower oil), hazelnuts and peanut butter.
Vitamin C protects stimulates the formation of antibodies, which are necessary to fight infection. Citrus fruits such as oranges, grapefruit and tangerines, red bell pepper, papaya, strawberries, and tomato juice are good sources of vitamin C.
Zinc is critical for wound healing and aids the immune system. This mineral can be found in lean meat, poultry, seafood, milk, whole grain products, beans, seeds and nuts.
Other nutrients, including vitamin B6, folate, selenium, iron, as well as prebiotics and probiotics, may also influence immune response.
Academy of Nutrition and Dietetics (2017). Protect Your Health with Immune-Boosting Nutrition. Retrieved at eatright.org.
Probiotics are beneficial bacteria that exist in our gastrointestinal tract. Prebiotics feed the beneficial bacterial colonies and work synergistically with probiotics. In other words, prebiotics nourish and maintain probiotics, which restores and improves gut health. Probiotic sources include yogurt, kimchi, sauerkraut, miso, tempeh and cultured non-dairy yogurts. Some good sources of prebiotics are bananas, onions, garlic, leeks, asparagus, artichokes, soybeans and whole-wheat foods. Products that combine both are called synbiotics. For best results, try combining pre- and probiotics in your usual diet by enjoying bananas with yogurt or stir-frying asparagus with tempeh.
Are probiotic supplements necessary for everyone? Probably not. In fact, there are risks associated with use of probiotic supplements. These include: systemic infections, metabolic disruption, excessive immune stimulation in compromised individuals, gene transfer, and gastrointestinal side effects (Doron & Syndman, 2015). By consuming regular food sources of probiotics, you can safely maintain the integrity of your gut and avoid disrupting your body's natural microbiome. At a minimum, prebiotics and probiotics are keys for optimal gut health. Research indicates that the gut bacterial environment has implications beyond digestive health. The microbiome may impact weight management and risk of central nervous system diseases (Shreiner et al., 2015). Incorporating health-promoting functional foods, such as foods containing prebiotics and probiotics contributes to a healthier you!
Our registered dietitian, Nasira, can provide more advice on obtaining pre- and probiotics for your specific health needs, especially if you have gut issues or a weakened immune system, Contact her today:
(425) 445-3914 or email@example.com.
Doron, S., & Snydman, D. R. (2015). Risk and safety of probiotics. Clinical Infectious Diseases, 60(suppl_2), S129-S134.
Shreiner, A. B., Kao, J. Y., & Young, V. B. (2015). The gut microbiome in health and in disease. Current opinion in gastroenterology, 31(1), 69.
A dancer’s progression to pointe work is a much anticipated moment. It is completely normal to be excited about this milestone, but it is extremely important not to rush into pointe work. There are a variety of factors that need to be considered to ensure that a dancer is ready to sufficiently meet the demands of pointe work.
Criteria for pointe readiness based on expert recommendation:
What are the risks if I start too early? If the dancer begins pointe work without adequate range of motion and/or neuromuscular control, they can hinder proper technique development, foster bad habits, and potentially increase the amount of stress on the developing bones as well as the surrounding musculature. There is rapid bone growth and remodeling between the ages of 9-15 years old. During this time, growth plates are weaker than the surrounding bone, making them less resistant to different forces and more susceptible to injury. In addition, there are neuromuscular changes that occur as the dancer accommodates to rapid growth. The dancer takes time to adapt to changes in strength, flexibility, and proprioception, which ultimately influences motor control and performance en pointe. Therefore, chronological age cannot be a sole marker for pointe readiness (Richardson 2017, Shah 2009).
It is important to communicate with your ballet teacher regarding the progress of your technique and whether you meet the criteria to initiate pointe work. Health care professionals (MD, PTs) with a background in dance can assist in conducting pointe readiness screens.
*Description of pointe readiness tests:
1) Richardson, M. Principles of Dance Medicine, Functional Tests to Assess Pointe Readiness. A webinar through the Harkness Center for Dance Injuries. Accessed Feb 23, 2017.
2)Bullock-Saxton, J. E., Janda, V., & Bullock, M. I. (1994). The influence of ankle sprain injury on muscle activation during hip extension. International journal of sports medicine, 15(06), 330-334.
3) Richardson, M., Liederbach, M., & Sandow, E. (2010). Functional criteria for assessing pointe-readiness. Journal of Dance Medicine & Science, 14(3), 82-88.
4) Shah, S. (2009). Determining a young dancer's readiness for dancing on pointe. Current sports medicine reports, 8(6), 295-299.
Vitamin D is a vital bone nutrient. Additionally, it aids in muscular contraction, nervous system function, and helps the immune system to fight off invading bacteria and viruses. There are three ways to get vitamin D: the sun, diet, and supplements.
Research shows that dancers are often vitamin D deficient (Constantini et al., 2010; Wolman et al., 2013). This essential vitamin plays a critical role in bone building and is important during growth phases. It works with calcium, proteins, and other minerals to maintain bone density and prevent stress fractures. Vitamin D acts as a hormone and is involved in immune system function. Most of the vitamin D in the American diet comes from fortified milk, cereals, orange juice, yogurt, cheese and soy beverages. The nutritional facts label will show the vitamin content of a food.
Other sources of vitamin D include:
Vitamin D is known as the "sunshine vitamin," because your body converts sunlight into vitamin D after it contacts unprotected skin. Remember to avoid extended exposure to sunlight without sunscreen. Because dancers train indoors and may have limited sun exposure, dancers may need to depend on their diet to obtain vitamin D. Needs vary widely, but typically, 800-2000 IU of D3 daily is recommended. Talk to your doctor or dietitian to verify your individual vitamin D needs.
Constantini NW, et al. High prevalence of vitamin D insufficiency in athletes and dancers. Clin J Sport Med. 2010 Sep;20(5):368-71. doi: 10.1097/JSM.0b013e3181f207f2.
Wolman R, et al. Vitamin D status in professional ballet dancers: winter vs. summer J Sci Med Sport. 2013 Sep;16(5):388-91. doi: 10.1016/j.jsams.2012.12.010. Epub 2013 Feb 4.