Irritable bowel syndrome, or IBS, is a class of disorders involving gut-brain interaction that affects up to 1 in 10 Americans. Diagnostic criteria includes abdominal pain at least once per week on average over the past three months associated with changes in stool frequency or form. Symptoms affect the large and small intestines and typically include periodic or chronic bloating, diarrhea, constipation, gassiness, and cramping.The cause of IBS is unknown, however genetics, allergies, infection, lifestyle, and gut microbiota may contribute to IBS and stress and certain foods may trigger symptoms. The large intestine has nerves that communicate with the brain, so stress can stimulate intestinal spasms resulting in pain and discomfort. Specific foods can initiate episodes of IBS, and many people with IBS notice that symptoms worsen after consuming high-fat foods or large meals.

Until recently, the medical advice provided to patients with IBS was to reduce stress and eat more fiber. Research has indicated that IBS can be managed with a focus on diet composition and eating habits, possibly with the assistance of medications, probiotics, and stress management. Consider the following modifications to your diet to provide relief from IBS and prevent future flare-ups.

• Consume small, frequent meals to ease the volume of food in the intestinal tract.
• Eat on a regular schedule to help regulate bowel movement. 
• Consume adequate fluid to help move foods through the intestine.
• Eat high-fiber foods, such as whole vegetables and fruits, beans, and whole grains (e.g., brown rice, rolled oats, whole-grain bread and pasta).
• Limit alcohol and caffeine, as both can stimulate the intestines and cause diarrhea. Note that beverages containing sugar alcohols can also stimulate diarrhea and carbonated drinks produce gas.
• A diet low in fermentable, oligosaccharides, disaccharides, monosaccharides and polyols (low-FODMAP) guided by a registered dietitian may help alleviate symptoms of IBS. FODMAPs are short-chain carbohydrates found in a variety of foods that are sometimes poorly absorbed in the gut. FODMAPs are fermented by gut bacteria and pull additional water into the intestine.

If you suspect you have IBS, be aware that additional testing may be needed if you observe blood in stool, unintended weight loss, or anemia. It is generally not necessary to test for food allergies/sensitivities unless reproducible symptoms exist. Blood tests to evaluate C-reactive protein levels and fecal lactoferrin are helpful to rule out inflammatory bowel diseases and celiac disease. Don’t allow IBS symptoms to interfere with your quality of life - a registered dietitian can help you identify triggers and learn how to manage symptoms.

According to the Center for Disease Control and Prevention, nutrient dense foods are those that provide an average of 10% or more daily value per 100 calories of 17 nutrients, including potassium, protein, fiber, iron and calcium. While there are numerous fruits and vegetables that are nutrient dense, there are some in particular that are best in the summertime because they also happen to be very hydrating. Citrus fruits and berries are excellent choices for summer snacking. According to CDC’s nutrient density approach, the healthiest of them all is the strawberry, with a nutrient density score of 17.6. According to the FDA, strawberries have more vitamin C than any citrus fruit, and are also rich in potassium and fiber. As an added bonus, strawberries are a good source of flavonoids, a group of phytonutrients linked to reduced risk of diabetes, heart disease, and some cancers. Strawberries are about 92% water, a proportion similar to that of watermelon; and, because of their electrolyte content, strawberries are an ideal source of hydration on warm days. If you aren’t a fan of eating a portion of plain fresh strawberries, the flavor of strawberries is delicious when sliced pieces are added to your ice water. There are also many healthy summer recipes, both sweet and savory, that contain strawberries, such as the Caprese Salad with Strawberries recipe below!
 
Refreshing Caprese Salad with Strawberries
2 pounds fresh strawberries, stemmed and halved
2 cups bite-sized fresh mozzarella balls (Bocconcini), drained and halved
2 tablespoons extra virgin olive oil
1/3 cup balsamic vinegar
3-4 fresh basil leaves, finely diced
Salt, pepper to taste
In medium sized bowl, toss strawberries and mozzarella balls with olive oil. Season mixture with salt and pepper. Add basil and toss again. Drizzle balsamic syrup over and around salad. Grind more pepper on top and serve.
 
References:

1. Di Noia J. Defining Powerhouse Fruits and Vegetables: A Nutrient Density Approach. Preventing Chronic Disease. 2014;11:E95.
2. Odriozola-Serrano, I., Soliva-Fortuny, R., & Martín-Belloso, O. (2008). Phenolic acids, flavonoids, vitamin C and antioxidant capacity of strawberry juices processed by high-intensity pulsed electric fields or heat treatments. European Food Research and Technology, 228(2), 239-248.
3. Arnoldi, A. (Ed.). (2004). Functional foods, cardiovascular disease and diabetes. Elsevier.
4. National Nutrient Database for Standard Reference, Release 28 slightly revised May, 2016, Software v.2.6.1.

A healthy diet takes planning, time, and effort. Having the right foods available when you need them is important for dancers with limited time and intense training schedules. Here are some nutritious food staples recommended for every dancers' kitchen.

1. Fresh fruit - incorporate variety by choosing in-season produce
2. Rolled oats - cooked oatmeal, overnight oats, or blended into a smoothie, oats provide energy, fiber, and B-vitamins.
3. Nut or seed butter - spread on whole-grain bread, rice cakes, or bananas for a source of healthy fat and protein.
4. Greek yogurt - enjoy with fruit, nuts and seeds, or granola as a versatile source of protein and calcium.
5. Lean protein - cooked fish, chicken, or turkey, canned tuna or salmon, and eggs are simple to incorporate into meals. Just pair lean protein with whole grains and vegetables for a complete meal.

​What is Joint Hypermobility?                                                                                                                                  
Joint hypermobility refers to greater than normal range of motion in a given joint. Excessive range of motion can be attributed to factors such as bone shape, hormonal influences, impaired proprioception, reduced muscular strength, and decreased collagen strength (Knight 2012). Collagen is a structural protein within connective tissue. Fascia, ligaments, joint capsule, tendons, skin, blood vessel walls, gastrointestinal lining, and respiratory tracts contain connective tissue. Defects in connective tissue proteins contribute to joint laxity and can result in widespread symptoms (Hakim 2015).

What are hypermobility disorders?
Hypermobility disorders refer to a group of conditions involving symptomatic joint hypermobility. Some hypermobility disorders such as Ehlers-Danlos syndrome are caused by abnormal structure and function of collagen and connective tissue proteins. Hallmark features of connective tissue disorders include stretchy skin, loose joints, and fragile tissues (Simmonds 2007).

What are common signs/symptoms of Hypermobility disorders?   

• Frequent joint dislocations
• High injury rate
• Fatigue
• Difficulty sleeping
• Chronic pain
• Frequent headaches/migraines
• Dizziness
• Orthostatic hypotension
• Gastrointestinal pain
• Anxiety
• Delayed healing
• Decreased proprioception and strength

Joint hypermobility is common among dancers and rhythmic gymnasts because of the flexibility demands in both disciplines. 

How do we screen for Hypermobility?
The 5-point hypermobility questionnaire, Beighton scale, and Brighton criteria are useful screening tools for hypermobility. Two positive responses on the 5-point questionnaire provides a sensitivity of 84% and a specificity of 85% for detecting joint hypermobility (Kumar 2017).

How is Hypermobility diagnosed?
Joint hypermobility is identified through a comprehensive patient history as well as a variety of clinical tests.

How can Physical Therapy help?
Physical therapy can play a vital role in providing treatment strategies for individuals with joint hypermobility to improve joint stability, reduce pain, and improve function. Treatments may include:

• Muscle Strengthening: Increasing muscle strength is vital for improving joint stability to counteract underlying joint laxity. 
• Education on safe flexibility: Understanding how to improve tissue mobility safely helps to prevent injury and protect the integrity of the connective tissue. 
• Endurance: Increasing cardiovascular and muscular endurance is important for reducing fatigue which is a common symptom in hypermobile individuals.
• Balance and Proprioceptive Activities: Increasing proprioception and improving postural control is key for increasing stability to reduce further pain or injury. Taping or bracing may be utilized to improve joint awareness and aid in further stability. 
• Manual Therapy: Hands on treatment such as soft tissue mobilization may be used to reduce myofascial pain and calm down the nervous system. 

 
References: 

1. Isobel Knight MSc, Moira McCormack MSc, 7 Howard Bird MA MD FRCP .Managing Joint Hypermobility – A guide for Dance Teachers. March 2012. https://www.onedanceuk.org/wp-content/uploads/2018/05/Managing-Hypermobility-for-the-Dance-Teacher-FINAL.pdf Accessed May 20, 2021. 
2. Hakim, Alan. What are Hypermobility Syndromes? May 2015. https://www.hypermobility.org/what-are-hypermobility-syndromes accessed May 23,2021.
3. Simmonds, J. V., & Keer, R. J. (2007). Hypermobility and the hypermobility syndrome. Manual therapy, 12(4), 298-309.
4. Kumar, B., & Lenert, P. (2017). Joint hypermobility syndrome: recognizing a commonly overlooked cause of chronic pain. The American journal of medicine, 130(6), 640-647.

Stress is a physiological condition associated with disorders of the nervous, endocrine, and immune systems. Uncovering natural remedies to combat stress continues to be a significant area of scientific research. In traditional Chinese Medicine known as Ayurveda, consumption of adaptogenic herbs is common practice to improve the body’s ability to adjust to exposures such as extreme temperatures, loud noise, strenuous physical exertion, chemical pollutants, and to help maintain cognitive function, blood glucose, lipid levels and blood pressure. Adaptogens are naturally occurring plant compounds or extracts known to exhibit protection against stress, fatigue, anxiety, and depression. According to Selye’s theory (Selye, 1950) the stress response and general adaptation syndrome includes three phases: alarm, resistance, and exhaustion. Recent pharmacological studies of individual adaptogens provide rationale to their effects at the molecular level, indicating several mechanisms of action that help the body maintain equilibrium. However, adaptogens supposedly act non-specifically, and may activate certain energy-producing chemical receptors and deactivate others to prevent overreaction to stress messengers. Combinations of adaptogenic plants may offer unique effects due to their synergistic interactions in organisms which are not achieved by isolated extracts or supplements of individual adaptogens.

The chemical compounds known as adaptogens are typically phenolics or triterpenoids. Phenolics are structurally similar to catecholamines, which activate the stress system in the early stages of stress response. Triterpenoids resemble the corticosteroids that act as stress hormones in deactivation of the stress system. Adaptogens often are included alone or in combinations in bottled beverages, herbal teas, smoothies, plant-based protein powders, and supplements. The following are adaptogens that have demonstrated beneficial health effects:

• Holy Basil
• Turmeric
• Ashwagandha
• Ginseng
• Rhodiola

Stress is a part of daily life, and many lifestyle factors, including diet, sleep, physical activity, and mental health practices such as meditation, yoga, Pilates, and deep breathing influence stress management. Although adaptogens may be a promising complementary therapy for stress, future research is needed to evaluate the complex potential of these herbal extracts and their possible effects on human health and longevity. As with all dietary supplements, the FDA advises that consumers consult with a qualified health care professional before taking any botanical or herbal supplement. It is important to be aware that adaptogens aren’t safe for everyone, as they may interfere with certain medications, and their use is contraindicated in pregnant and breastfeeding women because botanicals may alter hormone levels.
References:
Enyeart JA, Liu H, Enyeart JJ. Curcumin inhibits ACTH- and angiotensin II-stimulated cortisol secretion and Ca(v)3.2 current. J Nat Prod. 2009;72(8):1533-1537. 
Jamshidi N, Cohen MM. The clinical efficacy and safety of tulsi in humans: a systematic review of the literature. Evid Based Complement Alternat Med. 2017;2017:9217567. 
Lee S, Rhee DK. Effects of ginseng on stress-related depression, anxiety, and the hypothalamic-pituitary-adrenal axis. J Ginseng Res. 2017;41(4):589-594.
Liao, L. Y., He, Y. F., Li, L., Meng, H., Dong, Y. M., Yi, F., & Xiao, P. G. (2018). A preliminary review of studies on adaptogens: comparison of their bioactivity in TCM with that of ginseng-like herbs used worldwide. Chinese medicine, 13, 57. https://doi.org/10.1186/s13020-018-0214-9.
Panossian, A., & Wikman, G. (2010). Effects of Adaptogens on the Central Nervous System and the Molecular Mechanisms Associated with Their Stress-Protective Activity. Pharmaceuticals (Basel, Switzerland), 3(1), 188–224. https://doi.org/10.3390/ph301018
Selye H.  Stress. Acta Medical Publisher; Montreal, Canada: 1950.

These days you may find it harder to stay present, especially when being in the moment reminds us that things are not what they used to be. The inability to be present can lead to a decrease in body awareness which has a huge impact on our movement overall. 
You have the power to slow down, observe, and take action. By challenging your status quo and moving outside your comfort zone you create greater capacity to handle stress and the emotions that come with it. Think of it as your emotional gas tank. Adding to your movement profile, or all the movement at your disposal, creates a larger reserve which means less breakdowns on the side of the road as well as less trips to the gas station. When you increase your movement and body awareness you get more emotional miles per gallon.
So how do you maximize your emotional miles per gallon through movement to support resilience and overall well-being? Here are some tips:
 

1. Bring attention to your movement. 
   1. Take stretch breaks
   2. Find ways of moving other than dancing
   3. Connect to your sense and breath

 

1. Challenge your movement.
   1. Execute tasks with your non-dominant hand
   2. Try on different tempos and rhythms
   3. Move more, not better

 

1. Keep a movement journal.  Reflect on:
   1. How you moved
   2. How it felt
   3. How it was different

 
Looking for more support?
My workbook, Body Awareness for Mental Health, is for you! Rooted in theories and methodologies from the field of dance/movement therapy this workbook is designed for:

• Anyone looking for a more holistic approach to mental health.

• Individuals who have reached a plateau in traditional talk therapy.

• Anyone who has difficulty accessing and processing emotions.

• Anyone who is disconnected from their body due to trauma, anxiety and stress.

 

We’ve made it through the year 2020 and it is time for a new beginning and fresh perspective. Here is a delicious and healthy recipe to help you launch 2021! This vegetarian dish includes protein, fiber, and anti-inflammatory phytochemicals. It is also zesty and satisfying - enjoy! 

Spiced Black-Eyed Peas with Coconut Milk - recipe makes 6 servings
2 cups dried black-eyed peas
Dash salt
3 tbsp. canola oil
1 large red onion
1 1/2 tbsp. fresh ginger
3 cloves garlic
1 habanero chile
1 tsp. ground turmeric
3 medium tomatoes
1 cup light coconut milk
1 cup low-sodium broth
1 cup fresh cilantro
2 green onions

1. In a large saucepan, cover the peas with water and bring to a boil. Simmer over moderately low heat until tender, about 40 minutes. Add a generous pinch of salt and let stand for 5 minutes, then drain well.
2. Meanwhile, in a large saucepan, melt the butter. Add the onion, ginger, garlic and chile and cook over moderate heat, stirring occasionally, until softened and just starting to brown, about 10 minutes. Add the berbere and turmeric and cook, stirring, until fragrant, about 2 minutes. Add the tomatoes and cook, stirring, until softened, about 5 minutes. Stir in the coconut milk and stock and bring to a boil. Simmer over moderately low heat, stirring occasionally, until the tomatoes break down and the sauce is thickened, about 20 minutes.
3. Add the peas to the sauce and cook over moderately low heat, stirring, until the peas are lightly coated, about 10 minutes. Fold in the cilantro and scallions and serve.

As dancers return to the studio, it is important to gradually introduce jumps to prevent lower leg injuries. Foot and ankle injuries are often incurred during dynamic movements like jumping, and improper flooring, poor technique, and fatigue can increase the risk of injury.
Here are some important tips to lessen the likelihood of sustaining injury during jumps:

1. Dance on appropriate flooring (i.e., sprung floor with adequate shock absorption) 
2. Utilize proper technique while jumping
3. Wear supportive shoes that are in good condition
4. Apply periodization principles 
5. Train endurance: Dance-related injuries most commonly occur when the dancer is fatigued. Therefore, it is imperative to increase cardiovascular fitness to reduce injury. Examples include short bouts of jumping rope, jogging in place, fast walking, cycling, and/or swimming. 
6. Asses and train the specific elements of the jump:

• Improve plie depth: Address any muscular or joint restriction that could be affecting your plie depth. Seek a healthcare professional if you are having any pain on the top of the ankle with plie.
• Articulation of foot with take-off: Improve strength of foot intrinsics and calf complex. Jumping on the pilates jumpboard can be useful when working on articulating through the foot with jump take-off and landing. 
• Achieving full pointe range and knee extension in the air: Address any muscular or joint restriction that could be limiting full ankle plantarflexion or knee extension range of motion. Seek a healthcare professional if you have pain in the back of the ankle with pointing the foot. 
• Dynamic core/pelvic stability: Avoid sinking in the hip on the standing leg or collapsing forward in the trunk on the take-off/landing. Strengthen the core dynamically with exercises like squat jumps, skater jumps, and spring lunges to improve trunk alignment and pelvic control during jumping. This will ultimately reduce load on the foot/ankle. 
• Eccentric gluteal and soleus control on the landing : Strengthen the gluteals and soleus eccentrically to avoid collapsing in the hips or foot/ankle on the landing. This can be improved with working on squats and soleus rises with a slow and controlled descent to strengthen the muscle eccentrically. 
• Improving muscle power to achieve adequate height: Incorporate plyometrics into your cross-training and work on dynamic movements such as skater jumps, squat jumps, and spring lunges. Vary the speed of the exercise to improve muscle power. 
• Leg alignment/Hip control in fondu: Work on achieving adequate turnout from the hips and avoid collapsing of the knee inward during fondu. Practice plie in second position with correct alignment of the hip and knee. 

If you are experiencing pain that doesn't subside with rest, there are experts who can help.  Learn more about chronic pain and the importance of proper testing for treatment,
References:
Russell J. A. (2013). Preventing dance injuries: current perspectives. Open access journal of sports medicine, 4, 199–210. https://doi.org/10.2147/OAJSM.S36529