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10/6/2019 4 Comments

Dance Training, Exercise and Nutrition During Pregnancy

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Photo credit: Pacific Northwest Ballet
During pregnancy, a woman’s body will change more in nine months than it’s likely to change during any other life stage. Because of these changes, pregnant women are generally encouraged to rest and enjoy “eating for two”. For dancers, taking it easy is not always ideal or even possible. Pre-professional and professional dancers often continue to train until their due date and will return back to the studio soon after delivery. What does training while pregnant involve?  Will dancing while pregnant harm an unborn child?

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7/11/2019 1 Comment

Increasing Cardiovascular Endurance in the Dancer

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Cardiovascular demand during dance performances and rehearsals is much greater than during dance classes. Because of the low requirement during technique classes, many dancers lack adequate aerobic power. Therefore, supplementary cardiovascular training is needed to improve aerobic capacity and reduce the risk of injury during performances. High-intensity interval training, which involves short bursts of intermittent exercise, is recommended to meet the strain of performance (Wyon et al, 2005). The goal is to get your heart rate to a maximum level, and then recover quickly (Howell, L, 2019). 
 
Designing a cardiovascular program:
  • Frequency: 1-4 times/week for supplemental cardiovascular training (Wyon, M). 
  • Intensity: 70-90% of your maximum heart rate. This would be equivalent to the intensity of sprinting (Wyon, M). 
  • Duration: 15 to 20 minutes to avoid overtraining (Wyon, M). Start with a 5 to 10-minute warm up and finish with a 5-minute cool down. After the warm up, perform intervals of 30-90 seconds of high intensity work (70-90% heart rate maximum), followed by 1 minute of active recovery. Cycle through these high intensity bouts for 4 to10 times prior to cooldown (Howell, L). 
  • Type: Swimming, rowing, walking, and cycling are preferred. Running and elliptical promote overuse of hip flexors and quadriceps, and running is high impact on the joints (Wyon, M). 
 
Benefits of cardiovascular training:
  • Improves aerobic/anaerobic systems
  • Helps dancers prepare for dynamic choreography, rehearsals, and performances
  • Aids in recovery from long training hours
  • Delays fatigue
  • Increases lung capacity
  • Reduces lactic acid buildup in the muscles​
 
Regardless of your dance goals, incorporating cardiovascular training can have lasting benefits for health and  overall fitness level.
 
References:
  1. Wyon, M. (2005). Cardiorespiratory training for dancers. Journal of dance medicine & science, 9(1), 7-12.
  2. Howell, L. Cardio training for dancers.  Retrieved from https://www.theballetblog.com/portfolio/cardio-training-for-dancers/ on July 7, 2019. 

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5/4/2019 1 Comment

Resistance Training for the Adolescent Dancer

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Resistance training is essential for facilitating muscular development and fostering strength gains in young dancers. Rapid growth periods during adolescence can lead to reduced strength, impaired balance, and decreased flexibility, which can alter technical ability and increase the risk of injury [1]. Thus, it is recommended to start strength training before puberty to reduce the risk of injury and promote strength gains.

Muscular development in adolescents:
Peak gains in strength typically occur one year after peak height velocity is reached. Late maturers may gain strength later and may not obtain peak strength until their 20s or30s. Differences in hormone levels account for differences in strength gains between boys and girls. Testosterone, growth hormone, and insulin-like growth factors account for increased muscle bulk and accelerated strength in boys. Increased muscle mass typically proceeds strength gains [2].
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Key aspects to developing a strength program:
It is important to target areas of individual weakness when designing a strength program.  Pelvic stabilization,, gluteal, and abdominal strengthening are keys to improving neuromuscular control of the lower extremities. A progressive resistance program can increase muscular strength/endurance in as little as 6 to 8 weeks (Stalder, M). Most programs require 2 to 3 days of resistance training per week to see strength gains. Performing high repetitions with lower weight will target muscle endurance, whereas performing fewer repetitions with higher weight will target muscle strength. It is essential to have adequate supervision by a healthcare professional during training to ensure proper progression of training loads and correct technique to avoid injury [4].

Benefits of strength training:

  • Increased neuromuscular control/coordination
  • Increased muscle strength
  • Increased muscle endurance/anaerobic power
  • Improved performance
  • Reduced injury risk
  • Improved bone health 

References
1) Delegete, A. Health Considerations for the Adolescent Dancer. A webinar through the Harkness Center for Dance Injuries. Accessed September 23, 2018.    
2) Haff, Gregory G. Essentials of Strength Training and Conditioning 4th Edition 2016. Pages 144-145. (https://www.open.edu/openlearn/ocw/pluginfile.php/617068/mod_resource/content/1/e217_1_excf223_nsca_chapter7_p144_145.pdf)
3) Stalder, M. A., Noble, B. J., & Wilkinson, J. G. (1990). The effects of supplemental weight training for ballet dancers. The Journal of Strength & Conditioning Research, 4(3), 95-102.
4) Stracciolini, A., Hanson, E., Kiefer, A. W., Myer, G. D., & Faigenbaum, A. D. (2016). Resistance training for pediatric female dancers. Journal of Dance Medicine & Science, 20(2), 64-71.

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1/2/2019 1 Comment

Preparing for Auditions - Set Yourself Apart

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:
  1. Narrow down your list: Make an audition list based on your goals. Are you looking to participate in a summer program, improve your audition skills, or gain acceptance into a dance company?  
  2. Address prior/current injuries: Don’t audition with an injury! This can lead to further injury and hinder your chances of being accepted.
  3. Get adequate sleep: Sufficient sleep will allow you to focus during the audition and learn combinations quickly. Meal preparation: Bring adequate snacks to help fuel you before your audition.
  4. Check audition day requirements: Be prepared with your resume, headshot, proper attire, and audition fee.
  5. Arrive early: This will allow you to mentally prepare yourself and warm up properly.  
  6. Refine your technique: Avoid skipping technique classes. Take daily technique classes to prepare. Focus on your alignment and stability to avoid overuse injury.
  7. Increase your strength/endurance: Technique classes don’t always prepare you for dancing for extended periods. It is important to supplement with cardiovascular exercise and strength training to prepare for audition days (Koutedakis 2000).

Skills to focus on during your audition:
  • Good technique (correct alignment, core stability)
  • Musicality
  • Ability to pick up combinations and understand corrections
  • Artistry
  • Positive attitude
  • Avoiding injury during the audition season:
  • Avoid more than one audition per day
  • Plan local auditions if possible
  • Don’t work through fatigue, illness, or injury; seek help if an injury occurs.
  • REST! Muscle requires 12-24 hours of rest following intense levels of physical activity in order to heal and repair damaged tissue prior to additional workouts (Koutedakis 2000 & 2004).
  • If possible, allow for full rest days in between auditions to avoid overuse injury.

References: 
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.

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9/10/2018 1 Comment

Am I ready for pointe work?

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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
:
  1. Appropriate age  (at least 11 years old)
  2. Minimum of 3 to 4 years of ballet training
  3. Full plantar flexion range at the ankle (>90 degrees)
  4. Adequate balance control
  5. Good core stability and strength of the lower quarter  (Richardson 2017)                   
It is important to note that core strength and proximal hip control are better indicators of ankle stability than isolated foot/ankle strength. If a dancer has poor turnout control from the hip and inadequate core stability, the ankle is less stable en pointe,  thus placing the dancer at increased risk for injury (Bullock-Saxton 1994). According to research, the tests most predictive of readiness for pointe* are the airplane test, topple test, and saute test (Richardson 2010). These tests are an indication of the dancer’s neuromuscular control and skill set, which are more significant factors than isolated muscle strength (Richardson 2017).

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. Airplane test: the body is pitched forward into a flat back arabesque with the leg at 90 degrees and the pelvis square to the ground. The dancer must bring the fingertips to the ground while performing a plie with the supporting leg. The dancer returns to the starting position and performs five plies total. The knee must track over the center of the foot, the pelvis must remain in neutral, the head/trunk remains stable, the foot does not pronate, and the dancer does not lose balance for four out of five attempts.
  2. Topple test: pirouette en dehors from fourth position. Look for full releve, full passe height, straight supporting leg, vertical alignment, and controlled landing. The dancer must complete one successful turn out of two attempts.
  3. Saute test: 16 single leg saute jumps without support. The dancer must keep the pelvis in neutral, keep the trunk upright, fully straighten the supporting leg, roll through the foot on the landing, and point the foot in the air for eight out of 16 repetitions (Richardson 2010).
References:
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.


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6/4/2018 0 Comments

Adjusting Food Intake for the Off-Season

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Rest is essential for recovery and healing. It is a recommended to take a couple weeks off after a summer intensive. Adjustments in food intake should be made during these rest periods.  Typically, one week is not enough time for your metabolic rate to decrease or for lean mass to dissipate significantly. However, durations longer than one week can result in loss of muscle mass and fat gain if you're not supplementing with resistance training and/or adjusting calorie intake. Plan to make small, simple changes to account for the reduced calorie expenditure when you're not dancing. Be careful not to overcompensate with extreme calorie restriction.This is counterproductive and can cause muscle loss, illness, and injury when you begin training again.

What adjustments should be made to diet during the off-season?


  • Continue to practice healthy nutrition habits as recommended during training.
  • Slightly reduce portions of meals and snack sizes. Approximately 250 fewer calories per day are needed if your goal is to maintain your weight during your break. A larger reduction in calorie intake can lead to loss of muscle mass and should be avoided.
  • Be aware of hidden and unhealthy fat in foods like salami, biscuits, pastries, sausage, and other processed meats. Some of these convenience foods that you might eat while training for hours a day become a serious problem when you are sedentary.
  • Increase the proportion of vegetables in your meal and slightly reduce the starch or protein portions. Do NOT cut out entire food groups.
  • Consume at least 2 cups of fruits and 2½ cups of vegetables a day.
  • Don't skip meals and avoid fad diets (e.g., Paleo, detoxes, juicing).
  • ​Drink at least 6 to 8 glasses of water each day. Have no more than 2 to 3 cups of caffeinated drinks a day. Be aware of calories from alcoholic beverages.
​Cross-Training During Off-Season
Rather than restricting calories during vacation or off-season, consider cross-training with cardio and resistance training. Low-impact, moderate-intensity cardio such as swimming or fast walking are excellent options to allow for extra calorie burning and promote muscle retention. Walking at ~3.8 to 4 miles per hour (3 to 4 miles/day) or swimming for 30 minutes at a moderate intensity are good options. Add light resistance training with weights, Pilates, or yoga while on a break from dance in order to maintain flexibility and promote muscle gain.
Enjoy your summer and remember that you deserve a break!

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5/9/2018 0 Comments

Dancing Through Burnout

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Burnout or overtraining can be characterized by:
  • Long-standing fatigue
  • Reduced performance without a specific cause
  • Behavioral/emotional changes (Koutedakis 2000)

Risks for burnout and injury:
  • Inadequate rest: Muscle requires 12-24 hours of rest following intense levels of physical activity in order to heal and repair damaged tissue prior to additional workouts (Koutedakis 2000).
  • Fatigue: Dancing > 5 hours per day can lead to fatigue and increases risk for injury (Koutedakis 2000).  
  • High frequency of classes: Dancing >20 hours per week can increase likelihood of burnout.
  • Poor diet: Most dancers consume less than 70-80% of their recommended caloric intake. Inadequate intake can contribute to deterioration of lean body mass, which can negatively impact physical performance.
  • Lack of cross-training: Diversifying physical activity helps prevent muscle imbalances and can improve endurance and strength without redundancy.
  • Reduced endurance: Aerobic capacity levels are lower in dancers compared to other athletes.
  • Decreased strength: Dancers have less lean muscle mass and strength compared to other athletes. In addition, they load their muscles suboptimally, which can result in further strength decreases (Koutedakis 2004).

Signs/symptoms of burnout:
  • Frequent injuries
  • Constant fatigue
  • Frequent respiratory tract infections
  • Behavioral/emotional changes such as reduced appetite, loss of excitement for dance, irritability, anxiety, and depression  
  • Weight loss
  • Alteration in sleep patterns
  • Changes in technique
  • Inability to recover sufficiently after training
  • Menstrual changes
  • Weakening of the bone
  • Increased resting heart rate and blood pressure
  • Reduced heart rate recovery after normal levels of dancing
  • Decreased ability for the body to utilize oxygen during maximal exercise
  • Reduced muscle strength
  • Increased time to heal
  • Increased susceptibility to infection (Koutedakis 2000)​

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Solutions and setting realistic expectations:
1) Allow for full rest days in between heavy training days. This will provide adequate time for tissue healing and recovery and prevent further tissue damage. 
2) Set mandatory rest periods after performance seasons and summer intensives. It is recommended that a dancer takes a rest period of 3-5 weeks off from dance. Research shows that rest periods  improve/maintain strength, flexibility, and aerobic capacity. Cross training can be performed during rest periods (Koutedakis 2004). 
3) Get adequate sleep. Dancers may need up to 9 to 10 hours of sleep per night during intense training periods. Set an early bedtime for yourself and try to avoid screen time distractions before bed.
4) Eat a balanced diet. It is important to have adequate nutrition to boost your immune system and optimize your performance. 
5) Don’t work through fatigue, illness, or injury.
6) When returning to dance, slowly ramp up activity load. Consider starting with a modified dance schedule when returning from rest periods. 
7) Increase endurance. Most injuries occur when a dancer is fatigued and therefore it is important to improve aerobic capacity to delay fatigue. About 20 minutes of moderate to vigorous cardiovascular exercise such as swimming or cycling can bring about aerobic fitness increases. Swimming is a preferable choice for improving endurance over activities such as running or cycling, which place much more demand on the lower extremities (Koutedakis 2004).
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8) Increase muscle strength. Body conditioning, weight lifting, and pilates are excellent for increasing lean muscle mass. 
9) Address the signs of burnout early to avoid prolonged symptoms.
10) Consider reducing your schedule intensity if you are dancing > 5 hours a day or > 20 hours per week.

REFERENCES:
1) Koutedakis, Y. (2000). " Burnout” in Dance: the physiological viewpoint.
2) Koutedakis, Y., & Jamurtas, A. (2004). The dancer as a performing athlete. Sports Medicine, 34(10), 651-661.

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3/5/2018 0 Comments

Injury Incidence and Prevention Tips

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Dance is highly demanding and requires exceptional flexibility, balance, power, agility, coordination, and endurance. To properly execute movements, a dancer assumes positions that place excess stress on bones, muscles, tendons, and ligaments, thus leading to high injury rates. The injury incidence is reported to be as high as 5.6 per 1,000 dancing hours for pre-professional dancers, and 4.44 per 1,000 hours in a company of professional dancers (Allen et al, 2012). In comparison, the injury rate for elite gymnasts is 2.86 per 1,000 hours and 0.69 for novice gymnasts (Saluan et al, 2015).  Gymnasts have a higher percentage of traumatic injuries, whereas 75% of the injuries sustained in dance are related to overuse. Overuse injuries are caused by repetitive movements/stress which can lead to micro-injury of the tissue that is being loaded. If the injury rate exceeds the rate of healing/repair, the tissue can become damaged (Sephton, 1998).   

The majority of dancers are fatigued at the time an  injury occurs. This is because fatigue compromises muscle performance, coordination, joint stability, and neural feedback (Liederbach 2012). Overuse injuries tend to be more severe in nature and result in more dance time lost. Lower leg injuries are reported to be between 66 and 78% of the injuries, whereas foot/ankle injury comprises 14 to 57% of all injuries among dancers. Injuries sustained during class and performances are more severe than injuries that occur during rehearsals (Allen 2012).

Common risk factors for injury include:
  • Delay of recognition
  • Prior history of injury
  • Premature return to dance before full recovery
  • Lack of proper training
  • High number of dance hours
  • Insufficient warm-up prior to dancing
  • Lack of shock absorption from improper shoe wear and hard flooring
  • Nutritional deficiencies
  • Biomechanical imbalances such as inadequate turnout, lack of core control, or weak lower body strength (Russell, 2013)
General principles for avoiding injury include:
  • Increase aerobic capacity
  • Plan for adequate warm-up and avoid over-stretching
  • Improve technique
  • Cross-train to help with muscle imbalance
  • Know the signs of a potential injury and don’t resume dance until the injury is resolved
  • Wear protective and adequate fitting shoe wear
  • Establish rest periods
  • Hydrate and eat a balanced diet (Allen, 2014)
The injury rate has been significantly reduced with medical management. Therefore it is essential to seek a healthcare professional with experience in dance if pain persists. Dr. Chris Koutures (http://www.dockoutures.com) provides very useful insight on signs that an injury may be developing in "Dance Discomfort: Deciding to Dial Up a Dance Medicine Specialist" (http://www.activekidmd.com/dancersdiscomfort/). Koutures has extensive experience in treating dancers and is an excellent resource for all dance-related injuries. ​

References:
1.Allen, N. Nevill, A. Ballet Injuries: Injury Incidence and Severity over 1 Year. Journal of Orthopaedic and Sports Physical Therapy. Vol 42, number 9, September 2012. 781-790.
2.Saluan, Paul et al. “Injury Types and Incidence Rates in Precollegiate Female Gymnasts: A 21-Year Experience at a Single Training Facility.” Orthopaedic Journal of Sports Medicine 3.4 (2015): 2325967115577596. PMC. Web. 4 Feb. 2018.
3.Sephton, Sharlene. "Foot Injuries in Dancers." ADVANCE for Physical Therapy and Rehab Medicine (1998) Web. 4 Feb. 2018.
4.Liederbach, Marijeanne. "Epidemiology of Injuries in Dance: Biopsychosocial Considerations." Principles of Dance Medicine: Clinical Management of the Dancer Patient. July 12, 2012, New York University Langone Medical Center. 2012. Print.
5. Russell, J. A. (2013). Preventing dance injuries: current perspectives. Open access journal of sports medicine, 4, 199.
6. Allen, N., Ribbans, W. J., Nevill, A. M., & Wyon, M. A. (2014). Musculoskeletal injuries in dance: a systematic review. Int J Phys Med Rehabil, 3(252), 2

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