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 Navigating the Landscape of Injury
By
Nancy Wozny
The
complex role of dance teachers in preventing and treating
injuries
Dancers’
bodies are their instruments, and at some time during a
dancer’s life that instrument is going to run into trouble.
It’s always heartbreaking, but it goes with the territory.
When that dancer is a student, teachers take on a variety of
roles, from running interference between health care
practitioners and parents, to cheerleading on the road to
recovery, to bearing the brunt of the student’s emotional
needs. Although prevention is paramount, knowing how best to
aid students in their road to recovery is a necessity of life
for dance teachers.
Regardless
of how sound your training methods are, it’s important to
remember that students have various degrees of facility and
that certain body structures are more prone to injury than
others. Some aspects of a student’s potential are simply out
of the teacher’s control. Certainly they can work on tight
joints or weak ligaments, but each body copes with the demands
of dance differently. Several strategies can help teachers
minimize injuries among their students and, when they do
occur, maximize the body’s ability to recover.
Observation
A ballet
class is constructed in a linear way so as to avoid injuries;
solid training methods help keep injuries to a minimum. But
the reality is that most studios do not select students based
on their flexibility, turnout, and other natural facilities.
For Jane Tyree of The School of Boca Ballet Theatre, a large
academy in Boca Raton, FL, dealing with her students’ injuries
can be a daily task. With 450 students ages 3 to adult in her
school, plus 28 years of teaching experience, she knows a
thing or two about injuries. “The topic is in my face every
day,” says Tyree. “Injuries come from the athletic part of
dance, not the artistic.” She helps her students distinguish
between “good” and “bad” pain and learn how their bodies are
put together.
Dance
injuries are invisible for the most part. “I’m often the first
in line to hear what aches, and I have to make a quick
choice,” Tyree says. “If a student tells me their knee hurts,
I have to be ready with a litany of questions. I am not a
doctor, but I do know a great deal about the body.” She
watches a student carefully after hearing a complaint. When
pain persists, sending the student to a medical practitioner
is the next step. Tyree always errs on the side of caution
when it comes to diagnosis. “Pain doesn’t come from out of the
blue, and self-diagnosis is the worst,” she says. “Often I
need to look at their plié. Some students’ structures dictate
that they have to work harder to stay injury free.”
Tyree finds
that non-dance injuries proliferate in younger, overly
committed students. “If it’s soccer on Monday and dance on
Tuesday, that spells trouble.”
Adam and
Lisa Clark, whose studio, Dance Alliance in Saline, MI, is
located near ski and snowboarding areas, have to contend with
more than the usual dance-related troubles. Every ski season
the co-owners give their “try not to break bones” speech, but
the winter months typically bring plenty of fractures and
sprains. “This is an outdoorsy place, and teens want to
experience the world outside of the studio,” says Adam.
Students need to know that adventure can have a price for
themselves and their peers; they might miss an important show
or competition because of their choices.
The Clarks
take the potential for injuries into consideration in their
choreography. “There are some leaps I won’t teach because I
think they are an invitation to getting hurt,” says Adam.
“It’s a fine line between keeping it safe and continuing to
challenge the students.” He and Lisa have learned to spot the
silent types, the over-workers, and those with a fl air for
drama, and they keep an eye on them. That kind of close
observation, they say, is part of their job as studio owners.
Communication
Although
teachers are not doctors, they sometimes feel like they are
because of the number of injuries they see over the years.
Because they know how their stude nts move, it’s not unusual
for teachers to correctly identify an injury. But most defer
to medical practitioners for a diagnosis. Even so, their own
role expands when a student is injured. “[Then] we are more
than just a mentor and teacher,” says Adam Clark. “We are the
go-betweens, because the parent doesn’t always understand
what’s involved.” Parents who feel that the teacher
understands the injury better than they do may want them to
speak with doctors or physical therapists. However, due to the
Health Insurance Portability and Accountability Act of 1996 (HIPAA),
parents must authorize dance teachers to discuss a child’s
diagnosis. The patient or parent (if the student is a minor)
must sign a consent form before protected health information
can be released to anyone.
Kevin
Varner, an orthopedic surgeon at the Methodist Center for
Performing Arts Medicine at Methodist Hospital in Houston, is
continually impressed with the knowledge base of the teachers
he encounters in his practice. “The vast majority of teachers
know a great deal about dance injuries,” he says. “A physician
gets only the small picture, and that’s where the teachers
come in. They spend considerably more time watching a dancer
in motion. [They] also know a tremendous amount about
shoe-wear issues that a physician might miss. If it’s a
technique issue, I will have the dancer show me the actual
movement.”
Varner runs
a free, twice-monthly clinic at Houston Ballet, where he sees
everybody from academy students to principal dancers. He
communicates directly with the company’s in-house trainer who,
in turn, keeps the artistic staff informed. After seven years
he’s established a solid network of communication, which is
key in managing a dancer’s recovery. Generally, he finds that
dancers are eager to get better—and that can work for or
against them. “They are both compliant and a bit adventurous,”
he says. Varner believes that parents of young dancers need to
be involved with their child’s care plan. “Everybody needs be
on the same page,” he says. “A 16-yearold doesn’t always
understand what it means to take it easy; I need to enlist the
parent’s help.”
Finding the
right doctor is an important part of the communication
process. Some studio owners keep a list of doctors who have
experience working with dancers. “Dancing is a unique athletic
activity,” says Varner. “It’s best if you can find a physician
that knows something about it.” If you are located in a large
city with a major ballet company, chances are there will be an
arts medicine specialist. The alternative is a sports medicine
physician who is willing to listen and learn about the needs
of dancers. Good networking can lead students and parents to
the right practitioner.
Recovery
According
to Varner, about 75 percent of all dance injuries benefit from
some type of activity. “You want to minimize muscle atrophy,”
he says, and recommends Pilates conditioning to keep joints
mobile. “Keeping dancers moving is important, but not under
stress.”
At San
Francisco Ballet, dancers on the recovery path t ake a special
class that includes a floor barre. “The dynamics of a
professional class, from a psychosocial point of view, are not
ideal for the dancer in recovery mode,” says Michael Leslie, SFB’s
staff physical therapist. “The structure of a ballet class has
to be simplified. We don’t want the dancers to stop, but we do
want them to slow down. Dancers need to start back at a more
remedial level, where the tempo and rigor can be closely
monitored.”
Tyree and
Adam Clark agree that resuming classes at a lower level (once
students have been medically cleared to do so) is an ideal way
to keep ballet in the body without adding strain. The slower
pace can make all the difference.
Injury
as a learning experience
An injury
is a transition point for any dancer. The question “What now?”
immediately surfaces for both teacher and student. According
to Lauren S. Gordon, MSW, CSW, a counselor with Career
Transition For Dancers (CTFD), an injury can be an opportunity
to learn something new. “Other learning can take place when
one is not dancing. It’s a good time to check in about other
areas of one’s life,” says Gordon. “It’s so important to tap
into one’s supports and have safe places to voice fears and
feelings as one rehabs, as well as obtain medical, health,
financial, and other practical information.” Gordon urges
students to use their down time well, and teachers can be
instrumental in getting students involved in other capacities.
Interests pursued during a break from dancing can broaden
dancers’ horizons.
Leslie
agrees that an injury can provide a hidden growth opportunity,
but he describes it in terms of maturity and learning how the
body works. “Dancers are like sponges; they are eager to learn
and understand what’s happening with their bodies. Some of the
people who had injuries in their teens have had the longest
careers,” he says, “while others, who have managed to go
unscathed for most of their professional lives, can fall apart
when their bodies let them down.”
An injury
doesn’t have to separate a student from the dance world. The
Clarks work hard to keep their sidelined students involved in
the studio community by giving them jobs, like assisting at
rehearsals or taking notes at a master class. “We have an
environment they enjoy, and everybody feels they are a part of
the group,” says Adam. “For some students it would be
devastating to leave their dance studio family.”
Other
students do spend their recovery time away from the studio
atmosphere. “Being around dance when you can’t dance is
heartbreaking,” says Tyree. “Most [injured students] leave the
studio for a while.” For some, injury can be an exit point out
of dance, sometimes separating the serious students from the
dabblers.
Often, how
students deal with injury reflects their temperaments. Those
who tend to complain about every ache and pain may be trying
to tell us something. “Symptom magnification is particularly
high with children who are pushed into dance,” says Varner.
“When the complaint is out of proportion to what’s really
happening, it’s a red flag.” “I fell in PE today” is a common
complaint from younger students. Perhaps—or maybe they are
saying that they would rather be doing something else. Good
teachers are also good listeners—they know their student’s
personalities, and they also know the parents. They must be
attentive to situations that indicate that dance is not what a
child wants to be doing.
Prevention
Dance
teachers can be proactive and head off injury with education.
Deborah Vogel, founder of the Center for Dance Medicine in
New
York C ity,
director of the Institute for Performance Studies in
Oberlin,
OH,
and a functional anatomy teacher at Oberlin College,
recognized that dance teachers need to be better educated in
anatomy. So she and Anneliese Burns Wilson created
FUNctional Anatomy for Dancers, a series of teaching
guides. “University teachers usually have anatomy covered, but
the private studio owner is often left adrift,” she says.
Vogel, a former teacher, understands the demands on studio
teachers and created her series to fit into their lives. The
easy-to-use syllabus, which requires no special training to
implement, includes 10-minute lessons that are designed to be
introduced during class time. Clear instructions on what and
how to demonstrate allow the teacher and students to learn at
the same time.
Vogel’s
study with Irene Dowd, who teaches anatomy at The Juilliard
School and wrote Taking Root to Fly: Articles on Functional
Anatomy, has deeply influenced her teaching. “It has to be
interactive,” says Vogel. “The students need to feel it in
their own bodies.” Because lecturing to students can result in
a room full of glazed-over eyes, she created bite-sized
anatomy lessons that work on visual, intellectual, and
kinesthetic levels. Vogel’s book, Tune Up Your Turnout,
and DVDs, Turnout and The Standing Leg, are
valuable resources for both teachers and dancers, as is her
website, www.thebodyseries.com. For Vogel, education is key to
prevention. “The body was designed to move,” she says. “When
we follow its design, the risk is lessened greatly.”
Another
proponent of education as injury prevention is Prisca Winslow
Bradley, a former dancer and leading Feldenkrais teacher who
has offered “Intelligent Injury-Free Dance” workshops for
dancers and teachers for 11 years (see “FYI,” Dance Studio
Life, July 2007, page 12). Moshe Feldenkrais posed the
question “How does the whole body participate in every
movement?” Bradley reframes the question as “How do we dance
with our whole body?” The design and function of the body are
high on her priority list as well. She teaches with a skeleton
by her side. “Most of the training out there is on the
muscular system, with little attention to feeling one’s own
balance, which is skeletal,” she says. “When teachers get a
visual of how the hip joint, ribs, and spine actually work,
they begin to understand dance technique in a new way.”
Teachers
sometimes carry misinformation to their students, and Bradl ey
believes that there’s humility in admitting the limits of our
anatomical knowledge. Her straightforward approach helps
teachers get over what they don’t know and receive a hands-on
education. She says that some of the language and advice
regarding dance movement is not anatomically sound. Keeping
the pelvis stiff during an arabesque is one of those
misnomers. “The foot balances on the floor just as the pelvis
balances on the leg.” Bradley teaches balance as a dynamic
event—it’s about movement, not holding a static position and
hoping for the best. To enhance understanding of balance,
Bradley uses Feldenkrais cylindrical rollers. “You cannot
stiffen your pelvis when you do a développé on an unstable
surface,” she says. “Part of Dr. Feldenkrais’ strategy is to
create unusual conditions where we can’t default into our
inefficient patterns.”
Staying
alert to students’ physical and emotional needs is key to
navigating the sometimes challenging world of injuries in
dance. Though the prospect may seem daunting, taking it on
will lead to healthier students. As Bradley says, “It’s more
than just fixing the physical part. [It’s] empowering dancers
to be who they are, rather than simply doing what they are
told.”
Photo
captions (from top to bottom):
Houston
Ballet dancers like Melody Herrera (pictured here in
Stanton
Welch’s Velocity) help their bodies cope with the physical
demands of dancing during clinics conducted by orthopedic
specialist Dr. Kevin Varner. Photo by Drew Donovan
At Dance
Alliance, sometimes the show goes on even when a student
sports a cast. Photo by Dwight Cendrowski
Dance
Alliance co-owner Adam Clark listens when student Allie Harris
shares her concerns about a possible foot problem. Photo by
Dwight Cendrowski
Deborah
Vogel explains the role of the iliopsoas muscle, a hip flexor
that influences turnout and arabesque height, to students at
Oberlin College. Photo by Dylan Cowley
Dance
Alliance co-owner Lisa Clark uses dancer Katie Foley to
demonstrate a proper relevé. Photo by Dwight Cendrowski
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