Abstracts

Abstracts from the 16th Annual Meeting of the International Association for Dance Medicine & Science

Thursday, 19 October, 2006 achieving optimal performance in dance, using specific assessment and therapeutic strategies. 1. The science of qualitative and quantitative research with Success in dance, particularly , demands more dancers than talent, perseverance and a good body. It also depends on Lynda Mainwaring, PhD, CPsych., University of Toronto, Ontario, Canada; factors outside of one’s control, such as the arbitrary judgment of Steven Chatfield, PhD, Caroline Goodnight, BA, University of Oregon, others. Fortunately, dancers can reduce occupational stress by focus- Eugene, OR; Tom Welsh, PhD, Florida State University, Tallahassee, FL; irginia ing on their technical skills, emotional expression, interpretation Wilmerding, PhD, University of New Mexico, Albuquerque, NM, USA and creativity. In contrast, deficits in any of these areas can lead to Research informs dance medicine, science and practice by providing job related stress and a poor performance. understanding of a particular phenomenon brought into focus by a This presentation will demonstrate the practical application of particular question. Research questions asked by IADMS members are these principles associated with peak performance in a project with numerous and reach across varied interests, disciplines, and perspec- 24 senior students in a professional classical ballet school. During tives. Such diversity necessitates multiple approaches to the research Winter Term, 2006, these students were randomly divided into “in- process, which includes discipline-specific questions, cross-disciplinary tervention” and “control” groups. Each chose a personal performance questions, multidisciplinary and interdisciplinary foci, and diversity of goal, which was evaluated subjectively and objectively at baseline and method and methodology. The more methodological tools available three months later. The intervention group met with the psychological to dance science the better our chances of understanding the rich and coach each month and used one or more of the following strategies: complex issues related to dance and the dancer. The purpose of this in- fantasy, relaxation, visualization, mental rehearsal, thought stopping, teractive forum is to extend the current methodological repertoire for and other cognitive behavioral strategies. Effective interventions dance science by describing research methods within the framework ranged from cognitive techniques to address negative self-talk to that has been labeled “qualitative,” “alternative,” or “human science.” relaxation exercises for high anxiety. Outcome and process evaluations The methods of qualitative research will be juxtaposed with those of are discussed, as well as the choice of particular strategies. quantitative research to elucidate similarities and differences. Practical 3. Femoral neck and acetabular impingement syndrome: details of how to conduct research using these two approaches will be Review of the literature illustrated by two panelists, each employing a different methodological Peter E. Lavine, MD, INOVA Mount Vernon Hospital, Alexandria, VA, perspective to answer the question: “What is the psychological impact USA of injury on the professional dancer?” A third scientist on the panel In recent years there has been a burst of interest among orthopaedic will consider the implications of both approaches for research with hip and adult reconstructive surgeons in issues surrounding very dancers. The moderator will lead discussion among the panelists and early degenerative arthritic changes that lead to impingement of audience. The forum will emphasize the need for rigorous research functional range of motion at the hip. It is believed that this im- in dance science regardless of discipline or methodological approach, pingement leads to hip pain and decreased range of motion, and and builds upon previous forums dedicated to expanding competent actively promotes the degenerative arthritic process. This eventu- research with dancers. ally leads to severe arthritis of the hip, with the potential need for 2. The application of psychological principles to achieve total hip arthroplasty. optimal performance As this concept of hip impingement has advanced, hip surgeons Linda H. Hamilton, PhD, Ballet Wellness Program; Bonnie on the “cutting edge” have begun to develop techniques to treat the E. Robson, MD, FRCP(C), Quinte Ballet School of Canada, Belleville, condition and slow down or prevent the progression of osetoarthritis, Ontario, Canada with the eventual goal of delaying or preventing the need for total Most successful dancers use both mastery and learning goals to hip surgery in the young active patient (30-60 years old). perform at their peak. Within this milieu psychological techniques Although there are as yet no definitive data on the subject, it aimed at performance enhancement are effective in establishing is often anecdotally observed that many dancers in their 30’s–50’s obtainable goals in a step-wise progression. This presentation is develop hip problems. Hence, it is important for health profes- designed to educate the dance community about the process of sionals to be familiar with the possible treatment options available  Journal of Dance Medicine & Science • Volume 11, Number 1, 2007  to the dancer with early, often undiagnosed or misdiagnosed, 6. Self-report, clinical exam, and ultrasound of the degenerative changes of the hip. snapping hip syndrome in elite ballet dancers Paul Winston, MD;1 Raza Awan, MD, MHSc;2 J. David Cassidy, PhD, 4. Reliability and validity of goniometric turnout DrMedSci;3 Robert K. Bleakney4 (1Toronto Rehabilitation Institute, Division measurements compared with MRI and use of of Physiatry, University of Toronto; 2Department of Clinical Neurophysiology, retroreflective markers St. Michael’s Hospital; 3Al and Malka Green Artists’ Health Centre, Toronto Gayanne Grossman, PT, EdM, Muhlenberg College, Allentown; Kevin N. Western Hospital; 4University Health Network, University of Toronto) Waninger, MD, MS, St. Luke’s Hospital; Arkady Voloshin, PhD, Lehigh The purpose of this study was to determine the cause of snapping hip University, Bethlehem; William R. Reinus, MD, MBA, Temple University syndrome in ballet dancers and test the usefulness of physical exami- Hospital, Philadelphia; Renee Martino, RN, CRN, St. Luke’s Hospital, Bethlehem; Kathleen Bibalo, Muhlenberg College, Allentown; Rachael Ross, nation techniques and real-time ultrasound in making the diagnosis. SPT, Jefferson College of Health Professions, Philadelphia, PA, USA Twenty-six elite ballet dancers with 50 self-reported snapping hips participated in the study. Three physical examination techniques This study tested the validity and reliability of a single total pas- recommended in the literature were performed; then each dancer sive turnout (TPT) test taken with a goniometer. Fifteen female voluntarily reproduced the snap. The examiner recorded whether college dancers (30 legs) who began dancing before age ten were there was an audible or palpable snap with each technique. Real time recruited as volunteers. The components of turnout were tested ultrasound examinations of all hips were performed anteriorly and using various methods, including Magnetic Resonance Imaging laterally, and the diagnosis of snapping was recorded. (MRI), retroreflective markers with high speed photography, and Voluntary reproduction by the dancer produced a snap in 46 goniometric measurements, and then compared. Tibial torsion was hips, in contrast to 12 hips with the recommended maneuvers. calculated using T1 axial and coronal MRI images. The markers Inter-rater reliability for the recommended maneuvers was poor, testing rotation and torsion were located on the greater trochanter, but consistent for the voluntarily produced snap. Ultrasound di- adductor tubercle of the femur, tibial tubercle, medial malleolus of agnosed a snapping iliopsoas tendon in 59% of the hips and the the tibia, and second toe. Each leg was manually rotated from the o o o iliotibial band in 4%. A snap was felt by the radiologist through sagittal plane and photographs were taken at 15 , 30 , 45 , seated the transducer but not visualized in an additional 17%. and TPT supine, total active turnout standing, and turnout on It is concluded that: 1. iliopsoas snapping hip is very common rotational disks. Two physical therapists obtained blinded measure- in ballet dancers; 2. dancer reproduction of the snap was far more ments three times and reported the average. Promising results were useful than described examination techniques; 3. ultrasound was obtained with the pilot, and additional data collection is in progress. very useful in visualizing iliopsoas snapping hip; 4. iliotibial band These tests should catalyze progress toward a single measurement of snapping was evident by physical examination and ultrasound. passive turnout. This measurement will facilitate dance training to correct problems with over or under turning out, and prevent and 7. Am I going to be good enough for this profession? correct problems associated with turnout-related injuries. Emotional reactions to injury in ballet students Bonnie E. Robson, MD, DPsych, FRCP(C), Quinte Ballet School of Canada, 5. A psycho-educational model to facilitate the self- Belleville, Ontario, Canada development and mental health of the pre-professional This prospective study of students in a professional residential ballet classical dancer as individual and as artistic performer school reports on their emotional reaction to injury. In the spring Antoinette van Staden, DEd; Chris Myburgh, DEd; Marie Poggenpoel, RN, PhD, University of Johannesburg, Gauteng, South Africa terms of 2005 and 2006 respectively 58 and 72 female students, aged 13 to 20 years, were interviewed by a senior student within There is substantial evidence that classical dancers have difficulty one week of their attendance at the physiotherapy clinic attached with their personal lives and their lives as performers. Specifi- to the school. Information regarding their understanding of the cally, consistent emphasis on a performance-orientated climate injury, advice given, compliance with treatment, and initial and seems to be linked to the development of potentially maladaptive later emotional reactions, as well as fatigue and nutritional status dispositions. This study explored the present life-world of profes- before the injury, were obtained. At this time data are available sional classical dancers in order to determine the meaning of their for the first year only. Commonly, students catastrophized their attitudes and behaviors, and to assist pre-professional dancers in injuries initially (42%). Some expressed frustration, and a lesser dealing more appropriately with that world. number depression and anger. Many reported fears of not being A theory generative, qualitative, descriptive, explorative and able to take their ballet exams or perform in the spring gala. Al- contextual design was followed. The fieldwork was done through though 84% said they would follow the therapist’s directions, 32% semi-structured interviews with professional dancers of two classical worked through their injury against the physiotherapist’s advice. dance companies. The results were analyzed and contextualized, Forty-seven percent said they did not understand the instructions and a literature review was carried out. Findings suggest that the of the physiotherapist. Although the students have regular seminars external reality of the profession adversely influences dancers’ rela- on nutrition and injury prevention, underhydration was reported tionship with the self and others, and their future-directedness. The by 60% and fatigue by 40%. Few of them changed their diet to climate stimulates externalized goals that lead to self-destructive promote healing. Spring term, with exams, performances, and behaviors and problems with transitions from the profession. It auditions for companies is a time of stress in the senior year. One threatens the self-concept and self-esteem of the dancer. This has student spoke for many when she said: “Oh no, an injury! Just one a direct influence on the formation of self-identity. more strike against me; one more reason why I won’t get a job.” These results led to the development of a model to assist pre-profes- sional dancers to actively participate in their own self-development 8. Acute tear of the musculo-tendinous junction of the as individuals and as artists. Interrelated divisions were identified for iliopsoas muscle in an elite male ballet dancer: A case report the model, namely initiation, cultivation and implementation. The Timothy Buckley, BPhysio; Susan Mayes, BAppSci (Physio); The Australian model aims to promote mental health through the empowering of Ballet, , Victoria, Australia pre-professional dancers, and to facilitate their self-development and A case of an acute iliopsoas musculo-tendinous junction tear in a 26 self-actualization as individuals and as artistic performers. year old professional ballet dancer is described. Of particular interest 10 Volume 11, Number 1, 2007 • Journal of Dance Medicine & Science is the mechanism of injury: a rapid, ballistic side split movement arthroscopic debridement of a hip labral tear at least five months in the coronal plane during floor work. The hips were in neutral prior to follow-up (range: 5–51 months), and completed two rotation (parallel) while abducting, and the patient was supine. A questionnaires, the modified Harris Hip Score and a Dance Ques- musculo-tendinous lesion at the level of the femoral head was diag- tionnaire devised specifically for this occasion. The questionnaire nosed using MRI. Significant hemorrhage extending over a length results demonstrate significant pain reduction and restoration of of approximately 9 cm was also noted. The iliacus and psoas tendons function. Fifteen patients had returned at follow-up to full func- remained intact. The patient presented with an acute onset of anterior tionality. Close examination of the cases of the other 15 patients hip pain and had difficulty walking. Pain and weakness were noted suggests that most would also have been dancing at full capacity with a resisted straight leg raise test. The pain and weakness were but for factors extraneous to the surgery and/or related to the ex- significantly greater when the straight leg raise test was performed in treme demands of the discipline. It is concluded that, while labral a position of hip external rotation (turn-out). Resisted hip flexion at tears and the operation required to correct them are particularly 90 degrees revealed only a minor loss of strength and minimal pain. debilitating in this population, most dancers with this injury can Combined flexion/adduction of the hip reproduced anterior hip anticipate an acceptable outcome of surgical intervention. pain. Combined flexion/abduction/external rotation (FABER’s test) 11. ‘It’s something that I wasn’t aware was a skill’: The was unremarkable. The dancer has a past history of adductor longus development of imagery in dance tendinopathy, with marked residual weakness of his adductors. This Sanna M. Nordin, PhD, London Sport Institute, Middlesex University, report will discuss the mechanism of injury and outline the graduated London, UK; Jennifer Cumming, PhD, The University of Birmingham, rehabilitation program of this elite male ballet dancer. Birmingham, UK 9. Beyond ballet technique: The ‘emotional voice’: This study investigated the development of imagery among dancers. Personality typographies of student ballet dancers at elite Both qualitative and quantitative methods were employed. In Study dance conservatories 1, in-depth semi-structured interviews were conducted with 14 Thom Hecht, MA, London Contemporary Dance School, London, UK female (n = 9) and male (n = 5) professional dancers from a variety This study traces the emotional experience of eighteen student bal- of dance forms. The recorded interviews were transcribed verbatim let dancers over one academic term (twelve weeks) at an elite dance and content analyzed with NVivo 4.0. In Study 2, the main topics conservatory in the UK. The primary aim is to establish personal- emerging from the interviews were investigated quantitatively with ity typographies of student dancers, and the study highlights the 245 female (n = 218) and male (n = 27) dancers. The variables of importance of giving consideration to personality traits as a tool interest reflected imagery quality and quantity. The role of teachers in to improve ballet training at elite dance conservatories. imagery development was also explored. For Study 1, results fell into Using the lenses of Personal Construct Psychology theory (Kelly), three categories: Early Experiences, Teachers, and Imagery Changes. issues relating to occupational stress of individual student dancers were Findings indicated that few dancers were taught explicitly how to use analyzed. Practice-as-research represented a vital approach; i.e., the imagery, and that they preferred teachers who gave plenty of images. researcher joined the ballet classes with the participating student danc- The dancers also reported gradual changes toward more frequent, ers on a regular basis. This multidisciplinary approach of observatory complex, and kinesthetic images as they became more experienced. as well as participatory nature was used to maximize the perspective of In Study 2, the dancers perceived their images to have improved both an “insider doctrine with an outside eye.” Research data were collated in terms of quantity and quality across their years in dance. Better over a period of one year in the form of (a) individual interviews at dancers perceived greater improvements in their imagery, received two different points (week one and week ten) during the academic more encouragement to image from their teachers, and had been term, (b) video-recording of ballet classes at two different points given more images in class. In conclusion, it appears that imagery (week one and week ten) during the term, and (c) the analysis of an improves as a dancer improves, but that teachers can play a crucial role “emotion journal” that students kept for the duration of the study. in enhancing the awareness of this important psychological skill. Research data have been transcribed to a large extent. 12. Talent identification in dance, and considerations in The establishment of character and personality typographies training exceptionally talented young dancers: A literature will demonstrate the imbalance between the teaching of purely review technical skills and the lack of emotional learning (Emotional Sarah Irvine, MSc; Emma Redding, MSc, Laban, London, UK Intelligence) in ballet classes. This paper will conclude with is- The aim of this study was twofold; to review the various criteria sues of validity and implications for teaching ballet at elite dance that have been used to identify talent in dance, and to undertake conservatories. a comprehensive literature review of previous studies that have 10. Arthroscopic debridement of hip labral tears in dancers examined the physiological and psychological issues of training Mininder S. Kocher, MD, MPH, Children’s Hospital Boston, Division of young exceptionally talented dancers in relation to their gender. Sports Medicine, Harvard Medical School, Boston, MA; Ruth Solomon, Research suggests that raw talent is difficult to identify, and that Professor Emerita, University of California, Santa Cruz, CA; B. Minsuk Lee, some talented dancers do not immediately stand out because of BA, Children’s Hospital Boston, Harvard Medical School, Boston, MA; Lyle J. a desire to hide their talents. The environment in which talented Micheli, MD, Division of Sports Medicine, Harvard Medical School, Boston, dancers learn most effectively has also been defined in that higher MA; John Solomon, PhD, Freelance Editor, Santa Cruz, CA; Allston J. Stubbs, learning curves occur when learners are able to exert control over MD, Children’s Hospital Boston, Division of Sports Medicine, Harvard Medical their learning environment. Although there are physiological and School, Boston, MA, USA psychological issues that are generic to all young people training in Experience in our clinical practice suggests that tearing of the hip physical activity, there do appear to be issues that warrant particu- labrum occurs quite frequently in dancers. The purpose of this lar consideration when dealing with adolescent boys versus girls. presentation is to demystify this injury and the surgical procedure There may be some differences between genders in skill acquisition; commonly used to correct it, and to assess dancers’ prospects for however, there are clear fundamental differences in relation to their full post-operative recovery. We reviewed the outcomes of 30 danc- basic physical and training requirements. For example, in terms ers, median age 20.1 years (range: 14.1–38 years), who underwent of their motivation to participate, boys prefer more structure and Journal of Dance Medicine & Science • Volume 11, Number 1, 2007 11 task-based specific work in class, whereas girls prefer more explora- Pain, and right Foot Pronation, but clinically relevant prediction mod- tion, open-ended and creative tasks. els could not be determined. Very few differences were found between Methods for identifying talent in dance are under review so injured dancers and non-injured dancers, which is counter to many that more objective criteria can be defined. It seems no longer ac- assumptions in dance medicine. Practicality of screening programs ceptable to apply adult training regimens to the younger dancing should be carefully considered until more specific, reliable and valid population, and it is becoming apparent that there are physiological tests for injury prediction and prevention can be established. and psychological differences with regard to gender. 15. Posterior tibial tendon tears in professional ballerinas 13. Stability of Lisfranc’s joints in ballet pointe position with different foot types Nancy Kadel, MD, University of Washington Medical Center, Seattle, WA; Michelle Rodriguez, MPT, CMPT; Andrea Zujko, DPT, Westside Dance Mark Boenisch, RTR, New England Baptist Hospital, Boston, MA; Carol Physical Therapy, New York, NY, USA Teitz, MD, University of Washington Medical Center, Seattle, WA, USA; Elly The posterior tibial tendon is a very important dynamic stabilizer Trepman, MD, University of Manitoba, Winnipeg, Manitoba, Canada of the medial longitudinal arch of the foot. During the gait cycle, This study evaluated the relative importance of the pointe shoe it is the simultaneous co-contraction of the posterior tibial tendon and tarsometatarsal ligaments in promoting Lisfranc joint stability and the peroneus longus tendon that establishes a stable, rigid, su- on pointe. Eleven cadaveric feet were dressed with pointe shoes, pinated rear-foot so that a strong push-off can occur. Insufficiency loaded in foot flat with ligaments intact, and then loaded on pointe of the posterior tibial tendon leads to altered gait mechanics and before and after sequential sectioning of the dorsal, interosseous, the inability to relevé or jump. Tears in the posterior tibial tendon and plantar ligaments between the first and second metatarsals are most often associated with a pes planus foot type. However, and cuneiforms. Relative motion between the first and second among dancers the occurrence of these tears appears to be due more metatarsals and cuneiforms was determined radiographically. to overuse and improper alignment than to specific foot type. For Differences in angular measures were analyzed using one-way this presentation we looked at four professional ballerinas who had repeated measures ANOVAs with Scheffe’s post hoc tests for pair- undergone surgery for repair of posterior tibial tendon tears. One wise comparisons. Significant changes were defined by< p 0.05. ballerina presented with a pes planus foot type, one with a rigid No significant displacement of Lisfranc joints occurred when pes cavus foot type, and two with a flexible pes cavus foot type. the shod foot with intact ligaments was loaded in the foot flat or The mechanism of injury, the clinical examination to determine pointe positions. Serial sectioning of the ligaments from dorsal appropriate diagnosis, the location of the tears, and the rehabilita- to plantar in the shod foot on pointe demonstrated no change in tion process used will be discussed. alignment after the dorsal and interosseous ligaments were cut, but significant change in alignment between the second metatarsal 16. Healing the demi-pointe: Forefoot injuries in dancers and second cuneiform was noted after the plantar ligament was Roger M. Hobden, MD, DO(Q); Benoit Aubin, MD, FRCP(C); Nathalie cut (p<0.0001). Removal of the pointe shoe after cutting the liga- J. Bureau, MD, FRCP(C); Étienne Cardinal, MD, FRCP(C), University ments and applying a minimal (1-2 kg) load resulted in complete of Montreal, Quebec, Canada subluxation and diastasis through the first-second intermetatarsal A medical problem in the metatarsophalangeal joint complex can and intercuneiform region. Replacing the shoe showed improved be a career-ending injury for dancers, as many dance forms require alignment on pointe with similar loading. It is concluded that both the dancer to be able to dorsiflex the toes in a weight bearing or the pointe shoe and the plantar ligaments are major stabilizers of non-weight bearing fashion. The structures that may be injured the Lisfranc region in the loaded, shod foot on pointe. include cartilage, bone, joint capsule, ligaments, tendons and the sesamoid bones (in the case of the first toe). 14. Injury patterns in elite adolescent pre-professional A systematic treatment approach for injuries of this sort includes ballet dancers, and the use of screening data to describe and the use of rest, orthotics, modified shoes, and various physical and predict injury characteristics manual modalities. A comprehensive biomechanical analysis needs Jennifer M. Gamboa, DPT, OCS, Body Dynamics, Inc., Arlington, VA; to be done to evaluate intrinsic risk factors such as loss of joint Leigh A. Roberts, DPT, OCS, LAR Physical Therapy, Ellicott City, MD; Joyce Mahring, PT, EdD, George Washington University, Washington, DC; Andrea play in the hind-foot area, loss of motor control in the intrinsic Fergus, PT, PhD, Shenandoah University, Winchester, VA, USA muscles of the foot, and technical errors in weight bearing. Ex- trinsic variables such as class technique, choreography, and dance Ballet schools expend significant resources to conduct preseason floors need to be identified as potentially correctable factors. The screenings to identify and ameliorate risk factors for injuries in ado- systematic use of modern imaging techniques has increased our lescent dancers, although it is not clear that screenings adequately understanding of the natural evolution of these injuries. identify those dancers who are at risk for injury. For this study 207 Clinical cases and videotapes of patients from various dance adolescent dancers were screened at the beginning of the season over disciplines, including ballet, modern, folk, ballroom and flamenco, a three-year period. Screening data were collected in six categories: will be used to identify predictive variables leading to success demographics and past medical history, posture, strength, flexibility, and return to dance, or failure and the end of a dance career. A orthopedic testing, and functional testing. Injury data were collected systematic checklist of identifiable risk factors will be proposed to at the end of the season and classified according to location, nature help dance teachers, artistic directors, dancers, dance students and and month of injury. Screening and injury data were converted into health professionals identify and modify conditions related to the frequencies and means to describe injuries and differences between prevention and treatment of these injuries. injured and non-injured dancers. Follow-up t-tests, Mann Whitney, and Chi-square tests (p< 0.05) were used to identify significant dif- 17. Methods to improve turnout and abdominal strength in ferences. Results indicated that injury rates per dancer increased each ballet students: A pilot study year, but the percentage of dancers injured remained similar. The Judith G. Kimball, PhD, OTR/L, University of New England, Biddeford, most common injury was foot/ankle (45.8-55.6%), followed by hip ME, USA; With contributions from the following University of New England (11.1-45.8%), knee (4.2-25%), and back (4.2-9.3%). Statistically Occupational Therapy Master’s Degree Students: Barbara DeLuca, Danielle significant differences (p<0.05) were identified between injured and Wheaton, Michelle Baillargeon, Mckenzie Jones non-injured dancers for Disability Score Now, History of Low Back The purpose of this study is to compare three different exercise 12 Volume 11, Number 1, 2007 • Journal of Dance Medicine & Science programs to improve turnout and abdominal strength in ballet will be described. The utility of radiology, including MRI and students. The dependent variables are active and passive hip range muscle ultrasound, in the evaluation of various clinical scenarios of motion (ROM), abdominal strength, elbow and wrist ROM, will be discussed. Finally, rehabilitation methods will be presented and elbow co-contraction. Twenty-three advanced-level student to optimize a functional outcome for the injured dancer. dancers were randomly divided into three groups and pre-testing 20. Prevalence of joint hypermobility and correlation with was done. Each group performed a five-minute series of exercises at injury in professional and student modern dancers the same time each day, and post-testing was done weekly on Friday Shaw Bronner, PT, PhD; Mylah Garlington, PT; Sheyi Ojofeitimi, MPT, afternoons. The modalities used by the three exercise groups were ADAM Center, Long Island University, Brooklyn, NY, USA as follows: 1. A short section of Turn Out Dance selected by Irene Dowd as important in increasing turnout; 2. A series of theraband Research suggests that joint laxity predisposes individuals to exercises designed to increase turnout; 3. A series of theraband exer- musculoskeletal injury. In a preliminary investigation examining cises designed to increase abdominal strength. Preliminary review of the relationship between joint laxity and injury in modern danc- results indicates little overall difference in the dependent variables. ers these authors found a fair negative correlation (r = -0.431) in Further analysis of each variable is in process. The probable lack of students and no correlation in professionals. However, the study significance may be due to the small number of subjects in each only analyzed data from one year. The purpose of the current study group (only 22 students actually completed the project), or to the was to determine prevalence of joint hypermobility in professional short length of the exercise program (six weeks). It is interesting and student modern dancers, and examine hypermobility as a risk to note that the short section of Turn Out Dance appears to be as factor for injury in this population over a three-year period. affective as theraband exercises. Analysis of individual variables will The Beighton hypermobility scale is a nine-point scale that lead to better differentiation of findings and a better understanding provides a measure of global joint laxity. In our use of it dancers of how to proceed with further research on this topic. with scores ≥ 4 were considered to be hypermobile. Injury clinic data for the students and professionals were collected retrospectively 18. The relationship between physical characteristics of from physical therapy clinic records at the dance organization. Japanese ballet dancers and their injuries Beighton scores and number of injury clinic visits were examined Mayumi Kuno-Mizumura, PhD,1 Misaki Yoshida, MS,2 Ryoko Sugimoto, for correlation to see if joint hypermobility was a risk factor for MS,3 Ririko Seo4 (1Ochanomizu University, Tokyo, Japan; 2National Institute injury in this population. of Health and Nutrition, Tokyo, Japan; 3Showa Music College of Performing 4 The prevalence of hypermobility in the student and professional Arts, Kanagawa, Japan; Japan Institute of Sports Science, Tokyo, Japan) dancers and differences between male and female scores will be re- The purpose of this study was to investigate the relationship ported, along with correlations between Beighton scores and injury between physical characteristics and injury history in 28 female clinic visits. Joint hypermobility in this group of modern dances will professional Japanese ballet dancers (mean age 27.2 years). Ma- also be compared to ballet dancers, athletes and the general popula- lalignments of the lower extremity, such as increased Q angle, tion. Ballet somatotypes may differ from those of modern dance. genu varum or genu valgum, were evaluated. Passive ROM was The effect of the injury prevention program, with its emphasis at this determined for hip flexion, extension, external rotation, internal dance organization on joint protection, will be discussed. rotation, abduction, adduction, ankle pronation and supination 21. Effectiveness of a hip abductor strengthening program for both legs. The angles of functional turn-out and joint laxity on the prevention of anterolateral ankle sprains in a were also determined. All subjects answered a questionnaire about professional injury history and present and past exercise experience. Marijeanne Liederbach, MSPT, MSATC, Harkness Center for Dance Injuries, Subjects were divided into three groups: dancers with no in- NYU Hospital for Joint Diseases, New York, NY, USA jury history (Group C), dancers with one injury (Group 1), and dancers with more than one injury (Group 2). Group 2 showed Ankle sprains occurred in 37% of dancers over a one-year period in significantly longer dance experience and greater Q angle of the a New York City-based professional ballet company. Eighty-seven right leg compared to the other groups. It also showed significantly percent of the injured dancers had tested positive for weakness in greater ROM in hip flexion and external rotation, while ROM of their hip abductor (HAB) muscles during pre-season screening, hip internal rotation, ankle pronation and spination were signifi- and this was the only statistically discriminating factor between cantly smaller for Group 2. them and the non-injured dancers. The purpose of this study was The results of this study indicate that dancers with higher flex- to determine if a supervised HAB strength program would reduce ibility in hip flexion and external rotation and lower flexibility in ankle injury rates in a subsequent year. hip internal rotation and ankle pronation and supination may be at Sixty-two dancers volunteered to participate in the study. increased risk for injury. Japanese medical and scientific researchers Twenty (32%) of those tested positive for HAB weakness at interested in dancers should accumulate more data of this kind to pre-season. Each of those agreed to engage in a thrice weekly, enhance our understanding of the relationship between anatomical progressive resistance HAB strengthening program for eight weeks. factors and overuse injuries. Compliance was 80%. Dancers were assessed for strength before and after the 8-week 19. Hallux injury in classical dance: Evaluation and strength training program. The dependent variable was HAB treatment strength score as measured with a handheld dynamometer using Judith Peterson, MD; Julie Green, MSPT, OCS, , the break test described by Kendall. Injury occurrence was recorded Philadelphia, PA, USA for all dancers over one-year and injury rates were determined by Hallux pain and limitation is a common problem in classical dance. dividing the total number of injuries by the total number of class, Hallucal injuries may cause prolonged disability and necessitate the rehearsal and performance hours for each dancer and dividing that early termination of a promising dance career. This presentation will value by 1000. review the of the great toe, and present the most common All of the dancers who remained in the training program injuries to the great toe and their causative mechanisms in dancers. increased HAB strength by an average of 22% relative to pretest Physical examination tools that assist in diagnosing these injuries values. Injury rates trended downward, but did not reach statistical Journal of Dance Medicine & Science • Volume 11, Number 1, 2007 13 significance. Further analysis is required to understand the affect in dance medicine and science. of HAB strength on ankle injury rates in dance. 24. Prevalence of anterior cruciate ligament injury in 22. Influence of osteopathy on pointe work in elite ballet university-level dance students dancers Jatin P. Ambegaonkar, MS, ATC, George Mason University, Manassas, VA; Irene Galesso, MScA, GRT osteopath, Outremont Dance Academy, Montreal, Sandra J. Shultz, PhD, ATC; David H. Perrin, PhD, ATC; Mark R. Schulz, Quebec, Canada PhD, University of North Carolina at Greensboro, Greensboro, NC, USA The aim of this clinical study is to demonstrate the influence of Females in jumping and landing sports are susceptible to anterior osteopathic treatment on vitality of the ankle articulation, relative cruciate ligament (ACL) injury. Although dancing involves similar amplitude of motion between flexion and extension, verticality of movements, female dancers anecdotally appear to experience lower the foot and ankle, and finally stability of the body among elite ballet numbers of ACL injuries. The authors’ purpose in this retrospec- dancers during pointe work. The study is a randomized double blind tive injury surveillance study was to determine the prevalence of comparison of two groups, experimental with treatment, and controls. ACL injury in a cohort of female university dance students (n=145; It lasted five weeks for each participant, with pre-test, treatment, and age=21.9±3.9 years; experience=12.3±5.7 years). To use the univer- post-test. The subjects were 42 elite ballet dancers, all of whom were sity’s dance medicine services, all students completed health history doing pointe work on a regular basis and free of serious traumatic questionnaires. If a history of ACL injury was indicated on these injury at the time of testing. The independent variable is a series of questionnaires, additional information regarding mechanism was three osteopathic treatment sessions, always given at the same time collected. While a third of the participants (n=48; 33.3%) reported of day, following Collège d’Etudes Ostéopathiques guidelines. To history of knee injury, only two (1.4%) had had an ACL injury. reduce bias, treatment for the control group involved placement of Moreover, only one (0.7%) ACL injury occurred during dance, the hands only, without therapeutic intention. Dependant variables with the mechanism described as a plant-and-cut maneuver. These considered are as mentioned above. Vitality was evaluated by two results indicate that female dancers might be protected from ACL GRT and one DO osteopaths. For relative amplitude and verticality, injuries, in spite of routinely performing high-risk landing activities. A digital photography facilitated analysis of the dancer’s position dur- limitation of this study is the potential for survivor bias, as data were ing dynamic weight bearing in first classical ballet position à plat, in collected only from students who completed the questionnaires versus demi-pointe, and on pointe. Measures for stability were taken with a all dance students (~200) in the department. Additionally, injuries multi-component force plate for biomechanics. Results of the study were self-reported, and were not verified by physical exam. Further show a significant increase in vitality (p=0.05). However, with regard research is necessary to confirm these findings, and determine if this to stability there are no significant differences between experimental ACL injury rate differential exists at other levels (e.g., high school, and control groups after the osteopathy treatments. Analyses of the professional). numerical pictures for verticality measures and relative amplitude of the ankle and foot are not yet concluded. 25. Skin concerns in dancers Tracey Vlahovic, DPM; Howard Palamarchuk, Temple University School of 23. Systematic review and best-evidence synthesis of Podiatric Medicine, Philadelphia, PA, USA musculoskeletal injury and pain in dancers Conservative skin care is of utmost concern for dancers. This pre- Emily J. Morton, BSc, DC, Canadian Memorial Chiropractic College; J. sentation will outline how to recognize and treat the most common David Cassidy, PhD, DrMedSci, Artists’ Health Centre, Toronto Western skin disorders in dancers, with emphasis on getting them back to Hospital, Toronto, Ontario, Canada performance as soon as possible. It will focus on lower extremity skin This is a systematic review and best evidence synthesis of the epi- issues (verruca, blisters, corns), as well as atopic dermatitis (eczema) demiology (prevalence, incidence and risk factors), treatment, costs and shoe dermatitis. and prognosis of musculoskeletal injuries in dancers. In particular, it explores long-term effects of injuries in dancers and the use of 26. Predictors of lateral ankle sprains in dancers preventive strategies. A comprehensive search of the literature Claire E. Hiller, MSc, PT; Kathryn M. Refshauge, PhD, PT; Rob D. Herbert, published between 1966 and October 2004, using primarily the PhD, PT; Sharon L. Kilbreath, PhD, PT, University of Sydney, New South electronic databases Medline, Cinahl, PsycINFO, and Embase Wales, Australia was performed. Citations were screened for relevance to this study The purpose of this study is to assess predictors of ankle sprains in using a priori criteria. All relevant studies were critically reviewed dancers. One hundred and fifteen students from the dance and bal- for scientific merit. let streams of a performing arts high school were screened, and an In all, 1,842 citations were reviewed, of which 103 were judged ankle history taken. They are to be followed for 13 months to see to be relevant. Of these, 33 studies were accepted on their scientific who sustains an ankle sprain. Potential predictors include: previous merit and comprise our best-evidence synthesis. They indicate that: ankle sprain, balance on one leg, time to recovery after an inversion musculoskeletal injuries, both acute and “overuse,” are prevalent perturbation, hours of dancing per week, degree of dorsiflexion, and in dancers; the lower extremity and low back are affected most flexibility score. Balance on one leg was determined by number of foot often; and injuries may be recurrent and can interfere with dancers’ lifts in 30 seconds with the eyes closed, amount of lateral oscillation of ability to function. This literature identified potential risk factors the ankle on demi-pointe, and ability to balance on demi-pointe for 5 for injury in dancers. There were no acceptable clinical trials of seconds. Time to recovery of lateral ankle oscillation after a 15-degree therapy for dancers’ injuries. inversion perturbation was determined by 3D fastrak. Active hip In order to make informed choices in dance medicine, stake- external rotation was measured supine with the knee flexed over the holders must have access to valid information. The authors have plinth, and dorsiflexion was measured as distance of the big toe from compiled the best evidence on musculoskeletal injuries in dancers. a wall (cm) with the standing knee flexed to the wall. Analysis will In general, the literature was lacking in breadth and was method- utilize Cox stepwise regression. Each dancer’s ankles will be randomly ologically weak. Gaps were identified in knowledge from which we assigned to a “test” group and a “validation” group. The predictive have made recommendations for future research. Ours is the first model will be developed on the first ankle group and validated on the systematic review of this topic and is relevant to all stakeholders second. Final results will be available in mid-March, 2006. 14 Volume 11, Number 1, 2007 • Journal of Dance Medicine & Science

27. Can university-aged dancers accurately self-report their and preventing and overcoming injury. weight? In this workshop, the participants will discover the following: Jeffrey A. Russell, MS, ATC, University of Wolverhampton, Walsall, UK A. On the Ped-a-Pul: Weight is a fitness variable that is of primary concern to those in- 1. Proper execution of plíés and relevés using the two centers volved in dance. Measuring and reporting weight can cause great (lumbar and scapulae stabilizers in a Serape-like effect), hip distress among dancers. The purpose of this study was to determine rotators, adductor and hamstring recruitment and ground whether or not dancers of university age can accurately self-report reaction force. their weight. Dancers from two universities of different training levels 2. Initiation of the arms from the scapulae, with the scapulae and in different countries were asked to report their weight as part stabilizers. of a physical screening. Immediately thereafter they were weighed 3. Achievement of a lengthened and controlled upper body on a scale and their measured weight was recorded. The data were contraction. analyzed with a paired t-test to determine the differences between the B. On the Foot Corrector: Strengthening and mobilizing the self-reported and measured values. The results of the t-test showed feet. no significant difference between dancers’ self-reported weight and C. On the Toe Corrector: Alignment of the lower limbs, hips, their measured weight. The correlation between the two sets of scores and shoulders. was very high (r = .96). It is concluded that generally university-aged The participants will first perform simple dance skills and Pilates dancers accurately know and report their weight. However, because exercises, using breath patterns. They will then divide into three of the potential for weight to be improperly emphasized and for groups. Each group will try the Pilates and dance movements specific individual dancers to underestimate or overestimate their weight to the Pilates apparatus, under the supervision of an assistant. At the (either consciously or unconsciously), clinicians and educators should end the participants will execute the initial dance skills again, to sense maintain an appropriate regimen of weight screening. Finally, there are the improvement in technique resulting from the Pilates work. intriguing discussion points about possible motivations of dancers to Although it is easier to align the body using the apparatus, partici- underestimate or overestimate their weight, and about comparisons pants will also learn how to create similar movements using bands, of results between different university settings. balls and other objects. This knowledge can then be applied to dance technique. 28. Two exercises designed to facilitate confidence, coordination and dimensional integrity Friday, 20 October, 2006 Stephanie Saland, Seattle, Washington, USA 30. Conditioning and inertia training for dance This movement session will focus on the principles used in two bal- Michelle Khai-Cronin, BS, CSCS, Soma Fitness and Performance at The let combinations, one at the barre and the other in the center. Both Standard Spa, Miami Beach, FL; Jock Soto, School of American Ballet, New exercises are done slowly, as the body and the can York, NY, USA better absorb information in this manner. These exercises expedite the process of feeling connected, thereby facilitating a sense of the whole Beyond technique classes and traditional modalities, dancers need self. They address aspects of co-ordination of the arms, thoracic spine, physical conditioning that recreates the conditions of their perfor- sternum position and scapular rotation, while using opposing down- mance context in order to minimize injury, enhance performance, ward and spiral forces. In the legs and pelvis, both neutral positions and extend career longevity. Through experiential learning, this and external rotation are employed, articulated and stabilized. The movement session will demonstrate how kettlebell (KB) training is “hugging” barre exercise employs internal and external rotation of the an ideal modality for dance conditioning. KB training is an art form legs and feet in a flowing sequence, as well as flexion and extension of in itself, requiring a sophisticated and subtle motor skill ability that the spine. The exercise in the center is designed to reinforce what is has direct transferability to dance. Although simple in appearance, learned at the barre, and to challenge the dancer with unfamiliar pat- it is a powerful tool in developing the skill to control and direct terns. The purpose of this session is to offer the participants a learning inertia in a ground-based format with dynamic spatial-temporal experience that demonstrates the creative combination of traditional demands. The unique shape of the implement allows for large, and alternative teaching techniques and enhances expressiveness and creative ranges of motion with an emphasis on circular, spiraling vitality. Blending non-traditional approaches with classical ballet movements that move freely in space. KB training provides an technique helps to offset the patterns found in ballet training that are ideal complement to other mind-body modalities traditionally frequently problematic. Discussion in the session will include the use utilized by dancers, which allows for greater transferability from of language and its effects on judgmental attitudes, self-esteem, and the training room to dance performance. performance. The intention is to demonstrate an approach to teaching Participants will feel new neural pathways energized through and an atmosphere that co-create the development of fully fleshed out the circular power of the kettlebell swing, as well as a heightened individuals who can strive for excellence in balanced and joyful ways, sense of balance, coordination, and spatial-temporal awareness. By to foster an openness to input from all sources, and to hone dancers’ utilizing the power of the whole body to manipulate the KB while skills in translating their observations into performance. moving through space, the dancer will learn to partner more easily, jump higher, and land safely. 29. A movement workshop using the Pilates Ped-a-Pul, Kettlebell training can help dancers achieve a high level of per- Foot Corrector, and Toe Corrector to improve dance formance by developing the skills necessary to meet and exceed the technique demands of the dance performance context, create highly efficient Jennifer M. Stacey, MS, Peak Performance Pilates, San Francisco, CA, USA and effective movement patterns, and specifically prepare the body Joseph Pilates invented numerous apparatus to assist the mover in for the acute rigors unique to the art form. successfully accomplishing a skill. The Ped-a-Pul, Foot Corrector and 31. From theory to sensation: Reviewing practical concepts Toe Corrector are examples of some of his small, portable creations. to improve demi-plié and stretch feet Dancers can benefit from use of these apparatus for mobilizing, Peter Lewton-Brain, DO, MA, Les Ballets de Monte-Carlo, Monaco; strengthening, aligning the body, enhancing performance techniques, Annabelle Couillandre, PhD, PT, University of Paris X, Nanterre, France Journal of Dance Medicine & Science • Volume 11, Number 1, 2007 15

Putting into practice theoretical concepts concerning plantar in a sample of volunteers consisting of 20 male professional dancers flexion and improving the demi-plié, this movement session ex- (24±1.4 years of age). These dancers were tested for knee flexors plains biomechanical principals using mental imagery techniques, and extenors strength, and passive lower body musculotendinous anatomical palpation and movement so that participants can feel flexibility. This procedure was repeated twice, before and after in their bodies what they understand with their minds. The first seg- a three-month strength-training program (with up to three 50- ment of this two-part movement session reviews a biomechanically minute sessions per week, using mainly hamstring and quadriceps sound method of stretching the foot, followed by a practical series free-weight exercises), in which half of the dancers participated. of exercises. Intended not only to improve function and diminish The remaining dancers acted as controls. The data were analyzed risk of chronic injuries (such as posterior impingement in the ankle, by one-way Analysis of Variance (ANOVA) with post-hoc Tukey or tendinitis), it also concerns enhancing performance capabilities test, which was performed on each variable to find differences by creating an aesthetically improved, stretched foot. between the groups. As with the findings of a similar study of The second part of the session involves reviewing a specific female dancers, it was revealed that significant increases in lower method for teaching pliés that has been demonstrated by the use body muscular strength (P<0.01) were followed by significant in- of electromyographic, accelerometric and goniometric measure- creases in flexibility (P<0.05). The control group demonstrated no ments to aid in the development of improved teaching models that alterations in any of the studied parameters. These results indicate influence both the demi-plié’s function and the body’s dynamic that strength training may positively affect selected functional and alignment. Devoted to integrating the biomechanical concepts structural characteristics of the passive contractile elements, i.e., involved in making a correction, the hands-on work explains step connective tissue. This is one of the first sets of data that calls into by step the different stages by again mixing mental imagery tech- question the long-held view that fitness training—particularly in niques, anatomical palpation and movement patterns to allow the relation to muscular strength—would diminish dancers’ flexibility participants to integrate the correction and feel what the results do and, thus, negatively affect performance in dance. for their own bodies before trying to transfer it to others. 34. Communication through touch The session offers scientifically observed methods that can Janet Karin, OAM, School, Melbourne, Victoria, improve biomechanical function and potentially diminish the Australia risks of injury while enhancing performance. This information is important for dancers, teachers and health professionals alike. Dancers experience movement firstly as physical sensation, which develops a concrete view of the body and its actions and then 32. Monitoring energy expenditure in dance, motor stimulates abstract concepts such as line, focus and artistry. While actions, and lifestyle dancers bring all these elements together in performance, they usu- Fernando M. Duarte Pereira, PhD; Luís Xarez Rodrigues, PhD, Faculdade ally learn most efficiently through physical sensation. Hence, it is Motricidade Humana, Lisbon, Portugal logical for teachers to tap into this innate conduit to the dancer’s Coding and measuring physical activities (PA) obtained from PA brain by using touch as a diagnostic and teaching tool. records and determining intensity levels from physiological body Dancers who understand a fault of execution can usually make signals of specific activities performed in various settings is an a short-term correction, but the fault returns if the underlying mo- important subject, involving almost every medical specialty. The tor pattern is retained. Although dance is a holistic activity with aim of this study is to establish a practical methodology to access, the placement and movement of each part influencing the whole diagnose and monitor the energy expenditure of high-level ballet organism, it is easiest to locate inefficient motor patterns by break- dancers. A new concept in metabolic physical evaluation is used, ing an incorrectly executed action into its smallest components and combining a commercially available body monitor that acquires asking the dancer to imagine the movement fragment. Touch helps physiological signals (two accelerometers, skin temperature, near the instructor to diagnose a motor pattern as soon as it is initiated, body temperature/heat flux, galvanic skin resistance) and its re- before actual movement occurs. search software with an observational system specifically developed This crucial point of motor pattern initiation is the key to for dance actions during periods of active energy expenditure. By achieving better function. Instead of attempting to modify an combining the two instruments it is possible to monitor total daily established pattern, it can be better to present a different task expenditure or partial physical activity demands. One of the major which has no established pattern. The instructor can use touch as benefits of this user-friendly system is its ergonomic portability, that a cue for the new task, while using the other hand to monitor the allows a continuous monitoring of free-living individuals for several brain’s search for a new motor pattern. In this way, touch provides days in a non-intrusive way. The system also measures individual a three-way communication between the instructor, the dancer’s lifestyles and sleep efficiency/duration, contributing to exercise brain and the dancer’s body. safety, avoiding overtraining, and reducing the risk of traumatic Dancers, as artists, respond readily to abstract images. Touch can injury. Initial results are presented to illustrate energy expenditure be tied to evocative images which initiate desirable motor patterns in (1) dancers’ lifestyles and (2) a 45-minute rehearsal of a neo-clas- as well as serving expressive needs. Thus, touch can also create a sical duet by two high-performance dancers, as well as respective bridge between technique and artistry. energy costs to different dancers during performance of the same 35. The brain’s sense of movement: Support for somatic choreography, and comparable energy expenditures for several practices in dance education dancers during rehearsal and performance of the same piece. Glenna Batson, DSc, PT, Winston-Salem State University, Winston-Salem, 33. Do strength training regimens affect musculotendinous NC, USA flexibility in male professional dancers? For a quarter of a century somatic education has filtered into Yiannis Koutedakis, PhD, Thessaly University, Trikala, Greece; Constantin dance, challenging various assumptions about dance teaching and Bouziotas, PhD, Wolverhampton University, Walsall, UK; Christina learning. Justification for somatics in dance education has been Karatzaferi, Thessaly University, Trikala, Greece challenging, especially in relegating to it a larger role than recupera- The aim of the present study was to assess whether supplementary tion from fatigue or injury. One hallmark of somatic education strength training regimens can affect musculotendinous flexibility that sets it apart from dance is the concept of “non-doing,” or 16 Volume 11, Number 1, 2007 • Journal of Dance Medicine & Science reduction of effort in movement conception and execution. The and duration of exercises were considered, and functional fitness Alexander Technique, the Feldenkrais Method, and Ideokinesis, training preceded more dance-based exercises that increasingly for example, make liberal use of non-doing strategies in their replicated vocabulary from technique classes. The aim was for the pedagogy. Conscious awareness of moving with reduced muscular structure and content to be responsive to curriculum needs and effort enhances sensitivity to sensory feedback. This enables danc- to encourage dialogue with technique teachers and therapists. ers to refine proprioceptive and kinesthetic awareness to ensure This study, longitudinal and experimental in design, is the first coordination, i.e., that the intention to move matches the actual of its kind to address the need for specificity in dance training while movement outcome. Current neuroscience research sheds light on attending to theories and concepts from sports science. Hopefully how the brain constructs a “map” of the moving self. The brain’s other dance training institutions will consider adopting a similar map of the self is plastic, dynamically constructed, and sensitive model, so that findings can be shared and more effective training to proprioceptive input regarding force, especially in early phases programs for dancers devised. of motor learning. This presentation reviews current brain map- 38. Anthropometry in dance ping and other neurological research on the role of perception in Manuela Angioi, MSc, PhD Candidate; Emily Twitchett, BSc(Hons) GRS, organizing the self to move. Examples of learning strategies that PhD Candidate; Matthew Wyon, PhD, University of Wolverhampton, enhance or degrade the map of the self will be discussed, along Walsall, UK with their implications for dance education. The aim of this study was to explore associations between body 36. Postural strategies in professional dancers: A mass index (BMI), body fat percentage (%BF), somatotype and preliminary study injury rates in dancers. The assessment of body composition in Luana Poggini, MD; Ilaria Severi, PhD Candidate, Accademia Nazionale di dance, in particular %BF, can be useful in identifying whether Danza; Fabrizio Bernardini, MSc, Wellness Terapeutico, Rome, Italy the desired body weight is realistic, and safe. Anthropometric The purpose of this study is to investigate how professional danc- measurements were collected from professional ballet dancers ers use three different postural strategies—proprioceptive-visual, and full-time ballet students. The Heath Carter anthropometric upper limb compensation, and vestibular—to manage instability method of somatotyping was used. From the measurements, the situations. The Delos Postural System®, consisting of an electronic dancers’ BMI, somatotype and %BF were calculated. Injury rates rocking board with visual feedback (called DEB) and a steel struc- and sites were assessed using a standardized injury questionnaire ture with infrared sensor for hand support, was connected to a completed by the dancers, along with the time taken to recover computer provided with software able to analyze the different from injury. Results from similar studies showed that typical rela- postural strategies. Twenty healthy professional dancers, 15 fe- tive %BF values range from 16 to 18% in female ballet dancers males and 5 males, aged 18 to 32 years, who practice classical and and from 5 to 15% in males. The aesthetically ideal body type in contemporary dance for 3 to 5 hours, 6 days a week, have been many professional ballet companies is a mesomorphic ectomorph tested. During the first part of the session each dancer completed profile. However, although this body type may be aesthetically one static and two dynamic posturometric tests with eyes open favored, it has not been proven whether it is necessarily the most and closed. In the second part of the session all dancers repeated anatomically durable. Further, previous studies of classical ballet the two dynamic tests after a 45° rotation of the DEB to obtain dancers have found a relationship between dance injuries and low the “en dehors” of the standing leg. BMI values. Anthropometric results obtained in this study were The protocol of this study was specifically designed according to statistically compared to incidence, severity and nature of injuries Dr. Riva’s indications to compare the collected data with available sustained over the last 12 months. By conference time the collected published results obtained with other highly skill professionals, data will be analyzed for the predictive value of somatotypes and/or such as figure skaters and gymnasts, and also to investigate the “en BF vis à vis injuries. dehors” single stance, which represents a peculiar stance position 39. Breathing: Anatomy of movement for professional dancers. We will present data intended to describe Reetta Ronkko, MA, University of Kuopio, Kuopio, Finland; Jarmo Ahonen, the specific postural strategies of the professional dancers, and to PT, , Helsinki, Finland analyze imbalances due to poor training or technical errors. The Delos Postural System® might also be useful to stimulate danc- Breathing is commonly mentioned as an important part of condition- ers’ proprioceptive systems in order to prevent the occurrence of ing and dance exercises, but rarely explained in detail. The aim of this injuries. presentation is to highlight the movements of breathing and their control through a biomechanical and kinesiological analysis. 37. The effects of a one-year dance-specific fitness training A combination of mostly involuntary movements, reflexes program on undergraduate modern dance students: An and reactions to pressure function in concert to facilitate oxygen experimental study and carbon dioxide gas exchange in the lung tissue. Calm, relaxed Sonia Rafferty, MSc; Emma Redding, MSc; Sarah Irvine, MSc; Edel Quin, breathing is virtually unnoticeable, but when the intensity of MSc, Laban, London, UK exercise increases respiratory volumes increase and more skeletal The purpose of this study is to examine the effects of a one-year muscles must be recruited. In theory all muscles attached to the dance-specific fitness program on undergraduate modern dance ribcage can participate in respiratory movements, but different students. Existing screening information for each of 86 first-year muscles act in inspiration and expiration. Thus, overall balance students provided initial data on a series of physiological tests, and movement control of the torso and spine are connected to which were then repeated at the end of the one-year intervention the action of breathing. If a dancer tries to hide the breathing program. Students also completed an intrinsic motivation inven- movements, a rather common habit, full control of dynamic core tory, a questionnaire regarding their personal appreciation of the stabilization is not attainable. Furthermore, if the thoracic cage program, and kept a log of extra-fitness activities. is constantly tilted posteriorly it cannot be fully exploited for A weekly 90-minute fitness class was developed across the year breathing. From a “muscular economics” point of view, a common according to principles of periodization and specificity. Intensity mistake in breathing is over-recruitment of the elevators of the Journal of Dance Medicine & Science • Volume 11, Number 1, 2007 17 ribcage (i.e., m.scaleni, m.sternocleidomastoideus) coupled with on the motor neuron. Muscle activity may be reduced by GTO under-use of the intercostal muscles caused by shallow, superficial input, but not “turned off.” 4) During contract-relax stretching, breathing patterns. GTO autogenic reflex inhibition lasts only as long as the muscle’s The deep abdominal muscles are accessory expiration muscles active contraction. Therefore GTO is unlikely to significantly -af that can be trained with conscious exercises, like those in Pilates. fect the subsequent stretch-relaxation phase. Other receptors and Simple exercises can teach the three-dimensional directing of spinal circuits serve this function. breathing and the use of correct muscles attached to the ribcage. It is hoped that this updated information will correct several Through understanding both the automatic and voluntary, train- erroneous notions about the GTO that have persisted in the dance able nature of breathing, it is possible to incorporate purposeful kinesiology literature. Thus, dance kinesiology teachers and authors exercises into dancers’ training programs. can provide accurate information to their students and readers. 40. Imagining a new movement 42. The role of feedback in dance training Corinne Jola, MS;1 Marie-Claude Hepp-Reymond, PhD;2 Fred W. Mast, Marliese Kimmerle, PhD, University of Windsor, Ontario, Canada PhD3 (1Institute of Cognitive Neuroscience, London, UK; 2Institute for 3 Feedback is an integral part of dance training. Teachers and thera- Neuroinformatics, Zurich, ; Institute of Psychology, Lausanne, pists use different modes of augmented feedback in attempting Switzerland) to promote skills acquisition, but also assume that dancers have a Recent research has revealed evidence that imagery training (IT) highly developed kinesthetic sense and can use internal propriocep- can improve motor performance. In IT, a movement is repeatedly tive feedback to make corrections without the teacher. There is an performed in mind while the body remains still. However, it is extensive research base in motor learning that may be helpful in not clear whether IT modifies existing motor commands on the using feedback effectively for dance skill acquisition. Recently this neuromuscular or higher cognitive level. Most dancers already research has been applied outside the lab in sport skill acquisition, use IT frequently, independent of existing scientific evidence and direct translation to dance may be possible. regarding its efficacy. A deeper understanding of the underlying This presentation will review present knowledge of feedback processes at work in IT might increase its efficiency in dance and effectiveness in skill acquisition, and raise research questions that neurorehabilitation. should be studied in dance. Although feedback is certainly ad- The authors investigated the effect of IT on abduction of the big dressed in dance pedagogy, the focus has been on documenting toe. The ability to abduct the big toe supports stability in balance type and frequency of teachers’ use, or on the psychological effects and counteracts hallux valgus. Most people (at least in western of feedback on body image and self esteem. Research on the role civilization) find it difficult to execute this movement; thus, no of feedback in dance skill acquisition is sparse. previous motor program exists for this type of movement. The following are some motor learning topics that should Results indicate that IT can produce a pronounced increase in be researched in dance: How effective are the various modes of abduction strength. Moreover, the latency for movement onset feedback (verbal, touch, mirrors, video, biofeedback) in different decreased significantly with IT. Also, visual anticipation of the end dance forms or in therapy? How does this differ in novice versus position potentiated a significantly higher movement range. experienced dancers? What are the developmental limitations on This study shows an effect of IT on abduction strength. The feedback use? Does the “guidance hypothesis” apply in a dance results indicate that imagery does not rely exclusively on already context? What is the ideal content of the feedback? Is the debate existing motor commands. Furthermore, it seems that visual over internal versus external focus relevant in dance? Do dancers anticipation contributes to motor control. These results will be and athletes in aesthetic sports self-select to those with higher kin- discussed in relation to recent findings in movement observation esthetic sensitivity, or is this not a relevant issue? It is hoped that and imitation. this session will encourage debate, and many research projects. 41. Golgi tendon organs (GTOs): Neuroscience update and 43. Utilizing Pilates-based movement for rehabilitation of relevance to proprioception and stretching upper extremity injuries and scapular dysfunction Marjorie Moore, PT, PhD, College of St. Catherine, Minneapolis, MN, Alison Deleget, MS, ATC; Megan Richardson, MS, ATC, Harkness Center for USA Dance Injuries, NYU Hospital for Joint Diseases, New York, NY, USA The purpose of this presentation is to review the neuroscience of the Upper extremity (UE) injuries account for approximately 10% of Golgi tendon organ (GTO), and to update and correct erroneous all dance injuries. Because the majority of dance injuries are to the notions regarding its functional significance, particularly related lower extremities, UE rehabilitation can become an area of clinical to its involvement in proprioception and stretching techniques weakness for dance medicine practitioners. The purpose of this ses- used in dance training. sion is to introduce allied healthcare professionals to Pilates-based Recent research has provided a number of important correc- therapeutic exercises designed to restore function and recondition tives to earlier misconceptions. We now know that: 1) A GTO the dancer after UE injury. Participants will learn biomechanically responds to even tiny/weak active contractions throughout the sound exercises and movement techniques that focus on stability of range of motion, though GTO is much less sensitive to passive the glenohumeral and scapulothoracic joints. Exercise progressions tension. Its primary function is not protective, but is to provide will be explained and demonstrated so that participants learn to accurate information to the CNS about the amount of ongoing guide dancers from acute injury through complete return to dance. muscle contraction, and to counteract muscle spindle input. 2) Emphasis will be placed on functional rehabilitation through the GTO sensations do reach the cerebral cortex, buried in the fis- incorporation of core stabilization and movement integration sure between the motor and sensory “strips.” Thus, they provide principles. Audience members will learn how to identify faulty conscious sensation of body position and movement. 3) The GTO UE movement patterns and initiate corrective techniques using and its reflex (autogenic inhibition) reduce, but do not shut off, Pilates-based exercises. Tactile, verbal and visual cueing methods the excitability of the motor neuron and its innervated muscle. The to maximize therapeutic effectiveness will be demonstrated. ultimate reflex effect depends on the sum of multiple other inputs Upper extremity stability and strength is essential for many 18 Volume 11, Number 1, 2007 • Journal of Dance Medicine & Science genres of dance, whether the dancer is male or female. Also, the activity. This concept echoes a 13th Century Tai Chi classic: “The incorporation and integration of core stability principles into UE energy is rooted in the feet, develops in the legs, is directed by the gesture is a basic component of dance technique. Allied health waist, and moves up to the fingers.” Hartley (1995) describes a professionals will benefit from the expanded knowledge of Pilates- rehabilitation procedure to stimulate a leg extensor thrust pattern; based movements they gain in this session, which they can build a push, initiated in the foot and sequencing up through the body into their orthopedic rehabilitation repertoires. to connect parts into an integrated whole. Underlying, principle focuses of this movement workshop are described in the literature 44. The art and science of plié and practice of push/pull patterns as: attention, intention, initia- Eric Franklin, BFA, BS; Morten Dithmer, Institute for Franklin Method, Uster, Switzerland tion, and sequencing. The purpose of this workshop is to explore fundamental reflex The plié is one of the most common movements in dance. Yet, if patterns, and to invigorate and hone their application during skilled you question a group of dance students as to why they perform movement and habitual patterns in our daily lives. This work is this movement daily in their training, you will get a wide range of relevant to developing awareness of our neuromuscular patterns and partially contradictory answers. This movement session will elu- exploring alternatives that may be more functionally optimal. cidate the plié on a variety of levels: Its purpose in dance training and performance, its sound biomechanical performance, and how 47. Analysis of dancer screening forms used in the dance it is best employed in relevés, turns and jumps. medicine community Following a brief description of the anatomy of the pelvis and Marijeanne Liederbach, MSPT, MSATC;1 Tom Welsh, PhD;2 Marshall 3 1 legs, specific imagery and self-touch exercises will be presented that Hagins, PT, PhD ( Harkness Center for Dance Injuries, NYU Hospital for Joint Diseases, New York, NY; 2Department of Dance, Florida State promote increased safety for the lower back, knees and feet during 3 plié. The movement session will also explore how to introduce these University, Tallahassee, FL; Department of Physical Therapy, Long Island University, Brooklyn, NY) concepts to dancers who have little knowledge of anatomy, and how to increase motivation by linking anatomical knowledge with In 2004 the IADMS Research Committee (RC) began a consensus the experience of greater technical ease. The session will provide project aimed at encouraging the international dance medicine practical instruction in the subtle but important coordination of and science community to adopt uniform testing and reporting the legs and pelvis, which will lead to improved stability, flexibility methods. By standardizing assessment and documentation nomen- and alignment in the plié. Dance educators will be shown how clature and grading of dancer functional capacity screens, dance to use imagery and language that explains even complex subject environment risk factors and injury occurrence, the consensus matter to dancers at all levels of development. project strives to lay the groundwork for successful and coopera- tive sharing of information through a privacy-protected database. Ultimately, the RC aims for this coalesced information to facilitate Saturday, 21 October, 2006 effective risk reduction strategies in order to enhance the well-be- 45. Strategies for achieving hip health in dancers ing, career longevity and quality of life for dancers. The first step Jane Baas, MFA, Western Michigan University, Kalamazoo, MI, USA identified as necessary in advancing the consensus project’s goals This movement session is intended for dancers, dance teachers, was to solicit and analyze screening form items and methods cur- physical therapists and others interested in movement efficiency. rently in use in the field. Sixty-eight forms from 13 countries were Its purpose is to introduce participants to common anatomical collected over a period of eight months. The following countries differences and technical errors affecting dancers’ hips, and to were represented in the sample: Australia, Canada, China, England, provide strength and mobility exercises and other techniques and Finland, Greece, Ireland, Israel, Italy, Japan, Spain, Sweden and strategies that may be used to promote stronger, healthier hips in the USA. Healthcare professionals submitted 82% of the forms dancers. The presenter will briefly discuss how to identify com- and dance educators submitted 18%. From this material lists were mon anatomical differences of the hip, common technical errors, developed of all items surveyed and the frequency with which they and the implications of this information for dancers. Exercises for appeared among all forms. Analysis then cataloged the indicators targeted strengthening, stretching, self-massage techniques, and that members of the dance medicine community currently use to other activities to help dancers address these challenges will be assess dancer health and injury risk. This information will be used presented for participants to try. to stimulate community-wide discussion and determination of next steps toward consensus on standardization. 46. Application of fundamental push/pull reflex patterns in somatic practices, Tai Chi, and dance training 48. Assessment of knee strength, flexibility, and structural Steven J. Chatfield, PhD, University of Oregon, Eugene, OR, USA differences in dancers across four institutions Jane Baas, MFA, Western Michigan University, Kalamazoo, MI; Gary Galbraith, This movement workshop explores push/pull patterns used in MFA, Case Western Reserve University, Cleveland, OH, USA (Non-presenting rehabilitation systems based on neural developmental training. co-researchers: Karen Potter, MFA; Chad Fortun, PT, Case Western Reserve These patterns will be experienced through a somatics environment, University, Cleveland, OH; Carrie Janiski, ATC, Brenda Chapman, BSPT, functional applications from Tai Chi, and creative movement im- Western Michigan University, Kalamazoo, MI; Nancy Kadel, MD, University provisation and composition. Continuous movement, progressing of Washington, Seattle, WA; Carla Corrado, BSPT, Cornish College of the Arts, from warm-up through an exertional phase to cool down, will be Seattle, WA, USA) included. Theoretical background is interlaced throughout. The purpose of this research is to examine anthropometric and The session presents a convergence of research and practice biomechanical data collected as part of a dancer wellness screen to from neuromotor science, somatics, Tai Chi, and dance. Elec- provide a profile of knee health, limitations and anomalies common tromyographic data have suggested that an “ankle strategy” is a to college dance students. By examining results from an ever-ex- primary postural response in which ankle muscles initiate postural panding database the researchers hope to develop recommenda- sway by a push into the ground that sequences through the legs tions for enhancing the capacities required to meet the demands and the spine to provide anticipatory support for voluntary arm of dance activity, with the goal of promoting education, injury Journal of Dance Medicine & Science • Volume 11, Number 1, 2007 19 prevention and career longevity. The data collected to date from phrases with fewer motor actions, like Ruth St. Denis (8ma), Vaslav 60 college dancers representing four institutions include Beighton Nijinsky (6ma), Ted Shawn (6ma) and Mary Wigman (5ma). To score, squat, weight distribution, demi-plié angle, hamstring 90/90, learn sequences of movement and choreographies is part of dancers’ hamstring single leg raise, gastrocnemius flexibility, stork test, knee work. They learn great amounts of movement, and can remember it flexion and extension range of motion, quadriceps and hamstring later with more or less effort. But how many movements/items can manual strength tests, Ober test, patellar grind, patellar crepitus, a dancer remember at once? Does a professional dancer recall more Lachman’s test, as well as structural observations including genu than a non-dancer? Does experience in dance influence the capacity recurvatum, tibial torsion, pelvic tilt, and sub-talar joint position. to remember? Is it possible “to learn” to remember better? The aim This information will be correlated and analyzed with results of a of this study is to give answers to these questions. We hope to find technique screen, including the following notations regarding any the memory span for motor behavior. To date we have found that plié observed: knee alignment; pronation at the ankle; pelvic tilt; there are differences when people have experience in dance, when and loss of turnout at the hip. Initial analysis of data suggests signifi- movement is more or less complex, when the speed of movement cant differences in hamstring and gastrocnemius flexibility with the changes, and when it is recalled with or without music. left side being less flexible, and greater incidence of patellofemoral 51. Establishment of a health care service organization in grind and crepitus on the right side. Additional data collection and Japan based on dancers’ health data analysis is being conducted and will be ready for reporting later this Akiko Kishida, MA, RSME, Total Health Care for Artists Japan, Tokyo, year. It is hoped that more institutions will elect to implement the Japan web-based dance wellness screen, providing subjects and researchers with quantifiable evidence of improved dance wellness as well as The field of dance medicine and science has not been fully suggestions for intervention studies. established in Japan, and many dancers there have struggled with injury treatment and rehabilitation. Therefore, two surveys 49. From one extreme to another: What is the collegiate were carried out in 2004, one for dancers and one for medical dance teacher’s role in advising significantly overweight or practitioners, to investigate the current condition of medical care obese dancers? and its challenges as they pertain to dancers. These surveys were Sarah McCalister, MFA, Valdosta State University, Valdosta, GA; Karen Potter, done by questionnaire and interview; 86 dancers and five medical MFA, Case Western Reserve University, Cleveland, OH, USA practitioners responded. The results were analyzed by comparison Most research regarding dancers’ weight focuses on underweight to nationwide surveys of the general population conducted in tendencies and Anorexia/Bulimia Nervosa. Although these are the 1999 and 2002. largest areas of concern for dancers’ weight, research and discussion These surveys revolved around the following questions: have historically left out another often overlooked area: extreme 1. What kinds of injuries do dancers tend to have? overweight/obesity and Binge Eating Disorder in dancers. 2. What kinds of medical practitioners are taking care of dance In the collegiate setting the dance teacher not only teaches, injuries? but also advises. In most college and university dance programs 3. Who funds dance rehabilitation? the student population is mixed with students of different back- 4. What problems do dancers face when being treated for grounds, foci, and training. Many programs focus primarily on injuries? modern dance genres, which are known for being more accepting 5. What kinds of problems do medical practitioners face when of dancers of varying sizes and shapes. In America, where a 42 taking care of dance injuries? percent increase in the number of obese adults was shown between 6. What can improve this situation? 1983 and 2003, and where a 45 percent increase in the number of This study revealed the necessity of establishing an organization overweight children and adolescents was shown between 1988 and that will educate, coordinate, and support dancers, medical 2002, collegiate dance programs could potentially face a significant practitioners, and dance companies in terms of dancers’ health increase in the number of students who are extremely overweight, care. To that end a project team was organized at the end of 2004, obese, and/or dealing with Binge Eating Disorder. and a health care service organization for artists was founded in Fitt (1996) discusses biomechanical, physiological, and psycho- September 2005 (through generous private donations). logical dangers of the overweight dancer. There is also published In this presentation the results of the surveys mentioned above research confirming that overweight or obese and highly physically will be shared, and the audience will also learn how the first health active people have a greater risk for injuries. This presentation will care service organization for artists has been developing based on include an in-depth overview of research, discussion of pertinent data relating to dancers’ health. ideologies, and proposed methodology for advising such stu- 52. The relationships among early season screening dents. results, perception of health status, and injury rates in a 50. Memory span for motor behavior in dance professional ballet company Sofia Carvalheiro, MFA; Luís Xarez Rodrigues, PhD, Faculdade de Jennifer M. Gamboa, DPT, OCS, Body Dynamics, Inc., Arlington, VA, Motricidade Humana, Lisbon, Portugal USA There are many ways to learn a piece of choreography. You can, for The efficacy of pre-/early-season dance screenings in predicting or instance, see a videotape, learn with a partner, or read notation. Is preventing injuries remains unclear. In fact, there is a profound it better to learn all the choreography at once, or subdivide it into lack of published data to support the ability of musculoskeletal parts? If the latter, into how many parts should it be subdivided? screenings to predict injury, much less assign risk. The sports How many motor actions should it have? According to Rodrigues medicine literature, however, does report that increased life stress (1992) there are choreographers who create phrases of movement measured at the beginning of a season is associated with increased with a high number of motor actions (ma), for example: Roland risk for injury. The impact of life stress on health can be difficult Petit (21ma), Yuri Grigorovich (20ma), Lev Ivanov (18ma), Ken- to measure, as individuals have variable capacities to handle stress. neth Macmillan (17ma) and (17ma). Others have One potential measure of the impact of life stress on health is an 20 Volume 11, Number 1, 2007 • Journal of Dance Medicine & Science individual’s perception of his or her physical and mental health make a major change in the lifelong health of professional dancers. status. The short-form 36 (SF-36) is a survey instrument that is Additionally, it can provide an invaluable pool of nameless data to highly validated and widely used to assess individual perception help establish norms, injury patterns and other information that of health. Thus, it may be useful in testing the hypothesis that a can greatly advance our knowledge of dance and dancers. dancer’s perception of health can influence his or her risk for injury. 55. Communication between medical practitioners and To investigate the relationships among health perceptions, muscu- dancers loskeletal profiles and injury rates, a retrospective chart review of Ruanne Lai, BFA Candidate; Donna Krasnow, MS; Martin Thomas, PhD, 30 professional dancers was conducted. This presentation describes York University, Toronto, Ontario, Canada the dancers’ perceptions of their health status (as measured by the SF-36), summarizes the musculoskeletal profiles of the dancers, The purpose of this study was to investigate the communication and correlates these findings to the rate and severity of injuries between professional and pre-professional dancers and medical among the dancers. practitioners. One survey was developed and randomly distributed to family physicians, sports medicine physicians, chiropractors, 53. The construction of health by professional dancers physical therapists, and registered massage therapists. A second Sylvie Fortin, PhD; Sylvie Trudelle, MA, Université du Québec à Montréal, survey was distributed to volunteer ballet and modern dancers Montréal, Québec, Canada; Geneviève Rail, PhD, University of Ottawa, in professional dance training programs, college and university Canada dance programs, and independent dance artists. One hundred This paper examines dancers’ discursive constructions of health, and fifty surveys were mailed to the medical practitioners, and 50 and how dance practices impact these constructions. The authors’ were returned. Three hundred and fifty surveys were distributed to position is that dancers are constructors of their own health, dancers, and 200 were returned. The dancers ranged in age from within the constraints of artistic and social discourses. Themes 20-24 years old, and on average they had ten years of dance train- that have emerged from one-and-a-half-hour conversational-style ing. The data were analyzed using ANOVA. Preliminary findings interviews with 20 professional contemporary dancers and 15 show that medical practitioners rarely communicate with other choreographers will be presented. In this qualitative study, post- medical practitioners treating the same dancers. They also fail to structuralist theories are used as a lens through which to analyze communicate with teachers, choreographers, or directors of these and interpret the transcripts of conversations with the artists. The dancers. Similarly, dancers did not believe that it was necessary or resulting analysis suggests that artists’ constructions are complex beneficial to their injury recovery process for their medical prac- and varied, but most can be described as narratives that relate to titioners to communicate with their teachers, choreographers, or the concept of “healthism” in such a way as to focus on the role of directors. Furthermore, dancers did not fully understand the nature the individual at the expense of a social understanding of health of their injuries when they sought advice from medical practitio- ideology. These findings are discussed in detail for both women ners, nor did they question the medical practitioners for additional and men, and young and experienced artists. Understanding the information. Both groups believed that learning human anatomy meanings dancers and choreographers attach to health might was beneficial for dancers. In summarizing the material presented, facilitate the practices of dancers, choreographers, dance teachers, recommendations will be made to facilitate better communication dance program designers, health therapists and educators. between dance artists and medical practitioners, and to improve care of dance injuries through education of both populations. 54. An annual post-hire health screen for professional dancers: Phase one of a preventive healthcare program 56. Development of an international Internet dance injury for professional dance companies (from the Dance/USA surveillance system: Validity, reliability, confidentiality, and Taskforce on Dancer Health) implementation issues Richard Gibbs, MD, , San Francisco, CA; Mickey Cassella, Carla Murgia, PhD, Kean University, Union, NJ; Ralph Requa, MSPH, St. PT; Heather Southwick, PT, , Boston, MA, USA Francis Memorial Hospital, San Francisco, CA; Thomas Novella, DPM, New York College of Podiatric Medicine, New York, NY; Helen Laws, Dance UK, In February of 2005, a national dance service organization re- London, UK; Fay Nenander, Balettakademien, Stockholm, Sweden quested that their Taskforce on Dancer Health explore and make recommendations specifically on theprevention of injury and illness The benefits of establishing a Web-based International Dance in professional dance companies. Over a series of meetings, the Injury Surveillance System (WIDISS) are numerous, and have taskforce unanimously concluded that the most important step that meaningful applications for all professionals involved in activities companies can take to improve dancer health is to screen dancers for aimed at the prevention and treatment of dance injuries and modi- risk factors that contribute to injury and illness, and to council each fications to training practices. Nevertheless, the establishment of a dancer and recommend interventions based on the screening informa- Web-based program raises four general areas of concern: tion. Preventing injury and illness is vastly preferable to treating 1. Practical Concerns problems after they have occurred. Because professional dancers a) level of support in the dance community for such an are at high risk for physical injury, emotional stress and nutritional effort imbalances, the taskforce urges professional companies to incorpo- b) ease of use rate this preventive strategy into their annual routine. c) accommodation to language differences d) cost In February, 2006, the taskforce presented their recommenda- tions, along with a video demonstration of the Screening Tool de- e) personnel responsible for injury report veloped by the taskforce, to the executives of most North American g) personnel responsible for monitoring the central data base professional companies. The program was very well received and f) motivating/reducing fears in the dancer/student to report will be piloted by several major companies in the 2006-2007sea- injuries son. 2. Legal a) observation of legal standards The taskforce firmly believes that this screening program, -us ing a standardized protocol and a standardized Screening Tool, can b) assurance of confidentiality for the participants Journal of Dance Medicine & Science • Volume 11, Number 1, 2007 21

3. Accuracy of the Report A recent presentation at IADMS reported on a survey of a) reliability of the report Graham teachers who were asked to list difficult movements and b) validity of the report areas of potential stress to the body. Common regions of stress c) bridging the gap between standardization and flexibility of included the anterior hip and knees. This movement session will form format offer suggestions on how to warm-up more effectively for a Graham 4. Dissemination class, give ideas on how to restructure the Graham class sequence a) availability of information to legitimate dance medicine of exercises, and use props to clarify and support the structural researchers in a legal, fair, and equitable way information to minimize the potential for injury. b) mechanics of utilization and implementation of results Focusing on common technique errors, the presenters will dem- within schools and companies onstrate how to assist the beginner student studying this technique. There is no doubt that dance medicine and science professionals Educational strategies (use of yoga blocks, mats, and sandbags) and will find WIDISS helpful in the identification of appropriate -mo verbal cues to assist in the execution of “optimal” biomechanics dalities for the prevention, treatment, and rehabilitation of injuries. of the exercises will be offered. Participants will also familiarize This source should stimulate continued research and discussion, themselves with Graham terminology and movement. thus encouraging modifications to existing education and training Graham Technique has different vocabulary, mechanics and practices to reduce the incidence, recurrence, and severity of dance stressors than ballet, requiring very different strategies to minimize injuries. stressors. This movement session will provide alternative sequencing and structure to a traditional modern technique. 57. Exploring Thomas Myers’Anatomy Trains myofascial concepts while building muscles in clay on the Maniken® 59. Primary and secondary curves: Looking at movement skeletal model through a new lens Maureen O’Rourke, BFA, LMT, New World School of the Arts, Miami, Rebecca Nettl-Fiol, MA, M.AMSAT, University of Illinois, Urbana- FL, USA Champaign, IL; Luc Vanier, MFA, M.AMSAT, University of Wisconsin, With the emphasis on extreme flexibility in dance it is often difficult Milwaukee, WI, USA for young dancers to understand how to maintain a strong stabiliz- In this workshop we will investigate the primary and secondary ing “core,” or “center,” while allowing for the necessary freedom curves inherent in the human body in order to enhance our under- of arm and leg movements. The solution lies in dynamically con- standing of the performance of dance movements. The conceptual necting the upper and lower torso through coordinated eccentric framework comes from the work of anatomist and anthropologist and concentric contractions of the muscles of the shoulder girdle Raymond Dart, as developed by Alexander Technique teachers and abdomen. It takes, of course, training and awareness to build Joan and Alexander Murray. This work is known in the Alexander strength and coordination through this fuller range of motion. community as “Dart Procedures,” a series of movements derived How many times have teachers given corrections such as “Pull from developmental and evolutionary sequences. your shoulders down your back,” and gotten in response the ribcage The interaction of the primary and secondary curves provides popping out, with the back overarching? Other examples of images a lens for analyzing and inventing movement. In this session our or technical corrections gone wrong are: “Pull your shoulders down goal is to demonstrate these concepts through movement and away from your ears” - response: shoulders round forward, chest hands-on work, and to show applications to the teaching of dance. collapses; “Control your ribs”/“Knit your ribs together” - response: Having an understanding, both intellectually and kinesthetically, rounded shoulders and upper back, collapsed chest and ribcage; that the fluidity of the spine lies in the interplay of the primary “Open your chest/breastbone” - response: back overarches, ribs jut and secondary curves encourages dancers to allow for the natural forward, scapulae squeeze behind; and for the arms: “Shoulders adjustments that occur in the body, and especially at the top of the down, elbows lifted” - response: sternum sinks, chest collapses, up- spine, as they perform movements. It also discourages the brac- per back rounds forward. ing and rigidity, or over-straightening, that frequently happens as There is a connection between these actions, and the key lies in dancers strive to be “correct.” the muscles, their connecting fascia, and the bones to which they We believe that looking at movement through the lens of primary attach. The patterns involved become obvious when you build the and secondary curves of the body provides dancers with a more flex- muscles on the Maniken model. In this workshop we will explore ible and adaptable model when having to make decisions regarding these ideas while building the serratus anterior muscle and external movement. It moves us away from “posture” toward a dynamic use oblique abdominal muscle on one side of the body, and the internal of the whole body in action, and provides an understanding toward oblique abdominal muscle on the opposite side. proper changes. This is our definition of a healthy body. 58. Modifying the Graham class to minimize potential 60. Understanding athletic trainers and their role in dance stressors medicine and science Dana Hash-Campbell, BFA, LMT, Long Island University, Dance Katherine L. Ewalt, MS, ATC, San Diego Ballet, San Diego, CA, USA Department; Shaw Bronner, PT, PhD; Sheyi Ojofeitimi, MPT, Long Island The purpose of this presentation is to educate an international audi- University, ADAM Center, Brooklyn, NY, USA ence of dancers, dance teachers, choreographers, physicians, and It has taken nearly three centuries for the ballet community to allied healthcare professionals regarding the field of Athletic Train- accept that some modification of pedagogy may be warranted as ing and how Certified Athletic Trainers function in dance medicine we learn about risk factors for injury in dance. For example, many and science. Athletic Training is an Allied Healthcare Profession ballet teachers eliminate the grand plié in 4th position because of recognized by the American Medical Association. Certified athletic the resulting increased rotational torque to the knee. In modern trainers specialize in injury prevention, assessment, treatment, and dance pedagogy, teachers emphasize engagement of the hip rota- rehabilitation for physically active people. They manage chronic, tors when working in parallel to promote better hip-knee-ankle acute, and catastrophic injuries. Athletic trainers have been shown alignment. to increase productivity and decrease cost and time loss by provid- 22 Volume 11, Number 1, 2007 • Journal of Dance Medicine & Science ing quality and immediate care for musculoskeletal injuries in sport tion consisted of 35 dance majors and 70 theater majors for each and occupational settings. To become certified or licensed, athletic academic year. Each patient received orthopedic and functional trainers must complete a Bachelor’s or Master’s degree through an evaluations, followed when appropriate by acupuncture used in accredited Athletic Training Educational Program. Athletic train- combination with more traditional treatment therapies—including ing certification requires competency in the following areas: injury physical therapy, soft tissue and joint mobilization and exercise prevention; clinical evaluation/assessment; immediate care; treat- instruction. This study does not represent the total number of in- ment; rehabilitation/reconditioning; organization/administration; juries incurred during any academic year, but does examine a cross and professional development. Athletic trainers provide a major section of injuries and treatments. Thus, it provides a baseline of link between dance programs and the medical community; they information regarding dance injuries for which acupuncture may work in professional dance companies, collegiate and university be used as part of a comprehensive treatment plan. settings, community dance programs, and research institutions. 63. Practical application of theories of lateral bias in the They are present for dance class, rehearsal, and performances in ballet class addition to clinical time before and after these activities for injury Jolie Sutton-Simballa, MFA; Amy Farrar-Baker, BS; Virginia Wilmerding, evaluation, treatment, and rehabilitation. Under the direction of PhD, University of New Mexico, Albuquerque, NM, USA a physician, athletic trainers work and communicate with dance teachers/choreographers. Two of the major techniques utilized today in training professional By broadening the international dance and medical commu- ballet dancers, the Vaganova and the Cecchetti methods, base nities’ understanding of athletic trainers and their role in dance their curriculum on prescribed combinations that display pref- medicine and science, a common goal of promoting health and erential treatment of the right side (Farrar-Baker, 2004). Robson optimal performance among dancers will be facilitated. has commented that the discrepancy in lateral bias from right to left side may be as much as 4:1. This conjecture is borne out by 61. A randomized, double-blind, placebo-controlled trial of Farrar-Baker’s findings. oral aloe vera gel in contemporary dancers This presentation will begin with an explanation of theories of lat- Karen Holyoak-Çiftçi, MSc,1 Matthew Wyon, PhD,2 Emma Redding, MSc,1 eral bias in the general structure of a ballet class, emphasizing practical Sarah Irvine, MSc,1 Rachel Bradbear, BA(Hons)1 (1Laban, London, UK; 2 reasons why such bias might be harmful to the progress and health University of Wolverhampton, Walsall, UK) of dancers. Suggestions for reform of the structure of ballet class will This study looked at the effects of aloe vera gel and a placebo, taken then be explored, supplemented by actual observations made during orally for a period of four weeks, on the performance of full-time a one-year period of application in a classroom setting. contemporary dancers. Three experimental null hypotheses were Our research is in accordance with IADMS’ goal to train highly established to assess any affects attributable to the aloe vera for proficient dancers in the healthiest way possible. As a result of endurance, flexibility, and the feeling of wellbeing and energy. lateral bias in the ballet class dancers may find themselves not only Forty full-time dancers (7 males and 33 females) were recruited physically stronger on one side, which can lead to injury, but also to the study. The trial was double-blind, and all subjects were mentally predisposed to favor their “good” side, or the side that is randomly allocated their 28-day supply of either aloe vera or pla- generally practiced more. Having one side preferentially trained cebo. Pre- and post-trial tests of the dancers’ heart rates, BMI, and may be a hindrance to progress in today’s professional ballet world, shoulder, hamstring and trunk flexibility revealed no significant where dancers are expected to be more versatile than ever before. between-subject effects using repeated-measures ANOVA. The Dance Aerobic Fitness Test revealed a significant difference between 64. The effect of Ashtanga yoga practice on dancers’ pre- and post-trial heart rates at stage 5 for all female subjects at pulmonary functions, locomotor-respiratory coordination, p < 0.005, indicating that they all improved aerobically during and movement proficiencies the trial period. The dancers completed a BRUMS 32 mood- Netta Barnea, MSc; Emma Redding, MSc; Susanne Lahusen, MA, MSTAT; scale assessment and a questionnaire dealing with perceptions Alyson Nehren, MA, CMA; Jeffrey Longstaff, PhD, CMA; Hely Jarvinen, MA, Laban, London, UK of performance, energy and wellbeing. This revealed significant differences in the aloe vera group with regard to “feeling ‘relaxed’” The objective of this study was to analyze the effects of six-weeks (p < 0.05) and “increased feeling of energy” (p < 0.02), compared of Ashtanga yoga practice on dancers’ pulmonary functions, lo- to the controls. Thus, drinking aloe vera gel appears to promote comotor-respiratory coordination and movement proficiencies. an increased sense of energy and relaxation in dancers. A longer Eighteen full-time contemporary dance students (22±2.1 years of trial consumption period of at least 60 days is recommended for age) from a vocational dance institution volunteered to participate future trials to verify these results. in the study and were divided arbitrarily into two groups: an ex- perimental group (n=11) and a control group (n=7). A lung Micro 62. Acupuncture in the treatment of dance injuries Spirometer was used to measure two values: FEV1 and FVC. The Bill Russell, MFA, DC, Webster University, St Louis, MO, USA participants performed a dance sequence wearing the MetaMax In recent years the use of acupuncture as a treatment for perfor- 3B portable gas analyzer. Levels of breath were defined in relation mance arts injuries has been increasing. Currently there is little to the intra-breath graph data: rapid breaths, equal breaths and information regarding this development in the literature. This deep breaths. Four chosen movements were analyzed against these study looks at research into the mechanisms of acupuncture breath-levels. Dancers were filmed doing a dance sequence, and pre- (including functional MR studies), and its use as a treatment and post-performances of all participants were edited in random protocol by professional performance companies and individual order. A panel of three Certificated Movement Analysts evaluated dancers. Included are statistics from a three-year study examining the filmed performances. The internal consistency of their ratings the effects of acupuncture on treatment outcomes when used in a was assessed and demonstrated reliability. Mean “total-score,” multidisciplinary dance medicine clinic. The treatments considered “section-scores” and “categories-scores” were assessed. Results have took place at an on-campus location within the dance facilities of shown no statistical significance; however, a qualitative analysis has a four-year university dance program. The eligible patient popula- demonstrated improvement trends among the experimental group. Journal of Dance Medicine & Science • Volume 11, Number 1, 2007 23

Further research is recommended to provide a more solid scien- preparations. These were recorded with six cameras for 3-D motion tific validation. Yoga is an ancient form of somatics; investigating analysis of starting position, maximal knee flexion, and maximal this practice, which other somatic practices are based upon, will knee extension. Measurements were calculated for thigh rotation, establish an important link between the subjective experience of tibial rotation, and supination-pronation. Data were analyzed (one- somatics and the objective scientific findings. way ANOVA and Tukey post hoc tests) with SPSS for Windows (version 12.0). Statistically significant differences were found in 65. Does the floor matter? Science vs. marketing tibial rotation at start position for straight-small 4th, straight-ef- Peter E. Lavine, MD, INOVA Mount Vernon Hospital, Alexandria, VA, USA facé, fouetté-small 4th, fouetté-effacé, and small 4th-effacé; in All dancers, dance teachers, and administrators of dance schools maximum knee flexion for fouetté-small th4 ; and in maximum knee and companies worry about the surface composition of dance extension for effacé-small 4th, effacé-fouetté, and effacé-straight, floors. All forms of dance—be it modern or classical, hip hop or all at p<0.05. There were also statistically significant differences in ballroom, flamenco or waltz—would profit by the perfect floor thigh rotation at start position for straight-small 4th, straight-ef- to protect dancers from possible injuries. How important are the facé, fouetté-small 4th and fouetté-effacé, and in maximum knee various options for dancers? Is something sacrificed with multi- flexion for straight-effacé, small 4th-effacé and fouetté-effacé, use floors over single-purpose floors? Is there a difference with again at p<0.05. No significant differences were found for thigh regard to moving from the studio to the stage? What are the best rotation at maximum knee extension. Available data on turnout options, and why? composition are limited; therefore reliable comparisons could not This paper will attempt to look beyond marketing to analyze be performed. Also, of course, this was only a single-subject study. if there is any scientific evidence that floor composition causes It is recommended that different measurement techniques—e.g., specific injuries. It will try to identify any differences among dance in prone position, supine position, and on rotational disks—be forms that warrant the use of particular floor types. In doing so, the used to increase our awareness of turnout technique. This should intention is to provide insights and recommendations to protect aid in the prevention of injuries. dancers of all styles and all ages. 68. Does increased pelvis motion during grand rond de 66. Kinematic, kinetic, and electromyographic (EMG) jambe en l’air make it more ‘difficult’ or not? analysis comparing unsupported versus supported Margaret Wilson, MS;1 Joong-Hyun Ryu, MS;2 Young-Hoo Kwon, PhD2 (1 movements in the ‘en pointe’ position University of Wyoming, Laramie, WY, USA; 2 Texas Woman’s University, Nancy Kadel, MD, University of Washington Medical Center, Seattle, WA, Denton, TX, USA) USA; Annabelle Couillandre, PhD, PT, University of Paris X, Nanterre, In a previous study, skilled dancers showed more pelvis motion in Paris, France the execution of grand rond de jambe en l’air than did less skilled The purpose of this study was to compare differences between counterparts. However, the question remained, “What inhibits supported and unsupported movements in terms of joint angles, the unskilled dancer from utilizing as much pelvis motion as the moments, and EMG activity in ballet dancers. The authors hy- skilled dancer if it is beneficial in terms of the gesture leg ROM?” pothesized that the joint angles and moments would be similar, The purpose of this study is to investigate whether increased and the EMG activity lower in the supported movements. Subjects pelvis motion shown in the skilled dancers requires more gesture were sixteen female ballet dancers with mean age 21.6 ± 3.2 years leg and support leg joint moments, thus making it more difficult (range=18 to 28). All subjects were healthy and free of injury at to perform. the time of study. Thirty-eight reflective markers were placed on Two groups of dancers were recruited: skilled (n=8) and non- each subject in accordance with the Vicon plug-in gait model. skilled (n=6). Three-dimensional motion analysis with 6 cameras Surface EMG activity was recorded on the dominant leg. The was used to obtain kinematic data. Support leg ground reaction electrodes were placed in pairs on the medial gastrocnemius, lat- force was measured with a force plate. The dependent variable was eral gastrocnemius, soleus, peroneus longus, and tibialis anterior the net joint moments of the leg joints during the grand rond de muscles according to the SENIAM recommendations. Subjects jambe en l’air, as computed through inverse dynamics procedures stood with one foot on each of two force plates. Kinematic data using the kinematic data and ground reaction force data. The were collected using a ten-camera Vicon 612 System; marker non-skilled dancers performed grand rond de jambe at 90 and 105 displacements were recorded by infrared camera at 120 Hz, and degrees, while the skilled group performed three levels (90, 105 and EMG and force plate data were recorded at 600 Hz. The subjects full). The resultant joint moments of the leg joints were compared performed three trials each of three movements in two conditions among the groups and conditions (p <0.05). Data processing is (supported and unsupported): relevé sur les pointes, piqué retiré currently in progress. It is our belief that computation of the joint (onto one foot), and a two-foot spring up to pointe simulating a moment is a straight-forward procedure which can potentially sousous. The order of movements and support was randomized for provide valuable information for research in dance medicine and each subject. Data have all been collected and will be analyzed in science. Polygon, with ANOVAs for statistical evaluations. 69. Ground reaction force comparison between jumps 67. Turnout analysis of four different en dedans pirouette landed on full foot and on pointe preparations Christina Chockley, MFA, University of Utah, Salt Lake City, UT, USA Aniko Solti, MSc, Laban; Dan Scott, MSc; James Brouner, BSc (Hons), School Two female dancers did three trials of jumps landed by rolling of Life Sciences, Kingston University, London, UK through the full foot, and then three trials of jumps landed on The purpose of this study was to determine whether four en pointe. Data were recorded with a Spica Technology 3-D motion dedans pirouette preparations—straight, fouetté, small 4th, and capture system and an NMFL Force Plate 9281C. These data were effacé—differ in the use of turnout. This was a single-subject case analyzed using inverse dynamics to find joint reaction forces (JRF) study. A female ballet dancer with nine years of professional experi- at the ankle, knee and hip during landing. For the ankle, JRF, land- ence performed 128 en dedans pirouettes on pointe using the four ing on pointe, generated –71.3 N (± 2.6) on average, while landing 24 Volume 11, Number 1, 2007 • Journal of Dance Medicine & Science full foot generated –149.8 N (± 7.2). For the knee, JRF, landing in standing position, using a tailor’s tape measure. The long sitting on pointe, generated 85.2 N (± 3.1) on average, while landing position was then assumed, allowing palpation along the shaft of full foot generated 81.9 N (± 4.8). For the hip, JRF, landing on the second metatarsal. A pressure algometer recorded the force pointe, generated –80.4 N (± 2.2) on average, while landing full applied to the second MT. Analysis of results revealed many sig- foot generated –102.7 N (± 6.5). The force plate recorded ground nificant findings, the most important of which were as follows: reaction forces (GRF) averaging 448.6 N (± 37.3) when landing 1. On the left foot, for each centimeter that the second toe on pointe and 687.4 N (± 59.8) when landing full foot. This in- is longer than the first toe, there is an increased risk of periosteal dicates that landing on pointe generates 65.3 % of the force that thickening by 5.5 times (95% CI: 1.1 to 28). landing on the full foot does. Difference in jump height between 2. The difference in toe length increased the risk of developing the two jumping styles is a reason for the variance in JRF and periosteal thickening independent of other variables. GRF values. When jumping from and landing on pointe, due to 3. Taking oral contraception reduced risk of periosteal thicken- ankle mobility restriction, jump height decreased from that in full ing by 0.04 times on the left foot (95% CI: 0.004 to 0.48). foot landing. This accounts for the GRF difference and hip JRF It is concluded that a long second toe did not increase the difference. Ankle mobility restriction is related to the ankle JRF incidence of second MT stress response/fracture compared to a differences as well, since the ankle has a wider range of motion in shorter second toe. A larger difference between the first and second jumps landed on the full foot. toes increased the risk of periosteal thickening of the second MT in this group of dancers. The introduction of oral contraception 70. The effect of an inclined landing surface on significantly reduced this risk, thus appearing to have an influence biomechanical variables during a jumping task on bone remodeling. Marshall Hagins, PhD, PT; Evangelos Pappas, PhD, PT, Long Island University, Brooklyn; Ian Kremenic, MEng; Karl F. Orishimo, MS, Nicholas 72. Normative strength, supplemental training, and injury Institute of Sports Medicine and Athletic Trauma; Andrew Rundle, PhD, prevention in dancers: A literature review Columbia University, New York, NY, USA Andrea Brown, BS, CSCS, Professional Orthopedics and Sports Physical There is weak epidemiological evidence suggesting that inclined Therapy, New York, NY, USA floor surfaces (“raked stages”) are a significant risk factor for Muscular fitness is of utmost importance to dancers. In addition musculoskeletal injury in theatrical productions. Currently, no to allowing superior performance, adequate muscular fitness may experimental evidence exists to support this hypothesis. The pur- be related to injury prevention. The purpose of this review is to pose of this study was to compare the effects of inclined surfaces examine literature relating to normative strength data, response versus level surfaces on biomechanical and kinetic variables in to supplemental training, and the relationship between muscular performers. This was a repeated measures experimental study with fitness and injury in dancing populations. Normative strength data one independent variable, floor inclination, and three dependent regarding dancers are varied. When compared to elite athletes, variables: range of motion (ROM); muscle activation (EMG); dancers generally have less lower-body strength. In comparisons and peak vertical ground reaction force (GRFV). Eight Broadway among dancers, level is a factor: professionals are stronger than dancers performed a bilateral drop jump landing from a 40 cm plat- students and soloists are stronger than their corps de ballet coun- form while being measured for lower extremity ROM (knee, hip, terparts. Supplemental strength training has been shown to be ankle), EMG (quadriceps, hamstrings, gastrocnemius) and peak effective for improving general and dance-specific strength, with GRFV. The kinetic data collected from the force plate (GRFV) was training eliciting improved extension height in arabesque. While normalized to body weight, and EMG amplitude was normalized adequate strength is regarded as important for injury prevention, to the maximum linear-enveloped NEMG of each muscle. The there is little published research documenting the specific areas values of the kinetic, kinematic and EMG variables were calculated of strength most important to dancers. There seems to be a cor- at different points of the landing cycle (initial contact, 25°, 40°, relation between decreased lower-body strength and incidence of 55°, maximum knee flexion). Additionally, maximal and minimal lower-body injury, but which muscle groups are most involved is values that occurred at any point during landing were calculated. unknown. Future research should focus on specific ways in which The effect of the independent variable on the dependent variables strength and conditioning relate to injury prevention in dance. was determined by the use of repeated measures MANOVA. All data have been collected, with analysis to be completed by the 73. Reconsidering the need for specific tests of postural end of March 2006, at which time a full description of the results control in dance will be available. Filipe de Melo, PhD; Luis Xarez Rodrigues, PhD; Mercedes Prieto, MD, Faculdade de Motricidade Humana, Lisbon, Portugal Poster Presentations Learning can be considered as a set of underlying events that occur when practice produces relatively permanent changes in the capa- 71. Clinical examination of second toe length and the bility for skilled behavior. Learning a skill facilitates the emergence incidence of stress response/fracture in professional ballet of motor patterns. It promotes muscle activation, thereby eliminat- dancers ing unwanted activity. These processes occur at an unconscious or Anna Brodrick, MSc, UCL, Brunel University, London, UK reflex level. The success of movement is supported by balance and The purpose of this study was to investigate the relationship be- postural control of the body, which can be considered as the ongo- tween second toe length and incidence of stress response/fracture ing neuromuscular responses needed to maintain equilibrium as in the second metatarsal (MT) in female ballet dancers. Traditional the body moves in space. Since any course of dance is focused on views hold that people with a longer second toe have a higher technique, performance, and choreography, it would be expected incidence of foot related injuries. However, this notion does not that students in the fourth year of an academic program would appear to be founded upon research. have better postural control than students of the first year. The Twenty-eight female professional ballet dancers and ten con- effect of practice on postural control during standard postural trols, all in good health, had their first and second toes measured tests was examined in eight first year and nine fourth year female Journal of Dance Medicine & Science • Volume 11, Number 1, 2007 25 university dance students. A Balance Master System (Neurocom) which was relatively high compared to previous data for females. was used to evaluate the velocity, frequency and area of postural There was no significant positive correlation between MAOD and sway during three standard tests: mCTSIB (modified Clinical Test jumping performance in this study, although there was a tendency of Sensory Interaction on Balance), Unilateral Stance, and Limits to positive correlation between the two for the dance subjects only. of Stability. Analysis of variance (ANOVA) was performed to assess It is concluded that dance training might enhance the anaerobic between-group differences. No significant differences between the capacity of young Japanese female dancers and dance students. two groups were revealed in velocity, frequency, or area of postural sway on any of the tests. These results suggest a need for specific tests 76. Dance vs. sport psychology: Knowledge sharing to to evaluate the effects of dance learning (style of dance, technique avoid re-inventing the wheel approach), or training, on postural strategies. Specific tests based Sanna M. Nordin, PhD, London Sport Institute, Middlesex University, London, UK; Sarah McCalister, MFA, Valdosta University, Valadosta, GA, on different dance skills will be presented. USA 74. Teaching silent bodies: Historical and contemporary Sport psychology has expanded significantly in recent decades, with perspectives on emotional aspects of ballet education and research being used to improve the performance and wellbeing performing arts pedagogy at elite dance conservatories of athletes. In contrast, dance psychology remains in its infancy, Thom Hecht, MA, London Contemporary Dance School, London, UK with only sparse research available to indicate how psychology This paper deals with the importance of educational and emotional can support dancers. This presentation aims to compare the two issues in ballet training for contemporary and classical dancers at fields and suggest how dance psychology research could benefit elite dance conservatories. The study reviews the small pool of exist- by learning from sport psychology. Topics previously studied in ing literature on performing art pedagogy in the context of ballet dance psychology and others yet to be examined will be graphically education. In particular, the nineteenth century vocational training illustrated. Recent statistics regarding problems facing dancers will and its development will be discussed in relation to current teaching support our suggestions for future research. practices of ballet masters and ballet mistresses. The experiences of Several practitioners have already suggested that sport psychol- four established ballet teachers are analyzed in a number of ways: ogy can be used to benefit dancers (e.g., Hamilton, 1998; Hays and they reflect on their own ballet training, their current teaching Brown, 2004; Sharp, 2005; Tajet-Foxell, 1997). However, some practices, and debate the role of ballet education in relation to of these authors have also emphasized the need for a dance-spe- other dance forms. Focus group discussions revealed that all of the cific psychology that does not uncritically adopt sport psychology teachers had similar experiences in terms of being a “silent body” principles. In this presentation we argue that sport and dance psy- in their own training; that is, being fitted into a mold rather than chology have more shared interests than irreconcilable differences. treated as an individual. The nineteenth century vocational training Indeed, many areas of sport psychology originated in fields such model that still prevails in many dance conservatories echoes the as educational or industrial psychology. Sport psychology is also “silent body” that is intimately bound to the questionable master/ being used successfully in several other fields, including business, apprentice discipline/power relationship. Stringent training was life skills, and, to some extent, the performing arts. It is hoped and still is an authentic symbol of professional ballet training. In that this presentation will help inspire further dance psychology ballet education, the disciplined “silent body” is internalized as part research and provide suggestions for how it can draw upon sport of the dancer’s balletic system of values. This paper will conclude psychology to avoid “reinventing the wheel.” with a careful look at the shifting vocational teaching model. The interplay between ballet pedagogy and the psychology of dance is 77. The effects of an eight-week creative dance program on viewed in light of its many ambiguities, which offers new territory the physiological and psychological status of 11-14-year- for research in that area of concern. old adolescents: An experimental study Edel Quin, MSc,1 Emma Redding, MSc,1 Eleanor Quested, MSc,2 Peter Weller, 75. Anaerobic capacity of Japanese female dancers PhD3 (1Laban, London, UK; 2University of Birmingham, Birmingham, UK; and dance students, and its relationship to jumping 3City University, London, UK) performance Although dance educators are aware of the possible benefits of Aki Mori,1 Mayumi Kuno-Mizumura, PhD2 (1Graduate School of dance as a form of physical activity, much of this knowledge 2 Humanities and Sciences, Ochanomizu University; Faculty of Letters and is anecdotal rather than evidence-based. There is, therefore, an Education, Ochanomizu University, Tokyo, Japan) increasing demand from dance program providers for evidence Previous studies have demonstrated that dance performance places relating to the benefits of dance as a form of physical activity. The a greater demand on the aerobic and anaerobic glycolytic energy aim of this study was to measure the effects of a ten-week creative systems than that seen during class and rehearsal. This in turn places dance program on the physiological and psychological status of a greater emphasis on the adenosine triphosphate-creatine phos- 11-14 year old school children. phate system. However, there are no studies that have investigated A pilot study, involving 78 pupils from three schools, preceded the anaerobic capacity of dancers. Therefore, the purpose of this the main study in order to determine the most appropriate meth- study was to investigate the anaerobic capacity based on determi- ods. Two hundred and thirty-four children aged 11-14 years from nation of the maximal accumulated O2 deficit (MAOD) which seven schools across southern England took part in the main study. was established by Medbo et al. in 1988. In addition, the authors A battery of physiological and psychological tests was carried out developed a jumping performance test for dancers to evaluate their before and after the ten-week dance program. The physiological anaerobic capacity in the studio. The MAOD was determined tests measured lung capacity, aerobic fitness, and flexibility. The for 19 healthy Japanese females during 5-6 exhausting bouts on psychological assessments measured self-esteem, intrinsic motiva- a cycling ergometer lasting from one minute to more than four tion, and attitudes toward dance as a physical activity. minutes. The MAOD increased with duration of the bouts, while The dance training program that served as the intervention of there was large inter-individual variability in the exercise duration the study involved a 60-minute class once per week. This consisted with MAOD. Mean value of MAOD in this study was 61.0 ml/kg, of a 15-minute continuous warm-up followed by a series of creative 26 Volume 11, Number 1, 2007 • Journal of Dance Medicine & Science movement tasks. Statistical analysis and qualitative methods will be can have an impact on the performance, health and wellbeing of employed to determine the effects of the intervention. Results will athletes. Sports coaches and others working with athletes now use soon be available. It is hypothesized that pupils will show increased psychological devices to address areas that may negatively affect levels of physical fitness and psychological well-being. an athlete’s performance. These include goal setting, stopping negative thoughts, relaxation techniques, positive imagery and 78. Comparing fitness levels of current and former dancers positive self-talk. and soccer players More recently, researchers have identified a number of psy- Kendra Sakamoto, MS, ATC, Long Island University, Brooklyn, NY, USA chological issues faced by dancers during training, rehearsal and Recent studies suggest that soccer and dance mutually require a performance that may have negative effects on their work. These high level of endurance, hamstring flexibility, strength and balance. include low motivation, lack of self-confidence, high levels of anxi- In their prime, soccer players and dancers perform at a high level of ety (either in general or performance related), psychological stress, physical fitness; however, as humans age there is a natural decrease concentration deficits, and depression. Nervousness and anxiety in strength, cardiovascular endurance, balance, and flexibility. The may be the most common challenge confronted by performers. purpose of this study was to compare the physical fitness levels of Many dancers try to manage these issues by maladaptive means that collegiate dancers and collegiate soccer players with the physical interfere with their development and promote both physiological fitness levels of former dancers and former soccer players over the and psychological injuries. age of 40 in order to determine which population maintains a Further research is suggested to determine whether, as in sports, higher level of physical fitness. It was hypothesized that collegiate dancers may learn more effectively, perform better, get fewer inju- soccer players and collegiate dancers would have equal levels of ries, and recover from injury more quickly if they are well equipped physical fitness, while former dancers would have a higher level of with a range of psychological skills that can be used within all physical fitness than former soccer players. The present investiga- aspects of dance participation. It is also recommended that research tion examined the following factors in dancers and soccer players: be undertaken to explore prospects for training new dance teach- resting heart rate, recovery heart rate, resting blood pressure, ers in psychosocial and behavioral principles, and techniques for recovery blood pressure, body fat percentage, balance, flexibility, incorporating skills such as positive imagery and positive self-talk grip strength, and VO2Max. The following materials were used: heart into all of their work. If such practices could be implemented, rate monitor, sphygmomanometer, skin-fold caliper, the Balance by the time young dancers were performing professionally they Error Scoring System, sit and reach box, hand-grip dynamometer would be better equipped for success both psychologically and and a cycle ergometer. The physical fitness levels of each popula- physically. tion tested will be compared and discussed. It is anticipated that this kind of study will allow dancers and athletes to improve their 81. The body composition of dancers and its effects on training techniques, increase performance, and decrease injury. their physical functioning Rou Wen, MEd; Yan Lan, MEd, Beijing Dance Academy, Beijing, China 79. Depressive symptoms and associated factors in a sample The purpose of this study was to analyze the body composition of of injured collegiate dancers dancers and its effects on their physical functioning. The subjects Montse Sanahuja-Maymó, PhD Candidate; Carles Pérez-Testor, PhD; Carles Virgili, PhD, Ramon Llull University, Barcelona, Spain were 28 ballet and 30 classical Chinese dancers (30 males, 28 females) selected from a dance academy and 48 non-dancers (22 A recent study reported that 25% of injured collegiate dance males, 26 females) as a control group. Body fat percentage (BF%), students showed depressive symptoms, and 43% had hopelessness body fat (BF), lean body mass (LBM), vital capacity, abdominal symptoms at mild or higher levels (13% of the subjects had been strength, grip strength, and explosive force were tested. Results previously diagnosed with depression). The aim of this study is to show that the BF% of the dancers was much lower than that of take an in-depth look at those results in the interest of identifying the non-dancers, and the difference was significant (males p< 0.05, which symptoms occur most frequently, and with what causative females p< 0.01). Among the dancers, those of classical Chinese factors they are associated. The sample is composed of forty-four dance showed a much higher level of LBM, vital capacity, abdomi- injured collegiate dance students, 18 to 24 years of age, who vol- nal strength, grip strength, and explosive force than did the ballet unteered to participate. An in-depth analysis of the items from the dancers; female dancers differed significantly in all indices (p< Beck Depression Inventory (BDI-II) and the Beck Hopelessness 0.05-p< 0.01), and the difference between the males was mainly Scale (BHS)was conducted. Frequency of symptoms and correla- in explosive force (p< 0.01). The LBM of female dancers showed tions to injury, and associated factors to injury, will be analyzed. a mildly positive correlation with their vital capacity, abdominal The independent variable is the dancer’s injury, and the dependent strength, grip strength, and explosive force, and that of male danc- variables are the different items in the two tests. Preliminary results ers was mildly correlated with their grip strength. The above results indicate that over 60% of the dance students were more fatigued, indicate that the body composition of classical Chinese dancers showed changes in their sleeping patterns, and had less energy tends to correlate with lower BF%. Body composition can affect the after injury than before. Fifty percent were also more irritable than body capacity of dancers, and LBM is a main influencing factor. usual. This study shows which depressive symptoms are experienced most often by injured collegiate dance students. It is important 82. Assessing the screening process: How beneficial are the to be aware of this information in order to develop better support different screening methods at predicting injury within a programs for injured dancers, and to help dancers undergo the professional ballet company? 1 2 2 2 rehabilitation process and return safely to dance. Matthew Wyon, PhD; Nick Allen, MSc; Sian Morgan, MSc; Philip Birch; Jenny Mills;2 Alan Nevill, PhD1 (1University of Wolverhampton, Walsall, 80. How psychological skills and techniques may be of UK; 2 Jerwood Centre for the Prevention and Treatment of Dance Injuries, benefit in dance training and performance Birmingham, UK) Emily A. Twitchett, BSc (Hons), GSR, PhD Candidate, University of The need for a comprehensive screening process in dance is well Wolverhampton, Walsall, UK documented. Due to the number of possible screening method- It is widely recognized in elite sporting populations that psychology ologies available, the actual process can become unwieldy and Journal of Dance Medicine & Science • Volume 11, Number 1, 2007 27 time consuming. The aim of the present study is to examine individual survival guides, based on past history and present cir- each methodology used during a pre-season screening process cumstances. In addition, we shall mention some biomechanical with regard to its ability to predict and prevent injury in dance and physiological concepts that affect the teacher’s body: company members. • Physical body: Size, shape, changing body image, child bearing, All participants in the study underwent functional, medical, hyper- or hypo-laxity, posture, and postural muscle chains; physiological, musculoskeletal, and conditioning (Pilates) screen- • Past history: Injuries, operations, scar tissue, childbirth, illness, ing, and the resulting information was recorded. Each dancer chronic pain; was given an individualized program based on the results of the • Working conditions: Flooring, number of classes, size of studio, screening, with varying degrees of compliance noted. Injuries in variety of dance levels, footware; the preceding six months were recorded by type, cause, severity, • Working habits: Warm up, taking barre with the first class of the and days off. Regression and univariate statistical analyses will be day, conditioning routines, meditation, relaxation; carried out to assess the ability of each screening process to predict • The compressive nature of turnout and its potential relationship to different types of injuries, and to provide an indicator as to the hip disorders, especially with regard to standing/dancing/teaching optimal frequency of screening. without thorough stretching and self-massage; The presentation will provide guidance on streamlining the • Surviving the transition from dancing teacher to dance teacher. screening process, thereby reducing the workload of medical and In solving our own mysteries of survival we can nourish and feed support practitioners and the time demand on dancers. our capacity as teachers and avoid emotional burnout by creat- ing new learning patterns. The further we delve into the body Special Interest Groups Day in movement, the more we can appreciate the vast spectrum of A Day for Teachers, Sunday, 22 October, 2006 human forms and minds, that we in turn as teachers influence Dance Teacher’s Survival Guide: The Healthy daily in our students. Dance Teacher 85. Modalities for preventing injuries: Focus (another word 83. On degenerative injuries in the mature dancer/teacher for awareness of oneself in the present) Ruth Solomon, Professor Emerita, Certified Medical Assistant, University of Marika Molnar, PT, Lac, Westside Dance Physical Therapy, New York, NY, California, Santa Cruz, CA, USA USA A long-standing concern of mine has been how the biomechanics of This is a hands-on presentation of four exercise modalities that movement can be adjusted to prevent new injuries or work around are intended to aid in injury prevention. The names I have given existing ones in “mature” dancers. Any of the specific injuries/medi- them, functions they serve, and indications of what they entail cal conditions to which this population is particularly prone might are as follows: be used to illustrate these strategies. In this presentation I discuss 1. Eye-oga: to disassociate head and neck movements and just one: how to avoid bunion deformity and hallux ridgidus. improve range of motion of the cervical spine and alignment of There are several risk factors that contribute to these condi- the head. This involves a simple, sequential rotation of the head, tions. First, the cavus foot: This foot is extremely flexible, due to following the eyes’ focus. laxity in the midfoot. It requires special attention in training to 2. 3-D Breathing: reduces stress and muscle tension and moves strengthening the intrinsic (as well as extrinsic) muscles. Second, air into the blood-rich lower lobes of the lungs, expanding the rib poor biomechanics: The foot is especially vulnerable in turns. The cage, which helps it stay flexible. dancer needs to work to keep weight out of the lower extremities Breathe through the nose on both inhalation and exhalation. Fill so that turning can be accomplished without torquing the toes. up the lower, middle, and finally upper lobes of the lungs; exhale Pronation in demi-pointe is a third issue; weight must be distrib- in the same order. Send the breath to the lower lateral rib cage. If uted on at least four metatarsal heads in this position. Finally, some you feel an area of little movement, focus on that area with your dancers “wing” the whole foot on pointe, for “aesthetic effect.” This breath until it releases. will compromise the toes, forcing a forefoot pronation and hallux Dynamic Standing: Maintaining a neutral spine, use pelvic valgus. It is important not to force the foot into pronation when floor contraction to co-activate the deep abdominals with exhala- it is completely on the floor, in demi-pointe, or on pointe. tion while intentionally bearing weight on both legs equally. Shift The consequences of failing to make the adjustments required the pelvis from side to side to release the hips of any tension from to dance safely over the course of a career can be dire. In some the deep rotators. cases mature dancers may have to live with whatever damage they Interosseous Stretching: to make room for the nerves, liga- have wrought, but if they are also a teacher, and will learn from ments, muscles, and tendons between the metatarsals, and reduce the information that is increasingly available to them, they may the compression on them. help their students avoid similar problems. Place rolled up paper towel or toe spacers between all the toes to stretch the connective tissues between the toes and metatarsals. 84. Risk factors for teachers Extend the toes (metatarsal heads move toward the floor) and flex Peter Lewton-Brain, DO, MA, Ecole Supérieure de Danse de Cannes; Rosella Hightower, University of Nice, France, Les Ballets de Monte-Carlo, Monaco the toes (doming). The health risks involved in teaching dance are as numerous as 86. Musculoskeletal/biomechanical challenges for dance the elements making up the teacher. Our individual parameters— teachers: Assessment, management, care-seeking physical body, past history, working conditions, and working Gayanne Grossman, PT, EdM, Temple University, Philadelphia, and habits—all combine with emotional and psychological influences, Muhlenberg College, Allentown, PA, USA multiplying the variety of risk. Each individual ultimately needs Early dancing, like any exercise activity, provides physiological and to create a system to keep the body moving fluidly. Ideally, this psychological benefits that last a lifetime, such as development of involves using movement to create health. balance, coordination, strength, and a love of physical exertion In this presentation we shall look at some ways to develop that should carry over into adulthood. Lifelong exercise is one of 28 Volume 11, Number 1, 2007 • Journal of Dance Medicine & Science the most important health care activities a person can practice, theoretical coursework. The participants will then explore one providing preventative benefits for problems as far reaching as particular part of the body through movement as stimulated by heart disease and Alzheimer’s. Nonetheless, range of motion and memory, visual imagery, kinesiological information, touch, and strength inevitably begin to decline in middle age from disuse or sound. Using guided improvisation, partnered hands-on work, decreasing hormones. Weight bearing exercise will reduce these and discussion, this interactive hour is designed to offer teachers a effects; research has shown improved muscle strength after an ex- somatic experience; one that spans the different ways in which we ercise program well into the ninth decade of life. This presentation learn, process information connected with movement, and make will address the benefits of long-term dancing, and methods for connections between our teaching and our lives. As teachers we assessing specific musculoskeletal/biomechanical challenges that both present information to our students and model it. Teaching, may arise. Some of these challenges simply require awareness and with all its inherent challenges, can be even more fulfilling and adaptation; others may provoke injuries, and medical consultation rejuvinative when we find more effective ways to practice what and treatment should be sought. Yet, dancers frequently dance we preach. through an injury, hoping for healing in spite of ongoing stressors. 89. The multi-tasking teacher: Roundtables It is not uncommon for some dancers to routinely avoid doctors Sonia Rafferty, BA, MSc, Laban, London, UK and physical therapists. Why? There are many reasons, one being (in this author’s opinion) that dancers often find interaction with the Dance teachers operate in a variety of situations and institutions, medical community frustrating due to communication problems. and must often “multi-task,” if not “in the moment” then through- In some geographic areas access to a qualified specialist does not out the various settings and work cycles. As teachers we would be exist, and the dance teacher is required to educate the physician well served to develop strategies both physical and psychological to or physical therapist about the mechanics of dancing and the need prevent the potentially counterproductive effects of true multi-task- of the dancer to be 100% functional. Then there is always the ing. Fueling the need for such strategies is the change in stressors problem of cost. This presentation will close with suggestions for over the course of a teaching career. successfully interfacing with the medical community. Transitioning through the extremes of the professional spectrum can have great impact on how teachers deal with the demands made 87. Creating self: Self-perception and skills for managing on them and on self-esteem. The newly emerging teacher may self and stress need to build confidence, while the mature teacher, experienced Lynda Mainwaring, PhD, CPsych, University of Toronto, Ontario, and practiced, may have to deal with a changing physicality, aging, Canada and the prospect of no longer having dance as a functional part of The movement artist lives in a milieu that may create psychologi- his/her daily life. cal vulnerability related to negative perceptions of self. Maturing We should understand the importance of maintaining the “self” dancers and transitioning teachers, for example, face a discrepancy while educating others. Assessing personal needs in relation to between who they were in earlier, more physically active years, and multiple roles as teachers requires looking at safe practice, injury who they are in the less active and vocationally changing years. prevention, and treatment, especially given the repetition that Experiencing new parameters for living may cause symptoms comes with a daily schedule of several classes. We should develop of anxiety or depression related to self-concept, self-esteem, or new skills to positively stimulate our own on-going learning, in- self-identity. Given the focus on appearance and the idealism cluding staying abreast of the latest scientific knowledge in dance that penetrate dancers’ lives, one could conclude that the odds on training. dancers remaining positive as they make transitions in life are poor. Psychological as well as physical concerns have an impact on Fortunately, this is not the case. The self is reflective, dynamic, teachers’ ability to sustain their role. Maintaining motivation adaptable, and capable of evolving: It has the ability to build upon throughout a long-term career that involves cyclical repetition is its foundational knowledge and reflect a healthy perspective. Thus, paramount. Further, developing modalities to manage stress and as one’s professional life as a dancer and teacher transitions into the to build in needed relaxation and regeneration can have beneficial maturity of life, one has a golden opportunity to redefine, create, results. To survive the rigors of our profession requires, at least, that or re-create one’s self. An important objective of this presentation we give ourselves the same attention and care that we provide to is to provide teachers with various strategies and skills to help build our students. positive self-perceptions in both themselves and their students. Skills for managing stress related to the fluctuations in positive 90. Staying mobile: Daily preparation for the dance self-regard will be outlined, and include the following: creating teacher’s body and mind mastery and success; structuring activities for optimal experience Donna Krasnow, MS, York University, Toronto, Canada and flow; using relaxation and self-talk effectively. Dance teachers lead eventful lives filled with multiple demands, both personal and professional. In addition to teaching, many are 88. Somatic practices for our holistic lives also choreographers and/or artistic directors, administrators within Pamela Geber, MFA, University of Utah, Salt Lake City, UT, USA institutions or dance schools, mentors for other younger teachers There are many approaches to teaching movement while embracing and assistants, and some maintain their own performance careers. the complexities of whole-person learning. Some approaches that With all of these demands, it is essential that the dance teacher are now a part of many dance programs and classes fall under the take time each day for a personal warm-up and preparation for heading “somatics,” and include such forms as Laban/Bartenieff, studio work. Evidence suggests that there is a high rate of injury Alexander Technique, Feldenkrais Awareness Through Movement, in the dance population. In addition to rehabilitating and caring Body-Mind Centering, Pilates, Skinner Releasing, and sometimes for past injuries, dancers/teachers begin to experience age-related Yoga, Tai-Chi, and bodywork techniques. Whether the teacher is problems, such as arthritis, particularly in the hips, knees, feet certified or not in any one somatic form, a “somatic approach” to and spine. Spinal problems can be exacerbated by diminishing teaching has worked its way into many dancers’ classes. intervertebral disc size and spinal stenosis. Due to the excessive and In this session a “somatic approach” to teaching will be sum- repetitive motions common to dance, these problems often occur marized; one that can be used in studio-based classes and more at a relatively early age in dancers, and can be debilitating in daily Journal of Dance Medicine & Science • Volume 11, Number 1, 2007 29 life. Continued work on alignment, core support, strength and average follow-up was 12 months (range=10-12). flexibility, and neuromuscular patterning may extend the years of Average scores for the AOFAS improved from 54.7 preopera- physical activity for the dancer and dance teacher. This movement tively to 70.0 postoperatively, VAS improved from 6.6 preoperative- session will go through the body systematically, lubricating the ly to 2.7 postoperatively, and dorsiflexion range of motion increased joints and gently activating the muscles to prepare for contractile from 21.3 preoperatively to 51.0 postoperatively. Concomitant work and range of motion. Imagery and visualization, along with procedures included the following: plantar plate release/Moberg an emphasis on breathing, will be used to focus the mind and to proximal phalangeal closing wedge osteotomy to improve dorsi- reinforce neuromuscular patterns essential to dance practice. Exer- flexion; biplanar proximal phalangeal closing wedge osteotomy cises and imagery for core support will address alignment and full (Moberg-Akin) to address correction of hallux valgus deformity; body integration. Anatomical principles will be discussed during split EHL tendon transfer to address hallux varus deformity; and the session so that teachers understand the purpose of each exercise 1st interphalangeal joint arthrodesis to address combined IP and and can teach or modify the work for their students. MTP arthrosis. These preliminary results are encouraging, as there is a reduction Special Interest Groups Day in pain and the patients obtain modest increases in dorsiflexion Sunday, 22 October, 2006 motion. The HemiCAP partial resurfacing prosthesis appears to be Doctors Day for Orthopaedic Surgeons a reliable alternative for patients diagnosed with advanced hallux and other MD’s rigidus who would otherwise require a fusion procedure. Nota- bly, concomitant procedures may be tailored to meet the unique 91. Anterior cruciate ligament injuries in dancers needs of each patient. A prospective, long-term follow-up study Donald J. Rose, MD, Associate Clinical Professor of Orthopaedic Surgery, is presently underway, including three-dimensional kinematic gait School of Medicine; Director, Harkness Center for Dance analysis. Injuries; Director, Ambulatory Surgery, NYU Hospital for Joint Diseases, New York, NY, USA 93. Anterior tibial stress fractures In a recent survey study at the Harkness Center an incidence of David S. Weiss, MD, Associate Clinical Professor of Orthopaedic Surgery, New 0.3 anterior cruciate ligament (ACL) injuries per year per dance York University School of Medicine; Associate Director, Harkness Center for company was found. Eighty-seven percent of these were non- Dance Injuries, NYU Hospital for Joint Diseases, New York, NY, USA contact injuries, with single-leg landing from a jump by far the Tibial stress fractures are an uncommon injury in dancers, but they most common mechanism. Fatigue also played a role, with 60% of can be very problematic. These fractures predominantly occur on ACL injuries occurring at the end of a performance season, 71% the anterior surface of the mid-shaft (an infrequent location in other at the end of rehearsal or performance, and 21% in the middle athletes). The biomechanics of the tibia are such that the anterior of the day. Gender was significant: 66% of the injuries occurred surface is under tension or distraction. Anterior tibial stress fractures in females (at a female:male ratio of 4.9-10.6:1 in modern dance (ATSFs) are prone to delayed union and non-union. and 1.3-1.6:1 in ballet). At our biomechanics lab jump landing Acute ATSFs present with a small palpable lump on the ante- was analyzed, as a result of which we believe that injury preven- rior margin of the tibia, marked tenderness, normal radiographs tion programs should focus on training dancers to control knee (“normal” cortical hypertrophy) and a positive bone scan (scinti- valgus, land softly, and avoid hyperextended knees. Condition- gram). They should be treated with rest, limited weight-bearing, ing programs may ameliorate the adverse effects of fatigue. ACL and immobilization for 6 to 8 weeks, followed by a gradual, slowly injuries in dancers have been managed both non-operatively and progressive rehabilitation program emphasizing strengthening of operatively. We have performed 49 ACL reconstructions on danc- the proximal (hip, pelvis) and distal (foot) segments, including ers out of a total of approximately 400 ACLs seen. Post-operative impact retraining. Return to full dance activities should not be management consists of immediate partial weight bearing and expected until at least 6 months after initiation of rest. range of motion work. A knee immobilizer is used for sleeping and Chronic ATSFs demonstrate a long history of symptoms (several ambulating for five days, after which full weight bearing without months to years) and variable amounts of tenderness, depending brace or crutches is normally tolerated. Running and parallel barre on recent activity level. Radiographs will show a horizontal fissure are begun at approximately three months, with return to full dance on the lateral view (“dreaded black line”) and local cortical thick- between five and six months post-surgery. Ninety-two percent of ening of the lateral cortex on the AP view. CT or MRI will show these dancers returned to unrestricted dance. Six percent had to thickening of the anterior cortex. Unfortunately, the presentation modify dance technique to avoid jumps, with two percent electing varies greatly, and no grading system is available. These injuries to pursue another career. should be treated similarly to acute ATSFs, but with the addition 92. First metatarsal head hemicap resurfacing procedure: of bone stimulation (ultrasonic). Consideration should be given A new technique for the surgical management of advanced to drilling with autogenous bone grafting, especially if the black hallux rigidus with or without deformity line is wide and traverses most of the width of the anterior cortex. Thomas P. San Giovanni, MD, UHZ Sports Medicine Institute, Coral Return to full dance is even longer than for acute ATSFs. Gables, FL, USA 94. Spondylolysis and spondylolisthesis The purpose of this study was to propose a novel technique for Lyle J. Micheli, MD, Clinical Professor of Orthopaedic Surgery and O’Donnell treating advanced hallux rigidus which directly addresses the pa- Family Professor of Orthopaedic Sports Medicine, Harvard Medical School; thology of the 1st metatarsal head and may be combined with other Director, Division of Sports Medicine, Children’s Hospital, Boston, MA, USA procedures, if necessary, to correct concomitant pathologies. This presentation begins with definitions of spondylolysis, spon- In 2005, twenty-four cases (20 patients - 4 were bilaterals) under- dylolisthesis, and two related problems, pre-spondylolytic stress went first metatarsal head resurfacing. Eight patients were male, twelve reaction and spondyloptosis. The terminology used in classifying female. Average age at time of surgery was 56.5 years (range=30-77). and grading these conditions is then discussed, followed by some Each patient completed AOFAS, VAS, and ROM assessments pre- observations regarding etiology (heredity as a predisposing factor, operatively, and at 6 weeks, 3, 6, and 12 months postoperatively. The athletic versus non-athletic populations, factors that cause slippage, 30 Volume 11, Number 1, 2007 • Journal of Dance Medicine & Science etc.). A hypothetical case study is used to illustrate how clinical type selected into classical companies today make for a high injury findings are developed and analyzed, including the role of diag- rate. The hypermobile physique enhances the classical line, but the nostic imaging (plain radiographs, SPECT bone scan, computer- fragility and laxity of the tissues predisposes to trauma. ized tomography, and magnetic resonance imaging). Treatment is The extrinsic factors in injury such as floors, shoes, teaching and described in terms of its goals, which vary depending on severity of work hours could hardly be better controlled, and prevention is a the injury, and the protocols commonly used in our sports medicine priority. Our role is to see dancers through the inevitable overuse practice. These emphasize use of the Boston Overlapping Brace, injuries, with missing performances a last resort. Prevention is in physical therapy for hamstring stretching, and “relative rest.” In the form of foot exercises to strengthen the intrinsic muscles of the case of spondylolisthesis with progressive or persistent pain, the foot, proprioception exercises, and retraining biomechanics if spinal fusion in situ is an option, though it is anticipated that in necessary. Dancers take risks and accidents are part of the job, but the future greater use of pars repair will replace fusion. Another fortunately constitute a much smaller part of the injury total. future consideration is the use of electrical stimulation to enhance Ankle injuries fall into patterns of anterior and posterior im- union of pars defects. Several conclusions are offered, as follows: pingements due to muscle imbalance, and faulty biomechanics 1. Spondylolysis in athletes is a stress fracture caused by repetitive cause stress reactions within the foot. hyperextension; 2. The fracture can be healed by immobilization Quick diagnosis and a radiologist familiar with the types of in a rigid anti-lordotic brace; 3. Adults may also have degenera- injuries dancers experience are important. Conservative treatment tive discs, facet arthrosis, or spinal stenosis which can confound is the preferred option, with surgery the last resort. treatment. 97. Common foot and ankle injuries: Their causes and 95. The orthopaedic screening exam treatment in the modern dance population William G. Hamilton, MD, orthopaedic surgeon, St. Luke’s-Roosevelt Shaw Bronner, PT, PhD, Analysis of Dance and Movement (ADAM) Center, Hospital, New York City Ballet Company, and The Long Island University, Brooklyn, and Alvin Ailey, New York, NY, USA School of American Ballet, New York, NY, USA In our modern dance company foot and ankle injuries are the most Screening has become a vital part of injury prevention for both common (annual average 34%, range 23-57%), similar to the aver- student and professional dancers at the New York City Ballet. The ages of 37% and 38% reported by two major ballet companies. exam is divided into two parts. Part I is a brief medical history, The key to preventing these injuries is to understand the movement including lifestyle, onset of dancing, menstrual history (females), stressors of each technique, and observe the choreography. We prior injuries, etc. Part II, the physical exam, is performed in four work with the dancers to try to mitigate the potential for injury stages: standing, prone, supine, and over the side of the examina- in the various techniques they use, especially during intensive tion table. It is designed to be a simple, efficient way to pick up rehearsal periods when the hours of repetition required to learn technique flaws, tightness, weakness, and asymmetries that may new steps render them most vulnerable to overuse injuries. Thus, be corrected or improved by physical therapy before they lead to for example, although they will ultimately perform a dance in bare injury. Confidentiality is maintained at all times, and the results feet, we encourage the dancers to protect themselves at these times of the exam are not given to management, but are used to design through the use of shoes, sneakers, and padding. a specific physical therapy regimen based on the individual find- Similarly, with regard to treatment and rehabilitation, a me- ings. thodical evaluation with understanding of differential diagnosis This orthopaedic evaluation was validated on ballet students is the key. Dance-specific functional evaluation is important to at the New York City Ballet’s affiliated training academy, The understanding both alignment and motor control issues that School of American Ballet. The findings accurately predicted may have led to pathology, as well as for promoting functional who dropped out of the training program four years later (this progression and safe return to class. In our workup we closely was statistically significant at p<.01). The purpose of this exam, observe the following movements (as appropriate): parallel demi- however, is not to eliminate dance students from a professional plié, relevé, and full squat; turned out 1st position demi-plié, career, but to try to identify risk factors associated with injuries. relevé, and grand plié; single leg pressure relevé, a tendu series, It has the advantage of being brief, taking approximately 15-20 and jumps in 1st position. minutes to administer. It is now a standard part of the NYC Functional progression in rehabilitation emphasizes alterna- Ballet’s Wellness Program. tive cross-training to prevent deconditioning, and the following phases: Special Interest Groups Day • Phase 1: Protected postures A Day for Physical Therapists and Athletic • Phase 2: Protected early motion Trainers • Phase 3: Expanding movement boundaries Treatment of the Dancer’s Foot and Ankle • Phase 4: Progressive movement challenges. 96. Common foot and ankle injuries: Their causes and 98. Ankle and foot: Functional rehabilitation and treatment in the ballet population progressive return to dance Moira McCormack, PT, Royal Ballet Company, London, UK Megan Richardson, MS, ATC, Harkness Center for Dance Injuries, New Foot and ankle injuries take up a large percentage of our time in York, NY; Katherine L. Ewalt, MS, ATC, San Diego Ballet/AxXiom Dance the Physiotherapy Department of Company. Types Collective, San Diego, CA, USA and numbers of injuries are cyclical and depend on the choreog- The purpose of this session is to identify the basic principles in- raphy currently in our repertoire, with the traditional ballets such volved in dance-specific rehabilitation of ankle and foot injuries. as “” and “Sleeping Beauty” causing the majority of the Additionally, our goal is to open a dialogue among allied health problems for the female dancers. As the company works throughout professionals working with this population in order to share various the season of 150 performances fatigue is a major factor, but danc- methods of rehabilitating the dancer patient. We anticipate that the ers are versed in its causes and prevention, with fitness a primary discussion will be guided by such observations as the following: concern. Nevertheless, the nature of the discipline and the body General body conditioning is vital to maintaining the dancer’s Journal of Dance Medicine & Science • Volume 11, Number 1, 2007 31 fitness level in the unaffected parts of the body, as well as facilitating lower extremity helps us to diagnose and evaluate the mechanics his/her return to dance activity. behind many injuries. There is growing evidence that the foot Restoring muscular strength and endurance to the injured area, and its dysfunctions mirror problems higher up in the body, for in addition to preserving the strength and endurance of unaffected example in the knee, hip, SI-joint and lumbar spine. Conversely, body parts, is essential to the return to pre-injury function. poor shifting of body weight can cause misalignment of the whole Any rehabilitation program must address the reestablishment lower extremity or dropping of the arch in the foot. of proper proprioceptive input and motor control and skill. Lower extremity function is complicated, and needs to be stud- It is important to address postural deviations, muscle asym- ied carefully to understand its laws and principles. This information metries, and compensatory body mechanics throughout the reha- is universal, and is based on the normal foot biomechanics present bilitation process, as well as educate the dancer in how to maintain in gait, running, jumping, and any form of dance. Movement muscular balance once she/he returns to full dance participation. analysis can be used to provide guidelines for preventing lower Cardiovascular conditioning during the rehabilitation process extremity injuries. can help improve the dancer’s ability to resist muscular fatigue Especially important are the muscles that affect rotation of (and further injury/reinjury) by increasing the body’s efficient use the leg. The external rotators are six deep muscles behind the hip of oxygen. (piriformis, obturates and gemellii) and gluteus maximus. On the Rehabilitation of any injury should utilize both open and closed front side there are adductors and the iliopsoas, as well as sartorius. kinetic chain exercises to address dysfunctions throughout the They all work together to combat the effect of gravity, which turns entire kinetic chain. in the hip joint in loaded closed kinetic chain situations. These Functional progressions (a series of progressive activities de- muscles must be strong enough to prevent the internal rotators signed to assist the dancer in regaining normal function) should (adductor magnus, tensor fascia latae, anterior fibers of gluteus be incorporated throughout the rehabilitation program. medius and minimus) from getting too tight. Often imbalance in these internal-external rotators leads to poor pelvic control, 99. The importance of evaluating foot biomechanics in dancers SI-joint involvement, and lumbar spine problems. To be able to Jarmo Ahonen, PT, Finnish National Ballet Company, Finnish National Opera Ballet School, Helsinki, Finland control leg movements and avoid foot injuries dancers must have good balance in the rotator muscles. A large percentage of dance injuries occur in the feet. Thus, understanding the structure, biomechanics and function of the