INContact HARKNESS HCDI Newsletter ENTER Volume 1 C for Dance Injuries Issue 1 A publication dedicated to the prevention and treatment of dance injuries Spring 2005 Financial Assistance for Dancers: Director’s Message, Donald J. Rose, MD One Success Story Welcome to the Harkness Center for dancers, but began to realize over time Like so many dancers, Kimani Fowlin, a Dance Injuries' new newsletter, “In that dancers could not usually afford the performer, teacher, and choreographer, Contact”. We hope you will find this care they needed. Many of the injuries has no health insurance. It was only periodical filled with useful information sustained by dancers require x-rays or when an injury to her knee got so bad about the latest news in dance medicine. MRI’s, physical therapy, and, in about 2% that she couldn’t climb stairs, let alone of cases, surgery. These expensive dance, that she decided to ask ancillary services were simply colleagues where she should go for unaffordable for the uninsured or help. Kimani delayed seeing a doctor for underinsured dancer. Because of this, I a long time because she feared she approached the administrators of the couldn’t afford the visit. Luckily, Kimani Hospital for Joint Diseases to inquire if had a friend who told her about the we might be able to start a clinic that Harkness Center for Dance Injuries and would specialize in dance medicine, its many free and subsidized programs. providing a team of professionals well- versed in the health, performance and financial issues faced by dancers and dance companies. In response to this request, William Perlmuth, a member (and now Chair) of the Board of Trustee's for the Hospital Dr. Rose examines dancer Stephanie along with Theodore Bartwink, both of Guiland after a knee injury. the Harkness Foundation for Dance, proposed a collaboration between the The Harkness Center for Dance Injuries Hospital for Joint Diseases and the (HCDI) was founded as a program of the Harkness Foundation for Dance. It Hospital for Joint Diseases in 1989. Back Photo by R. Harris turned out The Harkness Foundation then, a critical need existed for “Without the financial assistance offered by was a natural fit to provide the seed The Harkness Center, I wouldn’t have been able specialized and affordable healthcare in money needed to begin this innovative to afford the tests and surgery I needed to dance the dance community. As an orthopaedic again.” says Kimani Fowlin. approach to dancer health because it surgeon in private practice, I began to combined the two primary loves of the One such program of benefit to Kimani see many dancers who were working Foundation's matriarch, Rebekah was the Center’s “Special Assistance incredibly hard for very little money and Harkness. Mrs. Harkness manifested a Fund,” referred to internally as the without benefit of any health insurance. I devout support of dance and the arts in “SAF.” As a result of the magnanimous volunteered my help to many of these the early 1960's. She sponsored support of the New York Community Inside this Issue: summer dance festivals, held workshops Trust’s LuEsther T. Mertz Advised Fund, in her home, and eventually created her the Harkness Center was able to Director’s Message .................................1 own ballet company, The Harkness establish an endowment to subsidize Financial Assistance Programs - Ballet. She also established the medical costs for dancers in financial A Success Story ................................. 1 Endowment Fund to Help Dancers ... 2 Harkness House for Ballet Arts, a school need (see related story on page 2). It Did You Know ? ...................................... 2 Continued on page 2 Continued on page 3 Who We Are - The Healthcare Team ...................Insert Programs at a Glance .....................Insert Harkness Center For Dance Injuries Factors Associated with Injury.............. 3 Special Thanks ....................................... 4 Quality Healthcare for the Dance Community Endowment Fund Helps Dancers Afford Needed Healthcare! No Dancer Turned Away The Harkness Center for Dance Injuries' creating a $1,000,000 endowment to spin off commitment to serving injured dancers the much-needed dollars for serving dancers in regardless of ability to pay was brought to the need. Indeed, the match was successfully met HARKNESS attention of the LuEsther T. Mertz Charitable in December 2002, and since that time the ENTER Trust in 1997 by the staff of the Mertz Gilmore Fund has helped more than 200 dancers care C for Dance Injuries Foundation. for their injuries, ranging from mild strains to completely ruptured ligaments needing Both the Trust and the Mertz Gilmore Director reconstructive surgery. Foundation, a separate philanthropy also Donald J. Rose, MD initiated by the Mertz family, had histories of While this endowment generates Associate Director strong support for New York City's dance approximately $50,000 per year to help David S. Weiss, MD community. It was Mrs. Mertz who was the dancers, demand for the Center's financial help primary benefactor behind the purchase of is actually closer to five times that amount, or Director of Research & Education Chelsea's Elgin Theater to create the current $250,000 per year. We are continuing our Marijeanne Liederbach, MSATC, Joyce Theater space. efforts daily to expand our base of support for MSPT, CSCS this most valuable and practical part of our When it became clear that the Harkness program. Please contact us if you’d like to help! Executive Assistant Center needed to develop a long-term solution Debra Spina, BS for providing dancers without financial means Research Assistant a way to access its critical services, a $500,000 challenge gift was made to the Megan Richardson, MS, ATC Center from the LuEsther T. Mertz Advised Advisory Board Fund of the New York Community Trust. Theodore S. Bartwink (Chairman) The Center was challenged to raise an Gerald Arpino additional $500,000 within five years, thus Photo by John Robison Etta Brandman, Esq Hon. Schuyler G. Chapin “Director’s Message,” continued from page 1 Beverly D’Anne Laura Dean located in one of New York City's most perform research and educate dancers, Carmen DeLavallade beautiful Upper East Side mansions. Mrs. teachers, company directors, managers Carole Dioguardi Harkness' contributions to the arts won and support organizations about ways to Alexander J. Dubé her high praise from President Lyndon B. prevent, treat and rehabilitate dance John P. Falk Johnson. She received awards from the injuries. As we celebrate our 15th City of New York and numerous cultural anniversary, I am pleased to announce Eliot Feld organizations around the world. Mrs. the introduction of "In Contact" to further Victor H. Frankel, MD, PhD Harkness was a strong advocate of help us accomplish this goal. Stephanie French medicine and research and is William G. Hamilton, MD remembered fondly by her company of The newsletter is intended to provide you Geoffrey Holder dancers for always having made with up-to-date information about our Judith Jamison healthcare available to them. programs and research findings. We will Bill T. Jones highlight resources available to dancers Harvey Lichtenstein In reflection of her vision, the Harkness and share expert advice about injury Murray Louis Center for Dance Injuries was founded prevention. We hope to hear from you ! with the goal of providing the highest Elaine Malsin quality musculoskeletal healthcare to Sincerely, Gayle Miller dancers regardless of their ability to pay Donald J. Rose, MD Arthur Mitchell for that care. It is the Center's mission to Martha Myers William A. Perlmuth, Esq Lawrence Rhodes Did You Know? Roslyne Paige Stern · Dance ranks with football as the #1 physically demanding activity 5 Paul Taylor · 80% of dancers experience a disabling injury during their careers 2 Liz Thompson · 65% of dance injuries are from overuse and 35% from accidents 3,7 Edward Villela · 90% of injuries occur when a dancer is fatigued 4 Carol K. Walker · 55% of dancers have no health insurance 7,8 · 98% of dance injuries are treated non-operatively 8 See references on page three Page 2 Factors Associated with Injury Occurrence in Dance While all dance forms follow fairly regimented, predictable Injury Statistics Breakdown movement patterns within technique class, each discipline has its own unique demands that can contribute to injury Site of injury tends to differ depending on the type of dance being performed. Ballet Some trends have been documented Pointe & Winging Relevé from 3/4 to full pointe results in forces at the big toe joint within each discipline as well as across of 12 times body weight.10 This can potentially lead to problems dance forms: such as inflammation of the tissues surrounding that joint.4 Turn-Out Some dancers use the floor for friction to increase the amount of turnout they can get. This can result in excessive force along the Dance Foot/ Lumbar inside of the foot and leg and can also adversely affect the spine.4 Disciplines Ankle Knee Hip Spine Modern Ballet 4,7 38.5 10.5 8.6 10.8 Partnering/Contact Women as well as men lift partners during improvisation and sometimes at high velocities and non-neutral angles which can Modern 4 13.3 20.1 11.3 15.3 overload the ligaments, making them vulnerable to injury.4 Flamenco 6 42.5 22.5 N/A 20.0 Weight Bearing Dancing on non-traditional bases of support (inverted on arms or neck, on knees, back or buttocks) may lead to undue loads on or Broadway/ near those structures.4 Musical 1 22.8 15.7 3.0 20.3 Broadway & Tap Harkness Percussion Vibratory motions are known to cause structural damage to Clinic 8 33.2 30.4 7.8 10.8 musculoskeletal tissues.6,9 Exposure Eight identical shows a week for weeks, months or years on end can result in overuse problems and/or an overtraining Note: Numbers represent percentage of injury per site syndrome, also known as “burnout.”1,3,4 References 1.