Meeting Abstracts

Twelfth Annual Meeting of the International Association for Dance Medicine & Science New York, New York October 25-27, 2002

Friday, October 25 Anterior Labral Tear in the Dancer: Etiology, Treatment, Rehabilitation Douglas Padgett, MD, Hospital for Special Surgery; Peter Marshall, PT, Anterior Hip Syndrome in Dancers: Differential Diagnosis American Ballet Theater; William Hamilton, MD, American Ballet Donald J. Rose, MD; Jeffrey Rosen, MD; Mark Hall, MSPT; Marijeanne Theater, New York City Ballet; Marika Molnar, PT, Westside Dance Liederbach, MSATC, MSPT, CSCS; Harkness Center for Dance Injuries, Physical Therapy, New York City Ballet, New York, NY, USA Hospital for Joint Diseases, New York, NY, USA It is often difficult to establish a clear diagnosis of hip joint problems. Dancers routinely practice movements involving flexion, abduction, and Often hip pain and dysfunction will cause sacroiliac joint and lumbar external rotation (FABER) of the hip. Repetition of these motions may spine dysfunction, with the pain in these regions masking the true pathol- cause symptoms of inflammation and pain in the anterior hip region. ogy. Dancers often complain of pain in the anterior hip joint that is often Procedures used to differentially diagnose hip pathology include history, evaluated as iliopsoas tendonitis. Another structure has been recently found physical exam, (palpation, passive and active motion testing, manual muscle to be the culprit of some of this hip pain, based on manual testing as well testing) and various radiological tests will be described. A review of the as diagnostic MRI reports. The anterior portion of the labrum has been hip region pathologies commonly seen in dancers, including internal coax torn in several cases of hip and back pain in dancers, probably due to its saltans, tendonitis, bursitis, capsulitis and labral tears will be reviewed association with the hip joint capsule and the extreme ranges of motion along with practical suggestions for treatment and prevention. the hip is put through. The hip flexion/adduction test has proven to be a Anterior Hip Impingement Syndrome in Dancers: A Physical positive indicator of labral problems and when surgically treated, has given a good prognosis. Dancers often require 6 to 8 weeks of rehabilitation Therapy Assessment and Treatment Approach following surgery before resuming class. Katy Keller, MS, PT, Juilliard School, Westside Dance Physical Therapy, New York City Ballet, New York, NY, USA Early Identification of, and a Preventative Intervention for Anterior hip impingement pain with “clicking” during movements such Anorexia Nervosa in Professional Student Dancers as passé and développé is a common complaint in dancers. Diagnoses Norma Morgan, BSc, Centre for Community Research, Faculty of Health associated with hip impingement syndrome include iliopsoas tendinitis, and Human Sciences, Department of Health and Social Care, University bursitis, snapping hip (transient subluxation of the iliopsoas tendon), and of Hertfordshire, Central School of Ballet, Hatfield, Hertfordshire, England hip flexor contracture. Characteristic findings on physical assessment in- To evaluate the benefits of a prevention strategy for anorexia nervosa in clude dysfunctional lumbo-pelvi-femoral rhythm, restricted lumbosacral female professional dance students, a research program was devised con- sidebending, positive hip scour test in the flexion/adduction quadrant sisting of psychometric questionnaires and group therapy involving cog- with restricted inferior, posterior and medial hip glides, lower quarter nitive, educational and behavioral elements. The psychometric question- muscle imbalances, and trunk stabilization deficiency. The theory is that naires were chosen or designed to identify personality characteristics, the separate diagnoses under this more generalized diagnosis of anterior attitudes, important influences, and behavior patterns that could directly hip impingement syndrome are inter-related via their shared pathome- relate to similar factors displayed by confirmed anorexics. Therapy ses- chanics. Specifically hip joint movement is impaired by tightness of the sions were designed to target those issues that most frequently occurred in posterior soft tissues (capsule and rotators); and restricted glide of the the responses since these were thought to be of greatest significance. The femoral head in the acetabulum creates pressure and irritation of the over- retests were to measure the effect of the therapy sessions on these issues. lying anterior soft tissues. A physical therapy treatment approach consist- Three months later the questionnaires were repeated to measure the longer- ing of manual soft tissue and joint mobilization and neuro-muscular re- term effects. The main aims of the therapy were to raise self-esteem and to education helps restore pain-free, functional movement patterns. provide the students with information that could help them cope with the pressures that affect young women today. Subjects were randomly Recognizing Eating Disorders assigned to intervention or control groups. The control group completed Beth Glace, MS, Nicholas Institute of Sports Medicine and Athletic all the psychometrics but had no therapy. The therapy sessions were moni- Trauma, Lenox Hill Hospital, New York, NY, USA tored and qualitatively analyzed and the psychometric answers provided The DSM-IV criteria for anorexia nervosa and bulimia will be reviewed, material that was quantitatively analyzed. however, a pragmatic examination of identifying behaviors and physical changes in eating disordered individuals will be the primary focus. The The Role of Hip Arthroscopy in Dancers with Acetabular Labral family and personal dynamics often associated with pathologic eating will Tears and Their Rehabilitation be discussed, as well as the underlying emotional issues and coping mecha- Brent Anderson, PT, OCS, Polestar Education, Balanced Body, University nisms. The workshop will cover the medical consequences of starvation of Miami, Miami, FL, USA; Marc Phillipon, MD, Orthopedic Center and vomiting, as a means of recognizing the physical changes that occur Holy Cross Medical Group, Pittsburgh, PA, USA and to provide the professional with a basis for intervention. Treatment of acetabular labral tears is a clear indication for hip arthroscopy.

56 Journal of Dance Medicine & Science Volume 7, Number 2 2003 57

In the past instrumentation has limited access to parts of the hip joint therapy visits, the pain scales and funcational abilities of all patients im- making arthroscopic management more difficult. The introduction of proved. A subset of patients had greater benefits and fewer physical therapy flexible instrumentation has made the management of these lesions more visits. These were patients who met the following criteria: 1. did not wait effective and safe. This presentation will focus on the interdisciplinary until the problem was chronic, 2. complied with a home exercise pro- approach of an orthopaedic surgeon and a physical therapist using pro- gram, 3. complied with class modifications, 4. accepted the source of their gressive approaches in both disciplines to aide in the treatment of dancers injury, 5. accepted the solution to their injury. Other limitations to recov- with internal derangements of the labrum and to prevent degenerative ery included the patient’s body awareness and age, as well as insufficient changes thought to lead to disability. support from artistic staff. A Survey of Menstrual Function in Adolescent Dancers Psychological Issues in Dance Medicine John Lavender, MS, ATC-L, North Carolina School of the Arts, Winston- Ruth Solomon, University of California, Santa Cruz, CA, USA; Linda Salem, NC, USA Hamilton, PhD, Fordham University, New York, NY, USA; Stanley Greben, North Carolina School of the Arts performs a biennial health screening MD, FRCPC, University of Toronto, Dancer Transition Resource Centre, on all dancers. The assessement includes menstrual cycle, age, height, Toronto, Canada; Lynda Mainwaring, PhD, University of Toronto, Ontario, weight, body fat percent, and BMI. Using this system 494 female classical Canada; Marijeanne Liederbach, MSATC, MSPT, Harkness Center for Dance ballet dancers and 494 female contemporary dancers have been assessed. Injuries, Hospital for Joint Diseases, New York, NY, USA Analysis of data collected shows no significant difference in any of these This forum is a follow-up to the two-part issue of the Journal of Dance characteristics for either group. It should be noted that 21% of all ballet Medicine and Science “Psychological Issues in Dance Medicine” [5(4), 2001, dancers were considered to have secondary amenorrhea as compared to and 6(1), 2002]. Three of the subjects introduced there—career transi- only 8.5% of contemporary dancers. While there was no correlation be- tions in dance, how dancers deal with pain, and fatigue as a factor in tween secondary amenorrhea and reduced body weight and fat mass, there dance injuries—will be reviewed, along with the results published on the was a tendency for the amenorrheic group (n = 105) to have slightly higher personalities of student and professional dancers. Primary emphasis will body weight levels than the non-amenorrheic group (n = 389) when looking be on the interface between the psychological and physiological aspects of at classical ballet dancers. There was no difference between the amenor- what dancers, and those who train and treat them do. rheic (n = 42) and non-amenorrheic (n = 452) contemporary dancers. When comparing groups, contemporary dancers were approximately 8 Adolescent Hip Pain: An Intervention Strategy pounds heavier than the classical ballet dancers for the same height. Kim Pedrick, BSc, MCSP, SRP, Leah Holdroyd, MCSP, SRP, MMACP, The Arts Educational School, Tring, Hertfordshire, England Are Dancers Psychologically Prepared? Hip injuries in professional dancers are generally uncommon however Rosine Bena, Sierra Nevada Ballet, Peninsula Ballet Theatre School, West research has suggested that the incidence is higher among girls during the Nevada Performance Art Center, California, NV, USA; Bonnie Robson, adolescent years. This study assesses a simple intervention strategy and its MD, DipPsych, FRCP, Ontario, Canada effectiveness in enhancing stability of the hip during the growth spurt. 78 Too often dancers are viewed only with respect to their physical make up. students, ranging in age from 12-16, were questioned regarding the inci- The dancer spends hours each day building muscle strength and physical dence of hip pain and whether this had limited their dancing. The stu- stamina to be prepared to perform. The young body is strong and well dents were then randomly allocated to one of two groups. Group 1 un- prepared. What about the mind, emotions, and behavior patterns? This derwent intervention therapy consisting of four simple exercises performed presentation will share experiences that illustrate the psychological aspects daily before their first class. Group 2 acted as the control group. A repeat of the dance experience. How dance and medical professionals can pre- questionnaire was collected six months post therapy and the results ana- pare the dancer to cope with these aspects will be addressed. lyzed to determine the effect of our intervention. The results of these measures and the implications for injury prevention highlighted. Anterior Hip Problems in Dancers: Clinical Observations and Literature Review Sacroiliac Mobilizations to Treat a Chronic Hamstring Strain Faye Dilgen, MSPT, Megan Richardson, MSATC, Julie Daugherty, MSPT, in a Jazz Dancer Marijeanne Liederbach, MSATC, MSPT, Harkness Center for Dance Jennifer Gamboa, MPT, OCS; Leigh Anne Roberts, MPT, Body Injuries, Hospital for Joint Diseases, New York, NY, USA Dynamics, Arlington, VA, USA; Peter E. Lavine, MD, Orthopaedic Private Thirty percent of the dancers seen in our clinic have been referred for Practice, Washington, DC, USA complaints of pain, weakness and motor dysfunction of tissues surround- Hamstring strains in dancers can be particularly difficult to heal. While ing the hip joint. Effective management of hip problems requires that such injuries may respond to traditional modalities, functional demands dance medicine practitioners and dance educators possess a systematic make the insertion of the hamstring vulnerable to re-injury. Furthermore, understanding of the related literature and an overview of the presenting an accurate biomechanical differential diagnosis is essential to rule out complaints paired with objective clinical measures taken during treatment. contributing factors from hip joint dysfunctions or pelvic obliquities. We Hip problems will be classified according to the taxonomy described by report on a unique clinical presentation of an intervention in a jazz dancer Shirley Sahrman and measures of strength and flexibility data from a sample with a chronic hamstring strain. In this case, all initial clinical tests and of healthy and hip region-injured dancers will be compared and presented. measures indicated an isolated soft-tissue lesion with no hip joint pathol- ogy. Kinetic testing of sacroiliac joint function was also normal. When the Bending the Rules: Is Modifying Class Good Enough for dancer failed to respond to traditional modalities, appropriate therapeutic Dancers with Hip Pain? exercise, and technique re-education, additional tests and measures were Leigh Anne Roberts, MPT, Body Dynamics, Arlington, VA, USA; Peter performed. Upon closer investigation, the excursion of posterior innomi- E. Lavine, MD, Orthopaedic Private Practice, Washington, DC, USA; nate rotation was unremarkable, but the associated end-feel was abnor- Jennifer M. Gamboa, MPT, OCS, Body Dynamics, Arlington, VA; USA mally hard. Further, posterior translation of the innominate on the sacrum Hip pain is a common complaint of classical dancers. We try to keep was significantly restricted. Once treatment was directed at posterior in- dancers dancing by condoning relative rest, but does this work? The par- nominate translation and rotation, the dancer’s hamstring strain resolved ticipants in this review were all elite level ballet dancers (age 13 to 16 and remained symptom-free at 2, 4-, and 8-week follow-ups. years) in a pre-professional program. All dancers experienced anterior hip pain that was exacerbated by doing a développé to the side and to the Psychological and Social Factors Associated With Performance- front (at least 45° off of the floor). Following a visit to an orthopaedic Limiting Injuries in Professional Ballet Dancers surgeon and a standard physical therapy exam, a diagnosis of hip capsulitis Maya Adam, Glenn S. Brassington, PhD, Stanford University School of or hip flexor tendonitis was made. After 7 to 10 days of complete rest, Medicine, Stanford, California, CA, USA students returned to class at different rates with directions from the physi- Recepient of the IADMS Student Research Award 2002 cal therapist for relative rest specific for their case. After 5 to 17 physical Although numerous studies have demonstrated an association between 58 Journal of Dance Medicine & Science Volume 7, Number 2 2003 psychosocial factors and sports injuries, few studies have examined psy- and footwork of the dancers will be presented. The technique consists of chological variables associated with dance injuries. This study assessed the a series of exercises using exercise balls to stabilize the pelvic area as well as relationship between a broad range of psychosocial variables and perfor- the dancer’s supporting leg. The principles of ball exercises and why and mance-limiting physical injuries in a sample of elite ballet dancers in or- how they apply to dancers will be introduced. Each basic barre exercise der to identify potential factors to be included in interventions to prevent (plies, tendus, ronds de jambe) will be demonstrated. and treat dance injuries. Participants were 30 female and 24 male (mean age 26.59 years; SD= 6.2 years) ballet dancers. Participants were asked to The Zena Rommett Floor-Barre and Ballet Technique® complete questionnaires including: a demographics questionnaire, the Zena Rommett, Camille Rommett, Zena Rommett Dance Foundation, Cohen Perceived Stress Scale, Arousal Predisposition Scale, the Social Sup- New York, NY, USA port Appraisal Scale, the Profile of Mood States, and the Pittsburgh Sleep Floor-Barre™ combines classical ballet with anatomical principles of align- Quality Index. Percent of performance and rehearsal days missed due to ment and kinetics. Using the floor, without the pressure of gravity, Floor- injury was computed as follows: (number of days missed due to injury/ Barre™ strengthens and properly corrects the placement of the pelvis, scheduled days) X 100. To identify potential correlates of injuries, Pearson hips and back. Based on ballet, Floor-Barre™ lengthens the muscles, toning product-moment correlation coefficients were computed between the in- hips and legs, creating long exquisite lines. The technique develops maxi- jury variable and each of the psychosocial variables. Absence due to injury mum extension and turn-out (outward rotation of the legs from the hips), was significantly positively correlated with stress, arousability, sleep dis- and strengthens the musculature and joints, while releasing tension. turbances, daytime sleepiness, and negative mood states (i.e., tension, de- pression, anger, fatigue, and confusion). However, absence due to injury was significantly negatively associated with social support. Future inter- Saturday, October 26 vention studies are needed to explore the effect of reducing psychological Teaching the Experiential Anatomy of the Hip in Modern distress and increasing social support within the dance company on the prevention of injuries and the treatment of injured dancers. Technique Class Jennifer Salk, MFA, Dance Program, University of Washington, Seattle, Ultrasound Imaging of Trunk Stability Musculature at Work WA, USA Craig Phillips, BAppSc PT, Prahran, Victoria, Australia The hip joint is one of the most difficult joints of the body to teach dance There has been much interest in research on the mechanisms and training students to use properly. By incorporating experiential anatomy into the of trunk and spinal stability. The most common injuries for dancers are technique class a teacher can educate students about the body and its spinal and spinal related. Although the work focuses on training the con- possibilities and individual differences in a way that will impact how they trol of the deeper layers of abdominal musculature it is proving to be a move. Several examples of how experiential anatomy and kinesiology of challenge as the activity of these muscles is not easy to identify. There are the hip are incorporated into the technique class will be demonstrated 2 systems involved in establishing an effective trunk stability mechanism. using simple partnering and movement exploration exercises, followed by First there are the deep or local stability muscles including transverses a thorough warm-up, and center and across the floor material that dem- abdominus, the anterior pelvic floor, the posterior fascicles of psoas major, onstrate how to incorporate the experiential hip-work into class. the diaphragm and deep lumbar multifidus. Second, there are the global stabilizers that take the load of the trunk and limbs and control move- Integrating Laban Movement Analysis/Bartenieff Fundamentals ment. These are the keys needed to ensure an effective stability pattern into the Ballet Classroom and examples of effective and ineffective activity will be demonstrated. Cadence Whittier, MFA, CLMA, Hobart and William Smith Colleges, Geneva, NY, USA Reconsidering the Training Needs of Dancers: Addressing Some This session will demonstrate one effective way to use the Bartenieff Fun- of the Psychological Elements of Dance damentals as an approach to conditioning within the ballet classroom. Elena Estanol, MFA, University of Utah, Academy of Ballet Arts, Salt The presentation will cover the following areas: How the Bartenieff Fun- Lake City, UT, USA damentals can be tailored to work within the ballet class; How the Funda- This workshop, will illustrate how the field of sport psychology and spe- mental Patterns of Total Body Connectivity facilitate both the wellness cialized consultants may aid our process of training and developing healthier and technical growth of ballet dancers; How the Laban Movement Analysis dancers. Teachers might support those efforts through the conceptualization theories of shape and space can be woven into the above areas in order to of training approaches that incorporate a psychological perspective. facilitate a dancer’s ability to communicate through his or her body. Biomechanical Dysfunction of the Sacroiliac Joint in Dancers: Discover Easier Turning: A Guided Exploration Using the Detection in the Studio, Diagnosis/Correction using Feldenkrais Method® Physiotherapy, Prevention Barbara Bell, PT, OCS, GCFP, Park South Physical Therapy; Anastasi Libby Lovejoy, BFA, MFA, University of Texas at Austin; Frankie R. Melder, Siotas, BS, MDance, MEd, GCFP, Infinite Moves, New York, NY, USA PT, Austin Physical Therapy Clinic; Austin, TX, USA Spinal rotation is an essential component of activities from walking to Biomechanical dysfunction of the sacroiliac joint causes many diverse symp- pirouettes. This session will explore the quality and pattern of rotation, toms in dancers, all of which include pain and limited technical ability. discovering areas where dancers may be “holding,” and how the effort Since dysfunctions of this joint are not readily recognized, correct diagno- involved in holding may be interfering with movement. Feldenkrais® chal- sis may be difficult. The sacroiliac joint structure and its movement ca- lenges the habitual nature of our actions, bringing them back into aware- pacity will be introduced. Supporting structures and their possible in- ness. By bringing attention to the four components of action (movement, volvement will also be discussed. Diagnosing sacroiliac joint dysfunction sensation, feeling and thought) participants will use neuromuscular path- will be presented. Instruction will be given in a mobilization technique to ways that reduce effort and improve the efficiency of movement. correct biomechanical dysfunction. Appropriate use of muscle energy, myofascial release and conventional procedures/modalities will also be Foot Morphology and Dance Training presented. Therapeutic exercises to stabilize the sacroiliac joint and to Juan Bosco Calvo, MD, Sanart-Dance Medicine; Javier Fernandez- stretch/strengthen the corresponding soft tissue will be taught. Camacho, Raul Sanz, Luis Gomez Pellico, Department of Morphological Sciences, University of Alcala, Alcala, Madrid, Spain Barre Training With Exercise Balls: An Alternative Training for This study analyzed the incidence of first ray deviation and correlations Dancer’s Core Stability with anthropometric data and clinical observations in dance students. Joelle-Rosanne Segers, BSc PT, Bsc, Kine, Motion Matters Physiotherapy 1,400 dance students of different dance centers have been tested during 8 Clinic, Ottawa, Ontario, Canada years. The sample was divided in four groups: prepuberty, puberty, ado- An original technique to improve general proprioception, coordination lescents and adults. The variables analyzed were: arch of the foot (normal, Journal of Dance Medicine & Science Volume 7, Number 2 2003 59 flat and cavus), digital formula, hallux joint alignment (neutral, hallux strength-training program for hamstring and quadriceps can prevent peak valgus, proximal phalanx valgus, distal phalanx valgus and proximal and torque decrements of these muscles following a dance-specific exercise. 22 distal phalanx valgus). Clinical examination included lower limb align- female dancers (25 ± 1.3 years) volunteered. Isokinetic dynamometry (at ments (external and internal rotation of the femur and lower leg, knee the angular velocity of 1.04 rad·s-1) was employed before and after a spe- hyperextension or flexion, genu valgus or varus, and pelvic tilt). Anthro- cifically designed dance-test aiming to cause fatigue within 10 minutes. pometric measurements include height, weight, BMI, degrees of the demi- Procedures were repeated after a 3-month hamstring and quadriceps plié and degrees of turn-out of the hip. We shall report the relationship strength-training program where only about half of the subjects partici- between each variable and dance training. pated. The remaining dancers acted as controls. Prior to strength-training program, the dance-specific exercise led to significant decrements in ham- The Development of a Dance Specific Anaerobic Fitness Test string (p < 0.01 to p < 0.001) and quadriceps (p < 0.05) peak torque levels Emma Redding, BA, Laban Centre London, London, England; Matthew of both experimental subjects and their controls. However, after the Wyon, MSc, St. Martins College, Lancaster, England strength-training program, only the control subjects revealed significant The aim of this study was to design a protocol for evaluating the anaerobic decrements in their hamstring (p < 0.005) and quadriceps (p < 0.05) peak fitness levels of dancers. Dance is a non-steady state activity of low to high torques following the dance-specific exercise. This was attributed to sig- intensity with intermittent bursts of anaerobic phases. Dance training should, nificant increases in muscle performance shown by the experimental group. therefore, include both aerobic and anaerobic exercises to help improve the We concluded that: a strength-training program for hamstring and quad- cardiovascular capabilities appropriate to dance. In recent years sports science riceps can prevent significant peak torque decrements of these muscles has demonstrated the importance of devising training programs and fitness following a dance-specific exercise, and dance and studio work alone is tests that are activity specific (i.e., running tests for runners and cycle tests for not enough to protect dancers from the deleterious effects of fatigue. cyclists). To date, there are no valid dance-specific fitness tests that measure anaerobic power. The protocol incorporates movements similar to those car- Dance Imagery for Technique and Performance ried out during the last part of a typical Limon style Modern Dance class; Eric Franklin, BS, BFA, Institute for Movement Imagery Education, jumps in first and parallel position, swings, lunges, and rolls to the floor. Move- Wetzikon, Switzerland ments were set to a steady beat using a metronome. The movement phrase was This session introduces imagery and self-touch exercises aimed at improv- carried out for 1 minute, followed by 1-minute rest. This sequence was re- ing technique and performance in the dance class setting. Teachers are peated several times until the movements became compromised either artisti- often confronted with large classes and time constraints. It is important to cally or technically or did not stay within the set tempo. The technical level of gain the student’s attention and motivate them by demonstrating how the movement phrase was kept as choreographically simple as possible so as to dance technique improves if imagery is applied correctly. The best images reduce the possible effect of movement economy within test-retest situations are those discovered by the student himself. One of the important skills and to allow the test to be used by less experienced as well as professional for the imagery-oriented teacher is to elicit the dancer’s personal imagery. dancers. The oxygen consumption and heart rates of the dancers were mea- sured throughout using portable gas analyzers. Blood lactate was also measured Smoothness During a Multi-Joint Movement: 2D and 3D at the end of each 1-minute movement phrase. Physiological testing is a funda- Analysis Between Groups of Differing Skill Levels mental component of training regimens, however, reliable and valid tests have Jonathan Spriggs, BE, Shaw Bronner, PT Bruce Brownstein, PT, Sheyi not up until now, been developed for dance. Such a test can be useful in deter- Ojofeitimi, MPT, SOAR Research, Long Island University, Brooklyn, NY, mining whether dancers are anaerobically fit enough for specific dance perfor- USA mances that require high intensity movement phrases. The test could be used Variation in motion between groups of dancers using a commonly per- for comparative analysis over time; before, during, and after training; pre-per- formed movement (arabesque) is investigated. A quantitative measure- formance/tour; or for dancers returning from vacation. ment of “smoothness” (jerk or rate of change of acceleration) is employed Anyone Can Dance! in order to evaluate how the control of variables altered with increasing skill levels and learning. A Jerk Cost function is used for comparison across Madeleine Samuelson White, ARAD, MSTAT, Society of Teachers of the subject groups. Numerous studies have typically been limited to 2D analy- Alexander Technique, London, England sis; due to the relative complexity of the arabesque however, in this study We will demonstrate that anyone can dance, even though they are con- 3D analysis is considered. A Vicon 5 camera system with data acquisition vinced they cannot. By using the Alexander Technique, “thought in move- software, sampling at 120 Hz, was employed to capture right toe marker ment,” we will become aware of the ease and naturalness we all have in us. displacement data from 30 male and female subjects (14 males and 16 females), age range 18 to 36 (mean: 22 years) in the Global X, Y, and Z Posterior Ankle Pain in Dancers and Athletes: Diagnosis and coordinate system. The subjects were allocated to groups representing three Treatment distinct levels of training: beginner, advanced and expert. 2D and 3D Jerk William Hamilton, MD, School of American Ballet, New York City Ballet, Cost was determined for the three distinct movement phases (passé, and American Ballet Theater, New York, NY, USA développé arabesque, and return) of the arabesque. The mean phase 2D Posterior ankle pain in dancers and “equinus athletes” is a common prob- (x-y), (x-z), (y-z) (frontal, transverse and sagittal planes respectively) and lem. It is usually one of three types: 1. posterolateral pain from impinge- 3D Jerk Cost results obtained for the three groups show reduction in ment on an os trigonum or trigonal process; 2. posteromedial pain from values from beginner to expert, implying increased “smoothness” within “Dancer’s Tendonitis” of the Flexor Hallucis Longus tendon; and 3. a the motion phases of the arabesque movement. Analysis into the validity combination of both conditions occurring at the same time. The history, of this approach with comparison of 2D and 3D data is underway. physical findings, nonsurgical and surgical treatment will be discussed. In our series of one hundred cases, the overall surgical results were 80% good The Cavus Foot: Help or Hindrance in the Dancer on Pointe? to excellent. A larger proportion of the fair and poor results occurred in Suzanne Martin, MA, MPT, Smuin Ballets, School of the San Francisco the amateur dancers versus the professionals. Ballet, San Francisco, St. Mary’s College, Moraga, CA, USA The biomechanical demands of the aesthetic of the cavus foot in the fe- The Effects of Dance-Specific Exercise and Strength-Training male ballet dancer, where the dance form often sacrifices structure over on Hip and Thigh Muscles Function function will be presented. The cavus foot, whether it occurs naturally or Yiannis Koutedakis, PhD, Thessaly University, Trikala, Greece, has been nurtured, creates a “windlass” effect, thereby intensifying the Wolverhampton University, Walsall, England; Constadin Bouziotas, high loads and strains of ballet technique. Understandably, then, the ankle- Wolverhampton University, Walsall, England foot complex is reported as the site of highest injury in a pointe dancer. It has been reported that unfavourable torque ratios and/or inadequate Case studies of the injuries of professional ballet dancers with cavus feet torque levels of selected hip and thigh muscles are associated with lower will be presented. The biomechanics will be explained and suggested con- back and lower body injuries in dancers. This study examined whether a servative treatment will include both active and passive modalities. Manual 60 Journal of Dance Medicine & Science Volume 7, Number 2 2003 therapy techniques and active treatment protocols will be presented. What Is Kinesiologically Wrong Yet Kinesthetically Right In Dance Training? The Science Meets the Imagery How Can We Assess Good Teaching from the Perspective of Pamela Geber, MFA, BFA, Dept. of Modern Dance, University of Utah, Dance Science: A Panel Presentation Salt Lake City, UT, USA Donna Krasnow, MS, Dept. of Dance, Centre for Fine Arts, Toronto, Student dancers integrate information from a variety of sources in order Ontario, Canada; Martha Myers, Connecticut College, New London, to improve their technique. Sources include internal proprioceptive sen- CT; Janice Gudde Plastino, PhD, University of California, Irvine, CA; sations, visual cues and directions or feedback from teachers. Teachers’ Jaclynn Villamil, CMA, New York University Tisch School of the Arts; directions and feedback are often given in the form of images they have Arwyn Carpenter, New York University, New York, NY; USA found to be effective in producing technical accuracy. These images may A panel will present views on teaching assessment, with a focus on dance be kinesiologically/anatomically incorrect even though they are kinestheti- science and its impact on current practices. The panel represents a range cally correct. It is not unusual for student dancers attending university of views, from different generations and settings. The goal is to present programs to have studied dance science more intensively than their tech- ideas about viewing dance education from the perspective of the dance nique teachers. Teachers depend on their own kinesthetic sensation of scientist/educator, and to stimulate discussion among participants on de- accurate technique to design learning opportunities and give directions veloping methodology for assessing good teaching practices. and feedback on student performance. The danger is such that if the im- age is kinesiologically/anatomically wrong, a student may prematurely Impact of Joint Laxity in Ballet Dancers Over the Full Age disregard it. As dance students are acquiring more kinesiological knowl- Spectrum From 11 Years Old to Dancers in a Professional Ballet edge alongside their studio practice, it is increasingly important that they Company understand the seemingly paradoxical relationship between kinesiological Moira McCormack, MSc, Janet Briggs, PT, The Royal Ballet School and evidence and kinesthetic sensation. Dancers are both athletes and artists Company; Alan Hakim, Prof. Rodney Grahame, Centre for Rheumatology, and their bodies’ expressive clarity as well as physical longevity rely upon a University College London Hospitals; London, England blending of both quantifiable and qualitative findings. This study is an extension of the research carried out in 2001 that looked at gender difference and impact of joint laxity in student classical ballet Anterior Tibial Stress Fractures dancers aged 16-18 years in which male and female ballets students were David S. Weiss, MD, NYU Medical Center, NYU-HJD Department of shown to manifest significantly more hypermobility than controls. People Orthopaedic Surgery, Harkness Center for Dance Injuries, New York, with Benign Joint Hypermobility Syndrome (BJHS) now identifiable by NY, USA internationally agreed criteria (1998 Brighton Criteria) are vulnerable to A review of the physiology, biomechanics, diagnosis, treatment, and reha- the effects of injury and overuse. In this extension, vocational ballet stu- bilitation for stress fractures of the anterior tibia in dancers is presented. dents aged 11-15 are investigated as well as the entire membership of a Anterior stress fractures are common in dancers and jumping athletes. professional ballet company. The following measurements were performed These fractures can be slow to heal and thus frustrating for the dancer, on 50-70 ballet students aged 11-15 and 80 professional ballet dancers teacher, and clinician. Diagnosis depends on obtaining a comprehensive and age, gender and ethnically-matched controls: the Beighton (qualita- history and performing a careful physical examination. The proper use of tive) and the Contompasis (semi-quantitative) joint hypermobility scores, diagnostic tests will be reviewed. Successful treatment depends on early and the angle of passive dorsiflexion of the fifth metacarpophalangeal joint identification, determination as to whether the fracture is acute or chronic, in response to a fixed load. The results will be analyzed to determine: ensuring sufficient rest, and implementing proper rehabilitation. Reha- whether there are differences between the dancers and controls and be- bilitation entails a graduated exercise program aimed at increasing strength tween genders within groups; and what proportion of the hypermobile and proprioceptive ability while also slowly increasing stress on the leg. subjects in each group satisfy the Brighton criteria for the BJHS and there- Return to full dance activities may take as long as 6 to 8 months. Due to fore might be at special risk. the slow nature of healing of these fractures, progression of an anterior tibial stress fracture to a chronic stress fracture (also termed a “mal-union” Treating Stress Fractures in Dancers – Art or Science or “dreaded black line”) can occur during treatment. At times a chronic Peter Lavine, MD, Orthopaedic Private Practice, Washington, DC, USA; stress fracture may appear as the first presentation of the injury. The evalu- Jennifer M. Gamboa, MPT, OCS, Leigh Roberts, MPT, Body Dynamics, ation methods and treatment options for a chronic stress fracture of the Arlington, VA, USA anterior tibia will also be discussed. Stress fractures are associated with repetitive demands on the skeleton that cause subthreshold insults that eventually lead to failure once the The “Theme Week” Concept: A Positive Mental Stimulant for micro damage and fatigue exceed the bone’s reparative abilities. The etiol- the Post High School Dance Student ogy of stress fractures in dancers is diverse. Abnormal mechanical loading Fay Nenander, Head of Studies, Balettakademien, Stockholm, Sweden may occur due to structural issues, muscle fatigue, changes in force distri- The problems concomitant with compacting a dance education into three bution or concentration, technical errors, over-training, and injury. Struc- or four years are common. The tendency to postpone professional dance tural concerns would include hyperpronation, hypermobile first metatar- education until after secondary school graduation has many positive as- sal, long second metatarsal, and a cavus foot. Hormonal abnormalities, pects - including improving the dancer’s situation when progressing to a especially amenorrhea, as well as dietary/nutritional disorders, contribute second career. However, for the dance educator, such students present a to increase the incidence of stress fractures in dancers. The hallmark of situation with not only insufficient hours in the day to provide an ad- clinical diagnosis is a high index of suspicion based on the dancer’s history equate technical training, but also a struggle to find time for even such and symptoms. Radiographic confirmation – standard radiographs, Tech- basic additional subjects as dance history, anatomy, physiology, and mu- netium-99 scan, computed tomography, and magnetic resonance imag- sic. Excessive physical demands are a daily reality for many post high- ing – may also contribute to differential diagnosis. Treatment may vary school dance students. A student who lacks the necessary mental well and depends upon the location and severity of the stress fracture. The use being essential to balancing the physical load, can easily spiral into loss of of immobilization, electric bone stimulation, and surgery, may be contro- energy, poor concentration, and below potential achievement. Dance edu- versial in this elite population. This is especially true when special accom- cators, increasingly aware of the importance of nurturing not “just the modations are made to prevent atrophy or a deterioration of conditioning dancer” but also “the whole individual,” are presented with a dilemma. and flexibility (use of relative rest). Often the focus of the treatment is How to promote mental well-being while striving within a time limit to toward early resumption of dancing. Issues surrounding hormonal imbal- maximize technical prowess? How to find time to address such essentials ance, menstrual regularity, anorexia, and dietary and nutritional concerns as exposure to related arts, life skills, role models and the world outside must be explored. A general review of the etiology, diagnosis, treatment dance? This presentation will concentrate on the concept that health, well and return to dancing schedule will be presented. being, and physical achievement in the professional dance student can be Journal of Dance Medicine & Science Volume 7, Number 2 2003 61 furthered by offering as wide a variety of cultural stimuli during training the studio. Digital photos and short video clips of dancers performing as possible. “Theme week” is a way to facilitate this - offering solutions for movements also enhance the design of the course while providing visual the nurturing of the “whole individual” and not “just the dancer,” while references to dance and the anatomical principles. The presentation will also recognizing the need to maintain an intensive dance program. discuss experiences in teaching anatomy to dancers. Back to Dance-Optimizing Lumbosacral Rehabilitation for the “Hands-On” Anatomy: Discovering Dancers’ “Key” Deep Twenty-First Century Muscles: Building Them In Clay On A Skeleton Judith Peterson, MD, Pennsylvania Ballet, Thomas Jefferson University Maureen O’Rourke, BFA, LMT, CNMT, New World School of the Arts, Hospital, Philadelphia, PA, USA Dance Division, Miami, FL, USA Low back injuries are common in dancers and may lead to prolonged Dancers, teachers, and therapists dealing with dance technique, injury disability. Optimizing rehabilitation promotes an earlier return to dance. prevention and treatment, often depend on 2-dimensional textbook illus- A review of the causes of low back complaints and the evaluation of the trations for an understanding of the musculoskeletal structure of the body. injured dancer will be presented. Treatment strategies and their rationale This can lead to confusion when dealing with a dancer’s 3-dimensional will be discussed. Acupuncture, spinal analgesia techniques, and new physi- body, and thus inaccurate or ineffectual corrections, images, or teaching cal modalities for pain control and rehabilitation will be reviewed. Partici- methods. The process of studying the location and attachments of key pants will learn strategies to optimize the use of these interventions and deep muscles, discussing their actions, and then building them layer by how to best combine them with physical rehabilitation. layer on a skeleton, accesses visual, auditory, and kinesthetic learning modes to increase musculoskeletal awareness. This allows a relationship of the Comparison of Kinetic, Kinematic and Electromyographic knowledge to one’s own body, aiding in retention of the information, and Activity and Strength in Dancers with ACL-Normal versus ACL- increasing understanding of technical corrections and dance images. This Reconstructed Knees workshop allows participants to work with a skeletal model, building the Marijeanne Liederbach, MSATC, MSPT, CSCS, Fay Dilgen, MSPT, Julie muscles in clay, or to simply watch and listen, to increase 3-dimensional Daugherty, MSPT, Megan Richardson, MSATC, Harkness Center for awareness of “turnout,” “center,” and other key dance concepts. Dance Injuries; Jeffrey Rosen, MD, NYU-HJD Department of Orthopaedic Surgery; Hospital for Joint Diseases, New York, NY, USA Anterior Cruciate Ligament Injuries in Dancers: Arthroscopic Surgical reconstruction of ACL-impaired knees often entails autograph Reconstruction Utilizing Hamstring Tendons donation of tendons. To date, no comparisons of the kinetic, kinematic Donald Rose, MD, Harkness Center for Dance Injuries, Hospital for and electromyographic activity or end-range flexion strength in dancers Joint Diseases, Brian S. Delay, MD, Thomas Joseph, MD, NYU-HJD of their ACL-normal versus ACL-reconstructed knees using semitendi- Department of Orthopaedic Surgery, New York, NY, USA nosus-gracilis grafts or patellar tendon grafts are available. Sixty female Anterior cruciate ligament (ACL) rupture has been an increasingly fre- and sixty male dancers volunteered to undergo a battery of human perfor- quent injury in dancers, often jeopardizing careers. ACL injuries have mance tests including single limb stance, dual and single limb jump land- been found to be two to eight times more frequent in females. This pre- ing, and manual muscle testing for end-range, eccentric hamstring strength sentation will discuss the etiology of non-contact ACL ruptures in danc- in the 130° to 90° range of motion. Subjects grouped according to ACL- ers and the possible causes of increased frequency in females. While non- status will undergo repeat measures of laboratory motion analysis and operative management has a role in both the prevention and treatment of strength testing. Data will be averaged from three test trials per condition ACL injuries in dancers, an additional focus will be to discuss the opera- and scrutinized for significance using one-way ANOVA at the 0.05 level. tive management using hamstring tendon reconstruction. The procedure Differences between subjects in the semitendinosus-gracilis surgical group currently used by the authors is an arthroscopic endoscopic ACL recon- and subjects in the patellar tendon group will be compared to subjects in struction using quadruple-stranded semitendinosus and gracilis tendon the normal group as well as to their own ipsilateral, ACL-intact limb. autograft with combined cortical and intraosseous fixation. Since June Autograft donation for ACL reconstruction is expected to impact the pat- 1997, more than170 such reconstructions have been performed, includ- terns of neuromuscular behavior and motor control strategy in the lower ing over 17 dancers. No graft failures have been noted to date. The surgi- limbs of dancers. The results will provide information about what special cal technique, as well as a 2 to 4 year follow-up of 50 patients will be attention beyond routine post-operative physical therapy protocols ACL- presented. An extensive subjective and objective postoperative assessment reconstructed dancers will need to ensure safe return to dance. was performed on all patients. Tegner, Lysholm, and IKDC scores all im- proved significantly. Average knee extension and flexion loss was 1° and Strengthen Transversus Abdominis, Pelvic Floor, Diaphragm, 3° respectively. 98% of patients had a 0 or +1 Lachman score. KT-1000 Multifidi (Core Muscles) and Iliopsoas with Pilates Exercises side-to-side difference averaged 1.6 mm, with a statistically significant Harriett Jastremsky, BA, Noho Pilates Studio, New York, NY, The improved scores in women (females: 0.9 mm, males: 2.0 mm), contrary Physicalmind Institute, Santa Fe, NM, USA to previous hamstring ACL reports. No significant difference was noted This presentation will provide experiential awareness of the core muscles between dancers and non-dancers. Chronicity of the injury and patient (transversus abdominis, pelvic floor, diaphragm, multifidi, and the iliop- age did not significantly affect objective results. All dancers returned to soas) so that practitioners can internalize the use of these muscles and dance, if desired. Arthroscopic ACL reconstruction using this technique more effectively communicate the importance of these muscles for sup- can have excellent results in the functionally unstable dancer while avoid- ported and efficient movement. Participants will experience how core ing some of the recognized morbidity associated with other graft choices. strength can be applied to dance as well as to everyday movement in order to make movement habits more biomechanically sound. Sunday, October 27 Teaching Anatomy to Dancers in a Web-Based Format: A Get Stronger by Stretching Collaborative Experience Noa Spector-Flock, St. Petersburg, FL, USA Judith Steel, MA, Department of Dance and Choreography, Lisa Donegan Working with an elastic band presents both artistic and therapeutic possi- Shoaf, MSPT, Department of Physical Therapy, Virginia Commonwealth bilities. Artistically, it breaks the traditional barriers and methods of teach- University, Richmond, VA, USA ing, allowing people with all body types to develop inner knowledge of This presentation reviews a web course designed to teach anatomy and self-alignment. As educators begin to use the band as a tool, it becomes basic anatomical principles related to injury prevention, to dancers study- possible to eliminate the restrictions that have forced dancers into a form ing in a college dance program. The web format allows for team teaching of dance based on body shape. The workshop will address the use of the while bypassing the scheduling difficulties of real-time collaborative teach- band, emphasizing eccentric contraction, with the elastic band serving as ing. The web pages contain text with numerous illustrations and is high- a tool for strengthening/lengthening the muscles. The goal is to offer a lighted by special notes referring to dance movements and experiences in method that prepares the body for physical activity by helping to increase 62 Journal of Dance Medicine & Science Volume 7, Number 2 2003 awareness, flexibility, strength, and the use of three planes of movement. ment of hip pain. “Footprints:” Finding A Strong, Stable Base (A Hands-On Study Dancers Find “Center” Using the Foam Roller of Intrinsic and Extrinsic Foot Muscles) Jennifer Stacey, MS, BS, Peak Performance Pilates Center, San Francisco, Maureen O’Rourke, BFA, LMT, CNMT, New World School of the Arts, CA, USA Dance Division, Miami, FL, USA The foam roller (from the Feldenkrais Method) is often used as a training Knowledge about the foot and arch support is crucial for good dance and massage tool for dancers. Dancers find their center, stability, balance, technique and injury prevention. Reviewing the basic structure and flexibility, coordination, and technique improved after roller work. It is muscles, then learning specific exercises and stretches for the area, can also incorporated into their injury prevention and rehabilitation programs. increase proprioceptive awareness and allow relaxation and better align- Proprioceptive training, myofascial release, foot lengthening, and trunk ment of the feet. This creates a broader, more stable base for more effective stabilization are a few of the ways that dancers work with the roller. Danc- balance, less work for smaller, “fine-tuning” muscles, and increased stamina ers enjoy the challenge of the roller, so their likelihood of adhering to a and shock absorption. Following a brief review of the bones and muscles protocol is high. Participants will be taught to perform the following exer- of the foot and calf, participants in this workshop will learn a sequence of cises on the roller: trunk stabilization exercises that emphasize use of the exercises, stretches, and massage. We will then compare “before and after” teres minor, latissimus dorsi, serratus anterior oblique abdominis, trans- footprints to see if changes result from the workout, looking at alignment versus, pelvic floor, hamstrings and adductors; exercises that lengthen the of foot and toes and the amount of foot surface touching the floor. thoracolumbar region, the psoas and the ilio-tibial band to allow for suc- cessful trunk stabilization and freeing of the hip, back and shoulders; foot Injuries in a Modern Dance Company: Effect of Comprehensive stretching; and movements that require sequential spinal articulation, Management on Incidence and Cost balance and fascial release. Participants will try simple dance movements Shaw Bronner, PT, MHS, OCS, Sheyi Ojofeitimi, MSPT, SOAR Research at prior to and following the roller work. They will notice it is easier to Long Island University, Brooklyn, NY, USA; Donald Rose, MD, Harkness perform the dance skills. Center for Dance Injuries, Hospital for Joint Diseases, New York, NY; USA The addition of case management and intervention services in several Total Hip Replacement in Dancers large ballet companies has been effective in reducing the physical and Boni Rietveld, MD, Inge Buyls, Medical Centre for Dancers & Musicians, financial impact of injuries. Smaller modern dance companies may ben- The Hague, The Netherlands efit from similar programs. The objective was to analyze the effect of com- In this study 15% of dancers over the age of 45 had hip complaints; 43% prehensive management (on-site case management and intervention, pre- (n = 6/14) of these hip injuries were due to degenerative changes in the vention, and treatment) on incidence, cost (time lost), and patterns of hip joints. Of this group 50% (only three) had a total hip replacement musculoskeletal injury in a modern dance company. Injury data at a mod- (THP). The number of total hip replacements in active dancers and dance- ern dance company in New York with 42 dancers was analyzed over a five- teachers is relatively low. We reviewed the 8 active dancers and dance- year period: two years with no intervention and three years with interven- teachers who had a total hip replacement between July 1993 and March tion. The number of new Workers’ Compensation (WC) cases and days 2001. There were 7 female dancers and 1 male (mean age:53 years; range: missed due to injury were compared across the 5 years in a repeated- 49-59 years). There were no dysplastic hips or epiphysiolysis cases. Al- measures MANOVA. Patterns of musculoskeletal injury were also reviewed. though the group is very small and can only serve as a retrospective clini- Case management and intervention significantly reduced the annual num- cal pilot study, there were some interesting observations: 7 had a unilat- ber of new WC cases from a high of 81% to 17% and decreased the eral osteoarthritis of the left hip, which is significant even in this small number of days missed 60%. The highest incidence of new WC injuries group. The female dance-teacher who had the operation on the right side occurred in younger dancers prior to the implementation of the program. is the youngest (49 years at her first operation), she has a bilateral osteoar- Benefits of comprehensive management included more effective manage- thritis and is scheduled to have her left total hip replacement in January ment of overuse problems before they became full-blown injuries and 2002, two years after the first, at 51 years of age. Mean follow-up was 3 triage to determine what required medical intervention, preventing over- years (range: 8.4 years to 9 months). There were no postoperative disloca- utilization of medical services. This on-site management program was tions or infections. All resumed their dance activities or are still in the effective in decreasing the incidence of new WC cases and lost time. rehabilitation process. Problems encountered in this group were a leg length Pistol-Grip Deformity of the Femoral Neck: A Predictor of discrepancy in absence of an adduction contracture and in favor of the operated leg: this may be caused by the combination of hypermobility Mechanical Impingement at the Hip Joint in the Professional and the surgeon trying to achieve the proper tension between the hip Dancer and Dance Student components during operation in order to avoid postoperative luxation. Roger Hobden, MD, DO, Department of Family Medicine, University Although the pain was gone in all, there was some subjective disappoint- of Montreal, Montreal, Quebec, Canada ment in the speed of the postoperative rehabilitation, although that was Pistol-grip deformity of the femoral neck is present in approximately 8% objectively normal and often faster in comparison to non-dancer patients. of the population. Its prevalence in the dance population is presently un- This may be due to their high demands as dancers and overly optimistic known. This condition has been described under various names includ- expectations in view of the very favorable results of THP in the, usually ing femoral head tilt-deformity, post-slip deformity, retroversion, and sub- much older, general population. It is concluded that better rehabilitation clinical slipped capital femoral epiphysis. Due to the mechanical effects guidelines are needed for dancer-patients. on the hip joint, this syndrome may lead to intermittent pain in the ante- rior groin area when dance movements involve lifting the leg at 90° and Initial Findings of the Second National Inquiry into Dancers’ higher. The deformity of the femoral head and neck that defines this syn- Health and Injury in the UK: A Comparison Study drome can lead to labral tears and eventually premature osteoarthritis of Helen Laws, Dance UK, Dance UK’s Medical Advisory Committee, the hip joint. Clinical diagnosis can be suspected when a sharp pain is London, England reproduced by a combination of flexion, adduction, and internal rotation We audited the health and injury experience in UK’s professional and pre- of the hip joint. The clinical significance of the x-ray findings are often professional dance population 8 years after the inquiry carried out by downplayed by many radiologists. These findings may include osteophyte Dance UK in 1994. We will focus on key findings of prevalence, site, formation, sclerosis, denting of the bony surface, peri-labral cysts, and type, and perceived causes of injury and compare current findings with stress fractures (misdiagnosed as “os acetabulum”). Surprisingly, more so- those from 1994. Questionnaires for dancers, teachers, and company/ phisticated investigative measures such as magnetic resonance with ar- school management, were distributed to the UK’s professional dance com- thrography will not necessarily add more information to that given by panies and vocational dance schools. Results from the survey carried out plain and frog view x-rays. Health professionals treating dancers need to in 1994 showed that over 80% of dancers (professional and pre-profes- be aware of this syndrome and it’s implications for diagnosis and treat- sional) had incurred an injury in the previous 12 months. The main sites Journal of Dance Medicine & Science Volume 7, Number 2 2003 63 of injury were the lower back followed by knees and ankles, and injuries logical skills and strategies associated with elite athletic performance are were predominantly muscular. The main perceived cause of injury was associated with level of achievement in professional dance. Participants fatigue or overwork. 60% of contemporary professionals and 57% of bal- were 30 female and 24 male (mean: 26.59 years; SD: 6.2 years) ballet let professionals agreed that this was by far the major cause, with unsuit- dancers from one of Germany’s largest professional ballet companies. Par- able floor, repetitive movements and cold environment the next most ticipants were asked to complete a slightly modified version of the Test of cited causes of injury. Dance UK’s Healthier Dancer Program has been Performance Strategies (TOPS), which is a self-report questionnaire de- disseminating information and providing educational talks and workshops signed to measure psychological skills and strategies used by athletes to for dancers since the early 90s. By comparing the initial findings of this enhance performance. The TOPS questionnaire yields 8 mental skills second UK inquiry with the findings 8 years ago we will see whether an subscales related to performance and rehearsal: goal, setting, use of imag- increased awareness of injury prevention issues in the UK has had an ery, ability to relax, ability to activate/energize, use of positive self talk, effect on injury rates. It will also help us decide on the areas of focus for emotional control, attentional control, automaticity (performing with- further education aimed at reducing dancers’ risk of injury. out thinking), and negative thinking. T-tests were computed to compare soloist, principle, and demi-soloist dancers (n = 24) with corps de ballet Follow-up Background Questionnaire Study of Dancers in dancers (n = 30) on each of the TOPS scales. Soloist dancers had signifi- Previous Study: Activity Level of Dancers after Total Hip cantly more professional dance experience (mean: 11.5 years; SD: 6.4 Replacement (THR) Surgery years) than the corps de ballet dancers (mean: 5.7 years; SD: 5.0 years). Judith Alter, EdD, UCLA Department of World Arts and Cultures, Los Dancers in the soloist group had significantly higher scores on each of the Angeles, CA, USA positive TOPS performance and rehearsal scales (p < 0.001) with the ex- This simple quantitative follow-up study using a questionnaire format ception of automaticity. Soloist dancers also reported engaging in signifi- seeks to provide information from 20 dancers concerning their activity cant less negative thinking during performance (p < 0.001) than corps de level after their total hip replacement. The questionnaire included: dance ballet. Soloist dancers were distinguished from corps de ballet dancers by background, dance surfaces for these dance activities, awareness of injury the mental skills and strategies they employed to perfect their dance. These causing techniques and actions of the teachers of these dancers; inherited data provide one possible explanation for why some dancers progress to body characteristics such as hyper-mobile or tight ligaments, leg length higher levels of professional ballet dance performance. Future interven- differences, leg preferences; other regular physical activities; medical back- tion studies should be conducted to determine whether implementing a ground such as causes of hip pain, other orthopaedic problems or proce- mental skills training program could improve dance performance. dures, other medical problems, dietary and nutritional background; and medical coverage, settings, support services, and financial issues. Development and Application of a Dance Science Support Programme Within a Dance Company: The Role of an Exercise The Use of the Alexander Technique to Help in the Prevention Physiologist of Hip Injuries Matthew Wyon, MSc, Department of Physical Education and Sport Madeleine Samuelson White, ARAD, MSTAT, Society of Teachers of the Science, St. Martin’s College, Lancaster, Lancashire, England Alexander Technique, London, England The role of the physiologist within a dance company is two-fold, educa- This presentation will demonstrate how the use of the Alexander Tech- tion and intervention, and both functions are closely linked. The first step nique can help prevent hip injuries. It will focus on steps, which, if incor- in the intervention process is to collect baseline data about the company. rectly performed, could cause hip joint injuries in later years. The Alexander This includes fitness test results and data from classes and performances. Technique works on a deeper level of coordination in the nervous system, These provide the backbone of the intervention strategies employed. Edu- which cannot always be reached by traditional exercise and correction. cation must run alongside the implementation of any intervention as ad- herence to a training program is greatly improved when the participant Identifying the at Risk Dancer: Who Gets Injured, and Why? understands what is required and why. The role of the exercise physiolo- Tony Lycholat, MSc, Centre for Sport and Exercise Sciences, Sheffield, gist within the healthcare team is focussed on returning the injured dancer Kim Pedrick, BSc, MCSP, SRP, Rachel Rist, MA, The Arts Educational back to dance fitness quickly and developing prevention strategies that School, Tring, Hertfordshire; Enlgand will reduce the chance of the injury reoccurring. Information from the As many as 75% of dance students at The Arts Educational School, Tring, dance staff provides specific goals and requirements for forthcoming pieces England, have been shown to suffer some form of musculoskeletal injury or baseline fitness levels that the dance staff deem necessary to cope with during their training. Although the risk factors for overuse injuries in class, rehearsal, or performance. The exercise physiologist is there to pro- dancers have been discussed, there is a lack of evidence-based research on vide supplementary training to complement the skill training provided by specific risk factors and proposed interventions. Using our on-going in- the dance staff. Initially the aim is to develop an underlying aerobic base jury database and a number of biomechanical tools and techniques, we and work capacity. Following this phase the training becomes more dance have developed an injury risk factor model to identify who may become specific with the development of appropriate energy and muscular sys- injured and why. More importantly, injury prevention based upon the tems. This lecture will present the baseline fitness tests and requirements modification of an individual student’s injury risk profile is now not only as set by the company. An example of the company’s year with a periodized possible, but quantifiable. Our approach has been to integrate existing training program based on prevention and preparation for multiple per- dancer screening techniques with movement analysis tools typically used formance periods will also be reviewed. in biomechanics; such as digital video capture and analysis and foot pres- sure distribution during class. A long-term program of rigorous additional Computerization of Dance Wellness Screening Data evaluation in the laboratory using force plate measurement, EMG and Gary Galbraith, MFA, BS, Karen Potter, Dance Program, Dept. of Theatre motion analysis has also just begun. This will eventually lead to the refine- Arts, Case Western Reserve University, Chad Fortun, Ohio Physical ment of our injury risk factor model. This presentation aims to describe Therapy Clinic, Cleveland, OH, USA our model of risk factor identification and subsequent injury prevention. A Dance Wellness Screen, defined as a process where dancers are evalu- ated using various established physical assessments and dance technique Mental Skills Distinguish Elite Soloist Ballet Dancers from assessments, is typically a lengthy and sometimes tedious event. Rotating Corps de Ballet Dancers or channeling dancers through the extensive battery of assessments is of- Glenn Brassington, PhD, Maya Adam, Stanford University School of ten a time consuming process of measuring, collecting data, and evaluat- Medicine, Stanford, CA, USA ing at each station. The author has written a computer program using Although intuition suggests that psychological attributes are associated Microsoft Access to expedite the process of data collection, analysis, and with elite performance, no empirical studies have been conducted to de- evaluation. A report complete with numeric and graphic output is gener- termine whether mental skills and abilities are associated with professional ated for each subject. Additionally, the report is written to provide sug- dance performance. This study attempts to determine whether psycho- gested strengthening and/or stretching exercises as a result of the evalua- 64 Journal of Dance Medicine & Science Volume 7, Number 2 2003 tions. Recommended protocols include photographs demonstrating the tion forces that are essential for optimal bone growth and development. techniques as well as instructions for execution, number of repetitions However, the intensity and rigorousness of their training, the incidence of and frequency. The report is an important aid in developing a personal- low body weight, under-nutrition, and consequential low hormone levels ized cross training program for dancers. place them at risk for overuse injuries (i.e., stress fractures) and early bone loss. The Sahara unit is ideal for a clinical setting: it is a quick, low cost, Of Boys and Men: A Comparison of Workload Demands and radiation-free screening tool with good longitudinal sensitivity. Between Student and Professional Men Dancers Bonnie Robson, MD, DCP, FRCP, Quinte Ballet School, Belleville, Biomechanical Survey on Arabesques and Attitude Croisée Ontario, Canada; Marijeanne Liederbach, MSATC, MSPT, Harkness Devant and Their Influence on the Hip Joint and Pelvis in the Center for Dance Injuries, Hospital for Joint Diseases, New York, NY, Open and Closed Kinetic Chain USA Jarmo Ahonen, PT, Finnish National Ballet, Helsinki, Finland; Roger This survey takes a psychological, developmental look at the lifestyle and Hobden, MD, DO, Department of Family Medicine, University of work patterns of the male dancer. The authors discovered that their previ- Montreal, Montreal, Canada; Christine Wright, New York, NY, USA ous research samples indicated very different patterns between the male Arabesques and attitude front are basic elements of ballet and parts of dance student and the male professional dancer. Such differences, if true, them form the basis for many other dance techniques and disciplines. To need to be made clear to teachers and medical professionals, so that pro- execute them well puts high demands on dancers’ skills. Studying these grams can be devised to meet the needs of the dancer depending on the movements provides the opportunity to review two different biomechanical stage of development. Male dance students typically state that they work functions: how the body does function in closed kinetic chain on the and are expected to work longer hours than the female students and that supporting leg and in open kinetic chain on the working leg. It also pro- they take better care of their bodies through exercise and good nutrition. vides an opportunity for looking at how the spine and back muscles as By contrast, professional male dancers report training and working 61% well as the shoulder girdle are cooperating with the legwork. This presen- fewer hours per day than their female counterparts in the professional tation will discuss the arabesques and attitude croisée devant, providing arena. Additional work which takes a psychological and developmental key insights into the proper performance of these movements. approach to the lifestyle, work, exercise, and injury patterns of male danc- ers would be useful for the formulation of programs to promote positive The Dancer as World Class Athlete health and recovery from injury. Health professional need to understand Tony Lycholat, MSc, Centre for Sport and Exercise Sciences, Sheffield, the phases of physiologic, psychological, and dance training development England in order to assist dancers with their transitions from one level of develop- The demands faced by the professional dancer aiming for performance ment to another. It is only through such an integrated approach that stu- excellence are similar to those faced by the world-class athlete. However, dent dancers can be helped to prepare safely for his performance career the dance profession often does not realize that the world-class athlete is and for the professional performer to prepare the next phase in his devel- likely to have a dedicated, individually tailored support program behind opment whether dance related or not. them. This support program, usually under the supervision of a perfor- mance director with experience and qualifications in sports science or Boys at the Barre: Examining Psychosocial Concerns of the sports medicine is detailed and comprehensive. It will have taken into Adolescent Male Dancer account the specific demands of the sport, the strengths and weaknesses Deborah Williams, CRNP, PhDc, Desales University, Center Valley, PA, of the athlete and will offer an evidence-based approach to year-round Marywood University, Scranton, PA, USA preparation and sporting excellence, with clearly identified objectives. This Social issues faced by the adolescent male dancer can intensify difficulty presentation will describe a “road map” to performance excellence and of developmental tasks and hinder healthy physical, psychological, and injury prevention, indicating the practical steps that can be taken to put social development. Many boys hesitate to start or continue a dance pro- in place a coherent strategy to become truly world class. gram due to social perceptions that devalue the boy who dances. This presentation explores developmental issues critical to the adolescent male Forum: Should School-Age Student Dancers Participate in dancer, outlines emerging themes, and discusses implications for practical Physical Education (“Gym”) Classes? application. Drawing upon Erikson’s Epigenic Theory of Personality De- Moderators: Tzaki Siev-Ner, MD, Israel Performing Arts Medicine Center, velopment, issues specific to the adolescent male dancer can be examined Tel Aviv, Israel; David S. Weiss, MD, NYU Medical Center, Harkness in the context of their lack of social support. Reviewing three years of Center for Dance Injuries, New York, NY, USA qualitative research and case study analysis involving over 150 adolescent Dance medicine practitioners receive many queries from parents about male dancers reveals social problems unique to the adolescent male dancer; the advisability of participation in physical education (“gym”) classes for deficiency of peer group or role models, societal perception of male danc- school-age dance students. School-age dance students may participate in ers as effeminate and the effects of that perception on the developing 9 hours or more per week of dance activity. Many students will be re- male’s self-concept, threat of physical violence in their academic setting, quired to participate in physical education classes as part of their regular unintentional undermining of the adolescent male dancer’s self-concept school programs. Whether this additional exercise, which may involve by traditional practices, and isolation from traditional support mecha- additional aerobic conditioning, is useful and or safe is controversial. There nisms. The result of unmet social needs in this population can lead to is a paucity of scientific research on this issue. This forum will begin with increased depression and anxiety, difficulty with maintaining relationships, a brief review of the literature. Discussion will involve the presentation of and increased risk of dance-related injury. the opinions and experiences of a group of medical practitioners, dance scientists, and dance educators. The Use of Quantitative Ultrasound in Assessing Bone Architecture in the Young Dancer Snapping Hip Syndrome in the Adolescent Ballet Dancer: Michelle Rodriguez, BA, MPT, Marika Molnar, PT, Westside Dance Potential Causes, Clinical Findings, and Treatment Outcomes Physical Therapy, New York, NY, USA Heather Southwick, PT, Michelina Cassella, PT, Christine Ploski, PT, This presentation introduces the use of The Sahara Clinical Bone Sonom- Department of Physical Therapy, Children’s Hospital, Boston Ballet eter, an FDA approved quantitative ultrasound device, as a clinical tool Physical Therapy Clinic, Boston, MA, USA for assessing bone architecture in professional ballet dancers. The Sahara A “snapping,” “popping,” or “pinching” in the hip area is a common com- unit measures the broadband ultrasonic attenuation (BUA) and the speed plaint among ballet dancers. This sensation often occurs with hip exten- of sound (SOS) of an ultrasound beam through the calcaneus in order to sion of the flexed, abducted, and externally rotated hip, which is a move- obtain the Quantitative Ultrasound Index (QUI) and an estimated heel ment repeated many times during ballet training. Often the “snapping” bone mineral density (BMD). The musculoskeletal systems of professional tendon is not initially painful. However, if the causes of the snapping are ballet dancers are exposed to mechanical loading forces and ground reac- ignored, a very painful and debilitating condition can develop. It is im- Journal of Dance Medicine & Science Volume 7, Number 2 2003 65 portant for the physician and physical therapist to determine the origin of presentations are being evaluated to classify the presentations according the snapping. According to Schaberg and colleagues, subluxation of the to type, topic, supporting evidence, and presenter demographics. A sec- iliopsoas tendon over the lesser trochanter or the iliopectineal eminence ond observer is rating approximately 25 percent of the abstracts and inter- appears to be the cause of the “internal” variety of snapping hip syn- rater reliability is exceeding 85%. Preliminary analyses for recent confer- drome. Other causes of “snapping hip” can be categorized as external in ences are suggesting that IADMS programs are well-balanced in terms of origin and may be attributed to the iliotibial band or gluteus maximus the topics covered and presenter backgrounds. Further analysis will reveal tendon moving over the greater trochanter. Prior to treating this condi- trends that can be used to identify areas for further investigation. tion, it is essential to determine the exact nature of the problem through a thorough clinical evaluation. Further diagnostic tests, such as MRI may The Effect of Positive Heel Inclination in Young Children also be needed to aid in the differential diagnosis. This presentation will Training in Flamenco Dance include: a detailed definition of “snapping hip syndrome”; potential causes Burke Gurney, PT, Ph.D., Physical Therapy Program, School of Medicine of this syndrome; comprehensive clinical assessment to aid in the differ- University of New Mexico; Virginia Wilmerding, Ph.D., Dance/Exercise ential diagnosis; and treatment approaches. Functional outcomes and cri- Science Program, University of New Mexico; Veronica Torres, M.A., teria for returning to full ballet activity will be outlined. National Institute of Flamenco; Albuquerque, NM, USA Sixteen children between the ages of 4 and 12 (10 girls, 6 boys, mean = Posters 9.5 years, SD = 2.5 years) participated in this study. All were currently training in various dance forms, including flamenco dance. A Vicon 250 Factors Involved in Flamenco Dance Injuries Motion Analysis System (Tustin, CA) was used to evaluate postural align- Juan Bosco Calvo, MD, Sanart-Dance Medicine, University of Alcala, ment by measuring the change angles of the joints of the lower body Alcala, Madrid, Spain (pelvic tilt, hip, knee, and ankle angles). No significant differences be- A total of 271 Flamenco dancers were studied: 126 professionals and 145 tween the barefoot and heeled stance were revealed at the pelvis, hip, or students. A questionnaire was distributed to determine demographic data. knee. As expected, a paired t test revealed that there was a significant We obtained Footprints (calculating Chippaux Index) at flamenco stu- change in the degree of plantar flexion of the ankle in the children when dios after classes. General exploration of the locomotor apparatus, range wearing heels (p = 0.001). The standard deviations of each site were quite of motion of spine extension, and ankle dorsiflexion were investigated. large, most likely accounting for the lack of statistical significance. This The data helped conclude that the four parts of the body most likely to be could be explained by the fact that different subjects compensated in dif- injured in Flamenco dancing are: the feet, the neck and shoulders (trape- ferent ways. The results of this study suggest that the teacher intending to zius region specifically); the knee; and the lumbar spine. The number of prepare the young dancer for a long and injury-free career in flamenco years of participation in flamenco are related to foot injuries. Dancers must develop an eye for individual postural differences. Each child must with leg and thigh injuries have lower Chippaux Index than normal (similar be observed to determine whether compensations are toward increasing to cavus foot). Spine extension is a factor in spine injuries. In the case of or decreasing the lordotic curve. Progressive alterations up the kinetic chain dorsal spine injuries, more flexibility can lead to an overextension, pro- from the ankle must be inspected, as any deviation from a normal stance moting pain and discomfort. The analysis of clinical cases let us relate the may predispose dancers to injury. lack of flexibility in spine extension to cervical injuries, and also the hy- perextension of the trunk with an increase of dorsal pain. Floor and sur- Negative Influence by the Intensive Rehearsals Toward the faces are a source of dance injuries. Sudden increase of hours devoted to Competition in Japanese Female Dance Students dancing is related to the appearance of lumbar, knee, foot and leg injuries. Mayumi Kuno-Mizumura, PhD, Misaki Yoshida, MA, Ryoko Sugimoto, MA, Division of Performing Arts, Ochanomizu University, Tokyo, Japan Undiagnosed Hip Joint Labrum Tear in a Dancer: A Case Study The effects of intensive rehearsal in university students preparing a com- R. Brick Campbell, MD; Norfolk PT Center, Norfolk, VA; Paula D Cole, petition were studied. Subjects were 21 Japanese female university dance MPT; Tidewater Association of Dance Medicine, Norfolk, VA; Gail C. students participants in the national competition of contemporary dance Grisetti, PT, EdD, Old Dominion University, Norfolk, VA, USA held at the end of July 2001. Before starting rehearsals, lectures were given We present the case of a 17-year-old female ballet dancer with a year-long to emphasize the importance of health matters. Subjects were asked to history of right hip pain who was unable to dance for 6 months. Before keep a training log to monitor changes in their physical condition. After injury she was a principle ballet dancer with a weekly class schedule of 10 the competition, all subjects were asked to answer a questionnaire about hours ballet, 2 hours pointe, and 2 hours modern dance. She underwent the occurrence of injury and changes in their physical condition. From a series of diagnostic tests and physical therapy over the course of one year the results of the questionnaire, they spent 153.0 ± 45.7 min in rehearsal with no resolution of symptoms. This dancer’s injury occurred landing a 4.4 days per week in May, 211.4 ± 72.5 min 4.9 days per week in June, split leap jump with immediate right lateral hip pain on landing. She had and 381.8 ± 137.0 min 6.7 days per week in July. Nine out of 21 students consulted a number of physicians and received a number of diagnoses were injured during rehearsal. Most injuries were foot sprains. Thirteen including: hip sprain, greater trochanteric bursitis, overuse, lateral snap- students attributed their injures to their deminished physical condition ping hip syndrome, ligamentous hypermobility, myalgia with myofascial (i.e., fever, sleeping disturbance, diarrhea, and other minor aliments). All pain, and right hip labrum tear. During this course she underwent a num- students showed weight reduction. Mean weight reduction was 3.1 ± 1.3 ber of diagnostic tests including: x-rays in supine and standing; hip MRI, kg. When the subjects were divided into two groups depending on the CAT scan; bone scan of pelvic region; x-rays of right hip; lumbar spine amount of weight reduction, the group with smaller reduction showed MRI; and right hip arthrogram with gadolinium and MRI. Treatment significantly higher rates of injury. The intensive rehearsal induced nega- interventions included: medications for pain and inflammation; marcaine tive influences on physical conditions of the dance students. and celestone injections; trigger point injections; physical therapy includ- ing ultrasound, electrical stimulation, heat, ice, therapeutic exercise, mas- A New Approach to a Comparison of Ballet Skills: fMRI of sage, iontophoresis, manual therapy, phonophoresis; and dance specific Classical Ballet’s Foot Movements training. The dancer underwent hip surgery in November 2001. She be- Kaori Muramatsu, MA, and Minoru Fukuzaki, PhD, Department of gan physical therapy late December and continues rehabilitation. Information and Networking, Tokai University Junior College, Tokyo, Japan; Seiji Nasu, MD, Masahiro Yamamoto, MD, PhD, Yokohama Stroke Presentation Trends in IADMS Conferences and Brain Center, Yokohama, Japan Nicole Durfee, B.S., Florida State University, Tallahassee, FL, USA; Jan A dancer’s perception of movement agrees with the movement itself when Dunn, M.S., Boulder, CO, USA; Tom Welsh, Ph.D., Florida State the spindle effect is preserved in Pirouettes. For dancers, body perception University, Tallahassee, FL, USA is crucial to produce motion, so to understand a dancer’s perception of A descriptive analysis of the types of presentations at IADMS conferences her body, we measured a dancer’s brain function during ballet movements during its 12-year history was performed. Abstracts from past conference with functional magnetic resonance imaging (fMRI). Using fMRI we 66 Journal of Dance Medicine & Science Volume 7, Number 2 2003 observed differences between beginning dancers and skilled dancers per- dance instructors and recommendations provided for warm-up activities forming similar movements. This can prove useful not only for improv- and technique corrections. The screening protocol is repeated again after ing the movement skills of dancers of all levels of proficiency, but also for three months to determine the effectiveness of the recommendations. The helping trainers to enforce educational guidelines during training. Using authors treat a significant number of professional dance company mem- fMRI to examine a dancer performing a simple ballet movement (foot bers and note the common deficits according to the repertoire performed. pointing and flexing in a lying position), it was found that skilled dancers The identification and prevention of poor technique, weakness and in- had less activated area in both primary and supplemental motor regions flexibility will decrease the risk of injury and prolong the dancer’s career. than beginning dancers. In observing beginning dancers, the visual re- gion of the brain tends to be activated to execute the unfamiliar task. The Effects of Cigarette Smoking and Physical Activity on the Bone Mineral Density of Collegiate Female Dancers Effect of Training on Postural Control and Center of Pressure Marti Wolfson, BS, Zachary Aria, BS, Kimberly Sweet BS, Patricia C. Displacement During Weight Shift Fehling, PhD, Skidmore College, Saratoga Springs, NY, USA Sheyi Ojofeitimi, Shaw Bronner, Jon Spriggs, Bruce Brownstein, Soar The effects of cigarette smoking on the bone mineral density (BMD) of Research, Long Island University, Brooklyn, NY, USA collegiate dancers compared to a group of non-active controls are exam- The effect of training on lower limb sequence, center of pressure (CP) ined. The subjects were 45 college-aged females categorized as dancers displacement, and movement strategies during weight shift followed by a (DAS) who smoke (n=10), dancers (DA) who do not smoke (n=12), non- unilateral balance were examined. Understanding the effects of dance train- active controls (CONS) who smoke (n=10), and non-active controls ing on postural strategies will facilitate improvements in rehabilitative (CON) who do not smoke (n=13). Measurement of anthropometrics methods for balance-related problems. Seventeen expert dancers and 17 (height, weight, circumferences, skin folds), current and past physical ac- non-dancers (20 females and 14 males, age 20 to 40) volunteered. 3-D tivity (by questionnaire), medical history, and smoking history were col- kinematic data of a reaction time weight shift sequence were collected lected. Dual energy x-ray absorptiometry (Lunar DXA-IQ, Waltham, MA) with a five camera motion analysis system. Force, moment, and CP data was used to determine BMD of the total body, lumbar spine (L2-L4), and were collected while standing on a force plate. Analyses included reaction proximal femur, and to assess body composition. The DAS smoked an time and joint movement sequencing of the ankle, hip, and pelvis. La- average of 10.3 ± 5.4 cigarettes per day for an average of 4.3 years (range: tency of CP displacement and coefficient of variability during the hold 1 to 8 years). The CONS smoked an average of 16.0 ± 5.6 cigarettes per phase were used to determine postural control differences between groups. day for an average of 6.2 years (range: 4 to 9). There was no significant Independent t-tests were performed to assess between group differences. difference among groups in age, height, weight, or percent body fat. Us- There was no significant difference in reaction times or joint movement ing a one way analysis of variance it is reported that the DA had a signifi- sequence between groups. Lateral CP displacement toward the gesture cantly (p ≥ 0.05) greater femoral neck BMD (1.15 ± 0.10 g/cm2) than limb occurred in both groups. Duration and amplitude of CP displace- the CONS (1.02 ± 0.12 g/cm2) and CON (1.01 ± 0.09 g/cm2). The DAS ment was significantly different between groups. Movement onset of the did not have a statistically different BMD than any of the groups for total gesture limb occurs before the end of body weight transfer in both groups. body and lumbar BMD. The lack of significant effects of physical activity Coefficient of variability of the gesture limb and CP during the hold phase on the total body and lumbar region suggests that the physical activity of was lower in dancers. Differences between displacements of the support the dancers induced a site-specific response in the femoral neck, a weight- limb acromion and trochanter markers revealed dancers maintained more bearing area. In addition, these data suggest that smoking may have blunted vertical trunk alignment during the weight shift task. Dancers maintained the osteogenic effects of physical activity in the DAS group. better control of their CP and gesture limb during unilateral balance. The Changes of EMG Activity with Fatigue During Heel-Rise A Two-Year Study: Acupuncture and the Treatment of Dance Test in Japanese Female Dance Students Injuries Misaki Yoshida, MA, Mayumi Kuno-Mizumura, PhD, Department of Bill Russell, MA, MFA, DC, DACBSP, Webster University, St. Louis, Performing Arts, Ochanomizu University, Tokyo, Japan MO., Performing Arts Rehabilitation, St. Louis, MO, USA The EMG activity of triceps surae muscles with fatigue in Japanese female The use of acupuncture in a university dance medicine clinic over a two- dance students during the heel-rise test was investigated. Six Japanese fe- year period is reviewed. In a number of studies, acupuncture has been male dance students with a mean age of 19.8 ± 1.0 years and 7 female indicated as the treatment of choice by many dancers for musculoskeletal students with no dance experience and a mean age of 20.0 ± 1.6 years injuries. Acupuncture has been used for the resolution of localized pain, participated. All subjects performed the heel-rise test on right leg until inflammation, and swelling that accompany acute musculoskeletal trauma exhaustion. During the heel-rise test, electromyographic (EMG) activity and overuse injuries. The clinic is in a university dance department and was recorded from medial head of gastrocnemius, lateral head of gastroc- furnishes dancers with diagnoses and treatment for acute and chronic nemius, soleus, and tibialis anterior muscles by using surface electrodes. injuries. Treatment includes physical therapy and functional retraining. There was no significant difference in the mean number of heel-rises be- How acupuncture fits into the comprehensive treatment plan for the dancer tween dance students (34.5 ± 16.7 times) and the non-dance students is discussed through comparing the duration and frequency of treatment (33.0 ± 10.7 times). Dance student showed significantly greater range of and number of injuries incurred by clinic patients. motion in each heel-rise compared to the non-dance students. This indi- cated that the dance students had greater total work by the muscle for Utilization of a Screening Tool for the Adolescent Dancer with each heel-rise than the non-dance students. During the concentric phase, Recommendations for In-Class Warm-Up Activities integrated EMG (iEMG) of all muscles increased significantly during the Donna Williams, MHS, PT, Katie Lemmon, ATC, Julie O’Connell PT, heel-rise test. In the non-dance students, soleus iEMG increased succes- ATC, AthletiCo Sports Medicine and Physical Therapy Ltd., Chicago, sively and mean power frequency (MPF) of soleus decreased with the IL, USA number of heel-rises. While, for the dance students, soleus iEMG did not A basic screening form to determine recommendations for stretching and increase significantly until 70% of total number of heel-rises and there strengthening exercises incorporated into the warm-up portion of dance was no significant change in soleus MPF throughout the test. These re- classes for adolescent dancers is reviewed. The screening protocol is ad- sults indicated that the soleus, which was mainly composed of type 1 ministered by physical therapists and athletic trainers and identifies weak- fibers, became more fatigue-resistant in the dance students. It was sug- nesses that may increase the risk of injury. The target population is the gested that the significant differences between the dance students and the adolescent dancer who participates in at least three to five classes per week. non-dance students in EMG activity of triceps surae muscles during the There are common deficits present in adolescents, dependent upon the heel-rise test might be attributed to the characteristics of dance training. style of dance or technique approach. These deficits are discussed with the