A Young Dancer's Guide: What every young dancer needs to know about injury prevention and rehabilitation: Video from the 2014 Annual Meeting
Presented by Bobby Bernstein
IADMS Bernstein from Steven Karageanes on Vimeo.
Dance today is an athletically strenuous art form and many young dancers suffer from injuries. My co-author, Nancy Kadel, MD, and I have many insights into why these injuries commonly occur and how they can be prevented. The focus of this blog is on cross training for young dancers, one of the most important topics we discuss in “A Young Dancer's Guide: What every young dancer needs to know about injury prevention and rehabilitation”.
There are approximately 32,000 dance schools in the United States alone , and countless young dancers are under-informed about dance injury, prevention, and rehabilitation. This lack of awareness can result in young dancers sustaining potentially preventable physical injuries. Knowledge in these areas may be improved if parents seek out qualified cross-training instructors. Great cross-training options for young dancers include Yoga, Pilates, GYROTONIC®, and Yamuna Body Rolling™.
Working as a GYROTONIC® instructor for more than eight years, I have experienced that cross-training greatly improves the overall sense of how young dancers use their bodies. In the beginning, they are usually good at showing the movements and at mimicking what is demonstrated. However, they soon learn to feel the movements in their own bodies, to discover the range, tempo, and quality of the movements, and they gain a deeper understanding of how the body works. The following is an example of this learning process.
One of the most important skills for young dancers to learn is how to correctly turn out (externally rotate) their legs from their hips. Not all bodies are built to be able to achieve the level of external leg rotation, that is often demonstrated by professional ballet dancers. Young dancers being told that they do not have enough turn out in dance classes can cause mental distress and often results in far too many young dancers forcing their turn out from their hips, knees, ankles, and/or feet. This can cause preventable injuries in those areas as well as in their backs. My favorite way to teach young dancers how access and/or improve their true turn out is by using the GYROTONIC® Full Circles exercise.
Please note: In this exercise the student is lying in a supine position on the bench with the upper straps of the GYROTONIC® pulley tower attached to their feet and ankles. The straps are counter weighted cables used to teach control and for muscle conditioning. The movement starts with the legs together, straight, in parallel, and slightly higher than the torso. The legs are then brought up to a 90 degree angle with the torso. Next, the legs are externally rotated, opened to the sides and brought down and around until they meet again at the starting position.
To begin, I ask my young dance students to execute the Full Circles without instruction other than to use their abdominal muscles to protect their backs and to stabilize the movement. In most cases, young dancers will overuse their muscular strength, try to open the legs as far to the sides as they can in as close to 180 degrees of external rotation as possible, and to complete the whole circle at a relatively quick tempo. The movement usually lacks control and generally young dancers do not naturally use the correct muscles throughout the whole movement. Specifically, they do not use the correct deep rotator muscles to achieve their full external rotation before opening the legs to the sides. In many cases (depending on how deeply the head of the femur naturally sits in the hip socket), if the femur bones are not properly rotated before opening the legs to the sides then the heads of the femurs can be “blocked" by the sides of the hip sockets. In addition to not being able to access their full external rotation, this also causes gripping of the muscles, discomfort, and tension in the body. I will then ask the young dancer how the movement felt and they will often report some level of pain in the hip while doing the exercise and a snapping in the hip might also be heard. With further conversation it usually comes out that they also feel some hip pain, and many additionally hear this same snapping sound, when lifting their legs in high positions in their dance classes. (The sound most often indicates that the young dancer is also suffering from Snapping Hip Syndrome or Dancer's Hip, which is where the snapping sound is usually caused by the movement of a tendon over a bony structure in the hip.)
The next step is that I teach my students to feel the difference between forced external leg rotation and correct external leg rotation. To accomplish this I move their legs one at a time into an assisted, relaxed, fully externally rotated position and then back into parallel multiple times. I then teach them how to use their deep lateral rotator hip muscles to achieve their full external rotation. I continue to cue (hands on teaching techniques) their movements and to gradually increase their range of motion while maintaining the correct muscle activation as they open their leg to the side. Usually, the first several times they try to do this by themselves they continue to grip in the front of their hip and to tighten their quadriceps and gluteal muscles. However, by continued use of hands on cueing they soon un-learn these incorrect movement habits. The end result is that they are able to turn on the correct external rotation muscles without assistance and to correctly execute the complete Full Circles (which also includes the use of the inner thigh muscles, hamstrings, and abdominals) without any hip pain and without the snapping sound if it was also previously present.
Learning to move in this new way requires a decrease in tempo. As young dancers become more proficient in correctly executing external leg rotation an increase in tempo becomes possible. Their quality of movement changes naturally as a result of their new body awareness. Full Circles that started out with a forced, slamming quality as the legs opened to the side, gain a soft, easy quality of movement. Once correct rotation of the leg in the hip socket is achieved, and young dancers have learned to access their true turn out without forcing and gripping, they can then use this information in numerous practical levels in their dance training.
For example, this is how using correct turn out activation is then transferred into doing a correct tendu from first position (First position is when the heels are together and the toes are pointing away from each other with the goal of achieving 180 degrees of external rotation). I ask the young dancer to start with the feet in parallel facing the barre and then to simply open and close their feet from parallel to first position and back again several times. As they do this, I cue them to feel the correct external rotation muscle activation the same as was achieved in the Full Circles exercise. Then we work on maintaining the un-gripped turn out on both the standing leg and working leg as the young dancer does slow tendus through the entire range of the movement (A tendu is when the working leg is extended away from the standing leg to the front, side, or back, until the foot is fully pointed while maintaining contact with the floor and then the motion is reversed). Improved self-knowledge of this kind can then be further applied to correctly doing all barre exercises and more complicated center work. Improved execution of advanced dance combinations and choreography is only achieved when young dancers increase their over-all body knowledge, but for many aspects of dance this foundation of true external leg rotation with correct muscle activation is key.
In addition to the cross-training modalities initially mentioned, there are many helpful exercises that can be easily done in the studio before dancing. For example, young dancers can greatly benefit from doing warm-up/strengthening exercises with a resistance band every day. Nancy Kadel, MD also recommends the following:
“Doing slow pliés and relevés in parallel with a tennis ball between your heels is my favorite recommendation for dancers to warm up the little muscles in their feet and ankles in correct alignment.”
It is incredible to see young dancers being able to dance pain-free through greater self-knowledge. Supporting this increase in understanding can help the young dancers of today reach their goals healthily and become the great artists of tomorrow!
Certified GYROTONIC® Instructor
 “Education Statistics-National Dance Education Organization”, Ndeo.org, 2015