Pair Your Studio with a Physical Therapist

What does science have to do with art? Ask dance medicine specialists, and they’ll say, “Everything!” Over the last decade, the number of formal partnerships between dance companies and schools and physical therapists has grown dramatically. Across the country, institutions such as Alvin Ailey, American Ballet Theatre, Boston Ballet, North Carolina School of the Arts, San Francisco Ballet and School of American Ballet have joined with health professionals to implement dance screens and injury prevention and treatment programs.

It’s possible to follow their lead, even within a limited budget. To find a reputable physical therapist in your area, contact organizations such as the International Association of Dance Medicine and Science or the Performing Arts Special Interest Group of the American Physical Therapy Association for recommendations. (See box on page 140 for contact information.) Some of these groups even offer continuing education opportunities for dance teachers interested in learning more about anatomy and injury prevention. Here are a few ways you can work with PTs to help your students reduce the risk of injury and enhance their performance.

If you own a small dance studio with, for example, 200 students, one cost-effective option is to hire a PT to come in two or three times a year to hold lecture-workshops for you and your students. In these sessions, he or she can discuss proper warm-up and stretching techniques, as well as basic dance kinesiology, alignment and strengthening exercises for different muscle groups. For each lecture-workshop, agree on a flat fee with the PT. Depending on your resources, you may choose to charge students a small amount to help cover the costs.

Cost: One to five hours may cost anywhere from $150 to $500, depending on the PT’s experience and your geographical location.

Another alternative is to hire a PT to conduct annual dance screens. Now a staple at many professional companies, dance screens are the equivalent of preseason screens in sports designed to detect athletes’ “red flags,” or medical conditions that warrant further investigation. These screens are necessary because athletes challenge and sometimes punish their bodies, putting themselves at more risk than the general public.

Dancers are no different. Yet your students may ask, “Why should I be screened? I know my body.” PTs will reply that dancers don’t always know everything about their structure, and that it’s difficult to be objective from within one’s own body. It’s possible that the PT may notice scoliosis and leg length discrepancies previously unknown to students, helping them understand why they can’t close in fifth position as easily on one side as the other.

While there are various versions, a typical dance screen takes 30 minutes per student and comprises structural alignment assessment (to ascertain asymmetries); muscular, joint and ligamentous testing (to ascertain weakness, excessive laxity or tightness); aerobic capacity measurement; and dance technique evaluation. Screening results provide students with an objective profile of their physical strengths and weaknesses and relate these issues to problems in dance technique.

In post-screening workshops, the PT can provide information on joint structure and its relationship to proper anatomical alignment, and can also recommend individual cross-training programs for students. These may include stretching and strenghtening exercises and cardiovascular training to improve aerobic capacity. Other topics may include a review of dancers’ dietary needs with guidelines for good nutritional habits.

Your involvement with the screen is critical, especially during the technique portion. Helping students understand what physical limitations must be protected and what can actually be changed helps to promote a partnership among the student, teacher and PT.

Cost: Fees for this service ($35 per person and up) vary, again, based on experience and geographical location. Your best bet may be to have interested students sign up and pay the designated fees themselves.

If you own a larger studio with 600 to 1,000 or more students, you may have the resources to hire a PT on a regular basis.

If you are interested in just a few hours once a week or once every other week, establish a space in your studio where the PT can work free of distraction—in a secondary studio where classes are only held intermittently, for example. Interested students can sign up on a first-come, first-serve basis for 15- to 20-minute time slots for a quick evaluation of an injury or strain. The PT can refer students with major injuries to a physician. If the complaint is minor, he or she will offer suggestions on how to manage it (rest, ice, anti-inflammatories, etc.). Frequently, minor adjustments in placement are sufficient to alleviate the complaint.

If you can afford visits more than once a week, designate a space solely for the PT, or find out if he or she already has a facility to which you can refer students during certain hours. In the latter case, simply fax or e-mail the sign-up sheets with students’ appointments. Small injuries—most commonly the result of a combination of poor placement and overuse—can be more closely supervised and better treated with this “clinic” arrangement before they become more serious.

The PT can evaluate a student with a minor injury and give recommendations accordingly (e.g., ice, strengthening, no grand pliés). He or she can then give the student a note to present to the teacher that includes the diagnosis and dance restrictions. For instance, the PT might advise a student diagnosed with Achilles tendonitis to ice three to four times daily, take anti-inflammatory medicine and avoid jumps, pointe work and full relevés for a few days. Retraining might also be in order if the student is jamming the ankle joint every time the foot is pointed. The student might be given a home exercise program and encouraged to come to the clinic two to three times a week to exercise and work on technique problems. Students can also learn how to handle other problems they have by observing the PT as he or she teaches another student about an injury.

In cases of traumatic injuries, such as a sprained ankle, fracture or torn ligament, the PT is on hand to evaluate the severity of the injury immediately and to facilitate referral to a physician when necessary. This way, students avoid spending hours in emergency rooms only to be told that nothing is broken and that they should see their orthopedist. Once the PT confirms the diagnosis with the physician, a call can be placed to the student’s teacher or advisor to discuss the injury, and explain the need for any cessation from dance and other ramifications.

Cost: This last option is not necessarily cost-prohibitive: Consider charging all of your students a mandatory fee, regardless of whether or not they plan to use the services, based on the number or students you have enrolled and how many hours of physical therapy you’d like to offer. (Be sure to notify parents beforehand.) For example, if your school has more than 1,000 students and you’re interested in offering therapy three hours a day, five days a week, the mandatory fee only needs to be $25 per student per semester. This will allow 55 to 60 students to be seen per week.

Students benefit from consistent interaction with a PT and learn how to use their bodies more effectively. With the concept of “active” rest and systematic progression, dancers can stay in technique class using guidelines on what they can do safely. This minimizes downtime and deconditioning as well as keeps dancers supported psychologically. The clinic also continues to educate dancers on how to integrate information about their joints and muscles to achieve proper placement, core stabilization and aesthetic goals such as a beautiful cambré or high développé devant.

If you observe general alignment issues among your students, you may also want to brainstorm with the PT about ways to introduce class activities to enhance students’ understanding of their problem areas. For example, you could incorporate physioballs into class activities to teach scapular (shoulder blade) activation and placement during port de bras.

The most crucial aspect of a successful in-house program is open dialogue between you and your PT. You will gain a better understanding of how the PT’s evaluation relates to technique, and students will lose less dancing time to injuries, enhance their training and understand their bodies’ mechanics more clearly. Science, it turns out, has plenty to do with better dancing. DT

Sheyi Ojofeitimi is a physical therapist with Alvin Ailey and a research associate at the Analysis of Dance and Movement Center at Long Island University in Brooklyn, New York. Shaw Bronner is the director of therapy services at Alvin Ailey and the director of the ADAM Center.