Anterior Pelvic Tilt in Dancers

Correct alignment is crucial to dance technique. A common alignment issue in dancers is an exaggerated anterior pelvic tilt - tilting the the pelvis forward. No two individuals will have identical spinal and pelvic alignment, and so it is perhaps useful to think of there being an  range that can be considered optimal rather than one set alignment that is perfect. The anterior pelvic tilt pulls the body out of correct alignment (outwith the optimal range), resulting in flawed technique and impaired performance. Your lower abdomen will protrude and your backside will stick out. Over and above the artistic flaw, anterior pelvic tilt impairs turnout and prevents proper muscle recruitment, can cause hip pain, back pain, knee pain and flat feet.

The hip flexors connect the femur to the hip and lower back; tight, short hip flexors cause the hip to pull forward. Any misalignment of the hips will effect the back, and anterior pelvic tilt will give a pronounced curvature of the thoracic spine. This in turn may then produce upper back pain, shoulder and neck pain, headaches and migraine.

Healthy hips are essential in dance, the turnout and all subsequent movement of the lower body originates here. While pelvic motion is central to many of the basic movements of dance (for example the battement de vant, a la seconde and derrière all display differing degrees of pelvic motion), the body should have a neutral home alignment. The internal rotation of the hip displayed with APT goes on to effect the lower limbs, producing subsequent internal rotation of both the femur and tibia, reducing turnout. This can cause or exaggerate existing over-pronation of the feet, causing foot, ankle and knee pain. Incorrect alignment further predisposes the dancer to injury.

Flexibility training - is it necessary?

Flexibility training can be divisive issue. Even I'm divided on it. On the one hand, you can improve your flexibility levels to a degree through appropriate training (stretching) methods. On the other, the gains you can make are somewhat limited, and I'll often argue largely outweighed by the likelihood of injury (up to 80% of dance injuries are sustained during flexibility exercises. That's an awful lot.).

Having spent the better portion of my life in dance training and surrounded by other dancers, I can honestly say I've seen a LOT of time wasted on flexibility training for next to no gains. 85% of your flexibility is down to your skeletal structure, 5% is down to environmental circumstances, leaving only 10% down to muscular elasticity.  10%. All those hours spent trying to push that little bit further, and the best you can hope for is 10%.

Fitness for dance...not dance fitness

For sedentary individuals, taking up dance as a hobby or a past time can undoubtably have a positive effect on their overall health, fitness and well being, just as taking up any physical discipline can have a positive effect. Movements such as Zumba, aerobics, Jazzercise etc are all forms of dance fitness; as well as the plethora of community dance classes across a range of disciplines. While great at getting otherwise sedentary individuals into physical exercise, dance fitness has no relevance to the dance professional.

As far as physical fitness goes, for the professional (or preprofessional) dancer, dance training alone is not enough. If you are serious about your dance performance you should get fit in order to dance, not dance to get fit. This means training outwith your technique and performance classes, to prepare the body for the demands you throw at it. Strength, aerobic, interval, plyometric and flexibility training are all necessary in order to condition your body to perform at the highest level.

Every professional athlete and sportsman/woman will train not only in their discipline, but for their discipline. A sprinter does not only sprint in their training sessions, a golfer does not spend all their time swinging clubs and a dancer should not spend all their time working on repetoire and syllabus.

Hypermobility in dancers

Despite hypermobility being a topic that is frequently discussed in both dance and dance science circles, it was not an area I've ever had a great interest in. My focus has generally been on supplemental strength training and endocrinology, and anything that falls outside of that I've been reluctant to delve into too deeply. That is until I was diagnosed with hypermobility syndrome after my most recent injury. Being the type of person I am, I can't be told something is affecting my body without then poring over every piece of information on the subject that I can get my hands on. I've never considered myself to have above average flexibility compared with both my dancer and non-dancer colleagues, in fact, my lack of hip flexibility and subsequent limited turnout had been a bone of contention for most of my performing life. Sure I had to resort to my knees rotating and sneakily compensating for what my hips lacked (terrible idea by the way), but the rest of my flexibility levels were pretty good so I accepted you can't win them all and figured I was working from a pretty typical physical start-point. I therefore assumed hypermobility wasn't going to be a problem that affected me. Turns out I was wrong - I was blessed with both average flexibility and sub-par joints. Hypermobility syndrome affects the stability and range of motion of several of, although not necessarily all the body's joints and subsequently can have a substantial impact on posture, joint pain, physical performance and proprioception. 

An overview of injury in dance

Dance medicine and science practitioners focus predominantly on three interlinked areas - injury prevention, healthier dance practice and the development of peak performance. When working towards these goals, it can be useful to take a step back and consider the extent of the healthcare issues facing dancers that must be addressed. Injury is the key factor in this, as neither healthy dance practice and peak performance cannot be achieved without addressing the significant problem of injury occurence in the dance profession.

Instances of injury are excessively high in the dancers. Across all disciplines of dance musculoskeletal injury is common in both student and professional dancers. Pushing the body to it's limits and the evolution of evermore demanding choreography means that dance will always be a risky profession; this does not mean however that steps cannot be taken to reduce the risk.
Collecting data on dance injury can be problematic due to dancers often being reluctant to report physical problems to directors or company doctors out of fear of losing professional position or opportunity. Therefore in many studies on dance injury, anonymous self-reporting has proven more useful than company medical records, as is the case with the studies discussed below. The extent of the problem, when providing the security of anonymity to dancers, is shown to be much wider than official company records state. What follows is a brief overview of the issue according to published research.

Timetabling in full-time training

Dance schools, conservatoires and companies have a responsibility to care for the overall health and well-being of the dancers they work with. This means on top of technical training providing measures for injury prevention, fitness training, nutritional support, psychological support and a measured approach to workload. Training frequency and scheduling is often waylaid due to other concerns; timetabling tends to be based on what is convenient for studio space or teacher availability, rather than what makes the most sense for the dancers. Scheduling of training can have a significant effect on the dancer's performance and well-being and it is important that companies and schools recognise the implications of their timetabling.

The importance of dance-specific medical practitioners

If you're a dance student, working freelance, part-time or recreationally, or indeed if you're aligned to a company that does not have it's own physio, podiatrist or osteopath, you've probably had some mixed experiences going to see medical practitioners about dance related injuries. In the UK we're lucky enough to have the NHS, meaning we don't have to pay to see a specialist. The downside of this is we usually don't get to pick who we see.

Overtraining

Overtraining or burnout refer to a condition where athletes or dancers note a marked decrease in physical performance for no apparent physical or medical reason, suffer from prolonged fatigue and display behavioral and emotional changes. Symptoms of overtraining will vary from individual to individual, the most common symptoms include:

• Increased perception of effort during exercise
• Excessive sweating
• Frequent upper respiratory tract infections
• Breakdown of technique
• Muscle soreness
• Sleep disturbance
• Lack of concentration
• Loss of appetite
• Mood disturbances
• Signs of depression
• Decreased interest in training and performance
• Decreased self-confidence

Working with recreational dancers

Working with recreational community dance groups poses a different set of considerations in class planning. Instead of working with a known quantity, you never know how many dancers you will have; what level of fitness they are at or what level of technique, if any, they have. It can make planning sessions and creating choreography tricky at best. You can have individuals brand new to exercise in with semi-professional dancers, or people who have trained to a high level alongside people with reasonable levels of fitness but absolutely no technical knowledge. Fitness and technical skill can vary wildly, and your job is to find a means of providing a diverse population with a useful, enjoyable and fulfilling class.

Physiological Considerations with Children

Most dancers work with children at some point, whether it's on a daily basis or once or twice a year; through teaching, outreach or company workshops almost all of us will work with young people on and off throughout our careers. In developing the skills of young dancers it's helpful to have an understanding of the implications of various growth stages on their physical performance.

Nutrition for Dancers - Calories

Adequate nutrition is as important for dancers as it is for any other professional athlete, yet very few dancers have ready access to professional nutrition advice. Owing to the pressures (whether perceived or actual) placed on dancers to adhere to specific aesthetic ideals, it is common for dancers to either under-fuel themselves and attempt to control body composition through restricted energy intakes or by experimenting with various fad diets. Insufficient energy intake means you're more likely to become injured due to fatigue or weakness - it's crucial that you fuel your body for the job it needs to do.

Injuries and dancing

Injuries happen, it's a fact of life. Studies have shown that in any given year up to 90% of professional dancers will sustain an injury that makes them lose time from work (it makes for some disheartening reading, but have a look - JDMS study CJSM study SJMSS study and MPPA study). That's a lot of injuries in a lot of dancers. Yes we can do our best to prevent them and we should, because it's possible to reduce the instances of injury and that should be a priority for all of us. However injuries happen in any activity where you are pushing your body to it's limits, and when they do we still need to be able to get on with our lives.

The rules of supplemental training

Supplemental training will make you a better dancer. There's no question about it. Being stronger, faster, more agile, more powerful, more flexible, generally fitter... all of it will improve your dance performance. But it's no good deciding you're going to push yourself and develop outside of the dance studio if you don't do it sensibly. There are some incredibly simple rules you need to follow if you're ever going to make progress in additional areas you're training, otherwise you're just going to waste your time.

Over-pronation of the feet

A degree of pronation is normal, as the foot needs to adapt to contact with the ground, however over-pronation occurs when the arch of the foot excessively flattens or 'collapses', the heel rolls inward and the soft tissues stretch. This is a common problem in dancers of many genres including jazz, modern and theatrical dance, but the problem is most pronounced in ballet dancers.

Managing your training

One thing almost everyone working within the area of dance science will push is supplemental training. I bang on about it constantly. It's important as exclusive dance-only training does not adequately prepare the body for the demands of performance. Class provides the training for technique and artistry, however for the required athleticism, you need to train your body in a range of areas so that when it comes to performance you are not only physically equipped to perform the choreography and therefore less likely to get injured, but you are also able to perform at your best.

Finding the time for this can be problematic. If you are lucky enough to be employed by a company that provides additional physical training you're in a very fortunate minority. For those who aren't, finding clear cut time for supplemental training can be difficult. For dance students, there is often the need to juggle practical training with course theory and part-time employment; for freelancers their is the balancing of rehearsal, performance, class and other employment, if you're working in an area such as hospitality to supplement your income your hours are erratic at the best of times and for those employed by companies full-time who do not receive supplemental training, it can be difficult to commit yourself to further training outside of the hours spent within in-company training. Out with all of that, you need to be careful not to overwork yourself.