The Dancer's Way
The New York City Ballet Guide to Mind, Body, and Nutrition
By Linda H. Hamilton, Paul Kolnik
St. Martin's Press Copyright © 2008 Linda H. Hamilton, Ph.D., and New York City Ballet
All rights reserved.
New York City Ballet's Wellness Program
I've had to acquire athleticism like strength and stamina — not just artistry — to get through the hardest repertoire today!
— ASHLEY BOUDER, NYCB principal
New York City Ballet cofounder George Balanchine likened his dancers to thoroughbred racehorses. Dance aficionados may scoff at the comparison, but there is no denying the athletic aspects of this constantly evolving art form. Extreme dance, multiple techniques, and acrobatic moves — all are par for the course in the current dance scene. The dilemma for aspiring professionals is that dance classes no longer prepare you to perform at this level. But do not despair! This book provides you with a concrete plan to reach your potential, based on NYCB's proven wellness program for serious dancers.
How can our program help you achieve your goals? Unlike in the past, when dancing longer and harder was the only way to excel, now there are practical tools to overcome common challenges, including physical and mental stress. NYCB principal dancer Jenifer Ringer agrees with Ashley Bouder that being an athlete is essential, after multiple injuries almost ended her promising career. "I'm so excited about the wellness program," she says. "It's incredible what you're doing for dancers."
You, too, can benefit by using New York City Ballet's program, which we have tailored to meet the needs of all dancers, not just in ballet. To begin, let's take a look at what it means to be a dancer in the twenty-first century.
Dancing in the New Millennium
Previous generations of dancers focused on a specific technique to succeed as a performer. Today's dancers do not have this luxury. Instead, they face unique requirements, and chief among them is the need to perform in vastly different genres. This new focus on versatility is both exciting and challenging. On the positive side, mastering more than one dance technique definitely expands your prospects for finding employment. The downside is that it stresses different areas of the body, leading to more injuries. According to a study conducted at the North Carolina School of the Arts, modern dancers had twice as many cervical and upper-back strains as ballet dancers. In contrast, ballet dancers reported close to 50 percent more strains to the lower back and hamstrings, as well as a higher number of shin splints than their modern-dance counterparts. Imagine all of the injuries you might face by mixing different techniques. Switching from pointe shoes to bare feet (without the protective calluses that modern dancers develop as they work shoeless), performing innovative choreography, and using alternate muscle groups can really catch you off guard.
Popular television programs such as So You Think You Can Dance demonstrate on a national stage the virtues and demands of being multifaceted as a dancer. The judges of this competitive reality show are looking for an employable, versatile dancer who can perform everything from hip-hop to ballroom dance. In 2007, the runner-up to the winner was a twenty-two-year-old male dancer who had performed in both ballet and contemporary companies before going on to do the show's fifty-city national tour after the final broadcast. Company dancers also switch genres by doing Broadway musicals like Fosse, The Lion King, and Movin' Out.
Meanwhile, preprofessional dance students are preparing to enter the work arena by enrolling in intensive training programs that include several techniques, and doing experimental workshops by the likes of Tony Award–winning choreographer Bill T. Jones. In the latter case, one eighteen-year-old dance student with years of ballet, modern, tap, African, and jazz under her belt was able to perform, but not name, this choreographer's eclectic movements. The steps simply weren't in her vocabulary.
These changes, while all well and good for dance as an art form, have personal costs for performers, who are taxing their bodies to the limit. In terms of survival, the old-fashioned approach to tough it out no longer applies to today's athletic dancer. The question is, how can dancers excel and still protect their bodies?
Shifting the Focus to Wellness at NYCB
To answer this question, I worked with experts from New York City Ballet's medical team to help reduce the rate of serious problems and disability. Similar to the rest of the profession, our company's dancers are taxing their bodies in ways never experienced by previous generations. NYCB rehearses and performs between thirty-eight and forty-three weeks a year. During this time, our dancers do everything — ballet, modern, musical theater, you name it. A dancer may perform George Balanchine's neoclassical ballets, Jerome Robbins's homage to Broadway, Peter Martins's contemporary movements, and modern works from the company's Diamond Project for experimental choreographers — all in one night! Our main objective as NYCB's medical team is to help the performers meet these demands by providing the latest interventions in dance medicine. We tackled this goal by taking a stepwise approach:
Increasing on-site health services to provide immediate medical care and education
Identifying challenges that create occupational stress using a confidential survey
Creating a holistic wellness program to address mental, physical, and nutritional needs
Measuring our progress by documenting workers' compensation claims
From all accounts NYCB's wellness program has been a resounding success for dancers' health and well-being. Workers' compensation claims for being completely "out" are down 26 percent, with 46 percent fewer weeks lost to disability. In addition, our research has identified ways to overcome common challenges in dance, providing the basis for our five keys to peak performance. Finally, NYCB's expenses for annual insurance premiums (which are a problem for most dance organizations) have decreased dramatically because of fewer workers' compensation claims.
This turnaround in the company has come about because we provided services that targeted our dancers' need to prevent injuries and achieve peak performance. Obviously, outside of NYCB each dancer's situation differs. However, we believe that it is possible to duplicate the major parts of our wellness program by enacting the following guidelines. Here is a brief preview of how you as a dancer can use this book.
In this book you'll find a number of ways to stay healthy by catching problems early. In fact, seeking timely medical help for injuries is crucial to a dancer's survival (see box). Why? According to NYCB orthopedist Dr. William Hamilton, many musculoskeletal problems are resolved during the first month with proper diagnosis and treatment. While he considers this initial month "a magic healing period," it can disappear if you ignore the symptoms. Sadly, this scenario happened to Emily, a talented sixteen-year-old dance student with chronic groin pain who finally visited her orthopedist and learned that she had torn the cartilage around the rim of her hip (called the labrum) — two years ago! Rather than benefiting from conservative treatment — rest and physical therapy — this young dancer now required arthroscopic surgery. The bottom line: It pays to know when to seek medical services, especially if you are a stoic dancer.
While many physical symptoms are not a cause for alarm, it is always wise to notice pain. If any of Dr. Hamilton's criteria for seeking medical help apply, do not try to handle the problem on your own. You can locate a doctor or physical therapist who works with dancers by contacting the International Association for Dance Medicine & Science. The resources in Appendix A provide additional information about where to find health insurance, health-care referrals at a sliding scale, and emergency student loans.
Becoming educated about your body is a central theme in this book. "People have a misconception that because you're a dancer, you know everything about your body," says NYCB physical therapist Marika Molnar. But, she explains, "You may not really know your body anatomically, kinesthetically, physiologically speaking. You know that you can lift one leg higher than the other, but you don't know why or what to do to make it work better." Many dancers have asymmetries or other minor problems like tight hamstrings without knowing how to deal with them.
NYCB principal dancer Yvonne Borree is a prime example, admitting, "I've had a rough battle with my foot throughout my whole career." For no apparent reason her foot will hurt while moving from flat foot to relevé. This can be due to many problems, including tendonitis. In Yvonne's case, says Molnar, it arose from cuboid subluxation, where the small cube-shaped bone on the outside of the midfoot shifts. This is a frequently misdiagnosed condition, and dancers may limp around in pain for months, or worse, get stuck in a cast because their medical provider is unfamiliar with the problem. Fortunately, Yvonne learned that whenever she experiences this strange sensation of pain and weakness, all she requires is a simple manipulation by a physical therapist to snap the bone back in place. For those of you with similar symptoms, ask your therapist to check out the Marshall and Hamilton article (listed in the bibliography, at the back of the book). Note: It is always a good idea to seek a second opinion and have your doctors confer if an injury isn't getting better. Appendix B provides a description of different medical professionals, diagnostic tests, anatomical terms, and common dance injuries.
The next step is to get screened before an intense dance program or season. After all, if top-notch athletes like the New York Knicks can benefit from yearly screenings, so can dancers. NYCB's wellness program focuses on general health, as well as orthopedic, fitness, and hypermobility issues to help identify and address potential problems. For example, in his fitness screenings NYCB's chiropractor, Dr. Lawrence DeMann, Jr., often finds subtle muscle imbalances in dancers that respond to an individualized exercise program at the gym.
You do not need to be a member of the company to have access to annual screenings. Just check out Chapter 3 to find out how they work. Then ask a dance medicine specialist to follow the screening protocols outlined in Part 3. NYCB's nutritional evaluation, which we describe in general terms in Chapter 2, will vary depending on the individual dietician. The key is to match your physical needs with the demands of dancing. Remember, the more you know, the better the odds of avoiding serious problems throughout your career.
NYCB's wellness program includes annual workshops on the specific areas of concern that are the heart of this book: the five keys to peak performance. These universal keys apply to all types of dancers. Here's what we find works best.
1. GOOD WORK HABITS. Rather than forcing yourself to perform back-to-back technique classes or demanding choreography, it pays to prepare your body for exercise. This means knowing how to warm up, stretch, cool down, pace yourself, and deal with the normal aches and pains of dancing while taking your unique body into account.
2. CROSS-TRAINING ACTIVITIES. While these exercises can improve your level of fitness, they may undermine your performance if done incorrectly. It helps to know how to achieve your objectives, such as increasing stamina without adding unnecessary muscle bulk — a major concern for female dancers.
3. EATING RIGHT TO STAY FIT. Of paramount concern for dancers whose demanding schedules make it difficult to find or prepare the right foods, it's important to know how to eat in all kinds of circumstances to meet your health, fluid, and energy needs.
4. EFFECTIVE WEIGHT CONTROL STRATEGIES. As you might suspect, this area is a mine field — even the smartest dancers sometimes succumb to the latest fad diets. Understanding the basics of weight management helps prevent eating problems and brittle bones.
5. STRESS MANAGEMENT TECHNIQUES. Perhaps the greatest challenge for stoic dancers, you need to know how to deal with physical and mental stress to get into the "zone" to perform at your peak.
What This Book Will Do for You
Like most challenging careers, dancing requires you to seek a balance between work and downtime. NYCB's wellness program is a perfect remedy for all dancers who want to excel without compromising their health. The company is a microcosm of the demanding versatility that we have seen in the art form at large. With this book, serious dancers everywhere, not just those in NYCB, will be able to duplicate the main components of our program. Succeeding in today's dance scene involves life-changing approaches based on the latest advances in dance medicine. This book describes exactly how to not only avoid problems but build yourself into a more effective athlete and artist. I am here to teach you the principles of wellness that NYCB's dancers have learned. They can do it — and I will show how you can do it, too, with insights, physical screenings, resources, diaries, and even a "dancer's kitchen" for those of you who are cuisine-challenged.
Common Challenges for All Dancers
It's better to deal with your strengths and weaknesses before you get into a tough situation in dance.
— ADAM HENDRICKSON, NYCB soloist
While injuries are without a doubt a dancer's worst nightmare, the biggest revelation from New York City Ballet's research is that many challenges exist long before a dancer is incapacitated. Demanding schedules, emotional stress, worries about food, and difficult floors, costumes, and props top the list. A dancer's first instinct may be to ignore these problems; however, doing so can compromise both health and career. This chapter describes the common challenges that every dancer faces in order to excel in this profession.
Why is dancing so challenging? Because it requires all of a dancer's abilities, energy, and resources to handle the artistic and athletic demands, in addition to pleasing an audience. The dancer's deep connection to movement as a form of self-expression is all- encompassing. These demands apply not only to company dancers with extensive touring and performance schedules (such as NYCB) but to Broadway "gypsies" in musical theater, "commercial" dancers who do world tours with pop stars like Beyoncé, and aspiring professionals and students. The message from NYCB's wellness program is that it's okay for dancers — from ballet to tap — to have problems. These should not be seen as a sign of failure; they just need to be addressed.
The Warning Signs in Dance
The biggest dilemma for many dancers is spotting the warning signs that lead to major problems. Before we focus on the findings from NYCB's survey, let's play detective by looking at three case studies of dancers who are experiencing occupational stress. Can you uncover each of their problems?
Amy is a seventeen-year-old ballet student enrolled in a six-week summer dance program. She's delighted to have passed the audition (scary!), even though it's intimidating to be surrounded by a roomful of talented dancers. A typical day begins at 9:00 A.M. and includes three to four technique classes. Amy tries to follow a nutritionally balanced 1,100-calorie meal plan because she wants to be thin enough to beat out the competition for a spot in the winter program. Yet she's gained five pounds over four weeks by pigging out on chocolate right before bedtime. What is she doing wrong? (Continues...)
Excerpted from The Dancer's Way by Linda H. Hamilton, Paul Kolnik. Copyright © 2008 Linda H. Hamilton, Ph.D., and New York City Ballet. Excerpted by permission of St. Martin's Press.
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