Eat, Sleep, Dance, Repeat: The Importance of Sleep for Dancers

importance of sleep for dancersBy Alyssa Hartley for Athletico Physical Therapy

As summer comes to an end, Fall brings a season of routine. This is especially true of dancers who are back to academia on top of rehearsal. Professional dancers, for example, will begin preparing their upcoming repertoire for programs like Joffrey Ballet’s Giselle and Hubbard Street Dance Company’s Fall Series.

While the days are getting shorter, rehearsals are getting longer and cutting into valuable time meant for counting sheep. The CDC recommends 8-10 hours of sleep for teens 13-18 years old, and 7 or more hours per night for adults 18-60 years old. This can be difficult to achieve for dancers, whose rehearsals consist of specialized physical activity of high volume, frequency and intensity throughout the week. Dancers also don’t usually have an off-season, which can contribute to increased incidence of altered sleep-wake rhythms, illness and musculoskeletal injuries. In fact, studies show:

Rarely Sleeping Beauty

In Germany, there was a small study of 24 classical ballet dancers and their sleep quality prior to a ballet premiere. The total time spent asleep and ratio of time asleep vs. awake in bed was low in the ballet dancers compared to age-matched athletes. Over the course of 67 days prior to the show’s premiere, there was an even greater exacerbation in these sleep factors. This was true while the amount of time spent in ballet class and rehearsal per day did not change. Now, imagine this same degradation in sleep over the course of multiple shows throughout the year. That adds up to be a lot of missed shut-eye for dancers!

Wide Awake

There have been hundreds of studies on athletes and disturbed sleep. Athletes that participate at the Olympic, international, national and professional level, such as professional dancers, are considered “elite”. A systematic review of the literature of sleep quality in elite sports shows that elite athletes generally show high levels of insomnia symptoms (inability to initiate and maintain sleep). Pre-sleep arousal (more brain activity) and sleep restriction (not having the time to sleep long enough) were the most prevalent issues. Thus, lack of sleep can actually exacerbate insomnia, creating a vicious cycle.

Benefits of Sleep for Dancers

The processes that occur during sleep have been widely studied, and the benefits are far-reaching for all humans, but certainly for athletes. Sleep increases the secretion of growth hormone, which is necessary for dancers to grow and get stronger. Memory consolidation and motor-sequencing occurs during sleep, which is necessary for dancers when learning new choreography or technique. Therefore long-term to even short-lived disturbances in sleep can cause a dancer to perform worse mentally and physically, possibly affecting his or her contracts professionally.

Sleep is an essential part of mental and physical recovery. Many dancers, from recreational to professional, have challenging classes and rehearsals on back to back days without enough time for recovery. If an athlete does not have enough recovery between high-intensity workouts or rehearsals, successive workouts or classes are done at a less than optimal physiological condition. If training stress is too high, and there is not enough adequate recovery, such as prior to a competition or performance, “overtraining” can occur.

Over time, this pattern results in a plateau of performance and possible injury. A meta-analysis shows that dancer injury is extremely prevalent, with ankle, foot, lumbar and cervical spine injuries being the most frequently injured. One small study even found highest illness prevalence after six weeks of an overload training regimen in athletes. No dancer wants to be injured or sick before a performance, indicating that appropriate recovery – and most notably sleep – is imperative for excelling on stage.

Tips to Catch Some Zzz’s:

  • Make sure you are in a cool, dark environment
  • Avoid alcohol, caffeine and drug use
  • Eliminate screen time prior to bed
  • Aim to go to sleep and wake up at the same time every day
  • If possible, consider a “post-lunch” nap for around 20 minutes for greater energy, but not within 4 hours of bed

Adequate sleep can help prevent injuries and improve daily functions, but it is still important for dancers to pay attention to their bodies. Should any unusual pain or discomfort occur during or after rehearsal, make sure to begin the healing process as soon as possible by scheduling a complimentary injury screen at your nearest Athletico location.

Schedule a Complimentary Injury Screen

The 6 Main Causes of Dance Injuries

Dance Injuries

Dance injury rates are significantly statistically higher than that of other sports. A study by Wolverhampton University found that professional dancers are more likely to suffer injuries than rugby players.

Statistics show that 80 per cent of dancers incur at least one injury a year that affects their ability to perform – compared to a 20 per cent injury rate for rugby or football players. Whilst not a contact sport or explicitly high-impact, dance training is intensively challenging and highly demanding for even the most conditioned and able athlete. Here we look at the six main causative factors that result in dance injury.

1. Anatomical Causes

Natural physical limitations and constraints may limit the development of a perfectly correct technique. Correct technique – beyond being prerequisite for professional success – is a fundamental element of avoiding dance injury. This is evident in the fact that the communist anatomical cause of potential problems and injuries is limitation of turn-outs (external rotation) of the hips. As such it is vital that the dance student and teacher recognise any potential physical limitations early on, so that the dancer may learn to work within their true physical range.

2. Incorrect Technique

When dancers allow their technique to slip – usually due to fatigue – they put themselves at a much higher risk of injury. Commonly this becomes an issue towards the end of a long tour or performance run. Slipping technique is why, typically, injury rates among cast dancers increase throughout the duration of a tour. Quickly learning and performing new, unknown choreography can also create injury issues, as regardless of the ability of the dancer, they have had insufficient time to become accustomed to the movements and fine-tune their technique accordingly.

3. Poor Coaching

As with all sports and athletic disciplines, expert teaching and coaching for the development of technical knowledge is vital. It is the responsibility of an excellent and highly knowledgeable dance teacher to be able to recognise, and react accordingly to, any anatomical weaknesses, physical limitations or onset of injury evident in the dance pupil. Furthermore it is imperative that they correctly relay and instill the fundamentals of correct technique and advise upon supporting lifestyle and cross-training that ensure optimum health, well-being and physical performance of the dancer.

4. The Floor

The floor is an extremely important environmental factor to the health and performance of a dancer. Purpose-built dance floors are vital in rehearsal and performance spaces. Floors that are not built for purpose do not provide sufficient supportive impact. Sprung wood floors support dynamic movement; reinforced, concrete or non-sprung wood floors create unsupportive and unsustainable support for the joints, which is highly detrimental to the physical health of the dancer in the long term. Lack of spring in the floor can produce many injuries, notably foot problems, injuries in the lumbar region of the spine, and in the muscles which are associated with take off and landing – mainly the tibia and metatarsals, which may result in stress fractures.

5. Temperature

Ambient temperature of rehearsal studio and performance space is of utmost performance in avoiding dance injury. Dancers have to take extra care to not get too cold before or after practice in order to avoid muscular injury. A standard advised temperature for a training and performance space is 68-70 degrees Fahrenheit, and should not be allowed to drop below this range.

6. Excessive Practice

Unavoidably, dancers often adhere to grueling training schedules – a necessary requisite to master the art, and a mainstay of rehearsals for dance productions and tours. Obviously this presents a high risk factor for creating overuse injuries, particularly when a dancer must continue to train at high intensity with an existing injury. Clearly the combination aforementioned factors – excellent physical cardiovascular fitness, diet, training, technique, ability and training environment – greatly reduces the risk of injury under the demanding training schedules of a professional dancer, however dancers at the top of their game still frequently incur significant injury.

By SportsInjuryClinic

The Importance of Sleep for Dancers; Treating Hand & Wrist Injuries

Episode 17.26 with Hosts Steve Kashul and Dr. Brian Cole. Broadcasting on ESPN Chicago 1000 WMVP-AM Radio, Saturdays from 8:30 to 9:00 AM/c.

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Segment One (01:25): Julie O’Connell PT, DPT, OCS, ATC, Performing Arts Medicine importance of sleep for dancersProgram Manager at Athletico-River North talks dancers vs other athletes regarding sleep; what happens during sleep for dancers and useful tips for quality sleep. While the days are getting shorter, rehearsals are getting longer and cutting into valuable time meant for counting sheep.

Julie specializes in the treatment of dancers and performing artists and has extensive experience working with organizations like The Joffrey Ballet, Hubbard Street Dance Chicago and Broadway in Chicago.

The CDC recommends 8-10 hours of sleep for teens 13-18 years old, and 7 or more hours per night for adults 18-60 years old. This can be difficult to achieve for dancers, whose rehearsals consist of specialized physical activity of high volume, frequency and intensity throughout the week. Dancers also don’t usually have an off-season, which can contribute to increased incidence of altered sleep-wake rhythms, illness and musculoskeletal injuries. More>>


Segment Two (13:11): Dr. John Fernandez from Midwest Orthopaedics at Rush describes microsurgery; recent innovations in hand and wrist surgery; re-plantation and transplantation of limbs; types of hand injuries experienced by athletes at all levels.

Dr. John FernandezDr. Fernandez has created and innovated some of the advanced surgeries currently popularized in the treatment of the hand, wrist, and elbow. His original research has led to techniques minimizing surgical trauma while maximizing outcomes. As an inventor, he holds patents in some of the very implants developed for these minimally invasive surgeries.

As director of microsurgery for Midwest Orthopaedics at Rush, he has performed hundreds of successful microsurgical procedures. These have included replantation of amputated arms, hands, and digits, as well as complex reconstructions for deformity and wounds.

He is a board certified member of the ABOS and holds the highest distinction in hand surgery with a certificate of added qualification in hand and microsurgery. He is a fellow of the American Academy of Orthopaedic Surgeons and a member of the American Association for Hand Surgery as well as the American Society for Surgery of the Hand.

Tips for Keeping Your Feet Dancing Through the Holidays

By  Kelli Barton for Athletico

The Nutcracker is the most iconic holiday ballet performed by ballet schools and professional companies around the world.

Between December 10th and December 30th, the Joffrey Ballet Chicago will perform The Nutcracker 27 times. That’s an average of 1.2 shows per day! For optimal performance, it is crucial that dancers are proactive in preventing injuries from occurring and correctly manage injuries when they do occur. Foot and ankle injuries represent 34-62 percent of all injuries reported by dancers. Female ballet dancers are especially vulnerable to these injuries because of the increased demand put on the foot and ankle when dancing en pointe.

To help prevent dancing injuries from happening, consider the following tips:

Overuse Injuries
Overuse injuries are aches and pains that occur due to the repetitive nature of danceballet-dancing movements and lack of adequate rest. Examples of overuse injuries are stress fractures and tendinitis. Fortunately, the risk for these injuries can be decreased through appropriate rest, adequate warm up and nutrition.

 

Getting Appropriate Rest

Fatigue has been cited as a common reason for injuries in dancers as overall injury rates vary from 0.8 to 2.9 injuries per 1,000 hours of dance training. When fatigued, decreased trunk control and faulty lower extremity alignment results in increased demand on joints and ligaments to provide stability. While you may not be able to alter the amount of time you spend dancing, you can control what you do during time outside the studio. For example, active rest is preferred over complete rest, including gentle movements, stretching, as well as strengthening and stabilizing muscle groups. This helps avoid excessive stiffness throughout the body.

It is also important to note that fatigue-related injuries have been reported to increase when psychological stressors such as work or school conflicts are present. Since performances may induce additional stress, it is important to find strategies to appropriately rest your brain in addition to your body to stay healthy during this time.

Warming Up

An appropriate warm-up primes the body for optimal performance. Morrin et al found that a combination of static and dynamic stretching provided a significant change in hamstring flexibility as well as superior balance and vertical jump values in comparison to a static-only or dynamic-only warm up.

Static stretching involves holding a specific position for a period of time whereas dynamic stretching has an aerobic approach in which the body part is repetitively moved through its available range of motion. Examples of dynamic stretching include leg swings, alternating kick-to-buttocks and scissor jumps.

Good Nutrition

Low energy availability occurs when a dancer is not consuming enough food for the amount of energy expended during physical activity. Therefore, a dancer will need to eat more as the volume of dance participation increases.

Signs of low energy availability include fatigue, difficulty concentrating and loss of menstrual cycle. Consistently low energy availability can cause sub-optimal bone mineral density and place the dancer at increased risk for stress fractures. High caffeine intake, noted as greater than two cups of coffee per day, can also contribute to low bone mass density. For specific nutrition recommendations, please seek attention from a nutritionist in order to develop a plan based on your individual needs.

Acute Injuries

Acute injuries occur when a bone, ligament, tendon or muscle is extended past its capability or excessive force is placed onto a region of the body. Examples of acute injuries are ligament sprain and muscle strain.

When an acute injury occurs, the body releases chemicals to create an inflammatory response around the damaged structure. The inflammation assists with promoting new cell growth, defending the body against harmful substances, and disposing of damaged tissue. However, this process results in swelling, redness, warmth, pain and loss of function at the area of injury. The following steps should be taken after an acute injury:

“PRICED”

P: Protection

Relocate to a safe space away from additional danger such as fellow dancers continuing to perform and provide support to the region of injury.

R: Rest

Avoid painful movements with involved body part as continual stress may increase injury and delay healing.

I: Ice

Apply ice to the injured area for 20 minutes every 2 hours for the initial 2-3 days. Ice will decrease blood flow to the area, slow conduction of painful nerve impulses, decrease abnormal accumulation of fluid, and lower temperature.

C: Compression

Utilize an elastic compression bandage to wrap the area. If you experience sensation of pins/needles, numbness or change in skin color, the bandage is too tight. Start away from the heart using a figure 8 pattern with a gradual decrease in tightness as you pass the site of injury. Avoid gaps in bandage that expose skin as swelling will accumulate here.

E: Elevation

Raise the injury area above the heart to increase return of blood and therefore remove waste products away from the area.

D: Diagnosis

All acute injuries should be evaluated by a health-care professional for advice regarding appropriate next steps, especially if not resolved with “PRICE” or unable to bear weight. Choosing a health-care professional who has a specialty working with performing artists will be helpful to allow for a gradual, safe return to dance.

Basic First Aid for the Foot

Although blisters, cramping, split skin and bruising will not likely take you out of a performance, they can be a source of discomfort when participating in a higher volume of dancing.

Blister Blisters are caused by a combination of friction and moisture at bony prominences of the feet. It may be a sign that shoes should be re-sized as the structure of the foot can change over time. Petroleum jelly or tape placed on more vulnerable spots can decrease friction. In addition, using less absorbent material for tights or pointe shoe padding can decrease moisture. Blisters will heal independently and should avoid being popped due to risk for infection. If a blister does pop, it is important to cover with an antibiotic ointment and bandage that will stay secured in shoes.

Cramps A muscle cramp is a strong, painful tightening of a muscle that occurs involuntarily.  Another name that is commonly used to describe a cramp is a “Charley horse.” To avoid cramping, stay hydrated and perform an adequate warm up as well as cool down. Stretching the cramped muscle can assist with relieving symptoms faster.

Split Skin Split skin often occurs in the area of a callous, particularly on the ball of the foot. Prevent skin from splitting by using a fat-based balm such as coconut oil over areas of tough, dry skin. If a skin split does occur, be sure to keep the area clean to decrease risk for infection. There are some over-the-counter products that help to seal the split skin together to promote healing.athletico300x250

Bruising The best prevention for bruising is to wear padding and control descents to the floor during choreography. Avoid heating pads or warming topical creams, as this will bring more blood to the bruised region and delay healing.

By following the above recommendations, you are now ready to tackle the Nutcracker season injury free! If you experience an injury, please contact your physician or set up a screen with a performing arts physical therapist at a conveni ent Athletico Physical Therapy location.

Schedule a Complimentary Injury Screen