Using mind-body medicine to ease pain and keep talented performers on their feet
"Dancing engages your body, mind, and spirit in such a complete way that it's thoroughly exhausting and thrilling," says former Feld Ballet dancer Buffy Miller, reflecting on the wonders and hardships of her calling. "It uses your whole self -- that's what I love about it."
Dance may be thrilling, but as with most other professions, the exhilaration comes after years of unswerving dedication and hard work. Dancers put their bodies through grueling workouts -- often eight hours or more a day -- in which they routinely risk injury and exhaustion. In addition, the twin specters of eating disorders and fears about aging stalk many dancers just as they are hitting their stride. Mental stress can affect dancers' minds the same way physical strain taxes their bodies.
"Someone once said that dancers work just as hard as policemen -- always alert, always tense," said George Balanchine, director of the world-renowned New York City Ballet until his death in 1983. "But, see, policemen don't have to be beautiful at the same time."
And eating disorders are still common in the dance world. In her 1983 book Off Balance: The Real World of Ballet, author Suzanne Gordon credits Balanchine, in part, with creating the expectation that ballerinas be bone-thin -- an unrealistic standard that took its toll on countless dancers. During the Balanchine years, Gordon says, entire companies were plagued by eating disorders, with anorexic and bulimic dancers using diet pills, laxatives, and even cocaine -- anything to stay thin. The consequences of eating disorders include hormone disruption, osteoporosis, and bone fractures.
Thin at any cost
Miller is familiar with the fallout from the Balanchine years. When she joined a professional New York dance company at age 17, she found herself surrounded by anorexic young women. Although body image weighs heavily on the minds of most young women, the stakes are higher when your body is your livelihood.
"Young women get into companies, and they haven't really completed their puberty," Miller says. "When that starts to happen, it creates a terrible chain of events. Hormones go crazy, and the body goes crazy, and then you have to react to that because it's not okay to suddenly get very voluptuous and curvy if you're in any dance company. Usually it's not okay with the director, and that fosters eating disorders."
In an attempt to address such issues, Jane Bonbright, executive director of the National Dance Education Organization and former prima ballerina, has created a way to screen for undiagnosed eating disorders among female dancers. In an attempt to alleviate some of the pressures ballerinas feel to be thin, she has been working for the past decade with instructors at universities and dance companies, as well as instructing students on sound nutrition.
"I think companies are a little more understanding of not having quite such bone-thin frames to work with," Bonbright says. "And, I tell them, if you leave the dancers alone, and don't turn them into eating-disorder patients, in time . . . they can live normally and healthfully and happily in the field."
Currently, more dance companies are working in conjunction with hospitals so dancers in distress can seek out counseling. A contemporary dancer's education -- now rich in science, medicine, physical therapy, counseling alternatives, and mind-body alternative therapies -- also helps to reduce stress and eating disorders.
Where's the next paycheck coming from?
Persistent financial woes add another dimension to the dancer's reality. "I think that it's pretty rare to be with a company that's actually viable enough to support salaried dancers for very long," Miller says. "I was guaranteed 30 weeks of work out of a year with the Feld Ballet, so I had to budget around those workweeks. And it was enough for me to live on, but I don't think that's the norm. Here in Portland, Maine, I don't know any dancers who make a living from their dancing, so they have to do other things. It's very stressful."
Finally, fear of aging and age discrimination are rampant. Like most professional athletes, dancers cannot remain on their feet forever. "There's such a small window when you're at your physical peak; I always assumed after that I would do something else," says Miller, who's 30 and already considered too old for many companies. "I am still dancing now, but it's changed a lot. I'm trying to bring other elements into it so it's not as physically rigorous. And I'm in control because I make my own work. But I know being forced to leave professional dance is a big fear for a lot of dancers." Miller suggests that all dancers keep an alternative career in mind so they are not devastated when they grow too old for the business or sustain an injury that prematurely ends their career.
Like stepping on needles
Indeed, severe injury and chronic strain can interfere with and even cut short a dancer's career. While minor injuries are hard to avoid, dancers need to take special care of their joints. They are particularly prone to overexertion in their feet, ankles, knees, and backs.
Working out long hours in tennis shoes can be painful, but a workout in high heels (worn by modern salsa and samba dancers) or in classic ballerina toe shoes can be devastating. "I've never had bunions before, but I've noticed that my feet are taking on a new shape," says Alicia Chacon, an award-winning San Francisco salsa dancer and teacher who wears three-inch heels when she performs. The worst part, she says, is getting out of bed the day after a long dance session. "It's like stepping on little needles when you step onto the floor."
Other than switching to flats, the only real relief for aching feet is rest and regular massage. More acute traumatic injuries in the feet and ankles should be monitored closely, according to a study on ballet dancers from the University of Utah. While ankle sprains may be common among dancers, they are generally not treated aggressively enough, the study says, and sprains that result from a more serious injury could eventually disable the dancer if left untreated. For all injuries, a dancer should allow adequate time for healing and getting back into shape to keep minor injuries from blossoming into major ones.
Yoga and strength training valuable
Women tend to have more problems with their knees than men, says Dr. Susan Haigler-Robles of the National Dance Association and Chair of the Columbia College Dance Department. Because they have wider hips, more pressure is exerted on women's knees when they land after a jump. She suggests using weights or a Thera-Band (a rubber resistance band) to strengthen the entire thigh, including the quadriceps, inner thighs, and hamstrings. "When you have strong muscle fiber and well-developed quadriceps and inner thighs and hamstrings, then there's enough muscular support to absorb the pressure of landing from a jump," she says.
Women are also prone to back problems because the shape of tight muscles in the pelvis causes it to poke out a bit, according to Haigler-Robles. "When you have that situation, your abdominals get weak because they're dropping forward," she says. "And when the pelvis is tilted in that way, the only way for you to get around and stand up is by holding, on a muscular level, the lower back." By using your back muscles to hold yourself up, you are putting undue strain on your back, she says.
Although female dancers can be afflicted by joint pain, men tend to have more problems in this area. "Men have issues with flexibility," Haigler-Robles says. "It can lead to muscle tears if they over-rotate." She says that men should spend long periods stretching to avoid muscle, tendon, and ligament tears, because they tend to be "more tightly woven" than women. Men are also often asked to attempt more demanding movements than women.
Beyond physical therapy and counseling, there are a number of spiritual and physical exercises, new and old, that dancers are incorporating into their lives. Not only are many of these exercises -- like yoga, meditation, and shiatsu massage -- relaxing, but they also help dancers complete their mind-body education. Yoga, for instance, is indispensable for maximum flexibility, says Haigler-Robles. And certain release techniques that have been popular since the '60s, she says, teach dancers to cushion the impact on their joints when they move.
"Dancers are learning how to take smart ways of thinking about the body from other disciplines and applying it to themselves," Haigler-Robles says. "If you think about it, their body is their material. They're going to use whatever skill it takes to make their material as well-informed and intelligent as possible."
National Dance Association (NDA)
This group has about 3,600 members including professional dancers, choreographers, dance educators, and dance medicine/science specialists. The NDA works to make dance education available to all Americans.
National Dance Education Organization (NDEO)
The NDEO is dedicated to providing healthy dance education, including dance science and medicine information, to instructors across the country.
Solomon R, Brown T, Gerbino PG, Micheli LJ. The young dancer. Clin Sports Med. Oct;19(4):717-39.
Bonbright, Jane M. Developing Screening and Education Programs for Detecting and Preventing Eating Disorders at the Sub clinical Level in Dancers. National Dance Association.
Evans, Randolph W., et. al. Survey of injuries among West End performers. Occup. Environ Med. Vol. 55: 585-593 pp.
Macintyre J, Joy E. Foot and ankle injuries in dance. Clin Sports Med. (2):351-68.
Columbia College. Dance Faculty. http://www.columbiacollegesc.edu/academics/dance/faculty.asp