The amount of factors that affect a performing artist's musculoskeletal health will make your brain hurt, especially if you start looking at how inter-related they are (see picture to the left).
Let's take a look at 4 of them:
1. Nutrition
2. Load management
3. Rest and recovery
4. Proper warm-up
1. Nutrition
Some athletes, particularly those in aesthetic sports like dance and gymnastics, do not realize that they are not taking in enough calories. This can actually lead to a cascade of events that can put you at a higher risk of bone stress injury or a chronic, overuse injury! Although it is outside of a PT's scope to give individual recommendations, I love to educate on how diet and lifestyle affect your pain, recovery, and injuries.
The Female Athlete Triad consists of • Intentional OR unintentional disordered eating
• Low bone mineral density (like osteoporosis) • Menstrual dysfunction
A more broad term, Relative Energy Deficiency Syndrome, is “an energy deficiency relative to the balance between dietary energy intake and the energy expenditure required to support homoeostasis, health and the activities of daily living, growth and sporting activities” (1).
Low Energy Availability, which can occur by under-eating or overtraining, may put you at a higher risk of stress injuries. Conditions such as Female Athlete Triad and Relative Energy Deficiency-Syndrome are common in adolescent athletes who may not be realizing that they are consuming too few calories to sustain their body's necessary functions.
Additionally, making sure that you are consuming enough fruits and vegetables is extremely important to keep you healthy and injury free. If you don’t consume enough plant foods, it may lead to...
Inadequate supply of vitamins phytochemical, and minerals
Excessive oxidative stress, which may
Decrease your ability to recover
Decrease immunity
Increase susceptibility to injury (1)
The CDC recommends that...
Adult women consume > 1½ cups of fruit and 2½ cups of vegetables daily
Adult men consume > 2 cups of fruit and 3½ cups of vegetables daily
Athletes may need an upwards of 13 servings! (Disclaimer: I am not a registered dietician. Contact a RD for your specific dietary needs). This, along with consuming enough calories, can be difficult to accomplish, which is why finding an alternative like Juice Plus+ can be helpful. Juice Plus+ is not another supplement or vitamin. It is literally dehydrated fruits and veggies IN A CAPSULE. Although it is made from real food, it does not take the place of your daily servings.
It has been shown that daily consumption of encapsulated fruits and veggies increases the amount of antioxidant vitamins in your blood, reduced oxidative stress, and reduced inflammatory markers in athletes (2). This has completely changed my life, as I am on the road ALL. THE. TIME. and have trouble getting all of my veggies in on travel days.
Health Made Simple, a company that partners with Juice Plus+ has a ton of free resources on how to incorporate more veggies into your diet. Get started with this video for dancers.
Check out the plant gummies, capsules, shake powder, and bars here.
Has 2020 made you want to be self-sustaining and want to grow your own greens?!
Want to be able to make a salad from the fruit of your own labor?
Check out the tower gardens here.
2. Load management
Do you think that a step-by-step progression for returning to sport will take too long? As a matter of fact, it will likely have you participating modified practice SOONER! Often times, you finish rehabilitation, and are “cleared.” This may set you up for doing too much too soon, which can trigger another injury or an exacerbation of your current injury.
The general rule of thumb is to increase activity by 20-30% per week. Exceeding this ratio may put you in the "DANGER ZONE" (3).
Sounds easy, but it can be quite difficult to calculate, especially if you are a multi-sport athlete or your are a performing artist, where your schedule and dance/event styles are different each week. This is where a professional comes in! You should feel comfortable reaching out to your local physical therapist, trainer, or doctor for specifics on how to ease back in.
Healthcare should be PATIENT-CENTERED. Yes, healthcare providers have advanced knowledge and training, but make sure you are advocating for yourself.
Your opinions and thoughts matter!
As a matter of fact, if you are withholding some of those fears and concerns, it can make your rehab take even longer. No one wants that!
A couple of ways that you can track your increase in activity:
Rate of Perceived Exertion (RPE)/Intensity
Duration
Repetitions of impact
Some apps may help
Ideally, use a combination of these
By grading your exposure with sport-specific activities, you can break the return-to-sport/injury cycle. A gradual increase in activity may get you to a higher level of activity more quickly by avoiding recurring set backs.
DID YOU KNOW?
MBody You offers return-to-sport services! Finished with your rehab program but need guidance with returning to the sport(s) you love? Email marybeth@mbodyyou.com or schedule a complementary phone call for more information.
3. Rest and Recovery
Drink up!
Water makes up about 85% of our brain, 80% of our blood, and 70% of our muscles. If you don’t drink enough water, you may notice some of these symptoms.
Dehydration may also increase your time to recover from a workout or an injury and affect your flexibility.
Chronically stressed?
In addition to finding the appropriate healthcare provider to help with stress-management strategies, physical therapy can help with some of the side effects of stress by teaching you breathing exercises, performing manual therapy techniques or dry needling, and providing exercise prescription and guidance on becoming more physically active
Having a history of negative stressors and stress response has shown to have a mild predictive relationship with injury (4). Stress can cause attentional changes, like general distraction, increased self consciousness, and narrowed attention, which may interfere with an athlete’s performance. It can also lead to increased muscle tension and coordination difficulties (5).
Specifically to dancers, studies have found that stress was related to the amount of time a dancer was injured (6) and that a stress intervention program has been shown to reduce the amount of time that dancers were injured (7).
Get some zzzzss!
Getting at least 8 hours of sleep may be just as important as proper nutrition and hydration for preventing injuries in adolescent athletes! Adolescents who chronically received less than 8 hours of sleep were associated with greater risk of sport-related musculoskeletal injuries (3). Younger athletes may need even more than 8 hours!
How do I stretch during a cool down?
Static stretching (holding a stretch for 30-60 seconds) without holding your breath
Foam rolling
Return you body to baseline, a relaxed state
4. Proper warm-up
According to the International Association of Dance Medicine and Science, a warm up should have the following components:
Pulse-rising section (get your heart rate up!)
Joint mobilization (like isolations, ankle rolls)
Dynamic stretching (I like to add muscle activation with this!)
Second pulse-rising section (keep your heart rate up!)
Here are 10 rules from a wonderful IADMS' article
Mindfulness: Bring attention to any areas where you need to give special treatment/modifications.
Specificity: Make your warm-up specific to the activity that you are about to do.
Graded exposure: Introduce an activity to gradually increase your heart rate.
Progress: Keep the movement simple to begin then progress to more complex and challenging movement patterns.
Mobility: Mobilize all the joints in your body and don’t forget about your spine and upper body, especially if your dance style includes upper-body weight bearing or/and partnering work.
Self-love: Give yourself a goal or try some positive self-talk.
DYNAMIC STRETCHING. AGAIN FOR THE PEOPLE IN THE BACK WHO ARE SITTING IN THEIR BUTTERFLY STRETCH TALKING TO THEIR FRIEND. DYNAMIC STRETCHING: Use dynamic stretching and take your body carefully through full ranges of motion saving the static stretching for the cool-down or the end of the day.
Proprioception: Wake up your nervous system by incorporating quick changes in direction and stopping to balance on one leg – this will engage your proprioceptors.
Plyo & Power: Once you are feeling warm and just a little bit sweaty, introduce some power movements like small jumps followed by some bigger ones.
To tempo: Towards the end of the warm-up, pick the pace and progress your movement to speeds nearer the pace of the following dance activity."
Mary Beth Foreman, PT, DPT, is a mobile and telehealth physical therapist in Louisiana and Ohio. She is a board-certified specialist in orthopedic physical therapist and has extensive experience treating youth athletes, cheerleaders, gymnasts, and recreational, pre-professional, professional, and competitive dancers. To contact Mary Beth, email marybeth@mbodyyou.com. MBody You offers complementary phone consultations and is now accepting both mobile and telehealth patients. At this time, she is only licensed in Ohio and Louisiana, but is considering expanding.References:
1. Williams, N., Koltun, Kristen, Strock, N, & De Souza, M. (2019).Female athlete triad and relative energy deficiency in sport:A focus on scientific rigor.Exercise and Sport Sciences Reviews.DOI:10.1249/JES.0000000000000200
2. Lamprecht, M. (2013). Supplementation with mixed fruit and vegetable concentrates in relation to athlete’s health and performance: Scientific insight and practical relevance. Nutritional Interventions and Athlete’s Health. Med Sport Sci Basel, Karger, vol 59, pp 70-85
3. Blanch P, Gabbett TJ. Has the athlete trained enough to return to play safely? The acute:chronic workload ratio permits clinicians to quantify a player's risk of subsequent injury British Journal of Sports Medicine 2016;50:471-475
4. Ivarsson, A, Johnson, U, Andersen, M, Tranaeus, U, Stenling, A, Lindwall, M. (2017). Psychosocial factors and sport injuries: meta-analysis for prediction and prevention. Journal of Sports Med, 47(2): 353-365. doi: 10.1007/s40279-016-0578-x
5. Herring, S, Boyajian-O’Neill, L, Coppel, D, Daniels, J, Gould, D, Grana W, Hong, E, Indelicato, P, Jaffe, R, Joy, E, Kibler, W, Lowe, W, Putukian, M. Psychological issues related to injury in athletes and the team physician: A consensus statement. https://www.sportsmed.org/AOSSMIMIS/ members/downloads/education/ConsensusStatements/PsychologicalIssues.pdf
6. Mainwaring, LM, Kerr, G and Krasnow, D. (1993). Psychological correlates of dance injuries. Medical Problems of Performing Artists, 8, 3–6.
7. Young-Eun Noh, Tony Morris & Mark B. Andersen (2007) Psychological Intervention Programs for Reduction of Injury in Ballet Dancers, Research in Sports Medicine, 15(1), 13-32, DOI: 10.1080/15438620600987064
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