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Project Summary

This study aims to gain an in-depth understanding of perspectives of osteopaths, physiotherapists and chiropractors with experience of caring for dancers. Drawing from recent findings on how dancers experience pain, injury and healthcare, the study will explore the other side of the patient-practitioner relationship. It will focus on manual therapists’ perceptions of embodiment and dancers’ identity, and how it might affect all aspects of care for this population. Communication and treatment strategies, as well as obstacles to a successful therapeutic alliance will be examined in order to continue to broaden knowledge and improve care. Findings could be of relevance to dance-medicine training programs as well as, within a patient-centred approach, be applied more widely by practitioners who might encounter a dancer in general practice.

Research Setting

This is an interview study which will be conducted using an online platform such as Microsoft Teams or Zoom. Days and times will be arranged according to participants’ convenience, between July 2021 and February 2022. Interviews will last 30-60 minutes and will be audio recorded.

Confidentiality and ethical approval

The study has received approval from the University College of Osteopathy Research Ethics Committee after following all procedures. Interviews will be transcribed and anonymised prior to analysis. A copy of the transcript will be sent to the participants so they can check for accuracy of their views and anonymity.

Inclusion criteria

We are looking for physiotherapists, chiropractors and osteopaths with experience of treating dancers for 2+ years.

Benefits to the participant

You will be contributing your experience to educational research, and information gathered from interviews has the potential to positively influence and help to guide future care of dancers. Taking part might also help you to reflect on your own practice during the interviews.

How to take part

If you are interested in participating in this study, please email  Paula.andrade@uco.ac.uk and she will send you more information.

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This is a collaborative research project between the University of Birmingham, One Dance UK and the National Institute of Dance Medicine & Science (NIDMS). This study seeks to understand the mental health and wellbeing experiences of dance freelancers in the United Kingdom during the course of the COVID-19 pandemic. Anyone who is over the age of 18 and working as a dance freelancer in the United Kingdom is welcome to participate. Participants will take part in a one-to-one online interview, which will last no more than one hour. During the interview, participants will be asked about any challenges and opportunities to experiencing good mental health and wellbeing over the course of the pandemic, as well as any perceived challenges and opportunities for experiencing good mental health and wellbeing moving as we move towards a life free of any COVID-19-related restrictions.

All participants will receive a £20 Amazon or One4All Multistore gift card as a thank you for their time.

All interviews will take place online using either Zoom or Microsoft Teams. If you are interested in participating in this research, or if you have any questions about this study, please contact Maria Kolitsida at
MXK029@student.bham.ac.uk.

This study has been granted ethical approval by the Ethics Committee at the School of Sport, Exercise and Rehabilitation Sciences at the University of Birmingham.

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Read more in this series here:
When the curtain goes up again: Building our fitness to perform | BAPAM
Returning to work in the performing arts after having COVID-19 | BAPAM

Dancers require optimal physical fitness to perform at their best and reduce injury risk. During the lockdown, our physical activity levels significantly decreased leaving many of us deconditioned. In addition, dancers may have been unable to access their normal training facilities and classes, leading to further loss of physical capacity. Despite taking online classes, replicating the physical and psychological demands of in-person classes and performance is limited due to spatial constraints, lack of floor space and flooring unsuitable for high-impact training. Therefore, a combination of general deconditioning, reduced training load and lack of exposure to performance conditions will reduce soft tissue resilience. However, there is lot that dancers can do to make their return to post-lockdown classes and performance safer and more productive.

What you can do now

Increase Activity

Gradually increasing your general day-to-day activity levels can help the process of re-conditioning. Aim for at least 10,000 steps a day by taking short walks and moving regularly. Even small bouts of activity can have positive mental as well as physical health benefits. Remember the 30:30 Rule: Every 30 minutes – move for at least 30 seconds.

Supplementary Training

Dance is a highly physically demanding activity, requiring strength, endurance, power, flexibility and aerobic fitness. Dancers are encouraged to use supplementary training to enhance dance ability and performance. The inclusion of supplementary training will be particularly beneficial during this time to mitigate deconditioning. There are some useful online resources for dancers who want to maintain and develop aspects of fitness at home.

• 11+ Dance: In conjunction with Elmhurst Ballet School, Strength & Conditioning Coach Nico Kolokynthas, has developed an evidence-based injury prevention programme specifically for dancers. Full instructions and videos for the 11+ Dance exercise series are available online.
• Jump Maintenance Programme: One Dance UK has an online five-week jump maintenance programme that uses explosive plyometric jump training to maintain lower limb strength.
• Calf Endurance: The Australian Ballet Health team describes single leg calf raises as their secret weapon for preventing injury in the lower leg. Their research found that increasing calf endurance significantly reduced injury in dancers. For details see their website:
• Flexibility: Dancers recognize the importance of flexibility and dedicate much of their training time to increasing range of movement, particularly in the hips. However, maintaining thoracic spine flexibility is often neglected. Improving thoracic spine mobility can have a positive impact on many aspects of technique. Try this exercise sequence developed by Physiotherapist Lisa Howell:

Prioritise Health Foundations

Sufficient, good quality sleep; a balanced diet and adequate hydration are the foundations of health and injury prevention.

• Sleep: Chronic sleep deprivation is a significant risk factor for injury and dancers can struggle to ensure they have sufficient good quality sleep. Research has shown that professional dancers have poor sleep quality, particularly when preparing for a performance. One study advocated taking daytime naps during periods of intense preparation. Practising good sleep hygiene has also been found to be effective:
• Diet: A healthy, balanced diet will provide all the nutrients needed to fuel your dance training and performance. It is also crucial for optimum immune system functioning and recovery from injury. For more guidance, read this ‘Nutrition for Dancers’ factsheet developed by One Dance UK:
• Hydration: The more energy a dancer uses, the more fluids they will require, and being dehydrated will harm performance. In addition, a dancer needs to be careful not to overhydrate to avoid electrolyte imbalance. One Dance UK offers advice on hydration practices for dancers including electrolyte replacement:

Refine Technique

The time spent away from your usual performance schedule could be an ideal opportunity to hone aspects of your technique. Several organisations are offering free online technique development classes such as Italia Conti Virtual and the Dutch National Opera & Ballet. Remember to progress slowly and plan plenty of recovery time.

Take Care of your Mental Health

Dancing is a form of creative expression and being denied the chance to perform has been psychologically challenging for dancers. Research has shown a marked increase in mental health problems in performing arts professionals during the lockdown. The National Institute of Dance Medicine and Science (NIDMS) has gathered a number of useful resources on topics such as anxiety, depression, bereavement and mindfulness to help dancers through this difficult time. In addition, see the BAPAM factsheet ‘Psychological Self Care – Enhancing Mental Health & Wellbeing’

Psychological Self Care BAPAM Factsheet

What you can do after lockdown

Dancers employed in companies may have been able to train normally and are also likely to receive support from company health professionals in their transition out of lockdown. Freelance and self-employed dancers will need to manage this process independently. At the earliest, in-person dance classes can resume on 17 May 2021 in COVID safe premises. It is hoped that performance venues can also re-open at this time. Here are some tips and advice for returning to performance environments and busier schedules safely.

COVID Risk Assessment

The risk of exposure to COVID-19 will remain once lockdown is eased, and dancers will need to consider their health and risk of exposure as they return to work and in-person classes. BAPAM has developed a guidance document that allows performers to assess their level of risk and how to mitigate COVID-19 risks within the work environment.

Individual Staff Risk Assessment for COVID-19 – v2.0 – 11th May, 2020 (bapam.org.uk)

Phased return

Taking your first post-lockdown class will be exciting and it may be tempting to push yourself. Be aware that your overall stamina will be reduced, and you may fatigue more quickly. Depending on how much training you maintained during lockdown you may wish to start with a lower-level class. If not, begin by gradually phasing back into your pre-lockdown levels of ability:

• Reduce your range of movement: Work with demi-pliés instead of full pliés; keep legs lower in battements and arabesque; don’t work with your full turn out.
• Reduce pace: Move more slowly across the floor; mark steps more often
• Reduce intensity: Hold back from dancing ‘all out’ for the first few classes; gradually work up to full jump height.

Warm-up and Cool-down Effectively

A well-structured dance class will prepare the body appropriately for the more challenging technique and choreography performed later in the session. However, not all teachers prioritise physical preparation and each dancer may have specific needs for warming up. Plan to arrive with enough time to complete your own individual 5–10-minute pre-class warm-up to ensure you are adequately prepared. Research has shown that a combination of cardiovascular exercises (to increase heart rate), followed by static (held for 30 seconds) and dynamic stretches provide optimal performance. Use clothing layers to keep your muscles warm at the beginning of class or if the class is stop/start. The cool-down is an opportunity for your body temperature to gradually return to baseline levels, encourage the dispersal of lactic acid, release muscle tension and work on flexibility using more prolonged static stretches.

Read this article by The International Dance Teachers’ Association (IDTA) for more information.

Plan Rest and Recovery

Planning adequate rest should be an integral part of your training strategy to promote muscle regeneration, reduce fatigue and avoid injury. The campaign, #dancersneedrest, led by One Dance UK aimed to encourage and support dancers to prioritize rest and this will be particularly important as you transition from virtual to in-person classes. You may experience Delayed Onset Muscle Soreness (DOMS), which is the muscle tenderness and pain experienced following certain types of physical activity and is more common when returning from a break. Dancing with severe DOMS carries a potential injury risk as it negatively affects range of movement and muscle recruitment patterns. Rest, or dance at a lower level of intensity for 1-2 days after the initial onset of DOMS.

Don’t Ignore Pain

Musculoskeletal injuries are extremely common in dancers, yet they are often reluctant to report an injury and continue to ‘push through’ pain. There are several reasons why dancers delay getting help. Freelance or part-time dancers may not receive appropriate support or have job-related concerns such as the risk of losing a contract. Company based dancers may also have fears about limiting their career progression or losing potential roles if they are injured. However, seeking help early can help reduce the impact of an injury, speed up recovery and lead to more positive outcomes. BAPAM provides free, confidential assessment clinics run by Performing Arts Medicine Ģ��tv healthcare professionals.

Performing Arts Medicine Clinics – BAPAM

Practise Self Compassion

The dance environment can be a competitive, pressurised and critically evaluative space that can foster negative self-perceptions. Returning to this environment when your dance ability, confidence and fitness levels are low could heighten those feelings. Research has shown that practicing self-compassion can be a useful tool to help dancers navigate feelings of anxiety, critical self-talk and fear of negative evaluation. Try these free guided meditation and self-compassion exercises by Dr Kristin Neff

The global pandemic has brought unprecedented disruption to dancers’ lives over the last year, but we are now starting to emerge from lockdown and return to some normality. This article has explored ways that dancers can help ensure they have a smooth transition back to full-scale training and performing. If you need any further help or advice with physical or mental health issues, please contact BAPAM helpline on 020 8167 4775 or email info@bapam.org.uk.

References

Spiro N, Perkins R, Kaye S, Tymoszuk U, Mason-Bertrand A, et al.  The Effects of COVID-19 Lockdown 1.0 on Working Patterns, Income, and Wellbeing Among Performing Arts Professionals in the United Kingdom (April-June 2020). Front. Psychol. 2021 11:594086. doi: 10.3389/fpsyg.2020.594086

Cheung K, Hume P, Maxwell L. Delayed Onset Muscle Soreness: Treatment Strategies and Performance Factors. Sports Med. 2003;33(2): 145-64.

Fietze I, Strauch J, Holzhausen, Glos M, et al. Sleep Quality in Professional Ballet Dancers. Chronobiology International. 2009;26(6): 1249-1262.

Morrin N & Redding E. Acute Effects of Warm-up Stretch Protocols on Balance, Vertical Jump Height, and Range of Motion in Dancers. Journal of Dance Medicine & Science. 2013;17(1): 34-40.

Vassallo AJ, Pappas E, Stamatakis E, Hiller CE. Injury Fear, Stigma and Reporting in Professional Dancers. Safety and Health at Work. 2019;10: 260-264.

Tarasoff L, Ferguson L & Kowalski K. Self-Compassion in an Evaluative Dance Environment. University of Saskatchewan Undergraduate Research Journal. 2017;3(1): 1-10.

Bolling C, Van Rijn RM, Pasman HR, Van Mechelen W, Stubbe JH. In Your Shoes: A Qualitative Study on the Perspectives of Professional Dancers and Staff Regarding Dance Injury and its Prevention. Transl Sports Med. 2021;00: 1-9.

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BAPAM are delighted to be working with the , who will host the clinic at the Philharmonic Hall, and Dr Marie McKavanagh, a Performing Arts Medicine Ģ��tv GP (and musician).

Liverpool Philharmonic have pioneered an exemplary approach to developing and supporting performance excellence through providing Ģ��tv health and wellbeing services to orchestra musicians. The positive effects of this investment are proving that performer wellbeing and artistic excellence are interlinked. Taking care of both also makes good business sense. Performers are healthier, happier, take less time off sick and are better prepared for elite performance. Through their key support for the new BAPAM clinic, Liverpool Philharmonic are now helping to bring this approach to the whole performing arts community.

The first clinic will be held on Wednesday 1^st���Ѳ���.

Belfast

BAPAM are also delighted to be working with the , Belfast’s music hub, who will host the clinic, providing vital support for a healthy and vibrant performing arts community.

The clinic is led by Dr Christine Hunter, a BAPAM and  NHS GP and Ģ��tv Adviser to the Ulster Orchestra.

BAPAM’s Belfast Clinic will be held monthly from May 22

Who is the clinic for?

If you make a proportion of your living from, or study in the performing arts, and have a physical or psychological health problem related to your work, BAPAM can help you. BAPAM clinicians can provide an accurate diagnosis and information to help you overcome problems. The BAPAM team can identify the best sources of ongoing care, both in the NHS and from other Ģ��tvs, and advise you about sources of financial support for people experiencing health problems affecting their ability to work or study.

Other regional clinics:

Glasgow: Friday 10th May, 7th June

Leeds: Thursday 2nd May

How to book a FREE confidential appointment?

Call 020 7404 8444 to register | Or email info@bapam.org.uk

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