Presentation on theme: "Conditioning protocols based on injury types in a professional ballet company: a case study and workshop David Outevsky MSc, PhD (candidate) Tanya Berg."— Presentation transcript:
1 Conditioning protocols based on injury types in a professional ballet company: a case study and workshopDavid Outevsky MSc, PhD (candidate)Tanya Berg MA, PhD.
2 Background Research on injuries in professional ballet dancers Research on conditioning for DanceSportWork as part of the health team for a professional ballet companyDancers asked for a remedial program inspired by dance science
3 Procedures Screening: Dancer Wellness Project (DWP). In section 1, we took participants health history and demographic information.In section 2, we conducted a physical assessment of aerobic capacity, hypermobility, ROM, strength, functional movement, balance, and alignmentWe thank the Dance/USA Task force on Dancer Health for the development of the Annual Post-Hire Health Screen for Professional Dancers and/or the standardized system for reporting injury.
4 Conditioning Program Remedial program: Based on analysis of each dancer’s weaknesses and injuries and relevant research, each dancer was provided with an individualized remedial conditioning program to be followed during the performance season.The use of C-I Training was instrumental in the development of the conditioning protocols as David is a certified trainer.
5 Summary of Results Common issues: Remedial exercises: Alignment and balance issues, especially in tests done in parallel (6th pos.). Several have also exhibited symptoms of hypermobility, spinal misalignments, as well as low strength and proprioception capabilities.Remedial exercises:Rooted in endurance, aerobic, and alignment conditioning for dance and athletics. See following chart.
6 Pre-Season Screening (weakest results) NameStep0=ex.BeightonAdamsPROMStrengthBalanceStep DownSaraScore4L ThoracicDec IR hipsfeet 3/5R/L 9F/FHolly5-hips, FHL5/5L 12; R 13EmmaL hip;R hip IR; FHLGM 3/5;L FootL 29; R41P/PSally1-goodL lumbar(pain w ext)L IRw pain in supine lieAbd 4GM 3 or 4feet3L; 4RL 5; R 10Ken9L 110; R 120Abd 3GM 3L ER 3foot L4;R 3L 60;R 60Leo3- average3L/R hip IRL/R HSGM 4/3R weakerL 60; R 9
7 Remedial exercises chart *discussed during workshop TESTWEAKEST RESULTEXERCISES FOR WEAKEST RESULT*3 Minutes Step TestScore: 3 (average)Cardiovascular conditioning*Beighton Hypermobility TestScore: 9Specific strengthening/alignmentAdamsL Lumbar (pain with extension)Turned out alternating leg liftsArabesque exercise proneSitting with folded leg stretchProgress to second positionPROMR/L Hip IRR/L HSPretzelOver-crossed passéHamstrings with legs across*Strength: Gluteus MediusScore: 3/5Outer leg liftsSitting or lying double leg hip abduction (snow angels)*Strength: Intrinsic FootPoints and Squeezy FlexesU shapes for anklesBalanceL 5; R10Proprioception exercises*Step DownF/FParallel pliés
8 DiscussionThe reason for screening (potential injury prevention, systematic/accessible knowledge base for institutions)The values of conditioning (potential preventative measures, easily applied and understood, shown to improve performance)Value to the teacher, more informed student (teacher can structure lessons based on results, use conditioning tools in the classroom/ student can be more mindful about his/her limitations and better prepared for dance)
9 Tests For Practical Demonstration Step Down TestBeighton Hypermobility TestStrengtha) Gluteus Mediusb) Intrinsic Foot Strength3 Minute Step Test
11 1) Step Down: Exercises for Dynamic Hip Alignment Basic Exercise for “Fail”:Plié in parallel (paying attention to alignment of knees), progress to one legadd relevé.Can be done lying downBarre maybe used but gradually eliminated.Progressions:Leg can be extended to a tendu en croix during each plié.If bossu half ball is available, repeat the above on the middle of the ball, then turn the ball over and do the same.
12 1) Step Down: Result in relation to ballet specific training The turnout required in ballet results in imbalances between in/out rotators and medial vs lateral flexors /extensors.Tightness in outward rotators is a potential cause of sciaticaLack of alignment during jump landings has potential to cause injuriesBalancing both groups by conditioning can improve these parametersIf trunk or pelvis misalignments are observed, core support issues might be present
14 2) Beighton Hypermobility Test Advice for weakest result:control hyperextend knees/elbows (esp. weight bearing)Strengthen supporting musculatureDo not work in ‘overstretch’ during flexibility training
15 2) Beighton Hypermobility Test Ballet specific training:Hypermobility is a common selective characteristic for ballet, often resulting in a need for more strength conditioning rather than stretching, as well as a comprehensive understanding of proper alignment to avoid injuryThe hyperextended knee position has the potential to create further postural misalignment that can be problematic for the dancer (e.g. lordosis)If choosing to use hyperextension while weight-bearing, the dancers must be aware of the risksHyperextended position of the knees requires a flexion action to ‘unlock’ which slows down the reaction during landing from jumps and can potentially cause injury
17 3)a) Strength: Gluteus Medius Exercises for weakest result:Outer leg liftsSitting or Lying double leg hip abduction (snow angels)Progressions:Use elastics and/or low weight for resistance
18 3)a) Strength: Gluteus Medius Ballet specific training: HipHip abductors help the dancer balance on one legConstant low grade contraction creates inelasticityDancers often have tightness and weakness in this muscle groupCan cause ‘lateral snapping hip’ and contribute to risk of arthritis in the aging dancerStretching and strengthening is recommended to remedy problems associated with the above issues
20 3)b) Strength: Intrinsic foot Exercises for weakest result:Points and Squeezy FlexesU shapes for anklesProgressions:Use of elastics/pushing against resistance
21 3)b) Strength: Intrinsic foot Ballet specific training:Pointe work and constant plantar flexion with ‘gripping of toes’ causes tightness in foot intrinsics at the MTP joint inhibiting the range of IP extension (‘toe spreading’)Weak/ tight foot intrinsic muscles can cause cramps especially after a breakTightness in the foot intrinsics decreases balance on demi pointe and therefore increases potential for injuryWorking in full ROM can help
23 4) 3 Minute Step Test Recommendations for weakest result: Sept. to Apr. Aerobic conditioning 30min 1-2 times a week, can be dance specific or cross training 60-85% HRmax or around on Borg scale (depending on her age). Begin with dancer almost unable to complete, then increase intensity as the cardiovascular capacities improve.Progressions:Apr. 21 – June 21 reduce training and conditioning: continue at own pace for maintenance.June 21- Aug. 21 increase the volume to 3 times per week, keep increasing intensity with improvement in cardiovascular capacity.Aug. 21 – Sept. 15, same as Apr. 21- June 21.
24 4) 3 Minute Step Test Ballet specific training: The interval based nature of traditional ballet training provides more anaerobic than aerobic conditioningLonger performances and training hours can tax the cardiovascular system and fatigue the dancers, creating potential for injuryRegular aerobic training can improve the dancers’ cardiovascular capacities
25 Conclusion Purpose of Screening Benefits and logic of conditioning The educators role in dancer healthCollaborating with health practitionersFuture directions in research: further screenings, dancers’ understanding of kinesiology, practical application
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