Changing your perspective on injury

I started dancing when I was 6 years old. My mom used to dance and she put me in ballet to help me open up and be less shy. I immediately fell in love with it. 20 years later I still love the fact that I can express myself without my voice or without words. Most often I find it so hard to explain what I mean but dancing provides that outlet.

By the time I was 11, I was dancing at the School of American Ballet, the school associated with New York City Ballet. I had just stopped doing rhythmic gymnastics and decided to focus all my attention on ballet. And at 13 I had my first major injury.

I remember what class and exactly what step I was doing when it happened. I went to take off for a turn and subluxed (a temporary, partial dislocation) my knee cap. I couldn't walk and was carried out and taken to the emergency room.

I remember waiting in the emergency room with my mom and telling her how upset I was about missing my next ballet class of that day. They did X-rays and... no broken bones.

It swelled to the size of my thigh. There was no distinction of the knee from my hip to my calf. It felt stiff and full. I went to a doctor who had to drain two large syringes of fluid from my knee. But it made it feel a lot better and I had better motion after that.

I got an MRI to see what sort of damage had occurred during the subluxation. We found that during the shifting of the knee cap I had broken off cartilage behind my knee cap in two places. One of which was floating around in the knee. I would need immediate surgery.

In some ways it was nice to have such a definitive outline of the problem and the solution. Majority of injuries that are the most frustrating are those where doctors cannot find the problem and don't know how to fix it.

So I had the surgery and it went as well as could be, considering it was a difficult procedure. I was fitted into a hip-to-ankle brace and crutches. And sent home same day with an anesthesia administration in the entire right leg

I didn't get back to dancing for about a year.

That experience changed me forever. I had never really had a major injury before that so I learned a lot about my body, physical therapy, and the ins and outs of the recovery process. I think it matured me as a dancer. I went back to dancing but I was smarter and more aware.

Shortly after that injury I was applying for high school. All the applications had to an include an essay and I wrote about my experience with this injury. I titled it "A Blessing in Disguise".

Even though I will carry the scars of that injury for the rest of my life, it's all in how you look at it. All of the injuries I have sustained since then, I am always reminded that it's more about how you stood up then how you fell.

We all struggle and some more than others but it's fascinating how much we can recover from. Your body for example is constantly finding ways to heal itself on its own. It never gives up. It's always reinventing itself. And there is definitely something to be said about the mind body connection of healing. There is an article in The Guardian, that interviews Jo Merchant the author of Cure: A Journey into the Science of the Mind over Body. In the interview she says

But there is a scientific explanation: factors such as social support and positive expectation inherent in these treatments can trigger physiological changes that ease symptoms.

I found the interview to be very interesting in learning about unconventional medicine and the true healing power of your mind. Check out the full interview here.

I think the idea of feeling less than (feeling inadequate and useless)... is something that is common when people get injured. It comes from being physically limited in some capacity and the emotional toll injury can take on dancers specifically, as I explained my one of my previous post, Depression is anger turned inwards. But I'm a strong believer in everything happening for a reason and there's a bigger picture behind the events that happen in life.

If I hadn't injured my knee, I wouldn't have gained that perspective and experience. I wouldn't have been left back a level in my ballet school, which ultimately wouldn't have landed me in my dream ballet company. We often don't see the fruits of our labor until much later on.

Photo by Paul Kolnik

My advice would be:

• Trust your body is doing all it can to help you
• Ride the wave of your recovery with all its ups and downs; meaning the injury will take the time it needs to recover no matter what you do or don't do so you have to just take every day as it comes and accept the process
• Try to stay positive, do things that make you happy even if it's in a limited capacity 
• Explore new interests, it will help expand your perspective
• Be open to new cross training and moving in new ways
• Remember that you are valuable, just as you are, right in this moment no matter what injuries you have sustained

As I was writing this post a friend of mine posted this quote on her instagram story and I thought it was very appropriate!

Just as the title of this post states, changing your perspective on injury is very important to successfully get through it and move on. Sometimes injuries can be a good thing because they teach you lessons and you grow from them. It isn't all bad. I hope sharing my experience has helped you feel better about whatever it is you are going through and made you feel more optimistic. 

3 nutrients for a speedy recovery

Injuries suck! The recovery time can be long and painful. They also can keep you away from doing things you love.

However, there are some nutrients that can help speed up recovery time by aiding in the healing process.  Let's look at 3 nutrients that can can help with certain injuries and how to get them into your diet.

1. Collagen

Collagen is a major component in the structural protein of the body. It is known as the glue that holds us together. Your body naturally produces collagen but after the age of 25 our collagen production begins to decline. Which means it takes longer for us to heal. 

It is an important nutrient for wound healing and healthy skin. It is often seen in beauty products. However, type one collagen makes up our bones, tendons, ligaments, connective tissues and muscles. That's why it is very important for maintaining bone and joint health, as well as speeding up recovery of strains, sprains, and other soft tissue injuries. 

Collagen also contains anti-flammitory properties and immune system boosters. Immune system cells are the first to respond to an injury. Which is why a healthy diet is essential to quick healing. 

You can find collagen in: 

tomatoes, rosehips, dark leafy greens, broccoli, pineapple, horsetail, berries, citrus, eggs, egg whites, wild fatty fish, and bananas.

Supplement I use:

Collagen peptides

Vital Protieins is my favorite brand. They sell it at Whole Foods or on Amazon or their website.

        2.  Glucosamine and Chondroitin

Both are usually sold together because they do they same thing. Glucosamine and Chondroitin are compounds found in healthy joint cartilage and connective tissues.  They also play an important role in tissue growth and repair.  These compounds are most commonly discussed around arthritis and osteoarthritis treatment. Studies have shown that they can also help with sports injuries  that involve torn cartilage and improve mobility in joint injuries.

You can find Glucosamine and Chondroitin in:

Bone broth, soft shell crab, small bony fish (sardines, anchovies), egg shell membrane, supplements from animal cartilage 

Supplement I use:

Nature's Bounty

You can find it at any drug store or on Amazon

      3. Hyaluronic Acid

This nutrient may seem familiar because it is in many new beauty products to help reduce the appearance of wrinkles. But, it is also great for relieving pain and to treat bone injuries and osteoarthritis. 

Hyaluronic acid is a molecule found in skin tissue, bones, tendons, and the synovial fluid around joints. One of it's primary roles is to lubricate and cushion the ends of bones to prevent wear and tear. 

You can find Hyaluronic Acid in:

Bone broth, animal skin, root vegetables, leafy greens

I have only begun getting hyaluronic acid injections from a doctor for my knee. 

***

It's important to eat healthy and have a well balanced diet when recovering from injury. Please only take the recommended amount for each if you are going to take supplements. Hopefully this list will help you explore more nutrients that can aid the body in all sorts of ways. Eat well and happy healing!!!

Injury playlist

My roommate and I are both currently injured. And we decided to go to the gym together, to motivate each other. When our workout was over we both discussed how certain songs really helped us feel better and more motivated to get through our modified workouts at the gym because of our injuries.

Here's a list of songs we came up with that you might want to listen to the next time you hit the gym!

1. Fighter— Christina Aguilera 
2. My Shot — Hamilton soundtrack
3. No tears left to cry —Ariana Grande
4. Breathin — Ariana Grande
5. Stronger — Kanye
6. Eye of the Tiger — Survivor
7. Stronger — Kelly Clarkson
8. Hit Me With Your Best Shot — Pat Benatar
9. I Will Survive — Cheap Trick
10. The Broken - Lit
11. Listen to a song of a role you really want to dance or music from a ballet you love to dance
12. It's My Life — Bon Jovi
13. Fight Song — Rachel Platten
14. Survivor — Destiny's Child
15. Roar — Katey Perry 
16. Girl on Fire — Alicia Keys
17. Just Fine — Mary J Blige
18. Fireworks — Katey Perry
19. You Gotta Be — Des'ree
20. You Haven't Seen the Last of Me — Cher

I put the playlist together on YouTube, click here to begin listening.

I hope you enjoy working out to these songs as much as we liked putting them together. Stay motivated and keep pushing!

Stepping back on stage for the first time in 6 months

I had been out for 6 months due to a tear in my posterior tibal tendon. I had gotten a PRP injection and was is a boot for 6 weeks. It was my first injury since entering my dream company of the New York City Ballet. I was scared because I didn't know what to expect.

The injury was caused by overuse and not working the right muscles. I worked really hard to change the way I worked my muscles so I wouldn't have this injury again. It was slow and took longer than the doctors had said it would take (which is always the case, I know that now). At one point in the recovery process it was hurting to do a certain movement. No one could figure out what was causing me pain. I ended up getting a cortisone injection and that seemed to solve the problem.

Finally after 5 1/2 months, I stepped into the studio, so excited to be back and dancing again. The first ballet I would perform was a ballet called Serenade. Serenade is the first ballet Balanchine ever choreographed. The music is exceptional and anyone who has seen it will tell you it is a transcendent experience. The women are in long light blue shirts that billow when you move. The skirts are made of thin tulle and when you move the air catches it and it dances on its own. There is no story line but there is definitely strong emotion portrayed in the choreography.

I had rehearsed the ballet over the course of 2 weeks. I was happy that I wasn't experiencing any pain and I felt strong.

Me in the starting position of Serenade

Opening night of our fall season. I put my make up on for the first time in a while and looked back at myself through the mirror feeling excited to see my "performance face". I went down to stage level and warmed up with the other women in the ballet. It felt so nice to be back with company, being a part of something instead of feeling so isolated. We all gathered around the rosin box, chatting and putting on our pointe shoes. I went to the dressing room to put on one of those iconic Serenade costumes. I looked at myself in the mirror. One last look on the way out and I thought "Yup, I'm ready."

The stage lights were turned on and the backstage lights were turned off. I heard the orchestra warming up. My anticipation was rising. The moment I had been thinking about for the past 6 months is finally here.

I stood in the starting position. The music began and the curtain rose. I began to dance and I felt like I could breathe again, like I've been suffocating and I didn't know it. With each section of the ballet progressing, I disappeared into the music.

During my last phrase of dancing, I felt emotion building in my chest. Finishing the last step, I ran off stage in a blur. Backstage, I cried and smiled at the same time. All the struggle of getting to this moment and I finally did it! It was the most amazing feeling.

The best core work out

One of the first things physical therapy will allow you to do when you are injured are core exercises. Strong core muscles help reduce load on your lower back and transfer force from your lower body to your upper body and vicea versa. Overall having strong and stable core muscles helps prevent injury and allows you to perform your best. Here are some simple but effective exercises to engage and strengthen your core.

First, lay on your back with your knees bent and feet flat on the ground.

Arch your back and then tuck your pelvis repeat this motion a couple of times before you settle into a neutral pelvis position (somewhere between the full arch back and tucked in pelvis).

Feet together and let one knee fall towards the ground. Keep the pelvis from moving and think belly button to your spine.  Alternate legs. 10 times, right and left equal 1 set.

Then march your legs up, up, down, down. Don't let your pelvis move and again think belly button to spine. 10 times right and left equal 1 set.

 

Next, raise both legs to a table top position and tap one foot to the ground one at a time. Don't let your pelvis leave that neutral position and keep your belly button sinking down to the floor. 15 times, right and left, equal 1 set.

Last, raise your legs to table top position and then drop one leg to the ground and extend it out and then return to table top position. Alternate legs. 10 times, right and left equal 1 set.

The exercises progressively get harder. The first two are to help you find your deep abdominals and turn them on. The second two are harder to help strengthen the muscles you have just found. The reps are suggestions. You should do as many as you can while still stabilizing the pelvis and engaging the lower abdominals. If at any point in these exercises your belly puffs out or your pelvis moves, stop and readjust to the correct position. This may mean that you can only do a few at first but the more often you do the exercises the stronger you will become. Happy exercising!!

An interview with Megan LeCrone

Megan LeCrone is a soloist dancer with the New York City Ballet. She has danced with company for 18 years and through the first 10 years of her career she experienced many injuries that prevented her from dancing for long periods of time. Eventually, she was able to stay strong and after a short time she was promoted to soloist. I thought she was the perfect person to interview because she has a lot of experience with injuries and she gave great feedback on what important things to focus on and how she got through it all to become so successful.

Me: Tell me a little bit about what injuries you suffered during the beginning of your career.

Megan: So I sprained my ankle in The Nutcracker the snow scene. I came back from that pretty easily and was back to dancing again. Then I started to feel pinching in the back of my ankle. It felt like I had glass back there. I got tons of imaging and no one could find anything wrong. By this point I was out for a year, and had tried all conservative treatments. Finally, my doctor and I decided to do exploratory surgery to see what was wrong. I had a tear in one of my tendons which would have healed without surgery but I had an extra bone rubbing exactly where I had the tear. So they fixed it and it was an incredibly successful surgery. I listened to my own pace when coming back, I think I took longer than my doctors or therapists were telling me, but I had already been out for so long I didn't want to push it.

Unfortunately, I came back from that and danced for a year and I began to feel the same pain on my other ankle. Instead of waiting, I knew what it was and I wanted to get surgery right away. They did the surgery and they said I did have a tear in my tendon but no extra bone. As I was getting back to dancing my foot still didn't feel quite right. Later we found out that I did have the extra bone but it was just hidden and they didn't see it. Since my foot didn't feel right but I was still continuing to dance, I had been compensating and using my leg weird and I developed a tear in my knee. So when they did the second surgery they fixed the extra bone and my knee at the same time. I had a couple more injuries after that but they weren't directly related to dance. They were traumatic accidents and they did keep me from dancing for a couple more years after both my foot surgeries.

Me: What was it like to be injured so much at the start of your career? What kept you going?

Megan: It was frustrating to be like I can only do the things I can do. I felt like I couldn't challenge myself. I couldn't go take another class, I couldn't do that step one more time. For so long I was just doing what I had to do to get on stage. There were some dark times. I remember at one point, everybody around me, they loved me but they were trying to be honest. Besides my boss Peter Martins, they all said "Maybe it's time [to stop dancing]". But Peter was like I will wait for you forever, because you have a spirit. I said to him I just know it's not over, when I know deep down it's over then I'll stop. I just have this feeling. And he said "I trust you and I'll wait for you, just get there."

And I'm so glad I did. It was really hard and it was embarrassing and it was lonely. Yes I had doubts, but there was just this little voice no matter how hard it got, that was like if I stop now I'll always wonder what would have happened I did one more day. I said to myself if I wake up and that voice goes away then I know it's done. Some days all I could do was get in a pool and move one leg, but at least I did something that day. I'm glad I continued and it helped me build up an internal strength that has helped me now whenever I get frustrated with myself when I'm trying to improve. I just remind myself that even the smallest achievement counts towards the bigger picture.

Me: Is there anything that you do now to prevent injury? Do you have any rituals?

Megan: I try to stay away from anything routine orientated because I don't want to feel like if one part of the routine is off then the whole day is off. But definitely getting enough sleep. I'm more willing to go in later and give myself my own warm up. I used to feel really guilty about missing the usual company warm up class but now I understand that sometimes I need to warm up differently and focus on myself in a different setting.

Stretching, water and also working in water. I love to swim and do anything in a pool. Also I've really found a sanctuary in taking ballet class at other places when I'm not in season at NYCB. It helps me grow as a dancer and widens my versatility as a dancer. I've taken class with the Paris Opera and Netherlands Dance Theater.

Yoga is good. I feel my spine lengthen and it moves my body in a gentle way that feels good. I also think spending some time alone can go a long way in helping rest and refuel your body and mind.

Me: What advice would you give to another dancer struggling with injury?

Megan: No matter what you are going through, try to move everyday. I think that there is a tendency to want to just sit in a dark room and wallow but trying to move even just a little bit everyday can help keep your spirits up and in turn put you in the right mindset for healing. Not just pedestrian movement  but creative movement.

I went to watch performances and rehearsals a lot. Though there were times when I couldn't because it wasn't helpful, but I tried not to stay away too long because I didn't want have the feeling of being at the theater and think 'I can't walk in because it's too traumatizing.' When it got intense I would take a break but I would force myself to go back. I needed to get over this trauma and I needed to feel confident being there because I am still a dancer and I belong with this company. 

Try everything! I did yoga, pilates, gyrotonics, acupuncture and working at the gym. Everything to see what works for you. I tried to work with instructors that were good but remember you are your own instructor too. So take the things that they give and make it work for you body. Make it so it's fun and makes sense and it works because if its fun and it makes sense you're going to make progress. 

***

It was a pleasure getting to know Megan and her  journey with ballet injuries. Hearing her talk about her recovery process was inspirational, especially knowing what a fantastic dancer she has become in spite of all that. I thought how she emphasized how much recovery is a full body experience not just the one specific part that is hurt was very insightful.  I encourage everyone to go catch Megan perform with New York City Ballet this week in Saratoga Springs, NY at SPAC.

Follow up on Wikipedia

A couple weeks ago I found the wikipedia page Dance and Health. I made some additions to the page, that I thought could add more clarity and make it more thorough. In my post 'The risks of dance', I write about what changes were made more specifically.

I decided to go back to the wikipedia page and check if my changes were removed or accepted. Much to my surprise, all of my changes have remained. Ultimately, I think they really add to the page. Even though they were minor changes, to me reading it as a dancer, they make all the difference. If you are interested in seeing the full wikipedia page, click here.

How to reduce inflammation

Tumeric! It's the popular spice of late. Mostly because of its natural anti-inflammatory properties. If you have been keeping up with my posts, then you know by now that inflammation is not a good thing for any injury and sometimes it can be very stubborn. Including anti-inflammatory foods in to your diet can help get rid of some lingering inflammation. One thing I started having everyday is GOLDEN MILK!

Here's a simple recipe to get you on your way!
This recipe is for one serving but can easily be multiplied.

You'll need:

1 1/2 cups of any kind of milk you prefer (including all nut milks)
1 teaspoon of honey
1/2 teaspoon of ground turmeric
3/4 teaspoon of ground cinnamon
1/4 teaspoon of ground ginger
1/4 teaspoon of ground black pepper

What to do next:

1. In a small saucepan, combine the milk, honey, turmeric, cinnamon, ginger, and black pepper. Heat on medium until warm, whisking occasionally.
2. Pour into a mug, serve with a sprinkle of cinnamon on top.

You can also make it iced:

1. Fill one glass with ice and 3/4 cups of milk.
2. Using a blender, blend the remainder of the milk with the honey, turmeric, cinnamon, ginger, and black pepper.
3. Pour the blended mixture over the ice, stir and serve.

Instead of honey you can use maple syrup if you like and you can even add some vanilla extract if you want as well. The black pepper is to help your body absorb the turmeric, so it is a very important ingredient.

Enjoy!

The Healthy Dancer

When I do research into looking for other blogs like mine, more often I find websites that are selling exercises and advice on injuries.  Honestly there aren't many blogs specifically about injury, many have one or two posts about them but not an entire blog dedicated to them. I came across a blog called The Healthy Dancer and I thought it was a very informative blog for dancers, not specifically on injury but many of her posts inform on how to keep a dancer healthy.

The woman who writes the blog studied dance education and exercise science and has taught dance at many institutions. I think her posts are very detailed about what things to be aware of in order to be a healthy dancer. She focuses mostly on nutrition which is very important in keeping dancers healthy but she explains in detail how everything can affect dancers specifically. Such as her The Female Athlete Triad and What It Means for Dancers post where she talks about caloric energy deficiency, irregular menstrual cycles, and osteoporosis. All of which can increase the risk of injury.

Overall I think it's a great blog that is highly informative in the world of health for dancers. I recommend checking it out!

Recovery update

In my post 'Knowledge is power' I discussed some of the injuries I'm dealing with currently. I wanted to update you on how my recovery has been going. My high ankle sprain was doing spectacularly. I had no pain. I was able to walk long distances with no kind of ankle support. I even began taking ballet class again, 3 times a week. No pointe shoes and no jumps yet but all was heading in the right direction. I also started working out in the gym with a new trainer trying to get my whole body stronger, so it would be easier to dance more.

I have the stage 3 sprain

Then about 2 weeks ago, I started having pain in the same spot I tore my ligaments. It was after a day of dancing in the morning and training in the afternoon. I didn't feel pain as I was dancing or training, only after. It hurt to walk more than a block and it throbbed. I followed the RICE protocol. And I spent about 5 days not doing too much until I felt the pain subside somewhat.

I went to see my physical therapist who did some physical tests to determine what is causing pain. He concluded that the ligaments that had previously been stable seem to be loose now. The instability is what he thinks is causing me pain. He recommended I go back to see my doctor. This setback has made me feel very frustrated. I literally had my foot in the studio finally after 7 months of no dance and now I have gone backwards in my recovery. I had a set a reasonable goal of being back to work by late August (when our fall season begins) and now I'm not sure that will be possible. I have already been out of dancing for the past 8 months. I'm anxious about what the doctor might say. He could say I need surgery (which would likely have me out for an additional 6-8 months).  I'm trying not to think of the worst case scenario until I actually go see the doctor. There's no point in getting worked up without knowing, but it's still a struggle sometimes.

***

The other injury I discussed was the osteoarthritis in my right knee. I left off with just having gotten the Monovisc injection. The injection was supposed to help alleviate pain and reduce the amount of crunching, clicking and locking my knee was doing. Doctors say it takes about a month to start feeling any effects. It has been a month now and I can't say it feels that different but I also haven't been able to dance as much as I normally do. I do feel that the crunching and clicking may be slightly reduced now. I can say that it doesn't feel any worse. I may have a better read on it when I'm further along with my high ankle sprain.

However, there is this weird phenomenon where if one area of the body starts hurting more than the other area, that was previously hurting, you suddenly stop feeling pain in the old area. Many dancers will say this happens often to them, but if it's not one it's the other. There's always something.

The risks of dance

While browsing for information on dance injuries, I came across Wikipedia's page on Dance and Health. I was really impressed with how thorough the information was. There was only a small detail I felt I needed to add. Under the subtitle "Injuries", there is information about the most common injury and about shoulder injuries. I felt this needed some modification.

This is the original quote:

Many dance movements, and particularly ballet techniques, such as the turnout of the hips and rising on the toes (en pointe), test the limits of the range of movement of the human body. Dance movements can place stress on the body when not performed correctly; even if perfect form is used, over-repetition can cause repetitive strain injury. The most common injury for ballet dancers is snapping hip syndrome.^[25] Shoulder injuries can be common in dancers due to lifting, partnering and floor work that is commonly seen in modern dance. The periscapular muscles assist in keeping the shoulder still and steady, these muscles are at greater risk for injuries among dancers.^[26]

 And I changed it to be:

Many dance movements, and particularly ballet techniques, such as the turnout of the hips and rising on the toes (en pointe), test the limits of the range of movement of the human body. Dance movements can place stress on the body when not performed correctly; even if perfect form is used, over-repetition can cause repetitive strain injury. The most common injuries for ballet dancers is snapping hip syndrome and foot and ankle injuries. ^[2] Foot and ankle injuries are vulnerable to a wide range of injuries including, stress fractures, tendon injuries, sprains and strains. Much of this is due to not only the emphasis on footwork in dance but also the foot wear. Dancers either wear pointe shoes, bare feet, a soft shoe of some kind or heels, all of which offer no support. Shoulder injuries can be common in male dancers due to lifting, partnering and floor work that is commonly seen in modern dance. The periscapular muscles assist in keeping the shoulder still and steady, these muscles are at greater risk for injuries among dancers.^[3]

As you can see I added some more information on ankle and foot injuries that I felt were lacking in the original statement. I also specified that shoulder injuries are more common among male dancers, which I felt was vague before. I highly recommend checking out this page, because it has a lot of  great information on dance injuries as well as the benefits of dancing for your health.

Where are the best places to rehab?

In order to recover successfully from an injury, it's important to have all the best resources. I put together a list of places that provide excellent care and cater to dancers but also non-dancers.

• West Side Dance Physical Therapy: This is one physical therapy center where many New York City Ballet dancers go to rehab. The therapists there are very helpful and good at their jobs. They work with the company very closely and specialize in dance physical therapy. However, they also work with non-dancers as well. They also offer pilates, massage, acupuncture, and classes on ankle stabilization, core muscles and body alignment.
• Manhattan Physio Group: Another physical therapy place for dancers and athletes. Similar to West side dance, Manhattan physio works with many dancers and many American Ballet Theater dancers rehab there. They also offer gyrotonic training, massage therapy, and acupuncture.
• Harkness Center for Dance Injuries: A center that offers physical therapy and an emergency clinic for injuries that need immediate attention. They also offer some financial assistance. NYU Langone Health has an entire section dedicated to dance where they do research and education for dance injury as well as hands on help for injured dancers.
• Articulating Body: Marimba Gold-Watts, a pilates instructor who gives one-on-one sessions and group classes. This is great for getting back in shape and getting the body to move correctly. Marimba is a former dancer who has a lot of personal experience with injuries and works with many dancers and non-dancers. 
• Riverside Wellness: This is a gyrotonics studio. Gyrotonics is similar to pilates with its mind-body properties and its fluidity of movement but it is also very unique with entirely different machines. Gyrotonics can help get the body back to being strong without any brute force. Riverside Wellness is a beautiful studio where they work with many dancers.
• Integrative Acupuncture with Diane Rooney: Diane Rooney is an excellent acupuncturist who is very kind. She helped me a lot when I was having tendon issues in my foot. The space is very relaxing and soothing. 
• Support Group for Injured Dancers: This 8 week program is really helpful in solving the isolation problem of injured dancers. This support group is a free resource that can help with the emotional challenges of injury.

I have either personally used these resources or have spoken with people that have used them. All of them come highly recommended. 

Ballet injuries: going behind the scenes

New York City Ballet is the ballet company I have worked for over the past 7 years. They are one of the top ballet company's in world. In 2013, AOL created a short web series following New York City Ballet and highlighting important aspects of this top ballet company. The series is called city.ballet and you can find me in the opening of some of the episodes.

Building on from last week's post on dancer's emotional battle with injuries, I wanted to include this episode about ballet injuries. The episode does an excellent job of showing what kinds of injuries ballet dancers get and what it's like when they are unable to do their jobs.

After watching the video on YouTube I read the comments underneath. Most comments are people relating with what injuries they have had. I find that to be really nice because just as Claire says in the video, when you are injured it can feel like you're the only one. Talking with others who are going through the same thing or have in the past can be very comforting. 

Other comments are those who realize how strenuous ballet can be. It's shocking to me that people still don't realize how hard ballet is on the body. I come face-to-face with that fact everyday but, to others who never see the ballet dancers in pain they don't believe they are. One of the comments comes from a man who says he knows nothing about ballet but is very familiar with American football and after watching this video he is rethinking whether football is really the most competitive sport/activity.

I think seeing the dancers in this video explain and show what it's like to be injured is really helpful in understanding how ballet injuries affect dancers. If you are interested in more videos like these watch the whole web series, it is worth it. There are 2 seasons and each episode has an important topic. They can be found on YouTube or AOLgo.com 

There are also two great documentaries about famous ballerinas careers and overcoming their injuries. The first is 'A Ballerina's Tale' which is about Misty Copland who dances with American Ballet Theatre. A portion of the fascinating film is dedicated to her recovery from potentially career-ending fractures in her left tibia.

The second is 'Restless Creature' which is about Wendy Whelan who danced with the New York City Ballet. It is a brilliant film about a 46 year old principal dancer who is struggling to recover from a very serious hip injury while also coming to terms with retiring after 30 years of dancing with the company.

Both films bring the audience in on the passion that each of these dancers have and their lowest moments when trying to recover from injury. They both show what it takes to get back to dancing at a professional level. Both films can be found on Netflix.

Depression is anger turned inwards

In addition to the physical toll injury takes on the body, for dancers the emotional toll can sometimes be even greater. I used this image taken by Henry Leutwyler, of a dancer's feet as a metaphorical representation.What may look fine on the outside (the foot on the right) is no indication of what is going on in the inside (the foot on the left).

When dancers get injured the first thing that happens is an immediate isolation. One minute they are working on a schedule with many people and the next minute they are home alone and only seeing doctors and physical therapists.  It can be lonely, feeling like you are the only one not dancing. The only thing that surrounds you is the injury. Why did it happen? How long will I be unable to dance? What is the extent of the injury? When can I get back to dancing? These are all questions that plague the dancer at first. Thinking about the injury constantly can lead to similar phases of grieving.

First is denial. You can't believe this happened especially at this point in your career. (Because there is never a good time to be injured, it always feels like the worst timing ever!) If only you didn't get injured you'd been able to do that role you always wanted to do or get that gig you've been rehearsing for all season. Then comes anger. You get angry at yourself and start blaming yourself. I wasn't strong enough. Why didn't I speak up and say it was bothering me beforehand.  A lot of emotions come from feeling like a failure or defeated. Dancers are so passionate about their art and their bodies are their main tools. When something happens to their most important tool it feels like a failure. This stage becomes intertwined with depression. The depression and anger rolled together usually tend to be the darkest period, since you also feel lonesome.

Finally you reach acceptance. There is a moment when you realize your love for dance is still strong and you are not willing to give up on it just yet. If you focus and not wallow, you could come back better then ever. At this point, the dancer has a diagnosis and is working towards goals one day at a time. It's slow progress but it's progress. They feel grateful for the small things they have achieved and move forward knowing they have gained new perspective and knowledge about the body.

It's certainly a journey but it pushes dancers to grow in ways that they may never have imagined. Getting injured makes dancers more aware of their bodies and how they work with them. It also makes them realize why they began dancing in the first place, a renewed sense of passion. I think it is an important part of becoming a professional artist. It's like they say sometimes, you have to hit rock bottom to know which way is up.

The 4 cardinal rules to follow when injured

So you fell in rehearsal and tweaked your ankle. Your knee has been hurting more and more recently after doing a new exercise class. You were doing weights at the gym and feel a twinge in your shoulder. The first thing you should do is remember RICE!!!

1. REST—Stop doing what hurts and rest as much as you can
2. ICE—Use an ice pack to ice up to 20 mins or you can ice massage for no longer than 5 mins
3. COMPRESS—Wrap the injury or use a compression sleeve
4. ELEVATE—Raise the injury anywhere above the heart to encourage blood flow to leave the injury

These steps are very important during the first 24 hours of an injury. Usually when something has been injured it swells with blood because the body is trying to heal itself. However, most of the time the body's reaction is excessive and RICE is used to help reduce the inflammation. The excessive swelling can do more harm, if left untreated. Prolonged swelling can lead to chronic or long term swelling making tissues more rigid, which make them more susceptible to injury. After doing all four steps over the course of 24 hours, see a doctor or physical therapist. 

5 tips to prevent injury

In my last post I talked about some statistics on ballet injuries and I wanted to include this week's post with some helpful tips on how to prevent injures from happening.

• Eat well—Having a balanced diet that includes the proper amount of nutrients to sustain an active lifestyle is important. If your body is not receiving the energy it needs, it will be weak and tired.
• Stay hydrated—Drinking a lot of water helps your muscles stay energized allowing them to activate more easily. It also speeds up the recovery time. If your muscles are dehydrated they will stay sore longer and won't get rid of the toxin build up as easily. 
• Get enough rest—Overtraining will definitely cause injury because your body will not have had time to recover and ultimately won't support you. This can be one of the most difficult things to accomplish as a professional dancer because of the rigorous schedule. But please get enough sleep and rest during the little time you may have. It's important!
• Do cross-training—Since overuse is one of the top ways dancers get injured, cross-training helps build other muscles that don't get used often. It gives the muscles that do work a lot a rest. This way you get a more balanced exertion of muscle.
• Warm up and cool down—Warming up before class or rehearsal is essential. Cold muscles are a sure way to get injured. Cooling down is most often forgotten but just as important. After exercise you should always stretch and roll out. Stopping abruptly after exercise slows your heart rate down, and the blood pools in your legs and feet which can make you feel dizzy. You should continue exercising slowly and gradually stop moving. 

These tips are all important to stay healthy and limit the risk of injury. However, dancers do a lot of repetitive movement for several hours a day and as the study in my previous post has shown it can lead to increased stress on the body. On top of the intensive training, there is very little down time between performance seasons and rehearsals. Therefore, follow these tips and you are on your way to being a healthier, stronger you!

Some ballet injury statistics

While doing some research on ballet injuries I found a study from Orthopedic Journal of Sports Medicine. I found the statistics to be very interesting and wanted to share them.

TYPES OF BALLET INJURIES

• 75% to 91% of all ballet injuries affect the lower extremity
• 39% to 53% of occur in the foot and ankle, specifically
• 29% of dancers have patellofemoral pain syndrome, according to another study
• 91% of dancers report a snapping hip, according to one study. 58% of those dancers have pain from it

INJURY RATES

• Amateur dancers have 0.97 injuries per 1000 dance hours. Professional dancers have a higher incidence of injuries—1.24 injuries per 1000 dance hours. Combined, amateur and professional dancers suffer 1.09 injuries for 1000 dance hours
• Male dancers have a higher injury rate than the females—1.29 injuries per 1000 dance hours compared to 1.03

OVERUSE BALLET INJURIES

• Overuse injuries comprise 75% of all injuries to amateur dancers
• 57% of injuries in professional ballet dancers are overuse injuries

I wanted to show in numbers how injuries affect ballet dancers and how important it is to understanding the demands on their bodies.  Once there is a complete understanding it becomes easier to create a plan to decrease injuries. Here is the link to the full study: https://doi.org/10.1177/2325967115592621.  This is a concise compilation of facts but there are a lot more interesting facts if you were to look at the full study.

The Myo-Care EMS

Part of my treatment plan for the osteoarthritis in my knee is to make sure my thigh, butt and hips are strong. Those are all the major muscle groups needed to keep the knee stable and alleviate stress on the knee joint. Using a portable electric muscle stimulator machine is a helpful way to get strong muscles. It is used to help activate a specific muscle that has a hard time engaging due to injury.

My physical therapist instructed me to get a doctor's prescription for a portable NMES machine to use on my quadricep muscles. Then he gave me the website Medi-Stim.com to order Myo-Care EMS. The Medi-Stim company will require the doctor to fax them the prescription or for you to mail them the original. My physical therapist recommended this model because it is the simplest one to use and it comes with 4 self-adhesive electrodes that you apply yourself. Some models come with pre-set electrodes to apply to the quad in the same area for everyone. However, with electrodes that you apply yourself you can make the stimulation more specific to your body and target the muscles you would like. My favorite thing about the Myo-Care machine is that it only take about 10 to 20 mins of exercise to feel the specific muscle you are trying to work. I use it everyday and I can really feel my muscles fatigue from use.

The best thing about the Myo-Care EMS is that it is simple and easy to use. Some other electric stimulation machines are too high tech and have too many buttons. There are only 3 buttons with two knobs to increase the stimulation intensity with the Myo-Care EMS. It has last setting recall, so when you use the machine to do your exercises it remembers your settings, that way you don't have to set them again. The back of the machine has a clip so you can attach it to your clothing and not hold it during use. It also comes in a carrying case that holds the machine with the electrodes, and it is small enough and light enough to carry anywhere. It is perfect when you are going on vacation or just commuting from work to the gym.

Similar to all electrotherapy equipment it is best to have a physical therapist assist you in your first try. This way they can tell you what exercises to do with the machine and where best to place your electrodes. After that, you will be off to stronger muscles in no time.

Athlete or artist?

When it comes to ballet dancers there is often a debate about whether they are artists or should they be considered athletes. Recently, ballet dancers have been appearing more frequently in main stream media like television and film. They have been abundantly used in advertising as well. Dance is everywhere. With the emergence of athleisure more and more people no longer see dance and ballet as an elite art form reserved for the wealthy and refined. Ballet has become more relatable and accessible. Part of this accessibility, I think, is having people understand the work behind becoming a ballerina. I think what makes ballet dancers unique is that they are both artists and athletes.

In order to be a successful ballet dancer both artistry and athleticism are needed. The physical work is hard, repetitive, and all of it is done in very unnatural positions.  Ballet dancers always work with turn out (where your toes, knees and hips all face outward instead of straight forward) and the women always work in pointe shoes, dancing on their toes. Ballet requires high jumps, low bends, and fast moving while always maintaining grace. This all requires a fit body, therefore making them athletes. Ballet is also an art form. No two dancers, dance the same because their personality comes through the dancing and that is the artistic side of ballet. The artistic side ties in with the performance factor. Since ballet is a live performance and not a competition, there are no scores or ratings, there is only expression and individuality. I think it is a beautiful thing to see both aspects, athletics and artistry, of ballet come together.

Knowledge is power

I want to go through some of the major injuries I've had over the past couple years and together we can learn a lot about the body. Let's start with the most recent. High ankle sprains are more rare than your typical sprain. The high ankle sprain is located, as the name suggests, anywhere above the ankle joint. The two major bones above the ankle joint are the tibia and the fibula. When you have a high ankle sprain you partially tear the ligaments that hold those two bones together. There are varying degrees of tearing, which an MRI can show how severe the sprain is.  Ligaments do not heal back together. Scar tissue will form over time and bridge the gap. The build up of scar tissue and how weight falls to the area above the ankle joint  are why high ankle sprains take longer to heal than low ankle sprains.

Your tibia and fibula separate slightly when you put weight on your foot and separate further when you increase dorsiflexion, which is flexing of the foot. Some doctors may recommend surgery where they insert a nail connecting the two bones making certain that the tibia and fibula are stable while the ligament heals (limiting the separation of the tibia and fibula). They remove the nail once the ligaments are stable enough. However, with ballet dancers this surgery is not recommended because it makes the ankle joint too stiff. Ballet dancers need to have more loose ankle joints than the average person because we do much of our dancing on our toes. Therefore, the recommended treatment for a dancer is to put the foot in a boot and use crutches since weight-bearing puts too much pressure on the ligaments if they aren't healthy enough. Crutches and a boot are necessary for about 6-8 weeks. I was on crutches for 3 months (which is longer than usual) because as I was about to get off crutches I slipped in my shower and re-sprained the ligaments and had to start the healing process all over again. That was a low moment for sure.

Now the other injury I'm dealing with is osteoarthritis in the knee.  This is a very common joint disease that most often affects people in their middle age or elderly years. Osteoarthritis is known as "wear-and-tear" where the joint experiences eroded cartilage (shock absorbers) and bone spurs. Even though it is commonly seen in older people it is also very common in most athletes including ballet dancers. I am certain most professional ballet dancers have some degree of osteoarthritis but depending on how severe it is, determines the treatment plan. Most athletes can handle a significant amount of osteoarthritis because of how fit they are. If the muscles surrounding the joint are strong, then the muscles can absorb the force rather then the force solely falling on the joint.

Osteoarthritis is treated with pain management. No matter how much cartilage has deteriorated each person's pain level is different. I for example have a significant loss of cartilage and bone spurs that cause my knee to lock and click. During certain movements the loss of cartilage causes grinding bone on bone. However, I don't feel a tremendous amount of pain and can dance without much limitation. My doctors have informed me that another patient may have the same degree of the disease and be in so much pain they can't walk up a flight of stairs. There are many things that can be done to improve the pain. Non-surgical options include acupuncture, massage, physical therapy, hyaluronic acid injections (help lubricate the knee), or PRP injections (help generate healing). If one wanted to have surgery it would most likely be some form of cartilage transplant.  I chose the hyaluronic acid injection called Monovisc which is a single injection said to last up to 6 months. I received the injection for the first time this Friday 6/7/19. It was not painful and it happened in under 10 minutes. I was able to walk out of the office with minimal soreness.

I hope all of this was informative, when dealing with injuries it is of utmost priority to get as much knowledge about your injury as possible. Seeing multiple doctors and exploring all your options of treatment is very important. Once you have all your information then you can decide, which doctor you feel comfortable with and trust. Ask many questions and do your own research. Talking to others who have had similar injuries also is very helpful. Especially with dancers it is important to see doctors who are familiar with a dancer's body and the requirements of the job.

Every setback is a setup for a come back...

Welcome to my blog, Tougher in a Tutu! Many people don't realize how strenuous and difficult ballet can be. Especially, since much of the point of dancing ballet is to make it seem easy. It is an art form that takes years to master and typically begins at a young age. The years of precise training can lead to very serious and detrimental injuries. The truth is that the wear and tear on the body results in a short career. Injuries are just part of the ballet world and very few avoid them.

Throughout my 20 years of dancing, I have had multiple injuries ranging from bruised bones to serious knee cartilage surgery. I am currently recovering from a high ankle sprain on my left ankle and partially related severe right knee arthritis. The way in which we work our bodies is unique and requires a full range of motion (beyond what is expected in a normal person's body). That is why when ballet dancers injure themselves it is important that we see the right doctors, physical therapists and trainers who fully understand the expectations of our craft. Similar to top athletes we push our bodies to the limit everyday and we need to be strong to handle that.

This blog is a resource for anyone coming back from an injury but will be focused on ballet in particular. It will include tips, advice, exercises, meal ideas, and an overall look into my personal recovery. The title of this post is a quote that has always inspired me to get back up when I fall. Injuries are no fun but they make you stronger and wiser. I hope you will join me on my road to recovery and in turn become stronger and wiser as well.