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.

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.

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.

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.