Keeping Up with the Count: When Has She Rehearsed Enough?

Keeping Up with the Count: When Has She Rehearsed Enough?

In youth sports, this message is clear – excessive training puts an athlete at risk for injury. Young dancers may or may not be comfortable comparing their training to that of other “athletes,” but the concern for their safety is similar. Scottish Rite for Children physical therapist, Julia Buckelew, P.T., D.P.T., O.C.S., works with many dancers in our sports medicine practice and hopes to reach others with this message.

Overtraining occurs when there is a high intensity or a high volume of training and performance declines. Overtraining is often associated with overuse injuries and burnout when the dancer no longer enjoys the activity. The year-round nature of dancing creates a culture and environment that, without deliberate efforts to avoid, lead to these conditions. Company auditions, numerous classes, rigorous pre-show rehearsals and summer intensives can run-down a dancer.

What are signs of overtraining?

  • General fatigue felt throughout the day despite amount of sleep.
  • Extended time needed to recover from post-exercise soreness.
  • Reduced performance/technical skill despite normal or increased training hours.
  • Difficulty concentrating.
  • Increased risk of injury.

How can a dancer avoid overtraining?

  • Shift attention to the quality of training over the quantity of training.
  • Apply common time management techniques to plan rest and cross training.
  • Implement training periodization by recognizing performance cycles.
  • Learn about sleep hygiene to improve sleep quality.
  • Learn the value of mental imagery for rehearsal to allow the body to rest.
  • Increase self-awareness about beliefs and behaviors that motivate.

Thoughts on Perfectionistic Dancers
Scottish Rite pediatric psychologist Emily Stapleton, Psy.D., says, “Perfectionistic dancers tend to be ambitious, determined and driven for success in their performance. Unfortunately, these traits that make them successful also increase their likelihood of overtraining.”

These athletes tend to focus on results and have potentially harmful motivations including:

  • Desire to avoid making mistakes.
  • Fear of failure.
  • Fear of negative evaluation by others.
  • Meeting parent or coach’s expectations.

These tendencies can cause significant frustration, low self-esteem and self-doubt when they are not meeting their expectations or the expectations of others (e.g., parent, coach). This leads to the drive to learn new moves, perfect a routine and difficulty taking a break from training. Since they feel training is never complete, they self-select into an inappropriately high-training load. The cumulative effects of endless run-throughs, long hours of rehearsal and impact and stresses from repetitive movements may lead to injuries, exhaustion and reduced quality in performance. 

Stapleton says, “Research has shown that when these athletes direct their perfectionistic behaviors toward progress-oriented goals, rather than focusing solely on results or performance, some of the risks of overtraining are mitigated.” Athletes can do this by implementing cognitive-behavioral strategies including:

  • Appropriate goal setting.
  • Redefining their definition of success in sport.
  • Using positive self-talk.

Emily Stapleton, Psy.D., and Julia Buckelew, P.T., D.P.T., O.C.S., contribute to the article series, Keeping Up with the Count. A collection of tips and information for dancers from a multidisciplinary dance medicine team. They recognize the needs for these highly specialized athletes and aim to help reduce the risk of injuries in this population.

Soaring to New Heights: Growth Spurt in Dancers

Soaring to New Heights: Growth Spurt in Dancers

In general, females undergo growth spurts earlier in life than males. This means that most girls experience significant growth at a younger age than boys. Julia Buckelew, P.T., D.P.T., says, “According to the American Academy of Pediatrics (AAP), peak height velocity occurs at an average age of 11.5 years old in girls and 13.5 years old in boys.” Some dancers can experience a delay in puberty which may cause the growth spurt to occur at a later age. Hormonal and weight changes that occur during growth spurts affect dancers in a unique way. Challenges include changes in:

  • Flexibility and strength.
  • Physique.
  • Balance and proprioception (the awareness of the body in space).
  • Body mass and center of gravity.

Sports medicine physician and former dancer Jane S. Chung, M.D., advises dancers to be aware that these changes that occur in this peri-adolescent period of growth, may predispose them to be prone to injuries. She says, “Techniques and certain routines which they were able to perform prior, can sometimes become more difficult for them to perform as a result of these changes that affect their body.” This can sometimes be frustrating for the young dancer, but Chung encourages dancers to be kind and embrace these changes, instead of fighting against them. Work with your dance teachers to help adjust and adapt to the new growing body.

Chung sees peri-adolescent and adolescent dancers in her clinic with these conditions and many others:

  • Bone, muscle, ligament and tendon injuries.
  • Stress fractures and other over-use related injuries.
  • Conditions specific to the female athlete such as the female athlete triad.

“Dancers should try to be patient with themselves during times of growth,” says Buckelew. She teaches dancers to recognize these changes and perceived setbacks as temporary. As a physical therapist and one of our dance medicine specialists, she sees many dancers who become discouraged with their movement quality and performance. “If we can help them understand and anticipate the changes associated with their growth spurt, they are likely to come through this phase with new respect and confidence in their bodies.” She recommends focusing on improving movement quality and technique during this time.

Three tips for dancers to rock their growth spurts:

  • Know it’s coming and won’t last forever.
  • Pay attention to your body.
  • Ask for help or modifications.

Chung and Buckelew have a passion for caring for dancers. They share their expertise to the community to help dancers and others prevent injuries and develop skills that help them perform at their best.

If your dancer has concerns or activity-related pain, request an appointment in our Sports Medicine clinic.

Keeping Up With the Count – This content is provided by a multidisciplinary team of staff that are passionate about keeping young dancers safe and healthy.

Get to Know our Staff: Jane S. Chung, M.D.

Get to Know our Staff: Jane S. Chung, M.D.

Where did you go to college? Medical school? 
College: University of California, San Diego
Medical School: St. George’s School of Medicine 
 
What is your role on the sports medicine team? How does your role overlap or differ from an orthopedic surgeon?  
I am a non-operative pediatric sports medicine physician. I treat sports injuries that do not require surgery. 

Why did you want to become a doctor? Have you always wanted to work in pediatrics?
The seed was planted during mission’s week in my fourth grade Sunday school class, when a missionary pediatrician from Burkina Faso shared her story and work. In college, I traveled to Nairobi, Kenya on a medical mission trip with my church and worked at a hospital helping young children, which solidified my passion for working with kids and the field of medicine.
 
Is there anything you want parents/kids to know about sports safety or returning to sports during/after COVID?
As with any return to play or return to sport following a prolonged period of rest and inactivity, it is important to take a slow and gradual approach to safely re-introduce the body back to activity.
What led you to Scottish Rite for Children? 
I’ve worked at Scottish Rite for about four and half years now. The people and values of the institution are what led me here. The well-being of patients and families always come first. It is amazing to work with a like-minded team that also shares a similar passion to advance pediatric orthopedic medicine through research.

How do you help your patients feel comfortable and confident? 
My belief is to treat the whole child, not just their physical injuries. It is important to also treat their emotional and mental well-being and health.

What is your favorite part of your job?
Working with young athletes to help them get back to their sport. 

What was your first job?
Working at a local surf shop in California.

Tell us something that might surprise us about you:
I don’t cook, but my husband enjoys cooking, so it works out well!

What is your favorite thing to do when you’re not working?
Spending time outdoors with my husband and our rescue dog. My husband and I also enjoy traveling the world and finding new spots to surf.

Keeping Up With the Count – Among other clinical and injury prevention interests, Chung works closely with a multi-disciplinary team providing patient care and content for young dancers.

Get to Know our Staff: Jessica Dabis, Therapy Services

Get to Know our Staff: Jessica Dabis, Therapy Services

What is your role at Scottish Rite for Children? 
I work in the Sports Physical Therapy department in Frisco. I evaluate and treat non-operative and post-op sports injuries, spanning all joints. I typically see patients one-on-one throughout the day in 45-minute blocks, implementing activities such as manual therapy, therapeutic strengthening, dynamic movement mobility and speed/deceleration/landing mechanics training. We focus on coordination and motor control development for our young, skeletally immature population. The goal for our athletes is to foster long-term athletic development and equip them with the tools needed to minimize future injury risk factors by building durability for once they return to sport.
What do you enjoy most about Scottish Rite?
I love the people –  my coworkers, the collaborating physicians and nurses, social workers, psychologists and leadership. Everyone seems to truly share a vision of compassion and patient-centered care that I feel contributes to our strong patient outcomes.

Why did you decide to do the work you are doing now?
Scottish Rite for Children was my first job out of physical therapy school. I have worked here for four years now. I was drawn to sports physical therapy because it is a way to use my passion for learning about and understanding the human body – from injury to healing. It is great to know that my work can help to get an athlete back to doing what fulfills them.
 
What’s the coolest or most interesting thing you’re working on right now?
From a rehab to performance standpoint, I have been working on some sport-specific programming resources. I also work on the Keeping Up With the Count dance project, where we have created a variety of resources for the dance community.
 
What are you currently watching on Netflix/Hulu/TV/etc.? 
I watched Money Heist during quarantine and am about to start the Japanese anime series, Demon Slayer.
 
What would be the most amazing adventure to go on?
I would love to make it to Thailand and Bali in the next few years – explore their culture, architecture and tropical landscape!

Keeping Up With the Count – Among other clinical and injury prevention interests, Dabis works closely with a multi-disciplinary team providing patient care and content for young dancers.​

Preventing Injuries: What Young Dancers Need To Know

Preventing Injuries: What Young Dancers Need To Know

We asked sports medicine physical therapist Laura Saleem to tell us about hip injuries in dancers and how they can be prevented.

Why do dancers commonly have hip pain?
Dancers put their hips in extreme postures repeatedly and this can cause changes in the soft tissues and/or the bony structures in the hip joint. As a growing child, the body will go through changes EVERYWHERE. Bones and muscles are just trying to keep up. If there is an imbalance of bone, muscles and ligaments, pain can be quite common and cause greater issues if left untreated.

What advice do you give young dancers to prevent hip pain?

Core training is critical for dancers and many other athletes. A strong and well-positioned foundation allows the dancer to move with control and minimize injuries. Also, symmetrical flexibility and body awareness is important as most front split aspects are with the right leg forward. Be sure to work on the left as well! Finally, taking strategic rest breaks each week and throughout the year can reduce the risk of injury from overuse.

What can dancers do to improve body awareness?
Learning how to breathe is the first step to body awareness. Next, foundational activation to trigger core strength, improve posture and reduce improper loading through the spine.

When dancers begin to have hip pain, what is your recommendation?
When any athlete begins to have pain, it is important to recognize which moves are painful and the body’s response to the pain (swelling or continued pain after activity greater than one day). Never ignore the pain. Pain during and after activity should be evaluated, often rest is the first line of defense. Though an athlete never wants to stop their sport or activity, a short break at the first sign of pain can prevent significant complications. If the athlete has rested and returned to activity and the painful response continues, it would be best to see a medical provider and physical therapist for appropriate evaluation and treatment.

Learn more about sports physical therapy and find resources for dancers.