SPORTS MEDICINE

body and affecting the dancers’ technique. They can also obscure visual fields affecting proprioception. All these factors can have an impact on injury. By careful monitoring it is possible for medical teams to influence the impact of these factors. During David Bintley’s Beauty and the Beast (figure 1), dancers who played the principal role of the Beast were monitored for weight loss during the performance. The dancers lost an average 3.5kgs despite ingesting 2 litres of fluid. The consequence of feedback led to further ventilation being applied to the costume, as well as provision of isotonic drinks in the wings.

The role of epidemiology studies Part of the reason behind epidemiology studies is not only to pro- vide causal factors, but to also provide the basis for therapeutic intervention. There may be elements within the extrinsic factors that fall outside the influences of the medical teams. There may not be an opportunity to change a theatre’s stage, and some costumes have remained the same over a number of years. Even scheduling may be subject to availability of visiting overseas choreographers, yet the accountability of keeping dancers fit, healthy and on stage still remains. One solution is to maximise recovery. According to Nick Grantham (21) recovery needs to be considered a multi-factoral strategy, incorporating the refuelling, rehydration and recovery of the body systems from the effects of training and performance.

Post performance protocol Our approach follows a 60-minute timeline from the end of the last session. Immediately post session, we advocate rehydration with water and isotonic drink, as well as ingesting a small quantity of high glycaemic carbohydrate. Within 30 minutes, the dancer is advised to undertake between 8-12 minutes of 50-60% HRmax exercise either on spin bikes or in the hydrotherapy pool. This is followed by a static stretching period. The dancers are then advised to undertake either contrast or ice bathing (individual dancers choose which is best for them). We also advocate the use of compression garments. Finally, the dancers are advised to ensure they get a full meal within 60 minutes of completion of their session. Within the scheduling there is rarely an opportunity to have a full recovery day post performance and so adherence to the immediate recovery becomes even more important in dance.

INTRINSIC FACTORS The management of intrinsic factors relating to injury continues to provide challenges for the attending medical team. Bronner et al (5) define intrinsic factors as those relating to specific individual physical characteristics.

It is here that baseline profiling plays an integral part in devel- oping preventative strategies for dancers. At the Jerwood Centre dancers and athletes undergo a rigorous screening programme, which includes taking the following profiles: ■ a medical and injury profile ■ functional movement profile ■ musculo-skeletal profile ■ physiological and anthropometric profile ■ core-stability profile ■ soft tissue profile.

These findings are then collated and form the basis of an 8

individualised development programme aimed at performance enhancement.

The underlying principal of management of the dancer as a result of the screening then becomes very simple. Forces naturally have to be absorbed through lever systems in the body to provide movement. If one of the sections along the ‘kinetic chain’ is not accepting its share of the work, it can result in energy loss, leading to a decrease in performance and the possibility of injury and so becomes the target area for conditioning and rehabilitation. There may also be occasions where, although no areas of significant energy losses are detected, establishing gains at various points of the chain eg. improvement in ankle, knee and hip strength, can lead to an overall improvement of performance. On a psychological note, it is much easier to sell an idea of performance enhancement than injury prevention, particularly to an athlete or dancer who has not had a significant injury.

Conditioning versus skill A key consideration when looking at the management of intrinsic factors in dancers as opposed to most athletes relates to the relationship between strength/fitness and skill.

With a finite amount of time available for training, both athletes and dancers are required to balance the amount of work done between strength and fitness and that of skill acquisition. Athletes tend to move into their chosen sporting discipline later in life compared with dancers, who usually begin around the age of eight and may have moved into vocational school training by the age of 11. Athletes tend to have a good general base of strength and fitness, while their skill acquisition is developing. Dancers by the nature of their training utilise a principal of repeated movements, leading to the development of an exceptional level of skill, performing tasks with an incredible efficiency. This has a two-fold effect, increasing the skill level that they ultimately then rely on to protect from injury, but through the efficiency of movement minimise a possible training effect due to the diminished overload principle.

However if a situation arises that prevents a dancer from performing that “perfect move”, for example the extrinsic factors previously mentioned, they often lack the underlying strength and fitness to protect them further. The opposite can be true of many athletes. Although athletes may not exhibit the perfect efficiency of movement, their protection from the “poorer biomechanical movement” is afforded by their underlying strength and fitness. But this will obviously only protect them so long, and prolonged or intense loading can result in injury.

This is by no means a criticism against athletes or dancers, but an analysis of risk factors whereby solutions can be implemented. As indicated previously, there only exists a finite amount of time in a day from which training and gains can be made, the balance of which needs to be examined, particularly in the presence of injury or identified risks as a result of screening.

CONCLUSION While the dance world may feel a disparity between itself and sport, the role of the medical team is to recognise the athletic needs of these highly skilled individuals, but to apply the same

sportEX medicine 2008;35(Jan):6-9