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Dance fitness article containing research findings from the IADMS.

International Association for Dance Medicine & Science. (2018). International Association for Dance Medicine & Science. [ONLINE] Available at: https://www.iadms.org/?. [Accessed 11 October 2018].

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The Skeletal System
The purpose of the skeletal system is to give you structure, movement and protection of vital organs. Without the skeletal system your body would not hold itself and would be like jelly. The system is made up of bones, cartilages, ligaments and other tissues.

6.1 The Functions of the Skeletal System | Anatomy & Physiology. 2018.

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6.1 The Functions of the Skeletal System | Anatomy & Physiology. 2018

Bones contain variable amounts of yellow and/or red bone marrow. Yellow bone marrow stores fat and red bone marrow is responsible for producing blood cells (hematopoiesis).

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Video describing the anatomy & physiology of skeleton system.

Published on Nov 24, (2015)

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Anatomy and Physiology of Skeletal System

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There are two basic types of Bone tissue :
Compact bone is dense and homogeneous and forms the walls of bone.
Spongy bone is composed of slender intertwined pieces of bone enclosing a space filled with non-bone tissue. It is found in the interior of normal bone.
Bones in their entirety can also be classified according to shape:
Long bones are longer than they are wide. All bones of the limbs except for the wrist and ankle bones are long bones.
Short bones are cube-shaped and are found in the wrist and ankle of the limbs.
Flat bones are thin and flat and often curved. These bones include some bones of the skull, the ribs and the sternum.
Irregular bones as their name suggests do not fit conveniently into any category according to their shape.

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Synovial joints allow for a number of different types of body movements. There are six types of synovial joints found at different locations in the body.

Pivot Joint: This joint permits rotational movement around a single axis. One bone is encircled by a ring formed by the other bone at the joint and a ligament. The bone that pivots may either rotate within the ring or the ring may rotate around the bone. The joint between the first and second cervical vertebrae near the base of the skull is an example of a pivot joint. It allows the head to turn from side to side.

Hinge Joint: This joint permits bending and straitening movements along one plane. Similar to a door hinge, movement is limited to a single direction. Examples of hinge joints include the elbow, knee, ankle, and joints between the bones of the fingers and toes.

Condyloid Joint: Several different types of movements are allowed by this type of joint including bending and straightening, side-to-side, and circular movements. One of the bones has an oval-shaped, or convex end (male surface) that fits into the depressed oval-shaped, or concave end (female surface) of another bone. This type of joint can be found between the radius bone of the forearm and bones of the wrist.

Saddle Joint: These distinct joints are very flexible, allowing for bending and straightening, side-to-side, and circular movements. The bones at these joints form what look like a rider on a saddle. One bone is turned inward at one end, while the other is turned outward. An example of a saddle joint is the thumb joint between the thumb and palm.

Plane Joint: Bones at this type of joint slide past each other in a gliding motion. The bones at plane joints are of similar size and the surfaces where the bones meet at the joint are nearly flat. These joints can be found between bones of the wrist and foot, as well as between the collar bone and shoulder blade.

Ball-and-Socket Joint: These joints allow the greatest degree of motion permitting bending and straitening, side-to-side, circular, and rotational movement. The end of one bone at this type of joint is rounded (ball) and fits into the cupped end (socket) of another bone. The hip and shoulder joints are examples of ball-and-socket joints.

Each of the different types of synovial joints allow for specialized movements that permit different degrees of motion. They may allow movement in a single direction only or movement along multiple planes depending on the type of joint. The range of motion of a joint is therefore limited by the type of joint and by its supporting ligaments and muscles.

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Published on Jul 9, 2015

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The Muscular System Explained In 6 Minutes

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Source G - Health & Well-being at The Royal Ballet School

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Source G - Health & Well-being at The Royal Ballet School

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Health screening and profiling

As part of this integrated approach to healthcare, students throughout the whole school undergo termly screening and profiling exercises, to gather research data and create individual conditioning programmes to support them in their training.

Sports science research

The school now uses a research database called Smartabase, to underpin the work of the Healthy Dancer Programme. Smartabase is used by healthcare teams at both The Royal Ballet and Birmingham Royal Ballet, which means our three organisations can collaborate, sharing research to contribute invaluable insights and expertise to the wider dance community.

We work with leading renowned institutions, such as Queen Mary University of London and St Mary's University, Twickenham, to achieve our aim to bring dance to the forefront of sports science.

The school is embedding research within its programme, including through a resident PhD in Sports Science. Fully understanding dancers' needs through this work means we can offer the best possible support.

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Healthy Dancer Programme - The Royal Ballet School

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Health screening and profiling As part of this integrated approach to healthcare, students throughout the whole school undergo termly screening and profiling exercises, to gather research data and create individual conditioning programmes to support them in their training. Sports science research The school now uses a research database called Smartabase, to underpin the work of the Healthy Dancer Programme.

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Source H - Health & Well-being at Elmhurst

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Source H - Health & Well-being at Elmhurst

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Information about all students Health and Wellbeing is shared and discussed during weekly Student Health and Welfare Meetings (SHWM), which is made up of a cross faculty team and designed to offer the students the best support possible when dealing with an on-going health or injury issue.

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Source I - Health & Well-being at Urdang

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Source I - Health & Well-being at Urdang

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Urdang's high-quality training is fierce and challenging but our fierceness never comes at the cost of our students' health.

Our student care programme ensures that we target all aspects of our students' wellbeing, not just their development into strong, versatile performers.

Pastoral Care

Our reputation is built on an ethos of caring and nurturing individuals and this care has been recognised as outstanding by Ofsted.

Urdang places the utmost importance on the pastoral care of its students, conscious that for many this will be their first time living away from home, with many new to London. The Academy's pastoral team provides student support and advice in many practical areas and can offer advice on accommodation, finance and related issues.

Urdang operates an open door policy so students may have private interviews with the Principal, the Pastoral Liaison Officers or other staff members on request.

Treatment Department

A performer's body needs to be kept in peak physical condition in order to cope with the demanding nature of training in the performing arts. It is Urdang's mission to keep our students' injuries to an absolute minimum.

Our team of therapists can attend to student injuries quickly and efficiently so that time away from training is minimised. The majority of injuries and accidents can be treated on-site in our fully equipped treatment facilities.

Osteopathy, Acupuncture, Pilates, Sports Massage make up the treatments on offer to help support student rehabilitation from injury. Our Treatment Department boasts an on-site Pilates studio which has a clinical Reformer/Tower and other various pieces of equipment. From January each year, all students are also offered rehabilitation classes.

Students are strongly advised to take out the private insurance option, which is offered to all new students during induction. Referrals to specialists and private hospital treatment may be needed in certain circumstances and the insurance option allows for quick and efficient specialist care.

Finding a Doctor

Once students have decided where to live they are then required to register with a General Practitioner Doctor (GP) in their area. Names and addresses of GPs in your area can be obtained from your hostel or local library. Students can also log on to www.nhs.uk and use the 'Find and choose services' link.

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Our student care programme ensures that we target all aspects of our students' wellbeing, not just their development into strong, versatile performers. Pastoral Care Our reputation is built on an ethos of caring and nurturing individuals and this care has been recognised as outstanding by Ofsted.

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Specialist medical advice for professional and student performing artists

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Caring for performers' health | BAPAM: British Association for Performing Arts Medicine

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Source K - Authoritarian Vs Non-Authoritarian teaching methods 

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Source K - Authoritarian Vs Non-Authoritarian teaching methods 

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Authoritarian Vs Non-Authoritarian Teaching Methods, V2

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From over 40,000 educational tutorials at Sophia.org

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Smore. (2018). Health & Skill Related | Smore Newsletters for Education.

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Static Stretching

Static stretching is most often recommended for general fitness. With this type, you slowly ease into the position and hold for 10 to 30 seconds before slowly releasing the stretch. Static stretching should be performed with warm muscles, such as after a warm-up or at the end of a workout. There are two forms of static stretching.

Active Static: This form of stretching is used in yoga and martial arts. The stretch is held by the strength of agonist muscles (muscles responsible for the movement). Think of the stretch across the upper body during the Warrior II pose in yoga. Your arms are extended as your back, chest, and shoulders are stretched. The muscles of the arms and shoulders are the agonist muscles that allow you to hold this stretch.

Passive Static: During this type of stretching, you hold the limb to perform the stretch without any assistance such as a bar or bands. Think of a standing quadriceps stretch in which you bend your leg behind you and hold the foot, pulling the heel in close to your bottom, which stretches the front of the upper thigh.

Dynamic Stretching
Dynamic stretching is stretching with movement. The body transitions gradually into a position and this movement is repeated as you increase your reach and range of motion. If you have ever taken a group exercise class, you have likely engaged in dynamic stretching. Movements such as alternating knee lifts repeatedly stretch the hamstrings while keeping the body in motion. Research has found that dynamic stretching is less beneficial than static stretching for increasing range of motion, but unlike static stretching, it is ideal during the pre-workout phase because it gently warms muscles while also stretching them.

PNF Stretching
PNF stands for Proprioceptive Neuromuscular Facilitation. This type of stretching is often referred to as partner stretching because two people are needed to perform the movements. There are many forms of PNF, but most involve an isometric hold followed by a static stretch of the same muscle group. An example of PNF is a hamstring stretch where one person lies on her back with the right leg extended straight up into the air. The second person grasps the ankle and gently presses the leg towards the other person’s head to stretch the hamstring. The pressure is released and then the stretch is repeated.

While PNF is as effective as static stretching for improving range of motion, it is less practical because of the necessity of a partner. It is most often used in clinical and fitness settings for training and rehabilitation.

Ballistic Stretching
This type of stretching uses bouncing movements to create momentum which moves the muscle into the stretch. For example, instead of holding a hamstring stretch you would quickly reach towards your toes and release repeatedly in short bursts of movement. Fitness trainers have long been warned about the dangers of ballistic stretching because it can cause a stretch reflex that injures the muscle. Current recommendations from the ACSM state that ballistic stretching can improve flexibility as well as static stretching when it is performed properly. It is best considered for those participating in ballistic exercises such as basketball and other athletics.

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Kidshealth.org (2018)

Female athlete triad is a combination of three conditions: disordered eating, amenorrhea, and osteoporosis. A female athlete can have one, two, or all three parts of the triad.

Triad Factor #1: Disordered Eating

Most girls with female athlete triad try to lose weight as a way to improve their athletic performance. The disordered eating that accompanies female athlete triad can range from not eating enough calories to keep up with energy demands to avoiding certain types of food the athlete thinks are "bad" (such as foods containing fat) to serious eating disorders like anorexia nervosa or bulimia nervosa.

Triad Factor #2: Amenorrhea

Exercising intensely and not eating enough calories can lead to decreases in the hormones that help regulate the menstrual cycle. As a result, a girl's periods may become irregular or stop altogether. Of course, it's normal for teens to occasionally miss periods, especially in the first year. A missed period does not automatically mean female athlete triad. It could mean something else is going on, like pregnancy or a medical condition.
Some girls who participate intensively in sports may never even get their first period because they've been training so hard. Others may have had periods, but once they increase their training and change their eating habits, their periods may stop.

Triad Factor #3: Osteoporosis

Estrogen is lower in girls with female athlete triad. Low estrogen levels and poor nutrition, especially low calcium intake, can lead to osteoporosis, the third aspect of the triad. Osteoporosis is a weakening of the bones due to the loss of bone density and improper bone formation. This condition can ruin a female athlete's career because it may lead to stress fractures and other injuries.

Usually, the teen years are a time when girls should be building up their bone mass to their highest levels — called peak bone mass. Not getting enough calcium now can also have a lasting effect on how strong a woman's bones are later in life.

Who Gets Female Athlete Triad?

Many girls have concerns about the size and shape of their bodies. But being a highly competitive athlete and participating in a sport that requires you to train extra hard can increase that worry.
Girls with female athlete triad often care so much about their sports that they would do almost anything to improve their performance. Martial arts and rowing are examples of sports that classify athletes by weight class, so focusing on weight becomes an important part of the training program and can put a girl at risk for disordered eating.

Participation in activities where a thin appearance is valued such a Ballet can also put a girl at risk for female athlete triad. Sports such as gymnastics, figure skating and diving are examples of sports that value a thin, lean body shape. Some athletes may even be told by coaches or judges that losing weight would improve their scores.

Even in sports where body size and shape aren't as important, such as distance running and cross-country skiing, girls may be pressured by teammates, parents, partners, and coaches who mistakenly believe that "losing just a few pounds" could improve their performance.

The truth is, losing those few pounds generally doesn't improve performance at all. People who are fit and active enough to compete in sports generally have more muscle than fat, so it's the muscle that gets starved when a girl cuts back on food. Plus, if a girl loses weight when she doesn't need to, it interferes with healthy body processes such as menstruation and bone development.
In addition, for some competitive female athletes, problems such as low self-esteem, a tendency toward perfectionism, and family stress place them at risk for disordered eating.

What Are the Signs and Symptoms?

If a girl has risk factors for female athlete triad, she may already be experiencing some symptoms and signs of the disorder, such as:

weight loss

no periods or irregular periods

fatigue and decreased ability to concentrate

stress fractures (fractures that occur even if a person hasn't had a significant injury)

other injuries

Girls with female athlete triad often have signs and symptoms of eating disorders, such as:

continued dieting in spite of weight loss

preoccupation with food and weight

frequent trips to the bathroom during and after meals

using laxatives

brittle hair or nails

dental cavities because in girls with bulimia tooth enamel is worn away by frequent vomiting

sensitivity to cold

low heart rate and blood pressure

heart irregularities and chest pain

How Doctors Help

An extensive physical examination is a crucial part of diagnosing female athlete triad. A doctor who thinks a girl has female athlete triad will probably ask questions about her periods, her nutrition and exercise habits, any medications she takes, and her feelings about her body. This is called the medical history.

Poor nutrition can also affect the body in many ways, so a doctor might order blood tests to check for anemia and other problems associated with the triad. The doctor also will check for medical reasons why a girl may be losing weight and missing her periods. Because osteoporosis can put someone at higher risk for bone fractures, the doctor may also request tests to measure bone density.

Doctors don't work alone to help a girl with female athlete triad. Coaches and trainers, parents, physical therapists, pediatricians and adolescent medicine specialists, sports medicine doctors, nutritionists and dietitians, and mental health specialists can all work together to treat the physical and emotional problems that a girl with female athlete triad faces.

It might be tempting to shrug off several months of missed periods, but getting help right away is important. In the short term, female athlete triad may lead to reduced physical performance, stress fractures, and other injuries. Over the long term, it can cause bone weakness, long-term effects on the reproductive system, and heart problems.

A girl who is recovering from female athlete triad might work with a dietitian to help reach and maintain a healthy weight while eating enough calories and nutrients for health and good athletic performance. Depending on how much the girl is exercising, she may have to reduce the length of her workouts. Talking to a psychologist or therapist can help her deal with depression, pressure from coaches or family members, or low self-esteem and can help her find ways to deal with her problems other than restricting food intake or exercising excessively.

Some girls may need to take hormones to supply their bodies with estrogen to help prevent further bone loss. Calcium and vitamin D supplementation can also help when someone has bone loss as the result of female athlete triad.

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Resource on nutrition from the International Association for Dance Medicine & Science

The recommendations below offer basic guidelines which have been adapted from sports nutrition research. A specialist should be consulted for a personalized nutrition prescription. Remember that a dancer’s needs are unique and sometimes nutritional choices are influenced by medical conditions. In general, the energy in a dancer’s diet should be composed of about 55%-60% carbohydrates (CHO), 12%-15% proteins (P) and 20%-30% fats (F). CHO, F, and P are necessary components the human body needs to maintain normal physiologic function.  All dancers need to ingest sufficient energy to meet the rigors of training. Consuming the right amounts and types of food and fluid will provide the body with the “high performance fuel” necessary to achieve optimal training benefits and peak performance. Because every person is different, many factors including food intolerances, allergies, cultural and religious reasons affecting food choice must be taken into consideration when devising any dietary program. Not only is what a dancer eats important, but when and how much needs to be critically evaluated as well.

Recommendations for dancers vary slightly compared to non-athletic adults whose intake would be more varied: 45%–65% CHO, 20%–35% F, and 10%–35% P.  Protein is recommended in absolute amounts. The recommended dietary allowance (RDA) for protein is 46g/day for women and 56 g/day for men or 0.8 g/kg body weight of P (1kg=2.2lb).11 Female dancers are advised to aim for 1g protein per kg body weight, while male dancers should aim for 1.5g protein per kg body weight and up to 2g per kg body weight if aiming to increase muscle mass.  For more information on carbohydrates, proteins and fats scroll down through the paper.  Each section contains reference charts with recommended amounts for typical foods in the group.
In addition, reading food labels or using nutrition apps can help roughly calculate the day’s nutrients. Limiting or restricting any macronutrient [fats, proteins or carbohydrates] group decreases feelings of fullness (satiety), both during the meal and thereafter. A combination of each nutrient in the right proportion is best in order for the correct signaling between the body and brain to occur. Each nutrient has a unique contribution to the body so over- or under- consuming one or another nutrient is not beneficial.  On the other hand, under consumption of food is detrimental to bone health as well as energy levels.

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CARBOHYDRATES
Glucose (simple sugar) is the sole fuel for the brain and a major fuel, together with glycogen, in the muscles.  CHO are broken down into glucose in the digestive tract to be used to maintain blood sugar levels, to fuel the brain and are also stored in muscle (350g to 400g) and in the liver (100g) in the form of glycogen. However the body storage of glucose (glycogen) is limited and sugars are converted to fat when the reserves are filled. CHO supply is critical for strength and endurance.
Not all CHOs and sugars have equivalent nutritional value.  Dancers tend to think that all CHO and sugars are inherently bad, are the source of empty calories (i.e. calories with no vitamins, minerals, or protein) and cause weight gain, but this is not true. Many foods contain CHO, in the form of starches and sugars found naturally within the food. Those foods where the CHO (whether sugar or starch)  is more processed, for example, white bread, white rice, cookies/biscuits, fruit juice, sweets, sweet drinks,  and chocolate, are generally less helpful to dancers than those which are less processed.  The more the food is processed, the fewer the micronutrients it contains. More processed foods contain fewer micronutrients and are easier to over consume.  Nutrient dense foods sustain energy and physiologic processes better over time. Dancers are advised to be careful about consuming too few CHO when they are in rigorous training or performance as insufficient CHO consumption compromises the ability to sustain energy which contributes to fatigue. As a guide dancers will typically need between 4 and 8 grams of carbohydrate per kg body weight. This will vary according to the duration and intensity of the workload, and at times may be even higher (during long or intense rehearsals or demanding pieces).

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FAT
Why do we need fat?  A mix of fat and glucose is needed for energy during exercise and at rest. Dietary fat is essential for the regulation of multiple physiologic systems; it is needed for the absorption of fat soluble vitamins, and is an important fuel for muscles.  Fat is stored in the body in muscle and adipose (fat) tissue in the form of triglycerides which are broken down during exercise into fatty acids that produce energy for muscles. Fat is the primary fuel used in aerobic exercise.  Accordingly, one needs fat to burn fat. Fat should be consumed in moderation so the dancer can meet their carbohydrate needs.  Excessive fat intake at a given meal will have a negative impact on the dancer’s ability to perform fully in class right after the meal as it sits in the stomach for several hours.
Like CHO, however, not all fat from food is the same.  Fat can be derived from either animal or plant sources. A cheeseburger with bacon and french fries has a completely different nutrient profile than a meal that includes salmon, brown rice and a salad with avocado. All fats have high calories and can contribute to weight gain if not eaten in moderation; therefore it is important to consider how much fat is eaten on a regular basis. A diet too low in fat can have serious health consequences and ultimately impair performance.
Fats can broadly be divided into saturated and unsaturated based on their chemical structure. While unsaturated fats tend to be found in fish, nuts and seeds, and other plant sources, saturated fats tend to be found in foods of animal origin as well as some manufactured foods. Diets high in some types of saturated fats and/or trans-fats have been shown to contribute to heart disease and cancer.
Processed or fast foods tend to be high in trans-fats and many countries have public health campaigns underway to reduce trans-fatty acid contents in foods. The US FDA has banned trans-fat ingredients from foods.  This change will take place within the next few years.  Restricting trans-fatty acid intake with continued emphasis on restricting saturated fat intake is recommended.

While many dancers consume cheeses and full fat dairy products to obtain essential nutrients, these should be consumed in moderation knowing that dairy products also are high in fat.  Again, balance is recommended.  Foods high in the omega fats play a role in overall cardiovascular health, brain function, and mood. An array of omega-3 and 6 fats are essential to a balanced diet; good sources of omega-3 fats are derived from oily fish, some nuts, linseed/flaxseed oil, and canola oil, whereas omega-6 fats may be found in vegetable oils. Diets high in the omega fats are beneficial to cholesterol management and heart health.
Research on fat is active and guidance in this area is likely to change. The amount of daily fat needed is approximately 1g per kg body weight, which means that a 50kg female dancer (110 pounds) should eat 45-50g fat over the course of a day, while a 70kg male dancer (154 pounds) should consume around 6570g fat each day.  However, if the dietary goal is weight loss then amounts may need to be lower.

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PROTEIN
Protein is a macronutrient and is composed of amino acids, some essential (cannot be made in the human body) and other non-essential (can be made in the body). Amino acids are responsible for the growth of every component and maintenance of every basic function in the human body.  Amino acids are used as supplemental fuel to CHO and F (especially when energy supply is insufficient). From the dancer’s perspective the importance of protein is its role in repairing muscle fibers that are stressed by constant use in dancing and related activities. Protein is also necessary for bone health.
Protein needs are based on body weight rather than on energy requirements for activity. Essential amino acids have to be supplied by food sources which can be derived from either animal or plant sources. Animal proteins provide the most complete array of amino acids, have a higher satiating effect and are more filling because they take longer to digest. Diets higher in protein preserve lean body mass during weight loss. Dancers and athletes are sometimes under the impression that consuming protein powders as a supplement will give them a performance edge or serve as a meal replacement that could be better than food. There is no magic to protein supplements – they deliver good quality protein -- nothing more or less.  If considering the addition of commercial protein powders, dancers are advised to understand why they are taking them and to verify that the supplements actually contain the ingredients as advertised on the label.  Information on purity, safety and contamination guidelines for protein powders can be found online at www.informed-sport.com.

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Vitamins and minerals
Vitamins and mineralscomprise the micronutrients in the diet from a wide variety of food and all play a key role in maintaining every system and organ in the body. Overconsumption can be equally as dangerous as deficiency. Minerals are classified into macro minerals and micro minerals (trace minerals). Although there is this division from a practical point of view they may be considered together, as intakes of all of them are at most a few grams per day (sodium and chloride), and other than calcium (around 1g per day), well under 1 g per day.  Many minerals are found in the body but only about 15 are currently known to be essential in our diet, although ongoing research may change this official position in the future. Iron and calcium will be discussed in more detail because of the importance of these minerals.

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Timing and digestion
Scheduling food intake (eating) is almost as important as the type of food and amount that is consumed.  It is important to factor in time for food digestion.  It is difficult to jump and turn comfortably with a full stomach of steak and eggs, for example, no matter how nutritious the meal.  Ideally an interval of 2-4 hours after eating is optimum to allow digestion to take place before dancing. However most dancers will have to cope with dancing while food is digesting because in the digestive process food takes at least an hour before it leaves the stomach and moves into the small intestine where absorption occurs. It is also nearly impossible to be adequately sustained for an entire day (with an afternoon technique class and evening rehearsal) on an unbalanced diet, whether too little or too much of any given nutrient. Therefore, dancers should research how to consume the type of foods and amounts that will not decrease, but increase the physical ability to perform well.  The skill is to learn how to balance timing and energy requirement.

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Performing Arts Medicine Association | About

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The Performing Arts Medicine Association was incorporated in 1988 by a group of physicians who had been involved individually with the medical care of musicians and dancers. The seeds for this organization were sown in 1983 at the first Symposium on the Medical Problems of Musicians in Aspen, Colorado.

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Source O - The Rudolf Nureyev Foundation 

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Source O - The Rudolf Nureyev Foundation 

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Health, wellbeing and performance of dancers - Rudolf Nureyev Foundation

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Official website of the Rudolf Nureyev Foundation

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