The heartfelt production looks at the aftermath of an intimate encounter between two Princeton college students, Tom and Amber, in a “he said, she said” storyline that examines the topic of consent.

“I am honored and elated to bring Anna Ziegler’s profoundly gripping story to life at The

Wayward Artist,” said Sydney Fitzgerald, director of the production, “I couldn’t help but fall in love as the two immensely detailed characters uncover layers of themselves in this riveting, poignant, and compassionate drama.”

According to playwright Anna Ziegler, “Actually” looks at how difficult it can be to determine what happened in a bed between two real people capable of all that humans are capable of – obfuscating, deceiving themselves, not understanding, not wanting to be impolite, or to embarrass themselves, or letting need or insecurity take precedence over empathy.

‘Actually’

Where: Grand Central Arts Center, 125 N. Broadway, Santa Ana

When: November 11 – November 20, Thursday-Saturday at 7:30 p.m., Sundays at 2 p.m.

For mature audiences only

More info: http://www.thewaywardartist.org/

The post Play examines the topic of consent in ‘Actually’ appeared first on Backstage Socal.

You are tired.

Dance seems more mechanical as your muscles feel heavy.

Jumps aren’t as high; turns aren’t as crisp.

Dance isn’t fun right now, just as requests for more classes and privates are being thrown your way.

You wonder, “What is best?” Should I make time for extra dance sessions or put that time into sleep and even a day off from dance?

When tired and choosing between sleep, an extra class, or even an extra recovery session, it is best to choose the extra time for sleep.

When tired and choosing between a day off, an extra class or an extra day of privates on top of regular dance sessions, it is best to choose taking the day away from dance.

Taking time off from dance can often happen in 2 ways.

The first and most sensible option involves scheduled and observed time off for recovery and rejuvenation.

Or a dancer could be forced into a second less desirable scenario – taking unanticipated time off due to injury or not being cast for roles due to underperformance.

When presented in this fashion, most dancers would readily select their time off before that time is selected for them.

Let’s take some time to further explore the importance of time off in the dance community.

The culture of dance puts an emphasis on skill acquisition through repetition. Repetition means practice, rehearsal, and more practice involving technique and choreography classes with privates or small group sessions routinely thrown in. Getting closer to a show or audition often means more rehearsals and more pressure to hone technique and company cohesion. The goals of these sessions are to build strength and endurance to enhance timing and overall technique. Taking time off brings a fear of losing those skills or falling behind other dancers.

So, in a culture focused on thin margins between getting cast or not, or nailing difficult routines, “what is best?” Is it getting in the extra work or putting extra time into sleep and rest?

When tired and choosing between sleep, an extra class, or even an extra recovery session, it is best to choose the extra time for sleep.

When tired and choosing between a day off, an extra class or an extra day of privates on top of regular dance sessions, it is best to choose taking the day away from dance.

So why practice the pause?

• A tired dancer runs the risk of injury and underperformance.

• Tired dancers take longer to maintain high level dance or learn new routines.

• Dancers who are tired have more muscle soreness and bone/joint pains.

• Many dance injuries occur late in a class or later in the evening due to fatigue.

• Tired dances aren’t just at risk for injuries on the dance floor. I have worked with far too many tired dancers who trip and fall or get into car accidents after leaving the studio late at night during tech or dress rehearsal weeks.

• Rested dancers learn more things in a shorter time.

• Rested dancers feel better, leap better, and enjoy their dance experiences.

• Good science teaches that high level performers, such as dancers, perform the best with a consistent and solid 7-8 hours of sleep a night. Consistent means just about every night – not “an average” or “I’ll make up sleep after the show is over.” Solid means restful sleep – not tossing/turning, lying awake, or snoring throughout the night.

RELATED TOPIC: Many things can get in the way of restful sleep:

• Too much caffeine, or too late in the day (after 12 noon can be too late)
• Alcohol (can help get to sleep but may cause awakenings)
• Nicotine (acts as a stimulant that keeps you awake)
• Snoring or gasping
• Anxiety (can’t get thoughts out of head or “calm down” enough to fall asleep)
• Muscle or joint pain (can’t find a comfortable position)
• Unfamiliar beds or rooms (dancer on tour)
• Screen and device use (especially in the hour before bedtime)

Click here for additional information on Effective Sleep for High Performance

Life outside of dance also plays a role in sleep and time away.

Dancers still in school must balance classwork, papers, projects, and exams.

Work schedules influence recovery times, as does a necessary social life off the dance floor.

How does a dancer balance out all these commitments?

By making sleep and time away a true priority and by planning ahead.

• One sleep enhancing suggestion: block out an 8-hour window every day for sleep. Don’t let anything get in the way – not an extra class, or the newest streaming movie, or even a later night with friends.
• Silence devices and put them on night mode.
• Blocking out that 8 hours of sleep will put a priority on your health and ability to continue high-level dance.

One way to get time away is to plan and keep days off.

• Take at least one full day off from dance and make it a true day off.

• No “extra” privates or “quick run throughs” with friends.

• Do non-dance things- get yourself recharged.

We’ll close with a bit more repetition on the importance of sleep and time away.

When tired and choosing between sleep, an extra class, or even an extra recovery session, it is best to choose the extra time for sleep.

When tired and choosing between a day off, an extra class or an extra day of privates on top of regular dance sessions, it is best to choose taking the day away from dance.

Dr. Chris Koutures is a dual board-certified pediatric and sports medicine specialist who practices at ActiveKidMD in Anaheim Hills, CA. He is a team physician for USA Volleyball (including participating in the 2008 Beijing Olympics), the U.S. Figure Skating Sports Medicine Network, Cal State Fullerton Intercollegiate Athletics, and the Chapman University Dance Department. He offers a comprehensive blend of general pediatric and sport medicine care with an individualized approach to each patient and family. Please visit activekidmd.com or follow him on Facebook (https://www.facebook.com/activekidmd/), Instagram (https://www.instagram.com/activekidmd/), or Twitter (@dockoutures).

The post Rest Is Best: How Sleep and Taking Time Off Improves Athleticism appeared first on Backstage Socal.

When COVID-19 and social distancing became the norm, people stopped going to movie theaters, and, as The Hollywood Reporter notes, the result was a major hit on the entertainment industry. Now, it’s a slow recovery. If this applies to you, remember that all is not lost. While we wait out the final throes of the pandemic, there are many work-from-home jobs that you can do to make money – and those might end up being gigs you maintain for supplemental income, even after things have fully returned to normal.

Here at Backstage SoCal, we understand the current struggle within the industry, so we have some tips on how to find work during these troubling times.

Writing Jobs

If there is any good news about the current situation, it is that many industry types bring different skills to the entertainment business, and those skills can be used in the real world as well. For instance, if you were a writer on set, you can easily make money as a freelance writer at home.

Anything that appears online or in print has to be written by someone, so you could make money writing anything from product descriptions to textbooks. Many corporate websites are working to build their online presence through entertaining and educational blogs, so you could make money writing those as well. If you were providing content for movie posters and things of that type, you could translate that talent into a marketing career as well.

Music Jobs

If you worked as a composer or sound designer in the entertainment industry or you just have a love for music in general, then there are several remote jobs that you could do in that arena as well.

The most obvious job is that of a music teacher or tutor. You can give lessons by either teaching people at their homes or by practicing with them over an online platform like Zoom. There is also the opportunity that you could teach people to write music or lyrics, and you could always use the time you have now to write your own musical.

Various Positions

Of course, you don’t need to be an expert in any specific field to get an at-home job during the pandemic as there are plenty of options out there from which to choose. For instance, many people are working as medical billers or data entry specialists from their residence. There is also a big need for customer service people to assist customers over call, chat, and email. 

There are also many jobs available at major retailers like Amazon, including package delivery and HR assistant positions. It isn’t always the most luxurious work but it will pay the bills.

Building Your Business

In many cases, you will be doing these jobs for a larger company that provides you with jobs and handles your pay. However, if you ever feel a passion for any of these jobs and you want to continue long-term, you can consider starting your own business. 

One of the first steps of launching is choosing your type of business structure, whether that be an LLC, sole proprietorship, corporation, or partnership. Many entrepreneurs opt to farm out the process of filing all the paperwork to a formation service. Some services are more affordable than others; those that are reasonably priced have stand-alone rates and don’t need discounts like you find with a Legalzoom promo code for that higher-priced service. It’s best to compare not just costs, but the amount of support you’ll get for the life of your business.

If you do decide to launch your own venture, you’ll need to get your own clients and customers, which is where networking is key. You can start by spreading the word about your business on social media and by studying the approach of your competitors. You can also entice people to want to sign up with your business by offering discounts and promotional items that will get them excited about coming to you rather than a competitor. Just remember that once you have a new client, you will want to do your best work so you can retain them for years to come.

The importance of having a strong social media presence cannot be overstated. The number of users on platforms like Instagram and Facebook is staggering. YouTube is no slouch, either, with 2.6 billion active users according to Statista. Fortunately, creating a YouTube channel with advertising is easy. By picking a YouTube banner template, you’re able to generate a banner ad with your customized messaging for free. It’s quick, and you’re assured that the platform’s sizing and other requirements are met.

While you will undoubtedly be excited when the world fully returns to normal, the jobs described here can help address your financial needs in the meantime. And who knows? Maybe this new career will be a better fit for you!

The post Ask the Experts: How to Find Work-At-Home Opportunities in Entertainment appeared first on Backstage Socal.

1. Holidays can be a Needed Recovery Time: If you had a particularly demanding Fall dance season, taking a break from dance can be the best gift for overall health. Now, I’m not advocating a total shut down status, but rather recommend taking any available opportunities for cross training, including yoga, Pilates, and gyrotonics. If you “must” dance, think about working on technical and strength skills that you don’t usually have time to address.
2. Strike a Solid Balance: Many traditional holiday dishes aren’t perhaps the most nutritious offerings. However, if you try to balance out the table with other selections that are more beneficial for overall health, you can still enjoy the unique offerings of the holiday.
3. Limit the Pre-Meal Snacking: Leave plenty of room for that holiday feast by reducing pre-meal snacks that might be tasty but commonly are full of unneeded salt, sugar, or unhealthy fats.
4. Slow Down and Slim Down at Mealtime: With a bounty of tantalizing foods, many people load up plates with large servings and then hurry through a first course to get to a second (or more) course. Use the size of your fist as a guide for a more proper serving size. Try to slow down between bites and wait for at least 20 minutes before going for another plate. Giving more time allows for a sense of fullness and less chance of overeating.
5. Make choices to Boost your Immune System: Vitamin C (commonly found in citrus fruits) can be beneficial for fighting infection, as can other anti-inflammatory items such as fish oil, flaxseed, ginger, and turmeric. Reducing processed foods and high sugar-content foods (can be tough with holiday sweets) can also be good for the immune system. Remember that moderate levels of exercise (4-5 days a week, 30-45 minutes a day) can support a stronger immune system.
6. Take the Family for a Turkey Walk Off: Speaking of exercise, rather than succumb to that post-Turkey nap, gather up family and friends and go for a brisk walk between meal and dessert. This will help overcome that food coma and give you more energy for the rest of the day.
7. Shop for Good Fitness: From grocery store runs to finding perfect gifts, shopping trips are another beloved staple of the holidays. While many might covet that prized close parking spot, parking the car farther away and getting in more steps can be a fitness bonus. If you are one to line up for precious deals, don’t be afraid to pass the time with exercise (push-ups, air squats, and even balancing on one foot) rather than just sitting or standing around. If you aren’t rushing to a particular sale, take time to window shop for 10-15 minutes before entering stores. Use the stairs instead of escalators or elevators and step up your shopping fitness for all year round.
8. Keep regular bedtimes and good sleep habits: During breaks from dance, school, and work, getting out of usual sleep routines can lead to less sleep and nightmares for the immune system. Younger children with less than 9-10 hours of sleep a night and teenagers with less than 8 hours of sleep are at higher risk for both illness and injury.
9. Be Truly Thankful: Part of good holiday health and fitness is the mental and emotional boost that comes from taking time to give appropriate thanks, especially for important people in your life.

The post Athletes & Dancers: How to Eat, Drink & Still Be Healthy Over the Holidays appeared first on Backstage Socal.

The end result is a tall dancer who bends more at the waist or hips instead of getting low enough by bending the knees and the ankles to get a strong, powerful stride. Dancers spend most of their dancing time with our feet pointed, known as plantar flexion. Because of the amount of time they spend with feet pointed, the result may be an imbalance in ankle mobility and limited range of motion when a dancer’s foot is in dorsiflexion or flexed upward

There’s little doubt that pain in the ankle is quite often ignored by dancers. The way the ankle moves or doesn’t move can not only affect the joint causing pain and injury but can also limit a dancer’s ability to get in certain positions needed to be successful in their performance. Mobility in the joint is the ability of the joint to move through a range of motion both unloaded and loaded.

In other words, a dancer may be able to gain certain range of motion, but can they do it
while jumping, landing, or pushing off. These motions are important in dance and other sports. The ankle does not have to be injured to lose mobility. Mobility in the ankle is the range of motion in the joint both weighted and unweighted and with the knee straight and bent. In healthy dancers, this mobility can be restricted by tight muscles in the calves. This can be due to recent growth spurts, an increase in intensity during dance or training such as running or jumping or just body type.

There is a myth that you should never get your knees over your toes. Look at most dancers and other athletes when they run, skate, dance, and jump. The knee slightly or sometimes extremely goes over the toes. When performing simple movement patterns such as squats or lunges, the knees need to go slightly over the toes to engage the proper muscles to maximize performance.

There are two major muscle groups that affect ankle mobility, the soleus and the gastrocnemius. Both muscles plantar flex the ankle as in performing a calf raise. In dancers, they assist in jumping and dancing as the movement typically finishes with the push off at the ankle. The big difference between the two is that the soleus originates below the knee whereas the gastrocnemius originates above the knee. Knowing this is important, because the dancer will need to stretch the ankle with both the knee straight and the knee bent.

So how do you know if your ankle mobility is restricted? A simple test is to place your foot flat on the ground and pointing forward with your toes approximately three inches from the wall.

You should be able to squat down a bit, bending your ankle forward (dorsiflexion) and touch your knee to the wall without lifting your heel or your ankle rolling inward. In this position, the front leg which is being tested, should have some weight on it and you should be able to bend down and forward getting the knee over the toes. Check both sides and look for symmetry. If you are unable to perform this easily, you may have limited ankle mobility.

Why is it important for a dancer to have improved range of motion in their ankles?
Decreased risk of injury
Peak mobility – better movement in your ankles for footwork patterns
Optimal stability – more stability = improved power
If you have failed the test mentioned above, there are a few simple things you can do to improve your ankle stability.

1. First, use a foam roll or lacrosse ball and roll out your calves from your Achilles all the way up to your knee to loosen the soft tissue. Then repeat the testing procedure, also known as ankle rocks ten times pausing each time you have rocked forward.
2. Add a calf stretch as well by placing your foot flat on the ground behind you with a straight leg, feeling the stretch up higher this time. Hold this stretch for 15 seconds.
3. Repeat these steps three times daily on the road to increased ankle mobility and better, more graceful dance moves.

No one wants to be that injured dancer. No dancer wants to miss time, let down the troupe, be unavailable to win the upcoming competition or not get the next big role.
Deciding between usual dancer discomfort and more serious problems can be challenging. Don’t take on that challenge by yourself. If concerns are on the floor, look at teaming with a sports medicine specialist as a way to add, not subtract from your dance experience. It’s always good to work with a healthcare professional such as an Athletic Trainer to make sure the dancer is doing movements correctly.

Chris Phillips is an Athletic Trainer, Strength and Conditioning Specialist and Sports Safety Specialist with over 25 years’ experience in professional hockey, football, dance, cheerleading, and soccer. Chris has worked with hundreds of professional, Olympic and Hall of Fame athletes and is the owner of Compete Sports Performance and Rehab in Lake Forest, California. For more information, visit http://competesportsperformance.com/

The post Dancers: How to Improve Ankle Mobility and Performance appeared first on Backstage Socal.

Active Fun in the Sun

Exercising doesn’t have to be boring, but sometimes it feels that way when you’ve done the same workout day after day. Getting outside is one way to beat that boredom. Now that you call 

Orange County home, you can find plenty of activities to do under the sun that will give you a good workout. Here are some of the best ways to get outside and get your body moving.

Surfing and Paddleboarding

Huntington Beach offers lovely beaches where you can fish and learn to paddleboard. Don’t be afraid to get creative and try new things. For instance, if you’ve never been surfing or kitesurfing before, consider taking surfing lessons here. Several beaches in the Orange County area also offer classes for all ages, and it’s a great workout for the entire body.

Horseback Riding

Riding on horseback works your entire core, so it’s a wonderful workout for your back, pelvic area, and abs. It’s also something you can do with the entire family, making it a perfect activity for the weekend that will allow you to have fun while getting in shape. 

Dog Walking

It can be difficult for new arrivals to the city to find time to workout amid crazy work schedules, so combining exercise with daily activities is ideal. Dogs need lots of exercise, so you can use your time wisely and find activities for both of you to do daily. This can include hiking, running along the beach, or walking through one of the many dog-friendly parks in Orange County.

Sites like OCDogFriendly.com not only list outdoor and indoor locations that welcome dogs, they also recommend adoption locations. If you are new to the city and don’t have a furry friend, why not adopt and learn about your new home together. After that workout, you can even grab a bite to eat at one of Orange County’s many dog friendly restaurants.

Take in Some History

There are plenty of historic locations in Orange County, and these are great places to get in some activity while learning about the amazing past of the place you now call home. Heritage Hill Historical Park and Founder’s Park offer several historical sites, such as the area’s oldest homes and churches and authentic adobes. Put on some comfortable shoes and get ready for an education while you put in your steps for the day.

Hiking

Orange County is famous for its gorgeous beaches with hiking trails, and there are several with different levels of difficulty. If you’re an experienced hiker, try Whiting Ranch, Santiago Canyon, and Ortega Highway. For easier trails, try Crystal Cove State Park, San Clemente, or of course, Huntington Beach.

With so much to do outdoors, you are sure to find ways to keep in shape. Not only that, you may make some new friends along the way. Orange County is not only a great place to stay active, but have tons of fun as well. You don’t have to wait until you are done unpacking. Get out there, explore, and have fun in your new home.

The post Active Fun Around Orange County: A Newcomer’s Guide appeared first on Backstage Socal.

Your goal is to make a return to the dance stage. What should you know and do to make as safe a comeback as possible?

Concerns about Covid in dancers

In many people who are exposed to Covid, there are no signs or symptoms of illness. For those who develop illness, there is a variety of symptoms that may include cough, elevated temperature, body aches, loss of taste/smell, fatigue, and chest pain. These symptoms maybe get better by themselves and last for just a few (2-3) days. In a smaller number of people, they may last longer or become so intense that hospital care may be needed.

Individuals who are exposed to Covid are recommended to quarantine at home for a minimum of 10 days. Those with symptoms are asked not to exercise until they are feeling better for at least 5 days (some mild fatigue or lasting loss of taste and smell is considered acceptable in allowing a return to exercise). If in quarantine due to exposure alone without development of symptoms, light exercise is allowed.

For most dancers, the time away from practice, strength training and performances is the biggest downside of exposure to Covid. These dancers need time to build up general fitness, strength and dance-specific movements before being able to return to the stage.

? KEY POINT: EASY FATIGUE IS SOMETHING TO TAKE SERIOUSLY- NOTIFY
YOUR MEDICAL TEAM IF YOU HAVE THIS AFTER COVID EXPOSURE

If there is any symptom that tends to stick around after Covid exposure, it is fatigue. We have seen patients that have had trouble walking across their apartment or doing basic schoolwork. This type of fatigue really gets a physician’s attention. Others are fine with regular life stuff but find themselves easy to tire when resuming exercise. This could be from that deconditioning, or perhaps from something more serious.

One of the most concerning challenges of Covid is the possibility of serious damage to the heart or lungs. Inflammation of the heart muscle, known as myocarditis, is a potentially life-threatening disease that can come after viral infections such as Covid.

Some of the first studies looking at Covid illness found an alarmingly high number of cases of myocarditis. While follow-up studies have thankfully showed a relatively lower number of identified myocarditis cases, the risk is still high enough to require additional evaluation before dancers return to practice, performances, and competition.

Inflammation of the small airways of the lungs, along with damage to other tissues, can also be a result of Covid exposure. This too can lead to easy fatigue as well as lasting cough and chest pressure. Dancers with previous lung issues, most namely asthma, might have more problems, including a worsening of asthma symptoms.

After Covid, get a medical evaluation before returning to dance. Once symptoms are fully or mostly gone, dancers should be evaluated by a medical provider and get written medical clearance before resuming any training, performance, or competition.

This is not just a formality for a team, company or school, but rather should be seen as an important opportunity to assess for lasting symptoms, the need for additional testing, and a sensible return plan.

The examination should be an in-person visit (telemedicine is not recommended) so that vital signs and a hands-on physical exam can take place. It is best to find a provider who has experience and the latest information in post-Covid return to dance evaluations.

Honesty is key during this evaluation. Don’t let the desire to get back to the dance stage silence any symptoms or concerns. Your immediate and long-term health are in play.

Make sure your medical professional is well aware of exactly when you first got sick or exposed, any/all symptoms that came up, and how things are currently doing. Report any past illnesses, such as heart issues, asthma, or diabetes that could have an effect on your recovery. The same goes for any medications that you used or are using.

In addition to the history and physical exam, additional testing may take place. Decisions to do additional testing are based on the number and length of Covid symptoms, longer-lasting fatigue, age/level of the dancer, and concerns found during the history and physical exam. The additional testing can include:

? Electrocardiogram (EKG) that looks at heart rate and shape/timing of the heart rhythm
? Troponin blood test (high in the event of heart muscle damage)
? Echocardiogram (ultrasound looking at size/shape of heart chambers, valves and blood
vessels, blood flow and pressures)
? Treadmill stress test that measures vitals and heart/lung function before and during
exercise
? Cardiac Magnetic Resonance Imaging (MRI) that takes an in-depth look at heart anatomy and blood flow within the heart muscle

Step-by-step return to dance

Once the medical evaluation is completed, clearance is given not just to immediately resume full activity, but rather that clearance is given to start a stepwise progression back to the dance stage. This return is done in stages to allow for reconditioning and also to watch for signs or symptoms of concern that did not come up before starting exercise.

The stepwise return starts with lower-level conditioning and individual dance-specific skills before advancing to higher intensity activities, weight-training, and eventual group-based practices, performances, and competition. Each stage should be done at least once with a minimum 24-hour period between each stage.

This is another time when that full honesty is absolutely vital. If things don’t feel right,
especially that sense of easy fatigue, stop the progression and alert the medical team. Ideally, this return is watched over by a certified athletic trainer working with the team or company. The athletic trainer can adjust the intensity and speed of return stages, monitor for issues, and be an advocate for dancers in communication with instructors and other medical personnel.

Many dancers have found that using a heart rate monitor can assist in this return process. This may include wearable chest-based devices (probably the most accurate but more costly) or even watches that can detect the number of heartbeats per minute. Another monitoring option is using a Rating of Perceived Exertion (RPE) scale. The RPE goes from a dancer reported level of 1 (very easy exercise) to 10 (most demanding level of exercise). Dancers can compare the reported RPE to instructor estimates for a certain level of activity. If the dancer’s RPE is much higher (2 or more points) above the instructor estimate, then there should be an immediate re-evaluation of
progress.

The post Dancers: How to Make a Comeback After Covid appeared first on Backstage Socal.

An awkward landing following by gut-wrenching pain.

Maybe it’s when after hoping that those weeks/months of pain will eventually go away, it
hasn’t. Or the time when your medical provider examines you with that look on their face or hands you a box of tissue before explaining your MRI report.

Either a long time off the dance floor, surgery, or both are in your immediate future.
At this time, your mind is probably turning non-stop pirouettes. You probably aren’t thinking about school, sleep, mobility, pain, food and mood. You should be, if you want to take some of the pain out of your injury recovery. In fact, if you are a dancer with a major injury, one should not schedule surgery or commit to a major rehab program without reading and sharing the information in this post.

Let’s start with the “pre-op” evaluation (also applies to the “post-injury” evaluation
Back in medical school, there was this. basic “pre-operative physical” format. Prepare
patients by reviewing medications, looking for any illnesses that could affect surgery or
anesthesia, and getting important lab work.

For most otherwise healthy dancers, there is a better pre-op or post-injury evaluation.
Yes, we need to review that past medical and medication stuff, but to really make those
upcoming weeks easier, we need to share some key tips. For most of these, you can thank your fellow performers who had misfortune of getting hurt before you. They have been my teachers with many “wish I would have known” moments. Thanks to them, we are all better prepared to handle injuries and surgeries.

School/Work

Missing school or work or attending either one in a fair amount of discomfort is no fun.
No one should be shocked with reports of significant drop in grades, risk of failing classes, and reduced workplace productivity after major surgeries. Does this mean that an injury will do the triple whammy of no dance, poor grades, and upset bosses and work colleagues?

I will often meet with families to discuss certain items and provide notes for post-
surgery/injury school or work life.

When to schedule surgery?

o I totally understand that most dancers want surgery ASAP to get the return-to-
dance clock started. However, unless the procedure is emergent it’s best to take a
step back and look at the calendar first. Assume that there will be pain, increase daytime sleep (often due to medications), and mobility issues right after surgery. This affects attendance, focus/concentration, and ability to complete important duties.

o Do you have an upcoming break or even a long weekend?

Can you schedule the surgery later in a week to use a long weekend for initial recovery? Get exams or that important project done first so you can have more focus on recovery.

How will you get around?

o Figure that you will need some new dance partners – crutches, cast/cast boots,
scooters or wheelchairs. Here’s a plug for elevator passes, carts, and preferential
parking. Ask to leave class early and/or arrive late to avoid crowded hallways.

Get some new props

o Can’t use your writing arm? See if you can get teacher notes ahead of time,
connect with a note taker, or borrow other’s notes (preferably one who is smart
and writes very clearly). I’m a big-time fan of allowing dictation or oral testing.

The show must go on (maybe)?

o Many will start a post-surgery or return with part-time work. The first goal is to
get back, then be able to complete regular work before stepping up for tests or
major projects.

Sleep

Ah yes – getting enough sleep a night. Here we go. What is your target?
I’ll throw out 8 hours a night. Anything less especially in the high school student can increase the risk for more injury and illness. How important is sleep? Very important. Vital. Essential. Sleep is by far the most important recovery modality to the point that no modality is worth losing even a few minutes of sleep.

I’ve seen some common sleep challenges with injury and surgery.

1) Immediately pain and swelling after surgery or injury can make it hard to find a
comfortable position. Everything just seems to hurt. In addition to using medically
recommended pain treatments, it is time to elevate your game. Swelling and
throbbing pain can be reduced by elevation, elevation and elevation. Use piles of
pillows or sleep upright in a chair.

2) Later, let’s say 3-4 weeks after surgery or injury boredom starts to kick in. hard to be
tired when you fell all shut down. Early on in the injury or surgical treatment plan,
find out what you can do especially with cross training early in recovery. Don’t let
your brain go on major shut down- can you reach out to friends, help with
choreography or do video review?

3) Moving 1-3 months out, I tend to hear of too little (or even too much sleep) due
to symptoms of depression or anxiety. Other things to look out for include poor
appetite, reduced motivation to attend school/rehab, and even turning to alcohol or
other drugs.

Mood

While we’d all like to see rehab move in a consistent upward straight line, the more
common visual is a scribble of peaks and valleys. There will be plateaus, step backs, and delays. This will let to doubts, anxiety, disappointment, and a depressed mood. Not only might this affect sleep, but also appetite, relationships, and just general mood.

I’ll openly ask about mood issues early and often in post-injury visits. This isn’t a time
for embarrassment or ignorance. This isn’t a sign of weakness or lack of strength.

I cannot emphasize the importance of full honesty about emotions and thoughts. Poor
emotional health can not only threaten recovery, it can be a threat for suicide and other forms of harm to self or others.

Food

Food and weight tend to be sensitive topics of worry in the dance community.
That worry is only amplified after a major injury or surgery. Dancers may be quite surprised by weight gain while others may deal with weight loss.

Why do you gain weight? Maybe it’s from well-intended higher calorie comfort food. Less activity may also be a factor. Weight loss could be due to the loss of muscle mass or poor appetite (often due to medications and pain). There is also the possibility of food insecurity- not dancing/working means less money to buy food.

Unnecessary deprivation is of no benefit. Ask your medical team to help evaluate calorie
needs and make adjustments in amount, types and timing of food intake. There are some low-cost, whole food based recommendations to share:

? I’m a big-time believer in protein – especially after exercise to help bone and muscle
recovery. Click here for good-tasting whole food and beverage protein sources.

? Reducing processed foods and increasing anti-inflammatory foods can increase recovery potential. Click here for information on a lower carbohydrate diet and interesting fruit and vegetable choices (including my favorite natural anti-inflammatory beverage).

? Check this US Olympic Committee Sports Nutrition link for a practical and
comprehensive review of Nutrients for Soft Tissue Recovery.

Keeping It Real

It’s that first post-injury question: “How long until I can get back to the dance floor?” I wish I had a crystal ball, but I don’t, so the best I can do is make an educated estimate.

Let’s say I come up with 4-6 weeks. I know exactly what is going on in the dancer’s mind. “4-6 weeks…that means 3-4 for me” If not back in 4 weeks, here comes disappointment, frustration and anger. (Re-read the mood section as needed).

We all want to get a date of return, mark it in our calendar, and be ready to go when that time frame is up. The best recoveries – those that return to a starring role and less risk of future crash and burn – aren’t just measured by time, but also by the ability to do certain skills and movements. Basing return on when you can leap, jump, and turn with good technique and no pain makes more functional sense then just waiting for a certain number of weeks or months.

Schedule meetings with your rehabilitation team early in the recovery process. Pre-
surgical exercise programs can make those first post-operative weeks easier and might put you ahead in the entire return process. Those visits can also create sensible skill-oriented goals and expectations for everyone to discuss.

Dr. Chris Koutures is a dual board-certified pediatric and sports medicine specialist who practices at ActiveKidMD in Anaheim Hills, CA. He is a team physician for USA Volleyball (including participating in the 2008 Beijing Olympics), the U.S. Figure Skating Sports Medicine Network, Cal State Fullerton Intercollegiate Athletics, Chapman University Dance Department, and Orange Lutheran High School. He offers a comprehensive blend of general pediatric and sport medicine care with an individualized approach to each patient and family. Please visit activekidmd.com or follow him on Facebook (https://www.facebook.com/activekidmd/), Instagram (https://www.instagram.com/activekidmd/), or Twitter (@dockoutures).

The post What to do after a dance injury? appeared first on Backstage Socal.

I’ve been seeing several dancers recently for annual physicals and have consistently found many of them have grown quite a bit taller since March.

This shouldn’t be a major surprise.

In the past, dancers and other performers/athletes who have taken months off have also tended to experience growth spurts.

So, why have dancers gotten taller when they aren’t dancing as much?

• Without the higher energy demands from full dance activities (even the best on-line classes don’t equal the fitness expenditures of in-studio work), the body can dedicate more calories to overall height accumulation. 
• Dancers spending more evening hours at home get increased numbers of home-cooked meals which tend to deliver better nutrient and caloric amounts needed for growth.  
• Then “at the end of the day” you throw in probably the most important variable for promoting more growth – sufficient sleep!

Without having to balance school, homework, and dance class commitments, suddenly the goal of 8 hours of sleep is being attained on a nightly basis.

Now, those growth spurts do bring some challenges with them.

How should instructors and parents be prepared for when those taller dancers return to the studio?

• Expect more awkward movements. The previously graceful ballerina who floated across the floor now routinely trips over everything. The key muscle support groups behind the shoulders and hips often need more developmental time to adequately control movements of the now longer arms and legs. In addition, the central nervous system also needs time to catch up with coordinating movements, overall balance, and joint positioning.
• Anticipate earlier fatigue due to that lack of central strength. Plan on fewer numbers of turn combinations, leaps or jumps with longer rest periods between sets of each.
• Overall soft tissue flexibility will be reduced, as increases in length of muscles, tendons and ligaments often lag behind bone growth. 
• Expect more soreness, especially at points called apophyses where larger muscles attach to growth areas of bone. Prime examples include the hamstrings coming off the pelvis, quadriceps attaching to the shin bone, and the calf muscles ending at the heel bone.
• There will be a higher center of gravity which may affect turns, leaps, and kicks.
• Accept less kick height due to tighter hamstring muscles.
• Instructors might have to identify different lifting partners (when allowed) due to changes in height and strength

This is a key time to return to the basics of dance — almost as if working with true beginners. Give dancers ample time to essentially relearn how to recruit and activate key muscles to control those longer legs and arms. Turns and tumbling will look somewhat out of control until the dancer becomes more accustomed to a higher center of gravity. This is also a good time to correct any bad habits or “cheating” that took place in the past.

Individualized assessment of technique and core strength development (again, back of shoulders, hips, and abdominal region) classes should be a priority. Don’t be afraid to move slow and focus on quality and details rather than quantity and rapid advancement.

How about flexibility and stretching?

This is probably not as high of an initial emphasis.

While many dancers may be concerned about lack of flexibility, trying to over stretch during or right after a growth spurt can actually do more harm than good. Over-stretching can tear muscle fibers leading to longer-term pain and reduced strength.  It can also lead to avulsion fractures at those apophyseal growth areas which are often the “weakest link” during rapid growth.  A fractured apophyses can take months to properly heal.

It is better to focus on development of central/core strength which then naturally leads to less tension and more flexibility in the longer muscles. For example, more proper activation and control of the hip gluteal muscles reduces stress on both the hamstring and iliotibial band regions of the legs.

Once more “usual schedules” resume, we must remember the importance of adequate caloric intake and sleep in the long-term growth and development of our teenage dancers.

Hopefully there will be more time carved out for those home meals, even if it means a reduction in total classes or private sessions. Not only does a good dinner help build stronger dancers, but it also can build stronger social connections for families.

The extra sleep (again at least 8 hours a night for high school students) is also absolutely essential for both physical and cognitive performances.

We won’t expect that dancers who continue to get more energy intake and sleep to keep getting taller. Obviously, there is an end point to final maximum height (can thank mom and dad for that). Those extra calories and hours of sleep will be converted into the development and maintenance of muscles (increased volume and number of motor units) and bones (higher bone mineral density).

A growing young dancer will be excited to hear the good news that those stronger bones and muscles ultimately will better handle repetitive forces and reduce risk of overload stress injuries.

Dr. Chris Koutures is a dual board-certified pediatric and sports medicine specialist who practices at ActiveKidMD in Anaheim Hills, CA. He is a team physician for USA Volleyball (including participating in the 2008 Beijing Olympics), the U.S. Figure Skating Sports Medicine Network, Cal State Fullerton Intercollegiate Athletics, Chapman University Dance Department, and Orange Lutheran High School. He offers a comprehensive blend of general pediatric and sport medicine care with an individualized approach to each patient and family. Please visit activekidmd.com or follow him on Facebook (https://www.facebook.com/activekidmd/), Instagram (https://www.instagram.com/activekidmd/), or Twitter (@dockoutures).

The post Growth Spurts in Lockdown: Is Your Young Dancer Getting Taller? appeared first on Backstage Socal.

The answer is quite simple – focus on the basics. Here are some recommendations for keeping your body in shape and dance ready while at home – even without the studio or gym.

Stretches

In general, maintaining good mobility can help alleviate general aches and pains. Here are 5 lower extremity stretches that can be easily worked into any routine. The optimal time to incorporate static stretches are after working out. Hold each stretch for 15 to 30 seconds, and repeat 2-3 times.

Figure-4 stretch: While laying on your back, bend your left knee and cross your right ankle over your knee. Pull your left thigh slowly towards your chest until you feel a stretch in your hip.

Hip flexor stretch: Start by kneeling on one knee with the other bent at 90/90 in front of you. Squeeze your glutes so that your hips are in neutral position and slowly bring your torso and hips forward as one unit until you feel a stretch in the front of your hip.

Hamstring stretch: Sit with your legs extended straight out in front of you. Without bending through your low back, lower your torso towards your thighs until you feel a stretch in the back of your legs.

Butterfly stretch: From a sitting position, bring the bottoms of your feet together so that your knees flare out to the sides. For added stretch, you can use your elbows to press your knees down and lean forward slightly without bending through your low back.

Calf stretch: Start by standing and facing a wall. Bring your toes up and press them into the wall and lean forward slightly until you feel a stretch in your calf. Repeat this with a bent knee.

Core

Keeping your core strengthened is key to the prevention of injuries to the shoulders, muscles in the back of the neck, front of the chest, lower back, and hips. When dancers think about core or abdominal exercises, they usually think that means sit ups and planks. Though these exercises can be effective, there are many more that can also be extremely effective. Many of the most popular core exercises are performed on the floor. However, the issue is that when you dance, you are standing up. With this in mind, adding core exercises in a standing position, either in a squat, split squat or single leg position can improve the benefit of core stability exercises.

The result of standing core exercises is a more stable dancer that will develop a better base for movement and reduce future injuries.

There are an infinite amount of core exercises that can be performed in a standing position and be extremely effective. One simple exercise that needs little equipment is the Pallof Press. It is a great anti-rotational exercise that works the abdominals, low back and hip musculature and helps create a more stable dancer. To perform this exercise, start with a resistance band attached to a fixed point. Facing ninety degrees from the band, start in a squatted position with the band in both hands and pulling your body sideways or laterally. With the hands at your chest, press the arms out, extending the elbows all the way. The resistance of the band, will pull back towards the fixed point. The objective is to resist this force. The resistance does not have to be too high. The biggest focus is to stay nice and stable as the arms extend directly in front of you. To add difficulty, change from a squatted position to a split squat position.

At some point studios will reopen and dance will resume. By stretching and keeping your core strengthened, performers will be able to return to the floor and stage more rested, healthy, and injury free.

Chris Phillips is an Athletic Trainer, Strength and Conditioning Specialist and Sports Safety Specialist with over 25 years’ experience in professional hockey, football, dance, cheerleading, and soccer. Chris has worked with hundreds of professional, Olympic and Hall of Fame dancers and is the owner of Compete Sports Performance and Rehab in Lake Forest, California. For more information, visit http://competesportsperformance.com/

The post Don’t Lose Your Step: Tips For Dancers to Stay in Shape in Isolation appeared first on Backstage Socal.

So realistically, how can the dance community prepare mentally and physically for when curtains start to rise?

During these days of being quarantined, seek out rays of positivity within current challenges. This time away from dance could grant gifts of needed rest, healing of overload and overuse injuries, and opportunities to appreciate new hobbies and build central dancer core strength.

Next, continue to strive for appropriate sleep (goal of 7-8 hours a night) and keep up those sleep goals once dance commitments start up again.

I’ve been impressed with reports of dancers and other athletes using time away to explore identities outside of dance and sports. Some of these have included running (yes, some dancers actually enjoy running), hiking, baking, and art projects. I do recommended keeping social distancing in mind when doing outside activities to protect those at greatest risk for COVID complications. The number of smiling faces reporting their new interests are proof positive that these activities have contributed to positive mood elevation. I certainly recommend that dancers make time to maintain these new activities even when dance returns.

Click here for ActiveKidMD You Tube Video: As a dancer, how can I strengthen my core?

From a dance medicine viewpoint, there are two “core” perspectives that we routinely see contributing to dancer injuries.

• The Northern Core – upper body including shoulder blade stabilizers, muscles in the back of the neck, and front of the chest
• The Southern Core – lower back stabilizers, hip external rotators and hip flexors

While the “Northern Core” provides the primary foundation for arm and head movement, the ‘Southern Core” is the backbone for hip, leg, and foot control. Don’t forget that these two regions also support each other. A strong and stable upper body supports the lower area and better lower control makes the upper region move more effectively.

Poor Northern Core control is often a main contributor to dancer headache, neck, shoulder, and arm pain. Without addressing those “core strength’ issues, it will be almost impossible to make the dancer feel and perform better.

It’s the same kind of story with dancer foot, ankle, knee, hip, and lower back pain issues. Sure, one can focus on the foot in cases of big toe or midfoot pain (and that is part of the treatment). However, if any Southern Core issues aren’t fully investigated and treated, then the foot pain will likely continue.

I highly recommend practical ways to look at basic technique. My favorite is evaluating plie in 2^nd position.

Click here for more information about proper leg alignment in plie

Plie in Second Position- solid line shows hip above kneecap, broken line shows kneecap above second toe

I also highly recommend doing an online or video group yoga or Pilates courses that can be an enjoyable way to build central strength and also connections with peers and instructors.

Take an inventory of any past or current bone or joint issues and use this time away from dance to address them now. Previous injuries are the biggest risk factor for future injuries. Not fully rehabilitating or treating a past injury makes a re-injury more likely. If necessary, schedule an appointment with a Sports Medicine physician.

ActiveKidMD is now pleased to offer telemedicine virtual visits in addition to in-office evaluations. 

Emotional concerns such as anxiety and depression already routinely encountered in the dance community are only more magnified with the COVID pandemic. There is associated fear and mourning, such as loved ones being sick or dying from infection, and individual concerns of getting infected. Dancers also must deal with losses of identity, community, connection, income, and roles. Do not hesitate to reach out and get professional assistance with any mental health or emotional challenges.

A focused treatment plan for any type of physical or emotional concern can give a sense of clarity during a time of uncertainty. So now let’s take a look at what the dance community may look like once there is a green light to return to the studios. The reality of dance return likely includes starting on a smaller scale and with a slow rate of advancement.

Don’t expect to start off right where things left off. As much as dancers want to dance and our communities want to see dancers back to dance, there will be limits placed on the rate of return. Be ready for a reduced schedule, and rather than push studios and companies to accelerate the pace of return, realize that public authorities and not instructors or owners are making the decisions.

From studio owners, company heads, to even physicians, we are all going to lean on the guidance of public health officials and other leaders to determine the group size and pace of post-COVID recovery.

Here’s what we think the dance studios will look like:

Dancers and instructors should prepare to start with small groups as public health authorities will likely limit initial gathering sizes. Social distancing in some form is not going away for a while. I’m guessing that the authorities’ may limit groups to a maximum of 10 people in a room or studio, and that will include instructors. For this reason, privates and small groups might be the first to make a comeback.

Dancers should also anticipate keeping six feet distances between colleagues which means plenty of room for marking steps and free movement. Partnering, use of shared props and heavy floor work will have to come later.

Dancers should also not be surprised if mask or other face coverings continue to be recommended, even with dance. Yes, there is no doubt that face coverings can be uncomfortable, keep falling off, and make breathing more difficult. However, it is best to try different types of masks and face coverings with your current level of dance and other exercise to see which ones fit better.

How about lining up at the barre? This will also likely need ample distance in between each dancer, and gloves may also be required.

Dancers will probably come into the studio, do their class, and then immediately leave. Hanging out and catching up with friends may not be an option for a while. There also might need be more time between each class for cleaning of the studio and floor.

With fewer participants in each class, an individual dancer may not be able to do as many classes per week. At this point, it might be best to start with a favorite genre or two, then add others as classes become more available.

Don’t be surprised if you start off at a level or even a few levels below where performance was before the COVID quarantines began. Honest communication between dancers and instructors can allow for appropriate individualized starting points and rates of progression.

So what does this mean?

This means the entire ensemble won’t be able to dance together. Competition teams will have to be split up. The first competitions and conventions will be further down the road. As dancers eventually return to performing and competing, it is best for instructors and coaches to orient dancers first into smaller group pieces rather than moving right into full company work.

No dancer, instructor or parent should anticipate or be planning competitions or recitals for at least several weeks if not months after dance resumes. Dancers won’t be ready, and very likely that public authorities are again going to be cautious with mass group activities. So, while it is natural to want to “get back to where we were” as soon as possible, there should be no time sensitivity or sense of rush.

Unfortunately, this does not look like the summer for summer intensives – both from dancer readiness and concern with large group points of view. It is also probably best to hold off on scheduling auditions to allow dancers to regain strength and relearn movements first. Waiting will allow a dancer to better demonstrate aptitude and talent.

A measured and gradual return approach is not only important to reduce infection and illness spikes, but also is actually quite sensible for overall dancer health.

Let’s all agree that after so much time away, everyone is likely going to be out of shape. Timing is going to be off, while leaps and turns won’t be as high or as crisp. Some might be in a better spot than others, but no one is going come back dancing at the same level as before the COVID quarantine interruption.

Trying to overcome the prolonged break from dance in just a few days, or maybe a few weeks is definitely not recommended. My fear is that dancers who push themselves too much, too fast or too soon to get to past levels of performance are at a greater risk for overuse injuries.

So yes, those first priorities should not be trying to return to previous levels of dance as soon as possible. A more sensible return should focus on the basics of technique, classes, and addressing basic dance movements and positions while also dedicating time to rebuild core conditioning. There is no better time for dancers to reintroduce themselves to the barre and mirrors (actually maybe only the mirrors to start as barres may be “hands off” in initial stages of return).

This is why those smaller classes and individuals/privates are actually exactly what this dance medicine doctor would order. Fewer dancers in a class will allow instructors to pay more individual attention to technical details with the value of smaller student to instructor ratios. Small nuances of movement and positions can be critiqued and improved without time-sensitive pressures of upcoming events. Instructors can be more aware of particular needs of individual dancers. Forming groups based on equal/near-equal ability and experience can foster collective advancement that is often more difficult with larger groups of dancers with varying levels of talent.

When planning weekly progression, please pay particular attention to the next sentence if you want to limit injuries. Back off during the third week back. I’ll repeat it again for emphasis- Back off during the third week. This is experience gained from military recruits in basic training and other groups of athletes starting new programs.

Instructors should anticipate a first week that is a blast filled with adrenaline. Dancers will be so excited to return that the resulting adrenaline rush will probably override any soreness and stiffness. By week three, muscles and bones are reaching the point of maximum overload. When demands continue to grow during week three, so do the risks of muscle strains and bone stress injuries. Backing off during the third week has been shown to reduce injuries and rates of drop out.

Many of you might be asking, “How long will it take to get back to prime dance performance?”

There isn’t an exact evidence-based study to quote, but in the performance medicine world, we’ve often figured that for every week someone is away from dance, there needs to be at least one week of rebuilding, relearning, and reconditioning needed for full recovery. That means if a break from dance was 10 weeks, then assume 10 weeks to get back to higher level skills.

Eventually the calls to dance will come bringing both senses of familiarity and discomfort as adjustments are made in the post-COVID environment. Having patience, heeding the recommendations of authorities, and focusing on the core foundations of dance movement will help the dance community work together in recovery and return.

Dr. Chris Koutures is a dual board-certified pediatric and sports medicine specialist who practices at ActiveKidMD in Anaheim Hills, CA. He is a team physician for USA Volleyball (including participating in the 2008 Beijing Olympics), the U.S. Figure Skating Sports Medicine Network, Cal State Fullerton Intercollegiate Athletics, Chapman University Dance Department, and Orange Lutheran High School. He offers a comprehensive blend of general pediatric and sport medicine care with an individualized approach to each patient and family. Please visit https://activekidmd.com/ or follow him on twitter (@dockoutures).

The post When the Curtain Rises – Returning to Dance in the COVID World appeared first on Backstage Socal.

First of all, follow those social distancing and home isolation orders and ensure your families and friends follow them also. This isn’t the time for get-togethers or in-person group practices. This is the time to protect the lives of vulnerable people and healthcare providers.

As a pediatric and sports medicine physician, many of the injuries I see are due to overuse and overload – too much activity, often amped up too fast or too soon for younger bodies. With many overload/overuse injuries, not only it is a volume thing that needs attention but often there are mechanical issues that need attention. For example, weakness in the central core areas (back of the shoulder and hip/lower back) can create poor function and pain in elbows, knees, legs, and feet/ankles. These weakness patterns can be in part from rapid growth and also due to too much activity and built-up fatigue.

Some just need a break – time away from repetitive activity to heal these types of injury. The usual response I get when recommending rest centers around a variant of “I/we don’t have time to rest.” Often, I’ll recommend rehabilitation exercise programs to address those issues. Even with the most diligent of dancer, it’s quite difficult to recover and get stronger/better while continuing to push through all the usual rehearsal and competitions.

Now, these types of focused exercises and movement education aren’t just designed for the injured. Many studios and institutions incorporate strength and conditioning exercises as part of regular training. Commonly, time is usually not an ally. Either performers have limited (or no) time to get the full benefit, or they are trying to complete these programs while again pushing through rehearsals, performances, and competitions.

Well, in the midst of the overwhelming COVID-19 pandemic, now there is time for rest – for active recovery exercises, for trying something different.

So, if I am giving some professional recommendations for young dancers and performers, I’m going with the following (pay special attention to 7-9).

1) Maintain appropriate social distancing.

2) Rest. This does not mean becoming a couch potato.

3) If you are in a high volume/repetitive similar action activity (jumping and leaping), take some time away. You may be shocked at how much better you feel with that relative rest.

4) If you’re worried about losing conditioning, technique, timing and precision, realize that without coordinating with other dancers, close-up coaching, and proper surfaces, it is hard to maintain high-level precision. Also realize that, unfortunately everyone else is at the same disadvantage, so take the best care of yourself.

5) If you have connections to on-line programs, enjoy the benefits of social interaction with coaches/instructors/fellow performers. This is a key time for some of that general strength and conditioning work that we talked about earlier. Some sports medicine professionals are still available in offices and many have developed on-line exercise programs. Don’t be afraid to reach out and use this time to your best advantage, but make sure you are getting sensible advice and very importantly…..

6) Please do use common sense when exercising at home. For example, trying to do repetitive leaps and jump combinations on the kitchen tile floor may put unnecessary stress on your legs. I have also talked with coaches and instructors who are cautious about assigning exercise programs- they worry about risk of injury due to lack of supervision.

7) I’m going to challenge you to look at things differently, especially if you see yourself as a single activity athlete. Let’s make a goal of not just trying to be a better dancer, but rather look for ways to become a better overall athlete. Can you jump more efficiently (without knees caving inward)? Can you work on making the muscles behind your shoulders more effective? Here’s the chance to work on those injury rehab/reduction or general strength programs that you somewhat tried (or never really began).

8) Speaking of looking at things differently, here’s my second and somewhat linked challenge – find something totally new (or something you haven’t done in a long time) and just do it! Go on a hike (social distance alert again), play board games, or write in a journal. Do something that you haven’t had time to do until now. Go out and do some free play. Add something new. Get creative and add things to past activities. Let kids direct what’s going on and have less adult organization and outcomes.

9) Get those 8-9 hours of sleep. This is always vital and especially now in stressful times. Try to keep a good schedule with regular bedtime and awakenings. Before going to bed, write down 2-3 things that went well during the day and you are grateful for. These positive habits of gratitude can help with feelings of lack of control that many are experiencing at this time.

At some point dance will resume and most performers will eagerly return to the floor and stage more rested, healthy, and hopefully injury free. On the flip side, some might realize that after time away and doing other things, they don’t miss dancing or performing at all, or at such a high level of intensity and time commitment. Both scenarios are quite likely and should be considered “OK.” All performers and athletes should be given full permission and opportunity to make decisions about future activity choice, level of intensity, and time commitment.

Dr. Chris Koutures is a dual board-certified pediatric and sports medicine specialist who practices at ActiveKidMD in Anaheim Hills, CA. He is a team physician for USA Volleyball (including participating in the 2008 Beijing Olympics), the U.S. Figure Skating Sports Medicine Network, Cal State Fullerton Intercollegiate Athletics, Chapman University Dance Department, and Orange Lutheran High School. He offers a comprehensive blend of general pediatric and sport medicine care with an individualized approach to each patient and family. Please visit https://activekidmd.com/ or follow him on twitter (@dockoutures).

The post Dancers: Social Distancing and Home Isolation – Now What? appeared first on Backstage Socal.

Dance instructors should always be careful when talking about body size and weight. What is said could be misunderstood or taken to extremes. Teachers of young dancers have a responsibility to be aware of the signs that might indicate problems, and to take steps towards early intervention.

Eating disorders commonly begin with normal dieting that gradually becomes more compulsive. Extreme weight control methods can develop, such as anorexia (lack of interest in food) or bulimia (combination of binge eating followed by purging, often as vomiting). Other examples of disordered relationships with food include fasting or overly restrictive eating, excessive exercise, and overusing diuretics and laxatives.

In some ways, the decisions behind these disorders give a dancer a sense of control in an environment where there are constant uncertainties about being selected for a troupe, cast for a particular role, having to wear certain costumes, or being able to meet the demands of the choreographer.

With initial weight loss, many dancers gain a boost of confidence with increased jumping and turning abilities. They often may hear approval and confirmation from colleagues and instructors. This definitely makes acknowledging early issues with energy intake more difficult, and often medical care is sought only when there is a later significant decrease in performance.

Issues with body self-image and food can also be connected with emotional issues such as anxiety or depression. Unique dance stressors such as a constant need to learn new routines combined with frequent sources of critique (instructors, earning a role, placing in a competition) can increase risk for many mental health concerns, including anorexia and bulimia.

What is Anorexia Nervosa?

Anorexia Nervosa is a psychological illness with devastating physical consequences. Anorexia is characterized by low body weight and body image distortion with an obsessive fear of gaining weight that manifests itself through depriving the body of food. It often coincides with increased levels of exercise and vomiting.

Anorexia is the most fatal of all psychiatric illnesses. Extreme food restriction can lead to starvation, malnutrition and a dangerously low body weight, and in some cases death. A typical anorexic person will severely restrict their food intake. They will maintaining very low calorie count, restrict the types of food eaten, eat only one meal a day, or follow obsessive and rigid rules such as only eating food of one color.

What is Bulimia?

Bulimia is an emotional disorder involving a disordered body image and an obsessive desire to lose weight. Bouts of almost out of control overeating are following with purging behavior, often in the form of vomiting.

Warning Signs

There are behavioral, physical and psychological signs or changes that often accompany an eating disorder. Warning signs may not be easy to detect. People with an eating disorder will generally experience great shame or guilt about their behavior, and will try to hide it. Some people do not realize they have a problem. Some will not want to give up their behavior, because it is their way of coping.

Dancers, in particular, often deal from a particular sub-type termed “exercise anorexia” where there is insufficient caloric intake to match often excessive exercise energy demands. This might occur in part due to ignorance of the nearly 4,000-5,000 calories that can be burned a day by intense dance, or the energy deficiency could also be intentionally created by dancers who do additional exercise (treadmill, stair machines, elliptical above and beyond usual dance requirements. In working with dancers, it is best to ask about the amount and frequency of exercise, both inside and outside the dance studio. This extra exercise may represent a compulsive behavior that is a direct part of the anorexia nervosa illness.

Many young dancers have limited financial resources which often means making compromises on the amount or type of food intake that can lead to lower levels of calorie intake. As a physician, I often see reduced intake dairy and meat products, which are high calorie food sources that also have calcium and iron.

Female dancers often report higher levels of caffeine, nicotine or even illicit cocaine use both for stimulating energy levels and appetite suppression. In dealing with dancers, one must address these more common dance world issues to provide individualized and comprehensive care. Initially, a dancer may deny any problems with food intake, excessive exercise, or substance use, but as rapport and comfort are built with the medical team, such concerns may be more readily shared.

Disordered eating can be linked with poor bone health and irregular or absent menstrual periods. This is known as the female athlete/performer triad, which can lead not only to a higher risk of bone stress injuries, but also diminished overall dance performance and overall health.

Getting Help

For all patients dealing with eating disorders, one of the main issues is acknowledging and accepting that they suffer from the illness. Given that many dancers have a high sense of self-identity with their dance work, it can be even more challenging to come to this initial stage of acceptance. There is a fear not being able to dance, which then leads to a fear of not being identified as a dancer, and then ultimately a collapse of how they view themselves. In approaching treatment recommendations, one has to focus on the eventual performance enhancement goals, such as becoming a stronger, healthier, and more confident dancer.

Instructors that suspect a student may have an eating disorder should recommend an urgent medical evaluation with professionals who are familiar with eating issues in the dance world. Treatment may involve a combination of medical monitoring, dietary counseling and psychological help.

Students diagnosed with an eating disorder need medical clearance to take part in exercise. Even moderate levels of exercise can result in severe health risk and teachers share the responsibility for safety in these situations. A student may need to be limited or restricted from dance activities to protect their health until they recover.

One helpful thing about dancers is that they are used to working with multiple team members, from fellow dancers to multiple choreographers and instructors. Thus, once they understand that optimal treatment of their eating disorder requires an inter-disciplinary approach including physicians, nutritionists, and mental health providers, a dancer is more apt to accept this team-based treatment approach.

Dancers are used to tight, goal-oriented schedules, so setting short-term realistic goals definitely help in building confidence and compliance. Regular visits to modify goals and constant communication amongst providers (with appropriate privacy safeguards, of course) are also quite helpful.

Dancers in general will be more receptive to working with medical professionals that know the culture of the dance world and the expectations/demands. When an apprehensive dancer hears that he/she is not the first to seek treatment with a medical provider who has helped others get healthy, that dancer will feel less isolation and have more confidence in a treatment plan.

Contributing Expert: Dr. Chris Koutures is a dual board-certified pediatric and sports medicine specialist who practices at ActiveKidMD in Anaheim Hills, CA. He is a team physician for USA Volleyball (including participating in the 2008 Beijing Olympics), the U.S. Figure Skating Sports Medicine Network, Cal State Fullerton Intercollegiate Athletics, Chapman University Dance Department, and Orange Lutheran High School. He offers a comprehensive blend of general pediatric and sport medicine care with an individualized approach to each patient and family. Please visit https://activekidmd.com/ or follow him on twitter (@dockoutures).

The post Athlete Eating Disorder: How to identify and get help appeared first on Backstage Socal.

SO WHAT ARE BONE STRESS INJURIES?

In describing bone stress injuries to patients, I often use the analogy of bending my penwhile bored in class one day.

If I just start trying to bend my pen, the pen doesn’t bend much. This represents normal bone.

As I continue to play withmy pen, it does start to bend more. This represents a stress reaction where the bone is softer and less able to resist continued load. A stress reaction will create swelling (bone edema) on a Magnetic Resonance Imaging (MRI) study. No true fracture line will be visible either on the MRI or plain x-ray study.

If I’m really bored in class, my continued bending the more weakened pen eventually will cause it tocompletely break on one side. This represents a stress fracture where a fracture line is seen on one cortex (outer lining of the bone) on either MRI or plain x-ray.

Even more attempts to bend my pen may result in breaking it in half. This represents acomplete fracturewhere the fracture line is now easily visible on either MRI or plain x-ray.

WHEN DO YOU SUSPECT A BONE STRESS INJURY?

If there’s that history of pain after progressing with too much, too fast, or too soon of dance activity, I worry about a bone stress injury. If there is an injury that just doesn’t seem to get better, I worry about a bone stress injury.

Now, if a dancer can take the tip of their index finger and point directly to a single spot on a bone,I definitely worry about a bone stress injury. If there is any worry about a bone stress injury often x-rays and Magnetic Resonance Imaging (MRI) studies are used to make a formal diagnosis.

WHY DID I GET A STRESS BONE INJURY?

In my sports medicine specialist eyes, part one of the bone stress injury challenge is to make the diagnosis. Part two of the challenge is equally, if not more important – figuring out what might have caused the injury.

Bone stress injuriesare usually caused by high loads on normal bone, or normal loads on weaker bones. I will routinely see dancers who have been diagnosed with a bone stress injury and are looking for clues about causes and how best recover and reduce risk of future problems.

• High loads canbe from too much, too fast, too soon: Too many hours a week or days a week without rest
• Too high an intensity of activity
• Improper technique overloading a certain region of the body
• Too many reps (jumps, swings, kicks)
• Amping up too quickly when starting something new
• Not getting enough restorative daily sleep (minimum of 8 hours a night)
• Weaker bones tend to come from:
• Unhealed past injuries
• Not enough calories (often takes sports nutritionist to calculate dancer’s individual daily
  calorie needs)
• Limited calcium/Vitamin D intake (recommend 3-4 servings a day of dairy and other
  calcium containing foods)
• Low red cell counts and iron stores
• Adolescent and older females not having regular periods that build bone strength (potential problems if less than 9 periods in 12 months or more than 3 consecutive months without a period).

Yes, I definitely understand dancers being uncomfortable talking about food choices, caloric intake, and menstrual periods. However, these are important topics for bone health. Sensitive discussions that explain why these questions are being asked can help identify injury causes, reduce future risk and improve future performance.

HOW DO YOU GET A BONE STRESS INJURY TO HEAL?

Knowing the exact location and type of bone stress injury can contribute to a most accurate treatment plan. Knowing sleep and nutrition needs while having regular periods (for females) is key for current healing and future bone development.

The usual healing goal is to protect the injured area by keeping activity below levels that cause pain. This could mean no impact exercise (running, jumping or leaping). In some cases, putting limited or no weight on the injured body part (by using a cast/boot, crutches or a scooter) may be the best plan.

There are certain types of higher risk bone stress injuries that may even need surgical repair. Knowing your exact type of bone stress injury can limit risk of further complications by helping determine what you should and shouldn’t do in your recovery.

WHAT CAN A DANCER DO WHILE RECOVERING FROM A BONE STRESS INJURY?

Healing a bone stress injury doesn’t always make someone become a couch potato. This is where the concepts of individualized modifications and cross training come into play. Again, remember the primary goal of limiting activity below levels that cause pain.

So, for lower body injuries, this often may include non-impact activities such as using exercise bike, elliptical machine work, or swimming/pool workouts. Some performers may be able to mark steps, do upper body movements, and use barre/mirrors for dance classes. Others might be able to work on improving technique to reduce abnormal loads. There are even specialized anti-gravity treadmills that may allow running during the recovery phase.

Non-injured body parts can be used in carefully selected and supervised stretching and weight training exercises.

Working with a sports medicine specialist can design individualized recovery programs involving cross training that help reduce emotional stress and keep up levels of physical activity.

This blog post does not intend to diagnose or provide management tips for any particular bonestress injury, or for any injury or illness. With any suspected bone stress injury or other injury, please immediatelycontact us or your regular sports medicine specialist for evaluation and treatment.

Dr. Chris Koutures is a dual board-certified pediatric and sports medicine specialist who practices at ActiveKidMD in Anaheim Hills, CA. He is a team physician for USA Volleyball (including participating in the 2008 Beijing Olympics), the U.S. Figure Skating Sports Medicine Network, Cal State Fullerton Intercollegiate Athletics, Chapman University Dance Department, and Orange Lutheran High School. He offers a comprehensive blend of general pediatric and sport medicine care with an individualized approach to each patient and family. Please visit https://activekidmd.com/ or follow him on twitter (@dockoutures).

The post How to Heal Bone Stress Injuries in Dancers & Athletes appeared first on Backstage Socal.

Pre-dance jitters and butterflies in the stomach are a common occurrence before a big show.

However, what do you do when it’s more than just pre-show jitters? Do yourself a big favor. Sit down, think about the last two weeks, and honestly respond with how often you may have been bothered by the following problems:

• Feeling nervous, anxious or on edge?
• Not being able to stop or control worrying?
• Feeling down, depressed or hopeless?
• Little interest or pleasure in doing things?

These questions are from the PHQ-4, which is a commonly used screening tool for depression and anxiety. If you answered one or more of the 4 question with at least several days a week, you might be dealing with depression or anxiety (more than just the anxiousness that happens before a performance). And please be aware, you are not alone.

This is not intended to increase any feelings of sadness, fear or feeling out of control. Rather, this blog is intended to empower you, to reduce feelings of isolation, erase stigmas, and make you more aware of the value of emotional health in the dance world.

If at any time you feel you might have depression, anxiety or any other emotional or mental health concern, please immediate contact a healthcare professional for urgent evaluation. If you have thoughts of harming yourself or someone else, or thoughts of suicide, immediately go to your nearest emergency room. The National Suicide Prevention Hotline at 1-800-273-8255 is confidential and available 24 hours a day.

What exactly is depression?

According to Mayoclinic.org, Depression is a mood disorder that causes a persistent feeling of sadness and loss of interest. It can affect how you feel, think and behave and can lead to a variety of emotional and physical problems. You may have trouble doing normal day-to-day activities, and sometimes you may feel as if life isn’t worth living. More than just a bout of the blues, depression isn’t a weakness and you can’t simply “snap out” of it.

Symptoms of depression may include:

• Feelings of sadness, tearfulness, emptiness or hopelessness
• Angry outbursts, irritability or frustration, even over small matters
• Loss of interest or pleasure in most or all normal activities
• Sleep disturbances, including sleeping too much or too little
• Tiredness and lack of energy, so even small tasks take extra effort
• Reduced appetite and weight loss or increased cravings for food and weight gain
• Anxiety, agitation or restlessness
• Slowed thinking, speaking or body movements
• Feelings of worthlessness or guilt, fixating on past failures or self-blame
• Trouble thinking, concentrating, making decisions and remembering things
• Frequent or recurrent thoughts of death, suicidal thoughts, suicide attempts or suicide
• Unexplained physical problems, such as back pain or headaches

What is anxiety?

Again, according to Mayoclinic.org, people with anxiety disorders frequently have intense, excessive and persistent worry and fear about everyday situations. Often, anxiety disorders involve repeated episodes of sudden feelings of intense anxiety and fear or terror that reach a peak within minutes (panic attacks).

These feelings of anxiety and panic interfere with daily activities, are difficult to control, are out of proportion to the actual danger and can last a long time.

Symptoms of anxiety include:

• Feeling restless, wound-up, or on-edge
• Being easily fatigued
• Having difficulty concentrating; mind going blank
• Being irritable
• Having muscle tension’
• Difficulty controlling feelings of worry
• Having sleep problems, such as difficulty falling or staying asleep, restlessness, or unsatisfying sleep
• Depression and Anxiety in the Dance World

Like many forms of exercise, dance can reduce some signs and symptoms of depression and anxiety. A studio is home to a host of emotional responses to the demands of dance. You’ve likely lived the highs of dance – the artistic expression, satisfaction of learning new routines, and the exhilaration of a standing ovation that can all amplify the sense of positive emotional health.

However, you also have likely experienced unique challenges and low points that can intensity feelings of depression and anxiety:

• The regular failure in dance – literally and figuratively falling down – and trying to get back up again
• Regularly hearing about inadequacies from instructors about technique and appearance
• Those inevitable comparisons to others about talent, skills and body appearance (and those studio mirrors and selection of costumes often don’t help).
• Mental and physical fatigue that comes from an enormous time investment in classes and performances
• Trying to balance dance with school, work, family and other social/community commitments
• That drive to excel can also be the same drive that leads to depression
• Living gig to gig often without consistent paychecks or medical benefits
• Your sense of identify seemingly dependent on hitting that last jump, earning that key role, or having it all thrown asunder after a major injury
• Being forced out of dance due to injury or not earning a role can have intensified feelings of inadequacy, isolation and sadness

Spending a tremendous amount of time with fellow dancers and instructors may reveal emotions and behaviors that may not be seen by others outside of dance. This unique perspective can in itself be stressful and at times frightening. You will watch others act (or yourself may feel) stressed out, anxious, and down in the dumps.

The dancer who admits to butterflies before a big audition or cries after not getting a desired role is showing more apparent (and common) emotional behaviors. However, there are other all too common behaviors that may suggest a more serious emotional disturbance.

If you feel, or see one or more of the following situations, this is the time to ask for help:

• Showing less connection with others and appearing distant or preoccupied
• Missing more classes and rehearsals
• Voicing multiple complaints of pain or frequent injuries
• Injuries that appear to take longer to resolve
• Sleeping too much or too little
• Loss of energy and endurance
• Having a plateau or reductions in technical skills
• Recent major injury
• Recent life stressors (family change, illness, loss of key role or position in a company)
• Increased use of prescription or recreational drugs or alcohol
• Readily apparent change in body weight (namely weight loss)
• Maybe you might now actually may be more aware that you are depressed or anxious but are afraid to share concerns with others. You may fear that no one else understand, or that others will cast judgement and you might lose roles, identity, and prestige.

And even if you honestly feel that you are doing okay, maybe a close friend or troop member is going through depression or anxiety. Perhaps they feel alone, that no one else understands their feelings too.

Final Thoughts

If you suspect a potential issue, don’t be afraid to dig deeper, even if it might seem personal, overly critical, or even nosy. You might be the next step to getting yourself or someone close to you important help. Maybe reading this will allow you to get help yourself or someone close to you out.

If you identify concerns, offer assistance, support, and help seek qualified expert healthcare evaluation and treatment. If at any time you feel out of control or feel scared for your safety or the safety of someone else, dial 911 or immediately go to the nearest emergency room. Medical treatment is essential and may include behavioral therapy and possibly medications that can lead to a higher level of emotional health.

How can studios and companies support emotional health?

• Establish relationships with local dance medicine and mental health resources to foster efficient and expert responses to dancers with immediate needs
• Open and regular discussions about emotional health should be encouraged
• Acknowledge failure as a regular part of dance, and place emphasis on best efforts and learning from mistakes
• Routinely asking dancers about school, family, and lives outside of dance
• An empathetic response to an injured or ill dancer that gives a greater sense of personal control can foster recovery
• Allow injuries or ill dancers to help decide how involved they want to be during their recovery period. Some will want to attend rehearsals and classes to remain part of the group, others may favor time away.
• Offer professional medical and emotional support and continually ask about needs
• Dancers and instructors should be prepared to support colleagues or students in need.
• Dancers who perceive supportive communities feel more enabled to report mental health issues, seek qualified care and ultimate be able to enjoy not only better dance performances, but overall higher life satisfaction.
• No dancer should be ignorant to the signs and symptoms of depression and anxiety.
• No dancer should ever feel the need to go solo with emotional health concerns.
• No dancer should never be afraid to seek help.

Dr. Chris Koutures is a dual board-certified pediatric and sports medicine specialist who practices at ActiveKidMD in Anaheim Hills, CA. He is a team physician for USA Volleyball (including participating in the 2008 Beijing Olympics), the U.S. Figure Skating Sports Medicine Network, Cal State Fullerton Intercollegiate Athletics, Chapman University Dance Department, and Orange Lutheran High School. He offers a comprehensive blend of general pediatric and sport medicine care with an individualized approach to each patient and family. Please visit activekidmd.com or follow him on twitter (@dockoutures).

The post Jitters vs. Depression: How to recognize the difference appeared first on Backstage Socal.