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Trips on the light fantastic
Monday January 21, 2013

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For the audience, "The Nutcracker" can be a dazzling sensory experience — dancers in ornate costumes gliding gracefully through the air in perfect synchrony, all choreographed to Tchaikovskyís sublime score.

But there is another story unfolding behind the scenes as dancers prepare for these awe-inspiring productions. In the months leading up to the performance, preprofessional teen dancers often practice 12-15 hours each week, while more experienced professionals will average at least 40 hours a week. During the Nutcracker season, physical therapists who specialize in treating dancers start seeing a jump in the number of patients suffering from foot, ankle, hip and back injuries.

For Marika Baxter, PT, MSPT, OCS, her passion for helping dancers combined with the right connections gave her the opportunity to take a novel approach — she helped open a physical therapy office within a dance school. In November, she started seeing patients at her Magna Physical Therapy and Dance Medicine clinic in a former studio space at the New England Ballet School, Orange, Conn.

"I was definitely excited about the opportunity to be so accessible to some of the younger dancers, but I was also nervous because I was new to the area, and itís a new location for the business," Baxter said.


Cameron Gomez, PT, works with a dancer at Westside Dance Physical Therapy. Photo courtesy of Cameron Gomez, PT
Recipe for injury

Baxterís interest in treating young dancers traces back to her own experience as a gymnast and dancer. At age 14, she tore her ACL, MCL and meniscus when she landed incorrectly after a double full — a flip with two twists — during warm-ups for a gymnastics competition. The rehabilitation after surgery taught her the importance of physical therapy. She also is fortunate be the niece of renowned dance PT Marika Molnar, founder of Westside Dance Physical Therapy in New York City. After completing her physical therapy program as an undergraduate, Baxter trained at Westside to hone her skills.

"I learned that instead of telling a dancer to just do three sets of 10 squats, I would have them do fewer repetitions more precisely," she said. "In dance and gymnastics you move at extremes of range, so it is critical to have precise movement patterns and control to prevent injury."

For teens, physiological changes that accompany rapid growth can be a recipe for injury, Baxter said. "Sometimes people can go through growth spurts, and their muscles do not lengthen at the same rate as the bones, so their muscles can get tighter and they lose flexibility. They can also lose some core strength and coordination when they grow quickly, which can increase the likelihood of injury."

Baxter recently treated a 15-year-old girl who had developed a hip flexor strain. The girl was slated for multiple roles in an upcoming Nutcracker performance. She had grown 2 inches in one year, and Baxter suspected this was one of the reasons she was suffering from an overuse injury. The young dancer was struggling to lift both legs higher than 90 degrees, and walking up and down stairs had become painful. Baxter gave her patient home exercises that included stretching and self-massage to loosen her muscles, followed by a core-strengthening routine. After just two sessions, the girl was able to return to practice.

The demands of a performance run often delay full recovery. "In cases like this, we donít want to tell patients to stop dancing to heal," Baxter said. "We are helping them to continue performing and not get worse."


Marika Baxter, PT, works with a dancer at Magna Physical Therapy and Dance Medicine.
Dancing without pain

Like Baxter, Melissa Buffer-Trenouth, PT, MS, manager of Sports and Physical Therapy Associates in Cambridge, Mass., enjoys treating dancers, but her clients are typically community dancers who are in graduate school or working full-time day jobs and performing on weekends. "Because these patients are sitting all day at work, they develop muscle imbalances," Buffer-Trenouth said. "Their hip flexors are excessively shortened, and their lower abdominals and gluteals are weaker than they should be. In therapy, we have to run through basics to get the hip flexors and gluteals back to neutral before the dance therapy will help."

Although these dancers have athletic builds, they often struggle to perform simple exercises to activate their gluteus medius, Buffer-Trenouth said. "It is humbling for them to realize that basic exercises are challenging," she said. "I also use a mirror to teach them about dance awareness, such as how to hold their bodies and activate certain muscles when they are dancing or even just walking."

Cameron Gomez, PT, DPT, a staff therapist at Westside, previously was a professional dancer who had trained at some of the most renowned ballet academies. He, too, was surprised when a PT suggested that he correct his alignment and change his movement patterns to heal from a chronic back injury. "But it ended up changing my whole perception of what alignment and placement should be for proper technique," he said. "I learned how to extend my hip first before arching my back, and how to stabilize my low back and pelvis when I was turning out."

Gomez continued these exercises and was not only asymptomatic, but also a better dancer, he said. The experience was so pivotal that after Gomez retired from dancing, he decided to become a PT. Now he works with dancers from the New York City Ballet and the School of American Ballet.

"Itís amazing to me that physical therapists outside of my initial dance teachers are the people who did the most to educate me about healthy movement patterns, how to have proper alignment and how to move without injuring myself," he said. "The most fulfilling moment for me as a physical therapist is seeing the dancer recover from a particular injury and then return to the stage dancing stronger and better than before the injury." •

Heather Stringer is a freelance writer.


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Monday January 21, 2013
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