Dancer Education Beyond The Conservatory:The Health Education Benefits of Pre-season Screens for a Professional Ballet Company

ABSTRACT

Traditional ballet classes teach dancers how to perform long-established vocabulary and choreographed roles within a time-honoured hierarchical structure that provides constant direction and methods for physical training. When the dancers proceed to professional companies, some of this structure remains in the form of daily ballet classes. However, the autonomy that the dancers are expected to have, with reference to their own physical and mental health, may challenge some young professional dancers if they are not educated in self-care or do not have individualized conditioning programs. Findings in this study with a Toronto-based professional ballet company, align with recent qualitative studies and literature supporting the physical and psychological benefits of screening including dancer education, optimizing performance, and developing rapport between dancers and physiotherapists/health care teams.

KEYWORDS:

• Dance
• education
• ballet
• screening
• autonomy
• professional dancers

Disclosure statement

No potential conflict of interest was reported by the author(s).

Three-Minute Step Test: Adam Center and Ailey-Fordham & LIU Protocol

The following description of the Three Minute Step Test is based on the Adam Center and Ailey-Fordham & LIU Protocol and the research by Bronner et al. (2014a), Bronner and Rakov (Bronner and Rakov, 2014b)). A metronome is set to 112 beats per minute for both males and females and utilize a 30-cm bench. If a heart-rate monitor is not available, take HR manually with a radial pulse. Record Prep HR, which is the resting heart rate in seated position before starting the test. At the end of three minutes of stepping ‘up, up, down, down’ on/off the bench, record the dancer’s heart rate while standing and note this figure as the dancer’s Max heart rate. After one minute of sitting in a chair, record the dancer’s recovery HR.

ADAM Center Interpretation (Annual Post-Hire Health Screen for Professional Dancers 2019-2020): NORMS FOR 3 MINUTE STEP TEST (Metronome: 112 beats/min)

(Based on 1minute recovery HR).

Table

9 Point Beighton Hypermobility Test

Each area indicated as positive is worth one point. Dancers are classified as hypermobile with a score of 4 out of 9 or greater. The joints assessed include: 5th MPC joint, thumb, knees (passive hyperextension beyond 10 degrees), elbows (passive hyperextension beyond 10 degrees) and active flexion of trunk.

Adams Forward Bend Test

The examiner stands behind the dancer as the dancer bends forward slowly and returns to standing. The examiner notes any asymmetries at the thoracic & lumbar spines and the prominent side is documented.

Passive Range of Motion

The guidelines state that all ROM tests are done passively and ‘stopped at the FIRST end feel, defined as the FIRST onset of resistance or compensatory, adjacent joint movement.’

Hamstring Tightness - Passive Straight Leg Raise

The dancer lies supine on the table with hips and knees extended and the pelvis in a neutral position. The examiner passively raises the leg keeping the knee straight with the foot relaxed. As soon as the ASIS of the ipsilateral LE begins to move posteriorly or the dancer reports pain, the test is stopped and the angle of hip flexion is measured with a goniometer.

Flexor Hallucis Longus tightness/inflammation

The dancer either lies supine on the table with hips and knees extended and the pelvis in a neutral position or sits upright with knee flexed over a foam roller. The ankle is placed passively in a position of maximum dorsiflexion and the first metatarsal phalangeal joint is stabilized with one hand. The examiner then passively extends the great toe at the 1^st MTP joint. The test is positive if there is resistance to 1^st MTP extension before or at 20 degrees of MTP extension.

Hip External and Internal Rotation with the hip extended

The dancer is supine with the leg to be measured bent at the knee off the table and the other leg is flexed at the knee and hip with the foot resting on the table. Rotate the hip passively until the first onset of resistance is felt or pelvic motion is observed. The test is positive if there is less than 45 degrees of external rotation with the hip extended. It is also positive if there is less than 45 degrees of internal rotation with the hip extended.

Strength Tests

As recommended in the guidelines, a standard Kendall and Kendall manual muscle test is used. Record score out of 5 for all strength tests below unless otherwise stated (Annual Post-Hire Health Screen for Professional Dancers 2019-2020).

A 2 or a POOR grade is recorded if the dancer, with the arms folded across the chest, can not hold the low back on flat on the table while lowering both legs to an angle of 65 degrees or less with the table.

A 3 or a FAIR grade is recorded, if the dancer, with the arms folded across the chest, is able to keep the low back flat on the table while lowering the legs to an angle of 60 degrees with the table.

A 4 or a GOOD grade is recorded, if the dancer, with the arms folded across the chest, is able to keep the low back flat on the table while lowering the legs to an angle of 30 degrees with the table.

A 5 or a NORMAL grade is recorded, if the dancer, with the arms folded across the chest, is able to keep the low back flat on the table while lowering the legs to table level.

Lower Abdominals MMT (Leg Lowering Test)

The dancer lies supine with arms behind head lifting both legs straight in the air at 90 degrees of hip flexion. The dancer slowly lowers the legs while maintaining the posterior pelvic tilt so that the lower back remains in contact with the table. When the pelvis moves forward or the dancer is unable to maintain the posterior pelvis tilt, the test is stopped.

Hip Adductor Strength

Guidelines use standard manual muscle testing, which is in side-lying with the top leg flexed at the hip and knee and positioned at rest on the floor in front of the body. The body should be in a straight line with the lumbar spine and the lower leg extended. The dancer actively lifts the bottom leg. The test is adduction of the underneath extremity upward from the table without rotation, flexion or extension of the hip or tilting of the pelvis.

Hip Abductor (Gluteus Medius) Strength

Guidelines use standard manual muscle testing, which is in side-lying with the underneath leg flexed at the hip and knee, and pelvis rotated slightly forward to place the posterior gluteus medius in an antigravity position. The muscles of the trunk as well as the examiner stabilize the pelvis. The dancer actively abducts the hip with slight extension and slight external rotation. Resistance is applied against the leg, near the ankle, in the direction of adduction.

Hip External Rotator Strength

Tested in prone with knee bend to 90 degrees of flexion. The dancer’s hip is externally rotated while the foot comes inward and manual resistance should be applied with the hand at the ankle.

Hip Extension (Gluteus Maximus) Strength

The dancer is in the prone position with the knee flexed 90 degrees. The examiner’s hand stabilizes at the ipsilateral lateral back/lumbar & abdominal muscles. The dancer extends the hip ‘without compensating with the lower back muscles or going into an anterior pelvic tilt. The examiner applies resistance against the distal posterior thigh in the direction of hip flexion’(Annual Post-Hire Health Screen for Professional Dancers 2019-2020).

Foot Intrinsic Strength

Grading as follows quoted from Annual Post-Hire Health Screen for Professional Dancers 2019-2020:

Grade 5 (normal): Dancer completes available range of MTP with IP extension, can hold for a count of 5 seconds and tolerate resistance against the plantar surface of the proximal phalanges to the four lateral toes.

Grade 4 (good): Dancer completes available range of MTP flexion, but cannot hold for a count of 5 seconds

Grade 3 (fair): Dancer understands the concept, but unable to hold without IP flexion

Grade 2 (poor): Dancer has difficulty understanding the concept and IP flexion is observed with MTP flexion. Cannot extend IP joint with MTP flexion at all.

Grade 1 (trace): Therapist notes contractile activity, but no toe motion

Grade 0 (zero): No contraction or muscle activity

The dancer’s ankle is in neutral, in short sitting with feet on the table. The dancer domes foot: flexing at the MTP joints and extending at the IP joints, contracting the lumbricals. As per Kendall (1993), pressure is applied against the plantar surface of the proximal phalanges of the four lateral toes. Weakness is indicated by the inability of the lumbricals to override the flexor muscle of the toes.

Single Leg Stance – Balance Test

The dancer stands in parallel passé, not making contact with the standing leg. The dancer crosses their arms across the chest then closes their eyes for 60 seconds and attempts to stand still on the weight-bearing leg. The dancer is not allowed to move around or hop on the supporting foot. They cannot touch the non-weight bearing foot to the ground, and they are not allowed to uncross the arms.

Weight Bearing Lunge Test (WBLT)

The examiner attaches a measuring tape to the floor perpendicular to the wall. The dancer stands facing the wall in parallel in a comfortable tandem stance (parallel fourth position) with the big toe of the front foot 10 cm from the wall. Their hands placed on the wall, hip width apart. The dancer bends the front knee towards the wall keeping knee in line with the second toe while maintaining back heel firmly on the floor. If the dancer is unable to touch the wall with the back heel down at 10cm, move forward 1cm at a time until the knee can touch the wall without the heel coming up. If the dancer is able to touch the wall with heel down at 10cm, move backward 1cm at a time. The examiner records the distance from the wall to the front toe when the knee is able to touch the wall without the back heel lifting.

Airplane Test

Dancer begins by standing in parallel first, with feet hip-width apart then brings the opposite foot into a detached parallel passé (or March Test position), while simultaneously bringing both arms to second position. The dancer moves their square torso forward until the torso is fully parallel to the floor, while moving the non-standing leg into a parallel arabesque position. There should be no rotation of the pelvis or trunk, and the arabesque leg and supporting leg remain parallel. The head should be in neutral alignment with the spine and shoulders and hips remain parallel. Maintaining this position, the dancer completes 5 consecutive demi-pliés at a pace of 4 seconds each (two to bend and two to recover). The dancer must keep the center of the standing knee over the 2nd toe of that standing foot, while bringing both arms downward toward the floor so that the fingertips of each arm touch the floor as they reach their maximal demi-plié depth. The ability to successfully complete all of the parameters listed in the Annual Post-Hire Health Screen for Professional Dancers results in a PASSING score. The limb that is scored is the STANCE limb.

Developmental Sequence Test

The dancer begins in a sitting position with buttocks on heels and feet in full plantar flexion. The torso is upright in neutral alignment, shoulders over hips with arms resting at the side of the body. In one continuous action, the dancer moves to sit tall on both knees, half kneel, and stand on a single leg in parallel passé. The examiner is looking for the dancer to successfully dissociate the limbs from a neutral spine position and to execute a ‘full and pain-free’ weight shift from two legs to one leg. The ability to successfully complete all of the parameters listed in the Annual Post-Hire Health Screen for Professional Dancers results in a PASSING score. The limb that is scored is the STANCE limb.

Sauté Test

The dancer stands in parallel first and places their hands on opposite shoulders across their chest. The dancer places one foot in a detached coup du pied position and performs 16 consecutive parallel sautés on the standing leg to maximal height. The dancer is required to fully stretch the leg and foot in the air at the height of the jump. The dancer FAILS if they change the alignment of their trunk, lift the hip of the jump side, or unfold arms to assist with takeoff or achieve maximum height. The limb that is scored is the jumping limb.

Notes

1. The 2018–19 data are currently inaccessible due to COVID-19 lockdown of the institution where the records are securely stored. This lockdown is currently in effect until 24 January 2021 with potential to be extended.

Additional information

Notes on contributors

David Outevsky

Dr. Outevsky is a researcher-educator specializing in dance conditioning, performance psychology, and cultural pedagogy. He holds an MSc in Dance Science from Trinity Laban Conservatory of Music and Dance and a PhD in Dance Studies from York University. David served as course director at the University of Calgary teaching courses in the areas of dance history and culture. He has presented at numerous international conferences and had his work published in several academic journals. David currently provides professional development courses for private dance studios and associations such as the Royal Academy of Dance.

Tanya Berg

Tanya Berg is a Toronto-based ballet teacher, dance educator, and researcher. Tanya holds a PhD in Dance Studies from York University and is a graduate of Canada’s National Ballet School Teacher Training Program. Tanya currently teaches in the Dance Department at York University, as well as in the Faculty of Kinesiology and Physical Education at the University of Toronto. She has presented her research at numerous international conferences and is published in multiple academic journals and anthologies