- The Washington Times - Tuesday, December 31, 2002

Posture, posture, posture physical therapist Pete Boyle can't say the word often enough to dancers, especially ballet dancers, for whom fitness and good health are key to excelling in their professional life.
One of the major things he says is required for ballet is understanding the strength of postural muscles those deep abdominal, pelvic and buttocks muscles.
The advice applies even more to young people who take dance lessons and aspire to a life onstage.
By the time dancers are fully trained, they may also need another reminder from Mr. Boyle to watch how they walk and sit in everyday life. He calls it "maintaining core stability."
"The biggest problem starts when little boys and girls start slouching at school," he says. "One of the most important things a dancer needs is strong postural and core muscles. They must be sure their bottom is back in the chair and that shoulders are straight and aligned."
Once a dancer has that core stability, "being stable around the pelvis," he or she goes on to high-velocity flexibility to be sure hands, feet, joints, spine and all the muscles are working well. Most dancers, Mr. Boyle says, work 40 minutes daily on stability work to limber up before going into their specific dance warm-ups.
Nearly all dancers eventually have back and hip pain and what he calls "imbalances," he says. The most common injuries occur to the hips, lower back and feet, and many of them are associated with overtraining, he adds.
A primary lesson dancers must learn is "getting in touch with your own body," says physical therapist Courtney Cooper Jenrath, who works with Mr. Boyle's Sports and Spinal Physical Therapy Group Inc., which provides services under contract to the Washington Ballet.
"Whenever I'm near Pete, I stand up straighter," says Brianne Bland, 24, a company dancer who has been ordered to stop performing for several weeks so stress fractures in her foot can heal. In the interim, she keeps the rest of herself in shape through Pilates and a related program called gyrotonics.
"Definitely learn how to do it right when you are young," urges dancer Charles Pregger, 23, in his second season with the company. However, he says he never has met a dancer who at one time or another has not been injured in some way. He has a bulging disc in his back that he thinks may have come from overwork. He is being treated with cortisone shots.
It's important to have what Mr. Boyle calls "an action plan" if something hurts. "It's probably more important to do a thorough full-body stretch after a workout probably more important than the work-up and listen where there is pain," he says. "Go through a range of motion for 20 minutes a few times a day to settle down an inflammatory response. If pain persists, consult health professionals."
One of the major situations causing injuries for dancers is downtime because "when they are outside [the performance arena], they are less focused," he says. "They must remember to have their feet face forward when they walk. Ballerinas especially walk with a terrible turnout that causes damage to the back because the posture [in dance] is not natural for the activities of daily life."
Not correcting their walk in everyday life puts them at risk for foot tendinitis and hip pain, Mr. Boyle says.
Any dancer with an ache or pain can sign up to see Mr. Boyle or one of his associates when they visit the company's studios twice a week. During the recent run of "The Nutcracker," when some dancers performed nine times a week, a therapist such as Mrs. Jenrath has been available backstage several evenings a week at the Warner Theatre. Mr. Boyle also will travel with the company when it performs in Tampa in early February.
If pain persists or if continuing to dance is liable to make a dancer infirm, Mr. Boyle and his associates recommend seeing a physician immediately. Some dancers may end up being treated by both a doctor and a physical therapist to ensure optimum health.
"Athletes and dancers are born and then made," Mr. Boyle says, adding that dancers "are some of the most amazing athletes I've ever worked on. People in ballet are born with an extraordinary range of motion, a completely different body type from a footballer, and some are born with more turnout of the hips and have better balance [than others]."
The Pilates strength and muscle-training program is especially good for dancers, he says, because it is a strengthening regime but not a weight-bearing activity. "They work on the floor but have full motion. Both Pilates and gyrotonics have very specific moves for dancers," he says.
Pilates is linear, Mr. Boyle explains, whereas gyrotonics involves more circular moves similar to how a dancer moves his or her body in space.
"They put their bodies through work almost more than NFL players," Mrs. Jenrath says while massaging the knee and thigh muscles of dancer Aaron Jackson to help him relax and warm up before one of the last performances of "The Nutcracker."
"Blood flow is your healer," she says. "Blood is what brings oxygen and is the life of the body."
Mr. Jackson was starting to get tendinitis in the knee, a swelling of the tendon where it connects to the bone. The pulling causes a small swelling, which gets worse the more it is irritated through repetitive motion.
"You try to catch it quickly because if you don't, it can become an injury that will keep a dancer from going on the stage," Mrs. Jenrath says.
Being strong and staying loose at the same time is a delicate balance that is almost a contradiction, but dancers must train themselves for both, say therapists and chiropractors involved in their care.
"Ballet is not natural," agrees Mr. Jackson, 23, who admits that when he first got tendinitis last year, he was "scared to death."
Mr. Jackson, who began playing baseball, track and gymnastics at age 11 before taking up dance, recommends that young people have something else in their life besides ballet "to get stretch movement. Swimming would be great because you also need the cardiovascular conditioning." But not track, he says, because "with track you use different muscles, and your thighs get too big."
Much of the same advice applies to actors and singers who are required to dance as part of their roles. A number of people in the cast of "South Pacific," now playing at Arena Stage, have been treated "for maintenance reasons" by Robert Wainer, a chiropractor who runs the Bowman Chiropractic Center in Arlington.
The Arena version of "South Pacific" contains considerably more movement than most other productions of the beloved Rodgers and Hammerstein musical and puts special demands on principals such as Kate Baldwin, who stars as Ensign Nellie Forbush.
A chiropractor is trained to manipulate the spinal system, which stimulates the whole body through the nerves. "You want to take as much pressure as possible off the nerves so the body can work at its maximum," says Mr. Wainer, who also ministers to a number of visiting ballet and theater companies when they come to the National Theatre, Ford's Theatre and the Kennedy Center.
In addition to swimming, he recommends speed walking on a flat surface for overall conditioning. Yoga also is good because, when done well, it teaches control and can get oxygen to all parts of the body. Some weight lifting and stretching with rubber pulls known as Thera-Bands are useful for keeping the upper body in shape, too, he says.
Miss Baldwin was coming in weekly to avoid the possibility of a serious injury. She had some discomfort in her lower back, so Mr. Wainer was applying electrical stimulation to the nerves as well as having her get a massage.
"You don't know how much energy you expend when you are onstage. It's all adrenaline," Miss Baldwin says, showing off a bruise on her knee whose origin she says she can't explain. She recently tried 90 minutes of Bikram yoga, which is done in an excessively hot room. She says she ached all over the next day.
"The basic need is to keep a full range of motion in the body," Mr. Wainer says, "because if you don't, that is when you start aging."

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