Towards a National Institute for Dance Health and Performance

by Helen Laws

In Dance UK News issue 61 (Summer 06) we began to talk about our vision to address the as yet unsolved problem of all dancers who work at a highly intensive level having access to the medical and science support services they need in order to prevent and treat injury and optimise performance.

The goal is for the vision to be delivered by developing a network of strategically located dance medicine and science ‘hub-sites’ situated around the UK.  Dancers will be able to obtain advice and information, health screens, supplementary training programmes and treatment and rehabilitation for injury when it occurs, all under one roof. This idea is based on the current model of medical provision provided to Britain’s elite sports men and women.

The hub-sites will be staffed by multidisciplinary teams of practitioners including doctors, physiotherapists, massage therapists, physiologists, nutritionists, psychologists, body conditioning etc. These hubs would together form an independently run ‘National Institute for Dance Health and Performance’. Individual medical practitioners who are treating dancers working more remotely could potentially also be networked into the system and able to refer to the nearest larger hub.

This is a large and radical idea. To test, on a smaller scale, how we can make it work, we have developed a Dancers’ Health Pilot Scheme with three of the potential hub-sites: Laban in London; The Jerwood Centre for the Prevention and Treatment of Dance Injuries based at Birmingham Royal Ballet; and the Olympic Medical Institute in Northwick Park Hospital, Harrow; with Wolverhampton University adding further research expertise.

The details of the Pilot are described here by the leading experts from the major sports and dance organisations who have been involved in its creation. We look to Dance UK members and the wider industry for your support, as we are about to embark on a major fundraising campaign to raise the £450,000 needed to realise the project.

Dancers’ Health Pilot Scheme HDP

‘The pilot scheme that is being proposed by Dance UK is vital to the long term health of dancers. There are many parallels between dancers and sports people, not least of which is the physical nature of their work. As with any top level performer, fitness and conditioning are crucial elements of their preparation and, unfortunately, injuries are a common side effect of pushing the body to its limits.

‘In sport we have been fortunate to be able to offer athletes a comprehensive medical insurance scheme for a number of years and access to expert support for more than 20 years. Initially, the British Olympic Medical Centre was the only dedicated centre offering that service but since 1999 lottery funding has been made available to sport. This has enabled National Governing Bodies to run comprehensive programmes of coaching and support and the Home Country Institute network to grow and develop. Doctors, physiotherapists, sports scientists, nutritionists, psychologists and more are now available to athletes within high performance programmes, free at the point of use, to ensure that injuries are dealt with promptly and effectively, often in a multi-disciplinary environment. Further work is being done, on a daily basis, on injury prevention and the education of support providers and coaches is continually improving to heighten their understanding of what causes, and how to treat, injuries.

‘The Olympic Medical Institute (OMI) provides the only dedicated intensive rehabilitation centre for sport in the UK and also offers specialist services including a bone health clinic, cardiac screening service and psychological support to overcome the mental effects of injury. A number of the specialist practitioners at the OMI also work in dance and our partnership with Dance UK seems an ideal way to begin to offer dancers the kind of support that athletes have been able to enjoy for a number of years. Not only can we help the dance world to avoid many of the potential problems involved in setting up a new service, but I believe that a parallel system, with overlapping aims, will represent a great legacy from the initiatives being undertaken by both sport and the arts in respect of the London Olympic Games.’

Nick Fellows, Head of the Olympic Medical Institute

‘Birmingham Royal Ballet Company have been at the forefront of investment into dancers health and well-being through the establishment of The Jerwood Centre. As part of its role in developing Dance Medicine in the UK, The Jerwood Centre has taken an approach to build on the existing expertise with a sound research base. This Pilot Scheme gives us the ability to continue the type of work that will enable the dance community in the UK to receive the specialist care that their discipline demands.’

Nick Allen, Clinical Director, The Jerwood Centre for the Prevention and Treatment of Dance Injuries

‘Though we have carried out two large surveys on dance health in the last 15 years we have only really touched the surface in trying to prevent and reduce the injury rate. The proposed research project will allow us to scrutinise more closely causes of injury and see if the availability of health care provision can help towards the reduction in time a dancer has off. The project will allow us to present a stronger case to funding bodies to allow health care provision to be included in company costs by being able to compare injury rates with other exercise activities such as sport and recreational activities. We will also be able to start to see if prevention interventions also have an affect on reducing these injury rates. The project will be another worldwide first for the UK, with Dance UK leading the way on “looking after the dancer” – the results will hopefully inform teacher training, funding bodies, schools and companies in how they look after dance and dancers. Obviously without support from dancers themselves this project doesn’t get going so do contact Dance UK to register your support for the scheme.’

Matthew Wyon, Reader in Performance Sciences and Course Leader MSc Dance Science, University of Wolverhampton

The Dancers’ Health Pilot Scheme explained

Since June we have been holding a series of briefings for the dance sector, outlining the plans for the Dancers’ Health Pilot Scheme and asking for dance professionals’ feedback. So far, we have met 132 dance professionals from a diverse range of backgrounds. These briefings continue around Britain with meetings planned in Newcastle, Edinburgh, Leeds and the South West.

Here way lay out the shape that the Pilot Scheme is taking and how various parties will, or can, be involved.

Starting points

The pilot scheme is a response to the main issues facing the dance profession and the development of dance medicine and science in the UK:

  1. The need to improve the availability of comprehensive, dance specific healthcare provision and dance science support services so that they are affordable and accessible to all dancers, not just those in the largest two or three companies.
  2. The need to have more detailed research into the circumstances of dance injury and what is needed to optimise the prevention of and recovery from injury, in order to effectively shape that provision.

The Healthier Dancer Programme brought together leading dance medicine experts to investigate a way of simultaneously increasing the medical provision for dancers who need it, while supporting those companies who already have good provision in the analysis of the huge amounts of data they are producing on their dancers’ injuries and recovery.

Both of these elements have potential to form the largest research project of its kind yet to be undertaken. The delivery and results of which would hugely benefit the health of dancers, both directly and through the resultant increased knowledge disseminated throughout the profession. The research would also, perhaps more importantly, help us to understand and develop the kind of support that will enable dancers to push the boundaries of performance, safely, to new heights, knowing that they are doing so in a fully informed environment with adequate back-up.

Aims of the Dancers’ Health Pilot Scheme

  1. To establish exactly what is required by the dance profession in terms of quantity and proportions of medical and dance science provision for optimum injury recovery times and performance.
  2. To monitor and provide evidence of the effects of introducing such provision on dancers’ injury rates/severity, health and fitness.
  3. To explore and test the kind of infrastructure needed to facilitate such provision for all professional dancers.
  4. To explore how dance and sport can effectively share medical and scientific resources and knowledge for their mutual benefit, in preparation for possible future, ongoing, structured collaboration.
  5. To monitor longitudinally the details surrounding the health, fitness and injury status of dancers (most previous research has been retrospective which is by nature less accurate).

This last point in particular will enable us to spot trends and patterns in dancers’ health  and injury, helping us to pin down the precise causes, specific to individuals or groups of dancers, which may be linked to workload, choreography, fitness, nutrition, strength and a whole range of other factors which will be noted and analysed in the research.

The analysis of the data collected over the course of the pilot will enable us to effectively design injury prevention and fitness programmes and make specific recommendations to individuals, companies as well as the sector at large that will help to improve dancers’ health and performance. Importantly, as a result of the pilot all this will be based on sound, individualised, dance specific evidence as opposed to theory, however sound, borrowed from other areas. The data collected during the pilot will also give us the information necessary to effectively plan and budget for long-term solutions to medical and dance science provision.

Who’s involved? Delivering the pilot

The pilot scheme is led by Dance UK and is a partnership between the Olympic Medical Institute, the Jerwood Centre for the Prevention and Treatment of Dance Injury at Birmingham Royal Ballet, Wolverhampton University and Laban’s Dance Science department (see diagram).

These particular partners have become involved for a number of reasons. The Jerwood Centre and Laban because these are two dance medicine / science centres that have great facilities and in their development plans always had the intention that they should be accessed by dancers outside of their own organisations.

The Olympic Medical Institute has come on board as a result of a shared belief that there is potentially much to be gained by sports and dance medicine practitioners working alongside one another and maximising valuable resources, intellectual and practical, by treating both dancers and athletes within the same facilities. We already have a history of many medical practitioners working in both fields and using the knowledge gained in one area for the benefit of the other, so it seems a logical step to explore formalising that connection for our mutual benefit.

Wolverhampton University comes into the picture due to its existing working relationship with the Jerwood Centre, providing dance science services there, and indeed has also collaborated with Laban on a number of research projects. It has a long history of producing research in dance science that has moved the field on.

So what this means is that we have sites in both London and Birmingham for dancers on the scheme to access medical care and dance science services.

Taking part in the pilot

The pilot scheme as it stands at the moment, will pay for a total of 100 dancers to have access to all the elements of the scheme (see ’what will the pilot consist of’). There will however be opportunities for a much larger number of dancers to be involved in the research / data-collection elements only.

The likelihood (based on feedback from the briefings so far) is that the 100 dancers will include a number of entire companies of dancers from the contemporary dance sector, a group of independent dance artists, a group of West End / commercial dancers and if possible a group of dancers from the African Peoples Dance and South Asian dance sectors.

The aim is for these dancers to provide as broad a representation of the wider dance sector as possible within the relatively small total number. For research and moral purposes we will have to choose whole companies of dancers or un-self-selected individuals. It is likely that we will set up application processes for companies and individuals so that we can choose fairly, make sure we cover a spread of different working circumstances and ensure that statistics aren’t skewed by only currently injured dancers joining the scheme!

While those accepted onto the pilot scheme in its entirety are likely to be those who don’t currently have good dance medicine / science provision, we very much hope to include those that do have good medical provision in the research and data-collection part of the pilot. We intend the pilot to be able to provide the research support and technology required to allow as many of the larger dance companies and colleges as possible, to join in these aspects of the pilot.

What will the pilot consist of?

The £450,000 that we need to raise to realise the Dancers Health Pilot Scheme will pay for the following:

Screening / profiling

All 100 dancers on the pilot will be screened when they join the scheme and then will have at least yearly if not six monthly follow-ups. This screen will include injury history, a health questionnaire, assessing aerobic fitness, strength, biomechanics, muscular function and psychological health. The purpose of this screening is to:

  1. establish the dancer’s base-line health and fitness level
  2. address any potential problems or niggles before they develop into injury and
  3. provide them with personalised information on how they can maintain and improve their health and fitness and prevent injury
  4. enable us to monitor changes and improvements over time and look at a number of different parameters in relation to injuries incurred and performance levels.

Individual feedback and training programmes

Following the screening the dancers on the scheme will be given advice and supplementary training programmes appropriate to their individual needs.

Medical care and insurance

All dancers on the pilot will be enrolled on the British Olympic Association’s Athlete Medical Scheme. In the event of dancers becoming injured while on the pilot scheme their first port of call for medical care will be the doctor and physiotherapist employed directly by the pilot, accessible from both the London and Birmingham sites. Further healthcare and rehabilitation will be provided as needed by the extended multidisciplinary teams of practitioners at these sites. These practitioners may include psychologists, massage therapists, Pilates practitioners, nutritionists, physiologists etc. If a dancer is more seriously injured and requires scans, consultations or an operation these will be paid for by the medical cover provided by the Athlete Medical Scheme and the dancers will be referred to suitable dance / sport medicine specialists working alongside the pilot scheme partners.

Data collection and analysis

Health and injury information from the 100 dancers on the full pilot scheme as well as those dancers in companies with their own medical provision but who wish to take part in the research, will be collected on a central, purpose-built database, paid for by the scheme, and accessible to the practitioners treating them. Two researchers employed by the pilot will facilitate the data collection and provide (confidential) analyses and feedback for individuals, dance companies and for the pilot scheme as a whole, working with the health practitioners and scientists to make recommendations as appropriate based on findings. The intention is to publish the results of the project in 2012.

Originally published in Dance UK  magazine, Issue 66 – Autumn 2007