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From Our Partner: Howard Brown Health

From cleanings to oral cancer screenings, restorative dentistry to pediatric dental care, Howard Brown Health has you covered. At their brand-new Halsted clinic and the 63rd Street clinic in Englewood, you can have a new reason to smile by receiving holistic and affordable dental care. Whether it’s for an annual cleaning, to have a cavity filled, or for a more serious oral health need, Howard Brown’s dentists can provide whatever you need.
 
As one of the largest queer-focused Federally Qualified Health Centers in the United States, Howard Brown has worked since 1974 to provide the highest quality of medical and dental services to all, regardless of ability to pay. Howard Brown accepts private insurance, Medicaid, and even a sliding scale for patients without insurance. And if you need further financial support for your care, you can apply to the Chicago Dance Health Fund for a General Health and Wellness grant.
 
With a new online scheduling tool, it is easier than ever to set up an appointment. An award-winning team of professionals will make you feel comfortable and seen just as you are. Don’t let finances keep you from the quality of healthcare you deserve. It’s never too late to have a confident, healthy smile, and the dental team at Howard Brown will be there for you every step of the way.
 
Make a first-time appointment today by going to howardbrown.org/schedule or by calling 773-388-1600.


NOTE: Chicago Dance Health Fund congratulates Howard Brown Health on its appointment of Robin Gay, DMD as Interim President and CEO. Dr. Gay most recently served as Chief Dental Officer and assumes the role formerly held by outgoing President and CEO David Ernesto Munar. This appointment helps ensure continuity of crucial community health care services for our Chicago dance community and beyond.

Cherish and Care for Your Voice
By William Z. Gao, MD

Have you ever lost your voice or experienced a raspy/strained voice? The medical term for hoarseness is dysphonia, and it can be frustrating when changes in our voice disrupts our ability to communicate easily and our sense of self. Our voice is an incredible gift that lets us express ourselves and connect with others. Let’s talk about phonotrauma and other causes of hoarseness as well as learn essential tips to keep our voice healthy and strong.

Common Causes of Hoarseness or Dysphonia:

• Phonotrauma: Excessive strain and stress on our vocal cords from using our voice too much or too loudly (e.g., screaming and shouting, but also frequent throat clearing or coughing) can cause phonotrauma. It is one of the most common causes of hoarseness.

• Infections: Colds and other viral/bacterial infections can cause laryngitis, which is when our vocal cords swell up. When swollen, the vocal cords become stiff and unable to vibrate normally, which causes us to lose our voice or have changes in quality.

• Acid reflux: If we have reflux often, it can irritate our throat and vocal cords, leading to a sore throat, throat clearing, and/or hoarseness. This can happen even without classic symptoms of heartburn.

• Irritants: Smoking or exposure to smoke, dust, and other irritants can cause problems with the vocal cords like the other conditions above. Post-nasal drainage from allergies can indirectly cause this as well.

• Vocal nodules or polyps: Straining our vocal cords too much over time (chronic phonotrauma) can lead to the formation of calluses or bumps on the vocal cords, which are known as nodules or polyps. Without treatment, these can lead to persistent voice changes.

Vocal Health Tips for Preserving Your Voice:

• Stay hydrated: Drinking enough water is essential for our vocal health to keep our vocal cords lubricated so they can vibrate well. Try to drink at least 8 cups or 64 oz of water a day and avoid excessive caffeine or alcohol, which can be dehydrating. Using a portable humidifier or steamer can be helpful for singers before performances.

• Warm up and cool down: Before and after using our voice a lot, like singing or speaking in public, warm up gently with vocal exercises and cool down afterward to avoid strain. Focus on good posture and powering the voice with deep breaths, and avoid pushing the voice out by straining your vocal cords or neck muscles.

• Practice good vocal hygiene: Avoid clearing your throat too often or shouting loudly. Instead, sip water and swallow gently to clear any mucus or itch in the throat.

• Avoid smoking and secondhand smoke: Smoking is harmful to our vocal cords, as is being around secondhand smoke.

• Rest your voice: If your voice feels tired or hoarse, take a break from talking and singing until it feels better. Planning for and scheduling voice rest breaks through the day can be helpful if you use your voice a lot daily.

• Seek professional medical help: If hoarseness lasts for more than two weeks or if you have serious vocal problems, schedule an appointment with a doctor specializing in voice care (also known as a laryngologist) to figure out what is going on and the best course of treatment.

Burnout in Dance
By Dr. Leda A. Ghannad

A dancer suffers from burnout when they experience fatigue and/or impaired performance as a result of overtraining. Burnout can lead to increased risk of injuries from overuse, decreased motivation, and mood changes. Unfortunately, symptoms of burnout are not uncommon due to increased demands on performers, including longer contracts and multiple shows per week or per day. Dancers, like any athlete, need sufficient time between shows and rehearsals for rest and recovery.

The necessary time for recovery can vary greatly between dancers. From a physiological standpoint, a performer needs rest after intense training or performing for their muscles to adapt. This period of recovery allows them to improve strength and endurance over time. 

Dancers are often very motivated and goal-driven, which may lead to feelings of guilt regarding taking time off for recovery. However, taking time off from training and exercise does not equate to laziness. It is a necessary part of any dancer’s physical and emotional well-being.

There are several ways to help combat and manage symptoms of burnout. One is to have an open conversation with artistic directors regarding expectations for performances; performing multiple difficult roles several days in a row may not be realistic. If possible, performing roles of varying difficulty throughout a performance calendar can allow the body more adequate time to rest and recover. It is also helpful to avoid exercise on days off and spend time connecting with friends and family to improve emotional well-being. Some dancers may even benefit from various types of rehabilitation, such as massage, acupuncture, and meditation. 

Pushing through symptoms of burnout can often make it worse. If a dancer feels overwhelmed, they should reach out to their healthcare providers and dance community for more resources and management.

Prostate Cancer
By Dr. Javier Guevara Jr.

• According to the CDC (Centers for Disease Control) approximately 13 of every 100 American men will get prostate cancer in their lifetime. Of these, two to three men will die from it. 

• The biggest risk factor is age. However, African-American men and those with a family history of prostate cancer are at an increased risk of getting prostate cancer and dying from it. 

• African-American men have also been found to get prostate cancer at a younger age and have more advanced disease when this cancer is found.  

• The most common symptoms of prostate cancer include:

  • Difficulty starting urination 

  • Weak or interrupted flow of urine 

  • Urinating often, especially at night

  • Trouble emptying the bladder completely

  • Pain or burning during urination 

  • Blood in the urine or semen 

  • Pain in the back, hips, or pelvis that does not go away 

  • Painful ejaculation

• It is important to note that some men may have no symptoms, and there are other causes of these symptoms.  

• The United States Preventive Services Task Force (USPSTF) recommends that men who are 55–69 years-old have a discussion with their providers prior to screening for prostate cancer, including an assessment of prostate cancer risks and the risks and benefits of screening.  

• Screening offers a small potential benefit of reducing the chance of death from prostate cancer in some men. However, many will experience potential harm from screening, including false-positive results, prompting additional testing and possible prostate biopsy; overdiagnosis and overtreatment; and treatment complications, such as incontinence and erectile dysfunction. 

• There is no standard test to screen for prostate cancer. However, the two most used tests include measuring blood levels of the PSA (Prostate Specific Antigen) and DRE (Digital Rectal Examination). 

• Of note, there are other conditions, such as infection, medications, genetics, and recently performed procedures that can impact levels of PSA. 

• Similarly, the USPSTF finds no evidence of the benefits of using DRE as a screening tool and recommends against screening in men who are 70-years-old and older. 

Causes and Treatment of Sensitive Teeth
By Alex Tanielian DDS

It’s a new year, which is a great time to pause and take a moment for yourself. That includes your dental health! Did you know having sensitive teeth is fairly common? You aren’t alone.

What causes sensitive teeth?

• Simply being overdue for a cleaning could be the culprit. Gum disease can cause you to have sensitive teeth. If you aren’t brushing or flossing regularly, or if it’s been more than six months since you had a cleaning, you should schedule a visit with your dentist.

• Do you drink a lot of bubbly water or lemon water? Do you snack on a lot of citrus? Anything acidic etches your teeth, making them more porous, which causes sensitivity. By definition, carbonated drinks are acidic, and any citrus has vitamin C (which is also called ascorbic acid).

• Do you have a specific area that is always sensitive? If it’s hot or cold or sweets that make your teeth sensitive, you may have a cavity. If you aren’t flossing regularly, it’s very easy to get a cavity in between your teeth, and the only way to see that kind of cavity is to have x-rays taken at a dentist’s office.

• Another cause of hot and cold sensitivity is gum recession, an area where your gum drops away from the tooth and exposes the root. The most common cause is brushing too hard, so make sure you aren’t pushing with that electric toothbrush! Let it do the work for you. The other causes of recession are having had orthodontics like Invisalign or braces (which many of us have had) and clenching or grinding your teeth.

• Speaking of clenching and grinding, does your sensitivity come and go? Is it not always in the same area or on the same teeth? A very common cause of sensitive teeth is clenching or grinding. “Oh, but I don’t do that,” you say. Although grinding is something more obvious that you or a spouse may notice, clenching is not. All that extra pressure on your teeth may not translate to a sore jaw, but it can still cause tooth sensitivity.
  
  So what can you do? If you’re overdue, schedule an appointment with your dentist. You can have your gums evaluated, have x-rays taken and see if your dentist and hygienist think you are clenching or grinding your teeth. If your sensitivity has persisted for more than a week, that’s another reason to see your dentist. In the meantime, use a sensitivity toothpaste. They are very common and actually work pretty well. It takes a week or two of consistent use for them to work properly, so don’t give up after a night or two of use.

Voice Care in the Professional Voice User
By Gaby Klugman MS CCC-SLP

Vocal care in professional voice users is an important topic that people often overlook. Professional voice users, whose occupations rely on their ability to effectively and efficiently use their voice, include singers, actors, broadcasters, teachers, therapists, servers, and many others. These individuals use their voices much more than the average person, often at much wider vocal ranges, putting them at higher risk of developing voice problems. Just as dancers and athletes must take extra care of their bodies to prevent injuries, professional voice users must do the same for their voices.

The vibrations of the vocal folds create the voice. The vocal folds are small bands of muscle and tissue inside the larynx (or voice box). The air from the lungs causes the vocal folds to vibrate, which creates sound. While singing, a person must ensure balance between their respiratory system and vocal fold vibration as their vocal folds stretch to reach higher pitches and contract to reach lower pitches. Voice misuse or overuse may lead to problems. Voice misuse refers to inappropriately using one’s voice (i.e., shouting, screaming, singing outside of the vocal range, coughing or excessive throat clearing, using excessive strain), and voice overuse refers to high vocal demand resulting from using one’s voice too much (i.e., speaking nonstop throughout the day, singing for prolonged periods, speaking or singing over noise). Some warning signs that may indicate voice overuse or misuse include breathy or hoarse vocal quality, tightness or discomfort in the throat, voice cracks/breaks, reduced ability to project one’s voice, and dryness in the throat.

Maintaining a healthy voice requires adequate vocal hygiene, vocal exercises, and warm-ups, all of which can prevent or even resolve symptoms of vocal fatigue. We have created videos to demonstrate two exercises to use as a vocal warm-up or cool-down before/after using one’s voice. Vocal warm-ups focus on exercises to engage respiratory and laryngeal muscles and create balance between them, such as exercises focusing on diaphragmatic breathing that can help decrease tension in the chest and larynx and improve breath support, especially for higher notes while singing. An excellent exercise is a lip or tongue trill or singing through a straw. These “semi-occluded vocal tract” exercises have been part of numerous studies showing improved voice with less impact stress, reducing the risk of vocal fold injury. These exercises create a positive oral pressure, relieving pressure at the vocal folds. A second exercise that can help vocal fatigue is a massage for the muscles of the larynx, which helps relieve tension and tightness in the muscles after overuse. The companion videos offer examples of how to complete these exercises.

It is critical that professional voice users take care of their voices., including not misusing or overusing the voice, maintaining vocal hygiene, and incorporating exercises to help prevent or alleviate any vocal tension. Anyone with concerns about their voice should see a laryngologist who may refer them to a speech language pathologist.

Gaby Klugman MS CCC-SLP is a speech-language pathologist currently working at RUSH. She works with patients with a variety of communication, speech, and swallowing disorders but specializes in patients with voice disorders. She completed her undergraduate education at the University of Wisconsin-Madison majoring in vocal performance and communication sciences and disorders. During her undergraduate degree she underwent classical vocal training and performed in operas and many classical choral works. She then went on to receive her master's degree in Speech-Language Pathology from RUSH University in Chicago. She has combined her love for singing and knowledge of the vocal mechanism in her practice as a speech pathologist. Currently she still performs with the Apollo Chorus of Chicago. She loves working with performers and helping them heal their voice from injury or improve their vocal efficiency.

A Dancer’s Most Common Injury: Inversion Ankle Sprains
By Maria Reese, MD

Given the intricacies of foot and ankle movements combined with the power and athleticism of dance, inversion ankle sprains are the most common acute, traumatic injury dancers encounter. Inversion injuries in dance may occur from rolling over the lateral (outer) aspect of the foot when landing from a jump, leap, or turn or when coming off of demi or full pointe.

The anterior talofibular ligament (ATFL) is the most commonly injured ligament; injury happens when the ankle is pointed downward. The calcaneofibular ligament (CFL) is the second most commonly injured ligament; injury occurs when the ankle is in a neutral or flexed position and inverted (sickled). The least commonly injured ligament is the posterior talofibular ligament (PTFL). The greatest risk factor for lateral ankle sprains is history of a prior ankle sprain. Those who have sustained an ankle sprain have impaired dynamic postural control and hence increased risk for re-injury.

Diagnosis includes a physical examination that typically reveals tenderness over the affected ligaments, swelling, and occasional bruising. The physician will determine if imaging is warranted based on the examination. Radiographs (X-rays) are indicated if there is tenderness to particular boney prominences of the foot and/or ankle and/or if the patient has the inability to bear weight on the affected leg at the time of injury or in the clinic. Additional imaging, such as MRI, may be indicated pending symptom progression and clinical concern. MRI can help assess the location and the severity of the sprain, which depends on the amount of damage to the ligament. Grade 1 is minimal stretching with no tearing of the ligament; Grade 2 is a partial tear; and Grade 3 is a full tear/rupture of the ligament. Typically, the more severe the sprain, the more significant the symptoms and the longer the recovery process.

Treatment of an acute ankle sprain begins with decreasing the pain and swelling to help prevent further injury. If pain is severe, recommendations include ice and rest as much as possible for the first 24–48 hours. Compressing the ankle with an elastic ankle sleeve can help reduce swelling. After the first 48 hours, the goal is to help restore ankle function while also preventing acute re-injury, possibly with the use of splinting/bracing. Within 48–72 hours, it is recommended that the patient initiate range of motion exercises. Thereafter, under the continued guidance of a physical therapist, the patient will progress to strengthening exercises, endurance training, balance/proprioceptive training, and dance-specific rehabilitation. The PT will ensure the patient has optimal ankle function and strength as well as assess and address contributing factors such as hip and core stability. Most ankle sprains heal well with guided conservative treatment, and a knowledgeable physician-physical therapist care team is paramount to optimizing recovery and minimizing future risk of injury.

Please note that the content within this article is educational and should not be used as a substitute for direct medical advice from a physician or other qualified clinician.

HIV: Preventable, Treatable, But Still With Us
By Dr. Ross Slotten

A few years ago, I received a frantic call from one of my patients who had been ill for two weeks with fevers, diarrhea, fatigue, and weight loss. It turned out he had contracted HIV. He was in his early 50s and had managed not to get infected because he practiced safe sex. For that reason, despite my strong recommendation, he’d refused PrEP, a medication prescribed to prevent HIV infection (the acronym stands for pre-exposure prophylaxis against HIV). Although he was certain the sex partner who infected him had worn a condom, the condom had come off, either accidentally or intentionally. My patient was devastated. He is now on treatment for HIV and doing well, but he has not recovered from the psychological blow.

No one wants HIV. Yet we have come a long way since the onset of the AIDS pandemic more than 40 years ago. What was once a death sentence—more than 40 million people have died of AIDS—is now a chronic disease, at least in countries with access to life-saving medication. An HIV-infected person can expect to live a normal life span if they adhere to their medication regimen. My oldest patient with HIV is 93. He will die not of AIDS but of some other old-age affliction. Such great success has created the illusion that AIDS is no longer a problem. But it is. Each year, there are 1.5 million new infections, mostly in sub-Saharan Africa, but also in Asia, the Pacific, and Eastern Europe. In the United States, the most affected subpopulation is Black/African-American gay and bisexual men, for whom the stigma of homosexuality has not lifted, despite the legalization of same-sex marriage.

HIV became a treatable disease in the mid-1990s with the development of HAART, highly active anti-retroviral therapy. HIV belongs to the family of retroviruses, which have a unique ability to convert their RNA genetic material into our DNA. The medications don’t cure AIDS; they send the virus into a dormant state, which awakens only if the person stops taking their medication. People with undetectable virus can’t transmit the virus to anyone else. The first treatments had many side effects. Most people have few if any side effects from current medications. Soon there will be medications people can receive twice a year by injection. As for a cure—that seems unlikely anytime soon. And no one has been able to create an effective vaccine, not because of greed or malice, but because HIV is a tricky virus that evades antibodies, the traditional way vaccines work.

HIV is preventable. Those at risk—gay and bisexual men, heterosexuals with multiple partners in vulnerable countries—can take one of three medications that are 100% effective at preventing infection, if easily available and taken properly. With effective treatments and preventive measures, we could in theory eradicate HIV even without a cure or vaccine. What we lack is the political will to do it.

Dance and Eating Disorders
By Emily Van Nelson, MA

Dancers have the highest incidence of eating disorders amongst elite athletes[1]. The physical demand, emphasis on body shape, and expectation of perfection aligns with the struggles that occur when working through an eating disorder. However, the topic remains taboo within the performance community.

In high performance athletics, the drive for perfection creates a breeding ground for eating disorders. The positive reinforcement one receives can lead to being reluctant to acknowledge and treat their eating disorder. There are many stories: A dancer receives a comment about their body from a teacher, parent, or director that sticks with them and makes them feel like the only way to be the best dancer they can be is to control their appearance. Then food and body shape or weight become an all-consuming obsession[2].

Eating disorders are extremely prevalent in the United States; 28.8 million Americans have an eating disorder in their lifetime, but only 20% of people struggling with an eating disorder seek help. Our society’s obsession with diet culture  and praising weight loss fuel this silent epidemic[3].

When most people think of an individual who needs help for an eating disorder, they picture a cis white woman who is emaciated or skeletal, someone who is severely anorexic. But individuals within a normal weight range can also be very ill[4]. In fact, only 6% of people diagnosed with an eating disorder are classified as underweight[5]. Anorexia is one type of eating disorder, but bulimia and binge eating disorder can be equally dangerous. Sadly, eating disorders have the second highest mortality rate of any mental illness. They also affect BIPOC and LGBTQ communities, and more research is surfacing within the veteran community[6]. Eating disorders aren’t only a “rich white girl” problem.

The good news is recovery is possible. The goal is to have a healthy relationship with food, one that allows for variety, balance, and moderation and a level of body acceptance that provides the freedom to care for our bodies and appreciate them for what they can do for us.

If you or someone you know needs help, there are many talented professionals who can offer support through healing without sacrificing your identity as a dancer. Make sure you find someone who specializes in eating disorders and understands your unique needs. It is your right to choose your providers and have complete confidentiality. You can also find helpful resources below:

NEDA – National Eating Disorder Association
https://www.nationaleatingdisorders.org/

National Alliance for Eating Disorders
https://www.allianceforeatingdisorders.com/

Emily Van Nelson, MA is director of operations at Farrington Specialty Centers. Her background is in dance/movement therapy, and seeing her fellow dancers struggle with eating disorders is what drove her to pursue a career in eating disorder treatment. 

[1] The National Center on Addiction and Substance Abuse (CASA) at Columbia University. Food for Thought: Substance Abuse and Eating Disorders. The National Center on Addiction and Substance Abuse (CASA) Columbia University; New York: 2003.
[2] https://pointemagazine.com/eating-disorders-ballet/
[3] https://www.psychologicalscience.org/observer/back-page-diet-culture
[4] https://med.stanford.edu/news/all-news/2019/11/normal-body-weight-can-hide-eating-disorder-in-teens--study-find.html
[6] https://anad.org/eating-disorders-statistics/

Spotlight: Nathaniel Ekman

Nathaniel Ekman is the new executive director of Chicago Dance Health Fund. He became interim director in October after four years at the helm of NAMI Cook County North Suburban, part of the National Alliance on Mental Illness. In January, he officially joined the CDU team. Nathaniel’s career includes extensive work in strategic planning, board development, fundraising, and consulting. He is a community mental health advocate who is personally invested in the field, has led support groups for people in recovery, and speaks publicly through NAMI’s speakers bureau, In Our Own Voice. He has served on community advisory boards for NorthShore University HealthSystem and Advocate Aurora Health. Nathaniel holds a master’s degree in public policy and administration from Northwestern University and a bachelor’s degree from Harvard.

You have a lengthy and multifaceted career in the mental health and wellness industry. How did that come about?
I have a personal connection to mental health and a strong need to help those living with mental illness. Fifteen years ago, I began working with NAMI Illinois, one of 600 NAMI affiliates in the U.S. I joined NAMI Northwestern Memorial Hospital and soon found myself leading the affiliate and support group as president. Wanting to “do more with more,” I was elected to the board of NAMI Cook County North Suburban and became vice president. All of this was in my spare time! Meanwhile, my nonprofit career was taking off, and I found my niche in development. People are often impressed when I tell them I love writing grants. I like being a part of the economic engine that drives the work of an organization. And I really like meeting and working with people from all backgrounds and walks of life.

Development work led to consulting, and before long I realized I wanted to lead an organization. A vacancy in the leadership of NAMI Cook County North Suburban materialized in 2019, and I raised my hand. I was hired as executive director, and my journey in nonprofit leadership was born. It takes a village to solve America’s mental health crisis, and as a NAMI leader, I had a seat at the table. I could truly effect systemic change.

And next came CDU. What was attractive about this opportunity?
CDHF challenges me to apply my nonprofit leadership skills to a corner of the sector that addresses healthcare more broadly than, while still including, mental health. At NAMI, we know there’s no health without mental health. I believe in the mind-body connection and integrated care. You are only as well as you feel. CDHF is, first and foremost, a healthcare organization. This position allows me to segue from grant-seeking to grantmaking. In a sense, I’m a program officer! A further draw is CDU’s caring, committed, and well-connected Board of Directors. I’m impressed by their wealth of knowledge and all they bring to the organization. I’m looking forward to taking CDU to the next level, growing the organization and its impact on the professional dance community by increasing grantmaking to meet as much medical need as possible.

What are CDU’s priorities in 2023?
This is a year of growth for CDHF. I look forward to taking this organization to the next level, to deepening its impact on Chicago’s professional dance community. Donor cultivation, fundraising, external relations, events---these are the building blocks of growth and change. With growth comes increased grantmaking in our community as we do our part to meet the overwhelming need. I’m up for the challenge.

On the personal side: Any background in dance? What do you enjoy doing outside work?
I attended high school outside New York City and spent my childhood in Washington, DC. Both cities are awash in culture and gave me a healthy appreciation for the arts, including dance, from a young age. While I have no formal training as a dancer, as many know, I love to dance! I discovered New York nightlife as a young adult, and as a “veteran,” I fully appreciate the joy of moving to great music, with great people, at the right place and time. Another of my passions is travel. I love to explore the world and get to learn about other countries and cultures.

Why are the Gluteal Muscles so Important?
By Dr. Leda A. Ghannad

The gluteal muscles consist of three muscle groups in the buttock—gluteus maximus, medius, and minimus—and are incredibly important in maintaining lower body stability in dance. The gluteus maximus primarily helps with hip extension and external rotation, while the gluteus medius and minimus are hip abductors (which help extend the leg laterally). These muscles need to be strong to stabilize the pelvis, lift the leg, land, and jump—all important maneuvers in dance.

Gluteal muscles can become weak due to lack of proper strengthening and conditioning. When this happens, the dancer might notice lateral hip pain and tightness, which can become worse when lying on their side at night, landing from a jump, and climbing stairs. A dancer might even start to have anterior hip pain due to overusing the hip flexors to compensate for weak gluteal muscles. This can also lead to problems lower down in the kinetic chain, i.e., knee and ankle pain and instability.

Proper mechanics and strength training can help maintain gluteal stability. It is important to actively engage these muscles (like squeezing butt muscles) when the dancer lifts up their leg in dance or stands on one leg. Focused strengthening exercises like using bands can be helpful as well; examples of good exercises include “fire hydrants,” “monster walks,” or “clam shells.” Videos demonstrating the correct way to perform these exercises are available online; a physical therapist who specializes in dance might provide more personal guidance.

Maintaining strong gluteal muscles can help decrease pain and injury in dance and ultimately lead to better performance.

Supplementary Training:
Bridging the gap between class, rehearsals, and performance
By Kathleen Darley, PT, DPT

Dancers today are facing demands that stretch both artistic and physical boundaries. For challenging pieces of choreography and challenging performance schedules, it may be necessary to look outside the traditional technique class to meet these demands. How often have you arrived to production week feeling tired, sore, and that you’re not fully enjoying the performance aspect of being on stage? These feelings can be extremely frustrating; for most dancers, the goal of rigorous training is to find freedom in movement and artistic expression. Ideally, every opportunity to perform on stage should be the culmination of technique and physicality that enables artistic expression.  

Dancers are unique in needing energy for artistic interpretation while demonstrating feats of muscular strength, power, neuromuscular coordination, and cardiovascular fitness. While daily technique class lays the foundation for a wide vocabulary of movement, it does not provide the necessary intensity for performance. Studies have shown that class and rehearsals require much lower levels of physiological intensity than dancers reach during performance, as well as that a high number of injuries occur when a dancer is fatigued, often due to a loss of alignment or neuromuscular control at proximal stabilizing muscles.  

Supplemental training can help lessen the gap between class, rehearsals, and performances and also prevent injuries. Research has shown that six weeks of strength and power training can significantly improve strength, power, and jumping ability in high-level university dancers. In addition to regular dance schedules, dancers participated in 45 minutes of plyometric strength training, twice-weekly weight training, or one additional 90-minute dance technique class. By the end of six weeks, both the plyometric and weight training groups demonstrated objective improvements on vertical jump height, power, and muscular endurance. However, the group that supplemented their training with one additional class per week did not make any significant gains.  

Most interesting is the link between dance artistry with physical fitness. Another recent study used video analysis to record two dance solos (pre- and post-intervention) of randomized dancers placed in either a six-week strength training intervention or a control group. The strength-training group showed significantly higher subjective artistic ratings on their post-intervention solo than the control group. It’s possible to attribute these results to increased ballon (jump height), extensions in développé, and general fluidity of movement.  

The benefits of including additional training in your schedule leading up to performance season could make the difference between trying to "just get through the performance” or having enough energy to facilitate your growth as an artist on stage. Stage time is precious during your career as a dancer, so make the most of it!

Practical Suggestions:  

1. Supplemental training should occur at intensities higher than technique class. Using a scale of perceived exertion from 1 to 10, identify your number during the most strenuous part of class. Supplemental training should occur at one number higher. For example, if you are working at a 7 during grande allegro, make it your goal to work at least at 8 during training.  

2. Incorporate plyometric-like exercises at the end of class by focusing on jumping in sequence with the emphasis on "explosiveness." Start with a series of double-leg soutees followed by single-leg soutees with focus on alignment and form. Incorporate speed work only after you’re warmed up and able to maintain good landing alignment at hips, knees, and ankles.  

3. Supplemental conditioning should take place well before the lead-up to performances. A six-week period will allow for improvements in strength, cardiovascular fitness, and neuromuscular control. Ideally, two weeks should separate the end of a conditioning program and the beginning of a performance period.

Works cited: 
1. Wyon MA, Abt G, Redding E, Head A, Sharp NC. Oxygen uptake during modern dance class, rehearsal, and    performance. J Strength Cond Res. 2004;18(3):646-9.. 
2.Twitchett EA, Angioi M, Koutedakis Y, Wyon M. Do increases in selected fitness parameters affect the aesthetic aspects of classical ballet performance? Med Probl Perform Art. 2011;26(1):35-8. 
3. Stalder MA, Noble BJ, Wilkinson JG. The effects of supplemental weight training for ballet dancers. J App Sport Sci Res. 1990;4(3):95-102. 
4. Koutedakis Y, Hukam H, Metsios G, Nevill A, Giakas G, Jamurtas A, Myszkewycz L. The effects of three months of aerobic and strength training on selected performance- and fitness-related parameters in modern dance students. J Strength Cond Res. 2007;21(3):808-12 
5. Koutedakis Y, Jamurtas A. The dancer as a performing athlete: physiological considerations. Sports Med. 2004;34(10):651-61. 
6. Wyon M, Twitchett E, Angioi M, Clarke F, Metsios G, Koutedakis Y. Time motion and video analysis of classical ballet and contemporary dance performance. Int J Sports Med. 2011;32(11):851-5. 
7. Wyon MA. Testing the aesthetic athlete. In:Winter E, Jones A, Davison R, Bromley P, Mercer T, (eds). Sport and Exercise Physiology Testing Guidelines: British Association of Sport and Exercise Science Testing Guidelines London and New York: Routledge, Taylor and Francis Group, 2007, pp. 249-62 

Breast Cancer and Latinx Communities
By Marina Claudio, MD

Despite significant declines in deaths during the last several decades, due in part to increased awareness, early diagnosis, and advances in treatment, breast cancer continues to be the most common cancer diagnosed in women after non-melanoma skin cancer. Breast cancer is the leading cause of cancer death in women worldwide and the second leading cause of cancer death overall in the U.S. While this diagnosis potentially impacts all women, the incidence of breast cancer in Latinx women in the U.S. is approximately 28 percent lower than in non-Latinx white women. While these numbers may seem reassuring, Latinx women are likely to be diagnosed at a younger age and often with more aggressive disease that may have limited treatment options. They are also diagnosed at a more advanced stage and are approximately 30% more likely to die from their breast cancer than non-Latinx white women. Latinx women, based on national origin and genetic ancestry, have a wide range of risk factors for developing breast cancer.Some factors that contribute to the racial disparities in breast cancer development and outcomes: 

• Genetics

• Lifestyle

• Access to healthcare

• Social determinants of health (SDOH)—conditions in the environment where people are born, live, work, play, worship, and age that affect a wide range of health, functioning, and quality of life outcomes and risks

• Limited research on people of color

From a genetics standpoint, Latinx populations are less likely to receive screening for BRCA mutations compared to other populations worldwide. BRCA 1 and BRCA 2 are genes that produce proteins that help repair damaged DNA, our genetic material. We all possess both genes, but when these genes become altered (mutated) or broken, they don’t work properly to protect us from uncontrolled growth of tumors, possibly leading to cancer. People with BRCA 1 or BRCA 2 gene mutations are more likely to develop breast cancer, especially at a younger age. The carrier of the mutated gene can also pass this mutation down to their offspring, thus impacting their children’s risk for developing cancer. While screening for BRCA1 or BRCA 2 gene mutations in the general population is not currently recommended, those that have higher risk should consult with their healthcare provider to ask if genetic testing is appropriate. 

Lifestyle can play an important role in breast cancer prevention. A diet rich in fruits, vegetables, and whole grains and low in red meat and alcohol is consistently associated with a decreased risk of breast cancer. Following a less balanced diet, whether by choice or due to lack of access to fresh foods, along with weight gain, can contribute to disproportionate breast cancer risk among Latinx women, especially after menopause.

As a direct result of social determinants of health (see definition above), there are lower rates of screening mammograms among Latinx women. Regular screening mammograms are essential and reliable methods to detect breast cancer in its early stages. Infrequent or delayed mammograms and lack of timely follow-up on abnormal screening results contribute to the potential for more advanced breast cancer at the time of diagnosis. 

And what about breast self-exams? 

Research has not shown a clear benefit of regular physical breast exams, either by a health professional (clinical breast exams) or women themselves (breast self-exams). 

The American Cancer Society does not recommend regular clinical breast exams or breast self-exams as part of a routine breast cancer screening schedule. However, this does not mean these exams should not take place. Women should be familiar with the normal appearance and feel of their breasts and report any changes to a healthcare provider right away. In higher-than-average-risk populations, healthcare providers offer these exams in the office.

Here are five steps to performing a breast self-exam: breastcancer.org/screening-testing/breast-self-exam-bse

Finally, there may be confusion around when and how often to get a screening mammogram. Recommendations differ from one medical organization to another (cdc.gov/cancer/breast/pdf/breast-cancer-screening-guidelines-508.pdf) so it is important to have a conversation with your healthcare provider. 

References:
bcrf.org/blog/hispanic-latina-breast-cancer-facts-statistics/
nationalbreastcancer.org/what-is-brca
ACS Breast Cancer Screening Guidelines

Dr. Marina Claudio, a board-certified family physician in practice since 2003, graduated from the University of Illinois College of Medicine at Chicago and completed her residency in Family Medicine at the UIC/Advocate Illinois Masonic Family Medicine Residency Program. She has worked in various practice settings and has been a preceptor to international medical graduates, nurse practitioners, and physician assistant students. She has been active in Chicago’s Spanish-speaking communities, having given numerous community presentations and media interviews for local and national Spanish-language news programs. She is currently a medical director at Molina Healthcare of Illinois/Wisconsin. She balances her daily left-brain work with her love of dance, especially flamenco. 

Diabetes and Hypertension in the Latinx Community
By Javier Guevara Jr., MD, FAAFP

Diabetes
According to the CDC, during their lifetime, U.S. adults have a 40% chance of developing diabetes; however, Latinx adults have a more than 50% chance of developing this disease, and it usually presents at a younger age. Currently, the prevalence and incidence of diabetes in the Latinx community in the U.S. is higher than the national average. Additionally, Latinx adults are more likely to develop complications from diabetes, such as kidney disease and vision loss or blindness. Unfortunately, the Latinx community is also less likely to receive proper diabetic care due to language and/or sociocultural barriers. Also, Latinx adults are 50% more likely to die from diabetes.

Genetics, weight, diet, and activity level are the major players in diabetes. Those with direct, close family members with diabetes are more likely to get the disease. Likewise, people with a Body Mass Index (BMI) equal to or greater than 25 are more likely to develop diabetes. A diet rich in carbohydrates, (aka “carbs, starches, sugars, glucose”) also leads to diabetes. Carbohydrates are not only in the sugar you add to coffee but in the flour, breads, pasta, rice, and beans that people eat. A sedentary lifestyle also contributes to getting diabetes.

Diabetes can be prevented by, among other factors, maintaining a healthy weight (BMI less than 25). You can learn about the risk(s) affecting your chances of developing this disease by knowing whether you have family members with diabetes. Eating a balanced diet low in carbohydrates can help; 45 or fewer grams of total carbohydrates per meal can lead to better glucose control. Another positive step is to aim for 150 minutes per week of moderate intensity aerobic exercise, such as a brisk walk, swimming, biking, or gym class, among other activities. Additional recommendations include incorporating moderate muscle strengthening exercises, such as weight lifting, at least two days per week. As muscles get activated, resistance to insulin decreases, leading to better glucose control. Members of the Latinx community should make regular and frequent healthcare provider visits to test for diabetes and assess the risk of having the disease or conditions predisposing to diabetes, such as prediabetes. Participation in community programs aimed to prevent diabetes has proven effective. Occasionally, doctors may prescribe medication for losing weight and preventing diabetes. If you are diagnosed with prediabetes or diabetes, it is important to make frequent medical visits and adhere to the recommended plan.

Hypertension
Elevated blood pressure, or “hypertension,” is a growing problem in the Latinx community. In the U.S., Latinx adults previously had less incidence and prevalence of hypertension; however, today Latinx adults are 40% more likely to have uncontrolled hypertension, which, in addition to other chronic illnesses such as diabetes and/or kidney disease, can lead to increased risk of an early death.

Maintaining a diet low in sodium (salt) and keeping an active lifestyle with moderately intense aerobic exercises (as described above) can help reduce the risk of developing hypertension. Additionally, maintaining a healthy weight also correlates with lower blood pressure. Smoking increases the risk of developing elevated blood pressure, heart attacks, strokes, and cancer; quitting or avoiding products containing nicotine is an essential measure to maintain good health. Frequent and regular visits with a primary care provider (PCP) also leads to the prevention of diseases such as diabetes and hypertension. Everyone in the United States should sign up for medical coverage regardless of their citizenship status, ability to pay, and/or health status. To find a healthcare center near you, please visit findahealthcenter.hrsa.gov/.

Javier Guevara Jr., MD, FAAFP is a board-certified Family Physician at Northwestern Memorial Hospital and a Fellow of the American Academy of Family Physicians. He practices hospital medicine in the emergency department. His clinical interests include LGBTQ health, academic medicine and leadership development. He earned his Doctor of Medicine at Northwestern University Feinberg School of Medicine after graduating from UNC Wilmington with a Senior Medallion award, a major in Biological sciences and a minor in Chemistry. He recently joined the executive leadership of Howard Brown Health as a board member. He is also a board member at Northwestern University Medical Alumni Association where he co-created and co-chairs the Inclusion & Allyship committee focusing on diversity. His research on interventions to improve diabetic care in the primary setting won top score during the 2015 Illinois Academy of Family Physicians Resident Research Symposium.

Spotlight: Shirley Ryan AbilityLab

Shirley Ryan AbilityLab is an important partner to Chicago Dance Health Fund, specifically through its Performing Arts Medicine Program. Their generous and skilled practitioners have contributed a wealth of information and accessible resources to our evolving health and wellness blog and, in turn, our community. At this year’s Dance for Life, AbilityLab will have staff backstage providing physical therapy to dancers prior to the performance.

We asked several professionals at AbilityLab what they like about treating dancers. Here are their thoughts:


Kathleen Darley, PT, DPT
During my career providing physical therapy to professional and amateur dancers, I have worked in a variety of practice settings, and I am convinced there is no place quite like Shirley Ryan AbilityLab when it comes to collaboration between clinicians. I work with physicians and my talented fellow physical therapists to ensure we address patients' needs efficiently. Our collaboration makes all the difference for faster recoveries and return to performance.

Here’s an example of that collaboration in action: A dancer comes to us with a prescription from their primary care physician for therapy to address chronic pain and popping and clicking at their hip. First, I complete an evaluation and examination—but, before I proceed with therapy, if there is anything I want to double-check or get an opinion on, I send the patient to Maria Reese, MD, director of the Performing Arts Medicine Program. From there, Dr. Reese can order an MRI or ultrasound imaging, have the patient start or adjust pain medications, and confirm what is most important to work on in a therapy session. Having the ability to immediately pull in a physician this way is incredibly rare and beneficial to the patient. With direct communication, nothing gets lost in translation between the therapist and physicians. Dr. Reese and I check in with each other both before and after she sees the patient, as well as during their course of treatment.

Another amazing aspect of our Performing Arts Medicine Program is our personal, specialized experiences with dance. I was a dancer, and two of my colleagues also have professional dance experience. We are all on the same page with dance terminology and understand the unique psychosocial aspects of dance training. I specialize in the pelvic region and hip, but if I have patients who also need to focus on their relevé alignment and lower extremity strength, I can send them to Lindsay Backiev or Katie Zisk. We all play on each other's strengths and can provide very specific treatment for each dancer’s presentations and ultimately get them back on stage faster!


Lindsay Backiev, PT, DPT
As outpatient physical therapists, we don’t treat patients in a laboratory setting; however, because we’re part of Shirley Ryan AbilityLab—and its translational research model—we maintain a strong center in evidence-informed practice. Because of this philosophy, we are empowered to use the latest literature to maximize patient outcomes for every diagnosis for which our patients seek our care. In practice, this means I am able to brainstorm with my fellow clinicians, physicians—and patients—to focus on an individual performing artist’s needs and expedite their return to rehearsal and stage!


Maria Reese, MD, attending physician, PAMP medical director
Our combination of a collaborative approach and state-of-the-art diagnostic tools sets us apart. I am a sports medicine physiatrist—a medical doctor who specializes in the neurological and musculoskeletal systems with a focus on function, so I am the first on the clinical team to see patients. For example, a dancer comes to me with pain in their Achilles tendon. First, I would perform an in-depth neuro-muscular evaluation of the lower extremity, evaluate their core and hip stability, assess each element of the kinetic chain, and provide a dance-specific evaluation. Next, I would perform a bedside ultrasound of the tendon to evaluate any injury and provide even more specific diagnostic information. After assembling data and my clinical findings, the collaboration starts: I meet with the physical therapist, who, it should be noted, has specialized experience both as a dancer and in treating dancers. The PT takes it from there, providing specific therapeutic treatments with the patient’s dance style and goals always in mind. The collaboration continues throughout the patient’s treatment time; we are constantly communicating about every patient’s progress and challenges and whether additional physician-led treatments like medications, injections, or further imaging would aid recovery. Whatever is necessary, our team always works together to optimize a patient’s outcome.

Hearing Preservation Tips
By Lori Halvorson, AuD, FAAA, CABA

• Protecting your hearing is the #1 modifiable lifestyle component you can change to reduce your risk for dementia.

• Custom ear plugs fit perfectly 100% of the time.

• Patented filters in custom plugs allow you to hear the fidelity of music and speech while keeping your hearing safe.

• A perfect ear mold impression is a must for good-fitting ear plugs.

• You are born with 16,000 hearing cells in each ear, and they must last your lifetime. Loud noise kills them.

• Dr. Halvorson recommends a cellular hearing exam with a preservation audiologist every six months.

Hearing Problem - Brain Problem - Life Problem: How to Preserve Your Hearing Now
By Lori Halvorson, AuD, FAAA, CABA

Hearing is the brain’s trump card. The brain ranks hearing above all other senses to help keep us safe. It is the only sense that never turns off and the last sense to shut down when we leave the earth. Hearing is a valuable resource our brain uses to gain an advantage. It warns us if danger is coming so we can seek safety. Hearing connects people to people. It nourishes positive emotions with healthy engagement and acts as an antioxidant against negative emotions. 

Hearing affects emotions more than any other sense. Hearing your loved one whisper, “I love you” or tell you they appreciate you or sing to you engages positive emotions. Research shows a link between upbeat emotions and improved health, reduced risk for heart disease, lower blood pressure, better blood sugar levels, healthier weight, and longer life. Hearing loss can trigger negative emotions, depression, isolation, fatigue, social withdrawal, changes to self-esteem, impatience, and raised voices from loved ones. Hearing loss not only affects emotions negatively, it can accelerate the risk of dementia.

Research shows:

• Untreated hearing loss can put you at five times greater risk of dementia. 

• Difficulty understanding speech in noise, even with normal hearing, can put you at 61% greater risk of dementia.

A recent Lancet study on hearing loss revealed that the number one thing you can modify in your life to reduce your risk of dementia is to treat hearing loss by midlife. Do not wait, thinking it’s not bad enough yet. When you get a cavity, you typically don’t wait until you need a root canal. Why do we give more routine care to our teeth than we do to our hearing? 

Hearing is one of the hardest tasks we ask our brain to do. The process involves sound traveling through our ear, changing from mechanical to electrical, traveling from the ear drum to three little bones, and transporting sound thru fluid in the cochlea to hearing hair cells. Each of your 32,000 hair cells are tuned to a precise frequency, like a fine-tuned piano, creating a frequency map for the brain. Damaged hair cells result in compromised sound, like playing a piano with missing keys. Physical movement of the hair cell converts sound into an electrochemical signal and sends it to the auditory nerve, which acts like a speeding highway transporting sound to the brainstem. Damage in the hearing highway slows down and destroys the signal, like big potholes in Chicago highways. Sound from both ears travels to the thalamus, which is the brain’s sensory relay station, where sound is quickly computed for direction and location and sent to the primary auditory cortex. Different auditory neurons respond to different frequencies, so it is vital that all of them are healthy. They carry the frequency map generated by the hair cells. If your hair cells are damaged or dead, your frequency map is not very accurate. We all know what happens when the map is wrong: we get lost or blame someone else.

Cortical neurons specialize in certain jobs. Some respond to intensity, duration, or change in frequency, while others specialize in tone. Neurons higher in the brain specialize in processing harmony, rhythm, and melody. Like your favorite recipe, hearing neurons combine the different ingredients of sound so you can recognize a voice, separate speech from noise, and make sense out of sentences. When you’re missing an ingredient in a recipe, it does not taste the same. When you are missing a sound ingredient because of damaged hearing cells, it does not sound the same.

Preserve your hearing to hear younger. Preserve your hearing with routine care. You brush your teeth every day to keep them healthy and visit the dentist twice a year. Nourish your hair cells every day to keep your hearing healthy. Visit a hearing preservation audiologist every year for routine care. Hearing loss is not an inevitable result of aging. It is the result of damage and death of hearing hair cells from metabolic stress, metabolic waste, loud noise, or change in blood flow causing a stroke in the ear. Just like brushing your teeth to avoid tooth decay, new research shows routine professional hearing care plus new science can preserve your hearing cells to avoid hearing decay.

Preservation audiologists specialize in keeping your hearing healthy so you may never need a hearing aid. Preservation audiologists are new specialists in the field of audiology, specifically trained on inner ear biology and hearing preservation. They provide routine hearing wellness exams and test, monitor, and nourish your hearing to keep it healthy and stable. Like a dentist and toothpaste help avoid a root canal, a hearing preservation audiologist and science can help you avoid a hearing aid.

The hearing doctors at Lake Forest Hearing Professionals are hearing preservation audiologists specially trained to keep good hearing healthy and treat damaged hearing with professionally programmed hearing aids to match the frequency map generated by your hair cells to help your brain age younger. Just making sound louder is not good enough. Waiting until hearing is bad enough for a hearing aid is not wellness. Choose hearing preservation. Choose hearing wellness.

Lake Forest Hearing Professionals
(847) 295-1185

Dr. Lori Halvorson is a visionary leader in hearing, brain wellness, and hearing conservation with more than 30 years of experience, opening Lake Forest Hearing 15 years ago. She attended Rush University Medical Center, where she earned her doctor of audiology (AuD) clinical doctorate degree. She is board certified by the American Institute of Balance and Vestibular Assessment and Management. In addition, Dr. Halvorson is certified for accreditation in Occupational Hearing Conservation and has published groundbreaking research on prenatal hearing. She is a Fellow of the American Academy of Audiology and a member of Mensa.

Fueling for Performance
By Heidi O’Brien

Whether you are in training, taking class, or performing, proper fuel before and after exercise is essential for a strong and healthy body. But what should you eat? How much? At what time? There is an abundance of information recommending specific foods to eat, amounts to prepare, and timing of intake, making nutrition information a bit overwhelming. Let’s break it down together!

Pre-workout nutrition: 

Don’t skip out on those carbohydrates!
Carbohydrate intake is an essential part of pre-workout nutrition. Carbohydrates supply quick energy for the body to use during aerobic exercise and are useful for sustainable energy throughout performance. Thus, the intake of carbohydrate rich foods before activity is vital for quality performance. This nutrient serves as the “fuel” your muscles need to endure long bouts of physical activity. The more strenuous your efforts, and the longer you engage in activity, the more carbohydrates you may need! Limiting carbohydrates may lead to sugar cravings; sugar may provide temporary energy, but often leads to plummeting energy levels, or what is commonly known as a sugar “crash.” It is imperative to provide your body with quality carbohydrates to perform at your best. Whole grains, fruits, and vegetables are complex carbohydrates that will not cause plummeting energy levels. Processed foods, sweets, sugar-sweetened beverages, and foods high in added sugar can often contribute to energy crashes and may negatively impact athletic performance. 

Some examples of pre-workout meals include: 

1. Greek yogurt and berries

2. Oatmeal with banana

3. Toast with peanut butter and jam

4. Fresh fruit

Generally, consuming a snack or meal one to two hours before exercise is recommended. However, this may vary from person to person. Some people perform best when they consume food right before a workout, while others require ample time to digest for best performance. It may take practice to determine how much time prior to exercise works best for you. Foods high in fat are not commonly recommended as pre-workout fuel. The body digests fat much slower than carbohydrates and protein, which may cause digestive disruptions during exercise. However, if it works for you and doesn’t cause discomfort while you exercise, don’t be afraid to add a fat source. Severely restricting fat from your diet can lead to decreased energy levels and leave you feeling hungry. However, not all fats are created equal. The more nutritious fats include olive and canola oils, nuts, olives, and avocado. Saturated fats such as butter, cheese, fried foods, and fatty meat cuts are best to avoid.

Post-workout nutrition:

Replenish, Replenish, Replenish!
Carbohydrate intake is again essential! Focusing on carbohydrate intake after exercise will help to replenish glycogen stores in muscles and tissue from a prolonged workout. Consuming foods high in protein after exercise also provides the body with essential amino acids to rebuild and repair muscles you used throughout the workout! Some recommended post-workout snacks include:

1. Smoothie with fruit, milk, and nut butter

2. Turkey wrap with hummus and vegetables

3. Low-fat chocolate milk (a quick on-the-go option full of protein and carbohydrates!)

Focusing dietary intake on whole foods rather than heavily processed foods is recommended for good health along with helping to enhance performance. Processed foods often contain added sugars and sodium, which can make you feel sluggish and impact athletic ability.

Heidi O’Brien is a Dietetic Intern and Graduate Student of Clinical Nutrition at Rush University Medical Center.

Osteoporosis
By Lindsay Backiev, PT, DPT

People who work in the performing arts—dancers, musicians, stagehands—as well as athletes and active individuals spend their time creating all sorts of movement with their bodies. These movements allow the muscles to contract and place tension on bones via their tendinous attachments, which stimulates the bone to produce more bone tissue and create a stronger, more dense skeletal structure. This process is known as Wolff’s law, which states that bone in a healthy person will adapt to the loads placed upon it. #loadyourbones 

But what happens if bone tissue breaks down and is resorbed, which occurs naturally with weight-bearing activities during a timeframe of 100–200 days, faster than new bone is deposited? Long-term, this leads to a condition called osteoporosis, or “porous bone,” for which there is no cure. At first glance, one may not consider an active individual to be at risk for osteoporosis. However, it is important to pay special attention to risk factors that contribute to the development of osteoporosis.

Some of the biggest risk factors include having a small frame, a deficiency in calcium and vitamin D, a history of long-term (three or more months) steroid use, an eating disorder, two or more alcoholic beverages per day, hyperthyroidism, or hormonal changes (think post-menopausal women here), or being a white or Asian female. Another is having a parent or grandparent who has osteoporosis. I’ll use myself as an example: I check three boxes of risk factors that I cannot control. Yikes! If you’re starting to panic after that knowledge bomb, please don’t. One more science-heavy item before we get to the fun stuff. 

Unfortunately, many people do not have symptoms of osteoporosis and may only receive a diagnosis after sustaining a fracture from a fall. To formally diagnose osteoporosis, a physician orders a test to measure bone density called a dual energy X-ray absorptiometry (DEXA for short) to examine a patient’s T-score at the hip and spine. A T-score of -2.5 standard deviations lower than age- and sex- matched normative values indicates osteoporosis, while -1 to -2.5 standard deviations lower indicates a condition called osteopenia. A score of +1 to -1 indicates healthy bones with normal bone mineral density. #bonegoals, am I right? 

As doctors of physical therapy, it is within our scope of practice—and I’ll take it further to say our responsibility—to provide patients and the general public with evidence-based exercise recommendations for a plethora of conditions. For those with osteoporosis, or risk factors for developing the condition, the main cornerstones are weight bearing and progressive strength training. #loadyourbonesalready! The following recommendations are hot off the presses from the new Clinical Practice Guideline published by the Academy of Geriatric Physical Therapy. All recommendations and guidelines are the same for cisgender and transgender persons. 

Postmenopausal Women:

• Long-duration (minimum of 6–48 months!) exercise programs of static weight bearing (e.g., standing on one leg for one minute three times per week) and strength training alone or in combination with walking, jogging, or aerobics

• Long-duration exercise programs of walking, tai chi, strength training, and different combinations of exercise types #mixitup 

Premenopausal Women:

• Long-duration (6–24 months!) exercise programs of high-impact exercise such as jogging, stair climbing, and weight training

Men:

• There is insufficient evidence to support exercise as a factor to improving bone density in men. It’s very safe to say that exercise is important and an effective way to maintain and improve health, function, and quality of life. #getupandmove 

We are still in the midst of the COVID-19 pandemic, and economic distress is real. If access to a health club and exercise equipment are barriers, have no fear! Plastic jugs filled with water, a heavy pot or pan, or elastic tubing are great options for weight training, and I recommend these items to my patients on a daily basis; in fact, I use them myself (check out CDU’s social media posts from Summer 2021 for examples). Brushing your teeth? Stand on one foot! The Academy of Geriatric PT recommends walking, jogging, running, jumping, and stair climbing, which do not require equipment or health club membership, and they’re even better when you ask a buddy to join the fun! 

One more thing before I go: Since May is physical fitness month, I challenge you to meet the guidelines recommended by the American College of Sports Medicine and the CDC for exercise: 150 minutes of moderate-intensity aerobic exercise per week and strength training two or more days per week that works all major muscle groups. #challengeaccepted 

To read the full Clinical Practice Guideline recently published in the Journal of Geriatric Physical Therapy, https://journals.lww.com/jgpt/Abstract/2022/04000/Physical_Therapist_Management_of_Patients_With.5.aspx

Ending the Snacking Struggle
By Kelsey Bognar

Consuming balanced meals with healthful snacks throughout the day is important for everyone’s health. Having three meals that contain adequate calories, sustaining carbohydrates, lean protein, and healthy fats can be a challenge due to busy days and long nights. Trying to include two to three nutritious snacks can be especially difficult. 

Ideally, snacks should supply important nutrients like fiber, protein, calcium, and iron whenever possible. However, snacks can often fall short of these nutrients and instead contain high amounts of fat, sugar, and salt. Snacking is an essential part of a dancer’s diet to ensure nutrient needs are being met to sustain rehearsals and performance.

In addition to incorporating healthful snacks, determining when to eat them around busy schedules is a key factor to snacking smart. Dancers and those with other jobs will find it useful to plan snacks ahead of time so as not to default to less nutritious options that are readily available. A good rule of thumb for dancers or anyone engaging in physical activity is to try to include snacks for both pre- and post-activity. A pre-active snack should include easily digestible carbohydrates to promote long-lasting energy and stamina, while a post-active snack should include protein and carbohydrates to aid in muscle recovery and replenishment. 

When throwing snacks together, it’s helpful to combine nutrient-dense foods that contain slower-digesting carbohydrates (like fiber) and high protein. Here are a few snacks ideas that are easily portable: 

• Trail mix with dried fruits, nuts, and whole grain cereal

• Veggies with hummus

• Whole grain crackers or pretzels with peanut or nut butters

• Fresh fruit like apples, grapes, oranges, or bananas with peanut butter

It’s best to carry an insulated lunch bag if no refrigeration is available for premade protein shakes, yogurt, hummus, and string cheese, which are also easy to transport. These snacks are nutritious for dancers and non-dancers. No matter what type of work someone does, fueling adequately will help ensure peak performance. Happy snacking!

Kelsey Bognar is a Dietic Intern and Graduate Student of Clinical Nutrition at Rush University Medical Center.

Spotlight: Julia Hinojosa, General Manager

Chicago Dance Health Fund is thrilled to welcome our new general manager, Julia Hinojosa!

Julia has more than 10 years of experience as a nonprofit professional working with a variety of arts, educational, cultural, and community-based organizations. Most recently she was assistant director of education programs at the University of Chicago's Arts+Public Life initiative. She previously spent nearly 10 years with Ensemble Español Spanish Dance Theater; as director of education and community outreach, she assisted in raising more than $1.5 million and increased program enrollment by 40%. She was also a principal dancer and artistic director of its youth company.

Julia shares a few thoughts about her new role.

You’ve worked on educational programs and initiatives for various organizations. What drew you to that area? And how do you envision using those skills and interests with CDHF?
As a child, I did not have access to arts education programs. It wasn’t until I was in college that I took my first formal dance class, a class that proved to change the trajectory of my life. I wholeheartedly believe in the transformational power of the arts, and I wanted to ensure that young people, especially those living in divested communities, had access to quality arts educational experiences. I hope to bring the same enthusiasm and passion to supporting the Chicago dance community. Administration and operations are the quiet drivers of change. I look forward to using my skills and knowledge in nonprofit arts management to advance CDHF’s mission to break down barriers for Chicago dance professionals to access health and wellness care. 

Have you participated in Dance for Life? What was your favorite part of that experience?
Performing in Dance for Life was one of my most memorable experiences as a dancer; they were always so much fun. I enjoyed being in community with other dancers and sharing the stage with companies I admired. But mostly, I loved the energy of the audience; they were always so generous and welcoming. 

Why do you think emphasizing the health and wellness of Chicago’s professional dance community is a priority?
The pandemic and the racial reckoning we endured the past few years have made it clear that we cannot go back to business as usual. We are still experiencing and processing the grief of losing loved ones, witnessing beloved organizations and creative spaces shutter, and enduring months of social unrest leading to increasing levels of uncertainty, stress, and anxiety. And now, as we slowly emerge past it, we face having to rebuild what we lost. The Chicago dance community is tough and resilient—they will rise to the challenge, but we need to ensure they are healthy, physically and mentally, to do so.  

What are you most looking forward to as you embark upon this position with CDHF?
I look forward to amplifying the work of CDHF, bringing more awareness to Chicago Dance Health Fund, and collaborating with our stakeholders to find new and innovative ways to support them with financial relief and provide them with health and wellness resources.

Julia Hinojosa (she/her/hers) is a non-profit arts professional with ten years of experience working with educational, cultural, and community-based organizations to develop arts programming and educational experiences for students of all ages. She is committed to supporting mission-driven arts and culture organizations in Chicago confronting complex social issues. Julia comes to this work from University of Chicago’s Arts+Public Life initiative, where she managed a portfolio of arts education programs for South Side Chicago teens to cultivate artistic and creative growth, leadership, and social development. Prior to her role at Arts+Public Life, Julia spent ten years with the Ensemble Español Spanish Dance Theater where she served as Director of Education and Community Outreach and assisted in raising $1.5 million and increased program enrollment by 40%. Julia holds a Master’s Degree in Arts, Entertainment, and Media Management from Columbia College, Chicago, and a Bachelor of Arts in English from Northeastern Illinois University.

Taking care of your body includes taking care of your teeth!
By Alex Tanielian, DDS

If you are a little (or a lot) overdue for a dental checkup, don't worry, you are not alone. Blame COVID if you want, but between losing jobs, switching jobs, and working from home, many people have pushed their dental visits to the bottom of their list.

Now is the time to come back!

Many people assume that if nothing is bothering them, everything must be fine. Sadly, that often isn't true. Small cavities frequently don't cause any symptoms or produce only minor sensitivity that people write off as “normal.” Gingivitis causes your gums to bleed, but so does its more advanced version, gum disease (periodontitis). There's no way for you to tell when one changes to the other. Only a dentist or hygienist with the proper instruments and x-rays can differentiate between them and take the steps necessary to deal with them.

So, you're ready to go back? Great! It may be obvious, but your first step is to find a dentist! Unfortunately, many offices closed during the pandemic, so first make sure your dentist is still open. Your insurance may have changed, so check to see if your dentist is still in-network or at least still accepts your insurance. If you have to find a new dentist, ask your co-workers for recommendations. Likely they'll have chosen a dentist in-network who is close to work, and a word-of-mouth referral from someone you trust is always the best.

In the meantime, here are some tips I give to my patients every day: 

• Everyone knows sugar is bad for your teeth, but did you know that acid can be just as bad or worse? Acidic things include anything bubbly (LaCroix anyone?), citrus (including lemon water), and vinegars. I always tell my patients they don’t have to cut these out of their diet, but they shouldn’t sip on something like lemon water all day. It increases the risk of cavities and is often a significant cause of sensitive teeth. 

• Whether it's from work, school, kids, or all of them together, we're tired at the end of the day. The last thing we want to do is floss, because let's face it, flossing is tedious. So, if you don't have the bandwidth to floss at the end of the day, do it another time. Floss in the morning, floss in the shower, floss at work. I'd rather have you floss every day during your coffee break than once a week at night. 

Stop brushing so hard! If you have a normal brush, make sure it's soft. Make small circles as you move along and think about holding it with only three fingers. If you have an electric brush, don't push at all. Put the brush gently against your teeth and just drift around until the timer stops (spoiler, it's two minutes).

Dr. Alex Tanielian is originally from Seattle, Washington, and spent the last decade in San Francisco before settling in Chicago. He originally moved to attend the University of California, San Francisco (UCSF) School of Dentistry, where he received his DDS. Following dental school, he completed further training at an Advanced Education in General Dentistry residency at UCSF. During his training, he advanced his expertise in laser dentistry, adhesive dentistry, 3D-printed crowns, bone grafting, and complex root canal treatments.

Dr. Tanielian prides himself on providing exceptional care, with a focus on optimal oral health and patient satisfaction. He fosters a low-stress, comfortable, even enjoyable dental experience. His practice emphasizes prevention and prioritizes shared decision-making so patients can make informed choices about their dental care. He has been an active member of national, state, and local dental societies since graduating with his doctorate and is constantly striving to provide the most state-of-the-art and evidenced-based care.

Dr. Tanielian spends most of his free time with his wife and two kids. If he isn’t spending time outdoors, it’s because he is searching for new and interesting restaurants, especially ramen restaurants.

Protein Needs: How Much is Enough?
By Madeline Wiemers, BS

Being athletes, dancers need to consume additional nutrients throughout the day for proper fueling and rebuilding of muscle. Protein is a nutrient that dancers must consume to repair the body after strenuous activity. The amount of necessary protein varies depending on the level of activity the dancer engages in and the amount they typically consume in their diet. The recommended amount of protein is ~ 1.2–2.0 g/kg daily to properly repair and strengthen muscles. Research has shown that the timing of protein intake post-physical activity can make a difference. Aiming to consume high-quality protein within two hours of a workout can promote greater rates of muscle repair and growth. What is considered high-quality protein? Protein sources that include easily digested “complete” proteins, which contain the essential amino acids or building blocks of protein. Examples of high-quality protein include lean meats, poultry, fish, eggs, soy, and dairy products such as milk, cheese, and yogurt. Other good sources include legumes (beans and lentils) and seeds/nuts.

It is important to understand that consuming protein will not necessarily build muscles. Resistance training along with a balanced diet and hydration is necessary. Research shows that athletes who consume an adequate amount of carbohydrates and fats use less protein for energy, which allows protein to help build stronger muscles while sustaining lean body mass. And more is not necessarily better. There is no consistent scientific evidence to support that consuming greater than 2.0 g/kg protein each day will help build muscle. In fact, large amounts may pose health risks such as osteoporosis, kidney issues, and dehydration. 

So, in conclusion, for a dancer who wants to perform to the best of their ability, consuming adequate amounts of protein is essential to repair and build muscular strength.

Madeline Wiemers was a competitive dancer for 10 years and competitive dance coach for 3 years. She is currently completing her master's degree in Clinical Nutrition and Dietetic Internship at Rush University Medical Center. She enjoys spending her time playing with her Australian Shepherd Mila, cooking, and reading.

Finding Great Health Care in 2022
By Martin J. Gorbien, MD, MHL, FACP

As the late Stephen Sondheim wrote, “art isn’t easy.” This idea is not revelatory to dancers and all who work to create dance. Something else that isn’t easy? Finding high-quality, accessible, affordable, culturally sensitive healthcare. Howard Brown Health has been providing care to the LGBTQ+ community since 1974 and has been an iconic source of care, comfort, and community for those living with HIV. Another important response to the AIDS crisis in Chicago was the creation of Dance for Life (DFL) in 1991. The Dancers’ Fund (the beneficiary of Dance for Life) has been providing grants to those with serious health challenges since 1991, and, for the first several years, grants were almost exclusively to support people living with HIV.

Happily, there have been many successes related to the treatment and prevention of HIV/AIDS, allowing Howard Brown to expand its primary care, behavioral health, and social services to better support accessible, affirming care. Chicago Dancers United, the nonprofit organization that administers The Dancers’ Fund and produces Dance for Life each year, has broadened the focus of the Fund’s grants.

Eight years ago, Howard Brown received the prestigious distinction of becoming a Federally Qualified Health Center (FQHC). This accreditation enhanced the agency’s growth and fostered significant expansion in the care it offers across the city. Today, Howard Brown serves the City of Chicago from 11 locations and sees individuals regardless of their ability to pay. While HIV/AIDS care remains at the core of the agency’s work, Howard Brown is proud to offer a range of services to LGBTQ+ people and their allies. The agency has great potential to help members of the dance community find high-quality primary care along with a variety of other important services, including, in part:

• Primary Care

• HIV/AIDS Care

• Sexual and Reproductive Health

• Trans and Nonbinary Health

• Pre- and Post-Exposure Prophylaxis (PEP/PrEP)

• Behavioral Health

• OB/GYN Services

• Insurance Enrollment Services

• Smoking Cessation

• COVID-19 Services

• Older adult services

Howard Brown is an ideal destination for artists who are in need of great, comprehensive care. I am very proud to have recently joined their team and hope that we will have the opportunity to serve Chicago’s vibrant dance community.

Our Mission
Rooted in LGBTQ+ liberation, Howard Brown Health provides affirming healthcare and mobilizes for social justice. We are agents of change for individual wellbeing and community empowerment.

To learn more, visit: howardbrown.org.

Dr. Martin Gorbien specializes in Geriatric & Internal Medicine. He served on the Board of Dance for Life/CDU for over 15 years. Dr. Gorbien sees patients at Howard Brown's 55th location in Hyde Park.

Social Determinants of Health: A Collective Dance
By Maya Green, MD, MPH

When I was asked to write a piece focused on African-American women and heart disease, I wrote it the same evening. Then I proceeded to write it over and over again, hoping that one of the iterations would give a glimpse of my authentic intention to communicate the root of chronic wellness or chronic "dis-ease" for so many women who journey through life stepping to the punch-card given to us, often by those who have no clue what it's like to dance in our shoes. 

Dance is a beautiful, dynamic, and intentional expression that often requires us to train our bodies and minds to move through space in a manner acceptable and beautiful to onlookers and least harmful to ourselves. As humans, we dance many types of dance in many phases of our life. There's the dance through physical space, for which the onlookers are an audience. There’s the mental dance for navigating personal growth, and the onlooker (and often worst critic) is our own self. Then there’s a third type of dance, for which the physical and mental combine to move through society. This type of dance is essential in constructing chronic wellness and/or lack thereof. Without addressing this last type of dance, there is no way to address heart disease in African-American women—so there was my conundrum.

African-American women have historically nurtured nations from our bosoms and created spaces that support everyone around us. If you're not an African-American woman, you may ask, "Don't I do that, too? What about my experience?" EXACTLY!  

Being able to hold a space that focuses on our own wellness isn't the norm and often prompts diversion to the plight of others. This truth applies to the disparity of outcomes for heart disease in African-American women, but also any chronic illness: diabetes, hypertension, elevated cholesterol, HIV, and so on; it's all the same. Much of the sickness that we bear the brunt of as minoritized communities manifests as disease, but the root cause is how we live in the world around us and how the world around us is designed to impact how we live. In some circles, we call these the social determinants of health. These include economic stability, education, neighborhood environment, and social community context in healthcare. Access to affirming forms of all those factors impact our wellness and how we live.

I would be remiss if I didn't offer an example, so here's what that looks like:

• Heart disease is the number one killer in women.

• The mortality rate from heart disease is 69% higher in African-American women than in white women.

• Cardiovascular disease kills nearly 50,000 African-American women annually.

• 49% of African-American women ages 20 and older have heart disease, yet only one in five African-American women believes she is personally at risk.

Understanding stats is one thing, but understanding the systemic structure of the lack of nutritious resources in our communities is another.  The educational disparities in offerings, the absence of healthcare entities (many times miles away in African-American communities), and the concomitant assumption that African-American women are often tasked to provide nutrition, education, and wellness to support our families, friends, and communities weighs heavy on us.

There is a dance African-American women perform as we juggle the woes of everybody else's world, many times effortlessly creating a safe space for others while forming a silo of health for ourselves. However, to live our full potential in a liberated manner, we must know how to navigate these systems to arrive at a physically, mentally, and emotionally affirming space.  

Here are some ways we can show up for ourselves and lower our risks of heart disease. Ironically, the first form of dance, physical dance, comes into play here. Dance and other activities are essential in controlling blood pressure, controlling cholesterol levels, keeping the heart healthy, and managing stress. Just 30 minutes of dance five days a week or one hour of dance three days each week addresses all these factors, which impact heart disease. A regular activity plan coupled with a diet of more fresh leafy greens is a significant way to start your heart wellness journey as you wait to check in with a healthcare provider you trust for any other heart-healthy add-ons.

Engaging in behavioral and integrative wellness is also very important because, in reality, we won't change our dance overnight, but we can find support to help us through the process. If you currently smoke cigarettes, stopping today will also take your heart health to the next level. Just minutes after you stop smoking, your blood pressure levels decrease. The day after, your chance of having a heart attack starts falling. This is just a start; smoking cessation decreases your risk of having throat, lung, bladder, and other cancers. One more fun fact: Smoking cessation also heals your tastebuds, so the nutritious food you eat will be much more enjoyable!

No matter where we are on our heart-healthy journey, it is crucial that we show up physically, mentally, and socially for ourselves and each other. We often dance in silos when the solution is collective movement. Marginalized communities did not create disparities in social determinants of health alone. We won't solve them in a silo.  

If you are reading this, walking away with the notion that you just read an article more focused on addressing social determinants of health than targeting African-American women and heart disease, then, after numerous iterations, I have successfully written a community call to action and invited you to a collective dance, supporting the health of African-American women and minoritized communities everywhere.

Hit the floor!

Maya Green, MD, MPH is a proud south side Chicagoan, who formerly served as an educator in the private and public school sectors. After obtaining her MD/MPH with a focus on Health Policy and Administration at the University of Illinois at Chicago, she completed a residency in family medicine at the University of Miami and a specialty fellowship in HIV medicine at Rush University Medical Center.

Dr. Green previously worked as an HIV specialist at the Ruth M. Rothstein CORE Center, and now she serves as the Chief Medical Officer for Howard Brown Health. Her client panels include pediatric, adolescent and adults who speak Spanish or American Sign Language and people who experience substance use disorder. Dr. Green is the founder of HIV Real Talk – NFP and a board member of Chicago Task Force Prevention & Community Services. Both of these organizations focus on decreasing disparities among Chicago’s marginalized communities.

New year, new diet, new workout, new supplements?
By Mary Kate McCarthy, MS

The start of a new year often means a reset for many individuals. This period of time often witnesses the most number of people joining new gym memberships, starting on the latest eating “trend” (i.e., vegan, keto, paleo, etc.), or setting more rigid goals for themselves. During the past few years, media outlets and social influencers have endorsed this ideology, promoting certain trends without knowing the nutritional advantages and disadvantages.

It is important to remember that the idea of “new year, new me” may not be beneficial for everyone because these “fad diets” are often not sustainable. Let’s say the new “popular diet” is a high-fat, low-carbohydrate diet. While influencers and social media outlets may send the message that it is healthy, in reality, this diet can strongly reduce energy levels and, for an athlete, hinder their performance. A high-fat, low-carbohydrate diet lacks essential nutrients, such as Vitamin E, Vitamin A, thiamin, riboflavin, calcium, iron, and fiber[1].

Calcium supports strong teeth and bones, which aid in reducing the risk of fractures. Additionally, calcium and Vitamin A deficiencies may put an individual at risk for developing health complications, including autoimmune or inflammatory diseases, hypertension, and metabolic syndrome, among others[1]. Fiber benefits the gastrointestinal tract and can influence cholesterol levels in the body. A high-fat, low-carb diet may cause a more rapid onset of fatigue, inhibiting athletic performance because, while fat produces energy, the body uses carbohydrates as its first source of energy.

Let’s think about this through the lens of an athlete. Although many people have promoted this diet as “healthy,” further research proved it can lead to nutrient deficiencies that can impact overall energy levels, digestion, bone strength, etc. Thus, it is vital to think carefully about changing existing, healthy routines simply because various sources are encouraging a certain idea or trend. As an athlete, maintaining a semi-consistent diet is favorable partly because the athlete can determine the foods that agree with them and fuel them best for optimal performance.

Ultimately, it comes down to balance—of one’s diet, exercise, sleep, and support[2]. While some ideologies that surface with the new year are proactive, there is a way to make dietary and lifestyle changes while not hindering one’s overall growth and progression. As a former dancer, I recognize everyone has different needs and preferences for the best options to fuel and support their body, whether they are an athlete or someone trying to stay active. Therefore, I challenge you to dig deeper into your nutritional choices, fuel your body to the fullest, and start the new year with your personal goals and desires!

References
[1] Mahan, L.K., Escott-Stump, S. Krause’s Food Nutrition & Diet Therapy, 14th ed. Philadelphia, PA: W.B. Saunders Company, 2011. ISBN-13: 978-1437722338 ISBN 9780323340755
[2]Pinnix, S. (2021, December 28). 5 Non-Diet New Year’s Resolutions | Appalachian Regional Healthcare System. Appalachian Regional Healthcare System; facebook.com/apprhs/. apprhs.org/5-non-diet-new-years-resolutions/

Mary Kate McCarthy is a World Champion Irish Dancer and recent graduate of Rush University Medical Center’s MS/Dietetic Internship. She danced with the Mulhern School of Irish Dance in the Chicago area for 14 years. She completed her master's degree in clinical nutrition and is currently working towards obtaining her Registered Dietitian credential.

Spotlight: Dr. Ross Slotten

Dr. Ross Slotten is a faculty member in the Department of Family Medicine at AMITA Health Saint Joseph Hospital in Chicago. He has a long history of representing and advancing the interests and wellbeing of LGBTQ communities through his medical practice. Slotten was among the earliest physicians providing sensitive and caring services at Chicago’s original Howard Brown Memorial Clinic. In 2014, he was inducted into the Chicago LGBT Hall of Fame. The University of Chicago Press published his memoir, Plague Years: A Doctor’s Journey through the AIDS Crisis, in 2020.

Ross and his husband, Ted Grady, are co-chairs, with Jennifer Edgcomb, of CDU’s annual fundraiser, Dance for Life.

What drew you to a career in medicine?
I think it had a lot to do with the friends I hung out with in high school, many of whom became physicians. We started an Aesculapian Club—Aesculapius was the Greek god of medicine—and invited physicians to give lectures. But it wasn’t until college that I had experience in medical areas. It was the best decision I ever made, I’m well-suited for it. I knew I wanted to help people without really knowing what that meant. Medicine turned out to be exactly what I wanted.

You were a pioneer in treating patients with AIDS. How did you end up in that specialty?
It was kind of an accident. I wasn’t trained to be an infectious disease specialist; I was a primary care physician. But I had an early connection with the Howard Brown Clinic. My business partner at the time asked me to volunteer there. It was a harbor for gay men because they couldn’t get care for sexually transmitted diseases and other issues anywhere else. I finished my training in 1984, which was about the time AIDS started to flare up in Chicago. That was when we started our practice, and we got a lot of referrals from Howard Brown. For about two years at St. Joseph, there was no infectious disease specialist on staff, so they brought people in. We were on our own and learned by the seat of our pants, and that’s how we became experts, if you will, because no one else would handle it.

Would you describe AIDS as “under control”? How would you compare it to what we’re experiencing with COVID?
With AIDS, we found a way through it. We haven’t cured it, obviously, but we’re able to deal with it. Access remains a problem though not as bad as 25 years ago. Now we have amazingly effective medications with no side effects. My oldest AIDS patient is 92, and I have several in their 80s, which is pretty remarkable. Had there not been effective treatments, I don’t think I could have kept doing it.

There are parallels to COVID but also a lot of differences. Whenever there’s an epidemic of this magnitude, there’s a period of denial, and both have had periods of politicization but in different ways. With HIV, people were being excluded, and because the government was ignoring people with HIV, the activists were trying to get the government involved. With COVID it’s the opposite: activists want the government to stay out of their business. As a physician, I’m not on the front lines taking care of people with COVID but there is an overlap. The AIDS pandemic was like a slow drip that went on for 20 years—for 20 years my life was consumed by people dying. It’s a different kind of stress than being overwhelmed all at one time with patient after patient after patient, running out of beds. I can relate to the fear of burnout, but COVID is like HIV compressed into a smaller period of time.

March is LGBTQ Health Awareness Month. Anything you’d like to raise awareness for?
Being prepared, especially younger people who don’t know anyone who’s had AIDS. We need to emphasize the importance of preventing HIV. Medications are virtually 100% effective at preventing HIV, with very few side effects; they’re very safe. I never want to see a new person who has AIDS that could have been prevented.

As co-chair of Dance for Life this year, do you have any particular thoughts to share about health and wellness for the dance community?
When HIV became less of a problem, I wondered about the role of Dance for Life. But now the focus has shifted to other health issues. This country doesn’t have universal health care, people don’t have insurance. Chicago Dance Health Fund offers an opportunity to help fill the gaps. Those who love and support Chicago dance have embraced this event. But it’s important that the professional dance community understand that Chicago Dance Health Fund is for the entire community, it’s not only for catastrophic health needs.

Understanding Back Pain
By Maria Reese, MD

Almost everyone will experience low back pain. The good news is that whether your back pain is mild or severe, short-lived or long-lasting, intermittent or constant, most cases will improve within a few weeks. (That doesn't make the experience any less challenging, however.)

To understand what causes back pain, it's important to first understand how the spine works. 

• The building blocks of the spine are vertebral bones, or vertebrae, stacked upon each other. 

• Between these bones are intervertebral disks made of flexible, gelatinous material that provides cushioning and allows for movement. 

• Muscles and ligaments stabilize the bones and disks.

• The spinal cord and spinal nerves are located inside the spine and allow for communication between the brain and body. 

• The lower end of the spine is called the sacrum. It meets the pelvis at the sacroiliac joint.

Now that you have a basic understanding of the components of your spine, here are five common causes of low back pain:

1. Strain/sprain. Muscles and ligaments can overstretch with activity, like shoveling snow, or returning to activity (i.e., dancing or golfing) after some time off. This resulting stiffness and soreness usually resolves within a few days.

2. Disk injury. The disks of the spine are like jelly donuts—crusty fiber on the outside ("annulus fibrosus") and gelatinous material on the inside ("nucleus pulposus"). Common injuries to disks include a small tear to the annulus, the nucleus pushing ("herniating") into the annulus, or a herniated disk irritating a spinal nerve. This condition causes pain that radiates into the leg (“sciatica”). Disk-related pain often worsens with bending, twisting, or sitting and improves with standing or lying down.

3. Disk aging and degeneration. The normal process of aging causes the disks of the spine to wear away, which causes added pressure and stress on the smaller joints of the spine ("facet joints"). The wear and tear on the disks and facet joints can cause osteoarthritis, leading to pain or stiffness. Prolonged sitting or standing can aggravate this pain, and movement can alleviate it.

4. Spinal stenosis. This condition involves narrowing of the space around the spinal cord and spinal nerves. With osteoarthritis of the spine, bone spurs develop and contribute to this narrowing, causing back, buttock, and leg pain or fatigue. This pain, which stereotypically affects older patients, is usually worse while standing and walking and better while sitting and leaning forward.

5. Sacroiliac (SI) joint pain. Too much or too little movement in the joint can cause SI joint pain. The pain is characteristically unilateral low back and buttock pain that may radiate into the leg. Women, especially those who are pregnant and post-partum, are most susceptible. This pain is typically worse with transitional movements, such as rolling over in bed or getting into or out of a car.  

No matter which of these conditions is causing your low back pain, treatment options are similar: ice, moist heat, and over-the-counter medications such as acetaminophen, non-steroidal anti-inflammatory drugs (NSAIDs) like ibuprofen and naproxen, and topical pain relievers like lidocaine.

But, to truly prevent or minimize low back pain, good posture and optimal ergonomics are important—when sitting, standing, lifting, and even walking. Physical therapy can help by alleviating pain, restoring range of motion and flexibility, and improving core stability.

Remember to fight gravity — sit and stand tall; lift with your legs, not with your back; and bend forward at the hips, not at the back.

Maria Reese, MD, is a sports medicine physician who specializes in non-operative management of musculoskeletal injuries with a particular interest and skill for treating performing artists. She completed her medical training at the Keck School of Medicine of the University of Southern California, where she received humanitarian and leadership awards. She completed her Physical Medicine and Rehabilitation (PM&R) Residency and Sports Medicine Fellowship at Northwestern University/Shirley Ryan AbilityLab, where she served as chief resident. She is an Assistant Professor of PM&R at Northwestern University Feinberg School of Medicine. She has served as the Medical Director of the Performing Arts Medicine Program at Shirley Ryan AbilityLab since 2014. As part of this program, she cares for amateur to elite performers from various theatres, pre-professional schools, and the local and national community. The Journal of the American Medical Association (JAMA) featured her dedication to performing artists in the article “A Day in the Life: Performing Arts Physician Saves Careers by Fine-tuning Artists’ Form” in its October 2019 edition. In addition to her clinical skills, Dr. Reese offers bedside ultrasound evaluation and performs ultrasound and fluoroscopically guided procedures to provide multiple treatment options for her patients.

Eye Health
By Ramez Haddadin, MD

January is National Glaucoma Awareness Month
More than 3 million people in the United States have glaucoma, and this number is projected to increase. Glaucoma is the leading cause of irreversible blindness, in contrast to cataracts, which are very common but treatable with surgery. The vision loss from glaucoma can “creep up” on someone; it starts with the peripheral vision dimming, then extends toward our central reading vision. Unfortunately, many patients may not be aware of early vision loss, realizing it only when it is too late. In other words, glaucoma is a silent blinder, similar to diabetes, which one catches early only through screening. Eye care professionals therefore recommend all adults undergo a comprehensive eye exam with glaucoma screening, even if they believe they are seeing well without glasses.

Although glaucoma is generally considered a disorder affecting elderly people, there are forms of glaucoma that appear in young and middle-aged adults. Glaucoma may be inherited, sporadic, or related to lifestyle choices. Most forms of glaucoma are caused by an elevation in the eye pressure, which produces damage in the optic nerve. The optic nerve carries the visual signals from the eye to the brain.

Although dancing is not known to cause elevations in intraocular pressure, head down positioning for prolonged periods—such as with yoga—can raise intraocular pressure, resulting in vision loss in patients with glaucoma. Bouncing or jogging can also raise intraocular pressure in a select group of people with a disorder called Pigment Dispersion Syndrome. Although this form of glaucoma may result in transient blurring of vision or eye pain after exercise, patients may have no symptoms while glaucoma silently progresses. The use of steroid creams on one’s skin or inhaled steroids through the nose can also increase eye pressure. Direct trauma to an eye can damage its natural drainage system and result in glaucoma.

There is no cure for glaucoma; however, medications, lasers, and surgery can slow or stop its progression. The key is to catch it early and start treatment before significant disease develops.

Eye strain and fatigue
Digital devices and computers are now a part of everyday life for most people, regardless of their line of work. As a result, eye strain and fatigue are very common. Patients typically describe sore, tired, burning, or itching eyes. These can be symptoms of a variety of issues, including a need for new glasses, dryness, or other ocular disorders. It is important to review your symptoms with your eye provider at your exam.

When symptoms relate to dryness or reading-related strain, consider some of the following tips:

• Remember to blink often. When we read or use digital devices, our brain overrides the impulse to rest the eyes by blinking. Blinking allows your eye to naturally replenish the surface with more tears.

• You may use artificial-tear eye drops, which are available over the counter, up to four times per day and will provide additional lubrication to the eye during visually demanding tasks.

• Try to keep devices at eye level or below so the eyes do not remain open as wide and are less susceptible to drying. Turning off fans or directing them away from your eyes may also alleviate these symptoms. During the winter months, running a humidifier may be helpful.

• Place computer screens or reading material farther away to reduce the focusing demands on your eyes. As we enter our 40s, this becomes more of an issue.

• Try to follow the 20-20-20 rule. Every 20 minutes, take a break and look 20 feet away for at least 20 seconds.

What is the story with blue lights?
The effects of blue or low-wavelength light on our eyes has become a common discussion topic. With increased digital device use in today’s world, blue light filters are marketed as protective for your eyes. Research in this area is still underway, and the medical community cannot always keep up with performing high-quality studies to answer important questions such as this. That said, there are laboratory and animal studies that suggest blue light may theoretically worsen dry eye, cataract formation, and macular degeneration. However, the strength of light used in these studies was not necessarily adjusted to represent what our eyes may experience when looking at digital devices. Blue light also affects our circadian rhythm, the basis for our sleep cycle. Blue light at the appropriate time of day may help establish a better sleep cycle, but exposure at night may be disruptive to sleep. There is, however, insufficient evidence to permit a doctor to recommend blue-blocking lenses in clinical practice. Being aware of this issue and perhaps limiting screen use before bed are probably reasonable measures.

Dr. Ramez Haddadin is an ophthalmologist specializing in cataract surgery, LASIK, and disorders of the cornea. He is an assistant professor of ophthalmology at Northwestern University. He sees patients in downtown Chicago at Northwestern Memorial Hospital.

nm.org/doctors/1447486329/ramez-i-haddadin-md

Hip Injuries
By Jorge Chahla, MD, PhD, Benjamin Kerzner BS

Femoroacetabular Impingement Syndrome (FAIS)
FAIS is hip impingement caused by bony abnormalities that lead to abnormal contact between the socket of the hip (acetabulum) and the ball of the hip (femoral head). The abnormality can be caused by injury or repetitive movements or due to a developmental deformity. Hip deformities and the abnormal growth of bone on the ball and/or the socket alter normal biomechanics and can lead to labrum injury and accelerated joint degeneration. FAIS is a common cause of hip and groin pain in young, active patients, especially dancers, as their range of motion is much greater than that of most people. Furthermore, dancers can develop impingement even with a normal hip shape.

Due to the increased contact and friction between both surfaces of the hip joint, patients can have changes in the mechanics of other surrounding muscle groups, including the abductor and adductor muscles, hamstrings, and hip flexors. Patients complain of motion-related or position-related pain in the hip region, usually located specifically in the groin area. Some symptoms dancers may complain of include stiffness, decreased range of motion, clicking, and catching sensation of the hip. A recent study showed that the incidence of labral tears in dancers is high even though they may have no symptoms; those with symptoms had more cartilage damage than dancers that did not have pain.

In the clinic, X-rays are very helpful to assist in the diagnosis of FAIS. Imaging can show abnormal/extra bone on the thigh bone, known as a CAM lesion; extra bone on the outer surface of the hip socket, known as a pincer lesion; or a combination of the two. In terms of treatment, conservative management mainly physical therapy, can reduce pain and improve function of the hip. Therapy focuses on correcting strength deficits of surrounding muscle groups and improving core stability which help to alleviate the contact to those bony structures. The most common type of surgery is a hip arthroscopy, involving three or four minimally invasive incisions and a camera that helps identify the abnormal bone growths, followed by removal of the affected bone. Hip arthroscopy works best for patients with minimal osteoarthritis of the hip, are younger than 50 years old, and have no signs of abnormal development of the hip, known as dysplasia. Therapy following hip arthroscopy is an intensive six-month process focusing first on healing of the tissue immediately after surgery, then improving range of motion and strength around the hip, followed by implementing more dynamic exercises and movements. A recent study at our institution found that 97% of dancers returned to dance at an average of 6.9 months after having surgery for FAIS, with most dancing at a level higher than before surgery and competitive dancers returning at a faster rate.

Labral Tears
Similar to the shoulder joint, the hip joint has a surrounding labrum that functions to reduce hip joint contact pressures and provide a suction seal, ultimately providing stability to the hip joint. A tear to the labrum can change the mechanics of the hip joint and result in pain symptoms with movement. One of the most common causes of labral tears is FAIS or hip dysplasia. A variety of physical exam maneuvers in the clinic can localize the pain to the labrum and help with diagnosis of a labral tear. In addition to X-rays showing bony abnormalities, an MRI usually can confirm the diagnosis. Non-surgical management includes activity modification, rest, injection into the hip, and a physical therapy protocol similar to FAIS. Repair of the labrum with a minimally invasive surgical approach, as in the management of FAIS, has resulted in significant reduction in pain and greater satisfaction than only trimming the surrounding tissue. Studies have found that athletes, including dancers, who have a labral tear due to FAIS are more likely to require surgery than succeed with non-operative management alone. For dancers who undergo surgery and have completed the appropriate physical therapy regimen, returning to activity is gradual with focus on less flexion of the hip, as in jazz or lyrical dance.

Greater Trochanteric Pain Syndrome
Greater trochanteric pain syndrome encompasses trochanteric bursitis, gluteus medius/minimus tendinopathy, and snapping hip syndrome. In this condition, dancers report pain on the outer part of the hip. The proposed cause of pain is repetitive friction of the IT band against the femur (thigh bone) due to overuse injuries, commonly seen in dancers, trauma, or altered gait patterns, resulting in inflammation of the region. People complain of pain with bending to the side, sleeping on the affected side, and sitting for prolonged periods. In snapping hip syndrome, patients may hear the snapping in addition to having painful hip movements. The snapping can ultimately result in thickening of the IT band. Nonsurgical management is successful in most patients with an emphasis on anti-inflammatory medications, corticosteroid injections, and physical therapy. Surgical management for this condition has been well-established and involves a combination of releasing part of the IT band and cleaning up the surrounding tissue that is affected as needed.

Dr. Jorge Chahla, MD, PhD is an orthopedic surgeon specializing in sports medicine at Midwest Orthopaedics at Rush and an assistant professor of orthopedic surgery at Rush University Medical Center in Chicago. He has special interest and expertise in the treatment of complex hip and knee disorders. Dr. Chahla is internationally recognized for his contributions to the field of sports medicine injuries through minimally invasive techniques as well as being a pioneer in novel biological treatments. He is the director of biomechanical research and the international fellowship program at Rush and serves as a team physician for the Chicago White Sox, Chicago Bulls, and Chicago Fire. He sees patients in downtown Chicago, Oak Brook, Naperville, and Munster, Indiana.

Benjamin Kerzner, BS is a clinical research fellow to Dr. Chahla in the sports medicine division at Midwest Orthopaedics at Rush and a fourth-year medical student at Rush Medical College in Chicago. His research interests include clinical outcomes following hip arthroscopy and ACL reconstruction, epidemiology, social media in orthopaedics, and operative techniques. In his free time, he enjoys volunteering with Special Olympics, running, cycling, spending time with friends/family, and rooting on the Badgers.

Website: jorgechahlamd.com

What Does it Mean to be a Performing Artist during the Pandemic?
By Rachel Epley, LPC, MT-BC

The COVID-19 pandemic has disrupted life in so many ways. Performing artists have been especially impacted by the economic, social, and emotional effects of the pandemic. Young artists who were just beginning their careers were halted in their tracks and progress toward their dreams postponed. Established artists who had come to rely on the security and consistency of regular work found themselves unemployed with uncertain prospects for the future. Performers who find a sense of belonging, meaning, and purpose in sharing their art were suddenly stripped of an important part of not just their livelihoods, but their sense of self. In these incredibly challenging times, we can explore what it means to be a performing artist, and what might help fill the void that so many of us are feeling.

Celebrate your many roles: Being a performing artist may be a very important part of your identity, but it is not the only aspect of who you are. Make a list of your other roles by completing the sentence, “I am __________.” For example: I am a musician, I am a friend, I am a daughter/spouse/parent, I am a cook/homemaker/neighbor, etc. Take a moment to look over your list and celebrate the many roles you play in this world. 

Focus on what you can control: Worrying about things that are out of your control is not only frustrating, it is fruitless. Instead, focus on what you can control. Try drawing two concentric circles and list all the things you can control in the center circle, then list all the things you can’t control in the outer circle. For example: Things I can control—How much of my free time I spend practicing, What auditions I sign up for, Who I reach out to for support. Things I can’t control: Which theaters stay open or shut down, Whether I get a part I auditioned for, How many other people are in the audition pool. 

Connect with others: Isolation can make hard times even harder. In COVID times, it may take extra planning or energy to connect with others. Take a moment to scroll through your contacts or make a list of your closest friends and loved ones, and make a point of connecting with each of them over the next few weeks. You may even think about reaching out to other performing artists to connect about shared struggles, hopes, and sources of inspiration.

Find a creative outlet: If you are not able to perform as much as you’d like, perhaps you can find another way to use your talents and cultivate your artistic interests. Maybe you could perform for your family or friends each week, make a video diary of pieces you’ve been working on, or challenge yourself to learn something new that is related to your art, like composition, writing, or choreography.

Practice self-compassion: Try to remember that this is a difficult time for everyone, and the challenges brought on by COVID-19 are not your fault. Think about what you might say to a friend in your situation, and then say that to yourself. You might try Kristen Neff’s Self-Compassion break when you’re feeling especially low or self-critical. More information at: https://self-compassion.org/exercise-2-self-compassion-break/

Rachel Epley combines traditional talk therapy with music therapy to help clients identify and work through difficult emotions and situations. Her approach focuses on personal strengths, creativity, intuition, and insight centered on areas of growth that are most important to the client.

Stretching for Dancers
By Kathleen Darley, PT, DPT

As a dancer, it is important to maintain both strength and flexibility. Dancing demands a level of control and stability while performing dynamic movements, requiring a greater range of motion than most other sports. Many dancers focus on the unique need for a classical dancer's line with positions such as arabesque, develope al a seconde, and high grande battements. How many times have you thought, “I should have gotten to class earlier to stretch”? As it turns out (no pun intended), you can achieve your personal best line and increase range of motion by following these guidelines.

When to Stretch
Stretching is not the same as warming up. The purpose of warming up before class or rehearsal is to increase the temperature of your core and muscle tissue[1], which is important for preventing injuries, not increasing flexibility. You should be warm when you are stretching; warm muscles are more extensible and responsive to stretching. Research shows that applying a small amount of stretch force to warm connective tissues lengthens them more effectively than a larger stretch force applied at normal body temperature.[2] There are also greater long-term benefits of stretching when warm; for example, lengthened tissue lasted more than twice as long when low load stretch was applied to warm tissues versus normal body temperature.[2] Studies have also shown that stretching with higher temperature tissues, such as after class or rehearsal, resulted in fewer injuries.[2] The most effective way to increase your flexibility is to make sure your muscles are warm and responsive to stretching—after your class or rehearsal.

When Not to Stretch
Do not hold static stretches before a demanding class, performance, or rehearsal. Additionally, intensive stretching of a muscle has actually been shown to impair strength, power, endurance, sprint time, and jump height.[3][4][5] Decreases in muscle strength are thought to be both mechanical and neurological and may not be recovered for up to one hour afterward.[6] This could interfere with making gains in strength during class. However, brief stretches of less than 15 seconds are less likely to cause performance problems. Dynamic stretching, such as dance movements, are also less detrimental to performance than static stretching.[7] For a practical application, perform a set of attitude leg swings as part of a dynamic warm-up rather than the traditional sustained leg on the barre—save that for after!

How to Stretch
Research indicates that holding a static stretch for 30 seconds, three to five repetitions at a time, is enough to maintain joint range of motion and current flexibility. There is little benefit in doing more than four repetitions of a stretch.[1] If increasing flexibility is your goal, it is vital to make sure the muscles are warm first. Increasing the frequency of stretching throughout the week also shows continued benefits and carryover.[7]  

Finally, each dancer’s body is different. It is important not to compare the flexibility of one dancer with another. Bodies that are naturally very flexible and hypermobile need more strengthening and stabilization exercises to avoid injury, while other bodies have denser connective tissue and require more stretching and flexibility. Each body is unique, and it is important to customize a combination of stretching and strengthening to a particular dancer’s needs for optimal performance.

[1] International Association for Dance Medicine and Science. Stretching for dancers. DanceScience.org
[2] Warren CG, Lehmann JF, Koblanski JN. Elongation of rat tail tendon: effect of load and temperature. Arch Phys Med. 1971;52:465-74.
[3] Behm DG et al. Effect of acute static stretching on force, balance, reaction time and movement time. Med Sci Sports Exerc. 2004;36:1397-402.
[4] Knudson D, Noffal G. Time course of stretch-induced isometric strength deficits. Eur J Appl Physiol. 2005;94:348-5.
[5] Nelson AG et al. Acute effects of passive muscle stretching on sprint performance. J Sports Sci. 2005;23(5):449-54.
[6] Fowles JR, Sale DG, MacDougall JD. Reduced strength after passive stretch of the human plantar-flexors. J Appl Physiol. 2000;89:1179-88.
[7] Viale F, Nana-Ibrahim S, Martin RJ. The effect of active recovery on acute strength deficits induced by passive stretching. J Strength Cond Res. 2007;21(4):1233-44

At Shirley Ryan AbilityLab, Kathleen Darley specializes in treating musculoskeletal disorders and pelvic and women’s health. She studied at the Houston Ballet and danced professionally for numerous companies including The Joffrey Ballet, the Lyric Opera of Chicago, Ballet Memphis, and Chicago Festival Ballet. Darley’s passion for dance—and the science behind the art—inspired her to earn a bachelor's degree in kinesiology from the University of Illinois at Chicago and a doctorate in physical therapy from Northwestern University Feinberg School of Medicine. She also has certifications in yoga and Pilates.  

Shirley Ryan AbilityLab, formerly the Rehabilitation Institute of Chicago (RIC), is the global leader in physical medicine and rehabilitation for adults and children with the most severe, complex conditions — from traumatic brain and spinal cord injury to stroke, amputation, and cancer-related impairment. The quality of its care and research has led to the designation of “No. 1 Rehabilitation Hospital in America” by U.S. News & World Report every year since 1991. Shirley Ryan AbilityLab is a 501 (c)(3) nonprofit organization.

Cross Training
By Dr. Leda A. Ghannad

Cross training is an important part of any dancer’s wellness. It can include exercise outside dance class or rehearsal that improves endurance, strength, or flexibility. Proper cross training can help significantly reduce the risk of injury. Some dance studios may include cross training as part of their programing; however, dancers often must find these opportunities on their own time.

One form of cross training is improving cardiovascular fitness through aerobic exercise, which is most important after a long break, in the weeks just prior to restarting dance training. Because dance is often high-impact, I frequently recommend focusing on low-impact aerobic exercise to reduce stress on your bones and joints. Examples include swimming, cycling, or elliptical. High Intensity Interval Training (HIIT) can be helpful as well, as long as you avoid excessive high-impact exercises like box jumps or burpees. At least 20–30 minutes of vigorous aerobic exercise three times a week is a good place to start, although some dancers may need to exercise longer depending on the demands of their dance work.

Another important form of cross training is strength training. Dancers benefit from strength training in the arms, core, and legs. Arm strengthening with resistance bands focusing on the rotator cuff muscles (the muscles surrounding the shoulder) are important to prevent shoulder instability and improve strength for lifts or partnering. 

Core and gluteal (butt) muscle exercises are important in stabilizing the body during single-leg activities, jumps, and running. Pilates is a great way to strengthen the core and gluteal muscles and is often possible with little equipment on a mat with resistance bands. Pilates reformer requires the use of more equipment but is also an excellent way to cross train. A full Pilates class once or twice a week is a great idea during off-season and dance performance season.

Leg strengthening including the calves, ankles, and feet helps prevent injury. Calf raises and resistance band exercises with the foot and ankle are typically the most important leg exercises.

Some dancers choose to cross train on their own at home or at a gym. Others may benefit from dedicated classes, like Pilates, spinning, or HIIT workouts at a gym or dance studio. It is most important to find what you enjoy so it is easier to maintain, especially when it seems difficult to find time to exercise with demanding dance schedules. Remind yourself that cross training will likely decrease your risk of injury and improve your ability to perform, regardless of the style of dance that is your specialty.

Dr. Leda Ghannad is a Primary Care Sports Medicine Physician with Midwest Orthopaedics at Rush and assistant professor in Physical Medicine and Rehabilitation at Rush University Medical Center. She has a special interest in treating performing artists including dancers. She has been co-medical director, along with foot and ankle surgeon Dr. Simon Lee, of The Joffrey Ballet since 2018 and is medical director of several upcoming shows presented by Broadway in Chicago. She is a member of the American Medical Society of Sports Medicine and International Association for Dance Medicine & Science (IADMS). She sees patients in Chicago, Illinois and Munster, Indiana.

Spotlight: Dr. Lindsay Backiev, PT, DPT

Dr. Lindsay Backiev, PT, DPT is a graduate of the University of Southern California, where she earned her doctor of physical therapy degree. She was awarded the Order of the Golden Cane, the USC Division of Biokinesiology and Physical Therapy’s highest honor for graduates who have demonstrated excellence in academic coursework, clinical practice, and scientific research. As a professional dancer, she performed with SHARP Dance Company, Anne-Marie Mulgrew & Dancers Company, Deeply Rooted Dance Theater, Harrison McEldowney’s Dance for Life finale, Beyoncé, and on The Oprah Winfrey Show. She has a passion for performing arts physical therapy and is thrilled to give back to her Chicago dance community; additional special interests include orthopedics, pelvic health, and youth athletics. Dr. Backiev has completed coursework through the Herman & Wallace Pelvic Rehabilitation Institute to further her professional practice, establishing the pelvic health physical therapy program at Midwest Orthopaedics at Rush. She joined the outpatient physical therapy team at Shirley Ryan AbilityLab in 2021 where she continues to provide individualized, evidenced-based care in orthopedics and pelvic health.

Please tell us a little about your dance background.
I trained intensively at Mid-Atlantic Ballet in Newark, Delaware; toured with the International Ballet Ensemble; and performed with a local dinner theatre to gain professional experience during high school. I earned my BFA in modern dance performance from The University of the Arts in Philadelphia, Pennsylvania. A few years after graduation, I moved to Chicago, where I was a company member with Deeply Rooted Dance Theater. Shortly after my move, I started taking professional ballet class with Claire Bataille* at Lou Conte Dance Studio. I found the Work Study program, under Claire’s direction, a great way for me to train without extensive costs!

How did you end up becoming a PT?
I’ve always had an interest in human anatomy and movement; I used to help a friend study anatomy flashcards and found myself learning just as much as he did! Fast-forward more than a decade later and thinking about transitioning to physical therapy, I worked as a rehabilitation aide at Midwest Orthopaedics at Rush to get a better sense of whether I thought it would be a good fit as a second career. Claire was actually a reference! She was so supportive and put in a good word with Donna Williams.

What do you enjoy the most about working with dancers?
I love sharing the same movement language in the PT setting. It is immensely helpful to get to the root of what might be causing pain or difficulty for a dancer in class, rehearsal, or performance and, ultimately, solving the “why” of the problem. Translating movement from the clinic to the studio setting (and vice versa) is my favorite part!

Please tell us what Claire Bataille* meant to you/did for you.
Claire was so supportive of my transition from dance to PT, and I am forever grateful for that. I may not have had the courage to take all the prerequisite courses and apply for grad school without her words of wisdom early in the process. Claire had a way of guiding, both in the studio and in life, that allowed for moments of reflection and opportunities for passion to ignite. I miss her dearly!

* Claire Bataille was a beloved member of Chicago’s dance community who died from pancreatic cancer in December 2018. She was a founding member of Hubbard Street Dance Chicago and director of its Lou Conte Dance Studio. She assisted choreographers, including Twyla Tharp, in setting work on the company and was a choreographer in her own right.

Nourishing Your Body During the Holidays
By Irene Hasse, NDTR

For many people, the holiday season can bring up overwhelming feelings around food and health. The pressure to look good at social gatherings, maintain weight, and stay active throughout winter months often drives people to adopt extreme behaviors, like restricting food intake, following fad diets, or simply trying to eat “smarter” for long-term health. But sometimes these efforts to stay healthy can actually lead down an unhealthy path. Whether following a diet that demands cutting out entire food groups or participating in week-long juice cleanses, many people will head into the season prepared to miss out on festivities involving food. “People and their diets cover a whole spectrum with extreme overeating at one end and extreme restriction at the other,” said Kelly Allison, PhD, director of Penn’s Center for Weight and Eating Disorders, who sees patients in her clinic who struggle to find balance. 

It’s common for painful emotions, loneliness, and family conflict to come to the surface during holiday gatherings. In an attempt to gain control when it is lacking in other areas of life, many people put food into black and white categories like “good” and “bad.” They might believe that cutting out certain foods altogether is easier than spending time planning balanced meals, since it requires fewer decisions in the midst of a busy schedule. While they may think they are simplifying eating guidelines, instead they are creating a false sense of security that can end up being harmful to overall health. 

Food is a social activity, and restricting it can lead to isolation and lack of connection during times when you may need it most. When you choose to skip gatherings altogether to resist temptation or attend events but experience food-based anxiety, you can develop feelings of depression and isolation. Social interaction explicitly affects not only your mental health, but also your physical health. A large 2016 study from the University of North Carolina, Chapel Hill found as levels of social connection increase, risks of physiological dysregulation, like inflammation, decrease. Connection during the holidays is just as important to our health as the number on the scale. 

Obsessing about food can also compound over time, leading to short-term isolation from friends and family—the very people we should be connecting with during this time of year. In the longer term, continually making severe dietary decisions can result in a lack of vital nutrients, an underweight body, and a weakened immune system.

Food gives us the energy we need to do all things—work, play, laugh, breathe, celebrate, and just be. We need that same energy—and more!—to carry us through the holiday season. Healthy eating can look many different ways, and eating well is not a “one size fits all” approach, but if you’re struggling to strike a healthy balance during the holidays, try some of these helpful tips: 

• Avoid restriction: The “perfect” diet with no room for error will likely be broken. Research tells us if we strive for perfection, we are more likely to feel anxious, depressed, and self-critical when we inevitably don’t meet our goals. We’re also more likely to eat past comfortable fullness after restricting food intake, so aim to keep your regular eating patterns intact around holiday scheduling. Three meals and two snacks per day is a great place to start!

• View food as pleasure: If you’re at a holiday event, think of it as a unique special occasion. Give yourself permission to enjoy the food in a moderate way. You might try an affirmation like, “This food experience will not break my goals” or “I always have permission to eat.” No foods are off limits. Love pasta? Enjoy a sensible portion. Saw a cookie that looks too good to pass up? Savor the experience and then continue on with your normal eating routine.

• Enjoy foods from all five food groups: Eating a balance of fruit, vegetables, protein, grains, and dairy is generally a reflection of a healthy eating style. Find foods that you like from each food group instead of forcing yourself to eat things that you don’t enjoy.

• Maintain variety: Choose different types of foods within each food group. For example, you might experiment with eating different colors of vegetables or switching up your usual type of grain (i.e., rice, bread, cereal, granola, oatmeal, popcorn, or pasta). Try exploring new ethnic foods, or invite a friend over for dinner and make some of their favorite dishes.

• Exercise for enjoyment: The key is to find activities that you truly enjoy and work them into your daily routine. Hate running? Don’t torture yourself. Go for a bike ride or long walk instead. Don’t enjoy working out at the gym? Try a yoga video on YouTube in the comfort of your own home or go for a hike with a friend. All activities that require movement count as exercise—even things that you have to do anyway, like walking the dog, cleaning the house, gardening, or having a dance party.

• Monitor alcohol consumption: Because individuals differ, the specific effects of alcohol will vary from person to person. But the general recommendation by the American Heart Association is to drink in moderation, meaning no more than one to two drinks per day, and drink water in between alcoholic beverages to stay hydrated.

Irene Haase is a Registered Nutrition and Dietetic Technician (NDTR) and a member of the Academy of Nutrition and Dietetics. Currently based in New York City, she works as a health and wellness intern for the Joffrey Academy of Dance, providing support to dancers in the year-round Trainee Program. As a former dancer, she has a deep understanding of the unique barriers to health that dancers face. Her counseling style offers nonjudgmental and interactive support, informed highly by her belief in the Health at Every Size and Intuitive Eating approaches.

Spotlight: Jorge Chahla, MD, PhD

Dr. Jorge Chahla is an orthopedic surgeon who specializes in the treatment of complex knee, hip, and other sports related injuries. He is an Assistant Professor of Orthopedic Surgery at Rush University Medical Center. Moreover, he serves as the Director of Biomechanical Research and of the International Fellowship Program. He is a team physician for the Chicago White Sox (MLB), the Chicago Bulls (NBA) and the Chicago Fire (MLS). Dr. Chahla completed several fellowships at the top programs in the United States. He earned his PhD at the Catholic University of Argentina (UCA) with Summa Cum Laude honors.

He is internationally recognized for his contributions to the field of sports medicine injuries through minimally invasive techniques as well as for being a pioneer in novel biological treatments. Dr. Chahla’s approach is based on a philosophy that each individual procedure is specific and customized to the individual needs of each patient. He uses minimally invasive arthroscopic techniques that help reduce recovery time. Dr. Chahla’s focus is not only a patient’s full recovery, but the speed of that recovery to return to sport. To this, his team coordinates post-operative care which includes objective assessment of motion and subsequent interaction with physical therapists, coaches, and athletic trainers to ensure pre-injury performance is achieved.

Dr. Chahla has a strong focus on joint preservation procedures and cartilage restoration techniques with more than 250 publications in prestigious scientific journals, over 30 book chapters, five edited books and presents his research both nationally and internationally at orthopedic conferences and meetings every year. He has a strong reputation for his anatomical knowledge that has helped develop novel surgical techniques that are imprinted in publications and books. He has received grants from various institutions such as IBTS, Colorado University, Cedars Sinai Kerlan Jobe Institute, Arthroscopy Association of North America (AANA) and The American Orthopaedic Society for Sports Medicine (AOSSM). He has recently received the American Academy for Orthopaedic Surgeons Award of Excellence, AOSSM Young Investigator Award, Excellence in Research Award and the Cabaud Award (two times) from the American Orthopaedic Society for Sports Medicine, the 2016 AAOS/OREF/ORS Clinician Scholar Development Program award and six best-paper awards at several meetings.   

Along with his commitment to providing outstanding patient care, Dr. Chahla believes strongly in the importance of advancing the field of sports medicine through involvement in leadership, advocacy, and education, and is actively involved in teaching medical students, residents, and fellows. He is a member of the prestigious knee collateral ligament group from the European Society for Sports Traumatology, Knee Surgery and Arthroscopy. He serves on numerous national and international committees,  including Advocacy Committee at the  Arthroscopic Association of North America (AANA), Education Committee at the  International Society of Arthroscopy, Knee Surgery and Orthopaedic Sports Medicine (ISAKOS), Research Committee, at the American Orthopaedic Society for Sports Medicine (AOSSM) and he is Deputy Chair, of the ICRS Next Generation Committee, International Cartilage Repair Society. Dr Chahla serves on the Editorial board of the Arthroscopy Journal. 

jorgechahlamd.com

Knee Injuries
By Jorge Chahla, MD, PhD

Knee injuries can be a major source of debilitating pain in both younger and older people. The pain can impact not only your ability to perform activities of daily living, such as walking and going up and down the stairs, but also your level of activity. Pain that lasts for several weeks or is more than a discomfort should be addressed with a knee specialist. Below we describe three knee injury patterns common with athletes such as dancers: patellar tendinitis, iliotibial band syndrome, and meniscal tears.

Patellar Tendinitis
This is a condition due to overuse of the patellar tendon, which helps to secure the kneecap (also known as the patella) to the shin bone. The overuse in dance, such as changing direction and repetitive jumping movements, leads to achy pain in the front of the knee. It is a common condition in teen athletes as well as dancers in their 20s and 30s but can occur in people of all ages. The repeat trauma to the tendon leads to small, microscopic tears, resulting in pain and weakness of the knee. In addition to a sense of achiness, people may notice swelling around the knee, improvement in the pain with rest, as well as pain that recurs with squatting and prolonged sitting. Treatment usually focuses on activity modification including rest, icing, and use of anti-inflammatory medications as needed. An eccentric exercise program to strengthen the quadriceps, hamstrings, hip abductors, and hip adductors will also be recommended. One exercise to target both quadricep and hamstring strengthening consists of performing squats on a 25-degree decline board for 3 sets of 15 repetitions usually about twice a day. Additionally, hip abduction and adduction strengthening can be achieved with the “around the world” method: You execute a set of one-legged straight raises on your back with toes pointing in the air, followed by another set of straight raises while turning the inside of the foot to face the ceiling. Next, perform one-legged straight raises while laying on your side and, last, on your stomach. These exercises should be done for both legs, regardless of whether or not there are symptoms in one leg. Physical therapy training is a step-wise progression starting with low-impact activities and increasing the level of intensity as you are able to progress throughout the rehabilitation program.

Iliotibial Band Syndrome
The iliotibial band, also known as the IT band, is a structure that starts on the outside of the hip and runs down the outside of the thigh before attaching on the side of the knee. Iliotibial band syndrome occurs in a wide range of people who participate in activity involving repetitive flexion and extension of the knee. The onset can be visible in people who rapidly increase their activity level or have poor shoe support. Other causes of IT band syndrome include issues with quadricep and hamstring strength and anatomical issues such as bowed legs. When the IT band rubs against the underlying soft tissue and bony structures, irritation of the band can occur, resulting in pain symptoms. Treatment is focused on physical therapy to strengthen the gluteal muscles and the hip abductor muscles. Additionally, temporarily changing activity level and using ice and anti-inflammatory medications can help address the symptoms.

Meniscal Tears
The meniscus is a shock absorber that sits in the knee joint between the thigh bone and shin bone to provide a cushion during movement. During activities such as walking, running, and dancing, this structure helps to protect the knee from bone-on-bone damage. There are two menisci in each knee, and they are C shaped. When people have meniscal tears, they usually complain of pain, swelling, catching, or locking of the knee with movement. If not addressed, the progression of the tear can lead to irreversible damage to the cartilage surface of the thigh and shin bones and result in earlier arthritis of the knee. In acute meniscal tears, dancers may describe sudden pain and/or popping sensation with twisting of the knee. They may also feel their knee is going to give out. These injuries can be diagnosed in the office with a physical exam and usually require an MRI to see the small meniscal structures inside the knee joint. Meniscal tears are classified based on the location of the tear (outer meniscus vs. inner meniscus vs. front/back of the knee) as well as tear pattern (bucket handle, oblique, radial horizontal, and root). Non-surgical treatment includes resting, ice, and anti-inflammatory medications. Surgery helps to correct the tear; the goal is to keep as much of the meniscus as possible. Options for surgical treatment depend on the type and extent of the tear and include debridement (cleaning up the edges of the tear), partial or total removal of the meniscus (meniscectomy), and meniscal repair (using sutures to put the meniscus back in correct anatomical position).

Dr. Jorge Chahla, MD, PhD is an orthopedic surgeon specializing in sports medicine at Midwest Orthopaedics at Rush and an assistant professor of orthopedic surgery at Rush University Medical Center in Chicago. He has special interest and expertise in the treatment of complex hip and knee disorders. Dr. Chahla is internationally recognized for his contributions to the field of sports medicine injuries through minimally invasive techniques as well as being a pioneer in novel biological treatments. He is the director of biomechanical research and the international fellowship program at Rush and serves as a team physician for the Chicago White Sox, Chicago Bulls, and Chicago Fire. He sees patients in downtown Chicago, Oak Brook, Naperville, and Munster, Indiana.

jorgechahlamd.com

Nutrition
By Mary Kate McCarthy, MS

Carbohydrates are not your enemy!

There are four main nutrients to consider when fueling the body: carbohydrates, lipids (fats), protein, and water. Carbohydrates are the body’s main source of energy, followed by lipids, whereas the body uses proteins for growth and repair.

Carbohydrates contain sugar, starch, and fiber and fall into two categories: simple and complex. Simple carbohydrates, which break down rapidly into sugar, may include white bread, white rice, cakes, pastries, honey, milk, and candy and should be limited in one’s diet. Complex carbohydrates contain starch and fiber, causing slower digestion. For athletes in particular, complex carbohydrates are recommended as they are packed with vitamins and minerals, provide more energy, and delay fatigue.[1] Sources of complex carbohydrates may include whole wheat bread, apples, bananas, sweet potatoes, and oats.

With that being said, it is imperative to understand that to fuel the body properly for athletic performance, the body needs energy (i.e., carbohydrates). For a normal individual, The Dietary Guidelines for Americans recommend 45 to 65% of calories come from carbohydrates.[2] An athlete needs roughly 50% or more of calories that come from carbohydrates (depending on their individualized needs). For a basic training session alone, athletes need 5 to 7 grams per kilogram of body weight.[1] Therefore, experts do not recommend limiting or cutting out carbohydrates in the diet. Carbohydrates are not the enemy! In fact, one of the most beneficial tactics for athletes meal-prep-wise is to focus on pairing carbohydrates with either a fat or a protein. Pairing foods helps with satiety and inhibits spikes in blood sugar levels. This can be as simple as eating an apple or banana with peanut butter, whole wheat crackers with a slice of turkey and cheese, or rice with salmon.

After dancing for more than a decade, I have heard numerous dancers speak negatively about consuming carbohydrates. Decreasing one’s intake of carbohydrates can negatively impact one’s performance in terms of energy levels, endurance, and onset of fatigue. With proper knowledge surrounding the benefits of carbohydrates, improved health, recovery, and stronger overall dance performance are on the horizon!

References

[1] Mahan, L.K., Escott-Stump, S. Krause’s Food Nutrition & Diet Therapy, 14th ed. Philadelphia, PA: W.B. Saunders Company, 2011. ISBN-13: 978-1437722338 ISBN 9780323340755

[2] Resources. Dietary Guidelines for Americans, 2020–2025 and Online Materials | Dietary Guidelines for Americans. (n.d.). Retrieved September 24, 2021, from dietaryguidelines.gov/resources/2020-2025-dietary-guidelines-online-materials.

Mary Kate McCarthy is a World Champion level Irish Dancer and recent graduate of Rush University Medical Center’s MS/Dietetic Internship. Mary Kate danced for 14 years under the Mulhern School of Irish Dance in the Chicagoland area. She completed her Master's degree in Clinical Nutrition and is currently working towards obtaining her Registered Dietitian credential.

Pelvic Health
By Sarah Hwang, MD

The Pelvic Floor: Answering Frequently Asked Questions
Most people have heard about the core muscles. As dancers, you are likely familiar with this group of muscles. A part of the core that is less talked about is the pelvic floor muscles. These muscles not only are important for stability but also play a major role in control of bowel, bladder, and sexual appreciation. When these muscles stop working the way we expect them to, we call this pelvic floor dysfunction. I’m going to spend some time expanding on this by answering some frequently asked questions about the pelvic floor. 

Who am I?
My name is Sarah Hwang (she/her). I am the director of Women’s Health Rehabilitation and Pelvic Health Rehabilitation at Shirley Ryan AbilityLab. I treat people who have pelvic pain, pelvic floor dysfunction, bowel and bladder issues, and pain during pregnancy. I work closely with physical therapists and other physicians (such as gynecologists) to provide multidisciplinary care for patients with pelvic floor dysfunction.

Do only women have pelvic floor muscles?
No! Women, men, and transgender and nonbinary people all have pelvic floor muscles. Let me say that again—men have pelvic floor muscles! Pelvic floor dysfunction is more commonly seen in women but can occur in men as well. About 15% of my patients are men.

What do the pelvic floor muscles do?
To understand what pelvic floor dysfunction is, we first have to talk a little about the normal functions of the pelvic floor. These muscles have five important jobs:

1. Stability: These muscles are part of the core muscles as I mentioned above. The pelvic floor helps to provide stability to the pelvis and low back.

2. Support of internal organs: These muscles support the pelvic organs, including bowel, bladder, and, in females, the uterus and ovaries.

3. Maintaining continence of bowel and bladder: The pelvic floor prevents leakage of bowel and/or bladder. When the time comes to have a bowel movement or urinate, the pelvic floor has to relax to allow this to occur.

4. Circulation: These muscles help to pump lymphatic fluid from the legs back up to the heart.

5. Sexual appreciation: These muscles contract and relax during orgasm.

What happens when the muscles aren’t functioning normally?
This is what we call pelvic floor dysfunction. There are two sides to pelvic floor dysfunction. Some people have high tone pelvic floor dysfunction, which means the muscles are constantly in a state of high tension and unable to relax. When people have this problem, they typically present with pelvic pain, pain during intercourse, chronic constipation, and/or urinary frequency or urgency. The other type of pelvic floor dysfunction happens when the muscles are weak, making contraction difficult. Patients with this problem typically present with incontinence (or leaking) of urine or stool or pelvic organ prolapse. One other important thing to know is pelvic floor dysfunction can result in problems in the hip-pelvic-spine complex.

What can we do for patients with pelvic floor dysfunction?
The most common treatment we use is pelvic floor physical therapy. We can also use medications or injections to help with high tone pelvic floor dysfunction.

Dr. Sarah Hwang is the director of Women’s Health Rehabilitation at Shirley Ryan AbilityLab. She is an assistant professor of Physical Medicine and Rehabilitation and Obstetrics and Gynecology at Northwestern University Feinberg School of Medicine. Dr. Hwang completed her Physical Medicine and Rehabilitation Residency at Shirley Ryan AbilityLab (formerly Rehabilitation Institute of Chicago). She served as director of Women’s Health Rehabilitation at University of Missouri in Columbia, Missouri, before joining Shirley Ryan AbilityLab in 2018. Dr. Hwang also serves as the associate program director for the Northwestern PM&R residency program.

Dr. Hwang is an active member of the American Academy of Physical Medicine and Rehabilitation. She serves as a member of the Program Planning Committee and has completed the Future Leaders Program. She is a member of the Association of Academic Physiatrists and serves on the Diversity and Community Engagement Committee. She has completed the Program for Academic Leadership through the Association of Academic Physiatrists and the Early Career Women Faculty Leadership Development Seminar through the AAMC.

Pelvic Health
By Kathleen Darley, PT, DPT

Pelvic Health: The Missing Link in Athletes’ Health

When I was starting out as a physical therapist, I worked often with dancers and other athletes.  I felt kinship with them, having studied at the Houston Ballet and danced professionally with many companies in Chicago. The majority of these patients had reported pain at the hip, pelvis, or spine; the standard treatment for these active, performance-based patients focused on strengthening, mobilization, myofascial release, and motor control.

However, there were some patients for whom standard treatment did not work: either they did not improve or their pain lingered longer than expected.

Thankfully, at the time I was fortunate enough to have a great mentor, who challenged me with the question, “Have you assessed their pelvic floor?”

Fast forward five years, and I am now at Shirley Ryan AbilityLab treating primarily pelvic health patients. While strengthening of pelvic floor muscles is often emphasized in pre- and post-natal health, pelvic floor muscle dysfunction is often missed as the source of pain among dancers and athletes. But the health of pelvic floor muscles in active patients is crucial: these muscles work as part of your core muscles alongside the diaphragm, abdominals, and spinal stabilizers. A healthy pelvic floor is able to both contract and relax, moving in tandem with the diaphragm as you breathe.

I find that dancers are at particular risk of pelvic floor muscle injuries. Many dance techniques promote poor biomechanics of the pelvic floor muscles. Gripping the eternal rotators of the hip, high-impact landing from jumps, constantly lifting lower abdominals “in and up,” and general overtraining contribute to a hypertonic, or overactive, pelvic floor. This means the muscles can refer pain to several places around the hip and hamstring.

People who report hip pain, high hamstring strain, a history of labral tears, and sacroiliac sensitivity and soreness should be screened for pelvic floor dysfunction. If the pelvic floor is contributing to the pain, it needs to be addressed within physical therapy treatments.

Quick Tips for a Healthy Pelvic Floor

Strengthen Your Hips
The obturator internus is a pelvic floor muscle that externally rotates the hip and can often be “gripped” and difficult to release with stretching. Focus on creating balance at the hip musculature by strengthening internal rotators and working in parallel.

Use Your Breath Optimally
Pelvic floor relaxation and contraction follow the natural cycle of inhalation and exhalation. As you inhale, the breath expands the diaphragm and lengthens pelvic floor muscles. As you exhale, there is a slight lift of pelvic floor muscles drawing up. Dancers typically remain stuck in the "in and up."

Reset the Pelvic Floor
After class or rehearsals, make sure to reset the pelvic floor and abdominal wall by allowing the breath to expand down into the lower abdomen. A practice such as yoga is great cross training, as it allows for extended periods of deep breathing with movement to reset pelvic floor muscle tone. Remember, a tight muscle, whether abdominal or pelvic floor musculature, is not a strong muscle!

Exhale on the Effort
During a dance class, when jumping, exhale on the effort. By allowing the natural contraction of pelvic floor that comes with the exhale, the muscles are able to better generate the force required for the movement.

At Shirley Ryan AbilityLab, Kathleen Darley specializes in treating musculoskeletal disorders and pelvic and women’s health. She studied at the Houston Ballet and danced professionally for numerous companies including The Joffrey Ballet, the Lyric Opera of Chicago, Ballet Memphis, and Chicago Festival Ballet. Darley’s passion for dance—and the science behind the art—inspired her to earn a bachelor's degree in kinesiology from the University of Illinois at Chicago and a doctorate in physical therapy from Northwestern University Feinberg School of Medicine. She also has certifications in yoga and Pilates.  

Shirley Ryan AbilityLab, formerly the Rehabilitation Institute of Chicago (RIC), is the global leader in physical medicine and rehabilitation for adults and children with the most severe, complex conditions — from traumatic brain and spinal cord injury to stroke, amputation, and cancer-related impairment. The quality of its care and research has led to the designation of “No. 1 Rehabilitation Hospital in America” by U.S. News & World Report every year since 1991. Shirley Ryan AbilityLab is a 501 (c)(3) nonprofit organization.

Spotlight: Dr. Leda A. Ghannad

I completed my medical degree at Rosalind Franklin University of Medicine and Science in North Chicago, followed by my residency in Physical Medicine and Rehabilitation at Northwestern University in Chicago. While at Northwestern, I spent time in sports medicine clinics seeing patients and providing care at various sporting events; through these experiences, I developed my passion for sports medicine. I love helping people stay active, whether in professional or recreational sports. Once I finished my primary training, I was driven to pursue an additional year of training through a fellowship in Primary Care Sports Medicine at Northwestern University. I believe our bodies were meant for movement, and particularly movement through the performing arts can bring tremendous joy to our lives.

I started working for Midwest Orthopaedics at Rush as a primary care sports medicine physician in 2015 taking care of patients with all types of musculoskeletal injuries and complaints. In 2018 the opportunity came to become co-medical director of The Joffrey Ballet in Chicago with Dr. Simon Lee, foot and ankle surgeon at Midwest Orthopaedics at Rush. Through this relationship with Joffrey, I began to grow my interest in taking care of performing artists and, since then, have helped take care of dancers, actors, musicians, and circus artists. I stay up to date with the medical care of performing artists through my memberships in Dance USA and the International Association of Dance Medicine and Science.

I am constantly impressed by the perseverance and ability of performing artists to rehabilitate and recover from even the most devasting injuries. I’ve had to send various dancers to undergo surgical treatment for their injuries and have always been impressed by their drive and rate of recovery. It takes a whole team of health care professionals and support staff to help a dancer recover, including company managers, physical therapists, physicians, and surgeons.  

I’ve learned through the years that dancers are very in tune with their bodies. My best piece of advice is to not ignore your intuition if you feel like something is wrong or injured. The sooner you can identify an injury, usually the quicker it can be effectively treated and allow you to return to full activity. There are tremendous resources available to dancers, especially in a big city like Chicago, and organizations like Chicago Dance Health Fund are incredibly important in supporting the health and wellness of dancers.

Foot and Ankle Injuries
By Lindsay Backiev, PT, DPT

Follow Chicago Dancers United on LinkedIn, Facebook, and Instagram to see demonstrations, alongside detailed descriptions, of the following exercises that are feasible during and complimentary to the rehabilitation of a foot injury:

Bird-dog
An oldie but a goodie! The bird-dog is a great exercise for core stability and control any day of the week and can be especially useful if you're non-weightbearing.

Swiss ball bridge with alternating battement
Battement that boot! This exercise incorporates a physio ball, but you can also use the seat of a chair or couch just as well.

Standing hip CARs
Progressive weight bearing exercises are an important phase of rehabilitation once cleared by your physician. Controlled articular rotations, or CARs, in standing are a great option to target trunk and pelvic stability while working on hip mobility.

Single leg hip thrust
There is strong evidence for gluteus maximus muscle activity during hip thrusts. Great news since you'll need a strong booty to get back to petit and grand allegro!

Foot and Ankle Injuries
By Leda A. Ghannad, MD

Lateral Ankle Sprains
Foot and ankle injuries, including lateral ankle sprains, are among the most common injuries endured by dancers—a lateral ankle sprain is an injury to the ligaments on the outer aspect of the ankle that typically occurs when the ankle is rolled inward. These injuries can range from minor to more severe depending on the degree of trauma. Minor injuries will cause soreness on the outside of the ankle, but typically will not lead to swelling, bruising, or inability to put weight through the foot. Minor injuries can be self-treated with ice; anti-inflammatories for pain; a brief rest from jumping, running, and pivoting; and simple ankle strengthening exercises. These injuries typically resolve in as little as a few days or up to one to two weeks. More serious injuries involve a tear of one or more of the ligaments on the outside of the ankle. This usually results in swelling, like the size of a golf or tennis ball, and bruising. These types of injuries often require medical attention and may be treated with a tall walking boot for two weeks to allow the ligaments to heal. Physical therapy and more intense rehabilitation exercises may be necessary to avoid ankle instability, and it may take up to six weeks to return to full dance activity. Whenever you have an ankle injury and are unable to put weight on the foot right away, it is important to seek medical attention immediately from a physician. The inability to put weight on the foot may be a sign of other associated injuries like a fracture or break in one of the ankle bones. While ankle sprains are common, there are things you can do to help prevent these injuries, such as adequate ankle strengthening exercises and proper footwear.

Metatarsal Pain
The metatarsals are the long bones in the foot and a common location of injury among dancers. A metatarsal stress fracture is a crack in the bone that often occurs due to overuse—like when you increase your activity rapidly for a dance intensive or have longer than usual rehearsals for an upcoming show. With these injuries, pain and swelling develops in a focal area on the bone. The pain is worse with activity, especially high-impact activity like running and jumping, and improves with rest. It is important to see a physician if you are experiencing this type of pain as early diagnosis can lead to faster recovery and return to full dance. Your doctor will likely order an x-ray; however, early stress fractures can sometimes be missed on an x-ray, so they may also order an MRI of the foot. These injuries are usually treated with a short walking boot, rest from high impact activities, and physical therapy. Stress fractures in the second metatarsal are most common and often heal well in about 6 weeks. A more serious injury is a stress fracture in the fifth metatarsal; this bone does not have a good blood supply and may take longer than six weeks to heal—sometimes even requiring surgery to heal completely. If your fracture is not healing in the typical six-week time period, your doctor may consider ordering you a bone stimulator, a small device that is attached to the foot for 20 - 30 minutes a day to help with bone healing. Increasing your training load gradually to condition your bones to handle the impact, making sure you have a good diet, and adequate calcium and vitamin D intake can often prevent metatarsal stress fractures.

Dr. Leda Ghannad is a Primary Care Sports Medicine Physician with Midwest Orthopaedics at Rush and assistant professor in Physical Medicine and Rehabilitation at Rush University Medical Center. She has a special interest in treating performing artists including dancers. She has been co-medical director, along with foot and ankle surgeon Dr. Simon Lee, of The Joffrey Ballet since 2018 and is medical director of several upcoming shows presented by Broadway in Chicago. She is a member of the American Medical Society of Sports Medicine and International Association for Dance Medicine & Science (IADMS). She sees patients in Chicago, Illinois and Munster, Indiana.

Bone Density
By Lindsay Backiev, PT, DPT

Exercise Recommendations
Weight-bearing activities are the best ways to increase healthy stress on the bones. Over time, the body responds to these forces by building more bone to become denser, and therefore, stronger. This effect is called Wolff's Law. While aerobic exercise is vital to a dancer's health and physical performance, resistance training is the best option for improving bone density. This is of particular importance for those assigned female gender at birth; bone density is at its highest when one is in their late 20s, then rapidly decreases with the onset of menopause. Vitamin D and calcium are commonly known for their positive effects on bone health; however, resistance training provides the added benefits of strength and balance on the musculoskeletal system!

Follow Chicago Dancers United on LinkedIn, Facebook, and Instagram to see demonstrations, alongside detailed descriptions, of the following exercises that can be readily adapted to a variety of spaces and available props:

Jump squat
80-20 jump squats—a plyometric exercise—require zero equipment and minimal space.

Iso lunge
This full-body resistance exercise is perfect for partnering.

Bulgarian split squat
No gym membership? No problem! All you need is a chair and a heavy pot or pan.

Modified side plank with shoulder external rotation
Dancers are notorious for their mobility and flexibility. The shoulder is the most mobile joint in the body, so why not keep it strong?

Dr. Lindsay Backiev, PT, DPT is a graduate of the University of Southern California where she earned her doctor of physical therapy degree. She was awarded the Order of the Golden Cane, the USC Division of Biokinesiology and Physical Therapy's highest honor for graduates who have demonstrated excellence in academic coursework, clinical practice, and scientific research. As a professional dancer, she performed with SHARP Dance Company, Anne-Marie Mulgrew & Dancers Company, Deeply Rooted Dance Theater, Harrison McEldowney's Dance for Life finale, Beyoncé, and on The Oprah Winfrey Show. She has a passion for performing arts physical therapy and is thrilled to give back to her Chicago dance community; additional special interests include orthopedics, pelvic health, and youth athletics. Dr. Backiev has completed coursework through the Herman & Wallace Pelvic Rehabilitation Institute to further her professional practice, establishing the pelvic health physical therapy program at Midwest Orthopaedics at Rush. She joined the outpatient physical therapy team at Shirley Ryan AbilityLab in 2021 where she continues to provide individualized, evidenced-based care in orthopedics and pelvic health.

Bone Density
By Leda A. Ghannad, MD

Many dancers, choreographers, and instructors are returning to the studio after prolonged closures due to COVID-19. The risk of bone injuries is higher when one increases high-impact physical activity, such as dancing, rapidly. Here are a few tips to identify bone injuries, treatment, and prevention.

What is a stress fracture versus a stress reaction?
A stress fracture is a crack in the bone, usually caused by increased activity or load on the bone, or abnormal bone health. Stress fractures usually are visible on a standard x-ray, although it may take up to two weeks after symptoms develop to show up. A stress reaction is swelling in the bone; this does not show up on x-ray but is visible on an MRI. Usually, a stress reaction develops first, and if a dancer continues high-impact activity, it can progress to a stress fracture.

What are symptoms of a stress fracture or stress reaction?
The symptoms can be the same for both: pain and soreness to the touch on a bone or joint, swelling or redness, and worsening symptoms with high-impact activity, such as running or jumping.

How can we treat stress reactions and fractures?
The earlier you catch a bone stress injury, the more quickly it can recover. Initial treatment is usually limiting impact to the bone by resting, using crutches, or sometimes even using a walking boot. Most bone injuries take six to eight weeks to recover.

How can we prevent bone stress injuries?
Increasing your impact activities gradually will decrease the risk of developing a bone injury. Make sure you have adequate nutrition, including enough calories to account for your exercise and training load and adequate calcium and vitamin D intake. Female dancers who have irregular menstrual periods may be at higher risk of bone injuries; it is important to discuss this with your healthcare provider.

When should we seek medical attention for a bone injury?
If you have more than a few days of bone pain that does not resolve with rest, it is worth reaching out to your healthcare provider for an evaluation. Remember, the sooner you identify a stress injury to the bone, the more likely it is to recover quickly and get you back into full movement.

Dr. Leda Ghannad is a Primary Care Sports Medicine Physician with Midwest Orthopaedics at Rush and assistant professor in Physical Medicine and Rehabilitation at Rush University Medical Center. She has a special interest in treating performing artists including dancers. She has been co-medical director, along with foot and ankle surgeon Dr. Simon Lee, of The Joffrey Ballet since 2018 and is medical director of several upcoming shows presented by Broadway in Chicago. She is a member of the American Medical Society of Sports Medicine and International Association for Dance Medicine & Science (IADMS). She sees patients in Chicago, Illinois and Munster, Indiana.

Bone Density
By Sharon P. Foley, PhD, RD, LDN

Many believe bone loss occurs only in women or later in life. We all experience bone loss as we age, and women have less bone mass than men, but no one is immune. Bone loss can occur in your teens and 20s, and what you do early on in your dance career in terms of diet, exercise, and lifestyle can impact bone health and injury prevention. Bone formation is greatest in the teen years with full formation occurring around age 25-30. Ensuring strong bones can prevent stress fractures and other related injuries. Dietary calcium, vitamin D, and other minerals are essential during the bone-forming years and can help maintain healthy bones throughout life.  

Calcium
Try to consume at least three servings of dairy products per day. A serving provides roughly 300 mg of calcium, and although you need more than this, the rest can come from non-dairy sources, such as kale, broccoli, almonds, tofu, or calcium-fortified foods, such as orange juice and some cereals. It is not necessary or recommended to take a calcium supplement if your dietary intake is adequate, but if you do supplement, the best absorbable forms are calcium carbonate or citrate. Space out your food and supplements throughout the day since it is difficult to absorb more than 500 mg of calcium at one time.

Vitamin D
Most calcium gets absorbed only with the assistance of vitamin D. Good sources of vitamin D include fortified dairy products, fortified almond or soy milks, fatty fish (salmon, tuna), and egg yolks. Often called the sunshine vitamin, we can make vitamin D when we expose our skin to sunlight, but we obviously must be cautious about sun exposure. Since vitamin D is a fat-soluble vitamin, it is best to check your levels before contemplating supplements.

Phosphorus
Bones need phosphorus too, but too much will inhibit your ability to use calcium for bone formation. Phosphorous is found in protein sources as well as in cola drinks. Consuming too much cola (36-48 ounces per day) or too much protein (meat, poultry, fish, nuts, beans) may throw off the balance of calcium necessary for good bone health.

Magnesium
This mineral is important for muscle contraction, nerve transmission, and cellular and bone formation. Although we do not need much, we don’t often consume good sources of magnesium, which include dark leafy greens, beans, nuts, whole grains, seeds, and bananas. Several multivitamin supplements do not contain magnesium.

Remember that losing bone is painless—you will not feel any symptoms until too late. If you are constantly getting injured, look at your diet. Is it balanced? Are you eating in a nonrestrictive way? Are you at a healthy weight? Also note that nicotine in cigarettes prevents the building of bone, and heavy alcohol intake is associated with low bone mass. Try to eat a balanced diet rich in fruits and vegetables, whole grains, healthy fats, with good protein, and fiber sources.

Sharon P. Foley, PhD, RD, LDN is an associate professor at Rush University in the Department of Clinical Nutrition. Her research interests include assessing psychometric properties of measures, investigating nutrition assessment methods, applying the trans-theoretical model of “stage of change” and motivational interviewing and participating in outcomes research. Foley and her students have worked with several professional Chicago dance companies throughout the years.

Lupus
By Sarita S. Connelly

May is Lupus Awareness Month
May is Lupus Awareness Month. Before I became an advocate for lupus awareness, I remembered having an acquaintance in college who had the disease. She didn’t share details, except for the side effects of the steroids she took to control symptoms, but we visibly saw its destructive effects on her joints, as her need for a cane made it difficult to get around on the hilly terrain of our Westchester, New York campus. I did not have a true understanding of the disease until years later, when I became a lupus research advocate and then a lupus patient.

What is lupus?
The Lupus Research Alliance describes lupus as a “chronic and complex autoimmune disease” affecting the joints, skin, brain, lung, kidneys, and blood vessels, causing widespread inflammation and tissue damage in the affected organ.”[1] Essentially, it is an autoimmune response that causes the body to attack its own healthy cells and organs.

The common types of lupus are SLE (systemic lupus erythematosus), which affects multiple parts of the body, and cutaneous lupus, which primarily affects the skin, but certain medications can also trigger the disease. Lupus primarily affects women (9 out of 10 cases) and is typically diagnosed between the ages of 15 and 44.[2] It occurs in African-American, Hispanic, Asian, and Native American patients more often than Caucasians.

Symptoms
Lupus symptoms may differ from person to person and often mimic other symptoms, which can cause difficulty getting a confirmed diagnosis or a delay in getting a final diagnosis. Some symptoms include:[3]

• Fatigue

• Fever

• Joint pain, stiffness, and swelling

• Butterfly-shaped rash on the face that covers the cheeks and bridge of the nose or rashes elsewhere on the body

• Skin lesions that appear or worsen with sun exposure

• Fingers and toes that turn white or blue when exposed to cold or during stressful periods

• Shortness of breath

• Chest pain

• Dry eyes

• Headaches, confusion, and memory loss

When reflecting back on my own lupus odyssey, I began showing signs of the disease in my late 20s, including unusual skin rashes (usually after sun exposure) and joint issues. However, as a professional dancer, it was absolutely impossible to tell the difference between joint injuries and aches from the day-to-day grind of class, rehearsals, teaching, and performances and something more systemic. I experienced chronic patellar tendon injuries after the first acute injury, chronic ankle sprains, and eventually a hip dislocation during a performance, which tore the hamstring and anterior and posterior labrum. After my diagnosis with diffuse connective tissue disease and rheumatoid arthritis, we had to consider the possibility that those were also contributing factors to my injuries – in addition to the wear and tear due to the rigors of the work.

My diagnosis took about seven years and fully came to light only after multiple miscarriages and complications at the late stages of pregnancy with both my children (which required emergency c-sections to save their lives). With my youngest, I developed post-partum eclampsia three weeks after delivery, and my blood pressure became so uncontrolled that it began affecting my organs. A leading nephrologist at Northwestern Memorial, who cared for me during that time in the hospital, said, “This is lupus.”

Advocacy in Action
Many organizations are doing excellent work in fundraising for efforts by the National Institutes of Health to provide grants to doctors for research efforts around lupus. Among their goals: to bring new drug therapies to market; to learn more about the disease; to bring awareness to communities around the country; and to develop clinical trials in conjunction with large research hospitals like Northwestern Memorial, Rush University Hospital, and University of Chicago Hospital Systems. I encourage you to look at them all.

I have been a Volunteer Ambassador for the Lupus Research Alliance since 2006 and, during the last few years, the co-MC and Warm Up Instructor for their Chicago Walk. The Lupus Research Alliance is the largest private funder of lupus research, providing $200 million in grants. I chose this organization because 100% of donations support research funding, not the Alliance’s operational expenses.

Unfortunately, due to COVID-19, we will not have a live walk in 2021. However, please join us on Saturday, May 22, 2021 for our ManyOne Can. Walk with Us to Cure Lupus. At 12 noon CST, I will teach a Zumba and fitness event. If you would like to join the free class, support our community team, or start your own fundraising page to support a cure for lupus, please sign up on the SC Community Team Page listed below.

I hope to see you there!

give.lupusresearch.org/team/353997
lupusresearch.org/faces_of_lupus/sarita-connelly/

[1] Lupus Research Alliance. (n.d.). About Lupus. Lupusresearch.org/Understanding-Lupus/What-Is-Lupus/About-Lupus/. Retrieved April 30, 2021.
[2] Lupus Research Alliance. (n.d.-b). What is Lupus. lupusresearch.org/Understanding-Lupus/What-Is-Lupus/. Retrieved April 30, 2021.
[3] Mayo Clinic Lupus Symptoms. (n.d.). mayoclinic.org/Diseases-Conditions/Lupus/Symptoms-Causes/Syc-20365789. Retrieved April 30, 2021.

Sarita S. Connelly is a member of the Chicago Dancers United board of directors. She is a nonprofit management consultant and CEO/founder of SS Connelly Consulting, LLC, an adjunct Instructor of dance at Loyola University, an advisory board member of Roosevelt University’s Chicago College of Performing Arts, a board member of the Oak Park Arts Council, and a guest teaching artist for Joffrey Ballet Chicago Community Engagement. She is a former dancer with Melissa Thodos and Dancers and Joseph Holmes Chicago Dance Theatre and performed in 11 consecutive Dance for Life finales.