A simple guide to choosing the right energy bar
Photo by Shelby Elsbree
Dancers love energy bars. As a quick, portable snack, the right one can provide a smart source of fuel between rehearsals. But some options can be little more than glorified candy bars. With dozens of brands and flavors available, what should you look for? Although you could spend hours comparing ingredients, there are three main things to pay attention to: carbs, protein and sugar.
Time Your Carbs and Protein
Before a rehearsal or performance, choose a bar that will sustain your energy with about 20 grams of carbs (from sources like oats, soybeans, dried fruit), advises Joy Dubost, spokesperson for the Academy of Nutrition and Dietetics. Afterward, she says, you want a bar with 8 to 10 grams of protein (seeds, nuts, nut butters, flax) to rebuild your muscles and jumpstart the recovery process.
Track Down Added Sugar
No matter when you’re eating, avoid too much added sugar, which provides little to no nutritional value and can lead to an increase in calories and, over time, weight gain if consumed too often. This is often a problem in protein-heavy bars: “The higher the protein, the more sugar they have to add to make it palatable,” says Dubost. It can be tricky to figure out how much sugar is naturally occurring from sources like fruit, versus added sugar, such as maple syrup or agave, but the order of the ingredients can offer a clue: “The further down a sweetener is on the ingredient list, the less there is.”
When a fall or collision affects your brain, the consequences are serious.
Houston Ballet corps dancer Elise Judson was rehearsing an overhead lift that transitioned from one partner to another when she fell headfirst to the floor. Adrenaline immediately took over. “But once that wore off, the left side of my head and face felt like they were pulsing, and I had a substantial headache,” she says. “I was loopy and extremely emotional—it was later explained to me that these were signs of trauma and adrenaline levels subsiding.”
Judson had a concussion, a traumatic brain injury that happens when a forceful blow to the head or body causes the brain (which floats in cerebrospinal fluid) to bounce against the skull, leading to damage. Royal Ballet principal Natalia Osipova suffered a concussion in February, for example, when she collided with another dancer during a performance of Wayne McGregor’s Tetractys—The Art of Fugue.
Though a concussion may not be an everyday dancer injury, it happens often enough that Dance/USA’s Task Force on Dancer Health recently published an informational paper on the topic specifically for dancers. “In the last couple of years there has been increased national attention on concussions and most states have passed legislation for student athletes, but dancers are usually ignored,” says Selina Shah, the medical director of dance medicine for Saint Francis Memorial Hospital’s Center for Sports Medicine in the Bay Area and a member of the task force. “Dancers are not immune to this type of injury. However, it’s very hard to get people’s minds around a concussion because it’s so different from a physical injury. You can feel the ache from a bruise or spot the swelling from a ligament, but you can’t see the brain.”
Yet concussions are extremely dangerous. Experiencing one leaves you more susceptible to another, potentially increasing both symptom severity and recovery time. What’s more, if symptoms from the first concussion haven’t completely resolved and another jolt to the head happens, you risk second impact syndrome, which is a rare, rapid and potentially fatal swelling of the brain.
Warning Signs
How do you know if you’ve gotten a concussion? Symptoms can include headaches, loss of consciousness, nausea, vomiting, balance issues, dizziness, double or blurry vision, ringing in the ears, sensitivity to light and noise, irritability, memory or concentration problems, mood or personality changes, insomnia or excessive sleep. “Not all dancers will experience symptoms right away,” says task force member Katherine Ewalt, owner of Performing Arts and Athletic Restorative Training Specialists in San Diego. She notes that some symptoms may appear immediately or a few hours after the original impact, while others may not be noticed for days or weeks afterward.
What To Do
Although severity varies, brain trauma experts agree there is no such thing as a minor concussion. Even “mild” cases can affect a dancer’s ability to perform mental and physical tasks. If you suspect you might have one, stop all physical activities and go to 
the emergency room as soon as possible for an official diagnosis. “If someone has suffered a concussion, ideally they are not going home alone after, but they will have a friend or roommate checking in on them every few hours,” says Shah. If someone with a concussion doesn’t wake up with relative ease every three or four hours, it may mean there is bleeding on or in the brain.
Right after Judson fell, she saw Houston Ballet’s physical therapist and he had her ice her head, neck and back and monitored her symptoms for an hour. The following day, she went to a local emergency care center for an MRI, CT scan and X-ray to diagnose the concussion. “Things were difficult—much more than I expected—even once the initial impact soreness went away,” Judson says. “If I turned around too quickly, I felt dizzy. If I stood up too fast, I became dizzy. I couldn’t even make the bed.”
The Recovery
Most people with a concussion fully recover in a week to 10 days with proper care, which includes both physical and cognitive rest until symptoms resolve. Some, however, experience symptoms for several weeks. Task force member Shaw Bronner, who serves as director of physical therapy services at Alvin Ailey American Dance Theater, warns that if you try to “push through” and ignore the symptoms, it could cause further damage to the brain and lengthen the recovery time significantly.
Because every injury is different, dancers should have a medical professional experienced in concussion management monitor their progression closely and develop individualized guidelines for returning to dance, such as starting with a partial class without jumping, then dancing without partnering and finally fully integrating back into class and rehearsals. As you return to the studio, Bronner says, be aware of potential side effects, such as decreased reaction times and balance issues.
If any symptoms recur, the task force recommends returning to the previous level of activity until they disappear. “Be honest about whether you are experiencing any symptoms. Do not try to hide them,” Ewalt says. “Everyone is anxious to get back to training and performing, but remember that this is an injury to the brain.”
It took Judson about three weeks until she was able to dance almost everything full-out, but with modified turns (single pirouettes) and ending class after petit allégro. “I truly didn’t expect how difficult it would be to return to class and rehearsal,” she says. “Your brain doesn’t heal like a muscle does. You can’t control the swelling and the actions of your brain. It has a ‘mind’ of its own.”
Dancer Concussion Tips
If there is any question whether you should keep dancing after a fall or blow, experts agree: “When in doubt, sit out.”
Less than 10 percent of concussions involve a loss of consciousness, so don’t rely on that as a main indicator of trauma.
Do not return to dance the same day as the injury, even if symptoms seem to resolve. You could risk additional damage.
Dancers should be monitored for mental or physical deterioration during the first few hours after injury. If the situation worsens, return to the doctor.
Like any injury, the body needs rest to heal. But because a concussion has both physical and cognitive effects, this can mean rest from television, computers, reading, texting and music.
Acetaminophen (Tylenol) can be taken safely, but do not take sleeping medications, aspirin or ibuprofen, which can cause bleeding at the site of the injury. Also avoid alcohol, which could slow your recovery and put you at risk for further injury.
All photos Thinkstock.
With the Affordable Care Act, dancers must carry insurance or pay a penalty. Here's a cheat sheet.
Barry Kerollis found himself in a health insurance conundrum after leaving his job with Pacific Northwest Ballet in 2011. He joined a contemporary ballet company that did not provide insurance, so he continued his PNB coverage through COBRA for $520 a month, with $30 copays. But then he got injured. “I couldn’t afford to pay for my physical therapy because I was paying for my insurance,” says Kerollis, who is now a freelance dancer, choreographer and teacher.
Although Kerollis eventually got a $150-a-month plan that covers physical therapy and chiropractor visits, the policy includes a $50 monthly fee for his asthma—something considered a preexisting condition by some insurers.
Kerollis’ health insurance woes are common among dance professionals. However, with much of the Affordable Care Act phased in this month, the public has a bevy of new health benefit opportunities. The new law requires insurance companies selling policies through state or federal “exchanges” to abide by specific consumer protections. Those include no discrimination based on preexisting conditions, no lifetime limits or restrictive annual limits and free preventative care, such as mammograms and birth control.
“Freelance professional dancers or those who work for companies that don’t offer coverage is exactly the type of group the ACA is meant for,” says Sarah Dash, a research fellow at Georgetown University’s Health Policy Institute.
But the law has a catch: It requires everyone in the U.S. to have health insurance this year and will penalize those who don’t get a policy with a $95 fee or about 1 percent of their income, whichever is greater, when filing 2014 taxes. The penalties will also rise each year. Open enrollment ends March 31—a date that applies to purchases made through the state and federal exchanges or directly with private insurance providers.
“I encourage dance professionals to at least make an informed decision, and if you choose to take the penalty, do it after having shopped around,” says Amy Fitterer, executive director of Dance/USA, a national service organization for professional dance.
Going to the Marketplace
The ACA created the Health Insurance Marketplace, a.k.a. the exchanges, at healthcare.gov. This site, for all its well-reported glitches, allows individuals and small businesses to search for and purchase health insurance coverage in different levels (bronze, silver, gold and platinum). An application can be submitted online, by mail or by phone, and you can then see what policies are available, purchase one and learn whether you are eligible for any income-based subsidies.
This year, 16 states (including ones with major dance centers like California, New York and Nevada) and Washington, DC will launch their own marketplaces. The remaining states opted for the federal government to run their exchanges either fully or partially. All exchanges can be reached through healthcare.gov.
“The exchanges provide more comprehensive information about the plans that are available than any other single source,” says Adam Huttler, founder and executive director of Fractured Atlas, a national nonprofit arts service organization. “Having said that, there’s a lot of confusion and misinformation out there.”
One item to note is that only through an exchange is it possible to get lower costs on monthly premiums through tax credits. These can bring the cost of a plan down to as little as $50 a month. For a single person buying an individual plan, the income range for tax credit eligibility is $11,490 to $45,960. “The median income for dancers, just looking at U.S. Census data, is about $21,000 a year or $27,000 for those employed full-time, which means as a whole, dancers are going to get some significant help through tax credits,” Dash says. Depending on which state a dancer lives in, if she makes less than $15,856 a year, she may be eligible for Medicaid.
“The Affordable Care Act is not a magic bullet, but it does greatly improve the access and affordability of health insurance for dancers,” says Huttler, who notes that for the past decade, Fractured Atlas had directly enrolled artists in health insurance plans. “We helped artists understand their needs and options and get the most appropriate coverage. But that was a labor-intensive process and we couldn’t help everyone, so I’m very glad that we’re no longer needed.”
Questions—and answers—for every dancer
Q: There were so many issues with the launch of the healthcare.gov site. Can I just go and purchase a policy on my own?
A: Yes, but if you purchase a plan outside of the exchanges, just be aware that not all private plans will meet the same standards as those sold through them. You also cannot get tax credits if you buy insurance outside of a government-run exchange.
Q: What all is covered if I buy through an exchange?
A: All private health insurance plans will offer the same set of essential health benefits, including at least the following items and services:
- outpatient care
- emergency services
- hospitalization (such as surgery)
- maternity and newborn care
- mental health and substance use disorder services, including behavorial health treatment (such as counseling and psychotherapy)
- prescription drugs
- rehabilitative and habilitative services, such as physical therapy or chiropractic services
- laboratory services
- preventative and wellness services and chronic disease management
- pediatric services
Plans may offer additional coverage. You can see what each plan offers when you compare them side-by-side in the Marketplace.
Q: I’m 23 and I heard that I might be able to go on my parents’ plan. Is this true?
A: Yes! If a plan covers children, they can be added or kept on the health insurance policy until they turn 26—even if they are married, not living with their parents, attending school, are not financially dependent on their parents and are eligible to enroll in their employer’s plan.
Q: When I go on healthcare.gov and try to compare plans, I get confused. Can I get advice on how to decipher the differences?
A: Not all of the plans there will be the same, even those within the same tier (bronze, silver, gold and platinum). However, they all cover essential health benefits (see list above) and meet standards for cost sharing. Read the “summary of benefits and coverage”--you can ask for it, if it's not given--and look to see if there are any limits on coverage, such as a 10-visit maximum for chiropractic visits or physical therapy. There is a 24-hour hotline to ask questions: (800) 318-2596.
Q: Yes, I am a dancer, and yes, I am a smoker. Does this matter when I pick out a plan?
A: There will be higher premiums for tobacco users. In most states, insurers will be allowed to charge up to 50 percent higher premiums for people who use tobacco, and tax credits through the exchanges will not cover the tobacco surcharge.
Q: As a freelance performer, I travel to several different states throughout the year. What does that mean when choosing a policy?
A: Once you enroll in a plan, you have to keep the plan you signed on with until the next enrollment period (which will be Oct. 15 to Dec. 7, 2014) or a qualifying life event (such as marriage or divorce). If you are going to be moving around a lot, pay attention to what the out-of-network benefits are for your plan. Going out of network often means your out-of-pocket expenses will be a lot higher.
Hannah Maria Hayes is a writer with an MA in dance education from New York University.
Don’t Get Cut Off
Key dates for ACA Coverage
January 1
If you enrolled in a plan during 2013 through the Health Insurance Marketplace, your new plan is now in effect.
March 31
After this date, individuals and families will not be able to enroll in Marketplace health plans until the next Open Enrollment period—Oct. 15 to Dec. 7—unless they have a qualifying life event.
2014—Through the year
Individuals can enroll in Medicaid at any time during the year, not just during open enrollment. If you do not have health coverage for more than three months in 2014, you must pay a tax penalty, unless you are exempted. —HMH
Image courtesy iStock
Laura Di Orio gets a boost of energy whenever she drinks a bottle of kombucha. “I feel my eyes open wider,” says the freelance New York City dancer. “Coffee leaves me jittery before a show and I don’t always want to eat when I’m about to perform, so I like to sip some in my dressing 
room.”
Kombucha is a tangy beverage made by fermenting green or black tea and sugar with a solid, live yeast and bacteria culture. As the culture consumes the sugars, it produces enzymes, antioxidant polyphenols, and amino acids. Kombucha can be purchased commercially—popular brands include Synergy and Kombucha Wonder Drink—or made at home. The drink has been used for centuries as a health tonic, with fans claiming it boosts energy and aids in joint recovery, not to mention increasing appetite control and contributing to healthier skin and hair.
Kombucha has a following among dancers, though little scientific evidence supports claims that the drink promotes good health or prevents ailments. The National Institutes of Health opted not to list kombucha in its database of dietary supplements, says Emily C. Harrison, a dietitian at the Centre for Dance Nutrition and Healthy Lifestyles, which is affiliated with Atlanta Ballet. Kombucha also has potential side effects, she notes. Unwanted mold can grow while kombucha is fermenting. Consuming a brew that has mold can result in an upset stomach and allergic reactions.
Harrison recommends that clients rely on other sources for a quick boost. “Dancers are always looking for a way to get more energy for fewer calories or less cost,” she says. “Since kombucha does have caffeine, yes, you may feel more awake after drinking it, but it is not fuel for working muscles. Dancers would be much better off having a meal or snack.”
Ideal energy snacks contain mainly carbohydrates, plus a little protein and fat to slow down their absorption and release calories more gradually. Harrison recommends half of a whole wheat bagel with one to two teaspoons of peanut or almond butter; a handful of carrot sticks with two tablespoons of hummus and half a pita; or a handful of blueberries and granola. All are about 150-250 calories, enough to provide energy for class or rehearsal.
Harrison is most concerned when dancers rely on kombucha to replace a meal. While she doubts the drink’s health benefits, she does not caution against using it, particularly if you eat something more substantial with it. “If dancers are having a commercial kombucha beverage and add a reasonable meal or snack,” she says, “it should be no problem.”
Hannah Maria Hayes is a freelance writer with an MA in dance education from NYU.
Pure Energy
White tea has a more delicate taste than other teas. It is the least processed type of tea and contains less caffeine than other tea varieties, according to the Tea Association of the USA.
White tea’s high concentration of L-theanine, an amino acid, stimulates brain waves to boost alertness and energy while producing a calming effect. It also has high levels of antioxidants, according to a 2009 study from Kingston University in London.
Tea experts recommend using loose-leaf white tea and brewing it for three to five minutes in very hot (but not boiling) water. To stretch your supply, resteep the leaves once or twice to extract all the nutrients. When reusing leaves, brew for several minutes longer than the first steeping. —HMH
Body Boost: Bow Pose
Yogis believe that back bending invigorates the central nervous system by squeezing the adrenal glands. One exercise that’s great for energizing the body is “bow pose.” Start by lying down on your stomach, then bend your knees, drawing the heels into your sitz bones, and grab onto your outer ankles. On an inhale, expand the chest and lift up your shoulders and knees, so the only parts of your body on the floor are your hip bones and stomach. Be sure to flex your feet and keep your knees parallel. Hold for a few breaths, then return to start. —Jenny Stahl
From top: Photo from istock; Photo from istock; Photo by Nathan Sayers.
Pointe work often brings blisters and calluses—par for the course for most ballet dancers. Raina Gilliland, 20, can attest to the challenges. The Minnesota Dance Theatre company member started pointe class when she was 8. Problems she’s already had include ingrown nails and a bunion. However, Gilliland admits some of her injuries could have been prevented if she had taken better care of her feet.
Dancers, pointe shoe fitters, and podiatrists all agree that finding pointe shoes that truly fit—and continuing to adjust that fit throughout your career—reduces the chances for injury. “Dancers think they get to a certain age and they stop growing,” says Jane Denton, a Bay Area podiatrist who works with San Francisco Ballet dancers. “But their feet get longer and wider with use over time.”
Marika Molnar, director of Westside Dance Physical Therapy in Manhattan and director of physical therapy at New York City Ballet, recommends that dancers get refitted for pointe shoes every six months to a year. “You could be a 7.5 when you’re 20, but when you’re 25, you could be an 8 or a 7.5EE,” she says.
Padding can help. Gilliland uses paper towels—“whatever’s in the bathroom”—and a toe spacer to help cushion her bunion. She’s seen many other kinds of padding used, including blue masking tape, which is waterproof and doesn’t slip. “But using lots of padding makes it not only harder to get into the shoe, but can change the shoe’s shape, or even contribute to its breaking in the wrong way,” Gilliland says. “Try to keep it simple, so you don’t mess with the shape of the shoe.”
Once you do find the right box, shank, vamp, width, and padding, you may still have to deal with minor foot problems. Here’s how to prevent and treat a few of the most common:
Blisters If you dance on pointe awhile, you build up calluses, so blisters usually aren’t as common. “On rare occasions if I get one,” says Gilliland, “I let it dry overnight, and maybe put on a little Neosporin + Pain Relief. Then I do what I can to avoid irritating it.” If she has to wear her pointe shoes the next day, she’ll rub more ointment on and cover it with her paper towel padding. Thin gel sleeves often can help to prevent irritation, but if there is chronic blistering, “you need to see if it’s the shoe that is causing it,” Denton says.
Corns Corns occur when pressure causes your skin to thicken into a deep, cone-shaped mass, pointing down inside the skin between toes. For a hard corn, pumice it gently so it doesn’t get too large, and wear lamb’s wool between the toes when in pointe shoes, Molnar advises. However, if you develop a soft corn, go see a podiatrist. “Dancers should not try not to gouge it out themselves,” Molnar says. “I’ve seen too many nasty consequences.”
Bruised Nails/Missing Nails If a bruised nail looks like it may be close to falling off, try to keep it attached as long as possible. If the nail is very loose on one side, bandage it. It helps to protect the nail bed from the pressure of the pointe shoe, Denton says. Molnar suggests that dancers also ice the toe as needed, or use Anbesol (an oral pain relief product) because it numbs the skin.
If the skin under the nail seems raw, keep it covered with a layer of antibacterial cream and bandage it, especially while dancing, to prevent infection. And if the nail falls off and you still have to dance, Denton suggests slipping on a gel toe sleeve for cushioning and protection.
Bunions Bunions, while hereditary, can be exacerbated if a dancer overdoes her turnout, rolling forward into the front edge of the big toe, causing joint deformity. A foam toe spacer helps keep the toes properly aligned and counteracts the pressure inside the pointe shoe. Denton recommends Voltaren gel, an anti-inflammatory available by prescription.
Gilliland has her own version of a foam spacer: She takes a makeup wedge, cuts it down to fit, and replaces it every couple of days. “It absorbs the sweat,” she says, “and they’re cheaper to buy in bulk.”
Hannah Maria Hayes is a New York writer with an MA in dance education from NYU.
Model: Sarah Hay. Photo by Nathan Sayers.
Ever since her first modern dance class, Adelheid B. Strelick has had to keep an eye on her toes for splits. “The seam just opens at the base of the big toe about a quarter of an inch, and you always worry about it ripping more,” she says.
At the beginning, Strelick’s ballet student feet weren’t used to direct floor contact and she got splits regularly. Now an independent dancer, instructor, and choreographer in New York City, she still finds herself with occasional splits, ingrown nails, bunion pain, calluses, and blisters.
Shoeless dancers can expect foot issues. However, if you don’t take time to monitor what’s going on with your toes, very painful injuries can result. Who wants to dance barefoot on a ripped callus? Proper preventative care starts with soaping feet daily and drying them well, especially between the toes. “It’s very important, especially for the barefoot dancer, because otherwise the skin will become overly soft,” potentially leading to athlete’s foot and skin cracks between the toes, says Brion R. Charles, physical therapist at San Francisco Conservatory of Dance and Alonzo King’s LINES Ballet.
Here are some tips for healthy toes:
Calluses Dancers need calluses, which are a thickening of skin resulting from friction and pressure, because they help protect the feet, especially for modern dancers. “It’s like wearing a shoe without a shoe,” says Strelick. “You turn better; you slide better.” But a callus can be painful if it becomes overgrown, so keep it in check with a pumice stone. “You wouldn’t want to mess with it too much unless you felt it thickening up,” Charles says. “You want it even and contoured with the softer skin around it.”
Cracks and Splits If a callus gets dehydrated, it can split. Strelick uses petroleum jelly, an ibuprofen cream she gets in Europe, or Neosporin to treat cracking or tearing from dancing barefoot. Use an emery board to gently file down the edges of a crack on the bottom of the foot, says Dr. Elliot Diamond, podiatrist for the Pennsylvania Ballet. Then use a piece of tape or bandage on one side of the wound, pull the split closed and tape the other side.
“If it’s in the inner space between toes, keep it impeccably dry,” he says. Take a square bandage and fold it in half lengthwise, place it in the split area and tape it on the bottom and top of the foot. Ask your physician about the drying antifungal solution Gentian violet, since it can be difficult to find in drug stores. It can be swabbed on the skin two or three times a day for a few days to fight fungal infections.
Blisters If you feel a blister developing, prevent it by padding the area. Charles recommends Elastikon, a brown elastic tape that moulds and sticks well to skin, to build up a protective layer around the blister until it reabsorbs. He does not recommend draining the blister because of the infection risk. If a blister pops, treat it like a cut to prevent infection. Strelick relies on 2nd Skin Moist Burn Pads from Spenco for flexible, waterproof antiseptic protection.
Bunions Although bunions are largely hereditary, joint deformity can happen if a dancer consistently rolls forward into the front edge of the big toe, either in relevé or in turned out positions. Use spacers or tape the toe to keep the joint in a normal position to help with pain. Diamond suggests elastic, therapeutic Kinesio tape. Strelick finds it helpful to focus on alignment outside the studio by walking in parallel. Diamond also notes that young dancers might benefit from the Bunion-Aider (www.3pointproducts.com/bunion-aider), a device worn at night to help reverse the beginnings of bunion damage. It slips over the big toe and creates a corrective, stabilizing stretch to reduce bunions.
Stretches and Exercises Keeping toes and feet in peak form and correcting alignment helps your feet remain injury-free:
• Sit on the floor with your legs straight out in front of you. Reach and gently pull the toes, either one at a time or as a group, toward the body.
• When you are standing, relevé and arch over your toes in a plié, keeping them long and straight.
• Cup the foot, or lift the arch ligaments up, and then relax, either in a seated or standing position (20–30 repetitions).
• Use a Thera-Band to wing and relax the foot (100 slow repetitions).
• Sit on a chair and use your toes like a cat to spread and retrieve a towel (20–30 repetitions).
Gentle massage helps release built-up waste products that cause toe cramping, Diamond says. And toe-stretching devices such as YogaToes can help provide spasm relief.
Sole protectors Devices like FootUndeez or Dance Paws can help, too, while dancing. These sole protectors allow a respite from friction, especially if you feel the start of a split occurring. “They are useful for a less-experienced dancer who wants to slowly build up her endurance,” Charles says. “They are also useful for the working dancer who needs a break from rehearsing the same movements over and over, or from dancing on floors that may not have an evenly smooth surface.”
Hannah Maria Hayes is a NYC writer and flamenco dancer.
Photo by Erin Baiano.
