Why dancers are having their trigger points released with a needle
We are all looking for a little magic when it comes to injury prevention and recovery. So it’s no surprise that dancers, always on top of new health trends, have recently started getting into dry needling. The treatment promises instant relief to some of dance’s most nagging injuries by releasing trigger points in the muscles with a needle. But it also has medical professionals buzzing with controversy. When your physical therapist pulls out a needle, should you question whether it’s safe for you?
What Is It?
Dry needling uses filiform needles—the same kind as traditional acupuncture. But although the tool is the same, the approach is different. Based in ancient Chinese medicine, acupuncture seeks to balance the flow of energy along pathways in the body called meridians. Dry needling, on the other hand, arose out of Western medicine in the 1940s: Dr. Janet Travell, a specialist in pain referral patterns, identified trigger points in the body that would relieve pain by releasing tension in the associated muscles. Initially she injected the trigger points with fluids such as saline. The term “dry needling” originated when she discovered that the technique had the same effect without the injection.
How It Helps
The practitioner inserts the needle using a technique that elicits a “twitch response,” an involuntary reaction in the muscle that enables it to release tension. The immediate elongation of the muscle fibers allows the muscle to relax. “When the needle taps the tight tissue, it creates a micro-trauma which brings a lot of blood to the area,” says Bianca Beldini, a licensed acupuncturist and physical therapist at Sundala Center for Wellness in New York City. “Immediately when you take the needles out, the patient’s range of motion improves and their pain decreases.” Acupuncture techniques vary, and this twitch response is not something that acupuncturists would normally go for, unless they use the trigger-point dry needling technique.
The Effects
Many dancers find that the muscle release dry needling provides has dramatic results. “I have needled dancers the same day as an injury and they are able to return to rehearsal after treatment,” says Erika Johnson, director of dance medicine at Marathon Physical Therapy and Sports Medicine in Massachusetts. “This is obviously case dependent, but it’s exciting to see this trend.” While it can’t help every injury, Johnson has used dry needling on muscle strains and spasms, tendonitis, sprained ankles and many of dance’s other most common injuries.
For New York City Ballet principal Sara Mearns, who has been treated by Beldini since she first joined the company in 2003, the approach combining dry needling technique with more traditional acupuncture has helped her heal faster and feel better. “If I have a strained calf, she is able to fix it within two sessions probably,” Mearns says. She admits that she was nervous about the needles at first. “But the needles are so tiny and the release that I get from them is deeper than any other therapy.”
The Timing
The first time a dancer experiences this type of needling, Beldini often encourages them not to dance for the next 24 hours. This gives them a chance to find out how long they will experience soreness. “The twitch response can release a fair amount of lactic acid, so the dancer is typically quite sore after,” explains Beldini. A good practitioner will be able to perform the technique gently and minimize this soreness as they get to know your body better. Mearns can be needled by Beldini and dance pain-free the next day. In fact, during performance seasons she sees Beldini every Monday even if she’s not injured because the treatment has become so therapeutic. “It’s a process,” says Mearns, “but once you get to that place where you can really handle that deep release in your muscles, your body will be completely different.”
How to become the kind of performer audiences can’t take their eyes off of.
Lesley Rausch, here in Swan Lake, uses visualization techniques backstage. Photo by Angela Sterling, courtesy Pacific Northwest Ballet.
After countless hours in rehearsal, the stage can sometimes feel like a foreign country. Mirrors are replaced with blackness, your periphery is filled with light, and the floors, spacing and even the rosin feel different. Suddenly the variation you’d mastered in the studio is shaky and your performance falls short of everything you’d accomplished in rehearsal.
Performing is a skill of its own, and great dancers are not always great performers. It takes a particular kind of confidence to share yourself onstage and relax into your body when the pressure is on. But by working on their performance skills, dancers can grow beyond what was possible without an audience.
Shake Your Nerves
Dancers who flourish under the spotlight typically focus on the work itself rather than outcomes like audience reactions, reviews or possible promotions. Because such results are beyond your control, fixating on them can zap your confidence and exacerbate nerves, explains Dr. Jim Taylor, psychologist and co-author of Dance Psychology for Artistic and Performance Excellence.
When those thoughts take over, Alvin Ailey American Dance Theater’s Demetia Hopkins-Greene practices deep breathing to calm down and slow her heart rate. “I focus on my goal for that performance: What’s my role? What am I trying to convey?” she says. She forces herself to stay in the moment and shifts her mind-set to revel in the blackness of the fourth wall, rather than worrying about all the people on the other side.
Other dancers learn to use their nerves to their advantage: If you can channel that adrenaline into controlled energy (while staying present), it can give you an extra boost. “Enjoy the butterflies,” suggests Houston Ballet II ballet master and coach Claudio Muñoz. “It’s the best part of the performance.”
Discover Your Ideal Prep
Whether you always listen to a certain song backstage or a put on a “lucky” pair of mukluks, there may be more power in your backstage routines than you think. “Great performers and athletes are meticulous in their preparation,” Taylor says. That means your makeup, hair and warm-up are all thoughtfully done on a schedule that makes you comfortable. “Consistency of preparation leads to consistency of performance,” he says.
Hopkins-Greene, here with Glenn Allen Sims in Chroma, uses the fourth wall to help her focus. Photo by Paul Kolnik, courtesy Ailey.
The trick is finding what makes you feel comfortable enough to open up and be vulnerable onstage. Dancers with an internal-focus style often need space and quiet to get into that zone—you’ll find them off in a corner with earbuds in, avoiding eye contact. But others, says Taylor, will begin to stress and self-criticize if they overthink things, so they might need to spend their prep time blasting silly pop music and laughing with friends.
Either way, get into performance mode from the moment you start warming up. “Don’t wait until you’re onstage,” says musical theater choreographer and performer Al Blackstone. “Immediately during pliés, be as present as possible, actually look at your hand, engage with the space around you, project energy. Then you won’t have to make a huge shift once it’s time to perform.”
Positive imagery should also be part of every dancer’s backstage prep. Studies have shown that visualization can have a real effect on how our muscles behave. Imagining your ideal performance can help embed it in your muscle memory before you go on. “I’ll visualize doing the steps successfully rather than focusing on the time that I fell out of the pirouette,” says Pacific Northwest Ballet principal Lesley Rausch. During the rehearsal period, go through your choreography mentally at least three times per week so that visualization feels natural come opening night.
Watch Your Body Language
The way you hold your posture can affect how an audience perceives you on a subliminal level, says Jennie Morton, an osteopath and former dancer. For example, by curling your stomach inward while pushing your chin up in a slumping position, you are communicating that you are afraid, whether intentionally or not. Similarly, elevated shoulders or tension in the neck and arms can denote a lack of confidence. “The audience will be waiting for something to go wrong because they don’t feel comfortable watching you,” says Morton. “For an audience to connect to a performer emotionally, trust has to be established.” Of course, these postures can be a choreographic or dramatic choice. But otherwise, Morton suggests aiming for neutral alignment—particularly focusing on your pelvic position—to give your body language greater authority.
Find Your Way Into the Role
When Hopkins-Greene was cast in the title role of Matthew Rushing’s Odetta last year, she was intimidated to depict the iconic singer known as the voice of the civil rights movement. But once she found herself in the role, she shined. “I can’t be Odetta,” she says, “but I can tell you what I feel from Odetta. I can show you how I see this woman.”
Claudia Muñoz coaches dancers to approach performances the same as rehearsals. Photo by Cameron Durham, courtesy Houston Ballet Academy.
Blackstone says that performers who struggle with being expressive onstage can improve by digging even deeper into the material. “Talk to the choreographer, ask yourself questions about the character and how you want the audience to feel,” he suggests. “Performance is about communication—how can you have a great conversation if you don’t know what it is you’re trying to say?”
Based on your interpretation, discover places in the choreography to play with your energy and focus, and find those moments when you can feed off other performers onstage by making eye contact. “Take those moments when you’re not engaging straight out to the audience to look down or over your shoulder or at your partner,” says Blackstone. Not only will this give your dancing more nuance, but it will leave you more energy to give to the audience when you are sending it out in their direction.
Don’t Aim For Perfection
Because the stakes are high in performance, dancers tend to put more pressure on themselves. “When I was younger I felt this sense of needing to be perfect technically in my performance,” says Rausch. She’s not alone. But this approach can backfire, aggravating stage fright and leaving dancers unprepared to bounce back from the inevitably imperfect moments in a performance.
When coaching dancers for competition, Muñoz tells them to approach it just like they do every day in the studio. “If they’re good, they’re going to win anyway.” A performance is not the time to try for an extra rotation in your turns; simply execute what you know you can do and remain open to what comes onstage. Strive for excellence rather than perfection, advises Taylor. “Excellence still sets the bar incredibly high, but it takes away the pressure of having to be perfect.”
Be Human
So what is that sparkle? The je ne sais quoi that makes certain dancers seem magical onstage? Simply put, it’s you. “The dancers that I enjoy watching the most are the ones who are very comfortable with who they are outside of the studio because they allow themselves to be that person onstage, too,” says Rausch. Watch other dancers to see what it is about their performances that you respond to. And replay videos of yourself performing to see how you’re coming across, whether you look comfortable in your own skin.
“With performers, their whole identity can be wrapped up with their label as a dancer,” says Morton. “It’s those who manage to retain their humanity, that connection with the self, that find it more natural to be expressive.” Make time for activities and friends that help you stay in touch with all the quirks and oddities that make you uniquely you. And once you’re in front of the footlights, don’t hold anything back. n
Kathleen McGuire is a contributing writer to Dance Magazine.
Decide which is best for you.
Cara Marie Gary, here in Joffrey's Romeo & Juliet, took AP courses and worked on yearbook. Photo by Cheryl Mann, courtesy Joffrey Ballet.
For most pre-professional dancers, it seems as though there are never enough hours in the day to get everything done. Your training may feel like a full-time job, but you have full-time high school to worry about, too. Balancing these responsibilities can become stressful, especially if you worry about it having an impact on your dancing during pivotal training years.
Many dancers consider abandoning high school for nontraditional alternatives, like cyber-school or home schooling. These options allow dancers to have a flexible schedule and fit in more dancing, but can come with academic and social sacrifices. How you tackle your education should reflect your personal goals and the circumstances of your training.
To Leave or Not To Leave
Your decision may come down to the demands of your dance program. At The Washington School of Ballet, director Kee Juan Han says most local students in the professional training program attend regular high school and work with their academic advisors so they can be at their first ballet class at 2 pm. (At some high schools, studio hours can stand in place of gym, art or music credits.) Out-of-town students at TWBS who are high school juniors and seniors take online courses. Regardless of the situation, Han works with parents to ensure students are meeting academic standards. If there is a concern, the dancer isn’t allowed to take class until her grades improve. He remembers one student whose parents insisted on straight A’s. “I supported it,” says Han, adding that the student is now dancing with Boston Ballet.
OBT's Paige Wilkey chose to finish high school online. Photo by James McGrew, Courtesy OBT.
When Paige Wilkey, now an apprentice with Oregon Ballet Theatre, left Los Angeles to study at Boston Ballet School during her junior year, she opted to finish her studies online because the cross-country move had already been a huge commitment to her dancing. “It was nice to be able to have dance as the main focus and have school work around it as opposed to the other way,” says Wilkey, who feels she was able to improve more when dance became her number one priority.
Wilkey took the same classes any high school student would, but completed them while working at home or at a coffee shop a few hours a day. And though subjects like British literature, creative writing and calculus were challenging, her teachers were available through e-mail or Skype. One bonus? When a big performance was coming up, she could reschedule her online tests.
Home-School Challenges
Beyond the dance world, there has been much discussion about how an independent or home-school environment can affect teenagers’ social development. The adolescent years are an important time for “separation and individuation,” says Brian Goonan, a sports psychologist at Houston Ballet Academy. When you don’t physically go to school, “what can happen is the dance part of the identity becomes almost too central.” This can affect your ability to see yourself as a whole person, and appreciate the many facets of who you are, rather than only as a dancer.
You’re also missing out on a built-in support system where a community of students are focusing on the same tasks. “Your friends are in the same classes and everything is due at the same time; you’ve got the same science test tomorrow, and everybody is studying for it,” he says. If you’re studying independently, try to find support in peers who are doing the same. And if you’re away from home, it’s especially important to find active adult mentors to help you stay on track.
Making High School Work
Perhaps your parents insist on traditional high school or you don’t want to give up the chance to have a “normal” teenage experience, with prom and football games. It’s possible to do it all. Joffrey Ballet dancer Cara Marie Gary went to high school while studying at International Ballet Academy in South Carolina. Despite her rigorous training schedule, she took advanced-placement courses and worked on the yearbook, while preparing for competitions like Youth America Grand Prix. And though she trained with girls who were homeschooled, she never fell behind. “I felt like we were equally coached and equally trained,” she says.
Gary admits that balancing high school and dance wasn’t easy. “I had flash cards in my ballet bag and pointe shoes in my backpack,” she says. But tackling both academics and ballet taught her how to focus and work hard. In May 2014, she graduated with a BA in business administration from North Greenville University while dancing with the Joffrey. “I think having a hard high school and dance load contributed to where I am now.”
The principal dancer moonlights as a nutrition entrepreneur.
Erickson fuels performances by snacking all day. Here, in Giselle. Photo by Rich Sofranko, courtesy PBT.
With five feet eight inches of svelte muscle, Pittsburgh Ballet Theatre principal Julia Erickson is celebrated for being quick on her feet and light in her carriage. Outside of Pennsylvania, though, she may be most well-known as the dancer who created Barre–A Real Food Bar with her husband, Aaron Ingley. The pair began selling the vegan whole-food energy bar in 2010 because Erickson got so many requests from colleagues who wanted to buy her homemade snacks. Today, the bars are carried by approximately 400 retailers across the country, including natural food outlets, dance studios and stores.
Erickson chose every ingredient based on snacks she eats in the studio—things like dates, nuts and rolled oats. “It has the perfect combination for me of slow- and fast-burning carbohydrates, protein, fiber and natural electrolyte replacement," she says. “You're not going to flame out, but it's not going to make you feel overly full." Erickson often snacks on half a Barre before a rehearsal to fuel her dancing and half immediately after to replace nutrients for her muscles.
Just as she is meticulous about what she puts in her body, Erickson also pays attention to how she challenges it. She practices yoga a few times a week to balance out the stress that dance places on her muscles and joints. “I like Bikram because it's not super-intense on the upper body," she says. “Mostly you are using your own body strength with calisthenics." She also attends the less-familiar yin yoga, which focuses on stretching in one position, such as the half pigeon, for as much as five minutes at a time. “It really goes beyond the muscle to the connective tissue," she says, “and I have found that it has been so helpful for me to even out the imbalances and asymmetries in my body."
Throughout her day, Erickson works out knots with a small, hard ball for her feet and a large, softer ball on her quads and back. “Sometimes soft is surprisingly more effective than mashing on the muscle with something hard," she says. Barre is currently seeking to expand its product line to include similar balls, as well as an all-natural dietary supplement and anti-inflammatory cream. The dancer-friendly items will soon be for sale at realfoodbarre.com.
Do they really lead to a job?
Former Joffrey trainee and current company dancer Amanda Assucena. Photo by Herbert Migdoll, Courtesy Joffrey Ballet.
When Amanda Assucena graduated from the Harid Conservatory, she hoped to work professionally right away. But as she auditioned for companies, she quickly began to feel that her dancing wasn’t as mature as everyone else’s. “My movement was very academic,” she says. Assucena realized she needed more time to prepare. She applied for trainee programs at her favorite companies, eventually accepting a place at the Joffrey Ballet. “I thought of the trainee program as a transition process.” The following year, she was hired into their main company.
The path to a professional career in ballet has changed. Today, getting hired straight out of high school is less common than it was just a decade ago. Dancers are turning to another leg of training to bridge the gap between their student and professional years. This allows them to gain professional experience and polish their technique and artistry, making them a more attractive hire to directors. It also gives dancers a look inside their dream company and a connection that could help make that dream come true. However, it comes with a price—sometimes more than $5,000 a year.
Trainee experiences vary widely, but most programs are very rigorous. Dancers spend 20 to 30 hours a week in trainee-level technique classes and rehearsals held at the school, plus additional time in company class and rehearsals. At most programs, trainees are used to fill out the corps de ballet in company repertoire. “During the first year or so as a company member it can be a real shock on your body and mind to be doing mostly corps works every day,” says former San Francisco Ballet trainee Jeanette Kakareka, who danced in the corps while working on bigger roles for trainee performances. “So to be able to still perform White Swan pas de deux on the same day as learning how to be in a straight line in the corps is very helpful.”
Many programs offer various ways to help dancers transition into their careers. Cincinnati Ballet gives students the opportunity to create dances through choreographic workshops. Joffrey holds monthly seminars on topics such as injury prevention, audition videos and career transition. And Ballet Austin trainees can put their dancing hours toward college credit at neighboring St. Edward’s University.
Trainee programs do get some flack. Critics argue that they allow companies to profit by collecting tuition while bolstering their corps de ballet, with no promise of a job upon completion. And even if trainees are offered a position, it’s often with the second company or an apprenticeship—not a full-fledged corps de ballet contract. Though Kakareka chose not to join SFB, accepting a contract with English National Ballet instead, she feels the extra time spent training there was well worth it: “My traineeship gave me every opportunity to succeed.”
Dealing with the self-doubt of coming back from injury
Photo by Matthew Murphy, Courtesy Pointe
A doctor’s tiny buzz saw was etching the path to freedom down Gabrielle Thurlow’s casted foot. It had been several weeks since the Pittsburgh Ballet Theatre dancer had rolled the wrong way out of a relevé, leading to a flood of bad news: broken, surgery, crutches, out for months. Now, with a metal screw in her fifth metatarsal, she had survived two weeks of immobility. The plaster was pulled back and Thurlow gratefully tried to stretch her foot to pointe—but it barely moved. A wave of panic rushed through her: It’s never going to be the same, the director will forget about me, I have to be back in time for Nutcracker. She realized the hardest part was yet to come.
The pain of injury goes far beyond tendons tearing or bones breaking. For many dancers, it is the fear, self-doubt and depression that cuts deepest. These mental hurdles may cause you to shy away from certain movements or push too hard on a healing body. But there are logical reasons for the fear, and simply acknowledging it may be the most important step in the process of overcoming injury.
When you’ve sustained a serious injury you are likely to confront both conscious and unconscious mental hurdles, according to Dr. Alan Goldberg, a sports psychologist who works with professional athletes and dancers. Unconsciously, your nervous system memorizes every aspect of that traumatic event. “The physical sensations, the movement that happened when you got injured, the thought process and the emotion will stay in your system for months and even years,” Goldberg says. Anything that triggers familiarity with the instance of the injury, be it a specific piece of music or a certain step, can cause a significant psychological reaction. “You start feeling unsafe,” he says, “and it triggers your self-protective motor programs.” Since you can’t fight or flee, most people freeze. “What I hear all the time is, ‘I can’t get my body to do what I know how to do.’ ”
Jennifer Green, physical therapist and founder of PhysioArts in New York City, recently witnessed this kind of trauma while working with a dancer who was performing a featured role in a Broadway show. “He tore his ACL doing a particular pas de deux and had to return to that show and that particular number,” she recalls. When it came time to rehearse, he would get to the point in the choreography where he had injured himself and be unable to continue. To address the fear, Green began playing the music from the pas de deux in the clinic while they worked, incorporating movements from the choreography into their exercise. She advised that he speak with a sports psychologist, which helped tremendously. She also went to the studio to work through the choreography with him during a rehearsal to make him feel confident that his placement was correct. Eventually, he was able to get over the hurdle, and return to the show for another year and half.
Recovery also comes with a host of fears that you are more consciously aware of, but you may not be addressing. Goldberg points out that for most dancers, your sense of identity and self-esteem come from dance. Dancing may also be the way that you’ve traditionally coped with stress. “There’s a feeling of being lost,” he says. “There’s identity confusion and there’s depression because you’ve lost your ability to be recognized.” For Thurlow, one of the lowest points was an afternoon she went to the studio for a Pilates session and saw a group learning Marie for The Nutcracker, a role she’d been hoping to learn. Standing at the door, Thurlow felt she had disappeared while everyone else kept dancing.
So how can you handle these emotions? Goldberg advises first and foremost that dancers acknowledge that they are going to be afraid and that it is normal to feel the loss. Addressing this is also for your physical benefit. “When there’s fear, your body tenses,” says Green. “So physically you’re making yourself more rigid and prone to injury.”
Manage your expectations by setting new goals. You are no longer competing with the best dancer in the room—you aren’t physically able to. “Where are you now and what are you able to do?” asks Goldberg. Focus on the progression you’re making in your physical therapy and cross-training. “Being involved in your own healing is a way to have power,” he adds. Green also suggests taking lower-level classes while working back up to full strength. This will allow you to focus on the basics, and it will help take the edge off—with a different teacher and classmates, you are less likely to push too hard. “Seek out places where you feel like you don’t have to impress anybody and can work on your own recovery,” she says.
Thurlow remembers every ballet she missed out on during the season she spent injured. But her foot eventually did pointe the way it used to, and she no longer feels the metal screw. The physical therapy and Pilates made her a stronger dancer. And she didn’t disappear. In fact, she was promoted to soloist for the 2014–15 season. “Looking back, I’m almost glad it happened,” she says. “I know now that I can get through it.”
