Is Fitness Necessary For Dancers

Is Fitness Necessary for Dancers?
Author(s): Yiannis Koutedakis, Paul Pacy, N. C. C. Sharp and Fiona Dick

Source: Dance Research: The Journal of the Society for Dance Research, Vol. 14, No. 2
(Winter, 1996), pp. 105-118
Published by: Edinburgh University Press
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BODY COMPOSITION AND WEIGHT CONTROL
are beneficial both in terms of performance and reduced injury

and permit good future health. The work commissioned by
Dance UK represents the first step along the road to a more heal-
thier dance community.
Acknowledgements
The authors would like to thank Professor Joe Millward, Mal-
colm Cox and Neil Gibson for their help, Dance UK for financial
support and all the professional and student contemporary dan-
cers who gave up time to allow us to study them and Fiona Dick
for her editorial assistance.
ADDITIONAL READING
Benson, J. E., Geiger, C. J., Eiserman, P. A. & Wardlaw, G. M.

(1989). Relationship between nutrient intake, body mass index,
menstrual function, and ballet injury. J Am Diet Assoc, 89, 58-63.
Bowling, A. (1989). Injuries to dancers: prevalence, treatment, and
perceptions of causes. BrMedJ, 298, 731-734.
Hergenroeder, A. C., Fiorotto, M. L. & Klish, W. J. (1991). Body
composition in ballet dancers measured by total body electrical
conductivity. MedSciSportsExerc, 23, 528-533.
Van Marken Lichtenbelt, W. D., Fogelholm, M. Ottenheijm, R. &
Westerterp, K. R. (1995). Physical activity, body composition
and bone density in ballet dancers. BrJNutrit, 74, 439-451.
IS FITNESS NECESSARY FOR

DANCERS?
riannisKoutedakis,
PaulPacy, V. C. C.SharpandFionaDick
Introduction
Dance is an activity which requires high levels of commitment

and skill that rival or may exceed many sports. Professional dan-
cers are usually involved in daily technique classes followed by
0o5

DANCE RESEARCH
several hours of rehearsal and/or stage performances. Such

demanding timetables render them as liable to suffer various
injuries, and even permanent disabilities, as most elite athletes.
But how fit are dancers to last the course. Are fitness and fitness
training missing factors from the traditional thinking in the
Dance World?
Physical fitness is a composite which varies markedly depend-
ing mainly on levels of performance (Sharp, 1988). In dance, fit-
ness incorporates elements of body composition (Hergenroeder
etal., 1991, 1993), joint mobility (van Gyn, 1986), cardiorespira-
tory fitness (Clarkson etal., 1984; Davidson, 1986), anaerobic fit-
ness, and muscular power (Rimmer et al., 1994) and strength
(Clarkson, 1988; Fitt, 1981). Regardless of the performance
level, sex and age, all dancers have to use one or more of these ele-
ments during their daily schedules. The purpose of the present
article is to: (a) introduce the main fitness components, with spe-
cial reference to dance, and (b) briefly discuss data obtained
from two studies showing the relationship between strength
levels and the incidence of injury in dancers.
1. Main FitnessComponents
in Dance
Definitions of Physical Fitness

There are two widely accepted definitions of fitness:
1. 'Fitness is the ability to cope with the demands of a specific
task', or
2. 'Fitness is the "gap" between performance requirements and
the individuals' maximal abilities.'
The first definition applies to physical tasks where success
depends on the performers' ability to work at maximal levels
(e.g. sprinting, weight-lifting). In contrast, the latter definition
refers to activities where performance takes place at sub-maxi-
mal levels, success for which (e.g. fencing, distance running and,
indeed, dance) is directly related to the ability to delay the detri-
mental effects of fatigue. This ability can be achieved by increas-
ing the 'gap' between performance requirements and the
individuals' maximal fitness.
io6

FITNESS FOR DANCERS
Body Composition- Body Weight Control

Body composition has two constituents:fat mass and lean mass.
The latter consists of muscle, bone, and other tissues and
organs. Since bone and other lean tissue are relatively stable,
any change in lean massis usually due to a change in muscle.Phy-
sical exercise, in conjunction with an appropriate diet, is fre-
quently used in body-weight control regimes to decrease the
quantity of fat.
When energy intakes are equally compensatedby outputs, the
body is said to be in caloricbalance,and body weight remainscon-
stant. However, if energy intakes exceed outputs (i.e. positive
energybalance),body weight - and more specifically body fat -
will increase. In contrast, when energy requirements exceed
levels of energy intake, the body will lose weight and is said to
be in negativebalance.This can occur either because of a reduced
food (i.e. calorie) intake, or from increased levels of physical
activity.
The most popular field estimate of body composition is the
skin-fold assessment, whereby regional subcutaneous fat-fold
thicknessesare measured at standard sites on the body. Percen-
tages of body fat can then be calculated as a function of the total
body weight. It has been found, for instance, that body fat
ranges from as low as 7% and 13% in male and female ballet
dancers respectively, to 23% and 30% in male and female
modern dancers (Evans et al., 1985; Freedson, 1988). These
values are similar to those found in athletic populations (Wil-
more, 1974;Koutedakis & Sharp, 1990).
Flexibility &Joint Mobility

Flexibilityandjointmobilitymay be defined as 'theabilityof thejoints
tomovethrough afull rangeofmovement'. Good flexibilityusuallyindi-
cates that there are no adhesions, or abnormalities, or serious
anatomical or muscularlimitations in or around the joint. Indi-
vidual differencesin flexibility are dependentupon physiological
characteristicsinfluencing the extensibility of the muscles and
ligaments around thejoint, as well as the genetically determined
anatomy of the joint itself. Age, body type, gender, and factors
I07

DANCE RESEARCH
such as temperature, humidity, warm-up and physiological

stressmay also influence the range of movement.
For many years, flexibility has been the main physical fitness
component which dancers have regularly sought to improve.
However, high flexibilitylevels seem not to resultin, say, reduced
incidence of low-back injury in dancers (Koutedakis et al.,
1996a), as has been previously suggested for other athletes
(Harrey & Tanner, 1991).
CardiorespiratoryFitness (Aerobic Enduranceor Stamina)

The ability to consumelarge volumes of oxygen duringincreased
physical effort, has been associated with the limits of human
endurance and cardiorespiratory fitness. In dance, although
increasedcardiorespiratoryfitnessdoes not guarantee a success-
ful performance,it is neverthelessan important factor in coping
with long hoursin the studio, and in facilitatingrecoveryfollow-
ing physicallydemanding sessions.
The term maximaloxygenintakehas been introduced to repre-
sent the greatest utilisation of oxygen in a given time. While
normally active 20-year-old men and women have maximal
oxygen intakes of approximately 45 and 35 millilitres per kilo-
gramme body weight per minute (ml/kg per minute) respec-
tively, trained distance runners may demonstrate values of 80
and 70 ml/kg per minute respectively). In dance, USA male
and female professionaldancers have shown values of 56 and 51
ml/kg per minute (Schantz & Astrand, 1984), which are higher
than their UK counterparts (Healthier Dancer Report). In
some cases, maximal oxygen intakes for the UK dancers were
close to those of untrainedindividuals. Lack of leisuretime, over-
work, and/or training traditions may account for these differ-
ences. Indeed, given that conventional dance exercisesalone do
not produce adequate changes in cardiorespiratory fitness
(Cohen et al., 1982), the introduction of optimal off-dance-
studio exercise (e.g. swimming,jogging, etc.) should be seriously
consideredby the profession.
MuscularEndurance (or Anaerobic Fitness)

Endurance is the ability to resist fatigue, and muscular endur-
ance, is usually taken to mean theabilityto resistrapidlyrepeated
Io8

FITNESS FOR DANCERS
movements of highintensity, as in a rapid series of leaps - or as in the

sports of canoeing or rowing or the gymnastic rings. Much of
the energy for such strong rapid movements is released with the
need of oxygen, hence the term 'anaerobic'. Such anaerobic
work is associated with the formation of lactic acid by muscle
and its release into the blood.
Anaerobic work and fitness may be measured by different var-
iants of what is called the Wingate Test, in which performers
pedal a cycle ergometer as fast as they possibly can against a
resistance which is set according to age, sex, body weight, and
whether the legs or arms are being tested. The duration of the
test is usually 30 seconds.
Monitoring levels of lactic acid in the blood is another method
of assessing anaerobic fitness. We found that fencers produced
less than 4 mmol/litre of lactic acid during competition. This is
relatively low compared to 18 or 20 mmol/litre found in Olympic
rowers and synchronised swimmers (Koutedakis & Sharp,
1990). Schantz & Astrand (1984) reported lactic acid values as
high as 11 mmol/litre in a ballerina performing 'Giselle', but
only 3 mmol/litre during basic ballet training sessions.
One of the widely held beliefs in sport, also widespread among
dancers, is that muscular soreness is caused by high levels of
lactic acid. However, muscle soreness is related more to the type
of exercise (e.g. jumps and rebounds) rather than to lactic acid
levels (Schwane et al., 1983). Also, lactic acid is over half way
back to resting levels after approximately 30 minutes, and is
usually back to normal after about an hour of moderate rest.
Liver, kidneys and heart - and other muscles - and the lungs -
may remove lactic acid from blood at the rate of about 100 gm
(3 ounces) per hour, an amount that can be produced in a few
minutes of highly intensive activity. Appropriate 'warming-
down' procedures, are probably the best way to optimise lactic
acid removal.
Muscle Power
Muscular power is the explosive aspect of strength (often called
'fast-strength' by athletics coaches) and is the sum of strengthand
speedin a movement.Thus, it is the functional application of both
speed and strength, and is a key component in most athletic
Iog

DANCE RESEARCH
events, including dance. Indeed, dance routines - where repeti-

tive jumping is required - can only be performed successfully if
dancers have sufficiently high levels of muscular power. How-
ever, as in the case of cardiovascular fitness, power is not likely
to improve beyond certain levels by using conventional dance
exercises along (Rimmer et al., 1994).
Muscular power in the legs may be simply measured through
various forms of 'vertical jump test' whereby the measured
height achieved may be assessed against body-weight. Power
may also be measured by the above described Wingate Test.
Peak power is usually attained within the first 10 seconds, and
often in the first 5, especially in those used tojumping.
Muscular Strength
Muscular strength may be defined as 'theabilityto overcome external
resistancebyusingskeletalmuscles', and it can be assessed by simple
mechanical dynamometers and computerised equipment. In
general, dancers demonstrate lower strength levels compared to
many other sportsmen/women (Kirkendall & Calabrese, 1983;
Koutedakis & Sharp, 1990). It has also been reported (Wolman
et al., 1990) that low strength levels in female dancers are related
to decreased one density and increased susceptibility to stress
fractures.
Strength training has been part of the athletes' life for at least
2,500 years. In dance, however, such training has not been gen-
erally considered as a necessary ingredient for a successful
career. This is partly because of the widely held belief that
increased muscle strength is inevitably associated with large
increases in muscle size, an unwelcome feature for both male
and particularly female dancers. However, marked improve-
ments in muscle strength may occur without proportional
changes in muscle size (McDougall et al., 1980). In view of the
limited literature on the physiology of male and female profes-
sional dancers, one of the aims of the 'Healthier Dancer Pro-
gramme' was to investigate possible relationships between
strength levels and frequency and severity of injuries.
I I0

FITNESS FOR DANCERS
vs.InjuriesinDancers
2. MuscularStrength
Until recently, dancers have not received the same medical

attention as sport competitors, as it has been assumed that dan-
cers' movements are not capable of generating sufficient power
to cause the muscular injuries seen in sports. However, dancers
do get injured and the effects of these injuries, on both their
health and career, may be detrimental. Yet, dancers usually
only refer to specialists if their symptoms have progressed to an
uncomfortable point, whilst doctors tend to wrongly diagnose
their injuries (Garrick, 1986).
In a period of two years, for example, 335 injuries were docu-
mented in 159 dancers (Clanin et al., 1986). The lower back
seems to be the most frequently injured anatomical site, which
together with pelvis, legs, knee and feet account for more than
90% of the dance-related injuries (Garrick & Requa, 1993;
Fig. 1). Overwork, unsuitable floors, difficult choreography,
and insufficient warm-up (Sohl & Bowling, 1990) are among
the factors which may contribute to such injuries. But what
about fitness - and more specifically muscle strength levels - in
relation to such a high incidence of injury in dancers?
2001:
150.
-.if i . 0 E;
5 I i^ l-,!
gramme).
III

DANCE RESEARCH
Is Severity of Lower-Extremity Injuries Related to Strength

Levels in Dancers?
The purpose of the first study was to investigate whether dancers
with lower muscle strength demonstrate more severe lower-
extremity injuries than their stronger counterparts. Twenty
male (mean age 26.6) and 22 female (mean age 27.1) profes-
sional dancers volunteered as subjects. The males were ballet
dancers, whereas most of the females were involved in modern
dance. The selection criteria were: (a) an affirmative response
to the question 'anyoccasional/chronic low-back,pelvis, leg, knee,and/
orfoot injuryduring the last 12 months?' and (b) the absenceof any
injuryat the timeof data collection. Severity of injuries was assessed
by recording the days-off dancing due to these injuries.
For each subject, muscular strength was assessed on an isoki-
netic dynamometer. Knee extensor and flexor muscle (i.e. quad-
riceps and hamstring) peak force outputs were obtained from
both dominant and non-dominant legs. The subjects were asked
to perform three maximal contractions, on alternative legs, for
each muscle group at 1.04 and 4.19 rad/s, i.e. at relatively low
and high speeds.
Figure 2 shows relationships between days-off dance due to
<,10
E FEMALE
DANCERS
z
?=^~~~~~~~ + MALEDANCERS
8
o
6
2q ' ' *++

4
w
LU \ -
0
+
. 2 +. --- +
U * * *\ + + + - +
a 0
2.9 3.1 3.3 3.5 3.7 3.9 4.1 4.3 4.5 4.7 4.9 5.1 5.3 5.5 5.7
QUADS& HAMSTRING
(Nm/kg BW)
2: Relationships between days-off dance due to lower-body injuries, and the
sum of knee hamstrings and quadriceps peak outputs at the test speed of 1.04
rad/s in male and female dancers.
I 12

FITNESS FOR DANCERS
lower-body (i.e. pelvis, legs, knees, and feet) injuries, and the
sum of knee flexors and extensors peak outputs, expressed in
Nm/kg body weight, at the contraction speed of 1.04 rad/s
(expressingthe values of kg of body weight - Nm/kg - removes
the influence of body-size differences).The general trend would
appear to be that the lower the thigh-power output (or thigh-
strength), the greater the degree of injury in both male and
female dancers.We suggest that the introductionof supplemen-
tary strength training may circumvent such problems and pro-
vide a relatively cost-effective way of reducing injuries in
dancers.Indeed, it has been previouslyfound that strengthtrain-
ing is more beneficial to weaker male (Koutedakisetal., 1996b)
and female (Stalderetal., 1990) dancers than their strongercol-
leagues.
The findings in Fig. 2 are also in line with a pool of anecdotal
evidence suggesting that most of the dance-related injuries
occur towards the end of rehearsalsand/or stage performances,
and more specifically towards the end of the season, when dan-
cers are physically tired. This trend, if valid, might reflect the
fact that fatigue normally causes a breakdown in movement
mechanics which would, in turn, place dancers closer to poten-
tial injury. Thus, it would be anticipated that the weaker the
dancer, the greater the injury risk as there would be a tendency
to work closer to his/her individual fatigue threshold. Indeed,
we found that the female dancers were both weaker and showed
more severe injuries than the males. No such correlationswere
found at the higher speed of 4.19 rad/s.
Thigh Muscle Imbalance & Low-Back Injuriesto Dancers

The purposeof the second study was to investigatewhether there
is any relationshipbetween thigh-muscleimbalanceand the inci-
dence of low-back injuriesin dancers.
As mentioned above, low-back injuries are frequent in both
athletes and dancers (Budgett & Fuller, 1989; Solomon &
Micheli, 1986). Factors which are thought to be linked to the
genesis of low-back problems include weak abdominal muscles
(Corbin & Noble, 1985), reduced range of movement in various
joints (Borms, 1984), disc degeneration (Stallard, 1994), inade-
quate lumbar flexibility (Farfan, 1978; Harrey & Tanner,
I 3

DANCE RESEARCH
1991), and short hamstrings (Cinque, 1989; Hochschuler, 1990).

Another factor associated with injuries in active individuals is
the simultaneous presence of strong and weak muscles, especially
antagonistic muscles (Falkel, 1990; Jackson & Nyland, 1990).
For example, the hamstring muscles are the antagonists of the
quadriceps that extend the knee.
Quadriceps and hamstrings are not only knee extensors and
flexors; they also act as hip flexors and extensor respectively,
and play a major role in the development of an optimal lumbo-
pelvic rhythm. Muscle imbalance may impair this mechanism
leading to increased local and general spine stresses, and thus to
irritation, inflammation and pain.
To test this hypothesis, 14 male (mean age 24.1) professional
ballet dancers were assessed before and after a 3-months training
period aiming to increase strength of various muscle groups
including the hamstrings. By recording the days-offserious dan-
cing due to back complications, the injury severity before and
after the data collection was assessed. No injuries were reported
at the time of testing.
An isokinetic dynamometer was used to assess thigh-muscle
performance. Knee extensor and flexor muscle peak force
output (i.e. strength) were obtained from both dominant and
non-dominant legs. As with the previous study, three measure-
ments were obtained at the knee velocities of 1.04 and 4.19 rad/
s. For further analyses, the ratios of peak knee flexion and exten-
sion outputs (Fl/Extrat) were calculated for each subject.
The number of days-offdancing due to low-back injuries prior
to the initial data collection, was plotted against Fl/Extrat
obtained at the speed of 1.04 rad/s. The general trend appeared
to be that the lower the Fl/Extrat- or the weaker the hamstrings
compared to the quadriceps - the worse the degree of injury
(Fig. 3).
The fact that the knee flexors demonstrated considerably
lower values than the knee extensors, confirms a long tradition
in dance where: (a) very little or no hamstring strength training
is normally undertaken, and (b) most of the dance routines
involved quadriceps more than hamstrings, with these muscles
showing disproportional training effects.
To test the effect of structured strength training on low-back
pain, the subjects were re-tested after a 3-month period, during
I 4

FITNESS FOR DANCERS
DAYS OFF TRAINING

16 - PRE-STR.TRAINING
14 + POST-STR.TRAINING
12
10 +.
8 ' " " ~
6
4'+....
4 \
2 +-...-I+
0
30 35 40 45 50 55 60 65 70
KNEE FI/Ext rat
3: Days-off dancing due to low-back pain versus hamstring to quadriceps
ratio (knee Fl/Extrat) in male ballet dancers before and after 3 months of spe-
cial strength training.
which a special hamstring strength training was introduced.

Figure 3 shows that, after training, the knee flexion to extension
ratio was higher (due to increased hamstring strength). Also,
there was a lower number of days-off dancing due to low-back
pain, compared to the assessmentsmade prior to strength train-
ing.
Again, no specifictrends were identifiedbetween days-offser-
ious dancing due to low-back injuries and knee Fl/Extratat the
higher test speed of 4.19 rad/s.
Conclusions
We have shown that certain aspects of physical fitnessare gener-

ally neglected by the dance profession, and that conventional
dance exercises alone are not sufficient to promote strength
enhancementsin male and female dancers. Training to elevate
standards of fitness, especially strength, may play a significant
role in coping with the increasednumberofmusculoskeletalinju-
ries. Within the limitations of our studies, no major differences
were noted between ballet and modern dancers.
II5

DANCE RESEARCH
Acknowledgements
The authors wish to thank the Director of the Birmingham Royal

Ballet Sir P. Wright, CBE, Phoenix Dance Company, Dance
UK, the London Contemporary Dance School at the 'Place',
and all the dancers who participated in the studies.
This article is dedicated in memory of the late Dr Peter
Brinson.
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are beneficial both in terms of performance and reduced injury

Benson, J. E., Geiger, C. J., Eiserman, P. A. & Wardlaw, G. M.