To your health: from injury to peak performance.

Have you ever been so nervous that your performance in class or onstage was affected? Has your teacher or director asked you to dance even though you were injured? In the second part of our comprehensive survey of dancers' health, Dance Magazine asked you about these concerns. Here's what you told us--and what you can do to make your dancing healthy and satisfying.

About the Survey

Dancing is a demanding art form in which a student's progress often depends--for better or for worse--on input from dance teachers. Injuries and performance anxiety can also put the brakes on a promising career. In Part II of Dance Magazine's comprehensive Dancers' Health Survey, we asked questions about teaching practices and dancers' mental and physical well-being. Some of the findings are alarming; other facts reassure us that the dance world is on the right track. Here are the results!

Why did we at Dance Magazine undertake this study? As with Part I, published in our November 1996 issue, we wanted to better understand dancers' health concerns. With this particular study, we were also seeking ways to help reduce occupational stress in dancers. Keeping this goal in mind, we also offer some practical suggestions

Who Answered the Survey

Nine hundred and sixty dance students, professionals, and ex-dancers completed the fifty-three-question survey (see Table 1). The average age was twenty-four, with a wide range from early adolescence to old age. One out of five of our dancers (18%) had parents who were amateur or professional artists. On average, dancers took six classes per week and had danced for fifteen years. Most studied ballet (97%), followed by jazz (73%) and modern dance (60%); only 8% had taken ballroom dancing. Twenty percent also had a college degree and nearly half (47%) were dance majors. When asked about the value of education in areas outside of dancing, a majority (77%) said that it was "very" important. This interest was reflected in our dancers' grades which were primarily A's (59%) and B's (35%).

Table 1
Who Are You?

               Female   Male

Student        82%      57%
Professional   12%      43%
Other (+)       6%      none

(+) This group includes ex-dancers who are now teachers.
choreographers, directors, administration, journalists,
professors, and therapist.

Comparisons

Because our sample is so diverse, we divided our dancers into several groups according to their age, sex, professional status, and level of success. This allowed us to make important comparisons between young dance students, older dance students (age twenty-five or over), professionals, and ex-dancers. We also looked at differences between corps, soloists, and principals. The results in this report are all statistically significant at .05, meaning that the likelihood of them occurring by chance is less than five out of one hundred. For this reason, we believe that our results represent real differences among these groups.

At what age did you begin your dance training? Female dancers have a certain advantage over males because they start dance, on average, at a much earlier age (seven versus seventeen years old). Family support may be a factor. As in Part I of our survey, we found that significantly more parents encouraged their daughters to take dance than they did their sons (19% versus 3%). Male dancers, in turn, choose dance only when they are determined to become professionals. Seventy-one percent of the men told us that it was "very" important for them to dance professionally compared to little more than half of the women (57%). Male dancers also pursued this goal much more vigorously (82% versus 59%). Unfortunately, a late start in dance can make it difficult to master technique. Body type was the number one factor that kept the men from excelling when their training was delayed (twenty-four versus sixteen years old).

Surprisingly, women's early advantage in dance seems to diminish as they get closer to looking for a job. In contrast to the men, female dancers were impeded by financial pressures, lack of opportunities, family responsibilities, pregnancy, age, and limited time and support. Other than pregnancy, opportunities, and time, female dancers who cited these reasons also had significantly more dance injuries. Dancers with poor training that interfered with their goals had significant problems with performance anxiety.

Mental Problems That Hurt Dancing

Performance Anxiety

In order to understand the impact of emotional problems, we took a closer look at the problem of stage fright. This reaction is not limited to performers. In fact, it affects a variety of people in all types of performance settings, including pilots, public speakers, students taking exams, and athletes. While anxiety under these circumstances is normal, a true case of performance anxiety is diagnosed if the fear of performing is seen as both excessive and unrealistic. In a survey of 2,212 members of the International Conference of Symphony and Opera Musicians, 24% reported stage fright as their number one health complaint. To our knowledge, no similar studies on dancers have been published.

Our results indicate that performance anxiety is also a problem for dancers, as 40% report suffering from symptoms. The less experienced the dancer, the more likely that stage fright is a problem. Younger (16%) and older dance students (10%) report more constant fear when dancing in front of others compared to ex-dancers (7%) or professionals (4%). In contrast, when professional dancers have a problem with stage fright, they are more likely to rate it as excessive (27%) compared to ex-dancers (15%) and students, whether they are older (16%) or younger (11%). Among professional dancers, principals report significantly less fear (3%) than soloists (8%) or corps members (14%) and are less likely to avoid performing in front of others (6% versus 8% versus 15%).

In terms of dance training, two factors contribute to performance anxiety. Dancers who are unjustly humiliated by their teachers in class--in contrast to those who were not--report significantly more symptoms of stage fright, including excessive fear (16% versus 12%), mental anxiety (18% versus 9%), physical anxiety (14% versus 6%), and constant alarm (12% versus 7%). Those whose teachers expect them to keep working with a serious injury also report more performance anxiety (14% versus 7%).

Here's What You Can Do

Lack of experience is a big factor in stage fright for all kinds of performers. As a result, dance workshops and other productions that give students a chance to perform onstage would help them cope with their nerves. Educational seminars similar to those being used by elite athletes could also be used to teach dancers techniques to control physical symptoms such as trembling, and to focus attention. Finally, dance teachers need to treat their students with respect instead of humiliating them in class or insisting that they work with a serious injury. Because of the important consequences of teachers' behaviors, we will look more closely at these practices in the section below called "Teaching Practices."

Physical Problems That Hurt Dancing

Injuries

Have you had a serious injury as a result of dancing? Unfortunately, the resounding answer is "yes." The most common injuries in dance occur from overuse, leading to chronic problems (52%), tendinitis (39%), and arthritis (15%). Strength may also be a factor during training; female dancers with hip problems and tendinitis were more likely to have begun pointe work before the age of twelve rather than after that age. Men had significantly more shoulder problems than women (28% versus 7%), probably from partnering and lifts.

The dilemma for dancers is that the longer they train, the greater their chance of developing injuries. Chronic injuries are significantly higher in professionals (61%) and ex-dancers (66%), compared to older (46%) or younger (47%) dance students. This is also the case for arthritis, especially in ballet and modern dance. Men and women who dance for eighteen years or longer report more injuries in every category than those who have danced for less than a decade.

What do dancers do when they get injured? Surprisingly, nine out of ten dancers (89%) try to handle their injuries alone. Sixty percent seek medical help only when they cannot dance full out, and almost half (49%) continue to work in spite of being injured. Dancers whose injuries keep them from reaching their goals experience significantly more symptoms of performance anxiety than those without this problem. These symptoms include constant fear when dancing in front of others (19% versus 11%) and bodily sensations of anxiety (22% versus 10%).

Here's What You Can Do

Orthopedists in dance medicine believe that injuries due to overuse respond best to modified activities that favor the disability. Dancers who work full out even when it hurts can aggravate the injury, leading to a history of chronic problems that impair performance. There are programs to prepare patients outside of the arts with real or simulated vocational activities to regain stamina and coordination. While this approach does not exist in dance, one solution might be to have special remedial classes to help injured dancers get back in shape slowly without the stress of competition. Pilates-based exercises and stress-free activities, such as swimming, can also improve performance. Most important, injured performers should pace themselves until their disability is healed.

Teaching Practices

To a great extent, dance training is based on the military: Teachers point out mistakes and encourage dancers to keep working in the face of pain. While these teaching practices can be useful at times, one out of four of our dancers (24%) report that they have been expected to keep working even with a serious injury. Forty-eight percent have also felt unjustly criticized by their teachers in dance class. These teaching practices have a significant effect on dancers' health and well-being.

Unjustly Criticized

Our analyses indicate that dancers with critical teachers continue to work while injured significantly more than those without this type of influence (61% versus 39%). These dancers also report a higher incidence of arthritis, stress fractures, chronic injuries, and tendinitis; and more foot, knee, back, hip, and ankle problems (see Table 2).

Table 2
Harsh Tongues

Your Dance Teacher Unjustly
Criticized You in Class

                             You         You
                             Were      Were Not
                          Criticized  Criticized

You Have These Injuries:

Arthritis                 19%         11%
Stress fracture           21%         11%
Chronic injuries          59%         45%
Tedinitis                 47%         31%

Site of Injuries

Foot                      30%         23%
Knee                      38%         29%
Back                      28%         17%
Hip                       26%         14%
Ankle                     45%         28%

Dancers with critical teachers were later unable to achieve their goals as professionals because of problems with self-sabotage (20% versus 9%). Not surprisingly, these dancers sought out a number of health-care providers during their careers, ranging from orthopedists to psychotherapists for emotional stress.

Expected to Work While Injured

Similar problems occur when teachers expect dancers to work with a serious injury. Our results indicate that these dancers continue to work with physical problems (75% versus 41%), and use more support services, including psychotherapy. They also have significantly more arthritis, stress fractures, chronic problems, tendinitis, and injuries to the shoulder, knee, foot, back, hip, and ankle (see Table 3).

Table 3
Walking Wounded

Your Teacher Expected You
to Dance with a Serious Injury

                          You Were    You Were
                          Expected  Not Expected
                          To Dance    To Dance

You Have These Injuries:

Arthritis                   21%         13%
Stress fracture             27%         13%
Chronic injuries            66%         48%
Tendinitis                  52%         34%

Site of Injuries:

Shoulder                    12%          7%
Knee                        40%         31%
Foot                        35%         24%
Back                        36%         19%
Hip                         33%         16%
Ankle                       52%         31%

Dancers whose teachers expect them to work with a serious injury do not achieve their goals as performers. Their reasons include injuries (24% versus 14%), self-sabotage (21% versus 13%), and poor health (9% versus 2%).

Here's What You Can Do

Destructive teaching practices put all dancers at significant risk for injuries, particularly if these occur under the guise of training students to be stoic and self-critical. A 1996 article in The New England Journal of Medicine on injured gymnasts has called for an external agency to establish coaching standards and monitor health and safety requirements for athletes. There is a similar need for an agency in dance. This might be made up of dance medicine specialists, many of whom are former dancers, who could bridge the current gap between health professionals and the dance community. Finally, dance teachers could benefit from required courses on kinesiology and child psychology to help students learn healthy work habits that contribute to their physical and mental well-being.

Careers in Dance

Have you achieved the goals you set for yourself as a performer? Approximately seven out of ten dancers (68%) said "no." When we look at professional status, we find that only one out of three dancers has performed as an apprentice, and even fewer (24%) have been employed full-time in a dance company. Among the professional dancers, 42% have performed as soloists, 39% as corps, and 19% as principals.

Compared to women, men seem to have fewer problems finding a job. More men have worked full-time in dance (61% versus 22%), and they are also more likely to achieve principal status as professionals (46% versus 18%). Even when women achieve a leading position, full-time jobs are significantly more common for men than for women (100% versus 42%).

These advantages also affect the men's age at retirement. Male dancers perform longer, on average, and retire eight years later than female dancers (at age forty versus age thirty-two). Still, professional status does add longevity to both men and women. Principals retire significantly later (forty years old) than soloists (thirty-five years old) or corps dancers (twenty-nine years old). Regardless of professional status, injuries also play a role in ending a career. Dancers with chronic tendinitis retire eleven years earlier than those without such injuries (at age thirty-two versus age forty-one). Likewise, foot problems result in a premature retirement (at age thirty versus age thirty-nine).

We were not surprised to learn that retirement is emotionally wrenching for most dancers (74%). But only 13% find that it creates financial problems. Interestingly, male and female dancers differ in how they handle these problems. Among the women, female dancers use psychotherapy more frequently if they are emotionally upset about retirement (34% versus 4%), whereas financial problems are dealt with at career transition centers by women in trouble (27% versus 2%). In contrast, male dancers use holistic medicine (75% versus none) if retiring proves to be emotionally difficult. Three out of four dancers (74%) continue to take class after they have left their careers.

Here's What You Can Do

Elisabeth Kubler-Ross, a noted expert on the subject of dying, has referred to retirement as one of the little deaths of life. This is particularly true for performers, who may spend over two-thirds of their lives in dance before they are forced to leave. Still, the pressures on dancers differ. According to the most recent census (1990), female dancers outnumber men three to one, which may make it difficult to find a position in a dance company. Retirement in middle age can be traumatic, whether for professionals or students who remain unemployed. Dance-related injuries can also impede progress and threaten to curtail an already short career.

To prepare for the future, dancers need to consider at a much earlier age the problems surrounding a career transition. In order to accomplish this smoothly, it is important for dancers to have established lifelong habits that will be an asset when the eventual loss of an artistic career occurs. Among other things, this entails the exploration of other interests, as well as the practice of time management so that dancers who may be interested in having another career are able to do so. Companies should also take a role in this process through their support and involvement with transition centers that have been established for dancers.

All Things Considered

The Dancers' Health Survey has focused on a number of sources of occupational stress in dance. Our hope is to generate new ideas while proposing possible solutions to some of dancers' more serious problems. Still, none of us should lose sight of the bigger picture. Dancing is a beautiful art form that brings pleasure to many dancers both on and off the stage.

Linda Hamilton, Ph.D., danced with New York City Ballet from 1969 to 1988. She is now a clinical psychologist whose practice focuses on performers.