There is a rather large list topics that I wish dancers were formally taught in the studio as supplementary workshops.
And FYI, if you’re a dance student at York University in Toronto, I will be coming at you with a free workshop series (starting in November), including exciting topics such as Making Breathing Sexy, Core Training Badassery, Developing Hip Mobility and Turnout Like a Boss, and, How to Warm-Up Like Jean Claude Van Damme. You don’t want to miss this workshop series.
In my dance career, workshops at our studio were limited mostly to applying stage make-up, pointe-shoe-tying, and how to audition. All very important things, but what good is knowing how to tie your pointe shoes if you you don’t have ankles to tie them to?
Which leads me to todays’ topic: Something I wish was taught on the FIRST DAY of every new dance training season…
How to choose a rehabilitative therapist that will actually help you.
As dance educators and professionals supporting dance wellness it’s important to recognize that we’re not going to be able to absolutely prevent injuries 100% of the time through out work and research, but we’re doing our dang best to minimize damage while optimizing performance.
Considering the (reported) injury rate in dance is between 80 and 100%, be aware that if you are a dancer (or even just dance for fun) you probably will get hurt at some point and you should absolutely know how to choose someone trustworthy to help you through those inevitable periods of injury and pain.
Knowing this, I recommend you make friends with a rehabilitative therapist (which I will refer to as therapists from here on in) such as a chiropractor, physiotherapist, massage therapist, movement coach etc.
I have personally had terrible experiences with therapists “back in the day” and I’ve worked with too many clients who have also worked with ineffective therapists. Sometimes this is how people find me- They’ve lost faith in the rehabilitation industry as a whole and are looking for exercise-based methods to reclaim their bodies.
This theme again showed up in the Facebook forum for the new trial version of the Dance Stronger program.
Here’s what one DS member asked:
My question is about finding someone to work with to do that, after I resolve my [pelvic floor] issues. I’ve read about studies where they compared various people who do posture correction work and none of them came up with the same diagnosis or treatment plan for a given person. I’ve also had personal experience with being told things by one practitioner that subsequent practitioners questioned, and also with practitioners who were stuck on one treatment approach even when things clearly weren’t improving. But they always seem so sure of themselves, it can be difficult and even seem arrogant to think that I know better than they do.
So what is the savvy healthcare consumer to do? Even people who come highly recommended can be the wrong choice. How do you know when “give it more time” and “spend more time on this at home” have worn out their welcome? Let alone sussing out whether the recommended approach has any merit at all; anatomical cause and effect isn’t always as obvious and logical as we think.
Getting second, third and fourth opinions can help, but in this country health insurance is always an issue and mine doesn’t cover anything “alternative” whatsoever. So getting enough care without can be difficult due to cost, and the more I can do it with traditional doctors and physical therapists who are included in my insurance coverage, the better.
If there are any strategies for finding really competent and compatible practitioners, I’m all ears (or eyes in this case).
Can I get a hell yes! I can relate. I know a lot of you can, too.
There are so many amazing practitioners out there waiting for you, but yet we still flip flop from therapist to therapist who rarely will agree on the cause on injury and treatment strategy, which can be very frustrating, consuming time and money you don’t have.
First, my own story (because this blog is all about Monika! Me me me!):
For years I kept going back to the same physio/chiro/massage therapist (yes he was all three) for my multiple lower-back and hamstring injuries. I chose him because his was the clinic I always walked by on the way to school. I didn’t do my research, I chose him because he was convenient.
Guess what- My injuries didn’t ever feel better. But I kept coming back to him anyway because I didn’t know better.
I didn’t know anything about what made a clinician good or bad, I didn’t know how quickly I should be recovering to gauge whether my progress was reasonable, and I didn’t know what a sensible treatment strategy was. But because he was such a nice guy, I trusted him to fix me.
I perceived all his specialties to be a good thing, and it wasn’t until later that I wondered “why he didn’t just focus on one thing, and do that one thing really well?” I should have known to look for a new therapist when, after asking what exercises I should be doing, he said, “You don’t need to do anything, just keep coming back”. Hindsight…
Dr. PT RMT would massage me, ultrasound me, put me in the traction machine, use the electrostim machine that made me giggle uncontrollably, all the modalities. But when I asked for exercises to help me strengthen my back, I got nothing.
He never tried to help me move better. He never tried to help me prevent future injuries. He didn’t give me any reassurance or guidelines for my return to safe dancing. But because he was a nice guy, I trusted him to fix me, and he let me down. It saddens me to see this still happens to dancers all the time. And we don’t know better!
I should have asked more questions. I should have gone to get a second opinion. And I definitely should not have assumed that just because I was in rehab that things were getting better, or that one round of physio will fix the issue forever.
Consider this conversation I had with a dance student in a class I was teaching:
Dancer: “My knees are both screwed up so I can’t do this exercise”
Me: “I would probably recommend you go see someone about that, I can give you a good referral.”
Dancer: “Oh it’s OK, I went to physio ages ago and I have exercises”.
Me: “… do you do them?”
Dancer: “No, but I don’t think my knees will ever get better so I just deal with it”
It’s like for some reason we think that just going once, to one therapist will cure us, and if it doesn’t that we have to accept that we must live with our pain forever.
If your therapist isn’t helping you get better, go find someone else. And there is no guaranteed time frame for recovery from any injury, so please do not assume that if things aren’t getting better after a month that you are doomed for life. It is very important to take ownership of your role in the rehabilitation process. You are not doomed to always be in pain unless you allow yourself to be.
And just how do you recognize the qualities that make a good therapist? It’s not just about the certifications, degrees, and fancy anatomy talk. Just what are these mysterious qualities?
The top 5 characteristics I would look for in a rehab specialist are:
1) Movement based approach
2) Absence of ego
4) Detective spirit
5) Interest in education
Knowledge is very important, and, of course, my favourite therapists to refer my clients to are incredibly smart; but, they also have my three other criteria, without which I would glance over their long list of credentials.
I also feel it is important to have a therapist who works with movement, not just passive modalities that require you to lie still for the entire session. Therapists should be able to admit to not being all-knowing. They should be curious enough to ask if you’re open to some safe and sane experimentation.
A practitioner should be willing to refer you to someone else who can help you better than they can when necessary, and they should communicate with that person to make sure you get the best treatment. A good therapist lastly should ask you lots of questions to make sure they understand your full history.
An effective therapist will be as interested in educating you as they are in treating you. You will want to look for a therapist that is also a good role model who practices what they preach. A compassionate therapist doesn’t make you feel bad about yourself, but gives you hope and empowers you.
Does your therapist give you homework and outcome measures to help keep you progressing? Do they make sure you fully understand your homework exercise and watch you do it before you leave? Do they have an efficient assessment protocol that looks not just at joint structure and passive range of motion, but active movement that is normally done in your life’s routine? Do they watch you walk, squat, lunge, twist and bend?
An honest therapist gives you realistic advice. They don’t promise that thirty minutes in the traction machine, three times a week, will cure you, or that you just need to keep coming back for an adjustment every week for the rest of your life.
A good therapist will guide you in your healing journey but also help you understand that YOU are responsible for healing yourself. They will remind you that rehabilitation is hard work and it is impossible to predict how swiftly you will recover. However, it is entirely possible that recovery will be quicker than you think.
You may have found yourself in the frustrating situation of hopping from therapist to therapist, each with their own opinion and “fix”, but still you get nowhere. For this reason, I think it is crucial that you find not just one therapist, but a network of them that see each other regularly, refer patients to each other, and you know are always working to continue their education.
When you choose to enter a network of therapists that all operate on the same principles and share a “detective” mindset, who communicate and refer to each other openly, you know that you’re going to come out with more solutions than questions.
These are the networks I would look into when choosing a practitioner (based on the results I have personally had, and those of my clients, colleagues, teachers, and friends):
- NeuroKinetic Therapy (NKT)
- Anatomy in Motion (AiM)
- Dynamic Neuromuscular Stabilization (DNS- The Prague School)
- Postural Restoration Institute (PRI)
- Selective Functional Movement Assessment (SFMA)
- Proprioceptive Deep Tendon Reflex (P-DTR)
But remember that despite the reputation of a network, not everyone will be brilliant, so do your research and interview your potential therapist. Make sure that their expertise matches your needs.
If you’re hypermobile and deal with chronic injuries due to spinal instability, for example, you probably don’t want to work with a massage therapist with no skills in strength or movement training. If your joints are already loose, you don’t need more muscle release- You need to learn how to use your muscles!
What have your experiences been with rehabilitation? Who was your favourite practitioner? What was the worst experience you had? Share in the comments below and tell other readers who you’d recommend in your area to spread the love.