A Case for Developing a Performing Arts Medicine Wellness Plan at Northern Kentucky University School of the Arts
Jacqui G. Haas
Northern Kentucky University
Master of Art in Integrative Studies Student
2021
Abstract
A female dance major suffers an injury on stage when her partner miscalculates her movement preparation and is unable to catch her. Her injury results in the dance teacher calling paramedics. During a musical theatre production an actor falls, separating his shoulder on stage and asks his instructor what to do (T. Bonner, personal communication, November 26, 2021). Both incidents happened here at Northern Kentucky University. Performers have a history of being skeptical of health care providers. Many dancers report going to their dance teachers for injury advice, even though they are not healthcare providers (Wang & Russell, 2018). Injury rates in college dance departments are high, one study reports 3.28 injuries per 1000 hours of dance participation. In the same study, 84% of the dancers sustained injuries that needed medical attention (Bronner & Bauer, 2018). Yet, many college dance departments lack adequate performing arts-specific care for their students (Cardinal et al., 2020). On the other hand, collegiate athletes receive advanced sports medicine care including on-site athletic training services, injury assessments, treatment, and side-line care provided by physicians and athletic trainers (Stanton, 2017). College athletic administrative staff are committed to the health and well-being of their athletes. But many theatre and dance departments lack the same administrative and health care provider support (Stanton, 2017). The objectives of this project are to educate the reader on collegiate performing arts medicine, analyze the need for specialized health care and create the design of such a program to present as a case for developing a performing arts medicine plan at Northern Kentucky University (NKU) School of the Arts (SOTA).
Specialized health care resources for performing artists include injury assessments, treatments, and screenings to identify injury risks (Russell, 2013). Resources also include backstage care during rehearsals and performances, resembling college sports sideline care, as well as mental health and wellness education. While many colleges are providing health, wellness, and counseling for all students, dance and theatre students are looking for providers that have a specific interest in the performing arts. It is well documented that college dancers report having bad experiences with healthcare providers. The providers don’t understand their needs and don’t provide helpful advice (Wang & Russell, 2018). Curricular design and dance training that encompasses safe practices and wellness aspects should also be part of this program model. While 60% of colleges with dance departments surveyed have some degree of a wellness program (Cardinal et al., 2020) NKU SOTA does not. This project will study:
· Whether theater and dance departments need specialized care?
· Are performing arts college students at risk for injury?
· Do performing arts college students face physical and emotional stressors?
A questionnaire was sent to SOTA dancers, 31 dance students responded, of those 31 respondents 90.3% had suffered dance-related injuries with 51.6% of those injuries occurring at NKU. A reported 48% of the injured students went to their dance teacher first, due to lack of specialized resources. The performing arts students at NKU are an underserved population, this project aims to support student need to provide a plan of care integrating specific health care resources.
A Case for Developing a Performing Arts Wellness Plan for Northern Kentucky University School of the Arts
Collegiate performing artists are highly dedicated individuals that put their bodies, minds, and souls through intense curricula training in hopes of becoming professional performers upon graduation. Their rigorous training and performances resemble athletic sporting events which put demands on musculoskeletal, neurological, and cardiovascular systems (Ambegaonkar & Caswell, 2011). Unlike college athletes, many college performing artists navigate their college careers without injury guidance, rehabilitation, or strength training assistance. Performing artists have had to learn about injuries and training from their teachers or other dancers (Stanton, 2017; Wang & Russell, 2018).
Musculoskeletal injuries, behavioral anxiety, occupational stress, and eating disorders exist in theatre and dance programs on college campuses (Cardinal et al., 2020). College athletic programs have long supported the total well-being of their student athletes by providing quality health care services with support from administrators and staff. NKU, a National College Athletic Association Division I school, provides three athletic training room facilities for their approximately 225 athletes. They have an on-site athletic training room at BB&T Arena, the Albright Health Center, and the soccer stadium, along with five licensed athletic trainers and one intern (NKU Norse, 2021). According to the Equity in Athletics and Disclosure Act Report of 2019-2020, NKU men’s teams generated $4,474,244 in revenue and the women’s teams generated 4,319,662 in revenue (NKU Norse, 2020).
Northern Kentucky University SOTA program has 900 students participating in approximately 136 performing events per year. According to the NKU marketing department revenue generated (pre-Covid) for the 2019 performance season was approximately $87,000 (Endres, R. personal communication, October 21, 2021). The wide disparity in revenue makes it understandable why SOTA is so limited in resources. Hopefully, this project will encourage college administrators to take a proactive role in learning about performing arts medicine and science to support student need, promote wellness, and provide a safe and nurturing environment.
Defining Performing Arts Medicine
What is performing arts medicine? Performing arts medicine encompasses care and medical concerns of dancers, musicians, and artists (Yang & Leek, 2018). Medical concerns address all things health-related:
· physical health
· mental well-being
· nutritional health (Yang & Leek, 2018)
Physical health encompasses musculoskeletal injuries and the treatment of those injuries. In a study of 169 college dancers, the most prevalent injuries were sustained in the foot and ankle at 63% followed by the knee at 51% (Wang & Russell, 2018). Injuries rates for collegiate dancers are as high as 95% (Allman et al., 2020). A prospective cohort prognostic study of a university modern dance program noted 3.28 injuries per 1000 hours of dance exposure (Bronner & Bauer, 2018). Performing arts medicine addresses the musculoskeletal concerns of these artists.
Mental well-being and lack of coping skills can play a role in injuries, as well (Skvarla & Clement, 2019). Psychological techniques and coping skills can be taught to dancers to help reduce injury risk and improve their body and mind self-care (Pollitt & Hutt, 2021). Emotional stressors and the inability to handle stress can have health consequences for musicians as well. Stress can limit effective breathing and constrict blood vessels reducing the control of fine motor skills (McIlwain, 2021). Therefore, performing arts medicine also embraces an overall health and wellness model, incorporating psychological issues specific to performers (Cardinal et al., 2020).
The nutritional needs of performers are also an important aspect of performing arts medicine. A recent presentation at the International Association of Dance Medicine and Science annual conference reviewed a study of college dancers and found that 49.4% were at risk for eating disorders. The same study found that most of the participants had never completed a nutrition course, and nutritional knowledge was generally low in all participants. (Shahan et al., 2021). Consequently, a comprehensive and successful performing arts medicine program should incorporate the musculoskeletal, psychological, and nutritional concerns of the artists.
History
As dance medicine began to break away from the traditional sports medicine field in the late 1970s and early 1980s, physicians were noting the unique problems associated with the dance population. During this time, information on dance injuries became available in books and videotapes (Cardinal, 2009). Orthopedic physicians began collaborating with professional dance companies to provide care for these unique orthopedic problems (Cardinal, 2009). Advances have taken place over the last 40 to 50 years with development of performing arts medicine organizations (Cardinal et al., 2020). Professional organizations were formed devoted to performing arts medicine and science, such as the National Dance Association with a Dance Science and Somatics Division, the Performing Arts Medicine Association, and the International Association of Dance Medicine and Science. These organizations offer different levels of resources for dancers, musicians, teachers, and health care practitioners (Cardinal et al., 2020). Newsletters, research publications, and journals all devoted to performing arts medicine have evolved in hopes of providing more evidence-based material to improve treatments and outcomes.
At the undergraduate collegiate level, there have been significant increases in the number of dance medicine and science-related courses available. In 1992 only 40% of colleges offered at least one dance medicine course, but by 2008 65.5% of colleges were offering at least one dance medicine course. As of 2008, 31.5% of colleges did not have dance medicine or science courses at the undergraduate level and 77% offered no dance science courses at the graduate level (Clark et al., 2013). Significant updates have evolved on college campuses, 92% of undergraduate colleges studied have included anatomy in dance curriculum and 83% have included kinesiology (Cardinal et al., 2020).
Several colleges have developed dancer wellness programs on campus for the benefit of the artists as well as professors. Case Western Reserve University, Cornish College, George Mason University, Hope College, and Ohio University just to name a few, participate in a dance wellness program. The Dancer Wellness Project is a specific program devoted to screenings, injury tracking, and injury prevention and was developed in the late 1990s (DWP, 2021). The program continues to grow, with approximately 85 participants from college dance departments and professional dance companies (DWP, 2021). As interest in performing artists’ health continues to grow, keeping up with the growth is imperative.
Universities are beginning to understand the importance of injury prevention and performing arts-specific health and wellness. A study published in June 2020 in the Journal of Dance Medicine and Science, noted 60% of 72 universities with dance departments offer a formal dancer wellness program, with 70% having at least one dancer wellness person on their faculty. The top five program courses offered are anatomy, kinesiology, somatics, dance conditioning, and dance injuries (Cardinal et al., 2020). University performing arts medicine health and wellness programming is on the rise.
The following universities currently offer various degrees or certificates with a focus on dance medicine and science:
· University of South Florida- Dance Medicine and Science Certificate
· California State, Long Beach- B.A. in Dance with an option in Dance Science
· Rider University-Dance Science Degree
· Goucher College- B.A. in Dance with a concentration in Dance Science
· Elon University- B.S. in Dance Science
· The University of California Irvine-B.A. in Dance with an option to focus on Dance Science
· University of Wyoming- B.F.A. Dance Science
· Texas A & M- B.S. in Kinesiology with a concentration in Dance Science (Stanton, 2017)
Artists in Need.
Northern Kentucky University School of the Arts offers a creative and high-quality education for its 900 students, with 12 different majors and 30 specializations. The program has established itself as a performing arts educational leader in the Midwest offering dance, music, theater, and visual arts opportunities (NKU Academics SOTA, 2021). Musicians, music theater students, and dance students all face musculoskeletal, behavioral, and nutritional challenges while in college (Cardinal et al., 2020; Clark et al., 2013; McIlwain, 2010; Wang & Russell, 2018). Healthy movement patterns are important for all collegiate performing artists to ensure participation in their classes, rehearsals, and performances. Missing classes due to injuries can have a negative impact on grades. Establishing an injury plan of care, injury risk education, injury assessment and referral advice would be beneficial for the students.
Musicians
Musicians create art by using their bodies and their instruments. They are passionate, but can also suffer from musculoskeletal injuries, nerve entrapment, fatigue, anxiety, depression, and stress-related conditions. Eighty-four percent of symphony musicians have reported that injuries effect how they play and 50% have reported playing hurt (Ewalt, 2010). Music students believe that music defines who they are. Once playing-related injuries commence, their technique falters and they eventually stop playing. Being unable to practice their craft has a serious impact on their college career given that playing their instrument is mandatory for their curriculum (Ford & Schmeig, 2014).
Musicians should not have to play in excessive pain. A total of 601 college students who play the clarinet responded to an online injury survey, 83% have pain while they play, 37% have numbness while they play and 21% have been diagnosed with a performance related injury. Odd postures, faulty technique, and abnormal finger positioning lead to their unique injuries (McIlwain, 2010). Finger and hand span has been associated with pianist’s pain, playing an instrument with poor posture has also been associated with musculoskeletal injuries. An assessment of the musician’s interaction with their instrument would provide warranted postural and injury risk education (Clark et al., 2013). Furthermore, taking time off from playing their instrument will not address the biomechanical or ergonomic cause of the injury. An on-site health and wellness program with health care providers specializing in performing arts can provide ergonomic assessments of these students and recommend technique changes, stretches, and exercises to help reduce performance-related injuries.
Musical Theater Performers
Music Theatre is a combination of dance, music, singing, and acting and is associated with a difficult schedule of rehearsing more than one genre. Many music theater productions require performers to participate in very physical acting, singing, and dancing (Ford & Schmieg, 2014). Broadway dancers perform almost every night with two performances on Saturdays and Sundays. For musical theater collegiate students, their injuries keep them from participating in their required courses, rehearsals, and performances. Reports show that 24% of injured students miss one week or more of classes (Chong, 2015). Losing 24% of the student body would certainly have a negative impact on student success, particularly if students could not participate in performances. Having easy access to a special facility for injury assessment, education, and treatment would be extremely beneficial for these performers.
Dancers
Dance offers the same timeless and universal aspects as music and is enjoyed by all ages, cultures, and races but encompasses a full body and mind component. Dance is an athletic art form, associated with high injury rates. A survey of 211 college-age dancers indicated that they participate in dance 13.3 hours a day and 80% reported having an injury that kept them out of classes, rehearsals, or performances (Wang & Russell, 2018). Of the dancers that participated in the questionnaire at NKU, 41.9% are physically active with movement classes, rehearsals, and performances an average of 5-10 hours a week. Seventy-one percent of the students also participate in a regularly scheduled fitness program. The dancers participating in the survey engage in several genres including modern, ballet, African, tap, jazz, and musical theater dance, creating their own various injury risks. The students are motivated and would embrace participating in a program to benefit their physical and mental health well-being.
Successful dancers need to have muscular strength, endurance, extreme flexibility, and cardiovascular health (Ambegaonkar & Caswell, 2011). Lower extremity injuries are the most prevalent, with the main contributors being improper training, faulty technique, poor floors, structural deformity, and biomechanical imbalance (Russell, 2013). Of the dancers surveyed at NKU the most prevalent injury location was foot and ankle at 78.6% with the knee and hip together coming in second at 32.1%. Some acute knee injuries can be very serious and career-ending (Ambegaonkar & Caswell, 2011). Some studies are showing high rates of upper extremity injuries in modern dancers due to the floor work and the amount of upper extremity weight-bearing choreography, while ballet dancers typically have lower extremity injuries (Russell, 2013). Injury rates are high in collegiate dancers, having a formal injury plan of care and access to specialized health care resources for performing arts students that develop injuries would show that SOTA prioritizes student health and could help to change the culture of artists avoiding health care providers.
Program Model
The program proposal for NKU is titled, School of the Arts Wellness (SOTAW) and will aim to provide an interdisciplinary approach to assist students in injury assessment, injury risk education, screenings, treatment, backstage care, as well as behavioral health assistance and nutritional counseling referrals, as needed. Currently, there is no formal strategic plan for injuries. One student, suffered a foot injury, was unsure of who to tell and how to get treatment, she danced for almost a year before seeking quality medical advice which resulted in surgery (L. M. Russell, personal communication, November 29, 2021). Having an organized plan of care would have been helpful in providing quality guidance for her.
The SOTAW can be designed by using ideas of program implementation from other universities. Bridgewater State University began its program by meeting with college administrators from the dance department and the athletic training department. A decision was made to organize an educational workshop for all parties to increase awareness on anatomy, kinesiology, injury risk, and self-care techniques for incoming freshmen (Stanton, 2017). The workshop provided an educational component for the dancers, administrators, and athletic training students involved.
Program development at The University of Nevada Las Vegas (UNLV) had similar beginnings. The dance department integrated resources with the physical therapy department to provide screenings for dance students, which began as a service-learning project. A location for screenings and treatment was established at their health center (Allman et al., 2020).
Dean College hired a full-time athletic trainer who works with the dance students. The athletic trainer improves communication with faculty, provides injury risk education, performs screenings, injury assessments, backstage care, and treatments. In the six years of the athletic trainer’s involvement, the percentage of injuries decreased from 65% to 35% (Dance Teacher, 2019).
Shenandoah University started a pilot program for musical theatre students by providing a foot/ankle workshop and individual foot/ankle screenings by a physical therapist/athletic trainer on faculty. The screenings were conducted by the faculty athletic trainer, physical therapist, and physical therapy students. The musical theater dancers received valuable personalized information on how to care for their feet, proper shoe fit, and individualized exercises based on the findings of the screening (Ford & Schmieg, 2014). The program provided an educational component for all parties involved and began as a course assignment within Shenandoah University’s performing arts medicine certification program.
Implementation of a new program would require meetings involving all stakeholders that commit to supporting the program. A needs assessment would include a questionnaire sent to all performing artists to assess their health literacy, define the most appropriate services to provide, and establish goals. If a facility is located, facility management would be determined. Coordinating efforts with St. Elizabeth physicians, the on-campus Athletic Training Education Program (ATP) and Health, Counseling, and Student Wellness department is imperative and will begin with educational presentations for all stakeholders. If barriers and resistance exist, patience and the medical evidence on the benefits of this program will prevail. The critical topics for planning and implementation:
· meet with stakeholder representatives for department needs assessment
· determine goals and leadership roles
· discuss logistics of utilizing graduate athletic training students
· investigate sources for funding
· establish the importance of outreach
· determine what services will be provided and what location is most suitable
· identify where to integrate resources from other departments
· be prepared to manage resistance and barriers with patience (Ambegaonkar, et al., 2021; Kusner, 2019)
The SOTAW program will also be of benefit to administrators and educators by providing objective information for an improved understanding of each student’s physical, emotional, and nutritional requirements. Once an injury occurs, students need access to an athletic trainer for an injury assessment. Depending on the severity of the injury, the student would then receive exercises or stretches along with a plan of care or a referral to a physician. Faculty members would be informed of the findings as it relates to participation in classes, rehearsals, and performances. All parties or stakeholders would be responsible for supporting the health and wellness of each injured student. The plan of care would continue with weekly updates from the injured student and the involved health care provider until the student’s treatment has ended and they have safely returned to class, rehearsals, and performances. The initial plan of care is only one piece of SOTAW, technique and functional screenings can occur during one of the curriculum courses, backstage care can come from graduate student athletic trainers, and referrals to St. Elizabeth physicians, and on-campus Health, Wellness and Counseling would complete the programming.
One of the factors associated with success of the program would depend on stakeholder support and student awareness every semester. Outreach is an important factor in program delivery. Faculty, health care providers, students, and administration must participate in supporting the program each semester. Presentations can be arranged at the start of various classes to educate the artists on what the program can provide and injury protocol. If a performing artist is injured during class, faculty must encourage the artist to contact the program administrator for an injury assessment (Allman et al., 2020). The SOTAW program will be successful with support from all parties.
Curriculum Development
To support health and wellness within the department, curriculum also needs to encompass health education. In addressing health literacy and curriculum for collegiate dancers, Kozai and Ambegaonkar (2020) studied the perceptions of health education in university dance programs and found that administrators and faculty believed there was a need for health and wellness courses but some lacked dance faculty expertise to deliver the content. After 104 participants completed a survey on health-related offerings at their university, results noted that the top three courses offered were functional anatomy, recognizing injury and illness, and strength and conditioning. But, the participants of the survey ranked recognizing injury and illness, basic personal health, and nutrition as the top three most important topics which were not being offered (Kozai & Ambegaonkar, 2020). There is a disconnect between the courses offered and the topics ranked as most important. Recognizing injury and illness was ranked as highly important and was being offered, but nutrition and basic personal health ranked highly important were not being offered (Kozai & Ambegaonkar, 2020). Overall, administrators are recognizing the need for health and wellness literacy in the university setting but still have a way to go in addressing the need.
The dancers at NKU, SOTA come from local dance studios where they have been teaching assistants, competition participants, and local performers. While some students have desires of becoming professional performers, others are looking for ways to become better instructors, dance studio owners, and choreographers. Developing student-centered health education courses is important to meet their needs. A successful performing arts medicine program depends on the theater and dance department support of total body health and wellness when creating curriculum. Post-graduate students should be well educated in health and wellness particularly if they have goals of teaching students, the next generation of dancers need to be prepared for the musculoskeletal and emotional demands of performing arts.
Currently, SOTA offers Foundations Seminar, and Physiology of Dance for undergraduate dance students (NKU Academics, 2021). Each of these courses provides a basis for supporting dance medicine and science. The Foundations Seminar course includes an introduction to the basic anatomy of exercise, kinesiology of movement and has mental health and wellness components for psychological awareness. Foundations Seminar also addresses dance conditioning, basic injury risks, nutrition fundamentals and is a pre-requisite to Dance Physiology (NKU Academics, 2021). The Dance Physiology course dives deeper into how dance affects the brain, the benefits of cardiovascular conditioning and strength training. Students study various principles of movement such as thoracic mobility, hip disassociation, spine stabilization, and efficient breathing with a focus on how the principles can be used to reduce injury risks (NKU Academics, 2021). Upon graduation and moving on as dance teachers or competition choreographers, gaining knowledge in movement as science will support health and wellness in their teachings for younger generations. SOTA has successfully incorporated health and wellness courses into the curriculum. A program that supports a dance medicine scientific approach and immerses its students in a culture of health and wellness sends a solid message on how the university values total body and mind wellness (Cardinal et al., 2020).
Performing Arts Training Facility
During implementation meetings, locating a small room where artists can go for screenings, assessments, and treatments would be beneficial (Allmann et al., 2020). An on-site training facility within SOTA located in the building where they practice and rehearse would be most convenient for the artists to access. The space would need adequate ventilation, lighting, and electrical outlets. The space would include an area for documentation with a desk, locked cabinets for storing files and a computer, as well as storage space to hold first aid and treatment supplies. The facility would also need treatment tables for assessments, manual therapy, and taping procedures, as well as modalities. Functional space is also recommended for rehabilitation and exercise execution. Various small apparatus such as Swiss balls, resistance bands, foam rollers, and mini trampolines would be ideal for balance training. Cleanliness is imperative so access to hot water, sink, and bathroom facilities is recommended for maintaining proper hygiene. Students would be able to schedule appointments for screenings, injury assessments, and treatment for minor injuries. George Mason University provides an in-house program using athletic training students from the university’s ATEP. The program estimated a yearly cost of $3000 their first year (Ambegonkar & Caswell, 2011). Securing funds to support this type of project is important for success and sends the message that NKU SOTA supports health and wellness for their performing artists. Funding options could come from Innovative Health Initiative Grants, healthcare provider donations, equipment donations, or fund-raising events (T. Bonner, personal communication, November 26, 2021).
Equipment and Supplies
First aid supplies and a medical kit should be housed in this facility, which would provide easy access in case of emergency. The medical kit would also be available backstage for minor injuries. Basic supplies needed are anti-bacterial soap and wipes, hand towels, disposable gloves, band aids, tape, ace bandages, ankle, knee, elbow, and wrist braces. The recommended modalities would be an ice machine and moist heat hydrocollator. Larger strategic planning equipment to compliment the athletic training needs, would include a Pilates Reformer and Trapeze Table to be used as tools to improve muscular strength and flexibility (Ambegaonkar & Caswell, 2011). A Strategic Investment Initiative Grant or Project Grants could be a source of funding (T. Bonner, personal communication, November 26, 2021).
Integrating Resources
Dean College, Indiana University, George Mason University, North Carolina School of the Arts, and Ohio University have all implemented performing arts medicine programs utilizing athletic trainers. The programs provide in-house health and wellness self-care education along with treatments and rehabilitation (Stanton, 2017; Ambegaonkar & Caswell, 2011). By designing in- house health and wellness programs, the performing artists can advance their skill set in the areas of self-care, injury risks, and body awareness as they move into the professional world of teaching or performing (Stanton, 2017). Integrating resources from the university’s ATP would provide opportunity for athletic training students to learn interactively. Student athletic training involvement will improve communication between artist and health care provider (Ford & Schmieg, 2014). Involving providers from the Health, Counseling, and Student Wellness department would provide another aspect of support for artists and education for providers. It is well documented that dancer’s negative confidence in their ability presents risks for injury (Russell, 2013). Dancers also have low levels of coping skills and high levels of anxiety. Psychological skills training would be advantageous (Skvarla & Clement, 2019). Collaborating with the Health, Counseling, and Student Wellness department would provide health and wellness education for all parties. Successful collaborations would allow performing artists to trust healthcare providers.
Ambegoankar and Caswell (2009) support the fact that university dancers represent an underserved population. The authors surveyed 175 colleges with dance departments, 56 of those colleges had an ATP. Out of the 24 returned surveys, participants agreed that the students deserve quality on-site care. When questioned about using ATP services, eight were willing to share costs with intercollegiate athletics and three were not interested in working with ATP (Ambegaonkar & Caswell, 2009). Discussions on developing relationships with ATP included concerns that dancers would not be the focus due to the importance of athletics in comparison to dance. Educating administrators from both dance and athletics would be beneficial for performing arts students. Once again, integrating resources and successful collaboration would improve education for all stakeholders.
How can athletic training students help? The National Athletic Trainers Association defines athletic trainers as skilled healthcare practitioners who work with doctors to provide injury prevention, acute care, on-site therapeutic intervention, and rehabilitation (NATA, 2021). They are certified to practice sports medicine. Athletic trainers have a long history of providing sports medicine care on the sidelines of high school, college, and professional sporting events. Athletic trainers have also been working in the field of performing arts medicine for almost 25 years, providing injury prevention and rehabilitation to dancers and musicians (NATA, 2021).
The SOTAW has the potential to collaborate with ATP by using graduate assistants. NKU currently has a graduate program for athletic trainers as of 2021 and is accredited by the Commission on Accreditation of Athletic Training Education (NKU Academics CHHS, 2021) Graduate assistant athletic trainers can administer physical screenings, conduct musculoskeletal testing as well as functional tests to identify anatomical weaknesses that could interfere with technical performance. The graduate assistant athletic trainers could schedule appointments in the performing arts training facility for the artists to be seen for screenings, injury assessments, and rehabilitation. (Kusner, 2019; Stanton, 2017; Ambegaonkar & Caswell, 2011). The graduate athletic training students can also be available to provide backstage care during rehearsals and performances, utilizing sports event side-line care as the model.
Depending on the outcomes of the screenings there is potential for integrating resources at the NKU Campus Recreation Center utilizing personal trainers to assist performers in strength training and cardiovascular conditioning. Currently, students in the Dance Physiology course spend time with personal trainers learning how to safely use exercise equipment for increasing strength and cardiovascular health. There is so much potential for integrating resources and increasing interprofessional education by offering a performing arts medicine program for the performers.
Screenings
The success of SOTAW depends on student participation and faculty commitment. Students will be asked to voluntarily participate in annual musculoskeletal screenings, which include functional assessment of their technique and medical history information questionnaires. Of the 31 students who participated in the survey at NKU, 93.5% were interested in participating in a performing arts-specific screening. This type of screening will give the dancer an idea of their strengths and/or weaknesses and is an excellent tool for promoting wellness. The screenings include postural assessments, musculoskeletal strength tests, joint laxity tests, flexibility measurements, balance testing, and functional tests (Potter et al., 2011). The functional testing analyzes their technique for faulty alignment. An article published in, Physical Therapy in Sport examined 180 college modern dancers and found that 89% had two to four tight muscle groups and dancers with one or more tight muscle groups are 2.7-4 times more likely to suffer from an injury that needs medical attention (Bronner & Bauer, 2018). Using screening results to address tight muscle groups could help reduce injury risks. The screening results will also be used to design customized conditioning, strength training and injury prevention protocols for each student.
Educating the providers to perform the screenings would be advantageous to build trust between the dance participants and the providers. The physical therapy students at UNLV, studied dance training videos to familiarize themselves with dance movement patterns. The physical therapy students also watched rehearsals and performances to enhance their evaluation skills (Allmann et al., 2020). The provider education helped to improve communication between dancers and providers making for successful screenings.
An interdisciplinary approach to the screenings will be important and will blend knowledge of anatomy, physiology, kinesiology, health, psychology, and nutrition. The interdisciplinary approach will provide valuable baseline information and will help to establish goals. The baseline data will be treated as confidential (Potter et al., 2011). Outcomes from the screenings will be used to educate artists on their strengths and weaknesses, develop strategies for improvement and set realistic goals for their college career. Having a better understanding of the performing artist will benefit the artist and faculty by learning more about their physical and psychological status.
Backstage Care
Athletic trainers have a long history of providing medical care to athletes on the sidelines during high school and college football games. Athletic training has continued to evolve since the formation of the National Athletic Trainers Association in 1950, in which professional standards and a code of ethics were formed. Although the role of the athletic trainer in the United States was originally developed to care for football players, it has grown to be an organization concerned with all aspects of an athletes’ health, wellness, and safety (NATA, 2021).
Performing arts is recognized as an emerging setting in the field of athletic training, in which a council on practice advancement has been established made up of licensed athletic trainers working in the field of performing arts medicine (NATA, 2021). College dance departments that have designed successful performing arts medicine programs for their students also provide backstage care during dress rehearsals and performances (Ambegaonkar & Caswell, 2011; Dance Teacher, 2019).
During several live performances at NKU SOTA, there was a lack of fundamental first-aid necessities available for the performers. One student suffered floor burns during a performance, causing her knee to bleed, there was blood transfer on the floor, her costume, and other dancers, which can become an infection control issue. There was no disinfectant and the available antiseptic solution had expired (T. Bonner, personal communication, November 26, 2021). During another stage rehearsal, a dancer landed on an electrical outlet on the floor, turning her foot and partially tearing three ligaments in her ankle (C. Robinette, personal communication, November 26, 2021). Unlike college or professional football games, dance performances continue even if a performer becomes injured. The department desperately needed a first aid medical kit to be available backstage. A successful grant proposal was submitted and accepted for a backstage medical kit to be accessible during performances and rehearsals and stocked with updated first aid items.
Referrals
Currently, the athletes at NKU are well taken care of by three team physicians, two team ophthalmologists, one team dentist, and seven licensed athletic trainers affiliated with Saint Elizabeth Healthcare. There are three different athletic training room facilities available for the athletes, located at BB&T Arena, Albright Health Center, and the Soccer Stadium (NKU Norse, 2021). Connecting with current staff providing health care services to the athletes would be advantageous as referral sources for performing artists. NKU currently has health, counseling and student wellness facilities for psychological testing, individual and group therapy sessions where performing artists can schedule counseling services. But, performing artists have a history of being skeptical about seeing providers, due to negative experiences surrounding not being understood or getting unhelpful advice (Wang & Russell, 2018).
The SOTAW will also be the first resource for referrals to nutritional or psychological counseling for the artists as needed. The information gathered will provide a framework for the artist’s psychological well-being (Russell, 2013). Support from wellness counselors can have a positive impact, goal setting and imagery can be incorporated into injury rehabilitation sessions to provide a holistic approach to recovery (Pollitt & Hutt, 2021). Having access to health care providers with a knowledge base of the physical and mental aspects of performing artists would provide a quality care component the artists can trust. Educating healthcare providers on the performing arts by inviting them to rehearsals and performances is a good place to start. Roundtable discussions, educational workshops, performance video reviews and interviews between artists and providers will also begin to build trust and support.
Conclusion
The overall goal is to promote health and wellness education for performing artists while providing specific quality care and plan of care guidance from providers familiar with the performing arts. Support from college administrators would be advantageous. The SOTAW has the potential to provide:
· injury plan of care protocol
· athletic training services designed for performing artists
· successful curriculum design
· facility management to assess and treat minor performing arts-related injuries
· screenings to provide objective measurements
· backstage care provided by athletic trainers.
· referrals to orthopedic physicians
· behavioral and nutritional counseling
Research is clear on the musculoskeletal and emotional demands of college performing arts students and the benefits of specialized health care. Dance and music theater classes, rehearsals and performances put physical and emotional demands on college students. Instrumental musicians also suffer from the same demands and repetitive injuries. Injury assessment and management should be handled by providers that understand the psyche of the performer as well as the physicality of their art form.
In the first year of the in-house healthcare program at George Mason University, there were 300 clinician healthcare sessions that treated 100 injuries. SOTAW has the potential to be just as effective. Integrating resources across campus for interprofessional collaborations will benefit SOTA by establishing their commitment to health and wellness for their artists. Promoting quality care for performing artists unique injuries will improve their well-being, build trusting relationships, and improve education for healthcare providers, college administrators, and faculty. It is my belief we want to empower our students and encourage them to live healthier lives by improving their musculoskeletal, behavioral, and nutritional health. I also believe a performing arts medicine wellness plan will have a positive impact on our students and will build a stronger dance and music community. The inclusion of a medical plan of care will send a strong message that NKU values their student’s musculoskeletal, behavioral, and nutritional health.
References
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