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  1. #1
    V.I.P. Kashmir's Avatar
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    Default Teacher training in safe dance practices

    I'd be interested to know if there are trends in training teachers in science based safe dance practice. I have just had a teacher from Australia visiting and over there, Ausdance has been involved in developing guidelines for dance teachers. This is, or will be, taken up by their insurance industry for liability insurance. As a result there are a range of University based programs available for dance teachers to take (and many venue hirers expect/require teachers to have their bit of paper).

    In NZ our ACC legislation means we have no fault accidents ie you cannot sue your dance teacher if you are injured and you get free (but limited) medical rehab.

    From discussions on this board it would appear safe dance training is optional in the States, which given the possibilities for litigation is surprising. Or have I got the wrong end of the stick?

    What about Canada? the UK? Europe?

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    Senior Member sedoniaraqs's Avatar
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    Some teachers in the states are ACE certified, especially if their teaching venues are fitness centers.

    At my teaching venue (a university recreation center), all instructors have to have emergency and CPR training. While I do not have "safe dance training" per se, I do have a Ph.D. in biology, which has given me a foundation and route to understanding the basic elements of human morphology and safety in oriental dance.

    As far as litigation goes, I think the risk is low simply because the risk of *acute* and immediate injuries in a belly dance class is quite low.

    Even if inadequately-trained teachers have students moving in potentially injurous ways (check out the thread about the Amira Mor youtube clip on bhuz -- owch!), these wrong techniques generally involves movements that do slow, insidious damage over time to the lower back that can take years or decades to show up. And are mostly going to injure people who lack core strength and are out of shape to begin with and have other sources of lower back damage. So 10 years later, how are you going to successfully sue the bad belly dance teacher?

    Anyway, if Americans were really as sue-happy as you think, then all the ballet teachers in this country would be sued for continuing to do all of the barr exercises that we've known for decades do slow, insidious damage to the ligaments and back.

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    Senior Member sedoniaraqs's Avatar
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    This is the clip I mentioned above. Absolutely horrendous "hip circles" that are presumably supposed to be tilting hip circles (umis or whatever you want to call them), but that are too big and externalized, hyperextend the lower back waaayyy to much, and it is very obvious from the swaybacks and protruding abdomens of the student dancers in the video that they have no core/ab strength to support such movements (Although the instructor probably does). Is this injurious? Yep. But it could take years to manifest, so it will be hard to pin it on Ms. Mor.

    It's not like an Irish step dance class where someone could very easily suffer an acute injury during class, like a sprained or broken ankle.


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    V.I.P. Kashmir's Avatar
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    Quote Originally Posted by sedoniaraqs View Post
    Anyway, if Americans were really as sue-happy as you think, then all the ballet teachers in this country would be sued for continuing to do all of the barr exercises that we've known for decades do slow, insidious damage to the ligaments and back.
    Good point - I wasn't just thinking of belly dance though - because as you say it is relatively safe. In fact the Ausdance spinoffs are really aimed more at ballet but there has been quite a bit of work done on the belly dance side another $20k should get it off the ground. Any sponsors out there?

    Worst class I ever attended was aimed at chorus for musicals. All 35 plus - in many cases had never danced before with desk jobs. Teacher was (a young, flexible) recent ballet graduate and started with some serious achilles stretches (no warmup). I know of at least two people who were put out of action for 2-3 weeks from that class.

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    V.I.P. adiemus's Avatar
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    I'm going to have to put my tuppence worth in here about 'injury' to the lower back through repetitive movements. There is no evidence that dance (or manual handling, sitting too long, doing yoga etc) damages your back with or without repetitive movements.

    Discomfort is common, but this occurs because of not stretching AFTER exercise (not before - studies have shown this makes no difference to discomfort or injury, but warming down does make a difference). Cardiovascular warmups on the other hand, have been shown to be helpful to reduce muscle strain.

    Any changes to bone (eg formation of osteophytes, development of osteoarthritis) occurs as a result of two main things - genetics, and direct trauma eg from slamming into another object at force - and the latter can develop into osteo in later life. Oh, and some people have congenital changes such as sponylolisthesis, or spondylolysis. So if you get OA and discomfort in your low back it's probably from the genetic influence of your parents, or you were born with it (and didn't know about it until later...).

    There is no evidence that 'core stability' makes any difference to low back pain or 'injury', although it does increase efficiency in biomechanics, which may mean you tire less quickly. Similarly for cardiovascular fitness - it reduces the onset of fatigue.

    This is a contentious point of view I know, but in terms of scientific evidence in my field of expertise (musculoskeletal pain), there isn't any evidence that any specific exercises 'fix' acute low back pain, or chronic low back pain, and if core stability did so, the evidence would be there by now (pilates has been around for how many years?)

    The main 'injuries' you may experience from bellydance are short term muscle strain from stretching or working in the outer range of movement, especially if you're a bit unfit, and enjoy vigorous movements, you may experience discomfort (not to mention falling over!), and pulling/straining muscles if you do deep backbends, and there could even be a potential for developing a hernia from this movement!

    Most of the discomfort is just that - muscles that are complaining about being used. It's not injury (although it's painful), and it's not going to harm in the long run. It's simply a sign to you that your body hasn't done this in a while.

    Safey in dance as in anything needs to be based on hard science. Most of us won't be working our bodies as hard as ballet dancers (even if professionally dancing), so IMHO this dance form is probably one of the ones we need least to be concerned about.

    I expect that physiotherapists, osteopaths, chiropracters etc who read this will find what I've written a bit hard to take, but bear in mind that a lot of people make their livelihood from treating people with aches and pains. One physiotherapist once said to me that physiotherapy was great for people who are too impatient to let themselves 'heal' naturally!

    Actually, given that one of the things that has been demonstrated to help people with low back pain is to move, and that fear of moving is more disabling than the pain itself, perhaps we could prescribe bellydance for people with low back pain?

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    V.I.P. Kashmir's Avatar
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    Quote Originally Posted by adiemus View Post
    There is no evidence that 'core stability' makes any difference to low back pain or 'injury', although it does increase efficiency in biomechanics, which may mean you tire less quickly. Similarly for cardiovascular fitness - it reduces the onset of fatigue.

    This is a contentious point of view I know, but in terms of scientific evidence in my field of expertise (musculoskeletal pain), there isn't any evidence that any specific exercises 'fix' acute low back pain, or chronic low back pain, and if core stability did so, the evidence would be there by now (pilates has been around for how many years?)
    The guy I work with in Australia did his post-grad on back injury and recovery and would disagree with you Reduction in multifidious muscle mass after a few days of pain is significant and reduces stabilization of the vertebrae. Degeneration of lumbar ligaments and discs has also been linked to over extension of the lower back without correct support.

    Problem with Pilates is that it has to be done correctly to gain core stability benefits. Too many big classes taken by people who've done a weekend workshop Real benefit needs at least one on one.

    I had my therapy via Mater Hospital with follow ups by physio and hydrotherapy. Core stability exercises were monitored by ultra-sound. In a matter of months I had significant reduction in pain compared to two years "treatment" by NZ physios.

    Maybe you can use this as an excuse to come to Brisbane and chat to them about it - time it right and you can attend the Winter Warmup with Denise Enan at the same time

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    V.I.P. adiemus's Avatar
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    There's a huge difference between one or two studies, and randomised controlled trials with meta-analysis! The problem with looking a changes in a single muscle (or even more) is that there isn't a good correlation between muscle changes and discomfort - or boney changes and discomfort. Pain and injury don't correlate, pain and ligament/muscle/bone changes don't correlate, and therapies either for prevention or treatment haven't been demonstrated to consistently have positive results. I'd be incredibly happy if I could find a preventative (or even treatment) strategy for ALBP, because then the prevalence of CLBP would be reduced and I could work more with people with complex regional pain, or fibromyalgia...

    Back to safety, however, and I really do think that bellydance doesn't have the demands of many dance forms (impact and extreme range of movement especially), it's based on normal body movements on the whole, so it's pretty safe. That doesn't mean that training in safe dance is a waste in any way - if even a few teachers can be taught NOT to do bouncing stretches, or stretches on a cold body - that would reduce the discomfort factor a whole heap!

    Ooooh! Brisbane - not quite as good as Melbourne for shopping, but hey, I can shop anywhere!

    What isn't so safe is the addictive nature of it...sigh...

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    V.I.P. lizaj's Avatar
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    Quote Originally Posted by Kashmir View Post
    I'd be interested to know if there are trends in training teachers in science based safe dance practice. I have just had a teacher from Australia visiting and over there, Ausdance has been involved in developing guidelines for dance teachers. This is, or will be, taken up by their insurance industry for liability insurance. As a result there are a range of University based programs available for dance teachers to take (and many venue hirers expect/require teachers to have their bit of paper).

    In NZ our ACC legislation means we have no fault accidents ie you cannot sue your dance teacher if you are injured and you get free (but limited) medical rehab.

    From discussions on this board it would appear safe dance training is optional in the States, which given the possibilities for litigation is surprising. Or have I got the wrong end of the stick?

    What about Canada? the UK? Europe?
    I am enrolled on and have attended the first of my week-end training in the JWAAD foundation teacher training course here in the UK. It includes anatomy tuition, health and safety, safe warm ups as well as technique, business and class management.
    I did wonder wether or not I needed it, being a retired schoolteacher with a couple of beginner classes but I am learning a fair bit above my common sense and professional teaching "knowledge".
    It's good to be taught by dance teachers of long standing who can apply what I need to know and not just by safety and first aid experts. Just been finishing off my second lengthy homework assessment..argh.. thought I was past all that!
    I think eventually all insurance companies and employers will demand proof some such training and not just your declaration that you are a competant belly dancer.

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    Senior Member sedoniaraqs's Avatar
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    Quote Originally Posted by adiemus View Post

    This is a contentious point of view I know, but in terms of scientific evidence in my field of expertise (musculoskeletal pain), there isn't any evidence that any specific exercises 'fix' acute low back pain, or chronic low back pain, and if core stability did so, the evidence would be there by now (pilates has been around for how many years?)
    Adiemus, I find this very difficult to believe. Perhaps I am misunderstanding what you are saying. Are you saying that even the standard core exercises (the bridge roll up, the dog/cat, the stick your right hand/left leg out while kneeling, etc) that are routinely prescribed for lower back problems are completely useless? As in, doctors may as well tell people to go home and pick their noses?

    Here are two recent peer-reviewed articles with control groups that indicate a signficant effect of pilates on lower back pain. Granted, I only read the abstracts because I'm at home and can't access the articles through my university's library subscriptions. The second article's abstract states something to the effect that few studies have tested the efficacy of Pilates on lower back pain treatment. Is this so? Lack of data is very different from negative results.

    Pilates training decreased lower back pain significantly over a control group Pilates-based therapeutic exercise: effect on subj...[J Orthop Sports Phys Ther. 2006] - PubMed Result

    A study in which both Pilates and Back School treatment improved lower back pain significantly Two different techniques in the rehabilitation tre...[Eura Medicophys. 2006] - PubMed Result

    I skipped a number peer-reviewed individual case studies indicating core exercise has positive effects on various injuries and pain in obese individuals, dancers, and runners.

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    V.I.P. adiemus's Avatar
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    I'm afraid so - and doesn't it hurt! No, there is no evidence that any specific exercises do anything more than get people moving (which may well counter the natural anxiety to fear doing things that hurt, which can develop into pain-related anxiety and avoidance)...
    The absence of data doesn't mean that if it were presented, it would demonstrate effectiveness - it just means we don't know. Negative results are often difficult to publish because journals love to publish results that are positive, while they don't find negative or neutral findings so interesting. So there is a publication bias that means there are more articles about things that have been demonstrated to help than not.
    There are lots of cautions to hold with respect to interpreting research - effect size, sample size, randomisation, the control group condition, blinded examiners etc etc.
    The only really solid findings for acute nonspecific low back pain (which is the majority of back pains) are:
    - exclude red flags
    - give good pain relief (so that people can then move)
    - adjust daily activities on a temporary basis,then return to normal activity asap but in a graded way
    - there is some evidence that manipulation (osteo or chiro or physio) can help short term only
    and reassurance +++

    Sub-acute and chronic low back pain is a slightly different kettle of fish - again with chronic, it doesn't seem to matter what exercise you do, it's that you do something, while with sub-acute there is some evidence that core stability and general fitness with exposure to feared activities in a graded way may be useful.

    There are so many studies out there, that it's preferable to refer to meta-analyses to interpret the findings. The methodology I think is generally accepted internationally is the Cochrane Collaboration, and they maintain an open-access collection of systematic reviews for many procedures for many conditions.

    There have been two recently published Guidelines for ALBP and CLBP, neither of which have been able to recommend any specific interventions including exercises - one was the European Guidelines, and another the American Academy of Physicians, and the American Pain Society who collaborated. They reaffirm the management that was proposed in the mid-1990's for ALBP should continue - which is what I outlined above.

    Re: stretching - you might be interested in this summary of the Cochrane Group on stretching Stretching to prevent or reduce muscle soreness after exercise
    which concluded that stretching "does not reduce delayed-onset muscle soreness in young healthy adults"

    There is also a review of insoles for back pain which concluded "There is strong evidence that insoles are not effective for the prevention of back pain. The current evidence on insoles as treatment for low-back pain does not allow any conclusions. High quality trials are required for stronger conclusions."
    That comment about more research typically applies to this kind of recommendation. I would prefer not to recommend an intervention when there is limited support for, and further research is required, because treatments:
    (a) cost in money terms
    (b) cost in time
    (c) often maintain a sense that 'I need to wait until I'm fixed' before returning to normal activity
    (d) encourage medicalisation of a very common and normal phenomenon eg low back pain
    (e) interfere with return to normal activities

    This reflects my personal bias that I prefer people to develop self management because many musculoskeletal conditions are short-term, recur frequently, and the natural history is of a fluctuating course. If people learn self management, they don't need to rely on other people to treat them!
    Sorry for the rant!!
    BTW there are 31 systematic reviews published for low back pain alone - given that these reviews go through probably 30 - 120 separate peer-reviewed studies, and summarise the findings, it's a relatively thorough way to establish efficacy. Definitely more robust than small-scale studies or case studies.

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