Unsolved Mysteries: Dance as a Precursor to Pelvic Floor Dysfunction

8/1/2022

In the first blog in the Unsolved Mysteries Series, I talked about the initial strokes I made on my voyage towards discovering my “Atlantis” – the undetected, mysterious pelvic floor residing deep within me. Why didn't I know about this "lost city" for so long? Perhaps being a dancer didn’t exactly clear the waters for me… 

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Every industry places demands on bodies that are unique to that industry. A software coder moving from desk to couch to kitchen island in their home will experience different physical stressors than that of a nurse clocking 20,000+ steps per shift or a hairstylist’s hands moving through speedy, finite movements over and over again. Some bodies walk away unscathed as if 9.5 hours of staring at a screen didn’t just happen – maybe they’re just lucky. Or maybe it was a longer journey – perhaps this person hadn’t been so lucky in years past and then found themselves learning about ergonomics and seeking out “anti-desk” exercises. Dance is no different

There’s a reason why dancers are also called artistic athletes – the nature of dance itself is intensely demanding on the body. The diverse physicality of dance alone can create the “perfect storm” for pelvic floor dysfunction, not to mention the myriad of mental, cultural, and emotional influences. So while some “boats” navigate these stormy waters without a scratch, others traveling the same waters may need some TLC… What makes dance so turbulent for the pelvic floor?  

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Though also true for many dance styles, one of the most iconic features of ballet technique is that it places dancers in a constant posterior pelvic tilt and external rotation of the hip, aka a tucked pelvis (sort of like a scared dog with its tail between its legs) in a turned out position. Over time, the muscles responsible for this positioning can get shortened, which in turn can create this strange combination of tight yet weak muscles. One of those muscles is the obturator internus – and it’s also a muscle of the pelvic floor! And since the pelvic floor reflexively coordinates and communicates within itself, one tight/weak muscle here can lead to others following suit OR cause others to compensate. 

Another muscle reflexively connected to the pelvic floor is the diaphragm, the primary muscle for breathing. It contracts with inhalation to expand the belly and ribcage, ultimately resulting in space for the lungs to take in oxygen. But when techniques, like jazz for instance, reinforce time and time again the idea of staying “lifted off the pelvis” with a ribcage that is suspended out of gravity in order to achieve the longest damn waist there ever was, it is very hard for the diaphragm to behave as it should… and I don’t blame it! Dancers’ bodies are asked by the pressures of society and peers, generations before them, and false markers of success to meet unattainable, unsustainable ideals of perfection, physique being just one of them. Rather than allowing natural movement and relaxation in the abdomen and diaphragm (therefore in the pelvic floor too), the practice of “flattened bellies” and thin, or dare I say “cinched,” waists becomes second nature. And though these “ideals” are being challenged, uprooted, and full-on abandoned (woo!), they are still woven into the fabric of dance. 

Words like “Squeeze together!” “Pull up!” “Hold in!” or, as we just heard, “Stay lifted off the pelvis!” are threads in the fabric. Sure, perhaps for a specific area in a singular moment in class, they are said with good intentions. Language is passed down from generations before, and even with conscious effort to rebel against “ideals”, it seeps through. These words; along with more than I could fathomably list from my own experience, let alone know from others’ unique experiences; begin to flood dancers’ minds and bodies without specificity and without an off switch. In addition, dancers characteristically do as they’re told, no questions asked, often at the sacrifice of their bodies. This obedient culture is rewarded, highly regarded, and an Achilles heel for dancers. And so, it is not surprising that we see verbiage go from instruction to concepts to a way of life. 

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A common outcome of the turned out and tucked positioning is a hypertonic (super tight yet often weak, unwilling and/or unable to relax) pelvic floor. A common outcome of a rigid, stuck, held diaphragm is a similarly rigid, stuck, held (*cough* hypertonic) pelvic floor. A common outcome of words like “Squeeze together!” and “Pull up!” reinforced by every inch of the studio dynamic, you can probably guess how the pelvic floor is going to behave (hint: starts with hyper). 

A hypertonic pelvic floor is that strange combination of being tight yet weak. Range of motion is limited by hypertonic states in that a muscle at rest has excess tone and essentially exists in a constant semi-contracted state. With a loss in range of motion comes a loss in power, or force production. If we think of a rubberband that is too tight, too rigid, and cannot get stretched enough, we understand it cannot be slingshot across the room. In other words, the rubberband here cannot build enough potential energy (stored energy) to then produce kinetic energy (energy of motion). It is tight yes, but it is also weak in that it cannot produce force. Same goes for the pelvic floor! To have the strength to resist gravity, endure petite allegro, control urinary or fecal leakages, it needs a healthy elastic relationship. 

I’m not here to bastardize any technique, language, or set of ideals. I understand why they’ve come into existence, for better or for worse – but what should stay and what should go is a loaded question for another blog perhaps ;) I’m also not here to say “you WILL have pelvic floor dysfunction if you are a dancer!!” Instead, I’m here with you simply to say dance, for obvious and nuanced reasons, can predispose dancers to a dysfunctional pelvic floor, more often than not from hypertonicity. And for the sake of long careers and happy humans, dance professionals and their physical therapy teams must understand the waters in which they swim in order to receive the best, most effective care.

Stay tuned for Empower Physio’s next month’s blog in which we continue to contextualize and break down the dance industry’s unique need for informed pelvic care, and how to help!

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Are you a dancer or dance professional with a pelvic floor? 

*cough* yes, everybody and every body has one ;)

 

Are you a PT Professional, pelvic health speciality or not, treating artistic athletes? 

 

Just curious?

GREAT! 

Keep an eye out for future blogs, share with your 

friends and colleagues, and give us a visit! Book an appointment here

 

 

Check out the first blog in the Unsolved Mysteries Series talking about 

the importance of dance professionals understanding their pelvic floors. 

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*I am unable to speak to social dance styles (salsas, swing, waltz, etc) nor world dance (bharatanatyam, Irish dance, traditional folk dances, African styles, etc). This blog is referencing westernized dance styles and techniques.