Dance and healthy bones

The RAD’s Artistic Director, Gerard Charles, recently took part in an online discussion with experts on osteoporosis and bone health for amateur and professional dancers of all ages and levels.

The conversation covered topics such as how teachers can help their students to spot problems, the way in which professional ballet companies are dealing with preventing injuries, and ways to intervene when a dancer is reluctant to miss a performance.

Here, we’ve summarised the main talking points:

Clockwise from top left: Gerard Charles – Artistic Director, Royal Academy of Dance, Sarah Leyland – Clinical Advisor, Royal Osteoporosis Society, Dr Nicky Keay – Sports and Dance Endocrinologist, Martin Lanfear – Head of Performance Medicine, Scottish Ballet.

What is osteoporosis?

Osteoporosis is a medical condition meaning that bones lose their strength, become weaker and break more easily, and can lead to pain and sometimes disability. Our bodies are constantly changing, and renewing themselves – a process normally in balance where bones stay strong. Sometimes things get out of balance, and we lose more bone than we gain, and this weakness leads to the condition.

It occurs in old age,  and it’s partly genetic, but there are lifestyle aspects to it, so the risks of developing it can be reduced by things such as eating healthily, not drinking excessive alcohol, not smoking, getting enough vitamin D, and getting enough appropriate exercise.

Bone health and dancing

Exercise is great for bones generally, but over-exercising without enough calorific intake to balance things out can lead to problems such as low body weight, eating disorders, low sex hormones, and can lead to weaker bones. This can affects athletes but can also affect dancers.

It’s paradoxical –  we’re encouraged to move more to strengthen our bones, but for a dancer who’s already moving a lot in classes, rehearsals, and performances, it might be that they are causing an imbalance. They are doing so much exercise that they aren’t providing enough energy to cover the demand from movement. The body will then look for ways to save energy and will go into ‘eco mode’, lowering hormone production. Dancers also tend to exercise indoors, and so receive lower amounts of vitamin D (derived from sunlight) and so bones literally starve and over time will become weaker, leading to potential injuries and fractures.

Recognising the signs

It’s important to spot the problem early, so teachers play a vital role. At first, there might not be an obvious sign and the dancer may feel fine. But gradually they might begin to feel more fatigued than usual and not as coordinated – forgetting steps or technique, having disturbed sleep, or just not feeling quite right. These are signs that the body doesn’t have enough energy in the system.

Dancers may intentionally restrict what they eat because they think they will fit into that tutu if they are slimmer, and may be picked for a part. We have to acknowledge that dance is aesthetic, that artistry is involved, and so there can be a perceived pressure to conform to looking a certain way, and so dancers have to be honest with themselves. This is where teachers play their part. If they notice that a student doesn’t have that spark of energy, or might be getting lots of niggling injuries, these are warning signs.

This is pretty common according to a survey of international dancers, male and female, where they were asked about their energy levels, sleep patterns, food, and their body shape. Nearly half of the female dancers showed signs of early indicators that something wasn’t quite right. There were fewer males in the survey, but a significant proportion also showed indications. If these signs could be picked up early, by themselves, by fellow dancers, or more importantly, the teachers, then hopefully we can reduce potential problems.

Watch the full discussion

Getting more information (for teachers and students)

Education is important because sometimes this can be a delicate issue and so going to a website which is objective, with clear information could be a good starting point to get yourself as a dancer or a teacher more familiar with what this condition is, and feel more comfortable that this is something that needs to be recognised before it results in an injury. A lot of dancers think just of performance, but fundamental to getting anywhere near your potential is your health. Your health is your most important tool.

There is lots of up-to-date information at the Royal Osteoporosis Society, the British Association of Sport and Exercise Medicine, and Raising awareness of Relative Energy Deficiency in Sport (RED-S).