Carrie Gaerte administers a test to evaluate a potential concussion.

Courtesy Carrie Gaerte, modeled by 2020 Butler University graduate Michela Semenza

Concussions Are More Than a Bump on the Head. Here's What Dancers Need to Know

Your partner accidentally drops you during a lift. You collide head-on with another dancer in rehearsal. Or you're hit in the face while you're spotting a turn. Even if you didn't lose consciousness, you may have a concussion, which can occur from a direct blow to the head or rotary force of the brain moving excessively or striking the skull.

As a dancer, your first instinct may be to keep going, but you shouldn't, says physical therapist and athletic trainer Carrie Gaerte, PT, DPT, ATC, who works with Butler University in Indianapolis and at Ascension St. Vincent Sports Performance. "What's really hard for dancers is admitting that maybe something isn't right," she says. "But the big thing about concussions is that your brain is not like your ankle, shoulder or knee. When your brain has an injury, that needs to take precedence over a role or a job."


If You Think You've Had a Concussion

"If you have a dramatic fall, hit your head and lose consciousness, that's an automatic 911 call," says Gaerte. Sometimes, though, a dancer might run into someone and jostle their head, but they feel fine completing rehearsal. It might not be until that next day or later that they notice any symptoms (see below). "That's when you call your sports medicine physician," she says, stressing that a general practitioner might not understand ballet's athleticism enough to suspect a concussion.

Following any impact, a dancer should spend about 48 to 72 hours (or until they are further evaluated by a sports medicine physician) in relative rest—meaning that you shouldn't dance, though the old advice about not falling asleep after a concussion doesn't typically apply to these types of sports-related head injuries.

When you speak with the physician, be very specific. Use language like "I think I may have sustained a concussion," advises Gaerte. Detail when and how you think it happened and any symptoms you're experiencing. "They will get a sense of your situation quickly, and there won't be as much of a delay in the start of rehab."

A dancer lies flat on a therapy table while a therapist cradles the dancer's head in her hands to test neck flexibility.

Cervical tests may be used to evaluate a potential concussion.

Courtesy Carrie Gaerte

Symptoms

A concussion isn't always evident when it happens, so monitoring your symptoms is crucial. The most common symptom is a headache, as well as dizziness, feeling foggy, blurred or double vision, or balance problems. Less common symptoms include memory dysfunction, sensitivity to light, fatigue or trouble concentrating.

Collegiate or high-school level dancers may notice the impact in their academic classes. "Sometimes they'll say that they can't pay attention, they feel very tired, their homework takes longer to do, or they have difficulty studying or taking notes," says Gaerte. Even if a collision seemed uneventful, these symptoms signal that you should seek treatment.

Diagnosis

Gaerte emphasizes that there is no single test to diagnose a concussion. A physician or athletic trainer may administer some of the following based on your symptoms: vestibular (balance) tests; oculomotor tests, which monitor your eye movements; cervical (neck) tests; or emotional tests, evaluating your moods.

One popular method in the sports world is ImPACT testing, which Gaerte hopes to implement with dancers at Butler. Athletes take a series of computer tests that evaluate neurocognitive function at the beginning of a season to establish a baseline. If a concussion is suspected, they can retake the tests to see where their deficits are and, later, how they've improved, says Gaerte.

A dancers in pointe shoes stands on a balance beam to test her balance.

A physician or athletic trainer may administer a balance test if you think you've had a concussion.

Courtesy Carrie Gaerte

Treatment Varies

There is no one-size-fits-all treatment for concussions. The nature and duration of your rehabilitation depend on the injury's severity and affected areas of the brain. A sports medicine physician will refer you to specialists who can treat your specific symptoms.

Dancers, in particular, may need to focus on neck rehabilitation. "They really need to make sure those muscles are working properly because of all the spotting and specific head movements," says Gaerte, noting that the neck's deep stabilizers are often impacted by a concussion. Other types of treatment may help you recoup your balance or deal with injury-related anxiety.

Returning to Dance

After rehabilitation, Gaerte, in conjunction with a physician, leads the dancer through exertional tests to see if they're ready for a gradual return to the studio. For example, she might have them do a jumping combination or a series of chaîné turns. "Like any other injury, you don't want to jump back in all at once. It might look like just barre for a week or two," she says. As you progress, if you start to have familiar symptoms, you might need to take a couple steps back.

Second Impact Syndrome

If you've had a concussion and return to dance before you've healed, you're putting yourself at risk for second impact syndrome. Having a subsequent concussion can result in life-threatening swelling of the brain. "Most dancers are very sensitive to the pressures they face, not wanting to be 'out' or injured," says Gaerte. "But it's really important for dancers to realize the gravity of a concussion."

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Here, Ball and two other experts share their advice for how to make the most of this precious opportunity to dive deep into dance—and how to handle complications that may get in the way, like injury and drama.

1. Show Off...Your Work Ethic

Summer intensives offer a preview of company life: You'll be dancing in a variety of styles over the course of the day, and all day, everyday. But that doesn't mean you have to be company-ready on day one! Though the first day may be filled with placement classes, try not to approach every class as an audition. "This year has taught us that the work is the important thing," says Ball. "Let go of trying to impress. The best impression I ever receive as a teacher is when I see someone receptive to doing things differently, even if that means taking one step backwards initially, to be able to take two steps forward by the end of the summer."

Angelica Generosa, a principal with Pacific Northwest Ballet, clearly made a splash during her first of three summers at the Chautauqua Institution's School of Dance. At 14, she was cast to dance the pas de deux from Balanchine's Stars and Stripes in the final performance. Generosa describes her younger self as "very eager." She'll be a guest teacher at Chautauqua this summer, and says that a similar eagerness catches her attention: "Dedication, and willingness to try. That twinkle in the eyes when a step is really challenging."

2. Make Friends

Even if friends from your year-round school will be with you this summer, branch out. During breaks at the studio, you may be tempted to spend time on your phone. "Take your headphones off," suggests Margaret Severin-Hansen, director of Carolina Ballet's summer intensive. "Share that ballet video with the person sitting next to you! Their eyes might see it differently; you could learn something. Or find that you have other things in common, too."

Do things outside the studio, too, even if your social circle is limited for safety reasons to a "pod" of classmates. "Sign up for activities," says Generosa. Go on that weekend shopping trip, or out for ice cream. "Be open," she says. "These are people you might see along the way in your future."

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Courtesy CPYB

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"The first week is tough—you're going to be sore," says Ball. "Prepare yourself." He means that literally. Before your program begins, ramp up cross-training, especially cardio to build your stamina. Severin-Hansen recommends you also keep dancing. It no longer matters that your regular school might be on break: We now know it's possible to take virtual classes from home or in a rented studio. If you're on pointe, make sure to put the shoes on every day, at the very least for some relevés. Keep the skin on your toes tough; the last thing you want is to be sidelined by blisters.

If you are recovering from an injury or managing something persistent like tendonitis, take action even further in advance. Find out if your intensive provides access to physical therapy, and if not, make a plan before you leave home. Learn exercises and massage techniques that you can do on your own, and ask about virtually checking in with your regular doctor or PT. Once you arrive, says Ball, communicate with your instructors. "Chances are it's a common ballet injury that teachers understand. They'll be able to help you."

During her summer intensives, Generosa often suffered flare-ups of inflammation. "I knew the tendonitis in my knees was from over turning out, and in my ankles from lifting my heels in plié." She was able to alleviate some of her pain by dancing more thoughtfully, addressing those habits. She also got creative about taking care of her tendons during off-hours. "I basically did ice baths in Chautauqua Lake."

4. Deal With Disappointment Constructively

Whether you're placed in a lower level than you'd like or were hoping for a soloist role that went to someone else, disappointment is understandable. Try, on your part, to understand too. The faculty may believe you'll thrive more in that particular group, or see a technical issue better solved by not pushing you too fast. If you're not sure exactly what you should be working on, ask. "Trust that you can make the most of your experience, whatever level you're in," says Ball. "Don't be afraid of the conversation."

5. Avoid Drama

Competition is inevitable, but unproductive competition is unnecessary, and bullying unacceptable. Severin-Hansen lays down a very clear guideline: "Nobody should ever feel uncomfortable." If you hear or see anything that bothers you—whether directed at you or someone else—don't hesitate to speak up. "If there's even one person creating drama, you feel it in the class. Summer is short. There's no room for that." Tell the resident advisor in the dorms, or bring the problem to the school administration.

Angelica Generosa performs an arabessque elong\u00e9 on pointe while her partner stands behind her holding her waist and with his left leg in tendu. She holds her left hand on her hip and extends her right arm out to the side with her palm up. Angelica wears a purple leotard, black tights and a white Romantic tutu while Kyle wears a yellow shirt, black tights and tan slippers.

Pacific Northwest Ballet principal Angelica Generosa (shown here in rehearsal with Kyle Davis) made notes of corrections she'd received and variations she'd worked on during her summer intensives to help retain what she had learned.

Lindsay Thomas, Courtesy PNB

6. Fuel the Long Day

Depending on your housing arrangement this summer, you may be on your own for buying or preparing your own meals. Generosa recalls her first time living in a dorm and eating cafeteria food: "I wanted to try everything: pizza, chicken tenders, the salad bar, the dessert section—that was also my introduction to coffee." She found, however, that caffeine and sugar rushes would give way to energy crashes, and soon enough her better knowledge prevailed. "I told myself, 'Angelica, get your protein, vegetables, complex carbs—the right kind of energy.'"

Masking requirements may make snacking at the studios slightly more difficult. Nonetheless, there will almost certainly be somewhere you can safely have a nibble in between classes, whether that's a dancers' lounge or socially distanced in the studio itself. Make sure you always have something with you that's easy to munch on during breaks. Ball recommends protein bars or fruits and veggies. "Hydrating is huge," he adds, and suggests bringing packets of powdered electrolyte supplements to add to your water.

7. Retain Corrections

Take a moment each evening, Severin-Hansen advises, to write a few things down. "Say the whole class got a general correction, like 'Use your head.' The person who takes notes will think about it: 'When could I have used my head?' It's all about how you come back the next day and improve."

Generosa set a goal for herself to get better every day. To accomplish this, she would stay late to practice, she says, "so my body could adjust to what I was trying to achieve in that class." If you're inclined to follow her example, ask a friend to practice with you. You can film each other to get a glimpse of your own progress.

At the end of her Chautauqua summers, Generosa made notes of some things she had worked on and which variations she'd learned. "Then it wasn't like I left and that was that. I brought the summer experience with me, for my whole year."

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