Brain-body dance: addressing mental health during injury rehabilitation (2024)

Brain-body dance: addressing mental health during injury rehabilitation (1)

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Brain-body dance: addressing mental health during injury rehabilitation

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  1. William Bracewell
  1. The Royal Ballet, Royal Opera House, London, UK
  1. Correspondence to Mr William Bracewell, Royal Opera House, The Royal Ballet, London WC2E 9DD, UK; william.bracewell{at}roh.org.uk

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    • Rehabilitation
    • Dancing
    • Psychology
    • Athletic Injuries

    My career in ballet is probably one that echoes many others. I started dancing around the age of 8, and was recognised by my teacher at the time as having potential to progress further. At the age of 11, I moved from Swansea to London, after receiving a place to live and train full time at The Royal Ballet School. This was an intense introduction into the ballet world to say the least; a pressure cooker environment that suited some and not others. At the time, there was a focus on hard training of the ballet skill, with less concern over the holistic development of the student. After 8 years of training I joined Birmingham Royal Ballet and danced professionally with the company for 7 years, touring nationally and internationally for most months of the year (sometimes for several months at a time). In 2017, I moved to The Royal Ballet, where I now dance as a Principal of the company. This means I perform the main or title roles in up to 13 productions each season.

    Spinal surgery

    My injury history had been sprinkled with minor ankle issues and growth-related problems, but in April 2019 I underwent microdiscectomy surgery on my L5-S1 level in my spine. After a herniated disc injury 3 years prior, I had been managing ongoing back pain, and after what I initially thought was a minor hamstring tear, it quickly became apparent it was much more serious and now restricting the sciatic nerve in my left leg. I could not move at all without intense searing pain which immobilised me for weeks. I began a very slow and conservative rehabilitation approach, but 6 weeks into the programme, my leg would intermittently give way during the most basic warm-up dance movements, and I would end up collapsed on the floor.

    At this point, I discussed my options with our clinical director: continue a conservative rehabilitation with the potential for surgery a year later, or opt for surgery immediately. The MRI suggested I had quite a severe herniation, which, coupled with the fact that I had been struggling with the rehabilitation mentally—including ending up in tears on the floor during coaching sessions—made the surgical route seem like a clear choice. The healthcare team supported this decision, and while there was, of course, a large amount of trepidation ahead of spinal surgery, I’m happy that 5 years later it seems to have been the right decision.

    Connecting mind and body

    I would describe myself as incredibly ambitious, so to have extended periods of stagnant time after my surgery was very frustrating. I tried to fill my time with other interests that were not physical, but I missed the rigour and passion of dancing. Being back in the gym, sweating and working towards my goal of returning to the stage was a huge relief mentally. My physical rehab went well. I tried to cross-pollinate the expertise of my rehab team (figure 1) as much as possible; my Pilates and strength and conditioning (S&C) coaches would watch ballet coaching sessions to assess posture and consider new exercises that would be beneficial. Incorporating exercises that I could clearly associate with dance helped transfer the strength I gained during S&C and Pilates into the studio, which I otherwise had a tendency to disassociate. In many ways rehab suited my personality really well: I could schedule my days as I wanted; I could rest when I needed; and there were clear goals to be achieved. I cannot overemphasise how aware I became of the link between my mental and physical health. It seems obvious, but it’s easy to detach the two.

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    Figure 1

    Celebrating with my rehab team following a successful return to the stage (from left to right: Gemma Hilton, Brian Maloney, William Bracewell, Jane Paris, Adam Mattiussi).

    Addressing my mental health

    An aspect I had not considered until it was looking me directly in the face was the potential loss of my profession and a huge majority of my life. I love my work, and the thought of that being taken away before I was ready was a difficult thing to process. There were also points early in the rehabilitation where I began to fear the loss of more general physical functions. For example, walking a dog that might pull in erratic ways, or bending to put on a sock comfortably. These fears eventually faded as my movement improved, but the initial worry was vivid. During this time I saw our in-house performance psychologist, who helped me work through the day-to-day mental difficulties, and identified elements of post-traumatic stress. With the advice of our wonderful internal healthcare department—and private funding from a generous individual—I saw a psychotherapist. This became a turning point as we discussed life from a wider lens and assessed why I was putting myself through such an extreme process to continue dancing. I realised there was no other option than to give everything I could to try to return to dance. I would not be able to walk away from the situation without knowing I’d done everything in my power to get back to the stage. We assessed why I love dancing so much and why it was worth the effort. I learned that it’s the effort that I love: I love to work, which in some ways was the reason I had become injured initially… by overexerting myself without adequate recovery.

    Moving mindfully forward

    I wanted to highlight the mental health aspect of rehabilitation as it’s maybe not always factored into a programme but in my opinion was a key pillar in getting me back to full capacity. I have come to realise that strength and mobility work will be a part of my life forever, and I relish that. My fundamentals will be keeping a strong and mobile core and hips and moving as much as possible for as long as possible. I am aware that the neurological connection and sensitivity to that area of my back remains heightened 5 years later. I have had two subsequent MRI scans on my back after being worried something had happened again due to pain. This will probably be something I do every few years while I’m dancing to keep my mind at ease as much as keeping an eye on the condition of the disc. I still worry that I might injure my back again, not so much that it stops me dancing but there are some movements that still scare me and probably always will.

    With high-profile athletes becoming more vocal about their mental health capacity and needs, I feel positive that this will become commonplace in dance rehabilitation.

    I would encourage practitioners to value mental health as highly as strength training, mobility training and other physical therapies:

    • Anticipate psychological challenges and programme therapy into a rehab plan.

    • Promote honest discussion around mental health and function.

    • Explore cross-pollination of coaches’ expertise through joint sessions.

    Ethics statements

    Patient consent for publication

    Not applicable.

    Acknowledgments

    I would like to thank Adam Mattiussi, Jane Paris, Gemma Hilton, Brian Maloney, Greg Retter and Angela Bernstein for their support in helping me back to the stage.

    Footnotes

    • X @will_bracewell

    • Collaborators Joseph Shaw: The Royal Ballet, Royal Opera House, UK

    • Contributors Content of submission: WB. Support with editing and submission: JS.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; internally peer reviewed.

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    Brain-body dance: addressing mental health during injury rehabilitation (2024)

    FAQs

    What are the psychological effects of injury on dancers? ›

    Dancers may initially respond to injuries with fear, distress, anger & depression. This may be due to the relationships that surround the dance community: choreographers, parents and fellow cast members. Injuries do not only affect the performer themselves- but this network of individuals that comprise the team.

    How does dance affect mental health? ›

    Ease depression and anxiety.

    Dance is an effective type of exercise that raises your heart rate and works your muscles. Exercise can help with symptoms of depression and anxiety by releasing certain chemicals in your brain. It also provides a way to escape repetitive negative thoughts and worries.

    How can physical injuries impact mental health in dance Magazine? ›

    A significant or chronic injury can also trigger a profound sense of identity loss for dancers, as the pain of a physical setback also jeopardizes their main creative outlet.

    How many dancers struggle with mental health? ›

    One in five (20.8%) dancers had at least moderate symptoms of either depression, generalised anxiety disorder or eating disorders.

    What is the most common traumatic injury in dancing? ›

    Ankle sprains are the number one traumatic injury in dancers. Traumatic injuries are different from overuse injuries as they happen unexpectedly. When an ankle is sprained, ligaments on the inside or outside of your foot get twisted or overstretched and may experience tears.

    How does dancing release trauma? ›

    Dancing aids trauma release by eliciting emotions which can be discharged and expressed through movement. In Flomotion we deliberately play certain tracks that evoke a heightened feeling response, so that they can be included and tolerated by the moving body rather than shut out.

    What happens to your brain when you dance? ›

    In a 2008 article in Scientific American magazine, a Columbia University neuroscientist posited that synchronizing music and movement—dance, essentially—constitutes a “pleasure double play.” Music stimulates the brain's reward centers, while dance activates its sensory and motor circuits.

    What does dancing do to the body? ›

    Health benefits of dancing

    improved condition of your heart and lungs. increased muscular strength, endurance and motor fitness. increased aerobic fitness. improved muscle tone and strength.

    How does just dance help mental health? ›

    Within the scientific community specifically, there is evidence that an abundance of mood-improving chemicals are released within the body while dancing. Once released, these chemicals help improve one's state of mind. So much so, that even one living room dance session can reduce an episode of depression.

    How can dancing change your mindset? ›

    Because dance releases positive chemicals in your body, it can also help decrease depression, anxiety and other mental health issues. Various forms of dance can offer differing benefits. Dancing with a partner provides social interaction, which improves mental health.

    Which of the following is a benefit for mental health when dancing? ›

    Mood: Dance releases endorphins, a naturally occurring “feel-good” chemical in our brain that increase feelings of pleasure and decrease pain. Endorphins help reduce depression, anxiety, and improve your self-esteem.

    How can injury affect mental health? ›

    Physical injury and mental health are closely linked. A serious injury or chronic illness can cause mental health problems including depression, anxiety and post-traumatic stress disorder (PTSD). Poor mental health can negatively impact on recovery rates of the physical injury or illness.

    What are the 4 mental skills in dance? ›

    Mental skills and attributes (during performance), including:
    • movement memory.
    • commitment.
    • concentration.
    • confidence.

    Which dance is good for mental health? ›

    Salsa, hip hop, freestyle, and ballroom are some of the dances that highly promote social confidence. Dancing enhances the brain's networking and transmission of chemicals, which help in the stabilization of mental health.

    What are two mental skills in dance? ›

    Mental Skills These include commitment, concentration, confidence, movement memory, systematic repetition, mental rehearsal, rehearsal discipline, planning of rehearsal, response to feedback and capacity to improve.

    What are the psychological effects of athletic injury? ›

    Psychological responses following injury can include negative emotions, fear of reinjury, lack of confidence, failure-based depression, mood disturbance, devastation, restlessness, and feelings of being cheated (1113).

    What are the physiological effects of dance? ›

    better coordination, agility and flexibility. improved balance and spatial awareness. increased physical confidence. improved mental functioning.

    What are the psychological factors associated with performance limiting injuries in professional ballet dancers? ›

    Psychological factors associated with both risk and outcome of dance injury included the following: stress, psychological distress, disordered eating, and coping.

    What are the psychological aspects of injury in gymnastics? ›

    Mental aspects of injuries include:

    Social isolation – Many gymnasts consider their teammates their sole social circle. When injured athletes are away from their team, they often feel lost, isolated, and down at a time when they need support most.

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