Annie O'Neill, Post-Gazette Marika Hartog, right, a physical therapist for the New York City Ballet, teaches a workshop Sunday for adolescent ballet dancers at the Pittsburgh Ballet Theater on how they can avoid injuries. Click photo for larger image.

The New York City Ballet held a workshop in Pittsburgh on Sunday to teach adolescent ballet dancers how they can reduce their risk of injury.

The workshop was conducted by Marika Hartog, 27, a physical therapist for the New York City Ballet. The program she described had been developed for the New York City Ballet by a team consisting of an orthopedist, a psychologist, a chiropractor and a physical therapist.

Adolescent ballet dancers are at greater risk for injury because their bones are growing, and bone growth is uneven, Ms. Hartog said.

"Just the fact that you are growing puts you at more risk," she said.

Limbs grow faster than the trunk (of the body), and strength typically lags six to eight months behind growth, Ms. Hartog said.

Rapid bone growth reduces proprioception, the awareness of the body in space and the ability to sense movement, she said.

Rapidly growing bones also are weaker, more susceptible to stress reaction (inflammation of the periosteum, the outer layer of bone) and to stress fractures, tiny cracks in the bone that develop if a stress reaction is not allowed to heal.

It can take up to a year for a stress fracture to heal, so dancers should be cautious about when they return to full activity, Ms. Hartog said.

"Even if you feel fine, you still could be at greater risk for injury," she said.

The keys to reducing the risk of injury are to do a proper warmup; to perform exercises correctly, and to do a proper cool down, Ms. Hartog said.

A proper warmup is very important because "stress fractures typically occur when muscles are tight," she said.

A proper warmup should consist of "dynamic" exercises such as jogging in order to warm and loosen muscles, Ms. Hartog said. Static stretching should be restricted to the cool down.

"Static stretching can make your muscles less effective [while you are dancing]," Ms. Hartog said.

The warmup should begin with breathing exercises and by thinking about the exercises and dances that are going to be performed, she said.

"Mental imagery reduces injury rates," Ms. Hartog said.

Many adolescent dancers skip the cool down because of time constraints, but this is a big mistake, Ms. Hartog said.

"The cool down is almost as important as the warmup," she said.

Annie O'Neill, Post-Gazette Adolescent ballet dancers learn how to use a resistance band during a workshop on preventing injuries at the Pittsburgh Ballet Theater. Click photo for larger image.

A dancer should stretch for 10 minutes for each hour she has danced, Ms. Hartog said.

A calcium-rich diet also can reduce the likelihood of injury in adolescent dancers, she said. In addition to dairy products, dancers should eat green leafy vegetables such as broccoli, which are good sources of calcium.

It's also important that dancers consume at least as many calories as they burn while they are dancing, Ms. Hartog said.

Some adolescent dancers work so hard they miss their periods, Ms. Hartog said. Amenorrhea is a warning sign that must be taken very seriously, she said.

"Adolescents who don't have periods have much higher rates of injury," Ms. Hartog said.

Worse, each missed period leads to a permanent loss of bone, she said.

Studies indicate amenorrheic athletes have up to 31 percent less bone density than normally menstruating athletes, 24 percent less than nonexercising women.

Strenuous exercise, which inhibits the production of estrogen, is the primary cause of amenorrhea. Stress and restricted calorie diets also contribute to it. The problem usually can be relieved by eating more and exercising less.

About two dozen dancers and their mothers attended the workshop, which was held at the Pittsburgh Ballet Theatre, 2900 Liberty Ave., in conjunction with auditions for the summer session of the School of American Ballet, an affiliate of the New York City Ballet. Additional workshops will be held in Boston, Philadelphia and Washington, D.C.