ATHLETIC TRAINING EDUCATION AND DANCE MEDICINE

A THESIS
Submitted to the Faculty of the School of Graduate Studies
and Research of California University of Pennsylvania in
partial fulfillment of the requirements for the degree of
Master of Science

By
Brian B. Rosenau

Research Advisor, Dr. William Biddington
California, Pennsylvania
2010

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ACKNOWLEDGEMENTS
Thank you...
For your tranquil atmosphere, strong coffee, and free Wi-Fi
hot-zones:
Culver Coffee Company (Culver, IN)
Lemonjello’s Coffee (Holland, MI)
Shay Station Coffee Company (Cadillac, MI)

For your constant manuscript reading, superb teaching, and
unforgettable humor:
Bill Biddington
Carol Biddington
Bruce Barnhart
Becky Hess
Bob Kane
Tom West

For your comfortable lodging, fine meals, and plethora of
one-winged chickens:
Mom & Dad
Kevin & Kim
Kyle, Kelly, Kory

For your natural beauty, vital animation, and being the
perfect Muse:
The Blue Lake Loons
Stella Terpsichore

For expressing all that you do
Through athletic and artistic talents
During your performances on the Eppley stage
Filling me with creativity and inspiration
And leaving imprints on my soul.
This project is dedicated to:
“CULVER DANCEVISION”
All my love,
Rosie

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TABLE OF CONTENTS
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SIGNATURE PAGE .

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ACKNOWLEDGEMENTS

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TABLE OF CONTENTS .

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LIST OF TABLES .

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LIST OF FIGURES .

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INTRODUCTION . . . . . . . . . . . . . . . . .
METHODS

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Research Design. . . . . . . . . . . . . . .

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Subjects.

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Preliminary Research. . . . . . . . . . . . .

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Instrumentation

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Procedures.
Hypotheses

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Data Analysis

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RESULTS . . . . . . . . . . . . . . . . . . .

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Demographic Data . . . . . . . . . . . . . .

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Hypotheses Testing

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Additional Findings . . . . . . . . . . . . .

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DISCUSSION

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Discussion of Results . . . . . . . . . . . .

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Formal Dance Training Experience . . . . . . .

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Dance Medicine Education . . . . . . . . . .

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Liberal Arts Education . . . . . . . . . . . 67
Bloom’s Taxonomy of Learning

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Cognitive Domain . . . . . . . . . . . . . 70
Affective Domain . . . . . . . . . . . . . 74
Psychomotor Domain

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Athletic Training Services Provided for
College/University Academic Major/Emphasis Dance
Programs . . . . . . . . . . . . . . . . 81
Conclusions . . . . . . . . . . . . . . . . 85
Recommendations

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REFERENCES

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APPENDICES

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A. Review of the Literature . . . . . . . . . . . 96
Movements of the Unconscious: “The Hidden
Movements of Dance” . . . . . . . . . . . . 102
Biomechanics and Pathogenesis of Orthopedic
Dance Injuries . . . . . . . . . . . . . . 120
Psychology and Sociology of the Dancer Athlete/
Artist Hybrid . . . . . . . . . . . . . . 138
Financial Costs and Employment Opportunities in
Dance Medicine . . . . . . . . . . . . . . 152
Summary . . . . . . . . . . . . . . . . . 160
B. The Problem . . . . . . . . . . . . . . . . 165
Statement of the Problem . . . . . . . . . . 166
Definition of Terms . . . . . . . . . . . . 170
Basic Assumptions . . . . . . . . . . . . . 174
Limitations of the Study . . . . . . . . . . 174

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Significance of the Study

. . . . . . . . . 175

C. Additional Methods . . . . . . . . . . . . . 182
Athletic Training Education and Dance Medicine
Survey (C1) . . . . . . . . . . . . . . . 183
Survey Cover Letter (C2) . . . . . . . . . . 192
Panel of Experts Letters (C3) . . . . . . . . 195
NIH Human Subjects Training (C4) . . . . . . . 202
Institutional Review Board (C5) . . . . . . . 204
REFERENCES
ABSTRACT

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LIST OF TABLES

Table

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1. General Demographics of ATE Program Directors

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2. ATE Curriculum Type .

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3. Gender of ATE Program Directors .

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4. Formal Dance Training Experience – Style .

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5. Formal Dance Training Experience – Years .

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6. Formal Dance Training Experience – Gender.

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7. Type of Bachelor’s Curriculum – PD .

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8. Completion Year of Entry-level ATE Curriculum

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9. Dance Injury Course Content during ELATEC.

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10. Dance Clinical Rotation During ELATEC .

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11. Type of Master’s Curriculum Completed .

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12. Dance Injury Course Content in Grad Curriculum .

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13. Dance Clinical Rotation in Graduate Curriculum .

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14. Dance Medicine Continuing Education Experience .

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15. Type of Bachelor’s Curriculum – ATE Students.

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16. Dance Program Affiliated with Athletics Dept.

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17. 2X3 Chi-Square Independence Test for the Presence
of Dance Medicine Course Content / Program
Director’s View of Bloom’s Taxonomy - Cognitive
Domain . . . . . . . . . . . . . . . 47
18. 2X3 Chi-Square Independence Test for the Presence
of Dance Clinical Experience / Program Director’s
View of Bloom’s Taxonomy - Affective Domain . . . 48

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19. 2X3 Chi-Square Independence Test for the Presence
of Dance Clinical Experience / Program Director’s
View of Bloom’s Taxonomy - Psychomotor Domain . .

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20. 2X2 Chi-Square Independence Test for the Presence
of Dance Clinical Experience / Presence of a Dance
Major/Emphasis Program at the College/University . 52
21. 2X2 Chi-Square Independence Test for the Presence
of Dance Clinical Experience / Extent of AT
Services Provided by AT Staff for the Dance
Program . . . . . . . . . . . . . . . 52
22. 2X2 Chi-Square Independence Test for the Presence
of Dance Clinical Experience / Extent of AT
Services Provided by AT Staff for the Dance
Program . . . . . . . . . . . . . . . 53
23. 2X2 Chi-Square Independence Test for the Presence
of Dance Clinical Experience / Extent of AT
Services Provided by AT Staff for the Dance
Program . . . . . . . . . . . . . . . 54
24. 2X2 Chi-Square Independence Test for the Presence
of Dance Clinical Experience / Extent of AT
Services Provided by AT Staff for the Dance
Program . . . . . . . . . . . . . . . 55
25. 2X2 Chi-Square Independence Test for the Presence
of Dance Clinical Experience / Extent of AT
Services Provided by AT Staff for the Dance
Program . . . . . . . . . . . . . . . 56
26. 2X2 Chi-Square Independence Test for the Presence
of Dance Clinical Experience / Extent of AT
Services Provided by AT Staff for the Dance
Program . . . . . . . . . . . . . . . 57
27. 2X2 Chi-Square Independence Test for the Presence
of Dance Clinical Experience / AT Services
Provided by AT Staff for the Dance Program – Yes,
No . . . . . . . . . . . . . . . .

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28. 2X2 Chi-Square Independence Test for Provides AT
Services for the Dance Program / Athletic
Training Budget Having Sufficient Resources – Yes,
No, I don’t know . . . . . . . . . . . . 58

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29. 2X2 Chi-Square Independence Test for Presence of
Dance Injury Course Content in PD’s Curriculum –
Yes, No / PD Received Dance Injury Course Content
in Entry-level ATE Curriculum – Yes, No . . . .

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30. 2X2 Chi-Square Independence Test for Presence of
Dance Clinical Rotation in PD’s Curriculum – Yes,
No / PD Received Dance Injury Course Content in
Entry-level ATE Curriculum – Yes, No . . . . .

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31. 2X2 Chi-Square Independence Test for Presence of
Dance Clinical Rotation in PD’s Curriculum – Yes,
No / PD Completed a Dance Clinical Rotation in
Entry-level ATE Curriculum – Yes, No . . . . .

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32. 2X2 Chi-Square Independence Test for ATC’s Need
Specific Dance Experiences in the Affective
Domain of Bloom’s Taxonomy – Yes, No / PD
Received Dance Injury Course Content in
Entry-level ATE Curriculum – Yes, No . . . .

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33. 2X2 Chi-Square Independence Test for Presence of
Dance Clinical Rotation in PD’s Curriculum – Yes,
No / Program Director’s Participation in a Dance
Medicine Continuing Education Experience – Yes,
No . . . . . . . . . . . . . . . .

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LIST OF FIGURES

Figure
1.

Pie chart illustrating formal dance training
experience among athletic training education
program directors . . . . . . . . .

Page

36

2.

Pie chart illustrating the percentage of
athletic training education program directors
having received dance injury course content
while a student in an entry-level athletic
training education curriculum . . . . . 39

3.

Pie chart illustrating the percentage of
athletic training education program directors
having completed a dance clinical rotation
as a student in an entry-level athletic
training education curriculum . . . . . 40

4.

Pie chart illustrating the percentage of
athletic training education program directors
having received dance injury course content
as a student in a graduate curriculum in
addition to, or beyond an entry-level
athletic training education curriculum . . 42

5.

Pie chart illustrating the percentage of
athletic training education program directors
having completed a dance clinical rotation
as a student in a graduate curriculum in
addition to, or beyond, an entry-level
athletic training education curriculum . . 43

6.

Pie chart illustrating the percentage of
athletic training education program directors
having completed a dance medicine continuing
education experience . . . . . . . . 44

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7.

Pie chart illustrating the percentage of
CAATE entry-level undergraduate athletic
training education curricula at
colleges/universities that also require their
undergraduate students to complete “core”
courses as part of a liberal arts bachelor’s
degree curriculum . . . . . . . . . 45

8.

Column-chart illustrating the program
directors’ views that the management of the
dancer patient by certified athletic trainers
requires specialized competencies (Yes, No, I
don’t know)in the 3 domains of Bloom’s
Taxonomy of Learning (Cognitive, Affective,
Psychomotor). The numbers in this chart
represent only the views of the program
directors overseeing ATE curricula offering a
dance clinical rotation experience . . . . 50

9.

Column-chart illustrating the program
Directors’ views that the management of the
dancer patient by certified athletic trainers
requires specialized competencies (Yes, No, I
don’t know) in the 3 domains of Bloom’s
Taxonomy of Learning (Cognitive, Affective,
Psychomotor). The numbers in this chart
represent only the views of the program
directors overseeing ATE curricula not
offering a dance clinical rotation
experience . . . . . . . . . . . . 51

10.

Column-chart illustrating a chi-square
independence test for the presence of a dance
clinical rotation (Yes/No) and the extent
of athletic training services provided by the
athletic training staff for the dance program
(ATC Assignment/Another Category). . . . .56

11.

Column-chart illustrating a chi-square
independence test for the presence of a dance
clinical rotation experience (Yes/No) in the
ATE curricula overseen by the program
Director, and the program director having
received dance injury course content as a
student in an entry-level athletic training
education curriculum (Yes/No). . . . . . 61

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12.

Column-chart illustrating a chi-square
independence test for the presence of a dance
clinical rotation experience (Yes/No) in the
ATE curricula overseen by the program director
and the program director having completed a
dance clinical rotation experience while a
student in an entry-level athletic training
education curriculum (Yes/No). . . . . . 62

13.

Professional baseball analogy applied to the
labeling of learning level progression of the
3 domains of Bloom’s Taxonomy of Learning;
Cognitive, Affective, Psychomotor . . . . 91

1
INTRODUCTION

Dancers are a unique subset of the sports
medicine patient population since they must combine
aspects of art and science. No physical activity
calls for greater physical versatility than dance.
From explosive bursts of speed punctuated by bravura
jumping to infinitesimally exquisite precision and
motor control creating the illusion of gravity defying
lightness, from seemingly supra-human flexibility and
balance to the strength necessary to carry one
another, dancers are athletes as much as they are
artists. Because of the range of demands on the
professional dancer, no single performer is equipped
with the “ideal” body to meet all the requirements of
their art. Each dancer must confront their own
technical weakness with self-discipline and dedication
and, until the last two decades, without the aid of
scientifically based medicine or conditioning.1
Dance is a creative manifestation of the human spirit
in the form of human movement.

From a cultural

perspective, dancers infuse their own language, creativity,
and spirituality into shaping unique human movement.
Similar to the tribes of Abraham, dancers and competitive
athletes are cousins.

The lives and careers of both

cultures require dedication, sacrifice, hard work, and lots
of energy in developing their skills.

And in the same way

that Jews, Christians, and Muslims all require their own
forms of spiritual medicine, dancers and competitive
athletes require their own forms of medicine; sports
medicine and dance medicine.

2
Ballet dancers constitute a human movement population
that has begun to attract the attention of injury
researchers.

Similar to athletes in competitive sports,

ballet dancers are an “athletic” population that perform in
a highly demanding environment and that is at high risk for
physical injury.2 Modern dancers represent another
population of athletes performing in demanding environments
as well, with physical injuries also occurring regularly.
Because the physical and psychological skills required for
success in this profession rival and in some cases exceed
those of other athletic populations, ballet and modern
dancers have attracted recent empirical attention by sports
medicine researchers.2 Even though the amount of dance
medicine literature available pales in comparison to the
amount of traditional sports medicine literature available,
dance medicine exists as a legitimate, specialized field of
study. It has its own approach to human movement, and even
has its own language to describe human movement.

Dance

medicine is its own culture.
Dance is everywhere.

In the United States, dance

study is a part of the lives of several million students at
any given time.

It has been informally estimated that as

many children study dance as participate in athletics.3 When
compared to the numbers of dancers throughout the United

3
States, the amount of literature seems to become even
smaller.
Dance injuries have been referred to as the “orphan
child” in the sports medicine family.

While it is

relatively common for a sports medicine physician to be
well versed in the mechanics of football and basketball,
relatively few have a sound knowledge of the different
disciplines that comprise the world of dance.4 Because of
the extreme and exaggerated movement patterns involved in
the biomechanics of dance, combined with their demanding
aesthetic requirements, the mechanism of dance injuries and
the rehabilitation of dance injuries are often unique to
this culture.

Numerous authors have commented on the

importance of not only appreciating the different facets of
dance, but of the unique role of technique in dance-related
overuse injuries and treatments.2,4,5,10 A prominent author in
the area of dance medicine, Marijeanne Liederbach5 expressed
the following thoughts in an article on the rehabilitation
of dance injuries:
Effective rehabilitation of dance injuries
requires a skilled therapist capable of understanding
the multiple factors involved in the injury’s etiology
and able to create a style-specific, staged
rehabilitation plan, and a dancer ultimately committed
to independent management of the injury, including an
attempt to understand its cause. Dance rehabilitation
is a dynamic process that ultimately depends on
careful communication between the dancer and

4
therapist. Fundamental to this process is the regular
reassessment of the dancer’s functional ability. In
order for rehabilitation to be fully complete, the
clinician-in-charge must possess a trained eye
sensitive to the full palette of demands and nuances
of the movement form to which the dancer wishes to
return. Partnership with the injured dancer’s teacher
or artistic director is advised, and perhaps
essential; the clinician should understand the
dancer’s work setting so that full movement skill
refinement can be attained and the dancer become ready
to seamlessly and confidently reenter her work
setting.
To understand and work with dancers, physicians must
understand that the dance world makes some assumptions
about the relationship between the mind and the body that
are fundamentally different from those of traditional
medicine.2,3 Similar to dance medicine, the study of mindbody connections is also in its infancy.

Language

conditions our mental habits and thinking processes just as
movement conditions our physical habits.
on unconscious and conscious levels.

The two interact

Language is therefore

integral to the sensations we experience.

A student

directed to “pull up” his knees and thighs and “lift” his
torso will feel and look different from the student told to
“release and lengthen” the thighs and spine, “allow the
torso to breathe,” and “let the head float off the neck.”6
Certified athletic trainers desiring to work in a dance
setting might need to “learn a new language” in order to
treat the dancer patient as effectively as possible.

5
Much of the skill needed in medicine is cognitive as
well, based on scientific learning as applied to clinical
situations in a logical way.2,3 Aspects of the medical
community may be required to re-learn some of its
traditional thinking and approaches to injury management
when working with the dancer as equal part athlete and
artist.

As a group, physicians are not often called on to

consider their own emotional states, and even more rarely
must consider their postural alignment, their movement
patterns, or the sensations in their muscles as they
move.2,3 A strong argument can be made that connections of
this nature are established through actually experiencing
the artistry of dance.

Dancers and dance educators have

long pondered the influence of the soma on the psyche and
vice versa for an understanding of their interrelationship
as it pertains to training, performance, and injury.7 It is
not by coincidence that all clinical specialists and
therapists employed at the Harkness Center for Dance
Injures (New York University Hospital for Joint Diseases)
have extensive backgrounds in dance.
Martha Myers8 indicated in an interview that Moshe
Feldenkrais (former Director of the Feldenkrais Institute
in Tel Aviv, Israel), was known for his insistence on the
unity of mind and body, and the arguments he drew from

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various scientific disciplines to support his conclusion
that thought, emotion, and sensation do not occur without
corresponding changes in the muscles of the body.
opposite is also true.

The

Changes in the interrelation of the

muscle patterns can activate and alter attitudes, thoughts,
and feelings. Feldenkrais’ mention of unity might be the
most overlooked portion of this statement.

The human

condition expresses itself through both sports and dance.
Do traditional athletic training practitioners desire to
unite with dance medicine practitioners through a shared
interest of learning more and understanding more about
human movement?

Does the athletic world desire to unite

with the fine arts world?
Dance training is very different (from other forms of
physical training); dancers are not encouraged to isolate
cognition from emotion or perceptual and movement skills;
they must be able to convey to an audience a wide range of
feelings through their movements.

They are not simply

playing the role of an actor, convincing the audience to
believe in an artifice; rather, performance is a reflection
of the dancer’s world view and life-style.2,3 Creativity and
innovation are widely recognized as essential to success in
business and so many aspects of our lives.

For over two

decades, Cirque du Soleil has been a world-renowned

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laboratory of creativity, enthralling audiences by fusing
dazzling acrobatics, staging, choreography, and music,
along with beautiful costumes and technical effects, to
inspire and create magical, almost otherworldly theatrical
experiences.

In The Spark (Cirque du Soleil; Igniting the

Creative Fire that Lives Within Us All),9 Cirque’s former
President of Creative Content, Lyn Heward, and veteran
journalist John Bacon, invite readers inside the world and
ideas of Cirque du Soleil.

One of the most interesting

characters in The Spark is Karine.

Originally a gymnast,

Karine transformed herself into a competitive swimmer, and
then transformed herself again into an Olympic synchronized
swimmer.

Karine represents the best of both worlds.

After

spending several years competing at a high level, she
transitioned into a performing artist for Cirque du Soleil.
Below are some of her thoughts:
I really don’t like competition that much.
That’s not the reason I was with my team every day. I
like to be a part of a team, doing something active,
something beautiful, something original. And that is
why I wanted to join Cirque du Soleil. Our shows have
nothing to do with being better than the person next
to you. It’s about finding the horizon and reaching
for it. There is a difference between wanting to
compete and wanting to participate. There’s a
difference between being an athlete and being an
artist.9
At Cirque you have to touch the crowd every
night. To do that, you need to find the little pearl
inside yourself and give it to the audience. Think
about how pearls are made – from a grain of sand, an

8
irritant. We all have these grains of sand.
need to nurture them, make them beautiful.9

But we

Since retiring as a performer, Karine is currently
working in a coaching capacity with Cirque du Soleil, and
from a coach’s perspective she had this to say: “When you
are teaching someone, you help them find that pearl.

And

when I see them find it and share it with an audience, I
feel I’ve achieved something.”9 Both the dancer athlete and
the competitive athlete have to find “their pearl within”
and share it with the audience every night through human
movement.

Finding that “pearl within” is essential for a

dancer to express herself through athletic and artistic
movement while on the dance floor or stage.
There are Psycho-social patterns also unique to dance,
and medical practitioners not familiar with these patterns
and issues commonly seen in the lives of dancers might not
be qualified to work with this type of athlete.

Research

indicates that substance abuse, depression, and suicidal
ideation have all been found to increase in performers when
injuries occur.2,10

When an injury occurs to a dancer, the

dancer will go through stages of emotional adjustment that
coincide with the stages of the physical healing process.
The most commonly seen patterns of adjustment occurring to
dancers have been identified.

For dance instructor Norma

9
Leistiko,11 “kinesthetic awareness is the most vital aspect
of dance training.

It is important to know your own

structure and to compare yourself with yourself rather than
with someone else.” When considering the perspectives of
these individuals involved in the artistic world, it makes
sense that certified athletic trainers experience the dance
culture to most effectively help an injured dancer patient
re-discover their “pearl within” after being injured.
The last decade has seen the most growth in the field
of dance medicine, as well as the most interest being
garnered by the sports medicine world.

Dance medicine was

slow to catch on in the 1980’s, with little interest being
shown in the athletic training world.

During the 1990’s,

the area of dance medicine witnessed more growth.

An

important milestone was the release of the quarterly
publication, “The Journal of Dance Medicine and Science” in
1997.

In the new millennium, dance medicine is beginning

to make its way into athletic training education. “Several
universities currently offer clinical rotations that
introduce students to dance medicine.

Indiana University

has had a performing arts position for nearly a decade, and
the IU Musical Arts Center boasts its own treatment
facility, staffed by a certified athletic trainer.”12

10
According to Marijeane Liederbach PhD, PT, ATC,12 “You
rehab a dancer differently from other athletes because they
have different functional tasks.” She also adds, “We don’t
let our employees go near a dance environment unless
they’ve had mentorship training.

You really need to build

a background by taking dance medicine classes or finding a
mentor you can shadow in that setting.” Liederbach is the
Administrative Director and Director of Research and
Education for the Harkness Center for Dance Injuries, a
Division of the New York University Hospital for Joint
Diseases.
The greater number of diverse experiences that
athletic training students have, the more prepared they
will be for the work force.

According to Liederbach,12 “An

athletic trainer graduating from a program that does not
include dance medicine should not expect to go straight
into that setting and succeed.” These comments by
Liederbach, a leading authority and veteran in the field of
dance medicine, provoke questioning the prevalence of dance
medicine preparation within athletic training education, as
well as what determines whether or not athletic training
education curricula offer specialized preparation in the
area of dance medicine for the athletic training students.

11
The purpose of this study was to answer the following
questions:

1) Is the presence of dance medicine course

content in CAATE curricula dependent on the program
director’s view that the management of the dancer patient
by certified athletic trainers requires specialized
competencies in the “Cognitive Domain” of Bloom’s Taxonomy
of Learning in addition to the cognitive domain
competencies required of certified athletic trainers for
the management of the traditional athlete patient? 2) Is
the presence of dance medicine clinical experience in CAATE
curricula dependent on the program director’s view that the
management of the dancer patient by certified athletic
trainers requires experiences in the “Affective Domain” of
Bloom’s Taxonomy of Learning?

The NATA Educational

Competencies (ed. 4) has removed the affective domain from
athletic training education; 3) Is the presence of dance
medicine clinical experience in CAATE curricula dependent
on the program director’s view that the management of the
dancer patient by certified athletic trainers requires
specialized competencies in the “Psychomotor Domain” of
Bloom’s Taxonomy of Learning in addition to the psychomotor
domain competencies required of certified athletic trainers
for the management of the traditional athlete? 4) Is the
presence of dance medicine clinical experience in CAATE

12
curricula dependent on the existence of a dance
major/emphasis program at the college/university? 5) Is the
presence of dance medicine clinical experience in CAATE
curricula (at colleges/universities also offering an
academic major/emphasis dance program) dependent on the
extent of athletic training services provided for the dance
program by the college/university athletic training staff?
and 6) Is the extent of athletic training services provided
for the dance program by the athletic training staff at the
college/university dependent on the athletic training
budget (staffing/supplies) having sufficient enough
resources to provide services for a program traditionally
not affiliated with the college/university department of
athletics?

13
METHODS

This section includes the following subsections:

1)

Research Design; 2) Subjects; 3) Preliminary Research;
4) Instrumentation; 5) Procedures; 6) Hypotheses, and 7)
Data Analysis.

Research Design

This project was completed in the form of a
descriptive study.

The dependent variables of the study

included the presence of dance medicine course content in
CAATE (Committee on Accreditation of Athletic Training
Education) curricula, the presence of dance medicine
clinical experience in CAATE curricula, and the extent of
athletic training services being provided for dance
programs by the athletic training staff at
colleges/universities offering both an athletic training
education curriculum as well as an academic major/emphasis
program in dance.
The first independent variable of the study was the
program director’s view that the management of the dancer
patient by certified athletic trainers requires specialized
competencies in the “Cognitive Domain” of Bloom’s Taxonomy

14
of Learning (mental skills – knowledge) in addition to the
cognitive domain competencies required of certified
athletic trainers for the management of the traditional
athlete patient.

The second independent variable of the

study was the program director’s view that the management
of the dancer patient by certified athletic trainers
requires experiences in the “Affective Domain” of Bloom’s
Taxonomy of Learning (growth in feelings or emotional areas
– attitude).

The affective domain has been eliminated from

the current edition (ed. 4) of the NATA Educational
Competencies.

The third independent variable of the study

was the program director’s view that the management of the
dancer patient requires specialized competencies in the
“Psychomotor Domain” of Bloom’s Taxonomy of Learning
(manual or physical skills – kinesthetics) in addition to
the psychomotor domain competencies required of certified
athletic trainers for the management of the traditional
athlete patient.

The fourth independent variable of the

study was the existence of a dance major/emphasis program
at the program director’s college/university of employment.
The fifth independent variable of the study was the extent
of athletic training services provided for the dance
program by the athletic training staff at the program
director’s college/university of employment.

The sixth

15
independent variable of the study was the athletic training
budget being sufficient enough (staffing/supplies) to
provide athletic training services for a program (dance)
traditionally not affiliated with the college/university
department of athletics.
The strength of this study was the content validity of
the instrument (a 23 question survey developed by the
researcher).

The validity of the survey was established

through a thorough review by a panel of experts with
extensive background and experience in the topic of the
study being conducted.

The limitation of the study was

that the conclusions were based only on the results of
questions included in the survey.

Other factors existed

that were not addressed through the questions of the
survey.

Subjects

A total of 216 athletic training education program
directors (CAATE undergraduate entry-level, CAATE graduate
entry-level, and NATA post-certification) were emailed the
survey, “Athletic Training Education and Dance Medicine”
(Appendix C1).

The email survey was sent with a cover

letter (Appendix C2) which asked for the program directors’

16
participation in the study, an explanation of the
objectives of the survey, and a section describing how the
researcher assured the program directors that their
responses to the survey questions would remain anonymous.
The informed consent of the program directors was implied
by their anonymous response to the web based survey.

After

distribution of the survey the researcher set the minimum
response validity standard as n = 65.

Preliminary Research

Prior to distribution of the survey developed by the
researcher, letters were sent to four individuals (Appendix
C3) with extensive background and experience in the topic
of the study being conducted.

The letters explained the

objectives of the study, the type of study to be conducted,
and asked each individual for their participation as part
of the researcher’s “panel of experts” for the study.
The researcher selected a well-rounded team to serve
as the panel of experts for this study.

Included on this

panel were two former collegiate dance majors, both of whom
are now certified athletic trainers employed as clinical
practitioners at The Harkness Center for Dance Injuries
(NYU Center for Joint Diseases) in New York City.

Both

17
individuals are also graduates of an NATA postcertification graduate level curriculum.

The Harkness

Center is the nation’s leading institution in all areas of
providing health care services for dancers.

The Harkness

Center clinicians are also leaders in contributing research
to the dance medicine body of literature.

Also included on

the panel of experts was a certified athletic trainer who
owns and operates her own pilates studio where she
regularly works with dance patients.

This certified

athletic trainer is also on faculty as an instructor in the
School of Graduate Studies in Exercise Science and Health
Promotion at California University of Pennsylvania.
Rounding out the panel of experts, and bringing a highly
respected perspective in the field of athletic training
education, is an NATA Hall of Fame Certified Athletic
Trainer and current Academic Provost at Hope College
(Holland, MI).

Prior to ascending to the position of

provost, this individual served as the athletic training
education program director at Hope College for over 25
years.
The purpose of the panel of experts was to review the
content of the instrument used to conduct the study; the
“Athletic Training Education and Dance Medicine Survey.”
The panel commented on the overall presentation of the

18
survey and also ensured that the questions were
appropriate, valid, and understandable.

The panel

recommended how certain questions should be re-stated and
also recommended adding some questions to the survey.

Instrumentation

The “Athletic Training Education and Dance Medicine
Survey” (Appendix C1) was the instrument used to conduct
this study.

As previously stated, this survey was

developed by the researcher in conjunction with a panel of
four experts with extensive background and experience in
the topic of the study being conducted.
One objective of the survey was to investigate the
frequency of dance medicine course content within CAATE
curricula as well as what determines its presence or nonpresence.

Another objective of the survey was to

investigate the frequency of dance medicine clinical
experience offered within CAATE curricula as well as what
determines its presence or non-presence.

A final objective

of the survey was to investigate the extent of athletic
training services being provided for dance programs by the
athletic training staff at colleges/universities also
offering an academic major/emphasis program in dance.

This

19
objective also included an investigation of possible
factors which might contribute to the extent of athletic
training services able to be provided for the academic
dance major/emphasis program by the college/university
athletic training staff.
“The Athletic Training and Dance Medicine Survey”
consisted of 23 questions.

Fourteen questions required the

program director to select one response from a list of
“Yes/No/NA.”

Four questions were written in a categorical

format requiring the program director to select “all that
apply.”

One of these categorical questions contained a

list with four possible responses, while three of these
categorical questions contained lists of six possible
responses.

Three questions were written in a short-answer

format requiring the program director to provide a one-word
(numerical) response.

Two questions were written in a

categorical format requiring the program director to select
a single response.

A total of four questions in the survey

offered the program director the option of providing
further information through a written response.

The

researcher estimated it would take approximately five
minutes for a program director to complete the survey.
Questions one through four of the “Athletic Training
Education and Dance Medicine Survey” were fundamental

20
demographic questions regarding the program directors’ work
setting, age, and gender.

The responses to these questions

provided the researcher with a base of informative data to
be applied to the statistical analysis of the study.
Questions five through 13 of the survey were
demographic questions more specific to the topic of the
study.

The intent of these questions was to gather

information about each subject’s personal experience in the
area of formal dance training, to gather information about
each subject’s educational background in general, to gather
information about each subject’s educational background
specific to the field of dance medicine, and to gather
information about each subject’s continuing education
experiences in the field of dance medicine.

The responses

to these questions by each program director provided the
researcher with informative data which was applied while
examining the validity of the program directors’
application of the content of questions 17 through 19.
Question 14 of the survey provided data for hypothesis
number one.

It accomplished this by revealing the current

frequency of dance medicine course content in athletic
training education curricula.
Question 15 of the survey provided data for hypothesis
number two, hypothesis number three, hypothesis number

21
four, and hypothesis number five.

It accomplished this by

revealing the current frequency of dance medicine clinical
experience in athletic training education curricula.
Question 16 of the survey investigated the frequency
of undergraduate entry-level athletic training education
programs that are part of a larger scope of learning
through that of a liberal-arts curriculum.

The responses

to this question provided the researcher with informative
data which was applied while examining the validity of the
program directors’ application of the content of questions
17 through 19.
Question 17 of the survey provided data for hypothesis
number one.

It accomplished this by revealing the

individual program director’s perspective to the following
question: “Does the management of the dancer patient by
certified athletic trainers require specialized
competencies in the ‘Cognitive Domain’ of Bloom’s Taxonomy
of Learning in addition to the cognitive domain
competencies required of certified athletic trainers for
the management of the traditional athlete patient?”
Question 18 of the survey provided data for hypothesis
number two.

It accomplished this by revealing the

individual program director’s perspective to the following
question:

“Does the management of the dancer patient by

22
certified athletic trainers require experiences in the
‘Affective Domain’ of Bloom’s Taxonomy of Learning?

The

NATA Educational Competencies (ed. 4) has removed the
affective domain from athletic training education.”
Question 18 also offered the program directors the option
of providing a written perspective response to the
statement regarding the most current edition of the NATA
Educational Competencies.
Question 19 of the survey provided data for hypothesis
number three.

It accomplished this by revealing the

individual program director’s perspective to the following
question:

“Does the management of the dancer patient by

certified athletic trainers require specialized
competencies in the ‘Psychomotor Domain’ of Bloom’s
Taxonomy of Learning in addition to the psychomotor domain
competencies required of certified athletic trainers for
the management of the traditional athlete patient?”
Question 20 of the survey provided data for hypothesis
number four.

It accomplished this by revealing the

frequency of an academic dance major/emphasis offering by
the individual program director’s college/university of
employment.

Question 20 was also a transition question of

the survey.

If the program director indicated that their

college/university of employment did not offer an academic

23
major/emphasis dance program, then the program director was
finished with the survey upon completion of question 20.
If the program director indicated that their
college/university of employment did offer an academic
major/emphasis dance program, then the program director
responded to three more survey questions.
Question 21 of the survey provided data for hypothesis
number five and hypothesis number six.

It accomplished

this by revealing the extent of athletic training services
provided for the dance program by the athletic training
staff at the program director’s college/university of
employment.
Question 22 of the survey provided data for hypothesis
number six.

It accomplished this by revealing if the

budget resources (staffing/supplies) available to the
athletic training staff at the program director’s
college/university of employment are sufficient enough to
provide athletic training services for a program (dance)
traditionally not affiliated with a college/university
department of athletics.
Question 23 of the survey provided data for hypothesis
number five and hypothesis number six.

It provided data

for hypothesis number five by revealing a possible key
factor in the extent of athletic training services provided

24
for the dance program by the athletic training staff at the
program director’s college/university of employment.
Question 23 provided data for hypothesis number six by
revealing a possible key factor impacting the extent of
budget resources (staffing/supplies) available to the
athletic training staff at the program director’s
college/university of employment in providing athletic
training services for the academic dance major/emphasis
program.

Procedures

The researcher completed the National Institute of
Health (NIH) on-line course in human subjects training
(Appendix C4).

Both the certificate of completion of this

course and the researcher’s validated survey were submitted
for approval to California University of Pennsylvania’s
Institutional Review Board (IRB) for Protection of Human
Subjects (Appendix C5) prior to the study actually being
conducted.
After approval was granted from the institutional
review board, the researcher completed and submitted the
NATA Research/Graduate Study Contact List Request Form.
The approval of this request form allowed the researcher to

25
obtain the services of the NATA list-serve for the purpose
of sending the survey via email to all 216 CAATE
undergraduate, entry-level graduate, and NATA postcertification athletic training education program directors
that are registered with the NATA to receive surveys.

As

previously indicated, the email containing the survey also
included a cover letter (Appendix C2) asking for the
program directors’ participation in the study, an
explanation of the objectives of the survey, and a section
describing how the researcher assured the program directors
that their responses to the survey questions would remain
anonymous.

The informed consent of the program directors

was implied by their anonymous responses to the web based
survey.
A link within the email cover letter provided the
program directors with direct access to begin the survey.
The researcher utilized “surveymonkey.com” to create this
direct link.

In conjunction with his advisor, the

researcher determined the best month/date to distribute the
survey via the NATA list-serve.

One day prior to

distributing the survey, the researcher utilized the “gift
music” module available at the web-based Apple iTunes Music
Store to promote the completion of the survey.

Each

recipient of the survey was gifted the U2 hit single “I’ll

26
Go Crazy If I Don’t Go Crazy Tonight,” redeemable via
download from Apple iTunes Music Store.

The researcher

attached the following note to the gifted single download:
You will soon be emailed the grad study survey:
ATHLETIC TRAINING EDUCATION and DANCE MEDICINE.
You’re probably thinking, “If I get another survey,
I’m gonna go crazy!!” And I’m thinking, “If I do not
get my response rate, I’m gonna go crazy!!” As a
symbol of my immense gratitude I am sending you this
iTunes gift of the “World’s Biggest Band.” The runtime of the song is the approx amount of time it will
take you to complete the survey. Thank you for your
help, and try not to go too crazy.
The researcher acquired a total of 53 completed
surveys during the first two weeks post distribution.

In

order to achieve the minimum standard of validity response
rate of 30% set by the researcher (n = 65), a second email
distribution was conducted (also via the NATA list-serve).
The second distribution kindly asked the program directors
who did not respond during the initial email distribution
to now complete and submit the survey.

Ever so determined

to achieve the minimum standard of validity response rate,
the researcher again utilized the “gift music” module
available at the web-based Apple iTunes Music Store to
promote completion of the survey.

This time, each

recipient of the survey was gifted the re-recorded hit
single “We Are the World 25 for Haiti” by Artists for
Haiti, redeemable via download from Apple iTunes Music

27
Store.

The researcher attached a new note to this second

gifted single download which read as follows:
You will soon (again) be receiving the grad
survey, “ATHLETIC TRAINING EDUCATION and DANCE
MEDICINE.” This “song of hope” was re-recorded on its
25th anniversary to inspire the rebuilding of Haiti.
I’m sending it with the added hope that it inspires
you to complete my grad survey. If you have already
completed the survey consider this my sincere THANK
YOU.
The researcher acquired an additional 23 completed
surveys during a time period of two weeks following the
follow-up distribution of the survey.

Based strictly on

“cardiac research,” it was determined that the iTunes
promotion was successful since the researcher acquired a
grand total of 76 completed surveys, achieving a 35%
response rate to the “Athletic Training Education and Dance
Medicine Survey.”
After accumulating the completed surveys, the
researcher tabulated the results.

Based on data analysis

of the demographic findings, hypotheses testing, and
additional findings (including lists of tables and lists of
figures), the researcher presented a written discussion of
the results.

Conclusions and recommendations were outlined

by the researcher with the intention of generating some
future direction and purpose for the discovered results of
the study in conjunction with the review of literature.

28
The researcher brought closure to the project by writing an
abstract which summarized the findings from the research
that was done, as well as the results of the study that was
conducted.

Hypotheses

The following hypotheses were formulated based on the
literature review and the intuition of the researcher:

H1:

The presence of dance medicine course content in CAATE

curricula is dependent on the program director’s view that
the management of the dancer patient by certified athletic
trainers requires specialized competencies in the
“Cognitive Domain” of Bloom’s Taxonomy of Learning (mental
skills – knowledge) in addition to the cognitive domain
competencies required of certified athletic trainers for
the management of the traditional athlete patient.

H2:

The presence of dance medicine clinical experience in

CAATE curricula is dependent on the program director’s view
that the management of the dancer patient by certified
athletic trainers requires experiences in the “Affective
Domain” of Bloom’s Taxonomy of Learning (growth in feelings

29
or emotional areas – attitude).

The NATA Educational

Competencies (ed. 4) has removed the affective domain from
athletic training education.

H3:

The presence of dance medicine clinical experience in

CAATE curricula is dependent on the program director’s view
that the management of the dancer patient by certified
athletic trainers requires specialized competencies in the
“Psychomotor Domain” of Bloom’s Taxonomy of Learning
(manual or physical skills – kinesthetics) in addition to
the psychomotor domain competencies required of certified
athletic trainers for the management of the traditional
athlete patient.

H4:

The presence of dance medicine clinical experience in

CAATE curricula is dependent on the existence of a dance
major/emphasis program at the college/university.

H5:

The presence of dance medicine clinical experience in

CAATE curricula (at colleges/universities with a dance
major/emphasis program) is dependent on the extent of
athletic training services provided for the dance program
by the college/university athletic training staff.

30
H6:

The extent of athletic training services provided for

the dance program by the college/university athletic
training staff is dependent on the athletic training budget
(staffing/supplies) having sufficient enough resources to
provide services to a program traditionally not affiliated
with the college/university department of athletics.

Data Analysis

The level of significance was set at 0.05.

H1:

A 2 (Presence of dance medicine course content –

Yes/No) X 3 (Program director’s view – Yes/No/I don’t kow)
chi-square test of independence was used to examine if the
presence of dance medicine course content in CAATE
curricula is dependent on the program director’s view that
the management of the dancer patient by certified athletic
trainers requires specialized competencies in the
“Cognitive Domain” of Bloom’s Taxonomy of Learning (mental
skills – knowledge) in addition to the cognitive domain
competencies required of certified athletic trainers for
the management of the traditional athlete patient.

31
H2:

A 2 (Presence of dance medicine clinical experience –

Yes/No) X 3 (Program director’s view – Yes/No/I don’t know)
chi-square test of independence was used to examine if the
presence of dance medicine clinical experience in CAATE
curricula is dependent on the program director’s view that
the management of the dancer patient by certified athletic
trainers requires experiences in the “Affective Domain” of
Bloom’s Taxonomy of Learning (growth in feelings or
emotional areas – attitude).

The most recent NATA

Educational Competencies (ed. 4) has removed the affective
domain from athletic training education.

H3:

A 2 (Presence of dance medicine clinical experience –

Yes/No) X 3 (Program director’s view – Yes/No/I don’t know)
chi-square test of independence was used to examine if the
presence of dance medicine clinical experience in CAATE
curricula is dependent on the program director’s view that
the management of the dancer patient by certified athletic
trainers requires specialized competencies in the
“Psychomotor Domain” of Bloom’s Taxonomy of Learning
(manual skills - kinesthetics) in addition to the
psychomotor domain competencies required of certified
athletic trainers for the management of the traditional
athlete patient.

32
H4:

A 2 (Presence of dance medicine clinical experience –

Yes/No) X 2 (Presence of a dance program – Yes/No) chisquare test of independence was used to examine if the
presence of dance medicine clinical experience in CAATE
curricula is dependent on the presence of a dance
major/emphasis program at the college/university.

H5:

A 2 (Presence of clinical experience – Yes/No) x 6

(Extent of athletic training services provided to the dance
program – no services, limited services, no formal
arrangement, formal arrangement, formal staff assignment,
other approaches) chi-square test of independence was used
to examine if the presence of dance medicine clinical
experience in CAATE curricula is dependent on the extent of
athletic training services provided for the dance program
by the college/university athletic training staff.

H6:

A 6 (Extent of athletic training services provided to

the dance program – no services, limited services, no
formal arrangement, formal arrangement, formal staff
assignment, other approaches) x 2 (Budgeted to provide
athletic training services – Yes/No) chi-square test of
independence was used to examine if the extent of athletic
training services provided for the dance program by the

33
college/university athletic training staff is dependent on
the athletic training budget having sufficient resources to
provide services to a program (dance) traditionally not
affiliated with the college/university department of
athletics.

34
RESULTS

Demographic Data

The population sample (N = 76) for this study
consisted of athletic training education program directors
(CAATE Undergraduate, CAATE Entry-level Graduate, and NATA
Post-Certification).

All respondents chose to participate

in this study on a strictly voluntary basis.

All responses

were anonymous.
The program directors were asked to provide general
demographic information.

The information included total

number of years served in the position of athletic training
education program director (all levels combined), the
program director’s age, and the program director’s own
dance experience/background by listing the total number of
years participating in formal dance training.

Table 1

illustrates the responses by the program directors to this
inquiry:
Table 1. General Demographics of ATE Program Directors
Characteristics
Range
Mean ± SD
Total Years(PD)
1-32
9.00 ± 6.99
Age
Total Years(Dance)

28-62

44.24 ± 7.99

0-13

.88 ± 2.27

35
The program directors were asked to indicate the type
of athletic training education curriculum they currently
oversee.

Table 2 illustrates the responses by the program

directors to this inquiry:
Table 2. ATE Curriculum Type
Classification
CAATE Entry-level
Undergraduate

Frequency
69

Percent
90.8

CAATE Entry-level
Graduate

5

6.6

NATA Post-Certification

2

2.6

The program directors were asked to indicate their
gender.

Table 3 illustrates the responses by the program

directors to this inquiry:
Table 3.
Gender
Female
Male

Gender of ATE Program Directors
Frequency
Percent
36
47.4
40
52.6

The program directors were asked to indicate their own
formal training (at any time of their life) in any/each of
a variety of styles of dance.

Table 4 illustrates the

styles of dance as well as the number of program directors
indicating formal training in each style:

36
Table 4. Formal Dance Training Experience - Style
Style
Frequency
Percent
Ballet
11
14.5
Contemporary
6
7.9
Tap
8
10.5
Jazz
4
5.3
Ethnic
4
5.3
No Experience
56
73.7

Formal Dance Training Experience

14.5

Ballet
7.9

Contemporary

10.5
73.7

5.3

Tap
Jazz
Ethnic

5.3

No Experience

Figure 1: Pie chart illustrating formal dance training
experience among athletic training education program
directors.

Table 5 is an expansion of Table 4 (above).

Table 5

illustrates the formal dance training experience of the
program directors in terms of total years of experience.

37
Table 5.
Years
0
1
2
3
4
5
7
10
13

Formal Dance Training Experience - Years
Frequency
Percent
56
73.6
7
9.2
5
6.5
1
1.3
1
1.3
1
1.3
2
2.6
1
1.3
1
1.3

Table 6 is also an expansion of Table 4 (above).

It

illustrates the formal dance training experience (yes/no)
of the program directors in terms of gender.
Table 6.
Gender
Female
Male

Formal Dance Training Experience - Gender
Frequency
Percent
15
75.0
5
25.0

The program directors were asked to indicate if the
college/university from which they received the majority of
their bachelor’s degree required students to complete
“core” courses as part of a liberal arts curriculum.

Table

7 illustrates the responses by the program directors to
this inquiry:
Table 7. Type of Bachelor’s Curriculum - PDs
Type
Frequency
Liberal Arts
63
Non-Liberal Arts
13

Percent
82.9
17.1

The program directors were asked to indicate the year
in which they completed their entry-level athletic training

38
education curriculum.

Table 8 illustrates the responses by

the program directors to this inquiry:
Table 8.
Year
0
1969
1970
1971
1973
1974
1975
1976
1978
1980
1981
1982
1983
1984
1985
1986
1987
1988
1990
1991
1992
1993
1994
1996
1997
1998
2000
2001
2002

Completion Year of Entry-level ATE Curriculum
Frequency
Percent
1
1.3
1
1.3
1
1.3
1
1.3
1
1.3
1
1.3
1
1.3
1
1.3
4
5.3
2
2.6
2
2.6
2
2.6
1
1.3
2
2.6
3
3.9
2
2.6
2
2.6
6
7.9
6
7.9
6
7.9
4
5.3
8
10.5
4
5.3
6
7.9
2
2.6
2
2.6
1
1.3
1
1.3
2
2.6

The program directors were asked to indicate if they
received any specialized course content in dance injuries
while a student in an entry-level athletic training
education curriculum.

Table 9 illustrates the responses by

the program directors to this inquiry:

39
Table 9.
Response
Yes
No

Received Dance Injury Course Content in ELATEC
Frequency
Percent
2
2.6
74
97.4

Received Dance Injury Course Content in
ELATE Curriculum
2.6

Yes
No
97.4

Figure 2: Pie chart illustrating the percentage of
athletic training education program directors who received
dance injury course content while a student in an entrylevel athletic training education curriculum.

The program directors were asked to indicate if they
had the opportunity to complete a clinical rotation in a
dance setting as a student in an entry-level athletic
training education curriculum.

Table 10 illustrates the

responses by the program directors to this inquiry:
Table 10.
Response
Yes
No

Dance Clinical Rotation during ELATEC
Frequency
Percent
1
1.3
75
98.7

40

Completed Dance Clinical Rotation during
ELATE Curriculum
1.3

Yes
No
98.7

Figure 3. Pie chart illustrating the percentage of
athletic training education program directors having
completed a dance clinical rotation as a student in an
entry-level athletic training education curriculum.

The program directors were asked to indicate the type
of master’s curriculum they completed in addition to, or
beyond an entry-level athletic training education
curriculum.

The options included:

NATA Post-Certification

Curriculum, Non-NATA Curriculum WITH an Athletic Training
Graduate Assistantship Position, Non-NATA Curriculum
WITHOUT an Athletic Training Graduate Assistantship
Position, No Completion of a Master’s Curriculum in
addition to or beyond an Entry-level Athletic Training
Education Curriculum.

Table 11 illustrates the responses

by the program directors to this inquiry:

41
Table 11. Type of Master’s Curriculum Completed
Curriculum Type
Frequency
NATA Post-Certification
27
Non-NATA w/ AT GA
38
Non-NATA w/out AT GA
10
No Master’s Completion
2

Percent
35.5
50.0
13.2
2.6

The program directors were asked to indicate if they
received any specialized course content in dance injuries
as part of their master’s curriculum (in addition to, or
beyond an entry-level athletic training education
curriculum).

Table 12 illustrates the responses by the

program directors to this inquiry:
Table 12.
Response
Yes
No
NA

Dance Injury Course Content in Grad Curriculum
Frequency
Percent
0
0
73
96.1
3
3.9

42

Received Dance Injury Course Content in
Graduate Curriculum
3.90

Yes
No
NA
96.1

Figure 4. Pie chart illustrating the percentage of
athletic training education program directors having
received dance injury course content as a student in a
graduate curriculum in addition to, or beyond an entrylevel athletic training education curriculum.

The program directors were asked to indicate if they
had the opportunity to complete a clinical rotation in a
dance setting as part of their master’s curriculum (in
addition to, or beyond an entry-level athletic training
education curriculum).

Table 13 illustrates the responses

by the program directors to this inquiry:
Table 13.
Response
Yes
No
NA

Dance Clinical Rotation during Grad Curriculum
Frequency
Percent
2
2.6
71
93.4
3
3.9

43

Completed Dance Clinical Rotation during
Graduate Curriculum
3.9 2.6

Yes
No
NA
93.4

Figure 5: Pie chart illustrating the percentage of athletic
training education program directors having completed a
dance clinical rotation as a student in a graduate
curriculum in addition to, or beyond, an entry-level
athletic training education curriculum.

The program directors were asked to indicate if they
have participated in a dance medicine continuing education
experience through attending a dance medicine conference or
workshop during their years as a certified athletic
trainer.

Table 14 illustrates the responses by the program

directors to this inquiry:
Table 14.
Response
Yes
No

Dance Medicine Continuing Education Experience
Frequency
Percent
19
25.0
57
75.0

44

Dance Medicine Continuing Education
Experience

25
Yes
No
75

Figure 6: Pie chart illustrating the percentage of
athletic training education program directors having
completed a dance medicine continuing education experience.

The program directors were asked to indicate if the
college/university of their current employment requires
undergraduate athletic training students to complete “core”
courses as part of a liberal arts curriculum.

Table 15

illustrates the responses by the program directors to this
inquiry:
Table 15. Type of Bachelor’s Curriculum – ATE Students
Type
Frequency
Percent
Liberal Arts
66
86.8
Non-Liberal Arts
8
10.5

45

CAATE Entry Level ATE Curricula as part of a
Liberal Arts Bachelor's Curriculum
10.5

Yes
No
86.8

Figure 7: Pie chart illustrating the percentage of CAATE
entry-level undergraduate athletic training education
curricula at colleges/universities that also require their
undergraduate students to complete “core” courses as part
of a liberal arts bachelor’s degree curriculum.

The program directors were asked to indicate if their
college/university of employment offers an academic
major/emphasis program in dance.

A total of 33 program

directors responded in the affirmative to this question.
Only the program directors who indicated their
college/university does offer an academic major/emphasis in
dance were asked to indicate if the dance program is
affiliated with the college/university’s department of
athletics.

Table 16 illustrates the responses by the

program directors to this inquiry:

46
Table 16.
Type
Yes
No

Dance Program Affiliated with Athletics Dept.
Frequency
Percent
1
3.0
32
97.0

Hypotheses Testing

All hypotheses were tested at an alpha level of .05.

Hypotheses 1:

A 2 (Presence of dance medicine course

content – Yes/No) X 3 (Program director’s view – Yes/No/I
don’t know) chi-square test of independence was used to
examine if the presence of dance medicine course content is
dependent on the program director’s view that the
management of the dancer patient by certified athletic
trainers requires specialized competencies in the
“Cognitive Domain” of Bloom’s Taxonomy of Learning (mental
skills – knowledge) in addition to the cognitive domain
competencies required of certified athletic trainers for
the management of the traditional athlete patient.

No

significance was found(X22 = .606, P > .05).
Conclusion:

The presence of dance medicine course

content is independent of the program director’s view that
the management of the dancer patient by certified athletic
trainers requires specialized competencies in the
“Cognitive Domain” of Bloom’s Taxonomy of Learning (mental

47
skills – knowledge) in addition to the cognitive domain
competencies required of certified athletic trainers for
the management of the traditional athlete patient (Table
17).
Table 17. 2X3 Chi-Square Independence Test for the
Presence of Dance Medicine Course Content / Program
Director’s View of Bloom’s Taxonomy - Cognitive Domain.
PD View
Yes
No
X2
P Value
Yes
3
19
.606
.738
No
6
44
I don’t know
0
4

Hypotheses 2:

A 2 (Presence of dance medicine

clinical experience – Yes/No) X 3 (Program director’s view,
Affective domain – Yes/No/I don’t know) chi-square test of
independence was used to examine if the presence of dance
medicine clinical experience is dependent on the program
director’s view that the management of the dancer patient
by certified athletic trainers requires experiences in the
“Affective Domain” of Bloom’s Taxonomy of Learning (growth
in feelings or emotional areas – attitude).

The most

recent NATA Educational Competencies (ed. 4) has removed
the “affective domain” from athletic training education.
No significance was found (X22 = 1.259, P > .05).
Conclusion:

The presence of dance medicine clinical

experience is independent of the program director’s view
that the management of the dancer patient by certified

48
athletic trainers requires specialized competencies in the
“Affective Domain” of Bloom’s Taxonomy of Learning (growth
in feelings or emotional areas – attitude), with the
knowledge that the most recent NATA Educational
Competencies (ed. 4) has removed the “affective domain”
from athletic training education (Table 18).
Table 18. 2X3 Chi-Square Independence Test for the
Presence of Dance Clinical Experience / Program Director’s
View of Bloom’s Taxonomy - Affective Domain.
PD View
Yes
No
X2
P Value
Yes
4
18
1.259
.533
No
10
39
I don’t know
0
5

Hypotheses 3:

A 2 (Presence of dance medicine

clinical experience – Yes/No) X 3 (Program director’s view,
Psychomotor domain - Yes/No/I don’t know) chi-square test
of independence was used to examine if the presence of
dance medicine clinical experience is dependent on the
program director’s view that the management of the dancer
patient by certified athletic trainers requires specialized
competencies in the “Psychomotor Domain” of Bloom’s
Taxonomy of Learning (manual skills - kinesthetics) in
addition to the psychomotor domain competencies required of
certified athletic trainers for the management of the
traditional athlete patient.
= .930, P > .05).

No significance was found (X22

49
Conclusion:

The presence of dance medicine clinical

experience is independent of the program director’s view
that the management of the dancer patient by certified
athletic trainers requires specialized competencies in the
“Psychomotor Domain” of Bloom’s Taxonomy of Learning
(manual skills - kinesthetics) in addition to the
psychomotor domain skills required of certified athletic
trainers for the management of the traditional athlete
patient (Table 19).
Table 19. 2X3 Chi-Square Independence Test for the
Presence of Dance Clinical Experience / Program Director’s
View of Bloom’s Taxonomy - Psychomotor Domain.
PD View
Yes
No
X2
P Value
Yes
5
16
.930
.628
No
9
44
I don’t know
0
2

50

12
10

10
9

8
6
4

8
Cognitive
6

Affective
5

Psychomotor

4

2
0

0
Yes

No

0

0

I Don't Know

Figure 8. Column-chart illustrating the program directors’
views that the management of the dancer patient by
certified athletic trainers requires specialized
competencies (Yes, No, I don’t know) in the 3 domains of
Bloom’s Taxonomy of Learning (Cognitive, Affective,
Psychomotor). The numbers in this chart represent only the
views of the program directors overseeing ATE curricula
offering a dance clinical rotation experience.

51

50
45
40

44

42
39

35
30

Cognitive

25

Affective

20
15

16

18

Psychomotor
16

10
5

4

0
Yes

No

5

2

I don't know

Figure 9. Column-chart illustrating the program directors’
views that the management of the dancer patient by
certified athletic trainers requires specialized
competencies (Yes, No, I don’t know) in the 3 domains of
Bloom’s Taxonomy of Learning (Cognitive, Affective,
Psychomotor). The numbers in this chart represent only the
views of the program directors overseeing ATE curricula not
offering a dance clinical rotation experience.

Hypotheses 4:

A 2 (Presence of dance medicine

clinical experience – Yes/No) X 2 (Presence of a dance
program – Yes/No) chi-square test of independence was used
to examine if the presence of dance medicine clinical
experience is dependent on the presence of a dance
major/emphasis academic program being offered by the
college/university.

No significance was found (X22 = .302,

P > .05).
Conclusion:

The presence of dance medicine clinical

experience is independent of the presence of a

52
dance major/emphasis academic program being offered by the
college/university (Table 20).
Table 20. 2X2 Chi-Square Independence Test for the
Presence of Dance Clinical Experience / Presence of a Dance
Major/Emphasis Program at the College/University.
Dance Major
Yes
No
X2
P Value
Yes
7
26
.302
.582
No
7
36

Hypotheses 5A:

A 2 (Presence of dance clinical

experience – Yes/No) x 2 (Extent of AT services provided by
the AT staff for the college/university dance program – No
Services/Another Category) chi-square test of independence
was used to examine if the presence of dance clinical
experience is dependent on the extent of athletic training
services provided by the athletic training staff for the
college/university dance program.

No significance was

found (X22 = 1.021, P > .05).
Conclusion:

The presence of dance medicine clinical

experience is independent of the extent of athletic
training services (no services) provided by the athletic
training staff for the college/university dance program
(Table 21).
Table 21. 2X2 Chi-Square Independence Test for the
Presence of Dance Clinical Experience / Extent of AT
Services Provided by AT Staff for the Dance Program.
Extent of Services
Yes
No
X2
P Value
Another Category
5
13
1.021
.312
No Services
2
13

53
Hypotheses 5B:

A 2 (Presence of dance clinical

experience – Yes/No) x 2 (Extent of AT services provided by
the AT staff for the college/university dance program –
Limited Services/Another Category) chi-square test of
independence was used to examine if the presence of dance
clinical experience is dependent on the extent of athletic
training services provided by the athletic training staff
for the college/university dance program.

No significance

was found (X22 = 1.056, P > .05).
Conclusion:

The presence of dance medicine clinical

experience is independent of the extent of athletic
training services (limited services) provided by the
athletic training staff for the college/university dance
program (Table 22).
Table 22. 2X2 Chi-Square Independence Test for the
Presence of Dance Clinical Experience / Extent of AT
Services Provided by AT Staff for the Dance Program.
Extent of Services
Yes
No
X2
P Value
Another Category
6
25
1.056
.304
Limited Services
1
1

Hypotheses 5C:

A 2 (Presence of dance clinical

experience – Yes/No) x 2 (Extent of AT services provided by
the AT staff for their college/university dance program –
Occasional Services, No Formal Arrangement/Another
Category) chi-square test of independence was used to
examine if the presence of dance clinical experience is

54
dependent on the extent of athletic training services
provided by the athletic training staff for the
college/university dance program.

No significance was

found (X22 = 2.843, P > .05).
Conclusion:

The presence of dance medicine clinical

experience is independent of the extent of athletic
training services (occasional services – no formal
arrangement) provided by the athletic training staff for
the college/university dance program (Table 23).
Table 23. 2X2 Chi-Square Independence Test for the
Presence of Dance Clinical Experience / Extent of AT
Services Provided by AT Staff for the Dance Program.
Extent of Services
Yes
No
X2
P Value
Another Category
7
18
2.843 .092
Occasional(No formal
0
8
arrangement)

Hypotheses 5D:

A 2 (Presence of dance clinical

experience – Yes/No) x 2 (Extent of AT services provided by
the AT staff for their college/university dance program –
Frequent Services, Formal Arrangement/Another Category)
chi-square test of independence was used to examine if the
presence of dance clinical experience is dependent on the
extent of athletic training services provided by the
athletic training staff for the college/university dance
program.

No significance was found (X22 = 1.056, P > .05).

55
Conclusion:

The presence of dance medicine clinical

experience is independent of the extent of athletic
training services (frequent services – formal arrangement)
provided by the athletic training staff for the
college/university dance program (Table 24).
Table 24. 2X2 Chi-Square Independence Test for the
Presence of Dance Clinical Experience / Extent of AT
Services Provided by AT Staff for the Dance Program.
Extent of Services
Yes
No
X2
P Value
Another Category
6
25
1.056 .304
Frequent (Formal
1
1
arrangement)

Hypotheses 5E:

A 2 (Presence of dance clinical

experience – Yes/No) x 2 (Extent of AT services provided by
the AT staff for their college/university dance program –
ATC Assignment/Another Category) chi-square test of
independence was used to examine if the presence of dance
clinical experience is dependent on the extent of athletic
training services provided by the athletic training staff
for the college/university dance program.

A significant

interaction was found (X22 = 7.880, P < .01).
Conclusion:

The presence of dance medicine clinical

experience is more likely when a certified athletic trainer
(full time, part time, or grad assistant) is assigned
formal responsibilities in providing athletic training

56
services to the college/university dance program (Table
25).
Table 25. 2X2 Chi-Square Independence Test for the
Presence of Dance Clinical Rotation / Extent of AT Services
Provided by AT Staff for the Dance Program.
Extent of Services
Yes
No
X2
P Value
Another Category
4
25
7.880 .005
ATC Assignment
3
1

25

25
20
15

Another Category

10
5

3

ATC Assignment

4

1
ATC Assignment

0

Another Category
Dance Clinical
Rotation - Yes

Dance Clinical
Rotation - No

Figure 10. Column-chart illustrating a chi-square
independence test for the presence of a dance clinical
rotation (Yes/No) and the extent of athletic training
services provided by the athletic training staff for the
dance program (ATC Assignment/Another Category).

Hypotheses 5F:

A 2 (Presence of dance clinical

experience – Yes/No) x 2 (Extent of AT services provided by
the AT staff for their college/university dance program –
Other, Not Listed/Previously Indicated) chi-square test of

57
independence was used to examine if the presence of dance
clinical experience is dependent on the extent of athletic
training services provided by the athletic training staff
for the college/university dance program.

No significance

was found (X22 = 3.636, P > .05).
Conclusion:

The presence of dance medicine clinical

experience is independent of the extent of athletic
training services (other - not listed) provided by the
athletic training staff for the college/university dance
program (Table 26).
Table 26. 2X2 Chi-Square Independence Test for the
Presence of Dance Clinical Experience / Extent of AT
Services Provided by AT Staff for the Dance Program.
Extent of Services
Yes
No
X2
P Value
Previously Indicated
4
23
3.636 .057
Other (Not Listed)
3
3

Table 27 is an expansion of tables 21 - 26 (above).

A

2 (Presence of dance clinical experience – Yes/No) x 2 (Any
amount of AT services provided by the AT staff for their
college/university dance program – Yes/No) chi-square test
of independence was used to examine if the presence of
dance clinical experience is dependent on athletic training
services being provided by the athletic training staff for
their college/university dance program.
was found (X22 = 1.021, P > .05).

No significance

58
Table 27. 2X2 Chi-Square Independence Test for the
Presence of Dance Clinical Experience / AT Services
Provided by AT Staff for the Dance Program – Yes, No.
AT Services Provided
Yes
No
X2
P Value
Yes
5
13
1.021 .312
No
2
13

Hypotheses 6:

A 2 (AT services provided by the AT

staff for their college/university dance program – Yes/No)
x 3 (Athletic training budget sufficient to provide
athletic training services to the college/university dance
program – Yes/No/I don’t know) chi-square test of
independence was used to examine if the capability of
providing AT services for their college/university dance
program was dependent on the athletic training budget
having sufficient enough resources in the areas of staffing
and supplies. No significance was found (X22 = 2.918, P >
.05).
Conclusion:

The capability of providing athletic

training services by the athletic training staff for their
college/university dance program is independent of the
athletic training budget having sufficient resources in the
areas of staffing and supplies (Table 28).
Table 28: 2X2 Chi-Square Independence Test for Provides AT
Services for the Dance Program / Athletic Training Budget
Having Sufficient Resources – Yes, No, I don’t know.
Sufficient Resources
Yes
No
X2
P Value
Yes
5
1
2.918 .232
No
11
13
I don’t know
2
1

59
Additional Findings

A chi-square test of independence was used to examine
if the presence of dance injury course content in an
athletic training education curriculum is dependent on the
program director having received dance injury course
content as a student in an entry-level athletic training
education curriculum.

No significance was found (X22 =

2.865, P > .05).
Conclusion:

The presence of dance injury course

content in an athletic training education curriculum is
independent of the program director of the curriculum
having received dance injury course content as a student in
an entry-level athletic training education curriculum
(Table 29).
Table 29: 2X2 Chi-Square Independence Test for Presence of
Dance Injury Course Content in PD’s Curriculum – Yes, No /
PD Received Dance Injury Course Content in Entry-level ATE
Curriculum – Yes, No.
Received DICC in ELATEC
Yes
No
X2
P Value
Yes
1
1
2.865
.091
No
8
66

A chi-square test of independence was used to examine
if the presence of a dance clinical rotation in athletic
training education curricula is dependent on the program
director having received dance injury course content as a

60
student in an entry-level athletic training education
curriculum.

A significant interaction was found (X22 =

9.097, P < .01).
Conclusion:

The presence of a clinical dance rotation

as part of an athletic training education curriculum is
more likely to occur if the program director received dance
injury course content as a student in an entry-level
athletic training education curriculum (Table 30).
Table 30: 2X2 Chi-Square Independence Test for Presence of
Dance Clinical Rotation in PD’s Curriculum – Yes, No / PD
Received Dance Injury Course Content in Entry-level ATE
Curriculum – Yes, No.
Received DICC in ELATEC
Yes
No
X2
P Value
Yes
2
0
9.097
.003
No
12
62

61

62

70
60
50
40

DICC in ELATC - Yes

30
20

0

10

DICC in ELATC - NO
12

2

DICC in ELATC - NO

0

DICC in ELATC - Yes
DCR in PD's
Curriculum - Yes

DCR in PD's
Curriculum - No

Figure 11. Column-chart illustrating a chi-square
independence test for the presence of a dance clinical
rotation experience (Yes/No) in ATE curricula overseen by
the program director, and the program director having
received dance injury course content as a student in an
entry-level athletic training education curriculum
(Yes/No).

A chi-square test of independence was used to examine
if the presence of a dance clinical rotation in an athletic
training education curriculum is dependent on the program
director having completed a dance clinical rotation while a
student in an entry-level athletic training education
curriculum.

A significant interaction was found (X22 =

4.488, P < .05).
Conclusion:

The presence of a dance clinical rotation

as part of an athletic training education curriculum is
more likely to occur if the program director completed a

62
dance clinical rotation as a student in an entry-level
athletic training education curriculum (Table 31).
Table 31: 2X2 Chi-Square Independence Test for Presence of
Dance Clinical Rotation in PD’s Curriculum – Yes, No / PD
Completed a Dance Clinical Rotation in Entry-level ATE
Curriculum – Yes, No.
Completed DCR in ELATEC
Yes
No
X2
P Value
Yes
1
0
4.488
.034
No
13
62

62

70
60
50
40

DCR in ELATC - Yes

30
20
10

0

DCR in ELATC - No
13
DCR in ELATC - No

1

0

DCR in ELATC - Yes
DCR in PD's
Curriculum - Yes

DCR in PD's
Curriculum - No

Figure 12. Column-chart illustrating a chi-square
independence test for the presence of a dance clinical
rotation experience (Yes/No) in the ATE curriculum overseen
by the program director and the program director having
completed a dance clinical rotation experience while a
student in an entry-level athletic training education
curriculum (Yes/No).

A chi-square test of independence was used to examine
if the perspective of certified athletic trainers needing
specific dance experiences in the “Affective Domain” of

63
“Bloom’s Taxonomy of Learning” is dependent on the program
director having received dance injury course content as a
student in an entry-level athletic training education
curriculum.

No significance was found (X22 = 5.042, P >

.05).
Conclusion:

The perspective of certified athletic

trainers needing specific dance experiences in the
“Affective Domain” of “Bloom’s Taxonomy of Learning” is
independent of the program director having received dance
injury course content in an entry-level athletic training
education curriculum (Table 32).
Table 32: 2X2 Chi-Square Independence Test for ATC’s Need
Specific Dance Experiences in the Affective Domain of
Bloom’s Taxonomy – Yes, No / PD Received Dance Injury
Course Content in Entry-level ATE Curriculum – Yes, No.
Received DICC in ELATEC
Yes
No
X2
P Value
Yes
2
0
5.042
.080
No
20
49

A chi-square test of independence was used to
determine if the presence of a dance clinical rotation in
an athletic training education curriculum is dependent on
the program director having completed a dance medicine
continuing education experience.

No significance was found

(X22 = 2.919, P > .05).
Conclusion:

The presence of a dance medicine clinical

rotation in an athletic training education curriculum is

64
independent of the program director having completed a
dance medicine continuing education experience (Table 33).
Table 33: 2X2 Chi-Square Independence Test for Presence of
Dance Clinical Rotation in PD’s Curriculum – Yes, No /
Program Director’s Participation in a Dance Medicine
Continuing Education Experience – Yes, No.
Dance Med CEU Experience
Yes
No
X2
P Value
Yes
6
13
2.919
.088
No
8
49

65
DISCUSSION

This section includes the following subsections:

1)

Discussion of Results (Formal Dance Training Experience,
Dance Medicine Education, Liberal Arts Education, Bloom’s
Taxonomy of Learning, Cognitive Domain, Affective Domain,
Psychomotor Domain, Athletic Training Services Provided for
College/University Dance Programs); 2) Conclusions, and 3)
Recommendations.

Discussion of Results

A total of 216 athletic training education program
directors (ATEPDs) were emailed the web-based survey,
“Athletic Training Education and Dance Medicine.”

A total

of 76 athletic training education program directors
(ATEPDs) completed the survey equaling a 35% response rate.
The minimum response rate standard was exceeded, and the
survey was deemed “valid.”

Formal Dance Training Experience
Of the 76 ATEPD respondents, a total of 56 (74%)
responded as having no formal dance training experience.
total of 20 ATEPDs indicated formal dance training in one

A

66
or more of the included styles of dance (ballet,
contemporary, tap, jazz, ethnic).

Only four (.05%)

reported five or more years of formal training.

Dance Medicine Education
The number of ATEPDs having never been exposed to
dance medicine in their entry-level classrooms is
significantly high, yet not surprising.

A total of 74

(97%) ATEPD respondents reported not having received dance
injury course content while a student in an entry-level
athletic training education curriculum.
The percentage of ATEPDs having never experienced the
dance culture as part of their entry-level clinical
rotations is also significantly high, and also not
surprising.

A total of 75 (99%) ATEPD respondents reported

never completing a dance clinical rotation as part of their
entry-level athletic training education curriculum.
The number of ATEPDs having never been exposed to
dance medicine in their advanced education classrooms is
significantly high, yet not surprising.

Out of 76 ATEPD

respondents, 73 (96%) reported having completed a master’s
curriculum in addition to or beyond an entry-level athletic
training education curriculum.

Out of these 73 ATEPDs, all

67
73 (100%) reported not having received dance injury course
content as part of their master’s curriculum.
The percentage of ATEPDs having never experienced the
dance culture as part of their advanced clinical rotations
is also significantly high, and also not surprising.

Out

of the 73 ATEPDs having completed a master’s curriculum in
addition to or beyond an entry-level athletic training
education curriculum, 71 (97%) reported never completing a
dance clinical rotation as part of their master’s
curriculum.
Continuing education among ATEPDs in the area of dance
medicine is minimal.

A total of 57 (75%) ATEPD respondents

reported never participating in a dance medicine continuing
education experience during their tenure as a certified
athletic trainer.

Liberal Arts Education
The Association of American Colleges and Universities13
offer the following description on the nature and purposes
of a “liberal-arts education:”
Liberal education is an approach to learning that
empowers individuals and prepares them to deal with
complexity, diversity, and change. It provides
students with broad knowledge of the wider world (e.g.
science, culture, and society) as well as in-depth
study in a specific area of interest. A liberal
education helps students develop a sense of social

68
responsibility, as well as strong and transferable
intellectual and practical skills such as
communication, analytical and problem-solving skills,
and a demonstrated ability to apply knowledge and
skills in real-world settings.
Of the 76 ATEPD respondents, 74 reported being
employed by colleges/universities that offered an
undergraduate entry-level athletic training education
curriculum.

A total of 66 of the 74 undergraduate entry-

level athletic training education curricula belong to
colleges/universities that require undergraduate athletic
training students to complete “core” courses as part of an
overall liberal-arts learning experience.

The data of this

study clearly reveals that an overwhelmingly high
percentage (86.8%) of CAATE undergraduate entry-level
athletic training education programs exist only as part of
a larger scope of learning within the liberal arts
curriculum of their college/university.
The data of this study also reveals 67 of the 74
undergraduate entry-level athletic training education
curricula (88.2%) do not offer any amount of specialized
course content in the area of managing the injured dancer
patient.

A total of 62 of the 74 undergraduate entry-level

athletic training education curricula (81.6%) do not offer
clinical rotations in any sort of dance setting.

69
When examining the data of this study alongside the
description provided by the Association of American
Colleges and Universities on the nature and purposes of a
liberal-arts education the inevitable and critical question
becomes, “Why do so few undergraduate entry-level athletic
training education curricula aim to develop social
responsibility in athletic training students by offering
experiential learning opportunities in a setting which
would empower athletic training students with broad
knowledge of the wider world (e.g. science, culture, and
society) as well as an in-depth study in a specific area of
interest?” The nature of this inevitable and critical
question is of course referencing experiential learning
opportunities for athletic training students in dance
settings.

The purpose of this question is to prepare

athletic training students for the diversity of the dance
culture, as well as the complexity of the mind, spirit, and
body of the dancer athlete/artist hybrid.

Bloom’s Taxonomy of Learning
In 1956 educational psychologist Benjamin Bloom
identified three domains of educational activities now
known as "Bloom's Taxonomy of Learning." The three domains
are still very much relevant in 21st century educational

70
practices and are applied in educational curriculums
throughout the United States.

The three Domains of

"Bloom's Taxonomy of Learning" include: Cognitive (mental
skills –knowledge), Affective (growth in feelings or
emotional areas – attitude), and Psychomotor (manual or
physical skills – kinesthetics).

“Cognitive Domain” (Mental Skills – Knowledge)
All 76 ATEPD respondents were asked the question, “Do
you think that the management of the dancer patient by
certified athletic trainers requires specialized
competencies in the “Cognitive Domain” of Bloom’s Taxonomy
of Learning in addition to the “cognitive domain”
competencies required of certified athletic trainers for
the management of the traditional athlete patient?”

A

total of 22 ATEPD’s (28.9%) responded “Yes” to this
question.

A total of 50 ATEPD’s (65.8%) responded “No” to

this question.

A total of four ATEPD’s (5.3%) responded “I

don’t know” to this question.

Excerpts from the “Athletic

Training Education and Dance Medicine Review of Literature”
follow:
According to Marijeane Liederbach PhD, PT, ATC,12 “You
rehab a dancer differently from other athletes because they
have different functional tasks.” She also adds, “We don’t

71
let our employees go near a dance environment unless
they’ve had mentorship training.

You really need to build

a background by taking dance medicine classes or finding a
mentor you can shadow in that setting.”
Because of the extreme and exaggerated movement
patterns involved in the biomechanics of dance, combined
with their demanding aesthetic requirements, the mechanism
of dance injuries and the rehabilitation of dance injuries
are often unique to this culture.

Numerous authors have

commented on the importance of not only appreciating the
different facets of dance, but of the unique role of
technique in dance-related overuse injuries and
treatments.2,4,5,10 Once again Marijeanne Liederbach,5 a
prominent author in the area of dance medicine, expressed
the following thoughts in an article on the rehabilitation
of dance injuries:
Effective rehabilitation of dance injuries
requires a skilled therapist capable of understanding
the multiple factors involved in the injury’s etiology
and able to create a style-specific, staged
rehabilitation plan, and a dancer ultimately committed
to independent management of the injury, including an
attempt to understand its cause. Dance rehabilitation
is a dynamic process that ultimately depends on
careful communication between the dancer and
therapist. Fundamental to this process is the regular
reassessment of the dancer’s functional ability. In
order for rehabilitation to be fully complete, the
clinician-in-charge must possess a trained eye
sensitive to the full palette of demands and nuances
of the movement form to which the dancer wishes to

72
return. Partnership with the injured dancer’s teacher
or artistic director is advised, and perhaps
essential; the clinician should understand the
dancer’s work setting so that full movement skill
refinement can be attained and the dancer become ready
to seamlessly and confidently reenter her work
setting.
The initial observation to the responses in the
“cognitive domain” involves questioning the ATEPDs
foundation for perspective in this area of dance medicine.
As detected in the demographic data, the percentage of
ATEPDs with substantive experience in dance culture is
glaringly minimal.

The majority response (“No”) to the

cognitive domain question by the ATEPDs suggests a
contradiction with the dance medicine literature review.
More research in needed in this area.

It was also detected

in the demographic data that 75% of ATEPDs have not
experienced continuing education in dance medicine.

The

capacity to adequately understand and value the mind,
spirit, and body of the dancer athlete/artist hybrid
requires experiential learning.

Further investigation is

needed into the validity of the ATEPDs application of the
Cognitive Domain of Bloom’s Taxonomy of Learning in the
area of dance medicine.
A second observation to the responses in the
“cognitive domain” is one of statistical analysis.

Because

the Athletic Training Education and Dance Medicine Survey

73
achieved a 35% response rate it was deemed as being a
statistically “valid” survey (30% being the minimal
response rate standard of validity).

The percentage of

“Yes” responses to the “cognitive domain” question was
barely under 30% (28.9%).

In keeping consistent with the

same statistical standard of validity, a response selection
receiving 30% is a “valid” point of view deserving of
further investigation.
A third observation to the responses in the “cognitive
domain” involves a historical analysis.

The Journal of

Dance Medicine and Science made its debut in 1994.

The

Harkness Center for Dance Injuries (A Division of the NYU
Hospital for Bone and Joint Disease) was established in
2002.

Both are significant contributors to the evolution

of dance medicine as a profession.

Hypothetically

speaking, if the “cognitive domain” question was to have
been asked of ATEPDs prior to 1994, what would have been
the percentage of “Yes” responses?

If this question is

asked of ATEPD’s ten years from now, what will be the
percentage of “Yes” responses?

Follow-up studies should be

conducted.
Finally, a chi-square test of independence determined
that the presence of a clinical rotation experience in a
dance setting is more likely to be offered as part of an

74
athletic training education curriculum if the program
director received dance injury course content as a student
in an entry-level athletic training education curriculum.

“Affective Domain” (Growth in Feelings or Emotional Areas –
Attitude)
All 76 ATEPD respondents were asked the question, “Do
you think that the management of the dancer patient by
certified athletic trainers requires specialized
competencies in the “Affective Domain” of Bloom’s Taxonomy
of Learning?

The most recent NATA Educational Competencies

(ed. 4) has removed the "Affective Domain" of Bloom's
Taxonomy of Learning from athletic training education.”

A

total of 22 ATEPDs (28.9%) responded “Yes” to this
question.

A total of 49 ATEPDs (64.5%) responded “No” to

this question.

A total of five ATEPDs (6.6%) responded “I

don’t know” to this question.

Excerpts from the “Athletic

Training Education and Dance Medicine Review of Literature”
follow:
The greater number of diverse experiences that
athletic training students have, the more prepared they
will be for the work force.

According to Liederbach,12 “A

certified athletic trainer graduating from a program that
does not include dance medicine should not expect to go

75
straight into that setting and succeed.”

Dr. Liederbach’s

thoughts are reinforced by the descriptive writings of
legendary dance instructor Rudolph Laban12:
The term “flow” is used in Laban theory to
describe how the movement passes through the body.
The term “dynamic alignment” refers to the
neuromuscular patterning or posture that responds
accurately and sensitively to changes in standing,
walking, and sitting, and provides a flexible
relationship with the environment. The term “body
attitude” describes the particular way in which a
person’s body reflects his or her internal feelings.
In Laban theory, this is the body’s “accommodation” to
space – convex, concave, or vertical, for example.
Posture is more than a physical relationship between
body parts; it is as personal as a signature, and body
therapists view it as a meaningful, revealing part of
a person’s life history.
The initial observation to the responses in the
“affective domain” invokes questioning the ATEPDs
foundation for perspective in this area of dance medicine.
As detected in the demographic data, the percentage of
ATEPDs with substantive experience in dance culture is
glaringly minimal.

The majority response (“No”) to the

affective domain question by the ATEPDs suggests a
contradiction with the dance medicine literature review.
More research in needed in this area.

It was also detected

in the demographic data that 75% of ATEPDs have not
experienced continuing education in dance medicine. The
capacity to adequately understand and value the mind,
spirit, and body of the dancer athlete/artist hybrid

76
requires experiential learning.

Further investigation is

needed into the validity of the ATEPDs application of the
Affective Domain of Bloom’s Taxonomy of Learning in the
area of dance medicine.
A second observation in the “affective domain” is one
of statistical analysis.

Because the Athletic Training

Education and Dance Medicine Survey achieved a 35% response
rate it was deemed as being a statistically “valid” survey
(30% being the minimal response rate standard of validity).
The percentage of “Yes” responses to the “affective domain”
question was barely under 30% (28.9%).

In keeping

consistent with the same statistical standard of validity,
a response selection receiving 30% is a “valid” point of
view deserving of further investigation.
A third observation in the “affective domain” involves
a historical analysis.

The Journal of Dance Medicine and

Science made its debut in 1994.

The Harkness Center for

Dance Injuries (A Division of the NYU Hospital for Bone and
Joint Disease) was established in 2002.

Both are

significant contributors to the evolution of dance medicine
as a profession.

Hypothetically speaking, if the

“affective domain” question was to have been asked of
ATEPDs prior to 1994, what would have been the percentage
of “Yes” responses?

If this question is asked of ATEPD’s

77
ten years from now, what will be the percentage of “Yes”
responses?

Follow-up studies should be conducted.

A fourth observation in the “affective domain” domain
takes into consideration the second half, or “disclaimer”
portion, of the affective domain survey question.

The

statement reads, “The most recent NATA Educational
Competencies (ed. 4)14 has removed the "Affective Domain" of
Bloom's Taxonomy of Learning from athletic training
education.”

The NATA Educational Competencies (ed. 4)

reads as follows:
“A major change in this edition of the
competencies is related to the Affective Domain (3rd
Edition). The competencies previously associated with
the Affective Domain have been distilled and
synthesized to create the Foundational Behaviors of
Professional Practice (Behaviors). Because the entrylevel credential signifies that the holder is a
practitioner prepared for entry into the practice of
athletic training, behaviors should be infused into
every aspect of students education in order to prepare
them for this public trust.”
The researcher has located several articles (dated
2007 – 2010)15-21 in support of a competency based approach
to measuring and assessing the affective domain in nursing
curricula with the most important consideration being
pass-rate on the NCLEX-RN (National Council Licensure
Examination – Registered Nurse).

A simple Google search

will locate numerous frameworks for teaching, measuring,
and assessing competencies in all three domains of Bloom’s

78
Taxonomy as well as the various levels comprising each
domain (see Figure 13).22,23 Furthermore, the researcher
teaches a course in Wellness Education at a 9th through
12th grade college preparatory school in a boarding school
environment.

The course places significant emphasis on

creative writing, reflective journaling, and group
discussion.

The students’ writings and participation in

class discussions are measured and assessed.

The intention

of the creative writing, reflective journaling, and group
discussion approach is to pull thoughts, feelings, and
emotions “out of the student,” as opposed to driving
information “into the student.”
Finally, a chi-square test of independence determined
that the presence of a clinical dance rotation is more
likely to be offered as part of an athletic training
education curriculum if the program director completed a
dance clinical rotation as a student in an entry-level
athletic training education curriculum.

“Psychomotor Domain” (Manual or Physical Skills –
Kinesthetics)
All 76 ATEDP respondents were asked the question, “Do
you think that the management of the dancer patient by
certified athletic trainers requires specialized

79
competencies in the “Psychomotor Domain” of Bloom’s
Taxonomy of Learning in addition to the “psychomotor
domain” skills required of certified athletic trainers for
the management of the traditional athlete patient?”

A

total of 21 ATEPD’s (27.6%) responded “Yes” to this
question.

A total of 53 ATEPDs (69.7%) responded “No” to

this question.

A total of two ATEPD’s (2.6%) responded “I

don’t know” to this question.
During the summer of 2008, the researcher attended the
Harkness Center for Dance Injuries, 2nd Annual Conference;
Principles of Dance Medicine: Clinical Management of the
Dancer Patient.

During the conference the researcher

attended the following lab sessions: “Pointe Shoes:
Nomenclature and Fitting,” “Techniques for Quantifying Foot
and Ankle Range of Motion,” and “Selected Padding and
Taping Techniques for the Dancer.”

All three lab sessions

contained dance specific “psychomotor domain” competencies
for certified athletic trainers in the management of the
dancer patient.
The initial observation to the responses in the
“psychomotor domain” invokes questioning the ATEPDs
foundation for perspective in this area of dance medicine.
As detected in the demographic data, the percentage of
ATEPDs with substantive experience in dance culture is

80
glaringly minimal.

The majority response (“No”) to the

psychomotor domain question by the ATEPDs suggests a
contradiction with the researcher’s continuing education
experience. More research is needed in this area.

It was

also detected in the demographic data that 75% of ATEPDs
have not experienced continuing education in dance
medicine.

The capacity to understand and value the mind,

spirit, and body of the dancer athlete/artist hybrid
requires experiential learning.

Further investigation is

needed into the validity of the ATEPDs application of the
Psychomotor Domain of Bloom’s Taxonomy of Learning in the
area of dance medicine.
A second observation in the “psychomotor domain” is
one of statistical analysis.

Because the Athletic Training

Education and Dance Medicine Survey achieved a 35% response
rate it was deemed as being a statistically “valid” survey
(30% being the minimal response rate standard of validity).
The percentage of “Yes” responses to the “psychomotor
domain” question was just under 30% (27.6%). In keeping
consistent with the same statistical standard of validity,
a response selection receiving 30% is a “valid” point of
view deserving of further investigation.
A third observation in the “psychomotor domain”
involves a historical analysis.

The Journal of Dance

81
Medicine and Science made its debut in 1994.

The Harkness

Center for Dance Injuries (A Division of the NYU Hospital
for Bone and Joint Disease) was established in 2002.

Both

are significant contributors to the evolution of dance
medicine as a profession.

Hypothetically speaking, if the

“psychomotor domain” question was to have been asked of
ATEPDs prior to 1994, what would have been the percentage
of “Yes” responses?

If this question is asked of ATEPDs

ten years from now, what will be the percentage of “Yes”
responses?

Follow-up studies should be conducted.

Athletic Training Services Provided for College/University
Academic Major/Emphasis Dance Programs
All 76 ATEPD respondents were asked, “Does your
college/university of employment offer an undergraduate
and/or graduate level dance major or dance emphasis
academic program?”

A total of 33 ATEPDs (43.4%) responded

“Yes” to this question.

All 33 of the ATEPDs responding

“Yes” to the above question were then asked, “Is the dance
major/emphasis program affiliated with the
college/university department of athletics?”

A total of 32

ATEPDs responded “No” to this question while only one ATEPD
responded “Yes.”

The same 33 ATEPDs were then asked, “Does

your athletic training budget (staffing/supplies) have

82
sufficient enough resources for the college/university
athletic training staff to provide athletic training
services to the dance program?”

A total of six ATEPDs

responded “Yes” to this question, while a total of 24
ATEPDs responded “No.”
Of the 33 ATEPDs that reported being employed by
college/university’s that offered a dance major/emphasis
academic program, 18 of these ATEPDs (55.0%) reported their
athletic training staff provided at least some amount of
athletic training services for the college/university dance
program.

An excerpt from the “Athletic Training Education

and Dance Medicine Significance of the Study” follows:
In a 2007 faculty presentation regarding the value of
“Spring Break in Mission” experiences for students, the
Reverend Thomas G. Steffen, former Dean of the Chapel at
The Culver Academies (Culver, IN) suggested:
These types of cross-cultural experiences provide
an opportunity for students to navigate a diverse
global community that moves together with graceful
rhythm and synchronicity. “There is little value in
suggesting that an artist, musician, or athlete could
finally capture beauty and grace once and for all.
Great art, music, and athleticism (like inspired
writings and experiences), do not capture but reveal
beauty and grace, and they open our eyes to see and
our hearts to feel what we might otherwise miss.
The first observation to the responses in the
“Athletic Training Services Provided for College/University

83
Dance Programs” section of this study involves the data
indicating over 45% of college/university athletic training
staffs do not provide any amount of athletic training
services for their dance programs.

In all fairness to

college/university certified athletic trainers, factors
such as “department affiliation” and “financial budgets”
(as indicated in the data above) must be recognized as
being influential to this statistic.

It is also important

to highlight that 11 of the 33 ATEPD respondents in this
section of the study indicated that their
college/university athletic training staff still provides
at least some amount of athletic training services for
their dance program even though the athletic training
budget does not have sufficient resources to do so.
For whatever the reasons or circumstances, almost half
of all certified athletic trainers employed by
colleges/universities with dance programs are not
experiencing the lives of dancers.

This is a missed

opportunity to understand and value another creative
manifestation of the human spirit in the form of human
movement.
If given the opportunity, and if open to the
opportunity, the skills and talents of dancers and
certified athletic trainers could potentially move together

84
with graceful rhythm and synchronicity.

Finding this

rhythm with other persons who are different (such as the
dancer patient) could potentially allow certified athletic
trainers to uncover human emotions and passions for another
form of athleticism.

Dissolving the athletic training

world’s isolation from the fine arts world and discovering
a synchronicity with the dancer patient could potentially
allow certified athletic trainers to discover untapped
knowledge and creativity within themselves.

Developing

relationships with the dancer patient would allow certified
athletic trainers to lend their skills and talents to a
whole other type of athletic population; an athletic
population which other health care providers are already
assisting.

Recognizing an interconnectedness that already

exists between the dancer patient and the athletic training
world would encourage certified athletic trainers to mentor
athletic training students in preparation for the dance
medicine work setting.

An excerpt from the “Athletic

Training and Dance Medicine Review of Literature” follows:
Las Vegas performing arts health care pioneer
Steve McCauley, ATC, indicates, “I want to employ as
many certified athletic trainers as I can, as often as
I possibly can. Certified athletic trainers employed
in the performing arts are making positive impressions
on their two primary stake holders. Performers
appreciate the benefits of health care such as longer
careers and stronger performances. Production
companies notice the effect on the bottom line,

85
especially in regards to workers compensation. The
reaction to all of this is to hire full time ATC’s as
an investment, which results in fewer worker’s comp
claims, because the ATC’s are able to do treatments on
site and return injured performers to the show
earlier.”31
Finally, a chi-square test of independence determined
that the presence of a dance medicine clinical rotation
experience is more likely to be offered by the athletic
training education curricula when a certified athletic
trainer (full time, part time, or grad assistant) is
assigned formal responsibilities in providing athletic
training services to the college/university dance program.

Conclusions

This study included six hypotheses containing a total
of 11 chi-square independence tests.

All six hypotheses

were formulated around the three domains of Bloom’s
Taxonomy of Learning (Cognitive, Affective, Psychomotor).
Each hypothesis investigated how ATEPDs view each domain in
the area of dance medicine.
Of the 11 chi-square independence tests, only one
revealed a significant interaction.

A total of four more

chi-square independence tests were reported in addition to

86
the hypotheses chi-square tests.

Of the four additional

findings reported, two revealed significant interactions.
One limitation of this study is the minimal number of
respondents representing CAATE graduate entry-level
athletic training education programs (5), as well as the
minimal number of respondents representing NATA postcertification athletic training education programs (2).
The results of this study represent CAATE undergraduate
entry-level athletic training education programs only.
Another limitation of this study is the minimal number
of respondents making up the three significant findings in
the area of dance clinical experience.

This is unavoidable

due to the vast majority of ATEPDs not having received
specialized dance medicine coursework and/or dance medicine
clinical experience.
The three significant findings discovered were all in
the area of dance clinical rotation experience:

1) It was

determined that the presence of a dance medicine clinical
experience as part of an athletic training education
curriculum is more likely to occur if the program director
received dance injury course content as a student in an
entry-level athletic training education curriculum, 2) It
was determined that the presence of a dance medicine
clinical experience as part of an athletic training

87
education curriculum is more likely to occur if the program
director completed a dance clinical rotation as a student
in an entry-level athletic training education curriculum,
and 3) It was determined that the presence of dance
medicine clinical experience is more likely when a
certified athletic trainer (full time, part time, or grad
assistant) is assigned formal responsibilities in providing
athletic training services for the college/university dance
program.
The significant findings suggest that ATEPDs who have
experienced the dance culture through specialized
coursework or clinical rotations have been profoundly
affected by the skills and talents of dancers.

The ATEPDs

learned to understand dancers and valued their dance
culture experiences enough to implement dance medicine
clinical experience as part of their athletic training
education programs.
In Laban22 description, those affected by the dance
culture will develop a feel for the “flow” of movement
passing through the body, a feel for a flexible
relationship with the environment through “dynamic
alignment,” a feel for a “body attitude” that describes the
particular way in which a person’s body reflects his or her
internal feelings, a feel for an “accommodation to space”

88
as being convex, concave, or vertical, and a feel for
“posture” as being more than a

physical relationship

between body parts; but as personal as a signature, and as
a meaningful, revealing part of a person’s life history.
In the views of the researcher, The Athletic Training
Education and Dance Medicine study has brought to life the
classical African idea known as Ubuntu; The essence of
being human.

The origin of the word is rooted in the Bantu

languages of southern Africa.

There is no word in the

English language that quite matches Ubuntu.

The word has

been described by Nobel Peace Prize Laureate, Archbishop
Desmond Tutu23 as: “A person is a person through other
persons.

You cannot be human in isolation.

only in relationships.

You are human

We are interconnected.”

I am

because we are.

Recommendations

The research study, Athletic Training Education and
Dance Medicine has explored major facets of the dance
culture and the dancer athlete/artist hybrid.

The results

of the study have yielded three primary recommendations by
the researcher.

89
The mission of the National Athletic Trainers’
Association (NATA) is to enhance the quality of health care
provided by certified athletic trainers and to advance the
athletic training profession.24 The first recommendation is
a call for the NATA to offer more readily available
continuing education opportunities for ATEPDs in the area
of dance medicine.
The second recommendation is a call for ATEPDs
employed by colleges/universities also offering an academic
major/emphasis curriculum in dance to implement dance
clinical rotation experiences for athletic training
students.

The athletic training education curricula at

colleges/universities which do not also offer an academic
major/emphasis curriculum in dance should begin to
investigate other venues for implementing clinical rotation
experiences in a dance setting (such as a local dance
studio, a local clinic or hospital that works with dancers,
a local high school, or another nearby college/university).
The third recommendation is a call for all ATEPs to
implement an “affective domain driven” clinical rotation
seminar experience.

The athletic training students would

be given the opportunity to discuss their successes,
failures, discoveries, and frustrations with their peers

90
and instructors while keeping a reflective journal and
writing creative essays about their clinical
experiences.

The seminar experience would provide a

creative and cathartic outlet for athletic training
students to express everything they do during their
clinical rotation experiences.

The assessment of the

creative writing, reflective journaling, and group
discussions could be a collaborative endeavor between the
instructor and student, and based primarily on student
effort.

Each student could self-measure his/her own

affective domain competencies through applying the
guidelines of the learning level progression framework of
Bloom’s Taxonomy (see Figure 13).

Dance is an art that imprints on the soul. It is with
you every moment, it expresses itself in everything you
do.25

91

Figure 13: Professional baseball analogy applied to the
labeling of learning level progression of the 3 domains of
Bloom’s Taxonomy of Learning; Cognitive, Affective,
Psychomotor. The levels are intended to be hierarchical in
order, arranged along a continuum of internalization from
lowest to highest. 26,27,28
Domain

“Cognitive”

“Affective”

“Psychomotor”

“A”

Remembering

Receiving

Reflex
Movements

“AA”

Understanding

Responding

Fundamental
Movements

“AAA”

Applying

Valuing

Perceptual
Abilities

“Big Leagues”

Analyzing

Organizing

Physical
Abilities

“All-Star”

Evaluating

Characterizing

Skilled
Movements

“Hall of Fame”

Creating

(Level)

Nondiscursive
Communication

92
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25. Selig JL. Thinking Outside the Church: 110 Ways to
Connect with Your Spiritual Nature. 1st ed. Kansas City,
MO:Andrews McMeel Publishing;2004:13.
26. Anderson LW, Krathwohl DR. A Taxonomy for Learning,
Teaching, and Assessing: A Revision of Bloom’s
Taxonomy of Educational Objectives. 1st ed. London, UK:
Longman Group; 2001:31.
27. Krathwohl DR, Bloom BS, Masia BB. Taxonomy of
Educational Objectives: The Classification of
Educational Goals; Handbook II: Affective Domain. 1st
ed. London, UK: Longman Group; 1964:95.
28. Harrow A. A Taxonomy of the Psychomotor Domain: A Guide
for Developing Behavioral Objectives. 1st ed. London,
UK: Longman Group; 1972:32.

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APPENDICIES

96

APPENDIX A
Review of the Literature

97
REVIEW OF THE LITERATURE

Ballet and modern dance are the core techniques
in American dance training. Each has very different
inner structure and conveys a unique image to the
audience and prospective students. Although it is
possible to be trained in only one of these forms most
dance students are at least briefly exposed to both,
usually choosing a distinct favorite from among them.1

The heritage and legends of dance are ancient.

The

authors of stories passed from generation to generation
through sacred Hebrew texts made a deliberate point to
reference dance as having an integral role in the culture
of important historical events. “So King David and all the
house of Israel brought up the ark of God into the city of
David with shouting, and with the sound of the trumpet; And
David danced before the Lord with all his might.” (2 Samuel
6:14-15)

The inspirations and traditions of dance are rich

and meaningful and their styles evolve and spread like a
giant web around the world, all sprouting out from the
original language of the heart.

Native Americans performed

sacred dance in honor of the seasons of Mother Nature. “To
everything there is a season, a time for every purpose
under heaven: A time to be born, and a time to die . . . A
time to weep, and a time to laugh; A time to mourn, and a
time to dance.” (Ecclesiastes 3:1-2, 4)

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The forms of dance that take center stage today are
ballet and modern (otherwise known as “contemporary”
dance).

Dance training was, and continues to be, based on

an apprentice system of passing knowledge from one
generation to the next.

In modern dance this teaching

lineage does not go back very far.

It has been said that

modern dancers lack a native language in the dance world.2
This chronology is also reflected in the medical
literature.

Much less information is available about the

frequency and type of injuries that occur in modern
dancers, and particularly in dancers at college and
university programs.3 Modern dance simply lacks the
centuries-old lineage of ballet.
Today, most young dancers do not look forward to
performing in a single company for all of their careers.
Thus, it is important that their training offer stylistic
flexibility by studying a variety of techniques.

However,

spending the early years in ballet offers the individual a
solid base and step-by-step progression.

Modern dance

students often turn to ballet for the “discipline” they
feel they need.2 Once again, this pattern is reflected in
the chronology of medical literature.

Studies of injury

rates in various populations have generally focused on
classical ballet dancers, both at the professional level

99
and early in their training.3 This trend presents an
opportunity available for injury researchers in the area of
modern dance injuries.
Ballet movement often appears effortless; gravity
seems readily defied.

When well executed, it is a high art

form, one of the most moving artistic experiences
constructed by Western culture.1 Examples will be provided
throughout this review of literature on why athletic
training education should include competencies in the
specialized area of dance medicine.

The above description

provides an excellent starting point for this discussion;
in order to provide athletic training students with a
better understanding of one of the most moving artistic
experiences constructed by Western culture.
Modern dance conveys a different image; an earthier,
grounded style, which originally capitalized on “natural”
movement and gesture.

Modern dance allows motions not

inherently attractive, such as angular movement, muscular
contractions, and a broad range of expressed feelings and
impulses.1 Examples will be provided throughout the review
of literature describing the dancer’s unique approach to
human movement, which plays an important role in placing
dance medicine into a specialized area of athletic training
education.

For example, the power of modern dance has been

100
the uniqueness of each choreographer’s vision of movement.
To achieve the vision, the choreographer often invented a
new dance vocabulary, which through time and the training
of a company became a technique.2 The biomechanics of dance
movements, combined with the dancer’s approach to human
movement, creates a need for dance injuries to be
rehabilitated through methods more functionally specific to
dance, as well as to the specific style of dance.

For

example, the patterns of strength and flexibility commonly
seen and felt to be necessary for ballet technique may be
very different from those required for a modern dancer, and
consequently musculoskeletal characteristics that may be
risk factors for injury in one population may be adaptive
in the other.1 These are prime examples of the types of
intricacies and traditions that athletic training students
would absorb by being around the dance culture and by
learning the different nuances between ballet and modern
dance.
The classical image of ballet is a stage of purity, of
innocence, of beauty and light, of elegance and grace.1

But

underneath the shroud of beauty and light, and elegance and
grace, sometimes lies a world of physical and emotional
pain that until recently has gone largely ignored by both
the medical community and the dance community.

From an

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aesthetic perspective, ballet is a world that feels
artistic, safe and secure.1 Parts of this review of
literature will expose the shadow side of this seemingly
innocent and safe and secure world.

However, the picture

of the rigors of dance training may seem at odds with the
literature: several studies of children, college students,
and adults have shown that dance classes raise self-esteem,
lower anxiety and depression, and promote a sense of wellbeing.1 Just like in competitive sports, positive
experiences in an individual’s growth and development
abound through dance training.

It is important to

acknowledge that dance is filled with healthy and
constructive elements for interested children and adults.
The issues examined in this review of literature will
investigate the possibility that the study of dance
medicine might be a unique subset in athletic training
education preparation.
sections:

They include the following

1) Movements of the Unconscious: The “Hidden”

Movements of Dance; 2) Biomechanics and Pathogenesis of
Orthopedic Dance Injuries; 3) Psychology and Sociology of
the Dancer Athlete/Artist Hybrid, and 4) Financial Costs
and Employment Opportunities in Dance Medicine.

At the end

of the four sections, a summary of the review of literature
will also be included.

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Movements of the Unconscious: The “Hidden” Movements
of Dance

I experience and nurture my soul when I’m
dancing, because for me, dancing is both the flight of
my body and the incarnation of my spirit. It is a
union of spirit and body. My soul is the bridge.4

Cross cultural experiences provide students with
valuable information and insight.

Operating within this

concept, the somatic systems are a gold mine, as vast a
resource of information and insight for creating dances as
they are for improving technical study and performance.
The applications extend across disciplines from
rehabilitation of the body to psychotherapy, nonverbal
communication (understanding human interactions),
anthropology, and beyond.5 The idea of “extending across
disciplines” would be the initial step for the next
generation of athletic training students and certified
athletic trainers in learning more about the dance culture.
“Every generation gets a chance to change the world.”6
The term somatics covers many individual systems (of
dance movement), each branch offering a particular point of
view and practice to the whole.
inadequate substitute at best.

Verbal explanation is an
Like a dance concert, the

work begs for live experience and examples.5 The nature of

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dance is meant to be experienced.

Words are often

insufficient when trying to explain or describe dance
movement.

Dancers are usually highly focused on breathing

patterns while dancing; breathing patterns void of words,
yet deep with feeling and awareness.

One could even

suggest the dance experience as being a type of “movement
meditation” or “movement prayer.” In her book Inviting
Silence, Gunilla Norris writes:
The point of practice is not to perform, but to
participate – not to achieve specific experiences, but
to develop a new relationship to experience itself.
To bring silence into our bodies and minds, we must
learn to be quiet. We have then begun to practice.
If we can learn to follow our breath in a steady
way, attending to the inhalation and the exhalation
until we feel that we are no longer breathing, but are
being breathed, we have grown in practice.
We cannot really experience anything without
being present to it . . . In silence we discover
ourselves, our actual presence to the life in us and
around us. When we make a place for silence, we make
room for ourselves. This is simple. And it is radical.7
At its very core, dance involves a radically altered
approach to human movement.

Because of this, it makes

sense that the actual physical movements that are the
result of this radically altered approach are unique to
dancers. “There’s a part of me in the chaos that’s quiet.”6
Dance explores beneath the level of gross muscle
action, to connect with subtleties of individual movement,
deepening awareness – the critical ability to sense and

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respond to micro-movement of the soma.

The aim is through

this to “unravel” – as one somaticist has described it –
old habitual neuromuscular patterns, and replace them with
new, more efficient ones.5 Being provided the opportunity to
learn about dance culture through experiencing it could
create a deeper awareness of human movement for athletic
training students and certified athletic trainers.

“A

change of heart comes slow.”6
There exist several approaches to the study of somatic
dance movement known as the “body therapies.”

Usually

included within each approach are the elements of observing
movement, imaging movement, feeling movement, modifying
movement, and dancing the movement.

Few young dancers in

this country today bring an exquisite instrument to an
inspired teacher in an ideal environment for learning.2
Michelangelo once said that the figure was always inside
the stone – it was just his job to chip away the unwanted
pieces to find the statue inside.

As in elite athletes, it

does not undermine the hard work and dedication to say that
elite dancers are born with certain body types and certain
muscle fibers.
chipped away.

However, the pieces still need to be
The body therapies offer a special approach

to neuromuscular re-patterning which helps dancers improve
their movement quality, aid in their own rehabilitation,

105
maintain health, and even increase technical virtuosity.2 To
individuals with minimal background and experience in the
fine-arts, the idea of applying scientific principles with
the objective of studying artistic expression might seem
ridiculous.

“The more you see the less you know, the less

you find out as you go.”8 But according to Martha Myers,
former head of the dance department at Connecticut College,
“To deepen understanding of movement education for dancers,
educators must analyze principles from many areas of
research and integrate concepts from the sciences with
those from traditional practice in the performing arts.”2
The study of somatics and body therapies is a noticeable
area where the thoughts of the “sports” medicine world and
the thoughts of the “dance” medicine world intersect.

“The

right to be ridiculous is something I hold dear.”6 It is at
this intersection where a deeper understanding of human
movement can be created for athletic training students
through analyzing principles from many areas of research
and integrating concepts from the sciences with those from
traditional practice in the performing arts.

The special

language used by the body therapies is of interest because
they affect the learning process.

The body therapies have

significant potential in altering the student learner’s
attitude in the realm of human movement possibility by

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stimulating growth in feelings and emotional areas.

The

originators of these systems (the body therapies) each
devised a particular vocabulary with which to describe
methods, actions, and effects.9 The study of somatics
provides the student learner with a taste of how the dance
world’s approach to human movement takes a very different
path from that of the sports world’s approach to human
movement. “Do you believe me, or are you doubting?”6
Through exposure, the student learner begins to develop a
greater appreciation for dance movement, and thus begins to
value its artistic form. “Valuing” is recognized as the
third level of the “Affective Domain” of Bloom’s Taxonomy
of Learning.

“Characterizing by value or value concept” is

the fifth and highest layer of the “Affective Domain.”
For example, in writing about the Irmgard
Bartenieff fundamentals of dance movement, Martha Myers10
identified a routine difference in approach to dance
movement that should be of interest to certified athletic
trainers.

She said, “Bartenieff and other body therapists

abhor the mechanistic approach to body movement.

They not

only dislike but disagree with the principle of single
exercises for specific body parts such as the abdomen,
upper chest, and lower back.

They are united against push-

ups, sit-ups, knee squats, and hamstring stretches as they

107
are practiced on athletic fields and gymnasia in most of
the Western world.” Bartenieff was a physical therapist,
dance therapist, movement analyst, researcher, and writer.
He co-authored the book, “Body Movement: Coping with the
Environment,” which was published in 1980.

Myers10

continued to describe the body therapists approach to “body
image” and “self awareness” as very different from the
entire fitness industry’s approach by identifying the “it”
factor.

She said, “The body therapists would be equally

against much of what pass for dance warm-ups, as would many
dance teachers.

It is not just the aesthetics of such

movement that concerns body therapists, or even the
potential anatomical dangers.

A mechanistic approach to

movement, the body therapists contend, is not desirable. If
you treat your body as an object, feeding, dressing, and
exercising ‘it’, you reduce the potential richness of your
body image and thus of your self-image.” In dance culture,
the “body” and the “person” are never separated. Everything
blends together.

A dancer is never working with only the

knee, or the shoulder, but with these parts in the context
of the whole body and person.

Movement, body therapists

feel, is part of the complicated tapestry of human
personality.

It is the enhancement of self-awareness and

self-image that body therapies ultimately encourage.10 The

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human condition is never divided.

Moshe Feldenkrais was

the director of the Feldenkrais Institute in Tel Aviv,
Israel, and a lecturer at Hebrew University.

Of his

sixteen published books, Awareness Through Body Movement
and Body and Mature Behavior are the most widely known.
Feldenkrais’s dance lessons engage students in making a
more accurate assessment of their bodies in space: how the
limbs lie as they rest on the floor; whether the parts are
symmetrical or asymmetrical; and how the energy flows
between them.

The goal is to help each individual

establish a more complete body image or “schema” and more
sensitive kinesthetic responses, which Feldenkrais sees as
leading to a richer sense of self.11 It is worth noting that
Feldenkrais also held a doctorate in physics, and had an
active career in physics until the age of 50.
Avoidance of the mechanistic in dance training is not
as simple as it may seem.

Both dancers and athletes must

have a technique that provides adequate muscle and joint
strength, flexibility, and endurance.

Building these

capacities requires repetition, and repetition can easily
become mindless and grim.10 So for the dancer, exercising or
rehabilitating an injury could very well involve navigating
a foreign realm.

Fitness training for these goals has thus

traditionally emphasized willpower and determination, and

109
has been based on an assumption that the body is a machine
that will only move by mechanical force.10 An informed
certified athletic trainer in tune with these elements and
who has an understanding demeanor with the artist can be of
great assistance in helping the dancer navigate.

There is

a vast difference between the kind of force and
determination needed to push a car out of the snow and the
effort that makes a dancer’s “developpe ‘a la seconde” melt
an audience’s heart.

Dance teachers intuitively have hit

upon the use of images – often poetic and occasionally
ridiculous – to help achieve this balance.

Would a

football coach suggest that a player kick the ball as if it
were a feather?10

And just like the hearts of their

audience, it might be more effective for the dancer to
“melt” the snow surrounding a stuck car rather than wasting
the energy trying to push it out.
One of the best known of the body therapies in the
United States is a movement recording method known as the
Laban Movement Analysis, developed by Rudolf Laban:
Rudolf Laban (1879-1958) was born in AustroHungary. Laban was a dancer, a choreographer and a
dance / movement theoretician. He is considered one of
the founders of European Modern Dance.
Through his work, Laban raised the status of
dance as an art form, and his explorations into the
theory and practice of dance and movement transformed
the nature of dance scholarship. He established
choreology, the discipline of dance analysis, and

110
invented a system of dance notation, now known as
Labanotation or Kinetography Laban. Laban was the
first person to develop community dance and he set out
to reform the role of dance education, emphasizing his
belief that dance should be made available to
everyone.
Rudolf Laban's ideas were influenced by the
social and cultural changes of the time and the
contexts that he worked in.
In Paris and Munich (1900 - 1914) Rudolf Laban
acquired his spiritual attitude and unique value
regardless of gender, social status or educational
standing. He interpreted this as valuing individuals
own choice of movement, and self initiated
vocabularies.
His search for the basic vocabulary of expressive
movement identified the basic factors of movement
flow, with weight, embodying time and space.12
As a whole, the focus of this method is on analyzing
movement through experience and observation.

The Laban

framework identifies different aspects of movement: the
mover’s body sensations, the mover’s feelings or inner
attitudes, and the way the mover uses the space and
environment around him.

These aspects, of course, are

interrelated and of equal importance in movement.10 The
following descriptions and interpretations from the Laban12
framework provide a good starting point for the dance
novice in absorbing the traditions of the culture:
The term “flow” is used in Laban theory to
describe how the movement passes through the body.
The term “dynamic alignment” refers to the
neuromuscular patterning or posture that responds
accurately and sensitively to changes in standing,
walking, and sitting, and provides a flexible
relationship with the environment. The term “body
attitude” describes the particular way in which a

111
person’s body reflects his or her internal feelings.
In Laban theory, this is the body’s “accommodation” to
space – convex, concave, or vertical, for example.
Posture is more than a physical relationship between
body parts; it is as personal as a signature, and body
therapists view it as a meaningful, revealing part of
a person’s life history.
Laban believed that dance, and all of the
inspirational inner hidden movements that go into it,
should be made available to everyone. “Blessings not just
for the one’s who kneel . . . luckily.”8
It is obvious that dancers’ rely on a strong
connection with their inner self in order to move the way
they do.

During his involvement with the Alexander

technique, former New York City dance instructor and
choreographer Remy Charlip13 said he danced more from “inner
sensation.” Lulu Sweigard taught for many years in the
dance department at the Juilliard School, and is probably
the most familiar of the body therapists among dancers.
She coined the term “Ideokinesis” to describe the work she
did in neuromuscular re-patterning: “ideo,” meaning idea or
the stimulator of the process, and “kinesis,” meaning the
movement induced by stimulation of the muscles. Sweigard14
said, “Many of the most important efforts we make in motor
performance are not visible in our movement.

Ideally,

dance training should, and in the best of circumstances,
does, help the student learn to work with these ‘hidden

112
movements.’”

In the descriptions of the Alexander

technique (mentioned by Charlip above) it is noticeable
that a delicate relationship exists for the body therapist
as an artist.

Dancers, like athletes, are interested in

performing at the highest level, which usually involves
examining some kind of empirical evidence in the area of
biomechanics.

The Alexander technique does not avoid this.

Its aim is to help the student develop a technique of his
own based on physiologically sound principles for
connecting his thought process with the action of his
body.15 An approach such as this should be good news for
both the dancer and the medical practitioner.

Whatever the

explanation of how emotional and bodily changes are linked,
it is as profoundly true that we are as much affected in
our thinking by our bodily attitudes as our bodily
attitudes are affected in the reflection of our mental
states.14 If one is open to the act of extending across
disciplines, such as is done in the Alexander Technique,
the process often leads to a more artistic and creative
source of undefined and unexplainable beauty.

“Creating”

happens to be the sixth and highest level in the “Cognitive
Domain” of Bloom’s Taxonomy of Learning.

The ability to

create new knowledge within the domain is considered to be
the ultimate revelation in acquiring knowledge through the

113
development of mental skills.

“The sweetest melody is the

one we haven’t heard.”6
Important to the Alexander technique is the concept of
“inhibition.”

Alexander believed that people can learn to

inhibit an inefficient movement pattern, and consciously
substitute one that produces more harmonious movement and
feelings of ease and well-being.

This inhibition is not a

physical action, but mental control.15 Frederick Matthias
Alexander (1869-1955) is one of the oldest originators of
body therapies and founder of the Alexander Center in New
York City. Martha Myers15 describes that in an Alexander
dance class the instructor points out to the student
(dancer) that each time he raises an arm, the shoulder also
is lifted.

If, to correct this, the student presses the

shoulders down, the original pattern that made it
impossible for the student to separate the arm action from
the shoulder action goes uncorrected.

The student has now

locked another portion of the body – the rib cage and
scapulae – an action that in turn affects the working of
related segments and the appearance of the whole.
has two bad habits instead of one.

He now

If the movement pattern

just described involved an injury to the dancer, a
certified athletic trainer without a trained eye for dance
movement might be missing an important link to successfully

114
treating the dancer.

With the Alexander technique, the

dancer is told to “inhibit” the initiation of the action in
the shoulder girdle.

He is advised to think of his head

moving forward and up, his neck moving back, and his back
widening to allow the arms to float up, freely, from the
joint.15 A trained eye for athletic movement is not the same
thing as a trained eye for dance movement.
How do different people see?

Do words of description

come easily or are visual images more powerful?

How is it

that one dancer responds to concrete bone and muscle
descriptions while another sees lines of energy, and yet
another responds most rapidly to touch?16

Different

experiences and influences create different realities.

The

human condition is complex, and it manifests itself in
different forms.

For Irene Dowd,16 former professor of

functional anatomy, dance technique, and neuromuscular recoordination at Columbia Teachers’ College, this meant a
continuing exploration of how the poetry and science of
movement can enrich each other, and how their basic
connection can be communicated.
and visually.

“I think kinesthetically

The English language is not very rich in

describing sensation – kinesthetic things – so I have to
search for metaphors to use with different people.”
Admittedly suspicious of language Dowd16 continued by

115
saying, “I would go crazy trying to put things down, things
I knew but didn’t have the language to express at the
time.”

Words and languages are often limited in describing

the true nature of emotions and feelings that are sacred to
us, and sometimes it drives us crazy.

In dance movement,

words and descriptions that work well for some dancers
might evoke thoughts and feelings that do not work for
other dancers.

Martha Myers17 described looking at energy

as a spiral through the body, like a flame free to move
through the spine and out the limbs, so that one can
interact with the environment as clearly as possible, as
spontaneously as possible.

For a dancer, identifying the

core emotion to a difficult movement can be a necessity in
being able to dance the movement.
Geography and surroundings also play a significant
role in forming experiences and influences that shape the
realities of people.

In her autobiography, Natalia

Makarova7 writes of the difference between Russian and
Western Ballet training as she describes her early years at
the Kirov School: “From the first lesson we were warned
against a formal execution of a movement, even if it was a
mere battement tendu.

Formalism is alien to Russian

culture in general . . . The ability to sense a movement,
no matter how simple, and to fill it with spiritual meaning

116
was developed step by step, by hard every day training . .
. Essentially, it is a capacity of the body to generate a
specific kind of energy in movement that affects an
observer.” Cultural norms have always had a profound effect
on the development of artistic expression and spiritual
meaning.

Variety keeps things interesting.

The type of

human movement energy that inspired Natalia Makarova is
most likely different from the type of human movement
energy that stimulated the interest of world renowned
choreographer George Balanchine.

In 1970, U.S. News and

World Report attempted to summarize Balanchine’s18
achievements.
"The greatest choreographer of our time, George
Balanchine is responsible for the successful fusion of
modern concepts with older ideas of classical ballet.
Balanchine received his training in Russia before
coming to America in 1933. Here, the free-flowing U.S.
dance forms stimulated him to develop new techniques
in dance design and presentation, which have altered
the thinking of the world of dance.
Often working with modern music and the simplest
of themes, he has created ballets that are celebrated
for their imagination and originality. His company,
the New York City Ballet, is the leading dance group
of the United States and one of the great companies of
the world. An essential part of the success of
Balanchine's group has been the training of his
dancers, which he has supervised since the founding of
his School of American Ballet in 1934. Balanchine
chose to shape talent locally, and he has said that
the basic structure of the American dancer was
responsible for inspiring some of the striking lines
of his compositions. Balanchine is not only gifted in
creating entirely new productions . . . his
choreography for classical works has been equally

117
fresh and inventive. He has made American dance the
most advanced and richest in choreographic development
in the world today."
Balanchine himself wrote, "We must first realize
that dancing is an absolutely independent art, not
merely a secondary accompanying one. I believe that it
is one of the great arts . . . The important thing in
ballet is the movement itself. A ballet may contain a
story, but the visual spectacle . . . is the essential
element. The choreographer and the dancer must
remember that they reach the audience through the eye.
It's the illusion created which convinces the
audience, much as it is with the work of a magician.”
Comparing the inspirations and styles of Marakova and
Balanchine brings to light the illusion created through the
eye of the beholder. “How can you stand next to the truth
and not see it?”6 The beauty in each style is always there,
but sometimes human eyes must look through the disguise.
Makarova9 found, in teaching La Bayadere to American
dancers, that “they did not understand . . . the difference
between ‘executing steps’ and ‘dancing steps.’”

She

describes the physical process of performing a ballet step,
the reasons for finding it difficult, and the feelings and
sensations when it goes wrong, some of which, she says, are
“too elusive to put into words.” Indeed, words often seem
to get in the way of the genuine human condition.
Hopefully, the common need for medical attention in both
the dance world and the sports world transcends words in
athletic training education.

118
Expanding on Makarova’s remarks, Martha Myers17 added,
“We all have such feelings daily, elusive sensations that
are vague, that emerge slowly, and that we have neither
time nor language nor skills to explore and express.

Some

members of the medical and scientific community have noted
that our inability to recognize and deal with these ‘silent
cues’ greatly hinders the operation of the body’s natural
defenses against stress diseases.”

The health and wellness

world often speaks of exercising as being a good way to
combat stress diseases, and it is.

But, make no mistake;

dance and all of the fine arts can stake claim to this as
well.
Myers17 thought athletics to be far ahead of dance in
embracing new concepts.

“Artists fear that science will

mess up the process of the unconscious, that science is the
death of art.” Apparently artists also perceive the idea of
applying scientific principles to artistic expression as
ridiculous, and are sometimes unsure of extending across
But Martha Myers17 feels that dancers should

disciplines.

question their techniques and that a functional knowledge
of the body is important.

She tells her students, “It’s

not a question of good or bad, but of asking: What do I
want to achieve?
efficient way?

What can help me do that?

Is it the most

Are there other ways I can do it?”

119
From the perspective of Martha Myers, it seems that
dancers are willing to step outside their comfort zones and
ask themselves difficult questions in order to achieve a
deeper understanding of their skills with the outlook, “The
right to be ridiculous is something I hold dear.”6 Are
certified athletic trainers willing to step outside their
comfort zones and ask themselves ridiculous questions in
order to achieve a deeper understanding of their skills?
This type of approach often does not come easy; sometimes
exposing vulnerabilities and weaknesses in the process.

It

should be considered paramount that athletic training
students (future deliverers of health care services) be
given educational opportunities that provide experiences
for growth in feelings and emotional areas of all types of
athletes.

One really good reason for this is to ensure the

most effective care and treatment for those that will be in
the certified athletic trainer’s care.

But there is also

another really good reason for athletic training students
to be given opportunities for this type of deeper inner
growth.

Certified athletic trainers numb to the realities

of those patients within their care (especially those
patients that navigate the world with another kind of human
movement experience from that of what the certified
athletic trainer is traditionally accustomed to and

120
predominantly exposed to) are most likely short-changing
their own experience of being a health care provider. “It’s
not a hill it’s a mountain, as we start out the climb.
Listen for me I’ll be shouting, shouting to the darkness,
squeezing out sparks of light . . . I know I’m not alone.”6
Dancers move in mysterious ways.

Biomechanics and Pathogenesis of Orthopedic Dance
Injuries

Dancers subject their bodies to the same stresses
that athletes do. The difference is that dancers have
an additional artistic component to consider.
Protective movements that are natural to the athlete
may therefore not be available to the dancer. As an
example, most jumping activities in sports allow the
gradual absorption of energy when landing through
flexion of the knees and trunk, or taking an
additional step. In contrast, dancers may have to
land on a jump in a position of full extension,
decreasing any opportunities of a more gradual
dissipation of energy. The majority of injuries
sustained by dancers occur in the lower extremities.
Although a world-class prima ballerina will create the
illusion of effortless grace leaping across the stage,
the lower limbs are actually subject to enormous
repeated loading.19

The dance world’s insular nature is one of the reasons
why information related to the incidence, type, and
distribution of injuries is not easily available.
Therefore, the questions most frequently and vigorously

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asked are: Why are dancers so injured?

And what factors

are causing such injuries?20 Is the dance culture really so
dark and mysterious as this description indicates?

Does

this description indicate that the dance culture would
reject more help from the athletic training community?

Or,

would the dance culture willingly open its doors to more
help from the athletic training community?
Dancers intentionally shape movement.

During their

routines dancers often “drop” and “release” their body
weight and then “catch” and “recover” the weight to create
a pause or change in the direction of the movement,
creating a unique look and feel to the choreography.21
Competitive athletes also shape movement, although with a
different approach and purpose, as part of their regular
routine through focusing on their mechanics.
pitchers are a perfect example.

Baseball

When the center of mass of

a body segment is moved out of equilibrium by bringing the
segment forward, gravity will tend to make it fall toward
the floor.

After allowing the body segment to fall (muscle

relaxation), the dancer can neutralize Newton’s law by
rapidly contracting the muscles that oppose the influence
of gravity eccentrically to decelerate the segments while
keeping with the desired movement path.21 At this point,
certified athletic trainers should ask themselves: Does the

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description of how a dancer shapes movement differ from how
a competitive athlete shapes movement?
biomechanics different?

Are the actual

Does the verbal description convey

a different tone?
The athletic spine is one of the most artistic and
inspiring of human features.

Dancers specialize in

bringing this most central anatomical structure to life
through their artistry.

A spinal movement unique to dance

is that of backward movement of the thoracic spine while
not allowing the rib cage to protrude forward.

A co-

contraction of the abdominal muscles and back extensors is
required to accomplish this maneuver.

The lower and upper

abdominals must contract eccentrically, holding the rib
cage down, all the while still allowing the thoracic spine
to extend.

The thoracic spinal extensors must contract

concentrically to control backward movement of the upper
spine to its desired positioning.21 Scheuermann disease is a
deformity in the thoracic spine often seen in younger,
developing dancers.

It involves a degeneration of the

vertebrae which gradually increases to the point where the
natural curvature of the spine begins to change.

Although

this condition can be brought on by hormonal and
nutritional deficiencies, it can also be attributed to
trauma of the growing spine.

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In order to achieve the desired neutral position of
the pelvis and normal curvature of the lumbar spine,
dancers need to contract the inferior abdominal muscles so
that the pelvis will rotate posteriorly, and decrease the
lumbar hyperlordosis.21 A nice supplemental activity for
dancers to practice this particular muscular contraction
(as well as many other movements) is adding sessions of
yoga to their weekly routine.

When attempting to achieve

neutral position of the pelvis, some dancers will
mistakenly contract the superior abdominals, contracting
the thoracic spinal extensors, which results in the body
leading with the ribs, and an undesired backward movement
of the upper back.

It is important to remember that the

pelvis is not horizontal but has an angle of inclination.21
Many yoga movements emphasize a lifting and lengthening of
the lower abdominals.

Dancers have made the discipline of

yoga a part of their normal routine for decades.

In recent

years, an interesting link between the dance world and the
athletic world has formed.

Competitive athletes are

reaping the benefits that regular sessions of yoga (and
pilates) add to their training and conditioning routines,
just like dancers.

Neutral position can be evaluated by

the dancer while practicing in front of the mirror.

The

dancer places their hands on the ASIS (anterior superior

124
iliac spine) and notes when the bony landmarks are
vertically aligned relative to the pubic symphysis.21 A
mirror can be a helpful aid to the biomechanics of the
dancer.

But as will be discussed in the next section of

the review of literature, the mirror also carries the
potential of being the culprit of physical and emotional
nightmares for the dancer.
Dance places a great deal of stress on the lower back
due to over-stretching and hyperextension of the spine.

A

spondylolysis (a stress fracture in one or more of the
lumbar vertebrae) is commonly seen in dancers.

A

spondylolisthesis (forward slippage of a vertebrae one
directly posterior) is also commonly present along with a
spondylolysis, and typically seen mostly in female dancers.
When this happens, the female will typically complain of
localized pain or a pain that radiates into both buttocks.
“Kissing spines” is a term for a condition in which the
spinous processes of adjacent vertebra are touching.

This

is an ailment to consider when a dancer indicates
experiencing pain in the lower lumbar vertebrae during
overarching extension motions.

If left untreated, the

dancer will experience limitation in both extension and
flexion motions of the lower back.

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The dance movements of “Battement tendu” and
“battement degage” are open kinematic chain movements that,
when maximized, place considerable force on the hip and
knee joints.

During this movement the heel begins facing

backward, rotates medially, and finishes slightly facing
forward.21 The movements of “battement tendu” and “battement
degage” are similar to that of “parallel position,” however
the dancer’s foot is not touching the ground (open
kinematic chain).

When executed properly, the upper and

lower leg should be moving as one continuous unit, with the
rotation initiated at the top (hip joint) and culminating
at the bottom (heel facing forward).21

Located underneath

the attachment of the muscles surrounding the hip joint,
the trochanteric bursa acts to cushion and reduce friction
between bones, tendons, and muscles.

Trochanteric bursitis

results from repetative movements (such as “battement
tendu” and “battement degage”) along with a lateral
snapping hip (resulting from the IT (Ilio-tibial) band
rolling over the greater trochanter).

Pain felt in front

of the hip, often over the adductor, is usually iliacus
tendonitis.
dancers.

This condition is most often seen in younger

It is also seen more in modern dancers due to the

increased emphasis on hip flexion and internal rotation
involved with this form of dance.

126
As has been described so far, the nature of dance
requires significant hip rotation and turnout.

Because of

this, the piriformis muscle can easily become tight and
restricted in dancers.

The tendon of this muscle has a

close interaction and proximity with the sciatic nerve, so
the chain reaction of hip rotation and turnout can also
lead to radiating pain into the buttock and lower
extremity.
The ability of the dancer to execute proper lumbopelvic movements is crucial to the stability and injury
prevention of leg, foot, and ankle injuries that often
accompany the skills of balance, jumping, turning, and
lifting.

Highly complex and high impact movement create a

recipe for lower extremity overuse injuries.

Lower

extremity injuries account for 58% to 88% of all dance
injuries irrespective of dance style.22 The majority of
dance medicine literature available in the area of
orthopedic injuries is attributed to lower extremity
injuries.
While performing most dance movements the lateral
thigh muscles are developed while the medial muscles remain
weak.

The classic picture of the dancer with large lateral

thigh muscles with minimal vastus medialis obliquus is the
norm.

This may increase the risk of medial collateral

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ligament sprains, medial meniscal tears, and the incidence
of patella tracking problems.23 Chondromalacia is a common
result due to weakness of the vastus medialis muscle.
Patellar subluxation is a more traumatic condition that can
also occur due to weak medial thigh musculature.

However,

when addressing the issues at the root of patellar injuries
in dance, sports medicine practitioners should understand
that choreographers (especially in ballet) are adamant
about maintaining similar symmetrical muscular “lines”
among the entire dance company.

The drawback of too much

conditioning in the musculature is that it can lead to too
much definition and an undesired visual appearance for the
dancer.

A careful balance needs to be maintained.

“Parallel position” is accomplished by the dance
movement known as “turn out.” It is a movement that, if
done correctly, requires a severe amount of external
rotation at the hip joint.21 This is one example of the
complexities and physical dangers involved in the desired
“illusion” versus the actual “reality” of dance movement.
The ideal result in “turn out” is the illusion of the
dancer’s knee joints performing the movement of flexion in
the “coronal” plane as opposed to the “sagittal” plane.

If

the required degree of movement is not achieved at the hip
joint, the dancer will compromise by externally rotating at

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the knee joint.21 Repetitive movement in this fashion will
eventually lead to pain and limited mobility for the dancer
due to damage of the structures on the medial aspect of the
knee joint.

In the case of a lack of “turnout,” if the

dancer, instructor, or choreographer do not respect the
dancer’s anatomical limitations, the dancer may compensate
by “screwing the knee,” externally rotating the tibia and
thereby stressing the medial structures of the knee.24
During rehabilitation, a balance must be reached between
the dancer’s physical abilities and the desired aesthetics
of the physical movement, otherwise the ultimate result
could be no movement at all by the individual dancer due to
injury.
A great deal of stress is placed on the knee joint
during movements involving going down to the floor such as
executing a “grand plie.”

In order to reduce the impact on

the passive tissues of the knee joint (such as ligaments
and cartilage), the dancer will practice using muscular
control to decrease excessive momentum on the knee joint.
To accomplish this, eccentric contraction of the quadriceps
muscles is used to control the flexion of the knee as the
body lowers toward the floor, and the contraction is
maintained as the dancer reaches full flexion.

Ballet

dancers also usually possess the capability of recurvertum

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in the knee joints.

This structural capability has the

potential to create a muscle imbalance in which the
quadriceps muscles are overactive and the hamstrings are
underdeveloped.

During movements such as “grand plie,”

high amounts of stress are placed on the lower legs that
often result in shin splints or tibial stress fracures.
The next two dance movements of “releve” and “pointe”
involve plantar flexion that should be thought of in terms
of pointing the foot with intention and purpose.

The

dancer must concentrate on generating the amount of force
from the floor that is needed in order to propel the body
in the desired direction.

The peroneus longus and peroneus

brevis muscles (lateral crural muscles) control the
function of extending the toes into plantar flexion and
pushing off of the floor.

Digging the toes into the floor

and pushing off with such force in this type of closed
kinetic chain is a common dance movement and also an
effective exercise used to strengthen the crural muscles.
Similar to the above closed kinetic chain movement,
pointing the foot while in an open kinetic chain also
requires a “more intentional” approach during a dance
routine.

As opposed to pointing the foot in terms of using

just the ankle joint, the dancer needs to think of pointing
the foot while intentionally using the talocrural,

130
subtalar, intertarsal, tarsometatarsal, and
metatarsophalangeal joints.

This simple movement, made

into an intricate movement, matches the mental focus that
the dancer must have in order to achieve a specific
aesthetic appearance.

Posterior impingement syndrome (also

known as “dancer’s heel”) is a common cause of pain
experienced by the dancer when pointing the foot (such as
during “releve”).

This painful condition involves

compression of soft tissues at the back of the ankle caused
by a bony formation or bump.

Anterior impingement syndrome

involves direct contact where the tibia meets the talus
and, with numerous “plies” over time, this direct contact
can eventually result in a bony formation at the front of
the ankle that compresses the soft tissue.

When this

happens, the dancer is unable to achieve “full plie” on the
affected ankle because of sharp pain.
Maintaining ideal standing alignment and the body’s
center of mass during “releve,” while rising to “demipointe” and “pointe,” requires that the dancer place a
great deal of repetitive force and torque on the lower
extremeties.

“Trigger toe,” medically described as

isolated stenosing tenosynovitis of the flexor hallucis
longus tendon, is not a commonly seen injury in the
traditional athletic population.

However, it is a

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condition that is fairly common in the field of dance
medicine.

Because of this, the uninformed certified

atletic trainer may be apt to not recognize this condition
when it occurs in dancers.

“Trigger toe” is mostly found

in female dancers due to extensive repetitive “pointe” work
required for the ballet technique.25
One of the more unorthodox movements in dance is that
of performing a “preparatory plie” prior to a jump or turn.
The dancer wants to avoid hesitating or stopping at the
bottom of the “plie” between the eccentric and concentric
movements.

Instead a rapid reversal from the “down-phase”

to the “up-phase” is the objective.21 The patellar tendon is
also a part of the extensor mechanism of the knee.

The

common occurance of jumping in dance routines requires a
great deal of force and loading on the knee joint which can
easily result in patellar tendonitis.

Sprained MCL’s are

also a common injury in dance routines due to the repeated
jumping movements, sudden twisting, sudden turning, and
sudden stopping.
The dance surface has been implicated as a
contributing factor to stress fractures.

Hard floors

increase ground reaction forces, which makes the skill of
“landing softly” after a jump an important practice of the
dancer athlete in order to reduce the wear and tear that

132
accompanies numerous “stiff” landings.

The basketball

player has the benefit of landing softly by wearing the
latest scientifically designed, custom made, athletic shoes
with excellent shock absorption and support while playing
on a hardwood basketball court.

The “landing softly”

technique for the dancer is accomplished through
establishing lower vertical ground reaction forces through
greater absorption of forces by the hip and knee muscles,
slightly less absorption of forces by the ankle plantar
flexors, greater hip flexion, greater knee flexion, and
slightly less plantar flexion at the beginning of floor
contact.19 The dancer is often barefoot.

The dancer

(especially the modern dancer) also does not have the
luxury of using exterior supporting material such as tape,
wraps, or braces due to maintaining the desired aesthetic
look.

An even “softer” landing is accomplished, through

greater force absorption, when the dancer focuses on a
“toe-heel” landing versus a “flat-foot” landing.

Combining

these jumping skills helps the dancer athlete to decrease
the risk of lower extremity injuries.21

The element of the

hard-floor, combined with the landing techniques described
above become even more of a factor when the dancer is
attempting to return to performance after being injured.
The rehab process of returning a dancer back to performance

133
as safe and as soon as possible is challenging in its own
unique way.
The “Dancer’s Fracture” occurs along the 5th metatarsal
and is the most common acute fracture seen in dancer’s.
The usual mechanism of injury is landing on an inverted
foot following a jump.

However, in one study, the usual

mechanism of injury involved the dancer rolling over the
outer border of the foot while in the “demi-pointe”
position on the ball of the foot with the ankle fully
plantar flexed.

Ankle instability is a relative risk

factor for this injury because the injury occurs with ankle
inversion while the dancer is in the “demi-pointe”
position.

Although metatarsal fractures are common

injuries, relatively little biomechanical or clinical data
are available to guide the orthopedic surgeon.26 More
research is needed on this disabling dance injury.
Injury at the base of the second metatarsal has
received relatively little attention in the literature, yet
can be a disabling injury.

The two common causes for this

clinical problem are traumatic synovitis of the second
tarsometatarsal joint and stress fracture of the base of
the second metatarsal.

An overuse syndrome at the second

tarsometatarsal articulation has been recognized in female
ballet dancers only.27 Ballerinas dance “en pointe,” rising

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to dance on the fully plantar flexed foot and tips of the
extended toes.

Male ballet dancers do not rise above the

“demi-pointe” position, remaining on the balls of their
feet.

In one survey of 54 professional ballet dancers, 17

dancers had developed a total of 27 stress fractures.

The

majority of these (63%) were located in the metatarsals,
with the most common location being the shaft of the second
metatarsal.28

More research is needed on this disabling

dance injury.
A common overuse syndrome in the dancer’s foot
involves the two sesamoid bones located on the underside of
the forefoot near the big toe.

These tiny bones provide a

support surface while the dancer is on “demi-pointe.”

The

tendon that runs between the sesamoid bones can become
inflamed, causing this form of tendonitis.
If a dancer’s big toe begins to point inward and is
painful, the condition is the development of a hallux
valgus and bunion.

Seen in the public at large, this

condition develops in dancers at a younger than typical age
due to the high demands of weight bearing and jumping
involved in their movement routines.

The dancer developing

a hallux valgus and bunion usually has a tendency to
pronate, or roll-in, during turned-out positions.

135
The dancer who indicates pain with “full releve” is
most likely experiencing the condition of hallux rigidus,
characterized by pain and/or restriction of movement at the
joints of the big toe.

To achieve full “demi-pointe” the

metatarsal-phalangeal joint must be able to make a 90
degree angle.

A dancer without mobility who forces a high

“demi-pointe” will cause the bones in the joint to impinge
on each other causing pain and eventual bone spurs and
degeneration if continued.
Another overuse syndrome seen in dance (often due to
the use of a hard surface or a non-sprung floor) is that of
plantar fasciitis.

It may also be caused because of

tightness in the calf or the Achilles tendon.
Metatarsalgia is characterized by pain and tenderness
along the ball of the foot.

For dancers, this is commonly

caused by instability in the joints of the smaller toes.
Years of overwork and forcing of extreme motion in the foot
can increase laxity at the joints of the smaller toes.
Most cases of Achilles tendonitis are due to
overtraining of the dancer during a short period of time.
Other contributing factors include returning to dance after
a long period of rest, a natural lack of flexibility in the
calf muscles, and dancing on a hard surface or a non-sprung
floor.

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The upper body of a dancer must constantly present
itself in an acceptable aesthetic posture at all times.
The dancer must focus on using the scapular adductors to
bring the shoulders backward to a desirable position, and
the thoracic spinal extensors to keep the amount of
kyphosis curvature to a minimum.21 With the majority of
dance injuries occurring in the lower extremity, the
available literature on upper extremity injuries is even
less prevalent.
When a dancer raises the arms overhead, many begin to
elevate their shoulders to an undesired level.

To correct

this, the dancer should focus on the inferior angle of the
scapula pulling slightly downward (recruiting the serratus
anterior) and then moving the scapulae outward (scapular
abduction), but all the while keeping well below the
armpit.21 Shoulder impingement syndrome appears in dancers
for a number of unique reasons inherent to dance:
Repetitive arm movements, especially with overhead
activities; frequent extension of the arm at high speed
under high load; and an increase in upper extremity
training by a dancer whose rotator cuff muscles are not in
good condition.

If a dancer falls while trying to execute

the landing of a jump, AC (acromio-clavicular) sprains and
rotator cuff tears can occur just as in other sports that

137
involve falling with an extended arm or falling on the tip
of the shoulder.
Dance involves extremely exaggerated and lengthened
body movements, combined with sudden bursts of jumps,
Juli29 proposes that when physical

turns, and bends.

activity is taken to its limits, extremely straining
muscles, tendons, bones, and joints, it can act as a
pathologic agent.

In other words, the desire to overcome

the body’s natural limits creates injuries.

The dance

medicine literature overwhelmingly suggests that the
required biomechanics involved with even the most basic and
common dance movements are primarily about the dancer
repeatedly overcoming the body’s natural limits.

The

desired aesthetics and artistic results of dance are
dependent upon the most demanding and complex of human
movement abilities.

The desired aesthetics and artistic

results of dance demand that the movements of the dancer’s
body be in a constant state of pathology unto itself.

138
Psychology and Sociology of the Dancer Athlete/Artist
Hybrid

Professional ballet is not just something that you do;
in a very deep sense it is who you are.30
Dancing . . . is no mere translation or abstraction
from life; it is life itself.30

The dance journey begins early on in life.

Children

begin taking dance lesson between three to four years of
age.

Somewhere after age seven, the amount of time devoted

to dance increases from one class per week to as much as
two to three hours per day after school and weekends.
Nationwide, modern dance classes for this age group are not
as numerous as ballet.1 Sacrifice is made by the child and
parents.

It does not take many years of dance training for

it to transition from just a fun activity to that of a
lifestyle.

If this is the chosen path, a great deal of

passion and commitment to this skill is required by the
individual.
As adolescence approaches, some students are enrolled
in regional dance schools that are often some distance from
home.

Transportation often becomes a major issue.1 It is

not uncommon for students of dance to leave school early in
order to attend their dance rehearsals that are in another

139
city.

During this stage, students also become highly

invested in the identity of “dancer;” they begin to embody
the dancer image, taking on the characteristics of others
they admire in the school.

The relationship with the

teacher can become highly important, with much time spent
trying to please the teacher with increasing levels of
skill and grace.1 The constant pressures of feeling as
though they have to please the instructor can take a toll
on the child.

They also might perceive important social

skills and relationships to exist only within their dance
world.

Trying to figure out how to retain friendships in

dance school as well as friendships and relationships in
regular school can be a difficult and confusing time for a
young person.
It is not uncommon for the adolescent dancer to lose
interest in academics.

It is difficult to complete

homework after a day of school, followed by a trip to dance
class, several hours of dance, and then the trip back home.
Over-training syndrome happens when a dancer presents an
unexpected drop in performance which is not attributable to
injury or illness.

Since dance knows no seasons and

training typically lacks sufficient rest periods, dancers
are at high risk for developing over-training syndrome.22 In
contrast to student athletes, whose sports seasons usually

140
last only several months, students of dance often take
dance classes throughout the entire school year.
As the child reaches puberty and moves into midadolescence, a number of issues arise.

First, the effect

of the sex hormones leaves little doubt that sexuality must
be addressed in some fashion.

Puberty is a time of

conflicting feelings, of having a body that changes faster
than one’s capacity to adapt psychologically.1 As if this
time period of the lifecycle is not awkward and difficult
enough, it can get even more complex when the issues
concern physically active females participating in a
discipline that is generally considered to require
aesthetically pleasing features.
Around age 14 to 16, the exceptionally talented ballet
student makes a decision to study full time at a national
ballet school.

If the student has not reached a certain

level of skill by this age, a serious performance career is
not likely.

For those in ballet who enter professional

company schools, the immersion into dance is total.1 Several
articles describe in detail the life of the ballet student
at these schools.

In brief, and painted in the extreme,

contact with those outside of ballet is minimal, and the
demands of the ballet-master become the important external
cues.

Internally, one tries to master one’s body, to make

141
it do what is asked of it.

Preoccupations with body shape,

weight, and successful execution of movement combinations
become paramount.1 Those who enter national ballet schools
in their mid-teens, and are successful, typically make the
jump to professional performers in the ballet companies by
their late teens or early twenties.
Within modern dance, the student usually completes
high school and then chooses between conservatory or
college/university settings.

Conservatories usually train

students over a two to four year period and include dancerelated subjects such as technique, composition, music, and
choreography.

Two-year graduates may then enter college,

while the four year graduates often enter their choice of
company schools.

Students in company schools continue

their major emphases on improving their technique in order
to become a company member and performer, while college
settings usually attempt to expand their students’ talents
to include choreographic skills, with a goal of training
future company leaders.
In ballet, many company dancers have relatively brief
careers as performers.

By the mid-to-late 20s, many

performance careers are over.

Injuries take their toll and

competition for space in the corps from younger company
school members is pushed.

Those who leave ballet at this

142
time often retrain for second careers, leaving the dance
world.

In modern dance, careers are often short; it has

been said that there are no mature company members, but
only mature choreographers.3 At a physical level, those who
suffer multiple injuries in their dancing days are likely
to experience the long-term complications such as posttraumatic arthritis.

Psychologically, one could expect

significant difficulties for the dancer forced to adjust to
a body that no longer does what it once could, a body
becoming less graceful and less beautiful.3 Such transitions
have not been formally studied in the dance population,
which could be another opportunity for future projects by
athletic training students.
Changes in a dancer’s body occur through various
stages of a dancer’s career, with the dancer adapting and
making adjustments along the way.

Women athletes who

participate in sports demanding extreme thinness often
exhibit disorders of the reproductive system.

Several

factors have been proposed to contribute to this
reproductive pathology including intensity and duration of
the training regiment, restrictive eating practices, low
body weight, and low percent body fat.32 Several studies
link inadequate nutrition and disordered eating to dance
injury in adolescents and in dance companies.

More

143
specifically, studies show a strong association between
restrictive eating practices and menstrual dysfunction.
Menstrual irregularities combined with intense training are
associated with overuse injuries.

Amenorrhea tends to

decrease the bone mineral density in dancers, leading to a
common cause of more stress fractures.28 Restrictive eating
practices also contribute to low energy levels.

The

athletic training community has long battled the problem of
low energy availability, coupled with dangerous methods of
weight loss.

The competitive sport of wrestling is a

relevant example.

Low energy availability has also been

demonstrated to disrupt luteinizing hormone pulsatility in
exercising women.

Caloric intake of amenorrheic women

athletes have been found to be less than those of their
eumenorrheic counterparts, despite similar or even greater
activity levels.32 Monitoring a dancer’s eating practices,
body weight, and percent body fat is not an easy challenge.
In one study, women were interested in learning their daily
caloric expenditure and in obtaining anthropometric data,
but did not return to the laboratory to answer questions
regarding their attitudes in regard to food and body image.
The dancer’s unwillingness to address the topic of
disordered eating may be indirectly suggestive of serious
eating pathology, as supported by the fact that they had

144
significantly lower body mass indexes and body percent fat
than did eumenorrheic dancers.

The lack of data on the

amenorrheic dancer was striking.32 Patterns suggest that
unhealthy methods of weight loss are often viewed as being
less time consuming and more practical and realistic to the
dancer athlete.

Traditionally, dancers have not been

properly educated as to the dangers of disordered eating
practices.

More research is also needed in this area.

Low body weight causes another problem as the young
female dancer approaches puberty and moves into the midadolescence stage.

Low body weight causes many girls to

experience late onset menarche due to low levels of sex
hormones.

The result is minimal development of secondary

sex characteristics.

Although puberty is delayed, psychic

and biological complications may develop, such as the sense
that it is possible and desirable to retain the preference
for pre-pubertal identity through pre-pubertal physical
characteristics and behavior.1 The unfortunate reality for
the child is that the sylphlike thinness, so preferred in
dance and especially ballet, might be literally impossible
to maintain without unhealthy restrictions of diet or
dangerous exercise/purgative regiments.
Given the nature of dance study, where students are
placed in mirror-lined classrooms five to six hours per

145
day, five to seven days per week, over the course of years
and where these same students are expected to look and act
certain ways and are applauded for thinness and carriage,
it is no wonder that their images of themselves are
affected by their study.1 One intensive review of ballet
students revealed that no matter how thin, all subjects
wanted to be thinner and their self-esteem was higher if
the teachers commented on their thinness.

Another study

found modern dancers to be at 88% of expected body weight,
compared to 75% of expected body weight for ballet dancers.
Weight concerns are registered by the age of five to seven
years in girls engaged in aesthetic disciplines, which is a
younger age range than girls in competitive sports.

During

adolescence, athletes in aesthetic sports have
significantly lower body mass index (BMI) and fat mass than
their peers who are not involved in such activities.33 It is
clear that further investigation into the training habits,
eating habits, and life style habits of dancers would be
most beneficial.

However, this type of investigation in

the dance population is a delicate matter.

Just asking a

dancer to step on a scale to measure body weight can
trigger problems.

It has been reported that random

assessment of body composition in dancers as part of a prepreparation evaluation is controversial.34 The health and

146
well being of the dancer must be kept central, and should
not be compromised for the success of obtaining empirical
data.

New and innovative methods must be created to help

dancers achieve their goals while at the same time
remaining healthy.
Dance, like traditional sports at the college and
professional levels, is practiced in an exceedingly
competitive environment with a large and talented labor
pool awaiting the opportunity to participate.35 Those
unfamiliar with the dance culture might be taken by
surprise by the cut-throat atmosphere.

When making it to

the top, the company dancers cannot afford to relax.
Instead, pressure of holding on to their positions from the
competition below (the company school) is the reality.
The dancer who is always hurt may, at contract time, be
viewed as being less desirable than a similarly talented
but non-complaining peer.

Thus, hiding injuries is a

common practice among dancers.35 The same pressures continue
of always being thin, always performing, and always
pleasing the choreographer.

Friendships with other dancers

are nice to have, but any dancer has the potential of
turning into a competitor.

Injury might mean the end of

employment (and possibly of a career).

These factors are

described in a study by Patterson et al:36 “The physical and

147
psychological demands placed on dancers in a sport that
requires near perfection in performance and fierce
competition for professional positions has previously gone
virtually unexplored in the role of psychosocial factors in
injury vulnerability.

More research is warranted.” The

psychosocial demands of the dance world are unique to
itself.

The realities making up the lives of dancers was

also investigated in a study conducted by Adam et al:37
“Classical ballet distinguishes itself from purely athletic
or artistic pursuits in that it combines the demands of
both fields.

For this reason, elite ballet dancers are

exposed to a tremendous amount of stress and anxiety in
their professional life.

Some of these sources of stress

include high expectation of artistic excellence, pressure
to maintain unrealistically low body weight, lack of social
support, exhaustive training schedules, fierce competition,
and lack of job security.” The elite dancer must juggle a
number of elements that are critical to their career, and
are unique to dance culture.

When something goes wrong in

one area, a chain reaction is likely to occur.
It is well documented that over the past 60 years, the
employment of certified athletic trainers has had a direct
impact on the prevention and treatment of sports injuries
as well as the altering of negative “traditional”

148
approaches associated with the training and conditioning of
athletes at the high school, college/university, and
professional levels of athletics. Interventions designed to
prevent and treat injuries may require that dance companies
change what many believe is the traditional approach to
dealing with dancers (i.e., breaking the dancer to make the
dancer) and instead provide support for dancers who are
experiencing psychological distress.37 It is also well
documented that certified athletic trainers have lengthened
the careers of athletes as well as promoted healthier lives
for athletes.

The benefits of such interventions may not

only reduce dance related injuries but also improve the
lives of elite ballet dancers: a potential win-win
situation for both dancers and dance companies.37 Athletic
training education should view these trends in dance
companies as opportunities for athletic training students,
and make sure the students are prepared to take full
advantage.
Living and dancing with painful injuries is so common
among dancers that some accept it as a sign of vocational
commitment.

This bleak image of what it entails to be a

dedicated dancer raises some important questions: Is it
possible to be passionate about one’s calling as a dancer
and at the same time preserve one’s physical integrity in

149
the long run?30

This debate has long been addressed in the

athletic world.

Although some athletes still battle

through pain and suffer in silence, modern professional
athletes are actually fined by management for not taking
care of themselves properly and for not keeping
appointments made with the organization’s certified
athletic trainer.

Maintaining physical health and

preventing injuries is less of a debate, and more of an
expectation.

Professional athletes are considered to be

investments.

It is an interesting paradox to think that

petite and elegant dancers are silently suffering through
pain, while the big and tough football players are
willingly going to player treatment sessions (sometimes
twice a day) in athletic training rooms all over the
country.

Which type of investment makes more sense?

Some authors have suggested that dancers are
internally compelled to dance and perform even when they
have an injury because they come to be psychologically
dependent on the sheer physicality of their working lives.30
Certified athletic trainers specialize in making injury
rehabilitation functional for athletes.

It makes sense

that experiencing dance culture and learning more about
dance medicine principles would provide certified athletic
trainers with the skills they need to make rehabilitation

150
functional for dancers.

And if injured dancers working

with certified athletic trainers notice they continue to be
physically productive, the demand for employing certified
athletic trainers in dance settings will continue.
The following description appeared in a study by Rip,
Fortin, and Vallerand:30 “Because dancers are devoted to and
passionate about their art form, and because the dance
milieu holds to a ‘culture of pain’ in which dancers are
expected to suffer in silence, helping dancers understand
that their passion can also be experienced in a manner less
detrimental to their health should be a goal of educational
programs informed by future research.”

It is very clear;

the psychology and sociology of the dancer is not the same
as the traditional, competitive athlete.

In order for a

certified athletic trainer to make the necessary referrals,
having the ability to recognize critical signs and “red
flags” of distress in the psychosocial area of the dancer
is vital.
Megan Richardson, MS, ATC,31 Clinical Specialist and
Research Associate at the Harkness Center for Dance
Injuries at New York University’s Hospital for Joint
Disease explains, “There’s a unique challenge in treating
performers. . . You have to treat them based on both their
cultural upbringing within the performing arts world as

151
well as their athleticism.

You have to understand where

they are coming from emotionally.” The psychological dance
literature in total comprises fewer than 100 scholarly
articles focusing on specific issues relating to dancers.
Any rehabilitation program must take into consideration not
only the specific injured tissue, but also the impact on
the dancer’s psyche as well.

Exercises that will maintain

or improve the dancer’s bodily self-image are more likely
to be met with compliance than those which are perceived to
alter the line of the body.22 This important concern in the
treatment of an injured dancer is not even on the radar in
traditional athletic training settings.

It is highly

unlikely that athletic training students in programs
without dance medicine preparation would be exposed to this
type of variable.
The literature that exists in this area of dance
medicine is overwhelmingly one sided.

The cultural

upbringing of dancers is drastically different from the
cultural upbringing of traditional competitive athletes.
This reality creates a variety of psychological and
sociological circumstances that are unique to dancers and
foreign to athletic training students and most certified
athletic trainers.

The implementation of dance medicine

pedagogy and discussion in the classrooms of athletic

152
training education will help to inform and create awareness
and knowledge of the psychosocial concerns with this
population.

However, cultural traditions need to be

experienced to be adequately understood.

This means that

dance medicine clinical experiences are also a crucial
variable in preparing athletic training students to be
cognizant of the psychosocial concerns of the dancer
athlete.

Financial Costs and Employment Opportunities in Dance
Medicine

Las Vegas performing arts health care pioneer
Steve McCauley, ATC, indicates, “I want to employ as
many certified athletic trainers as I can, as often as
I possibly can.” McCauley is now the head of Health
Services for Wynn Las Vegas (a luxury hotel featuring
the show “La Reve” in its Aqua Theatre). Certified
athletic trainers employed in the performing arts are
making positive impressions on their two primary stake
holders. Performers appreciate the benefits of health
care such as longer careers and stronger performances.
Production companies notice the effect on the bottom
line, especially in regards to workers compensation.
The reaction to all of this is to hire full time
certified athletic trainers as an investment, which
results in fewer worker’s comp claims, because the
certified athletic trainers are able to do treatments
on site and return injured performers to the show
earlier. At Wynn Las Vegas the cost of worker’s
compensation claims are only thirty percent of what
they would normally be without certified athletic
trainers.31

153
If athletic training education programs were known to
offer preparation in dance medicine, it is reasonable to
speculate that the programs would potentially stimulate the
interest of a more diverse spectrum of applicants, as well
as increase the number of applicants.

For instance, when

contemplating a future career, many students become
interested in athletic training because of a dual interest
in medicine and sports.

It stands to reason that there

would be students contemplating future careers with a dual
interest in medicine and dance.

Just like many athletes

transition into certified athletic trainers, former dancers
might desire to transition into certified athletic
trainers.

Athletic training students with substantial

formal training in dance would be well qualified to enter
the dance setting/athletic training job market.

No

published literature exists in this area.
A recent epidemiological study of ballet injuries by
Garrick and Requa revealed that over a three year period,
104 dancers in a professional company sustained a total of
309 injuries of sufficient severity to result in medical
costs of nearly $400,000 (and reported an average of $1,298
in medical costs per injury).35 This type of documented
information makes a strong case for the need of on-site
medical care and injury prevention necessary to cut company

154
medical costs.

The chain reaction is the hiring of

certified athletic trainers as an investment for
professional dance companies.

However, the dance companies

prefer to hire only certified athletic trainers with
experience in the area of dance medicine and dance culture.
Dance organizations also incur extra indirect costs
associated with injuries.

Just as a college athlete cannot

lose his or her scholarship while injured, the dancer, like
the professional football or basketball player, cannot be
“cut” while injured.

Thus, the cost of the contract or

scholarship continues even though the injured person is no
longer participating.35 Certified athletic trainers
specialize in returning athletes back to participation as
fast and safe as possible.

Their skills in this area have

proven to be effective in the athletic arena.

Depending on

the visibility of the injured dancer, such nonparticipation
can even result in lost revenue in the form of impaired
excellence and lost ticket sales.35 It is reasonable to
surmise that a certified athletic trainer with a
specialized set of competencies in dance medicine would
also be effective in returning dancers back to performance
as fast and safe as possible for a professional dance
company.

Some ballet companies in the United States have

instituted in-house medical and therapy services to reduce

155
the physical and financial impact of injuries on the dancer
and company.

In one ballet company of 70 dancers, this

resulted in a decrease of annual injuries from 94% to 75%
and savings in excess of $1.2 million over a five year
period.38 This type of data legitimizes the dance setting as
a market already in existence, and open to expansion, for
the employment of certified athletic trainers with dance
medicine experience, as well as a background in dance
culture.
Modern dance companies tend to have fewer dancers and
smaller budgets than ballet companies.

High injury rates

in smaller companies put a greater strain on dancers, who
must cover for injured company members.

These injury-

related costs, in turn, strain the finances of companies
with smaller budgets.38 To curtail the cost of injuries in
these smaller modern dance companies, it is possible that a
certified athletic trainer could be employed by multiple
dance companies, or be contracted out to multiple dance
companies through a sports medicine clinic in the same way
that high schools all over the country retain the services
of certified athletic trainers.
Based on the positive results from in-house medical
and therapy services at several ballet companies, a
comprehensive management program was established at a

156
professional New York City modern dance organization.
Comprehensive management services at this modern dance
organization resulted in more timely and appropriate
medical referrals, decreased the number of new workers’
compensation cases, and decreased the number of days missed
because of injury.38 This is good news for all parties
involved; the dance company management saves money,
choreographers and instructors maintain their talent, and
the dancers maintain their health and ability to perform.
Establishment of this program resulted in change to a more
beneficial workers’ compensation carrier and contract and
eliminated unnecessary medical visits, thereby decreasing
injury-related costs.

The incidence of new workers’

compensation cases decreased from a high of 81% to a low of
17%.

The number of injuries per injured dancer decreased

from 1.5 to 1.0.38 The dance medicine literature indicates a
need for more consistent dance injury data being documented
and monitored through accurate and reliable methods of
injury surveillance.
For certified athletic trainers, dance injury
surveillance and data establishes the type of bottom line
that potential employers (dance company management) are
most interested in seeing.

Although many systems are used,

sports epidemiologists have reiterated the need for uniform

157
reporting standards and methodologies.

Dance medicine

researchers have echoed this same call for a uniform
standard.

No consensus exists in dance medicine concerning

injury definition and reporting.39 The literature suggests
that in order to optimize these efforts, the dance medicine
world collaborate with colleagues across disciplines.
Injury reporting systems have been used by the sports
community for the past three decades and have provided
athletes and the persons who train them and care for their
health a better understanding of risk variables associated
with injury onset.

It is only by similar discipline that

the dance community can become truly effective at reducing
its injury rates.40 This is an area where the dance medicine
community could learn from discussions with the sports
medicine community.

Although many systems are used, the

sports medicine community has an extensive working
knowledge of injury surveillance.
Probably the most challenging aspect of any injury
reporting system is in the measurement of exposure.
Currently, the literature on dance injuries is weakened by
inconsistent exposure measurement techniques.
particularly hard to monitor in dance.

Exposure is

The energy

expenditure in dance varies extremely based on the type of
impact, the rehearsal or performance length, the musical

158
cadence, the choreographic intensity, the continuous versus
interval nature of the repertoire and the effort with which
each dancer executes the movements on a given exposure.38
More investigation is needed into the surveillance issue of
how to best measure the exposure of dance injuries on a
more consistent and reliable basis.
In the study, “The Cost of Injuries in a Professional
Ballet Company: Anatomy of a Season,” Solomon et al36 report
the following:

“The changes in procedure that have

accompanied this experiment – essentially, paying selected
health care providers directly for their services rather
than through an insurance company, and keeping more
detailed records – hold out promise for addressing the cost
of injuries.

There is every reason to believe that what

appears to be working for the Boston Ballet could work
equally well for other dance companies.” This is more solid
evidence that a legitimate and growing market in dance
medicine exists for the employment of certified athletic
trainers with experience in dance medicine and a background
in dance culture.
In a follow-up study titled: “The Cost of Injuries in
a Professional Ballet Company:

A Five-year Study,” Solomon

et al39 describe the positive impact that in-house health
care was having on the comfort level of dancers in a major

159
ballet company.

“There has been a noticeable improvement

in company morale during the years studied.

This is due in

part to increased awareness among the dancers that the
company is making a concerted effort to prevent injuries,
and to limit the impact of injuries when they do occur by
providing reliable medical assistance.

The availability of

a company physician, and through him of in-house health
care providers who are known and trusted, is a major
factor.” This is an encouraging example of health care
services being provided with a genuine focus and motivation
on the health and well being of the patient.

This type of

health care approach is a natural fit for certified
athletic trainers.
A previous installment of the study conducted by
Solomon et al42 was titled, “The Cost of Injuries in a
Professional Ballet Company: A Three Year Perspective.”
This time the authors documented significant injury data.
Injury rates in this company declined steadily from 137 to
88, and the percentage of injured dancers from 94% to 77%.
The authors concluded that this was strong evidence that
the injury prevention measures implemented by the ballet
were having the intended effect.

One of the

recommendations listed in the conclusion of this study
stated the following: “Employ in-house health care

160
providers to increase quality control and reduce the rate
and severity of injuries.”

This statement solidifies the

employment potential for certified athletic trainers (by
dance companies) possessing the competencies needed to take
care of the dancer athlete/artist hybrid.
If the evidence is in the literature, then the proof
is in the pocketbooks; dance companies are saving money
using in-house health care providers, and the job
description is a good fit for certified athletic trainers.
It is time for athletic training education programs to
implement specialized coursework in dance medicine, as well
as clinical experience in dance settings, so athletic
training students are able to experience dance culture.

Summary

Stretanski and Weber29 define a dancer as a hybrid
between athlete and artist.

The review of literature has

examined this unique hybrid through four primary areas of
dance medicine.
The first section highlighted the artistic and
spiritual, “Movements of the Unconscious: The ‘Hidden’
Movements of Dance.”

Deepening and extending the internal

process of working with movement, new choices become

161
possible that go beyond ordinary movement invention.10 It is
well documented that the athlete/artist hybrid known as
“the dancer” applies a unique approach to human movement.
The second section detailed the more athletic and
scientific, “Biomechanics and Pathogenesis of Orthopedic
Dance Injuries.” Dancers represent a population of highly
trained individuals that are at significant risk for injury
due to the repetitive, reproducible, and consistent nature
of their movement patterns.43 It is well documented that the
athlete/artist hybrid known as “the dancer” sustain
injuries that must to be managed with a different approach
than injuries sustained by traditional athletes.
The third section revealed the shrouded, “Psychology
and Sociology of the Dancer Athlete/Artist Hybrid.” Dancers
pay a heavy price for their art.

Despite the obvious

aesthetic rewards of being a professional dancer, the
enormous physical and psychological stresses without
financial security make the art of dancing one of the most
demanding of occupations.

Leanness is not only an artistic

standard in many professional dance companies – it is an
occupational absolute.

Dancers constantly strive to

perfect the form of the human body while they struggle with
the trials of dance technique.44-45 It is well documented
that with a lack of health care attention, the

162
athlete/artist hybrid known as “the dancer” is at a high
risk for mental and emotional difficulties.

These mental

and emotional difficulties are also manifest themselves
differently than in traditional athletes, and must also be
managed using a dance medicine approach.
The fourth section outlined the practical “Financial
Costs and Employment Opportunities in Dance Medicine.”
There continues to be a growing mainstream interest in
medicine for performing artists.

This heightened interest

in performing arts medicine is reflected in an increasing
number of articles appearing in a broader range of peerreviewed medical journals, the establishment of dance
medicine programs at college and university levels, and
increased exposure to the healthcare issues of artists in
popular media venues.43 It is well documented that there is
a unique job market in existence for certified athletic
trainers with specialized competencies in working with the
athlete/artist hybrid known as “the dancer,” as well as
experiences in dance culture.
Several professional organizations that focus on the
care and training of performing artists now exist.43 The
NATA (National Athletic Trainers’ Association) is one
organization.

According to its website, “Performing arts

athletic trainers provide specialized injury prevention and

163
rehabilitative care to dancers, musicians and vocalists.
Studies show that the on-site medical care that the
certified athletic trainer can provide to performers
reduces both the frequency and severity of injuries as well
as reducing operating and production costs.46 If certified
athletic trainers are to be competitive at the forefront of
providing the unique health care services required of this
population, more extensive educational preparation in this
realm is required.

The literature on this is clear.

It is

also supported by certified athletic trainers already
working in the field.

Athletic training students are in

need of entry-level competencies in the area of dance
medicine, as well as experiences with dance culture.
Consider the following description:
Although the public is generally aware and
appreciative of the art of dancing, it is not usually
cognizant of the physical, intellectual, and emotional
demands of being a dancer. The dancer prefers to bear
this pain in silence. There is nothing glamorous or
aesthetic about an injured dancer performing in pain.
What is deemed admirable and courageous in sports
would seem foolish and inappropriate in an art form.
It is this odd analogy that seems to verify the
worthiness of dance for study, not the sociological
impact of the injured dancer as talent untapped and
art lost.45
A dancer delivering a performance in an auditorium is
communicating her art to the audience; she is not competing
on stage.

However, dance medicine is a competitive field,

164
and athletic training students entering the work force will
be competing for jobs based on how well they communicate
with artists and dancers.
The mission of the National Athletic Trainers’
Association is to enhance the quality of health care
provided by certified athletic trainers and to advance the
athletic training profession.47 Athletic training students
in curricula without sufficient dance medicine coursework
and clinical experience is talent untapped and art lost.

165

APPENDIX B
The Problem

166
The Problem

Statement of the Problem

The presence of a dancer can change the atmosphere of
a room.

The graceful walk, the stylish turn-out, the

elegant posture, the poised demeanor, the polished
attitude, the attractive lines, the signature spine, the
natural beauty.
The addition of dancers being treated in college and
university athletic training rooms would complete a missing
dynamic through the presence of the dancer’s creative
manifestation of the human spirit in the form of human
movement.
Imagine the opportunities for certified athletic
trainers to uncover hidden emotions and passions for
another form of athleticism.

Imagine the opportunities for

certified athletic trainers to discover untapped knowledge
and creativity within themselves.

Imagine the

opportunities for certified athletic trainers to lend their
skills and talents to another type of athletic population.
Imagine the opportunities for certified athletic trainers
to mentor athletic training students in preparation for the
dance medicine work setting.

167
Athletic training rooms are laboratories for exploring
the human condition through the common need and love of
human movement.

The health care services provided by

certified athletic trainers should bring to life the
classical African idea known as Ubuntu; The essence of
being human.

The origin of the word is rooted in the Bantu

languages of southern Africa.

There is no word in the

English language that quite matches Ubuntu.

The word has

been described by Nobel Peace Prize Laureate, Archbishop
Desmond Tutu49 as: “A person is a person through other
persons.

You cannot be human in isolation.

only in relationships.

You are human

We are interconnected.”

Imagine

the athletic training world not trying to understand and
value the dance world’s creative manifestation of the human
spirit through the way a dancer shapes movement.

It feels

extraneous because the two worlds are already
interconnected.

I am because we are.

Based on the review of literature, the following areas
of dance medicine are well documented:

1) From a cultural

perspective, dancers infuse their own language, creativity,
and spirituality into shaping unique human movement.
Deepening and extending the internal process of working
with movement, new choices become possible that go beyond
ordinary movement invention;10 2) From an athletic and

168
scientific perspective, dancers represent a population of
highly trained individuals that are at significant risk for
injury due to the repetitive, reproducible, and consistent
nature of their movement patterns.43

Dancers sustain

injuries that must be managed with a different approach
from injuries sustained by traditional athletes; 3) Dancers
are at a higher risk for mental and emotional difficulties
due to lesser health care attention, combined with the
demands of their environment.
for their art.

Dancers pay a heavy price

Despite the obvious aesthetic rewards of

being a professional dancer, the enormous physical and
psychological stresses without financial security make the
art of dancing one of the most demanding of occupations.
Leanness is not only an artistic standard in many
professional dance companies – it is an occupational
absolute.

Dancers constantly strive to perfect the form of

the human body while they struggle with the trials of dance
technique,44-45 and 4) There continues to be a growing
mainstream interest in medicine for performing artists.
This heightened interest in performing arts medicine is
reflected in an increasing number of articles appearing in
a broader range of peer-reviewed medical journals, the
establishment of dance medicine programs at college and
university levels, and increased exposure to the healthcare

169
issues of artists in popular media venues.43 A job market in
dance settings exists for certified athletic trainers with
specialized competencies in dance medicine as well as
experiences in dance culture.
The purpose of this study was to investigate the
current frequency of specialized dance medicine coursework
in athletic training education programs, to investigate the
frequency of clinical rotation experience in dance settings
offered in athletic training education programs, and to
investigate the extent of athletic training services being
provided for academic dance major/emphasis programs by the
athletic training staff at colleges/universities.

The

purpose of this study was also to investigate possible
factors which might contribute in determining the frequency
of dance medicine preparation in athletic training
education programs, and to also investigate possible
factors which might contribute in determining the extent of
athletic training services being provided for academic
dance major/emphasis programs by the athletic training
staff at colleges/universities.

170
Definition of Terms

The following terms have been defined to increase the
overall understanding of the study.
1.

Ballet – A classical form of theatrical dancer
characterized by specialized movements, techniques,
traditions and vocabulary.

Soft ballet flats are worn

and women often wear pointe shoes.48
2.

Battement - A unilateral leg raise that begins and
ends with a knee extended position.48

3.

Dance – (from French dancier) generally refers to
movements used as a form of expression, social
interaction or presented in a spiritual or performance
setting.48

4.

Degage - Consists in the pointing of the foot from a
closed position to an open position, and the foot
slightly leaves the floor with the heel raised and the
instep stretched.48

5.

Demi – Half, or small. Applied to plié and pointe and
other movements or positions to indicate a smaller or
lesser version.48

6.

En - Literally "in.” This term is usually used to
describe the position in which the dancer is situated;
i.e. en plie, en rélevé, en pointe.48

171
7.

Modern (or Contemporary) – A form of theatrical dance
created to break away from the traditional ballet
technique and allow for more emotional expression
through movement.

This technique is normally

performed with bare feet.48
8.

Parallel position – 6th standing position of the feet
(See “Basic Standing Positions of the Feet,” below).48

9.

Pirouette – Literally, whirl. A turn where the body is
supported by one leg while it rotates around its
vertical axis.48

10.

Plie’ – A bending of the knees, while the torso is
held upright.

Two types of plie.

Demi and Grand.

The action relies on varied degrees of hip and knee
flexion, with ankle and MTP dorsiflexion.48
11.

Pointe – Performing steps while on the tips of the
toes.48

12.

Porta Breaux – Carriage of the arms, combined with
basic feet and head positions.

Names of positions

vary with style of dance.48
13.

Releve’ – A heel raise of varying height where the
knees are extended, the ankle is plantar flexed and
the MTP’s are dorsiflexed.

In full releve, or pointe,

the MTP would be plantar flexed.48

172
14.

Tendu – A “stretched” action of the unilateral
gesturing limb from a stance position.48

15.

Turn out – A rotation of the leg from the hips,
causing the knee and foot to also turn outward.
Properly done, the ankles remain erect and the foot
arch remains curved and supporting.

Turn-out

technique is a defining characteristic of Classical
Ballet.

Not all dancers do have a perfect turn-out;

but it is definitely a measure for selection.

In

beginner classes, a less-than-perfect turn-out is
tolerated to save stress to knee joints until the
ability is acquired.48

Basic Standing Positions of the Feet:
16.

1st Position – Keep heels together, turn feet outward
in external rotation.48

17.

2nd Position – Turn feet outward in external rotation;
feet are seperated by distance of one foot.48

18.

3rd Position – Turn feet outward, place heel of one
foot in the arch of the other. *A less extreme version
of 5th position.48

19.

4th Position – Turn feet outward, place one foot in
front of the other on a parallel line, seperated by a
distance of one foot.

Heels and toes are in line

173
forming a square. (In modern technique 4th Position is
when the dancer is seated on the floor with the front
leg in outward rotation and the back leg in inward
rotation, with both legs at a 90 degree angle).48
20.

5th Position – Turn feet outward, place one foot
directly in front of the other, the first joint of the
big toe projecting beyond either heel.48

21.

6th Position – Parallel hips, knees and feet.

With

feet either aligned with hips, or touching at
midline.48

Basic Arm Positions:
22.

1st Position – Slightly rounded arms are raised in
front of the body in line with the diaphragm.48

23.

2nd Position – Slightly rounded arms opened to the
sides of the body.48

24.

3rd Position – One arm overhead and slightly forward.
One arm slightly rounded to the side.48

25.

4th Position – One arm forward and slightly rounded at
the height of the chest.

One arm overhead and

slightly rounded.48
26.

5th Position – Slightly rounded arms creating a circle
above the head, palms inward.
peripheral vision.48

Fingers should be in

174
Basic Assumptions

The following were basic assumptions associated with
this study:
1.

The questions in the survey of this study were
valid in their application to the topic of this
research project as determined by the panel of
experts.

2.

All questions in the survey were answered
with honesty and to the best knowledge of each
participant of the study.

3.

The sample population of this survey was
legitimate to the content of this research project.

Limitations of the Study

The following are possible limitations to this study:
1.

Conclusions were based on responses to the
questions of the survey only.

Other factors could

exist that were not addressed in the survey.
2.

A low response rate from a particular level of
athletic training education program directors (CAATE
entry-level undergraduate, CAATE entry-level graduate,
or NATA post-certification) reduced the validity of
the results for the particular level.

175
3.

A disproportionate number of responses from CAATE
program directors at colleges/universities without
dance programs would reduce the validity of what
determines the presence of dance medicine clinical
experiences.

Significance of the Study
To watch us dance is to hear our hearts speak.4

In the pursuit of enhancing the quality of health
care provided by the athletic training world, how can
certified athletic trainers constructively apply the above
Hopi saying?

Dance (from French dancier) generally refers

to movements used as a form of expression, social
interaction or presented in a spiritual or performance
setting.48 Could the Hopi saying be used as a doorway
leading to a strikingly similar parallel that pertains to
the sociology of this project?

The parallel involves the

spiritual act of uncovering sacred human emotions and
attitudes through experiencing the lives of other
[different] people.

Albert Einstein once said, “Dancers

are the athletes of God.”4 It has also been said that all of
life’s questions are spiritual questions.

Brian D.

McLaren50 suggested the following on this point:

176
Orthodoxy is not merely correct conclusions, not
just correct ends but right means and attitudes to
keep on discovering them, not just straight answers
but a straight path to the next question that will
keep on leading to better answers. This kind of
orthodoxy will welcome others into the passionate
pursuit of truth, not exclude them for failing to
possess it already.
Is the relationship between the “sports world” and the
“dance world” not unlike the relationship between the great
religions of the world?

Take for example, the “pearl”

known as Judaism and the “pearl” known as Christianity.
Through listening to each other, and learning from each
other, Jews and Christians are able to discover a strong
bond shared from original grains of sand.

But the

opportunity to actually experience other religions and
cultures carves a much deeper understanding of the need the
world has for human expression.

For example, through study

abroad experiences students learn to value the sacred forms
of expression through which human beings nurture, and make
beautiful, the deepest pearls of their hearts.

As part of

a February, 2007 faculty presentation regarding the value
of “Spring Break in Mission” experiences for students the
Reverend Thomas G. Steffen, former Dean of the Chapel at
the Culver Academies (Culver, IN) suggested, “These types
of cross-cultural experiences provide an opportunity for
students to navigate a diverse global community that moves

177
together with graceful rhythm and synchronicity.”

It is

this type of experiential learning that often creates an
environment for the student to even discover the pearl of
the other [different] person within their own heart.

And

it is on matters of the heart that Reverend Steffen
continued by saying, “There is little value in suggesting
that an artist, musician, or athlete could finally capture
beauty and grace once and for all.

Great art, music, and

athleticism (like inspired writings and experiences), do
not capture but reveal beauty and grace, and they open our
eyes to see and our hearts to feel what we might otherwise
miss.”

Cross-cultural experiences illuminate a

multidimensional approach to learning.
uncovered and valued.

Sacred emotions are

The individual develops a deeper

understanding of self and the wider world.
is inspired and released.
as human beings.

Creative energy

People value their differences

Judaism is treasured as the heart of

Christianity.
Both the dancer athlete and competitive athlete exude
tremendous amounts of emotional and physical energy . . .
the sweat and blood of hard work . . . the mental strain of
commitment and dedication . . . the life lessons of
teamwork . . . the joy of a successful performance and
victory . . . the heartbreak and tears of an “off” night

178
and defeat.

These elements, while being intertwined with

the importance of human movement, carry a common potential
for the frustrations of physical injury, as well as the
complications of emotional wounding.

Both types of

athletes require a mutual need for the best that modern
sports medicine services have to offer.

Athletes and

artists are pearls from the same grains of sand.
Therefore, certified athletic trainers should value this
common bond and work on making it stronger.

Certified

athletic trainers should respond to the medical needs of
the dance world with eagerness and pride by listening and
learning about dance culture as well as by studying the
culture’s sacred form of human expression.

Athletic

training students should experience the lives of the dancer
athlete in order to carve a deeper understanding of another
creative form of human movement provided by the
athlete/artist hybrid.

If given the chance, perhaps more

future athletic training students will aspire to discover
their dancer pearl within.

The athletic training world

should consider it a major disappointment of “talent
untapped and art lost”45 if athletic training students
continue to be deprived of such a unique and inspiring
cross-cultural learning opportunity.

179
Albert Einstein amazed the world by theorizing matter
and energy to be the same thing.

Consider the thoughtful

insight of University of Maryland Professor of Physics,
S.J. Gates Jr51:
The thing I love most about Einstein’s scientific
work is the clear demonstration of the universality of
creativity. In our society, many people will describe
a musician, dancer, artist, or singer as “creative.”
This appellation is much less given to the scientist.
And yet Einstein said: [After a certain high level of
technical skill is achieved, science and art tend to
coalesce in aesthetics, plasticity, and form. The
greatest scientists are always artists as well . . .
The power of the artist, and the scientist, is to
imagine].
Does the ability to perceive and value creative beauty
in unexpected environments impact the ability to uncover
sacred human emotions?

Amidst all of the chaos inside an

ice hockey rink, there is a graceful flow to a hockey game
being played by two well-coached, highly skilled, hard
hitting teams.

When played at its best, the game quietly

exudes an artistic quality of a high caliber.

Could the

ability to perceive and value the athleticism found in the
creative form of dance provide certified athletic trainers
with an added appreciation for their patients involved in
the creative form of traditional competitive sports?
Similar to dance partners, a baseball middle infield must
learn to move together with extreme amounts of rhythm and
precision in order to turn double plays.

It is an

180
inspirational experience to watch this type of dance being
performed game after game, especially during those plays
when it seems like the dance will be impossible to execute,
and yet the infielders somehow pull it off.

The experience

is even more profound when the two individuals who have
found this “connectedness” with each other have very
different personalities and are from very different
backgrounds.
The sports community, the dance community, and the
athletic training community must navigate a diverse world
that moves together with graceful rhythm and synchronicity.
With the appropriate educational background, certified
athletic trainers could be the bridge that connects the
hearts and talents of the different people that make up
these communities.

Is the need for health care intertwined

with the love of human movement common ground enough?
There is a moment of surrender while absorbing the
beauty and grace of a Jewish ballerina’s heart-felt,
emotionally driven performance during the Nutcracker
Ballet.

According to the Muslim mystic Hafiz, “The earth

braces itself for the feet of a lover of God about to
dance.”

Her gifted talents in athleticism and artistry

reveal a sacred pearl of the human condition that radiates
with life.

It is because of her that the traditional story

181
told during the Advent season comes to life on stage.
watch her dance is to hear one’s own heart speak.
Imagine . . .
It’s easy if you try . . .
You may say I’m a dreamer . . .
But I’m not the only one . . .
I hope someday you’ll join me . . .
And the world will live as one.52

To

182

APPENDIX C
Additional Methods

183

APPENDIX C1
Athletic Training Education and Dance Medicine Survey

184
Athletic Training Education and Dance Medicine
Survey

Instructions:
•

Please answer ALL of the questions contained in this
survey.

•

Please answer ALL of the questions contained in this
survey to the BEST OF YOUR KNOWLEDGE.

•

For all of the questions contained in this survey, the
term “Dance” refers to any/all of the following forms:
“Ballet,” “Contemporary,” “Tap,” “Jazz,” “Ethnic.”

1. Please indicate the type of athletic training education
curriculum you currently oversee as program director?
____ Entry-level Undergraduate
____ Entry-level Masters
____ NATA Post-Certification

2. Please indicate the total number of years you have
served as an athletic training education curriculum
program director. If you have served as a program
director at more than one level (CAATE Entry-level
Undergraduate, CAATE Entry-level Masters, NATA PostCertification) please combine your total years of
service into one number.
____ Years of Service

3. Please indicate your gender.
____ Male

4. Please indicate your age?

____ Female

____

185
5. Using the list below, please indicate the styles of
dance in which you have (at any time of your life), had
formal training. In the box at the bottom, list your
total years of formal dance training.
____
____
____
____
____
____

Ballet
Contemporary
Tap
Jazz
Ethnic
I have not had formal training in any
of the above styles of dance.

Years of dance training: ____

6. Did the college/university from which you received the
majority of your bachelor’s degree require students to
take “core” classes as part of a “liberal arts”
curriculum?
____ Yes

____ No

7. Please indicate the year in which you completed your
entry-level athletic training curriculum?
Completed in the year: _____

8. Did you receive any specialized course content in dance
injuries while completing your entry-level athletic
training preparation?
____ Yes

____ No

9. Did you have the opportunity to complete a clinical
rotation in a dance setting while completing your entrylevel athletic training preparation?
____ Yes

____ No

186
10. Please indicate which type of master’s curriculum you
have completed (in addition to, or beyond and “entrylevel” graduate athletic training curriculum). Please
check all that apply:

____ NATA post-certification curriculum (Please specify
your GA position or internship/clinical assignment
in the box below).
____ Other master’s curriculum WITH an athletic
training graduate assistantship position (Please
specify the master’s curriculum and athletic
training GA position in the box below).
____ Other master’s curriculum WITHOUT an athletic
training graduate assistantship position (Please
specify the master’s curriculum in the box below.
If the master’s curriculum involved any sort of
athletic training clinical/internship experience,
please list this information as well in the box
below).
____ I have not completed a master’s degree in addition
to, or beyond an entry-level athletic training
curriculum.
Type of master’s curriculum/GA position/Internship:
__________________________________________________
__________________________________________________

11. Did you receive any specialized course content in dance
injuries as part of your master’s curriculum?
____ Yes
____ No
____ I have not completed a master’s degree
in addition to, or beyond an “entrylevel” athletic training curriculum.

187
12. Did you have the opportunity to complete a clinical
rotation in a dance setting as part of your master’s
curriculum?
____ Yes
____ No
____ I have not completed a master’s degree
in addition to, or beyond an “entrylevel” athletic training curriculum.

13. While a certified athletic trainer, have you
participated in a “dance medicine” continuing education
experience through attending a “dance medicine”
conference or workshop?
____ Yes

____ No

14. Do any of the courses offered in the athletic training
curriculum you currently oversee as program director
provide specialized educational content in the
area of managing the injured dancer patient?
____ Yes

____ No

15. Does the athletic training education curriculum you
currently oversee as program director offer clinical
rotations in a dance setting? Please check all that
apply.
____ Yes, with our college/university dance program.
____ Yes, with another nearby college/university dance
program.
____ Yes, with a local dance company.
____ Yes, with a local clinic/hospital which
works with dancers.
____ Yes, in a dance setting not listed here (please
describe the clinical rotation/dance setting in
the box below).
____ No, the curriculum does not include clinical
rotations in a dance setting.
Other dance settings:
____________________________________________________
____________________________________________________

188
16. Does the college/university of your current employment
require undergraduate athletic training students to
take “core” classes as part of a “liberal arts”
curriculum? (Please answer this question even if you
work only in the graduate school at the
college/university).
____ Yes
____ No
____ There is not an undergraduate athletic
training curriculum at my
college/university of employment.

IMPORTANT BACKGROUND INFORMATION FOR ANSWERING QUESTIONS
#17, #18, and #19:
In 1956, educational psychologist Benjamin Bloom identified
three domains of educational activities, now known as
“Bloom’s Taxonomy of Learning.” The three domains (listed
below) are still relevant in 21st Century educational
practices and are still being applied in educational
curriculums throughout the United States.
The 3 Domains of “Bloom’s Taxonomy of Learning:”
• Cognitive: mental skills (knowledge)
• Affective: growth in feelings or emotional areas
(attitude)
• Psychomotor: manual or physical skills (kinesthetics)

17. Do you think that the management of the dancer patient
by certified athletic trainers requires specialized
competencies in the “Cognitive Domain” of Blooms
Taxonomy of Learning (mental skills – knowledge) in
addition to the “cognitive domain” competencies
required of certified athletic trainers for the
management of the traditional athlete patient?
____ Yes
____ No
____ I don’t know

189
18. Do you think that the management of the dancer patient
by certified athletic trainers requires experiences in
the “Affective Domain” of Blooms Taxonomy of Learning
(growth in feelings or emotional areas - attitude)? The
most recent NATA Educational Competencies (ed. 4) has
removed the “Affective Domain” of Blooms Taxonomy of
Learning (growth in feelings or emotional areas –
attitude) from athletic training education.
____ Yes
____ No
____ I don’t know

19. Do you think that the management of the dancer patient
by certified athletic trainers requires specialized
competencies in the “Psychomotor Domain” of Blooms
Taxonomy of Learning (manual skills – kinesthetics) in
addition to the “psychomotor domain” competencies
required of certified athletic trainers for the
management of the traditional athlete patient?
____ Yes
____ No
____ I don’t know

20. Does your college/university of employment offer an
undergraduate and/or graduate level “dance major” or
“dance emphasis” academic program?
____ Yes

____ No

If you answered “NO” to question #20 above, you do not need
to answer questions #21, #22, and #23. You are finished
with the survey. Thank you.
If you answered “YES” to question #20 above, please
continue with the 3 remaining questions of the survey (#21,
#22, and #23).

190
21. Which of the following descriptions describe the extent
of involvement by your college/university athletic
training staff in providing athletic training services
for the dance major/emphasis program? Please check all
that apply:
____ Athletic training services are not available to
the dance program.
____ Limited athletic training services are available
to the dance program.
____ No formal arrangement/communication exists between
the athletic training staff and dance program.
However, dancers occasionally visit the athletic
training room and are treated with the same
standard of care as any other athlete.
____ A formal “outreach” meeting is held at least once
a year with the instructors and/or dancers of the
dance program to discuss the athletic training
services available. Dancers frequently
visit the athletic training room and are treated
with the same standard of care as any other
athlete.
____ A certified athletic trainer (graduate student,
part-time staff, or full-time staff), or a
combination of graduate/staff certified athletic
trainers, are assigned specified responsibilities
in providing athletic training services for the
college/university dance program.
____ Other health care approaches (please describe in
the box below):
Other health care approaches:
_________________________________________________
_________________________________________________
_________________________________________________

22. Does your athletic training budget have sufficient
enough resources (staffing/supplies) to provide
athletic training services for the college/university
dance program?
____ Yes

____ No

191
23. Is the dance major/emphasis program at your
college/university affiliated with the department of
athletics?
____ Yes

____ No

You have completed the survey.

Thank you.

192

APPENDIX C2
Athletic Training Education and Dance Medicine Survey Cover
Letter

193
February 10, 2010

Dear Fellow Certified Athletic Trainer:

I am a master’s degree candidate at California University
of Pennsylvania requesting your help to complete part of my
degree requirements. I have been doing research in the
area of dance medicine and have completed my “review of
literature.” The purpose of the study is to determine the
prevalence of dance medicine preparation within athletic
training education, as well as what determines whether or
not athletic training curricula offer specialized
preparation in the area of dance medicine for athletic
training students. This invitation to participate in the
“Athletic Training Education and Dance Medicine Survey” is
being sent to all athletic training education program
directors (CAATE entry-level undergraduate, CAATE entrylevel graduate, NATA post-certification). This student
survey is not approved by NATA. It is being sent to you
because of NATA’s commitment to athletic training education
and research.
At the bottom of this letter is a web-link to a
questionnaire. The questionnaire will take no more than 5
minutes to complete. The questionnaire consists of 23
questions broken down as follows: 16 YES/NO response
questions, 3 one-word (numerical) response questions, 3
“check a category” response questions, and 1 “check all
that apply” response question (with the option of providing
additional information by way of a short written response).
Your participation in this survey is completely voluntary.
If you choose to complete the survey, neither your name nor
email address will be attached to your answers. The survey
is being sent to all subjects via the NATA list-serve. The
NATA will then forward all responses to the researcher
without any subject’s identification attached. Your
identity is guaranteed to be anonymous and your response
entirely confidential. Furthermore, your participation
in the survey may be discontinued at any time without
penalty and all data discarded. All data will be kept in a
secure location where only the researcher and the faculty
advisor will have access. This study has been approved by
the California University of Pennsylvania Institutional
Review Board. The effective date of approval is 11-18-2009

194
and the expiration date is 11-17-2010.
As a CAATE program director, your knowledge and opinions
regarding this topic makes your input invaluable. If you
feel you need more information or clarification regarding
this study, please feel free to contact the researcher
(contact information is listed below) or the researcher’s
faculty advisor (contact information is listed below).
Please take five minutes to fill out the anonymous
questionnaire you will find by clicking on the web-link
below and submitting it by Wednesday, February 24, 2010.
By submitting the survey you are indicating consent for the
researcher to use the data.
(http://web page link/)

Thank you for your time and consideration.
Sincerely,
Brian B. Rosenau
Brian B. Rosenau
Master’s Degree Candidate
California University of Pennsylvania
Email: rosenab@culver.org
Office: 574-842-8476
Dr. William Biddington
Faculty Thesis Advisor
California University of Pennsylvania
Email: biddington_w@calu.edu

Participants for this survey were selected at random from the NATA membership
database according to the selection criteria provided by the student doing the survey.
This student survey is not approved or endorsed by NATA. It is being sent to you
because of NATA’s commitment to athletic training education and research.

195

APPENDIX C3
Panel of Experts Letters

196
October 6, 2009
Dear _______:
My name is Brian Rosenau. We met in July ‘08 when I
attended the Principles of Dance Medicine conference at The
Harkness Center. I am employed as a certified athletic
trainer at The Culver Academies (Culver, IN), a 9th through
12th grade college prep/boarding school. I hope the more
recent ’09 conference was every bit as informative and
inspirational as the ’08 conference. Since I was unable to
attend this year, I hope this letter finds you well. I
have spent a lot of time reflecting, researching, and
writing on all I learned at last year’s conference, which
brings me to the purpose of this letter . . .
In addition to working at Culver, I am also a graduate
athletic training student at California University of
Pennsylvania pursuing a Master’s of Science degree in
Athletic Training. In partial fulfillment of this degree,
I am conducting a descriptive study. The purpose of this
study is to investigate the presence of dance medicine
preparation in athletic training education.
In order to increase the content validity of the instrument
(a survey), I need a panel of experts to review questions
of the survey. The survey will be distributed to all
program directors of CAATE entry-level undergraduate, CAATE
entry-level masters, and NATA post-certification
curriculums. At this time, I would like to ask you to be
one of four professionals to be on this panel. Due to your
position and experience, your feedback is very important to
the success of this study. The information obtained by
this panel of experts review will be used to make revisions
and create the final survey to be distributed to the
population sample. Your responses are voluntary and will
be confidential. Please let me know if you will agree to
be on the panel.
If you do agree to be on the panel, please answer
following questions (below) based on the attached
and make any other additional comments you deem
appropriate. I ask that you return your comments
revisions via email no later than Friday, October
I have also attached the “survey cover letter” as
additional information. If you have any questions
concerns, please do not hesitate to contact me.

the
survey
and
17, 2009.
or

197
Questions:
1.

Are the survey questions appropriate, valid, and
understandable?

2.

Comment on the overall presentation of the survey.

3.

Which questions of the survey, if any, should be
restated? Why?

4.

Are there any questions that should be added to the
survey? Why?

Thank you in advance for your time and efforts.
Brian B. Rosenau
Brian B. Rosenau
California University, PA
The Culver Academies
1300 Academy Rd, #95
Culver, IN 46511
Cell: 574-780-3935
Office: 574-842-8476
rosenab@culver.org

198
October 6, 2009
Dear _______:
My name is Brian Rosenau. We met in July ‘08 while
attending the Principles of Dance Medicine conference at
The Harkness Center in New York City. You and I were in a
workshop together on the last day, and realized we had a
common connection through California University, PA. I am
employed as a certified athletic trainer at The Culver
Academies (Culver, IN), a 9th through 12th grade college
prep/boarding school.
In addition to working at Culver, I am also a graduate
athletic training student at California University of
Pennsylvania pursuing a Masters of Science degree in
Athletic Training. In partial fulfillment of this degree,
I am conducting a descriptive study. The purpose of this
study is to investigate the presence of dance medicine
preparation in athletic training education.
In order to increase the content validity of the instrument
(a survey), I need a panel of experts to review the
questions of the survey. The survey will be distributed to
all program directors of CAATE entry-level undergraduate,
CAATE entry-level masters, and NATA post-certification
curriculums. At this time, I would like to ask you to be
one of four professionals to be on this panel. Due to your
position and experience, your feedback is very important to
the success of this study. The information obtained by
this panel of experts review will be used to make revisions
and create the final survey to be distributed to the
population sample. Your responses are voluntary and will
be confidential. Please let me know if you will agree to
be on the panel.
If you do agree to be on the panel, please answer
following questions (below) based on the attached
and make any other additional comments you deem
appropriate. I ask that you return your comments
revisions via email no later than Friday, October
I have also attached the “survey cover letter” as
additional information. If you have any questions
concerns, please do not hesitate to contact m

the
survey
and
17, 2009.
or

199
Questions:
1.

Are the survey questions appropriate, valid, and
understandable?

2.

Comment on the overall presentation of the survey.

3.

Which questions of the survey, if any, should be
restated? Why?

4.

Are there any questions that should be added to the
survey? Why?

Thank you in advance for your time and efforts.
Brian B. Rosenau
Brian B. Rosenau
California University, PA
The Culver Academies
1300 Academy Rd, #95
Culver, IN 46511
Cell: 574-780-3935
Office: 574-842-8476
rosenab@culver.org

200
October 6, 2009
Dear _______:
I hope this letter finds you well and enjoying another Hope
College school year. Things are good at Culver.
As you know, I have been pursuing a Master’s of Science
degree in Athletic Training from California University of
Pennsylvania. In partial fulfillment of this degree, I am
conducting a descriptive study. The purpose of this study
is to investigate the presence of dance medicine
preparation in athletic training education.
In order to increase the content validity of the instrument
(a survey), I need a panel of experts to review questions
of the survey. The survey will be distributed to all
program directors of CAATE entry-level undergraduate, CAATE
entry-level masters, and NATA post-certification
curriculums. At this time, I would like to ask you to be
one of four professionals to be on this panel. Due to your
vast experience in this area, your feedback is very
important to the success of this study. The information
obtained by this panel of experts review will be used to
make revisions and create the final survey to be
distributed to the population sample. Your responses are
voluntary and will be confidential. Please let me know if
you will agree to be on the panel.
If you do agree to be on the panel, please answer the
following questions (below) based on the attached survey
and make any other additional comments you deem
appropriate. I ask that you return your comments and
revisions via email no later than Friday, October 17, 2009.
I have also attached the “survey cover letter” as
additional information. If you have any questions or
concerns, please do not hesitate to contact me.

Questions:
1.

Are the survey questions appropriate, valid, and
understandable?

2.

Comment on the overall presentation of the survey.

201
3.

Which questions of the survey, if any, should be
restated? Why?

4.

Are there any questions that should be added to the
survey? Why?

Thank you in advance for your time and effort.
Brian B. Rosenau
Brian B. Rosenau
California University, PA
The Culver Academies
1300 Academy Rd, #95
Culver, IN 46511
Cell: 574-780-3935
Office: 574-842-8476
rosenab@culver.org

202

APPENDIX C4
National Institute of Health (NIH) Human Subjects Training
Certificate of Completion

203

204

APPENDIX C5
California University of Pennsylvania Institutional Review
Board for Protection of Human Subjects Form

205

206

207

208

209

210

211

212
Institutional Review Board
California University of Pennsylvania
Psychology Department LRC, Room 310
250 University Avenue
California, PA 15419
instreviewboard@cup.edu
instreviewboard@calu.edu
Robert Skwarecki, Ph.D., CCC-SLP,Chair

Dear Mr. Rosenau and Dr. Biddington,
Please consider this email as official notification that your proposal titled "Athletic
Training Education and Dance Medication” (Proposal #09-018) has been approved by the
California University of Pennsylvania Institutional Review Board with the following
stipulation:
approved as amended with the following stipulation:
-The text of the cover letter must appear on the website prior to viewing/completing the
questionnaire.
-Please ensure that all references to the University and the IRB use the correct name (at
one point “of California” is missing).
-The cover letter (and website notice) must contain approval and expiration dates as
specified below.
Once you have made these changes, you may immediately begin data collection. You do
not need to wait for further IRB approval.
The effective date of the approval is 11-18-2009 and the expiration date is 11-17-2010.
These dates must appear on the consent form .
Please note that Federal Policy requires that you notify the IRB promptly regarding any of
the following:
(1) Any additions or changes in procedures you might wish for your study
(additions or changes must be approved by the IRB before they are
implemented)
(2) Any events that affect the safety or well-being of subjects
(3) Any modifications of your study or other responses that are necessitated by
any events reported in (2).
(4) To continue your research beyond the approval expiration date of 11-17-10 you
must file additional information to be considered for continuing review. Please
contact instreviewboard@cup.edu
Please notify the Board when data collection is complete.
Regards,
Robert Skwarecki, Ph.D., CCC-SLP
Chair, Institutional Review Board

213
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ABSTRACT

TITLE:

ATHLETIC TRAINING EDUCATION AND DANCE
MEDICINE

RESEARCHER:

Brian B. Rosenau, ATC

ADVISOR:

Dr. William Biddington, ATC

DATE:

27 May 2010

TYPE:

Thesis

PURPOSE:

The following questions were investigated by
the researcher: 1) Is the presence of dance
medicine course content and clinical
experience in CAATE curricula dependent on
the program director’s view that the
management of the dancer patient by
certified athletic trainers requires
specialized competencies in the “Cognitive,”
“Affective,” and “Psychomotor,” Domains of
Bloom’s Taxonomy of Learning? 2) Is the
presence of dance medicine clinical
experience in CAATE curricula dependent on
the existence of a dance program, and the
extent of athletic training services
provided for the program by the athletic
training staff? and 3) Is the extent of
athletic training services dependent on the
athletic training budget having sufficient
enough resources?

PROBLEM:

Based on the review of literature, the
following areas of dance medicine are well
documented: 1) From a cultural perspective,
dancers infuse their own language,
creativity, and spirituality into shaping
unique human movement; 2) From an athletic
and scientific perspective, dancers
represent a population of highly skilled
individuals that are at significant risk for
injury due to the repetitive, dynamic nature
of their unique movement patterns; 3)
Dancers are at a higher risk for mental and

219
emotional difficulties due to lesser health
care attention, combined with the demands of
their environment; and 4) A job market in
dance settings exists for certified athletic
trainers with specialized competencies in
dance medicine and experiences in dance
culture.
METHOD:

A descriptive study was conducted by
emailing 216 athletic training education
program directors the “Athletic Training
Education and Dance Medicine” survey. The
survey consisted of 23 questions. A total
of 76 program directors (69 entry-level
undergraduate, 5 entry-level graduate, 2
post-certification graduate) responded with
completed surveys (35% response rate). The
survey was deemed “valid.”

FINDINGS:

Chi-square tests of independence were
conducted on all hypotheses. The level of
significance was set at 0.05. The following
significant results were discovered: 1) The
presence of dance medicine clinical
experience in ATE curricula is more likely
if the program director received dance
injury course content as a student in an
entry-level curriculum; 2) The presence of
dance medicine clinical experience in ATE
curricula is more likely if the program
director completed a dance clinical rotation
as a student in an entry-level curriculum;
and 3) The presence of dance medicine
clinical experience in ATE curricula is more
likely when a certified athletic trainer
(full time, part time, or grad assistant) is
assigned formal responsibilities in
providing athletic training services for the
dance program.

THEME:

The classical African idea known as Ubuntu;
The essence of being human. I am because we
are.