Allie's story

Allen High School senior Allie has loved dancing for as long as she can remember. A student at the Hathaway Academy of Ballet in Plano, she dreams of dancing professionally. For Allie and dancers like her across the world, getting ready for the holidays means preparing to perform in the seasonal classic "The Nutcracker."

This year, Allie will dance the role of the Flower Fairy in "Waltz of the Flowers" in the Collin County Ballet Theatre's performances of "The Nutcracker" at the Eisemann Center for Performing Arts. It's a challenging part, but she feels both excited and ready.

"I have danced since I was little," says Allie. "My aunt was a professional dancer with the Houston Ballet Academy and the Ballet Arkansas – she was my inspiration. Seeing that someone in my family could do it made me believe that I could also be a dancer if that's what I wanted to do."

With the dream has come hard work. Allie rehearses two to three hours a day. Because she depends on her back, abdominal, and pelvic muscles for stability, she trains to keep those muscles strong as she leaps, spins and holds poses. She also seeks help and advice regularly from Holly Nieman, an athletic trainer who leads outreach for the Dance Sports Medicine program at the Children's Health℠ Andrews Institute for Orthopaedics & Sports Medicine.

Holly visits the Hathaway Academy twice a month to assess injuries and provide therapies such as massaging and cupping, a healing method that uses suction on the skin to increase blood flow and ease pain. She is often on hand, either backstage or in the audience, for big performances in case Allie or other dancers have an injury or emergency during a show.

"She helps me feel better in the moment," says Allie. "But she also gives me exercises to do at home. She suggests things like using a simple lacrosse ball to roll out my hip. It also prevents future injury, which is so important."

Care tailored to dancers

The outreach arm of the Children's Health Andrews Institute Dance Sports Medicine program delivers services like these to preprofessional dancers in studios across North Texas. Operating much like the institute's Sports Performance outreach initiatives, which serve numerous independent school districts and athletic programs throughout the Metroplex, Dance Sports Medicine outreach is filling a need in a rapidly growing region where interest in dance is high, says Troy Smurawa, M.D., Director of Pediatric Sports Medicine at the Children's Health Andrews Institute.

In addition to the Hathaway Academy, the program serves other acclaimed training academies such as the Chamberlain School of Ballet and the Texas Ballet Theater School. Together with its physicians, athletic trainers and physical therapists who specialize in dance injury recovery and prevention, its outreach efforts make the Andrews Institute Dance Sports Medicine program one of the most comprehensive of its kind in the nation and the only such program in Texas.

"Dancers have unique needs and the potential for certain injuries that can impact their performance and ability to dance, so they require specific expertise," says Dr. Smurawa, who helped launch the Dance Sports Medicine program. "They are athletes, but they're aesthetic athletes. Like figure skaters and gymnasts, there is more to their athleticism."

When the Andrews Institute facilities on the Children's Medical Center Plano campus were in development, Dr. Smurawa worked closely with the facilities design team to ensure that plans included features that would benefit dancers as well as other types of athletes.

"I wanted to make sure we had therapeutic tools specific for dance," Dr. Smurawa says. "We installed a specialized spring wooden dance floor because the surface that dancers dance on is important and can relate both to their injuries and recovery and to injury prevention."

The specialized dance floor, which includes mirrors and a barre, a handrail used for balancing, allows dancers to mimic the movements and patterns they have been doing or want to do so therapists and trainers can help them prevent future injuries or transition while recovering.

"One of the things that we focus on is trying to maximize their ability to keep dancing," he says. "That means not just having the facility with the dance floor but also having the people in place who understand dance therapy and know what dancers need."

Trusted relationships

Holly joined the team five years ago to help build the outreach program. A trained dancer who discovered a passion for dance-focused athletic training, she allows the Children's Health Andrews Institute to support young dancers where they spend much of their time, in their studios and onstage. Her background makes it easy for dancers to talk to her. "I can understand their passion for wanting to dance because I was one of them," she says.

In addition to providing therapeutic services at rehearsals and performances, Holly serves as an educational resource for coaches and dancers. She gives continuing education presentations and leads summer intensives about injury prevention. As young dancers advance to higher-level techniques such as dancing "en pointe," or on the tips of their toes, she and Dr. Smurawa provide pre-pointe assessments to make sure their bodies are up to the challenge.

A few years ago, Dr. Smurawa discovered that Allie had an extra bone in her ankle called an os trigonum. It's estimated that between 15% and 30% of people are born with the extra bone, which is a small round bone in the back of the ankle that gets pinched when a dancer goes en pointe. Often it remains undetected, but for ballet dancers, it can lead to problems, and in Allie's case, the extra bone was interfering with her ability to dance en pointe and causing pain. "It came out of nowhere like no pain I had had before," recalls Allie, "and over the course of a week, it went from simple pain to I couldn't walk without pain."

Some dancers respond to physical therapy depending on the size and location of the os trigonum. After trying several months of physical therapy and intensive home exercises, Allie was still having problems, so she decided to have the bone removed surgically at the Children's Health Andrews Institute.

"We did try steroid injections, and it helped a little bit, but I knew it wasn't going to be a long-term fix," says Allie. "We knew the only other option was surgery. Working with Miss Holly made me feel a lot better about going into the surgery. I knew this was the right choice because we had done everything else we could to try to fix it."

For Hathaway Academy dancers, Holly serves as their "go-to" adviser when they have questions about muscular tension or pain, says co-director and owner Linda Hathaway.

"These kids are here six days a week, three hours a day and sometimes longer for rehearsals," says Linda. "They're here all-day Saturday, so their bodies get fatigued. Sometimes they don't know if it's an injury or overuse. Holly can guide them. She's also that liaison when she thinks that a dancer needs to see the doctor.

"Kids don't always want to tell me or my husband [co-director and owner Kurt Hathaway] when something is wrong," she adds. "They don't want to be removed or sidelined, as they say in sports, so they'll hold it in. Holly is our safe person. They can sign up online, then go see her when she is here."

Positive impact

As ballet studios across North Texas learn about the Children's Health Andrews Institute program, demand for outreach dance therapy continues to grow. Earlier this year, Nadine Creel, a licensed massage therapist with the Pain and Headache Management Center at Children's Health, joined forces with Holly to provide outreach massage therapy to dancers at the Chamberlain Ballet and other studios.

"Nadine has been a great asset for the program," says Holly. "She is able to offer services for our dancers that may not require formal physical therapy but that immensely benefit from body work during their performance or competition seasons. And she has amazing rapport with all of our youth athletes."

Working with aspiring dancers is rewarding, they say. "You feel like you're contributing to that knowledge base that they're going to take into the rest of their adult lives," says Holly. "You realize you can help and that you're making a difference."

Long after the familiar refrains of this season's "Nutcracker" have faded, Allie plans to keep following her dream.

She is applying to respected college dance programs and hopes to join a professional company after she graduates. "I can't picture myself doing any other job that isn't dancing because I love it so much," she says.

Holly has taught Allie to listen to her body on and off the stage.

"It's a concept that dancers kind of have to figure out on our own," says Allie. "How do I feel doing this? It's so easy to forget to take care of ourselves, especially during this season when we're rehearsing all the time. Holly helps make sure that I'm doing that. It's very important and something that I will take with me into the future as I continue to dance."

Learn more

The Dance Sports Medicine program at Children's Health Andrews Institute for Orthopaedics & Sports Medicine is specifically tailored for the treatment, rehabilitation and injury prevention of dancers to help them get back on their feet. Learn more about our comprehensive sports medicine programs and services.