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The Invisible Injury

Two dancers discuss concussions in dance and the recognition, treatment, prevention and significance of this often misunderstood brain injury By Justine Comfort
Awareness of the significance and frequency of concussions and traumatic brain injuries has grown considerably in recent years. Professional sports organizations and institutions are bringing to public awareness the startling number of athletes who suffer from this injury and its serious and long-term repercussions. As dancers and choreographers push the human body to discover new movement possibilities, how concerned should they be about injuries to the brain?

 

Justine Comfort, a graduate of York University’s BFA program, with a disciplinary certificate in dance science focusing on concussion research, met with two dancers with different experiences of concussions to discuss the scope and seriousness of this health condition for the dance community.

 

Mugabi Mpagi CAT(C) is a Toronto-based athletic therapist and breakdancer. From a movement philosophy that combines aspects of minimalist/bodyweight conditioning, yoga and traditional strength training and conditioning, Mpagi works with athletes in a variety of sports and arts, including football, basketball, hockey, dance and martial arts, to help prevent injuries and create more resilient and explorative movers. His work with injury prevention and treatment, in addition to his own experiences as a breakdancer, a dance form with a particularly heightened risk for head injuries, gives Mpagi a uniquely danceinformed health perspective on concussions. I sat down with him to discuss his experiences with brain injury as an athletic therapist and dancer and to gain insight into the recognition and prevention of this injury.

Justine Comfort Mpagi, as both an athletic therapist and breakdancer, you must have seen your share of concussions. Can you speak about your experiences?

Mugabi Mpagi Yes, I have definitely seen it happen more than once, and twice, I have experienced concussion-like symptoms myself. In breakdancing, concussions often happen when feet slip out from underneath dancers in the middle of a power move. A lot of momentum is generated going into a move, and for that to mess up and someone to hit their head – that’s a huge deal. With my own experiences, I was in denial and that is actually one of the symptoms of a concussion. The first time I denied it, ignored it and tried to push through. I continued dancing with dizziness and nausea – my two main symptoms – and luckily it wasn’t too severe as I recovered quickly. However, the second time I was able to recognize the signs right away and realized I needed to back off from dancing.

JC How can we better recognize a concussion as dancers and educators so we know when it is time to take a step back from activity?

MM A concussion is an impact injury to the brain that causes inflammation of the brain and cognitive dysfunction. If a mechanism of injury is present, for example an impact to the head from either a fall or being hit, everyone should be concerned right off the bat. As a teacher, witnessing an impact to the head, paired with marked discomfort or any concussion-associated symptom, means a concussion is quite possible. If it’s not witnessed, or if you hear about it the next day, it’s a matter of seeing how [the individual] responds, reacts and functions. Are they avoiding certain movements? Acting differently than normal? If a concussion-associated symptom exists, at any level of severity, then [it’s] more than likely a concussion and it should be treated as that.

JC If the presence of a concussion is established, what do you recommend next in terms of assessment?

MM If someone loses consciousness, it is immediate protocol to go to the hospital, even if they return to consciousness quickly. We usually recommend an athlete with any symptoms see a doctor, regardless [of the severity of the symptoms], in order that they get the proper assessment before being cleared. With my certification, I am allowed to assess and pull an athlete from activity, but as far as continuing to play, a doctor has the final say. This is unfortunate, as the doctor doesn’t see the athlete in the field or know how they function normally. A lot of the time, they will give the green light when perhaps they shouldn’t. Knowing the athlete, we may see something different, that the doctor doesn’t see, about the way they are functioning, and we may still see symptoms once they have returned to being active. Therefore as a teacher or coach, it is important to monitor the injury closely, even after a patient may have been cleared. 

JC What is the recommended treatment protocol for a concussion? 

MM Rest – a lot of rest. In a concussion, the brain is in an inflamed state, so anything that increases circulation or blood pressure will affect the function of the brain. When this happens, symptoms such as headaches, nausea and dizziness come in. Thus, putting the brain in physical stress by engaging in activity [such as a sport or any type of movement practice that causes a rise in heart rate] increases the time the brain needs to heal. This means cognitive stress as well, anything that gives you high stimulation of the sensory system. Reading, bright lights, loud sounds, television and other technology are all things we need to take a step back from. You’re not just resting your body, but you are literally resting your mind. The main thing [therefore] is rest, but after the symptoms are gone, you also need a gradual progression back into activity. So, it is a process.

 

 

 

JC How long can this treatment process take?

MM Usually, as far as the guidelines go, we see people recover within a week. But I have seen cases where it is anywhere from three or four weeks to a couple months. Generally, in those cases you are looking at post-concussive symptoms, and it is stemming from something deeper. This could be from another injury related to the brain or spinal cord that may have been missed. You can also see multiple concussions or post-concussion syndrome if the athlete [does] not follow the guidelines they are given. Persistence of symptoms is usually seen in patients that do not take proper rest and get into activity too early, resulting in reinjury.

JC Is this where long-term symptoms can come into effect?

MM Not always, but there are cases and studies recently coming to light that are seeing long-term effects. People are starting to pay a lot more attention to this possibility. For example, in football players, there have been studies finding athletes dying at a younger age, developing depressive symptoms or committing suicide due to altered brain function. Muhammad Ali and other boxers of his era are another example. After years of repetitive brain trauma, they are now in a very dysfunctional state. It is a growing topic of research, but it is very possible to experience long-term symptoms in cases of repetitive traumas.

JC How can we avoid situations with the potential for concussion?

MM Know the activity and the associated risks you’re putting yourself into. This could be partner work, the lighting or the environment you are working in. In dance there is a lot of physical exploration; we are always pushing bodies in different ways. In that sense, dance is unpredictable. It comes down to educators and the people in leadership roles knowing and understanding who they are working with, [being able] to recognize if something has been altered. This is also true of dancers functioning under a state of exhaustion. Like any injury, fatigue can lead to something going wrong. So once again, dancers, choreographers and educators need to be aware of their limitations. 

JC What is the educator’s role in ensuring a dancer does not return to activity too soon after a concussion or injury?

MM I think a big reason why [dancers] want to push through an injury is their perceived expectations from a leader, be that a choreographer or a teacher. [A dancer might] feel like there is a lot expected of them and that they should push through it if it is not a visible physical injury. It is very important for leaders to educate themselves and have a good understanding of this injury so they can recognize when it is, in fact, too soon to return. They need to be responsible: telling them they should sit out and enforcing the focus on recovery. It is [important] that leaders make this clear. [The recovery from a] concussion can get discouraging, particularly in a more severe case where [the dancer is] out for weeks. Emotional and psychological symptoms become a part of it too. The leader needs to help provide motivation when a dancer is not able to do anything. Focus on easing them back into the environment and activity by finding other ways they can be involved.

Amie Blaire Chartier was born in North Vancouver, British Columbia. After ten years training as a competitive gymnast, Chartier began dancing at the age of fifteen. She started her dance training at a recreational studio but quickly switched to the pre-professional program at Pacific DanceArts. Chartier is now in her fourth and final year in Ryerson University’s dance program. As an emerging dancer, she has worked with artists including Vicki St. Denys, Karen Duplisea, Nadia Potts, Hanna Kiel, Robert Glumbek, Roberto Campanella, Kate Hilliard and James Kudelka. After hearing about Chartier’s struggle with a concussion from a mutual colleague and choreographer, I met with her to discuss her experiences. As a student and an emerging artist, Chartier provides a window on the importance of prevention and early assessment and the personal toll of the treatment and recovery.

JC Amie, how did you experience your concussion? 

Amie Chartier It happened while performing in March 2015. I was in a piece that had dark lighting, mesh blindfolds and was very physical. The show ran for ten nights, so by the eighth, I was exhausted and not really thinking about what I was doing. At the end of the piece, we dropped to the ground and log-rolled off. Between my depth perception being off [because of] the lighting, and the relief of finishing the piece, I didn’t see the ground as I collapsed, and I smashed my head right into it. It didn’t really hurt at the time, because of my adrenaline, and I was more embarrassed than anything, hoping nobody had seen me hit my head. When I got off stage and turned around, everyone was like, ‘Oh my God, your head is bleeding!’ It bled more and more, and I began feeling dizzy and nauseous. But again, I was feeling more embarrassed than anything, like I was in the way, a nuisance. I didn’t realize that something might actually be wrong until I got to the hospital and I was trying to fill out the forms but couldn’t really see them. 

JC Did you go back to finish your shows after your injury? 

AC The school told me not to finish the rest of the shows, which was sad, but it was also good they stopped me. At the time though, I was dancing for another company and we had a show that weekend. It was only one show, and we had no backup, so I felt if I didn’t perform, I was screwing everyone over. I did the show, but I don’t … remember doing it. I remember before it began, and feeling absolutely terrible after it was over, but not actually being onstage at all. From then on, I felt dizziness all day, a lot of nausea and had a headache for almost five months.

JC After this show you must have realized something was wrong. Did you see another doctor? 

AC Yes, the night it happened I had been to the hospital but was cleared to go. After that next show, I went to a different doctor and different hospital because I felt horrible. They said I definitely had a concussion and should not do anything but rest, get my papers ready so I could be exempt from school and get ready for a long haul. I was to stay in bed for two weeks. That turned into a month, which turned into two months, which turned into postponing my exams and dropping a course. I just finished my exams at the end of July [three months late], and I was able to start dancing again at the beginning of August. One thing I still feel is head pressure. Head pressure, in my  experience and from talking to other dancers I have known with concussions, is a feeling of an overwhelming buildup of pressure in your head. This pressure then morphs into a headache. When I feel that, I know it is concussion related and not just a headache. This happens particularly when I am reading, including texting. If I am on my phone for too long, I really start to feel it.

 

 

JC Can you speak a little bit about your treatment process?

AC I worked with a sports medicine doctor and an osteopath. My treatment really was rest – which was the hardest part. I’d be resting, in a dark room, not doing anything, feeling completely fine – which is great, but when you feel completely fine, you’re not going to want to stay there. It became about how much pain could I tolerate so that I would not be bored out of my mind. It’s frustrating that there is no way to speed up the process. I don’t think I could have taken more time mentally. I really did my best, taking as much time as I did.

JC Besides rest, is there any other rehabilitation for your lingering symptoms?

AC For my troubles with reading, I am now working with an optometrist who specializes in concussion patients. The team I had been working with thought that my symptoms might actually be coming from something else, something wrong with my eyes. My optometrist did a test where I wore 3-D glasses and had to line things up. For example, I was asked to move a circle along the table and line it up on top of an X. I would think they were perfectly lined up, but when I took off the glasses, I was completely off. From these tests, the optometrist found out that the concussion had damaged my ability to converge and diverge my eyes. I now have a forty-five-day, at-home program to retrain my eyes to read. It is a very new treatment, and my optometrist said if I had gotten this concussion two years earlier, he wouldn’t have been able to help; it’s that new. 

JC What made you follow through on your treatment so diligently?

AC I felt very supported by the faculty at the Ryerson Theatre School. The technique teachers didn’t want to see me in class, and they knew I needed the rest because a lot of them had experienced concussions themselves. I also feel if I wasn’t in a university program, I wouldn’t have cared as much. I sat in my first lecture this September and came out feeling awful. I had been dancing for two months and felt relatively fine, but the reading and coursework let me know I am still not fully recovered and is the main reason I notice I am still dealing with it. I remember, as a kid growing up in sports, a teammate might get a concussion, but I had no idea what that meant. We’d say, ‘Oh, whatever … push through it.’ Now I feel so bad; concussions are horrible and under-reported by a lot of coaches and institutions.

JC What is your advice to other dancers who experience concussions?

AC Take all the precautions you can. As dancers we say we can deal with anything. We’ll just push through the injury, and it will be fine. But don’t take it lightly, and know that you have no idea what is going to happen. I have talked to other concussed dancers who were healed in two weeks, but I’ve had mine for six months – and some people continue to experience symptoms for years. [After the injury,] when I would go out for a walk to get some sunlight, unlike before, I’d notice I was very closed off from everyone. I’d be walking down the street with my eyes down, not wanting to hear anything or anyone. I wouldn’t really be aware of it until I was halfway down the street and then I would ask, “What am I doing? This isn’t like me.” I think that was one of the hardest things I have struggled with. Your brain isn’t just a muscle; your brain is who you are as a person.

This article was originally published in the January/February 2016 issue. 

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Dans les dernières années, nous avons beaucoup appris sur l’importance et la fréquence des commotions et des lésions cérébrales. Les organismes et institutions en sports professionnels mettent en lumière le nombre surprenant d’athlètes qui souffrent de blessures au cerveau, et les conséquences sérieuses et à long terme de telles blessures. À titre de danseurs et de chorégraphes qui oeuvrons à découvrir de nouvelles possibilités en mouvement, à quel point devrions-nous nous en faire avec les traumatismes crâniens? Justine Comfort détient un baccalauréat en beaux-arts de l’Université York avec un certificat disciplinaire en science de la danse axé sur la recherche sur les commotions cérébrales. Elle discute avec deux danseurs de différents parcours de leur expérience des commotions cérébrales et de l’envergure et de la gravité de cette blessure pour le milieu de la danse.

 

Editor’s Note: At the time of print, the Legislature of Ontario was poised to pass Rowan’s Law, the first concussion legislation in Canada for young athletes. The law’s name honours a young seventeen-year-old rugby player who died after a game in 2013. An inquest found that she had suffered multiple concussions in the week preceding her death. The legislation would create an expert advisory committee to advise on the implementation of the recommendations of that inquest. The legislation aims to increase awareness of concussions and their symptoms, particularly through Ontario’s public school curriculum.

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