MRI Talk - What Is It Like to Have an MRI?

Maybe you've noticed, maybe you haven't. I haven't been sharing much about my performance experiences this season. The reason for this is because I have barely performed since the 2013-2014 dance season. I spent the end of this past summer and all of fall in Anchorage directing Alaska Dance Theatre. Upon returning, I coached a few of my students successfully through the Youth America Grand Prix semi-finals in Philadelphia, taught a handful of master classes, started sending out my choreography in search of commissions, and am working on another choreography project that I soon hope to share with you all. A lot is still going on in my freelance career, but my 2014 - 2015 season has been more about growing outside of my performance career and healing my body.

Coaching one of my students for Youth America Grand Prix at the Alvin Ailey studios

I've had injuries before, just like every professional dancer I know. But my most recent injury has been much different than any I've had in the past. While the initial injury was extremely painful and immobilizing, unlike other injuries, I have never had such an odd recovery period. In the past, I have seen marked improvement with rest, physical therapy, and time. But this time around, my gains have been marred by multiple steps back in pain and inflammation.

With my current injury, I seemed to be on the right track to recovery with physical therapy and my continuing obsession with maintaining my core strength. But when I came home from Alaska and had difficulty finding practitioners that would accept my Alaskan insurance, I was forced to continue treatment on my own. I kept up my exercises and saw a chiropractor regularly, but my pain was continuing to come back. And it was coming back stronger than it was before.

This graffiti I found in Philly perfectly represents how I felt

What I found particularly odd was that I still had my full mobility and range of movement in my body. I was taking ballet class, struggling through the first few combinations until I was warm. Then once I got warm, I could do most anything without pain, except lift my leg behind me. By the time class was over, I would feel good for about 20 minutes before my back would start to seize up. It got to the point where I couldn't sit for more than five minutes.

What confused me even more about this injury was that I couldn't figure out how to take care of it. I had been dancing in pain for some time, so I took a week off. When I took that week off, the pain got worse. So, I assumed that keeping blood flowing through those achey muscles must have benefitted them. I finally decided to take an entire month off in the middle of February and was lucky to finally find a practitioner that would treat me with my insurance.

After months of pain, struggle, and frustration, I was finally able to get a much overdue MRI yesterday. Having this type of imaging of my injury would finally give me a clue as to what has been happening in my body since October. As I prepared my MRI-seasoned self, I had to remind myself what I was getting into before I went through with the process.

Anybody that has had an MRI could quite easily scare you to death by explaining the procedure. Most people wince at the prospect of being shoved into a coffin-like tube of cacophony. But if you understand what you are getting yourself into and mentally prepare accordingly, you will have no problem acing this scan in a shavasana-like state.

Magnetic Resonance Imaging machine, or MRI

What exactly is an MRI? MRI stands for Magnetic Resonance Imaging. Essentially, this style of imaging, or looking inside your body noninvasively, is like a much, much more detailed X-ray (without radiation) for whichever part of the body needs to be studied. According to the Mayo Clinic website, an "MRI is a technique that uses a magnetic field and radio waves to create detailed images of the organs and tissues in the body." While I could go into more detail about what exactly happens to make an MRI scan work, I'd prefer to move on to the experience of getting an MRI.

Before I left home for my appointment yesterday, I left all of my jewelry at home and took out my earring. Since magnets are used for these scans, you can't have any loose metal on your body. I don't know exactly what would happen, but I imagine some Matrix-like shit going down where you are lifted off the table from your ear. All kidding aside, you seriously can't have any metal on your body. There are questionnaires about pace-makers and signs about watches being destroyed. So, make sure that you leave most of your valuables at home before you head to the facility to be seen and speak up if you have any metal objects inside your body.

After arriving you will answer questionnaires about general health and metal objects in your body (shrapnel, pace-maker, etc.). Then you will be moved into a changing room to put on a gown or pair of paper shorts, which depends on the part of your body you are having scanned (I only had to put on paper shorts and got to keep my underwear, socks, and shirt on). Once you've changed and locked your belongings in a locker, you will be brought into the MRI room.

There is no specific protocol for being prepped to get your scan done, but I will give you a general idea of what happens. You will be asked a few questions that you have probably already answered, like, "Are you wearing a watch?" Then, you will be given ear plugs to put in your ears, which you will want to make sure are secure before you are put into the machine. Sometimes, facilities will have headphones with music. Once you are prepped, you will be asked to lay down on what looks like a table without legs. When they ask you if you would like a blanket, say yes. Take the blanket whether you want it or not. It gets quite cold and lonely in there.

Is it an MRI machine?

Once placed on the table, you will be scrolled into a very tight, cannoli-like tube. If you have severe anxiety issues relating to small spaces, be sure to ask your doctor before your appointment about possible medication (usually valium) to calm your nerves for the procedure. One of the last things you will be told by the technicians before you can't see more than the creme-colored ceiling of the machine will be, "Stay as still as possible." Any movement by the patient can distort the imaging process. If you move too much, it will only extend the amount of time you are stuck in the tube. Usually (but not always), you will be given a panic button in one of your hands to squeeze if you start to feel overly claustrophobic or present symptoms of a panic attack. Relax! You won't need to use this. I suggest keeping your eyes closed as the technicians put you into the machine and just keep them closed until they move you out of the machine.

If it seems that this procedure is already stressful enough, you are given those earplugs early on for a major reason. Very few things in life, besides concerts and airplanes, can mimic the sound of an MRI machine doing it's job. According to the California Institute of Technology, an MRI is so noisy "because its magnetic field is created by running electrical current through a coiled wire—an electromagnet. When the current is switched on, there is an outward force all along the coil. And because the magnetic field is so strong, the force on the coil is very large." Essentially, you are in a small space with an overzealous magnetic tap dancer practicing like there is no tomorrow on the tube you have found yourself in. While many people find this noise unpleasant, I close my eyes and choreograph movement to the techno sound of the electromagnetic noises passing over (and through) my body. If you focus on something other than what is really happening, the time passes much more quickly and you will be out of the machine before you know it. 

If you are able to stay still and manage your fears and phobias, most MRI's don't really last too long. And, honestly, they really aren't that bad. The worst thing that could happen is that they have to pull you out. You are not stuck inside the machine. Once you are finished, you are brought out of the tube and can go about your day as if nothing unusual happened to you. You will either be given a CD or physical scans of the part of your body that was being reviewed. Be sure to bring these with you to your next doctor appointment.

An MRI scan (not my own)

As for me, I was lucky enough to get my scans looked at only 24 hours (this morning) after I had them taken. Since this injury has been so odd and lengthy, I went into my appointment prepared for some pretty bad news. I was pleasantly surprised to hear the doctor tell me that I will recover and be out of pain again. Honestly, I had convinced myself that I would be given the career-ending injury conversation. While I still need more rest, therapy, and work to recover, I should be able to dance again and live my life without any pain (beyond normal dancer aches). While I may not be able to perform for the rest of this season, I will dance again. Perhaps, the best news I've heard in a long time! So, for the time being, I look forward to continuing to push my choreography, pass on my craft, and share my stories.

Can't wait to move like this again (Photo: J.J. Tiziou)

Injuries: How to Handle Injury & Preventable Factors

On the table with one of my favorite people, PNB Physical Therapist Boyd Bender

I feel it is time that we have an open, honest conversation about injury. One of the worst things you can do in this dance world is to speak publicly about a current injury. A dancer doesn't want to be thought of as weak, a liability, a repeat offender, or anything else. Even worse, a dancer doesn't want an employer to turn to them years after their last injury and say, "I read that you've had this injury before and you lied about your health when you arrived." But I am going to do it anyway. I am going to proclaim in public that I am injured. I feel that it is important that dancers stop hiding issues like this and speak out about our experiences. Every professional dancer will face injury at some point, and while many will share their comeback stories after they're fully recovered, few will share about it as they are going through it. Yes, I have been lucky enough to spend the last 2 1/2 years healthy (albeit minor aches and pains). But today, and for the last month, I am suffering from an injury that kept me from performing at my last gig and has forced me to take the last month completely off from most physical activity.

Where does one start with a topic like this? Usually the first question is, "How did you get injured?" Again, another taboo topic, but I'm gonna be as honest as possible here. While there are times that a dancer may become injured due to some freak occurrence, one can usually look to a variety of components that contributed to their injury. I have a pretty clear idea of what caused me to suffer a lumbar (lower back) sprain.

There are what I consider to be four factors that, when neglected, often lead to a dancer's body breaking down. Rehearsal/ performance conditions, rehearsal procedures, physical maintenance, and rest periods. When I became injured back in the beginning of May, I felt that three of these factors had absolutely contributed to me needing to pull myself out of a performance series.

When it came to rehearsal conditions, we rehearsed for weeks on end in a studio that was not sprung and without proper heating. Throughout the rehearsal period, we were also asked to perform on concrete at multiple venues indoors and outside, often without any spacing rehearsals.

Our rehearsal procedures were also uncommon throughout much of the process. While we had six weeks to prepare for our performances, we learned a majority of our choreography at breakneck speed. After urgently learning the material, we immediately began running the complete works full-out. A very important part of the rehearsal process was lost. The actual rehearsing, digesting of material, and building of stamina. As for rest periods, our typical 2-day weekends during rehearsal weeks were often taken away by outreach and event performances.

What I looked like sleeping in that child's loft bed

Lastly, housing wasn't provided for out-of-town dancers. I definitely learned my lesson here, as a host that I found through a home-exchange website stopped responding to my messages after I had already arrived. This left me to move 5 times over 5 weeks; sleeping on couches and a child's loft bed for an entire month. While I made sure that I had enough sleep, my body and mind couldn't ever fully rest. Not having a proper place to sleep surely had a great impact on my spinal health.

It seems that the only factor that was positively met during my stint was in my physical maintenance. I found a great chiropractor, San Francisco-based Dr. Kevin Linzey, who not only was a skilled practitioner, but cared more about my ability to practice my art than charging me a rate I couldn't afford. If you look at all of these items, you can see that it came as no surprise that I left this gig in so much pain that it prevented me from performing.

In a full-time company without freelancers, there is a common procedure that most dancers follow when it comes to an injury. Initially, most dancers aren't sure if their injury will improve enough to perform. Unless they experience a fracture or major sprain, there is always the possibility that the dancer can dance through/around their pain. It isn't uncommon for a dancer to mention to artistic staff that they have an injury and need to rest for a few days or take it easy in rehearsal. This period is an assessment for the dancer to determine if treatment and/or rest is improving their condition or if it is going to take a longer period of time to get better. Once a dancer determines that they are unable to dance, the director will usually find a replacement for the dancer and allow the injured dancer to take the necessary time to rehab and get better. From here, a dancer will usually open a worker's compensation claim, which is their legal right as an employee of the organization. Generally, worker's comp will provide the necessary treatment (doctor, X-ray, MRI, therapy, surgery, etc) for a dancer to get back on point. Beyond taking care of treatment, worker's compensation will often pay a portion of an injured dancer's salary, so that they can sustain themselves during the recovery process.

The initial stage of dealing with an injury as an independent contractor looks very much like that of a fully contracted dancer. When I woke up one morning barely able to walk, I sent the director an email giving him a heads up about my condition. Following the email, I hobbled on in to the studio to have a conversation and come up with a plan. Prior to entering the studio, I had already come up with my own ideas of how to resolve my potential absence. If you enter a tricky conversation with a plan, it can likely alleviate some of the stress that an injury can throw on an organization. Most freelancing jobs that I have worked have used 10 or less dancers. One dancer going out can cause a lot of stress and panic when there is nobody to cover for that person. My plan took into account that we had a week and a half before the performances. If I acted immediately on my pain and took myself out of the show, I may have put undue stress on the company had my back calmed down quickly. I told the director that I was going to get as much treatment as possible and would give them an answer by the beginning of our performance week, if not earlier. We, then, agreed that I would teach other dancers significant parts of choreography (as much as I could in my state) that only I knew. I also mentioned that I had some strong medication to help with my inflammation and that I would take it to give myself the best chance of a quick recovery (I always ask my doctor for a prescription when I travel for work in the event of an emergency while I am away from home. I have never used it in my 3 years of freelancing until this moment. Still, most any traveling freelancer should carry emergency medication with them in the event that they get injured. This saves a great deal of time, money, and stress). Once I had fully informed him of the possible scenarios, it was his choice to wait or take me out of the shows. We agreed to wait.

The hardest part about assessing an injury while nearing a performance period is staying calm. Most people's natural tendency is to keep testing their injured area to see if it is feeling well enough to perform, whether taking class or stretching into the injury. I really wanted to jump into class to see how much I could do when the medication started kicking in and relieving my pain. But I knew that I needed a few more days before I could test anything. Once I finished the medication and most of the inflammation had dissappated, I tested out my back with a few exercises at home. When I realized that twisting and bending was still causing me pain, even with my recovered mobility, I immediately messaged the director that I would need to pull out of the performances. I did this a day earlier than we agreed. I figured that the more time the company had, the more prepared my colleagues would be and the less stress would be added to their preparations.

Freelance dancers, unfortunately, don't have the privilege of utilizing their employer's worker's comp if they get hurt on the job. Since most freelancers are independent contractors, the leadership of different dance companies have absolutely no responsibility to a dancer beyond paying them and other loose terms in their agreement, even if they contributed to them getting hurt. If a director doesn't provide a safe workplace and a dancer chooses to continue with that production, the dancer has to deal with the conditions, speak up in hopes of resolving the issues, or, in a last resort, quit the job. If, like me, a dancer does become injured, they are on their own in taking care of their health.

My E-stim unit (my savior)

As soon as I became injured, I had an appointment with the chiropractor I had found. I also started seeing an acupuncturist, getting massage, and using an E-stim (electrical stimulation) unit that I was given by my physical therapist when I had been previously injured. While I knew I couldn't afford to pay for multiple treatments per week, I sucked it up and put nearly $300 on my credit card during the first week alone to try and get better. Not only was I losing money for therapy, but I was also in danger of losing money because I could no longer fulfill the terms of my contract. I knew that this would be a great financial stress for me, so I went ahead and asked the company if I could perform office work to continue getting paid. My flight didn't leave for another week after I stopped rehearsing and if I couldn't pay for my therapy, I surely couldn't afford to pay to change my plane ticket. Also, if I was still in town, I might as well make myself useful. This is always a reasonable request to consider if you are hurt and have to remain on location.

Luckily, the company agreed to let me do this, and I continued helping the organization by writing a blog, doing menial office work, and speaking at outreach events. While it was very helpful that the company was willing to do this for me, they had no responsibility to agree to it. Since returning home, I have taken nearly a month off with no physical activity for 2 weeks. I started incorporating gym exercises on week 3 and yoga on this 4th week. I have also maintained my therapy and am on a clear road to recovery, if hurting a bit in my pocketbook.

Now that I am home and have spent the last month recovering (and I'm feeling a lot better), it is easier to look back and see where things went wrong. There were multiple factors that amounted in my getting injured. It is clear to me that prevention is the most important item I would like to address in this post. I did my best when I began to fear for the worst by pulling the director aside and speaking about my concerns. After a good conversation, unfortunately, the conditions only showed minor improvement. At that point, I had to make a decision. Do I quit the gig or do I continue dancing in an environment that has a high risk for injury? For multiple reasons, I decided that quitting just wasn't the right decision. Once I did become injured, I handled the situation in a very thoughtful and respectful manner.

While injuries are not always preventable, they can be greatly reduced by considering the conditions and procedures that dancers have to rehearse in. I call on all companies that hire freelancers to please think about the four factors I've mentioned above before hiring dancers as independent contractors. While you are hiring them to help raise your level of dancing, create something new, or to fill in gaps in your productions, please take into consideration that our health is extremely important to us and our survival is our body. If conditions are dangerous and a dancer gets injured, you have no obligation to them. If a freelance dancer gets hurt because of conditions that could have been prevented or thought out more carefully, they can't make a living, may struggle to pay and get care for a faster recovery, and may lose their dancing career altogether. I urge each and every employer to consider what I have written and to do their best to assure dancers who are independent contractors (or any dancer) a safe and respectful environment.

PLEASE DON'T HURT ME