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For many adult dancers, dance is more than just a passion—it's a way of life. Yet, the pursuit of grace and precision often comes with the risk of pain and injury. If you want to dance freely, without physical limitations, an exercise physiologist might just what you need.
The expertise of exercise physiologists encompasses a deep understanding of physiology, the orchestration of the body's unseen systems, and a specialised approach to movement tailored to your unique needs.
Recently, I interviewed exercise physiologist and health coach, Cherie Noble, to discover more about her profession and how it can help adult dancers dance with longevity and performance in class, while keeping pain and injury at bay.
You can listen to my interview with Cherie on Soundcloud.
Cherie is based in our Adelaide studio, Dragonfly Dance, and has been working with some of our adult dancers to improve their experience on the dance floor.
In this article, we’ll unpack what an exercise physiologist is, how they differ from physiotherapists and personal trainers, and how they weave their magic.
What is exercise physiology
Exercise physiologist are allied health professionals, at the same level as physiotherapy, podiatry, occupational therapy and those types of professionals. They undertake a four year bachelor degree and 500 hours of clinical practice to be qualified and able to practice.
Their distinctive approach centres on harnessing exercise and movement as powerful tools for treating, preventing, and managing chronic illnesses and injuries. In Cherie's words, "We use exercise as the modality."
Cherie is also a health coach, which stems from the broad scope of exercise physiology.
“An exercise physiologist’s scope of practice also includes lifestyle and behaviour modification. There is a link between mental and physical wellbeing, and we use exercise and lifestyle as therapy to improve mental health.” she affirms.
Difference between exercise physiologists and physiotherapists
While exercise physiologists and physiotherapists share a common goal of aiding physical wellness, Cherie highlights some crucial distinctions.
“The main difference is that physiotherapists diagnose and have hands-on therapy, like manual therapy, ultrasound, dry needling, and various other techniques that means they are actually physically doing something to you.” explains Cherie. “There is a crossover, and physiotherapists also prescribe exercise. But generally, as a rule, they have a more hands on treatment approach.”
“Exercise physiologists don’t diagnose or do any invasive therapy such as dry needling. The only point of care testing we do is blood sugar levels.”
One of the other things my conversation with Cherie taught me is that exercise physiologists don't just look at your muscles and skeleton, they look at the neuromuscular connections and the patterns of movement in which we habitually engage that can cause problems in various parts of our body.
Difference between exercise physiologists and personal trainers
If exercise is the treatment tool, you might wonder why you’d go to an exercise physiologist instead of a personal trainer. Cherie underscores the depth of knowledge possessed by exercise physiologists.
“Exercise physiologists have an indepth understanding of physiology. It’s not just muscles and bones moving. It’s all the other systems at play as well, like the cardiovascular system, autonomic (hormones) and nervous system, and how these systems interact. It’s not just about the physical, it’s also about the unseen stuff. With four years of tertiary university level training you have a much deeper depth of knowledge that a personal trainer who would have done about six months to be qualified to practice.”
Cherie also points out that personal trainers are really only supposed to work with what is known as ‘apparently healthy people’. Personal trainers’ insurance does not cover working with people who have diseases, illnesses or injuries
“Exercise physiologists are trained, and our insurance allows us, to deal with chronic conditions and illnesses, such as cancer, osteoporosis, cardiac issues, and diabetes.” she explains. “Exercise physiologists have a level of training where they can safely prescribe movement when you have an injury.”
What is a health coach
In addition to being an exercise physiologist, Cherie is a health coach. Health coaching is based on a whole of life model, or the biopsychosocial approach, which is not just about the body, but also the mind and the environment. She emphasised that as a tertiary qualified health professional, her health coaching is based on evidence, not fads or personal opinions.
“We used an evidence-based practice model to see how different parts of your life interact with one another. If you influence one, it’s going to influence all areas.”
Evidence-based practice means using evidence from high quality research studies that employ a scientific approach, such as randomised controlled trials, systematic reviews, and meta-studies.
“Sometime people recommend something that has worked for them, which can be great, but it is a sample size of only one, whereas scientific studies have taken a collection of people and introduced a specific model or intervention and they have the results that support their interventions.”
Cherie explains the importance of the ‘whole of life’ model, which considers the link between physical and mental, emotional, environmental and other factors.
“Sometimes the body is what presents with physical symptoms, but the underlying root cause could be your mental and emotional wellbeing, which is causing excessive stress on your body, which then puts mechanical stress on your body, which causes the physical symptoms.”
Cherie stresses that as a health coach, she can’t, and doesn’t attempt to, fix everything. She may refer you to another expert.
“If it’s environment, this could refer to financial factors, workplace issues, dissatisfaction or stress in relationships. Some of these things are outside my scope of practice, but from a health coaching perspective, we can triage it and give you all the information.”
Cherie stresses that as a health coach, it’s not her job to advise her clients, but to help them find the information for themselves.
“It’s my job to pull the information from you, make sense of it, and give you space and time to actually think about it. Kind of like a guided self-reflection. I like to use a treadmill analogy where it’s like pausing the treadmill and hopping off for a minute to take the time and space to ask what your life really looks like now. “From there I might refer on. For example, if it is a mental health issue, I might refer to a mental health practitioner.”
Why see an exercise physiologist
If you want to improve your overall health and wellbeing and quality of life, or if you have niggles or an injury that stops you from fully participating in life or dance, an exercise physiologist can help. This includes any head, neck or shoulder pain, as well as back, hip, knee, and ankle pain.
Cherie is quick to point out that she doesn’t say you should see an exercise physiologist instead of a physiotherapist, stressing that the best outcomes are when physiotherapists and exercise physiologists work together
“One of the things I generally see with my clients is that they’ve been given really good exercises by the physiotherapist, but they never do them, or don't do them effectively. This is because the physiotherapist doesn’t usually have the time to go through check that they are doing it correctly. I my work, I make sure you walk out with better knowledge of yourself, and you are so connected to your body that you can easily replicate the exercise a few days later. You’re better off leaving with one exercise that you do well than five that you’re not sure about and that you’re never going to do, or that you hate doing.”
Cherie points out that exercise physiologists don’t just offer exercises, but they work out what exercises you are most likely to actually do and enjoy.
“There was some interesting research done at the University of South Australia a few years ago about the enjoyment factor of exercise and adherence. Enjoyment is why dance is such a great way to exercise. How you feel before, during and after exercise is important. We also look at why someone exercises. We call this ‘linking’. You might be doing an exercise that isn't fun, but if you know you are doing it so you can do something fun, like dance, then you are more likely to stick with it. Because you know that the reward is being able to do the thing you enjoy."
How can exercise physiology help adult dancers
As adult dancers, we have things like deteriorating joints, decreasing muscle density, diminished flexibility, and declining strength. In our day job, we may do work that has a negative impact on our body and wellbeing over the long term.
“You may have a dancer who works in an office during the day, so they are seated all day and then come to dancing” Cherie notes. “Their potential issues are going to be very different to someone who works in a physical job all day, in relation to their stress levels and other lifestyle factors.”
Cherie stresses that an individualised approach is the key to success:
“I like to find out what really concerns the client” she notes. “It might be performing a particular movement in class. We can analyse and unpack the issues causing that problem, which could be weakness on one area of their body, or problems in their muscles or motor patterning. In other words, is your brain talking to your muscles in the most efficient way? If we aren’t our body will compensate and do a movement in any way. It will find a work around to make you do what you need to do.”
Mobility, stability, and strength
There are three key areas that an exercise physiologist will focus on, in order of priority, which are mobility stability, and strength. For adult dancers, they would start by breaking down the movements you do in dance, and work out the mobility, stability and strength required to maintain those movements.
Mobility
Mobility is the first thing Cherie assesses, because if you don’t have mobility in your joints and t hey aren’t woring as they should, it creates a restriction that leads to problems elsewhere.
“We start with checking that the joints are mobile and working as they should. Then we focus on stability. It’s not good having hypermobile joints because you don’t have the stability to sustain that base of support for movement. We need mobility and stability first. That’s probably one of the biggest mistakes I see is people trying to strengthen before they’ve got mobility and stability.”
“You might have shoulder pain that is stemming from an ankle because we are a kinetic chain that is all connected." she continues. "As an exercise physiologist, I check that the joints are working within the range of motion that is appropriate to the level of dance the dancer is doing, and that there is symmetry in the body. If you have a restricted ankle on one side and not the other, that will affect your ability to dance, because your body will compensate.”
Cherie points out that she didn’t refer to ‘flexibility’ because she is not talking about muscle flexibility. Instead, she’s talking about joint mobility.
Stability and strength
After joint mobility has been assessed, Cherie looks at stability and strength.
“We have two different types of muscles – stabilisers and movers.”she explains. “We want to make sure the stabilising muscles are on and can sustain the movement. For example, core strength is needed to support postural control so we can move our limbs. Dancers need to stand on one leg a lot, so the supporting leg needs stabilising muscles. All the muscles need to be working together.”
Stability is not just about the strength of the stabilising muscles. It is also about whether the muscles fire in the right sequence.
“When you are standing on one leg, we want our buttocks to work with the inside of our thigh. Ensuring those two muscle groups can recruit together increases stability and can make a huge difference in balance on that leg. Then there is also the control that you have in that standing posture to be able to move the other leg. People tend to focus on the leg that is moving, but don’t realise the amount of effort it’s taking through the supporting leg. Also consider trunk control. The more we can stabilise through the supporting leg and trunk, the more power you have to create through the other leg to lift it or do whatever it is you want with it.”
Age related changes in strength
Adult dancers in particular need to work on their strength because muscle mass declines as we age.
“From about age 30, we lose one to two percent every year of muscle mass just due to age” Cherie notes. “Keeping the strength in muscles can only be done through resistance training. You might think you are strong because you can bench press or lift weight, but it doesn’t necessarily mean you are strong in all the right places. Dancers need to do resistance training that replicates the movements we are doing in dance class to allow those joints and muscles to be strong for that movement.”
Conscious movement
The approach that underlies Cherie’s work is conscious movement, which means that when you are moving, you pay attention to how it feels, which muscles are working, what is engaging and what isn’t.
“I am working with a dance client at the moment who was finding turns quite difficult. We found out one of the reasons why was because her muscles weren’t recruiting at the same time to help stability and glute activation. It’s often about the connection between the brain and the muscles that we have to reconnect. And it can happen really quickly and improve performance quickly.”
Cherie points out that the dancer may look as if they are doing the movement correctly, so a dance teacher may not notice the cause of the problem. Taking the time to work through these things via conscious movement will increase the dancer’s confidence and give them a lot more enjoyment from dance.
“I generally find that there are a lot of muscles working overtime, doing things they don’t really need to be doing. It’s like that office worker that does everything and then everyone else thinks ‘well she’s doing everything I might just as well have rest’.”
What to expect when you see an exercise physiologist
Initial consultation
Cherie advises that the initial consultation is about collecting information.
“The majority of the initial consultation is more of an interview. I like to find out why they’ve come to see me. There is a main driver they has prompted them to come in. Then it’s working through specific goals.” she explains. “We think about what you want to achieve and then look at the barriers, such as an injury precluding you from dance. After that, we dig into the steps that we need to take.”
Cherie says that it’s vital to look at the client’s current circumstances to find the best away to address their concerns.
“The client may agree on the value of the exercises and really want to do them, but then they go back into their life and they’re working, or looking after kids or parents, and there’s stress” she clarifies. “The question is, are the recommendations realistic gives what the client has going on in their life? We make a realistic plan to move forward and set them up for success. It may mean we need to push the timeframe out, but it means you’re more likely to get where you want to go than setting unrealistic goals.”
The brain and change
A part of the process of working with an exercise physiologist is about being able to make change without relying on will power or motivation alone. An exercise physiologist's role is to help you make change with less effort. Cherie's knowledge of neuroscience can help you overcome the habits you’ve formed over a lifetime, and start creating new habits.
“Our brains can work against us” Cherie notes. “Our brain is amasing at keeping us alive. It thinks that everything we’ve done until now is important and has kept us alive, so it must be working, so it wants to keep doing that, even if it works against what we want.”
Cherie explains that making lasting change is about rewiring your brain and nervous system.
“Well used neural pathways are insulated, or myelinated, which makes the electrical impulse faster and easier for the brain. If you want to change your normal routine, you need to create and strengthen new neural pathways. The more we choose the new behaviour, the stronger those pathways become, and those we no longer use will be weakened.”
Cherie is adamant that seeing an exercise physiologist shouldn’t create more work for you.
“We don’t want to add to our plates, and I think that’s where exercise physiology is different. It’s not something else that you should do. It’s something else that will enhance and complement what you’re doing. It’s not about doing extra things, but finding ways to incorporate exercises into what your usual routine.”
Cost of exercise physiologist
Some people may avoid seeing an exercise physiologist because of the perceived cost. But Cherie explains that as they are an allied health professional, there is a good chance you can have the fees at least partially covered.
“If you have private health insurance, you may be able to get some reimbursement for your visit. Check with your provider though as it depends on the level of your cover. If you have a chronic disease, illness or injury, you can go to your GP and get a ‘care plan’ – you are entitled to five Medicare visits under that plan with an allied health practitioner. There’s also NDIS funding and return to work if you have an injury. So there are lots of avenues for rebates.”
Cherie aims to keep further reduce costs for her clients by offering packages of five or ten session, which are discounted compared to single visits.
“We make these decisions and we don’t realise that subconsciously we tell ourselves stories like ‘I’ll do that next time’ or ‘I can’t afford it’, but underneath it’s actually comes down to self worth and all the underlying reasons why we don’t do things for ourselves. To make that commitment upfront helps remove another obstacle.”
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If you have any niggles or chronic pain that haven't been improved by seeing your physiotherapist, consider seeing an exercise physiologist. Maybe even consider going there first. It will be an investment in greater understanding of your own body and movement, and may help avoid recurring problems.
You can book an initial complementary consultation with Cherie to see if she can make a difference to your life and your dance. Visit her website www.cherienoble.com, scroll down to services.
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