Professional Dancers on Connecting the Mind and Body for Optimal Performance

Episode Transcript

Dr. Correa:
Welcome back. This week on the Brain & Life podcast by the American Academy of Neurology, I talked to dancers. This week, I talked to Madelyn Ho and Jake Vincent. They're both New York City professional dancers with the Paul Taylor American Modern Dance Company. I wanted to hear from them about how they get into the zone to stand up on stage, perform super complicated and challenging and physically taxing performances in a beautiful way in front of thousands of people without just completely falling apart.

Dr. Nath:
Absolutely. I mean, it's clearly more than just the major structures of the brain. There's clearly tons and tons of training that goes into this, and probably a little bit of genetics, I would think, behind the greatest dancers. I just think that's awesome. I grew up performing piano. That was kind of my whole life before this, and I think it's fascinating how the creative mind works.

Dr. Correa:
And something we don't think about. With many athletes, including dancers, they do so much physical activity day-to-day in their training and with performances that they are constantly balancing recovery and injury. And Jake shares with us some of his experience of having a major injury that takes him offstage and working his way back to be able to perform at Lincoln Center and all these amazing locations in New York City.

Dr. Nath:
Absolutely. These are people that we see in our clinics for a variety of reasons, and I'm glad he got better. And I'm glad you got to see them dance.

Dr. Correa:
They're actually going to be having their fall season coming up soon, so I have my tickets already now. So we follow up that discussion with Madelyn and Jake with discussion with Dr. Jeff Kutcher. He is a neurologist and actually a sports neurologist who focuses in on helping athletes with recovery and helping people recover from things like concussion and traumatic brain injury.

Dr. Nath:
Absolutely relevant to these dancers lives, and can't wait to hear it.

Dr. Correa:
Welcome back to the Brain and Life podcast. Today I'm overjoyed to welcome two friends and guests to the show. Since moving to New York City in 2016, my wife and I have found friends, beauty, and joy in New York City arts and dance community. This started with an introduction to Dr. Madelyn Ho, who is so dedicated to movement and dance that she actually worked out a unique schedule away from Harvard Medical School so that she could both complete medical school and develop as a professional dancer with the Paul Taylor Dance Company.
Her experiences have led her to a deep interest in sports medicine, recovery, rehab, and the performance mentality. And we're also joined by Jake Vincent, another Paul Taylor dancer, who has turned a love of movement in sports into a career in dance. Jake and Madelyn are here today to talk with us, to go beyond living with neurologic conditions and to help share their experience managing the challenges of a demanding performance schedule, recovery and rehab, getting back on the stage after injuries, and how they get in the zone. Thank you both for taking the time to join us today.

Jake Vincent:
Thank you for having us.

Dr. Correa:
So Jake, you grew up playing soccer, but what got you into dance?

Jake Vincent:
Yeah, so I grew up playing sports my entire life. My father was the coach. All my cousins and friends played sports, and I loved the athleticism of that lifestyle. And then, I next transitioned into theater. There was something about theater that really captivated me. I always wanted to do it, but I was very nervous to do it. And then my mom was like, "That's it, I'm signing you up for theater. I've had enough of you always talking about it, so I'm just going to make you do it."
So I started doing some theater. From there, I worked with the choreographer of one of the shows in high school who owned a dance studio. And she was generous enough to say, "You're pretty good. You have some raw talent, but you got to learn some more stuff."
So she gave me a scholarship, and I was very fortunate to train at her school and then moved to continue my education in dance. And from there, I think I really found the connection of my athleticism that I grew up with playing sports and being very active. Also, my love of theater as well, and that perfect combination for me, is dance.

Dr. Correa:
So Madelyn, what about you? Before, when you were at college at Harvard, you had some experience with dance, but what made you consider taking a break from med school to pursue a career in dance?

Madelyn Ho:
Well, that wasn't my intention. I had been dancing with Taylor too before medical school, and my thought was that I was retiring from dance to begin medical school. While I was there, I wanted to show my boyfriend what my previous life was before medical school. And so I was looking at the Paul Taylor Dance Company's website, and saw that they were having an audition, and something in me... It was an automatic response that I had to be there. I thought it was so unlikely that I had actually signed a lease in Boston two weeks before the audition. I was going very much for myself. It was one of those things that I felt like I needed to do just to provide some closure for myself.

Dr. Correa:
With your time in medical school and the training that you've had, how is your understanding of the body and health... How does that change what you bring to dance and your role in the company?

Madelyn Ho:
For me, medicine and dance are very much intertwined. Even during college and even for medical school, my motivation for going to medical school was very much with the intention of taking that training and knowledge and being able to help dancers heal from their injuries.
So for me, on a day-to-day basis, I think when I'm dancing, there's so much going on. I'm not thinking about each muscle that I'm using. My trainee comes into play mostly in terms of the pre-habilitation or rehabilitation. And also helping fellow company members better understand their injuries or their aches and pains, and sort of being able to help guide people towards their healing, and also being able to help answer questions that people may have.

Dr. Correa:
Jake, maybe you can help us and our listeners. Some people have varying levels of exposure to dance, but how would you describe what is modern dance and what's the difference from ballet or dancing in a play?

Jake Vincent:
The way I like to describe modern dance is it's a complete departure from ballet, which most people tend to understand that visual, right? There's tutus, there's point shoes, there's fairy tales, and it's very classical in form. Where modern, I think, is a departure from that. It's a little more earthbound. It's a little more visceral. I like to say that if you take off the point shoes and you have all the same lifts and all the same jumps, but just add in some slides to the floor, then that's Paul Taylor.
There's a huge gamut of emotion that we're asked to call upon in this company, and physically as well. We're asked to do very technical and classical things. We're also asked to do very quirky and angular shapes that you may not see in a ballet. I would say that in Paul Taylor, you're getting that access to both things that are seen and something that you'll never see before as well. And that's my take on modern dance.

Dr. Correa:
That's great. And each of you, day-to-day and each time you step on stage, are asked to really put yourself and emotion out there in a way very differently than the rest of us. But we can all relate to that because, in some way, at work or day-to-day, we all have to perform. In the face of the many challenges as dancers and performers and your demanding schedule, Madelyn, how do you strengthen and maintain a performance mindset?

Madelyn Ho:
A performance mindset comes about from all the work and training that comes beforehand. So for me, when I am on stage and the lights are on me and the curtain has risen, there's almost as transformation that occurs. Because, for me, that's a moment where everything that I have prepared comes together.
So all the cross training, all the rehearsals, all that information, rather than thinking of each moment or each thing step by step, it's all come together. And so it gives me that freedom to really be in the moment. And there's something very freeing about that. Knowing that I have already put in all the work and that whatever happens in the moment is unique in that moment. There's no way to be able to try and recreate something.

Dr. Correa:
I think back to so many of the challenges that I had with med school and tests, and really the things I was most successful with were the ones that I could go into it with the confidence of preparation. So I can relate to that idea of your having the performance mindset really being not a momentary thing you're turning on, but it's really a product of many, many hours that you've put into it.

Madelyn Ho:
Absolutely.

Dr. Correa:
And Jake, movement arts like dance are amazing expressions of emotion, power, and beauty. But internally, they can be really physically taxing. How have you experienced balancing the physical and the mental challenges of dancing for the Paul Taylor Company?

Jake Vincent:
That is definitely a lifestyle that I'm trying to balance more in a healthy way, and I think I'm starting to get a better grip on it each month. Each year that I spend in this company, I'm able to realize that this job is a synergy between mental preparation and physical preparation. And I think when I first joined, I really saw this as, "Oh, it's a physical art form. I need to go to class. I need to go to the gym. I need to learn my steps."
But then, the older I got and the more I did the dances and performed, I realized that the audience sees, yes, they see what you look like. It is a visual media. However, they feel things as well. And if you don't put the time in to put yourself in that mental state prior to the dance starting, or even in rehearsal, right? We're performing in rehearsal. That would be considered our nine to five, right? We're performing during that time as well when we're running the dances.
And that can be taxing on your mind, and it's definitely taxing on your body. However, I would say it's almost more of a release mentally than it is taxing. And I would say that's the balance of dancing smart, right? You want to dance in a way that you're supporting longevity in your career and you're not repeating injuries, you're not injuring others, you're dancing in a very healthy, smart way, but you're also able to continue to grow as an artist and support yourself mentally as well.

Dr. Correa:
And what has been your experience with injury and recovery from injury with dance?

Jake Vincent:
I unfortunately sustained my first injury of my dance career this past year. It happened opening night of our city center season. It was something that I never saw coming. I was feeling a hundred percent confident, and I was having a wonderful performance, if I don't say so myself. It's just the name of the game. It's the nature of the beast. You can land a jump one time. Could be a million different things. I unfortunately sustained an injury that night, and been very difficult mentally.
I would say the mental game is much more of a challenge than the physical game. But there were definitely dark times mentally in the recovery period. But I'm continuing to take the necessary steps mentally to push myself. And that would include positive reinforcement to myself, right? As dancers, we tend to be a little negative on ourselves. I got really into meditation and relaxation techniques because your mind can roam when you have so much time. And unfortunately, with an injury, you're just left with a lot of time because you're just waiting for your body to catch up and heal again.

Dr. Correa:
And Madelyn, beyond the difficulties of the performance schedule or injuries, the mental health challenges, performing at high altitudes can pose significant physical challenges. Having performed all around the world, what has been your experience with the changes in altitudes that you have to perform at?

Madelyn Ho:
Sometimes that can mean figuring out how to dance smartly and pacing yourself in particular dances to know which parts are particularly hard and how to navigate that smartly. And yeah, it's just one of those things that comes with experience of knowing when those parts of the dances are. And also, just making sure to hydrate both before, during, and after. That's definitely one of the things that I experienced once when we were dancing altitude. I had made sure to hydrate beforehand, but didn't do as good of a job afterwards, and had a terrible, terrible headache that just wouldn't go away for hours. So definitely recommend making sure that you get enough water throughout the day.

Dr. Correa:
That's so relatable. Just the idea of changing environments for us, but for you, it's particularly physicality of what you have to do all of a sudden showing up somewhere. You have to still go out and perform. If you'll indulge me quickly, let's do a few little quick checks of a brain health activities check.
You've both talked about rest and things that help you recover and adapt, both from your performing but when you're traveling. So I'm just wondering how each of you do with some of the things that we've recommended that help with your brain health. So, let's start with sleep. How many hours are you averaging a night? Or have you adapted your sleep schedule to think about your brain health?

Jake Vincent:
I definitely have added hours to my sleep schedule since getting injured, and I really need my eight hours now.

Madelyn Ho:
I function best at 10 hours of sleep, which is not always feasible. So I do try to get between eight to nine hours. At nine hours, I feel pretty good. And it also varies too, depending on what the rehearsal or performance is, right? And the amount of strain that I put on my body. That also dictates how much sleep my body needs.

Dr. Correa:
You're both rehearsing sometimes four or six hours or more, sometimes in a day. But when you're thinking about your health and diet for recovery and for your body's and your brain's health, are you eating vegan, vegetarian? Do you do a Mediterranean diet? What do you adapt to your life?

Jake Vincent:
I like to have my most calorically dense meal in the morning. I usually make a power oats oatmeal that will sustain me for hours of dancing. And I usually have it after the gym, so I'll work out fasted, and then I'll have my oats, and that'll keep me satiated throughout the entire rehearsal day with little snacks here and there, because it's hard to have a large meal when you're dancing for five hours a day. It's hard to really digest it and feel great to dance. So I'll do little snacks throughout the day, and then I usually like to have a lean protein with greens and grains, so I'm getting all my food groups.

Madelyn Ho:
I feel like this is something that I'm still trying to figure out. I'm a generally pretty slow eater, and sometimes I get distracted during rehearsal. And during our lunch break, I am working on notes or prepping for the next thing or discussing certain parts of the dances with people. I set aside the time to have food throughout the day, and having something that can be fast. And I've discovered that smoothies are a good way of getting food in while I'm slow chewing, so still trying to figure out what is best for me.

Dr. Correa:
Well, thank you both so much for taking the time, helping us learn kind of how you adapt to the challenges in your schedule, and what it is to perform movement arts like dance, and on such a demanding level. I look forward to seeing each of you on stage again this fall for the upcoming season. Madelyn, Jake, what else do you have coming up next?

Madelyn Ho:
We have a couple performances coming up. And then, we'll have our big Lincoln Center season in New York City at the beginning of November.

Jake Vincent:
And all this information can be found on social media, so definitely follow us and keep up with the company on Instagram, and Facebook, and all the things. Paul Taylor Dance.

Dr. Correa:
Well, thanks again for joining us.

Jake Vincent:
Thank you.

Madelyn Ho:
Thank you.

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Dr. Correa:
Welcome back to the Brain & Life podcast. We had a great discussion with Madelyn Ho and Jake Vincent. And I'd like to introduce now our medical expert guest for this episode. Dr. Kutcher is an expert in sports neurology, specializing in the diagnosis and the management of concussion and post-concussion syndrome, and many of the neurologic complications or challenges that athletes can deal with.
Prior to launching his own Kutcher Clinic in Michigan, Dr. Kutcher founded and directed the University of Michigan NeuroSport Program. He also founded the sports neurology section that helps organize the specialists in sports neurology within the American Academy of Neurology. He's a team physician for the US ski team and snowboard, been a team neurologist for several other US teams, both in Pyongyang and Sochi, and several of the winter games, and has served as a director of the NBA concussion program and has worked with the NCAA, the National Football League, and National Hockey League. You spend a lot of time alongside athletes, Dr. Kutcher. Thank you for joining us and taking the time.

Dr. Kutcher:
Thank you very much. Great to be here.

Dr. Correa:
So we had a discussion with Dr. Madelyn Ho, who's also a professional dancer with the Paul Taylor American Modern Dance Company, and her colleague there in the company, Jake Vincent, to talk about recovering and coming back from injury and some of the challenges that athletes like dancers experience. But before we get to that, what is a sports neurologist?

Dr. Kutcher:
A sports neurologist is a neurologist who specializes in really three, I would say, areas specifically. It is first, any neurological injury as it relates to sports or athletic activities. Obviously, concussion is the one that comes to everybody's mind. However, there are many other injuries. Repetitive use injuries, peripheral nerve injuries, spinal cord injuries, that whole series of any injury from playing a sport or physical activity. That's only thing one.
Thing two is really becoming expert in managing more common neurological diagnoses when they occur in very athletic individuals who may have, as an aspect of their life, a reason to need to perform, whether they are a professional athlete or a dancer. So, in other words, how do you manage multiple sclerosis? How do you manage stroke, migraine, epilepsy, in the setting of somebody who is trying to perform at an elite level? So, that's incredibly important.
And then the third gets really more to the performance side of things, so understanding how the brain works, how networks are formed, and underlying physiology and pathophysiology. We can apply that to how can we make somebody a better athlete? And at the end of the day, being a really good athlete has a lot to do and it's a neurological output. And so, understanding how to train people the most efficiently is also something a sports neurologist does.

Dr. Correa:
I think that ties in great to sort of the discussion that we had with Madelyn and Jake. And we started it off really talking about how each of them get into that performance mindset and take care of their own brain health to maintain themselves as athletes and healthy performers. What do you talk about with athletes and other performers that you work with about maintaining that brain health and then what things that they can do to prepare themselves on the day of performance?

Dr. Kutcher:
I love that question because too often the focus is on injury, the focus is on concussion, yes or no. I mean, at the end of the day, brain health is a bigger issue. Brain health has to do with the long term over the course of your life, and not just performing in any particular day, but how are you doing in day-to-day activities?
When we talk about brain health with our patients, we start with the basics. Let's look at sleep, let's look at hydration, let's look at nutrition, and let's look at exercise and what types of things you're doing. And those four things are incredibly important. I think we all know they are, and I try to emphasize just how much they are. And so, that's something that we always stress.
And then beyond that, obviously, there's an incredibly important role that being physically active plays in having positive brain health. And not only when you're developing through your teen years and early adult years, but throughout your whole life. Having an active athletic life is certainly beneficial for overall brain health.
We know that physical activity, for example, can help mitigate symptoms of many of our neurodegenerative diseases, Parkinson's disease and Alzheimer's, so on and so forth. Specific to my athlete patients, we talk about really, the old term is, getting in the zone, whatever that means. I think that means different things to different people, different athletes, and there are different techniques and different ways to get there.
But at the end of the day, I think it has a lot to do with confidence, especially coming back from injury, right? I think that's obviously one of the more important things, is you need to go out there and do what you need to do, not only for whether it's a sort of traditional sport where you're trying to perform to win a game, or on the dancing side, you're trying to perform to entertain and be artistic and get your vision across and all of that. To get back to that level after an injury, you need to really be confident. And so how you progress back, not only physically, but I would say mentally and cognitively.

Dr. Correa:
Jake and Madelyn pointed out many people think of the performance, but don't always realize the number of hours and time and dedication both in the studio or in the practice setting, and then at home just recovering and maintaining themselves to be able to on that one day step on the stage.

Dr. Kutcher:
Absolutely. And that's one of the joys, I think, of being a sports neurologist is seeing the rest of that understand the training that goes into, whether it's professional dancing or any other high-level activity like that, it's incredible to be involved with patients like that who are so dedicated and really do some really incredible things.

Dr. Correa:
As a sports neurologist or just in that process of discussing with your athletes and patients about returning from injury, how do you approach that discussion?

Dr. Kutcher:
Like everything else we've talked about so far, it is rather individualized. And one of the reasons I love sports neurology is, for me, it is very much what I always thought of as old school "neurology". We spend a lot of time with patients. We get to know them. We do a complete history. We understand kind of where they came from, and even family history can play into this, because when you're returning from an injury, there's going to be the actual physical part of recovery, the mental part of recovery, the cognitive part of recovery, and all of that is intertwined.

Dr. Correa:
Now, you brought up one of the key injuries that many people think about and talk about with sports neurology, concussion and mild traumatic brain injury. Now, another aspect of that that you also specialize in working with patients and athletes on is post-concussive syndrome. So, what's the difference between concussion and post-concussive syndrome?

Dr. Kutcher:
Well, I'll tell you the reality is it has to start with what is concussion? And then, we have to be very careful to stick to that, because in, I would say, in society in general, for sure, and in a large part of the medical community, the term concussion is thrown around quite loosely to really either imply the actual injury itself, like the hit that occurred, right? Like the actual physical entity, or they'd use it to imply or relate to any symptom, brain-related symptom, that somebody's having sort of into the future indefinitely after they hit their head.
And the reality is that concussion specifically is a brain injury. And it is an injury of essentially poor network formation as it relates to neurons being unable propagate signals in an efficient manner. So I would say the most important thing right out of the gate is to make sure that you have the right diagnosis, because just because you hit your head, or something hit your head, and you have symptoms, doesn't mean you're concussed.
Sometimes you have a brain injury, sometimes you have a peripheral nerve injury, or a cranial nerve injury, or some of the process creating symptoms. They overlap. Understanding how they evolve over time, because concussion itself should be a pretty straightforward symptom resolution. I refer to that as a monophasic process. It resolves over time, several days to a week or two. If you feel the injury is over, the brain injury, and any symptoms are persisting, that's post-concussion syndrome.

Dr. Correa:
Those are all excellent points. It helps us understand that concussion itself as a term is in itself basically the mild traumatic brain injury, but that the persistent symptoms afterwards are a whole different set. You've worked with so many different performers and athletes over the years. Is there something that you've learned from them that you've taken into your own life?

Dr. Kutcher:
The thing that comes to mind first when you say that is just resilience. I think we all obviously have challenges in our lives and things that come up, and just seeing how to work through that. Yes, there's time to pull it back and rest and reflect and deal with that part of things, but just being resilient and knowing kind of what the final outcome is.
So when I see patients, this, to your point earlier in covering the Olympics, for example, on TV you might see the two or three runs in the half pipe. These athletes are every single day just getting after it, right? And so, just understanding that when they have a setback, the reaction that they have is truly inspiring.
Otherwise, it's a joy, I think, of being human, for lack of a better way of putting it. Because I think just being able to get out and do things that are just incredibly demanding but also exhilarating and beautiful and all that, it speaks to the artistic side of us too, a lot of times. And I think seeing what these athletes can do just inspires me to just go out and have fun, frankly.

Dr. Correa:
Wow. Thank you so much, Dr. Kutcher. Athletes and sports and performers often are inspirations for all of us out there to learn from their resilience and the dedication and beauty that they put in their work. And I really appreciate and thank you for everything that you do to help them get back out there to train and to perform for us as a sports neurologist. And thanks for taking the time today to speak with us and our Brain & Life listeners.

Dr. Kutcher:
You are very welcome, and I definitely appreciate the opportunity to be here today.

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Professional Dancers on Connecting the Mind and Body for Optimal Performance

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