Dealing with Injuries

Safety from injury is a dancer’s prime concern. The body is the dancer’s instrument, with over 200 bones, 600 muscles and numerous ligaments and tendons; it is hardly possible for dancers to totally avoid injury. Nonetheless it possible to minimize it and understand how to deal with it. For one, pain is your body’s warning signal. Listen to it.

The information provided here is for general knowledge only and is not meant for the use of self-diagnosis or treatment. If you are experiencing pain or dysfunction of any sort, seek professional medical advice.

Causes of Injury

Acute injuries such as ankle sprains and muscle tears and pulls happen suddenly. Chronic injuries such as tendonitis and stress fractures are built up over a period of time and repetitive stress.

Injuries are most likely to occur in or are caused by these situations:

• Extreme fatigue and lapse in concentration
• Lack of flexibility in a certain area
• Lack of control or muscular strength in an area
• Poor alignment and technique
• Dancing on hard or non-sprung floors
• Increase in workload when returning to dance after long period of rest
• Lack of warm up and cool down
• Pushing limit of strength too far
• Poor nutrition
• High workload during growth in which bones and muscles may be growing at different speeds

Dancers also need to be aware that dancing on painkillers or anti-inflammatory drugs may mask the sensation of pain, consequently leading to further tissue damage in the area or injury in other areas.

Common Injuries

Ankle and Lower Leg

Ankle, foot and lower leg injuries are common among dancers, especially classical ballet dancers. It plays a vital part in balance and stabilization and is responsible for the push off as well as landing phase of jumps. Proper articulation of the metatarsal and phallanges cushion the landing of the jump and absorb shock loads transmitting through the body.

Lateral Ankle Sprains

This is the most common type of ankle injury sustained by dancers. The ankle has stronger medial ligamentous and weaker lateral ligamentous support, which is why there is a high frequency of lateral sprains. These often occur from a lost of balance of a bad landing from a jump. A swelling will usually appear around the lateral side of the ankle, accompanied by varying degrees of pain depending on the severity of the sprain.

Impingement Syndrome

In Posterior Impingement syndrome, the tissues at the back of the ankle are compressed. There is some pain when pointing the foot and when on “full releve”. Rest and anti- inflammatory drugs are often prescribed. Stretching the calf and Achilles tendon are important to reduce stress placed on the area.

Anterior Impingement syndrome occurs at the front/top of the ankle. After many knee bends or plies, there is sometimes bony formation at the front of the ankle, causing pain when in contact with soft tissue. It is important that this is diagnosed early because it is irreversible.

Fractures, Stress Fractures and Shin Splints

These injuries are always a great hazard to dancers because they can take very long to heal. New bone takes 6-8 weeks to form and fractures in some areas like the anterior cortex of the tibia take up to double this time. Even after this rest period, dancers take a significant amount of time to rehabilitate and return to full dance activity safely.

Dancers often sustain acute fractures in the metatarsals while landing from a jump. If the fracture is not accident related such as in a stunt, it is usually a chronic stress fracture. These are developed over a period of repetitive stress. The muscle around the bone is fatigued and more impact transfers to the bone, eventually resulting in a crack. Stress fractures commonly occur in the major weight-bearing bone of the lower leg, the tibia or in the feet. Similar to this, Anterior/Posterior Compartment Syndrome, also known as Shin Splints, results when tight shin muscles pull on the tibia, sometimes resulting in a fracture. This is common in growing teenagers.

The only treatment for fractures is rest, to allow time for the bone to heal. Prior to returning to dance activity, dancers should consult their physician.

Knee

The knee is a very vulnerable area. The knee joint comprises three bones, the femur, tibia and patella. These bones provide it with very little bony security. The ligaments and muscles are thus particularly important in limiting ranges of motion of the knee. When these fail to resist unwanted sideways movement or excessive rotation, serious meniscus or cartilage and ligament (anterior, posterior cruciate ligaments) tears can occur.

Knee injuries are more probable in classical ballet dancers with limited hip rotation because dancers tend to twist their knees to force more rotation, often resulting in meniscal damage. Dancers with leg anomalies such as bow-legs or genurecurvatum (hyper-extension) are also more prone to knee injuries because they tend to have technical deficits in terms of leg alignment.

Patella tendonitis is another common knee injury sustained by dancers. The patella is the bone in the front of the knee, otherwise known as the knee cap. When the patella tendon and the tissues around it become inflamed, causing pain, the dancer is said to have patella tendonitis. The patella is sometimes also dislocated.

Severe knee injuries such as cartilage tears require surgery; the most common of these being arthroscopy where a tube is inserted to remove cartilage mince which cause irritation.

With all knee pains, it is important to stop the pain causing activity and consult a physiotherapist or physician.

Spine

Increasing demands on dancers today (being able to wrap your legs around your head etc!), requiring extreme range of movement, makes the lower back a common site for injury. Dancers with scoliosis, hyper-mobility, tight hamstrings and leg length inequality are prone to back injuries.

Lower back sprains and strains are the most common of back pains. Muscle strains and sprains occur when a muscle is torn or overstretched. This can be caused by overuse, suddenly lifting a heaving object or faulty technique. The muscle sometimes goes into intense spasm to protect the joint. These should not be ignored as they can lead to further injury.

Spondylolysis is a stress fracture in the vertebrae of the spine, usually the lumbar spine. This is sometimes hereditary but is also caused by repetitive stress to the lumbar spine. The dancer will typically experience back pain when doing back bends or any movements which involve lumbar extension. The pain can progress to daily activities and in severe cases even interfere with sleep. As with all fractures, a period of rest is usually prescribed. Spondylolysis can sometimes progress to Spondylolisthesis where a vertebrae slips forward onto the one below.

Back injury can be avoided through good technique and correcting any imbalances in the abdominal and back muscles. Massage and osteopathy can also come in useful in keep the muscles and joints loose and free.

Shoulder

Injuries in the shoulder are less common to dancers than those in the lower extremity. However, choreography that requires the upper limb to weight-bear (now increasingly popular in contemporary dance) and repetitive lifting required of males can sometimes cause injury to the shoulder.

The shoulder joint is the body’s most mobile joint. While this gives us great mobility and freedom in the area, it also means this joint is easily dislocated. Muscle tears are also possible. Dislocations usually occur during a fall or when the arm is in an extended or an awkward position. Repeated dislocations make the joint lax and more prone to dislocation. Strong muscles of the back and shoulder girdle, especially the intrinsic rotator cuff muscles, can help stabilize the shoulder, preventing dislocations.

Treatment

With most injuries, the RICE is a safe and useful protocol:

Rest – avoid any activity that caused the pain
Ice – apply ice to the area; this helps to reduce inflammation and swelling
Compression – wrap a bandage around the area; this is sometimes optional
Elevate – try to place it above heart level

With all persistent pains, seek professional help from your dance physiotherapist who may sometimes refer you to a sports doctor or orthopedic surgeon for proper diagnosis. This is very important for the prevention of further damage or reoccurrence of injury.

Preventive Measures

Warm Up and Cool Down

Warm up and cool down can help prevent injury. Warm up should involve some cardiovascular activity, light stretching and the strengthening of certain muscle groups which will be involved in the specific dance activity. This serves to increase body temperature and muscle viscosity, preparing the body for activity. Full range stretching alone as a warm up is inadequate and sometimes results in lost of control due to nerves being stretched.

Cool down is often neglected by dancers. A sudden stop in activity and drop in heart rate results in lactic acid build up and blood pooling. Cool down prevents these and can help the body to start recovering from activity faster. It should consist of slow walking and circulatory movements at joints and can be a reverse of the warm up.

Supportive Footwear

Proper daily footwear can help prevent foot injury. Although not possible during dance activity, supportive foot wear such as good trainers and sports shoes should be worn as often as possible during daily activities especially if the dancer has a large amount of high impact activity on the feet (e.g. en pointe).

Conditioning

Conditioning the muscles that support and protect the skeleton is an important injury prevention measure. For example, strong abdominals support the spine. This is not merely of aesthetic value because muscles move as well as protect the bones. Pilates (a method based on gaining core stability through the deep abdominal muscle, transverses abdominus), Yoga and other various conditioning methods not only help to strengthen specific muscles but also help to correct imbalances and mal-alignment in the body, thus preventing injury. These are often used in various rehabilitation processes, helping to “target” weak or vulnerable spots and imbalances, preventing reoccurrence of the same injury.

Rest

No matter how strong and efficient you are in terms of fitness, stamina or muscularly, there is a limit to the workload and impact each body can take. Dancers should also allow sufficient time for the body to heal from daily wear and tear and maintain energy levels through proper rest and nutrition. It is important to stop activity if pain or swelling occurs and seek medical help if the pain persists. Treat your instrument with loving care, it’s worth it!

Contributed by Christina Chan