Participation in any sort of physical activity comes with a risk of injury and dance is no exception. Dancers perform repetitive movements for several hours a day. Therefore, dancers must build their strength and flexibility slowly and safely. Despite our best intentions, however, dance injuries do occur. Following are ten suggestions for reducing the risk of a dance injury.
- First, it is important that dancers confidently learn the basic steps of each type of dance before progressing to more advanced routines. This is important not just for beginners. Dancers coming back from injury often benefit from reviewing basic technique steps. Also, dancers going through growth spurts should relearn basic steps to better use longer arms and legs.
- Next, I recommend that instructors frequently use mirrors and the barre to help young dancers. I often ask injured dancers to start dance return with barre use for support and mirrors to monitor technique.
- In ballet, a proper turnout should start at the hips and has the kneecap underneath the hip and over the second toe. Don’t be the dancer who “cheats” to get extra turnout by rolling out the feet. Collapsing knees with second position plie is often associated with hip, knee, leg and foot issues. Increased strength in the back of the hips and better motion of first toe and ankle can make turnout less painful.
- An especially firm dance floor or hard undersurface can increase the risk of bone stress injuries. Dance floors laid over concrete (such as at conventions) or dancing on asphalt/concrete sets are particularly risky. Check out all surfaces for excessive sweat or moisture that increases chances for slips or falls.
- When dancers pair up, it is key to combine dancers of the same height, talent level, and strength. Pairing by these measures, and not just by age, can reduce risk of falls, drops, or overload injuries. Remember that girls mature earlier than boys. While a young female might be ready to partner, a male of the same age may need more time to develop. When starting the pairing process, do not hesitate to use padded floors to make less than perfect landings less uncomfortable.
- Pairing requires strong upper bodies, and I am impressed with the number of shoulder injuries seen in dancers. This is often due in big part to tightness in the front of the neck and chest. Dance movements favor forward positions of the upper body, and common non-dance activities (like smartphone use) add more stress as well as weakness of muscles that support the scapula (bone that is the foundation of the shoulder). Dancers can greatly benefit from specific strengthening and stretching exercises (just as we prescribe for overhead throwing athletes). Dancers and performers also tend to have more motion of the glenohumeral (ball and socket) joint of the shoulder. While some increased motion may allow for amazing artistry, too much motion can lead to pain and an unstable shoulder. Seek dance medicine evaluation with any feeling of shoulder “giving out or giving way” especially with floor work or partnering.
- Let’s head back to that common finding of relative weakness in the lower back and pelvis region. Artistic demands often place unique challenges to this area, such as with arabesque and other leaning back/rotation movements. Without proper coordination of the lower back and pelvis muscles, chronic pain can be a common problem. Those tight muscles in the front of the shoulders are going to be another stressor to the lower back. I find that back pain is in big part from over-extending (leaning back) to overcome tight shoulders with overhead dance moves.
- Always pay attention to the feet and footwear. There are several parts of the foot that cause trouble, but one of the biggest is the big toe. It is amazing that limited motion of this joint can throw off the lower leg, knee, hip and even the back. Even more amazing is how often pain in those areas gets better with proper diagnosis and treatment of big toe issues. Selection of properly fit shoes and slippers can also reduce big toe/foot issues. Dance slippers and shoes should be in good condition and fit well especially with rapidly growing dancers. Feet can swell and become a ½-1 shoe size larger at the end of the day. When fitting for new dance shoes, do so at the end of the day. Don’t forget the importance of proper shoe wear off the dance floor. Sandals and flip-flops are great for the beach or pool but not for regular walking around the mall or amusement parks.
- When is not okay that the show must go on? Dance and pain are frequent partners, and most dancers do not want to stop because of an injury. What do I tell dancers, instructors, and parents about when to dance with pain, and when to see me instead? First of all, any finger-tip pain (“it hurts right here”) worries me for a stress injury/fracture or other serious injury. Pain that seems to be only getting worse, or pain that is there at rest is also a concern. A dancer who limps, cheats, limits leaps or has other changes in technique shouldn’t be on the dance floor. Returning to dance after an injury often isn’t an all or nothing deal. I’m big on working with injured dancers and instructors to allow as much safer dance without bringing on new problems. I strongly believe that part-time is better than no time. Proper modifications and supervision have allowed dancers to perform with some injuries that may have otherwise kept them sidelined.
- Let’s not have any failures to communicate. As noted above, when we talk, we can definitely improve the lives of our dancers. Dancers (and parents) must be strong advocate for their needs (or needs of a child). When practicing multiple disciplines with multiple instructors, often only the dancer or family truly appreciates the overall demands. Ask instructors to work with each other to set sensible schedules with necessary rest to reduce physical and emotional overload. Uncertain what sensible schedules and necessary rest looks like? Dial up a dance medicine specialist to help you out!
For more information on returning to the dance floor after an injury, check out the following video:
Dr. Chris Koutures is a dual board-certified pediatric and sports medicine specialist who practices at ActiveKidMD in Anaheim Hills, CA. He is a team physician for USA Volleyball (including participating in the 2008 Beijing Olympics), the U.S. Figure Skating Sports Medicine Network, Cal State Fullerton Intercollegiate Athletics, Chapman University Dance Department, and Orange Lutheran High School. He offers a comprehensive blend of general pediatric and sport medicine care with an individualized approach to each patient and family.
Please visit activekidmd.com or follow him on twitter (@dockoutures).