“The artistic path is a fearless occupation.” — Alonzo King
Dancers are extraordinary. They hurl themselves about at incredible speeds, doing stuff many people can’t even attempt, and making it look easy, as though they had discovered the secret of flight. It’s a wonderful, exhilarating illusion, but, as every dancer knows, now and then reality intervenes, there’s a crash landing, and somebody gets hurt.
“Dancing appears glamorous, easy, delightful. But the path to paradise of the achievement is not easier than any other. There is fatigue so great that the body cries, even in its sleep. There are times of complete frustration, there are daily small deaths.” — Martha Graham
Dancers are prone to musculoskeletal injury: some studies put injury rates as high as 80%[1]. There’s frequent damage to feet, ankles, knees and lower back among young students as well as professional dancers[2][3]. One study[4] followed foot and ankle injuries over five years in the Royal Swedish Ballet, and quotes previous research citing injury rates among professional dancers of 94% in one year[5]. That’s a pretty alarming statistic. The male dancers suffered back, arm and shoulder injuries, possibly from partnering, and knee trouble. Swedish female dancers suffered overuse injuries to feet and ankles, possibly linked to pointe and demi-pointe work.
A Norwegian survey discovered over 75% injury rates among dancers, but in Oslo, interestingly, there were no reported back injuries[6]. This might be because the Norwegian company uses flat studio and stage floors, while the Royal Swedish Ballet trains, rehearses and performs on a rake. The effects of dancing on a rake are still being researched, so there isn’t much precise scientific evidence on how this might affect injury rates. It seems likely, though, that working for a long time on a slope would affect performers somehow. Much of dance involves movement around a vertical central axis of balance. If this axis rests on a tilted floor, there’s probably a price to pay sooner or later for the stress from the altered biomechanics of the dancing body.
If you become injured, report it and get attention at once. Most injuries need protection, rest, ice, compression, elevation and diagnosis, the so-called P.R.I.C.E.D. protocol. If you’ve torn or strained a muscle or a ligament, there may be an ultrasound scan or MRI to check the amount and type of damage and decide on treatment. After surgery you might have to rest for several weeks, treating the site with ice and a compression bandage, and taking the necessary anti-inflammatory medication to encourage healing. Give yourself a chance to recover. You’ll need patience and courage. Don’t try to rush it – if you return to dancing before you’re properly healed, you’ll make things worse, and be off for longer, so be sensible. Once the injury begins to recover there’ll be rehabilitation, which for dancers is maddening, because it feels as if nothing’s happening. Even if you’re not getting much physical buzz, do the exercises, carefully and consistently; they will help you regain range of movement, proprioception and strength, all of which you really need. Other injuries like fractures or tendinitis need other treatment protocols, but your contribution to your own recovery is always essential. Do what the therapist prescribes, take the meds, do the rehab, take the time your body needs, and eventually it will get better (it does…) and you’ll be dancing again. I’m not saying you need to remain completely inactive, quite the contrary. A sprained ankle offers the perfect opportunity for upper-body strength training, or some flexibility work in the non-injured joints. Keep moving, get out in the sun and fresh air, exercise everything you can, including your mind, adjust your nutrition to reflect the fact that you’re not burning as much energy as usual, and get enough sleep, which is a vital and often overlooked part of the process.
“Our greatest glory is not in never falling but in rising every time we fall.” — Confucius
Many factors contribute to dancers’ injuries. These are classified as intrinsic (to do with the dancer’s own body and mind) or extrinsic (due to outside considerations like environmental influences). An example of intrinsic influence on injury risk would be nutrition. We’ve discussed the importance of proper, balanced diet to the development of healthy bone growth. The actual process of growing is in itself a risk factor, particularly for dancers. A 1999 study noted that girls as young as eight to ten years old were taking on increasingly intense levels of training at the same time as entering their pre-pubertal and pubertal growth phase[7]. The authors add that puberty comes later to female dancers than to non-dancers, and point out that as few as eight hours of dance training a week can be accompanied by attempts at weight control through inadequate diet, the desire to be thin enough for a ballet career. This produces a dietary imbalance, which is implicated in a high incidence of stress fractures. Other growth-related injury causes are the relative vulnerability of your skeleton in the growth stage, the faster growth rate of bone as compared to muscle, which puts the student dancer at risk in the attempt to deal with suddenly unfamiliar body proportions, reduced range of movement due to unexpected tightness in growing muscles and tendons, vulnerability of the epiphyseal growth plates at the ends of your long bones, and reduced muscle strength during the growth spurt. All of these can be intrinsic causes of injury.
Other intrinsic factors which could contribute to dancer injury might be physical anomalies (some aspect of body structure which hinders classical technique, such as insufficient turnout at the hip, lack of ankle plantarflexion, swaybacked, bowed or knock-knee legs, scoliosis, differences in leg length or various other anatomical problems), ongoing weakness from previous injury, stress, overwork, insomnia, poor fitness, fatigue, increasing age, psychosocial factors like isolation or depression, substance abuse, career anxiety, muscular imbalance which has not been corrected through supplemental training, misalignment, overweight, underweight, inadequate warmup, incorrect technique, financial or domestic distractions, hyperhydration, compromised immunity and lack of attention to detail.
Among extrinsic causes of injury are unrealistic expectations on the part of rehearsal directors, teachers, dancers or students about what the dancer’s body is able to deliver. Degrees of turnout may change rapidly during the growth phase, one leg may grow longer or faster than the other, one hip may display less turnout. If attempts are made to force turnout by jamming the feet into extreme “toe-to-heel” fifths, the resultant strain on the phalangeal, metatarsal and tarsal joints of the foot and ankle, and the unnatural stresses on the knees, hips and back may produce serious injury. Great care must be taken during this phase to reduce the requirements on dance students to surpass themselves, and to redress muscular imbalances with consistency, patience and a realistic sense of what can be achieved.
Other extrinsic causes of dance injuries might include hard, raked, uneven or slippery floors, incorrect footwear, poor preparation, obstructions in the dance space, improper heating or ventilation, stress, overwork, poor training, overtraining, excessive expectations on the part of choreographers, directors or ballet masters, incorrect or unrealistic scheduling of classes, tours, performances or rehearsals, weather conditions, bad casting, and environmental failures in the dance space (costume malfunction, draughts, leakage, dangerous conditions, accident, technical failure and so on).
“There are three steps you have to complete to become a professional dancer: learn to dance, learn to perform and learn how to cope with injuries.” — D. Gere
These lists convey one overriding message, which is that you can very easily get hurt while dancing. If you want to avoid injury, concentrate on your health, your nutrition, your sleep patterns, your training and yourself. Try to ensure that the conditions in the dance space are safe — if not, try to get someone in charge to sort it out. You, after all, are your instrument, and you can’t function in your dancing life without it. To put it simply, you need you.
©Jeremy Leslie-Spinks
References
1. Shan G. (2005). Comparison of Repetitive Movements between Ballet Dancers and Martial Artists: Risk Assessment of Muscle Overuse Injuries and Prevention Strategies. Research in Sports Medicine 13(1):pp.63-70.
2. Allen N., Nevill A., Brooks J., Koutedakis Y. & Wyon M. (2012). Ballet Injuries: Injury Incidence and Severity over 1 Year. Journal of Orthopaedics and Sports Physical Therapy 42(9):pp.781-792.
3. Steinberg N., Siev-Ner I., Peleg S., Dar G., Masharawi Y., Zeev A. & Hershkovitz 1. (2011). Injury pattenrs in young, non-professional dancers. Journal of Sports Sciences 29(1):pp.47-54.
4. Nilsson C., Leanderson J., Wykman A. & Strender L.-E. (2001). The injury panorama in a Swedish professional ballet company. Knee Surgery, Sports Traumatology, Arthroscopy 9:pp.242-246.
5. Ramel E. & Moritz U. (1994). Self-reported musculoskeletal pain and discomfort in professional ballet dancers in Sweden. Scandinavian Journal of Rehabilitative Medicine 26:pp.293-298.
6. Byrhing S. & Bø K. (2002). Musculoskeletal injuries in the Norwegian National Ballet: a prospective cohort study. Scandinavian Journal of Medicine and Science in Sports 12(6):pp.365-370.
7. Poggini L., Losasso S. & Iannone S. (1999) Injuries during the Dancer’s Growth Spurt: Etiology, Prevention, and Treatment. Journal of Dance Medicine & Science 3(2):pp.73-79.
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