Injury Intervention

Posted on March 15, 2008 by

Gigi Berardi is an assistant editor of the Journal of Dance Medicine & Science. Parts of this article have been adapted from her recent book, Finding Balance: Fitness, Training, and Health for a Lifetime in Dance.

Some injuries happen unexpectedly: An off-balance landing, a poorly timed lift or a slippery floor can cause a strain or sprain in a split second. Most often, however, injuries develop slowly over a period of time and are caused by overuse or continual, low-level stress.

Therefore, it’s essential for teachers to be on the lookout for destructive movement patterns and signs of pain among students. Is a dancer favoring one side? Is she constantly rubbing her calf muscle? Learning what to look for will enable you to intervene before a condition becomes chronic.

Some risk factors to watch out for include excessive pronation (feet rolling in), excessive eversion (feet rolling out, or “sickling”), muscular imbalance, forced turnout and structural anomalies (e.g., differences in leg length). Other factors include inadequate warmup and training overload, as well as poor nutrition, disordered eating and menstrual dysfunction or irregularity. Here, we take a look at seven common dance injuries, as well as risk factors and methods of treatment.

Ailments: Achilles Tendonitis and Shin Splints 

Risk Factors: Poor technique, anatomical limitations (a high instep), environmental factors (hard floors). Dancers who land with their “heels up” (i.e., with the heels of the feet not making contact with the floor) are also at risk. Those with a shallow plié or weak thigh muscles will have problems rolling through the entire foot during fast-tempo ballets.

Treatment: At early onset, rest and ice (and, for tendonitis, compression and elevation) are recommended. An evaluation by health professionals may indicate the need for corrective devices such as orthotics. An orthotic shoe insert limits excessive rolling in and out of the foot and repositions joints to alleviate pressure put on muscles and tendons. Alternatively, dancers may follow a course of extensive manual and physical therapy practices. In the studio, teachers should advise quadriceps conditioning, as strong thigh muscles help to stabilize the knee joint and control the plié.

Ailment: Ankle Sprain 

Risk Factors: Poor technique, fatigue, weak ankle and lower-leg muscles, history of ankle sprains.

Treatment: For immediate treatment, application of ice, compression and elevation is recommended. Ice should be applied about three times per day for 10 to 20 minutes each time. Ice has an analgesic effect, and allows for exercises that move the joint through full range of motion. Strengthening work should include resistance exercises in pointing and flexing the foot, as well as with lateral ankle movements.

Ailment: Stress Fracture

Risk Factors: A pronated foot and genu valgum (knees rotated to the outside). Repetitive loading with demanding movements, predisposition to amenorrhea (absence of menstruation) and restricted caloric intake may also contribute.

Treatment: Rest and ice, until a diagnosis can be made.

Ailment: Patellofemoral Syndrome

Risk Factors: Patellofemoral syndrome is caused by poor patellar (kneecap) tracking or excessive loading of the patella, which generally results from the outside hip and thigh muscles (the vastus lateralis) being stronger than the inside thigh (vastus medialis), pulling the kneecap to the outside. When jumping or practicing lunges, many students contract their quadriceps tightly throughout their plié, producing constantly high patellofemoral compression forces. The situation can be aggravated by a pronated foot, anterior pelvic tilt (swayback) and decreased external hip rotation.

Treatment: Rest and ice can be effective until a diagnosis is made. Rehabilitation of patellofemoral syndrome involves conditioning for strength and flexibility of the quadriceps, hamstrings, gastrocnemius and soleus (calf muscles), as well as stretching of the iliotibial band (outside leg). Giving feedback in technique class also helps—emphasizing that the dancer’s knees should be over her feet in lunges, and that external hip rotation should be used to initiate plié.

Ailment: Low Back Disorders

Risk Factors: Lifting and jumping with poor alignment, muscle imbalance (which may involve a tight psoas, or hip flexor) and training overload. Environmental factors, such as non-resilient floors, tight costumes or lifting a partner mismatched in height or weight, or with improper timing, may also contribute.

Treatment: Rest and ice are recommended for immediate treatment. Following a diagnosis and treatment, core strengthening and stretching exercises, including those for tight hip flexors, are recommended. Conditioning programs that focus on abdominal and back extensor strengthening, hip flexor stretching and exercises to release tension in the low back area can help to relieve pain. Rehabilitation also could include Pilates work. Any number of soft tissue (manual mobilization) treatments will ease spasms and release the tissue. Physical therapy adjuncts may include massage, electrical stimulation and ice.

Ailment: Anterior Shoulder Impingement

Risk Factor: This occurs when the many tendons that envelope the head of the shoulder bone are “pinched against” the roof of the shoulder joint, as with improper overhead lifting.

Treatment: Rest, ice, compression and elevation, as well as gentle shoulder mobilization, manipulation and massage of tight shoulder girdle muscles, stretching and strengthening exercises. DT 

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