In the Magazine

Shinsplints—or Stress Fracture?

Spot the differences between these easily confused injuries.

It’s news that Dr. David Weiss doesn’t like to give. Sometimes dancers see him thinking they have shinsplints, when they actually have a stress fracture, a more serious injury that requires a longer recovery. “When dancers come in with stress fractures, I see a lot of denial,” says the NYU Langone Medical Center orthopedist. “They say, ‘This is just shinsplints, isn’t it?’”

Because the symptoms of shinsplints and stress fractures are very similar, it can be easy for dancers to misjudge a lower leg injury. In fact, the injuries are so closely related that shinsplints occasionally lead to stress fractures. Recognizing which a student has is essential for proper treatment and recovery: One might call for just sitting out of grand allegro, while the other could require several months off.

Identifying the Injury

Shinsplints, or tibial stress syndrome, is an overuse injury that occurs when the bone’s lining and muscles become irritated, making them unable to absorb shock. If shinsplints are left untreated, the irritation may cause a stress fracture. (Though stress fractures do not always begin as shinsplints.)

The placement and size of the area where a dancer is feeling pain is key to determining which injury a dancer has. Dr. Weiss says shinsplints’ burning ache is felt along the inner side of the tibia, where the calf muscle begins to protrude, and extends several inches down the bone. Though pain felt with a stress fracture is similar, it is usually concentrated in one small area, about a half-inch long. “If a dancer has pain on the front of the shin, especially if the pain is only in one spot, that’s much more suggestive of a stress fracture,” he says. In both cases, more intense pain is felt when taking off for jumps or landing.

Causes

The most vulnerable time for both injuries is during a sudden increase in activity, like a summer intensive or when a student returns to class after vacation. Hard or unsprung dance floors make landing jumps difficult on joints and muscles and can put dancers with structural problems, like short Achilles tendons or joint hypermobility, at risk. (See below, “Injury Prevention,” for strengthening exercises.) But Alison Deleget, athletic trainer at Harkness Center for Dance Injuries, says the most common cause is from dancers’ training habits, usually related to landing jumps incorrectly. Common culprits include not getting the heels down in plié or pronating the ankles and forcing turnout, which cause the calf muscles to carry the stress of preventing the feet from rolling in.

Stress fractures do not occur often—of the approximately 85 dancers at Juilliard, Dr. Weiss typically sees one a year—but when they do, they need to be treated early to prevent a larger, chronic crack. He says nutrition plays a role in this injury specifically. For example, dancers who spend little time in the sun may not have enough vitamin D in their bodies to help absorb calcium, which they may also not be getting enough of. Paying attention to these intakes and using multivitamins can help avoid chronic injury.

Solutions

Dancers who feel shinsplints pain should abstain from jumping for a few days. By dancing with shinsplints, the body may alter its mechanics of the takeoff and landing, which puts stress on other areas. Professional treatment for shinsplints isn’t essential, though Deleget recommends seeing someone if the pain lasts more than two weeks, or if it prevents dancing entirely.

If a student thinks they may have shinsplints, there are a few ways to find relief during recovery, including icing, using Kinesio tape or compression socks to encourage the muscles to relax, and wearing athletic shoes with good arch support to keep the lower legs properly aligned. When easing back into class, dancers should pay close attention to stretching out the hips and calves, which take the most stress during landings, causing the joints to grip.

Dancers who have pinpointed pain indicative of a stress fracture should see a doctor immediately for a leg X-ray. Rest is the only solution for this injury, with recovery time taking six weeks to several months, depending on the severity of the fracture and how long the dancer has been jumping on it. Extreme cases may require wearing a walking cast or boot to immobilize the leg. DT

Ashley Rivers is a writer and dancer in Boston.

Injury Prevention

Alison Deleget, athletic trainer at Harkness Center for Dance, says dancers can use these exercises as a warm-up to help prevent shinsplints and stress fractures. For each exercise, perform 10–15 reps, two to three times. The goal is not to fatigue the muscles, but to activate them.

Exercise Purpose How-To
The Clamshell Strengthens deep rotators in the hips, stabilizing turnout. Lie on one side with legs bent at a 90-degree angle, feet in line with your hips. Keeping your feet together, rotate your top knee toward the ceiling, engaging turnout muscles, and return to parallel.
Arch-Doming Strengthens the feet, so that they properly interact with the floor during jumps. Sitting with your knees bent and feet flat on the floor, contract the arch muscles of your feet so they create a dome with the toes still touching the floor. Release to neutral.
Thera-Band Warm-Up Strengthens the feet, ankles and calf muscles that control ankle alignment. In a seated position with legs extended, grip the ends of a Thera-Band, looped taut around one foot. Slowly point and flex the foot, circle the ankles and move through sickled and winged positions.

Photo ©iStockphoto.com

Former students of Kelley gather around a cardboard cutout made in his honor at the recent tribute. Photo courtesy of Merritt

Every dancer has a teacher who makes an impression. The kind of impression that makes you want to become a dancer or a teacher in the first place. For Mara Merritt, owner of Merritt Dance Center in Schenectady, NY, and countless others, that teacher was Charles Kelley.

Known as "Chuck" to most, Kelley was born December 4, 1936. He was a master teacher in tap, jazz and acrobatics, who wrote syllabuses for national dance conventions like Dance Masters of America. Growing up in upstate New York, Merritt's parents, both dance teachers, took her into Manhattan every Friday to study with Kelley. First at the old Ed Sullivan Theater and the New York Center of Dance in Times Square, then years later at Broadway Dance Center.

Keep reading... Show less
Photo courtesy of DM archives

"It's hard not to get too hurt in this profession."

Ann Reinking got real earlier this month at New York City Dance Alliance Foundation's Bright Lights Shining Stars gala. She was being honored as a 2017 NYCDA Foundation Ambassador for the Arts, and her speech was so moving that we had to share the entire thing with you.

Keep reading... Show less
popular
Photo by Grant Halverson, courtesy of ADF

As a soloist with William Forsythe's Ballet Frankfurt and later as his assistant, Elizabeth Corbett got to experience firsthand the groundbreaking choreographer's influence on contemporary ballet. "I find it fascinating and never-ending," she says of his work. "It was a repertory that was constantly changing over time and still is." Now on faculty with the American Dance Festival, Corbett brings Forsythe's repertory and processes to the dancers in class every summer.

Keep reading... Show less
Dancer Health
During seated stretches, I encourage my students to sit straight on their sits bones and then fold forward at the hips—even if they don't go forward very far. One student tells me that if she sits as I instruct, she can't reach forward at all. Why?
Keep reading... Show less
Teachers & Role Models

In 2011, New York City–based choreographer Pedro Ruiz returned to Cuba after 21 years of dancing with Ballet Hispanico and more than 30 years being away. The experience was so moving that he created The Windows Project as a continuous cultural collaboration between American artists and Cuban dancers.

"I was so overwhelmed seeing all the dancers do Afro-Cuban dance with live music. It was the moment my soul reconnected to Cuba and to my roots," says Ruiz of his first trip back. "I started weeping." He saw that, while Cuban companies and schools have amazing knowledge and passion for dance, they needed access to train with teachers in a variety of techniques, and choreographers outside of Cuba. "Cuba is still struggling economically, so the dancers also don't have good ballet shoes or costumes, and The Windows Project was my way to begin to help," he says.

Keep reading... Show less
How-To
Thinkstock

Midway through every semester at Indiana University Bloomington, contemporary professor Stephanie Nugent notices that her students aren't quite as awake as they were the first week of classes. They're tired from midterm exams and bring less energy to the studio. Nugent, too, feels the lull. "Teaching in academia is an arc with many peaks and valleys," she says, noting that the repetition of exercises can get monotonous. "On days when it feels like we've been doing the same thing over and over, I give students an improvisational prompt, and it reignites all of our interests. It's something to investigate, rather than something to repeat."

Most teachers experience a moment of stagnation at some point. Maybe students aren't progressing as fast as you feel they should, or you feel uninspired by the daily routine. Factors outside the studio, like administrative work, can also deplete your energy reserves. During these low and slow times, consider the following ideas to find inspiration and give yourself—and your students—a boost.

Keep reading... Show less
Teachers & Role Models
Photo by Jennifer Zmuda, courtesy of BalletMet

Long before switching from ballet to Broadway became de rigueur, Edwaard Liang shocked everyone by leaving New York City Ballet to join the Broadway cast of the musical Fosse. Eleven years later, he defied expectations again by taking over as BalletMet's artistic director—without putting his robust freelance choreography career on hold. Liang, it seems, doesn't pay much heed to the conventional approach to a dance career.

In his four years with BalletMet, Liang has sought to challenge his dancers with diverse repertory that goes far beyond the typical confines of classical and contemporary ballet. This month, to celebrate BalletMet's 40th anniversary, the company teamed up with Ohio State University's dance department and the Wexner Center for the Arts to offer a smorgasbord of dance styles: from William Forsythe's singular brand of leggy-brainy dance to Ohad Naharin's exuberant Minus 16, performed alongside OSU dance students. Here, he talks to DT about the effect his choices have had on his career.

Keep reading... Show less

Sponsored

Videos

Sponsored

mailbox

Get DanceTeacher in your inbox

Win It!

Sponsored