Injury Intervention

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 envelop 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 

Technique
Nan Melville, courtesy Genn

Not so long ago, it seemed that ballet dancers were always encouraged to pull up away from the floor. Ideas evolved, and more recently it has become common to hear teachers saying "Push down to go up," and variations on that concept.

Charla Genn, a New York City–based coach and dance rehabilitation specialist who teaches company class for Dance Theatre of Harlem, American Ballet Theatre and Ballet Hispánico, says that this causes its own problems.

"Often when we tell dancers to go down, they physically push down, or think they have to plié more," she says. These are misconceptions that keep dancers from, among other things, jumping to their full potential.

To help dancers learn to efficiently use what she calls "Mother Marley," Genn has developed these clever techniques and teaching tools.

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Teachers Trending
Alwin Courcy, courtesy Ballet des Amériques

Carole Alexis has been enduring the life-altering after-effects of COVID-19 since April 2020. For months on end, the Ballet des Amériques director struggled with fevers, tingling, dizziness and fatigue. Strange bruising showed up on her skin, along with the return of her (long dormant) asthma, plus word loss and stuttering.

"For three days I would experience relief from the fever—then, boom—it would come back worse than before," Alexis says. "I would go into a room and not know why I was there." Despite the remission of some symptoms, the fatigue and other debilitating side effects have endured to this day. Alexis is part of a tens-of-thousands-member club nobody wants to be part of—she is a COVID-19 long-hauler.


The state of Alexis' health changes from day to day, and in true dance-teacher fashion, she works through both the good and the terrible. "I tend to be strong because dance made me that way," she says. "It creates incredibly resilient people." This summer, as New York City began to ease restrictions, she pushed through her exhaustion and took her company to the docks in Long Island City, where they could take class outdoors. "We used natural barres under the beauty of the sky," Alexis says. "Without walls there were no limits, and the dancers were filled with emotion in their sneakers."

These classes led to an outdoor show for the Ballet des Amériques company—equipped with masks and a socially distanced audience. Since Phase 4 reopening in July, her students are back in the studio in Westchester, New York, under strict COVID-19 guidelines. "We're very safe and protective of our students," she says. "We were, long before I got sick. I'm responsible for someone's child."

Alexis says this commitment to follow the rules has stemmed, in part, from the lessons she's learned from ballet. "Dance has given me the spirit of discipline," she says. "Breaking the rules is not being creative, it's being insubordinate. We can all find creativity elsewhere."

Here, Alexis shares how she's helping her students through the pandemic—physically and emotionally—and getting through it herself.

How she counteracts mask fatigue:

"Our dancers can take short breaks during class. They can go outside on the sidewalk to breathe for a moment without their mask before coming back in. I'm very proud of them for adapting."

Her go-to warm-up for teaching:

"I first use a jump rope (also mandatory for my students), and follow with a full-body workout from the 7 Minute Workout app, preceding a barre au sol [floor barre] with injury-prevention exercises and dynamic stretching."

How she helps dancers manage their emotions during this time:

"Dancers come into my office to let go of stress. We talk about their frustration with not hugging their friends, we talk about the election, whatever is on their minds. Sometimes in class we will stop and take 15 minutes to let them talk about how their families are doing and make jokes, then we go back to pliés. The young people are very worried. You can see it in their eyes. We have to give them hope, laughter and work."

Her favorite teaching attire:

"I change my training clothes in accordance with the mood of my body. That said, I love teaching in the Gaynor Minden Women's Microtech warm-up dance pants in all available colors, with long-sleeve leotards. For shoes, I wear the Adult "Boost" dance sneaker in pink or black. Because I have long days of work, I often wear the Repetto Boots d'échauffement for a few exercises to relax my feet."

How she coped during the initial difficult months of her illness:

"I live across from the Empire State Building. It was lit red with the heartbeat of New York, and it put me in the consciousness of others suffering. I saw ambulances, one after another, on their way to the hospital. I broke thinking of all the people losing someone while I looked through my window. I thought about essential workers, all those incredible people. I thought about why dance isn't essential and the work we needed to do to make it such. Then I got a puppy, to focus on another life rather than staying wrapped in my own depression. It lifted my spirit. Thinking about your own problems never gets you through them."

The foods she can't live without:

"I must have seafood and vegetables. It is in my DNA to love such things—my ancestors were always by the ocean."

Recommended viewing:

"I recommend dancers watch as many full-length ballets as possible, and avoid snippets of dance out of context. My ultimate recommendation is the film of La Bayadère by Rudolf Nureyev. The cast includes the most incredible étoiles: Isabelle Guérin, Élisabeth Platel, Laurent Hilaire, Jean-Marie Didière, who were once the students of the revolutionary Claude Bessy."

Her ideal day off:

"I have three: one is to explore a new destination, town, forest or hiking trail; another is a lazy day at home; and the third, an important one that I miss due to the pandemic, is to go to the Cathedral of Saint John the Divine, where my soul feels renewed by the sermons and the music."

Teachers Trending

Annika Abel Photography, courtesy Griffith

When the murder of George Floyd in Minneapolis last May catalyzed nationwide protests against systemic racism, the tap community resumed longstanding conversations about teaching a Black art form in the era of Black Lives Matter. As these dialogues unfolded on social media, veteran Dorrance Dance member Karida Griffith commented infrequently, finding it difficult to participate in a meaningful way.

"I had a hard time watching people have these conversations without historical context and knowledge," says Griffith, who now resides in her hometown of Portland, Oregon, after many years in New York City. "It was clear that there was so much information missing."

For example, she observed people discussing tap while demonstrating ignorance about Black culture. Or, posts that tried to impose upon tap the history or aesthetics of European dance forms.

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