Yesterday Jan Dunn talked about causes of injury in dance–listing five risk factors of ten. Today she’s back to cover the remaining five. If you missed the first post, read it here.

by Jan Dunn

5)  Muscular imbalance:

To avoid injury, the muscles surrounding a given joint should be relatively equal in strength and flexibility (“balanced”), so that one side of the joint is not being stressed more than the other.  Different dance forms affect the body differently in this respect, depending on how it is being used. In ballet, for example, there are three common muscles imbalances:

-Quadriceps (front of the thigh) vs. hamstrings (back of the thigh):  the hamstrings are usually weaker, and are one of the most frequently injured muscle groups in dance.  One reason for this imbalance is often the emphasis on forward motion through space, which is powered by the quadriceps.  One way to address this particular concern, besides actual hamstring strengthening exercises, is to create class sequences which move into the back space  — for example running backwards in combination with a turn into a forward leap, then turning again into the backwards run.

-Gastroc-soleus (calf muscles) vs. anterior tibialis (front of the shin):  In ballet, because of the constant pointing of the foot, the calf muscles are usually the stronger of this muscle pair.  This imbalance can be one of the possible causes of “shinsplint” pain.  Using motions / exercises which flex the ankle often in dance training can help to address this imbalance, as well as specific strengthening exercises for these muscles.

-External hip rotators (turn-out muscles) vs. internal hip rotators (turn-in muscles):  This imbalance frequently exists because of the excessive amount of turn-out used in ballet, as opposed to parallel or turn-in movements.  The muscles which control internal rotation are usually weaker and more frequently injured because of that imbalance.  Creating parallel and internal rotation movements to add to the ballet barre is one way to address this situation, as well as strengthening exercises for the weaker muscle groups.

Many research studies have proven the importance of outside (of class) conditioning for dancers.  By addressing their imbalances with a specific conditioning program, such as Pilates / Gyrotonics / Franklin Method / cross training, they are able to more fully prepare for the demands of dance, and to decrease their injury risk.

6) Lack of warm-up:

Going into a class / rehearsal / performance without being adequately warmed-up first is almost like asking for an injury to happen.  Some dance medicine physicians even suggest that teachers lock the studio doors when class starts, so no one can enter late ! –that’s how important it is.

Some things to keep in mind regarding warm-up:

-Every dancer’s body is different, and has different needs in terms of what best warms up their muscles. No teacher, no matter how brilliant, can give a class warm-up that fits every individual person in that class.  The smart dancer learns what his / her own body needs, and designs his / her own brief warm-up to do BEFORE going into the studio.

-Many factors affect your warm-up, and how much    you personally need:

-Age: the older you are, the more time you need

-Injury: an injured area will need more time

-Weather: the colder it is, the longer you may

need, and vice versa with warm weather

-Physiologically a warm-up means that you have raised your internal body temperature by several degrees. This accomplishes several things:

-increases blood flow / oxygen intake

-increases joint lubrication

-increase the speed of neural transmission-

i.e, the message gets from your brain to your

muscles faster !

For most dancers in their teens or 20’s, it usually takes 15-20 minutes to reach the warmed-up state, depending on weather and other factors mentioned above.

-Once your body is warm and ready to dance full out, it can quickly lose that wonderful warm-up by standing still / not moving – for example, in a rehearsal, when you’re waiting to be shown the next section.  If you have to stand and wait in a class / rehearsal, keep moving in place !  Doing small movements will help to keep your body in it’s warmed-up state.

7) Psychological Factors:

Stress plays havoc with the body, in many ways. It can cause your Central Nervous System (CNS) to function at less-than-peak efficiency, slowing down the transmission of signals from your brain to your muscles, and makes it harder to concentrate.   Dance is a high-stress profession, and dancers who take good care of themselves learn stress reduction techniques, such as meditation.  This kind of self-care will do much to lesson your risk of injury in terms of psychological factors.  We’ve all heard the phrase “leave your ‘stuff’ (emotional baggage) at the studio door” – and it’s good advice – but hard to do. That’s why it’s important to incorporate stress relieving practices into your daily and dance life.

8) Premature Point Work:

This is something most dancers and teachers are aware of, but it’s still an important aspect of injury prevention. There are many factors that should be considered before putting a child on pointe. Chronological age (such as automatically at 12, an age where many students start pointe work) is not the most important factor.  It is very important to consider factors such as core stability, leg alignment, foot / ankle flexibility and strength, frequency and length of dance training.  The website of IADMS (The International Association for Dance Medicine and Science) has an excellent Resource Paper on this topic, available to all dancers / teachers / parents (www.iadms.org).

9) Adolescent Growth Spurt (AGS) concerns:

This is the age when rapid growth takes place, and the young dancer is at higher risk for injury.  It is also the age when students on a career path begin to train very intensively.  It is vital that teachers, parents, and students are aware of the many changes the growing body is undergoing at this point, and how to best adapt dance training to avoid injury.

The AGS usually happens between 11-14 (often later for boys), and lasts from 18-24 months.  Dancers may lose:

–          flexibility

–          -strength

–          coordination

–          technical control and skill

A dancer who could do triple pirouettes easily at age 10 may suddenly find her / himself having difficulty doing even one.  Loss of self-esteem is common, especially if you, the dancer, and your teacher / parents, do not understand the changes that are happening in your body, and how it is affecting your dance life.  As with the Resource Paper in Pointe Work, IADMS has a Resource Paper available on “The Challenge of The Adolescent Dancer”.  We will talk about the AGS in greater detail in a future article on 4dancers, but for now, be aware that it can have an impact on injuries happening to young dancers.

10) Poor  Nutrition:

Dancers frequently worry about their weight, and in consequence don’t eat the foods (or fluids) that they really need to dance in a healthy manner.  Our bodies need fuel, it’s as simple as that, and especially in a profession that demands peak physical performance.  Learning about nutrition is so important — and again, IADMS has an excellent resource paper on this topic, “Fueling the Dancer” !

One important point to make regarding nutrition is on calcium intake, and how it’s SO important, especially to the young dancer still in his / her teens.  This is when we are building our “bone bank” – laying down the bone that will last us for a lifetime.  If we don’t do this during these teen years, it may be too late to make up the loss.  Some studies have shown professional dancers in their late 20’s / early 30’s who have the bone density of 70-year olds, because they did not have adequate calcium intake when they were young.

Poor nutrition can also affect a young woman’s menstrual cycle, leading to ammenorhea (lack of regular periods). This hormonal imbalance can wreck havoc with the body, and also lead to the low bone density mentioned above.

So bottom line —learn about good nutrition and eat healthy foods / fluids !

So now we have our list of risk factors for dance injuries.  I mentioned at the beginning that most often an injury is caused by a combination of these factors.  Here’s an example:

-You haven’t been eating well for several months, trying to lose weight and not going about it in a healthy, knowledgeable manner.

-Your long time boyfriend / girlfriend broke up with you two days ago, and you are very stressed not only about that, but about a big audition coming up.

-You also have, unknown to you, some major muscle imbalances around the hip joint (you’ve had some pain / clicking in your hip joint, but you have chosen to mostly ignore it).

-You go into the studio without adequately warming-up, along with all these other factors coming into play, and during class you sustain a significant injury to the muscles around that hip.

So – now you’ve been injured – what do you do about it???  That’s the topic for next month’s 4dancers Wellness blog!  “Talk” to you then !!

BIO: Jan Dunn is a dance medicine / Pilates / Franklin Method specialist  based in Denver / Boulder, CO, and Los Angeles, CA.  She is Co-Director of Denver Dance Medicine Associates, and Adjunct Professor, University of Colorado – Boulder, Dept. of Theatre and Dance.  She has been active in Dance Medicine since 1984. Previously she was Coordinator of The Dance Wellness Lab, Dept. of Theater & Dance, Loyola Marymount University, Los Angeles, CA , and has held dance faculty positions at Connecticut College, Florida State University, Hartford Ballet, Washington Ballet, and Colorado Ballet.  She has been active with the International Association of Dance Medicine and Science (IADMS) for 22 years, serving as Board member, President, and Executive Director. Jan was Associate Dean / Workshop Coordinator at the American Dance Festival 1983 – 1991,  originated The Dance Medicine/Science Resource Guide; and was co-founder of the Journal of Dance Medicine & Science.  She has taught dance medicine, Pilates, and Franklin workshops worldwide, has published numerous articles, and presented at many US / international conferences.