KEEPING DANCERS DANCING

by Jan Dunn, MS

This month’s topic in our ongoing Dance Wellness series is “Causes of Dance Injuries” (also called “risk factors” in the dance medicine world).  We all know that dance is a risky business – injuries do happen.  But learning what causes them can go a long way in helping to reduce that risk, and keep you “Dancing Longer / Dancing Stronger” (actually the title of an excellent dance medicine books for dancers!).  All of the information in this article is supported by dance medicine research over the last thirty years.

The risk factors discussed below are NOT listed in any order of importance!  In many dance injury situations, more often it is a combination of “causes” that may result in injury (I will explain what I mean by at the end !). We’ll cover five today, and five tomorrow:

1)  Poor alignment and faulty technique:

While it is true that many injuries result from a combination of factors, this one is usually agreed to be one of the most important.  Dr. Justin Howse, longtime physician to The Royal Ballet in England (now retired) and one of the early pioneers in Dance Medicine, went so far as to say that all injuries were the result of faulty technique. Most current experts would agree that while faulty technique is a major component of injuries, they would not necessarily concur that it is the only factor.

By “Alignment problems” we mean such postural patterns as:

-forward head (the head not in good alignment with the spine and torso)

-forward shoulders (rounded shoulders)

-lumbar lordosis (“swayback”)

-thoracic hyperextension (protruding ribcage)

-hyperextended knees (knees straightened beyond 180)

– foot pronation or supination (rolling in or out)

A dancer who has good alignment is more likely to have “efficient movement” (using only the muscles and amount of energy necessary to accomplish the movement), and is less likely to be putting strain and tension on soft tissue (ligaments / tendons / muscles) around the joint, thus resulting in less possibility of injury.

An example:

A young dancer complains of knee pain. The dance medicine physical therapist or physician gives a diagnosis of patellofemoral syndrome, which frequently involves the patella (kneecap) not tracking properly in the patellar femoral groove (the groove in the femur through which the patella glides, on knee flexion and extension).  Looking at the dancer’s plie in first, the medical specialist and the dance trainer note that the dancer’s feet are turned out to 65 degrees, and the knees are not aligning over the toes, but falling instead in front of the great toe.  Foot pronation (rolling in) and lumbar lordosis (“swayback”) is also noted. The dancer’s external rotation (turn-out) in the hip joint is then tested lying prone (on the stomach), and is found to be 48 degrees – so she is “forcing her turn-out”, which can cause knee pain (and possibly other problems).  Recommendations are given for medical treatment for the knee pain, and she is also given cueing for proper plie technique, using her natural turn-out of 48 degrees, and not forcing at the knee and ankle.

The crucial point here is that ALL injuries in dance need to be evaluated for technique concerns, to see if this may have played a causative part.  If the dancer rehabs the injury without knowing if faulty technique is involved, the injury is more likely to re-occur when returning to full dance activity.

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