Thursday, 28 January 2016

How to Maintain and Prevent Dance Injuries


My name is Imogen; I'm a Certified Athletic Therapist in Cambridge, ON and owner of Hespeler Village Athletic Therapy. My area of expertise is with dancers and their injuries. During my childhood and teenage years, I was a competitive dancer which has given me the insight and experience to better help my dance clients. I'm so excited to talk about dance injuries because it allows me to bring my two passions—dance and Athletic Therapy--together into one topic! I hope you enjoy reading it as much as I enjoyed writing it!  But, please be aware that it's kind of a long one.

When you think of athletes, dancers probably don't pop into your mind. This is unfortunate, because dancers are athletes who pour their mind, body, and soul into a passion for their sport, not unlike football, hockey, or rugby players. If young dancers are at a high level, they can be at the studio upwards of 4 hours per day, and professional dancers spend even more time in the studio!

For young dancers, their time spent dancing is outside of the hours spent in school and on homework, they may even have a part time job to work around. Can you imagine the physical and mental toll this can put on their body? For this reason, a major factor in dance injuries is fatigue. These athletes are so passionate about perfecting their jumps, turnout, or pirouettes that they don't take the needed time off for recovery. In the grand scheme of things, this is not the best way to improve your performance. But we'll come back to this in a few minutes.

Now, we all know that dancers are known for being extremely flexible and graceful, but a common misconception is that they aren't "real athletes". Dance takes an incredible amount of strength, control, agility, and balance, which often brings along the typical types of injuries you'd see in sports. The most common injuries seen in dancers include:

  • Muscle spasm
  • Strains/sprains in the lower extremity and back
  • Overuse injuries such as tendonosis
  • Chronic fatigue

Typically, when dancers sustain these injuries, they tend to “dance through the pain” rather than going to their local Athletic Therapist for an appropriate dance specific rehab program—shameless self promotion! In some instances, the dancers seek help from a therapist who doesn't specialize in dance. This can lead to frustration and a non-committal attitude to their rehab program because they feel misunderstood and don't see the relevance in the exercises or advice given--I'm speaking from first hand experience here. For this reason, it is my opinion that the most important step in treating and maintaining your dance injuries is to seek help from an appropriate medical professional that knows and understands the demands of dance.

The second most important piece of injury prevention advice I can give is for every dancer to ensure that he/she has a very strong core. I don't mean the “hey, check out my six pack” type of “core” that you may be thinking of. I mean the deep deep muscles that stabilize your spine and keep everything in control, so all of your other muscles can do their jobs.

Do you know what I'm talking about? If not, don't worry, I'm going to tell you!

Your core is comprised of some very deep muscles that attach to your spine and are within your abdominal cavity. See how this can be confused with that awesome six pack you've got going on?

If you were to look even deeper, under that six pack, you'd find a broad flat muscle that wraps around you like a weight lifter's belt, called transverse abdominus. This is what most people are talking about when they say “core.” 

But wait! There's more to it than that! You also have to consider the small group of muscles that run up and down each side of your spine on the back side, called multifidus. They control the rotational stability between individual vertebrae and assist in extension of the spine. Then there is the pelvic floor and diaphragm which create the “floor” and “roof” of the entire functional unit we like to call your core. If you picture these muscles contracting together, they theoretically create a small, dense cylindrical shape within your abdominal cavity which is your “core.”

Now, consider this example: dancers require excellent strength in their hip flexors and surrounding muscles to lift their nice straight leg, with a beautifully pointed foot, high up in front of them and gracefully hold it there for what seems like an eternity. But let's pretend this particular dancer has a weak core and is struggling to hold her leg for a few seconds at an eye-soring level of just above 90 degrees—oh my!

Part of the struggle here is because her core muscles are not working with her in this position to stabilize her spine so her hip flexors can do their job. In a lot of cases, the hip flexor (specifically psoas major in this case) is left to split it's task between stabilizing the lumbar spine that it's attached to and lifting the leg into forward flexion. Since this muscle's main job is to bring the leg into hip flexion, it really struggles when you ask it to do both.

Maintaining a strong core is so so SO important for dancers to be able to do the movements required of them. I've also been reading up about how a weak core can cause chronic neck tightness in dancers (and other athletes), so check out my website for a blog on this soon!

If you want a more in depth explanation of how important your core is, read my blog post about it!

Another important aspect of maintenance for dancers is ensuring proper breaks from dance. See? I told you we'd come back to this. You probably thought I forgot, didn't you?

“Take breaks from dance” is meant in two ways, full out rest OR do something else for a while. Yes, you should schedule down time into your busy schedule! Everyone should, it's good for your mental health and gives your body some time to recover from the demands you place on it.

Taking a break from dance doesn't always have to mean complete rest and doesn't mean it needs to be for an extended time! Cross training is an important aspect for any athlete and is equally important for dancers. 

In the studio, a dancer works a lot on technique, plyometrics, and agility but there isn't much strength or cardiovascular training. For this reason, it is very important that dancers build in time for cross training, which also gives them a little break from too much dancing—yeah right, there's no such thing, right? Wrong! Build “dance breaks” into your schedule, it will help you to stay fresh, strong, and avoid over training.

There have been many research articles suggesting that strength training is quite helpful with injury prevention for dancers, and if it's done properly there will be no major muscle bulking, which is what every dancer is trying to avoid. In fact, it helps to ensure that every muscle is working to it's full capacity, therefore you can jump higher, lift higher, dance longer, and look great while you're doing it! 

I've also been reading that the Fartlek Interval Training method is the most highly recommended method for dancers looking to work on their cardio endurance—you should all want to do this, it will help your performance immensely! Think about it. Try and schedule some cross training into your life and you'll see the positive effects on your performance both in class and on stage. Maybe you'll even finally get that solo you've been working so hard for!

Also, please consider your ankles when strengthening! If you're planning on starting pointe or already are en pointe, keep working on that ankle strength! And I don't mean just sitting on the floor with a theraband pointing and dorsiflexing your ankle. You need weight bearing, functional, ballet specific movements to be strong enough to be successful! Ask your teacher for advice, or you could ask your local, friendly, Athletic Therapist--there it is again ;)--for some dance specific training exercises to get you started.

The last thing I'll mention is that you NEED to take care of your feet! Just like musicians have to take care of their hands, dancers need to care for their feet! This means:

  • Keep your toe nails short and cut straight across—a curved cut can leave you prone to ingrown nails and nobody wants that
  • Don't wear coloured nail polish on your toes all of the time—you won't be able to easily see if you're having any of the typical dancers foot problems
  • Look after your calluses, they aren't all bad—don't file them off unless they are becoming too big and cumbersome/painful and interfering with your dancing. They protect you from unnecessary blisters and abrasions
  • Be sure to keep your blisters clean and covered—there are products and methods that can help reduce friction on a blister or blister prone area. Ask your dance teachers for advice, they know what you're going through!
  • If you find that you are getting blisters often, even after your shoes are broken in, consider going back to the store and being refitted. Chances are, your shoes aren't right for you. Maybe you need a different shape/size/style

I know I've thrown a lot of information at you in this post but here is a recap of the main take-home messages:
  1. Seek professional medical advice from a therapist who has got a lot of experience with dancers and preferably has first hand experience dancing at a high level
  2. CORE STRENGTH—I can't stress this enough. It will improve your dancing noticeably and help you to be less prone to injury.
  3. Schedule “dance breaks” into your week and try cross training sometimes too. It will help your performance immensely!
  4. Strength training is important. You should all be doing it, no exceptions.
  5. Take care of your instruments—YOUR FEET!
  6. Most importantly, HAVE FUN!  Dance is meant to be a fun, educating, and worthwhile experience.  Don't try so hard that it becomes less fun for you.  Take advice from your teachers, appreciate what they're telling you, and try to apply it to your own dancing.
"Great dancers are not great because of their technique.  They are great because of their passion" --Martha Graham

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