Injuries in Professional Dance: What Every Dance Studio, Parent, And Dancer Needs to Know

Injuries in Professional Dance: What Every Dance Studio, Parent, And Dancer Needs to Know

 

Dancing has been called the art of storytelling through movement.  A well-choregraphed piece will transport a viewer to another world and move your heart to a wave of new emotions. The grace of a dancer as they move across their canvass paints a masterpiece unlike any other as they jump, land and sashay on the stage and into your heart. 

Dancer

What gets forgotten through the beauty of dance is that dance is also a sport. Like any sport, dance requires a high level of strength, stamina, coordination, and determination

After having the pleasure of working with aspiring competitive dancers in the Bay Area, I believe dancers are incredible athletes with control and grace like no other.  Their tenacity to which they address their craft is something to mimic (all you other athletes out there). 

With any sport that requires a high level of competition, comes the increased risk of injury.  Let’s take a look at the sport of dancing from an injury detection and prevention standpoint.

Rate of Injury in elite competitive dancers

Did you know that professional dance companies reported that as many as 67%-95% of their dancers are injured on an annual basis1 and one dance school reported that over 75% of their adolescent dancers were injured in one academic year2! 

This rate of injury is high compared to other sports and it may partially be attributed to the volume of dance performed in a dance season.

Most dancers spend around 20 hours a week dancing including practice and rehearsal.  Compare this to say a soccer athlete that practices for 2 hours per day for 5 days and has a weekly volume of 10 hours.  You can see the difference in total time performing each sport.

Also, we must look at the type of work being performed during dance.  Dance, for the most part, is a single athlete sport.  This means that during practice and performance a dancer is constantly moving in technical and complex ways without any “break in the action”.  Compare that to other sports where if the ball isn’t near you then you can “ease off”.  So, not only does the total weekly volume of dance matter but the total time in purposeful intense movement also needs to be considered.

You might look at this information and think, “dancers need to dance less to avoid injury.”  On face value this holds some merit and I will relay some research later on ways to decrease the volume of dance while remaining active.  Instead of avoiding the problem (dance less) I firmly believe that by diagnosing the cause of dance injuries and improving the biomechanics surrounding those injuries will allow passionate dancers to continue their sport and stay competitive.

With the amount of complex movement and high demand on a young dancers’ body it is no wonder that when sounds biomechanics aren’t utilized the rate of injury is well over 50%.  Plus, dance is a highly repetitive movement often performed by young athletes who are not quite skeletally mature and ready for the cumulative strain.  This will be explored in a subsequent blog post.

Most Common Injuries in Dance

In a recent study, Gamboa, et al. followed over 300 dancers enrolled at and elite ballet school, over a 5 year period, found that over 50% of dance injuries occurred in the foot/ankle, 21.6% at the hip, 16.1% at the knee and 9.4% at the back3.  Starting with the hips and looking down the chain of movement, we see that 87.7% of all injuries to dancers occur from the hip down!

Dancers spend a majority of their time on their feet and the high speed of movement and leaps places over 2x their body weight stress onto their legs and ankles! This high amount of pressure, without proper control, through the lower extremity chain causes breakdown at the key locations; hips, knee and ankle.

This data brings to light the need for screening tools to determine which dancers are at more risk of injury compared to their cohorts.  Many studies have sighted that pre-season screening programs are inconsistent with their ability to properly highlight those at risk.  That said, it has been noted that a few risk factors were more associated with injury than others.

The findings suggested foot pronation, decreased plantar flexion range of motion (toe point), previous history of lower back pain, and lower extremity (mainly hip) weakness were correlated to a higher injury risk.

In Gamboa’s study, dancers with increased right foot pronation and reduced right foot plantar flexion angle were more likely to be injured.  In fact, injured dancers were 74% percent more likely to have a pronated right foot than non-injured dancers, and 50% percent more likely to have limited right plantar flexion3.

This is a very important finding as the majority of dancers are “right leg dominant”.

Programs to address lower extremity strength, flexibility, and motor control along with a screening procedure to determine which dancers had a history of back pain would be beneficial and assist in keeping dancers injury free.

Dance Injuries by Competition Calendar

In speaking with dancers, parents, and dance instructors about when dancers are most likely to get injured a consistent response was provided…

…At the start of the school year and mid spring.

Why these times??

When probing further many mentioned that at the start of the school (and dance) year there are “intensives” where the volume of dance is increased compared to normal.   These intensives are long days of dance, almost every day of the week, for multiple weeks in a row (2-4).  What a way to enter the dance year!

Additionally, in mid-spring competitive dancers are gearing up for competitions and the intensity of dance increases along with the time spent dancing.

Hearing such a consistent finding among dance families I decided to see if this was a common finding in research.

 Chart

As it turns out, as sighted by Gamboa, most dance injuries occur in the  2nd, 3rd, 7th, and 8th months of the dance year.  That coincides with the months of October, November, March, and April.  This was exactly what we were seeing in the dancers we were treating.

So, volume of dance plus the specific time in the dance season, coupled with the biomechanical findings on right lower extremity issues all play a role in dance injuries.

Now what can we do about it??

 

Preventative Care versus Reactionary Care

Instead of reacting to dance injuries when they happen, we must be proactive and keep them from occurring.  If any of you are former dancers, you know all too well that dance injuries can come back to haunt you later in life.

Dance instructors, parents, dancers, and the “rehab team” (physical therapy, Pilates, massage) need to work together to create a system to address the known issues head on.

One fascinating aspect of Gamboa’s research was that when this specific elite dance study employed “cross training” to their dance program injuries from dance decreased.  They utilized Pilates and lower extremity strength training to offset the highest volume dance weeks and months.  Although the dancers were still active and working hard, it was in a different movement pattern than dance so as not to stress already overworked patterns and tissues.

Reducing dance load in peak intensive dance months, employing a cross training program, and using specific pre-season screening techniques will help keep dancers from injury and will help them perform their best come competition.

 

Our Dance “System”

Here at Competitive EDGE we have had the pleasure to work with many competitive dancers, studios, and families.

We are delighted to have found a South Bay “team” that is helping dancers in the San Jose area stay strong and injury free.

Working with the instructors at Dance Attack we have provided education on risk factors and what to watch for to catch potential issues early and they have educated us on proper dance technique and their programs for development.

We have also had the pleasure to work with a Joanna Ramos, one of the Bay Area’s top Pilates practitioners.  Her knowledge of training movement in the competitive dance world is key to progressing and maintaining a solid dance foundation.

Using our expert knowledge in biomechanics and human performance along with comprehensive dance specific evaluations and industry leading biofeedback our team at Competitive EDGE adds to the dance system and team.

Having a team that involves the dance studio, Pilates professional, and biomechanical specialist allows for prevention of injuries through early detection and fast return to dance through pinpoint evaluation, biofeedback, and training.

I encourage all dance studios to find a “team” to build a system around to keep these amazing, powerful, graceful, and passionate dancers doing what they love.

Written by: Kevin Vandi DPT, OCS, CSCS

 

 

 

Citations:

  1. Bronner S, Ojofeitimi S, Rose D. Injuries in a modern dance company: effect of comprehensive management on injury incidence and time loss. Am J Sports Med. 2003;31:365-373
  2. Luke A, Kinney S, D’Hemecourt PA, Baum J, Owen M, Micheli LJ. Determinants of injuries in young dancers. Med Probl Perform Art. 2002;17:105-112
  3. Gamboa JM, Roberts LA, Maring J, Fergus A. Injury patterns in elite pre-professional ballet dancers and the utility of screening programs to identify risk characteristics. J Orthop Sports Phys Ther. 2008;38(3):126–136