Dance Injury Guide

Posted by Lena - February 12, 2010

Welcome to the injury information page. This information is provided to help you understand some of the more common injuries seen in the dance population. This information is intended as a resource and should not be used to self-diagnose or treat. It is strongly recommended to seek medical attention if you are experiencing pain or dysfunction.

Back, Neck and Spine

Baastrup's Disease (touching vertebrae): This is a syndrome from arching the back too hard into hyperextension. If a pain occurs when arching it could be that the vertebrae have hit each other in the flex position. This usually is caused by distress or degenerative change in the ligaments along the tops of the individual vertebrae. A dancer with Baastrup’s Disease will feel tenderness when arching.  A dancer should try to arch as little as possible if diagnosed with this condition…

Herniated Lumbar Disk: This is when low back pain extends all the way down the leg. The herniated disk in the back can press against a nerve causing pain. This is from the shielding materials between the vertebrae being worn away from overuse. This can happen from a fall or a severe twisting movement or repetitive strain. Surgical treatment may be required to fix a severe case causing a dancer to be out for 6 to 8 weeks following surgery. In this case immediate medical attention must be sought.
                                    
Low Back Strain/Spasms (over stretched or torn fibers): low back strain and/or spasms are pretty common. This can happen when the fibers are accidentally stretched or torn. A rip or overstretching will later cause spasms. Repetitive improper technique or a fall could cause this. Unrelated to dance, lifting a heavy item could also cause lower back strain. Seek medical attention to determine!

Spondylolisthesis (slipped vertebrae): This is when the vertebrae slip forward. Stress fractures can cause this type of injury if the back is severely arched too often. Dancers with this type of injury usually have tightness in the hamstrings and an exaggerated lower back curve. One with this type of injury will feel pain in the lower back and buttocks as well.

Spondylolysis (stress, fracture in the vertebrae): This is a stress fracture in one or more of the vertebrae which can happen with repetitive port de bras or severe strain. The only way this can be diagnosed is with an x-ray, one may be asked to stop dancing temporarily until this heals. A physical therapist will need to be sought out and a great deal of inactivity and rest will be required in order for this type of injury to completely heal.

                                         Shoulder and Arms

Acromioclavicular Joint Sprain: The Acromioclavicular is the ligament where the shoulder blade and the clavicle bone meet. These ligaments can get injured by a direct a fall or hit. If the ligament is torn completely a painful bump will arise on the shoulder. Stop dancing and see your doctor.

Carpal Tunnel Syndrome: Carpel Tunnel is an overuse injury in the wrist area which could happen with activities such as repetitive partnering. If this happens be sure to consult with your doctor and  take special notice of every-day activities inside the classroom and out.

Lateral or Medial Epicondylitis: Lateral Epicondylitis is another name for “tennis elbow” which means the inside elbow joint is inflamed. Medial Epicondylitis means both the outside and inside of the elbow is inflamed. Dancers who have elbow pains while partnering may have one of these two injuries. Any dancer who has this type of injury needs to be examined by a medical professional.

Rotator-Cuff Tear: When the muscles or tendons that attach to the upper arm bone are torn away from it, the dancer will have a hard time raising the arm if they’re able to at all! A bad fall could cause this type of injury. If you notice pain in this area, Seek medical attention  immediately!

Shoulder or Wrist Dislocation:

The shoulder or wrist could become dislocated on dancer’s who have very loose joints. This joint can become partially or entirely located which means the top of the arm bone or lower arm bone could pop out of the joint. See you doctor!

Thoracic Outlet Syndrome: If the arm and/or hand begins to feel weak or the blood supply seems to lessen causing a coldness or numbness then this may be what the dancer is experiencing. This area where the veins and arteries run from the head through the arm can become compressed causing major issues. Poor posture and form could cause this and repetitive incorrect placement while partnering as well as a heavy dance bag. A dancer who has this type of injury may notice the pain progresses and will have to take measures to correct it such as posture improvement, lightening the dance bag and correcting poor partnering technique. Make sure the upper body is always properly stretched and awkward postures are corrected.

                                         Hip and Upper Leg

Femoral Stress Fracture: If a deep pain is noticed in the groin, hip or thigh then the dancer may have this type of injury that is caused from improper technique or muscle imbalances. The pain from this type of injury may be present during or after class, or during stretches. Medical attention should be sought for this type of pain.

Hamstring Pull: If a dancer pulls the muscle in the back of their upper leg then a hamstring pull is what they have. Do not try to dance if the muscle is torn! This type of injury requires medical attention.

Iliacus Tendinitis: If a dancer experiences pain near the front of the hip near the groin while doing hip rotation or flexion movements then the dancer may have this syndrome. Most common in modern dancers, Iliacus Tendinitis comes from overuse and may force the dancer to decrease their dancing schedule until it heals.

Piriformis Syndrome: If pain is in the low back and/or buttock area during turn-out then the dancer could have Piriformis Syndrome. During turn-out the muscle may become extremely tight and painful and the sciatica nerve could also cause a pain down the leg.

Snapping Hip: If the hip makes a snapping sound while doing grande battlements or any type of leg extensions this means the tendon is passing over the bones but is not a serious condition, however this can happen in the inner or outer hip area and medical attention should be sought if it is accompanied by pain.

Trochanteric Bursitis: The Trochanteric Bursa is a wide connective tissue that decreases friction between bone, muscle and other connective tissue in the outer portion of the hip. It is the attachment of several large muscles, to the hip bone and is a common area of pain among dancers. A muscle imbalance could cause this area to become inflamed. This may be caused if one leg is much longer than the other or just plain old overuse. If the spine is irregular it can also cause such an injury. Medical help must be sought for this type of injury! A dancer diagnosed with this injury will have to seek physical therapy attention that focuses on stretching and strengthening. Anti-inflammatory medication will most likely be prescribed while the dancer heals and corrects this.

                                                                            

                                                     Knee

Anterior Knee Pain: If a dancer feels pain in the front of the knee or hears a crackling sound on the knee they may have this type of injury. Excessive stress caused by increase activity in young dancers especially can aggravate the patella. This can happened during growth spurts where the bone is growing faster than the muscle can adapt causing pain. Ice and rest are the remedy, be sure not to over do it until it heals! Also, be sure to warm up entirely before dancing and wear supportive street shoes outside of dance. Be sure not to perform any dancing on hard surface areas as well. Make sure the teacher does an assessment of plié if this injury is developing. This may be another cause.

Hyperextension: Those with hyper-extended knee joints can sometimes overstretch that area causing trauma to the joint. This strain can cause pain in the patella or shin splints. In the most serious case, hyper-extension injuries can lead to a stress fracture. For those dancers with hyper-extended knees; be sure to not “lock up” that area and to use plié properly. An imbalance of muscle may occur so special strength exercises may be necessary to keep the legs in good shape. They say dancers with this type of leg needs to work first position with the heels together so they can learn to pull up and out of the leg rather than lock back into the hyper-extension. The leg will not feel perfectly straight but it will possibly save an injury later down the line.

Meniscus Tear or Medial Collateral Ligament Tear: If there is pain in the knee as well as a feeling that it “locks up” then the dancer may have a Meniscus tear in the cartilage. This is the area that protects the upper and lower leg bones from each other. Some tears require surgery while others just require ice, rest and ibuprofen. If it’s a Medial Collateral Ligament Tear then it’s the ligament of the knee that is responsible for movement. Tearing this ligament can happen during a bad landing causing a pain on the inside of the knee. This type of tear is painful and requires surgery depending on the degree of the injury. Otherwise physical therapy may be required as well as lots of rest.

Patella Dislocation/Malalignment/Tendonitis: The Patella can become displaces or maligned or injured from overuse. This is the cartilage disk in your knee. Sometimes when the kneecap gets out of place it either pops back in or a physician is needed to assist and can be very painful. Sometimes surgery is required. If it is tendonitis that develops in the knee, a pain will occur during jumping. If this happens then the soft tissues have become inflamed and an anti-inflammatory medication will be needed. Rest and ice will also help the injured or over-used knee.


                                          Lower Leg and foot

Ankle Sprain: Many dancers experience an ankle sprain at one point in their career. This happens when the soft tissue is injured by force. Oftentimes it happens when a dancer lands a jump badly. Once an ankle sprain occurs, the dancer has no choice but to rest, elevate and ice the area. They will have to take time off from dancing so it can heal properly!

Dancer's Fracture: A bad landing can cause a stress fracture in the metatarsal bone causing swelling and pain. This type of injury happens when landing badly on a turned in foot. This kind of fracture will cause pain while walking so it needs immediate rest, ice and elevation. Any weight-bearing exercise will worsen this injury. Stay off the feet until it heals!

Sesamoiditis: This dancers injury is when a pain develops behind the big toe. Sesamoid bones are unique in that they aren’t connected to other bones, they are “floating” bones in the foot. Sesamoiditis is when the tendon running right through these bones in the foot gets inflamed. This condition can progress gradually and will affect the big toe. This requires a break until the pain goes away. Working through this type of pain will only cause a permanent problem leading to the possible removal of the Sesamoid bones!

Bunion: If the big toe has started pushing inward and becomes painful then a bunion may be forming. A bunion may form in dancers who “roll-in” and don’t correct this foot posture. A bunion can be very painful and may require a dancer to take a long break from dancing. Surgery may be required for severe cases and can end a dancing career altogether if not taken care of early. Attention to technique is crucial if a dancer does not want this type of injury, especially with: jumping, relevé and plié.

Plantar Fasciitis: This is a common condition among athletes and dancers alike. A dancer who finds it painful to walk barefoot may have already developed this injury. It is basically an overuse injury of the sole of the foot. Be sure to only dance on sprung floors and to not practice on hard surfaces. If the sole is especially painful after class be sure to see a physician.

Metarsalgia: If a tenderness develops over the balls of the feet this can be due to weak little toes or repeated overstretching and/or sprains of the toes/foot. If this develops in a dancer’s foot then the muscles must be strengthened by using rubber-band material to point and flex the foot. This material is sold on any dancer apparel site.

Achilles Tendinitis: This type of overuse injury is one of the most common amongst dancers. If the heel and lower calf hurt after jumping and the pain does not subside then a dancer may have developed Tendinitis in their Achilles tendon. This is the main tendon that attaches through the heel up through the calf. When this tendon is overworked over and over it can become inflamed indefinitely. Be sure to keep this area flexible and strong. If a dancer has taken a break from dance, be sure to start dancing again only gradually; a thick agenda of dance after inactivity is one of the causes. This tendon needs to be pampered; keep it warm, stretched and give it proper rest. The sooner this injury is noticed, the quicker it can heal. Don’t ignore Achilles pain!

Trigger Toe: If the big toe clicks or gets caught to where the dancer has to manually loosen it, then “trigger toe” may have developed. This is most common in long time pointe dancers. While on pointe, if the big toe seems weak and locked, this condition may be occurring. The tendon that goes from the big toe throughout the ankle can sometimes get caught on the boney structures around it and it can lock into tendon canal near the big toe causing that toe to do “dead”. This may be happening because of inflammation or a partial tear in the tendon. When it swells up, it will start to cause these problems for the dancer on pointe. Come to class early, go slow, take care of this area and ice it after class and see your physical therapist. It wouldn’t hurt to decrease dancing for a bit.

Posterior/Anterior Impingement Syndrome:If a dancer has pain while pointing or on relevé they may have P.I.S. and if they have pain while in plié then they may have A.I.S.. P.I.S. is otherwise known as “dancer’s heel”. The dancer will have pain in the heel area and will need to ice and elevate the area and rest. A.I.S. is in the top of the ankle where the boney structures can rub together. A dancer will notice pain in plié on the top of the ankle and will also need ice and rest and most importantly see your doctor to detemine. Severe symptoms could require surgery.

Shin Splints:Dancers who get pain in the shin bone after dancing heavily may have Shin Splints. This is a minor stress fracture of the shin bones which can become quite painful. Dancers who do a lot of jumping may develop this type of injury. And those with hyper-extended knees are prone to this kind of injury as well. If pain starts to develop then make sure proper rest is taken between dance classes. Staying off the feet is a good idea. Do not dance on floors that are not properly sprung either. Also, it is very important that jump landings are proper; make sure the plié is deep and the feet aren’t rolled in or out! Have your instructor pay close attention to your jumping methods.

Sprained toe:Most dancers will experience a sprain sometime in their career. A sprained toe is one of the more common types of sprains that can occur if the dancer lands a jump with an incorrect placed foot. This also happens if a dancer is used to pointe shoes and tries to go on pointe without them on – forgetting that they are wearing soft shoes. If a toe gets sprained, immediately stop dancing, ice the area, and sit out for the rest of the class. Elevate the foot and let the area heal for a week or two.


                                        Muscle and soft tissue

Bruises and bumps:One of the most common injuries a dancer faces is bruises and bumps! Bruises and bumps happen often during modern dance or any dancing that involves contact with the floor or props. Dancers who get bruised often may need to focus a bit more on depth and try to take it easy. Dancers can also wear protective gear to avoid knee bumps and the like by wearing knee pads or protective clothing.

Osteoarthritis: A mature dancer who has constant pain may have developed Osteoarthritis. This type of injury comes with overuse from dancing for many years. It is a breakdown of cartilage and inflammation of the joints causing stiffness and pain for the dancer. If a dancer received this diagnosis they may be required to stop dancing. If a dancer continues to dance through this pain they may cause permanent damage to bones causing possible hip replacement or other bone replacement surgery. This will affect mobility and is very serious. Take calcium, decrease strenuous exercises and continue to stretch. Maybe it’s time to take up yoga or pool exercise if this is diagnosed! To prevent this avoid dancing on hard floors that aren’t sprung, eat food high in calcium and make sure technique is proper.

References

• Information adapted from Harkness Center for Dance Injuries.