Physiotherapy and Dancing
Now while I am certainly not a Physiotherapist who specialises in working with dancers, I have however had the privilege in recent years of working with several elite ballerinas and contemporary dancers. I hope this blog might help junior Physiotherapist or Physiotherapists working with dancers for the first time and dancers who are interested in preventing injury or recovering better from injury.
Don’t underestimate the load Dancers put their body through
Dancers put their bodies under exceptional amounts of load for extraordinary periods of time. Even children and adolescents dancing a couple of nights a week after school will be training for up to 10 hours a week. I often think of dancers (part and full time) as triathletes in terms of the stress and intensity of their training. Added consideration to this equation is that many dancers are also quite young and have immature skeletons and are usually on the hyper mobile scale of joint mobility.
Putting an immature skeleton through vigorous and time intense weight bearing activity puts dancers at risk of various stress injuries to bones. This is because the muscles repetitively pull on the bone and as the bone is still not fully developed it can become inflamed. Some common areas to see this occur are at the front of the knee and back of the heel but are not limited to these areas. Little can be done with these sorts of injuries other than correcting biomechanics and strength deficits and then allowing for the bone growth to catch up to the muscle strength.
Many dance styles require its participants to use an extraordinary amount of joint range such as high leg kicks, coming up on point and the splits. As such many athletes that excel in the sport tend to be more bendy or hyper mobile than the rest of the population. As a general rule people who are hyper mobile have difficulty controlling their vast amount of range and tend to be at a higher risk of dislocation/subluxation injuries. Participating in a sport that puts repetitive stress on joints at their end ranges puts many dancers at a high risk of injury.
As a physiotherapist once you have a sound understanding of the magnitude of the load your athlete is going through you can better equip that athlete to withstand the load and cut back certain loads when necessary in the case of injury.As a general rule people who are hyper mobile have difficulty controlling their vast amount of range. #performbetter @pogophysio Click To Tweet
Always build good core and hip control
As a segue from the previous paragraph about how dancers are vulnerable to certain types of injuries I have found one of the keys to injury prevention and rehabilitation is ensuring your dancer has sound trunk and pelvic stability. The trunk and pelvis are the base of support to the upper and lower limbs and it is where dancers will generate their power from. Ensuring these often young athletes have exceptional abdominal, back, glut, quad and groin strength is a great place to start. Pilates (reformer or floor) is one of the most readily available, popular and well researched ways to gain this type of strength. It is something that I have used a lot clinically and have found it demonstrates the most powerful results and provides the best outcomes for the dancer. It can be used for ongoing injury prevention as well as rehabilitation and there are thousands of dancers around the world that already engage in and endorse pilates.
Communicate well with parents and teachers
Like working with any athlete it is paramount that you have good communication with parents and instructors. Injury often requires modification of activity and load to allow the damaged tissue to heal. Ensuring parents and teachers are educated about the injury and the type/duration of load modification required allows a more seamless transition for the athlete from injury back to peak performance.
Many dancers are also quite young and are subsequently shy about telling their dance teachers that they cannot do something. Many young athletes will choose to push through pain than encounter conflict. Subsequently if you place any restrictions on your clients dance please always take the time to contact their coach/teacher and let them know instead. In some (usually more elite dancers) cases it might also help to go and meet the teacher in person and familiarise yourself with the dance school. It will allow you to build better rapport and trust and subsequently and less bumpy road to recovery for your dancer.
Where possible watch the client performing their dance routines
Taking the time to go and watch your dancer do what they do is very important to understanding the type of load their body is being put through. If you are not familiar with ballet go and watch you dancer rehearse, if your dancer has just started a new dance get them to demonstrate it. You don’t need to grow up doing a sport to get a good understanding of different loads on the body. When necessary there are many slow motion analysis apps you can use on your phone to break down movements and observe any poor or maladaptive movement patterns. It is very empowering as a Physiotherapist and will hold you in good stead to give recommendations around what to continue and what to avoid and what you need to do more or less of to prepare your athlete.Like working with any athlete it is paramount that you have good communication. #performbetter @pogophysio Click To Tweet
Don’t lie about pain to teachers and Physiotherapists
This point is definitely one for dancers themselves. Lying about your injury and soldiering on through pain will often only delay the inevitable and in some circumstances can make injuries worse. As touched on in this blog dancing is a very vigorous sport and teachers and coaches are used to having injured athletes. Make sure you notify your teacher immediately at the onset of any kind of pain and where possible avoid the types of movements that hurt it until you can see a good sports doctor or physiotherapist. Coping with any injury or illness is difficult, especially when it stops you from doing something you love to do. In some cases seeing a sport Psychologist may be necessary for the athlete to better cope with the mental burden of the injury. Remember rushing and not fully completing your rehabilitation may put you at greater risk of injury in the future and looking after your body in the short term will always help in the long term.
Lindsay Christie (APAM)
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Reid, D. C. (1988). Prevention of hip and knee injuries in ballet dancers.Sports Medicine, 6(5), 295-307.
McCormack, M., Briggs, J., Hakim, A., & Grahame, R. (2004). Joint laxity and the benign joint hypermobility syndrome in student and professional ballet dancers. The Journal of rheumatology, 31(1), 173-178.
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