Various Injury-Prevention Techniques

Dance requires incredible strength, stamina, and flexibility. Broadway and touring
performing artists dance an average of eight shows a week. Add to that, the countless hours in
rehearsals. Their exertion level rivals, if not exceeds, that of professional athletes! Therefore,
it’s not uncommon for dancers to experience pain.
Performing repetitive movements for hours a day coupled with a low amount of recovery
time in between shows, increases the performer’s risk for chronic overuse injuries (in
addition to the ever-present risk of an acute injury). In most cases, pain is due to muscle
soreness that resolves in a day or two. However, sometimes there is something more to blame
—that’s when you should see a physician or your physical therapist!
Here are some common dance injuries, including the pain associated, how to prevent and
how to treat them if it occurs:
1. ANKLE SPRAINS
Ankle sprains are the most common traumatic (or acute) injury in dancers. Most dancers will
experience their first sprain by age 13. This injury is caused by any movement that forces the
ankle outside of the normal range of motion, resulting in an overstretching or in tears to the
ligaments of the ankle.
 Pain: acute onset with pain on the inside or outside of the ankle, swelling and bruising
may be present in more severe cases
 Prevention: 4-way ankle exercises, hip strengthening
 Treatment: RICE, joint protection, early mobility, physical therapy
o PT is extremely important because the ligaments will never heal back to the
pre-injury level. Therefore, strength and motor control must be improved in
order to avoid re-injury.

2. ACHILLES TENDONITIS
Achilles tendonitis is an inflammation of the tendon in the back of the ankle that connects the
prime mover for pointing to your foot. As the Achilles is active during relevé and pointing
the foot, this overuse injury is quite common in dancers, especially those utilizing improper
technique or participating in excessive training.
 Pain: gradual onset of pain and tenderness just above the heel which may feel better
when warmed up, but worse with jumping, relevé, or pointe work
 Prevention: stretching your Achilles with your foot in parallel, quadriceps/hip/core
strengthening to decrease force absorption at the ankle
 Treatment: Physical therapy focused on correct training technique, modalities to
decrease inflammation, calf stretching, and soft tissue to calf and surrounding
musculature
o It’s important to treat early as to prevent tendon rupture!
3. “TRIGGER TOE” (FLEXOR HALLUCIS LONGUS TENOSYNOVITIS)
Trigger toe is another overuse injury that causes inflammation and damage to muscle that is
active during pointing the big toe.
 Pain: gradual onset of pain along inside of ankle and under the foot while pointing the
big toe which may also feel like big toe is “stuck”
 Prevention: good form with your relevés and not crunching your toes to force a
pointe, rolling out the arch of your foot with a ball (but not to the point of pain)
 Treatment: physical therapy (correct technique, modalities to decrease inflammation,
stretching, massage), surgery to release tendon from surrounding tissues if symptoms
do not resolve

4. ANKLE IMPINGEMENT
Ankle impingement is the pinching of tissues at ankle (tibia and talus) at either the front or
the back of the ankle
 Prevention: stretching your Achilles and stretching (but not forcing) your pointe
 Anterior (front) Pain: pain at the front of the ankle with plie and landing
o Treatment: PT to improve mechanics and technique (manual therapy)
 Posterior (back) Pain: pain at the back of the ankle with tendu or relevé
o Treatment: PT to improve ankle mechanics and technique (manual therapy),
surgery if there is a bone spur or “extra bone” between heel and back of tibia
5. SNAPPING HIP
Snapping hip syndrome often starts as an annoying snapping sound in the front of the hip
with developpé or battements. However, over time, iliotibial band (IT band) tightness and
weakness of the outside of the hip can cause the snapping to become painful.
 Pain: snapping/clicking sound in front of the hip with developpé and battements
 Prevention: foam rolling your hip flexors, quadriceps, IT band, and glutes as well as
strengthening your glutes
 Treatment: PT with core strengthening, pelvic stabilization, modification of class and
rehearsal work until symptoms resolve

6. HIP IMPINGEMENT
Hip impingement can be caused by many different factors from arthritis, labral tear, stress
fracture, muscle strain, snapping hip syndrome, sacroiliac joint dysfunction, to piriformis
syndrome. It is extremely common in dancers due to the imbalance between the amount of
external rotation (turn out) they have compared to the amount of internal rotation (turn in).
 Pain: passé, developpé a la seconde, pain with flexion and internal rotation (turning
in)
 Prevention: foam rolling your hip flexors, quadriceps, IT band, and glutes as well as
strengthening your glutes
 Treatment: PT with stretching, hip/core strengthening, pelvic stabilization, dance
modification and rehearsals; may result in surgical intervention as needed
7. PATELLOFEMORAL PAIN SYNDROME
Patellofemoral Pain Syndrome, also known as “jumper’s knee,” results from the kneecap
“tracking” incorrectly due to muscle imbalances like tight hamstrings and calves coupled
with weak quads. The placement of repetitive forces on the patella, like through performing
jumps or plies without proper form puts a dancer at increased risk.
 Pain: pain in the front of the knee with jumping, plie, or stair negotiation
 Prevention: core and hip strengthening; foam rolling hip flexors, quadriceps, IT band,
and glutes
 Treatment: physical therapy with focus on core and hip strengthening, IT band
stretching, and re-education of dysfunctional movement patterns

Generally, dancers have a much lower rate of anterior cruciate ligament (ACL) injuries than
other athletes. One explanation could be that dance training involves much more intense
jumping from an earlier age than other sports, which helps improve muscle control.

How do we know if the pain is from an injury?

In most cases, the pain you experience after dancing is muscle soreness that usually subsides
within 24 to 48 hours. Sometimes, it takes a few days for muscles to get sore, which is also
normal. However, if you experience the following types of pain, you may have suffered an
injury:

1. Pain that wakes you up at night

2. Pain that is present at the start of an activity
3. Pain that increases with an activity
4. Pain that makes you shift your weight or otherwise compensate your movements

If you experience such pain, consult with a medical specialist — preferably a physical
therapist or physician with experience in treating dancers. They will be able to determine
whether additional testing is needed and will formulate an appropriate treatment plan.
Why do dance injuries happen?

Dance is a physically demanding activity. Dancers perform repetitive movements for several
hours a day. Studies have shown that dancing five hours a day or longer leads to an increased
risk of stress fractures and other injuries.

On top of the intensive training, many dancers get little time to recover between the sessions
and have no "offseason." Restrictive diets and unhealthy body weights may also contribute to
dance injuries. Proper nutrition is important for dancers of all ages.

Dance Injury Prevention

How can dance injuries be prevented?

The majority of overuse injuries and even some traumatic dance injuries can be prevented.
Follow these guidelines to reduce your risk of injury:

1. Eat well and stay hydrated before, during and after class.
2. Get enough rest and avoid overtraining.
3. Do cross-training exercises to build strength and endurance in all parts of your body.
4. Always wear proper shoes and attire.
5. Always warm-up before training or performances.
6. Lead a healthy lifestyle and get to know your body.
7. When injuries happen, address them immediately and get advice from a doctor or
physical therapist.

References:
https://www.hopkinsmedicine.org/health/conditions-and-diseases/sports-injuries/common-
dance-injuries-and-prevention-tips

https://www.neurotour.com/blog/7-common-dance-injuries