By: Alex Bauer, MPT-student
This blog post is written by MPT student, Alex Bauer. Alex’s current studies in physical therapy and previous background of dancing stems her interest in dance related injuries. After completing a placement with the Royal Winnipeg Ballet, Alex further explores her interest by reviewing the current literature of dance injuries with a focus on ‘overuse’ injuries. This blog post will explain what an overuse injury is, outline strategies on how to prevent them and suggest rehabilitation tips on how to help manage overuse injuries in dancers.
What is an overuse injury?
An overuse injury is defined as “repetitive, submaximal stress applied to a tissue that occurs when the adaptive capability of the tissue is exceeded and injury results” (Marshall, 2011). Dancing may appear effortless, but to execute technical movements, the body takes on positions that can potentially place a lot of stress on bones, muscles, tendons, and ligaments, which can then lead to injury. Studies by Campoy et al (2011), Russell (2013), and Witkowski (2012) found that the most common type injury in dancers are overuse injuries. In Sobrino’s (2017) study of Overuse Injuries in Professional Ballet, he found that more than 75% of the injuries sustained by the dancers were the result of overuse. To summarize, overuse injuries refer to injuries sustained from a repeated action in such a way that the body cannot adapt, which can then lead to injuries. Campoy et al (2011) found the most commonly affected anatomical site from overuse injuries in dancers was the ankle/foot. Witkowski (2012) also found that the most prevalent injuries in dancers occurred in the foot/ankle, followed by the hip, knee, and back. Some examples of common overuse injuries in the foot/ankle seen in dancers include:tendon overuse injuries to the big toe, achilles and plantar fascia, as well as foot stress fractures.
Preventing Overuse Injuries
Campoy et al (2011) found that knowledge on the causes of injury in dancers is important to the understanding of how such injuries occur. Therefore, in order to prevent overuse injuries from occurring, we must be aware of the risk factors of sustaining an overuse injury. Overuse injuries in dancers can occur for a variety of reasons, such as: an increase in the amount of workload (Campoy et al, 2011), muscle and joint imbalances of strength and flexibility (Witkowski, 2012), suboptimal nutrition intake (Russell, 2013), and fatigue (Soloman, 2017). Some tips these researchers found to avoid these risk factors are:
- Be aware of the frequency of training hours, especially with approaching competitions and shows (Campoy et al., 2011);
- make sure you are properly warmed up and not overstretching. The muscles surrounding a joint should be relatively equal in strength and flexibility (Solomon, 2017);
- dance teachers should be teaching how to properly stretch without compromising ligaments (Solomon, 2017, p 67);
- dancers should be encouraged to keep themselves warm during rehearsals and breaks in performances when they are not dancing for extended periods of time (Solomon et al., 2017);
- avoid repetition without rest in training schedules (Batson, 2011); and
- make sure to get a proper intake of adequate vitamin D and calcium in the adolescent years to maintain good bone health (Soloman et al., 2017).
Rehabilitation Strategies to Manage Overuse Injuries
Physiotherapy can be a beneficial option for dancers who have sustained an overuse injury. Goals of a rehab program for the dancer would include pain reduction, restoration of full range of motion to all joints, and restoration of balanced strength and flexibility of muscles (Witkowski, 2012). These goals can be achieved by using a combination of modalities (such as cupping, acupuncture, dry needling, TENS, taping) exercises, and manual therapy techniques as indicated (Witkowski, 2012). Soloman et al (2017) suggests that rehabilitation should begin immediately following an injury and should not end until the dancer has returned safely to full activity. A physiotherapy program for a dancer with an overuse injury includes:
- Guiding the dancer through a “relative rest phase” that would allow for rest and restoration to the injured area, while also allowing the dancer to participate safely as much as possible in class or rehearsal before returning to full activity (Soloman et al., 2017);
- exercises to restore balance and proprioception (Soloman et al., 2017; Witkowski, 2012);
- proper stretching, but not overstretching (Witkowski, 2012);
- strengthening to restore muscle balance (Witkowski, 2012); and
- dynamic stabilization training of the lumbar spine to address core and pelvic stability (Soloman et al., 2017; Witkowski, 2012).
In conclusion, overuse injuries are a result of repetitive micro traumas to a particular musculoskeletal unit over a period of time that results in changes to the surrounding tissues. Overuse injuries are prevalent among dancers and particularly affect the ankle/foot in dancers. For this reason, dancers should take preventative steps and be made aware of the risk factors for developing an overuse injury in order to avoid these injuries from occurring. Finally, physiotherapy can be a beneficial way to help manage overuse injuries in dancers by creating a personalized program with the dancer to help guide them with return to play and full function.
If you have a dancing related injury, our Zen Physiotherapy team is here to take care of you and rehabilitate you back to your activity goals!If you have any questions about physiotherapy or want to give it a try, please reach out to our amazing Zen team on our contacts page!
References
Batson, G. (2011) Revisiting overuse injuries in dance in view of motor learning and somatic models of distributed practice. Journal of Dance Medicine & Science, 11(3), 70-75.
Campoy, S. et al. (2011). Investigation of Risk Factors and Characteristics of Dance Injuries. Clinical Journal of Sport Medicine, 21(6), 493-498. Doi: 10.1097/JSM.0b013e318230f858
Marshall, D.L. (2011). Treating Sports Overuse Injuries. Pediatric News, 45(4), 20-20. doi: 10.1016/S0031-398X(11)70126-6
Russell, J.A. (2013). Preventing dance injuries: current perspectives. Open Access Journal of Sports Medicine, 4, 199-210. Doi: 10.2147/OAJSM.S36529
Sobrino, F.J. (2017) Overuse Injuries in Professional Ballet. The Orthopaedic Journal of Sports Medicine,5(6), 1-11. doi: 10.1177/2325967117712704
Soloman, R. (2017). Prevention of Injuries in the Young Dancer. Contemporary Pediatric and Adolescent Sports Medicine. doi: 10.1007/978-3-319-55047-3