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Devils Lake Journal - Devils Lake, ND
  • Flexible Fitness: How dancing may lead to overuse injuries

  • Dancers are both artists and athletes. They push their bodies to the limits of flexibility, balance and strength in order to achieve a certain aesthetic. As with many sports, over time, the bar is continually pushed higher for the skills they must be able to perform. For example, the number of consecutive turns a dancer can do while balanced on a single foot.

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  • Dancers are both artists and athletes. They push their bodies to the limits of flexibility, balance and strength in order to achieve a certain aesthetic.
    As with many sports, over time, the bar is continually pushed higher for the skills they must be able to perform. For example, the number of consecutive turns a dancer can do while balanced on a single foot. 
    Mastery of certain skills may be required to be on a high school dance team, become a ballet company member or get hired for a role in a Broadway show. And with the growing popularity of competition-based reality TV shows, such as “So You Think You Can Dance,” dancers are increasingly cross-training in a variety of styles, including ballet, contemporary jazz, hip-hop and breaking as well as various forms of ballroom. 
    Each style has unique demands on the body of the dancer in regards to strength, flexibility, balance and aerobic capacity, which can also lead to a variety of injuries.
    Dance injuries have not been as extensively studied as many popular sports, but there is a growing body of study in the area of dance medicine, most of which is focused on ballet and modern dance. The majority of knee injuries in dancers are  known as “overuse” injuries, including patellofemoral pain (pain in area of the knee cap) and jumper’s knee, or patellar tendonitis (an inflammation of the tendon that attaches from the bottom of the kneecap to lower leg bone).
    This type of overuse injury is also common in other female athletes and often related to alignment of the leg with squatting, running or landing from jumps. Traumatic injuries, such as torn ligaments or cartilage in the knee, are much less common in dance than in sports, such as soccer or basketball.
    Some factors that contribute to knee pain in dancers include forced turnout, hyperextending already overly flexible knee joints, repetitive bending (pliés) and jumping (sautés), hard training surfaces and over-training. Forced turnout is when dancers try to turn their feet outward beyond the flexibility of their hips, resulting in excessive strain on the knee. 
    Forced turnout and knee hyperextension are very common in ballet dancers trying to achieve a particular aesthetic or “line” with their body. Improper alignment of the knees, usually pointing inward relative to the direction of the feet, as with the pliés and sautés, can lead to abnormal stresses at the knee joint and tendon resulting in pain.
    Over-training, including factors such as inadequate rest time, dehydration and even poor nutrition, can result in fatigue, putting dancers at more risk for injury. Hard training surfaces can be unkind to the knees when a dancer has poor landing technique for jumps. For example, keeping the knees relatively straight, as well as when choreography involves a lot of kneeling.
    Page 2 of 2 - A dancer looking to minimize his or her risk of injury should educate themselves about proper alignment. For example, keeping the knee in line with the second toe and over the ankle in pliés or when going into or landing jumps. Cross-training to help improve strength, with activities like Pilates, and aerobic capacity, with swimming or running, are highly recommended to prevent injuries. Knee pads can be protective on hard surfaces if choreography involves a lot of floor work. Adequate nutrition to fuel long practice sessions and maintain a healthy body weight are important to keep muscles and bones strong.
    Dancers who are underweight might consider consulting a sports nutritionist for counseling. Those with injuries should seek care early from a medical professional experienced with dance medicine to minimize any need to stop participation and minimize the risk for recurring injuries.
    Rehabilitation with a physical therapist experienced in working with dancers can help with successful return to dancing after an injury. It is also important to communicate with the teacher to see if technique or training can be modified to minimize stress on the injured knee.
    Stephanie Jones, PT, DPT, OCS, NCS is a Physical Therapist at Spaulding Outpatient Center Framingham with a special interest in treating athletes including dancers.
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