How many dancers get injured every year

Injuries in professional modern dancers: incidence, risk factors, and management

. 2012 Mar;16(1):17-25.

Selina Shah¹, David S Weiss, Raoul J Burchette

Affiliations

Affiliation

¹ Center for Sports Medicine, St. Francis Memorial Hospital, 900 Hyde Street, San Francisco, California 94109, USA. [email protected]

PMID: 22390950

Selina Shah et al. J Dance Med Sci. 2012 Mar.

. 2012 Mar;16(1):17-25.

Authors

Selina Shah¹, David S Weiss, Raoul J Burchette

Affiliation

¹ Center for Sports Medicine, St. Francis Memorial Hospital, 900 Hyde Street, San Francisco, California 94109, USA. [email protected]

PMID: 22390950

Abstract

Modern (or contemporary) dance has become increasingly popular, yet little has been reported with respect to modern dance injuries and their consequences. The purpose of this study is to define the incidence, risk factors, and management of musculoskeletal injuries in professional modern dancers. A total of 184 dancers in the United States completed an anonymous 17-page questionnaire on their injuries, including extensive details regarding the two most severe injuries that had occurred in the prior 12 months. According to their self-reports, a total of 82% of the dancers had suffered between one and seven injuries. The foot and ankle (40%) was the most common site of injury, followed by the lower back (17%) and the knee (16%). The rate of injuries was 0.59 per 1,000 hours of class and rehearsal. Injured male dancers returned to full dancing after a median of 21 days, while females returned after a median of 18 days. Most dancers missed no performances due to injury. Of the medical consultations sought by dancers for their injuries, 47% were made to physicians, 41% to physical therapists, and 34% to chiropractors. The majority of dancers adhered to the advice given them by consultants (87% of males and 78% of females for the most severe injury). While the majority of injuries were considered work-related (61% of the most severe injury and 69% of the second most severe), few were covered by Workers' Compensation insurance (12% and 5% respectively). These professional modern dancers suffer from a rate of injury similar to other groups of professional dancers. Most dancers return to a partial level of dancing several weeks before attempting full-capacity dancing.

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MeSH terms

Ballet Dancers Get Racked Up About as Often as the Rams or Raiders

SAN FRANCISCO —

Tracy-Kai Maier felt an annoying twinge in her hip while rehearsing one of the more difficult moves in a modern ballet piece.

Like most athletes, Maier at first denied that she had a serious injury. Instead she continued to dance and the injury became more and more debilitating. The 27-year-old prima ballerina with the San Francisco Ballet had unfortunately entered the dark side of her profession. A place where pain replaces beauty, grace and elegance.

“I kicked my leg up and there was a pinch,” Maier said. “Every day after that it got weaker and weaker until I lost all strength in it.”

Maier had ripped part of a tendon in her hip joint during a movement that requires the dancer to turn her entire leg inward and kick it up in back of her. “The leg just isn’t supposed to do that normally,” she explained.

Pyriformis syndrome, as the hip injury is called, is common among ballet dancers, who constantly push their hip joints farther than nature intended they be pushed.

Each year, ballet dancers suffer debilitating joint injuries at a rate that is rather shocking to those outside the dance world.

“The injury rate with professional dancers depends on age and longevity,” said Dr. Jean Rosenbaum, director of the American Aerobics Assn. “The younger a dancer starts, the more injury prone they are because the joints have not yet fully formed. The older dancers, because of their longevity, are also more prone to injuries. The injury rate as a whole is very high--more than 80%.”

Rosenbaum’s studies define an injury as any incident that keeps a person from dancing.

Sports Medicine Pioneer

Dr. James Garrick, one of the nation’s pioneers in sports medicine and the director of St. Francis Hospital’s revolutionary DanceMedicine Clinic, says the injury rate for dancers is similiar to professional football.

“There were just slightly more injuries in the (San Francisco Ballet’s) company in the course of last year that required time out than there are people in the company,” Garrick said. “That injury rate is about what it is in professional football.”

A recent study of 85 ballerinas over a three-year period revealed that 72 of the study group suffered 268 injuries collectively. Knee injuries accounted for 7% of the total, but when it came to career-ending injuries, knee injuries accounted for 56%. Treatment of the 268 injuries cost the ballet companies involved $363,000.

While most football injuries are related to contact, ballerinas usually become injured because of technique and turnout problems, resulting in stress fractures, tendonitis, bursitis and other slowly developing “overuse injuries.”

Maier is rather typical of all dancers. She started dancing at age 6 as a child in Sacramento, has had sprained ankles, lower back problems, tendonitis in her feet and ankles, and various other injuries in her feet and legs.

She spends hours on damage control, applying ice, ultrasound and friction massage to the injured areas of her body. She also takes preventive steps and does exercises to keep from getting injured.

Maier says she has been lucky during her eight years with the San Francisco company and has only had to stop dancing once, in her first season, before she learned how to keep from getting seriously injured.

Garrick began concentrating on the treatment of sports injuries while at the University of Washington in the early 1970s. He later moved to San Francisco and started one of the country’s leading sports medicine centers at St. Francis Hospital, where he has treated Joe Montana, Brian Boitano, Billie Jean King and others.

In the early 1980s, after seeing a steady stream of aerobic dancers coming to his clinic for treatment, he opened the nation’s first dance medicine department along with an associate, Patrice Whiteside.

Over the last few years, his DanceMedicine clinic has become a focal point for injured ballerinas. Dancers such as Natalia Makarova and several company members from the Bolshoi Ballet have been among those treated.

Garrick and other specialists at the clinic see about 2,500 patients a month for injury diagnoses, treatment, preventive measures and surgeries. Their aim is to get athletes back on the field, in the gym or on the stage as soon as possible.

The dance medicine portion of the clinic features rooms for diagnosis, an evaluation area similar to a dancer’s studio and several rooms for treating various injuries.

“Dancers have been all but ignored except for certain areas of the country,” Garrick said.

“Everybody in sports medicine wants to take care of football players, but the truth is that there are more little girls taking dance lessons than there are little boys playing football,” he said.

When a dancer comes to Garrick with an injury, he asks him or her to reproduce the movements that cause them pain in a diagnosis area of the clinic that is equipped with a mirror and a wooden bar.

Routine Observed

At the bar, Garrick watches the dancer go through his or her routine, while asking questions about the specific causes of pain.

But he doesn’t ask, “Where does it hurt?” He asks what specific ballet movement causes the most pain: “when you do a rond de jambe, pas de chat or sous-sous? “

Once the diagnosis is made, Garrick and his team then pattern a rehabilitation program designed to get the dancer back to work as quickly as possible.

Whiteside, always outfitted in dance wear, oversees a room full of rehabilitation equipment that looks like medieval torture devices. The machines allow dancers to strengthen weak muscles or keep uninjured muscles in shape while the dancer is sidelined, by encouraging movement that replicates ballet movements precisely.

“It’s a complete approach to rehabilitation,” Whiteside said. “Elite dancers are so good at cheating around injury you have to get to know their body.”

Serious dancers usually begin their careers before the age of 10, spending about three hours a week at the barre and in front of the mirror. At this earliest stage of dancing, injuries are mostly “growing children things,” such as sore joints and toes, Garrick said.

The more critical stage in ballet occurs at age 11 or 12, when most children become weeded out because they have the wrong build or are not serious enough.

“If you have certain kinds of hips, you’re not going to be a ballet dancer,” Garrick said. “You start to see real ballet-type injuries at age 11 or 12,” he said.

‘Turnout Problems’

Young ballerinas become injured most often because of “turnout problems,” which occur because they attempt to turn their toes out, in Charlie Chaplin-type fashion, farther than their hips will turn out in their hip sockets, Garrick said. A well-turned-out leg is a basic element to the graceful movement and appearance of the dancer.

But young dancers, in their enthusiasm to make the all-important cut, sometimes push their legs too far or try to “cheat” by turning their toes out farther than their hips will allow, causing hip muscle strains and knee injuries.

The largest number of injuries occur between the ages of 13 and 18 when the intensity of training “increases tenfold,” with dancers spending more than 20 hours a week in the studio, Garrick said.

During these “pre-professional” years, female dancers learn to dance on their toes in pointe shoes, causing foot soreness and problems such as bunions and tendonitis, and both male and female dancers learn to dance as partners, leaving many dancers with back problems and muscle strains.

But the most commom injuries among pre-professionals are similar to those among professional dancers, mostly 19 to 25, Garrick said. They are foot and toe stress fractures and tendonitis, injuries that develop slowly often because of problems of technique and choreography.

Garrick and rehabilitation specialists often work with dancers to pinpoint technique problems and help them to change their movements to prevent recurrence of injuries caused by faulty technique.

In other cases, the choreography of a certain performance can cause a dancer to become injured, as when the San Francisco Ballet performed a ballet called “Papillon,” French for butterfly, in 1986.

“Dancers had to wear wings so that they would look like butterflies,” Garrick said. “In order to look like proper butterflies they had to arch their backs, so during the weeks they performed Papillon, everyone had back pain,” he said.

The most common injuries in dance sport and how to avoid them

Luxurious dresses, beautiful movements, long-awaited victories and unfortunate defeats - all this is seen by spectators and fans of ballroom dancing, but this is only one side, which is usually called art. In training, the dancer meets precisely with the sports component of the dance. Unfortunately, as in any sport, a great load is accompanied by its faithful companions, injuries. And today we will tell you how to avoid such unpleasant moments in order to dance happily ever after...

Dancing is, of course, a useful activity. Many children are recommended to practice them to correct their posture and develop coordination of movements. But where the sport begins, the benefits of physical activity fade into another plane.

High psychological motivation for success, not always provided by the body's capabilities, early onset of high physical exertion, chronic microtraumatization and injuries during the formation of the body, the need for rehabilitation as soon as possible so as not to lose or let down a partner - all this can be called an unpleasant specificity our sport. And today we will try to formulate the basic rules so as not to harm the most valuable thing, health. nine0003

A qualified teacher is important

Dance lessons, as a rule, begin with the fact that the coach explains to his student the correct (often, only in his opinion) body positioning. It is very important that a qualified teacher works with beginners. After all, with the wrong positioning, too large loads fall on the back, which is very harmful to health.

You should also be careful with sharp, often even jerky movements. Sometimes it only seems that such efforts will be appreciated by the judges, but in fact they only injure children. If the teacher lays the wrong "base", then, most likely, in the future it will be necessary not only to retrain, but also to consult a doctor. nine0003

But dancers often experience constant discomfort even at a high level, and this is not always due to the fact that the muscles have not yet got used to the new movement.

For example, in the "Junior" and "Youth" in the European program, many girls suffer from neck pain. But if it becomes uncomfortable at the tournament, something gets tight somewhere, then this will immediately affect the dance. And this is most often due to the initial incorrect setting and the fact that many are trying to make movements on the clamp. “And my neck fell off, and my mother also ran to me between visits, trying to rub something. But only now I realized that I just used my body incorrectly,” Olesya Kargina shared with us. nine0003

Of course, if all teachers had a sufficient understanding of the structure of the human body, how it can and should move, then there would be much less injuries.

Warm-up is not an empty formality

Even at school, at physical education lessons, we were all told that before going in for active sports, you need to properly prepare your body.

Moreover, after a hard working or school day, it is sometimes not only difficult, but even unhealthy, to switch instantly, for example, to an incendiary jive or a sharp tango. And after a few minutes of light warm-up, a special secretion begins to be released in the joint, which reduces friction in it and brings the muscles into a training state. nine0003

Sprain is one of the most common injuries in our sport. This can be either stretching of muscles and ligaments, or tendons and other tissues without violating their anatomical integrity.

Muscle strain most often occurs due to a large physical load, disproportionate to the dancer's capabilities, as well as from excessively fast and active movements with a load on unheated muscles. You may feel as if something is tearing or bursting when the muscles are pulled tight. In this case, you should immediately stop training and start treatment. nine0003

An elastic pressure bandage should be applied to the injured area and kept in an elevated position. During the first two days, it is recommended to apply ice to the sore spot every 4 hours, but it is best to protect the skin with a cloth or napkin. And only after 48 hours you can use hot compresses. In addition, it will be very effective if you start doing light stretching exercises in a hot bath. Just don't overdo it! You only need to stretch the muscle a little, and not injure again! nine0003

It usually takes 1-6 weeks to heal a sprain, but after such an injury, the muscle may already lose its former elasticity. If the joint was too tense, then the tissues of the ligaments and other elements supporting the joint may be torn.

Ligament sprain occurs when sudden movements in the joint exceed its normal amplitude and do not coincide with its direction of work. Severe pain, bleeding at the site of injury, painful palpation, and severe limitation of the joint, are sure symptoms of this sprain. nine0003

You can give yourself first aid, just like you would for a sprained muscle. But if you have a suspicion of a fracture or displacement of the bone (these are friends of sprains), there is a change in skin color over the joint, and the pain does not decrease after three days - hurry to see a doctor. Indeed, in the event that you have not just a sprain, but a tear or, even worse, a torn ligament, you simply need the help of a doctor. Indeed, for the treatment of the most complex ruptures, the surgical method is often used. nine0003

Of course, such troubles can arise in other unfortunate situations, but, of course, it is best to try to protect yourself from them in advance. Therefore, it is necessary to warm up. A few demonstrative "pulls" or correcting the hair in front of the mirror do not count. This process must be taken seriously.

Before training on the European program, first of all, do not forget to pay special attention to the feet, knees and hips, because they help you demonstrate the best possible beautiful movement on the floor. Therefore, you should not immediately proceed to the execution of complex steps, start the lesson with exercises, and then move on to the main figures. nine0003

This will not only help to prepare the body for the load, but also will not let you forget about the importance of basic in dance. And in order to immediately stretch all the important muscles and immediately train your balance, you can always do a simple but effective exercise: slowly rising and falling on one leg, balance back and forth with the other, and do not forget to keep your hands in a competitive position!

For Latinists, the recipe is similar: the basic steps have never harmed anyone! And if literally one melody of the rumba is danced "cucaracha", of course, not hack-work, then the body will immediately tune in to the desired mood. In addition, before starting the main workout, you can do a few turns - this will immediately give you concentration and a sense of control of movements. To avoid injury to the shoulder joint, be sure to pay enough attention to it. After all, one bad turn from a partner, and you can forget about training for at least a week...

Neck pain is also often the result of insufficient warm-up. Therefore, before practicing sharpness in tango and unimaginable waves, say, in samba, do at least elementary exercises. In addition, if partners have a big difference in height (more than 15 cm), then out of habit, pain can also occur: many do not immediately get used to constantly looking so low or vice versa, high. And so that this does not affect the quality of the dance, be sure to consult your coach. nine0003

And it is recommended to complete the workout by stretching the muscles. This will not only help you become more flexible, but it will also be good for your health. The load should both gradually increase at the beginning of the lesson, and gradually go to "no" at the end.

But do not forget that the task of any dancer is to develop his body. And this complex and lengthy process can also cause some discomfort. Often, after intense exercise, pain and sometimes even muscle cramps are felt. nine0003

Of course, every athlete is accustomed to this kind of "pulling" of the muscles after fruitful workouts. But if the pain is really very strong and there is a limitation of mobility, you should not only immediately stop training, but in no case should you strain these muscles for 1-2 days.

If there is no injury, then you can slowly stretch the muscle, but this must be done very carefully. Various ointments and balms will also help to cope with pain, but be careful: if the pain does not go away within a few days, you should consult a specialist. The doctor will be able to exclude the occurrence of other, more serious injuries and prescribe treatment, which will consist of painkillers and anti-inflammatory drugs. nine0003

Improper loading of the muscles can cause painful lumps in the form of nodules in the muscle, the so-called "bumps". Massage is very well suited as a treatment, and it can often be painful.

And many dancers struggle with muscle pain with their own folk methods. For example, if you lie down in a hot (up to 40 degrees) bath with sea salt or milk, then the next day your muscles will feel much better. But do not forget that doctors recommend spending no more than 10 minutes on such a procedure. nine0003

Be careful on tricks!

Of course, at some level every dancer wants to bring something of their own to the dance that no one else can do. Probably, it is precisely because of this that various tricks came to ballroom dancing, in which grace, beauty and a certain amount of risk are masterfully combined. And the last component should never be forgotten.

Do not experiment with hazardous elements until class and age permit. Early difficult poses and supports can be bad for the health of the partner, and problems with the back and joints can occur later. After all, a partner, even the best and most beloved, has the weight that in such elements is assigned to the partner. But girls also have to take risks: not every boy by the age of 14 develops a sense of responsibility for his dance half. And if the partner forgets to support or pick up in time...

And to avoid such unpleasant moments, you should always contact the teacher to explain which muscles work in a particular position and how to properly lift a partner from low positions. After all, partners should do all such lifts not with the help of the back, but with the help of the legs, and the task of the partner is to keep her body in good shape and not relax.

However, when inserting a trick element into the choreography, start with a slow work, gradually increasing the tempo. If you need to sit on your knee, then do not forget about protection in the form of a knee pad. nine0003

No, not about the rigid plastic thing that comes with the inline skate kit - now it is very easy to find soft and elastic protection in the store that does not hinder movement. But if the partners at the tournament still have to perform everything with bare legs, then young people may not take off their knee pads - they are completely invisible under the competitive trousers.

Unfortunately, bruises and fractures are true companions of complex movements, falls and collisions. Bruise is a closed tissue injury without a significant violation of their structure. Soft tissues are especially affected, which are pressed against the bone during impact.

Ice should be immediately applied to the bruised area, warm compresses and iodine mesh can be used only after 24 hours. But if the pain does not go away, do not be lazy - consult a doctor. Indeed, sometimes even with a severe bruise, you can be put in a cast for a week.

A much more unpleasant injury is fracture . In our sport, the most common fractures are closed fractures - when the bone is broken or cracked, but the skin is not damaged. The cause of the fracture can be not only a blow or fall, but also excessive load can lead to fractures of the muscles of the feet, lower leg, tibia, ankle. nine0003

If you notice bone deformity, limitation of movement, severe shooting pain - contact your doctor immediately! Before receiving medical attention, you should fix the damaged bone, but in a way that does not cut off blood circulation, and apply ice to the sore spot - this will help reduce pain and inflammation.

The doctor, after examining the X-ray, must set the fracture and apply a cast for a period of one month. After removing the cast, you may need to go through a recovery period, which will include massage, therapeutic exercises and physiotherapy. nine0003

Protecting the knees and back

The knees and back are the most traumatic parts of a dancer's body. Therefore, they should be treated with special trepidation, because for rehabilitation after an injury, you will have to sacrifice not only time, but, possibly, your entire dance career.

Meniscal injury is the leading injury in the knee. Meniscus is a formation of a cartilaginous structure that is involved in the formation of the knee joint, they are, as it were, its shock absorbers. Of these, the inner one looks like the letter C, and the outer one looks like the letter O. Most often, in 75% of cases, the outer meniscus is injured. A torn meniscus is a very complex injury, however, among injuries of the knee joint, it ranks first. nine0003

Increased loads, excessive extension of the joint from a bent position, as well as various microtraumas - all this can lead to a rupture of the meniscus. In the acute period of damage to the menisci, the patient feels a sharp pain, because the inflammatory process is going on in the joint.

In addition, movement in the joint is severely limited, especially in extension. After 2-3 weeks, the reactive conditions in the joint subside, and it is possible to identify the characteristic symptoms of meniscus damage. For the most part, they are based on the removal of pain samples during certain movements. In addition, sometimes when a section of the meniscus is torn off, a characteristic click can be heard during movement. nine0003

In the acute period, a conservative method is used as a treatment - the blockade of the joint is eliminated, and painkillers and anti-inflammatory drugs are used. With repeated injuries of the meniscus, surgery is prescribed as a treatment, which consists in removing part or all of the menisci.

Tears that occur at the marginal part of the meniscus are more treatable as there is a good blood supply in this area. But if the inner part is damaged, they do not heal on their own. In this case, it may be necessary to completely or partially remove the meniscus. But do not forget that the complete removal of the menisci inevitably leads to arthritis. nine0003

Constant characteristic twisting, incorrect initial preparation, blows from collisions with opponents, excessive loads - all this leads to various back diseases.

One of the most common of them is spondylolisthesis , a defect in a part of a vertebra, which is caused by slipping of one vertebra from another. The most common symptoms are back pain and leg pain.

In addition, sometimes there is such a form of the disease as isthmic spondylolisthesis, when the body of one vertebra slips off another due to a fracture of the interarticular part. This is a very thin plate with poor blood supply, which is often fractured. But her fracture is far from always and not everyone causes pain and other uncomfortable sensations. But dancers are attentive people. Adolescents are especially susceptible to such slippage of the vertebrae. nine0003

Fortunately, in most cases, slippage is not more than 50% and can be easily treated. Treatment includes anti-inflammatory drugs, physical therapy, epidural injections (a steroid drug is injected into the area surrounding the back of the brain), and manual therapy.

Just be careful with manual therapy on yourself: it's so common to see a dancer inserting his own vertebrae. It is better to go to the doctor once again and pay special attention to pumping and stretching the muscles of the back, because if one day the ill-fated vertebra slips more than usual, surgical intervention will be required, followed by a difficult recovery period. nine0003

The most important advice

Dancers and their parents! In pursuit of stunning results, do not risk your own health and the health of your children! After all, partners, most often, come and go, and it is with us forever, regardless of the place taken. Choose a qualified teacher who will always explain how to perform the movement correctly and not harm the body.

And, most importantly, do not forget that no reading of the article will replace a visit to the doctor. Feel free to contact him. Be healthy! nine0141

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- Up to 500,000 people suffer spinal injuries every year
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Up to 500,000 people suffer spinal injuries every year. Spinal injury survivors are 2-5 times more likely to die prematurely, with lower survival rates in low- and middle-income countries. A new report from the WHO, the International Spinal Injury Review, presents the best evidence available on the causes, prevention, care and experience of people with spinal injury.

Men are most at risk for spinal injury at 20-29years and at 70 years of age and older, and the highest risk for women occurs at 15-19 years of age and at 60 years of age and older. According to studies, the ratio between adult men and women at risk is at least 2:1.

Up to 90% of spinal injuries are caused by traumatic causes

Up to 90% of spinal injuries are caused by traumatic causes such as traffic accidents, falls and violence. There are differences between regions. For example, road traffic crashes are the leading cause of spinal injuries in the African Region (nearly 70% of cases) and the Western Pacific Region (55% of cases), while falls are the leading cause in the South-East Asia and Eastern Mediterranean Regions (40 % of cases). Non-traumatic spinal injuries occur due to pathologies such as tumors, spina bifida and tuberculosis. A third of non-traumatic spinal injuries are associated with tuberculosis in sub-Saharan Africa. nine0003
Sequelae of spinal injury

Most individuals with spinal injury experience chronic pain and 20-30% are estimated to have clinically significant signs of depression. Individuals with a spinal injury are also at risk of developing secondary pathologies with disabling and even life-threatening consequences, such as deep vein thrombosis, urinary tract infections, pressure sores and respiratory complications.

Spinal injuries are associated with lower rates of schooling and economic participation. Children with a spinal injury are less likely than their peers to get into school, and if they do, it's hard for them to do well. Adults with spinal cord injury face the same barriers to social and economic participation, with an unemployment rate of over 60% worldwide. Spinal injuries result in significant costs to individuals and society. nine0003
Many of the consequences of spinal injury are not the result of the pathology itself, but of inadequate medical care and rehabilitation services, as well as physical, social and political barriers that prevent people with spinal injury from participating in their communities. To overcome these gaps and barriers, the Convention on the Rights of Persons with Disabilities must be implemented urgently and in full.

“Spinal injury is a medically complex and life-threatening disorder,” said Dr Etienne Krug, Director of the WHO Department of Violence and Injury Prevention and Disability. “However, spinal injury is preventable, manageable, and may be compatible with good health and social integration.” nine0003
Basic measures to improve life

Key interventions to improve survival, health status and social participation of individuals with spinal injury include:
- timely and appropriate management of patients prior to hospitalization: prompt identification of suspected spinal injury, rapid assessment and transition to injury management, including spinal immobilization;
- providing emergency medical care in accordance with the level and severity of the injury, the degree of instability and the presence of neural compression; nine0141
- access to regular medical care, health education and medical supplies such as catheters to reduce the risk of secondary disorders and improve quality of life;
- access to qualified rehabilitation and mental health services to maximize functioning, autonomy, general well-being and integration into community life;
- access to appropriate aids to enable people to carry out activities of daily living, thus reducing functional limitations and dependency; nine0141
- specialized knowledge and skills of health care providers and rehabilitation services.
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How many dancers get injured every year

Injuries in professional modern dancers: incidence, risk factors, and management

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MeSH terms

Ballet Dancers Get Racked Up About as Often as the Rams or Raiders

The most common injuries in dance sport and how to avoid them

Up to 90% of spinal injuries are caused by traumatic causes

Sequelae of spinal injury

Basic measures to improve life

Learn more