Ouch! Five common dance injuries & how to treat them

Dance Magazine, April, 2005 by Linda Hamilton

DOCTORS, PHYSICAL THERAPISTS AND DANCERS SHARE THEIR HEALING TIPS.

WITH OVER 600 MUSCLES, 206 bones and countless nerves, ligaments, and tendons in the body, it's almost impossible for dancers to escape getting injured. Acute injuries, such as a sudden sprain or muscle pull, seem to happen out of the blue. One minute you're dancing, the next minute you've hit the floor. Chronic problems, like tendonitis, develop from repetitive stress over time. The dance community is paying mare attention, with companies like New York City Ballet and Pittsburgh Ballet Theatre providing cross-training, pre-season screenings, and educational seminars to reduce injuries. In today's fast-paced, competitive world of dance, the new catch phrase is injury prevention. Though there are many types of injuries, some are more common among dancers than others. DANCE MAGAZINE interviewed health care specialists and performers about five of the most prevalent injuries.

ANKLE SPRAINS

Few dancers manage to perform without ever spraining an ankle. According to Dr. William Hamilton, orthopedic consultant to the New York City Ballet, American Ballet Theatre, and the School of American Ballet (and my husband), ankle sprains are the most common acute injury in dance. Less well-known is that they also tend to happen more than once. Megan LeCrone, a promising young corps dancer, has had three sprains since joining New York City Ballet three years ago. Her most recent ankle injury occurred in a late afternoon rehearsal of The Nutcracker when she says she felt a "pop after slipping in a pile of snow."

Fatigue may have been a factor. LeCrone recalls feeling tired before she slipped, due to back-to-back rehearsals. It was impossible to tell if the injury was serious because her "ankle looked like a balloon!" Luckily the swelling went down after she began the standard treatment for all acute injuries: RICE, an acronym for rest, ice, compression, and elevation.

The next step in rehabilitating a dance injury is to grade the severity. According to Marika Molnar, director of Westside Dance Physical Therapy in Manhattan, a Grade 1 ankle sprain could be a microtear or excessive stretching of the ligament with no looseness, while a Grade 2 involves a more severe tear, at times with a noticeable pop, and some instability. Grade 3 is a complete tear of the ligament with significant instability. LeCrone remembers, "My first sprain was so bad my foot was just hanging off the end of my leg." This time it wasn't that serious, most likely because she had kept her ankle strong with daily physical therapy exercises. If the ankle is still weak, painful, or swollen in spite of time and rehab, you may need surgery. Dr. Hamilton believes that operating on torn ligaments in professionals with Grade 3 sprains can allow for a faster and more solid recovery.

KNEE INJURIES

The knee is vulnerable to injuries that range from mild to severe, including meniscal or cartilage tears. Apart from the usual wearing out of cartilage from loading the joint, Dr. Douglas Padgett, who practices at the Hip and Knee Center at the Hospital for Special Surgery in New York, believes that some of these knee problems may occur in dancers with limited hip rotation. Twisting your knees to improve turnout may place you at risk for meniscal damage.

Choreography that involves deep squats or sudden grand plies can also damage knee cartilage. "It's like pinching your finger in a door hinge," says Katy Keller, clinical director of physical therapy service at the Juilliard School. Johary Ramos, a former dancer in the Fosse national tour, remembers performing a somewhat brutal number where he had to jump from a ladder backstage onto a trampoline and land in a squatting position on the stage. In one performance, Ramos says, "I felt a weakness but didn't know anything was structurally wrong. I did nine more performances until my bad knee was so swollen that I couldn't walk."

At first, it may be difficult to tell if an injury is mild, moderate, or severe, especially if you're like most dancers, who rarely give in to pain. So, unless your physical evaluation indicates that you need surgery because your knee is locked, you follow the same procedure for ankle sprains: RICE and rehab, including hands-on therapy and exercises. You may also try other modalities like electric stimulation to speed up the healing process. If your knee continues to catch or cause swelling and pain, your doctor may order an MRI for a more accurate diagnosis. Dancers who require surgery usually have it performed with an arthroscope, which is an instrument about the size of a drinking straw that can remove bone fragments and trim the meniscus.

HAMSTRING INJURIES

Muscle pulls are rarely serious, unless they occur in a vulnerable area, such as the hamstring. According to Dr. Hamilton, this muscle spans two joints (the knee and hip), with "a large blood supply that causes inflammation and scar tissue when it's torn." Dancers use the hamstring in almost every movement of the lower body, making it easy to overload. Tightness is the main cause of these injuries, although Keller believes that other factors include structural asymmetries, like a crooked pelvis, and muscle strength imbalances. Many young dancers experience these imbalances during growth spurts, when they temporarily lose flexibility, strength, and balance. What to do? Like most good dancers, they work harder.