Acute injuries do occur in dance but overuse injuries are the most common because of the repetitive nature of dance exercises and movements. Overuse injuries can occur in the bone, leading to stress fractures (small cracks in a bone), or in the tendon, leading to tendinitis. The most common dance-related injuries include inflammation (swelling) leading to tendinitis in the tendons of foot and ankle joints; stress fractures in the foot; and ankle sprains in ballet dancers when they go “en pointe” (on the tips of the toes). Techniques requiring unique positioning of the foot and hip place repetitive stress on the knee, which can lead to overuse injuries such as anterior knee pain (patellofemoral pain) or jumper’s knee (patellar tendonitis).
“Dance injuries span all ages but the risk is greatest during a young dancer’s growth spurt, usually from the ages of 8 to12 for girls and 10 to 14 for boys,” says Dr. Levin. During this period, a child’s bones are at their weakest, which places the dancer at high risk for fractures and stress fractures. The growth spurt is also a time when bones are growing a lot faster than soft tissues, such as muscles. This results in tight ligaments and loss of muscle strength, which cause reduced flexibility and coordination for growing dancers.
Keeping young dancers free of injury is key to helping them enjoy years of physical activity and dance. According to Dr. Levin, that takes teamwork among parents, teachers and medical professionals. “Parents play a large role in dance injury prevention,” he says. Most important, parents must be careful not to encourage their children to advance to higher levels of training at an unsafe rate. Specific to ballet, parents should ensure that the decision to begin pointe training is not made before the child's feet and ankles develop enough strength. Age 12 is the generally accepted lower limit but strength and maturity are more important than age. “Parents must ensure that young dancers are wearing properly fitting shoes and that they are getting appropriate rest and nutrition, especially fluids,” says Dr. Levin. “And they must be careful observers, alert to signs of over-training, fatigue, soreness and excessive perfectionism, any of which can be forerunners of injury.”
From the onset of instruction, dance teachers should establish a class environment in which students are comfortable sharing that they may be injured and need a break. Students should also be instructed consistently on the importance of warm-ups and cool-downs, proper equipment, and at what point, whether by age or maturity, it is appropriate to move on to the next level of dance. The dance studio should be equipped with flooring that is resilient and absorbs shock; a hard, unforgiving floor may predispose the dancer to increased stresses on the foot and leg.
The medical professional also plays a significant role not only in treatment and rehabilitation but also in preventing injuries. Dancers respond well to medical providers who respect both the aesthetics and intensity of dance and who can initiate and facilitate screening to help identify potential problems and prevent future injuries. A dancer should return after an injury only when clearance is granted by a health care professional.
“Young dancers must be taught to resist the temptation to dance through pain,” Dr. Levin concludes. “They must pay close attention to correct technique, be mindful of the limits of the body and not push too fast too soon.”
Somers Orthopaedic Surgery and Sports Medicine Group, founded in 1988, is one of the most comprehensive and specialized practices in the region. www.somersortho.com
Scott M. Levin, M.D., F.A.A.O.S is a board certified orthopaedic surgeon and sports medicine specialist.
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