DANCE MEDICINE:

WHAT IS DANCE MEDICINE?

Dance Medicine is a form of Sports Medicine but with some very unique characteristics. The dancer is different in many ways. This includes not only their types of injuries but also their physical exam, evaluation and treatment. Injuries to dancers are very common. In evaluating injured dancers, one must not only focus on the injury but an effort must also be made to understand .the reason for the injury. This is true for all types of dance, from jazz, tap and ballet to hip-hop and folk dancing.  In understanding the types and patterns of injury we can hopefully prevent many in the future, or lessen the extent of the injury if it should occur.  There are only a handful of physicians nationwide with in-depth experience in the medical care of dancers and other performing artists.

INJURY TYPES

An understanding of the dancers physical demands and techniques are essential to both the treatment and prevention of dance injuries. There are several types of injuries that occur. A single macrotrauma represents the more obvious acute injuries as illustrated by ankle-sprains, lumbar strains, collisions and falls. Evaluation and treatment of these injuries are very similar to other areas of Sports Medicine.

Injuries also can occur as a result of repetitive microtrauma. These are the chronic overuse type injuries. These are much more common in dance and make up the majority of the injuries seen. They are often subtle and related to improper dance technique. Treatment should not focus only on the injury but should involve an evaluation of the dancers biomechanics and technique. Examples in this category include any types of tendonitis, bursitis, chronic ligament strain, and stress fractures. Also an acute injury can occur superimposed on a chronic overuse injury. An example of this would include a chronic achilles tendonitis which then  ruptures acutely. Possible reasons for the chronic overuse injuries must be assessed.

THE "WHY" OF INJURIES

The reason that injuries occur, other than accidents, are several fold. There is no ideal sport, and imbalances can occur as a result of any single activity or sport done repetitively. Also specific sports (especially dance) have very specific patterns of injury as a result of technique and repetitive stresses. Also individuals can have "weak links" in their musculoskeletal system which when overstressed can begin to breakdown. Patterns of injuries in ballet are fairly predictable. Anatomically, usually 50% will involve the foot ankle region. Different types of injuries occur depending on the stage of development of the dancer.

The younger dancer commonly has the knee and hip. problems which are often related to forced turnout. The older or professional dancer tends to have problems with the lower leg, foot .and ankle. Back injuries occur at any age or level of skill. Darwinism (Survival of the Fittest) is a factor. Males are spared many of the foot problems females experience related to point work. Instead, the male dancer experiences more ankle and back injuries secondary to lifting, jumping, partnering.

INJURY PREVENTION

For injury prevention attention must be given to proper technique. This is especially true with younger dancers in their training years. Injuries must often be evaluated along with the teacher and one should not always focus on the specific injury because it may be secondary to a compensation or a primary problem elsewhere. Forced hip turnout is a classic example of this and can often result in pain syndromes about the foot, knee, and lower back. Dancers have great athletic demands and should condition themselves accordingly.

THE DANCER AS ATHLETE

Dancers often do not consider themselves as athletes, but in reality, the physical demands they place upon themselves rival almost any athletic endeavor. In fact, a recent article in Philadelphia Magazine tried to determine who was the toughest athlete in the rough and tough pro sports City of Philadelphia. Their choice was a ballerina, Arantxa Ochoa (see below). The article, "Real Jocks Wear Tutus" went on to describe the rigorous training, schedule and physical demands that dancers face just about every day of there life. They are indeed athletes, and just as other athletes can learn a great deal from dancers, dancers would be wise to embrace many of the proven strategies athletes use in the areas of training, nutrition and rehabilitation. The same way Arnold Schwarzenegger (bodybuilding), Bruce Lee (martial arts), Greg Louganis (Olympic gold medal diver), Willie Gault and Hirschl Walker (pro football) and many other high level athletes have used ballet training to make them better at their sport, dancers can "cross-train" like athletes to make themselves more resilient, less injury prone and improve performance.

Overall athletic conditioning, including a balanced program of cardiovascular, strength and flexibility training, will extend dance careers and lessen the chance of injury.  Dance Medicine goals as I perceive them are similar to Sports Medicine in that they include injury prevention, early accurate diagnosis and treatment, and full functional rehabilitation, but also must take into consideration the dual roles of the dancer as both artist and athlete.

GETTING BACK IN ACTION

Dancers typically do not take injury well/ so permitting the injured dancer to carry out as many of the ballet exercises as possible, without incurring further injury or delaying recovery, will alleviate anxiety and promote cooperation. One must preserve overall strength, flexibility, and endurance while the injury heals. This often takes creative techniques. Other Dance Medicine goals include bridging the dancers gap between artist and athlete as well as educating both the dancer and the doctor.

Arantxa Ochoa- ballerina with Pennsylvania Ballet (photo by Sreve Belkowiz) Pound for pound, ballerinas are amongst the toughest athletes out there!

More to Come... Stay Tuned!