Injuries in dancers have been studied and documented extensively. Common injuries include: plantar fasciitis, metatarsalgia, patellar tendinoisis, iliotibial band syndrome, iliopsoas (hip flexor) tendinopathy, lumbar and cervical facet irritation, and sacroiliac dysfunction, to name a few.[i] The list is extensive.
Why are dancers suffering injuries and can chiropractic help?
Researchers have sought to answer the former by focusing on various dance forms and the biomechanical loads endured by each respective artist. In ballet dancers, focus has been placed on benign joint hypermobility as a potential indicator for injury; however, research indicates that most injuries occur as a result of overuse.[ii] In one study of ballet dancers, seventy-six per cent of all injuries occurred in the lower extremities. Most significant: Ankle sprains.[iii] Evidently, the types of injuries experienced will reflect the style of dance being performed and rehearsed. In a study of bboys (a.k.a break dancers), the most common injuries (69%) were in the wrist[iv] – some enduring non union scaphoid fractures.[v] However, a ballet dancer (particularly females) will rarely report wrist injuries. A ballet dancer en pointe will have disparate biomechanical demands when compared with a popper, locker, or bboy; hence, will have exceedingly different rehabilitation and preventive strategies in a clinical environment.
In an article by Dr. Scott Howitt, risk factors that relate to dance injuries are both intrinsic and extrinsic. The intrinsic risk factors include: anatomical characteristics, biomechanical imbalance, past medical history and dance experience. Extrinsic risk factors include: improper training, faulty technique, fatigue, stress, diet, flooring, and footwear.
Chiropractic addresses both intrinsic and extrinsic risk factors. A physical assessment and treatment – including a comprehensive history, biomechanical analysis, and manual muscle testing- can be paramount to both injury prevention and injury management in dancers. Chiropractic addresses various questions: Does the dancer have biomechanical impairment in the feet such as pes planus (or flat feet)? Does the dancer require a custom orthotic that could be utilized in the dance or training shoe? Is there sufficient lateral hip stability and quadricep strength? Are the hamstrings disproportionately weak relative to the quadriceps? [vi] Does the dancer have benign joint hypermobility syndrome? Is there observable hypermobility in the hip flexors, hamstrings, and adductors, yet below average flexibility in the internal and external rotators of the hip? Are the external hip rotators disproportionately strong relative to the internal rotators of the hip? Chiropractic care can effectively address these questions and restore optimal joint motion – particularly in dancers who endure excessive and repetitive compressive spinal forces. Examples: bboys (headspins, hollow back), traditional dancers (Arabesque position/extensions), acro dancers (chest stands), and hip hop dancers (rocking/rapid flexion-to-extension movements). Chiropractic addresses biomechanical impairments that can cause or prolong injuries, and provides homecare strategies targeting prevention. Manual muscle release techniques can release restrictive adhesions (or scar tissue); hence, restore mobility to soft tissue layers including injured muscles, tendons, and ligaments. Importantly, manual muscle techniques prevent exacerbation or re injury. Howitt’s article states that 30-50 per cent of dancers are injured annually, and the lifetime injury incidence is 90%. Hence, it is exceptionally important, with respect to career longevity, that dance artists receive regular chiropractic care focused on injury management, maintenance, and prevention.
67% of injuries in ballet dancers occur in the lower extremities
A dancer displaying hyperextension of the lumbar spine.
Common injuries in bboys: wrist (69.0%), finger (61.9%), knee (61.9%), shoulder (52.4%), lumbar spine (50.0%), elbow (42.9%), cervical spine (38.1%), ankle (38.1%), foot (28.6%) and hip (16.7%).
Acro dancers are prone to SI dysfunction, lumbar facet irritation, and can be screened for spondylolysis/spondylolesthesis. Spondylolysis is a stress fracture in a region of the spine called the pars interarticularis. Spondylolesthesis occurs when a vertebral body (typically L5) shifts forward due to a stress fracture or bilateral pars defect. This is common in sports with hyperextension of the lumbar spine.