Dance Injuries: What Causes Them and How to Avoid Them

It’s no question that dance is one of the most artistic forms of movements; dancers can tell stories and evoke deep emotion through their choreography.

But, dance is also highly complex, which is easy to forget with how easy dancers make it all look.

Dance requires a high level of strength, stamina, coordination, and determination — all combined with complexed technique and beautifully complicated components.

To achieve this balance of movement and skill, dancers have an incredibly high training load… which unfortunately means that they also have an increased risk of injury.

Sustaining injury as a dancer can be devastating. Not only does it sideline you for a period, but it can also have long term effects on how well (or how much) you can train and perform down the line. This is even a bigger issue when participation is an all year round commitment that doesn’t allow a traditional “Off-season” that other sports do to allow healing and rehabilitation.

However, even though injury is common in the dance world, it’s certainly not inevitable! There’s a lot that can be done to prevent injury — or come back stronger if you are already in recovery..

Our office has had the pleasure of working with many of the top aspiring dancers in Rockland County (and even some accomplished professionals and former professionals), and we’ve seen firsthand that dancers are incredible athletes with control and grace like no other. (Plus, their tenacity and dedication to their craft is admirable!)

Common Factors Associated With Dance Injuries

· Training Workload

Training time is the biggest cause of dance injury. Many dancers spend upwards of 20 hours a week practicing whether in rehearsal, on their own, or performing—and that number only goes up before a performance, recital, or competition.

Most other athletes spend about 2 hours a day for 5-6 days a week practicing their sports. Those athletes continuously train to get better at their skills to work better as a team and improve their current skill set…

While dancers spend their time improving their technique with current skills, and then are often challenged with new and more complex techniques…

Also, dancers can never relax while performing…when they are on stage, every movement is under a microscope by the director and the audience and is done “Full Out”, which leads to quicker fatigue than..say…during a basketball game where if the play is on the other side of the floor and not designed for you may allow a period of lesser effort to conserve for later in the game. By easing up and catching your breath, the athlete gives their muscles the opportunity to refuel for the next charge…that is not available on the stage.

“So, if the volume and intensity of dance that these dancers do can lead to overuse injuries, it would make sense to decrease the hours spent dancing?” you may ask.

Yes and No…

On the surface, that makes sense and, at times, it is the answer. There is a fine line between just enough and too much.

It’s not as simple as just cutting down training hours; there are many technical aspects of dance, and each requires a significant amount of practice to master.

Instead of avoiding the problem entirely, dancers should equip themselves with the knowledge and techniques to address injury risk head on.

· The Calendar

As I mentioned earlier, there is no dance off-season! Dancers are constantly increasing their skill, whether in dance class, rehearsals, extra intensive programs, and performances.

In my experience, dance injuries increase at 3 specific times of the year:

1. The beginning of the school year or beginning of the new training season

2. Right before performance season (when dancers need to be at their absolute best) as the intensity and frequency of training ramps up.

3. During a time of increased load, such as in the summer when dancers go to intensive programs or the end of the college as college dancer ramp up for final projects and performances. Training frequency also increases during mid-spring when competitive dancers are gearing up for competitions.

This isn’t just a pattern for the dancers our office works with, either — studies have shown that most dance injuries occur in the 2nd, 3rd, 7th, and 8th months of the dance year. (This translates to the months of October, November, March, and April, which are all congruent with the dancers we work with.) We, also, see nagging injuries at other times of increased workload, such as after school breaks (due to getting back to training after a break in routine) and during summer intensives (where the time dancing increases and rest decreases)

Of course, competition and performance calendars aren’t in the dancer’s control, but that doesn’t make injury inevitable. Be aware of these training timelines, and focus on recovery and injury prevention needs during these times of year to combat the issue ahead of time.

· Biomechanics—Form and Execution

In addition to being highly complex and demanding, dance requires A LOT of repetitive movement…done mostly by young, skeletally immature athletes, who’s muscles and bones are not ready for this cumulative strain.

Dancers spend the majority of time of their feet with high velocity movements that put up to 2x their body weight through their legs and ankles, thus putting their feet, ankles, hips and knees at risk of stress injuries (such as tendinitises, strains, or bony stress reactions) or fatigue failures (ligament sprains, muscle tears, or even fractures that the muscles should have stopped) that can derail all their hard work.

Not surprisingly, the most common sites of injury for dancers are in the legs and back. One study followed over 300 dancers at an elite ballet school for over 5 years. The researchers found that over 50% of dance injuries occurred in the foot/ankle, 21.6% occurred at the hip, 16.1% occurred at the knee and 9.4% occurred in the back. And when looking at the full Lower half, 87.7% of dance injuries occur from the hip down.

The common biomechanical factors that lead to these lower extremity injuries include foot pronations and toe point limits, previous back injuries, and lower extremity (mostly hip) weakness and (hip and ankle) instability

How to Reduce the Risk Of Dance Injury

Based on loads of research findings and in-person conversations with dancers, choreographers, instructors and dance rehab experts), we’ve found patterns that identify the likelihood of injury, as well as the most common risk factors that can lead to injuries.

Therefore, we have the knowledge to PREVENT injury in dance (or at least significantly reduce risk of injury).

· Don’t Wait Until Your Injured

It may sound obvious, but it is the number one reason people have injuries…The most important aspect of reducing injury is to start BEFORE it happens.

The key is to be proactive!

Preventative care includes reducing dance loads during the peak months, adding cross training, getting your form and biomechanics assessed by a specialist, and using specific strengthening programs designed for a dancer to decrease the risk of potential injury.

It seems like a lot of work to plan to prevent an injury, but is an absolute necessity to prevent injuries (and the flaring up of old injuries that the former dancers feel as they age)

· Make Time To Cross Train

In a study of over 300 elite dancers, the dancers used a combination of Pilates and lower extremity strengthening to keep them active and remain at a similar training intensity without the risk of overuse injury that is caused by doing the same activity over and over again during dance training.

By cross training appropriately and after a biomechanical assessment, the training can also be used to address the muscle and motion imbalances that the dancers have that lead to injuries. Dancers will benefit from a customized program of strength training, core stability exercises and appropriate motor control exercises to limit their injury risk.

· Increase Your Ankle and Core Stability

Ankle, hip, and trunk stability is essential for dancers to avoid injuries.

Dancers tend to complain of tightness in their hamstrings, hips, back and ankles, however when we do length and flexibility testing of these same dancers, these dancers all have better than normal flexibility.

So, what is the cause of the tightness?

Most of these dancers are experiencing a phenomenon that involves the muscles increasing their tone to create more stability in the joint that they are unable to control. The human brain is amazing, in that, when your body knows it cannot control the joint appropriately, the body adds a basal level of contraction to hold the joint still in opposition to the force caused by the large movements. This basal level of contraction feels like “tightness” to the dancer, but is really a strength and stability issue.

Therefore, the dancer needs to increase their stability by working on exercises like:

• Ankle Isometrics in multiple positions

• Single Limb Stance:

• Controlled Arabesques

• 3 Way Planks

To name a few…

As great as this stability training is, it is solely a start in avoiding injury. Many times, dancers need the help of an outside specialist.

· Head To a Physical Therapist that Knows How to Treat Dancers

Not all Physical Therapists are equal!

Many people think that they should just find ANY therapist and that we can all treat everyone equally.

There is nothing that could be further from the truth. Not even all sports therapists are equal or can even think through how to treat a dancer.

As I mentioned earlier, dancers usually have too much motion and need to concentrate on stability and the quality of the movement. We very rarely need to stretch what the dancer thinks needs to be stretched, and need to stretch the thing the dancer doesn’t…which is the complete opposite of the general population—including most athletes.

Find a Physical Therapist that has experience with high level dancers. Someone who knows how to evaluate dance positions and each joint in each specific position, someone who speaks the same language of the dancer, and someone who understands that these athletes need to be treated as individuals.

Find a PT who can do these things for your dancer, and your dancer will be on stage sooner than you would have ever thought.

Dancers, parents, instructors, and the whole “rehab team” (physical therapists, Pilates instructors, massage therapists, etc.) all have to work together. This combined expertise will create a strong foundation to address and prevent injury risk factors.

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