Injury prevention for dancers

with advice from Elisabeth Wheeler, PT, DPT
Ann Cowlin, MA, CSM, CCE,
Mark Salandra, CSCS,
and Wayne Seeto, OT, MSPT

Injury prevention for dancers

Most dancers know that one of the challenges of the performing arts is to make it look easy, effortless – and painless. According to Elisabeth Wheeler, a physical therapist who works with dancers at Allegheny Chesapeake Physical Therapy in Pennsylvania, up to 90% of dancers will have an injury at some point during their training. So whether you are a professional dancer in a company, or one who takes classes for physical (and mental) activity, it is important to pay attention to your body in order to avoid injury.

Elisabeth notes that dancers can have a variety of injuries throughout the body:

A physical therapist can determine the causes of chronic pain and develop a treatment plan.Like any athlete, if a dancer begins to feel pain that does not go away after a day or two of rest, Elisabeth advises visiting a physical therapist to determine the cause of the pain. Physical therapy treatments may include strengthening or stretching exercises to address muscular imbalances; neuromuscular re-education during dance-specific movements; modalities, including ultrasound and moist heat; and manual treatments like joint mobilizations and massage. If physical therapy can’t eliminate the pain, she says, an x-ray or MRI may be necessary for a diagnosis, along with a trip to an orthopedic doctor for further advice and treatment, and possibly surgery.

A dancer’s body is her instrument. As such, it is vital to keep the body well-tuned at all times. Aside from regular dance classes and training, dancers should consider cross training to keep less-used muscles well-toned and to help avoid injury. A certified strength and conditioning specialist, Mark Salandra, the founder of StrengthCondition.com (a Physiquality partner), also reminds dancers of his mantra: Train hard, but rest harder. “It is only after your workout, when you are resting and replenishing your body with protein and other nutrients, when the body heals and gets stronger,” he says.

Given that dancers are prone to lower extremity injuries, as listed above, it is no surprise that Mark recommends exercises to strengthen the foot and ankle, knee and thigh, hip, and spine. Let’s take a look at training recommendations body part by body part:

Feet and ankles

Dancers require strength, flexibility, resilience and relaxation in their feet in order to offset impact, torsion and shear forces.Women’s health specialist and dancer Ann Cowlin agrees with Mark, pointing out the special needs of dancers’ feet: “Muscles and connective tissue controlling the area require strength, flexibility, resilience and relaxation to help offset impact, torsion and shear forces.” The creator of Dancing thru Pregnancy, one of Physiquality’s partner programs, Ann emphasizes strengthening the feet and ankles to avoid injury.

Mark notes that there are a variety of exercises for the feet; some of them can even be done while reading a book or watching TV. He particularly recommends this regimen created by the American Association of Orthopedic Surgeons. It includes the heel cord stretch (with and without a bent knee) to stretch the Achilles tendon; the golf ball roll, marble pickup and towel curls (to work the plantar fascia), calf raises (known to dancers as relevés); and two different exercises to improve range of motion in the ankle. (The regimen also includes a towel stretch to lengthen the calf, but unless the dancer has injured that muscle, most will not need a towel for the stretch.)

Knees

As the largest joint in the body, the knee absorbs a great deal of stress during movement. Strengthening the knee and its surrounding muscles, says Mark, will help to prevent injury. At home or the studio, dancers can do squats and lunges to strengthen the hamstrings and quadriceps. For dancers who go to the gym, Mark recommends such exercises as leg curls and leg extensions with exercise machines, and doing deadlifts and squats with light weights — and proper form. Some dancers, particularly those that do more modern forms that change direction more quickly than the more traditional, linear styles, may also benefit from programs developed to reduce ACL tears and injury.

Hips

A well-controlled, full range of movement is critical for healthy and aesthetically-pleasing movement.Wayne Seeto, along with Ann and Mark, points to the importance of strengthening the hip outside of class. Wayne, a Pilates Master Instructor Trainer and rehab specialist for MERRITHEW™ (another Physiquality partner program, notes that Pilates can be used for general strengthening, as well as rehabilitation after a dance injury. Whether on the reformer or a mat, he notes, Pilates movements can be used to improve both strength and flexibility at the same time. Dancers, he says, should focus on strengthening the glutes, and stabilizing and strengthening the local hip muscles to build proximal control. They can also use Pilates exercises to improve calf flexibility and increase control of the dorsiflexors in the ankle and foot, he adds.

Mark points out that the squats and lunges recommended for the knee and thigh can also strengthen the hip. Dancers can also benefit from the standing iliotibial stretch (which also benefits the knees and thighs), and the seated rotational stretch shown at the upper left. “A well-controlled, full range of movement is critical for healthy and aesthetically-pleasing movement,” adds Ann. She recommends a stretching program that she initially created for pregnant women, but found that dancers gained flexibility and movement from the exercises. The series works the inner and outer hip muscles and should loosen any tight muscles in the joint.

Back and shoulders

Mark also recommends strengthening the core and back to reduce spine injuries, which can range from simple lower back pain to serious issues, like herniated discs. Lower back exercises like bird dogs and Supermans, and core exercises like planks and crunches, can all contribute to a stronger core and less change for injury.

And even though injuries to the upper body are less common for dancers, it is important to strengthen the arms, and particularly the shoulders, to keep the shoulder joint stable during movement. Mark recommends such exercises as rows (with one arm and two), deadlifts and lat pull downs, while Ann points out that improving range of motion in the shoulder joint is key to reducing and avoiding injury.


Finally, Elisabeth reminds dancers to listen to their bodies and to rest regularly, particularly if they are feeling any pain. Dancers should be sure to include a proper warm-up and cool down, and only work or dance if they are pain-free. Don’t wait to address pain or other limiting symptoms, she advises, as chronic injuries are much more difficult to recover from!


Elisabeth Wheeler, PT, DPT
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Ann Cowlin, MA, CSM, CCE
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Mark Salandra, CSCS
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Wayne Seeto, OT, MSPT

Elisabeth Wheeler, PT, DPT, is a staff physical therapist at the Eastside office of Allegheny Chesapeake Physical Therapy, a Physiquality member with several locations in Pennsylvania. A ballroom dancer who particularly enjoys the tango, Elisabeth specializes in the treatment of performing artists, including musicians, dancers and actors. She also serves on the Bodiography Contemporary Ballet Board of Directors.

Ann Cowlin, MA, CSM, CCE, is the creator of Dancing thru Pregnancy, one of Physiquality’s partner programs. Ann is the author of Women’s Fitness Program Development, a guide to creating girls’ and women’s health and fitness programming, and is the expert consultant for the U.S. Army’s Pregnancy and Postpartum Train the Trainer Program.

Mark Salandra, CSCS, is the founder of StrengthCondition.com, another Physiquality partner program. Mark educates and trains athletes young and old in strength and conditioning, with the goals of better fitness and lower rates of injury.

Wayne Seeto, OT, MSPT, is a Master Instructor Trainer and Rehab Specialist for MERRITHEW™, a third Physiquality partner program. He is certified to teach MERRITHEW’s STOTT PILATES® Rehab program and is sought after internationally for private and professional instruction.


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For further reading, look through our selection of articles on dance, in addition to the below links:

Physiquality.

CATZ Needham Physical Therapy. CATZ home exercise: Sunshine and Superman. YouTube.com, September 14, 2014.

U.S. National Library of Medicine. Spondylolisthesis. Medline Plus, September 8, 2014.

Bursitis. Mayo Clinic, August 20, 2014.

American Academy of Orthopaedic Surgeons.

Steinberg Nili et al. Injuries in female dancers aged 8 to 16 years. Journal of Athletic Training, January-February 2013.

Cowlin, Ann. Release of the deep rotators: A non-invasive intervention for increasing range of motion. Yale University, 2012.

Gillanders, Robert for the American Physical Therapy Association. Physical therapy: Bird dog exercises. YouTube.com, January 3, 2011.

Berglund, Christine L., Laura E. Philipps and Sheyi Ojofeitimi. Flexor hallucis longus tendinitis among dancers. Orthopaedic Practice, May-June 2006.



The material and information contained on this Web site is for information only and is not intended to serve as medical advice or consultation.

Consult your personal physician before beginning any exercise program or self-treatment.