From the poise of pointe ballet, to the elegant flow of ballroom dance, to the strength of break-dancers — these incredible athletes seamlessly fuse balance, endurance and control to create effortless movement.
Dancers embody grace, strength and power. Like all other athletes, dancers put their bodies through physical and enduring tasks, so they are prone to certain injuries. Dancers, parents and coaches should know as much as possible to prevent or manage these injuries.
Regardless of the type and extent of the injury, my end goal is always to return the dancer to performance at their absolute best. For dancers, overuse injury is an unfortunate but common happenstance.
The physical demand involved with dance can take a toll on an athlete. Overtraining, overuse, or athletic burnout have all been used synonymously to describe the buildup of both training and/or non-training stress that can negatively impact long-term performance. Between conditioning, rehearsals, performances, competition and everyday life, dancers may risk injury without proper preventative knowledge.
Although by no means comprehensive, here are some common injuries I’ve seen in dancers.
Lumbar stress fractures
Lumbar vertebrae run down the lower back, and two diagnoses are common causes of lower back pain in children and adolescents: spondylolysis and spondylolisthesis. The repeated stress that dancing puts on this part of your spine can cause the outer part of the vertebrae to crack and/or break apart slightly. Dancers have an increased joint range of motion and typically perform with an extended, or arched, back, creating stress through their lumbar spine.
Snapping Hip Syndrome
Just like the name, this common condition among dancers and young athletes is characterized by a snapping sensation caused by the motion of muscles and tendons over bony structures surrounding the hip joint. While it can sometimes be felt on the outside of the hip, the most common form is felt over the front of the hip. This snapping is often described as the eerie feeling of the hip coming “out of place” and is often accompanied by pain, swelling and difficulty with everyday activities like walking.
A very common overuse injury, this can cause knee pain in dancers and young athletes. It is usually described by patients as vague pain around the knee or behind the knee cap. Patellofemoral pain involves biomechanical changes in normal alignment of the patella (kneecap) with several root causes, including increased joint overload (jumping, lunges, squats), patellar hypermobility, strength imbalance of the quadricep muscles, tight hamstring muscles, hip stabilizer muscle (gluteal muscles) inhibition/dysfunction, or even poor foot support.
Stress injuries and fractures are common overuse injuries. An analogy I use with my patients is to imagine a paperclip. If I were to continually bend a paperclip, eventually it would break. Like a paperclip, if the tibia or fibula (the two bones of the lower leg) receive enough mechanical stress, either could eventually fracture.
The point at which a paperclip is about to break is like a stress injury — where the bone is weak and susceptible to fracture. Stress injuries can occur in the leg, lower back or foot. However, fifth metatarsal shaft fractures, also known as “dancer’s fracture,” is most common among dancers. The primary symptoms are pain in the front of the foot that worsens with weightbearing or activities. Pain over the outside of the foot can also occur at rest and awaken some at night because of discomfort. Because the outside of the foot functions as a lever for push-off when walking or jumping, the repeated movement leaves dancers susceptible to injury at this location.
Dancers will commonly find themselves on the ball of their foot while performing, regardless their dance style – lyrical, hip-hop, jazz, and more. With the toe pointed like this, the ankle is in its most unstable and vulnerable position. When the toe is pointed, the ankle has the least amount of bone on bone contact within the joint. Only three smaller ligaments on the outside of the ankle prevent it from “rolling,” or causing a sprain. While this can seem minor, without proper care, a nuisance can become much worse. Re-injury of the ankle is a big concern as proprioception – awareness of the joint position and its relation with body movement – is disrupted.
How do I know if pain is from an injury vs. normal soreness?
Dancers should be aware of an actual injury versus normal soreness when they notice persistent pain. An athlete may need to remove themselves from practice or conditioning due to the pain.
An athlete with an injury may find even routine workouts difficult, or have to modify their body mechanics to compensate for pain. Despite conservative treatments including rest, ice, compression, elevation or even over-the-counter anti-inflammatory medications, an actual injury may continue to linger. A warning symptom that dancers, coaches and parents should be aware of is pain at-rest or pain that awakens an athlete from sleep.
Who should I see if I am concerned with an injury?
If pain persists despite conservative treatment and allowing ample time to recover, there are multiple avenues to initially evaluate an injury.
An orthopedic clinic with specialty in sports medicine is a wise place to start. After a formal history and physical examination, a sports medicine physician may recommend further diagnostic imaging such as an X-ray, an ultrasound, or possibly an MRI. The sports medicine physician will work with the athlete to create an individualized plan to return them to their sport or activity in the safest and soonest fashion possible.
Dr. Abcejo is a fellowship-trained primary care orthopedic physician who joined OrthoNebraska in 2020. He provides personalized and compassionate treatment for sports and orthopedic injuries. Learn more at orthonebraska.com.