‘The dance, just as the performance of the actor, is kinesthetic art, art of the muscle sense. The awareness of tension and relaxation within his own body, the sense of balance that distinguishes the proud stability of the vertical from the risky adventures of thrusting and falling – these are the tools of the dancer.’ (Rudolf Arnheim)

Dance is an art form which the body is the instrument of expression. In seeking optimal style and technique, dancers often exceed their capabilities, overstretching or abnormally loading the body’s tissue. These forces result in injuries such as muscle strain, joint and ligament sprains or even fractures and dislocations that may be temporary or permanent.

COMMON DANCE INJURIES
Common dance injuries and conditions dancers are susceptible to include:
• overuse injuries (often resulting from poor technique and/or training)
• sprains/strains, predominately affecting the knees and ankles
• shin splints
• muscle spasms, predominately of the hamstrings (back of thigh), calf and back
• dislocations, predominately affecting kneecaps and shoulders
• knee pain and meniscal injuries
• blisters on feet and toenail injuries
• impact injuries (bruises and contusions)
• dehydration and malnutrition.

Many dance forms, especially ballet, demand an unusual combination of extreme flexibility and motor control in addition to artistry. The use of ‘turn-out’ at the hip and dancing en pointe (on the tips of the toes) are good examples of elements required in dance that place unusual stress on the body. The practice of such techniques can therefore place the dancer at risk of sustaining various traumatic and overuse injuries different from those seen in the sports world.

Dancers commonly push their bodies to physical and anatomical limits. Human tissue is governed by the laws of mechanics. The most common forces affecting the human body are those produced by muscles and those occurring as a result of gravity, inertia and contact. When a force, such as a push, pull or twist, acts on an object, the force creates mechanical stress. This may cause tension or compression of tissue that may result in injury.

Localised tissue damage causes mechanical and chemical changes in the area. This is often followed by heat, redness, swelling and pain. Ignoring these early warning signs by continuing to dance can result in further damage to the tissue, increasing the severity of the injury and prolonging recovery time (and the return to dance activity).

It is often difficult for the dancer to know whether it is safe to continue dancing. Pain is associated with tissue damage or the probability that damage will occur. It serves as a warning sign for the body to withdraw from the painful stimulus, i.e. continued dancing, and therefore serves to protect the injured body part.

In general, pain that should not be ignored is pain associated with a traumatic injury, pain that recurs during dance activity, gets worse and is still apparent after the activity ceases, night pain, or any pain that you are worried about.
Delayed-onset muscle soreness that occurs 24 – 48 hours after unaccustomed bouts of intense dance activity may respond to continued gentle dance activity or gentle stretching, once you are warmed up.

TREATMENT OF DANCE INJURIES
Treatment from the time of injury up to 48/72 hours should consist of rest, ice, compression, elevation and diagnosis (RICED).

Rest. To protect the injured part from further injury, you should stop dancing immediately until a diagnosis is made. Avoid activities that stress the injured tissue.

Ice. To get the best physiological effect, ice should be applied immediately after the injury (within 5 – 10 minutes) and be kept on for 20 minutes. It should then be reapplied for 7 minutes every 30 – 60 minutes for the first 48 hours. Ice reduces swelling and bleeding, and also helps control muscle spasm and reduce pain.
Never apply ice directly to the skin, as this can cause an ice burn. Use an ice pack, frozen peas, ice cubes, or gel packs wrapped in a thin towel or through one layer of clothing.

Compression is used with ice to reduce swelling, e.g. by bandaging or maintaining pressure with your hand. The compression should be sufficient to limit the formation of swelling in the damaged tissue but not to compromise blood flow to the area. Always check the skin colour below the compression, e.g. for an ankle injury check toenail colour – the nail should go white if squeezed, but its normal pink colour should return in a few seconds if there is no compromise.

Elevation also reduces swelling and stops bleeding with the assistance of gravity.

Diagnosis. If the pain or swelling gets worse, or if you are unsure what the injury involves or how to manage it, always consult a medical professional such as a medical doctor or an osteopath for advice. In particular it is important to exclude serious damage such as a fracture, so seek qualified medical advice at the first sign of injury. Far too often dancers avoid health professionals until unbearable pain or loss of function drives them to seek medical help. Be prepared before an injury occurs, and make contact with an osteopath, orthopedic specialist or appropriately qualified physical therapist who has a background in dance and thoroughly understands the dancer’s profession.
After sustaining an injury, do not return to dance until rehabilitation is complete, even if the injury seems trivial. A complete recovery lessens the chances of re-injury.

‘There are three steps you have to complete to become a professional dancer: learn to dance, learn to perform, and learn how to cope with injuries.’ (D Gere)

PREVENTING INJURIES
It is important to realise that injuries can often be prevented. If you are fortunate enough never to have been sidelined by injury, a balanced musculature and awareness of your body can keep you that way. Many dance injuries can be prevented by increasing the level of awareness and knowledge among dancers, parents and instructors. If you have recovered from an injury, the following suggestions may help you avoid a recurrence.
• Work with a dance teacher who is knowledgeable about injury prevention, correct technique and training, and proper placement of children and adolescents into appropriate age groups, levels and styles of dance.
• An effective way to prevent overuse injuries is to complement your dance classes with exercises that strengthen and stretch muscles that aren’t developed by your dancing activity.
• Dancers can prevent injuries by cross-training with appropriate conditioning programmes such as Pilates, learning correct dance technique principles, and resting any previously injured areas.
• Osteopathic evaluation of any musculoskeletal weaknesses will help to correct muscle imbalances. A common muscular imbalance in dancers is in the legs. The quadriceps muscles (the ones at the front of the thigh) are often stronger than the hamstring muscles (at the back of the thigh), whereas they should be almost equal in strength. Advice will then be given on appropriate exercises to strengthen the hamstrings and stretch the quadriceps muscles.
• Warm up before class, rehearsal and performance even if you have already taken a class that day. Remember that the body has to be prepared for each activity.
• Cool down after each class, rehearsal and performance.
• Be aware of your moving postural alignment. Many dancers who have acceptable postural placement at the barre or in the exercises routinely performed at the beginning of dance class lose their alignment once they begin to move across the floor. This weakens the basic support of the body.
• Be as careful about your posture while walking and standing as you are when you are dancing. Avoid the ‘dancer’s walk’ in everyday gait. This walk is typified by turned-out feet, underslung (tucked under) hips, slumped shoulders, and a forward position of the head.
• Anyone who dances should ensure that they understand how a dance shoe functions, and how it must be fitted in order to function correctly.

One final plea – don’t forget to breathe correctly! Dance requires respiratory efficiency as well as elegance, and to achieve this efficiency a balance between thoracic and diaphragmatic breathing is important. So don’t overlook the importance of breathing in ensuring good health – and good dancing.