Important Considerations in the Care of Young Dancers

This article discusses the following:

  1. Various dance styles and their differences
  2. Dance injuries
  3. Challenges present in youth specialization in dance
  4. Injury prevention in the dance population

1

Ballet emphasizes the technical aspects of body alignment, flexibility and strength in an effort to appear weightless and free from restrictions. Ballet slippers provide a mechanism with which the dancer can present en pointe with the use of special box to encompass the toes.

Tap dancing applies rhythm and percussion through the use of a metal plate on the forefoot. The drumming of the feet were a reflection of the ability to communicate during the American slave era. Several styles developed such as classical, hoofing, and clogging. Steps include the brush, flap, shuffle and ball change.

Jazz developed out of the African dances in the early 20th century and incorporates some elements of ballet. Jazz steps include the jazz square, walk and layout. Shoes can have thin or thick soles, are often flexible and close fitting.

Modern dance encompasses a wide variety of new styles that attempted to eschew the rigid formality of ballet. Notable figures include Wigman, Graham, Hortan and Cunningham.

Contemporary and lyrical dance incorporates ball, jazz and modern techniques. Footwear can be non-existent or specific to a show.

Hip-hop developed in New York as a form of street-dancing and includes Old school and New school. Breaking, popping, locking are elements of the old school whereas krumping, jooking, and street jazz are elements of the new school. A cornerstone of both is the use of improvisation.

Irish step dancing can be described as holding a stiff upper body while the legs perform rapid and precise movements. Footwear includes soft shoes, or ghillies, that are black lace-up soft slippers. Hard shoes are similar to tap shoes without metal plates.

Ballroom dancing includes the waltz, tango, foxtrot, samba, cha-cha, rumba, jive, swing and mambo. The emphasis is on poise, posture, alignment, emotional expression, foot action and steps. Costume and footwear vary depending on the style.

Competitive dance can include any style of dance, may be performed as a solo or in groups. Shoes are usually choreographed and are unique to the competition structure. 

2

Dance injuries are on the rise, with an increase of 37.2% from 1991 to 2007. Female teenagers are more likely to be injured. The lower extremities are the most frequently injured body part. Falls and non-contact injuries accounted for nearly 70% of the type of injury. Thirty to seventy percent of preprofessional dancers sustain an injury within one year. The variability reported is due to a difference in how an injury is defined. Overuse injuries account for 55-88% of all injuries. Ballet students often report foot/ankle and lower leg injuries whereas multidisciplinary dancers more frequently sustained knee injuries. Break dancers experience a higher proportion of upper extremity injuries due to the use of the floor to produce movement. 

Lower extremity injuries specific to the dance population include ankle inversion sprains, metatarsalgia, Achilles tendinopathy, stress fractures of the second and third metatarsals, cuboid syndrome, posterior ankle impingement syndrome (os trigonum), flexor hallucis longus tendinopathy, sesamoiditis, sesamoid stress fracture, Feiberg necrosis, peroneal tendon subluxation and posterior talus osteochondritis dissecans. 

3

Youth sports specialization, wherein young athletes participate in a single sport, such as dance, at an early age and the exclusion of other types of sport, may predispose athletes to overuse injuries. The prevention of injuries requires attention to early warning signs and specific knowledge about the intrinsic and extrinsic factors that lead to injuries. The developing body requires a different approach to technical training, strength training, rest and coaching. Growth spurts can affect aesthetics and performance. This includes an increase in muscle tension (flexibility, strength), alteration in the center of gravity (balance) and kinesthetic awareness (coordination). Dance rehabilitation should consider the elements of the dance style, the dancers goals, and communication with the dance teacher and care takers. Activity modification, progressive return to sport and complimentary strength training programs will facilitate a safe and confident return to dance. The use of a mirror, recording and feedback from a professional (coach, therapist) will allow the dancer the opportunity to progress with qualitative bench marks. Cross-training may incorporate pool exercises, barre to deload the body. The choreographer and therapist can develop a plan to limit exposure to aggravating movements such as battement when experiencing hip pain or jumping when experiencing knee pain.  Another important element to consider is relearning proper movement patterns. Injuries can be precipitated by poor alignment, muscle imbalance, flexibility and coaching strategies. Relearning how to move after an injury can provide an advantageous atmosphere in regards to internal feedback and building of confidence. Compensatory movement strategies should be addressed and normal movement restored prior to a full return to sport. 

Other considerations include the female athlete triad or “relative energy deficiency in sport”. This includes a cluster of symptoms such menstrual irregularity and impaired bone health due to energy deficiency, or poor nutrition. By the age of 18 year, 90% of a woman’s bone mass is accrued. Poor dietary habits can lead to future complications including osteopenia, osteonecrosis and increased fracture risk. Dancers are often at higher risk due to the aesthetic nature of the sport. One study found that nearly one-third of dancers had disordered eating. This requires a multi-disciplinary approach of a primary care physician, sports medicine physician, physical therapist, sports dietician and psychologist. Disordered eating also limits a dancers ability to rebound from an injury due to lack of proper nutritional intake. Additional psychological stress may occur due to the time-based nature of preparing for a show on a specific date. Activity modification may seem catastrophic to a dancer. 

4

Injury prevention program can include a pre-season or pre-competition screen that may help identify movement disorders, flexibility limitations and strength deficits. Cardiovascular health is important as well. Studies of dancers have discovered that rehearsals may not provide a great enough stress to adequately prepare a dancer for the demands of a competition or a show. Cross-training may provide a a stimulus strong enough to prepare a dancer for an event. 

Conclusion: Primary prevention, in the form of preseason screenings, may help identify areas that require attention prior to an injury occuring. Secondary prevention requires a comprehensive approach to injury rehabilitation, understanding the unique demands of the different types of dance and the specific types of injuries sustained within the dance community. 

About Me

My name is Dr. Cory Abbate, I am a physical therapist in Miami, FL currently helping performers from all over the world while they rehearse at Royal Caribbean Studios in North Miami. These talented athletes are chosen from a select few performers that audition in England, Canada, Australia, Italy, Romania and the United States.

Dancers from all different backgrounds, professional handstanders, aerialist and acrobats as well as vocalists and contortionists come to Miami to learn the shows they perform on the cruise ships. If they are injured I facilitate their successful return to dance to continue on with their contracts and professional careers. 

I wrote these blogs to help you, the performer, develop and evolve your technique so you can show the world your talent.