To survive and ascend, a dancer must be self-analytical and self-critical virtually to a fault. For dancers, dance is more than an art; it is an all-consuming lifestyle. The aesthetic, the technique, the teachers, and perhaps most importantly, the dancer must constantly push to exceed, to overcome, to persist and to persevere. The love of dance and desire to dance are intrinsic to dancers of all levels and talent. Many have sacrificed so much just to have those few moments of pure movement where the physical price was no measure of the artistic reward.
The Role of The Individual
Athletes may initially respond to a recent injury with a negative outlook- the fear of losing their spot in the cast, the frustration of not being able to perform as well as they wish or feeling pressure from choreographers and cast members. This can effect the healing process.
If the problem lingers around for long enough, the chronic pain may be ignored, resulting in severe damage and maybe psychological distress.
Personality types, understanding of anatomy or an injury, coping skills and social support all play a dynamic role in the rehabilitation process. Often, the athletic culture of “pushing past the pain” or perhaps outright ignoring it may result in a “disruption of self”. This can have profound effects on the performers psyche, and ultimately, their capacity to perform.
When we speak of injuries in athletics, performers in particular tend to have a high level of fear of being replaced, losing potential income and often distrust traditional health care practitioners.
Takeaway: consider the individual, not just an “injury”
Old vs. New Thinking
An old way of understanding coping skills when injured is Kubler-Ross’ 5 stage theory: shock/denial, anger, bargaining, depression, acceptance. We’ve moved away from this linear model and focus instead on the circumstances surround the the athlete.
Personality type, locus of control (who is responsible for this injury?), hardiness (mental toughness), achievement motivation (how far are you willing to go?), external stressors (rehearsal process, finances) and coping resources (social support) must be considered.
The initial response is often a cognitive appraisal of the injury- what am I dealing with, what can I do, what can I not do?
Secondly to an emotional response- am I optimistic or pessimistic?
And finally a behavioral response- what actions need to be taken to resolved this issue?
First time injuries tend to be more stressful. Pessimism, fear and frustration often accompany even seemingly minor injuries.
Injury “veterans” have a bit of a different outlook- they may have a better understanding of their injury, how it will affect their performance and the steps needed to address their predicament. They tend to be less anxious & are able to “wrap their head around” the injury to continue on with dancing, albeit modified.
Athletes that sustain a more severe injury might experience greater levels of fatigue. This is perhaps due to the intense psychological effort spent on the injury- what it means to the performer, how their peers are affected by it and what it means to their dance career.
Like learning a new show or beginning a new exercise program, goal setting, taking the time to relax and positive self-talk can have a strong influence on the recovery process.
Respecting the constraints of human anatomy, tissue healing & the body to adapt and overcome all types of stress (physical, emotional, social) is the cornerstone for recovery. Having realistic expectations can be helpful to the athlete and support team.
Takeaway: a team approach to individual treatment must take into account all life factors
Psychological Impact of Dance Injury
A few studies have demonstrated that many dancers do not report their injuries to medical doctors. Nearly every dancer will experience at least one injury in their career, and about 2.5 on average. Lack of reporting was described as dancers not being confident in a medical doctors appreciation of dance culture; not understanding the performance curriculum, where taking 2 weeks may spell career suicide; lack of knowledge about what it is that dancers go through on a daily basis; and the physical demands of their chosen career.
The vast majority are overuse injuries, meaning the performer did too much too soon without adequate rest.
In the athletic community itself there seems to be a culture of tolerance which encourages dancers to push through the pain. If physical pain is not addressed, this may lead to psychological and emotional pain.
It is one thing to be gritty- to persevere through pain with proper support, and another to fail to address pain that can cripple.
Takeaway: athletes suffer from injuries, be proactive in treatment
Dancers may initially respond to injuries with fear, distress, anger & depression. This may be due to the relationships that surround the dance community: choreographers, parents and fellow cast members.
Injuries do not only affect the performer themselves- but this network of individuals that comprise the team.
Takeaway: everyone around the athlete is affected
Role of Pain
Dance releases a large amount of feel-good hormones in the body, suppressing the sensation of pain. Think of a time when you (or a cast member) were performing and fell. You (they) might not have experienced any pain at that moment, but when the adrenaline wore off an hour or so later, it came on like a tidal wave.
This natural pain-blocker is a good thing, but it can sometimes blunt the effect of properly dealing with injury. An understanding of pain & how our bodies react is important because it allows for an avenue of better coping skills. Dancers in particular have very specific injuries that are very prevalent in the performance community but not elsewhere. Pinching hip pain, clicking knees and aching ankles are just three of the very many injuries I treat as a physical therapist. Many dancers might choose to “just deal with it” because there are often 3 or 4 other performers in their cast that have these symptoms as well.
However, no two people, and thus injuries, are the same. A proper understanding of anatomy and the recovery process can be worlds of a difference between performers.
Takeaway: pain is more than just tissue damage and swelling (biology), it also includes mental attitudes (psychology) and peer support (society)
Want to learn more about pain? Read my article What is pain?
For dancers, their work is their dancing: it is a way of life that defines who the dancer is. Any barrier to self-expression and movement may be a threat to the dancers identity. Identity is the most examined personal factor in recovery from athletic injury. The more narrowly defined the sense of self, the more threatened the athlete will be by any challenge to identity. In the case of injury, the more an athletes self-self-identity is linked to his or her role as athlete, the more likely reactions to injury will be negative. A period of “restoring the self” after injury is a cornerstone of recovering from an injury.
Psychological Issues with Treatment
Even when dancers receive medical treatment, their fears and frustrations might not be addressed. Medical advice offered to performers is often: “take medicine and take two weeks off, then come and see me”. What might not be understood on the medical side are the myriad of consequences this can have. Dancers usually don’t have the luxury of taking 2 weeks off. There is no “off-season” when learning a new show.
Seeking medical advice from a practitioner that understands the demands of the performer can help steer appropriate treatment, bolster confidence, and improve relations with the dance community as a whole.
Takeaway: Not all medical professionals are the same, seek someone who understands you and the injury you’re suffering from
Stress, Injury & Social Support
Negative life stressors (family, relationships) can impact the onset & duration of injury as well as the number and severity of injuries in dance. In one study 24% of dancers accounted for nearly 50% of all the injuries sustained. They found that high social stress & low social support may increase risk and severity of injury. Even minor daily “hassles” can compound the effects of injury.
On the flip side, strong social support form peers, educators, dance companies, friends, choreographers, medical staff & family can facilitate a successful recovery.
Keeping the athlete active by offering an opportunity to help with choreography, record the performance or encouraging them in exercises can make a world of a difference. Acknowledging the emotional distress of “losing yourself” when injured can place the community on the “right side” of the athlete.
Takeaway: Support the athlete by acknowledging their point of view
Culture of Injury, Tolerance & Pain
While pain & injury may be a common occurrence in most athletes’ lives, the belief that outright ignoring an injury might not be the best approach.
Dancers in particular are very aware of their body image, weight and food intake. Inappropriate behaviors including eating less food to make up for lost time exercising or overtraining non-injured body parts may consume the athlete.
It is important to recognize these changes and address them accordingly. These behaviors can have a negative, spiraling effect on injury recovery. Improper nutrition and increasing the risk of additional injury.
Takeaway: injuries are often a part of an athletes career, attendance to influencing factors can make or break an athlete
There are many things that have not been written about in this article. Some things that health care providers always want to know more about so we can extend our hand to the dance community and provide the best possible treatment include the following:
- Personal experiences of dance injury
- Personality traits & experience of dance injury
- The bodies response to stress throughout the injury process
- Coping styles & strategies
- The dancers perception of pain & recovery
- How emotional reactions differ between acute & overuse injuries
- Proper social support
- Dance culture of injury/pain/tolerance
- Eating behaviors associated w/ injury
- Education & intervention strategies
And the Dance Goes On: Psychological Impact of Injury. Lynda M. Mainwaring, Ph.D., C.Psych., Donna Krasnow, M.S., and Gretchen Kerr, Ph.D. Journal of Dance Medicine & Science, Volume 5, Number 4, 2001.