The practice of dance, although it is established as an art form, presupposes a physical demand and a volume of training time that leads dancers to a strong exposure to the risk of musculoskeletal injury (especially from overload).
The trauma profile varies among different populations of dancers. Young people have pathology associated with growth cartilage; men are more prone to spine and shoulder pathology; while women have more stress fractures due to decreased bone mineral density and posterior ankle conflict (associated with practicing dance on spikes).
The following is a brief description of potentially disabling pathologies specific to pre-professional and professional level dancers:
ANCA:
Hip Bounce: Audible or palpable bouncing sensation. It consists of the friction of the iliotibial band or gluteus medius tendon on the greater trochanter; or it corresponds to the rebound of the psoas-iliac tendon on the pubic bone. It is usually not pathological, but intra-articular bounce that may be associated with paralabral cysts or free fragment fracture should be excluded.
Labrum injury: Degeneration or rupture of the cartilage that lines the acetabulum. Associated with femoroacetabular conflict. Long term contributes to osteoarthritis. Progressive onset pain, initially only on impact. May evolve to pain on external rotation of the hip and later to disabling pain on walking.
KNEE:
Patellar tendinopathy (jumper's knee): An inflammatory process, which may progress to degenerative, of the rotulian tendon, subjected to widely varying loads and tensile forces. The most common symptoms are sharp pain on the call of a jump or a stinging sensation distal to the kneecap during grand-plie or after a long period with the knee in flexion.
Meniscal rupture: Menisci are intra-articular cartilage structures of the knee that absorb 50% of load forces in the standing position. In athletes it is usually of traumatic cause, in the general population it is more often degenerative. The severity of the tear will depend on where it occurs, especially if it occurs in the innermost portion of the meniscus which is poorly vascularized and has little healing potential.
Osteochondroses (Osgood-Schlatter and Sinding Larsen Johansson): In children and adolescents there are growth cartilages at the peri-articular level, which are very sensitive to compression and traction forces because they are less resistant than the surrounding bone. In Osgood-Schlatter disease there is traction of the anterior tibial tuberosity, with associated inflammation and pain. In Sinding Larsen Johansson disease there is traction of the inferior pole of the patella by action of the rotulian ligament. It worsens with sports and jumping, and relieves with rest.
ANKLE AND FOOT:
Ankle sprain: The most common injury in dancers. The usual mechanism is plantar flexion with inversion of the foot. It can be a mild injury but can also be very serious with associated bone fracture or ligament injury. It can evolve into chronic tibio-tarsal instability.
Posterior tibio-calcaneal conflict: Inflammation and pain caused by repeated plantar flexion movements and the compression of anatomical structures and space conflict in the posterior ankle region. Sometimes leads to the formation of an accessory bone (the trigonum).
Stress fractures of the metatarsals: Frequent in overtraining from tip work and associated with low bone mineral density and energy restriction syndromes. They lead to prolonged stops of dance practice because rest is required for bone healing.
Sever's disease: Osteochondrosis of the growth cartilage of the calcaneal bone, in connection with traction of the Achilles tendon.
SPINE:
Spondylolysis: Fracture of the pars interarticularis - junction of the pedicles with the laminae and superior articular facet of the vertebrae. Low back pain that worsens with movement and improves with rest. Neurological signs or symptoms are rare. Typical in adolescents and associated with hyperextension movements of the trunk, with little control and muscle strength deficit.
Spondylolisthesis: Anterior or posterior slippage of one vertebral body over the adjacent one. Associated with jump training and also hyperextension of the trunk. If the slippage is greater than 25% it can cause instability of the spine.
For injury prevention, it is essential that dancers are accompanied by an interdisciplinary team. The most widespread sports injury prevention program is FIFA 11+ for soccer. It has been shown to reduce the incidence of muscle breakdowns, overall rate of lower limb injuries, and has also been shown to reduce work absenteeism. In 2022, Kolokythas et al. created Dance 11+. In addition to proprioceptive and flexibility training, muscle strengthening of the pelvic stabilizers, glutes, abdominals, lumbar paravertebrae, quadriceps, and hamstrings is recommended.
References
1. Smith PJ, Gerrie BJ, Varner KE, McCulloch PC, Lintner DM, Harris JD. Incidence and Prevalence of Musculoskeletal Injury in Ballet: A Systematic Review. Orthop J Sports Med. 2015 Jul 6;3(7):2325967115592621. doi: 10.1177/2325967115592621. PMID: 26673541; PMCID: PMC4622328.
2. Stracciolini, Andrea & Yin, Amy & Sugimoto, Dai. (2015). Etiology and body area of injuries in young female dancers presenting to sports medicine clinic: A comparison by age group. The Physician and sportsmedicine. 43. 1-6. 10.1080/00913847.2015.1076326.
3. Smith PJ, Gerrie BJ, Varner KE, McCulloch PC, Lintner DM, Harris JD. Incidence and Prevalence of Musculoskeletal Injury in Ballet: A Systematic Review. Orthop J Sports Med. 2015 Jul 6;3(7):2325967115592621. doi: 10.1177/2325967115592621. PMID: 26673541; PMCID: PMC4622328.
4. Mendes-Cunha S, Moita JP, Xarez L, Torres J. Dance-related musculoskeletal injury leading to forced time-loss in elite pre-professional dancers - a retrospective study. Phys Sportsmed. 2022 Oct 3:1-9. doi: 10.1080/00913847.2022.2129503. Epub ahead of print. PMID: 36166373.
5. Kolokythas, Nico PhD1,2,3; Metsios, George S. PhD1; Galloway, Shaun M. PhD1; Allen, Nick PhD3,4; Wyon, Matthew A. PhD1,4. 11+ Dance: A Neuromuscular Injury Prevention Exercise Program for Dancers. Strength and Conditioning Journal 44(5):p 1-9, October 2022. DOI: 10.1519/SSC.0000000000000692
