Over the years, it seems I get certain types of clients all at once. This summer, for instance, could easily have been renamed “The Summer of Sciatica,” with every new client coming in experiencing sciatic pain (when one of your referral sources is a doctor specializing in pain management, this happens). Needless to say, I brushed up on my sciatica knowledge and became quite adept at programming for this population, only to be greeted in the fall by an entirely different type of client, making September of 2014 “The Autumn of Dance.”
I have worked with the occasional former dancer in the past (“I did modern dance 20 years,” or “I did ballet when I was in high school in 1960”). This was entirely different. These were young women, all of whom had danced at a very high level in the not so distant past. While none were currently dancing professionally or collegiately, they moved with a level of grace and ease that was representative of their athletic background. They would listen or watch the movement description and repeat it, in this lovely way, often with really odd cheats that I had never seen before. It is easy to be foiled by this (“that is so pretty, do that again- wait, no, don’t do that again because you are using your back, not your hip, but that is really quite pretty”). They all had a history of injuries, and all wanted to get strong. Programming for this population required a different level of observation (seriously, amazing workaround), and an emphasis on motor control and stability. I also learned some things about dance related injuries and movements. The research regarding this topic is consistent with what I observed. For instance, a systematic review of the literature on dance related injuries by Jacobs et.al (2012) found a high incidence of lower limb injuries, hip and back injuries, patterns of hamstring injury affecting the tendon rather than muscle and a history of ankle sprain increasing likelihood of contralateral ankle sprain. Thomas and Tarr (2009), interviewed and surveyed 204 modern and contemporary dancers in the UK. 90 percent reported they were either currently injured or had experienced injury in the past, with the most common injury sites being the knees and low back. The dancers I began working with this fall had career ending foot injuries, back pain, and knee pain. Interestingly, the researchers point out that injury rates among dancers do not appear to be decreasing, even though injury prevention and healthy dancing is something that is currently being promoted in dance schools in the U.K. I suspect the reason for this is multi-faceted; I read an article recently about young dancers participating in dance year round, rather than taking a break in the summer. Any time a young person is filtered into year round sport (and while dance is artistic, the high level of performance required from dancers makes them athletes, at least in my eyes), the risk of overuse injuries is going to increase. Recovery, variable movement, and creative play are critical for all high level athletes looking for longevity, both in their sport and in their ability to move well later in life.
The one thing all of my dance clients had in common was difficulty differentiating movement. They moved beautifully on a global scale, but when asked to isolate a specific area, for instance, extend from the hip rather than the back, there was a moment’s pause. When you consider that low back pain appears to be an issue in dancers, this makes sense. Dancers create the illusion of lines and shapes using their entire body; there isn’t really a need for them to move just one area. I became creative at getting the glutes to fire, learning to use the wall to create feedback for RDL variations and contralateral reaching. I took the time to use activation exercises in the warm-ups, attempting to create stability (it is a thing to ask someone to reach a leg forward and watch the hip move seemingly out of the socket). I learned to watch my cueing, asking for small movements rather than large movement, teaching control over small ranges of motion and gradually working to bigger ranges of motion. Interestingly, the other thing these individuals all had in common was overactivity in the upper trapezius. My suspicion is this is the dance posture, that requirement to have shoulders back and head up. Obviously, stability needs to come from somewhere, so a disconnect in the anterior core coupled with the requirements of the activity might lend itself to this compensation. I tackled this with some diaphragmatic breathing and consistent cueing, relying on the dancer’s incredible body awareness to assist in acquiring alternative stabilization strategies. Roussel et.al (2014) examined the role of a 4 month strength and conditioning program on aerobic capacity, explosive strength, and pain in high level dancers. The conditioning program consisted of motor control, endurance, and strength training. At the end of the 4 months, there was little change in explosive strength and aerobic capacity in both the strength and conditioning group and the control group; however, there was a significant decrease in low back pain in the conditioning group. While I can’t speak to program design of this particular study (I could only find the abstract), this is again consistent with my experience with the dancers I am working with; motor control is an issue, and it seems incorporating some form of motor control/strength based training should be considered for the health of the dancer. It is easy for coaches and teachers to care about what is happening to the athlete/artist in the moment, but what about long term health? And what happens when the athletic career is cut short by an injury? This is an across the board problem in western athletics, and I hope we begin treating out athletes in a way that encourages not just short term success, but long term health.
Yours in health and wellness,
Jacobs, C.L., Hincapie, C.A., & Cassidy, J.D., (2012). Musculoskeletal injuries and pain in dancers: a systematic review update. Journal of Dance & Medical Science, 16(2), 74-84.Thomas, H., & Tarr, J., (2009). Dancers’ perceptions of pain and injury: positive and negative effects. Journal of Dance & Medical Science, 13(2), 51-59.Roussel, N.A., Vissers, D., Kuppens, K., Fransen, E., Truijen. S., Nijs, J., De Backer, W., (2014). Effect of a physical conditioning versus health promotion intervention in dancers: a randomized controlled trial. Manual Therapy, 2014 (Epub ahead of print).