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No one likes to be injured. But how often does it really happen?


Research shows it happens probably more that you think.


Lets look at the stats, the why and what can be done about it.


A review of previous studies done on injuries is dancers (and dance teachers) found that among recreational dancers, 43% will become injured and as many as 86% of pre-professional dancers (those studying dance full time) will become injured.


The majority of these injuries are found to be caused by repetitive stress and affect the

  • Foot

  • Ankle

  • Shin

  • Knee

  • Lower Hip

So basically, anything below the waist!


What is repetitive stress?

Repetitive stress is damage caused to a bone, tendon, ligament or joint when movements are repeated over and over. It can occur when you are training too much, have a weakness due to previous injury or incorrect training or from incorrect technique. Examples include tendonitis, bursitis, stress fractures, shin splints or jumpers knee.


BUT ! The rates provided in the research might not tell us the whole picture.


In dance there appears to be what’s called an avoidance culture. Students avoid telling staff about any little niggle or injury in case they are held back a grade, miss out on a competition or are taken out of their dance concert. So, the figures quoted in most dance research based on injuries is probably missing a large chunk of data.


THIS IS NOT GOOD!!

We need to change the culture so that students are identifying things that aren’t quite right sooner rather than later. In most cases, it is much easier and quicker to recover from a little niggle than a full-blown injury. This needs to come:


1. From the dance students. Get to know your body and how it feels after class or rehearsal. If you begin to feel something different going on, talk to someone. Your parents / guardians, your teacher and / or your dance health professional.

2. From the dance teachers. In many cases there will be no need to take a student out of class, a concert piece or replaced in a competition, but this does involve a good recovery and rehabilitation plan to be discussed between the dance medicine professional and the dance teacher. Often, an injured dancer can still participate in many aspects of dance class and rehearsals.

3. From the health professionals. Non dance specific Physiotherapists, Doctors or Exercise Physiologists do not necessarily have the background in dance and therefore do not fully understand what a class or a rehearsal may look like. Without this information they are unable to fully advise how a rehabilitating dancer can participate. In many cases, these specialists will simply tell a dancer not to dance (at all) for X number of weeks. Resulting in frustration and sometimes non-compliance from students. Where possible, if you do need to go to a medical professional, try and find a dance specific or at least a sports specialist and work with them to ...


...Find out what you CAN do, not just what you CAN’T do.


So, what can we takeaway from all of this information?


1. Injuries are prevalent throughout the recreational and pre-professional world of dance. Don’t just assume it won’t happen to you.



2. Don’t avoid talking to your teacher or health professional if you have a little niggle. Get yourself looked at sooner rather than later.



3. Work with your health professional and dance teacher to incorporate what you can do in class and / or performance.




If you have any questions, or like me - believe that prevention is better than the cure, contact me for an initial consultation and take steps to becoming a stronger, safter and more informed dancer through Exercise Physiology. Go to www.dancewright.com.au for more information.



As a side note:

Despite all of the research we have access to, the article does say that there are not enough prospective studies (studies done during the time the dancer is injured, rather than relying on the dancer to relay the information after they are recovered). So, the dance medicine world has much work to do on clarifying the prevalence of injuries in dancers, . I would therefore encourage anyone involved in dance to participate in any relevant studies that may come your way. Just make sure the study is legitimate and ethical. If you have any doubts, please feel free to reach out to me and I can help you confirm if a study is legitimate.


References and Resources


Critchley M, Kenny SJ, Ritchie A, McKay CD. Injury rates and characteristics associated with participation in organized dance education: a systematic review. J Dance Med Sci. 2022;26(2):87-105.








One of the most exciting times for a young aspiring ballerina is the day when they go to get fitted for their first pointe shoe. I still remember mine vividly. But....


What determines readiness for pointe?


According to a 2022 Systematic Review (where the authors gather all the information from every research article they can find on one particular subject), many factors have been used to determine pointe readiness. These include:


· Age,

· Core, ankle & pelvic stability.

· Core, lower limb and ankle strength,

· Range of motion (ROM) or flexibility of the foot and ankle (90 – 100 degrees of plantar flexion),

· Balance,

· Lower limb alignment,

· Technique,

· Years of training (at least 2 years of ballet),

· Musculoskeletal maturation

· Stability and control when going up and down from pointe,

· Undertaking at least 2 other ballet classes per week.


...phew! That's a lot to consider.....


There is, however, no Universal screening protocol…!


This means that it is up the individual teacher to ensure that they are recommending their dancers be assessed by the appropriate health professional before commencing pointe classes.


Age


When looking at age, it is important to note that chronological age does not necessarily correlate with musculoskeletal / bone age. Growth plates become vulnerable to remodeling during puberty which may cause malformations and muscle growth may not keep up with bone growth resulting in changes in motor patterns, changing the way the dancer moves and / or balances. This may also result in higher rates of injury.


“The ankle is exposed to 12 – 13 times your body weight of force”


Due to the increased loads, if the gastrocnemius, soleus and flexor hallucis longus muscles are not strong enough to keep the ankle and foot stabilised, the risk of injury is increased.


Some of the injuries that may occur include:

· Posterior ankle impingement and ankle sprains

· Stress fractures (due to decreased ROM)

· Inflammation of the bursa where the Achilles tendon attaches and

· Inflammation at the small bones on the ball of the foot near the big toe (due to poor technique while wearing ill-fitting pointe shoes).


Picture from https://james-mccormack.com/advice-centre/posterior-ankle-impingement/

According to the 2022 review, some of the tests that have been used to date to determine pointe readiness include:


· Saute test,

· Airplane test,

· Topple test,

· Releve endurance,

· Isometric and isokinetic strength and

· Star excursion balance test – 3 directions.

Airplane test- Picture from IADMS Bulletin for Dancers and Teachers, Volume 6, Number 1, 2015 pg. 7

The review concludes by stating that there is a lack of research and statistical evidence confirming any conclusive testing protocols, indicating that more research is needed in this area.


Dancewright therefore recommends that dancers approaching the age and / or ballet level where they may be recommended to begin pointe engage in a pre-pointe readiness program. This would entail strength and conditioning for the areas mentioned above that will reduce the risk of injury and confirm pointe readiness upon a screening by a health professional such as a dance physiotherapist.


Some dance schools incorporate a pointe readiness class into their timetable which is a fantastic addition for young dancers, however not all schools are equipped, have the time or knowledge to provide this service. If your school does not have this type of program, it is highly recommended that dancers do not start pointe without a comprehensive review by an dance specific health professional such as a physiotherapist.


As an Exercise Physiologist, I am able to assess strength and weaknesses in your dancers’ body and prescribe a progressive exercise program for optimal preparation for pointe work. Sessions may be individual, group or a home exercise-based program and will soon be able to be claimed through Private Health Insurance (depending on level of cover). For more information, please go to www.dancewright.com.au and / or contact me here.


Source: Journal of Dance Medicine & Science, Volume 26, Number 4, December 2022, pp. 213-225(13)

Demi-pointe features in many dance types, (or even walking in high heels!) But most particularly in ballet. Before getting into point shoes, dancers use the single leg demi pointe position to turn, balance in various positions such as arabesques and the movement at the ankle and foot contributes to jumps.


A recent study done by Ishihara et al 2022 looked at the contributing factors to successful stability in the single leg demi-pointe position and confirmed some interesting findings. Through out the information below you may encounter some unfamiliar terms. Please see the pictures for clarification of names of bones or muscles you may not be familiar with. Feel free to message me if you want any clarification on any of the names or ideas below.


The demi pointe is a unique position as it requires your whole centre of gravity to shift onto a small base of support. Your ankle joint should plantar flex (point down) to its fullest position and the toe joints (specifically the metatarsophalangeal joint) will extend (point up) by 80 – 100 degrees.





The study found that the muscles that flex the toes (Flexor Digitorum Longus or FDL) and the big toe (Flexor Hallucis Longus or FHL) are important for stability and controlling the centre of pressure or support when on demi point. These muscles were also found to be stronger in dancers than those found in non-dancers.

In particular, the muscles that flex the toes assist with forward and backward sway. This is vital information to assist us when approaching balance improvement for steps or combinations involving a single leg demi-pointe position.


Additionally, strength in the FHL helps to reduce injury occurrence in dancers as it reduces the pressure on the metatarsal heads.

(Metatarsal heads are the ends of these green coloured bones closest to the toes)


In Summary…..

Essentially, the study found that dancers with stronger toe flexor strength and stronger FHL demonstrated better postural stability when standing in a single leg retire on demi pointe.


What does this mean for dancers?

If you find you wobble when holding an arabesque en demi- pointe or fall out of your pirouettes, you may want to try spending some time working on your toe flexor strength, particularly that of the FHL. Balance is more dynamic than you would think, with muscles such as the FHL and FDL adjusting constantly. See my previous Blog : Stability – Static or Dynamic? for more information.


Need some assistance with FHL and FDL exercises?

Contact Dancewright on 0493 536 222 or find details on the website www.dancewright.com.au to book in an initial session where your strength and balance can be assessed and addressed in your own individualised program.


References used for this Blog

Ishihara H, Maeda N, Komiya M, Toshiro T, Urabe Y. Investigation of the relationship between the morphology of the toe flexor muscles in ballet dancers and the postural stability during standing on demi-pointe: a cross-sectional study. J Dance Med Sci. 2022;26(4):205-12. https://doi.org/10.12678/1089-313X.121522a (Including picture of leg on demi-pointe)



Picture of foot bones - www.kenhub.com




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