Sen Cap Research Paper

Daniel Quinn
SMS 459.01 – Senior Capstone
Research Paper

Dancers use their body to illustrate music, combining athleticism with artistry. A highly demanding dance environment could possibly spell out a career ending injury for a dancer attempting to push themselves to their limits. From under stretching to over use, injuries are a common factor in dance. What are the most common dancer injuries, and how do they occur?
Injuries are difficult for dancers to avoid, if one would even consider it avoidable.
"Anatomic alignment, poor training, technical errors, unfamiliar choreography or style, and environmental factors including flooring surfaces and theater temperature have been implicated as contributing factors to dance injuries. (Kadel 2)" An injury in dance seems to be inevitable. Although, taking proper precautions will help decrease the odds of an injury occurring, as well as the severity of the injury.
Dancing on pointe, a beautiful form of ballet from the audiences' perspective, however, the physical strains on the dancers toes and ankles are highly significant. Females who practice pointe apply their full weight to the tips of their toes, which are supported by the toe box of the pointe slipper. "The stability observed in the pointe shoe demonstrated that the shoe and the closed pack position of the foot in the pointe shoe, share in the remaining 70% to 80% of the load. This supports the hypothesis that the shoe acts as an additional major stabilizer of the foot on pointe. (Kadel 3)" Pointe shoes are initially very hard, but with heavy use the toe box becomes worn down and soft rather quickly, when this occurs dancers are especially at risk for injury. "Pointe Shoes that have been fitted incorrectly will accelerate issues with calluses, blisters, toenail trauma and, inevitably, bunions and hammertoes. Many dancers without properly fitted shoes will resort to stuffing various padding items into the shoe in attempting to adjust the fit, often making matters worse. (Weiss)" Issues such as loose or tight fitting dance shoes are often pushed aside, even though they pose a risk for all pointe dancers. One of the most common injuries in point dancers is called Hallux Valgus otherwise known as bunions. Bunions can occur when practicing improper technique as well as when shoes are fit too tight or the toe box is too narrow. "Hallux valgus is an overuse injury which occurs when the big toe starts to deviate at an angle toward the second toe. As this angle increases, a bump may begin to form at the joint; this bump is called a bunion. (Steinberg)" Bunions may have to be removed surgically, which is not advised to dancers whose careers are still fully active, as surgery can effect one's full range of motion. If surgery is required immediately then the dancer would be looking at a lot of time off of their feet, otherwise, surgery is saved for retired dancers.
Ballet requires many small or emphasized repetitive movements; where as modern calls for more abstract movements, with many intricate shapes and arm motions. "A high incidence of shoulder injuries was observed among collegiate modern dance students. Study findings suggest that upper extremity strength and endurance measurements should be included in pre-participation physical screening protocols for dancers. (Sides 3)" Dancers know they need to strengthen their legs to better their dance performance, the arms and shoulders cannot be forgotten. While for many male dancers this is not as prevalent of an issue, due to training for lifts as well as natural body strength. Female dancers may neglect working their upper body due to the amount of time and concentration they put towards their lower body. Modern dance companies typically have fewer dancers and smaller budgets than ballet companies, this being the case, any injuries would have quite a hindrance on the company's ability to function fully. "Modern dancers are prone to musculoskeletal injuries. Many companies do not have the financial means to provide their dancers with adequate health insurance, Workers' Compensation, or a comprehensive intervention program. (Fuhrmann 532)"

Flexor Hallucis Longus (FHL) Tendonopathy or Tendonitis continues to hold the place as the most common injury throughout all types of dance. This occurs through constant point and flexing of the foot leading to irritation and inflammation of the tendon. The FHL tendon is basically the Achilles tendon of the foot, meaning it's the most crucial tendon in foot activity. Specifically for dancers the FHL is used for jumping and takes on pressure while turning. Tendonitis occurs most commonly in ballet due to the amount of repetitive movements. The FHL can become irritated when transferring from a plié to a relevé position; it can produce force up to 10 times the dancers body weight.
A recent study performed by Dr. Hershkovitz includes young dancers aged from 8-16. "Of the 1336 dancers examined, 42.6% manifested an injury during their screening. The prevalence of injured girls increased significantly from age 8 to age 16 years. In the 8-year-old cohort 1 in 10 girls experienced an injury, whereas in the 16-year-old cohort every third girl sustained an injury. (Steinberg)" Dancers have an increased amount of pressure to push themselves the further they get into their career. Injuries are unavoidable, just as the body feels pressure when applied, an injury will occur in all dancers, the degree of this injury all relies on the treatment during the healing process.

Injuries in dance may seem to be completely unavoidable, however this is not the case. With proper education a dancer can practice more discretion when stretching and pushing themselves to the limit. A dancer cannot learn what will help them most by simply going online, or even by spending countless hours researching injuries. The best way for a dancer to prevent their own injuries from occurring is to regularly visit their health care provider. "It is critically important for health-care providers to be integrally involved in all aspects of dance medicine to identify predisposing conditions, manage and treat existing injuries, and provide rehabilitation for both acute and chronic conditions to facilitate an optimal outcome. (Peer 46)" The last thing a dancer wants to hear is that they need to be off of their feet for a couple of weeks, this could leave a huge setback in their ability to keep up with the other in their class or production. If a dancer ignores their health care providers instructions they are instantly putting themselves at risk for a more severe or possible career-ending injury. "Dance athletes often rely on self-care techniques that they learned as they progressed through the dance ranks to treat injuries. (Peer 47)" This includes wrapping of the feet and or toes to reduce pain, as well as simply over-wearing a knee brace to reduce soreness. Dancers often have the idea that they know their body the best, when dancing this may be the case, however when experiencing injuries dancer must accept that they do not know their body best and the physician's word is final.
Younger dancers, most often in their twenties, are most likely to avoid surgery on an injured problem area because of the amount of setback they would experience. "They may be living alone and taking sole responsibility of themselves for the first time, while learning balance in their lives in a highly competitive environment." (McGuire) Cutting corners and skipping physical therapy may seem to make the young dancers life less hectic, however these are the factors that can lead to injuries. An article by Kathleen McGuire published in Dance Magazine brings up an interesting solution for injuries. Instead of viewing the injuries as a setback, one should thing of the healing process as a time of learning and listening to the body. "Remedies in response to a specific injury – a sprain, tear, or spasm – often address only the emergency. The focus is on the part rather than the whole. I've found excellent often startling results with therapies that take into account the whole system of the body, not just the site of the trauma. Here, the 'why' of the injury may be found. (McGuire)" The time of healing is a delicate process that takes very much time and patience, with proper attention a dancer can utilize this time to figure out what caused this injury and what can be done differently to prevent it.
A common cause of many dancer injuries is they way a dancer executes their landing, however even with a perfectly executed landing a dancer is still at risk for an injury. Improperly built dance floors can affect the amount of mass pushing on a certain problem area, commonly distal from the knees. Manufactured dance floors have the same characteristics as volleyball and basketball courts, however there are no issued "required standards" for dance floors. Dancers can feel the difference in their weight distribution while moving on various different floors. A dance floor with no springs can affect ankle joint stress during movement. Orthopedic surgeon, Dr. Boni Rietveld states, "In my opinion, a dance floor should be neither too supple nor too soft. A hard floor has the effect of causing serious return shock waves and can bring about injuries or premature wear in the cartilage. A soft floor causes the muscles, and therefore the tendons, to work harder. Additionally, a floor that is too soft can be dangerous for dancers because of the effect of surprise. (Rietveld)" The effect of surprise on a dancers body will always lead to injury, dancer bodies don't like surprises, especially dancing on many different types of floors. This is most often seen in dance companies on tour performing on multipurpose surfaces and stages. This causes injury due to shock absorption, or how much "give" a dance floor has. "A 'good' dance floor will have a shock absorption value of at least 53%. This means that the floor will absorb a minimum of 53% of the impact energy of a person landing on the floor, while the remaining 47% is absorbed by the person on landing. A concrete floor has a shock absorption value of 0%, leaving the full 100% shock of impact to jar the person landing. (Roach)" Dancers have the ability to feel the amount of force a dance floor is putting on their body, hence the common preference to practice in an actual studio rather a room with wooden floors or a gymnasium. The best way to prevent dance floor related injuries is for the dancer to pay close attention to their weight distribution on certain dance floors, and refrain from dancing on floors not specifically built for dance. When a dancer must perform on a substandard floor the best way to prevent injury would to simply practice more discretion and be careful when executing hard landings.
Dancing en pointe is an important skill for many ballet dancers, however it is imperative that a dancer does not begin training pointe at a young age. "Dancers who begin pointe before the age of twelve have significantly more hip problems and tendinitis than those who start at a later age. After four years of ballet classes, you may be strong enough for toe. But why risk it at your age? In Russia, dance medicine specialists advise students to wait until age fourteen to go on pointe in order to prevent injuries." (Hamilton) In many dance studios it can be common for young ballet dancers to want to pursue training in pointe, especially being exposed to the older girls dancing. There is no set age distinguished as "old enough for pointe" it is basically up to the studio to decide how young is too young. The bones and muscles in the foot are not physically finished growing until at least the age of nine. Mr. Justin Howse, Consultant Orthopaedic Surgeon to the Royal Ballet Schools and the Royal Academy of Dancing makes an interesting point. He says, "the only factor which matters is the state of development of the child, and to be dogmatic about an age does not make any reference to the child's maturity or immaturity. (Weiss)" In other words, deciding when to start point classes is not so much a question of what age, as it is about where the individual dancer is in their training. A younger dancer who has been practicing ballet their whole life will be much more prepared to take on pointe classes. However, one cannot simply rule out the factor of age, due to bone growth and development beginning pointe work at any age before eleven would be detrimental to the dancers health, making them more prone to injuries. "George Balanchine, master of choreography on pointe, has been credited with having created the 'baby ballerina.' He is reported to have said that there is no reason to get a young dancer up on full pointe if she cannot do anything when she gets there. (Weiss)" Pointe work requires very specific skills, and full leg strength, as well as enough balance. Basically there can be no set age for all girls to be fully developed and able to perform point work. The average issued age, eleven or twelve, is simply a ballpark estimate, and is impossible to apply to everyone as a norm. "Are all girls at the same stage of development at age 12…No. There may be significant differences in girls' physiologic development, depending on the onset and tempo of puberty. A knowledge of statistical averages is not accurately predictive, as chronological age does not necessarily correlate with bone age. (Weiss) When a little girl, who is simply too young for pointe, poses the question "When can I start pointe classes?" the only logical answer is, when your body is ready for it. There should be no rush to train in pointe, due to the fact that it is a style of dance that requires extremely slow and gradual training. An instance where a dancer may be in a hurry to learn point could possibly be a young girl excited to move up in her skill level, or a mother or teacher pushing their children to be the best. Both of these situations can be completely unhealthy for a dancers body. "The potential dangers to the child from being placed on pointe before she is ready have less to do with actual bone or joint damage, although these are real, than with inadequate range of motion, strength and stability. These factors may cause undue stress on the leg, pelvic girdle, and trunk. (Weiss)" When a teacher sends her nine year olds out to be fitted for pointe shoes, one cannot begin assuming that they are trying to abuse the little girls, as much as they are ignorant to the fact that there is a time in these girls lives when they will be ideally fit for this style of dance. The teacher most likely needs to be educated more in the health risks beginning point too early can cause, as well as how to efficiently evaluate students. A teacher must pay close attention to any of their students who wish to train in pointe, some bodies have certain alignments and health hazards that make it so they may never be able to train in pointe. A teacher cannot be afraid to deliver this news to a student, as much as it may break their heart that they won't be able to pursue a type of dance they love, in the long run they'll be happy they aren't experiencing the repercussions of beginning pointe too early.









Works Cited

Hamilton, Linda. "Advice For Dancers." Dance Magazine 72.2 (1998): 32. Academic Search Premier. Web. 7 Nov. 2013.

Sides, Summer N., Jatin P. Ambegaonkar, and Shane V. Caswell. "High Incidence Of Shoulder Injuries In Collegiate Modern Dance Students." Athletic Therapy Today 14.4 (2009): 43-46. Academic Search Premier. Web. 7 Nov. 2013.

Peer, Kim, and Karlene Dubois. "Preventing Dance Injuries, Part I: Biomechanical And Physiological Factors." Athletic Therapy Today 9.6 (2004): 60-62. Academic Search Premier. Web. 7 Nov. 2013.

Fuhrmann, Tracy, et al. "Injury Prevention For Modern Dancers: A Pilot Study Of An Educational Intervention." Journal Of Community Health 35.5 (2010): 527-533. Academic Search Premier. Web. 7 Nov. 2013.

McGuire, Kathleen. "Listening To Your Body." Dance Magazine 86.7 (2012): 30-34. Academic Search Premier. Web. 7 Nov. 2013.

Steinberg, Nili, et al. "Extrinsic And Intrinsic Risk Factors Associated With Injuries In Young Dancers Aged 8–16 Years." Journal Of Sports Sciences 30.5 (2012): 485-495. Academic Search Premier. Web. 7 Nov. 2013.

Rietveld, A. "Dancers' And Musicians' Injuries." Clinical Rheumatology 32.4 (2013): 425-434. Academic Search Premier. Web. 7 Nov. 2013

Roach, D. "Dance Floor Research." The Latest Dance Floor Research. N.p., n.d. Web. 07 Nov. 2013.

Kadel, Nancy J. "Foot and Ankle Injuries in Dance." Department of Orthopaedics and Sports Medicine. N.p., n.d. Web. 7 Nov. 2013.