performs involve positions requiring ex- tremes of fl exibility, repetitively challenging the limits of power and endurance. Historically, even at the heights of their careers, dancers did not train their aerobic power,muscular strength ormuscular bal- ance adequately, electing for a dance-only training regiment1 . This was a refl ection of the misconception that exercise training, which is not directly related to dance, may diminish esthetic appearance. Recent data from studies done with dancers has changed this traditional ap- proach to training. Supplementary exercise training has been shown to contribute to improvements in fi tness parameters that not only increase performance, but reduce incidence of injury, without interfering with artistic or esthetic requirements1 . Fur- thermore, research on the effect of different modes of activity, and forms of prepara- tion, on strength and muscle contractile characteristics show no differences in per- formance between professional dancers, Olympic bobsledders or Olympic rowers1 In consideration of neuromuscular, psy- . chometric, and environmental parameters some researchers rank ballet just behind football as the overall most demanding activity2 . It is interesting to note that lac- tic acid blood levels have been reported to reach 10 mmol/L during a choreographed dance solo, which is comparable to what top-class football, squash and hockey play- ers achieve during a game1 . INJURIES IN DANCE As in other sports, levels of physical fitness, particularly strength, can contribute to the development of injuries in dancers. Re- searchers have demonstrated that dancers with low thigh strength levels had a greater degree of injury in the lower extremity. Similar results were also evident when the hamstrings were disproportionately weaker than the quadriceps, among dancers1 As a matter of fact, an entire recent issue . of Clinics in Sports Medicine was devoted to injuries of the lower leg and feet in danc- ers.The demanding nature of dance results in a lifetime injury incidence of up to 90 per cent with 30-50 per cent of dancers being injured in a given year, with a previ- ous injury recognized as a significant risk factor1,2,3,4 . The most common injury is in the foot/ankle (53 per cent), followed by the hip (21.6 per cent), the knee (16.1 per cent), and the back (9.4 per cent)5 general, dancers experience lower extremity . www.canadianchiropractor.ca In CONSIDERING CAUSE AND CONTEXT OF THE INJURY In general, dancers can suffer from a myriad of athletic injuries due to the extreme de- mands and repetitive nature of their moves. Overuse tendon injuries associated with improper technique are most common; however, pathologies of the bones and liga- ments must also be ruled out6 . I cannot overstate the importance of assessing dance injuries not in isolation, but rather through tracing the cause of the injury. Intrinsic anatomic misalignment or extrinsic poor form, technique or training regime must be considered. Another aspect of physical perfor- mance to be considered with dancers is overtraining or burnout. Most dancers participate in shows that can be year- round undertakings, and if starring in a production like Dirty Dancing, the same choreography is performed every night throughout the production’s run. Over- training in dancers is not related to the energy cost itself, rather to the sheer number of stage performances. Inciden- tally, a three-to-four-week rest period af- ter the end of a demanding run of shows has been linked to a return to normal Common Overuse Injuries Metatarsalgia Plantar fasciosis Tibialis posterior dysfunction Ankle instability Peroneal tendonosis Patellar tendonosis Iliotibial band syndrome Hamstring tendonosis Hip fl exor tendonopathy Sacroiliac dysfunction Lumbar and cervical facet irritation/syndrome Rotator cuff tendonopathies Lateral and medial epicondylosis • • • • • • • • • • • • • CANADIAN CHIROPRACTOR | JUNE 2008 • 9 injuries during diffi cult jumps, specifi cally landing. However, male dancers can also be prone to injuries in the upper extremities, or back, due to lifting manoeuvres. CHIROPRACTORS STEP UP As anyone can imagine, treating dance inju- ries can often be challenging. In my experi- ence, dancers often have unusual difficul- ties related to specific movement patterns necessary to perform their routines. My understanding of movement patterns, bio- mechanics and functional anatomy helps guide me in finding the true cause of their disability, particularly with respect to over- use injuries. Of course, a complete history which includes a description of the mecha- nism of injury, aggravating factors and a careful physical examination is necessary for an accurate diagnosis, treatment, and advice on return to performance. fi tness-related parameters in all athletes, including dancers2 . My experience, through working with athletes from various sports – particu- larly the cast of Dirty Dancing – is that elite competitors and performers are very much in touch with their bodies. Although some neglect their acute inju- ries, when they do have an injury that affects performance, they typically have an understanding of how or why it may have occurred. By carefully listening to the history of the injury, and systemati- cally analyzing the biomechanical and anatomical function of the injured area, the underlying cause can be identifi ed. Treatment to reduce the acute symp- toms, minimize residual effects, prevent re-injury and ultimately decrease lost performance time is the end goal. A combination of maintaining, or en- hancing, physical fi tness, and treating the causes of injuries before they prog- ress to full-blown debilitating situations is the best way to ensure the performers of Broadway productions such as Dirty Dancing keep “having the time of their lives.” • For article with references please go to www.canadianchiropractor.ca. Factors That Relate to Dance Injuries Intrinsic risk factors include anatomical characteristics, biomechanical imbalance, past medical history, and dance experience. Extrinsic risk factors include improper training, faulty technique, fatigue, stress, diet, fl ooring and footwear.
Chiropractic + Naturopathic Doctor June 2008: Page 9
