Dancer-Related Injuries- An Overview
Probably the most common dance injuries that dancers will have are to their feet. This would make sense because the feet are the most over-worked and over-used part of the dancer's body and while injuries can not be prevented, there are a few things that we can do to speed up the healing process or cure. Knowledge is always the key, and it is important to recognize the problem when it occurs and begin effective treatment immediately.
Bunions:
Bunions are caused by excessive pressure placed on the joint of the big toe causing the toe to shift. Calcium deposits form at this point of stress and can often be very painful. Bunions are often part of ones genetic inheritance and may occur simply because of the shape of the foot that you were born with. Expertly fitted pointe shoes and good flat street shoes will go a long way to help with this condition. Also soft silicone wedges placed between the toes will help alleviate some of the pressure on the toe joint.
Blisters:
When the skin of the toes and the shoe constantly rub against each other a blister will form to protect the toe. Once a blister has formed the area will need to be drained, sterilized and kept as dry as possible to stop an infection forming. Taping the toes individually and wearing tights will go a long way to help prevent blisters from forming as will good foot hygiene, keeping the feet and shoes as dry as possible and well fitted ballet shoes.
Shin Splints:
Shin splints also known as "medial tibial stress syndrome (MTSS)", is a catchall term that indicates pain in the anterior part of the shin. Conditions such as stress fractures, muscle strains, and chronic anterior compartment syndromes have all been termed shin splints. Shin splints account for approximately 60% of all conditions that cause pain in dancer's legs.
There are many possible causes for shin splints. Among the least frequently encountered causes of shin splints are alignment problems, a tight heel cord, a hypermobile pronated foot, or a forefoot supination. Weak leg muscles are one of the most common causes of shin splints as well as improper footwear (shoes with little or no support for the heels and ankle region). For this reason it makes logical sense that dancers would be common sufferers from shin splints since almost all of their footwear is made entirely of cloth and provides virtually none of the necessary support needed to prevent shin splints.
Shin splints can also be caused by continuously overworking a muscle group in the lower leg. Repeated jumps are a good example of repeated micro-trauma that could potentially lead to shin splints.
Running or conducting repeated movements on hard surfaces is also a further factor that influences the likelihood of shin splints. Since many dance classes and performances often take place on hard dance floors with relatively no spring in them, it is again made clear as to why dancers are at an especially high risk for this injury.
Despite the prevalence of shin splints among dancers, they can be prevented. The first step of prevention for dancers is to work correctly, with correct alignment and correct technique. Always ensure that the turnout is originating from the hip and not forced from the knee, ankle or foot. Having a qualified instructor that actively gives corrections is one way to make sure that this necessary precaution is taken.
Dancing on a sprung dance floor (one that has a small amount of "give" in it) is also another prevention that should be taken wherever possible because it reduces the amount of impact on the muscles and bones of the lower leg. A further preventative measure is to wear supportive footwear when possible (for example gels in the heels of the ballet shoes), and make sure that the muscles in the legs are built up gradually so that they are strong enough to handle larger jumps and leaps when they present themselves.
Despite heeding necessary precautions, shin splints can still occur, and when they do, they produce pain. There are four grades of pain can be attributed to shin splints.
Grade 1, the first level, refers to pain that occurs after athletic activity.
Grade 2, the second level, refers to pain that occurs before and after activity but does not affect performance.
Grade 3, a semi-severe level, refers to pain that occurs before, during, and after athletic activity and affects performance.
Grade 4, the most severe level of shin splint pain, refers to pain that is so severe that performance is impossible. No matter what level pain a sufferer has, there are some medical precautions that should be taken.
Activity modification along with measures to maintain cardiovascular fitness should be set in place immediately. For dancers, activities that don't involve large amounts of jumping and leaping (such as only the barre portion of class or even a floor barre) are both good ways to maintain fitness levels while preventing further injury. Icing shin splints directly for five minutes after activity is also helpful.
Keeping an injury cool reduces swelling and inflammation. When the pain is at least Grade 3 or above, referral to a physician to rule out the possibility of stress fractures via the use of bone scans and x-rays should be completed. For dancers, wearing a brace around the foot may help fix the problem of improper footwear; and having an instructor check alignment and technique to ensure proper movement can also help to correct the problem and prevent the re-occurrence of shin splints in the future.
Plantar Fasciitis:
The next most common dance injury that we will examine is plantar fasciitis, (inflammation of the connective tissue on the bottom of the foot), which is more commonly known simply as "heel pain" or pain in the proximal arch.
The plantar fascia runs the length of the sole of the foot, and is a broad band of dense connective tissue that is attached proximally to the medial surface of the calcaneus. It fans out distally, with fibers and their various small branches attaching to and merging into the capsular ligaments. The function of the plantar fascia is to assist in maintaining the stability of the foot and in securing or bracing the longitudinal arch. Plantar fasciitis can be attributed to several things, including heel spurs, plantar fascia irritation, and bursitis.
There are several possible causes of plantar fasciitis. It can occur when tension develops in the plantar fascia both during extension of the toes (pointing of the toes in dance and during depression of the longitudinal arch as the result of weight bearing (jumps). When the weight of the body is principally on the heel, as in ordinary everyday standing, the tension exerted on the fascia is minimal. However, when the weight is shifted to the ball of the foot (as is done in a common "releve" in ballet), tension is dramatically increased. Pushing off of the ball of the foot involves both a forceful extension of the toes and a powerful thrust by the ball of the foot which increases fascial tension to approximately twice the body weight. Examples of this excessive tension can be almost any jump or leap that is a part of dancing. Trauma can also occur when a drastic change in footwear is incurred (such as switching from a street-shoe to a soft ballet slipper) or running or exercising on an overly soft surfaces (such as sand).
Where anatomical conditions are concerned, leg strength discrepancy, and inflexibility of the longitudinal arch are common causes.
Although not completely preventable, plantar fasciitis can be treated by a variety of means. There is no overall cure for plantar fasciitis and the patient needs to experiment with different treatments.
To begin, excessive pointing of the toes can cause plantar fasciitis, so making sure that the muscles in the foot and toes are strong enough to endure such repeated stretching is important. Also, pushing off of the balls of the feet when jumping or leaping is another cause of plantar fasciitis, so making sure to "put your heels down" when in demi plie before all jumping is crucial. Dancing on a floor that is not too soft or "bouncy" is another measure of prevention that should be taken. Calf stretches before and after class enables the foot to bend backwards and therefore lessens the stress on the fascia under the foot. As with shin splints, if plantar fasciitis becomes an unbearable pain that makes performance impossible, medical advice should be sought so that treatment, rehabilitation, and changes in activity can be determined.
In order to prevent shin splints and plantar fasciitis and almost all foot injuries we should remember three things: first, listen to and heed the correction that your instructor is giving you because they are for your own physical safety. Second, make sure that your muscles are adequately strong for the movements that you are attempting to do and third, where possible, dance on a floor that is neither too soft nor too hard. If these three suggestions are taken into consideration and followed, the risk of most foot injuries will be greatly reduced.