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Injuries in Street Dancers. A Guide to Injury Recovery & Prevention.

Injuries in Street Dancers. A Guide to Injury Recovery & Prevention.

Street dance encompasses many different styles of dance, all with their own unique history, culture, and evolution over time. PhysioTec’s dance physiotherapists regularly assess and develop dance injury prevention and management programs for dancers. This blog will highlight some common street dance injuries and what you can do to prevent or recover from these injuries if you are a street dancer. Research in this area has been emerging gradually as many of these styles are relatively new in comparison to other genres. Street Dance styles appearing in research so far has included hip hop, breaking, popping, locking, house, and krump.

COMMON STREET DANCE INJURIES

Street Dance styles have originated from different scenes including streets and clubs, with these various styles being expressed through freestyle, cyphers, grooves, and choreography. Street dance is increasing in popularity as these dance forms appear more and more across social media and competitions. Physical demands are becoming higher, and dancers are expected to have high levels of fitness, strength, agility, coordination, and motor control to meet the unique demands of each genre.1

Hip hop dancers have a similar injury incidence rate to gymnasts, and this rate of injury is higher when compared to modern dance and ballet. This highlights the importance of prevention strategies as this has been found to greatly influence the number of injuries sustained over a dancer’s career.2

 

COMMON INJURIES IN STREET DANCERS

KNEE INJURIES IN STREET DANCERS

Knee injury comes in at number one as the most common injury in street dancers, accounting for 42% of all street dance injuries.3 Street styles involve dancing techniques that require quick and intricate footwork – twists, sudden changes in direction, moving the body into unnatural positions and deep squats. Some hip hop components are quite acrobatic in nature and require dancers to land or stomp with great force. The risk of knee injury is therefore relatively high when considering the volume of rotating and jump landings with either flexed or extended knees.

It is common for dancers to have a dominant side which poses a challenge when it comes to group performances where dancers are required to perform in unison. Dancers with a larger preference for one side increase their risk of knee injury as there will likely be a lack of strength on the non-dominant side.4

Knee injury risk in street dancers is also increased during lengthy performances as the muscles gradually become more fatigued and efficiency in controlling the knee joint subsequently reduces. Choreographers are of course more interested in the way a move looks, than how it feels to the dancer, meaning that some moves may be particularly challenging for the knee, placing this joint at greater risk of injury.5

LOWER BACK INJURIES IN STREET DANCERS

Lower back injury is the second most common injury in street dancers (32%).3 Dance techniques in street styles often involve a combination of footwork and fluid movement from upper body grooves which require use of core muscles and trunk control. All turns, jumps, and landings require dancers to have high levels of control around the back and hips.6

Lower back injuries in street dancers are most commonly reported to be linked to the way the muscles around the back, pelvis and core activate and coordinate, with altered muscle strength and/or behaviour potentially increasing risks of injury. Risk of lower back injury is increased during high-impact, repetitive loading involved in street dance training and performance.7

ANKLE INJURIES IN STREET DANCERS

Ankle injury ranks as the third most common injury in street dancers (15%).4 This should come as no surprise due to the volume of jumping, hopping, and variations in landing involved in street dance. Factors that increase the risk of ankle injury in street dancers include poor technique, inadequate muscle control around the ankle and/or dynamic balance but may also occur from external factors such as performing on an uneven surface, unsupportive footwear or contact with another dancer.8 It is essential to address these external factors to reduce the risk of sustaining an ankle injury in street dancing.

 

TYPES OF STREET DANCE INJURIES

Street dancers have been found to injure themselves mostly by overuse (50%), landing (42%), twisting (36%), or slipping (31%).9 Dancers predominantly experience more overuse and chronic injuries due to poor technique, strength, and balance.10

When looking specifically at breaking, dancers are most likely to injure their wrist (69%), finger (61.9%), and knee (61.9%). Injury mechanisms are typically joint sprains, muscle strains and tendon injuries.11 It is important to consider breaking as a potentially high-risk dance sport.

It has been found that even when breakers sustain severe injuries, they only allow a limited time for recovery before returning to training.12 A lack of recovery and rehabilitation will increase the risks of developing an ongoing issue. A new injury might also occur due to the dancer needing to protect the injured or weakened area, moving extra forces to a nearby body part.

 

WHAT CAN I DO TO PREVENT OR RECOVER FROM STREET DANCE INJURIES?

There are several ways of preventing dance injuries from occurring, or assisting in injury recovery.

1. WARM-UP BEFORE STREET DANCE TRAINING OR PERFORMANCES

WARM-UP BEFORE STREET DANCE TRAINING OR PERFORMANCESPrevention is key. No matter how big or small a performance, a dancer in any style should conduct an adequate warm-up. This involves increasing the heart rate with cardio exercise such as running on the spot, jumping and hopping. This cardio can be followed by dynamic lengthening of the muscles to ensure they are warm, and the body has been moved through the ranges it will need to move through during training or a performance. Dynamic warm ups are preferred over passive stretching (holding a sustained stretch), as sustained stretching can reduce the natural reactivity needed for dynamic actions in street dance.

It is important that dancers work together with their family, dance teachers, and health professionals as a team, to ensure dancers are taking care of their body properly and staying healthy. If the dancer is in the middle of a busy training period in preparation for competitions and routine rehearsals have become the focus of training, the dancer should take it into their own hands to warm themself up prior to class. This is a crucial time as dancers will know training volume increases and so does the level of expected performance, meaning it is not the time to stop conditioning the body and warming up correctly.

2. BALANCE TRAINING FOR STREET DANCERS

BALANCE TRAINING FOR STREET DANCERSResearch has found balance and proprioception (awareness of body position in space) to be a key component of injury prevention, as this helps control large forces that cross the joints.5 Positive effects can be seen from quick balance training of 4-15 minutes per session conducted twice a week.13

For street dancers, balance training needs to be more than simply practising standing on one leg or on a wobble board. Our dance physios can provide balance programs specific for the challenges of dancing.

 

3. STRENGTH AND CONDITIONING FOR STREET DANCERS

Strength and Conditioning for Street DancersStreet dancers should add strength and conditioning to their weekly routine to complement their dance training. The aim is to increase the muscles’ ability to maintain the capacity to perform the tasks required in dance, and to reduce the impact of training and performance on the body.8

It is always best to consult a physiotherapist prior to commencing a strength and conditioning program. Our dance physios aim to identify any risk factors for injury and provide a targeted exercise program to assist the dancers training and performance.

 

4. REST & RECOVERY FOR  DANCERS

REST & RECOVERY FOR DANCERS

It is also extremely important for dancers to reduce fatigue and receive adequate nutrition to sustain the body during training sessions and performances to prevent injury.6 Adequate recovery time should be allowed between training and exercise sessions.

 If a dancer does unfortunately become injured, it is vital that they do not simply push through severe pain, as we often see happening within the dance culture. Dancers must allow sufficient time for their injury to heal. Dancers are encouraged to seek advice from a physiotherapist on when they may return to dance or if they will need a graduated return to their training program.

For advice on prevention of dance injuries, or for rehabilitation and treatment of dance injuries, make an appointment with Rhianna or Joanne today. Call 3342 4284 to book.

 

References

  1. Grˇci´c, V.; Mileti´c, A.; Kuzmani´c, B. Construction of Tests for Evaluating the Level of Hip Hop Performance. Res. Phys. Educ. Sport Health 2015, 4, 57–60.
  2. Uršej E, Zaletel P. Injury occurrence in modern and hip-hop dancers: a systematic literature review. Zdr Varst. 2020;59(3):195-201. doi: 10.2478/sjph-2020-0025.
  3. Ursej E, Sekulic D, Prus D, Gabrilo G, Zaletel P. Investigating the prevalence and predictors of injury occurrence in competitive hip hop dancers: prospective analysis. Int. J. Environ. Res. Public Health 2019, 16, 3214
  4. Kimmerle, M. Lateral bias, functional asymmetry, dance training and dance injuries. J. Dance Med. Sci. 2010, 14, 58–66.
  5. Knight, K.L. More precise classification of orthopaedic injury types and treatment will improve patient care. J. Athl. Train. 2008, 43, 117–118.
  6. Russell JA. Preventing dance injuries: current perspectives. Open Ac­cess J Sports Med. 2013;4:199-210. doi: 10.2147/OAJSM.S36529.
  7. McGill, S.M. Low Back Disorders, 3E; Human Kinetics: Champaign, IL, USA, 2015.
  8. Hrysomallis, C. Relationship between balance ability, training and sports injury risk. Sports Med. 2007, 37, 547–556.
  9. Ojofeitimi S, Bronner S, Woo H. Injury incidence in hip hop dance. Scand J Med Sci Sports. 2012;22(3):347-55. doi: 10.1111/j.1600- 0838.2010.01173.x.
  10. Lee, L.; Reid, D.; Cadwell, J.; Palmer, P. Injury incidence, dance exposure and the use of the movement competency screen (Mcs) to identify variables associated with injury in full-time pre-professional dancers. Int. J. Sports Phys. Ther. 2017, 12, 352–370.
  11. Cho, C.H.; Song, K.S.; Min, B.W.; Lee, S.M.; Chang, H.W.; Eum, D.S. Musculoskeletal injuries in break-dancers. Injury 2009, 40, 1207–1211.
  12. Kauther MD, Wedemeyer C, Wegner A, Kauther KM, von Knoch M. Break­dance injuries and overuse syndromes in amateurs and professionals. Am J Sports Med. 2009;37(4):797-802. doi: 10.1177/0363546508328120.
  13. Gebel, A.; Lesinski, M.; Behm, D.G.; Granacher, U. Effects and dose-response relationship of balance training on balance performance in youth: A systematic review and meta-analysis. Sports Med. 2018, 48, 2067–2089.
How can we prevent dance injuries ?

How can we prevent dance injuries ?

One of the most common questions I get asked as a physiotherapist with a special interest in dance rehabilitation and injury prevention is, “How can we prevent dance injuries?”.

GOOD QUESTION!

It’s a very valid question considering:

  • the rate of injury in young and adolescent dancers is higher than that reported in young soccer players or gymnasts
  • the injury rate of dancers aged between 9 -18 years is even higher than that of professional ballet and contemporary dancers!4,7

Why do dance injuries occur?

First, let’s take a look at why dance injuries happen.

The reason for young dancers reporting more injuries than their counterparts in other sports is partly due to growth spurts in this age group, coupled with the high physical demands of dance. There are also numerous other factors that have been identified as risks for injury. Some are intrinsic – related to the individual such as growth, hormones or previous injuries1 – and others are extrinsic or external, such as environmental factors like dance floors, equipment or training load.2 Research on both intrinsic and extrinsic risk factors, and their relationship to dance injuries is a growing area of research and hence, more information will continue to emerge.

There does seem to be a growing consensus that the majority of dance injuries in ballet dancers is due to overuse3,6,9. Dancers are familiar with the repetitive nature of dance training – having to repeat a move over and over again in order to learn and perfect a new skill or piece of choreography. This can prove somewhat tricky to manage among aspiring young dancers. In addition to this, the rigors of dance can increase at particular times of the year4, and we certainly see more injured dancers here in clinic around exam and performance periods.

What are the most common injuries for dancers?

In young dancers of ballet, tap, jazz, hip hop, contemporary, ballroom and Irish dancing, it may be no surprise that the lower limb (leg) is most commonly injured. This includes the knee, ankle and foot – with rate of occurrence in that order – followed by the hip and spine. Ligaments tend to be the most commonly injured soft tissue, with muscles and tendons making up about 30% of injuries, while bone injuries make up around 20% of all injuries.5

Acute versus chronic dance injuries

Traumatic injuries are usually referred to as acute injuries, while injuries relating to overuse are often longer lasting or slowly developing injuries, referred to as chronic injuries. Research has shown that the majority of injuries sustained by young ballet dancers are of the ‘overuse’ type, with more than three quarters of all injuries falling into this category.6 With overuse-type injuries, the dancer is usually unable to pinpoint exactly what caused the injury and often reports pain increasing over time. Tendinopathy and bone stress reaction/stress fractures are examples of this type of injury, typically caused by repetitive stress and/or overloading.  Other causes of chronic injuries can be structural or genetic in nature, such as hyperextended knees usually seen in the hypermobile population.

Acute injuries are usually a result of an “accident”. Examples of an acute injury are a slip on the floor or landing poorly from a jump, resulting in a muscle strain or ankle sprain.

So, what can we do to help prevent dance injuries?

Accidents do happen, however the majority of dance injuries can be prevented, and there are ways of reducing a dancer’s risk of injury.15 Some of the ways we can help reduce the risk of dance injuries are:

Dance Screenings or Dance Profiles

Dance screenings have long been performed by qualified physiotherapists to identify areas of weakness or concern, with the aim being to prevent dance injuries. Pre-pointe assessments or pre-pointe profiling (a term we prefer) is a good example. Although there is not a great consensus as to what elements and tests can accurately predict who is more likely to be injured, it is highly beneficial in identifying possible risk factors and facilitating improvements in strength and technique.

Screening dancers should not be limited to girls wishing to progress onto pointe. Research shows male dancers sustain dance injuries at the same rate as females, and as they mature, male dancers require higher levels of dance strength and flexibility. It is therefore a logical course of action that, during the important period of growth and adolescence, young men undertake a dance profile to identify any potential injury risks and develop appropriate and individualised training goals.

A good time of year to undertake a screening is during the school holidays. During this period, the student usually has more time to address any strength or flexibility deficits that may have been identified by the physiotherapist. They can use the extra time over the holidays to focus on these areas and begin the year a step ahead.

Check out the dance environment for potential injury risks

Acute injuries are sometimes a result of an environmental factor, and are therefore preventable. For example, purpose-built dance floors are an extremely important factor for keeping a dancer safe. Checking the floors for spills or items that may cause injury is another way of preventing accidents. Wearing properly fitting clothing and professionally fitted shoes appropriate to the style of dance can also help prevent environment-related injuries.

Always warm up before dancing

It is vital that dancers warm up before class, rehearsal or performance – skipping a warm up can lead to injury. The goal of a warm up is to raise the heartrate, warm up the muscles and mobilise the joints. This should be a gradual process conducted in phases. First a light sweat should be achieved by raising the heartrate and getting the big muscles working, for example, jogging, skipping or lunges. Then, dynamic stretches should be done.

It’s important, especially for young dancers, to understand that static stretches should not be done in early warm up. Static stretches should instead be left for the end of class, during cool-down.

Keep your body Dance-Fit with an individualized dance conditioning and exercise program

Individualized conditioning programs have been shown to reduce the rate of injury in professional dancers.7 These types of programs are created using information obtained during the dance profile, and takes into consideration the dancer’s history and previous injuries. Historically, supplementary strength and conditioning programs were avoided by ballet dancers,  who were concerned that this type of training would result in reduced flexibility or a non-aesthetic physique. There is, however, little evidence supporting this theory, and this opinion has now mostly been replaced by integrating elements from sports research showing the benefit of such programs8 with a dance-specific approach. Physiotherapists, especially those with extensive dance knowledge, are perfectly placed to guide  young dancers in their supplemental training.

Get enough rest and monitor your loading to help prevent dance injuries 

Finally, and of great importance to young dancers, is rest and load management. Since research shows ‘overuse’ as the main cause of injury in young dancers, monitoring their loading is of paramount importance.9-10 Young athletes who train in the same sport for more hours per week than their age (in years), were shown to have 70 percent more overuse injuries13. Furthermore, a 2014 study showed that young athletes who had less than 8 hours of sleep each night were more likely to sustain injuries than those who slept 8 hours or more.14

 

So, a short answer to the question of how to prevent dance injuries is….

Ensure the young dancer has a healthy dance schedule, has been screened for deficits and potential injury risks, and has an individualised conditioning program.

The dancer, as well as their family, dance teachers and health professionals, all need to work together to help the young dancer remain as injury-free and healthy as possible!

For more information about PhysioTec’s Dance Physiotherapy services, including dance screenings and pre-point profiling, injury rehabilitiation or dance-specific strength and conditioning, click here or call 3342 4284 to book an appointment with Joanne Manning.

 

References

  1. Kenny SJ, Whittaker JL, Emery CA. Risk factors for musculoskeletal injury in preprofessional dancers: a systematic review. Br J Sports Med. 2016;50(16):997–1003.
  2. Russell JA. Preventing dance injuries: current perspectives. Open Access J Sports Med. 2013;4:199–210.
  3. Leanderson C, Leanderson J, Wykman A, Strender LE, Johansson SE, Sundquist K. Musculoskeletal injuries in young ballet dancers. Knee Surg Sports Traumatol Arthrosc. 2011;19(9):1531–5.
  4. Prevention of Injuries in the Young Dancer (Contemporary Pediatric and Adolescent Sports Medicine). Springer International Publishing. Kindle Edition.
  5. Fuller M, Moyle GM, Hunt AP, Minett GM. Injuries during transition periods across the year in pre-professional and professional ballet and contemporary dancers: a systematic review and meta-analysis. Phys Ther Sport. 2020 Apr 3;44:14-23.
  6. Shah S, Weiss DS, Burchette RJ. Injuries in professional modern dancers: incidence, risk factors, and management. J Dance Med Sci. 2012;16(1):17–25.
  7. Steinberg N, Aujla I, Zeev A, Redding E. Injuries among talented young dancers: findings from the U.K. Centres for advanced Training. Int J Sports Med. 2014;35(3):238–44.
  8. Faigenbaum AD, Kraemer WJ, Blimkie CJ, Jeffreys I, Micheli LJ, Nitka M, et al. Youth resistance training: updated position statement paper from the national strength and conditioning association. J Strength Cond Res. 2009;23(5 Suppl):S60–79.
  9. Prevention of Injuries in the Young Dancer (Contemporary Pediatric and Adolescent Sports Medicine). Springer International Publishing. Kindle Edition.
  10. Allen N, Nevill AM, Brooks JH, Koutedakis Y, Wyon MA. The effect of a comprehensive injury audit program on injury incidence in ballet: a 3-year prospective study. Clin J Sport Med. 2013;23(5):373–8.
  11. Ekegren CL, Quested R, Brodrick A. Injuries in pre-professional ballet dancers: incidence, characteristics and consequences. J Sci Med sport. 2014;17(3):271–5.