Research: What is Known About the Effect of Fatigue on Injury Occurrence Among Dancers?

This review article discusses and compares the injury incidence in dance, the relationships between fatigue and dance injuries (as has been studied so far), and the inter-play between fatigue, diet, and menstrual status. Reporting an injury incidence as high as 75%-97%, the authors point out that dance injuries are activity-specific (much like sports injuries). While some studies have found that the highest rate of injury among dancers occurs during performance seasons, others have discovered that the greatest number of injuries occurred during the rehearsal stages of a season, when the amount of repetitive activity was the highest. One study, examining female professional ballet dancers, found that subjects who danced more than 5 hours per day were significantly more likely to suffer a stress fracture than those who danced less. Another study found that the incidence of ACL injuries in dancers was higher late in the day and late in the season, indicating fatigue as a possible cause of injury. Like a previous review article examining fatigue and dance injuries, this article also examines the diet with respect to injury incidence. All of the information presented in this review article can lead to important educational content for dancers and, more importantly, dance administrators.

Liederbach M, Schanfein L, and Kremenic, IJ. What is known about the effect of fatigue on injury occurrence among dancers? J Dance Med Sci. 2013;17(3):101-108.

Guide: String Instruments, Part 1

There are several instruments that fall into the category of “string instrument.” To keep from presenting an overwhelming amount of information, this installment of a guide to string instruments focuses on the four most common string instruments encountered when treating classical musicians: violin, viola, cello, and (upright/acoustic) bass. Additional instruments will be discussed in later articles.

Research: Overuse, Tissue Fatigue, and Injuries

This review article breaks down the inter-related factors of overuse, fatigue, and related injury-causing factors for bone, cartilage, tendon, ligament, muscle, and neural tissue and functioning. The author states that it is a widely accepted fact that rest and adequate nutrition are imperative for injury prevention, injury healing, and improving performance and conditioning, but there is a disconnect between understanding this concept and implementing it into practice for dancers. This lack of proper nutritional support, combined with the long hours of a dancer’s typical workday, are a recipe for injury. The concepts presented in this article are an excellent primer for examining the common overuse injuries suffered by dancers, addressing dance-specific mechanisms of injury including the increased torque caused by Graham spirals and the forces placed on the menisci by Horton hinges. Fatigue-related injuries are especially prevalent in dance due to unforgiving schedules (often dictated more by tradition or pursuit of perfection than by medical considerations), misinformed “health” decisions and practices, and the tendency for dancers to push-through an injury for fear of losing a role. 

Murgia C. Overuse, tissue fatigue, and injuries. J Dance Med Sci. 2013;17(3):92-100.

Injured Dancers and Modified Activity

Dancers traditionally do not have a great (psychological) relationship with medical professionals. There is an overabundance of avoidance behaviors and, to some extent, denial about the injury itself. Many of these behaviors and fears stem from the belief that going to see a medical professional – or simply admitting that an injury has occurred – will result in losing a role or being forced to stop dancing.

The concept of absolute rest is abhorrent to performing artists, especially dancers. More often than not, dancers will push through pain for a significantly longer time before seeking help than traditional athletes. Sometimes, “toughing it” without seeking medical help even goes to the point of allowing the injury to worsen so much that the dancer can’t walk without pain.

Research: Lower-Limb Proprioceptive Awareness in Professional Ballet Dancers

Balance and proprioception in dancers has frequently been studied. To add to the existing knowledge, this study set out to compare lower-limb proprioceptive awareness and postural control of professional ballet dancers to matched controls with no dance training. The researchers examined joint position reproduction at the ankle, knee, and hip in both groups and found that dancers demonstrated significantly better awareness of their joint positioning (and reproduction of this positioning) than the controls. Additionally, the dancers’ proprioceptive awareness of specific joint positioning was equal among all three joints whereas controls had significantly less awareness of their ankle position compared to their awareness of the hip and knee. In addition to examining joint reposition sense, the researchers also took center of pressure excursion and path measurements during an eyes-closed bipedal stance task. The results related to this portion of the examination did not indicate a difference between dancers and non-dancer controls. It is possible that this task, like other simple, non-specific tasks examined in previous studies, is not difficult enough to require the dancers to utilize any enhanced postural control mechanisms they may have as compared to the control group.

An Ounce of Prevention...

While it is common to think only of exercises and stretches when discussing injury prevention, there are actually several other factors, both intrinsic and extrinsic, that contribute to preventing injury.

Research: Musculoskeletal Pain and Injury in Professional Orchestral Musicians in Australia

A survey of the members of Australia’s eight fulltime professional orchestras examining performance-related musculoskeletal disorders found that 84% of the respondents had experienced pain or injuries that interfered with playing or with participating in normal rehearsals and performances. This number is slightly higher than the previously reported 70%-80% rate of performance-related injury. In this study, the most commonly injured sites were the back, right upper extremity and neck, left upper extremity and neck, and the neck alone. Perhaps the most important finding from this study was that less than half of the injured musicians reported recovering completely from their injuries. Additionally, half of the 377 respondents were experiencing an injury at the time of the survey and more than 50% of these performers reported that their current pain had been present for more than 12 weeks.

Guide: Dance Footwear

Dance footwear can facilitate the dancer’s performance, enhance aesthetics, and protect the dancer from injuries. However, dance shoes can potentially put the dancer at risk of developing an injury from the shoes themselves (blisters), from ground reaction forces applied to the body during jump landings, or from altered mechanics or gait due to the structure and nature of the shoe.

There is a wide variety of footwear in use in the dance world.  While many types of shoes are primarily used by one particular genre or style of dance (like pointe shoes in ballet), dance genres are not always clearly delineated, meaning that your patient may face many challenges from many different types of footwear (ballet companies will perform pieces in character shoes, sneakers, or even barefoot). In fact, some ballets will place some dancers in pointe shoes, others in ballet slippers, and still others in character shoes. Some dancers may even have to switch types of footwear during a show (sometimes even in the middle of a piece).

As a clinician, it is important to understand the differences in dance footwear when evaluating a dancer’s injuries. This guide overviews the most common types of footwear in dance.