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.

While working with dancers, you can attempt to break this cycle by demonstrating your understanding of the dancer’s desire to continue dancing and by showing your willingness to allow them to participate in modified activities, if able. Obviously, in some cases, absolute rest is necessary (and possibly even immobilization and/or surgical intervention), but you’ll win over more dancer patients (and expand your loyal patient base) by guiding them through active rest and modified participation whenever their injuries allow.

However, prescribing modified or restricted participation is heavily dependent on the emotional and mental maturity of the patient. Thankfully, as a whole, dancers tend to be very responsive to being asked to take responsibility for their own care and progression. A key component of getting this patient involvement is communication. Setting defined guidelines or rules for the various stages of the dancer’s care and, most importantly, explaining why these rules are in place is critical.

As medical professionals, we are familiar with the injury development and healing processes. We understand the consequences of attempting to return to full activity too quickly after an injury, but your dancer patient may not. Patient education – stated in a way that the dancer can understand – will increase compliance with your treatment plan. If you convey that you have a plan for the duration of their injury treatment or rehabilitation, they’ll have more confidence that you aren’t just holding them back from dancing because it’s the easiest plan of care right now.

One of the best things you can include in your patient education for the dancer is to explain to them that when they first begin your regimen of exercises and restricted activity, they are likely going to feel that they can handle doing more than your plan allows. Remind them to focus on the “big picture” of coming back as quickly, safely, and smoothly as possible – without any setbacks caused by doing too much, too soon. This is more important than doing everything in dance class or rehearsal as soon and often as possible.

Fortunately, ballet class seems to have been designed to facilitate a graduated, controlled return to activity. Classes start with slow, controlled movements that are slight variations on standard early-rehab exercises: calf raises; quarter- and full-squats; standing hip flexion, abduction, and extension; trunk flexion; arm flexion and abduction. A very simple way to keep your dancer patients involved in ballet class (and in front of their dance teachers and casting/artistic director) is to have them participate in portions of the class. A typical plan will have the dancer start the class and participate until a specific point in the class, identified by what the teacher has the students do (i.e. jumping, traveling across the stage with more speed and power). Depending on the injury and the dancer’s stage of healing, specific exercises within the class (like single-leg activities standing on the injured leg) can be excluded, too.

A great way to increase compliance with your instructions to stop participating in class at a specified point is to give your patients some stretches and exercises to do on their own in the back of the studio while their peers continue with class.

Allowing your dancer patients to participate in portions of class not only helps them continue to feel associated with dancing and their peers, but it also frees up some time in your rehab sessions with them to focus on other exercises and activities that may require more guidance or correction.

Most serious, more experienced dancers are used to caring for their injuries on their own. If you give them guidance and instructions on what to do (and what to avoid), they will gladly implement your plan of care and work with you to return to dancing as quickly and safely as possible.