Physical therapy as a treatment option for common dance related injuries

Physical therapy as a treatment option for common dance related injuries

By Dr. Jessie Lesar, PT, OCS, physical therapist at IRG Physical Therapy – Murphy’s Corner

Jessie graduated with a Bachelor of Arts in Dance from the University of Montana prior to obtaining her Doctor of Physical Therapy. She is a member of the International Association of Dance Medicine & Science and is affiliated with Seattle Dance & Performing Arts Medicine.

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Dance related injuries can vary widely depending on dance style and level of dance involvement. Common sites, regardless of style, involve the foot and ankle, knee, and hip. Ballet dancers most frequently injure the lower extremity[1][2][3][4] while contemporary and modern styles may see higher instances of back and upper extremity injuries, comparatively.[5][6] The majority of dance related injuries can be classified as overuse.

Common foot and ankle injuries include flexor hallucis longus tenosynovitis and peroneal tendinosis due to repetitive foot and ankle flexion. These muscles can get overused as they are working hard to point the foot and provide stability to the ankle. This repetition can cause them to get inflamed, causing pain. Posterior ankle impingement, either due to soft tissue or an os trigonum (accessory bone), is frequently seen in ballet dancers who perform on pointe due to extreme ranges of plantar flexion motion, moving the foot in a downward motion away from the body.[7] Hip labral tears are common due to the extreme ranges of hip motion needed for many dance movements.[8]

Physical therapy, especially treatment provided by dance medicine specialists or those with a dance background, can be helpful to address these injuries. Treatment can include targeted strengthening, manual therapy – including soft tissue massage and joint mobilization – and assisting in modifying dance technique movements to achieve performance in a pain free manner.

Many dancers train primarily in dance and often benefit from cross-training in Pilates, the Gyrotonic® Method, or general strength and cardio conditioning. A dance medicine specialist can provide insight on modifications to shoes or dance wear, utilize taping techniques that can be worn during performance, and further customize treatment to fit the specific dancer’s needs. Young ballet dancers who are ready to transition to pointe should be assessed for adequate strength, range of motion, technique and balance.[9]

Dancers can have unique considerations that may impact treatment. Intrinsic factors that impact injury can include hypermobility spectrum disorders, RED-S (relative energy deficiency in sport, formally known as the Female Athlete Triad) and mental health disorders. Extrinsic factors can include performance venue, technique, touring or rehearsal schedule and nutritional needs.[10][11] Treating dancers is often a team approach and should utilize providers such as primary care providers, physical therapists, dieticians, mental health providers, massage therapists, acupuncturists, chiropractors and specialty doctors, such as orthopedists. Physical therapists should be the first line of defense for musculoskeletal conditions both acute and chronic. They can also be utilized as an excellent resource for physical maintenance throughout a dancer’s career as physical needs change. 

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Dr. Jessie Lesar, PT, OCS, is a physical therapist at IRG Physical Therapy – Murphy’s Corner with specialized training in dance medicine and blood flow restriction training (BRFT). Call IRG Physical Therapy – Murphy’s Corner to learn more about Jessie’s service offerings at 425.337.9556 or click here to request an appointment with Jessie today.

Learn more about service offerings at IRG here, including physical therapy, hand therapy, massage therapy, performance enhancement, athletic training and more.

Footnotes:

[1] Gamboa J, Roberts L, Maring J, Fergus A: Injury patterns in elite preprofessional ballet dancers and the utility of screening programs to identify risk characteristics. JOSPT. 2008;38:126-136.

[2] Soares Campoy FA, Raquel de Oliveira Coelho L, Bastos FN, et al: Investigation of risk factors and characteristics of dance injuries. Clinical J Sport Med 2011;21:493-498.

[3] Ramkumar PN, Farber J, Arnouk J, Varner KE, Mcculloch PC: Injuries in a professional ballet dance company: A 10 year retrospective study. J Dance Med Sci 2016;20:30-37.

[4] Turner Vosseller J, Dennis E, Bronner S: Ankle injuries in dance. J Am Acad Orthop Surg 2019;27:582-289.

[5] Bronner S, Gill A, McBride C: Musculoskeletal injury in professional modern dancers: A prospective cohort study of 15 years. J Sports Sci 2018;36:1880-1888.

[6] Ojofeitimi S, Bronner S, Woo H: Injury incidence in hip hop dance. Scand J Med Sci Sports 2012;22:347-355

[7] Turner Vosseller J, Dennis E, Bronner S: Ankle injuries in dance. J Am Acad Orthop Surg 2019;27:582-289.

[8] Kern-Scott R, Peterson J, Morgan P: Review of acetabular labral tears in dancers. J Dance Med Sci 2011;15:149-156

[9] Richardson M, Liederbach M, Sandow E: Functional criteria for assessing pointe-readiness. J Dance Med Sci 2010;14:82-88

[10] Gamboa J, Roberts L, Maring J, Fergus A: Injury patterns in elite preprofessional ballet dancers and the utility of screening programs to identify risk characteristics. JOSPT. 2008;38:126-136.

[11] Liederbach, M: General Considerations for Guiding Dance Injury Rehabilitation. J Dance Med Sci 2000;4:54-65