Ask the Chiropractor: Part 2
Q: What are the top 3 injuries you see in dancers and the ways to prevent them?
A: If we look at the 2017 Systematic Review “Injuries in Professional Dancers” by Cardoso et al, it is highlighted that the most affected body segment for dancers is the lower limbs. The three most common injuries I see in practice are ankle strains and sprains, patellofemoral pain syndrome, and snapping hip syndrome.
I often refer to the muscles around our ankles that stabilize the motions inversion and eversion (similar to sickling and winging) as our ‘muscular stirrup’. These muscles can be strained when we roll an ankle. It’s also these same muscles that help us prevent rolling our ankles. Because dancers often wear minimal footwear, I always suggest including prehabilitation of your muscular stirrup. The muscles that comprise this ‘stirrup’ include the muscles on the outer edge of your calf (fibularis group), and your tibialis posterior (the muscle attached to the back of your shin bone that runs behind the inside ankle bone attaching to and supporting the medial arch). By including some cross training geared towards these muscles, you will improve ankle stability, protecting against potential injurious mishaps while training or performing.
The second injury mentioned involves the joint between your knee cap and your femur. Four muscles attach to our kneecap (our quads), and when there is an imbalance in tension, it can lead to irritation of the joint between the kneecap and the femur. For dancers, if they are gripping their turnout with their gluteus maximus (the largest glute) as opposed to their deep six external rotators, this may be part of, if not the cause of the knee cap being pulled too much to the side. By focussing on improving how we turn out, and where we activate and initiate our turnout, we can decrease pain behind and above the kneecap. As always, I also recommend ensuring dancers are landing their grand allegro with proper knee alignment during their plié (knee directly over the foot). Any misalignment during landing can lead to not only irritation between the kneecap and the femur, but also of the meniscus.
Finally, for snapping hip syndrome, there are four types (intra-articular, anterior, lateral, and posterior). A correct diagnosis on which type you have and how this relates to your biomechanics is step one when dealing with this syndrome. For prevention, we must look at our pelvic stabilization. I often find dancers benefit from improving lateral hip stability, as well as core strength and function with breath control. I also recommend discussing training the front of our core (abdominals) without gripping in our hip flexors. By digging deeper into how we use our core and pelvic stabilizers, as well as how we cross train them, we can improve the function of our hip and decrease any pain experienced with adagio work.
Q: How to know when you need to see a professional about your back pain?
A: Although there is no black and white answer for this question, I do have a few suggestions. If your pain is stopping you from doing any activities of daily living or any hobbies you enjoy, I personally would see a professional. Your typical appointment with an evidence-based manual therapist will include some sort of rehabilitation during your appointment. If seeing your professional helps get you moving and motivates you to continue following your rehabilitation or prehabilitation plan, then you may want to book in to get that dose of healthy motivation. If your back pain is getting worse, or you are starting to get any nerve pain, then I would highly recommend seeing a professional. The worse your pain is, or the longer you have been experiencing this pain, the longer it may take to improve. This is another reason to see a professional early on from the onset of pain. Again, none of these concepts are too set in stone, but if you are experiencing back pain, don’t suffer alone. Get checked out, get some manual therapy and an active care plan with exercises and stretches you can do at home to decrease pain and increase function. The more you develop an understanding of your body and it’s needs, the more longevity and happiness you will experience as a dancer.
REFERENCE LIST:
1) Cardoso AA, Reis NM, Marinho AP, Vieira MD, Boing L, Guimarães AC. Injuries in professional dancers: a systematic review. Revista Brasileira de Medicina do Esporte. 2017 Nov;23:504-9.
