An overview of injury in dance

Dance medicine and science practitioners focus predominantly on three interlinked areas - injury prevention, healthier dance practice and the development of peak performance. When working towards these goals, it can be useful to take a step back and consider the extent of the healthcare issues facing dancers that must be addressed. Injury is the key factor in this, as neither healthy dance practice and peak performance cannot be achieved without addressing the significant problem of injury occurence in the dance profession.

Instances of injury are excessively high in the dancers. Across all disciplines of dance musculoskeletal injury is common in both student and professional dancers. Pushing the body to it's limits and the evolution of evermore demanding choreography means that dance will always be a risky profession; this does not mean however that steps cannot be taken to reduce the risk.
Collecting data on dance injury can be problematic due to dancers often being reluctant to report physical problems to directors or company doctors out of fear of losing professional position or opportunity. Therefore in many studies on dance injury, anonymous self-reporting has proven more useful than company medical records, as is the case with the studies discussed below. The extent of the problem, when providing the security of anonymity to dancers, is shown to be much wider than official company records state. What follows is a brief overview of the issue according to published research.

Defining Injury

Injury means different things to difference people, and so it can be difficult to come to a common definition that can be used effectively to collect reliable, meaningful data.
For the purposes of dance science research, the two following descriptions of injury are useful -

1. "A pain or musculoskeletal condition resulting from training that is sufficient to disrupt or discontinue typical training routine in terms of form, duration, intensity or frequency" 
2. "A physical or psychological problem deriving from stress or other causes to do with performance, rehearsal, training, touring or the circumstances of dance life"

Injury Frequency

• A 2011 study found that 377/500 dancers studied reported injury within the past 12 months -75% of the dancers.
• In a 1996 study of 658 British dancers, 83% of ballet dancers, 84% of contemporary dancers and 83% of dance students reported injury within a 12 month period.
• A1988 study found 81% of dancers included in the study sustained injury during their career, with 42% of those in the 6 months preceding the study.
• A 1994 report found 76% of musical theatre dancers reported injury during their career.
• A 1982 study of Ballet West found 90% of ballet dancers being injured during their career.
• In a Swedish study from 1994, 95% of professional ballet dancers reported injury within a 12 month period.
• A 1996 study noted 56% of Broadway dancers were found to have been injured over a 12 month period

From these sample of studies, it is safe to say that not only will the majority of dancers will suffer injury during their career, but the majority will suffer injury in any given 1 year period.

Injury Sites

1996's excellent report into dance injury, 'Fit to Dance? The Report of the National Inquiry into Dancers' Health and Injury', took a comprehensive look at the types of injury sustained in dance.

Most Common Injury Sites Across All Dance Disciplines:

• Lower back (45% dancers presenting injury)
• Knees (34% dancers presenting injury)
• Ankles (32% dancers presenting injury)
• Feet (22% dancers presenting injury)

Most Common Injury Sites in Ballet Dancers:

Lower back, ankles, feet, knees

Most Common Injury Sites in Contemporary Dancers:

Lower back, knees, neck, ankles

Most Common Injury Sites in Other Dance Professionals:

Lower back, ankles, knees, neck

Male dancers were shown to have higher instances of lower back, shoulder and neck injury than female dancers, however female dancers showed higher instances of foot injury than males. These findings are probably due to the the lifting requirements for male dancers, and the use of pointe work in females.

Causes of Injury

Numerous factors can contribute to incidence of injury. From the literature, the most common contributing factors to dance injury are:

• Poor fitness levels
• Fatigue/Overwork
• Unsuitable flooring
• Repetitive Strain
• Ignoring early warning signs

Injury Prevention

While it is impossible to eradicate the risk of injury, steps can be taken to minimise the likelihood of injury occurring and protect the body by addressing the common types and causes of dance injury. 

• Improved physical fitness will reduce the onset of fatigue, allowing the dancer to perform for longer at a with less physical stress on the body
• Improved strength levels will decrease likeihood of muscular injury, stabilise joints therefore decreasing likelihood of sprains, strains and dislocations and minimise likelihood of stress fractures.
• Upper body strength training is especially important in male dancers due to the high instances of back, neck and shoulder injury.
• Lower limb strength training in female dancers will increase foot and ankle strength and stability, decreasing likelihood of foot and ankle injury. Owing to the chance of muscle imbalances developing, a whole body strength training programme is recommended. 
• Dance facilitators should book rehearsal and performance space in environments with suitable flooring, this means sprung dance floors that will put less strain on the joints.
• Overtraining should be avoided, and any development of pain or excessive fatigue on any joint, limb or muscle group should result in a change of training routine.
• Dancers should move away from the "no pain no gain" mentality, and recognise pain as a warning sign from the body. Working through pain should not be promoted or rewarded.

References

Fit to Dance? The Report of the National Inquiry into Dancers' Health and Injury. Brinson and Dick. 1996.

Bowling, A. (1989) Injuries to dancers: prevalence, treatment and perceptions of causes. British Medical Journal. 

Kitchin, C. (1994) Musical theatre: a dance injury survey. Dancing Times.

Ryan, A. and Stephens, R. (1989) The epidemiology of dance injuries. The Healthy Dancer. 

Evans, R. et al. (1996) A survey of injuries among Broadway performers. American Journal of Public Health. 

Ramel, E. and Moritz, U. (1994) Self-reported musculoskeletal pain and discomfort in professional ballet dancers in Sweden. Scandinavian Journal of Rehabilitative Medicine. 

Campoy FA et al. (2011) Investigation of risk factors and characteristics of dance injuries. Clinical Journal of Sport Medicine.