Dance

Dance is an entertaining and fun combination of art, performance, and social activity. Whether you choose an individual form of dance, such as ballet, a variety of cultural dances, or couple’s dancing, such as Country & Western or Ballroom, the control of your entire body is extremely important in the beauty and satisfaction of your performance.

Dance is a form of exercise, and if you do not give appropriate consideration to your overall physical conditioning, the potential for injury will increase.

Achieving performance quality dance skills require a lot practice, repeating the same moves or dance steps over and over until fully mastered. If this unvaried practice is not managed carefully, the constant repetition can lead to a variety of injuries, either due to trauma caused by muscle fatigue, or due to overuse. Avoid practicing too much in too short a period of time. Just as in all sports, the body needs a chance to recover before being pushed further in either dance practice or performance.

CORE CONDITIONING & CARDIOVASCULAR EXERCISE:
All forms of dance often involves placing unaccustomed stresses across the back and through the pelvis and hips. Thus, core body conditioning is extremely important in helping to reduce the chances of back and hip injuries. Your regular weekly exercise routine (in addition to your dance schedule) should include three to four days of some form of core body workout per week.

Thigh conditioning plays an important role in helping to protect the knees. Quadriceps strengthening exercises, such as doing 50 leg lifts a day while sitting in a chair, should become a habit. It is also important to follow an exercise program which will maintain good balance between the strength of the quadriceps and of the hamstrings.

Dancers need to do what they can to prevent falling. Something as simple as walking forwards and backwards for a few minutes every day on a 2x4 or 2x6 plank will help maintain ankle strength and, even more importantly, increase good proprioception.

Your regular exercise program should also include general flexibility training, especially for your back, hamstrings, and Achilles tendons.

For cardiovascular fitness, concentrate on non-weight bearing activities, such as swimming, running in a swimming pool, or riding a bike. The demands put on the feet, ankles, legs, and knees in dance provide amply opportunity for potential overuse injuries, so it is best to avoid putting unnecessary stresses and weight loads on these areas for your cardiovascular exercise.

MECHANICS OF BODY MOVEMENT:
Dance steps and dance movements are often contrary to what is normal for the body to do, such as kicks and spins (from ballet to C&W). A dancer's technique can be just slightly off without being too obvious. It is important to have your instructor watch your technique closely and help you make corrections. A slight imbalance in technique can lead to a variety of injuries over time. In couples' dance, the male also needs to be very conscious of how he provides the lead to his female partner, as a slight miscue could lead to an injury.

Posture is very important, and your instructor should be very aware of your posture at all times. Proper posture enhances the performance, and also helps to prevent injury. However, some dance movements naturally do put the spine in a position not otherwise normal for the body. Core body conditioning and limiting the time of repetitive practice can help.

BALLET FOR YOUNG CHILDREN:
Young dancers are likely to develop muscle strength imbalances, which can lead to abnormal stresses on bones and joints in a growing, immature body. If not corrected through instruction and overall conditioning, more serious orthopedic conditions can develop, such as physical changes in the surface of the joints, and damage to the discs of the spine. Over time, this could lead to painful overuse injuries which might end dancing as either a potential professional career or a pleasurable recreational activity.

Because so many of the fundamental ballet movements taught to young children require the use of muscles on the inside and outside of their legs, and because these muscles in young children are not yet strong, these movements are perhaps best taught at the barre where the child can easily maintain weight and balance on the other leg while also holding onto the barre. As the children's inner and outer leg muscles get stronger, they will be able to do these moves independently.

It is also important not to push for "perfect" foot positioning with young children. To do so would put inapporpriate forces across young joints and bones which are still growing. Striving for "perfection" should wait until the child has achieved more height.

PROPER DANCING SHOES:
Just as with all sports, there are special shoes made for dancing. You should select shoes which will slide across a dance floor, but neither slip or stick. A leather or soft suede sole is best. Trying to dance in improper shoes is dangerous, and one should definitely not try to dance in a shoe with a rubber sole.

Shoes needs to fit your feet appropriately. Your shoes should be comfortable on your feet, providing good support. They also should be comfortable to the ball of the foot. Shoes that are too tight can cause problems like Morton's neuroma, a pinched and swollen nerve in the toes. Shoes which are too loose will allow your foot to move around too much, resulting in potential blisters, improper technique, and ankle sprains.

Dancing in a shoe which has too high a heel is also a problem. That can make all dance moves much harder to do, and will put the spine in an improper position just to maintain balance. It also is a little embarrassing to have to tell your orthopedic surgeon that you got hurt because you "fell off" your shoes.

DANCING SURFACE:
The quality of the dance floor is important in the prevention of injuries. A "giving" floor is less stressful on the muscles and joints, and is much preferable to a hard surface, especially concrete. Also avoid floors which are either too slick or too "sticky". Young dancers sometimes like to do some of their dance routines in the grass or on the living room carpet wearing sneakers. This can quickly get to be hard on knees, and might result in other injuries, such as sprains or fractures.

POINTE:
Every little ballerina dreams of dancing pointe. There is a school of thought that starting to study pointe is associated with having reached a certain age (often around age 12) or having had a given number of years of ballet (3 or 4 years of training). From an orthopedic perspective, neither is correct. The maturity of the bones of the foot are of primary importance. Growth plates of the bones of the foot start to close for children at different ages and with different degrees of maturity. The bones of the feet should not be the only consideration, however. Being en pointe puts the entire body at a different posture, creating new stresses and loads. The entire body's physical strength and overall conditioning needs to be mature enough to handle these new forces.

Even though pointe shoes can be expensive, the shoes need to be thought of as "proper equipment". They must fit correctly and be in good condition. Continuing to dance in broken or worn out pointe shoes is a problem. A dancer should always have an extra pair of pointe shoes (in good condition) in her dance bag, ready to switch into as soon as a shoe problems occur. It may be a good idea to alternate between pointe shoes at least once during an extended practice. And keep in mind that injury can occur from something as simple as poor placement of the pointe shoe ribbon.

Bloody toes from pointe are not a "badge of honor". It is a clear indication that something is wrong. Seek medical help, and take your pointe shoes with you for the appointment.

Because of the position of the feet must be in when dancing pointe, and because this requires the Achilles tendon to be shortened, plantar fasciitis can be a common problem. The Achilles tendon needs to be kept in good, flexible condition. The Achilles tendon should be gently stretched as part of the warm-up and cool-down. Wearing a supportive, high-top aerobic shoe after practice can help, as can sleeping with a 90 degree night splint.

               — Tom Parr, M.D.

Reviewed and updated: 06/28/2011

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For after-hours orthopedic emergencies, Dr. Parr prefers you call him directly at 281-491-7111 or 281-537-4318. He may be able to help you get treatment faster and save you an expensive ER bill.