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From Risk to Recovery
Don't get waylaid by these five common dance injuries.
Photo by Nathan Sayers, modeled by Gabrielle Sprauve of Marymount Manhattan College.
No matter how careful you are, sporadic overuse injuries are an occupational hazard of professional dance. “Dance looks great because it’s an unusual movement—it’s not natural to the body, so your body may react negatively to it over time,” says Johann Howard, physical therapist at the Harkness Center for Dance Injuries at New York University Langone Medical Center. Fortunately, you can minimize the occurrence of chronic problems if you recognize the warning signs and are prepared to let your body heal effectively.
- FHL Tendonitis
Also called “dancer’s tendonitis,” flexor hallucis longus tendonitis is an inflammation or tear in the tendon that travels under your calf muscle, inside the ankle bone and along the bottom of the foot to help point the big toe. “This is one of the few tendons that passes through a bit of a tunnel, so when it’s swollen and inflamed, it can get stuck,” says Nancy Kadel, MD, orthopedic surgeon and chair of the Dance/USA Task Force on Dancer Health. “Ballet dancers with FHL tendonitis will generally feel pain when going from demi-pointe to full pointe, since that bends the big toe down.” FHL tendonitis can also cause a “trigger toe,” meaning the big toe clicks or gets caught, sometimes requiring straightening out with your hand.
Risk factors: FHL tendonitis comes from repetitive pushing off with your foot during jumps or while going from plié to relevé. “The key is to have balanced strength and flexibility all around your ankle,” says Kadel, who adds that it can be helpful to be evaluated by a physical therapist to be sure you’re not overstretching or compressing the tendon while dancing.
Recovery: It usually takes four to six weeks (or longer for a tear) to recover, as long as you don’t ignore the pain and seek medical treatment. “If your pain is above a 3 out of 10, don’t dance,” Howard says. “Instead, ask your physical therapist for safe strengthening exercises.” Kadel has her patients gradually return to class, perhaps leaving out pointework, grand pliés or jumps until pain has completely subsided. She may also recommend ice massages to reduce inflammation, or sleeping in a night splint to keep the foot in a neutral position.
Prevent relapse: Dancers should be able to avoid relapse as long as they maintain proper foot alignment and continue strengthening and stretching the area throughout their career.
- Stress Fractures
Photo by Nathan Sayers, modeled by Gabrielle Sprauve of Marymount Manhattan College.
In dancers, stress fractures—tiny cracks in the bones due to repetitive overloading—are often found in the metatarsals (the long bones of the foot). “Dancers will describe a toothache-like pain on the top of the foot that gets worse when jumping or turning,” Kadel says. “In the beginning, you may not see any swelling or bruising, but it will gradually become more painful.”
Risk factors: Kadel suggests thinking of the long, thin metatarsal bones like wire hangers. “It won’t break the first time you bend it, but after bending it 50 times, it may,” she says. “Every time you load the bone beyond its limit, it has a reaction and then heals itself, but with overuse, you’re not giving that bone enough time to heal, so it cracks.” Stress fractures become more likely during periods of increased activity—like in preparation for a big performance or during a summer intensive—or for dancers with weaker bones due to poor nutrition.
Recovery: Katie Lemmon, certified athletic trainer at Athletico Physical Therapy in Chicago, says this injury may land you in a boot for several weeks, especially if it hurts to walk. “Dancers with stress fractures shouldn’t be doing weight-bearing activity, but I’ll often give them other strengthening exercises like Pilates, so it’s only a modified rest,” Lemmon says. You’ll be able to monitor your recovery by how much pain you feel, but you should still be under the care of a medical professional to determine when it’s safe to return to different stages of dancing. It may take three weeks or more before you’re able to try jumping on two feet, and longer before you’re able to safely perform grand allégro.
Prevent relapse: “Since stress fractures are often caused by a muscle imbalance, use the recovery time to look for the underlying cause, which will prevent it from happening again,” says Lemmon. As long as you listen to your body, bone heals without scar tissue, so relapse is unlikely.
- Lower Back Pain
Dancers are at especially high risk for straining their lower back muscles. This pain feels like a dull ache or discomfort on one or both sides of your spine (not directly on it), and may feel especially painful in arabesque.
Risk factors: “Lower back pain often comes when dancers are trying something new, whether it’s new choreography or a different style of dance, and when dancers have weakness in their core muscles,” Kadel says. “For example, dancers’ back muscles may get overwhelmed by all the penchées on one leg while rehearsing La Bayadère.” Too much repetition on muscles that aren’t quite strong enough may lead to the muscle fibers being stretched, torn or inflamed.
Recovery: Strains in the lower back can take quite some time to heal—according to Howard, up to two or three months. Depending on the injury, you may be able to take modified class throughout your recovery or need to suspend all dancing to allow for proper healing. When appropriate, a physical therapist may help you stretch the affected muscles and offer back and abdominal strengthening exercises, like planks and movements that target the lower abs.
Prevent relapse: “With lower back pain, you can almost guarantee it will come back,” Howard says. “So it’s important to self-manage and come back to physical therapy when you anticipate something will aggravate it or if you start feeling pain.”
- Ankle Sprains
“A sprained ankle means you’ve partially torn one of the ligaments between your ankle bones,” Kadel says. “They’re often caused by fatigue, and are by far the most common injury I see.” While ankle sprains usually happen suddenly, the precursors are often dwelling for some time.
Risk factors: The biggest risk factor for spraining an ankle is having done it before. Others include higher-arched feet, very flexible ankles and, like most chronic injuries, muscle imbalances. Kadel encourages dancers to spend just as much time strengthening the outside muscles as the inside muscles of the ankle—those you use for winging and sickling.
Recovery: Sprains are generally graded on three levels, with the least severe healing in about three weeks and the most severe taking up to 12. For bad sprains, Howard says dancing at all may be off limits, and you may have to wear a boot for a few weeks. “Some ankle sprains are so painful that there’s no way you could dance even if you wanted to,” he says. “In physical therapy, we’ll slowly start to introduce perturbation exercises, which means balancing on a pillow or wobble board to build ankle strength.”
Prevent relapse: Your physical therapist may recommend core workouts to build strength to help prevent future sprains. “Even after you heal, it’s important to keep doing those physical therapy exercises like a religion,” Howard says. Once you’ve had one sprain, you’ll always be at a higher risk to get another.
- Shin Splints
Shin splints, or medial tibial stress syndrome, describes a generalized pain on the inner edge of the shin bone (tibia). Shin splints may feel worse with certain movements, like jumping or pointing your foot.
Risk factors: Shin splints often occur during an increase in activity, which overworks the muscles, tendons and bone tissue. Hard floors can exacerbate the pain. Shin splints can be more likely in dancers with very high arches or flat feet. “We also see shin splints caused by dancers gripping their toes too hard on the floor,” Lemmon says. Teenagers are particularly at risk: When dancers grow quickly, their lower leg bones often grow faster than their muscles, which can lead to discomfort.
Recovery: With proper care, rest and ice, the pain of shin splints should subside in two to four weeks. “In physical therapy, we’ll work on core exercises, calf stretches and hip-strengthening exercises so dancers aren’t using their toes to keep their balance,” says Lemmon. “Usually we’ll start with less-weight-bearing exercises and progress to more-weight-bearing exercises over time.” Dancers can take a modified class, but as with any chronic injury, any movement that causes pain is preventing your body from healing and should be avoided.
Prevent relapse: Continuing physical therapy exercises and stretches long after you’ve healed can prevent relapse.
Rachel Zar is a writer based in Chicago.
Whether playing a saucy soubrette or an imperious swan, Irina Dvorovenko was always a formidable presence on the American Ballet Theatre stage. Since her 2013 retirement at 39, after 16 seasons, she's been bringing that intensity to an acting career in roles ranging from, well, Russian ballerinas to the Soviet-era newcomer she plays in the FX spy series "The Americans."
We caught up with her after tech rehearsal for the Encores! presentation of the musical Grand Hotel, directed and choreographed by Josh Rhodes and running March 21–25 at New York City Center. It's another tempestuous ballerina role for Dvorovenko—Elizaveta Grushinskaya, on her seventh farewell tour, resentfully checks into the Berlin hostelry of the title with her entourage, only to fall for a handsome young baron and sing "Bonjour, Amour."
When Andrew Montgomery first saw the Las Vegas hit Le Rêve - The Dream 10 years ago, he knew he had to be a part of the show one day. Eight years later, he auditioned, and made it to the last round of cuts. On his way home, still waiting to hear whether he'd been cast, he was in a motorcycle accident that ended up costing him half his leg.
But Montgomery's story doesn't end the way you might think. Today, he's a cast member of Le Rêve, where he does acrobatics and aerial work, swims (yes, the show takes places in and around a large pool) and dances, all with his prosthetic leg.
When you spend as much time on the road as The Royal Ballet's Steven McRae, getting access to a proper gym can be a hassle. To stay fit, the Australian-born principal turns to calisthenics—the old-school art of developing aerobic ability and strength with little to no equipment.
"It's basically just using your own body weight," McRae explains. "In terms of partnering, I'm not going to dance with a ballerina who is bigger than me, so if I can sustain my own body weight, then in my head I should be fine."
Last week in a piece I wrote about the drama at English National Ballet, I pointed out that many of the accusations against artistic director Tamara Rojo—screaming at dancers, giving them the silent treatment, taking away roles without explanation—were, unfortunately, pretty standard practice in the ballet world:
If it's a conversation we're going to have, we can't only point the finger at ENB.
The line provoked a pretty strong response. Professional dancers, students and administrators reached out to me, making it clear that it's a conversation they want to have. Several shared their personal stories of experiencing abusive behavior.
Christopher Hampson, artistic director of the Scottish Ballet, wrote his thoughts about the issue on his company's website on Monday:
Camille A. Brown is on an impressive streak: In October, the Ford Foundation named her an Art of Change fellow. In November, she won an AUDELCO ("Viv") Award for her choreography in the musical Bella: An American Tall Tale. On December 1, her Camille A. Brown & Dancers made its debut at the Kennedy Center, and two days later she was back in New York City to see her choreography in the opening of Broadway's Once on This Island. Weeks later, it was announced that she was choreographing NBC's live television musical Jesus Christ Superstar Live in Concert, to air on April 1.
An extraordinarily private person, few knew that during this time Brown was in the midst of a health crisis. It started with an upset stomach while performing with her company on tour last summer.
"I was drinking ginger ale, thinking that I would feel better," she says. Finally, the pain became so acute that she went to the emergency room in Mississippi. Her appendix had burst. "Until then, I didn't know it was serious," she says. "I'm a dancer—aches and pains don't keep you from work."
A flock of polyamorous princes, a chorus of queer dying swans, a dominatrix witch: These are a few of the characters that populate the works of Katy Pyle, who, with her Brooklyn-based company Ballez, has been uprooting ballet's gender conventions since 2011.
Historically, ballet has not allowed for the expression of lesbian, transgender or gender-nonconforming identities. With Ballez, Pyle is reinventing the classical canon on more inclusive terms. Her work stems from a deep love of ballet and, at the same time, a frustration with its limits on acceptable body types and on the stories it traditionally tells.
The latest fitness fad has us literally buzzing. Vibrating tools—and exercise classes—promise added benefits to your typical workout and recovery routine, and they're only growing more popular.
Warning: These good vibrations don't come cheap.
My life is in complete chaos since my dance company disbanded. I have a day job, so money isn't the issue. It's the loss of my world that stings the most. What can I do?
—Lost Career, Washington, DC
Dance Theatre of Harlem is busy preparing for the company's Vision Gala on April 4. The works on the program, which takes place on the 50th anniversary of the assassination of Dr. Martin Luther King Jr., reflect on the legacy of Dr. King and his impact on company founder Arthur Mitchell. Among them is the much-anticipated revival of legendary choreographer Geoffrey Holder's Dougla, which will include live music and dancers from Collage Dance Collective.
We stepped into the studio with Holder's wife Carmen de Lavallade and son Leo Holder to hear what it feels like to keep Holder's legacy alive and what de Lavallade thinks of the recent rise in kids standing up against the government—as she did not too long ago.
The encounter with man-eating female creatures in Jerome Robbins' The Cage never fails to shock audiences. As this tribe of insects initiates the newly-born Novice into their community and prepares her for the attack of the male Intruders, the ballet draws us into a world of survival and instinct.
This year celebrates the 100th anniversary of Jerome Robbins' birth, and a number of Robbins programs are celebrating his timeless repertoire. But it especially feels like a prime moment to experience The Cage again. Several companies are performing it: San Francisco Ballet begins performances on March 20, followed by the English National Ballet in April and New York City Ballet in May.
Why it matters: In this time of female empowerment—as women are supporting one another in vocalizing injustices, demanding fair treatment and pay, and advocating for future generations—The Cage's nest of dominant women have new significance.