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By Nancy Wozny
Photo by Jacob Pritchard for Pointe.
Ashley Browne spends most of the time in Larry Keigwin’s Elements in the air. While she relishes Keigwin’s high-octane choreography, the combination of hard and repetitive movements contributed to a full-blown stress fracture several years ago. “We do these off-kilter pony steps in a flocking formation, which put a lot of stress on the outside of my foot,” she says.
Stress fractures, tiny fissures in the bone, often occur in the foot and leg when too great a burden has been placed on the bone without adequate recovery time. Bone cells constantly replace themselves, but if you break down bone tissue through repetitive wear and tear faster than you replace it, microscopic cracks can develop in the bone itself. “When bone is under stress, bone-making cells work a little harder to make the bone thicker and stronger, but those cells can only work at a set pace,” says Craig Westin, MD, who is affiliated with the Chicago Center of Orthopedics and works with the Joffrey Ballet’s dancers. “If the stress is too high or for too long, the bone-making cells can’t keep up and the bone starts to break down.”
Stress-fracture symptoms include pain, swelling, and sensitivity in one spot. The pain and swelling are likely to increase with more use. Diagnosis can be tricky. X-rays can often catch a stress fracture, but sometimes you need an MRI for a diagnosis. “MRI’s allow us to see swelling in the bones, too,” says Westin. “Bone scans are used as well, but less often.”
The Causes kDancers are particularly vulnerable to these types of fractures for a number of reasons: inadequate rest time, upping your rehearsal load suddenly, or coming back from vacation without adequate preparation. “A rapid increase in bone load is the culprit,” says Westin. Technique can be a factor as well. “Poor lateral and medial rotation of the foot can predispose a dancer to stress fractures,” Westin adds. He notes that the way a dancer lands from a jump can add stress on the skeleton.
Nutrition pays a big role, too. “The ‘terrible triad,’ when you have a combination of absent menstrual periods (amenorrhea), disordered eating, and low body mass, makes you especially prone,” says Westin. “Low hormone output and poor nutrition lead to poor-quality bone.” (This syndrome also is referred to as “the female triad.”) This can prove a particular issue for dancers early in their professional careers. The combination of too little body fat and scant experience dealing with the pressures of a full rehearsal schedule can cause stress fractures.
How To Heal Them
Nurse and massage therapist Sam De Benedetto works with the performers at Jacob’s Pillow. Many arrive at the health office with stress fractures. The initial treatment is a variation on RICE (rest, ice, compression, elevation). “I massage the area, relieving pressure along the bone line, recommend taking ibuprofen at night, and frequent icing,” says De Benedetto. “If there is swelling, I do a wrap for support.”
Long-term healing takes months, and recurrence is common because the area can remain weak if it doesn’t heal right initially. Older dancers tend to incur stress fractures less often, however, particularly once they are over 40. In part, this is due to their working more efficiently once they have more professional experience.
“In addition to ice and ibuprofen, I recommend active rest, which means the dancer keeps moving as much as possible without pain. Our motto is ‘No pain, no problem,’ ” says Westin. “We want to keep stressing the bone because that’s how you build bone.”
Nancy Wozny writes about health and the arts from Houston.
Bone Stimulators: Do They Work?
When a dancer develops a stress fracture mid-season and doesn’t have the luxury of a long recovery period, some doctors recommend a bone stimulator.
– These devices send waves to penetrate the bone marrow to produce immature bone cells and cartilage cells. The older type of stimulator provides a weak electrical current; some newer models use an ultrasound pulse.
– Typically, patients use them at home a half-hour a day to speed recovery. “Studies show traditional, magnetic-field bone stimulators induce stress-fracture tissue to turn into bone,” says Craig Westin, MD.
– “We’re talking about cutting recovery time for a dancer with a stress fracture from six months to a few months. Not every stress fracture heals completely. Bone stimulators help increase the chance of healing.”
Eating for Strength: Berry Smarts
Dancers get a lot of exercise, which can strain the immune system in periods of intense activity. Keep your antioxidant quota up with the powerful açaí berry. Studies show that this superfruit from the açaí palm tree, found in Central and South America, can help prevent heart disease and cancer. Rich in anthocyanins and flavonoids (which gives it a purple color), the açaí berry’s immune-boosting powers exceed those of the cranberry, raspberry, blackberry, strawberry, or blueberry. Get your daily dose in—and hydrate—with a V8 V-Fusion, Emergen-C, or other juice.
Inset: Photo from istock.