Why do back injuries seem to be so common these days among dancers?
"It used to be that if you were in a company, you did all the work of that choreographer," says Rocky Bornstein, a New York City–based physical therapist who specializes in professional dancers. "Now companies feel like they have to bring in choreographers to work with the company, so the work is much more eclectic." More and more dancers are also building freelance careers, which forces them to hop between various styles. This is an unprecedented challenge for the body.
Dr. William Hamilton, who was an orthopedic consultant for New York City Ballet and American Ballet Theatre for four decades, adds that even big companies are getting smaller, which puts more pressure on each individual dancer. A minor injury in one member can cause a domino effect within the company: Other dancers need to do double duty, which puts their bodies at risk for injury as well.
Although back injuries may not be any more common than hip or ankle injuries, there are a few issues that show up over and over again in dancers.
Knowing common symptoms and risk factors can help you catch minor problems before they become major. Photo via Getty Images.
What Are The Most Common Back Injuries in Dance?
Muscle Pull in Quadratus Lumborum
Symptoms: In women, this typically happens in the lowermost part of the back, while in men, it occurs higher up, where the thoracic spine joins the lumbar. It feels like localized tenderness when you move (with no radiation down the leg).
Causes: In younger dancers, it's often caused by upper-body weakness. It can also happen to men when they lift off-balance.
Recovery: This injury heals easily with relative rest. "If it's achy, dancers can work with it," Hamilton says, "but if it's disabling, a week of rest helps." It can, however, become a chronic condition, persisting for several months. In that case, treatment involves a strengthening program, especially for the core.
Symptoms: The joints in the back get locked up, which generally feels like a spasm.
Cause: This happens most typically when forward or backward bending is combined with spinal rotation.
Recovery: This can put you out for a week. Acupuncture, massage and rest can help.
Stress Fractures of the Lower Back
Symptoms: Back pain might radiate up or down the spine and into the glutes. It will be particularly acute in an arabesque.
Causes: Overtraining, bad posture and mechanics (hyperflexibility in one part of the back, stiffness in another), or impacting the bone over and over during jump landings until it fractures. This is common among women and adolescent males.
Recovery: Physical therapy usually lasts for several months and involves a lot of reeducation and strengthening.
A related issue: There is a difference between a stress fracture and a stress reaction. "If you take a paper clip and bend it, it eventually breaks," Hamilton explains. That is a fracture. A reaction is "when you bend a paper clip, but it hasn't broken yet. If you don't stop, it will break." A fracture shows up on X-ray. A reaction will light up, but no crack will show, and it has a much faster healing rate. If you have a reaction, allow yourself relative rest, which means cutting back on—but not eliminating—activity. "Take away the activities that caused the reaction," Bornstein says. "You don't want a reaction to turn into a fracture."
Symptoms: When a disc herniates, the tear causes bleeding. The blood in that area of the body is attacked as a foreign substance and an inflammatory reaction occurs. The bigger the tear, the more inflammation, which causes nerve pain.
Causes: Bad mechanics or alignment, excessive movement in the lumbar spine or executing lifts improperly. "Or sometimes you just do the wrong move and tear the fibers of the disc," Bornstein says.
Recovery: A dancer can be out anywhere from nine months to a year. Recovery can involve physical therapy, acupuncture and/or cortisone injections.
Extrusion of the Disc
Symptoms: This is a more serious version of a herniation. The casing of the disc tears, fluid comes out, along with a small piece of disc. The symptoms can be almost identical, or it can cause excruciating pain that can render you almost incapacitated. The biggest red flag is a palsy—when you suddenly lose motor function in a lower extremity, most commonly in a foot.
Causes: Same as herniation.
Recovery: Steroid injections can help in the first three months. Surgery may be an option.
Side effects: This can affect the functioning of the nerves. "As long as dancers can do a single foot relevé, the nerve is okay," says Hamilton. "If the pain is very slow to go away and all of a sudden you can't do a relevé, see a neurosurgeon."
Dr. William Hamilton advises against anti-inflammatories, which can delay healing: "Mother nature is telling you what needs healing." Instead, don't do what hurts. Photo by Larm Rmah/Unsplash
What Are The Biggest Risk Factors?
How many times has a dancer heard, "Let me see you do that again?" Dancers—especially younger ones—typically have no control over how much they dance, says physical therapist Rocky Bornstein. In addition to not being able to determine days off or rehearsal length, they can go from having no schedule to a 16-hour day. This can lead to a dangerous amount of fatigue.
2. Inadequate Conditioning
Bornstein says that dancers who don't get somatic and biomechanical training in school may know little about the cross-training modalities like Pilates and Gyrotonic that enable a dancer's body to thrive over the course a long career.
Dancers are uniquely overly flexible in the back and hips, which can lead to instability if there is also a lack of strength and inefficient motor control.
4. Being Underweight
Not eating enough calories can have a huge impact on bone health.
Working on core strength can help stabilize the back and hips to help protect against injury. Photo by Getty Images.
What Can You Do To Prevent Back Injuries?
It is impossible to make a blanket statement about what exercises all dancers need to keep their backs healthy, but there are a few basics that can work for everyone:
Learn how to walk and stand correctly. Too often, dancers lean the pelvis too far forward of the heels and shoulder girdle, or walk with their feet turned out. Bornstein suggests using bony landmarks to assess if you're standing well. The pubic bone and the front bones of the pelvis should be on the same vertical plane. The breasts should be horizontal and over the pelvic bones. The tips of the shoulders should be at a 90-degree angle (not drooped down, which isn't good for the neck or shoulders). Knees should be pointed forward.
Go swimming or use the elliptical. A good cardio system will help you avoid fatigue.
Do basic pelvic-floor abdominal exercises. Lie on your back or side. Focus on your pelvic floor and lift your vaginal muscles (or, for men, the scrotum) into your body without bringing the sitz bones together.
Follow an upper-body strengthening program. Planks, push-ups and side planks are the most helpful, if you keep good posture. "Guys need to do squats with bicep curls, practice overhead lifts while maintaining pelvic position, and use their legs and arms at the same time," says Bornstein.
Cardio activities like swimming can build your endurance, helping you fend off fatigue. Photo by Marcus Ng/Unsplash
How Can You Recover Stronger?
After repairing an injury, remaining healthy requires going back to address the vulnerabilities that caused the problem in the first place. "It is a forever thing," says Bornstein.
An injury is an opportunity to get to know your body better. This is where a good physical therapist can come in. "Dancers need to learn movement strategies that are more effective and biomechanically safe," Bornstein says. "They need to learn what tissue and joint issues make them susceptible to the specific injury."
Jennifer Brilliant, a certified yoga therapist and medical exercise specialist, adds: "Not all things work for all people. If you need to take a private lesson so you understand something better, do it. Invest the time to understand why this is happening in your body. It is an indication that deeper work needs to be done, and there's no shame in that."