Your Essential Guide to Dancers' Back Injuries
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."
For the past few months, the dance world has been holding its collective breath, waiting for New York City Ballet to announce who will take over the helm as artistic director.
Though former ballet master in chief Peter Martins retired over a year ago after accusations of sexual harassment and abuse (an internal investigation did not corroborate the accusations), the search for a new leader didn't begin until last May.
Nine months later, the new director's name could be released any day now. And we have some theories about who it might be:
Some people take this profession as just a chapter of their life. They feel like dance is a job—a fun job, but a job. Other people live their life through dance. I never considered being a ballerina a profession. It's a lifestyle.
If I don't have a performance, I feel like a tiger trapped in a cage. I have so many emotions, I feel I need to give them to somebody, to exhaust myself—I need to cry or laugh, or else it's suffocating. Other people might scream or throw bottles into the wall. We dancers scream onstage through our movement. For me, it's like sweeping off the dust in my soul.
Back in 2011, Yale University's dean of science was thinking about refreshing the program's offerings for non-majors when he happened upon a Pilobolus performance. A light bulb went off: Dance is full of physics.
That realization led to what has become an eight-year collaboration between particle physicist Sarah Demers and former New York City Ballet dancer Emily Coates, both professors at Yale who were brought together to co-teach a course called The Physics of Dance. Their partnership has involved everything from directing a short film to presenting a TedX Talk and performing a piece that Coates created, commissioned by Danspace Project. This month, they're publishing a book about what they've discovered by dialoging across two seemingly disparate disciplines.
Sebastian Abarbanell remembers being asked as an undergrad at Trinity Laban in London to perform wearing only a dance belt. "I said no," he says, "because I felt uncomfortable." Now a performer with Sidra Bell Dance New York, he's performed partially nude several times, without reservation. The difference? "It comes with more experience and maturing as a dancer," he says. "When you see a dancer living in their skin, you don't need to put anything else on them. When I said no in college, I wasn't in my skin yet."
Getting in your skin—and getting comfortable wearing only your skin onstage—requires a particular alchemy of vulnerability, agency, preparation and practice.
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Birmingham Royal Ballet announced today that international star Carlos Acosta will be taking over as director in January of 2020. Current BRB director David Bintley will be stepping down this summer, at the end of the company's 2019 season, after a 24-year tenure. "It is a tremendous honor and privilege to have been appointed to lead Birmingham Royal Ballet," Acosta said in a statement.
Since retiring from The Royal Ballet in 2015, Acosta has focused much of his attention on his native Cuba, where he's proven his directorial abilities at the helm of Acosta Danza, the contemporary company that he founded in 2016. In 2017 Acosta also opened his first Dance Academy through his foundation, which provides free training to students. We don't yet know how Acosta will balance his time between his projects in Cuba and his new role at BRB.
My personal life has taken a nosedive since I broke up with my boyfriend. He's in the same show and is now dating one of my colleagues. It's heartbreaking to see them together, and I'm determined never to date a fellow dancer again. But it's challenging to find someone outside, as I practically live in the theater. Do you have any advice?
—Loveless, New York, NY
The inimitable Carol Channing, best known for her role as the titular Hello, Dolly!, passed away today at 97.
Though she became a three-time Tony winner, Channing was born in Seattle, far from the Great White Way, in 1921. After growing up in San Francisco, she attended the famed Bennington College, studying dance and drama. She later told the university, "What Bennington allows you to do is develop the thing you're going to do anyway, over everybody's dead body." For Channing, that meant decades of fiery, comical performances, bursting with energy.
Something's coming, I don't know when
But it's soon...maybe tonight?
Those iconic lyrics have basically been our #mood ever since we first heard a remake of the West Side Story film, directed by Steven Spielberg and choreographed by Justin Peck, was in the works. THE CASTING. THE CASTING WAS COMING.
Well, last night—after an extensive search process that focused on finding the best actors within the Puerto Rican/Latinx community—the WSS team finally revealed who'll be playing Maria, Anita, Bernardo, and Chino (joining Ansel Elgort, who was cast as Tony last fall). And you guys: It is a truly epic group.
Rehearsal is in full swing, and Leta Biasucci, Pacific Northwest Ballet's newest principal dancer, finds herself in unfamiliar territory. Biasucci is always game for a challenge, but choreographer Kyle Davis wants her to lift fellow dancer Clara Ruf Maldonado. Repeatedly. While she's known for her technical prowess, lifting another dancer off the floor is a bit daunting for Biasucci, who stands all of 5' 3". She eyes Maldonado skeptically, then breaks into a grin.
"It's absolutely given me a new appreciation for the partner standing behind me!" Biasucci says with a laugh.
Looking at Biasucci, 29, with her wide smile and eager curiosity, you think you see the quintessential extrovert. In reality, she's anything but. "I was an introverted kid," Biasucci says. "That's part of the reason I fell in love with dance—I didn't have to be talkative."
It's only one of the seeming contradictions in Biasucci's life: She's a short, muscular ballerina in a company known for its fleet of tall, long-legged women; she's also most comfortable with classical ballet, while taking on a growing repertoire of contemporary work.
Sergei Polunin, whose recent homophobic and sexist Instagram posts have sparked international outrage, will not be appearing with the Paris Opéra Ballet as previously announced.
POB artistic director Aurélie Dupont sent an internal email to company staff and dancers on Sunday, explaining that she did not share Polunin's values and that the Russian-based dancer would not be guesting with the company during the upcoming run of Rudolf Nureyev's Swan Lake in February.
Before spending a summer at Los Angeles Ballet School, Lillian Glasscock had never learned a Balanchine variation. "The stylistic differences, like preparing for a pirouette with a straight back leg, were at first very challenging," says Glasscock, 17. "But it soon got easier."
Los Angeles Ballet company members were in class daily, motivating and inspiring her. Trying out a new style and expanding her repertoire gave Glasscock more strength, and a better understanding of the varied demands of ballet companies today. Months later, the Balanchine variations she learned are now personal favorites.
While the early years of training are typically spent diligently working through the syllabus of a single ballet technique, when you start to prepare for a professional career, versatility is key. There isn't just one correct version of each step. And as ballet companies continue to diversify their repertoires, directors need dancers who can move fluidly between an array of styles.
Throughout your dancing life, you've heard the same corrections over and over. The reason for the repetition? Dancers tend to make the same errors, sometimes with catastrophic results. Dance Magazine spoke to eight teachers about what they perceive to be the worst habits—the ones that will destroy a dancer's technique—and what can be done to reverse the damage.
To get a 180-degree first position, dancers will sometimes let their arches roll forward. But turnout is not about forcing your feet open; it's about opening up in the hips. “Turning out is an activity, not a position," says Irene Dowd, who teaches anatomy at the Juilliard School. “If we stop sustaining that movement, our feet will passively roll in." Rolling in places stress on the tendons of the feet and leads to injury because the rest of the body compensates for the imbalance when your knees can't line up over your toes.
Dowd warns against using only the arch to combat rolling in. “Dancers will try to lift up their arches and pull up on the inside of the ankle," she says. This can result in the inflammation of the tendons in the ankle and lead to tendinitis, a painful overuse injury that's common in dancers. What she feels are “Victorian furniture feet—feet that aren't fully in contact with the ground" should be solid in three areas: the heel, the ball of the big toe, and the ball of the little toe. Imagine how your weight is being transferred from above, through the body and down the legs, rather than gripping the foot and lifting from the arch.
Misaligning the Spine
Distorting the back, either by crunching the lumbar vertebrae and splaying the rib cage open or by hunching the shoulders forward and tucking the pelvis under, affects every other part of the body. Since the proper placement of the torso is the foundation of any movement, a dancer with a misaligned spine will develop other deadly technique sins. Problems can ripple all the way down to the extremities and upward to the neck and head. The core will be loose, unable to provide essential support. A pelvis that either tips back or tucks under will limit the range of motion in the hips.
Christine Spizzo's students at the North Carolina School of the Arts constantly work on their placement. “The one directive I give in class more than any other," she says, “is tailbone down, navel muscles lifted." She emphasizes that the tailbone lengthens downward without tucking under, and the navel muscles lift upward, not inward. This opposition allows the external rotator muscles to be actively engaged at the top of the thigh. Spizzo uses the expression the Four Ts—“no tucking, tipping, tilting, or twisting of the pelvis"—as a reminder for students.
Clenching the Toes
Clenching, curling, knuckling—no matter what it's called, this condition hampers a dancer's ability to articulate the feet. Clenched toes also make the feet an unstable platform to stand on, creating problems for the rest of the body. The muscles and tendons of the foot, knee, and ankle must work together to perform a relevé or jump, says Edward Ellison, director of Ellison Ballet Professional Training Program in New York. Clenched toes will place unwanted stress on the joints of the legs, leading to imbalance and overuse injuries. On pointe, knuckling over can damage the bones and tendons of the feet.
Master ballet teacher Sara Neece of Ballet Arts in New York says that when the first joint of the toe presses down into the floor too hard, the second joint of the toe jams into the metatarsal. For Neece, the key to remedying clenched toes lies in “bringing sensation to those unused tendons" beneath the second joint, and teaching the toes how to work in a careful and deliberate manner. While seated, a dancer should prick the back of each clenched toe with a fingernail about 20 times. Sitting on a chair with the foot on the ground, she should drag it back toward the body, slowly raising it to demi-pointe with a forced arch. Teachers must pay attention to the response of the feet to this localized work, since overstressing the tendons can damage them. Another way to teach the toes to stretch out is to weave a strip of cloth over the second toe and alternate below and above successive toes, leaving it there during barrework and nondance activities.
Giving In to Extreme Hyperextension
Hyperextended legs, in which the straightened knee naturally curves behind the thigh and calf muscles, are prized in the world of extreme ballet bodies. Christine Spizzo sings the praise of a moderately hyperextended leg line, as the leg fits snugly in fifth position, and the arabesque looks gorgeous, with that slight curve offsetting the arch of the foot. However, dancers with extreme hyperextension must take special care. “The hyperextended dancer tends to have weak external rotator muscles," she says, so the legs are more prone to collapse in on themselves when landing from a jump, letting the body weight fall on the knees. This can result in damage to the joints that maintain the alignment of the leg, including twisted knees and sprained ankles. Even if the dancer understands how to avoid giving in to her hyperextension, she has to learn how to express herself fully while restraining her legs.
But Spizzo points to dancers such as international star Sylvie Guillem, who has used her extreme hyperextension to her advantage. The dancer must think of lengthening rather than straightening or locking the knee, even if it feels slightly bent. She must develop a heightened awareness of the turnout muscles from the top of the thigh down to the calf. “The muscles must be activated to not allow the dancer to give in to the hyperextension," says Spizzo. She uses the image of the barbershop pole to encourage dancers to apply that feeling of an infinite spiral to their legs. Somatic practices such as Pilates can help to strengthen those stabilizing turnout muscles. Spizzo insists that dancers stand with the heels together in first position and never be allowed to press back into that knee joint. To do this, “the quadriceps must remain soft. As soon as you grip, it pulls that kneecap back dangerously."
Using Unnecessary Tension
“Tension," says Daniel Lewis, dean of dance at the New World School of the Arts, “pulls you off balance. It tightens the muscles and causes injury." Stiff muscles are injury-prone muscles, which make free and confident movement impossible.
Unwanted stiffness can also limit your versatility as a dancer. “Modern dance is concerned with trying to go into space off-center and off-balance," says Mary Cochran, chair of the dance department at Barnard College. “If you spend too much time holding your body stiffly, it's hard to make the transition from working in-balance to working off-balance."
Rhythmic breathing helps dissipate tension. Think of the lungs as another limb and pace the breath with the dynamics of the music. Sustain a sense of motion in the body, even when you are still, advises Cochran. Doing so will help reverse the muscle memory of using tension as a form of stability.
Pinching Your Shoulder Blades
Although used as a strategy to open the chest in front, pinching your shoulder blades together immobilizes the back. The serratus anterior on the sides of your rib cage is so overstretched that it can't work. Edward Ellison says that pinched shoulder blades impede the freedom of the arms and the support of the upper spine. He feels that they “cause your weight to fall behind your axis, and strain the trapezius and rhomboid muscles of the back."
Irene Dowd suggests thinking about widening the tips of the shoulders to the side, to allow plenty of room for the chest. “It helps to think about the chest—full of your lungs, your heart, all those organs—as a sphere," says Dowd. “We need to have enough room for all those precious organs to breathe." To relax shoulder blades, sometimes she will tell students to focus on the movement of the hands. “Is the hand really a lively part of my being?" Dowd has her students ask. “The shoulder blade should support that hand."
Getting Stuck in a Rut
While physical habits impede progress, the deadliest sin is losing the drive to improve technique at all. Franco De Vita, principal of American Ballet Theatre's Jacqueline Kennedy Onassis School, says good technique begins with a dancer's approach to class. Being present and focused enables the dancer to learn combinations quickly—and correctly. “Not listening and changing the exercise is unacceptable," says De Vita.
Michael Vernon, chair of the ballet department at Indiana University, feels the worst thing a dancer can do “is to get fixed into doing something a certain way, being safe. I love young dancers who understand that you have to dance for tomorrow, and not yesterday." Keeping an open mind means more than just trying a different preparation for a pirouette. “Being open to new styles of dance and new ways of moving the body is vital to keeping the art relevant."
What's next for the dance world? Our annual list of the dancers, choreographers and companies that are on the verge of skyrocketing has a pretty excellent track record of answering that question.
Here they are: the 25 up-and-coming artists we believe represent the future of our field.
Just before retiring in 2015, Sylvie Guillem appeared on "HARDtalk with Zeinab Badawi," the BBC's hard-hitting interview program. Badawi told Guillem,
"Clement Crisp of the Financial Times, 14 years ago, described your dancing as vulgar."
"Yeah, well, he said that. But at the same time, when they asked Margot Fonteyn what she thought about lifting the leg like this she said, 'Well, if I could have done it, I would have done it.' "
They were discussing Guillem's signature stroke—her 180-degree leg extension à la seconde. Ballet legs had often flashed about in the higher zones between 135 and 160 degrees before. But it wasn't until the virtuoso French ballerina regularly
extended her leg beside her ear with immaculate poise in the 1980s that leg extensions for ballet dancers in classical roles reached their zenith. Traditionalists like Clement Crisp were not taken with it.
When coming up with phrases of movement, choreographers all have their habits: certain patterns they return to again and again, tendencies that repeat themselves whether they mean for them to or not.
What if artificial intelligence could be used to help choreographers mix things up by suggesting thousands of other options—and ones that still fit their choreographic style, no less?
In the early 1960s, a group of dancers started questioning the existing rules of choreography. Influenced by John Cage, they created dances that were startling in their simplicity and risk-taking. Yvonne Rainer, Steve Paxton, Trisha Brown, David Gordon, Deborah Hay, Elaine Summers and Lucinda Childs were all part of this group. Most of them had studied or danced with Anna Halprin or Simone Forti. Visual artists like Robert Rauschenberg and Alex Hay were part of this cauldron of experimentation as well as composer Philip Corner.
The Museum of Modern Art has mounted an expansive exhibit called "Judson Dance Theater: The Work Is Never Done." It gathers photos, artwork, scores, objects and films that bring the period alive. If you get there before January 16, you'll see the films of Brown's early work. Her piece Walking on the Wall was so disorienting that it was almost hallucinatory. (Actually, this film and most of the Brown pieces are from the 70s.) Playing with perception was a big part of the Judson and post-Judson eras.
Balanchine and Stravinsky. Cunningham and Cage. Graham and Copland. Twentieth-century dance was dotted with memorable partnerships between musicians and choreographers that wrought magical, full-bodied, brilliant works.
Today's composer-dancemaker duos, though, have gone in a decidedly different direction. In ever-growing numbers, mainstream musicians are this century's dance collaborators. Sufjan Stevens has aligned himself with New York City Ballet's Justin Peck; Bon Iver's brought his signature indie folk to Minnesota contemporary troupe TU Dance; and even Sia's getting in on the act, working with Akram Khan on a dance theater piece premiering this summer.
What is it that's drawing pop artists to the dance floor?
Though Polunin has long had a reputation for behaving inappropriately, in the last month his posts have been somewhat unhinged. In one, Polunin, who is Ukrainian, shows off his new tattoo of Vladimir Putin:
I've just read Emma Sandall's piece on hyperextension and the 180-degree position. It's intelligent, interesting, well-written. But there are a few mistakes and some misleading remarks. I can't resist writing the following.
1. If Guillem says Fonteyn said would have lifted her leg higher if she could, then that's what Guillem says.
But she's wrong. Keith Money's book "Margot Assoluta" (published in 2000) includes a photo of Fonteyn in rehearsal doing a seconde almost to shoulder-height: she told Money "I can get the leg that high—but it ruins the line." Fonteyn wanted level hips, something crucial to many ideas of placement but not discussed by Sandall.
The cover star of the January 1974 issue of Dance Magazine was beloved Italian ballerina Carla Fracci. She was adored by ballet fans in the U.S. for her guest appearances with American Ballet Theatre, and a bona fide celebrity in her hometown of Milan. But she nevertheless made time for her director husband and their young son, who often accompanied her on tour. "I don't like to be only ballerina," she told us. "I say: the dance—all right. I like it. I like my work, and I do the best that I can. But it is not 'all' for me...Most dancers are closed, in a way, because it takes so much to dance, the physique is under so much stress, that often they are too tired, even to read, or to go to the theaters, the museums, to hear music, to be with people. But you can't be a dancer without these things...You can't just close your eyes and go to the barre. You get lost in this obsession with the barre and toe shoes. Your life can be destroyed that way."