Op-Ed: It's Time To Re-Evaluate the Term "Overuse"

November 8, 2017

Injuries occur in dance frequently. Numerous studies show that at any given time, 40 to 95 percent of the dancers in a given studio or company are injured. This is not news to anyone. But how many times have you been told your injury is because of “overuse”? Doctors use this term often when dancers have pain that comes without any specific injury.

I think It’s time to re-evaluate this word, especially in the dance world. Calling injuries “overuse” may actually be harmful.

The term “overuse” in verb form literally means excessive use—to utilize a body part so often that it breaks down. Dancers practice for hours a week from early ages of life to perfect movements large and small. So this seems to make sense: a dancer is dancing many hours a day, a dancer hurts in a specific location, this means overuse.

But compared to other dancers, the amount of use may be ordinary. If 20 high school dancers are all dancing six hours a day, five days a week, and only one develops lingering knee pain, is that really an “overuse” injury? Why doesn’t anyone else have pain?

Natalie Cantalino, photo by Steven Karageanes

In these situations, the injury is due to “repetitive use” of an area of the body that has mechanical flaws. The flaw causes inefficiency in movement, putting excessive load and stress in the affected area, which leads to pain, tissue breakdown and injury. These flaws may be rooted in dance technique or human biomechanics. Perhaps it’s a lack of intrinsic strength to stabilize the body, which causes other muscles to compensate. Or maybe it’s a pelvic malalignment or a functionally shorter leg on one side.

By comparison, most “overuse” injuries are related to training errors, like a sudden large increase in hours dancing, change to a new dance surface, doing extra work outside of normal training, dancing for a new choreographer with a different style or jumping back into classes after a prolonged injury.

Why care about “repetitive use” versus “overuse”? Because each term implies a different treatment. Most overuse injuries are treated by rest and adjustment to training levels and environment. But many times, a dancer is told to take off two weeks, four weeks, wear a walking boot, go on crutches, and then when they go back to class, the pain is still there! That does not sound like overuse if the body part had time to heal and still hurts.

In repetitive use injuries, the flaw needs to be corrected, while treating the pain source as well. So that may mean a full history and physical exam, physical therapy, manual medicine, icing, KT taping, medication and a lot of other things.

So if you are told that you have an overuse injury, think about your situation and see if that makes sense, or whether it’s more likely a repetitive use injury. Most of the time, you will be right.