Health & Body

The Stress/Injury Connection


If you're sitting out of rehearsal today, chances are you're not alone: Dancers are among the most frequently injured of all athletes. The long hours of training, along with repetitive and wide-ranging movements, put dancers at an exceptional risk. But knowing you're not the only one on the sidelines doesn't make it any easier. “Dancers identify so strongly with their bodies. If something is inhibiting their ability to execute a tendu pain-free, that can create a lot of stress," says Suzanne Semanson, DPT, a physical therapist at Harkness Center for Dance Injuries at New York University's Langone Medical Center.

Yet many dancers don't realize that stress and injuries can sometimes raise a question of chicken-or-the-egg. Stress has both psychological and physical components, and the two are not easily separated. While stress usually results from injury, it can sometimes be part of the cause—and the reason why it takes so long to heal. Nadine Kaslow, PhD, past president of the American Psychological Association and psychologist for the Atlanta Ballet, advises: “If you find that your body is just not serving you well—it's shin splints this month, you hurt your shoulder next month—you need to stop and look at what might be going on for you emotionally."

The Body on Stress

How can an emotional state affect your body? When we feel stressed, our nervous system goes on high alert, and our brain signals the release of a hormone called cortisol. This ancient physical response can be helpful when we need to, say, quickly outrun a saber-toothed animal. But cortisol can cause problems if ongoing stress means our bodies are exposed to too much of it. “Cortisol needs to come in waves," says Brad R. Moser, MD, founder and director of the Minnesota Dance Medicine Foundation. “When it is released for too long at a very high rate, it can cause injury to cells and tissues."

Cortisol decreases bone formation, an essential part of the healing process when bone is injured, bruised or broken. And it triggers an anti-inflammatory response, which affects the immune system, making it harder to fight illness. “It can also lead to depression and fatigue, which eventually lead to more frequent injury," says Moser.

Physical symptoms of excessive stress can include dizziness and loss of balance, putting dancers in danger. Additionally, we tend not to sleep or eat well when distressed, compromising our strength.

Psychological Effects

In a catch-22, injury itself is one of the leading causes of stress among dancers. For a study published in the Journal of Dance Medicine and Science in 2013, researchers in the Netherlands surveyed more than 150 injured dancers. The subjects answered questions about a variety of psychological symptoms, including trouble concentrating, paranoia, anxiety and feelings of inferiority, as well as physical symptoms like dizziness or loss of balance. About 60 percent of the respondents had psychological symptoms far enough out of the norm that they warranted referral to a psychologist or psychiatrist for treatment.

Dance culture isn't helping. “Dancers often don't pay attention to the signals that their body is hurting," says Kaslow. “They've learned that they have to keep going." The injured dancer, she says, is afraid to be viewed as weak. “When a dancer has to take time off because of a bad injury or they need surgery, they feel like they have lost everything," she says. Often, injured dancers are forced to give up roles or take a hiatus from the company, compromising their personal identity, and compounding the stress further.

Take Charge

So what can a dancer do? The key is to lower your stress baseline before you get injured. Stress builds on itself: With each new stressor, “that baseline just goes up and up," says Kaslow. If you can lower your stress level a bit each day, new problems that arise—like a sprained ankle—won't take as big of a toll.

Start by taking your breaks. During heavy rehearsal periods, dancers will often chat with each other or keep dancing during their lunch or 15-minute rest periods. “Your body actually needs a break," says Kaslow. “Learn how to do some relaxation training. Go into a quiet space in the studio, and focus inward." Use the time to squeeze in a few minutes of meditation or mindfulness while letting your muscles recharge.

Also learn to wind down at the end of the day. “It's usually hard to go to sleep after a show," says Semanson. “The nervous system needs a chance to transition from that heightened state of performance to calming down. The muscles need to relax so that when you go to bed, your nervous system levels out." Semanson teaches her patients cool-down exercises that combine deep breathing with gentle body movements (see sidebar below). This combination cues tense muscles to relax and dials down the nervous system.

Kaslow also recommends researching meditation books and tapes. “Find something that fits the way you think about the world: You are more likely to use it."

But if the stress feels like too much to handle on your own, don't be afraid to seek out a psychologist. Make sure you're getting the best medical attention possible from an expert who understands the demands of dance. Just the way you take care of injured limbs, take care of your emotions, too.

Write It Out

In 2013, researchers in New Zealand found that expressive writing for 20 minutes three days in a row sped healing in healthy adults who underwent biopsies. Study authors believe writing about our thoughts and feelings can help reduce stress.

Exercises to De-Stress

Each of these sequences, recommended by physical therapist Suzanne Semanson, starts by lying on your back with your knees bent and feet flat on the floor.

Full Complete Breath

Place one hand on your lower abdomen, the other on your chest, and close your eyes. Take a full breath. With the inhale, expand your abdomen and chest. Notice how your body responds. What moves first? What is not moving? As you exhale, notice how your chest and abdomen soften back toward the floor. Repeat for 10 slow breaths.

Pelvic Rocks

Rest your hands in a triangle on your abdomen, the heel of your hands on your hip bones, and your fingertips pointing toward your pubic bone. Inhale and gently move into an anterior pelvic rock where the triangle is pointing down. Exhale and tuck your pelvis under so that the triangle points up as your back flattens against the floor. Repeat 10 times.

Bridging

Place your arms at your sides, palms down. On an exhale, press through your heels to lift your hips up. Hinge through your hips so you're not tucking or rolling your spine. Pause at the top for an inhalation. Exhale and lower your hips back to the ground. Repeat 10 times.

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