Houston Ballet corps dancer Elise Judson was rehearsing an overhead lift that transitioned from one partner to another when she fell headfirst to the floor. Adrenaline immediately took over. “But once that wore off, the left side of my head and face felt like they were pulsing, and I had a substantial headache," she says. “I was loopy and extremely emotional—it was later explained to me that these were signs of trauma and adrenaline levels subsiding."
Judson had a concussion, a traumatic brain injury that happens when a forceful blow to the head or body causes the brain (which floats in cerebrospinal fluid) to bounce against the skull, leading to damage. Royal Ballet principal Natalia Osipova suffered a concussion in February, for example, when she collided with another dancer during a performance of Wayne McGregor's Tetractys—The Art of Fugue.
Though a concussion may not be an everyday dancer injury, it happens often enough that Dance/USA's Task Force on Dancer Health recently published an informational paper on the topic specifically for dancers.
“In the last couple of years there has been increased national attention on concussions and most states have passed legislation for student athletes, but dancers are usually ignored," says Selina Shah, the medical director of dance medicine for Saint Francis Memorial Hospital's Center for Sports Medicine in the Bay Area and a member of the task force. “Dancers are not immune to this type of injury. However, it's very hard to get people's minds around a concussion because it's so different from a physical injury. You can feel the ache from a bruise or spot the swelling from a ligament, but you can't see the brain."
Yet concussions are extremely dangerous. Experiencing one leaves you more susceptible to another, potentially increasing both symptom severity and recovery time. What's more, if symptoms from the first concussion haven't completely resolved and another jolt to the head happens, you risk second impact syndrome, which is a rare, rapid and potentially fatal swelling of the brain.
How do you know if you've gotten a concussion? Symptoms can include headaches, loss of consciousness, nausea, vomiting, balance issues, dizziness, double or blurry vision, ringing in the ears, sensitivity to light and noise, irritability, memory or concentration problems, mood or personality changes, insomnia or excessive sleep.
“Not all dancers will experience symptoms right away," says task force member Katherine Ewalt, owner of Performing Arts and Athletic Restorative Training Specialists in San Diego. She notes that some symptoms may appear immediately or a few hours after the original impact, while others may not be noticed for days or weeks afterward.
What To Do
Although severity varies, brain trauma experts agree there is no such thing as a minor concussion. Even “mild" cases can affect a dancer's ability to perform mental and physical tasks. If you suspect you might have one, stop all physical activities and go to the emergency room as soon as possible for an official diagnosis.
“If someone has suffered a concussion, ideally they are not going home alone after, but they will have a friend or roommate checking in on them every few hours," says Shah. If someone with a concussion doesn't wake up with relative ease every three or four hours, it may mean there is bleeding on or in the brain.
Right after Judson fell, she saw Houston Ballet's physical therapist and he had her ice her head, neck and back and monitored her symptoms for an hour. The following day, she went to a local emergency care center for an MRI, CT scan and X-ray to diagnose the concussion. “Things were difficult—much more than I expected—even once the initial impact soreness went away," Judson says. “If I turned around too quickly, I felt dizzy. If I stood up too fast, I became dizzy. I couldn't even make the bed."
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Most people with a concussion fully recover in a week to 10 days with proper care, which includes both physical and cognitive rest until symptoms resolve. Some, however, experience symptoms for several weeks. Task force member Shaw Bronner, who serves as director of physical therapy services at Alvin Ailey American Dance Theater, warns that if you try to “push through" and ignore the symptoms, it could cause further damage to the brain and lengthen the recovery time significantly.
Because every injury is different, dancers should have a medical professional experienced in concussion management monitor their progression closely and develop individualized guidelines for returning to dance, such as starting with a partial class without jumping, then dancing without partnering and finally fully integrating back into class and rehearsals. As you return to the studio, Bronner says, be aware of potential side effects, such as decreased reaction times and balance issues.
If any symptoms recur, the task force recommends returning to the previous level of activity until they disappear. “Be honest about whether you are experiencing any symptoms. Do not try to hide them," Ewalt says. “Everyone is anxious to get back to training and performing, but remember that this is an injury to the brain."
It took Judson about three weeks until she was able to dance almost everything full-out, but with modified turns (single pirouettes) and ending class after petit allégro. “I truly didn't expect how difficult it would be to return to class and rehearsal," she says. “Your brain doesn't heal like a muscle does. You can't control the swelling and the actions of your brain. It has a 'mind' of its own."
Dancer Concussion Tips
- If there is any question whether you should keep dancing after a fall or blow, experts agree: “When in doubt, sit out."
- Less than 10 percent of concussions involve a loss of consciousness, so don't rely on that as a main indicator of trauma.
- Do not return to dance the same day as the injury, even if symptoms seem to resolve. You could risk additional damage.
- Dancers should be monitored for mental or physical deterioration during the first few hours after injury. If the situation worsens, return to the doctor.
- Like any injury, the body needs rest to heal. But because a concussion has both physical and cognitive effects, this can mean rest from television, computers, reading, texting and music.
- Acetaminophen (Tylenol) can be taken safely, but do not take sleeping medications, aspirin or ibuprofen, which can cause bleeding at the site of the injury. Also avoid alcohol, which could slow your recovery and put you at risk for further injury.