Injuries of the lower extremities account for the majority of pain and reduced activity among adolescent ballet dancers.
Ballet requires a high level of skill and precision in order to execute a variety of movements in a controlled and purposeful manner. As dancers progress throughout each level, the physical requirements of training and performance generally become increasingly demanding. With heightened demand often comes increased risk of injury generally attributed to one or more of the following factors:
- Poor technique
- A specific incident
- Hypermobility at the cost of reduced strength
Injuries of the lower extremities are responsible for the majority of pain and reduced participation in activity among adolescent ballet dancers. 53% of injuries occur in the foot/ankle, 21% in the hip, 16% in the knee and 9% in the back. Studies indicate that 32-51% of dancers are injured each year.
Common Foot and Ankle Injuries
Flexor Hallucis Longus Tenosynovitis
Flexor hallucis longus tenosynovitis is the terminology used to describe inflammation of the tendon responsible for flexing the big toe. Tenosynovitis of a tendon occurs due to a combination of repetitive movements and increased load. Excessive practice of releves, jumps and pointe are examples of movements which may cause flexor hallucis longus tenosynovitis and dancers will present with pain, tightness and/or weakness along the path of the tendon which travels through the arch of the foot to the inner aspect of the ankle.
Symptomatic Os Trigonum
An os trigonum is a small accessory bone which either develops or is present at birth in the back of the ankle. Generally they remain asymptomatic however become aggravated with activities involving excessive or repetitive plantarflexion. The accessory bone gets pinched in the posterior portion of the ankle resulting in pain, swelling and reduced range of motion.
Anterior Talar Impingement
Anterior talar impingement refers to compression of the distal tibia (shin bone) on the talus (superior ankle bone). This occurs due to repetitive ankle dorsiflexion for example plies or landing from a jump and this can result in bony formation over the anterior aspect of the ankle. This causes soft tissue structures that travel over the anterior aspect of the ankle to become irritated and inflamed and may result in swelling around the ankle. If left untreated the entire joint capsule can become aggravated causing ankle synovitis.
Anterior Talofibular Ligament (ATFL) Sprain
This is the most common traumatic injury experienced by dancers and commonly occurs when landing incorrectly from a jump, over balancing on demi-pointe or full pointe or during a turn. Here the ankle is forcefully ‘turned in’ and varying degrees of stress are placed on the outside (lateral) ligaments. Ligaments are responsible for providing stability to the bones of the ankle and if inadequately rehabilitated will lead to weakness and the likelihood of repeated ankle sprains. Assessment of biomechanics by a physiotherapist is beneficial in evaluating ankle and foot alignment. Those whose ankles ‘sickle’ are more likely to reinjure their ankle as are those with discrepancies amongst either side. Bilateral strength is vital for performance and injury prevention.
Common Knee and Hip Injuries
Patellofemoral Pain Syndrome (PFPS)
PFPS generally presents as a dull non specific ache at the front of the knee around the kneecap. The cause of this condition is multifactorial and manifests as irritation to pain sensitive structures around the kneecap causing pain and dysfunction particularly with bending the knee, plies and jumps. Causal factors may include: poor quadriceps muscle recruitment patterns, poor foot biomechanics, inadequate hip and core stability.
A snapping hip is a sensation often experienced by dancers when they transition their leg from one position to another and an audible or palpable snap is heard/ felt. This sensation is attributed to a muscle, tendon or the iliotibial band flicking as opposed to gliding over particular bony prominences within the hip region. The iliotibial band runs from the outer aspect of the hip down the lateral thigh and attaches to the outside of the knee. It is a thick fibrous band responsible for pelvic stability and will often tighten in response to poor pelvic control or increased Q-angle. This sensation may or may not be painful however should be rectified by improving mobility, releasing the surrounding musculature and improving pelvic control and knee tracking.
Injury Prevention for dancers
In order to prevent injuries amongst dancers one must master the foundations and participate in proper training with focus on strength, technique and skill development. It may be necessary to perform additional strengthening exercises in order to maximise function and reduce the likelihood of strength discrepancies. Dancers and their parents should be aware of over training and educated in appropriate nutrition and the importance of adequate rest. Early recognition of pain and symptoms is also crucial and activity should be modified until the core issue is identified.
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