Are dancers getting injured more? Part I

A big leap, a multiple turn, an intricate phrase of choreography – and, pop. There goes an injury. Alternatively, other dancer injuries are quieter, yet no less debilitating — building up over time from misalignments or simply the physical demands of a certain style. Injuries have always been an unfortunate phenomenon in the dance field. Dancers are athletes, after all (and more!).

Post-COVID lockdowns, however, teaching artists and dance medicine specialists are (anecdotally speaking) seeing a concerning rise in injuries. Why might this be? One factor could be more and more dancers looking to social media and other internet sources (with no guarantee of expertise, or of working from evidence-based guidelines) for guidance on stretching, conditioning and more.

Photo courtesy of Shortcut Socials and Heal Yourself and Move.
Photo courtesy of Shortcut Socials and Heal Yourself and Move.

Environmental factors such as dancing in small spaces, on non-sprung floors – also due to COVID-inflected factors – seem to have not helped there. Additionally, also due to COVID, dancers have come back to packed seasons when they may very well not have been able to stay in the kind of shape necessary to meet the demands of dancing full-out through program after program.

In the first installment of a three-part series on this phenomenon, we’ll explore those factors – what we know about them, at least (before we can say that we really know for sure, dance medicine researchers need to validate what we’re seeing with empirical data). Next, we’ll investigate some technical and anatomy/physiology principles that can help reduce the risk of injury (not to mention enhance dancers’ artistry!). Finally, we’ll lay out some more overarching principles for pushing back against this (seeming) current trend of an increase in dancer injuries.

Dance medicine specialists will lead the way. For this series, Dance Informa speaks with Sue Mayes, Principal Physiotherapist of The Australian Ballet; Zac Jones of Heal Yourself and Move; and Joshua Honrado, Doctor of Athletic Training with NYU Langone’s Harkness Center for Dance Injuries. Without further ado, let’s explore.

Sue Mayes. Photo by Christopher Rodgers-Wilson.
Sue Mayes. Photo by Christopher Rodgers-Wilson.

Information from questionable sources: Stretching guided by ‘influencers

Mayes works mostly with professional dancers, who do tend to rely on trained, reputable sources for conditioning and stretching guidance (and of course, there are exceptions there). Yet, she does see images on social media that concern her, of dancers going to extreme end ranges of flexibility. Considering the actual, ultimate goal of dance artistry, “why do we need that [sort of] range of motion if we can’t control it?” she asks.

She’s firm that there are much safer ways to achieve that end range of motion – those which also ensure that the flexibility is supported by musculature and the necessary anatomical structures (such as ligaments). Indeed, flexibility without the necessary anatomical support can have dangerous outcomes – and not only those that are immediate (for example, dysplasia of acetabulum of the hip joint, which can occur down the line as a result of continuous and extreme passive stretching, Mayes notes).

Zac Jones of Heal Yourself and Move. Photo courtesy of Shortcut Socials and Heal Yourself and Move.
Zac Jones of Heal Yourself and Move. Photo courtesy of Shortcut Socials and Heal Yourself and Move.

Jones, on the other hand, does work with young dancers. From what he’s observing there, he’s also concerned. He sees certain social media accounts sharing exercises and tips on stretching that are “detrimental to technique.” He’s also seen what’s shared on these accounts influence the actions, priorities and perspectives of various individuals involved in a young dancer’s training — from teaching artists to parents to the dancers themselves.

One might wonder how all of this has happened. As Jones sees it, during COVID lockdowns, dancers wanted to continue working on goals for flexibility, technique and conditioning, various things that matter to dancers when it comes to their craft. When studios were closed (apart from sometimes sporadic online class offerings), the internet was where they had to go for that information on all of that. Sadly, “a line was cut between the teacher and student. That daily discipline and close guidance were no longer there,” Jones explains.

Moreover, “social media has made it even more attractive to find information online” – as noted, not all of it being scientifically sound (shout out to dance health professionals who are sharing great information online – you are very much out there and doing great, important work!). For as advantageous and enjoyable as it can be, social media is not exactly built for context, deep-dives of good information, or nuance (tune in to Part II for lots of anatomy/physiology information – we will proudly go there!).

Joshua Honrado at screening table. Photo courtesy of Harkness Center for Dance Injuries.
Joshua Honrado at screening table. Photo courtesy of Harkness Center for Dance Injuries.

Mayes reiterates a key problem with that lack of context when it comes to images of dancers at extreme end ranges of motion. “Can they really support themselves in their technique, in a way that makes you want to watch them on stage?” She notes that “when you’re looking at pictures on Instagram, it’s a static picture and not movement.” The latter could be a whole different story. Also lacking in these images, Mayes and Jones both agree, is context around dancers’ skeletal structures – in other words, the skeleton you were born with being the one that you have to work with.

For example, we can’t change the length of our limbs to alter the look of our lines or our hip structure in order to safely increase our turnout. Jones notes that it is possible to work with some of these skeletal limitations in order to make technique and aesthetic adjustments. That needs to be done in an anatomically-informed, careful and intentional way, however. That’s most often not going to come through exercises from Instagram. It takes careful one-on-one work.

On the other hand, there are things that we can look for in images of dancers to get a better idea of supported, stable technique (or lack thereof) – are they aligned, for one. “There’s a lot of cheating going on,” and that cheating can be obvious in some images, Mayes notes bluntly. That can further sharpen concerns about dancers taking stretching/conditioning instruction from social media.

Sue Mayes with dancer Sara Andrlon. Photo by Christopher Rodgers-Wilson.
Sue Mayes with dancer Sara Andrlon. Photo by Christopher Rodgers-Wilson.

Space, flooring, navigating layoffs: Dancing with the right supports 

Dancing in small spaces, with the potential to knock into furniture or other objects – not to mention dancing on floors with less-than-adequate support to dancers’ joints – can’t have helped things when it comes to this seeming rise in dancer injury rates. Toward the latter, Honrado notes that research on dance flooring makes it fairly clear that the right kind does make a difference.

He shares that at Harkness, they’re seeing many dancers with low back and knee discomfort – which may very well be linked with more-than-occasional dancing on non-sprung floors. Yes, COVID lockdown-era virtual classes could be harder to find than in-person classes prior to it (and now, one could argue). Yet, dancers still did dance – at home and at other spaces available to them. Not all of those spaces could offer them the safest, most supportive features for their moving body.

Joshua Honrado taping Dance Theatre of Harlem on tour. Photo courtesy of Harkness Center for Dance Injuries.
Joshua Honrado taping Dance Theatre of Harlem on tour. Photo courtesy of Harkness Center for Dance Injuries.

Honrado notes that there (unfortunately) aren’t a plethora of studies focusing on the effects of COVID lockdowns on dancers. Yet, there have been a couple, those that speak to best practices when it comes to dancer layoffs. One, out of Portugal, looked at the effect of physical preparation classes offered to dancers during COVID lockdowns. The study found that dancers came back to the studio, when it was safe to do so, with even more flexibility and mobility (in other words, muscle-supported flexibility – for instance, the height at which a leg can lift itself versus being assisted by an outside force).

Honrado believes that these results indicate “dancers shouldn’t completely rest” during layoffs or other times away from the studio. “We know that flexibility is the first to go, so dancers should keep working on that” – in a safe, evidenced-based manner, he’s clear to add. However, another study out of China found that when dancers returned from a layoff – without physical preparation classes – they had fewer injuries and decreased fatigue. Honrado explains that those outcomes could be from dancers having time for their body to rest and recover, but it’s not quite clear.

(Stay tuned for Part III to learn more from Honrado, and all our experts here, about how dancers can be more informed consumers of online information on stretching and conditioning – such as how to spot “red flags” for information that’s not reputable or empirical.)

Zac Jones. Photo courtesy of Shortcut Socials and Heal Yourself and Move.
Zac Jones. Photo courtesy of Shortcut Socials and Heal Yourself and Move.

A better focus: Technique, strength, artistry 

Yes, there’s anecdotal evidence that we’re seeing an unfortunate, concerning rise in dancer injuries post-COVID lockdowns. There’s also hope that we don’t have to get stuck there. Jones points to bringing everything back to technique and artistry (more on that in Part II, from pedagogical best practices to cross-training principles for injury prevention). The flashy Instagram images of dancers stretching at extreme ranges of motion – that, in the end, aren’t really what the art form of dance is about – can then begin falling out of focus.

When all is said and done, the dancers who we see on social media aren’t us. We don’t have their body, and they don’t have ours. We don’t have their unique artistic gifts, and they don’t have ours. “Rather than copying someone else, you have to figure out your own body and how you can access” the technique and movement at hand, Mayes reminds us.

By Kathryn Boland of Dance Informa.

The post Are dancers getting injured more? Part I appeared first on Dance Informa Magazine.

Supporting connection over comparison

Some of my earliest memories from my formal dance education are of watching the “model” student stand in the front of the class and demonstrate how to execute (input said skill). Without realizing it at the time, this behavior, while attempting to support education and skill building, actually created an unhealthy atmosphere for comparison. I would spend the next 20 years either comparing myself to the “best” student or striving to be the best student who showcased everything, which didn’t happen very often. This often left me feeling inadequate, frustrated and disappointed.

Some of you reading this may be nodding along. It’s not an uncommon practice, especially in dance to compare and contrast ourselves with our peers. While it can foster healthy competition and encourage students to work toward a goal, improve skills and achieve a greater level of performance, it can also lead to unhealthy behaviors that can harm a dancer’s mental and physical health. This can lend itself to comparison of things beyond skills like body image and aesthetics.

I don’t believe any of us got into the field of dance or became dancers to meet an impossible standard or to be anyone else but ourselves. And yet, somewhere along the line between our first ballet shoes and our first job audition or class lecture, we find ourselves being more concerned with how we measure up to others than how authentic we are in our own body. This culture of competition over connection has deep roots in the dance community and well, the arts on a broader scale. Comparison is not all bad, but it can lead to dangerous outcomes if not properly cultivated and managed. There are many ways educators can foster connection over comparison and for individual dancers to keep their need to compare in check.

For educators:

Support student’s individuality by focusing on strengths.

Offer constructive feedback while also pointing out an accomplishment.

Facilitate mentorship over competition or comparison.

Encourage more advanced dancers to move with less experienced or novice dancers.

Create space for all bodies and abilities in the dance studio.

For students:

Focus on strengths outside of the studio to support confidence and self-esteem.

Ask more experienced dancers for advice or support on skills you are looking to strengthen.

Explore opportunities to dance with people with different lived experiences from your own.

Find a confidant or mentor who models connection and collaboration, not just competition.

Reach out for professional support that prioritizes your mental and physical health.

Additionally, there are steps you can take to reinforce connection on a body level through gentle simple movement practices. Thanks to the mind-body connection, this can help support and challenge thoughts and habits associated with comparison and competition. Here are five movement practices to support connection over comparison.

#1. Explore your spine.

The spine encapsulates your self-awareness. Engaging the spine in any and all movement possible support identity formation, self-awareness, and connection to our own need, ideas and values. This allows you to honor and focus on your own values, strengths and abilities ideally without judgement.

#2. Connect to your pelvis.

The pelvic region of the body is connected to feeling rooted and grounded which facilitates connection to self as well. Feel the weight of your body as you shift or rock your hips. Try on different rhythms. Or simply sit and breathe into your lower abdomen and back.

#3. Find your balance.

Play with your center of gravity. Challenge your balance and find opportunities to regain or explore your balance from a position of instability. This reinforces your ability to stand on your own two feet, stand your ground, and stand up for yourself and your needs.

#4. Embrace the push and pull.

Engage in movements that focus on pushing away or pulling into the body. This supports exploration of personal boundaries which are often compromised when comparison and competition are prioritized. Explore the oscillation between the two polarities, finding the middle ground as an opportunity to connect and recognize your individual needs and strengths.

#5. Slow down to check in.

It is vital to slow down your movements in order to create time and space to recognize your emotional and physical needs. Competition and comparison has the ability to speed us up while we try to “keep up” with those around us who we see as “better” or more skilled. Speeding up will only lend itself to injury and burnout. Even taking a few minutes a day to slow down and check in with your emotions, feelings and thoughts can have a huge impact on your ability to connect to yourself.

Most importantly, become aware of your need to compete or compare yourself to others. This will create a baseline for where you are on your journey. It is vital to recognize where you currently are in this process in order to assess where you would like to be. Practice compassion over judgment, as this may be a new process and will take time to re-pattern in the body and mind.

By Erica Hornthal, LCPC, BC-DMT, Dance/Movement Therapist, Chicago Dance Therapy.

Erica Hornthal, known as “The Therapist Who Moves You,” is a board-certified dance/movement therapist and licensed clinical professional counselor. She is the founder and CEO of Chicago Dance Therapy and the author of Body Aware: Rediscover Your Mind-Body Connection, Stop Feeling Stuck, and Improve Your Mental Health through Simple Movement Practices.

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