Treating Professional Dancers for Injuries: Perspectives from a Physician and Dancer
Summer in New York City would not be complete with out its rich and colorful dance scene. Every summer talented students from all over America and the world spend their summer studying with one of the many professional dance training programs in NYC. Don’t forget the various touring companies that stop through to perform, or the international guest artists that perform with NYC’s resident companies. NYC is the destination hub for all things dance. Mixed into the professional scenes are the various outdoor summer dance parties and socials where you can see amateur to professional ballroom, tango, salsa, African and hip hop dancers, to name a few, just having fun. However, all of this dancing means more than average office visits for various dance and performance-related injuries.
Dance injuries can be categorized into acute and overuse injuries. The most common injuries occur to the foot and ankle, followed by spine, knee and hip, depending on the style of dance practiced. Some injuries are unique to dancers such as tenosynovitis of the Flexor Hallucis Longus (FHL) tendon, sometimes called “dancer’s tendonitis.” This is the muscle and tendon responsible for pointing the large toe and explains why it is most common in classically trained ballet dancers. Tenosynovitis of the FHL typically causes pain in the medial ankle behind the ankle bone and can sometimes cause triggering of the large toe due to inflammation of the sheath around the tendon, tendon fraying, or areas of tendon enlargement that prevent the tendon from gliding smoothly through as it travels around the ankle. Pain usually occurs as the dancer transitions from demi-pointe to flat foot positioning. Diagnosis relies on the physical exam and palpating the course of the tendon to check for areas of tenderness, assessing for the loss of normal range of the first toe, and imaging such as an ultrasound or MRI. Treatment incorporates gentle stretching of the FHL, relative rest, ice, and sometimes footwear or a boot to rest and immobilize the first toe joint while walking. Sometimes surgery to release and repair the tendon is considered when symptoms persist despite various non-surgical treatments.
With such a busy and full summer, and not much time to waste, dancers want to return injury free and fully healed as quickly as possible. This is often the most challenging part when treating dancers. Dancers want to return to dance and often don’t allow themselves time to heal or they may dance on injuries without seeking medical treatment out of fear that they may need to slow down.
Prevention is key when preparing for a busy dancing summer. Student dancers often take two to three times as many dance classes in the summer, not including extra rehearsal time for performances at the completion of their program. This means allowing for enough rest and eating a nutritious diet to account for the extra energy expenditure. Touring companies often dance on unfamiliar floor surfaces and stages. All the added unknowns may accumulate into increased anxiety. Traveling compounds the stress of being away from home and its familiar supportive environment.
As a professionally trained dancer and having personally experienced various dance injuries while away from home, I remember how alone and uncertain I felt when seeking treatment from health professionals. That is why I find it so important to really listen to my patients and allow time for them to ask questions so they are comfortable with their treatment plan and journey to recovery. It is also important to make yourself available for questions or concerns that may arise after the office visit. I find that patients are more compliant with treatment when they have all of their questions answered. Having an injury is not easy for any athlete. Recovery requires patience and support from friends, family, and their doctors.
Dr. Elizabeth Manejias is a physiatrist and acupuncturist at Hospital for Special Surgery. Professionally trained in ballet, Dr. Manejías is active in the performing arts community and provides educational lectures to dance programs on injuries and medical problems common in the female athlete. She treats dancers from Broadway to professional ballet.