Author: Elsa Urmston on behalf of the IADMS Education Committee 

Well, it’s the moment that all dancers and their teachers dread. Sustaining an injury in dance can be at best, a ‘momentary’ interruption to dance training and performance, at worst a career-ending catastrophe. Thankfully, dance medicine and science colleagues have produced a vast range of conditioning and injury prevention strategies to enable dancers to be stronger and ever more versatile, as well as take ownership over injury if, as and when it might occur. Yet of course, by just looking at the repertoire of our modern dance and ballet companies, we can see that choreographers and audiences have increased their expectations of what the human body can achieve. Injury remains a very real possibility.  

Improving awareness of dance injury, in terms of how and when it might occur, and ensuring dancers know about injury care, can play a large part in the successful rehabilitation and timely return to dancing. This blog post is one in a series which introduces dance injury. Subsequent posts will focus on how we might be able to prevent dance injury in the first place, through screening for dancer health and wellness, and by ensuring dance educators’ practice is safe and effective for all involved. 

Research suggests that the most commonly perceived causes of injury were cited as ‘fatigue’ and ‘overwork’, along with repetitive movements amongst dancers and managers alike. Organisations such as IADMS, Dance UK and Harkness Center for Dance Injury amongst many other dancer wellness initiatives, all advocate for optimising dancers’ training and performance through supporting dancer fitness and conditioning, ensuring sound biomechanical function in dancing and promoting an autonomy supportive environment for dancers to flourish. New research from ArtEZ Institute for the Arts in Arnhem, Holland has sought to reconceptualise how the undergraduate dance curriculum is shaped to maximise performance through the principles of periodisation. The programme year is designed as a series of macro- and micro-cycles in which the training intensity alternately increases and decreases, ensuring that the dancer develops and recovers without causing staleness or overtraining. The approach has seen a significant reduction in injuries and less course dropout since the instigation of this system. Take a look at this easy-read overview of the project at ArtEZ here. 

So what actually happens when I sprain my ankle or strain a muscle?
Essentially, if cells become damaged, the body releases a number of chemicals that create an inflammatory response, usually resulting in swelling, redness, heat, pain and loss of function. Inflammation is the body’s natural response in promoting new cell growth, and is a necessary stage of the healing process. The injury process can be conceptualised like this: 

How can we help our dancers manage injury in the short-term?
Try and help your dancers remember the acronym PRICED – it’s an invaluable first aid guide to immediate treatment which can be self-administered, and when used in the first minutes and hours after injury can help in controlling pain and inflammation and assist in the safe return to dancing.

• PROTECTION: Remove additional danger or risk from injured area.
• REST: Stop dancing and stop moving the injured area.
• ICE: Apply ice to the injured area for 20 minutes every two hours.
• COMPRESSION: Apply an elastic compression bandage to the injured area.
• ELEVATION: Raise the injured area above the heart.
• DIAGNOSIS: Acute injuries should be evaluated by a health-care professional. 

And in the first few days after injury, help them to avoid HARM too.

• HEAT: Any kind of heat will speed up the circulation, resulting in more swelling and a longer recovery.
• ALCOHOL: Alcohol can increase swelling, causing a longer recovery.
• RUNNING OR OTHER EXCESSIVE EXERCISE: Exercising too early can cause further damage to the injured part. Exercise also increases the blood-flow, resulting in more swelling.
• MASSAGE: Massage increases swelling and bleeding into the tissue, prolonging recovery time. 

And what about managing injury more long-term?
Drawing on some of the most recent research findings about injury, such as the periodisation work at ArtEZ, the growing body of research-informed practice around screening dancers and the importance of safe dance practice, we should be seeking ways to embed these examples of best practice in our work to minimise the likelihood of injury first and foremost. But in managing injury more long-term, we should aim to reduce swelling, restore proprioception (awareness of where the body is in space without relying on the visual system), maintain cardiovascular health and ensure a healthy, balanced and varied diet to facilitate healing. IADMS have a very accessible resource paper full of practical ideas about First Aid for Dancers here. 

Local provision
In the UK the establishment of the National Institute of Dance Medicine and Science means that through shared expertise and a network of multidisciplinary partners, better and more affordable, high quality, evidence-based, dance specific health care and dance science support services are being offered to dancers across the sector. Please check out their website.
In the USA the Harkness Center for Dance Injury is dedicated to providing the dance community with the highest quality injury care and preventative resources. Harkness offers many subsidized and free services including orthopaedic and sports medicine clinics, physical therapy and athletic training services, and injury prevention lectures and workshops. Please check out their website. 

For information about dance injury and treatment have a look at the following recommendations: Laws, Helen. Fit to Dance 2-Report of the second national inquiry into dancers’ health and injury in the UK, 2005. Solomon, Ruth L., John Solomon, and Sandra Cerny Minton, eds. Preventing dance injuries. Elsevier, 2005. 

For more information about optimising dancers’ fitness have a look at these texts too: Welsh, Tom. Conditioning for dancers. University Press of Florida, 2009. Krasnow, Donna and Jordana Deveau. Conditioning with imagery for dancers. Thompson Educational Publishing, 2010. Additionally there are some useful introductory videos on Krasnow and Deveau’s approach here. 

Don’t forget to watch out for our forthcoming posts continuing this series about preventing dance injury. 

Elsa Urmston MSc PGCAP AFHEA is the DanceEast Centre for Advanced Training Manager, Ipswich, UK and a member of the IADMS Education Committee.
Email: elsa.urmston@danceeast.co.uk