Common Causes of Dance Injuries and How to Prevent Them

It’s no question that dance is one of the most artistic forms of movements; dancers can tell stories and evoke deep emotion through their choreography (and sometimes even improv!).

But, dance is also a highly complex sport, which is easy to forget with how easy dancers make it all look.

Just like any other sport, dance requires a high level of strength, stamina, coordination, and determination — all combined with nuanced technique and aesthetic components.

In order to achieve the balance of  movement and skill, dancers have an incredibly high training load… which unfortunately means that they also have an increased risk of injury.

Sustaining injury as a dancer can be devastating. Not only does it sideline you from your sport (with no real off-season), but it can also have long term effects on how well (or how much) you can train and perform down the line.

However, even though injury is common in the dance world, it’s certainly not inevitable! There’s a lot that can be done to prevent injury — or come back stronger if you’re already in recovery..

Common Factors Associated with Dance Injury

One of the first steps to combating injury is understanding when and why it happens, as well as some of the most common risk factors that can lead to it…

Did you know that professional dance companies reported that as many as 67-95% of their dancers are injured on an annual basis?

That particular research article was published back in 2003, but plenty more articles that have been published since that reflect similar statistics. One study that focused on full-time, pre-professional dancers found that 86% of the athletes sustained one or more injuries within one academic year.

Not only is this one of the highest rates of injury in athletics, but it’s also one of the most consistently high rates. There are many factors that can contribute to a dancer’s risk of injury, but the following training aspects are among the most common causes.

Training Workload: High Volume and Demand

This is by far one of the biggest contributors to dance injury: between practice and rehearsal, most dancers spend around 20 hours a week dancing.

Compare that to a soccer athlete, who might practice for 2 hours a day for 5 days. That also takes a lot of hard work, of course, but their weekly total only adds up to 10 hours — half that of dancers’ average training time.

Plus, the difference between the volume of work doesn’t even account for the type of training that’s being performed.

Dance, for the most part, is a single athlete sport. This means that a dancer is constantly moving in technical and complex ways without many breaks. With many other sports, you may have some moments of respite throughout: if the ball isn’t near you, or you don’t have to push as hard while running or cycling downhill, you’re able to catch your breath and ease up for a bit.

So dancers have to account for a high weekly volume and a high proportion of time spent on purposeful, intense movement.

You might look at all this information and wonder, “Okay, but if dancers danced less, wouldn’t that help them avoid injury?”

And at face value, the idea holds some merit… but reducing (or stopping) your activity is rarely the first or best solution.

After all, a sport is more than just something to keep you busy — it’s an activity that you love to do, and one that improves your quality of life. Choosing not to do it out of fear of injury is discouraging and can reduce an athlete’s confidence.

Plus, it’s not as simple as just cutting down training hours; there are many technical aspects of dance, and each requires a significant amount of practice to master.

Instead of avoiding the problem entirely, dancers should equip themselves with the knowledge and techniques to address injury risk head on! (But, we’ll get into that a little later in this article!)

Timing: Competition Calendars

In addition to having high training volume on a regular basis, dancers also have to adapt their schedules to suit competition calendars.

When speaking with dancers, parents, and instructors about when dancers are most likely to sustain injury, there were two consistent responses: at the start of the school year, and mid-spring.

The start of the school (and dance) year typically involves dance intensives, where the volume of dance practice increases beyond their usual workload. On average, intensives consist of almost daily periods of dance for about 2-4 weeks in a row. (Quite a way to start the year, right?)

Training frequency also increases during mid-spring when competitive dancers are gearing up for competitions.

This isn’t just a pattern for the dancers our clinic works with, either — studies have shown that most dance injuries occur in the 2nd, 3rd, 7th, and 8th months of the dance year. (This translates to the months of October, November, March, and April, which are all reflected in the dancers we work with.)

Of course, competition calendars aren’t in the athlete’s control, but that doesn’t make injury inevitable. Be aware of these training timelines, and focus on recovery and injury prevention needs during these times of year to combat the issue ahead of time.

Biomechanics: Form and Execution

On top of dance being a highly complex and demanding sport, it also requires A LOT of repetitive movement.

And in most cases, these movements are performed by young athletes who are not skeletally mature yet, so their bodies aren’t prepared for the cumulative strain of their training.

Dancers spend a majority of their time on their feet, and the high movement velocity can place over 2x their body weight onto their legs and ankles. Without proper control or shock absorption, this increased pressure through the lower extremity adds stress to the hip, knee, and ankle joints.

Unsurprisingly, these are the most common sites of injury for dancers. One study followed over 300 dancers at an elite ballet school for over 5 years. The researchers found that over 50% of dance injuries occurred in the foot/ankle, 21.6% occurred at the hip, 16.1% occurred at the knee and 9.4% occurred in the back. And when looking at the full chain of movement, 87.7% of dance injuries occur from the hip down.

Through this study, researchers also identified some of the most common biomechanical risk factors that are associated with these injuries.

Their findings suggested that foot pronation, decreased plantar flexion range of motion (toe point), previous history of lower back pain, and lower extremity (mainly hip) weakness were correlated to a higher injury risk.

Dancers were more likely to sustain injury when presenting increased right foot pronation and reduced right plantar flexion, as well. In fact, injured dancers were 74% more likely to have a pronated right foot than non-injured dancers, and 50% percent more likely to have limited right plantar flexion. This became a significant finding, as the majority of dancers are right leg dominant, only further increasing chances of biomechanical deficiencies that lead to injury.

How to Reduce the Risk of Injury in Dance

Based on loads of research findings and in-person conversations, we’ve found patterns that identify the likelihood of injury, as well as the most common risk factors that can lead to it…

Meaning: we have the knowledge to PREVENT injury in dance (or at least significantly reduce risk of injury).

Doing so requires a team effort — dancers, parents, instructors, and the whole “rehab team” (physical therapists, Pilates instructors, massage therapists, etc.) all have to work together. This combined expertise will create a strong foundation to address and prevent injury risk factors.

Don’t Wait Until You’re Already Injured!

It sounds obvious when we say it out loud, right? Yet, it’s one of the most common reasons why people sustain injury in the first place…

One of the most important aspects of reducing injury risk is to start BEFORE any injury actually happens.

The key is to be proactive and prevent further injury or reinjury. (If you’re a former dancer, you know all too well that injuries can come back to haunt you later in life.)

Preventative care can include a wide range of methods: reducing dance loads during peak intensive months, adding cross-training into the calendar, getting your form and biomechanics assessed by a specialist, and using specific pre-season screening techniques to identify potential injury risks.

If that sounds like it requires a lot of forethought, you’d be right. Injury prevention — especially for such a complex sport — has to be deliberate and thorough in order to be successful.

So, get ready to rework those training schedules!

Make Time for Cross-Training

Research has consistently shown that the rate of injury decreases when dancers employ sufficient cross-training into their programs.

In the study with over 300 elite dancers, the athletes utilized a combination of Pilates and lower extremity strength training to offset their highest volume dance weeks and months. This allowed them to stay active and retain a similar level of training intensity without exacerbating the same movement patterns as their dance practice. By including enough variety in their training programs, they could hone their athletic caliber without constantly overworking the same tissues.

Plus, with the right approach, cross-training can be an excellent way to address biomechanical risk factors, like that pronation or limited plantarflexion.

Dancers benefit most from training programs that target lower extremity strength, improve control through end range, and increase motor control. These components will increase your muscular functionality and prevent biomechanical deviations in the long run.

However! In order to know what your cross-training should consist of, there’s one more vital step…

Get a Dance Analysis

And we don’t just mean a standard, pre-season physical — a sport as complex as dance requires an assessment that’s just as nuanced.

Dancers need a comprehensive, sport-specific evaluation to truly maximize their recovery and training time. In our clinic, we utilize a combination of advanced technology and biomechanical expertise to pinpoint specific movement deficiencies found as the athlete moves (rather than in static positions).

This video demonstrates two of our key pieces of technology: our inertial measurement units (IMUs) and in-ground force plate. The IMUs create the 3D skeletal avatar to the left of the dancer’s image, and they allow us to assess joint angles, posture, and movement patterns during activity.

As for the force plate, when athletes move on it, the plate will measure how much force is being generated, as well as what direction the forces are moving in. For dancers, this can be especially helpful for assessing alignment, jump height, and stability.

And this is only a portion of the data we collect during a full analysis — we also utilize technology like dynamometers for testing strength, or electromyography sensors to test muscle activation. All of this data collection and assessment allows our team of experts to identify what exactly the dancer may be struggling with, why it’s happening, and what can be done to correct and prevent the issue from worsening.

Working with biofeedback allows our movement experts to create a highly specialized, tailored plan suited to each athlete. This data-backed care is the ideal supplement to a dancer’s training system and team.

Start Preventing Injury Now

Just because dancers have a high risk of injury doesn’t mean that they’re destined to endure it!

Our clinic has had the pleasure of working with many aspiring, competitive dancers in the Bay Area, and we’ve seen firsthand that dancers are incredible athletes with control and grace like no other. (Plus, their tenacity and dedication to their craft is admirable!)

This makes it incredibly rewarding to play a role in their rehabilitation and injury prevention. Dancers gain so much empowerment in understanding why and how injury happens, and it’s a vital step in the longevity of their dance careers.

Having a well-rounded team of experts is essential for dancers’ success — parents, instructors, Pilates professionals, movement specialists, you name it.

Focus on building a dance support system for the longevity of your sport, and harness the power of expertise to guide you through recovery and injury prevention along the way!

By Dr. Kevin Vandi DPT OCS CSCS

Dr. Vandi is the founder of Competitive EDGE Physical Therapy — with his background in physical therapy, orthopedics, and biomechanics, he is a highly educated, compassionate specialist. Using state-of-the-art motion analysis technology and data-driven methodologies, Kevin has assisted a wide range of clients, from post-surgery patients to youth and professional athletes. When he isn’t busy working or reading research, he spends his time with his wife Chrissy and their five wonderful children, often enjoying the outdoors and staying committed to an active lifestyle.

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