What’s the Best Way to Rehab an Injury? Prevent it!
Between school, work, rehearsals, and performances, it can be easy to push off self care until tomorrow. While many of us have been in your shoes and can empathize, I sure do wish that I knew then what I know now. After many years of schooling and residency, my goal is to teach dancers that it doesn’t take a doctorate degree to take care of your body, and to empower them to advocate for themselves. Let’s look at daily habits that you can adopt to keep you moving optimally and efficiently.
1) Injury prevention screen
Through Doctors for Dancers, you are able to find several healthcare practitioners who offer dance-specific injury screens. During the screening process, a healthcare provider may look at your range of motion, flexibility, strength, stability, balance, proprioception (the body’s inherent ability to know its position in space), and dance-specific movement patterns and identify deficits that may put a dancer at risk of injury. Some providers may offer this as part of outreach to local studios. To see an example, visit https://blog.cincinnatichildrens.org/safety-and-prevention/youth-dance-injuries-how-to-identify-the-issue and watch the YouTube video associated. A clinician who is knowledgeable in dance should be able to provide you with exercises to prevent injury, and/or a warm up that is specific to your deficits and choreography. This leads into point number two…
2) Proper warm up
Why do dancers need to warm up? Proven to reduce injury and improve performance, jumping, and agility, a proper warm up is essential to incorporate into your routine (Fradkin, 2010). Some current “warmups” may consist of sitting in a stretch and chatting with friends before class. This common practice does not prepare your body, mind, or particularly, muscles, for the high demands of dance. Your ballet warm up should not look like your hip hop or contemporary warm up. The International Association of Dance Medicine and Science offers many resources to help develop a proper warm up (included in the link below), and recommends a 15-20 minute warm up comprised of four phases: “a gentle pulse-raising section, a joint mobilization section, a muscle lengthening section, and sometimes a second pulse-raising section” (IADMS, 2017). It may be beneficial to include a phase of muscle activation, core stabilization, and proprioceptive training.
The pulse-rising section is intended to increase your heart rate and core temperature, which will prepare your muscles and joints to function efficiently. Following this, the dancer should begin to mobilize his or her joints, which is a great opportunity to acknowledge any problem areas and prepare your joints for dance’s great ranges of motion. Contrary to popular belief, the muscle lengthening section should not consist holding stretches. Actually, holding a stretch for greater than 15 seconds has been shown to have a negative affect on balance, reaction time, power, proprioception, and muscle force (Morrin and Redding, 2013; Behm, 2004). On the other hand, a dynamic stretch can lubricate joints and improve elasticity of your muscles. Adding a phase of muscle activation and core stabilization can be important in preventing or rehabbing injuries, and this can be made specific to the muscles that are required in your choreography. For example, if you have partner work in your choreography, consider performing some partner PNF stretching to make it more entertaining and movement-specific. Finishing with a second pulse-rising section is recommended, as the benefits of your warm up are reduced or lost once your heart rate and core body temperature returns to a resting state (IADMS, 2017). By activating the cardiorespiratory, muscular, and nervous systems throughout this process, a proper warm up can prepare the body for both technical and power demands of dance, improve performance, and decrease risk of injury.
3) Cool down
Here’s your opportunity to perform stretch holds. Static stretching has been shown to improve muscle length, but should be saved for post-activity only (Borges, 2017). This is because of the possible detriments to power and performance as mentioned above. There is variability in the literature as to how long a stretch should be held. Generally, you should hold a stretch for 30 – 60 seconds, and repeat 3-5 times (Konrad 2019). It is important to note what you are feeling when you stretch. If you are truly feeling a stretch or pull throughout a muscle’s length, you are likely performing the stretch correctly. However, if you are feeling joint pain or pinching when performing a stretch, you should consider some modifications to your position so that you are not over-mobilizing a likely hypermobile joint. Additional options for a cool down may be foam rolling, soft tissue work, or an ice bath.
4) Incorporate exercises into your day-to-day activities
Sometimes, a healthcare provider may recommend specific exercises to rehab an injury, that may not be appropriate for your warm up or cool down. If you find it difficult to set time aside to perform the recommended exercises, consider incorporating them into your daily routine. Consider a couple of examples:
- Working on endurance and technique of your relevé while waiting for the elevator
- Training intrinsic foot muscles while sitting or standing at work or school
- Practice your breathing pattern while you are sitting at your desk or walking around the city.
Remember, these suggestions should not take the place of a formal rehabilitation program and do not encompass every way to prevent an injury. The primary intent is to encourage you to find a dance specialist, ask the right questions, and adopt healthy habits that can keep you dancing efficiently and optimally.
References:
Behm D, Bambury A, Cahill F, Power K. Effect of acute static stretching on force, balance, reaction time, and movement time. Medicine and Science in Sports and Exercise 2004; 36(8): 1397-1402.
Borges MO, Medeiros DM, Minotto BB, Lima CS. Comparison between static stretching and proprioceptive neuromuscular facilitation on hamstring flexibility: Systematic review and meta-analysis. Eur J Physiother 2017; 1-8
Fradkin AJ, Zazryn TR, Smoliga JM. Effects of warming-up on physical performance: a systematic review with meta-analysis. J Strength Cond Res. 2010;24(1):140-8.
International Association of Dance Medicine and Science. “The Importance of a Good Warm-Up: Are you warm enough to start dancing.” 2017. https://cdn.ymaws.com/www.iadms.org/resource/resmgr/resource_papers/warm-up-importance.pdf
International Association of Dance Medicine and Science. “Stretching for Dancers.” 2012. https://cdn.ymaws.com/www.iadms.org/resource/resmgr/resource_papers/stretching.pdf
Konrad, A., Reiner, M. M., Thaller, S., and Tilp, M. The time course of muscle-tendon properties and function responses of a five-minute static stretching exercise. Eur. J. Sport Sci. 2019; 19: 1195–1203. doi: 10.1080/17461391.2019.1580319
Morrin N, Redding E. Acute effects of warm-up stretch protocols on balance, vertical jump height, and range of motion in dancers. Journal of Dance Medicine and Science 2013; 17(1): 34-40.
About Mary Beth Foreman
Mary Beth received her Bachelors in Kinesiology and Doctorate of Physical Therapy from Louisiana State University, completed an orthopedic residency program in 2018, and became a board-certified specialist in orthopedic physical therapy in 2019. She is a member of the International Association for Dance Medicine and Science and treats a wide variety of recreational, pre-professional, and professional dancers in Cincinnati, as well as on professional tours. She is actively involved in community outreach with recreational and pre-professional studios, in which she performs injury prevention screenings, educational sessions, and pre-pointe evaluations. Mary Beth has presented research involving second ACL injury at the American Physical Therapy Association’s Combined Sections Meeting. Mary Beth was a dancer herself and graduated from Gerami Academy of Fine Arts in Lafayette, Louisiana, and has a passion for treating dancers of all ages and styles.