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. 

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.  

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). 

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!).

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.

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. 

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.) 

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.

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