The worst has happened: You landed a jump and felt an oh-so-terrifying pop in your ankle. As your friend rushes over with an ice pack, your entire dance career flashes before your eyes. All you really want to know is how bad it is—and how long you’ll have to stay off your toes.
Dancers endure a lot of physical stress on a daily basis, making injuries like sprains, strains, fractures and stress fractures fairly common throughout the body. Here, Dance Spirit breaks down the differences between the four diagnoses—so you’ll know what to expect when your doctor gives you the news.
The diagnosis: a strain
Strains usually build up gradually over time but can also happen suddenly. They occur when muscles or tendons (tissues that connect muscle to bone)—frequently in the lower back or hamstrings—are stressed by prolonged repetitive motion. Strains often come with pain, swelling, limited mobility or muscle spasms. “I usually see strains in dancers who are trying to get a muscle to stretch or contract more than their body can tolerate,” says Katie Lemmon, an athletic trainer with Athletico Physical Therapy in Chicago, IL.
Treatment strategy for strains depends on their severity. You may make significant recovery with a few days off, but you may also need up to six weeks working with a physical therapist, or even surgery. Lemmon recommends turning to a dance-friendly physical therapist as soon as possible, since they can often help correct anything in your technique that might increase your risk for re-injury. “It could be an imbalance in your muscles,” she says. “For example, if the pulling feeling is in your hamstring, you might need to stretch out the front of your thigh. We always recommend a technique assessment to look at how all the parts of your body are working together.”
The diagnosis: a sprain
A sprain is usually accompanied by pain, swelling, bruising and limited mobility. It indicates a stretching or tearing of ligaments, the bands of tissue in your joints that connect two bones. In addition to the classic sprained ankle, you can also sprain ligaments in your knee with an unexpected twist, or in your wrist during acro or partnering. Sprains usually happen suddenly, and they’re more likely if you’re tired or haven’t warmed up properly.
While a mild strain may only require a few days of rest, ice and wrapping, most ankle sprains will require some time in a brace or a boot. Podiatrist Ronald Werter, who works with professional dancers in NYC, says moderate sprains may only require two weeks in a boot followed by two weeks in an ankle brace. The more intense the tear, the longer you’ll have to stay off the foot. If the ligament is completely severed, it could take six months or more to heal. In that scenario, many dancers opt for surgery to repair the ligament, since it typically won’t reconnect on its own.
It’s important not to return to dancing too soon after a sprain. “If the ligament is still overstretched, you may be at risk of making the injury worse or tearing it completely,” Lemmon says. “Even when your doctor says you can go back to dancing, start gradually with movements that don’t require twisting, turning or jumping.” Working with a physical therapist can help you regain balance, strength and range of motion. And your doctor may recommend taping the affected area to add support when you first return to the studio.
(Photo by Lucas Chilczuk)
The diagnosis: a fracture
A fracture, or broken bone, happens suddenly, usually from landing a jump wrong, falling or being dropped while partnering. You’ll often feel and hear a snap, followed by throbbing pain, swelling, bruising and sometimes noticeable deformity. Werter says he commonly sees broken toes in dancers, which, at best, heal with taping and a couple days of rest.
However, a broken metatarsal may require surgery to insert a pin or screw in the bone. “After surgery and six weeks in a boot, it should be stable enough to dance on carefully, but you’ll likely need about another three months to be completely healed,” Werter says.
To avoid fractures, Lemmon suggests checking in with a nutritionist to be sure you’re eating a bone-healthy diet. Often, dancers with poor nutrition or amenorrhea (lack of periods) will have weaker bones, which can make them more susceptible to fractures. The good news is that once your bone completely heals, the chance of breaking it again doesn’t increase in healthy dancers. In fact, Lemmon says, the bone may actually heal stronger.
The diagnosis: a stress fracture
A stress fracture happens when a bone begins to develop thin cracks due to prolonged stress. Dancers usually get them in the bones of the foot (metatarsals or sesamoids) or in the bones of the lower leg (tibia and fibula), and they may not be easily spotted with an X-ray. They’re usually caused by overuse or repetitive pressure on the bone—jumping repeatedly on a hard floor, for example, or even wearing pointe shoes that don’t fit correctly.
“For foot fractures, I start by immobilizing it in a walking boot for just a week,” Werter says. “After a week, if there’s no pain, I’ll wrap it and ask the dancer to take it easy. If treated properly, a stress fracture should be OK to dance on after about three to six weeks.”
Lemmon adds that being diagnosed with a stress fracture, much like being diagnosed with a strain, is a sign that you may be fatigued or need to reevaluate your technique. “A stress fracture in the foot, for example, could actually be caused by an imbalance in your hips or core,” she says. “Taking time off to heal is an opportunity to figure out what caused the injury in the first place.”
It seems like Derek Hough is carrying the whole dance world on his shoulders—or, more realistically, his feet—these days. Between his starring role in the Radio City Spring Spectacular and his stellar partnership with Nastia Liukin on "Dancing with the Stars," he's become a bicoastal dancing MACHINE.
A machine that is now, sadly, suffering some mechanical problems: DHough just had a freak accident and ended up suffering injuries to both his right foot and his left ankle. Yipes.
What happened, exactly? Unclear—but apparently it was stair-related. "Wish I had a cooler story to tell," Hough said in an Insta caption. "All that dancing, flipping, jumping and the thing that stops me in my tracks is something as simple as a light and some stairs."
Luckily, best bud Mark Ballas was by his side in the emergency room. And luckily for us, even in the face of ickiness, the two of them were still able to snap goofy sadface photos, as best buds do:
Double womp. (Instagram)
Hough's understudy, Taylor Frey, will be taking over for him in the Spring Spectacular. But at the moment it's unclear who might step into his "DWTS" shoes—or if there's a chance he'll be back in time for Monday night's performance. We're sending all our healthy-foot vibes his way!
In the meantime, true to form, Hough is staying positive:
Take care of your body so you can stay in the studio—and not on the sidelines.(iStock)
Every dancer, at some point, is faced with physical pain. Fractured bones, inflamed tendons and muscle strains seem to come with the territory. They might even force you to take an unwanted break.
But injuries, particularly overuse injuries, can be prevented. DS talked to medical experts about the most common problems dancers face. Take their advice to stay ahead of the pain—and off the injured list.
What they are: Stress fractures are small cracks in the bone that occur when too much force goes through the bone. They’re commonly seen in the second and third metatarsals, but shin splints can also turn into stress fractures if you’re not careful. “The muscle pulls on the outside lining of the bone and becomes inflamed,” says Michelle Rodriguez, physical therapist and owner of Manhattan Physio Group. “If you keep jumping and pushing through it, you can end up with a stress fracture.”
How to prevent them: When your workload or class schedule increases over a short amount of time, you’re at risk for a stress fracture. Try not to do too much too soon. Slowly build up the number of classes you take, and limit the number of big jumps you do in one day.
It’s important to get plenty of calcium and magnesium in your diet, since they keep your bones strong. Foods like spinach, broccoli and dairy products will give you a boost. It’s also crucial that you get your period, since estrogen plays an important role in bone density. “Many young dancers don’t get their periods within the average age range because of the pressure to be thin. They’ve got all this physical demand on an immature skeletal system,” Rodriguez says. If you don’t have your period by age 15 or 16, talk to your doctor.
How to treat them: Rest for 4 to 10 weeks. Your doctor might put you in a walking boot to protect the injury. If you start having tenderness in the middle of your shin or feel a bump on that bone, see a doctor right away. Tibia fractures will keep you from jumping for several weeks.
Not nearly as pretty as pointe shoes... (iStock)
What it is: Inflammation of the sheath around the tendon, or tendinitis, is another overuse injury. “I see the condition most in the Achilles and the FHL (flexor hallucis longus) tendon, which points the big toe,” says Dr. Kevin Varner, an orthopedic surgeon who works with dancers at Houston Ballet. “It happens when dancers overwork their bodies and get muscle fatigue, like during a long run of Nutcracker shows.” Also common is patellar tendinitis, or jumper’s knee. As your quadricep muscles get tighter and tighter, they put tension on your kneecaps and pull the patella up toward the thigh.
How to prevent it: One of the most important ways to prevent tendinitis in the ankles is to practice good alignment. “Be sure to relevé over the middle of your foot and ankle,” Rodriguez says. “The more you wing your big toe, the more you overuse your FHL.” Since the FHL muscle is deep in your calf, you can use a ball to massage it and release its pull on the tendon. For jumper’s knee, get into the quadriceps with a foam roller or a dense rubber ball—and then stretch.
How to treat it: “When you have recurring tendinitis, make sure you find the underlying cause,” Varner says. “Forcing your turnout and rolling in on your ankles will make your Achilles tendons tight, for example.” Physical therapy, ice and anti-inflammatories can help reduce pain and swelling.
Protect, rest, ice, compress and elevate—then say goodby to that pesky sprain. (iStock)
What it is: Ankle sprains catch you by surprise. One minute you’re fine, and the next you’ve twisted your foot and overstretched or torn ligaments around your ankle. “The typical ankle sprain is in someone with a high arch, because they tend to roll the ankle to the outside more,” Varner says. Varner sees more ankle sprains in younger dancers, usually because of poor technique. “They don’t land from a jump the way they should and end up twisting their ankles.”
How to prevent it: Strengthen the peroneal tendons on the outer sides of the ankles to provide more stability. Do Thera-Band exercises to practice winging and sickling the foot and multiple series of relevés with proper alignment.
How to treat it: Protect, rest, ice, compress, elevate (PRICE). “Make sure you’ve recovered fully before returning to the studio,” Varner says. “Injuries that aren’t rehabbed all the way tend to recur.”
Lower Back Strain
What it is: Many dancers experience lower back strains and tightness. “Sometimes they try to attain a certain line, like arabesque, and compress their lower backs in an attempt to get their legs up higher,” Rodriguez says.
How to prevent it: Lower back strains can be prevented by strengthening the core muscles. If your midsection is strong, you’ll engage your core muscles when you’re working instead of your back muscles.
How to treat it: “Get a massage,” Varner says, “and try alternative medicine like acupuncture. Dancers find that it decreases swelling and lessens pain.”
Pain is your body’s way of telling you something is wrong. Because daily aches and pains are a part of every dancer’s life, how do you know when what you’re feeling is simply soreness from a tough rehearsal or something more serious like a pulled muscle? The following advice will help you decide when it’s OK to go to class and when you need to see a doctor.
Know Your Body
“Some aches and pains with dancing are normal,” says Genevieve De Celles, MPT, who has worked with Indianapolis-based Ballet Internationale. Knowing what symptoms aren’t normal to your body is key to identifying a serious injury. One indicator is pain that shows up suddenly. If your hamstrings are tight and an intense class usually leaves them sore, the pain is likely nothing to be concerned about. But if you’ve never had problems with your back and it suddenly seizes up when you bend over, your body is telling you it’s injured. De Celles recommends asking yourself the following questions when trying todecide whether or not you should be taking class.
1. Do I have swelling now?
2. Do I have pain now?
3. How bad is the pain? Give the pain a number on a scale from 0 to 10, where 0 is no pain and 10 is I-need-to-go-to-the-hospital-now pain.
4. Do I have difficulties accomplishing daily activities, like walking up the stairs or bending over to pick
If the answer to any of these questions is yes (or in the case of #3, higher than 4), De Celles recommends sitting out of class.
During and After Class:
1. Do I develop swelling during class or immediately after class?
2. Do I develop pain during class or
immediately after class? Use the pain scale to rate your discomfort.
3. If the answer to #4 from above was yes, are these difficulties made worse during or after dance class? For example: Is it
difficult to put weight on the injured leg?
4. Do I have difficulty landing on the leg when jumping in dance? Is it harder to walk after dance?
If you answer yes to any of these questions, call a doctor.
Know Your Options
When you’re sidelined due to an injury, take the opportunity to learn from observation. When Stephen Schroeder, a member of Minneapolis’ Zenon Dance Company, sits out class, he says that he picks up tips on technique by studying how other dancers execute movements. He also pays attention to the mistakes they make, so when he’s back in class he knows what to avoid.
If missing a class or a rehearsal is simply not an option, ask your teacher—before class starts, or the moment you feel pain—if you can mark the choreography. Patricia Blair, director of the School of Ballet Chicago, reminds students that sitting out one day could prevent being sidelined for much longer.
If your teacher tells you to go to a doctor, take the advice, but choose your caregiver wisely. Many dancers view conventional doctors as bad guys who will automatically tell them to stop dancing. While some doctors may tell you to back off, there are many who understand that quitting dance isn’t an option. Look for doctors who have experience treating dancers and ask fellow dancers for recommendations.
Pulls, Strains, Sprains, What?
Definitions of three common types of injuries:
• Pulls and strains are injuries to muscles or tendons (the tissue that connects muscle to bone). Tears happen when there is a contraction to the muscle that is more forceful that what the muscle is conditioned for.
• Sprains are injuries to ligaments; ligaments connect one bone to another. They provide stability to joints and are not meant to be stretched, so you may have sprained a ligament if your joint is unstable, painful and swollen.
• Stress fractures are small breaks in the bones. These are common injuries for dancers, typically found in the feet and shins. They develop from repeated impact into the bone. You’ll have pain during impact activities—for example, when landing from a jump. De Celles cautions, “These need to be paid attention to, because if you continue to dance on them, you can actually [fully] break the bone.”
Ever wonder about the little blue tubes you see at the health food store? The funny names on the labels, like Bryonia Alba or Arnica Montana, are intriguing, but what are they all about? These little containers hold homeopathic remedies—natural medicine used to treat illness and injury holistically.
If you go to a traditional doctor with a sore throat or a fever, the doctor will look at your throat and ears and prescribe a medicine to treat the symptoms. A homeopathic doctor, however, might ask if you favor warm drinks over cold drinks, or what side of your body a cold usually starts on. These might seem like unusual questions, but from a homeopath’s point of view they have everything to do with why you are sick in the first place.
Ancient Greek Wisdom
Homeopathy, which literally means “treating like with like,” was founded over 200 years ago by a German doctor named Samuel Hahnemann, who was practicing medicine at a time when people were bled (blood was drawn), or given emetics (an agent that induces vomiting) and purgatives when they were sick. It was believed that illness was the result of bad blood or poisons in the body; however, Hahnemann found these practices made people sicker because they became weaker and less able to function, and often died prematurely.
“Hahnemann refused to practice medicine like that, and, because he was a linguist, started supporting himself by translating old medical journals from the Greek language,” says homeopath Maria Bohle. “He began reading ancient Greek medicinal journals, which said if you wish to cure, let like be treated with like.” This was how he got the idea to treat people with the substance that would cause the same symptoms that they were having, and ultimately led him to found modern-day homeopathy. “It is the hair-of-the-dog-that-bit-you theory,” says Bohle. “For example, if you need to vomit, ipecac will make youvomit if you take a large dose, but if you are already vomiting, a tiny dose of ipecac could help to stop that vomiting.”
Homeopathy uses remedies—diluted doses of plant, animal, or mineral substances in the form of pellets, creams, gels, or liquid—that jump-start your body into curing itself without using prescription drugs. If you have a headache, homeopathic treatment will not try to hide the headache, but rather will focus on why you have a headache.
For example, if you have a pounding headache, it could be because you are sensitive to light or have a salt imbalance. Natrum Muriaticum will help regulate your salt balance and relieve excess body fluids which cause pain and pressure, thus eliminating the headache. It would not suppress the symptoms, but instead bring them out and use your body’s own defenses to cure what ails you. “Once something is put right, it tends to stay right,” says Emlyn Thomas, author of Homoeopathy for Sports, Exercise and Dance.
A Complementary Treatment
Homeopathic treatment is not for all illnesses and injuries. If you break your arm, for example, you need to see your medical doctor. “If a dancer tears a ligament, homeopathy will help to reduce inflammation, bruising and pain, but it will not repair the damage,” says Thomas. “See a sports physiotherapist and make sure you get the correct surgery or rest that is recommended.”
Your first visit to a homeopath is more like a visit to a psychologist than a doctor. “There is a lot of talking in the first session,” says Bohle. “Homeopaths have a ‘Sherlock Holmes’ tendency [as] they try to get to the root of your physical problem through your emotional side as well. We treat holistically, so every aspect of the patient is important.”
A good diagnosis is the key to using homeopathy, and taking the correct precautions is crucial. “If a dancer is seriously injured, it is not the end of the world if you have to stop dancing for awhile,” says Thomas. “Allowing your body to heal is essential. Homeopathy does not offer miracles, but when used in conjunction with the right care, it makes recovery quicker and reduces the time a dancer must spend out of commission.”
Homeopathy is relatively risk-free because remedies contain such minuscule doses. It doesn’t interfere with any other drugs and has no side effects.
Remedies to Remember
Below are a few homeopathic remedies that may come in handy for symptoms common to dancers. Note: The symptoms and descriptions listed below are generalized. Before you try homeopathy, speak to a homeopathic professional.
Argentum Nitricum is for problems associated with nervousness. Can be helpful if you are feeling overly anxious about performing, or feeling so nervous that you have trouble remembering your routines.
Arnica Montana helps with healing damaged tissue. Can be used for most muscle injuries. If you fall in class, Arnica Montana helps reduce swelling, bruising or shock from the injury.
Ruta Graveolens is good for muscles that are beginning to contract or cramp. It can also be used if you have inflammation in your muscles or if your arms and legs are feeling unusually heavy when you dance.
Bryonia Alba eases aching muscles. Can help if your arms and legs are extremely tired or if all movement is painful.
When taking a homeopathic product orally, it is important to remember to have a clean mouth. This means not to have eaten, drank (besides water), or brushed your teeth within 20 minutes before taking the product. Food and toothpaste can interfere with the effectiveness of the homeopathy.