LOWER LEG INJURIES IN DANCERS
By Terri J. Carson PTA
Pain between the knee and ankle is very common in dancers. According to the Journal of Dance Medicine and Science (2001), the occurrence of lower extremity injuries in dancers ranges from 60.9% - 73.3%. The leg and shin account for 16.8% - 40.5% of these injuries. The following injuries will be discussed below: stress fractures, medial tibial stress syndrome, ankle sprains, and Achilles tendonitis.
Stress fractures occur as a result of performing repetitive movements that have little variety. Dancers that dance more than 5 hours per week or those who are amenorrheic (without menstrual periods) for intervals greater than 6 months have a greater risk of developing stress fractures. The primary symptom is localized bony tenderness that often continues even when activity is stopped. RICE (rest, ice, compression, and elevation), is the indicated treatment for a stress fracture. X-rays, bone scan, and MRI are means to properly diagnose a stress fracture.
Medial Tibial Stress Syndrome
Although “shin splints” have been used to describe medial stress syndrome, this injury refers to pain in the posteromedial distal two - thirds (lower inside part) of the tibia. Much like a stress fracture, the cause is performing repetitive movements. Unlike a stress fracture however, the pain is diffuse, not localized. In addition to RICE, massage, stretching, and strengthening are used to treat this injury.
Ankle sprains most commonly occur when the ankle inverts (turns in.) The ligaments on the lateral aspect (outside) of the ankle are injured. Due to the pain and swelling of these ligaments, it is often difficult to rule out other associated injuries such as a stress fracture or peroneal tendon injuries.
Treatment for the majority of acute ankle sprains is RICE. Weight bearing is sometimes limited. The Physical Therapist focuses on two stages of rehab: First stage- to control pain and swelling; second stage- to increase range of motion and strength for return to function.
Much like a stress fracture, injury to the Achilles tendon can result from a combination of both structural abnormalities and dance technique. Overuse is typically the etiology for this type of lower leg injury. The Achilles tendon, whether a partial or complete tear becomes inflamed. An acute rupture is rare and usually occurs with a quick burst of power, such as performing a leap or jump across the dance floor without being properly warmed up.
Common positions that the dancer studies and practices can over-stress the Achilles tendon. The releve’ position contracts the tendon and the plie’ stretches the tendon. The repeated micro trauma to the tendon induces inflammation, crepitus (a crunchy sensation), and degeneration of the tendon.
In addition to dance technique, biomechanical abnormalities such as tightness of the gastrocnemius-soleus muscles, pronated feet, the type of dance surface practiced on, and the type of shoe worn stresses the Achilles tendon.
Activity modification is indicated to treat Achilles tendonitis. Physical Therapy treatment includes ultrasound and deep friction massage, which assists in increasing circulation and oxygen to the tendon and decreases adhesions that have developed. Taping can decrease tension on the tendon and provide support.
The majority of lower leg injuries in dancers are due to repetitive stress and practicing on floors that do not provide support. Correction of dance technique and assessing biomechanical abnormalities are important to decrease and prevent injury.