Dancers' X-Ray Map

Hover over the dancers' bodies to learn more about common injuries and complaints.

The Hand

  • Carpals/Metacarpals/Phlanges
  • There are no muscles in the hands, only the tendons of the digitorum muscles and ligaments, which connect the bones.

Partner work in particular can place great strain on the tendons in the hand, due to an enormous amount of gripping, holding and ‘catching’ of the other dancer’s hand and fingers. If there is much work to be done with the hands, it is important to warm them up - taking the fingers to their maximum range of movement and holding for a moment, to warm and stretch the area.

Although injury of the hand is not the first thing someone might think of as a career changing incident, the importance of the hands in finishing a ‘line’, or in famous dance styles such as Fosse (Jazz hands and ‘tea cup fingers’) cannot be underestimated! The choreographer Lea Anderson has been known to focus on specific body parts such as the hands and even the tiniest movements of the eyes. This is a perfect example of the intricate details that are so important in dance and why respect of a dancer’s body (every last bit of it) is of the utmost importance. I would imagine a sprinter could run 100 meters with a sprained index finger… try performing ‘finger spins’ in a Salsa number with the same condition!

The Knee

  • Tibia/Fibula/Patella/Femur
  • Quadriceps/Hamstrings/ITB/Gastrocnemius/Popliteus

Muscle balance in the quadriceps is of prime importance in knee function and injury prevention. The 4 muscles of the quadricep group insert into the tibial tuberosity (top of the shin bone), by way of the patella tendon (across and below the kneecap). Because of this, they control the tracking of the patella. The Vastus Medialis pulls the patella towards the midline of the body against the strong forces created by the angle of the femur and the other quadriceps. There can be rapid wastage of this muscle, so it is often affected as a consequence of other knee injuries, due to lack of use. Patella-femoral syndrome is a result of faulty tracking and causes pain underneath the kneecap as it rubs against the end of the thighbone. Failure to pull-up the knees when standing in a tight 5th position, for example, is a cause of Vastus Medialis weakening.

Pain on the outside of the knee is often due to tension in the ilio-tibial band. This is a large, tough band of connective tissue, which originates at the hip. Other injuries to the knee are sprained ligaments, which can be torn if a dancer twists and pushes at the same time, or meniscus/cartilage tears, which may even require surgery.

The Back

  • 33 Vertebrae = 7 cervical/12 thoracic/5 lumbar/5 sacrum/4 coccyx
  • Erector Spinae Group/Multifidi/Quadratus Lumborum/Core/Latissimus Dorsi/Trapezius

The spine is the support system for almost every movement and injuries of the back tend to have the most overall effect on a dancer’s performance for this reason. There are layers upon layers of muscles, which are susceptible to injury if not maintained in order to cope with the demands placed upon them. The back is fundamental in jumps, turns, lifts, port-de-bras, arabesques, grand battement and even pilés. (This is not an exhaustive list)!

As well as strength, flexibility is integral. A beautiful cambre or back bend is the feature of many a choreography, but must be performed by lifting up and extending the spine, not just back and down. Technique like this is essential in preventing injury. As part of the support system for the trunk of the body, the back muscles work in conjunction with the core, which forms a kind of belt around the lower back. Any movement involving the back must therefore include support from the abdominals. Weak or disengaged abdominals is a classic cause of lower back injury and pain.

The Abdominals

  • Rectus Abdominis/External and Internal Oblique/Transverse Abdominis

The transverse abdominal muscle is located between the ribs and hips. It is the deepest of the abdominal muscles, lying underneath the internal oblique. As the name suggests, the muscle fibers run horizontally, which helps in the function of supporting the lower back and pelvis, not dissimilar to a large belt.

If there is atrophy in these core muscles due to injury, disease or lack of use, then the lower back can suffer. It has been suggested that muscle activity occurs at the core in anticipation of movement in the hip*. This activity prevents lower back strain and indicates the importance of engaging the abdominals in grand battement, for example. The significance of both the pelvic floor and transverse abdominal during exercise can be seen in the practice of Ashtanga Yoga. Here, two ‘locks’ are encouraged while performing the yoga postures. The Pelvic floor is engaged in ‘Mula bandha’ and the transverse abdominal is engaged in ‘Uddiyana bandha’. These ‘Bandhas’ are included in the practice to seal in energy, but also to protect against lower back injury.

* Hodges P.W., Richardson C.A., Contraction of the Abdominal Muscles Associated With Movement of the Lower Limb. Physical Therapy. Vol. 77 No. 2 February, 1997.

The Hips

  • Femur – Greater Trochanter/Pelvis – Acetabulum, Ischium, Illium, Sacrum/Sacroiliac joint
  • Tensor Fasciae Latae/ITB/Quadriceps/Adductors/Gluteals/Hamstrings/Iliopsoas/Lateral Rotators

The hips are a source of trouble for many dancers, not least because this is where turn out should come from. The 6 lateral rotators, which are deep (underneath) to the gluteals play a major role in maintaining turn out, but when excessively tight, they can refer pain into the lower back, or down the back of the leg. It is very important that while this muscle group is strong, it does not hold tension to the point that a dancer walks in a turned out position (which is commonly seen in Ballet dancers).

The hip flexors can become tight with repeated high kicks if the dancer ‘lifts’ from the thigh rather than lengthening the leg and ‘feeling’ the energy come from underneath. In Latin Ballroom, where the dancer often stands and dances with hyper-lordosis (curve to the lumbar spine), this can lead to tightness in the iliopsoas and eventually an anterior tilt in the pelvis, which often results in back pain. Snapping hip can be caused by a taut Ilio-tibial band passing over the Greater Trochanter (bony prominence at the side of the hip), but is usually harmless. However, the bursa (small fluid filled sacs that prevent friction) can become irritated by constant rubbing, in which case, ice should be applied and lengthening of the IT band should be addressed.

The Calf

  • Tibia/Fibula
  • Gastrocnemius/Soleus/Achilles Tendon

The calf muscles must be very strong in dancers and a defined Gastrocnemius (the big muscle at the back of the calf) is often a tell-tell sign of a dancer. Most people are conscious of the Gastroc, because of its size and definition, but dancers MUST be aware that there is another muscle, which lies beneath this one called the Soleus. Many dancers fail to stretch this muscle*, which results in calf tension and pain and can eventually lead to shin splints, stress fractures or Compartment Syndrome.

Achilles Tendonitis is another common injury in dancers, which can occur due to overuse, too little rest or inadequate stretching. Technique such as always pressing the heels into the floor in between jumps will also help to prevent Achilles injuries, in addition to improving elevation.

* Stretch the calf by putting one foot behind the other, feet parallel and bending the front leg (this stretches the Gastroc as the back leg is straight). By bending the back leg slightly, you should feel the stretch lower down in the calf – you’ve found the Soleus!

The Foot

  • Calcaneus/Talus/Tarsals/Metatarsals/Phalanges
  • Extensors and Flexors of the toes/Plantar Fascia

Beautiful feet are a particular asset to a dancer. The arch that is created when the toes are pointed (flexed) is developed early on in a dancer’s career - remember ‘good toes, bad toes’? Strong feet are not only aesthetically pleasing, but are imperative in providing the strength for jumps, relevé and of course Pointe work in Ballet. Good alignment of the feet is crucial in dance as this is the base from which the rest of the posture develops. Allowing the feet to roll in when standing in a turned out position is an example of bad technique, which may cut short a dancer’s career. Muscle imbalance can result, which in turn, puts stress on the ankles, knees, hips and spine. In addition, conditions such as Bunions (Hallux Valgus) are aggravated by poor alignment and muscle weakness.

A common injury in the feet is Plantar Fasciitis. This is an inflammation of the connective tissue in the foot, which is brought on by dancing on hard floors, inadequate rest or poor technique. Pain tends to be worse around the heel and is particularly bad first thing in the morning. It can be treated with ice, massage and sometimes orthotics (foot support).

The Hamstrings

  • Biceps Femoris/Semimembranosus/Semitendinosus

The hamstrings cross two joints. They extend the hip (arabesque position) and flex the knee (bending the knee into a fondue). They originate at the bottom of the pelvis, which is called the ischial tuberosity. This is the bony area you can feel when you sit on the floor (the sits bones), and is a common point of pain in hamstring injuries, as the tendon that attaches the muscle to the pelvis becomes inflamed (tendonitis), through over use or excess tension in the muscle. The hamstrings attach by winding around the back of the knee and onto the tibia (the main shin bone). You can feel their long tendons if you bend your leg and roll your fingers around the back of the knee on either side – they’re incredibly strong and prominent.

Flexibility here is particularly important to dancers for high kicks. The hamstrings are often a point of soreness and strain due to repeated stretching in class and performance. A good warm up is essential to help prevent injury in this muscle group.

The Wrist

  • Radius/Ulna/Carpals
  • Retinaculum/Flexors and Extensors of the wrist – Flexor and Extensor Carpi

Most dance injuries occur to the lower body and trunk – back, hips, legs, knees, ankles and feet. However, depending on the style of dance (break-dancing in particular), the wrists and arms can take a lot of strain and become injured. This is also a danger area in partner dancing (Ballroom), choreography that requires floor work and various lifts.

One of the main dangers in any work that places stress on the wrist is of spraining the tendons and ligaments. During floor work especially, or in a fall from a lift, there is danger of fracturing the scaphoid (one of the 8 small carpal bones), or the end of the radius or ulna. Injuries like these may call for immobilization, which can lead to muscle atrophy. ST4D will improve recovery time with massage, joint mobility and exercises to rehabilitate and strengthen this area.

The Shoulder

  • Humerus/Scapula/Clavicle
  • Rotator Cuff – Supraspinatus, Infraspinatus, Teres minor, Subscapularis/Deltoid/Pectorals

In dancers, injuries to the shoulder and arm are not as common as lower extremity injuries. However, acute and overuse injuries from repeated spins, lifting, and drops can lead to injury. Also, choreography that involves weight bearing on the shoulder and/or arm can produce atypical stresses to the shoulder joint and can also lead to injury.

Male dancers often experience shoulder injury due to the strains of partner work - overhead lifts in particular. Female dancers can help prevent this by supporting their own weight and feeling the ‘tempo’ of the lift (launching into it in unison). One of the most common shoulder injuries for men is biceps tendonitis, where pain can be felt just at the front of the shoulder, at the top of the arm. Massage and ice treatments will encourage healing, as well as stretching of the biceps muscle.

The Ankle

  • Lateral and Medial Malleoli (Distal ends of the Tibia and Fibula)/Calcaneus/Talus/Lateral and Medial ligaments.
  • Tibialis Anterior and posterior/Gastrocnemius/Soleus/Peroneals/Achilles Tendon

Lateral ankle sprain is the most common dance injury of them all. It can occur due to tiredness, weakness in the muscles, type of footwear, bad technique or just landing badly from a jump! Technique for example, is critical in ankle strength and stability. The reason you were told not to ‘sickle’ your feet in ballet class was not just because it ruins the line, but also because if you land from a jump with a ‘sickled’ foot, it is very likely to roll and thus, sprain the ligaments. Damage to ligaments is dangerous because they do not have a good blood supply, which means they don’t heal well. Unlike muscle tissue, ligaments are quite inelastic – once they have been stretched, they tend to stay that way – which is why repeated ankle sprains are so common.

Proprioceptive exercises are INTEGRAL in re-habilitating an ankle sprain. They will re-educate the muscles’ receptors, telling them what is a ‘safe’ range of movement in a certain joint. Theses are performed with equipment such as a wobble board, or even by standing on a rolled up towel (dancers must be resourceful)!

The Elbow

  • Humerus/Radius/Ulna
  • Biceps Brachi/Brachialis/Brachioradials/Flexors and Extensors of the wrist

Most dance injuries occur to the lower body and trunk – back, hips, legs, knees, ankles and feet. However, depending on the style of dance (break-dancing in particular), the arms and elbows can take a lot of strain and become injured. This is also a danger area in partner dancing (Ballroom), choreography that requires floor work and various lifts.

Constant gripping, lifting or repetitive arm actions can result in a condition called lateral or medial epicondylitis (commonly known as tennis or golfer's elbow). ST4D uses a technique called Soft Tissue Release to relieve the pressure on the tendon and so reduce the pain. To avoid damaging the elbow joint, it is important for the dancer to maintain a degree of tension in the arms at all times, especially when partner dancing (holding the frame). This will reduce the forces on the joint and protect it from jarring and locking. It is also important not to allow the joint to hyperextend when bearing weight as this stresses the connective tissue.

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