Learn the most common dance injuries and treatment options

Although there are many physical and psychological benefits to dancing, the sport causes unique injuries, noted Rebecca Fishman, DO, during a presentation at OMED 2015.

“Imagine you have a patient who is running without wearing a supportive shoe, and they’re running on concrete,” she said. “What if they were running barefoot on concrete? How about running on metal?”

Tap dancers wear shoes with aluminum plates on the bottom, which are akin to dancing on metal, Dr. Fishman said. Dancing on such a harsh surface can lead to shin splints, knee and back injuries.

The advanced training DOs receive in the body’s musculoskeletal system prepares them to address these injuries as well as the other conditions frequently observed among dancers.

Hoping to educate DOs on how to best treat their dancer patients, Dr. Fishman recently offered insights into the most common dance injuries she sees.

The basics

Musculoskeletal abnormalities can often make dancers more prone to injury, Dr, Fishman said. For instance, dancers with overpronated feet are more vulnerable to tendonitis and shin splits.

Dr. Fishman, a physical medicine and rehabilitation specialist and a former dancer herself, has anteversion of the hips, or femurs that rotate toward each other. To compensate, she had to learn how to strengthen her leg muscles to avoid injury.

Dr. Fishman also stressed the importance of correct diagnosis and immediate treatment of injuries because continuing to dance on an injury can lead to “injury cascade” and sometimes the end of a dancer’s career.

Some of the most common dance injuries include:

• Spondylolisthesis, a condition in which one vertebra slides forward over the vertebra underneath it. Dancers with this condition should rest; they need to avoid extension of the lumbar to provide time for the pars interarticularis to heal and to avoid movement that can cause anterior pelvic tilt. A modified Boston brace can help remind patients who need to continue dancing not to hyperextend.
• Herniated lumbar discs.
• Annular tears, or tears in the lumbar discs, can result in pain and cause the muscles around them to spasm, Dr. Fishman said.
• Sacral hypermobility.
• Hip injuries.
• Knee injuries.
• Sesamoiditis, or injury of the sesamoid bones, which are little bones under the great toe on the ball of the foot. Sesamoid fractures don’t always show up on X-rays but can sometimes be identified via a bone scan if the X-ray is negative. To treat, patients can try taping the big toe into a bent position and using a J-pad, a special pad for sesamoiditis, to relieve pressure.
• Foot injuries such as bunions.
• Shin splints.

Diagnostic and treatment options

• Osteopathic manipulative treatment: Techniques to stretch the psoas muscles are important to encourage correct alignment in dancers.
• A musculoskeletal ultrasound provides a dynamic view of the tendons and joints and can be used for guided therapeutic injections, Dr. Fishman said.
• Prolotherapy.
• Platelet-rich plasma injections.
• Pilates. A strong core is vital for dancers, Dr. Fishman said, because the limbs need to be able to move without pulling or injuring the core muscles.
• Proprioceptive training can give patients a better understanding of the location of their bones, muscles and joints, which can improve balance.

Dr. Fishman’s presentation slides are available on the American Academy of Osteopathy website.