Dance by the Numbers

Interesting Information

• Being on pointe increases the force transmission through the foot by 12x. In contrast, being on demi pointe only increases forces by 4x. 
• Most dancers have lots of range of motion, so stretching is not always helpful. Often it is stability or control that needs to be improved. 
• Classical ballet ranked first in activities generating physical and mental stress, followed by professional football and professional hockey.
• The risk of all lower body injuries may be reduced by up to 50% with regular participation in a balance training exercise program with a resistance training component. 
• It is recommended to limit dance training to 5 days per week with one day completely free from physical activity
• Having a low BMI and lower levels of body fat had been shown to increase the risk of dance injury
• Getting less than 8 hours of sleep can increase your rate of injury by up to 70%
• The ideal foot shape for being on pointe is with the first 3 toes being the same length. If the second toe is longer than the big toe or if they taper from big toe to little toe it can lead to more pain, blisters, or foot issues based on pressure distribution.  
• The ideal amount of turnout is 180 degrees, 60% should come from the hips and only 40% from the feet
• Radiographic appearance of growth plate closure doesn't correlate with the completion of bone maturation. This occurs in the later teenage years, therefore x-rays are not needed to determine readiness to progress on pointe
• Being a professional dancer is the hardest profession in the US, according to the Occupational Information Network

Dance Injury Information

• Injuries in Pre-professional elite dance schools: 72% are overuse and 77% are lower extremity. In non professional dancers: 75% are overuse and between 66% and 91% are lower extremity.
• Young dancers sustain 0.77-1.55 injuries per 1000 hours of dance  
• The most common sites in the lower body for injury are the knee and ankle 
• The spine is implicated in 30% of injuries
• Dancers have a lower incidence of ACL tears and other knee traumatic injuries
• Research has shown that the top 5 risk factors for lower body injury in a dancer are 

1. Alignment Issues
2. Poor movement control in the low back and pelvis
3. Incorrect contraction of the deepest abdominal muscles
4. Weakness in the lower extremities
5. Insufficient aerobic fitness 

• Many dancers have poor calf endurance, when you stand in turnout you tend to loose the arch in the feet. This can disengage your medial calf, which is used in stability and endurance. This can lead to ankle injuries. Doing calf raises in parallel will help to strengthen the calf muscles.
• Excessive calf stretching can lead to pinching or injury of the tendon that lifts the big toe and if done before dancing can reduce the muscles power output. Instead try shaking out the calves, rolling, or doing a dynamic warmup/cooldown

Common Dance Injuries

Achilles Tendinosis- Presents as pain above the heel that increases with activity or stretching. If the pain has been present for more than 2 weeks you may experience pain/stiffness in the morning or at the beginning of an activity until warmed up. Sometimes there is swelling over the area, but not always. Proper warm-up, stretching, and proper shoes can help to prevent achilles issues.  At home management includes Ice, pain free calf stretching (both bent knee and straight leg) and switching to non weight bearing activities for 1-2 weeks is advisable. 

Bunions/Hallux Valgus- Presents as pain where the big toe joins the foot. A bunion is an inflammation of the joint capsule and tissues whereas Hallux Valgus involves the big toe deviating towards the outside of the foot. 80% of Hallux Valgus are pain free. At home management includes ice and using a bunion pad/silicone toe spreader/or night splint to help protect and hold the joint in position. 

Flexor Hallucis Longus (FHL) tendinopathy/Trigger Toe- Presents as pain in the ankle joint, on the medial side or down into the medial foot /big toe. There is initially pain with movement that gets better or goes away as you warm up. With Trigger toe the big toe can get stuck in flexion due to injury to the FHL. Improper technique,  foot pronation, and excessive stretching can contribute to FHL issues. At home management includes ice, taping/support, and strengthening the toe and foot intrinsics can help the improve the condition.  

Hammer Toe- Presents as pain in the toe, most commonly the second toe, and it is often secondary to Hallux Valgus or Morton's Neuroma. At home management can include taping or a night splint, stretching toe extensors and flexors, and proper footwear. 

Morton’s Neuroma- Presents as pain, numbness, and or abnormal feeling on the bottom of the foot and between two toes. Often feels like you have a pebble in your shoe. At home management includes a pad or tape for support, ice, and foot intrinsic exercises.  

MTSS (Medial Tibial Stress Syndrome)- presents as pain on the inside of the lower leg with exercise, and is more commonly referred to as “shin splints”. However “shin splints” is a catch-all term for pain in the shin and not an actual condition or specific diagnosis. MTSS involves the Tibialis Anterior and Flexor Digitorum longus and/or soleus muscles. The pain usually presents in the middle ⅓ of the tibia. Proper foot support, adequate warm-up, and gradual increase in training can help prevent MTSS. At home management includes ice, reducing intensity of activity, compression, gentle stretching, foot intrinsic exercises and taping for support.  

Plantar fasciitis- Presents as pain on the bottom of the foot in the heel or midfoot arch region. Pain increases with initial standing (especially first thing in the morning) , walking, or running but improves as activity continues. It then gets worse at the end of the day or the next day but improves with rest. Proper footwear and stretching can help prevent it. At home management includes ice, NSAIDs, rolling the foot on a golf ball, intrinsic foot exercises, calf stretches, and taping or padding are helpful.  

Posterior Ankle Impingement- Presents as chronic or recurrent posterior ankle pain caused or exacerbated with forced / hyper plantarflexion or push off manoeuvres. PAI can be caused by a number of factors including: osteochondritis, fractures, tenosynovitis, calcification of tissues. At home management includes ice, NSAIDs, rest, and avoidance of plantar flexion. Most serious cases would require casting or wearing a boot for 4-6 weeks. Strengthening and proper movement patterns once healing has occurred is key to return to dance safely. 

Hip Labral Tears- A labral tear involves a tear or damage to the labrum surrounding your acetabulum (pelvis bone). This structure helps hold the femoral head in place as well as helping it move smoothly in its socket. Labral tears will present as hip pain and/or stiffness, pain in the buttocks or groin area, the feeling of being unsteady on your feet, and a clicking sound when moving the hip around. At home management includes rest, NSAIDs, gentle mobility and strengthening programs. In this situation, proper referral to a sports medicine physician and an orthopaedic surgeon is key as conservative treatment will only help limit symptoms, not fix the issue. 

Snapping Hip- Presents as a click or snap accompanied with pain in the hip during movement. Depending on the location of the noise will determine which muscle is problematic. Snapping hip is not considered problematic if there is no accompanying pain with the click or snap. Hip hypermobility, muscle imbalances, pelvic dysfunction, and lumbar spine posture can all contribute to the development of snapping hip.  At home care includes heat, stretching and strengthening of thigh muscles, and correction of low back posture. 

Hip Impingement- Medically known as FAI (Femoroacetabular impingement); Presents as stiffness in the hip, groin, or thigh; the inability to flex the hip fully; pain in the groin area that worsens with the hip flexed. At home management involves stretching of the lower body