Minding your sprained ankle: a psychological approach to rehabilitation.

You have just sprained your ankle. Now what do you do? While an acute injury is always unexpected, most people can adjust after they get used to their crutches, crack a few morbid jokes, and encourage friends to cover their casts with graffiti. This is not the case with dancers. The stakes are completely different when your livelihood, not to mention your self-esteem, depends on peak performance. Still, there's no need to panic. Dancers who take a practical approach to their recovery can often perform even better than before. This article addresses the psychology of injured dancers and the successful rehabilitation of a sprained ankle.

Getting a Diagnosis

A sprained ankle is the most common injury in dance. However, the degree of injury can vary dramatically, so it is important to get a correct diagnosis from your orthopedist. Your ankle sprain will be rated, based on the damage to three ligaments, as Grade I (a mild stretch with no instability), Grade II (a partial tear with some instability), or Grade III (a complete tear with gross instability). Early active use and rehabilitation are the treatments of choice for Grade I and II sprains. A Grade Ill sprain could require surgery and approximately three months to heal.

The Injured Psyche

Beyond the pain and damage to the dancer's body, the most disturbing element of an injury is being unable to work. As with other dedicated professionals, it is the process of regularly engaging in meaningful activity (class) that is truly rewarding to the dancer, not just the school recital or getting a glowing review in the New York Times. This intrinsic enjoyment is based on physical mastery, with little or no separation between who you are as a person and your ability to perform. As a result, dancers lose more than just their physical fitness when they are injured. They may also feel they have lost their identities.

Another loss suffered by injured dancers is caused by their separation from the dance community. Because of grueling schedules, dancers spend most of their time in the company of other dancers. This is particularly true for professionals, who begin company class at ten o'clock in the morning, rehearse six to eight hours during the day, and finish with the evening performance--twelve hours later! This schedule contributes to significant camaraderie, as dancers share their experiences and work together on a daily basis. Unfortunately, injuries can interfere with this process. Sometimes dancers feel that they are only valued as long as they are healthy enough to perform. With few resources to fall back on outside of their work, injured dancers are at a distinct disadvantage. They may be isolated from their peers and may have to confront the slow process of recovery alone.

Given the short duration of this career, dancers who experience work dysfunctions caused by age, illness, or injuries are particularly vulnerable to psychological distress. This is most commonly manifested by anxiety or depression, which are indicative of mental strain. However, dancers' responses may be either transient or incapacitating, depending on their ability to cope effectively. Injured dancers may experience dread, avoid rehab, and perceive themselves as failures. Some even resort to substance abuse, a maladaptive approach to occupational stress. A more positive approach to recovery is to use the injury as a catalyst for personal renewal.

Coping Mechanisms 

Injured dancers can call upon several sources of help and support throughout their rehabilitation. Support from friends and colleagues plays a vital role in alleviating periods of high anxiety and depression. Dancers' life-styles and positive health habits often make coping with injuries easier, however, the biggest factor in successful recovery lies in identifying what is and is not within your control. Unrealistic expectations or fears will only lead to further despair. Once you are injured, you must realistically evaluate your condition and your ability to stay in shape and to improve.

PHASES OF REHABILITATION

As with any traumatic event, there is often an initial period of shock when any serious injury occurs. You are no longer able to participate in physical activities and must find alternative ways to feel secure. During the first week after the sprain, most dancers report feeling isolated and depressed. The tendency is to give up and withdraw; however, this will only exacerbate the initial negative response to stress. Instead, it is crucial to remain active, to keep contact with friends and colleagues, and to connect with a physical therapist who can provide emotional support. You will be given a reassuring routine to follow, as well as a new peer group comprised of other injured athletes and dancers in recovery.

The primary task at this stage is to set goals that are compatible with your present level of functioning. This means that dancing is not an option in other than Grade I sprains. Fortunately, there are several positive strategies that you can pursue, such as observing class and taking notes on how others apply corrections effectively, analyzing your own technique in the light of what you learn, or studying roles by watching a choreographer. Modern dancers may even be able to assist in choreography when their injury permits.

This is also a time when you should eat less to prevent your weight from becoming a problem. Because treatment options vary with serious ankle sprains (Grades II and III), some initial immobilization may be necessary. It may be several weeks before you are in an air cast and can engage in even moderate aerobic exercise, such as swimming. Thus, the best defense against weight gain is to eat fewer calories and less fat. It is also important for dancers to ease up on their quest for perfection, which is rarely constructive when there is a wide gap between reality and their aspirations. Instead, you can be creative by exploring other interests, furthering your education, or investigating different careers after dance.

A dancer's frame of mind usually improves during the middle phase of rehabilitation with the first tangible signs of progress, although there are distinct limitations to what can be accomplished. Learn to enjoy each of the small victories associated with healing. Your physical therapist will reassure you that it is normal to experience a certain amount of pain and stiffness, as well as minor setbacks along the way. Rather than thinking the worst ("I'm sure to reinjure myself"), dancers need to remain objective and think positively ("Relax and concentrate on the exercise") to counteract their fears.

During this phase you can also focus on body conditioning to avoid getting out of shape. In addition to rehab, there are a number of ways to proceed. For example, a Pilates-based exercise program is ideal for injured athletes because it maintains a balance between strength and flexibility and between agonist and antagonist muscle groups (flexors and extensors). It is a safe and well-supervised program that offers ballet dancers the additional benefit of exercising in the turned-out position. Other options for conditioning include remedial classes and aerobics, which will help to improve your technique and stamina and to maintain a proper weight. The more you are able to analyze your bad habits, the better your chances of improving. By directing your attention to healthy avenues of pursuit, you can feel more secure and will be less likely to focus on the possibly negative consequences of the injury to your career. Remember, many dancers sustain injuries during the course of their careers, but most of them recover and go on to new heights of accomplishment.

Full Recovery

The last phase of injury rehabilitation is self-sustaining. Practice and classes have been resumed, and it is clear that you will eventually be able to perform. You are at your ideal weight, and you feel fully reconditioned and ready to discard, old habits. But your injury is still in recovery. Give it some more time. Don't return to a full schedule of activities prematurely.

You can also get into trouble in this final phase by cutting back on your physical therapy. Doing so can easily sabotage all of your efforts as you regain full stamina and coordination. At this point it is important to set realistic goals based on your physician's advice in order to avoid setting yourself up for reinjury. To curb your frustration, it helps to remain close to prior systems of support, such as physical or Pilates-based therapy, where there is minimal stress of competition.

Another potential problem for injured professionals during recovery is losing valued roles to others . Time will most likely rectify this loss, too, as long as you are patient and remain injury-free. Meanwhile, you can enjoy being back with your peers and the rewarding routine of dance.

Injured dancers are particularly vulnerable to psychological stress if the recovery period is protracted. To make this a constructive experience, it is important to adapt to the various stages of physical rehabilitation. Dancers who find themselves unable to cope effectively with anxiety or depression should seek outside counseling as an adjunct to the rehabilitation process. Remember: The right approach to injury rehabilitation can turn adversity into triumph. You can dance even better than before after you return.