Post-injury investigations.

A post-injury evaluation of possible injury-causing movements and habits should be made to prevent recurrence of the injury. Obvious as that seems, most physicians and physical therapists, probably because they lack knowledge of or interest in dance, never investigate the possible movement causes of injury after treatment. If the misuses of the body that caused the original injury are reinstated, another injury will occur. Alignment, technique, posture, and muscle imbalance are the areas to investigate.

Therapist L. Sunday Homitz says, "I ask the patient in rehabilitation to do plies, releves, and many other dance movements as a means of determining what configuration may have caused the injury.

"Added to incorrect technique as a possible causative factor are the bringing of personal problems into the work area, fatigue, burnout, unsuitable stage surfaces, and destructive muscular pulls from other areas of the body. For example, in a case where tendinitis occurs several times over a period of years, the cause may well be in the back instead of the ankle."

Programs to prevent recurrence require that the dancer-patient have a solid understanding of the factors involved in the cause of the injury and be willing to realign the injury-prone area in class and rehearsal with time-honored warm-up and cool-down exercises.

"Dancers almost everywhere are overstretched," Homitz adds, "but specific stretching in the case of rehabilitating an ankle, for instance, is important. Added stretches should be in the lumbar, foot, and hamstring areas."

Correct stretching prepares muscles for activity, helps the dancer relax physically and mentally, and assists in the prevention of injuries and muscle soreness. According to Cleveland Clinic Foundation (CCF) stretching should be slow and sustained Bouncing and bobbing stretches should be avoided at all times. Often ballistic (bouncing) stretching will encourage small tears within the muscle and may cause temporary muscle shortening. Holding a stretched position for thirty to sixty seconds, repetition of the stretch three to five times, and right-left alternating is recommended.

There is, as well, a psychological component to injury that should be addressed. Although injured dancers are adept at denying pain, they must acknowledge an injury and report their pain on a scale from uncomfortable to extreme. The next step is to contribute to the healing process by following the medical directions, readjusting mechanically to prevent further damage, and going on from that point psychologically. Fearful dancers must learn to trust rehabilitation exercises and practice the healing in visualizing safe and correct movements.

Relaxation through breathing or any other procedure that calms the dancers before a performance is important when the injured performer returns to the stage. [See "Performance Anxiety," December 1993, page 82.]

"Patience is also a factor in healing," explains Homitz. "Dancers are not content with small goals and expect an injury to be repaired immediately." Short-term treatment goals begin at making the patient pain-free and increasing circulation and flexibility. Long-term goals include creating programs that strengthen weak areas based upon evaluating and exploring movement habits. Pilates-based exercises and gym equipment, as well as a swimming pool for water-barre therapy, are available to Cleveland Ballet dancers at any time.

PREVENTION

Preventive measures through seminars and exercise supervision are part of CCF'S program. These are to allay the mixed messages sent to students and parents via myth and media. Society in general, because of the wide media coverage of sports injuries, thinks dance-because it is physical-is dangerous. Dancers are erroneously compared to athletes who perform competitively and engage in rough physical contact. If both dancers and athletes fail to warm up and do strengthening exercises consistently, both may become injured on the basis of wear and tear, time, and unexpected damaging conditions. Dance is not dangerous when correctly performed, when technique has been methodically and carefuly tutored, and when a congenitally healthy and strong body has been properly trained.

Another current damaging concept is that dance is "hard work." Hard work is burdensome; dedication and love of dance are easier and safer concepts. The number of teachers who emphasize "hard" in dance are oppressed by having to teach classes having undisciplined students of unequal accomplishment, who do not have a capacity to analyze or unravel complicated movements. Margot Fonteyn had a safe and suitable suggestion for pupils who encountered a movement they considered hard; she would say, "Let's just get on with it. If dance is that hard for you, why are you doing it?"