MIAMI — Snapping hip syndrome, labral tears, and tibial and metatarsal fractures are injuries unique to dancers, Dr. Craig C. Young said at the annual meeting of the American Medical Society for Sports Medicine.
Most research focuses on ballet, given its relatively high risk of injuries from dancing en pointe and from landing jumps in an external hip rotation. However, jazz dancing also is associated with injuries from internal hip rotations; modern dancing injuries are caused by knee flexion, dancing barefoot, and women doing lifts; and injuries associated with ballroom dancing are often associated with high heel throws.
“One myth is that dancers aren't athletes. Some are in better shape than my ballplayers,” said Dr. Young of the Medical College of Wisconsin in Milwaukee. Dancers also are extremely competitive and may not be forthcoming about their injuries because of this competitiveness.
Choreographers don't necessarily look at dance from a biomechanical perspective, so their pieces often include repetitive hyperextension and flexion, incorrect lifting techniques, and snapping motions, he said.
About 90% of the dancers treated in Dr. Young's practice do ballet. “We see a lot of external snapping hips.” Internal snapping hip injuries are less common, but can occur when the dancer is in a non-weight bearing position. Hip labral tears occur quite often, too. Patients present with sharp pain in the groin. An MRI arthrogram can aid diagnosis.
Stress fractures of the tibia and metatarsal shaft are quite common. Spiral fracture of the fifth metatarsal shaft is unique to dance and, in fact, is commonly referred to as a “dancer fracture.” This inversion injury occurs while en pointe. Patients do well after casting, he said.
Injuries in the upper extremities occur when dancers hold their arms in unusual positions for prolonged periods; they also frequently lift and carry weight away from the body. Adverse outcomes include rotator cuff tendinitis, thoracic outlet syndrome, and effort thrombosis.
Ankle impingement, bunions, hammertoes, and nail problems also occur. Dancers can present with subungual hematomas, paronychia, and ingrown nails. “They shouldn't clip their toenails, but use an emery board every day or every other day to keep their nails the same length.”
Unusual forms of tendinitis common in dancers include sartorius tendinitis from overuse of the hip external rotator. Dancers experience pain with external rotation, full flexion, and hip abduction. Rectus femoris tendinitis occurs from repetitive forward extensions of the leg. Groin pain occurs, especially when the knee is extended. Extensor hallucis longus tendinitis causes pain when a ballet dancer is in demi-pointe. Achilles tendinitis also occurs from overuse or ribbon friction. “Make sure they bring their pointe shoes. Have them show you how they tie their ribbons. Often, we can treat it without any other changes.”
The sole of pointe shoes is a piece of cardboard with no protection at the toe, so the dancer's muscles and the floor act as shock absorbers. “Ask what kind of floor they are dancing on. A dancer at a small studio may be dancing on concrete.”
Physicians who treat dancers must learn the French ballet terms because dancers often use them. Ask them to explain the move or have another dancer demonstrate it, he said.