Ankle Sprains

          “There are three steps you have to complete to become a professional dancer: learn to dance, learn to perform, and learn how to cope with injuries.” - D. Gere

         Last week’s post on the anatomy of the ankle explained how the two joints that comprise the ankle and the ligaments surrounding the ankle work.  When everything goes as planned, the ankle moves as it should and is prevented from moving in directions that could damage and/or compromise its stability.  Sometimes, however, there are factors that cause the ankle to move in dangerous ways and an injury occurs.

 

            Ankle sprains account for 15% of all athletic injuries, and an ankle sprain is the most common injury among all forms of dance.  A 2006 article published in Physical Medicine and Rehabilitation Clinics of North America reported that ankle injuries account for up to 62% of all dance injuries, up to 24% of all modern dance injuries, up to 95% of all ballet injuries and up to 45% of musical theatre dance injuries in professional dancers.  The same article reports that females are at a higher risk of injuring the ankle because of the amount of stress placed on the joint during pointe work.

            A sprain occurs when one or more of the ligaments surrounding the ankle joint are overstretched or possibly torn.  Since ligaments are designed to prevent movements from occurring, an overstretched or torn ligament allows for movement in a direction that the joint is not meant to go.

Lateral sprain

            The most common sprain among dancers is on the lateral, or outside, of the ankle.  This sprain occurs in the lateral collateral ligaments when the foot turns inward, or inverts, while the ankle rolls outward.  A less common sprain can occur on the medial, or inner side, of the ankle if the foot twists outward, or everts, while the ankle rolls inward.   Consequently, one or more of the deltoid ligaments and/or the calcaneonavicular ligament can be overstretched.  The least common type of sprain among dancers occurs at the top of the ankle and is called a high sprain.  It would involve the syndesmosis ligaments that connect the tibia to the fibula.

            Sprains can caused by either rolling over when on demi-pointe or pointe, landing a jump incorrectly, or dancing on poor surfaces like slippery floors.  Rolling over or a poor landing could be the result of poor alignment at the ankle joint.  If a dancer’s foot tends to pronate, or roll in, the ankle may become chronically misaligned.  Ankle misalignment can also occur if there are muscular imbalances in the leg, if turnout is forced, or if there are misalignments in other parts of the body.  Fatigue and/or a sudden increase in training or rehearsal time can also stress the body and cause it to respond to movement differently than expected.  Slippery floors limit the amount of control a dancer has when dancing and can cause unexpected movements or falls.

            When a sprain occurs, the dancer will experience immediate pain followed by swelling.  A mildly sprained ankle will be swollen, be tender and stiff, and cause a small amount of pain when walking.  When the swelling and tenderness are accompanied by bruising and extreme pain while walking, the sprain is classified as serious or moderate.  A severe sprain often results in an audible pop or snap and a feeling of tearing when it occurs.  The ankle will seem “wobbly”, and the dancer will be unable to walk on it.

            As with all injuries, the dancer should immediately stop dancing, ice the injured area, and elevate it.  The reasons for following these steps are reviewed in my post on caring for injuries.  Dancers should always be evaluated by a dance medicine specialist.  Depending upon the severity of the sprain, the injury can take anywhere from 6 weeks to 3 months to heal.  After the injury heals, it is important that the dancer work with a physical therapist to re-establish the strength of the ankle joint and to determine what may have caused the injury.  If the cause was misalignment and/or a muscular imbalance, a physical therapist can help the dancer retrain his/her body to keep another injury from occurring.

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Kadel, N. (2006). Foot and Ankle Injuries in Dance. Physical Medicine and

            Rehabilitation Clinics of North America, 17, 813-26.

O’Loughlin, P., Hodgkins, C., & Kennedy, J. (2008).  Ankle Sprains and Instability in

Dance.  Clinics in Sports Medicine, 27, 247-62.

Russell, J. (2010).  Acute Ankle Sprain in Dancers.  Journal of Dance Medicine and

            Science, 14(3), 89-96.

Common Injuries of Muscles, Ligaments & Tendons

            “There are three steps you have to complete to become a professional dancer: learn to dance, learn to perform, and learn how to cope with injuries.” - D. Gere

            Dancers ask a lot of their bodies on a daily basis.  Although they may try to dance healthy, sometimes an injury is unavoidable.  It is important that injuries be cared for immediately as I described in an earlier post on injury care.  This week’s post describes some common soft tissue injuries of the muscles, tendons and ligaments that are common among dancers.

            Anytime a soft tissue injury occurs, cells called fibroblasts gather at the site and form a web that eventually becomes scar tissue.  The swelling that occurs with an injury is partially caused by this gathering of cells.  Although fibroblasts are necessary, the body overproduces them.  It is important to keep the swelling minimal to discourage large amounts of scar tissue from forming.  Scar tissue is extremely strong, but its fibers are not organized in a parallel fashion like those of muscle tissue.  The jumbled pattern of fibers makes scar tissues inelastic.  Gentle stretching is recommended as the injury heals because it is believed to realign the scar tissue fibers to encourage elasticity.

            One of the most common dance injuries is often referred to as a “pulled muscle” and is actually a strained muscle. A strained muscle occurs when excessive or rapid stretching causes a tearing of muscle fibers.  Muscle strains can vary in degrees from a minor tear to a complete tear and can involve tearing within a muscle, muscle fibers tearing away from a tendon or a tendon tearing away from a bone.  Hamstring and groin strains are the most common among dancers.  The RICE method, followed by gentle stretching once healing has begun, is usually sufficient treatment, although complete tears require surgery.

            Sprains are tears that occur in ligaments and can be caused by improper body alignment or a sudden twisting movement.  Dancers usually experience ankle or knee sprains that often occur during turns or when landing from a jump.  Sprains, like muscle strains, can range in severity from a minor tear to a complete tear.  The RICE method should be used immediately.  Some sprains may require immobilization while the ligaments heal and/or physical therapy to re-build strength around the injured joint.  Since ligaments are not as elastic as tendons or muscles, they have great potential for re-injury and must be allowed to heal completely before a dancer returns to class.

            While strains and sprains are acute injuries, fasciitis and tendonitis are chronic conditions that can linger and be very frustrating and painful for dancers.  Fascia, which is the tissue surrounding muscles, can become inflamed from overuse or as a result of body misalignment.  Tendonitis is similar to fasciitis but involves inflammation of the tendon and its sheath, or the membrane that surrounds it.  Tendonitis causes pain whenever the connected muscle contracts and pulls on the inflamed tendon and can be caused by body misalignment, muscular imbalances or inadequate conditioning.  The most common site for this condition in dancers is at the achilles tendon.  Incorrect alignment of the foot combined with the tendency to not place the heels down between jumps and relevés contribute to this chronic condition.  Caring for both these conditions involves using the RICE method and ibuprofen to decrease the inflammation and bring the dancer relief.  When the inflammation decreases, a sports medicine doctor or physical therapist will be able to prescribe stretches to strengthen the joint, determine what may have caused the condition and help the dancer correct any flaws in his or her pattern of training that may have contributed to the inflammation.

            Injury prevention should always be the dancer’s goal.  Awareness of body alignment, proper training and creating balanced muscle pairs can help to keep soft tissue injuries from occurring.  If an injury does occur, proper care will allow the body to heal itself quickly.