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.

Muscles, Tendons & Ligaments

“It is a dancer’s responsibility to know the parts of her instrument and study how they work in unison to create a beautiful work of art.”

            Understanding the different parts of the body and how they work is an essential part of dance training.  Physical activities, like dance, require a thorough knowledge of the instrument in order to produce the best possible performance.

         Skeletal bones are the body’s foundation, but they require muscles to hold them securely together and to allow for movement.  Muscles are organs that are composed of thousands of individual fibers.  These fibers have four important qualities:  excitability, contractility, extensibility and elasticity.  Excitability means that muscles are able to receive stimuli, or messages, from the nervous system and react to them through movement.  When a muscle receives a signal to move, it contracts, or shortens, to pull on the bone to which it is attached.  The abilities to shorten and exert a force and to release afterward are contractility and extensibility.  Muscles are also capable of being stretched.  Elasticity is the quality that allows the muscle to return to its original length after being stretched.

            In order for muscles to move the skeleton, they must be connected to the bones by tendons.  Tendons are thick bands of tissue that can be stretched and, like muscles, are elastic and will return to their original length.  Studies have shown that tendons respond to forces like muscles do, and when they are used repeatedly, they will also grow stronger.  A recent study published by The Proceedings of the Royal Society in March 2012, showed that, in addition to connecting muscles to bones, tendons act as shock absorbers.  When a dancer lands a jump, it is the tendon that absorbs the primary shock and not the actual muscle.  Resultantly, the tendon is also thought to act as a spring and provide recoil strength after landing.

            While tendons connect muscles to bones, ligaments connect bones to each other.  The main purpose of a ligament is to limit or prevent certain movements.  The knee joint is one joint in the body where ligaments predominate.  The medial (inside) and lateral (outside) collateral ligaments limit sideways motion of the patella, or kneecap, while the posterior cruciate ligament prevents the knee from bending backwards.  Ligaments do not possess the same amount of elasticity that muscles and tendons do.  Once a ligament is stretched forcibly or for an extended period of time, it will not return to its original length and may require surgery.  It is for this reason that a bone dislocation should be cared for as soon as possible to prevent permanent ligamental damage.  Some people are born with extremely loose ligaments and are incorrectly labeled “double-jointed”.

            Knowing the body and how each part functions helps dancers to understand how to get the most from their training, understand how to care for injuries if they happen and learn how to optimize their performance.