Ballet: Ideal Body Type
Injury Treatment and Prevention
"Only the astronaut in our society is a more selected
individual than the professional ballet dancer."
- Dr. William G. Hamilton
What is dance?
Dance is defined as a conscious effort to create visual designs in
space by continuously moving the body through a series of poses and pattern
tracings. The movements must also be in sync to a particular rhythm.
There are three basic dance genres:
- Classical Ballet
characterized by the turnout of the hip, rising up on toes, elevation,
beats, turns and toe dancing
- Modern Dance
characterized by barefoot dancing, asymmetry and personal choreographic
or dance styles
- Folk Dance (including Jazz)
characterized by folk rhythms and traditional dance steps from a particular
area or ethnic origin.
Professional dancers may create artistic and beautiful movements but,
compared to the 61 common sports, only professional football is more physically
demanding than ballet. Like football, dance is not an endurance sport. Dancers
will experience short bursts (1-2 minutes) of high cardiac output followed by a
period of rest or less intense dance. Because of the extremely high level of
natural physical and artistic ability needed, only a small number of aspiring
dancers will have the body type required to reach the level of professional
ballet dancer.
What defines the ballet dancer's body?
There are specific body shapes and characteristics that naturally
determine which dancers have what it takes to become professional ballet
dancers. However, dancing can still be a rewarding experience for the amateur
with an "imperfect body." The amateur can gain poise, improve posture,
balance and self-discipline as well as concentration, flexibility, endurance,
speed, strength and power. Some physical imperfections can be overcome with
talent but, a perfect body without talent will not make it as a professional.
The professional ballet dancer's ideal body is identified by the following:
- Proper proportions
Small head, long neck, shortened torso, long, thin, lean (not emaciated)
and attractive legs. Less acceptable aesthetically is long torso, short
legs, big buttocks, swayback, round shoulders, spinal curves, big heads and
a short neck.
- Loose joints
This could be a matter of genetics or training, either way it is
important for the dancer to have enough strength to control motion.
- Turnout of the leg
This is the cornerstone of classical ballet. The turnout begins at the
hip and moves down to the knee, tibia, ankle then foot. If hip motion is
limited then turnout comes from the floor up. This is more stressful to the
knee and other parts of the leg and increases the risk of injury. The ideal
dancer is "duck footed" (toes point outward) which is caused by
femoral retroversion (leg is naturally angled outward) or anterior capsule
stretching (extending flexibility through stretching). Hip version (ability
to rotate at the hip) is probably genetically determined and set by age
eleven. If it can be changed training needs to begin before this age.
- Slight knee hyperextension
When leg is straight the knee is bent slightly backward. This produces
more visually pleasing "S" line of the leg on pointe. It also
moves the center of gravity above the knee which gives the dancer's torso
and upper body a forward and upward appearance. The dancer must have
strength and proper technique to control the knee and avoid injury.
- Genu Varum (bowlegged)
Bowleggedness (riding a horse) is favored for the ballet dancer for both
practical and visual reasons. External tibial torsion (outward rotation of
the lower leg) is favorable in that it can increase turnout of the leg.
- Adequate plantar flexion of the ankle and foot
A dancer must be able to flex the foot far enough forward to be vertical
from knee to toe while on pointe.
- Foot shape
The best foot shape for a dancer is broad and square. This allows forces
to be shared by all the metatarsal (foot bones). The first toe must flex 80
to 90 degrees to allow a full releve (from tip of toe to flat foot) and from
pointe (standing on toe tip) to demi-pointe (half toe). This flexibility
usually results from dancing while the musculoskeletal system is forming.
What are the different stages of ballet? What are the
health concerns at each stage?
There are three fundamental stages in the development of a ballet
dancer. Children generally begin training at 8 years old.
The beginning dance stage
These are the pre-pointe years. This stage usually trains children from 8 to
12 years old. Stress is increased gradually which allows the body to slowly
adapt as the child grows. Because stress is minimal injuries at this stage
usually occur from natural limitations including body proportions, flexibility,
leg turnout, ankle/foot plantar flexion, musicality or an ability to learn.
The middle dance stage
These are the development years. Children from 12 to 16 years old are
trained in this stage. This is a period of rapid growth and progressive
acceleration in training demands. Most dancers can go on full pointe about 4
years after beginning serious dance lessons (but there's no reason for a dancer
to get on full pointe if she cannot do anything when she gets there). Most
health concerns during this stage include excessive thinness, delayed onset of
menstrual cycles, scoliosis (curvature of the spine), poor nutritional intake,
eating disorders, and overuse injuries.
The apprentice stage
This is the start of a professional career. Dancers can begin from 16 to 20
years old. High level stresses are placed on a not quite mature skeletal system
due to delay in menarche (first menstruation) and skeletal maturation. Most
injuries occur at this stage because of overuse.
How are dancing injuries evaluated?
The age, sex, number of years dancing, amount of time spent
practicing and history of previous similar injuries all play a role in
determining proper treatment or behavior modifications required to heal and/or
prevent the recurrence of an injury. The following is additional information
your orthopaedist will need to know to ensure proper diagnosis, evaluation and
treatment:
- Date of injury
- Onset of injury; acute or chronic
- Mechanism; how did it occur
- Pop or snap heard at time of injury
- Swelling or discoloration; where, when, how much
- Pain; it's nature, location, radiation, what makes it worse, what lessens
it
- Mechanical symptoms; does it lock up, buckle, give way or catch
- Nerve symptoms; any numbness, tingling or weakness
- Onset of menarche (menstruation begins), amenorrhea (absence of
menstruation), or eating disorders
- Success or failure of current treatments
- Schedules; training, rehearsal, class and performance
- Proper footwear; dance shoes, pointe shoes
- Dance surface; hardwood, spring, rubber, plastic, concrete, smooth or
irregular
- Functional abilities
- Body alignment; injury may be caused from excessive stress on particular
limb or area of the body. A dancer could also overcompensate for a chronic
injury resulting in additional problems.
What injuries commonly affect dancers?
Injuries in the amateur ranks are often due to the dancer trying to
do things with their bodies that they are poorly suited to do. Injuries to
professional dancers are usually related to the background and training of the dancer,
choreography (dance routine) tour schedule, type of stage or pattern and length
of layoffs. The following are common injuries suffered by ballet dancers:
Spine
--Kissing spines - interspinous sprain
--Schuermann's disease - deformity of vertebrae
--Spondylosis- stiffness of vertebrae joint
--Spondylolithesis - partial dislocation of vertebrae
--Herniated lumbar disk
--Low back muscle strain and spasm
--Sacroiliac joint sprain- sprain in pelvic joint
Hip
--Snapping hip - iliotibial band, iliopsoas (connective muscle and tissue)
--Bursitis - iliopsoas, greater trochanter (inflammation of connective tissue)
--Tendinitis - sartorius, rectus femoris, iliopsoas, pectineus, tensor fascia
lata, pyriformis (tendon inflammation)
--Stress fracture - femoral neck (thigh bone)
--Arthritis - hip dysplasia
Knee
--Patellofemoral pain, chondromalacia patella
--Patellar malalignment
--Patellar subjuxation/dislocation
--Tendinitis - IT band, quadriceps, patellar
--Osgood Schlatter's disease - inflammation in knee
--acute muscle strains and ruptures - quadriceps, patellar tendon
--Meniscus tear - discoid lateral meniscus
--Medial plica, bipartite patella
--Osteochondritis dessicans- detached piece of cartilage
--Acute ligament sprain - ACL, PCL, MCL, LCL, posterior capsule
Leg
--Perostitis - shin splints
--Acute muscle strain
--Stress fracture
--Chronic exertional compartment syndrome
Ankle
--Anterior ankle impingement syndrome
--Posterior ankle impingement syndrome; often mistaken as peroneal tendinitis
--Achilles tendinitis
--FHL (big toe) tendinitis - dancer's tendinitis; often mistaken as posterior
tibialis tendinitis
--Trigger toe
--Os trigonum syndrome
--Painful accessory navicular
--Lateral ankle sprain - inversion injury
--Osteochondritis dessicans of the talus
--Fractures (acute and stress), dislocations, arthritis
Foot
- Acute muscle strains
Fractures
--a. stress fracture base of 2nd metatarsal (foot bone)
--b. stress fracture base of 5th metatarsal
--c. avulsion fracture base of 5th metatarsal
--d. acute fracture distal third of 5th metatarsal - dancers fracture
--e. sesamoid
- Epiphysitis - first ray, proximal phalanx
- Bunion
- Cuboid subluxation
- Plantar flexion sprain of the 1st MTP joint
- Hallux rigidus - deformity of big toe
- MTP joint subluxation; dorsiflexion sprain, gradual capsule stretching in
older dancer
- Avascular necrosis of the metatarsal (Freiberg's disease)
- Interdigital neuromas - abnormal tissue growths
- Sesamoiditis - contusion,sprain, stress fracture, avulsion fracture of
proximal pole, osteonecrosis, osteoarthritis, entrapment neuropathy
Skin
--Fissuring - grooves in skin
--Callouses
--Soft and hard corns
Toenails
--Subungual hematoma - blood beneath a nail
--Onycholysis - separation from skin
--Paronychia - toe infection
--Ingrown toenails - nail grows into skin of the toe
How are dancer's injuries cared for?
Care for professional dancers is usually a team approach. The goal is
prevention as well as treatment of injuries. The team may consist of a primary
care physician, orthopedic specialist, sports medicine doctor, podiatrist,
chiropractor, physical therapist, athletic trainer, massotherapist, dance
teacher, technique coach, director and psychologist. The following are common
treatments for chronic and acute injuries and preventive techniques:
- NSAID, corticosteroids, analgesics - these will help reduce swelling
- Warm up with moist heat and stretch
- Use ice on injury after workout for 10-15 minutes
- Sleeves, braces, splints, casting, orthotics, pads - these restrict
mobility and lower stress on injured areas
- Physical therapy exercises: motion and flexibility, posture, muscle,
tendon balance, strength, endurance, balance and timing
- Physical therapy modalities: ultrasound, estim, phono/iontophoresis
- Massotherapy, osteopathic, chiropractic manipulation, accupuncture
- Surgery
- Don't rush back: begin with bar exercises, progress to floor, class then
rehearsal and finally return to performing
©
Copyright 1995-2005 The Cleveland Clinic Foundation. All rights reserved
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