Introducing our latest article and first post for 2019 from Physiotherapist at Science in Dance: Clémence Tourneur.
Rest or move? What to do when I’m in pain?
Most of dancers dance in pain: 81 % of dancers quote that pain is the main symptom which leads to the decrease of their activity. However, it does not mean to dance in suffering. It is also important for them to know how to manage their training load to return back to dancing in optimal conditions after a musculoskeletal complaint.
To rest or to stay active ?
How can we find the balance ?
To illustrate, take a first example.
A dancer had an ankle sprain a few months ago, the ligaments are still inflamed now: although there are no swelling or no bruise anymore, the ligaments are still painful under palpation and in certain movements, which tend towards decreasing the range of motion of the ankle. A stiffness and a loss of strength set up, which are risk factors of chronicity and relapse, but also cause a drop of his performance. How can we explain this maintenance of the inflammation ? Go in class and you will know: the dancer practices intensively all the day, jumps and performs demi pointe actions repeatedly. The total training volume of the day has been high and the ankle is swollen. The next day, the pain is worse. In this situation, it is necessary to understand the importance of decreasing (but not stopping!) his practise in order to make disappear the inflammation. Besides, no jumps for as long as the inflammation is here could be a good advice. It does not mean that you have to stop all your activity! First and foremost, it is important to maintain the mobility of the ankle and the foot, gain strength in the lower limb and work on proprioception and balance. In a second time, as soon as the ligaments are not inflamed anymore, we could work closer to dance activity with a return back to jumps for example. Mobility, strength and stability are the three pillars of an optimal body. Managing the training load is essential in terms of a better rehabilitation and an optimal return to prior level of practice. To avoid relapse, it could be then recommended to continue maintaining a good fitness with regular strength conditioning and have a great way of life, such as an efficient warm up, time of rest, good sleep and nutritional intake.
As a second example, look at a low back pain situation. The dancer has changed his motor pattern in order to avoid to bend his back: he always moves with a flat back, even the idea of bending seems to hurt. On the contrary, arching the back is possible. Nevertheless, in class, we can observe that he avoids hip extension, which is linked with arching the back, limitation explains by pain. In this case, the dancer has to rediscover the movement of his back by himself, in a progressive way. He has to stay active, move his back gradually, reinforce all the muscles of the posterior chain, core strength and proprioception. But most of all, to have confidence in his back. Moving is the best way to release pain in a low back pain situation. So stop thinking that massage is the only therapy for this ! Low back pain is mostly associated with the fear of moving, to have pain: your pain is not an out of control factor, you have to learn to move again harmoniously and safely, to reclaim the control of your body. Some factors affect this complaint too, like stress or bad events in life. Being aware of them helps to control them and change his way of living to get better. Even so, a massage from time to time provides temporarily relaxation and serenity. But keep in mind that an adapted physical activity is the key on the long term to improve your well-being.
To sum up, there is no typical outline to release pain and return safely to dance: pain is a complex process, associated with several factors like physiological, psychological, cultural... always integrated in a specific context. Each individual responds and copes differently with a same pain: each therapy has to be specifically adapted to each situation and personality, there is no magical bullet ! That emphasises the importance to observe the dancer in his own practise and analyse his technique. Though most of dance teachers pay close attention to the efficiency of movements, many dancers incorporate altered patterns, which can lead to pain and injury by overuse process. For example, a repeated misalignment during a développé seconde favour the risk of the creation of a hip impingement or labrum tears. You can have a perfect rehabilitation, if the technique is not corrected, the symptoms will come back ! Besides, it is important to note the influence of the psychological factors (like stress, anxiety, fatigue...), the environment (like the atmosphere in class, the social network...), the way of living (warm-up and stretching, nutritional intake, sleep, training load...). Seeing the dancer in their individual entirety is the key to offer them the best way to manage their musculoskeletal complaint in order to help the individual continue dancing as long as possible in the best conditions possible.