Quite often a dancer or theatrical performer gets injured in the weeks prior to show time or during the actual performance. What does this professional do, besides panic? Some might resort to home remedies of elastic wraps, hot rubs, etc. Fortunately, with the advent of specialization in treating dance-related injuries, the injured performer can continue their activity. During the rehabilitation process, attention is focused on eliminating the cause of the problem, not just the symptoms.There are two types of injuries which may affect a performer-overuse and acute. An overuse injury starts with an ache or moderate pain that progressively gets worse. These injuries tend to show up more frequently in the pre-show week(s) than acute injuries. This is because the performer increases their physical activity prior to the opening of a show. About 80 percent of the population has some sort of structural malalignment, which is greatly exaggerated during intense and repetitious activity periods. These malalignment problems may include uneven leg lengths, lack of hip turn out, swayback, knock knees, bow legs, flat feet and bunions, etc.Due to a structural or flexibility problem, or an activity that constantly uses certain movements, some muscles must bear more work than others. After a prolonged rehearsal these muscles fatigue and are subject to strain. Excessive forces and pulling are then transmitted to the bone, exposing it to overuse injuries. This is a common cause of shin splints, stress (fatigue) fractures, and avulsion or chip fractures in which the tendon pulls a portion of the bone off. Often, the professional performer ends up in the emergency room and receives x-rays, a cast, and crutches. Hard casts for these types of injures prolongs healing. They cause the foot to remain inactive and therefore, the muscles do not function to reduce swelling, which normally would occur. Many injuries or fractures appear acutely, but are actually due to overuse. This is magnified by the use of crutches, which maintains the leg in an inactive, lowered position during walking which further increases swelling in the foot and leg, and thus slows healing. It takes 2-3 weeks of rehabilitation for every week in a cast due to muscle atrophy, weakness, and stiffness that occurs.To treat overuse injuries and fractures, the key is to determine the cause of the problem and be specific in the treatment plan. Certain bones in the foot are non-weight bearing and therefore, do not require casting if fractured. If the injury is the result of tendon attachment to the bone, the fracture must be restored into corrected position and stabilized. One option is an individually fabricated flexible cast that eliminates the destructive motion and forces. This is used along with various pads on the bottom of the foot to hold the joints in corrective position and takes weight off the fracture. The advantage of this treatment method is that movement in all other directions is maintained, which allows the injured person to continue to participate in their activity. The treatment is followed by the use of specific in-shoe orthotic devices designed to prevent the stresses, pains, and injuries from returning. Many injuries or fractures appear acutely, but are actually due to overuse. If the injury is truly acute such as an ankle twist, misstep, bruise, or fall, then attention should first be aimed at reducing the swelling. The more swelling present, the longer the recovery period. Twenty-minute periods of ice and compression several times a day are necessary within the first 48 hours. When swelling is severe a prescription medication may be needed to decrease the swelling. Recent advances have been made in acute injury care with the advent of the compression air splint. This device stabilizes the ankle, reduces swelling through compression, and offers a restricted, but important, ability to utilize muscles. A strengthening program to prevent the injury from lingering or recurring must follow.Many of the sudden types of injuries discussed are actually hidden overuse injuries. The cause of the problem must be determined to eliminate the pain from returning. This is accomplished through examination, correct realignment of the injured area or joints, rehabilitation of the muscles, and prevention of recurrence through the use of corrective devices worn in the shoe or on the foot. In addition, through the field of dance/sports medicine, quicker healing methods have been developed resulting in fewer missed rehearsals and cancelled performances. After all, the show must go on.
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