The Nutcracker is the most iconic holiday ballet performed by ballet schools and professional companies around the world.
For optimal performance, it is crucial that dancers are proactive in preventing injuries from occurring and correctly manage injuries when they do occur. Foot and ankle injuries represent 34-62 percent of all injuries reported by dancers.5 Female ballet dancers are especially vulnerable to these injuries because of the increased demand put on the foot and ankle when dancing en pointe.
To help prevent dancing injuries from happening, consider the following tips:
Overuse injuries are aches and pains that occur due to the repetitive nature of dance movements and lack of adequate rest. Examples of overuse injuries are stress fractures and tendinitis. Fortunately, the risk for these injuries can be decreased through appropriate rest, adequate warm up and nutrition.
Fatigue has been cited as a common reason for injuries in dancers as overall injury rates vary from 0.8 to 2.9 injuries per 1,000 hours of dance training.2 When fatigued, decreased trunk control and faulty lower extremity alignment results in increased demand on joints and ligaments to provide stability.7 While you may not be able to alter the amount of time you spend dancing, you can control what you do during time outside the studio. For example, active rest is preferred over complete rest, including gentle movements, stretching, as well as strengthening and stabilizing muscle groups. This helps avoid excessive stiffness throughout the body.
It is also important to note that fatigue-related injuries have been reported to increase when psychological stressors such as work or school conflicts are present.6 Since performances may induce additional stress, it is important to find strategies to appropriately rest your brain in addition to your body to stay healthy during this time.
An appropriate warm-up primes the body for optimal performance. Morrin et al found that a combination of static and dynamic stretching provided a significant change in hamstring flexibility as well as superior balance and vertical jump values in comparison to a static-only or dynamic-only warm up.8
Static stretching involves holding a specific position for a period of time whereas dynamic stretching has an aerobic approach in which the body part is repetitively moved through its available range of motion. Examples of dynamic stretching include leg swings, alternating kick-to-buttocks and scissor jumps.8
Low energy availability occurs when a dancer is not consuming enough food for the amount of energy expended during physical activity. Therefore, a dancer will need to eat more as the volume of dance participation increases.
Signs of low energy availability include fatigue, difficulty concentrating and loss of menstrual cycle. Consistently low energy availability can cause sub-optimal bone mineral density and place the dancer at increased risk for stress fractures.1 High caffeine intake, noted as greater than two cups of coffee per day, can also contribute to low bone mass density.1 For specific nutrition recommendations, please seek attention from a nutritionist in order to develop a plan based on your individual needs.
Acute injuries occur when a bone, ligament, tendon or muscle is extended past its capability or excessive force is placed onto a region of the body. Examples of acute injuries are ligament sprain and muscle strain.
When an acute injury occurs, the body releases chemicals to create an inflammatory response around the damaged structure. The inflammation assists with promoting new cell growth, defending the body against harmful substances, and disposing of damaged tissue.4 However, this process results in swelling, redness, warmth, pain and loss of function at the area of injury. The following steps should be taken after an acute injury:
Relocate to a safe space away from additional danger such as fellow dancers continuing to perform and provide support to the region of injury.
Avoid painful movements with involved body part as continual stress may increase injury and delay healing.
Apply ice to the injured area for 20 minutes every 2 hours for the initial 2-3 days. Ice will decrease blood flow to the area, slow conduction of painful nerve impulses, decrease abnormal accumulation of fluid, and lower temperature.
Utilize an elastic compression bandage to wrap the area. If you experience sensation of pins/needles, numbness or change in skin color, the bandage is too tight. Start away from the heart using a figure 8 pattern with a gradual decrease in tightness as you pass the site of injury. Avoid gaps in bandage that expose skin as swelling will accumulate here.
Raise the injury area above the heart to increase return of blood and therefore remove waste products away from the area.
All acute injuries should be evaluated by a health-care professional for advice regarding appropriate next steps, especially if not resolved with “PRICE” or unable to bear weight. Choosing a health-care professional who has a specialty working with performing artists will be helpful to allow for a gradual, safe return to dance.
Although blisters, cramping, split skin and bruising will not likely take you out of a performance, they can be a source of discomfort when participating in a higher volume of dancing.
Blister – Blisters are caused by a combination of friction and moisture at bony prominences of the feet. It may be a sign that shoes should be re-sized as the structure of the foot can change over time. Petroleum jelly or tape placed on more vulnerable spots can decrease friction. In addition, using less absorbent material for tights or pointe shoe padding can decrease moisture. Blisters will heal independently and should avoid being popped due to risk for infection. If a blister does pop, it is important to cover with an antibiotic ointment and bandage that will stay secured in shoes.
Cramps – A muscle cramp is a strong, painful tightening of a muscle that occurs involuntarily. Another name that is commonly used to describe a cramp is a “Charley horse.” To avoid cramping, stay hydrated and perform an adequate warm up as well as cool down. Stretching the cramped muscle can assist with relieving symptoms faster.
Split Skin – Split skin often occurs in the area of a callous, particularly on the ball of the foot. Prevent skin from splitting by using a fat-based balm such as coconut oil over areas of tough, dry skin. If a skin split does occur, be sure to keep the area clean to decrease risk for infection. There are some over-the-counter products that help to seal the split skin together to promote healing.
Bruising – The best prevention for bruising is to wear padding and control descents to the floor during choreography. Avoid heating pads or warming topical creams, as this will bring more blood to the bruised region and delay healing.
By following the above recommendations, you are now ready to tackle the Nutcracker season injury free! If you experience an injury, please contact your physician or set up a free assessment with a performing arts physical therapist at a convenient Athletico Physical Therapy location.
The Athletico blog is an educational resource written by Athletico employees. Athletico bloggers are licensed professionals who abide by the code of ethics outlined by their respective professional associations. The content published in blog posts represents the opinion of the individual author based on their expertise and experience. The content provided in this blog is for informational purposes only, does not constitute medical advice and should not be relied on for making personal health decisions.
1. Bone Health and Female Dancers: Physical and Nutritional Guidelines. International Association of Dance Medicine and Science. http://c.ymcdn.com/sites/www.iadms.org/resource/resmgr/resource_papers/bone_health_female_dancers.pdf. Published 2010. Accessed November 11, 2016.
2. Caine D, Goodwin BJ, Caine CG, Bergeron G. Epidemiological review of injury in pre-professional ballet dancers. J Dance Med Sci. 2015;19(4):140-148.
3. Christopher Wheeldon’s Nutracker. Joffrey Ballet Chicago. http://www.joffrey.org/nutcracker. Accessed November 11, 2016.
4. First Aid for Dancers. International Association of Dance Medicine and Science. http://c.ymcdn.com/sites/www.iadms.org/resource/resmgr/resource_papers/first_aid.pdf. Published 2010. Accessed November 11, 2016.
5. Kadel NJ. Foot and ankle injuries in dance. Phys Med Rehabil Clin N Am. 2006;17:813-826.
6. Liederbach M, Schanfein L, Kremenic IJ. What is known about the effect of fatigue on injury occurrence among dancers? J Dance Med Sci. 2003;17(3):101-108.
7. Liederbach M, Kremenic IJ, Orishimo KF, Pappas E, Hagins M. Comparison of landing biomechanics between male and female dancers and athletes, part 2: influence of fatigue and implications for anterior cruciate ligament injury. Am J Sports Med. 2014;42:1089-1095.
8. Morrin N, Redding E. Acute effects of warm-up stretch protocols on balance, vertical jump height, and range of motion in dancers. J Dance Med Sci. 2013;17(1):34-40.