​How to prevent common dance injuries from progressing to irreversible damage that restrict mobility.

From traditional dance forms to modern genres and fitness routines, more people are embracing dance as a performing art, leisure activity and exercise today.

With the growing popularity of the art form, dance-related injuries are also becoming more widespread. Injuries may seem trivial initially, but not getting foot or ankle sprains or mild injuries seen to can lead to serious problems or complications later.

“Ankle sprains, apart from causing injury to ligaments and tendons, can also cause internal cartilage injury. A severe sprain can also cause fractures, while an unstable ankle (one that is prone to recurrent sprains) can lead to irreversible arthritis in the long run if left untreated,” said Dr Kevin Koo, Consultant, Department of Orthopaedic Surgery, Singapore General Hospital (SGH).

The most common reason for people to visit the emergency department, acute ankle sprains account for up to 40 per cent of all sporting injuries in some reports, Dr Koo said. “Of these, 20 to 30 per cent may develop chronic ankle instability, with some studies showing even higher figures.”

Indeed, foot and ankle injuries are most common among dancers, in particular ballerinas, locally. “Over the past three or four years, I have seen a steady 20 to 30 per cent increase in such injuries in my own practice,” said Dr Koo. Constantly adopting the en pointe position (standing on the tip of their toes) can cause posterior impingement or pain at the back of the ankle, as well as flexor hallucis longus tendinopathy, which is inflammation or degeneration of the big toe flexor muscle.

Besides traditional ballet, contemporary pole dancing and cheerleading can also lead to injuries, but of a different kind. Dr Koo said these groups have a greater tendency of falling and fracturing their bones. An increasingly popular exercise among older people is Zumba, a vigorous dance form that can aggravate problems relating to wear and tear over the years.

Seek treatment early

Dance injuries can occur at every skill level and age group, said Dr Koo. In young children, they may be the result of an attempt to perfect a technique without proper coaching or progressive training. In seniors, they tend to be due to the lack of proper conditioning before trying out a vigorous routine.

Possibly due to the lack of public awareness, many people dismiss such injuries instead of seeking timely treatment. It is known that many dancers, because of their passion for the art form, will keep on dancing even when they are in pain, Dr Koo said, citing studies from the West.

“By the time they seek treatment, it is no longer a simple ankle sprain — the ankle has become arthritic. We cannot simply repair the ligament; we have to do an ankle replacement or ankle fusion. Such surgeries could have been avoided if they had come in for treatment early,” said Dr Koo.

For mild injuries, such as simple first-time sprains, doctors may simply recommend rest, ice, compression and elevation (commonly referred to as RICE). For more severe or recurrent injuries, a referral to an orthopaedic specialist may be necessary.

To be sure, the majority of dance injuries can be managed with the help of a physiotherapist, who may recommend exercises to strengthen and improve the range of movement and positioning.

Patients who cannot return to normal activity after physiotherapy may have to consider surgery. The latest minimally invasive techniques reduce pain, wound complications, and scarring. In the case of ankle injuries, a keyhole surgery can address cartilage defects, or tighten the ligament and repair it to reduce instability.

Dance injuries may be minimised by engaging a professional coach to learn proper techniques, and access fitness levels and training intensity. Training progressively and knowing one’s limits can reduce injuries, too.

“Warm up exercises prepare the body by gradually increasing heart rate and circulation, thus increasing blood flow to the muscles. Keeping the muscles warm will prevent acute injuries, such as muscle strains, and overuse injuries by allowing the body to prepare steadily and safely. Stretching the muscles also prepares them for physical activity,” Dr Koo added.

Although dance is a healthy form of exercise and self-expression, Dr Koo said it is necessary to take proper precautions, as well as seek appropriate medical treatment to prevent more serious and debilitating injuries.