"I was 18 years old. It was the late 1960s and I was just beginning my dance career. One day I was taking a dance class and I jumped—I was a very high jumper—and when I landed, I broke my foot. I broke all my metatarsals," recalls Jacqulyn Buglisi, artistic director of Buglisi/Foreman Dance, chair of the modern department at the Ailey School, and a former member of the Martha Graham Dance Company. "Back then, what the doctor did was to put my foot in a heavy cast that extended all the way up to the top of my leg. He wanted to be sure that I wouldn't move at all. But being in a heavy cast like that for nine weeks caused terrible atrophy of my leg muscles." Keeping a leg immobile for such a great length of time can be devastating to a dancer's ability to return to performing. After the cast was removed, Buglisi was given no specific guidance as to how to rehabilitate her foot and leg. She was simply told to "start back slowly." If she broke her foot today, her injury would be treated much differently.
"Yes, in the old days we were big believers in immobilization," says Marijeanne Liederbach, director of research and education at New York's Harkness Center for Dance Injuries. "Then it was discovered that the downside of casting and immobilizing was enormous. It took someone almost three times as long to get back to dancing. Nowadays we'll just do minimal early weight-bearing immobilization. The tissue remains much more viable, so people can return to their activity much faster. In the old days, someone might be stuck on crutches or told to stay home for eight to 12 weeks for something that today would be put in an air cast for just a few days. Also, the referral into physical therapy after an injury like that is almost immediate today, so the restoration of function is much faster. But the patient must be guided by an understanding of which tissue is injured and what kinds of external forces it can handle—what stimulates regrowth versus what would prolong the injury. There's a lot of knowledge that goes into those kinds of decisions."
The science of treating dance injuries has changed dramatically in the last 20 years, and not only in terms of immobilization. A former dancer, Liederbach once suffered an anterior cruciate ligament injury. "I was maybe 18 or 19 years old, and the orthopedic surgeon I went to said, 'Quit dancing. You will never jump again,'" she recalls. "Today we do minimally invasive surgeries on dancers with ACL [injuries], and we can get them back to full function within five to nine months. They'll be back to activities of daily living within just a couple of weeks. Our understanding of how the body is able to compensate through motor control and neuromuscular re-education is much more sophisticated than it previously was."
While significant strides have been made in the treatment of specific dance injuries, Liederbach feels the greatest change in the field of dance medicine involves the way the dance community approaches the whole idea of injury: "I've been practicing for 25 years and, though there have certainly been important changes in the field from the medical perspective—in terms of surgeries, for example, the instrumentation, the techniques, and all the advances in orthopedics in general—I think the biggest change is the inculcation of a younger generation of dancers to embrace a dance-medicine model into their lives and into the culture of many dance organizations, a model that was totally absent three decades ago. The fact that dancers know there's professional medical help available that's dance-related and evidence-based—and can seek out such resources without there being a stigma attached to it—represents a radical change. Dancers are consuming specialized quality medical resources earlier, when they're just beginning to experience problems, rather than waiting until they get a more catastrophic injury and are truly disabled. That gives them a much better prognosis and may explain why dancers are now being able to dance longer."
Dance medicine is a subspecialty that dates to the late 1970s, when it was pioneered by a few isolated practitioners in Boston, New York City, San Francisco, and North Carolina. In large part, its body of knowledge grew out of the field of sports medicine, as injured dancers began visiting high-end sports-medicine doctors. Explains Liederbach, "What happened is that the physicians, the physical therapists, and the athletic trainers who became very interested in working with dancers banded together, as they discovered that there's a huge subset of factors going on in the performing arts and dance that don't happen in athletics. There are some unique types of injuries that are only seen in dancers and don't occur in athletes. For example, flexor hallucis longus tendonitis is very common in ballet dancers, yet virtually unheard of in athletics. It involves the tendon that flexes the big toe, the tendon that helps push you from three-quarter pointe up to full relevé."
According to Liederbach, the most common dance injury, now and across time, is the sprained ankle. New research in dance medicine has stimulated significant changes in the treatment and, more important, prevention of ankle sprains. "We now know that individuals who demonstrate poor dynamic balance function can be predicted to be at greater risk for sprained ankles. Sometimes this poor balance can result from a prior ankle injury that wasn't treated properly: The minutiae of the neuromuscular behavior that has to become reacclimated was never addressed through physical therapy. So while on a macro level the person may be able to compensate fine, their tissues are vulnerable for reinjury because they can't fire as rapidly on a micro level, such as when they have to land from a jump, maybe slightly off-center. But now we can analyze and measure their performance of such movements."
Several years ago, the Harkness Center was awarded a grant to build a high-end motion-analysis laboratory. "It's based on the same technology they use in Hollywood to make such films as The Matrix and The Polar Express," explains Liederbach. "What we're able to do is put electrodes and markers on dancers and animate them into cartoon characters. We can then measure the forces at their joints during different functional tasks. Right now we're doing a lot of analysis of jump landings. Our latest study involves looking at landings on flat surfaces versus raked stages, in both bare feet and flat shoes and also in character shoes." Because objective measurements of external variables—such as the floor and shoes—are now obtainable and can be combined with information about "intrinsic" variables (those that concern the dancer's body), it is possible to more accurately predict and prevent injuries.
Ironically, whereas dance medicine originally derived from sports medicine, Liederbach says that "now the sports world is turning to dance and saying, 'Hey, why are they getting so few ACL injuries compared to us?' We've always thought that it was because of the virtuosic training dancers receive in jumping and balance. Remember how, for a while there, football players were studying ballet? They seemed to feel there was something about dance training that would be beneficial for athletes. But that belief was just based on intuition. Now we have the scientific research to demonstrate that, at least on an injury level, it's quite true."
Performers interested in accessing the wealth of new research emerging about dance injuries are advised to consult the Journal of Dance Medicine & Science, which is published by the International Association for Dance Medicine & Science (www.iadms.org). New York–based dancers should also be aware of the extensive services available at the Harkness Center, which offers a special assistance fund for uninsured dancers and runs free injury-prevention clinics. Dancers can make an appointment for an hourlong one-on-one session with a dance physical therapist to discuss any physical problems they have and be tested for their injury risks.