Words of Advice: Injury Inquiries

November 28, 2001

If I’m trying to work through a minor injury, when do I know it’s time to sit out or see a doctor?

Mickey Cassella, PT, director of physical therapy services at Boston Ballet:
There’s no such thing as a “minor injury” when you’re a dancer. If you have a hint of something not feeling right, seek the advice of a doctor or physical therapist who works with dancers. We can often prevent major injuries by looking after minor ones.

Know your body’s limitations. Sometimes you’ll tweak something in rehearsal but it just goes away. If it keeps getting worse as you dance, stop. When you’re not sure if it might go away, rest for 24 hours—if it still bothers you, see a dance medicine professional. Don’t compare your injury with other dancers’ because no two injuries are alike. Even teachers won’t have all the answers about your body.

Every dancer hurts at some point during the day. You have to listen to your body and figure out how far can you push before you have to take a few steps back and rest.

I’m anxious about the process of coming back from an injury. What’s it like?

Lauren Toole, dancer with Los Angeles Ballet:
I tore my meniscus and had to have surgery on my knee in June. It took me six months to come back 100 percent. You have to listen to your body and take the time it needs to heal. Once you get the OK from the doctor to go back to dancing, be confident knowing that you’re healed and you have your strength and mobility back. There might be residual pain from scar tissue, but the actual injury is no longer there.

Follow all of the instructions your doctor and physical therapist give you. I had to be on crutches for six weeks. It was hard, especially when I started thinking that I was getting better. Don’t rush to get back. Do all of your physical therapy exercises every day. It will help you return to dancing without fear once you’re better. I had to ride the stationary bike every day and do Pilates on the Reformer and leg lifts with a Thera-Band. By doing those exercises, you’re working on your body as a dancer, so you never get so removed from dancing.

Another important thing is to keep yourself busy. It will help your overall state of mind, both when you’re injured and when you’re coming back.

What should I be doing to prevent Achilles tendonitis?

William Hamilton, MD, consulting orthopedist for New York City Ballet and American Ballet Theatre:
Tendonitis happens when the tendon is overstrained, causing microscopic ruptures and an inflammatory response. The most common cause is tightness. Stretch out your calves whenever you can (especially on the triangular wooden stretch box). Overload, which happens as the tendon gets weak, is the second most common cause. This can be compounded by working on hard floors. If you have to dance on a hard floor, do a very careful warm up, a lot of stretching and keep warm all day with wool legwarmers. At the end of the day, give your Achilles an ice massage for 20 minutes.

Following an injury, make sure to allow for adequate rehabilitation to strengthen your calves. And don’t force your turnout by using the floor instead of your hips. Ten percent of dancers have an os trigonum bone in the back of their ankles that keeps them from rising to full relevé, which means the Achilles is constantly strained. The only way to fix that is to surgically remove the bone, but we don’t recommend it unless the dancer has chronic pain.

Putting elastics in your pointe shoe ribbons won’t prevent Achilles tendonitis, but it’s recommended for dancers who’ve had Achilles tendonitis before.