Low back pain and injury in dancers

Dance is a popular and physically demanding pursuit, inclusive of all genders and ages across the lifespan, around the world. Dance is both artistic and athletic, requiring a combination of extreme strength, flexibility, and coordination, for the purpose of making intricate movements appear effortless. Dancers are increasingly recognized as both artists and athletes; however, unlike their athlete counterparts, dancers may not have ready access to trusted medical practitioners when injured, especially those familiar with dance-specific terminology, movements, styles, and injury patterns.

The lumbar spine, or low back, is a common site of pain and injury in all athletes, and the second most common site of injury in dancers.¹ Repetitive flexion (forward bending), extension (backward bending), and axial loading (compression) through the spine are thought to contribute to increased rates of low back pain and injury in physically demanding sports such as football and dance.^1,2 A recent systematic review by Swain et al found indications that approximately 73% of dancers experience at least one episode of low back pain per year; however, back pain only led to time loss or medical attention in 11% of the cases.³ Simply put, dancers appear to be able to maintain high levels of performance despite pain, and low back pain and its impact may be underestimated in this population.^2,3

Common causes of low back pain in dancers

Spondylolysis and Spondylolisthesis

Sometimes referred to as “spondies,” these injuries are prevalent in activities that involve repetitive hyperextension of the spine and occur more often in adolescent dancers compared to the general population.² Spondylolysis is a stress reaction or stress fracture in part of a vertebra called the pars interarticularis, and spondylolisthesis is the forward or backward slippage of one vertebra relative to another. A dancer with a “spondy” may experience dull pain on one or both sides of the low back that worsens with activity and is often provoked by spinal extension and impact.² Medical imaging is warranted to diagnose and stage injury severity, and frontline treatment is usually conservative, including relative rest and physical therapy.^1,2

Facet Sprain / Sacroiliac Joint (SIJ) Sprain

These injuries also occur due to repeated lumbar hyperextension which causes compression of the posterior elements of the spine and pelvis. Symptoms include lower back and buttock pain, muscle tenderness, and occasionally pain that radiates into the thigh.² Jumping, hyperextension of the back, and abduction of the hip as in développé à la seconde can all exacerbate pain.² Treatment includes physical therapy with an emphasis on hip and core strengthening, manual techniques, and gradual reinstatement of dance maneuvers that previously aggravated pain.²

Discogenic Back Pain

Accounts for 40% of mechanical back pain and is attributed to repetitive spinal flexion and compression such as occurs in lifting a dance partner overhead.^1,2 The dancer with discogenic pain may report dull, diffuse lower back pain that is aggravated by forward or backward bending, rotation, and prolonged sitting. Symptoms may progress to include radiating pain down the leg and neurologic deficits such as muscle weakness and loss of sensation.^1,2 Treatment typically includes early return to pain-free activities, core strengthening, and a stepwise return to full dance.^1,2

Lumbar Strain

Muscle spasm is a common cause of lower back pain that should be considered a diagnosis of exclusion in adolescent dancers.² As with most other lower back pain, muscle imbalances and overuse are common contributing factors, and adolescent growth spurts may play a role in the onset of pain.² The dancer with a lumbar strain might complain of sharp pain located adjacent to the spine, tenderness to touch through affected musculature, and pain and difficulty with movement.² Treatment includes physical therapy focusing on correcting muscle imbalances around the hip and core and addressing faulty technique.

Prevention

Dancers as artist-athletes have a paradoxical mindset towards pain: tending to accept it as part of their artistic pursuit and deny it out of fear they will be told to stop dancing.⁴ Specialized knowledge of dance and the ability to work with dancers to minimize their time away from dance are key to managing dancers’ health and recovery from injury², as well as becoming a provider of choice in the dance community. To reduce risk of low back pain and injury, physical therapists specializing in dance medicine often recommend: 1) safe training loads to minimize overuse and fatigue; 2) cross-training and technique re-training to correct muscle imbalances and reduce repetitive strain; and 3) healthy lifestyle to manage stress and promote adequate rest and recovery. These recommendations not only serve to reduce risk and occurrence of low back pain and injury, but also to enhance performance and longevity in the dancer.

References

1. Ball J, Harris C, Lee J, Vives M. Lumbar Spine Injuries in Sports: Review of the Literature and Current Treatment Recommendations. Sports Medicine - Open. 2019;5(1):1-10.
2. Gottschlich LM, Young CC. Spine Injuries in Dancers. Current Sports Medicine Reports (American College of Sports Medicine). 2011;10(1):40-44. Accessed May 23, 2023.
3. SWAIN CTV, BRADSHAW EJ, EKEGREN CL, WHYTE DG. The Epidemiology of Low Back Pain and Injury in Dance: A Systematic Review. Journal of Orthopaedic & Sports Physical Therapy. 2019;49(4):239-252.
4. Aliberti A, Milidonis MK, Long KL. Performing with Pain: Tools to Guide Rehabilitation and Injury Prevention for Professional Ballet Dancers. Orthopaedic Physical Therapy Practice. 2020;32(4):197-201.