Cross-training, body awareness, and old-fashioned common sense mean fewer injuries among students

By Darrah Carr

“Break a leg!” The theatrical well wish for actors and dancers has an irony that often escapes young performers. Indeed, for most young, healthy dancers, the possibility of injury feels remote and doesn’t factor greatly into their daily routine. For their older, more experienced teachers, however, the reality of injury and the desire to prevent it create a serious responsibility.

Sarita Zuniga of Sarita’s Dance Studio leads students in a prerehearsal yoga session, in which she encourages the integration of mind and movement. (Photo by Marina Zuniga-Johnson)

Fortunately, for as many potential problems that dancers can face, there exists an equal number of precautions that teachers can take. To begin with, teachers must establish a healthy working environment within the studio, taking into consideration the need for safe physical facilities as well as for strong emotional support.

As Richard d’Alton, director of International Ballet of Houston, notes, “the artistic director is responsible for having good flooring. Dancing on concrete or wood with no marley is an archaic thing of the past. Thank goodness our standards have come a long way since then!” Having a well-stocked first-aid cabinet with plenty of ice on hand is another must for studio owners, as are operating hours that reflect a balanced, realistic schedule. “Overwork, multiple private lessons, and late night rehearsals are not necessary,” d’Alton says. “Dancers must be considered as human beings. And, as human beings, we all shut down at some point during the day. There is no need to go until 10 p.m. I believe in quality rather than quantity of instruction.”

Balancing the studio schedule by offering a wide variety of classes can also reduce injuries related to overuse. Sarita Zuniga, owner of Sarita’s Dance Studio in San Antonio, TX, explains, “We aim to have a well-rounded, balanced program and encourage the students to try different disciplines of dance. On Mondays we offer ballet and jazz; on Tuesdays it is folklorico; on Wednesday nights we have flamenco, and so on. If the students can do different movements every day, then they are not constantly relying on the same muscle groups and they don’t run as high a risk of injury from overuse.”

Studios with a more singular focus can also promote balanced musculature by encouraging their students to cross train. Zola Dishong, who runs Contra Costa Ballet in Walnut Creek, CA, along with her partner, Richard Cammack, advocates Pilates for her population of serious classical ballet students. “Bringing Pilates into the studio has been great because the philosophy of the class is all about injury prevention,” Dishong says. “You can strengthen any weaknesses and even work through an injury with Pilates.”

D’Alton encourages his ballet dancers to seek additional Pilates training outside of the studio and to spend time lifting weights as well. “Boys especially need weight training,” he says. “I don’t want them to be the size of champion prize fighters, of course. But they must be strong enough to partner the girls correctly. It is another means of injury prevention.”

Zuniga enhances her dancers’ training with yoga. “We always do 30 to 40 minutes of yoga before beginning rehearsal. We play soothing music, lower the lights, and meditate a bit so that the dancers can start listening to their bodies. I try to inspire them to integrate their whole mind into the movement,” she explains. “I’ve seen a big change in the dancers. Yoga strengthens their core and balances their muscles. In dance, many problems stem from overuse injuries. If dancers are straining their quads, for example, then yoga can balance that by lengthening their hamstrings.”

A studio owner’s efforts to create a healthy working environment must be maintained by the entire teaching staff. Diane Pippen, who co-owns Diamond Dance Center in Forrest Hill, MD, along with her sister, Barbara Peterson, believes that faculty education is of primary importance for injury prevention. “If you have a big faculty, you must sit down with them and review teaching expectations in terms of the physical developmental stages that children go through and the anatomical principles that apply. Teachers have to be on the lookout for things like pronation and hyperextension, and they must know what the proper anatomy is,” Pippen says. “Teachers also have to be aware of growth-spurt injuries such as problems with ligaments and tendons. As girls hit puberty and their hips widen, for example, we start to see problems with pronation, especially in the knees. Teachers can’t force a perfect fifth position on those kids.”

 ‘Bringing Pilates into the studio has been great because the philosophy of the class is all about injury prevention. You can strengthen any weaknesses and even work through an injury with Pilates.’ —Zola Dishong

Pippen cites a number of anatomical variances among students that can lead to injury if not properly monitored, including tibial torsion, hyperextended knees, shin splints, hip popping, pelvic tipping, and ankle issues involving the peroneal and posterior tibialis tendons. She believes that students must be made aware of the unique, individual structures of their own bodies. “Children need to be educated about their own bodies and made to understand that ‘My body does this, but not this,’ ” Pippen explains. “The culture at the studio needs to be supportive enough that students feel comfortable speaking up [about physical concerns] and modifying certain movements if need be.”

Whatever the style of dance, certain movements tend to lead to injury more than others. Teachers must be aware of potential pitfalls within the given vocabulary and take precautions to demonstrate those steps safely. Dishong recommends introducing new petit allegro jumps at the barre so that students become familiar with the intricacies of the steps before moving to the center. D’Alton suggests that teachers set a goal for the day and then build the structure of the class accordingly. “You can’t do big jumps before small jumps. You can’t make dancers go up on pointe or do anything in the center until they are properly warmed up,” he notes. “We don’t do grand pliés until the middle of the barre. They are bad for you in the very beginning of class. And, I never encourage grand plié in fourth. It is a position we don’t use very often in ballet anyway, and it causes unnecessary strain.”

Heightened body awareness and a thorough education can extend to the waiting room, where pamphlets and articles on injury prevention can be made available to students and their parents. The International Association of Dance Medicine, the American Council on Exercise, and Deborah Vogel’s “The Body Series” are just a few invaluable resources for teachers to draw upon.

“Many times parents don’t know how to help a child who is complaining of pain,” Zuniga notes. “We educate both dancers and their parents on the RICE method (rest, ice, compress, and elevate), and we encourage Epsom salt soaks for minor aches and pains. We also explain that if the body is tired and not getting proper nutrition, then the chances of injury increase. Rest, nutrition, and injury prevention are all connected. Many parents don’t understand this.”

When addressing both parents and students, d’Alton stresses the importance of allowing time to warm up even before class begins. “It is not OK for a student to sit in the car for 40 minutes, or even 15 minutes, and then run into class,” he says. “Students shouldn’t arrive 2 minutes before class time, or, even worse, 5 minutes after class begins.”

Many teachers also advise families about the risk of injury from non-dance–related activities. Dishong notes, “Nine times out of ten, when a dancer comes to me with an injury it is from gym class, running track, or some other kind of sports activity.”

Zuniga too recognizes the prevalence of sports injuries. “Coaches tend to be more abusive to the body than instructors in the fields of dance or fitness,” she says. “They can have a mentality of ‘No pain, no gain,’ which really is the philosophy of the past.”

Even when students get injured outside of the studio, dance teachers are often sought out for advice. “Parents tend to think that you know everything about the body, so they’ll call and ask your opinion even if the child got injured in school,” Zuniga says. “I’ll say, ‘Call a doctor; I’m not qualified.’ Then I’ll always refer them to a medical professional.”

Often dance teachers act as important facilitators among an injured dancer, a concerned parent, and a doctor. “I’m not qualified to diagnose a dancer. No teacher should attempt to do that,” d’Alton states. “It is my job to ensure that an ache or pain doesn’t turn into something more serious. I have to make sure that if something is hurting, dancers are being honest with themselves and are also letting us know. Dancers are very motivated people. We know that they always want to be in the studio. But if they are in pain, then the first thing they need to do is to take a few days off.” If the pain is severe or persistent, d’Alton insists that the dancer see a doctor in order to determine whether an X-ray or MRI is needed. He’ll also serve as the dancer’s advocate. “If I don’t agree with the doctor’s diagnosis, then I’ll encourage them to seek a second or even third opinion,” he says.

Many studios develop relationships with local medical professionals who specialize in dance medicine, sports medicine, or physical therapy. These specialists are often more helpful in treating an injured dancer than pediatricians or other general practitioners. Pippen, whose own background as a nurse comes in handy when addressing her students’ injuries, says, “We do have to counsel our parents to see a sports medicine doctor or one who has a dance background. We find that ‘regular’ doctors frequently do not understand the needs of dancers; their first inclination is to put them on crutches, in huge braces, or completely off dance when ‘relative rest’ and other treatments are warranted. We also find that some doctors do not always explain the diagnosis to the parent or the child, which I do not agree with at all. I want them to understand what is going on and how to fix it.”

An injury often leads to a greater understanding of the body and can have a lasting impact on a dancer. “I’ve seen very positive results when girls return after an injury,” Dishong says. “They are forced to be more intelligent about their work, to work more slowly, and to make better choices. They are often better off for it.”

While guiding dancers along the road to recovery, d’Alton requires them to watch classes and rehearsals. “The dancers usually want to watch anyway. They always hate being away from the studio. They can learn so much by watching their teacher teach and by watching both the good and bad examples of their fellow students,” he says.

Easing into classes after an injury is important in preventing reinjury. D’Alton does not believe in putting recovering dancers back into their regular class schedule right away. For one, the other dancers in the class need to continue to be challenged and shouldn’t be held up by a recovering dancer’s slower pace. “Working with a recovering dancer requires a good deal of one-on-one time. I don’t mind going in early or staying late to help a dancer with specific exercises until they can be incorporated back into their regular class,” d’Alton says. “It is a slow process. As their teacher, you have to put all expectations aside. Let them know that they don’t need to prove anything; they just need to get better.”

The recovery process requires patience from the dancers, of course, but also from their parents. “Often parents are very driven for their child to succeed in dance,” d’Alton says. “But you can’t get a quick fix in this business. And there is nothing more important than the long-term health and safety of the dancer.”