Dance Injuries & Rehab; PVNS

With over 600 muscles, 206 bones and countless nerves, ligaments, and tendons in the body, it is almost impossible for dancers to escape being injured. Many injuries are caused by constant stress and over worked and fatigued muscles. There are many ways to prevent injuries such as warming up, strengthening muscles, and building stamina. Many dancers do not give in to pain because they do not want to stop their training. Even though there are hundreds of different injuries dancers can acquire, here are the top five most common dance injuries and how to treat them:

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ANKLE SPRAIN: This is the most common acute injury among dancers. They are usually caused from fatigue during dancing. It tends to occur more than once in a dancers career because the ligaments are stretched and therefore weaker. If an ankle is sprained, the beginning treatment is RICE to reduce swelling. Once the swelling has gone down then there are three ways of grading the severity of the sprain:

Grade 1: This could be a micro tear or excessive stretching of the ligament with no looseness.
Grade 2: This is a more severe tear with some instability. Sometimes there is a noticeable pop that is heard at the time of injury.
Grade 3: This is a complete tear of the ligament with significant instability.
- When grade three occurs, an operation to repair the ligaments might allow for a faster and stronger recovery.
- Physical therapy exercises should be done to rebuild and strengthen the ligaments.

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KNEE INJURIES: The knee is vulnerable for injuries that range from mild to severe, including meniscal or cartilage tears. In dance, good technique is dancing in turnout. When dancers twist their knees to improve their turnout that is when injuries happen. To prevent this, dancers should turnout from the hip and not the knees because the knees cannot withstand that much strain and force. Certain choreography that has deep squats can cause damage to the knee cartilage as well. Sometimes it is difficult to tell if the injury is mild, moderate, or severe. RICE and rehab including massaging and exercises should be done to take care of the injury. Severe knee injuries may need to have surgery performed.

HAMSTRING INJURIES: Muscle pulls are rarely serious unless they occur in vulnerable muscles like the hamstring. The main cause of hamstring injuries is tightness of the muscle and structural asymmetries (which may happen during growth spurts). Stretching is not good for pulled muscles until after rest.

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HIP INJURIES: The envy of all dancers is the perfect turnout, and some people are born with that. However, when you have been dancing in turnout, and you reach the age of 35, then the hip may develop labral tears, which is the first step towards degenerative arthritis. Nevertheless, the problems leading up will be groin pain, which can be attributed to the labral tears. The dancer should avoid certain movements that cause the pain, if possible, and rest with strengthening exercises.

BACK PAIN: Dancers usually get back injuries from fatigue, hypermobility, scoliosis, leg length inequalities, and emotional stress. The back may freeze up, there may be spasms, and there may also be pain over a specific joint that limits movement. Doctors recommend physical therapy to reduce inflammation, alternating heat and cold, which speeds up the exchange of fluids and brings a fresh blood supply to the area, which helps healing. In addition, exercises for the deep abdominal muscles are given to stabilize the back and the pelvic girdle.

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Even though injuries are sometimes inevitable, here are the top ten injury prevention tips for dancers:

1. Proper training and teaching are essential to allow dancers of all ages to develop their skills without injury.

2. Take adequate rest to allow the body to heal itself from daily wear and tear.

3. Maintain energy levels by eating and drinking adequately.

4. Conditioning and strengthening of the leg muscles that support the arch are crucial.

5. Try to avoid dancing on hard or uneven surfaces, which could cause injury.

6. Take care of your shoes.

7. Dancers should adopt new training schedules slowly.

8. Although not always possible when dancing, but more so off stage or out of class, wear supportive footwear, and if you need to wear orthotics, wear them as often as possible.

9. Focus on different muscle groups and techniques on different days.

10. Early recognition of symptoms is important. Stop activity if pain or swelling occurs. If the pain persists after a few days rest, consult a sports-medicine physician.

Pigmented Villonodular Synovitis of the Hip: PVNS

Background: PVNS in the hip is a very uncommon disease. A surgical procedure called Synovectomy is the most common treatment for the disease. The cause of PVNS has yet to be determined, since the disease is so rare there have not been a sufficient number of studies done to conclude the exact reasons for the disease. There are very few commonalities in PVNS, and therefore researchers have not been able to target the reason behind the occurrence.

The Disease: is a highly aggressive mass (called hyperplastic synovium) in the bone, which are large effusions and bone erosions. PVNS is located in the joint and causes extreme discomfort and pain.
Intraoperative photograph showing characteristic
Intraoperative photograph showing characteristic Gross specimen after total synovectomy.
hypertrophic synovium (arrow) and villonodular
fronds in pigmented villonodular synovitis.

Complications: PVNS is locally aggressive and can spread to tissues surrounding the infected area. If the disease is not treated early enough, it can spread to surrounding joints. The rate of re-occurrence is 45%.

Diagnosis: PVNS is generally found through an MRI. It is difficult to diagnose because the symptoms are non-specific and paucity. PVNS is confirmed by a biopsy, of the hyperplastic synovium.
An MRI of a hip joint with PVNS

Treatment: A surgical procedure called an Synovectomy is the most common treatment for PVNS. This procedure is common in people who have arthritis in their hip, it is the surgical removal of the joint lining, and is done to remove the inflamed joint lining in arthritis, and the hypertrophic synovium in PVNS. Many times, during the surgery the PVNS has spread to the ball joint in the hip and in order to sufficiently remove the hyperplastic synovium, it is necessary to dislocate the hip. Which is a difficult process in itself. When the hyperplastic synovium is removed from the bone, it is replaced with a compound of plaster and bone to fill the holes which were left by the hyperplastic synovium (known as bone grafting). In more server cases it is necessary to use screws and bolts to hold the hip in place and the give the bone more support.

Screws are set in the bone to give it more support.

Vastel, Laurent, MD. The Journal of Bone and Medicine, "Surgical Treatment of Pigmented Villonodular Synovitis of the Hip". Paris, France. 2005. residentprojects/pvns.html