Dance medicine

Dance medicine is sports medicine for dancers that includes more than orthopedics and, among other things, also takes care of cardiovascular aspects, psyche and nutrition. It is used to prevent and treat typical dance injuries and permanent damage . The focus is on regaining full functionality after an injury .

Incorrect strain in dance is a common cause of health problems

Subject

Dancers use their bodies as a tool for dance. Expressive dance is only possible when this tool works. Dance medicine offers the dancer the basis for maintaining this functionality, on the one hand by imparting knowledge of the functional relationships and on the other hand by providing the methods to restore impaired functionality and to recognize the causes of the functional disorders and to treat them effectively. Based on this, an important field of activity for dance medicine specialists is the imparting of dance medicine knowledge to dancers and dance teachers. Dance medicine specialists advise when it comes to assessing the suitability of the body for professional dance. Not every healthy body can cope with the high demands that the profession of a dancer places on the body and a mismatch between the physical requirements and the demands forms the basis for permanent health problems for dancers.

Typical occupational diseases among dancers

In classical ballet

• Chronic injuries and overloading of the physical apparatus especially of the feet ( toe dance ), knees, hips (outward rotation) and the lower back.
• low blood pressure; Dancing slows down your metabolism . The performance consists of peak performance interrupted by breaks.
• Pressure damage to nerves on the inside of the foot (tarsal tunnel syndrome) with tingling, sensory disturbances and muscle weakness; The cause is an increased tilting on the inside of the foot with forced "en dehors" (outward). Even too tight shoes and shoelaces can trigger a tarsal tunnel syndrome through pressure . "Small feet" are still seen in many places as an ideal to strive for, so that dancers often dance in too small, constricting shoes from childhood on.

In contemporary stage dance (Ballet Modern, Contemporary)

Depending on the style of modern dance , training conditions, loads and thus also the typical diseases of the dancers differ. Depending on the style, acrobatic elements, falling techniques or strength training of the arms must be trained separately.

• "Sprain" of the ankle ( supination trauma );
• Fractures of the toes and metatarsus from dancing barefoot;
• acute injuries to the knees, especially strains and tears of the collateral ligaments , cruciate ligament injuries and meniscus tears or bruises .
• Blockages of the spine in all areas due to swinging, unguided and insufficiently muscular controlled movements;
• Chronic injuries and overloading of the feet, knees, hips (see above), but also of the entire back as well as the shoulders and wrists.

In jazz and show dance

• "Sprain" of the ankle (supination trauma);
• Muscle injuries, especially in the back, thighs and lower legs;
• Chronic strain on the knees (e.g. irritation of the capsule-ligament system), lower back and shoulders.

In tap dance

Quilting is done on relatively hard floors in order to produce the desired sound. The dance technique requires constant relief of the heel. Contrary to popular belief, however, it is not necessary to constantly pull the tip of the foot up into the flex position, but rather a hindrance for a flexible and professional quilting technique. Rather, the foot hangs loosely in the ankle in the unloaded leg. 90 percent of the technique is initiated from the hip or knee. This allows for easy, isolated movements from the foot and ankle. Feet and legs are exposed to particular stress. The consequences are

• Achilles tendon irritation ; Constant work on the ball of the foot overloads the calf muscles and the Achilles tendon.
• Irritation of the metatarsals; The transverse arch of the foot can be overused by the hard floor. The physiological shape of the foot changes and the main load shifts. The result is an (acquired) flat foot , and fatigue fractures of the metatarsal bones ("marching fractures") also occur.
• Overloading of the knees with cartilage damage occurring relatively early due to repeated compression loads.

Physical requirements for professional dance

hip

en dehors (away) in classical dance

Dancers need exceptional flexibility in the hip joint . The flexibility of the joint must be well above the normal range of motion in all directions. The turning of the legs ( en dehors ), also called outward , is represented in almost all dance styles. In classical ballet , sufficient “en dehors” is an important prerequisite for the proper execution of the movements.

The external rotation of the leg is largely determined by the external rotation ability of the hip. The rotation of the lower leg in relation to the thigh in the knee is anatomically much more limited (outwards approx. 20 °, inwards approx. 10 °) and can only be influenced little by early training. Forced training of this mobility does not make sense because if it is successful it would lead to a significant loss of stability in the knee.

The external rotation in the hip joint depends on several factors:

• "Decisive for the outward rotation of the hip joint, the axes of the hip joint angle and near-end of the thigh bone, are femoral neck orientation and depth." Of the acetabulum as well as the position of the joint head also play a role. The angle of antetorsion (the angle in the horizontal plane between the femur neck and thigh bone) is decisive for the size of the "en dehors". This angle averages around 13 degrees. The smaller it is, the greater the innate ability to unscrew.
• Numerous ligaments stabilize and protect the hip joint and thus limit its mobility. The body's strongest ligament, the iliofemorale ligament (also known as the Y-ligament), is located at the front of the hip joint. A part of this ligament is stretched during external rotation and thus limits the “en dehors”. By starting training early, this band can gain elasticity and the away can be increased significantly. At the end of puberty, influenceability is over.
• Many muscles are involved in movement in the hip joint. It is helpful to actively relax the antagonists of the externally rotating muscles. In this way, the “en dehors” is trained to the limits set by the bone structure and the ligament structure. After puberty, this is the main mechanism for improving the away.

Determination of the outward direction: The patient to be examined lies on his stomach, extends both legs, knees parallel. One knee (test side) is bent at a right angle. The desired angle is to be measured between a vertical line above the knee and the lower leg. The dancer's pelvis must not detach itself from the floor and there must be no rotation from the knee joint. From at least 60 ° external rotation in the hip, the examined is well suited for classical dance.

Knee joint

A desired, aesthetic line is created by overstretching the knee (10 ° to 15 °). The leg axis is straight, however, the hyperextension is only visible from the side. Hyperextensible knees are congenital, less often acquired through early childhood training (artist families). Often they are also signs of general hypermobility . From about 15 ° and more in the standing leg, instability occurs, the knee is excessively stressed, especially in the menisci , cruciate ligaments and the posterior muscle and tendon attachments. The balance is lost, those affected “hang” on their overstretched knees. The 1st and 5th dance positions can only be performed with the legs bent.

foot

The foot is not only the basis in dance - in many styles it attracts special attention, as it extends the aesthetic leg line. The ideal is the highest possible back of the foot (instep), which, together with shaped calves or overstretched knee joints, forms a sinus curve with the most slender ankles at the apex. Some feet already have a high instep in the unstretched state, others achieve this by overstretching the ankle joint, whereby the back of the foot arches far outwards and thus appears high. In particular, the toe dance and “relevé” (“on the ball of the foot”, “half toe”) require great mobility of the foot in all its joints and a high instep. This is the only way to bring the metatarsals, talus and lower leg bones into line. The “ideal” dancer's foot is not only of great importance in terms of aesthetics, but also in terms of prevention. Too much mobility in connection with a weak ankle / instep can have a negative effect, because such a foot is difficult to stabilize and tends to twist. The arched foot, which is often preferred in dance, is only suitable to a limited extent because of its lower stability and the tendency towards premature loss of movement. The muscular strength of the small muscles of the foot as well as the permanent mobility of the metatarsus and the tarsus are particularly important.

The foot forms the extension of the leg axis

The mobility and shape of the foot are mainly determined genetically. They can only be improved and changed through early and correct training. Flexibility training should never be done without additional stability training. Because only a flexible and strong foot can meet the demands of dance.

• The mobility in the upper ankle can be improved to a small extent by coordinative training. This movement training also improves incidents of accidental twisting.
• Mobility in the tarsal area is limited by tight ligament structures and can only be improved in childhood and early adolescence through suitable personal and external mobilization.
• The mobility of the metatarsophalangeal joint of the big toe is little determined by the bony structure. Here, too, tight ligament structures limit its mobility, but the most well-developed extensor and flexor muscles make a decisive contribution to function and mobility. Chronic overstretching of the ligaments if a specifically trained muscular stabilization is neglected almost inevitably leads to forefoot deformities such as hallux valgus .

In order to be able to perform dance technique correctly, the following range of motion is necessary:

• Upper ankle: active at least 70 degrees in extension (Point position);
• Tarsus: active 15 to 20 degrees in extension;
• Big toe joint: passive at least 80 degrees in flexion (big toe up).

Spine

The full mobility of the entire spine is the basis for a variety of dance movements. Every movement of the pelvis continues in the spine. Incoming movements are mainly compensated in the lumbar spine.

The following requirements are important for a healthy dancer's back:

• homogeneous distribution of the spinal column vibrations;
• normal curvature of the lumbar spine;
• balanced pelvic balance (no forced hollow back in "en dehors");
• good mobility in all parts of the spine;
• stable small back muscles;
• strong deep abdominal muscles.

The small joints between the vertebrae determine the direction of movement of the individual spinal column sections through their bony structure. It cannot be changed through training. The range of motion in the individual areas, however, can be improved through targeted training. A homogeneous mobility of the entire spine is important. This is best judged while standing.

• When you bend sideways, the entire spine should form a harmonious arch. All areas should be involved in this movement.
• When bending back, the movement should also take place homogeneously over the entire back. Pay attention to a possibly increased backward bending in the lumbar spine. In the long run it could lead to overloading in this area.

Evenly flexible spine is also suitable for dance in the presence of moderate scoliosis (lateral bending of the spine). In the case of severe scoliosis, a doctor trained in dance medicine should be asked for clarification.

The following important information is missing from this article or section:

The previously existing section "Examination and Treatment Methods" only contained alternative medical, unproven approaches. It has to be replaced by scientifically proven methods of examination, prevention and treatment.

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References

1. ↑ Dagmar Möbius: Learn your own "body use instructions" . In: Dresden University Journal . Volume 19, No. 9, May 20, 2008, p. 8 ( online ).
2. ^ Josef Huwyler: Dance Medicine. Anatomical basics and healthy movement., Verlag Hans Huber Bern 2005, ISBN 3-456-84134-5
3. ^ Elisabeth Exner-Grave: TanzMedizin. Medical care for professional dancers , Stuttgart 2008, ISBN 978-3-7945-2562-1 , p. 20

literature

• Josef Huwyler: Dance Medicine. Anatomical basics and healthy movement. Verlag Hans Huber Bern 2005, ISBN 3-456-84134-5
• Liane Simmel: Dance medicine in practice: anatomy, prevention, training tips. Henschel Verlag 2009, ISBN 3-894-87596-8

Web links

• Brochure dance medicine - training and workplace dance. An introduction for doctors and therapists , Unfallkasse Berlin, 2011 (PDF; 6.3 MB)

This article is about a health issue. It is not used for self-diagnosis and does not replace a diagnosis by a doctor. Please note the information on health issues !