The holiday season is in full swing, which means the Christmas Spectacular Starring the Radio City Rockettes, presented by Chase, is kicking off to get you and your loved ones in the spirit. And because of Rothman Orthopaedic’s recent multi-platinum partnership with the Radio City Rockettes, we’ve decided to dive a little further into the physicality behind this astonishing performance.
Although the Radio City Rockettes make their performance look effortless - it’s anything but. If you’re headed to the Christmas Spectacular this holiday season, understanding just how much hard work goes into it will make it all the more incredible as a viewer.
Why Are Dancers Susceptible to Injuries?
The art of dancing, while beautiful and graceful, requires a lot of strength, flexibility and stamina to perform. Because of its physically demanding nature, injuries are very common. Dancers execute complicated choreography with skill and precision honed over years of hard work and training. They’re performing the same motions and movements over and over for their routine. This repetition typically continues for several hours a day which leads to an increased risk of stress fractures and other injuries.
During the height of the season of The Christmas Spectacular Starring the Radio City Rockettes, one cast can perform four shows per day. Even in highly trained professional dancers, the cost of achieving such expertise can come at the expense of certain overuse injuries in a dancer’s body.
While this intense training alone is enough to cause multiple injuries, dancers typically aren’t getting a lot of time between practices and performances to rest. Also, there isn’t usually an “off-season.”
Below are a few of the most common dance injuries that dancers typically suffer from.
FHL Tenosynovitis of the Foot/Ankle
The foot and ankle are the most common area to be injured in dancers. Almost half of all injuries in professional ballet companies can be foot and ankle. (Liederbach, 1985) Flexor Hallucis Longus (FHL) tendinopathy is seen in classical ballet, particularly those who go en pointe, because the FHL tendon is responsible for pointing the big toe. It starts in the calf and travels through the ankle and the bottom of the foot to attach at the very end of the big toe. Overuse or misuse of the FHL tendon due to poor technique can lead to pain, swelling and even catching – called trigger toe.
Dancers are known for their flexibility, which requires moving a joint throughout the full range of motion. The hip is particularly vulnerable to impingement when forcing certain movements common to dance, such as turnout or the splits. The bones of the hip joint can start to build up, or the cartilage between the joints might tear. Sometimes hip impingement is not even a problem in the hip at all, and instead is due to when the lumbar spine is hyperextended (swayback).
Spondylolisthesis of the Lower Back
Stress fractures can occur in all athletes. The risk for dancers can be higher due to a number of factors, including overuse, poor biomechanics, rehearsing or performing barefoot or slippers on hard floors such as concrete or steel, or even a nutritional deficit due to disordered eating. Spondylolysis, a type of stress fracture of the spine, happens with repeated low back hyperextension.
Hamstring Injuries affecting the Knee/Meniscus
Hamstring injuries occur in all types of dance, causing pain in back of the thigh up high by the buttock area or down low where the hamstring muscles connect below the knee. Kick lines, such as those done in precision dance companies, put particular stress on the hamstring muscle group. Lifting the leg up in the kick puts the muscles on full stretch at the end range of hip and knee motion, followed by a strong contraction of the hamstring muscles to bring the leg back down quickly.
The hamstring muscles are vulnerable during that quick transition from full passive stretch to strong active contraction, particularly if a dynamic warm up or cool down after the previous rehearsal or performance was not done properly.
5th Metatarsal Shaft Fracture (Dancer’s Fracture)
The fracture of the fifth metatarsal is commonly referred to as the “dancer’s fracture,” as it frequently occurs when the ankle is rolled while the dancer is up on their toes. The fifth metatarsal is the bone that connects the little toe to the midfoot, which is elongated as the dancer performs their pointe position.
Pain, tenderness and swelling of the foot will occur immediately following the injury and walking will be painful. The outside of the foot and the base of the toes may also become noticeably bruised. X-rays must be run to identify the break and diagnose the injury.
This injury can be treated by immobilizing the foot and eliminating weight-bearing activities, so the patient should be using crutches or a wheelchair. After a few weeks, the foot can be placed in a boot and weight can be applied. Typically, it will require about six weeks to heal completely. Dance activities can usually be resumed in about ten weeks. In some cases, if the foot doesn’t heal during this time, or is dislocated, surgery may be required.
Among these specific injuries, stress fractures are also very common in dancers. The dancers are on their feet, bearing their own weight, for hours at a time every day. And during the repetitive movements of dance, the feet are constantly being moved in various ways, including up on toes, back down again.
This overuse causes repetitive impact on the foot and the weakening of bone, which results in a stress fracture. Symptoms will come on over days or weeks in the form of progressive pain after activity, tenderness and swelling, and even a limp.
A stress fracture must be diagnosed by an x-ray. Most stress fractures only require a few weeks of rest to heal.
Although these injuries are common in dance, many other injuries can also occur in dancers. Frequently these improve when given time to heal or with a small modification. If you think you might have an injury that is limiting your ability to participate in dance class, rehearsal or performance, seek out a physician with experience in assessing, diagnosing, and successfully treating injuries due to the sport-specific demands of dance. Visit our Foot and Ankle specialty page for more information on these types of injuries.