Dance Medicine

logo_home3.gif"Dancing with the Surgeon"- A Brief look at the Biomechanics of Dance and Injury Prevention. Click here for the presentation


Ballet and football have been linked since at least the 1970s, when Steelers great Lynn Swann credited dance classes with helping him set NFL records for receiving.

So perhaps it's not surprising that the two disciplines would meet in the office of an orthopedic sports surgeon. Dr. Reed Estes, a surgeon in the Children's Sports Medicine department at Children's of Alabama treats athletes at UAB, including football players. He has also developed a growing specialty in dance medicine, treating both youth and professional dancers with injuries suffered in ballet, modern, and jazz dance.

Dr. Reed Estes

"Dancers tend to have a lot more injuries of the foot and ankle" than football players, Estes said. "They put their ankles in some pretty extreme positions."

According to research compiled by the Harkness Center for Dance Injuries at the NYU Hospital for Joint Diseases, the nature of dance injuries varies with the type of dance and skill level of the dancer.

Foot and ankle injuries are by far the most common injury among both amateur and professional ballet dancers, accounting for nearly half of ballet injuries. Lower back injuries are also fairly common among professionals in ballet and modern dance.

Hip, knee, and neck injuries also occur in all forms of dance, but are less common, the Center's compilation of studies indicates.

Unlike football in which most injuries are the result of a single event, most dance injuries are the result of overuse, said Estes, who will lecture on dance injuries later this month at the Alabama Dance Festival.

Growth spurts put young dancers at increased risk for such injuries, according to the International Association for Dance Medicine and Science. As young dancers grow quickly the proportion of limb to torso length changes, as does body mass. The result is fluctuations in coordination and balance and, often, a decrease in strength and flexibility.

"As technical control decreases, the risk of injury increases," the Association said in a briefing paper.

That is why Estes urges parents to be especially careful in managing their child's dance training. His basic advice:

  • Parents of young dancers should see that their children get enough rest and don't over-train.
  • Don't wait until a developing injury becomes severe to seek help. Early detection makes treatment and recovery easier.
  • Cross-train. Activities such as swimming and exercises that strengthen hip and core muscles will lead to a longer, more injury-free career.

Dance MedicineOf all dance forms, ballet has the highest rate of injury, Estes said, and among young ballet dancers a single maneuver is the most problematic.

The rite of passage in ballet in which dancers begin dancing on the tips of their toes, known as going "en pointe," is a little like the curveball in youth baseball. Start doing it too soon, and trouble is likely to follow, Estes said.

Conventional wisdom holds that children can begin to dance en pointe at age 12, but that's just a rule of thumb, he said. Not all 12-year-olds are the same.

"It's a matter of understanding where a child is in the developmental phase," Estes said.

For both youth and professional dancers, the prognosis for most injuries has improved as both treatment options and awareness of injuries have grown, he said. While about 90 percent of professional ballerinas will have at least one significant injury during their careers, most injuries are now manageable.

Before coming to Birmingham, Estes did a fellowship with a leader in the field at Children's Hospital of Boston.

In that program, under Dr. Lyle Micheli, Estes treated dancers from the Boston Ballet and a host of other dance programs, and said he first came to appreciate what it is like to sit in the audience and watch a ballerina who he treated perform.

"I think it's very rewarding to see them doing what they love to do, being able to be happy," he said. "For me personally, it's very rewarding."