Did you know that almost every professional dancer has some type of injury or chronic pain condition including hip abnormalities? For dancers, it may promote wellness through strengthening and developing one’s self, but with pain and injury, people fall into other issues consisting of fatigue, tension, and disabling conditions. Most work through pain as pain and illness is considered a form of communication that offers an “insight between the body and the social and cultural worlds” it is part of (Alten 2007). The hips, knees, ankles, lower back, and shoulders are the most common areas where pain and injuries can occur in dancers.
In my most recent article, “Eating Disorders in Ballet Dancers: Anorexia, Bulimia, and Ednos” I discuss the physical and emotional aspects that dancers experience on a day-to-day basis revolving around eating disorders and body image. However, another aspect that dancers deal with, especially at the professional level, is dealing with chronic pain and injuries. As a past dancer, body discourses and body practices are one of a kind in a professional dance environment. In this blog post, I will discuss common dancer abnormalities including hip dysplasia, femoral acetabular impingement, and foot injuries and also reveal the various ways that people deal with these issues on a day-to-day basis.
My Story of Pain: Hip Dysplasia and Impingement
In my youth, I participated in ballet and pointe, contemporary dance, and always had an active life. There were some slight pains here and there in my hips and I felt some clicking and catching, but it was never debilitating. I also struggled with some ankle pains, foot surgery, and bunion pain,and I felt that I also had to push through the pain.
In high school, I played tennis year-round, and then, in my college years, I ran and built myself up to running 5-7 miles and participating in a Cross Fit Gym. My feet no longer bothered me. By the time I started working in the food industry, I started having dull aches and pains daily in my groin and thigh, but it was never a problem that I thought would lead me to have two substantial hip surgeries on the horizon.
Fast forward a few years, and I learned I was suffering from several chronic pelvic pain issues that actually seem to be a result of having abnormal hips and a tight pelvic floor. My gynecological issues manifested first back when I was in my teens, which were improperly diagnosed and assessed. For my specific case, my orthopedic issues need to be treated “differently” first before I can actually treat the pelvis. Sometimes the orthopedic issues don’t manifest until you’ve been treated by several people.
Later in early 2021, I found that I had bilateral hip dysplasia, cam impingement, and labral tears on both sides. My pain in my hips and instability had gotten so bad to the point that physical therapy was no longer working and my body could no longer hold itself up well with my unstable hips. I felt that I had to push through the hip pain in order to keep being successful in my career and life, but the pain only got worse.
I had my left periacetabular osteotomy and arthroscopy on June 10. They found cartilage damage but no labral tears and the surgery itself went smoothly. My recovery has been overall much easier than I anticipated and I am planning to have my right hip surgery in December. Additionally, my pain has improved much already on my operated side.
There is hope for people with unstable hips. While it is long debated on what causes these hip injuries, there definitely is an association between dancers and hip issues. Suffering and dealing with pain is common, and most learn to work through the pain. Drawing on theory from previous and contemporary anthropologists, I reveal the pain and suffering that dancers endure is deemed as necessary and considered even heroic.
Hip Dysplasia
One of the most common abnormalities in dancers is hip dysplasia. Hip dysplasia is responsible for the flexibility that we commonly see while they lunge, twist, and pivot. Soft tissue and other anatomical factors can also play a role as well. Hip dysplasia is congenital and it has to do with the structure of their hips. Most have shallow hip sockets (dysplasia), allowing them to have 160 degrees of flexion and 120 degrees before having impingement. Symptoms consist of uneven leg lengths, limping, difficulty with spreading (pelvic exams, happy baby yoga pose, and child’s pose), and also pain in the buttocks, lower back, groin, and, of course, the hips (anterior, lateral, and posterior pain).
Treatments
With most dysplasia issues, if the abnormalities are caught before arthritis develops, the hips can be treated with strengthening exercises through physical therapy surrounding the glutes, abdomen, and back, and/or periacetabular osteotomy surgery. Cortisone injections don’t always guarantee painless hips.
During the periacetabular osteotomy surgery (PAO) procedure, the acetabulum is reshaped over the femoral head (ball) and is twisted and realigned with screws. The surgery itself can take up to four hours, but you are actually under anesthesia for seven to eight hours. If an individual has a very skilled surgeon who does over 100 PAO’s a year, the actual surgery itself is about 1.5 hrs of active work. Recovery takes about a year per hip, so it is not a small procedure. However, with a skilled surgeon, you are guaranteed to have a great outcome.
Sometimes, dancers will have PAO surgery and the surgeon will not get rid of all of the dysplasia in order for them to keep their mobility. Oftentimes, dysplasia will not cause pain until people reach their mid-20s and most people won’t even know they had it. Dysplasia can be responsible for causing femoral acetabular impingement, which I will discuss in this next section. That being said, if you think you have hip abnormalities or sense catching, clicking, or locking, please get your hips checked as this issue can lead to early-onset arthritis.
Painful Hip Condition: Femoral Acetabular Impingement
Femoral Acetabular Impingement, also called FAI, is also another painful condition that many dancers experience, but it also does not always cause pain. Some may never know that they even have it. FAI can also form as a result of having hip dysplasia.
There are three types of FAI called pincer, cam, and combined impingement. Pincer usually forms when there is extra bone that occurs over the normal rim of the acetabulum, and cam occurs when there is a non-round femoral head and the femoral head cannot rotate smoothly. For cam impingement, the bumps rub against the cartilage and cause labral tears and cartilage damage. Combined can occur when there is both pincer and cam impingement. The rarest type of impingement is called femoral ischiofemoral impingement and it occurs when there is the narrowing of space between the ischium and the femur (Gollwitzer, Hans et al 2017).
The recommended treatment for these issues are arthroscopy, hip injections, and physical therapy. However, arthroscopy may be the one way to ensure that the abnormality is corrected.
Foot Pain
Dancing can cause foot pain. Foot pain and ankle injuries are quite common in the dance world as they are putting the most weight and they are doing tremendously difficult jumps with unique feet placement that could be deemed as unnatural. Tendonitis, sprains, hallux rigidus, and dancer’s heel are all common injuries in the foot.
Now that a basic foundation of hip abnormalities and foot pain has been presented, it is important to touch on the anthropological theories and bodily practices, and discourses that revolve around dancers that experience chronic pain on a day-to-day basis.
The Suffering Body in the Dance World
According to Anna Alten in her article, In the Presence of the Body: Theorizing Training, Injuries and Pain in Ballet (2007), the body becomes used as a material object and is defined as a phenomenologically “absent body” with a temporary disappearance of awareness of pain. The author conducted many formal in-depth interviews of male and female dancers during tours, backstage conversations interviews in order to collect “individual life stories and material on actual experiences” (59).
A dancer’s career is deemed to be short as most reach their peak by the end of their 20s, and there is a rule that prohibits injured dancers from being cast at all. Many wait until their injuries have become so extreme due to fear that they will be prohibited from dancing at all (Aalten 55). It is important for each dancer to have a large amount of flexibility and range, especially at the hips, femur, foot, and ankle, so they can do a “turn-out position” but these positions are really quite unnatural, which can sometimes lead to injury later on.
For dancers, the vast majority of people view injuries as a “disaster” (Aalten 2005, Wulff 1998; Wainwright, Williams and Turner (2005). However, for some, having an injury can heighten awareness in their body and teach them how far their body can go.
One woman describes her perception of injuries as, “I think you feel pain when you are doing nothing.. But when you are dancing you do not feel any pain” (Aalten 2005: 63). All the dancers that Aalten interviewed were shown to ignore the pain and physical problems as they believed it was an expected part of their profession. Every dancer believes they have to suffer in order to be skilled and “good.”
Heroism and Pain
The experience of pain in a dancer’s mind might not be negative, as most think that pain is associated with working hard and improving yourself. The pain is simply accepted and welcomed in a dancer’s mind and even welcomed, and also deemed as heroic. According to Anna Aalten (2005), some dancers learn to close off the feeling of pain, it takes your ability away to feel any sort of pain or remember that you had it to begin with (64).
One dancer describes that she learned how to diminish the distance between her two bodies, her own and her ideal. “I had a good feeling when I left school. I was so strong that I pulled my tendons when they snapped. Looking back now, I know that I treated my own body with hatred. I danced when I was in pain or injured… What you learn is to close off that feeling and it takes away your ability to feel pain” (Aalten 64). In this type of environment, dancers believe in the heroic status that they give to pain but it can also call attention to further injuries that progressively get worse with time.
Is the pain all worth it? In an article from the Houston Chronicle in 2015, doctors at Houston Methodist suggest that ballet dancers have an “anatomical advantage” allowing them to cover a huge range of motion but the pelvic structure that helps them leaves them definitely at a disadvantage later on in life.
Conclusion
The body has become a center of academic analysis and serves as a productive focus for theoretical and empirical work (Aalten 2003, 11). The microculture of ballet has its own rules and cultural norms. As said before, nearly half of female dancers suffer from an eating disorder and also suffer from “silent injuries” (Scharli 2005, 34). There is quite a dearth of ethnographic research portraying ballet dancers, their companies, and various psychosocial aspects and routines. Many lack the understanding of the bodily techniques being used, and the art form itself.
Different types of hip injuries that are not included in this paper consist of degenerative changes and osteoarthritis, stress fractures, bursitis, and damage to the sciatic nerve (Sohl and Bowling 1990). Foot injuries occur in the foot and ankle area and can progress and worsen over time. Through this mini-ethnographic approach, while looking at the various types of injuries, the mental health of dancers, and how injuries are perceived psychologically, the body becomes a true presence that needs action and needs more attention.
References
Aalten, A. (2007). Listening to the Dancer’s Body. The Sociological Review, 55(1_suppl), 109-125. https://doi.org/10.1111/j.1467-954X.2007.00696.x
Aalten, A. (2005). In the Presence of the Body: Theorizing Training, Injuries and Pain in Ballet. Dance Research Journal, 37(2), 55-72. doi:10.2307/20444641
Gollwitzer, H., Banke, I. J., Schauwecker, J., Gerdesmeyer, L., & Suren, C. (2017). How to address ischiofemoral impingement? Treatment algorithm and review of the literature. Journal of hip preservation surgery, 4(4), 289–298. https://doi.org/10.1093/jhps/hnx035
Hanna JL. The power of dance: health and healing. J Altern Complement Med. 1995 Winter;1(4):323-31. doi: 10.1089/acm.1995.1.323. PMID: 9395627.
Wainwright, Steven P. and Bryan S. Turner 2004. “Epiphanies of embodiment: injury, identity, and the balletic body.” Qualitative Research (4) 3:311-337.
Scharli, Andrea (2005). Fit to dance- The Netherlands. A national inquiry into Professional Dancers’ health and injury. Amsterdam: MA thesis Vrije Universiteit
Sohl P, Bowling A. Injuries to dancers. Prevalence, treatment and prevention. Sports Med. 1990 May;9(5):317-22. doi: 10.2165/00007256-199009050-00006. PMID: 2188333.
