Introduction
Dancer injuries require quick and targeted rehabilitation. To address this issue, rehabilitation protocols can be established to provide therapists with guidance on completing the process in a reasonable amount of time. The first thing to consider would be the personal experience of the dancer throughout the rehabilitation process.
While the recovery techniques used today at the rehab clinics are clear set in the protocols, yet the rehabilitation program should be always personalized according to the dancer´s personality and capabilities. This approach puts a new challenge on the therapeutic team who need to be more aware of the patient than ¨the guidelines¨. It doesn´t mean that the dancer decides how the treatment will be performed but the dancer is a part of the decisions, takes responsibility and accepts the constraints that dictate their new recovery process.
Rehab clinics today have set protocols designed to deal with specific injuries. Nevertheless, this is not sufficient as the rehabilitation process should be personalized to take into account each individual’s technique, capabilities and personality. Rehabilitation following an injury involves more than just following a set of guidelines. It is a process in which every member is actively involved; including the dancers themselves which become a part of the decision making. This approach allows the therapies and recovery timeline to be tailored to the dancer’s individual characteristics.
There are two main aspects to the rehabilitation process:
The CLINICAL recovery
The STUDIO recovery
The protocol detailed below is based on therapeutic guidelines written at Harkness Clinic for Dancers Rehabilitation. It has been adapted for use at our clinic, which specializes in Multidisciplinary treatment of Sports and Dancers Injuries. This protocol involves four stages, each of which will focus on four therapeutic phases:
Physical recovery in the clinic
Physical re-adaptation in the studio
Mental training
Nutritional education
The Diagnosis
It is imperative that the injury be recognized promptly at the stage or studio and that the correct diagnosis be made as soon as possible. If medical attention is required, it should be sought out immediately to determine if further diagnostic and interventional procedures are needed. If the injury is severe enough to require surgical correction, then early intervention is a critical part in achieving rapid and complete recovery.
During this phase of physical recovery, input from the cast manager, choreographer, and artistic director are crucial to determine the dancer’s lifestyle and habits prior to the injury. This information will be essential to build a holistic rehabilitation program that encompasses all aspects of recovery: physical recovery, emotional recovery, and even building nutritional programs to facilitate the road to recovery.
Writing the right recovery protocol
The protocol writing process starts when the therapist has collected all the required information pertaining to the dancer’s injury, emotional condition, and nutritional habits prior to the injury. In order for the protocol to be personalized to each individual, the therapist will need to familiarize himself with factors relating to the show (schedule, rehearsal, choreography), and to the dancer themselves (personal life, emotional support …). The protocol is designed with clearly set milestones for recovery. This provides the dancer and the therapist with an agenda to work off, and examine the recovery progress at each step. It also allows for a gradual recovery, while minimizing the risk of re-injury during the process.
Stages of Recovery
1. First Stage: The Acute Injury
Following the injury, the dancer is not allowed to perform any physical activity that may worsen the injury.
1.1 Phase 1: Physical Recovery in the Clinic
Primary goal:
Reduce the pain and swelling, sustained due to the injury. The bulk of the work is completed at the clinic under the direction of the physical rehabilitation team (physiotherapist and sports therapist, trainer).
Secondary goals:
Maintain optimal aerobic condition
Preserve muscle tone and strength in non-affected areas of the body
1.2 Phase 2: Physical Re-Adaptation in the Studio
The studio plays a small role in this stage of recovery. We nevertheless still encourage the dancer to remain involved, as allowed by the extent of the injury, in the studio life through attending rehearsals, social activities and cast briefings. This uninterrupted engagement in the studio life is an essential part of promoting the necessary level of emotional wellbeing required for the recovery process. The dancer may perform, with medical clearance, exercises aimed at maintaining strength and flexibility, provided they do not involve the injured site.
1.3 Phase 3: Mental Training
The therapist will perform an early assessment of the mental and emotional condition of the dancer immediately after the injury. Understanding the dancer’s perception of the injury and goals for recovery are essential in designing a tailored treatment protocol. This will require constant re-assessment and discussion between the dancer and the therapist, with both participating equally to the decision making process. Having clearly set goals and expectations helps overcome the disappointment from the injury, and sets sights for a speedy and full recovery.
1.4 Phase 4: Nutritional Education
The projected timeline of recovery will dictate the nutritional support required for each dancer. This phase will focus on two main aspects:
Ensure intake of appropriate nutrients required for the healing process
Maintain a healthy weight and prevent loss of muscle mass
2. Second Stage: Gaining Movement
During this stage, the dancer gradually returns to activity with restrictions. Dancers are at the highest risk of re-injury during this stage.
2.1 Phase 1: Physical Recovery in the Clinic
During this phase, the therapist will focus on re-establishing movement in the injured area. This includes integration of the injured area into complex joint movements, balance and coordination, as well as weight bearing exercises.
Primary goal:
Recover range of movement in damaged tissues using simple motions and contractions
Secondary goals:
Partial weight bearing involving the damaged tissues
Achieve complex joint movements with gradual increase in contractions
2.2 Phase 2: Physical Re-Adaptation in the Studio
The studio plays an integral part in the dancer’s active recovery at this stage. Based on recommendations from the medical and therapy team, the studio will allow the dancer a gradual return to activity. This may not involve more than marking on floor choreography. There needs to be an open line of communication between the clinic and the studio to ensure that the recovery process goes uninterrupted, and that no further setbacks occur.
2.3 Phase 3: Mental Training
This phase of the recovery will focus on setting clear expectations and timelines for return to full activity. This will be agreed upon by all involved parties, including the clinic, dancer and the studio. This will prevent a hastened return to activity and risk of re-injury; and will avoid unnecessary delays in the recovery process.
2.4 Phase 4: Nutritional Education
If the recovery process is projected to last longer than 3 weeks, the following evaluations are indicated
Full anthropometric (body fat composition, muscle mass ...).
Aerobic conditioning evaluation (VO2 max test)
If the recovery process is projected to last longer than 6 weeks, these evaluations are repeated on a monthly basis until full recovery is attained.
3. Third Stage: Active Re-Education
During this stage of treatment, the dancers will return to near “normal”activity, where they are allowed to perform at 80% of their maximum potential*. The transition from stage 2 to stage 3 of the recovery process is a multidisciplinary decision agreed upon by all involved parties, including the clinic, dancer and the studio.
The main role of the therapist during this process is to clear the dancers for return to their activity within the cast. This may involve assistance in regaining physical strength, cardiovascular fitness, self-confidence, and nutritional habits to return to their baseline capacities.
3.1 Phase 1: Physical Recovery in the Clinic
During this phase of recovery, a large emphasis should be placed on adapting the treatment exercises to the choreography. The therapist will focus on isolating contraction and resistance, as well as perform combination movements, including ones that address the initial injury. During this phase, 80% of the recovery time is spent in the clinic with the therapist.
Primary goal:
Full weight bearing and joint movement (80% maximum potential*)
Secondary goal:
Re-Education of non-injured body areas to allow return to full activity
Strength, Flexibility, Balance and Coordination
Cardiovascular fitness (**)
(*) Maximal potential will be applied counting the normal time, intensity, frequency of the regular studio workout divided by 80%. For example: if the usual length of the rehearsal is 60 minutes, then the recovering dancer will perform only 45 minutes of an active physical activity and another 5 minutes of stretching and cooling down. The Intensity will be measured according to the different elements on the dance / show / performance and considering the weights, height of jumping, pulling and pushing, etc. All these are going to be divided by 0.8 to get the amount of effort to be placed on the dancer at this time.
(**) Cardiovascular fitness: Improvement of the cardio-respiratory and aerobic skills should be worked out considering the injury condition. If the injury involves the lower body area, upper body aerobic activity is advised, using the appropriate equipment like Upper Body Rotation Machine (Steady Hands bicycle), Rowing machine (depends on the kind of lower body injury) and Elliptical (depends if the lower body permits weight bearing). If the injury involves the Upper body, then lower body workout is advised, using the appropriate equipment like Treadmill, Steady bicycle, Elliptical machine (with the possibility to combine in this last one other lower body exercises, including core coordination and stability).
3.2 Phase 2: Physical Re-Adaptation in the Studio
During this phase, the dancer should be able to perform most of the activities with the cast, while staying within the boundaries of 80% of their maximum potential. This is important to adhere to avoid re-injury, while making sure the dancer is not being unnecessarily exempted from certain parts.
The decision to participate in the show will be at the cast manager’s discretion, based on the dancer’s limitations, and their role in the dance.
3.3 Phase 3: Mental Training
Following the injury imposed leave, the dancer is once again a part of the studio life. This is when conflicts may arise between the dancer and other team members, such as other dancers, the cast manager, or the choreographer. These potential conflicts can affect the dancer’s successful return to activity, as it may impact their motivation, enthusiasm and confidence. It is important that each party’s expectations and responsibilities be clearly set from the beginning. This will help make the transition back to the studio as smooth and successful as possible for all involved parties.
3.4 Phase 4: Nutritional Education
At this point, the dancer should go back to their pre-injury diet based on their expected daily energy expenditure.
4. Fourth (last) Stage: Return to full physical activity / Injury Prevention
This stage aims mainly at prevention further injuries as the dancer returns to full pre-injury physical activity. The dancer at point should be able to perform to the maximum of his/her physical ability without any restrictions.
4.1 Phase 1: Physical Recovery in the Clinic
The therapeutic team in the clinic will put together a training routine focusing on strengthening areas of weaknesses for each dancer. The dancer will continue to follow up routinely with the clinic to monitor progress, as well as improve strength and technique to avoid any future injuries.
4.2 Phase 2: Physical Re-Adaptation in the Studio
At this time, full recovery has been achieved, and the dancer is back to 100% capacity in the studio. There is no further indication to address the previous injury in the studio.
4.3 Phase 3: Mental Training
At the end of the treatment protocol, it is important for the therapist and the dancer to go over a recap of the rehabilitation process. This will help pinpoint the strengths and weakness of the process, and provide important feedback on areas and ways to improve it. This will help the therapist better design treatment protocols down the line.
4.4 Phase 4: Nutritional Education
The dancer at this point is back to their regular diet, as dictated by their daily energy expenditure