The Spine 147and Madsen, 1981); and a decrease in range in spinal
extension has been shown to generally accompany
aging in men, but not necessarily in women. How-
ever, extreme range (hypermobility) as well as low
value (hypomobility) appears to increase the risk for
low back trouble. So although spinal flexor stretches
are not recommended for dancers who already have
high values, they can be useful for dancers who are
trying to develop their range or older dancers who
are finding a decrease in range.
However, since hyperextension is a classic mecha-
nism for spinal injury, these stretches should be
done only if there is no history of lumbar lordosis
or low back pain and with particular care, starting
with a mild stretch and gradually increasing range
over time, always staying in a pain-free range. The
prone press-up shown in table 3.7C was selected
because arm support will allow for easy control of
stretch intensity. As range improves, support can
progress to using the hands (with elbows extended)
in front of the shoulders, and then further progress
through gradually bringing the hands closer toward
the shoulders. Range in spine hyperextension can
also be improved if one performs this exercise with
the hips on an exercise ball (starting with pressing
with the elbows and progressing to pressing with the
hands against the ball), as seen in figure 3.47A, or
uses a gravity-assisted position by lying supine with
the back arched over the ball (figure 3.47B).
The upper back drape (table 3.7D) offers a stretch
that focuses on improving range in the upper back.
One can also add a strength component to the exer-
cise by pressing down with the hands and arching the
upper back while attempting to keep the pelvis in a
neutral position in a supine rather than sitting posi-
tion (supine upper back arch, figure 3.47D). Hold this
position for 5 seconds, starting with two and gradually
progressing over time to six repetitions. Precede and
follow this active component with the passive stretch
(figure 3.47C) held for 20 to 30 seconds.
Spinal Lateral Flexor Stretches
Adequate flexibility of the lateral flexors is important
to allow the spine to bend fully to the side. The side
bend (table 3.7E) is an effective stretch that can be
performed sitting on the floor or standing with one leg
up on the barre. To get full benefits from your stretch,
focus on keeping the pelvis level and stationary as the
spine arches “up and away” with the ribs lifting “up
and over” rather than shifting to the side.
Spinal Rotator Stretches
Adequate flexibility of the spinal rotators is necessary
to allow the torso to twist relative to the pelvis, or the
pelvis relative to the torso. Dancers are often asymmet-
ric in this motion, and stretching more to the side with
less range can help improve symmetry. However, if the
genesis of this asymmetry is scoliosis, any stretching or
strengthening should be performed under the direc-
tion of a qualified physical therapist. The supine spine
twist (table 3.7F) is a stretch for the spinal rotators.
When performing this stretch, focus on keeping the
spine extended and trying to rotate around a central
axis without letting the ribs shift to the side.Back Injuries in Dancers
Because of inherent structural weakness and the great
forces it is subjected to from body weight, externally
applied forces, and contraction of muscles, the lumbar
spine is particularly susceptible to injury. Back injuries
appear to have a particularly high incidence in athlet-
ics involving 1) weight loading and high compression
forces, 2) forceful twists, and 3) activities involving
spinal hyperextension, such as competitive swimming
(60%), track and field (48%), and weighlifting (40%)
(Aggrawal, Kaur, and Kumar, 1979; Mutoh, 1978).
Since dance contains all of these elements, it is not
surprising that back injury is prevalent. One study of
Broadway dancers found 26% of them sustained an
injury to the back or neck during rehearsals while
45% sustained injuries to these areas during the pro-
duction season (Evans, Evans, and Carvajal, 1996). A
study of professional ballet dancers in Sweden found
69% in 1989 and 82% of surveyed dancers in 1995
reported low back pain some time in the previous 12
months (Ramel, Moritz, and Jarnlo, 1999). Another
study reports 60% to 80% of ballet and modern
dancers had a history of back injuries, while two
other surveys involving longer time frames reported
incidences of 86% (Clippinger-Robertson, 1985) or
higher (Seitsalo et al., 1997). Probably because many
dancers sustain multiple injuries and some do not
seek medical help for low back pain, the reported
percentage of total injuries to the spine is lower than
one might suspect from prevalence surveys, often
being second only to the ankle-foot region. Some
reported percentages of total injuries to the spine
were 31% for professional ballet dancers (Garrick
and Requa, 1993), 17% for modern dancers (Bron-
ner, Ojofeitimi, and Rose, 2003), 18% for university
dance students (Rovere et al., 1983), 20% to 50% for
flamenco dancers (Salter-Pedersen and Wilmerding,
1998), and 18% to 34% in Broadway dancers (Evans,
Evans, and Carvajal, 1996).
It is also noteworthy that back injuries may require
more time off from dancing than some other types
of injuries, in some cases requiring dancers to be out