The Spine 149for weeks, months, or even a whole year (Micheli,
1983). Furthermore, spinal injury can often result in
chronic or recurrent back pain. One survey of adult
dancers from various styles found that 17% of all
dancers and 23% of dancers with scoliosis reported
a history of chronic or recurrent low back pain (Lie-
derbach, Spivak, and Rose, 1997).
Prevention of Back Injuries
Considering the relatively high injury incidence
and the potential for a more serious or recurring
condition, dancers should take aggressive measures
to prevent back injuries. The dancer can reduce
injury risk by being adequately warmed up prior to
stressful movement; focusing on correct abdominal
stabilization and spinal alignment; developing bio-
mechanically sound partnering techniques; develop-
ing adequate abdominal, spinal extensor, and upper
extremity strength; and developing or maintaining
adequate spinal, hip, and shoulder flexibility.
Common Types
of Low Back Injuries in Dancers
A few common back injuries will be described here.
However, it is important to realize that the same
symptom of low back pain can come from numerous
very different sources including infections, tumors,
rheumatologic conditions such as rheumatoid
arthritis, congenital abnormalities, Scheuermann’s
disease, and chronic and acute injury (Gerbino and
Micheli, 1995; Weiker, 1982). Hence, it is emphasized
that any dancer who experiences persistent or severe
back pain should seek medical help to evaluate and
provide appropriate treatment. Self-treatment is
particularly ill advised with the back because there
are so many causes of low back pain, treatments for
one type of injury may aggravate another, and some
conditions can have very dire consequences if not
properly diagnosed and treated at an early stage.
Lumbosacral Strain or Sprain
Lumbosacral strains or sprains involve excessive
stretching and injury to the spinal extensor muscles,
ligaments of the spine, or both. Lumbosacral strains
often result from extreme movements of the spine
involving very forceful concentric contraction, force-
ful eccentric contraction used to decelerate the torso,
mis-timing of a particular movement, or a sudden
unexpected exertion during carrying of a heavy
object. In the workplace, such injuries often involve
muscular overexertion associated with bending and
twisting in an asymmetrical manner (Caillet, 1996).
During lifting of heavy weights, or another dancer,
small spinal muscles (e.g., deep posterior spinal
group) with small moment arms must counterbal-
ance very large external forces with large moment
arms, and injury can readily occur. Lumbosacral
strains may follow a single trauma, and the dancer
may describe the back as “locked” and say that he or
she was “unable to move.” In other cases, the onset is
insidious and results from repetitive stresses of dance
training that exceed healing capacity.
Lumbosacral strains are characterized by localized
back pain that is relieved by rest and aggravated by
activity. Muscle spasm on one or both sides of the
spine is often present. Symptoms tend to resolve rela-
tively quickly if there is not more serious underlying
pathology such as injury to the disc or bone (Mercier,
1995). Approximately two-thirds of individuals will be
relatively symptom free and able to function in work
or sport by two weeks (Harvey and Tanner, 1991);
90% of such injuries resolve within two months
(Deckey and Weidenbaum, 1997).Mechanical Low Back PainMechanical low back pain involves a localized aching
in the low back region without any well-defined ana-
tomical cause. It is typically associated with lumbar
hyperlordosis. Mechanical low back pain commonly
occurs in young dancers and is believed to be asso-
ciated with rapid growth spurts in which tight low
back musculature and lumbodorsal fascia, tight
hamstrings, tight hip flexors, and weak abdominal
muscles often create a temporary imbalance lead-
ing to an excessive lumbar curve (Micheli et al.,
1999). This hyperlordosis may be present in stand-
ing posture or may manifest itself only in dynamic
movement such as jumping or partnering. In a study
comparing back pain in active teens to that in adults,
26% of teens were diagnosed with mechanical back
pain while no adults received this diagnosis (Micheli
and Wood, 1995).Spondylolysis and SpondylolisthesisSpondylolysis (G. spondylos, vertebra + lysis, loosen-
ing) involves a defect in the weakest region of the
lamina located between the superior and inferior
articular facets (the pars interarticularis) of the
vertebrae, most commonly occurring in the lower
lumbar spine (figure 3.48A). Although this condition
may be congenital, in many cases the defect is due to
a stress fracture. Although other factors come into
play, the mechanism for injury is often hyperexten-
sion (particularly combined with rotation or axial