The Spine 153to the iliopsoas and potential stretch on the sciatic
nerve. Recommendations are also often provided
for activities of daily living that will tend to preserve
the lumbar curve, such as using lumbar supports
and avoiding prolonged sitting or flexed postures. In
terms of dance, when return is permitted, jumping,
lifting, full spinal flexion, flexion with rotation, and
extreme hyperextension are often initially avoided
and then gradually reintroduced as healing and
symptoms allow.
As pain subsides and healing occurs, treatments
for different types of injuries become more simi-
lar and incorporate the development of balanced
strength and flexibility in all of the spinal muscula-
ture, development or restoration of adequate flexibil-
ity in the spine and hip (particularly in the low back,
hip flexors, and hamstrings), correction of any spinal
alignment or technique problems, and reestablish-
ment of normal core stabilization. Studies of individu-
als with chronic low back pain have revealed a delay
and disruption of the normal firing pattern of the
abdominals prior to movement of the limbs (Hodges
and Richardson, 1996), a disruption in the timing and
amount of firing of the different sides of the spinal
muscles (Grabiner, Koh, and Ghazawi, 1992), very
localized wasting of the multifidus thought to be due
to neural inhibition (Hides et al., 1994), type II fiber
atrophy of the spinal extensors, increased postural
sway, and decreased ability to balance in challenging
positions (Laskowski, Newcomer-Aney, and Smith,
1997). So, successful rehabilitation appears to require
not only adequate strengthening (of sufficient inten-
sity to recruit type II fibers) of the trunk muscles but
also restoring of normal stabilization functions and
neuromuscular coordination (Richardson, Hodges,
and Hides, 2004). It is very important that dancers
participate in long-term conditioning that addresses
these issues and the specific demands of their dance
form and not just stop their exercises when the pain
diminishes, as recurrence rates of back pain have
been reported to be about 40% to 60% (Roy and
Irvin, 1983).Upper Back and Neck Injuries in Dancers
While injuries to the spine occur much more fre-
quently in the lumbosacral area in the general popu-
lation and in ballet, in some dance forms injuries
to the upper back and neck can be quite prevalent.
A study of professional ballet dancers found that
only 9% of injuries to the spine were to the thoracic
spine and 16% were to the cervical spine (Garrick
and Requa, 1993), while a study of performing arts
dance students found that 21% were to the thoracic
spine and 10% to the cervical spine but noted that
cervical and upper back strains occurred roughly
twice as often in modern dancers as they did in ballet
dancers (Rovere et al., 1983). An even greater occur-
rence of upper back and neck injuries was reported
in Broadway dancers during the performance season;
29.4% of injuries to the spine involved the upper
back and 35.3% the neck (Evans, Evans, and Car-
vajal, 1996). So, it appears that the different use of
the head and neck associated with modern and jazz
dance may increase the risk of injury to the upper
portion of the spine.
A strain of the neck generally involves injuries
to the ligaments, tendons, and musculature of the
neck. However, many of the injuries that occur in
the lumbar region can also occur in the cervical
region, including disc herniation, spondylolysis, and
spondylolisthesis. With the relatively small vertebrae
supporting the relatively large weight of the head, it
is not surprising that injuries occur in this region. In
a large sample of individuals, cervical disc degenera-
tion was documented in 12% of women and 17% of
men in their 20s, and in 89% of women and 86% of
men over 60 years of age, often without accompany-
ing pain (Levangie and Norkin, 2001). As with the
lumbar spine, the cervical spine is vulnerable to
forceful hyperextension or flexion, particularly when
combined with rotation. Examples of these motions
occur with head isolations and head rolls in jazz
and African dance. Dancers training in these dance
forms should begin executing such movements with
a smaller range of motion until adequate strength
and skill are developed.
Another vulnerability for the neck occurs with
weighted flexion such as that utilized in the plow or
shoulder rolls (back somersaults rolling over one
shoulder). Although a controversial area, other low
back stretches can be easily substituted for the plow
that do not place such large stresses on the neck.
Regarding shoulder rolls, such moves should beFIGURE 3.50 Rest position often recommended for
relief of low back pain.