Dance Anatomy & Kinesiology

452 Dance Anatomy and Kinesiology

Shoulder Horizontal Adductors

Adequate flexibility in the shoulder horizontal adduc-

tors is necessary to allow the arms to be adequately

“open” when held in second position and to help

prevent rolled shoulders. The wall shoulder stretch

(table 7.12D) is a stretch for this muscle group.

Shoulder Horizontal Abductors

and Posterior Capsule

Recent studies suggest that tightness in the posterior

capsule and posterior rotator cuff may be an associ-

ated factor with some shoulder injuries (such as the

impingement syndrome). The supine elbow across

shoulder stretch (table 7.12E) is designed to provide

a stretch to this area. However, to be effective, the

scapula must be stabilized through conscious use of

the scapular adductors to maintain the scapula close

to the spine so that a stretch is applied to the poste-

rior shoulder versus the scapular adductors.

Upper Extremity Injuries in Dancers

Because dance is primarily weight bearing with the

lower extremity, the reported incidence of injury in

the upper extremity has been historically much lower

than in the lower extremity. In fact, many reports

of female ballet dance injuries do not even include

upper extremity injuries, and there are a very lim-

ited number of studies addressing upper extremity

injuries in dancers. However, some forms of dance

such as break dancing (Washington, 1987) show a

higher incidence of upper extremity injuries, and

the incidence of upper extremity injuries in some

modern, ballet, and jazz dancers appears to be on

the rise.

In terms of increasing incidence, demands for

the upper extremity have markedly increased in

some choreography with more use of nonclassical

partnering by men, women partnering other women

or men, floor work, and demanding movements

requiring support of the body by the arms. In the

modern arena, contact improvisation can produce

additional stresses to the upper extremity when

unanticipated movements require rapid use of the

arms to support the body weight of the dancer or

another dancer. In jazz, the trend to incorporate

acrobatic types of movements and hip-hop/break

dancing choreography has markedly increased the

stresses to the upper extremity. One older study of

50 male break dancers showed that about 23% of

the total injuries occurred in the hand, 7.5% in the

wrist, and about 9% in the shoulder (Washington,

1987). After reviewing 20 years of ballet injuries

at the Lewisham Hospital, Millar (1987) noted a

slow but steady increase in injuries to the neck and

upper extremities that he attributed to the greater

and more varied choreographic demands placed

on ballet dancers who have to perform modern

ballets.

Prevention of Upper Extremity Injuries

A common mechanism of injury to the upper extrem-

ity involves falling on an outstretched arm; but in

dance, injuries more commonly relate to performing

repetitive overhead movements or demanding move-

ments in which the upper extremity is supporting

the weight of the dancer or another dancer. When

forces exceed the passive mobility, stability, and

dynamic control of the shoulder joint, injury can

occur (Warner et al., 1990).

Dancers can lower the risk of injury by develop-

ing adequate and balanced strength, developing

and maintaining adequate flexibility, properly

warming up, avoiding fatigue, and focusing on

good technique. In regard to strength, performing

supplemental strength training two to three times

per week can develop a base of upper extremity

strength. Then, when unaccustomed choreography

places high demands on the upper body, injury is

less likely to occur. Including exercises for the rota-

tor cuff and scapular muscles, as well as the large

shoulder muscles, will provide greater joint stability

and foster proper shoulder and scapular mechan-

ics necessary for avoiding impingement syndromes.

Lastly, focusing on correct arm placement with an

appropriate scapulohumeral rhythm can reduce

shoulder stress.

Rehabilitation of Shoulder Injuries

Although different injuries often require specific

treatments, some general principles follow for treat-

ment of the shoulder. For more specific treatment pro-

tocols, interested readers are referred to the related

references provided at the back of this book.

As with injuries to other joints, initial recom-

mended treatment usually involves the use of ice,

anti-inflammatories, and relative rest/protected

movement to control pain, swelling, and inflam-

mation (Goldman and McCann, 1997). When

symptoms are adequately controlled, various other

physical therapy modalities such as ultrasound,

electrical stimulation, or phonophoresis are often

prescribed to help restore normal range of motion