What to do after a dance injury?

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women in black top and black leggings stretching
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This is a big dance injury.

An awkward landing following by gut-wrenching pain.

Maybe it’s when after hoping that those weeks/months of pain will eventually go away, it
hasn’t. Or the time when your medical provider examines you with that look on their face or hands you a box of tissue before explaining your MRI report.

Either a long time off the dance floor, surgery, or both are in your immediate future.
At this time, your mind is probably turning non-stop pirouettes. You probably aren’t thinking about school, sleep, mobility, pain, food and mood. You should be, if you want to take some of the pain out of your injury recovery. In fact, if you are a dancer with a major injury, one should not schedule surgery or commit to a major rehab program without reading and sharing the information in this post.

Let’s start with the “pre-op” evaluation (also applies to the “post-injury” evaluation
Back in medical school, there was this. basic “pre-operative physical” format. Prepare
patients by reviewing medications, looking for any illnesses that could affect surgery or
anesthesia, and getting important lab work.

For most otherwise healthy dancers, there is a better pre-op or post-injury evaluation.
Yes, we need to review that past medical and medication stuff, but to really make those
upcoming weeks easier, we need to share some key tips. For most of these, you can thank your fellow performers who had misfortune of getting hurt before you. They have been my teachers with many “wish I would have known” moments. Thanks to them, we are all better prepared to handle injuries and surgeries.

School/Work

Missing school or work or attending either one in a fair amount of discomfort is no fun.
No one should be shocked with reports of significant drop in grades, risk of failing classes, and reduced workplace productivity after major surgeries. Does this mean that an injury will do the triple whammy of no dance, poor grades, and upset bosses and work colleagues?

I will often meet with families to discuss certain items and provide notes for post-
surgery/injury school or work life.

When to schedule surgery?

o I totally understand that most dancers want surgery ASAP to get the return-to-
dance clock started. However, unless the procedure is emergent it’s best to take a
step back and look at the calendar first. Assume that there will be pain, increase daytime sleep (often due to medications), and mobility issues right after surgery. This affects attendance, focus/concentration, and ability to complete important duties.

o Do you have an upcoming break or even a long weekend?

Can you schedule the surgery later in a week to use a long weekend for initial recovery? Get exams or that important project done first so you can have more focus on recovery.

How will you get around?

o Figure that you will need some new dance partners – crutches, cast/cast boots,
scooters or wheelchairs. Here’s a plug for elevator passes, carts, and preferential
parking. Ask to leave class early and/or arrive late to avoid crowded hallways.

Get some new props

o Can’t use your writing arm? See if you can get teacher notes ahead of time,
connect with a note taker, or borrow other’s notes (preferably one who is smart
and writes very clearly). I’m a big-time fan of allowing dictation or oral testing.

The show must go on (maybe)?

o Many will start a post-surgery or return with part-time work. The first goal is to
get back, then be able to complete regular work before stepping up for tests or
major projects.

Sleep

Ah yes – getting enough sleep a night. Here we go. What is your target?
I’ll throw out 8 hours a night. Anything less especially in the high school student can increase the risk for more injury and illness. How important is sleep? Very important. Vital. Essential. Sleep is by far the most important recovery modality to the point that no modality is worth losing even a few minutes of sleep.

I’ve seen some common sleep challenges with injury and surgery.

1) Immediately pain and swelling after surgery or injury can make it hard to find a
comfortable position. Everything just seems to hurt. In addition to using medically
recommended pain treatments, it is time to elevate your game. Swelling and
throbbing pain can be reduced by elevation, elevation and elevation. Use piles of
pillows or sleep upright in a chair.

2) Later, let’s say 3-4 weeks after surgery or injury boredom starts to kick in. hard to be
tired when you fell all shut down. Early on in the injury or surgical treatment plan,
find out what you can do especially with cross training early in recovery. Don’t let
your brain go on major shut down- can you reach out to friends, help with
choreography or do video review?

3) Moving 1-3 months out, I tend to hear of too little (or even too much sleep) due
to symptoms of depression or anxiety. Other things to look out for include poor
appetite, reduced motivation to attend school/rehab, and even turning to alcohol or
other drugs.

Mood

While we’d all like to see rehab move in a consistent upward straight line, the more
common visual is a scribble of peaks and valleys. There will be plateaus, step backs, and delays. This will let to doubts, anxiety, disappointment, and a depressed mood. Not only might this affect sleep, but also appetite, relationships, and just general mood.

I’ll openly ask about mood issues early and often in post-injury visits. This isn’t a time
for embarrassment or ignorance. This isn’t a sign of weakness or lack of strength.

I cannot emphasize the importance of full honesty about emotions and thoughts. Poor
emotional health can not only threaten recovery, it can be a threat for suicide and other forms of harm to self or others.

Food

Food and weight tend to be sensitive topics of worry in the dance community.
That worry is only amplified after a major injury or surgery. Dancers may be quite surprised by weight gain while others may deal with weight loss.

Why do you gain weight? Maybe it’s from well-intended higher calorie comfort food. Less activity may also be a factor. Weight loss could be due to the loss of muscle mass or poor appetite (often due to medications and pain). There is also the possibility of food insecurity- not dancing/working means less money to buy food.

Unnecessary deprivation is of no benefit. Ask your medical team to help evaluate calorie
needs and make adjustments in amount, types and timing of food intake. There are some low-cost, whole food based recommendations to share:

? I’m a big-time believer in protein – especially after exercise to help bone and muscle
recovery. Click here for good-tasting whole food and beverage protein sources.

? Reducing processed foods and increasing anti-inflammatory foods can increase recovery potential. Click here for information on a lower carbohydrate diet and interesting fruit and vegetable choices (including my favorite natural anti-inflammatory beverage).

? Check this US Olympic Committee Sports Nutrition link for a practical and
comprehensive review of Nutrients for Soft Tissue Recovery.

Keeping It Real

It’s that first post-injury question: “How long until I can get back to the dance floor?” I wish I had a crystal ball, but I don’t, so the best I can do is make an educated estimate.

Let’s say I come up with 4-6 weeks. I know exactly what is going on in the dancer’s mind. “4-6 weeks…that means 3-4 for me” If not back in 4 weeks, here comes disappointment, frustration and anger. (Re-read the mood section as needed).

We all want to get a date of return, mark it in our calendar, and be ready to go when that time frame is up. The best recoveries – those that return to a starring role and less risk of future crash and burn – aren’t just measured by time, but also by the ability to do certain skills and movements. Basing return on when you can leap, jump, and turn with good technique and no pain makes more functional sense then just waiting for a certain number of weeks or months.

Schedule meetings with your rehabilitation team early in the recovery process. Pre-
surgical exercise programs can make those first post-operative weeks easier and might put you ahead in the entire return process. Those visits can also create sensible skill-oriented goals and expectations for everyone to discuss.

Dr. Chris Koutures is a dual board-certified pediatric and sports medicine specialist who practices at ActiveKidMD in Anaheim Hills, CA. He is a team physician for USA Volleyball (including participating in the 2008 Beijing Olympics), the U.S. Figure Skating Sports Medicine Network, Cal State Fullerton Intercollegiate Athletics, Chapman University Dance Department, and Orange Lutheran High School. He offers a comprehensive blend of general pediatric and sport medicine care with an individualized approach to each patient and family. Please visit activekidmd.com or follow him on Facebook (https://www.facebook.com/activekidmd/), Instagram (https://www.instagram.com/activekidmd/), or Twitter (@dockoutures).

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