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Ballet dancers and the lumbar region of the spine [read the french version]
Docteur Anne Thiescé
Ballet dancers and the lumbar region of the spine: mechanical pathology
Back ache is not synonymous with mechanical pains resulting from trauma or microtrauma. Back pains can, in actual fact, be a transference of pain from a visceral pathology. These pains can sometimes reveal complex rheumatological complaints. This is why it is essential that a strict medical examination be carried out, coupled with X-ray examinations in line with the symptomatology, before any kind of treatment is undertaken.
Spinal pains, according to several authors, rank second in the pathologies of a ballet dancer's locomotion system. The lumbar region of the spine is the main site for these pains. These pains can be the result of an awkward movement or a fall but usually come from overexertion due to repeated microtrauma. Muscular pathologies such as elongations and contractures are the main causes. Doctors must question the dancer's technique and his level of practice. Making the dancer perform certain movements can be useful. The clinical examination must take the entire body into consideration and not just the spine.
Main causes
Hyperlordosis
Hyperlordosis is common in ballet.
When the external rotation of the hip is insufficient, hyperlordosis is static as it allows the anterior hip ligaments to stretch and increases the turn-out. Hyperlordosis is usually dynamic and can be seen when the dancer is turning, jumping or lifting. Hyperlordosis creates spinal hyper-pressure.
Breaking the spinal axis: trunk bending movements, the arabesque
The "penché en avant" or "sur le coté" and the "cambré" are trunk bending movements. The dancer must lift up his chest at the beginning of these movements. He must not sway his back. He must not "break", he must "stretch".
The arabesque is an extension-external rotation-adduction of the thigh, knee straight. The maximum hip extension is rarely greater than 40°, the lift is performed, in the main, using a pelvic tilt. This pelvic tilt is controlled by contracting the abdominal, the glutaeus maximus and the quadratus lumborum muscles. In the classical arabesque, the dancer must keep his torso vertical. Once again, he must not "break", "he lifts his leg, pulls in his ribs, lifts up his chest and stretches his back".
And so, in all these movements, the breaking of the spinal axis must be avoided. The dancer, by learning how to "lift up his chest", learns the principles of self-growth by contracting his abdominal muscles lengthwise. This training should help him, not only to perfect his technique, but also to avoid incidents of spinal hyper-pressure.
Lifts
The lift requires great physical strength, good posture and good co-ordination. Lifting a female dancer weighing 50 kilos, puts enormous strain on the intervertebral discs, especially disc L5S1. This strain can be the source of discopathies, discal hernias, sprains, elongations which are, for that reason, more common amongst male dancers. Good musculature as well as a good technique is essential; the female dancer stands close to the male dancer, his initial impetus must come from his legs whilst he contracts his abdominal muscles.
Pace changes in practice.
It is possible that a dancer, especially one who works free-lance, who was training for just 2 hours a day, suddenly gets a contract, and has to begin practising for more than 10 or 12 hours a day.
The floor
Performing jumps on a hard floor can result in spinal problems. Performing on a slippery floor, the dancer has a tendency to alter his balance which creates muscular crispation, this in turn causes spinal disorders.
Ballet's evolution towards a more spectacular, acrobatic and athletic form of expression also puts more aggressive demands on the spinal column.
It is, generally, a combination of all these factors that leads to a spinal disorder. These lumbar pains respond well to an exercise programme designed to increase abdominal strength and banish hyperlordosis with instructors being more vigilant.
Adult lumbar pathology
If all lumbar pathologies were put together, lumbar pains originating from muscles would dominate and, in the main, would concern the piriformi muscle. The piriformi muscle is a pelvi-trochanteric muscle; an external hip rotator which is used to perform the pelvic tilt. It is often the seat of contractures, leading to lumbar glutael pains.
Dynamic spinal instability, ill compensated by an insufficient musculature, is also common. This lumbar instability does not have any precise symptoms other than short, shooting pains. X-rays show a discal gap, a short radius lumbar scoliosis, Fig 1, an osteophytosis and even, a degenerative ante or retro-listhesis.
Lumbago and lumbar radiculalgia resulting from a discal hernia are in themselves fairly rare. They are often associated with the dynamic hyperlordosis previously discussed.
Sacro-iliac pains are common, associated with pelvic imbalance and often caused by a dancer landing badly on one foot whilst performing "grand sauts" or by performing lifts badly. It is generally a question of ligament pathology with sprained sacro-iliac ligaments.
Lumbago and lumbar radiculalgia must above all be treated medically with NSAIDs, RRF, lumbar belt, infiltrations. It is sometimes necessary for the dancer to wear a corset or, at least, a lumbar support belt. The wearing of the belt may or may not be permanent and must be coupled with a re-education programme. Faced with non-resolving radiculalgia of discal origin despite medical treatment, surgery can be considered with a return to previous activities possible.
Bibliography:
Micheli L.J., Back injuries in Dancers. Clin. Sports Med. V2, No.3, Nov 1983, p473-484
Pelletier A., Spondylolisthésis. Médecine et Sciences de la danse. IVe congrès international. 18/6/94.
Sabourin F., Pathologie rachidienne microtraumatique et danse. Médecine des Arts 1996 No.15 p37-40.
Seznec J.C., Danse et la de dos. Médecine des Arts 1997 No.22 p37-40.
Thiescé A., Le geste dansé et ses conséquences en rhumatologie. Ed Laboratoires Ciba-Geigy 1996.
Back ache is not synonymous with mechanical pains resulting from trauma or microtrauma. Back pains can, in actual fact, be a transference of pain from a visceral pathology. These pains can sometimes reveal complex rheumatological complaints. This is why it is essential that a strict medical examination be carried out, coupled with X-ray examinations in line with the symptomatology, before any kind of treatment is undertaken.
Spinal pains, according to several authors, rank second in the pathologies of a ballet dancer's locomotion system. The lumbar region of the spine is the main site for these pains. These pains can be the result of an awkward movement or a fall but usually come from overexertion due to repeated microtrauma. Muscular pathologies such as elongations and contractures are the main causes. Doctors must question the dancer's technique and his level of practice. Making the dancer perform certain movements can be useful. The clinical examination must take the entire body into consideration and not just the spine.
Main causes
Hyperlordosis
Hyperlordosis is common in ballet.
When the external rotation of the hip is insufficient, hyperlordosis is static as it allows the anterior hip ligaments to stretch and increases the turn-out. Hyperlordosis is usually dynamic and can be seen when the dancer is turning, jumping or lifting. Hyperlordosis creates spinal hyper-pressure.
Breaking the spinal axis: trunk bending movements, the arabesque
The "penché en avant" or "sur le coté" and the "cambré" are trunk bending movements. The dancer must lift up his chest at the beginning of these movements. He must not sway his back. He must not "break", he must "stretch".
The arabesque is an extension-external rotation-adduction of the thigh, knee straight. The maximum hip extension is rarely greater than 40°, the lift is performed, in the main, using a pelvic tilt. This pelvic tilt is controlled by contracting the abdominal, the glutaeus maximus and the quadratus lumborum muscles. In the classical arabesque, the dancer must keep his torso vertical. Once again, he must not "break", "he lifts his leg, pulls in his ribs, lifts up his chest and stretches his back".
And so, in all these movements, the breaking of the spinal axis must be avoided. The dancer, by learning how to "lift up his chest", learns the principles of self-growth by contracting his abdominal muscles lengthwise. This training should help him, not only to perfect his technique, but also to avoid incidents of spinal hyper-pressure.
Lifts
The lift requires great physical strength, good posture and good co-ordination. Lifting a female dancer weighing 50 kilos, puts enormous strain on the intervertebral discs, especially disc L5S1. This strain can be the source of discopathies, discal hernias, sprains, elongations which are, for that reason, more common amongst male dancers. Good musculature as well as a good technique is essential; the female dancer stands close to the male dancer, his initial impetus must come from his legs whilst he contracts his abdominal muscles.
Pace changes in practice.
It is possible that a dancer, especially one who works free-lance, who was training for just 2 hours a day, suddenly gets a contract, and has to begin practising for more than 10 or 12 hours a day.
The floor
Performing jumps on a hard floor can result in spinal problems. Performing on a slippery floor, the dancer has a tendency to alter his balance which creates muscular crispation, this in turn causes spinal disorders.
Ballet's evolution towards a more spectacular, acrobatic and athletic form of expression also puts more aggressive demands on the spinal column.
It is, generally, a combination of all these factors that leads to a spinal disorder. These lumbar pains respond well to an exercise programme designed to increase abdominal strength and banish hyperlordosis with instructors being more vigilant.
Adult lumbar pathology
If all lumbar pathologies were put together, lumbar pains originating from muscles would dominate and, in the main, would concern the piriformi muscle. The piriformi muscle is a pelvi-trochanteric muscle; an external hip rotator which is used to perform the pelvic tilt. It is often the seat of contractures, leading to lumbar glutael pains.
Dynamic spinal instability, ill compensated by an insufficient musculature, is also common. This lumbar instability does not have any precise symptoms other than short, shooting pains. X-rays show a discal gap, a short radius lumbar scoliosis, Fig 1, an osteophytosis and even, a degenerative ante or retro-listhesis.
Lumbago and lumbar radiculalgia resulting from a discal hernia are in themselves fairly rare. They are often associated with the dynamic hyperlordosis previously discussed.
Sacro-iliac pains are common, associated with pelvic imbalance and often caused by a dancer landing badly on one foot whilst performing "grand sauts" or by performing lifts badly. It is generally a question of ligament pathology with sprained sacro-iliac ligaments.
Lumbago and lumbar radiculalgia must above all be treated medically with NSAIDs, RRF, lumbar belt, infiltrations. It is sometimes necessary for the dancer to wear a corset or, at least, a lumbar support belt. The wearing of the belt may or may not be permanent and must be coupled with a re-education programme. Faced with non-resolving radiculalgia of discal origin despite medical treatment, surgery can be considered with a return to previous activities possible.
Bibliography:
Micheli L.J., Back injuries in Dancers. Clin. Sports Med. V2, No.3, Nov 1983, p473-484
Pelletier A., Spondylolisthésis. Médecine et Sciences de la danse. IVe congrès international. 18/6/94.
Sabourin F., Pathologie rachidienne microtraumatique et danse. Médecine des Arts 1996 No.15 p37-40.
Seznec J.C., Danse et la de dos. Médecine des Arts 1997 No.22 p37-40.
Thiescé A., Le geste dansé et ses conséquences en rhumatologie. Ed Laboratoires Ciba-Geigy 1996.
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