Musculo-skeletal   [back to the Category]

Teenage lumbar pathology   [read the french version]

Author :   Docteur Anne Thiescé

Dancers begin practising their art at an early age and many devote themselves to intensive training during their growth years. Furthermore, dancers have not usually finished growing, when, from the moment they enter a company, they have to perform numerous lifts. Spinal risks are proportional to the lack of flexibility which comes from the difference between the osseous and the musculo-tendinous growths: an imbalance which is often overlooked in ballet.

Sheuermann's disease

There is, therefore, often a decrease in flexibility as the same time as the growth spurt. This leads to an imbalance between osseous growth and the relative tightness of the tendino-muscular system. This relative tightness of the hamstrings and anterior hip muscles increases lumbar lordosis and dorsal cyphosis and, can lead to Sheuermann's disease or spinal growth dystrophy. This illness, usually not painful, can become symptomatic with the practising of lifts which starts at too young an age in teenagers.

Stress fractures of the spinal isthmi

In addition to the morphological anomalies of the lombosacral hinges, the collective aetiological factors for stress fractures of the L5 isthmus, Fig 1., are: stress during compression and shearing movements, muscular imbalance of the trunk flexors - extensors, the hyperlordosis required to compensate for the lack of lower limb turn-out or to perform certain choreographic gestures, the retraction mainly of the psoas, the hardness of certain floors, repeatedly performing lifts badly and the growth of disharmonious musculature.
Isthmoid fractures would affect 20% of dancers and usually occur between the ages of 9 and 15. They are usually localised on L5, but can be multiple and occur at superior lumbar levels. Fig 2, 3 et 4. The discovery of an isthmoid lysis or a spondylolisthesis does not mean that ballet must be stopped as long as L5 does not slide over S1 by more than 40% (spondylolisthesis in stages 1 or 2)Fig 5.
Treatment, when the diagnosis is early, lies in the dancer wearing a corset for at least a month. Ballet can then be resumed progressively with a lumbar belt, coupled with a suitable re-education programme. This lumbar belt can be worn later on for practising new lifts or new choreography.
A symptomatic treatment is necessary when diagnosis is delayed and the stage of chronic stubborn pains is reached. Dancers must wear a lumbar belt when they feel pain and, after an appropriate re-education programme, follow a personalised daily exercise itinerary which will usually allow them to continue dancing.


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.