Musculo-skeletal   [back to the Category]

Over the Head Lifts in Dance and Low Back Strain   [read the french version]

Author :   Jarmo Ahonen, PT Helsinki, Finland

Over the Head Lifts in Dance and Low Back Strain.

A Biomechanical Survey Supported by a Case Study

Jarmo Ahonen, PT
Finnish National Ballet, Helsinki, Finland

The strain placed on the spinal structures in over the head lifts is of great amount. The commonness of spondylolysis and spondylolisthesis among dancers is often connected to extension forces in the lower lumbar spine. When lifting the fellow dancer over the head, the dancer´s back is placed under more stress. Any deviations out of the perfect alignment of the spine may be crucial for dancer´s back. The role of proper abdominal control and lower extremities is important to control the pelvis. Even greater importance is on the position of the upper body of the dancer on the top of the pelvis. Dancer’s own upper body puts a load on the lowest vertebras of the spine equivalent of half of the body weight. The load caused by the fellow dancer in vertical lifts is more than doubling the strain on the lower back on a dancer lifting over the head. The poor control of pelvis may be caused by hip flexor tightness, poor abdominal control and misplacement of the thorax on the top of the pelvis. This however, is often caused by tightness of the shoulders and limited shoulder/scapular flexion. Arms are needed in vertical position in over the head lifts. If the shoulder/scapula flexion movement is limited thorax will compensate by posterior rotation causing the thoracic spine to hyper extend. This on it’s behalf is changing the forces on the low back and extends the lowest lumbar vertebras.

A case study: A 35 years old male ballet dancer was studied through an extended period of time. He had a serious history of back pain with severe spondylolysis and spondylolisthesis in LV along with the radicular symptoms in LV l.sin. He was diagnosed with spondylolysis and olisthesis twenty years ago at the age of fourteen. He was not given advice to change his technique at that time. Pain disappeared with some treatment so he continued dancing without changing anything. Later on pain started again. After many years of on and off coming problems he was finally diagnosed with radicular pain and MRI showed disc prolaps with osteophytes and scar tissue. He went through a surgical operation 1996 and returned to dance after rehabilitation. The symptoms disappeared and he was able to go through a good soloist career as a principal dancer. However in August 2002 he finally faced the reality with his back and doctors told him that there is nothing surgical that can be done. And if they would try his chances were no better than 50 percent. This finally helped him to decide to start changing his working patterns. He was taken out of dance training in August 2002 because of a constant severe pain in his low back with the blessing of the company director. MRI showed severe changes in between the vertebras. The back was so tender that he could not even be touched for any treatment. Pain was accompanied with cramps in the legs, especially in calves. Pain medication was for no help. Gentle exercise program was started to relieve the pain and gradually he was able to sleep fairly well. The basic principal for training was to change the posture of the low back in all every day movements and later apply all the changes in to his dance training. Applied Pilates training was the key in planning the program. He was very well motivated and was able to deal with some collapses in the rehabilitation period. In two months he was able to start dance training in ballet class barré but no more. Weight training was introduced when there was adequate control on the spine. The great break through was right before Christmas 2002 when he was able to lift a ballerina weighing 46 kilograms over his head. Later on he took up jumping and was able to perform Tybalt in Romeo and Juliet in mid January. And in the beginning of February he danced as Romeo with great success.


Discussion: It was very encouraging to see how fast somebody who has danced more than 25 years can still change the patterns of his dancing. The pirouette axis was found and he became a much better turner. His lifts over the head improved and became more elegant. And best of all his pain was gone. He also bought a few more years to his career. It is emphasised how important it is to consider the role of good technique in injury prevention. There is plenty of literature on this. But many dancers are hard to convince that they really have to make a big change in their movement patterns before they can be well again. It is also encouraging to see that the principles set by Dr. Seppo Seitsalo in his studies with spondylolysis on dancers really make a difference and dancers don’t have to stop dancing although they may have both spondylolysis and spondylolisthesis.