Physiotherapy   [back to the Category]

You Classical Dancer’s Neck   [read the french version]

Author :   Errol Toran, D.C

This month’s Case en Pointe concerns a dancer who presented with acute and sharp neck pain. The ranges of motion of the neck were severely reduced. She was unable to bend her head forward due to the intense pulling of muscles in the back of her neck and mid back. Tipping her head back or to the sides (ear to shoulder) were all severely limited and sharply painful. Neck rotation to the right and left were approximately half of the normal ranges although turning to the right was less limited that left rotation. When the pain was severe, she noticed shooting pain down into both shoulders and down the left arm to the elbow.

The pain onset gradually, and there was no trauma noted with the onset of symptoms. She described the pain was reduced in the morning but her neck was very stiff. If she took extra special care and time to warm up her neck and upper back she could get through class and rehearsal. The problem was that as the day went on the pain increased becoming sharper and "knife like" with certain movements. The neck ranges of motion also reduced as the day went on. She frequently got the correction that throughout her port de bras she would grip her shoulder muscles.

When we examined this dancer we found that the posterior neck and mid back musculature were in spasm. We also notice that the muscles under the chin were also in spasm, causing her head to be tipped downward (chin and nose to be pointing towards the ground). Her head was pitched forward, and not centered over her shoulders. The forward position of her head put extra tension into her shoulders causing the gripping of the shoulders in port de bras. When we took x-rays of her neck. We found that the normal curve was not only reduced but was reversed. The front of middle vertebrae were found to be severely degenerated. The degeneration was due to the chronic pressure on the front of the vertebrae.

The curve reversal is a common finding in classically trained dancers. This is due to the forced lengthening of the neck from a young age. In order for the neck to stand tall and straight, the muscles along the front of neck vertebrae (longus coli) are trained and get stronger and stronger. The strong muscle straightens the configuration of the neck bones then continues to pull them until the normal curve reverses. The increased pressure on the front of the vertebrae causes them to grind and gradually deform. This we know as arthritis.

This condition can be prevented if treated early. The idea is to counter act the effects of class and training. First one must understand that the vertebral segments lock and become less mobile as a protective mechanism. Mobilization in the correct direction is a must. This is the initial phase of chiropractic care. The tight longus coli muscles must then be stretched so that the compressive tension is reduced. We accomplish the stretching using massage, stretching routines, cervical traction and the use of a special pillow to support the neck during sleep.

The goal is to reestablish the normal cervical curve, while at the same time maintaining enough range of motion to allow the tall, lengthened neck line. This is the goal of the rehabilitative phase of care. It can last from several months to years. The length of time depends upon the severity and progression of the case. This young dancer had a relatively severe condition when she came in, her case will probably take longer. As one can expect, the sooner the condition is addressed the better the prognosis and the less care will be needed.