When to Seek Care
When it comes to joining a new dance company, starting a summer intensive, or increasing your level of physical activity after a break, muscle soreness is to be expected. In some cases, additional aches and pains like reactive tendinopathies may come with the territory as well. The question often arises regarding how to differentiate between delayed onset muscle soreness (DOMS) from increased physical stress or an ache or pain that is more emergent. When, in other words, is it that you should seek an evaluation from a healthcare practitioner?
Here are a few rules of thumb:
In the first week or so of dancing, you might experience DOMS. DOMS is common with a sudden increase in activity or with particularly strenuous training sessions or rehearsals. Though the exact mechanism of DOMS is not clearly understood, symptoms typically include feeling achy, tender or sore. DOMS should subside after 2-3 days and should generally feel better after you’ve warmed up your body. Most of the time, there’s no reason to visit a health care professional if you have DOMS1.
There are some aches and pains that should not be ignored. If you experience soreness that keeps getting worse with each class you take, that changes the way you move or dance, or that persists for more than two days, you should get it evaluated by a healthcare practitioner. It should go without saying that if you have a sudden injury in class as well, you should have it examined by a professional*.
If your intensive, school, or company has a physical therapist in-house, go to them first. If you don’t have care in your facility, ask your teacher for the name of a physical therapist, osteopath, or medical doctor and make an appointment sooner rather than later. Injuries tend to get worse the longer they go untreated, so even if you think it’s not such a big deal now, still consider seeking care. As the saying goes: better safe than sorry.
*In this case, a professional includes: athletic trainers, physical therapists, medical doctors, osteopaths etc.
Seeking care and becoming an advocate for yourself
Every school or company has a different healthcare system in place and has its own way of dealing with injuries. It is important to familiarize yourself with the way your school, company or studio is structured so you can make it work the best for you. Some schools have medical doctors and/or physical therapists in-house who will evaluate you. Make sure you know how to sign up for these services. If you have questions, ask your dance instructors, your studio or school’s administrator or your counselor if you are in a summer intensive. In some cases, your school or studio’s healthcare system might be explained in a handbook.
If you find that you have an injury and cannot be seen by the medical professional on staff because their schedule is full, you have a few options. You could (1) ask for a referral for a healthcare professional outside of your studio and schedule an appointment with them or (2) contact the physical therapist or physician on staff at school to let them know that you are concerned about your injury and need to be seen, but there are no slots available. If your only option is to schedule an appointment during class time, it is imperative that you contact your teachers, counselor and/or your studio’s administrator to let them know where you will be or why you will be late.
During your visit with a medical professional, you should be evaluated and have your questions answered. They should then give you recommendations as to how to proceed given your present symptoms. Health care professionals like physical therapists and doctors have your best interests at heart, but sometimes they can miss the mark for a variety of reasons. You know your body best, so it is important to speak out in the following events:
If something your doctor or therapist is doing hurts or is making your pain worse, speak up and let them know. Some pain might be expected, but your healthcare provider should always know how to redirect their treatment to make you feel most comfortable.
If your doctor or therapist has told you they think you can dance through something, but that advice does not feel right, tell them or seek another opinion. Dancing through significant pain can make things worse.
Conversely, if your doctor or therapist has told you NOT to dance and you think there is a way you can modify class and keep doing part of the choreography, tell them and discuss this. It might be that the best option is rest, but you can educate yourself by having this discussion with your healthcare practitioner.
If you don’t understand WHY you are doing something or want more comprehensive guidelines for how to manage your issue, ask.
One thing to keep in mind, however, is that whatever you and your healthcare practitioner decide, it is important to stick to the plan you’ve put in place. For example, if you’ve decided it’s best not to jump for a week, you should refrain from jumping in class, rehearsals and out of the studio!
Dealing with your injury in class
It is important to communicate with your teachers about your injury. Not only is it respectful to tell your instructors why you may be modifying or not participating in parts of class, but it will also keep you from pushing yourself beyond what is safe or appropriate at your stage of healing.
If you have been working with an injury, find your teacher prior to the beginning of class to speak to them about your limitations or constraints. In the event that you are in class and you find you have mounting pain with movement or you twisted your ankle in the middle of a jump combination for example, it is your duty to inform your teachers in a way that will not disrupt class. Kailey Lasley, executive director of The Lasley Centre in Warrenton, Virginia and ABT® Affiliate Teacher, has her students abide by the following guidelines, “In the event that an injury occurs during class, our students know that they need to inform us immediately as we would not want a small injury to become exacerbated because a dancer tried to push through the pain. Our students are trained come to the front/side of the room and curtsy and wait until the instructor can acknowledge them, they can then explain any minor pains that might be potential problems, these are always addressed without breaking the continuity of the class.” Some summer intensives have counselors assigned to a particular level or cohort of students. You will also want to communicate with this individual about your injuries, aches, and pains so they can help you navigate the process of finding healthcare or speaking to your teachers.
In the event of an injury, you may feel like it is a good idea to leave the classroom to find help, but no matter what, remember to communicate with your teachers first! Ms. Lasley says, “As a matter of classroom etiquette it would never be acceptable for a student to leave the classroom without permission (in addition to being disrespectful it becomes a safety issue because we are responsible for students while they are on the premises), or interrupt a class already in progress.” Your teachers are there to help you and have your safety and best interests at heart!
Remember, if you need to sit out of or modify a class, you should always be evaluated by a healthcare practitioner to make sure you get the care you need to keep your injury at bay. And as Ms. Lasley suggests, “always follow up!” Be sure that you continue to keep your teachers abreast with your progress.
A Few Things to Remember
Your company, studio or school’s healthcare and dance faculty care about you immensely, but it is important to remember that you are your own best advocate. It can feel daunting and challenging to find your voice, but in the event that you feel uncomfortable or are having pain, speak up for yourself! You are the person in the room who cares most about your long-term career. Learning how to communicate your needs will enable you to have a long, healthy dancing career.
Cheung K & Hume PA. Delayed Onset Muscle Soreness: Treatment Strategies and Performance Factors. Sports Medicine. 2003; 33(2): 145-164.
Dr. Marissa Schaeffer earned her bachelor's of fine arts from SUNY Purchase College Conservatory of Dance, her doctorate in physical therapy with honors from Columbia University, and is a Certified Strength and Conditioning Specialist. Dr. Schaeffer has worked with dancers of all stripes from SUNY Purchase and Barnard Colleges to Alvin Ailey American Dance Theater, to Broadway, to the New York City Ballet. Additionally, she co-hosts DanceWell Podcast which releases bimonthly episodes on health and wellness for dancers.
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photo credit for second photo: Photo by Danica Paulos @lens_of_the_heart