The diagnosis and treatment of injuries isn’t up to you…
Experienced dance instructors have seen hundreds of sprained ankles. We know the signs, symptoms, and basic treatment of common dance injuries. Heck, I spent the last year of graduate school studying how to identify and treat injuries.
Regardless of the extent of our knowledge, it’s important that all dance instructors understand the clear boundaries between our jobs and that of a health care professional. Though doctors often lack experience working with dancers, there are a few reasons why dance teachers should steer clear of diagnosing or treating their students’ injuries:
Health care professionals have licenses for a reason.
While it is fine to make “recommendations”, you should be very clear when talking to an injured student and/or her parent that you are not a doctor, and use extreme caution when mentioning any sort of treatment or medication. Using suggestive rather than definitive language looks like this:
“Well, it looks like it might be a sprained ankle. You may want to put some ice on it and elevate your foot. I’m not a doctor, but your symptoms are consistent with a sprain. To be sure, I would get it checked out.”
What NOT to do:
“You sprained your ankle. Put some ice on it and elevate it, take some ibuprofen and in about a week or two you’ll be ready to dance again.”
If, in fact, your student didn’t sprain her ankle but instead broke her foot, tore a ligament, snapped a tendon (or perhaps has an allergy or negative reaction to the medication you recommended), following your advice is a quick way to a shortened career and, potentially, a lawsuit.
Injuries can be complicated, and aren’t always what they appear to be.
During college, a friend and fellow dancer Melissa Carlson (now Lewis) found this out first hand. In her words:
After landing a grand jete with my left foot turned under, I noticed immediate pain; severe bruising and swelling ensued within an hour or two. Thinking that it may just be strained or sprained (or in truth–NOT THINKING!) I attempted to dance on it the next day, despite the fact that my foot was much too swollen to fit inside a ballet slipper. I finally went to the ER for x-rays and found that the 4th and 5th metatarsal bones had broken.
Later that week, I went to see an orthopedic specialist who prescribed three months of total rest and a regimen of nutritional supplements to help increase my lacking bone density. Being extremely unhappy with this reality of a diagnoses, combined with being headstrong and immature, I decided that the best way for me to heal was to pretend as much as possible that nothing was wrong and go back to dancing as soon as I was able to bear weight on my injury.
Of course my foolish inaction resulted in disaster, with improper and incomplete healing and the specialist suggesting surgery and a full year of rest… I did nothing of the sort, and went back to rehearsing and classes as soon as I was able. The short-tem results of the injury were pain and discomfort, whereas the long-term results have been the inability to wear pointe shoes or stand unsupported for long periods of time, and arthritis within that area of the foot.
Thankfully, through good nutrition and supplements I was eventually able to bring my bone density up to normal and keep it that way. Had I originally listened to the doctors advice, I think the injury may have healed with no severe consequences, like the ones I forced my self into suffering through bad judgement!
Dancers are passionate people, and our careers are short. During injury, we are so anxious to return to our craft that we often shortchange the recovery period. In truth, this probably contributes to why our careers are so short, and a little patience might create more longevity among dancers. Small injuries, left undiagnosed, misdiagnosed, or untreated can become career-ending injuries faster than you can say “metatarsal”.
The Dance Instructor’s Role
Instead of playing doctor, there are several important functions you serve that support a student’s recovery. Angeline Lucas nicely outlines a plan for dancers with chronic illness here on Dance Advantage. Injury management can and should follow a similar plan, and to summarize, here are a few key points:
Talk to the dancer, and the parent, on an ongoing basis throughout recovery.
Work in tandem with the doctor(s) using a team approach.
Provide a modified training plan and/or alternative activities.
Speaking of alternative activities, there are a few considerations for students who are returning from injury. Just because a dancer is down, it doesn’t mean she is out, and once cleared by a physician to return to activity it’s possible to train and take class keeping these important points in mind:
Let the dancer drive the bus.
Only the dancer herself knows what she’s feeling as she returns to dance. While you can provide a barometer based on feedback from the medical team and the student’s body language, it’s important to try and allow the dancer to take control of her recovery. This may sound contradictory to the story above, so let me reinforce that this is in cases where the dancer has been cleared for activity from her doctor.
Training the uninjured side while the affected side recovers creates a bigger problem.
Injuries often occur on the weaker side of the body, so if the dancer is recovering from a foot, ankle, knee, hip, shoulder, etc. injury it is important to not simply keep on with the uninjured side during recovery. If able to continue training, work equilaterally. Find activities that decrease, rather than increase the strength disparities between the two sides of the body. Maybe that means working on the floor, or in a pool, or simply not raising the arms overhead. If needed, work with a physical therapist to identify the needs of the student and create a program that will assist in her recovery.
That can be really hard in a class of 30 dancers…
Indeed. An older, trained dancer may be able to take responsibility for making some modifications, but it may be more productive to work one-on-one with her or have her work exclusively with a physical therapist.
In all cases, don’t be afraid to recognize what you don’t know, or can’t handle, and ask for help.