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Chronic low back pain in young dancers: why do many suffer from "back pain"?




















Lumbago, or pain referred to the lumbar part of the spine, is one of the most common problems among dancers of all ages: in some studies carried out on professional dancers, for example, this problem is reported by over 70% of the interviewed subjects (Solomon et al., 1989). The problem of "back pain", as it is commonly called, is therefore very vast and can be referred to multiple causes: for this reason, I decided to divide the topic by dealing, from time to time, with specific types of low back pain.


We begin to consider the causes of chronic low back pain in young dancers, or in the students of dance schools: we will, therefore, talk about that sense of soreness and stiffness in the lumbar spine that often accompanies children for long periods without ever becoming unbearable, that is it is more intense in the last part of the lesson and/or tests, which response only partially to drug therapy and which, ultimately, does not require the suspension of activity but which prevents the correct execution of many exercises.


One of the first specialists to deal with the problems of young dancers was Dr Lyle J. Micheli of Children's Hospital in Boston who, in a 1983 article published in the journal Clinics in Sports Medicine, spoke of "mechanical low back pain" as the most common type of low back pain among students of dance schools both at professional and amateur level. This term means a pain localized to the lumbar spine which arises due to the inability of the spine to correctly distribute (and therefore to bear) the load, in the absence of signs of the suffering of the anatomical structures involved. back pain.into consideration not only the relationship between the position of the pelvis and lumbar spine but involving in the I also work the rest of the spine, creating a constant connection between the position of the head, chest and pelvis both in static and dynamic conditions (control of the "centre").


After a period of more or less time from the onset of pain, the child is normally visited either by the General Practitioner or by a specialist: the physical examination is almost always negative, or all the maneuvers performed by the doctor are unable to evoke the pain, there are no signs of involvement of specific anatomical structures and, above all, the mobility of the vertebral column is not at all limited indeed, if compared with that of the normal population, it is still higher than the norm. Even the instrumental investigations are of little help: the radiographs do not show any damage and even more in-depth examinations, such as for example the Nuclear Magnetic Resonance, do not describe problems that can certainly be referred to as the cause of the pain.


At this point the question that arises is: why then does this young dancer have "back pain"? The answer is theoretically simple: "because he does not correctly use his back during the dance lesson" while it is more difficult to systematize this clinical condition and above all to plan its treatment from a medical point of view.


One of the first specialists to deal with the problems of young dancers was Dr. Lyle J. Micheli of Children's Hospitale in Boston who, in a 1983 article published in the journal Clinics in Sports Medicine, spoke of "mechanical low back pain" as the most common type of low back pain among students of dance schools both at professional and amateur level. This term means a pain localized to the lumbar spine which arises due to the inability of the spine to correctly distribute (and therefore to bear) the load, in the absence of signs of suffering of the anatomical structures involved.


Still in the same article, still today a point of reference for all those who deal with Dance Medicine, it was explained that young dancers are almost always able to align their spine more or less correctly at rest but, often, they lose the control of their "lumbar tract" during the execution of the movement, placing the rachis in a condition defined by the Author "dynamic hyperlordosis".


More than 20 years after the publication of the aforementioned article, strengthened by the most recent advances in the field of biomechanics and physiopathology of the spine, we are able to reconnect the appearance of low back pain in young dancers to different conditions linked both to the setting of the trunk and to real technical defects. As for the setting, we can say that already a simple inability to control the "center" during the entire excursion of the movement, puts the lumbar spine in a condition of functional fatigue that, in the long run, can manifest itself with the appearance of pain.


To make a diagnosis of mechanical low back pain, all other possible causes of low back pain must be ruled out and, for this reason, a young dancer who has been complaining for a certain period of time of an insistent lumbar pain must nevertheless be subjected to instrumental diagnostic investigations (Rx, MRI ; etc.) and to a careful clinical examination that includes not only a static postural analysis but, possibly, the observation of some movements involving the vertebral column. The ideal would be for the doctor to be able to analyze the execution of even simple dance movements such as relevé, arabesque or cambré to check whether, in these situations, the subject is able to properly detune or mobilize the rachis correctly.



The inability to stabilize the lumbar tract is linked, always and in any case, to a defect in the setting of the pelvis: if this is too much tilted forward (anteversion), the curves of the spine tend to be accentuated and all the weight rests precisely on the stretch lumbar (see figure, position B). Since the attitude just described does not fit well with the aesthetic canons imposed above all by the study of classical dance, this defect is, at present, relatively rare to observe even among amateur students.


There are several clinical studies that show that this defect is prevalent in the students of the first courses rather than in those of the more advanced courses (Clippinger-Robertson, 1991); among older children, however, it is quite often possible to point out another wrong postural attitude commonly referred to as "fatigue posture" which consists in the habit of tilting the pelvis forward and moving it anteriorly to the axis of gravity so that the standing can be maintained almost without muscular work (see figure, position D). This attitude is observed with greater frequency in boys who present a "generalized capsuloligamentous laxity" and who associate, to this position of the column, an evident hyperextension of the knees.


To prevent the development of mechanical low back pain in boys who show the defects described above, it is not enough to recommend a generic work of "strengthening of the abdominals" because the work of this muscular group must always be related to that of the chain of the posterior muscles which, in the in most cases, they appear shortened and rigid, especially in adolescents under development. Postural re-education, as already mentioned above, must be based on a slow and continuous stimulation to the global rebalancing of the muscles involved in the control of the trunk position, taking into consideration not only the relationship between the position of the pelvis and lumbar spine, but involving in the I also work the rest of the spine, creating a constant connection between the position of the head, chest and pelvis both in static and dynamic conditions (control of the "center").


But the fear of being with "the sit outside" leads, very often, both pupils and teachers to run into the opposite defect: the pelvis is tilted back (retroversion) and the curves of the column tend to flatten until they disappear (see figure , position C). This erroneous attitude of the pelvis, which is still confused with the correct setting of the trunk (see figure, position A) causes a stiffening of the entire vertebral column, a constant stress in flexion of the lumbar tract and, as in the previous case, an overload functional of the same that can become the main cause of low back pain.


I think it is also useful to point out that the retroversion of the pelvis can only be obtained through an excessive and constant contraction of the large gluteal muscle (especially of its lower fibers): the result of this type of work is muscle hypertrophy, or its increase in volume accompanied by a shortening. In simple terms, the more the young dancer tries to "keep his bottom in", the more the muscle mass of the buttocks increases and becomes evident.


In the long run, this setting defect also has repercussions on the development of the musculature of the lower limbs which, forced by the position of the pelvis to work constantly in shortening, hypertrophy in turn making the dancer's body take on a "stiff" and "squat" appearance ". Finally, in classical dance students, retroversion of the pelvis interferes with the extent of the external rotation of the hip and, unlike what many think, decreases the chances of performing a correct en dehors.


Also in this case postural re-education is based on the realignment of the vertebral column and on the rebalancing of the deep musculature (to reduce the activity of the superficial musculature and correct the hypertrophies), with particular regard to the work of the diaphragm and the pelvic floor muscles since , the boys used to work with the pelvis in retroversion, are not able to correctly use neither the breathing nor the impulse and the energy derived from the activation of the musculature of the pelvis.


In conclusion, the role of the doctor in the treatment of mechanical low back pain of young dancers is relatively marginal: through a careful evaluation, he can in fact put a correct diagnosis and facilitate, with the prescription of a possible pharmacological therapy, the immediate attenuation of pain. The definitive disappearance of painful symptoms, however, can only be achieved by modifying the way in which the dancer moves.


This process, in most cases slow and tiring, involves first of all the subject in question who must become aware of his difficulties and his postural defects with the help of a Rehabilitation Therapist and / or a Support Technique Teacher , and secondly the Dance Teacher who must be able to favor and constantly monitor the correct use of the spine during the dance lesson.

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