Ankle sprain is the most commonly experienced acute injury in dancers. Adolescent dancers have an even higher risk of ankle sprain than adult dancers. While sprains are often perceived as trivial injuries, they should be taken seriously to ensure proper recovery.
Ankle sprain is a stretching or tearing of a ligament(s) in the ankle. It is usually caused by “rolling out”, specifically when landing from a jump or while en pointe or demi-pointe. Ankle sprain is the most common dance injury, and is especially common in individuals with high arches. Approximately 85% of ankle sprains are lateral sprains, in which the pinky side ligaments of the ankle become stretched and injured (Dubin et al., 2001).
A mild sprain (Grade I) is a stretching or slight tear of the ligament, and increases the chance of a second injury. Moderate and severe (Grades II and III) sprains are a partial or complete tear of the ligament, and accompanied by swelling and bruising, as well as impaired walking and weight bearing.
Although it may be tempting to get an x-ray to determine the extent of the injury, x-rays cannot detect ligaments. An MRI, or arthoscopy (in the case of surgery) are the best diagnostic tests.
Treatment and the Return to Dance:
Mild to moderate sprains can be treated with ice, rest, and a gentle range of motion (ROM) compression wrap around the ankle. Moderate sprains may also require a boot or aircast for up to 3 weeks. Aircasts, tape and soft stirrup-style braces are effective only when used in combination with a shoe, so barefoot dancers are better off using a soft leather lace-up style brace.
While it may be tempting to “dance it off” or take little rest since “it’s just a sprain”, long-term complications can include osteoarthritis, chronic inflammation and neuralgia (pain and tingling). Dancing through an injury can also lead to compensatory changes in technique that can lead to overuse injuries.
According to Brotzman & Manske (2011), a dancer may return to normal activity in 1-2 weeks for a Grade I sprain, 4-8 weeks for Grade II sprains, and 12-16 weeks for Grade III sprains. However, cross-training of the upper body and other non-injured areas will help maintain the dancer’s level of fitness, making the return to normal activity easier.
More severe sprains may require surgery and/or physical therapy, and can cause long-term complications if left untreated.** A study in the British Journal of Sports Medicine demonstrated that 70% of ankle sprains resulted in chronic symptoms, including post-traumatic ankle arthritis.
Proper rehabilitation including proprioception training and strengthening exercises are important to regain the wide range of motion required for dancing.
In a study involving 115 adolescent dancers, previous sprain was found to increase the likelihood that a sprain will occur on the other (contralateral) leg (Hiller et. al, 2008). The same study cited articles (McHugh et. al, 2006 & Tyler et. al, 2006) that suggest that previous ankle sprain (on the same leg), increased body mass index, and decreased range of motion in dorsiflexion are implicated in increased risk for lateral ankle sprain, however Hiller et. al (2008) were unable to substantiate those findings. It should be noted that the findings of McHugh et. al (2006) and Tyler et. al (2006) were not specific to dancers.
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