Exploring the Impact of Chronic and Overuse Injuries on the Psychology of the Dancer
I currently work in a High School context where we offer dance from S3-S6 incorporating National Progression Award level 4, National 5, Higher and this year, for the first time, Advanced Higher and HNC units for those dancers who already have Higher and are looking to progress. As well as offering dance on the school day curriculum we offer an after school Higher which gives pupils outwith S5 and 6 but with the required expertise to complete the course, as well as pupils who may wish to take a sixth Higher. We also offer this course to pupils from schools within the council area and beyond who don’t yet have dance available.
Additionally, I teach as part of our after school programme and I have devised and teach a Wellbeing Award which involves health and fitness modules taking advantage of our onsite gym facilities.
Finally, I am on the supply teaching list at Dance Base in Edinburgh delivering a diverse mix of classes including Highland (beginners and improvers), Musical Theatre and Lyrical Jazz.
Unfortunately due to an ongoing foot injury my work is seriously hampered. I have been unable to train as a Highland dancer for over a year and I find I can do less and less in terms of modelling when in class. After school is less of an issue as I have S6 dance leaders who has been delivering the classes and I am ably supported by the Midlothian Dance Development officer when teaching S3. Choreography is my focus for Higher this year to lessen the impact on my foot.
Six years ago I fractured the third and fourth metatarsals in my left foot while highland dancing. As is the nature of the competitive world of highland dance there is a lot of pressure (both from teachers and self) to ‘dance through the pain’ and so I strapped it up and carried on, not realising the extent of the damage to my foot. After a couple of weeks the pain got too much and I eventually went to hospital. I was forced into recovery but as with many dancers found it difficult to rest for the allotted amount of time. I went through extensive physiotherapy to get me back dancing as soon as possible and was able to return to competitive highland dancing. Unfortunately, two years ago I started to develop pain in the ball of my foot underneath the two previously injured metatarsals which was initially diagnosed as metatarsalgia. I was able to dance through the pain with strapping and anti-inflammatory medication for a year but after being admitted to hospital with ligament damage due to my gait when dancing more thorough investigations got underway.
I tried a series of orthotics and steroid injections but nothing worked and I eventually had to give up highland dancing and be very careful about other exercise I was doing. I was diagnosed with a Morton’s Neuroma (a swollen nerve in the ball of the foot caused by rubbing of the metatarsals with the nerve tissue.) Even walking is painful. Now, after a series of scans I am on a waiting list for surgery which is due to take place in early February.
Chronic or overuse injuries such as these are common in dancers but what is the impact on the psychology of dancers who face these problems? And how will understanding this psychology develop teaching and learning of dance?
Donna Krasnow, Gretchen Kerr and Lynda Mainwaring conducted a study into the ‘Psychology of Dealing with the Injured Dancer’ as part of Medical Problems of Performing Artists (1994) which explores the practical and psychosocial barriers which prevent dancers from seeking medical assistance following injury and how some of these barriers can be removed.
It is perhaps no surprise that:
“Although the majority of dancers report experiencing pain during or after class, few cease training because of injuries.”(Krasnow et al, 1994).
More startlingly, 97% of dancers studied (the study looked at amateur and freelance dancers rather than professionals with access to medical treatment on site) reported having been injured but of this amount only 20% reported these injuries.
Of the 20% that did report injury, 43% carried on dancing despite doctors’ warnings. (Robson and Gitev, 1991). This makes dancers highly prone to reinjury.
The researchers found the main problems encountered by dancers were:
- Not enough medical professionals with training in dance medicine
- Long waiting lists for treatment
- Most dancers injuries are chronic or overuse rather than traumatic so therefore are not seen as an emergency amongst medical professionals
- If a dancer is asked to temporarily stop dancing they appraise this as traumatic and ‘impossible’ perhaps due to short careers, fear of deconditioning, losing technique, delay of graduation (university or college students) and pressure from above (teachers, choreographers, companies etc.)
The recommendations Krasnow, Kerr and Mainwaring give at the end of their study are:
- To increase expertise in dance medicine
- Work on better dialogue between medical professionals and dancers
- Counselling for dancers
- “Educate dance teachers and choreographers about their roles in injury prevention, recognition, acceptance and rehabilitation.”
- Education is also needed for teachers, choreographers and companies to reduce overuse injuries
Having suffered from an injury for a number of years I agree with much of the research study, particularly that teachers, rather than allowing dancers to rest, often push too far and teach with a ‘mind over matter’ philosophy. We did it as children so we expect those we teach to do it too.
Given the nature of my research area it is important to recognise that there is much to be gleaned from the world of sport and also to recognise that dance is not as well researched so in order to understand the psychology of injuries I must read from the world of sport initially.
There is a dearth of lists on the internet of negative emotional responses to injury: sadness, isolation, irritation, lack of motivation, anger, frustration, changes in appetite, sleep disturbance, disengagement, low self-esteem. These are expected findings of this type of research, however, could there be a positive psychological impact?
A Spanish study by Rebeca Liberal, Andrés López-de-la-llave, María C. Pérez-Llantada and Alexandre Garcia-Mas, Psychological Impact of Sports Injuries and Psychological Wellbeing in relation to Sports Performance in Competition Gymnasts (2014) found a positive correlation between injury and improved performance in their research.
The authors had felt that there were lots of studies into the physical aspects of injury but few into the psychology, how it effects sports people’s lives and how it effects them both pre and post injury. Therefore, they conducted a comparative study into the issue.
Much as with dance, injuries are considered part and parcel of competitive sport but Liberal, López-de-la-llave, Pérez-Llantada and Garcia-Mas were interested in how the athletes themselves felt about these injuries using an integrated model of personal development composed of six dimensions: self-acceptance, positive relations, autonomy, environmental mastery, purpose in life and personal growth.
They were conscious before they started investigating that mental preparation is vital for all sports people and hoped that the impact of this on injury would be paramount. Although for many this may be an unexpected expectation they were proved right:
Although it is “logical to think that the impact of having suffered a sports injury would subsequently affect wellbeing and performance….on the other hand, it is possible that the state of psychological wellbeing could help improve athletic performance.” (Liberal et al, 2014)
Fourteen gymnasts were selected for the study and each was asked to rate the impact of their injuries to their lives on a scale from 1 to 10 where 0 meant no impact and 10 indicated severe impact. Not one gymnast rated their injuries less than 6 in severity of impact and more than half rated the impact as 9 or 10.
However, delving into the psychology behind the injuries researchers found that as competitive athletes the gymnasts were motivated to get back to their best and this motivation translated into a significant improvement in overall athletic performance in the aftermath of injury compared to their competition results pre-injury.
Of course the sample size was small and focussed on just one specific sport but it was interesting to read an alternative point of view and to read about positive rather than negative impacts.
In completing this project, my overarching aim is to better understand the psychological impact of chronic and overuse injury in dancers and be able to adapt teaching and learning accordingly, based on results. In order to achieve this, I aim to:
- Investigate potential negative and positive psychological impacts of injury
- Critically evaluate my own experience of dance injury and how this impacts my teaching
- Critically evaluate the impact of injury on young people and develop strategies to lessen the potential negative psychological harm caused by them
- Raise awareness of psychological impacts of injury on dancers (and potentially other competitive athletes)
- Develop my own research and project management skills
- What are the possible negative psychological impacts of injury on the dancer?
- Are there any positive psychological impacts of chronic and overuse injury on dancers?
- How do these potential psychological impacts manifest in the dance studio environment?
- What can be done to limit any negative psychological impacts of injury on dancers (both teachers and students)?
- How will these findings impact teaching in learning in my dance studio?
As an arts student I am more naturally inclined to use a qualitative approach but much of my reading on the course to date has used quantitative or mixed methods approaches. I know that interviewing and questionnaires will form a sizeable part of my research but Likert scales are an increasingly popular way to get mass opinions quickly. “Likert scales use psychometric testing to measure beliefs, attitudes and opinion. The questions use statements and a respondent then indicates how much they agree or disagree with that statement. Usually, a scale of 0-10 is provided with Likert Scale questions, although shorter scales may also be possible.” (https://blog.smartsurvey.co.uk/advantages-of-using-likert-scale-questions/)
This will allow me to gain lots of opinions quickly unlike my qualitative research which will involve the in-depth interviewing of a small sample of ‘injured dancers’.
I will use a non-probablity, purposive sample. I have chosen this type as I need a specific set of candidates for my research with specific experiences, however, during my research into sampling methods it became clear that there are dangers with this method. As each sample is based entirely on the judgment of the researcher, there is a possibility of researcher bias towards the subjects and therefore the answers they give (Oppong 2013). Having clear intentions and a sound understanding of ethics should limit or negate this impact.
Researchers need to be constantly aware of how and why they are conducting their research and recognise at what points their own beliefs, opinions and prior assumptions might influence data collection or analysis. Researchers must be professional at all times, ensure they get the informed consent of all participants, ensure protection from any harm during the process, have respect for the integrity of the participants, ensure privacy, make participants aware of their right to withdraw at any time and do not get personally involved and lose objectivity. This could be potentially difficult given the nature of the study looking at potentially sensitive issues but with professional integrity at the heart of all we do as teachers I must just be aware of the potential problems with conducting a small scale study and keep them at the forefront of my mind when I am conducting my research.
Finally, in order to understand how teaching and learning can be adapted, observation of uninjured and injured students will be necessary. With the injured students it will be an interesting observation to note at what stage of their injury they are in and watch them progress through the various stages and observe what teachers need to do to support learners through each stage.
During and following the research my hope is to better understand myself as a dancer and teacher and self-evaluate the skills I have and the psychological impact my own injury has had on me. With further study of other test subjects I hope to see a pattern of common impacts of chronic and overuse injuries and, based on this, to develop strategies to help young people overcome these potential difficulties.
Depending on the success of the project this information could be vital not only to dancers and dance teachers but to sports professionals and coaches, PE teachers and the medical profession. This could be disseminated through presentation and/or publication.
Advantages of Using Likert Scale Questions. (2016) [online] Available at: https://blog.smartsurvey.co.uk/advantages-of-using-likert-scale-questions/ [Accessed 4 November 2016]
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