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Being involved in the dance field both as a dance teacher and a movement analyst, I have guided many dancers through their injuries. My focus is as an educator, having a strong belief that if students understand how the body was designed to move anatomically, then they can find the best way for their body to create the beautiful gestures and movements that are asked of them. I have been incredible fortunate to have a very minimal injury history even though I have danced since I was 5 years old. (I'll say no more than more than 40 plus years have passed since then). Recently, I had my first significant injury that took me down a whole new path of being the patient instead of the teacher or therapist and it has been an eye opening experience.
It all began innocently enough, reaching backwards as I sat on a chair by the computer to catch a heavy book that was sliding off the pile of papers at my desk. I successfully caught it and immediately felt a sharp pain in my shoulder joint, and what felt to be warm fluid flowing down the inside of my arm. I grabbed my arm, thinking to stop the blood flow - fearing to take my hand off - sure that I would see blood.
Most gratefully, there was no blood to be seen when I released my hand, and I began to gingerly move my arm and shoulder to make sure everything was still working. I was clear that something significant had happened to my shoulder, but also thought that if I went to the emergency room or my favorite sports medicine doctor, there wouldn't be much they could do for me as I could still move my arm in almost full range of motion with only a small amount of tenderness. No one wants to be thought a hypochondriac, right?
Mistake Number 1: Trust what you know about your body!
Most dancers tend to minimize what they feel in their body. Perhaps it is because we are taught that there is a certain amount of pain that goes along with being a dancer. Perhaps it is because we know the uninjured dancer who would love to go on for us is waiting just off stage. Perhaps we have stopped listening to our bodies years ago when we were ridiculed for showing emotion when we were scared or sad, or injured. Whatever the reason, I decided that even though I KNEW something significant had happened inside my shoulder joint, I decided that it wasn't 'bad enough' to go to the doctor.
Since the original injury happened after Christmas, I had a few weeks before returning to my normal teaching schedule. At first, my shoulder would only bother me if I slipped on the ice and my arms flew up to balance me. Then it began to bother me when I raised my arms to fifth position - so I just allowed the left arm, which was the injured shoulder, to open to the side a bit, and could fake my way through. What finally convinced me to get to the doctors (almost a month after the original injury) was that my range of motion was decreasing. I also began to feel more pain when I was taking my arm out to second or doing an arm circle.
Rule number 2: The body ALWAYS compensates for injuries and sometimes the compensation will create more trouble than the original injury.
Off I go to my favorite sports medicine physician, Dr. Vernon Patterson. He's a model for the type of dance doc we all want to have. He is part of the team that takes care of the Cleveland Indians and also the soccer players, ice skaters, dancers; whatever type of athlete comes his way. (I'll also mention that he is a DO or Doctor of Osteopathy.) He listened carefully, watched me show him the problem movements, put his hand on the joint and surrounding muscles to feel what was happening as I move it, and then calmly went through the possibilities of what may have happened.
“Deborah, you've clearly irritated the bursa which gets impinged when you take your arm out to the side. You may have torn some cartilage - but we can't know for sure unless we get an MRI. Let's take a look at the shoulder with an x-ray, get the inflammation calmed down and see where we're at - maybe we need to do some physical therapy.”
(Silently, inside my head, I'm saying thank goodness - he's saying 'we' - we'll work on this together - and he's not ridiculing me - I guess it was okay to come in - he's taking my complaints seriously!)
I have to laugh at myself - I'm a mature, intelligent, articulate woman who works with rehabbing dancers through their injuries as my profession - and this is what is running through my head as I'm in his office? Shame on me, I know better!
Insight number 3: When you are a dancer or person who defines themselves as a physically active and healthy individual - you sometimes lose perspective when something happens to your body. This is why we need a network of qualified support.
Time passes. Addressing the inflammation helps some, going through a course of physical therapy helps some, but the range of motion is not returning, if anything feels as if it is getting worse, even though my pain is not increasing. (A clue that I don't understand at the time - more on this later.)
The MRI shows a little of this, a little of that, (a slap tear, possible bicep tendon tear, some fraying of tendons, some inflammation) in other words, some possible problems areas, but none that explains fully why I am continuing to have these problems. As Dr. Patterson told me, my shoulder looks like the shoulder of someone who has been active all his or her life - which I have, first in gymnastics, and then in dance. I have always had what would be considered flexible, mobile shoulder joints. It's what allowed me to participate in gymnastics, and gives my port de bras a nice line. No signs of arthritic changes in the joint or the bones, so I was okay with hearing that perhaps my muscles and tendons were showing some signs of age.
Three months after seeing Dr. Patterson and doing everything I could do that was non invasive we decide that it is time to see a surgeon who specializes in shoulders. I was lucky. I live in northeast Ohio, and got an appointment with the surgeon who takes care of the Cleveland Indians. (A major league baseball team for all of us who don't follow sports)
Dr. Mark Schickendantz is the surgeon and he is a pro. I can sense his incredible expertise as he looks over the MRI report, compares the motion of my two arms, and briefly goes over the possibilities of what arthroscopic surgery would entail. My assessment of him was friendly, articulate, and he didn't seem at all bothered by my questions. How someone answers my questions is extremely important to me, as I need to understand the situation and build trust in our relationship before I feel comfortable in letting anyone care for me. I make the date for arthroscopic surgery at the end of the semester.
Fact number 4: Dancers can find creative ways to make it 'look right'.
During the next 4-5 weeks prior to surgery I explore teaching a beginning modern dance class when only one arm will cooperate. My students quickly came to understand the directions - “two arms please” - as I pulled back in my demonstrating. I didn't appreciate how many ways there were of cheating until my upper back and neck muscles were yelling at me to give them a break. I decided that I would be better off not using that arm in any regular way because I was abusing all the muscles that were attempting to muscle my arm up when it stopped rotating correctly.
My ability to give verbal directions and use imagery improved as I demonstrated less - and my students began to own their own movement - rather than trying to look like me. This is a lesson that I will take with me into my next semesters of teaching, especially being a more mature teacher. (That's what dancers and dance teachers become as they age, wiser and more mature, not older, yes?)
Surgery goes extremely well. I have a block instead of general anesthesia, wake up in recovery, and feel extremely well. No post-operative pain! My friend Judy is there to take me home. I wait the hour or so that is required and go home with the coolest shoulder ice pack ever. It's a big square that you slide into a cover, and then with Velcro straps wrap over and around your shoulder. It is a memento from the surgery that I am glad to have. Icing with it effectively took care of the discomfort over the few weeks. I will admit to enjoying getting extra help around the house from my kids AND feeling pretty chipper and good.
Surprise number 5: MRI's are great, but don't always tell the whole story.
The big surprise was finding out that I had a good case of adhesive capsulitis. This is when fascia or scar tissue binds the joint together, limiting its range and creating painful movement. Or, as I came to find out, if you simply don't take the arm into the painful range, then it will continue to bind the joint, and only hurt when you try to push it into ranges it doesn't want to go.
Adhesive capsulitis happens more to women than to men, and is considered an autoimmune disorder. In my case, it came on secondary to a traumatic injury (me trying to partially dislocate my shoulder by reaching back like I did). My body responded to the initial injury by creating these adhesions that then were surgically peeled away from the joint. (My surgeon gave me some before and after pictures during the surgery - very cool!)
I begin physical therapy about two weeks after the surgery, which was slightly delayed by scheduling. I requested of my surgeon that I work with someone who was highly skilled in biomechanics as I intended to get full strength and range of motion back. It was my incredibly good fortune to begin work with Jim Mahalik, a physical therapist for the Cleveland Indians.
Our first visit was an hour-long beginning with detailed measurements, watching my movement, and then Jim began to manipulate my shoulder through many different ranges of motion. Physical therapy continues over the next 3 months.
Fact number 6: Physical therapy requires patience, discipline, and willingness to work through your frustrations and disappointments.
Even though there was incredible discomfort through the first few weeks of physical therapy, I really appreciated being under someone else's able hands. Jim relentlessly worked to break up adhesions and increase my range of motion. I would go home and immediately ice my shoulder. Like most dancers, I didn't mind the discomfort when I felt like we were going in the right direction.
Jim was amazingly patient with me, helping me to understand both the focus and the reasoning behind what he was doing and in what he was giving me for my home program. I was going to be his most compliant patient every, I vowed to myself. This wasn't going to be like when I vowed to do cardiovascular work 5 days week, or stay away from sweets - I was determined and unwavering in my own focus. Dancers have a special relationship with their bodies - most would say that their worse nightmare is to be immobilized. This certainly is true for me, and even though it was my shoulder that was affected, and not my hip, knee or ankle, I still didn't feel complete, my life felt slightly 'off' because of this injury.
I get the go ahead to begin strengthening - I can begin working on the Pilates again, and with a theraband. I'm ecstatic! If once a day is good, then perhaps twice a day is better! This point in rehabilitation is a tricky one - it's like a dancer with tendonitis. You are walking a fine line between strengthening and overworking and can expect to take 5 steps forward and then 2 steps back, as Jim constantly reminded me.
Reminder number 7: Let your pain be your guide. Make sure you are deciphering its messages correctly. Check with your doctor or therapist if you aren't sure.
What took me by surprise was how hard the two steps back would be. I was the dancer who picked combinations up quickly, and had an excellent relationship with her body. When my shoulder started to ache and I started getting impingement pain when I lifted my arm up, it was so easy to drop into thinking that I was back to square one, that this was going to take forever and I was a failure at rehab!
I'd catch myself in my erroneous thinking - and Jim was quick to remind me that there is a certain length of time that is needed for the tissues to heal and respond. This time period is going to be the same for me, or for the professional baseball player, or for the executive who is a couch potato. I forgot where I was just a few short weeks ago and how far I had come. I decide that keeping a notebook for my observations and comments/questions would be useful during this process - a way of doing my own reality checks on how well I was doing.
Fact number 8: The last 20 percent of gain will take 80 percent of the rehabilitation time.
Jim tells me, “you're doing great, and you have to expect this last bit of rehab to take the longest. It may be 6 months to a year before your arm feels right,” he cautions. I nod my head that I understand and silently vow to take one day at a time, to not let my fears get the upper hand in this process. I remind myself to appreciate and revel in how well my body can move and function and how wonderfully responsive it is to my wishes and demands.
Insight number 9: There are always unexpected lessons to be gained from challenging situations.
I come away from this process with a new appreciation of how strong an identification dancers have with their bodies. I am thankful that in the greater scheme of things, this was a relatively small challenge to overcome. I am more convinced than ever that as a dancer you must find qualified resources to help you through the ups and downs of an injury.
The dialogue with my body is deepening from this experience. With the incredible guidance from my extraordinary therapist, Jim, I know I will more effectively guide other dancers in their own rehabilitation processes from going through them myself. Their experiences and injuries will always be uniquely their own, but certainly there are common issues and concerns that we can help each other with - even if our experiences aren't exactly the same.
Fact number 10: Prevention is always better than rehabilitation.
One cannot turn back the hands of time, but if I could, I would have focused more on my upper body. Dancers need to make sure they have the appropriate strength and flexibility in their shoulder girdle. The dancers I see tend to be woefully deficient in their ability to stabilize their shoulder joint against injury. (I include myself in that list.)
The elegance of the port de bras is determined both by the flexibility of the shoulder girdle and it's ability to stabilize the shoulder blade to allow for that long neck and graceful line. Balancing out the strength and flexibility can be tricky to do only in class and it may be useful to supplement your class work with time spent doing free weight work, or some form of Pilates or yoga to strengthen the area.
If an injury occurs, breathe deeply, trust your inner knowing, and be patient. Time and competent guidance are needed along with knowledge that you can become a stronger and more beautifully balanced dancer because of the rehabilitation process - not in spite of it.
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