Q&A: Life as A Touring Physical Therapist

Posted On: November 19, 2019

Dance requires incredible strength, stamina, and flexibility. Broadway and touring performing artists dance an average of eight shows a week. Add to that, the countless hours in rehearsals. Their exertion level rivals, if not exceeds, that of professional athletes! Therefore, it’s not uncommon for dancers to experience pain.

Performing repetitive movements for hours a day coupled with a low amount of recovery time in between shows, increases the performer’s risk for chronic overuse injuries (in addition to the ever-present risk of an acute injury). In most cases, pain is due to muscle soreness that resolves in a day or two. However, sometimes there is something more to blame—that’s when you should see a physician or your physical therapist!

Here are some common dance injuries, including the pain associated, how to prevent and how to treat them if it occurs:


Ankle sprains are the most common traumatic (or acute) injury in dancers. Most dancers will experience their first sprain by age 13. This injury is caused by any movement that forces the ankle outside of the normal range of motion, resulting in an overstretching or in tears to the ligaments of the ankle.

  • Pain: acute onset with pain on the inside or outside of the ankle, swelling and bruising may be present in more severe cases
  • Prevention: 4-way ankle exercises, hip strengthening
  • Treatment: RICE, joint protection, early mobility, physical therapy
    • PT is extremely important because the ligaments will never heal back to the pre-injury level. Therefore, strength and motor control must be improved in order to avoid re-injury.


Achilles tendonitis is an inflammation of the tendon in the back of the ankle that connects the prime mover for pointing to your foot. As the Achilles is active during relevé and pointing the foot, this overuse injury is quite common in dancers, especially those utilizing improper technique or participating in excessive training.

  • Pain: gradual onset of pain and tenderness just above the heel which may feel better when warmed up, but worse with jumping, relevé, or pointe work
  • Prevention: stretching your Achilles with your foot in parallel, quadriceps/hip/core strengthening to decrease force absorption at the ankle
  • Treatment: Physical therapy focused on correct training technique, modalities to decrease inflammation, calf stretching, and soft tissue to calf and surrounding musculature
    • It’s important to treat early as to prevent tendon rupture!


Trigger toe is another overuse injury that causes inflammation and damage to muscle that is active during pointing the big toe.

  • Pain: gradual onset of pain along inside of ankle and under the foot while pointing the big toe which may also feel like big toe is “stuck”
  • Prevention: good form with your relevés and not crunching your toes to force a pointe, rolling out the arch of your foot with a ball (but not to the point of pain)
  • Treatment: physical therapy (correct technique, modalities to decrease inflammation, stretching, massage), surgery to release tendon from surrounding tissues if symptoms do not resolve


Ankle impingement is the pinching of tissues at ankle (tibia and talus) at either the front or the back of the ankle

  • Prevention: stretching your Achilles and stretching (but not forcing) your pointe
  • Anterior (front) Pain: pain at the front of the ankle with plie and landing
    • Treatment: PT to improve mechanics and technique (manual therapy)
  • Posterior (back) Pain: pain at the back of the ankle with tendu or relevé
    • Treatment: PT to improve ankle mechanics and technique (manual therapy), surgery if there is a bone spur or “extra bone” between heel and back of tibia


Snapping hip syndrome often starts as an annoying snapping sound in the front of the hip with developpé or battements. However, over time, iliotibial band (IT band) tightness and weakness of the outside of the hip can cause the snapping to become painful.

  • Pain: snapping/clicking sound in front of the hip with developpé and battements
  • Prevention: foam rolling your hip flexors, quadriceps, IT band, and glutes as well as strengthening your glutes
  • Treatment: PT with core strengthening, pelvic stabilization, modification of class and rehearsal work until symptoms resolve


Hip impingement can be caused by many different factors from arthritis, labral tear, stress fracture, muscle strain, snapping hip syndrome, sacroiliac joint dysfunction, to piriformis syndrome. It is extremely common in dancers due to the imbalance between the amount of external rotation (turn out) they have compared to the amount of internal rotation (turn in).

  • Pain: passé, developpé a la seconde, pain with flexion and internal rotation (turning in)
  • Prevention: foam rolling your hip flexors, quadriceps, IT band, and glutes as well as strengthening your glutes
  • Treatment: PT with stretching, hip/core strengthening, pelvic stabilization, dance modification and rehearsals; may result in surgical intervention as needed


Patellofemoral Pain Syndrome, also known as “jumper’s knee,” results from the kneecap “tracking” incorrectly due to muscle imbalances like tight hamstrings and calves coupled with weak quads. The placement of repetitive forces on the patella, like through performing jumps or plies without proper form puts a dancer at increased risk.

  • Pain: pain in the front of the knee with jumping, plie, or stair negotiation
  • Prevention: core and hip strengthening; foam rolling hip flexors, quadriceps, IT band, and glutes
  • Treatment: physical therapy with focus on core and hip strengthening, IT band stretching, and re-education of dysfunctional movement patterns

When should you be concerned that the pain you are experiencing is something that you should get checked out by a healthcare professional?

If you experience pain at night, pain at the start of your activity, pain that increases with activity or pain that causes compensations and changes in mechanics while dancing (or in day-to-day life), you should check in with your physical therapist or physician.

In the meantime, try to stay healthy by staying hydrated, eating a well-balanced diet, avoiding overtraining, allowing for rest days, participating in proper cross-training, making sure you are wearing well-fitted shoes and listening to your body!

If you do experience an injury, it’s better to address it sooner rather than later, so that you can take care of it and get back on stage. The sooner you address injuries, the less severe the complications may be and therefore, the less time (if any) you’ll have to spend away from dance!


Dance Injuries: Diagnosis, Treatment, and Prevention Webcast

Johns Hopkins Medicine

Rajwinder Deu, MD; Amanda Green, DPT, COMT; Andrea Lasner, MSPT, PMA-CPT