Bending over backwards

As part of our blog series we wanted to open up the floor to our therapists to write about something that they are truly passionate about. Today's post is from Lucie Rayner. Lucie is an experienced Chartered Physiotherapist specialising in treating performing artists with a wide range of musculoskeletal problems, having worked with dancers, musicians, and musical theatre performers from amateur to elite level.

Lucie is a great fit for Production Physiotherapy as she has completed a Sport Science degree and Post Graduate teaching qualification at Loughborough University before gaining a first-class honours degree in Physiotherapy. In 2020, she completed the MSc in Performing Arts Medicine at University College London (UCL), where her research on spine screening in dancers won the Dean's Prize for research.

Having  gained experience in the NHS, school and private sector as well as with us at Production Physiotherapy for nearly two years, Lucie has been an assessing clinician for The British Association for Performing Arts Medicine (BAPAM) and runs workshops on health-related topics such as injury prevention. This year, she will co-lead the 'Pain Management and Disability in the Performing Artist' module for the Performing Arts Medicine Master’s programme at UCL. Needless to say we are so happy that Lucie works with us, and now we have a platform to help her share her vast experiences with you, here. Take it away, Lucie.

Dancing at an elite level requires significant flexibility of the spine, enabling the dancer to execute good technique and perform challenging choreography. A key feature of the dance aesthetic is spine extension or ‘back bending’ movements. In classical ballet this can be seen in movements such as arabesque, grand battement derrière and cambré, which require significant amounts of spine extension. Many other dance styles such as jazz, contemporary and hip-hop also feature back bending movements, often into extreme ranges of motion.

That said, the lower back itself is one of the most common injury sites for dancers and has been linked with performing movements which repeatedly take the spine into maximal end range extension, this significantly tests muscular control in these extreme ranges. For this reason, most dancer health screenings for vocational schools or professional companies include measurement of spine range of movement. This helps to identify both hyper and hypomobile spines in dancers who may benefit from specific interventions is an injury prevention programme.

Dancers often strive to gain extreme levels of flexibility in the spine, and this has sometimes been encouraged by choreographers, social media, TV dance programmes and competition judges. However, research has shown that pushing to exceed certain limits of spine extension can cause strain on anatomical structures and lead to injuries such as Spondylolysis. In addition, dancers may adopt poor technique when attempting to achieve positions of hyperextension, leading to strain on the vertebral discs and compression of the Sacroiliac Joint.

A simple depiction of spinal extension

Spine extension is also a composite movement, with many segments contributing to the overall range. It has been proposed that if one segment is significantly more flexible than others (i.e., ‘hinging’) this will increase injury risk, as the hypermobile segment is exposed to greater loading. From a performance perspective, an equal contribution from all segments is considered more visually appealing, although this is subjective. Injury prevention focuses on optimising range of movement, and strength through range, in the spine through a carefully supervised programme with a Physiotherapist or coach. This ensures that a dancer can adequately control their available range of movement with relatively uniform loading throughout the thoracolumbar spine. These programmes should be tailored to the individual dancer and could include strengthening, facilitating core/trunk control, technique adjustments and/or proprioceptive training.

Well-executed dynamic spine extension movements are stunning to watch, not only in dancers but in other performers such as circus and aerial artists. In my work, I aim to support the performing artist to optimise this key element so they can achieve the desired aesthetic lines without compromising safety and wellbeing.

Thanks for taking the time to ready this