Kirsten Patrick on dance medicine

Kirsten PatrickThis week, thanks to a pledge of £30K from the dance floor company British Harlequin, Dance UK’s dream of establishing a UK National Institute of Dance Medicine and Science chasséd a little closer towards becoming a reality. Two years ago Dance UK, along with Laban, Birmingham Royal Ballet’s Jerwood Centre for the Prevention and Treatment of Dance Injuries and the University of Wolverhampton announced that they would like to set up an Institute of Dance Medicine, and the Jerwood Charitable Foundation pledged the first £80K of the 550K that would be needed to fund the project. So now they’re a fifth of the way there. Tough job raising money for good causes in the current economic climate, it seems!

But why have a national Institute of Dance Medicine? Dance UK conducted two surveys of dancers in the UK, in 1996 and 2005, to gather information on the types and rates of injury suffered by dancers as well as information about key aspects of their health and well-being and what health services companies provided for dancers. They found that rates of injuries amongst dancers are high and that only a few of the large professional dance companies provide a tailored medical service for their dancers. Since dancers are athletes and it’s rather unsurprising that they get hurt frequently it seems crazy that Dancers don’t get the kind of athlete-specific medical care that ‘sports’ athletes do. But most often they don’t.

Picture the scenario. Injured dancer, pretty low paid so not on private health insurance, shows up at A&E or GP surgery with injury. Can the general doctor he or she sees meet the needs of this person? Can they treat effectively and refer efficiently enough to ensure that the dancer has the best possible outcome for them? Are doctor and dancer on the same page in terms of what they see as a good outcome? I’d say it’s likely that they aren’t. The most important things for the dancer, as would be the case for any serious athlete, would be “how soon can I get back to my training?” and “will the treatment that I get now set me back in my training and fitness?” The treating doctor, focused on acute management of the injury might not have these things top of their agenda, might not refer to a specialist, might not consider physiotherapy to be necessary … might not “get” how important a good recovery is to the dancer, who will hope to return to a level of functioning that is beyond that of your average Joe English. I suppose one might argue that this is the plight of the good-but-not-elite sportsperson too, someone to whom sport is a really important part of existence and who wants to go back to function at a high level.

As an ex-dancer who had to stop dancing following an injury I sympathise with the plight of dancers. However, I wonder if we really need a National Institute of Dance Medicine and Science in order to make sure that dancers start getting the sort of care they need, especially since it seems that the funding to set it up isn’t flooding in. Couldn’t we just class dancers as athletes and remember to treat according to the principles that we’d use to manage sporting athletes? And also remember that we need to find out what is important to the patient in terms of his or her outcome.

Earlier this year the BMJ published a Patient Journey article in which Isobel Knight told her tale of life with Joint Hypermobility Syndrome. She’s a dancer and notes, unsurprisingly, that joint hypermobility syndrome is more common among dancers than non-dancers “because of the desirable aesthetic qualities of hypermobile limbs.” In her article she describes years of pain, injury and fatigue related to the interaction between her syndrome and her choice of occupation. On reading the article for the first time I realised that the reaction of many would be, ‘So why did she not just stop dancing?” I both thought this and understood why she didn’t. I have joint hypermobility and my dance-related injuries began at the age of 15 when my kneecaps began to subluxate every so often owing to laxity of my patellar tendons (still makes my skin crawl to think of it). I did have to give up dancing but I was gutted. I’d have given away organs to be able to carry on. There’s something about the way that having an incredibly fit and flexible body to run around in makes you feel that is hard to let go of. Dancers, and athletes, find it hard to shift down a gear when they injure themselves. We clinicians should remember that and consider that the outcome they want is not necessarily the same as the outcome that we consider to be adequate.

Kirsten Patrick is clinical reviews editor on the BMJ.