This is what I have currently written for my literature review, I now understand that it is not quite what was required although I will probably use and edit bits for my critical reflection but I thought I would share it anyway so people could get an insight into what kind of literature I have been researching for my inquiry.
Dancers Experiences of Injury and How They Cope
Literature Review
In my inquiry I want to explore dancers experiences of injuries. To do this I have split my review into four subheadings; Accepting Injury, Dance Injury vs Sport Injury, Coping Mechanisms and Treatment. Over the past few months I have been reading, watching and listening to other experts findings in order to create an accurate perspective on the topic. I have been able to access many sources which has allowed me to examine many debates which have expressed different views on the subject making me aware of the many variables which can affect how people cope with injury. I have used several different sources for my literature in this review to allow me to focus on a range of views and allow me to be inspired by or debate different theories that have been bought up in other peoples findings.
Accepting Injury
Injury rates for dancers can be as high as 97% (Kerr, Krasnow and Mainwaring, 1994) and 60 to 75% of dance injuries resulting from overuse (Thomas and Tarr, 2009). What I have discovered is that a negative emotional response frequently follows the onset of injury. The physical loss of not being able to train and perform is often accompanied by a loss of self-identity (Crossman, J. Macchi, R. 1996). These are some of the contributors which present amongst dancers and prevent them from seeing a medical professional.
Dancers are unique in the challenges they face during injury and rehabilitation. Due to circumstances and pressures that occur in the dance community many dancers are reluctant in acknowledging that an injury exists. Being injured in the dance world can result in being replaced, losing income and affecting future employment. Dancers have a lot of pressure from choreographers, peers, audiences and themselves to perform causing them to push through the pain (Thomas and Tarr, 2009; Anderson and Hanrahan, 2008).
Dancers also my have issues differentiating between the origin of their pain thus making it difficult to make the appropriate decision whether to carry on performing (Anderson and Hanrahan, 2008). There are two categories of pain, “good pain” (a result of exertion and pushing the body to its full capacity which is common during performance) and “bad pain” (pain caused by an injury). If a dancer is not correctly educated in the characteristics of these individual pains they may further exacerbate an unrecognised injury.
Dance Injury vs Sport Injury
Much of the literature I have studied has compared sport injury to dance injury. One thing that is often bought up is the high tolerance to pain that dancers have, this is a characteristic which is common with professional sports people. In 1995, Tajet-Foxwell and Rose carried out an investigation comparing dancers to non dancers using a Cold Pressor Test - A standard laboratory technique used to measure pain and pain tolerance thresholds. Their results demonstrated a clearly higher tolerance in professional dancers similar to professional sports people.
Clearly, although both dance and sports people are bought up in very different cultures with different training there are certain aspects of there profession which overlap. Due to the exposure to very physical training and increased fitness in both professions there are bound to be similarities in areas such as pain threshold and response to injury and I think this will is an interesting aspect to consider.
Encarnacion, Meyers, Ryan and Pease (2000) carried out a similar study and subsequently found no difference in the pain coping style in a group of 135 ballet dancers taken from a variety of stages in their training or career. This might suggest that ballet dancers, regardless of skill or age, tend to cope with pain and injury in a particular way. Contradictory to other studies, the authors suggested that ballet dancers do not exhibit pain coping styles similar to those of professional sports people. Both studies used measures of pain and coping style drawn from sports psychology, which may not take into consideration all the artistry involved in dance. Additional the second study did not take into account the severity of the injuries that the dancers had sustained.
Although a lot of research in dance psychology is derived from studies and research methods used in sports psychology I have observed that attributes of dance and dance injury are unique to the profession. For Example, Anderson and Hanrahan (2008) note that dancers experience a higher percentage of overuse injuries than athletes.
Coping Mechanisms
Every dancer has different ways of coping with the emotional strains that come with injury and it is something that I am very interested in exploring in my inquiry. An article which I read by Wozny (2012) Explores two contrasting perspectives about watching performances and rehearsals during a time of injury. On one side a dancer may want to distance themselves from the dance world as they may feel uncomfortable watching others do what they cannot. On the other hand some find comfort in maintaining a connection by watching or taking notes as a way of feeling involved. Both these are valid coping mechanisms which has allowed me to come to the conclusion that reactions to watching class or rehearsal vary in each individual.
Dancers can often feel pressured into returning to dance before injuries were fully healed. Since they invested a lot of time into reaching the current stage in their career they feel that they must perform through an injury. Due to the physical pain from injury and the pressures placed on them by fellow dancers these factors had triggered an emotional pain within the dancer (Alexander, Fields, Nehrenz and Rivera, 2012). They suggest that a dancer would push through the pain or past what they may feel comfortable doing in order to complete a performance or rehearsal. These findings are similar in studies conducted by Crossman and Macchi (1996) and Kerr, Krasnow and Mainwaring (2001).
A post by Long (2012) also compares three situations of dancers during different stages of their careers. Kate was a student who suffered from chronic stress fractures in her years of training. Jason tore his Achilles tendon leaving him unable to dances for a prolonged period of time leaving him feeling depressed and isolated and Jeanette was a retired dancer who had a successful career spanning over two decades without any setbacks cause by injury. These observations cause her the raise the questions;
“What was her secret? Was Jeanette simply older and wiser?”
Tarr and Thomas (2009) claim ‘there is evidence to show that as dancers age they are likely to be more aware of the warning signs of injury and to take steps to prevent it’. This could partially explain why through time Jeanette was able to have a greater understanding of her body and therefore prevent the onset of injury.
Treatment
In an interview by Christiansen (2011) the resident psychologist at the Royal Ballet Company Tajet-Foxwell observed that “two dancers with the same injury could respond to it in completely different ways, one making a full recovery, the other never even making it back on stage.’” This inspired her to discover more about the psychology of dancers. She now uses visualisation as a way of aiding people through a particularly tough injury. She encourages people to create an image of an injury, an example used in the article was one where a principal dancer Steven McRae had suffered from a ruptured achilles tendon which seriously threatened the future of his career. Having suffered from anxiety over the injury during recovery he turned to Tajet-Foxwell for help and he says “she made me visualise my good heel and my bad heel: the good heel was running water and blue sky, the bad heel was gnarled broken twigs and barren landscape. Slowly, I learnt to see the bad heel as good heel too, and I realised that the pain was in my head, not in my heel.”
This technique used by Tajet-Foxwell is one that greatly interested me so I want to look further into her studies.
All of the information I have gathered will help greatly in my inquiry especially in producing my professional artefact as I am aiming to create an accurate and genuinely helpful self-help guide for dancers suffering with injury. I have come to understand that there is no straight forward formula that if someone follows will help them cope the best during injury. Human nature dictates that everyone is individual in mind and body therefore each person has there own way in which to recover. Looking into a variety of literature has helped me to understand why people behave the way they do while injured, given me inspiration into things to including my survey and interviews and has allowed me to form my own opinions on how to help and advise people on how to cope with injuries.
References
Kerr, G, Ph.D., Krasnow, D, M.S., and Mainwaring, L, Ph.D. (2001) ‘And the Dance Goes On: Psychological Impact of Injury’. Journal of Dance Medicine & Science, Volume 5, Number 4
Kerr, G, Ph.D., Krasnow, D, M.S., and Mainwaring, L, Ph.D. (1994) ‘Psychology of Dealing with the Injured Dancer’. http://www.citraining.com/pdfs/Psychology-of-Injured-Dancer.pdf [Accessed January 2014]
Rose, F, D. and Tajet-Foxwell, B. (1995) ‘Pain and pain tolerance in professional ballet dancers.’ J Sports Med. 29(1): 31–34.
