No Pain? You Can Still Gain from Physical Therapy!

If Benjamin Franklin were a dance artist, he would undoubtedly revisit his famous quote about death and taxes to include one more of life’s eventualities: injury. Even if you manage to avoid an acute traumatic injury, you will likely encounter some kind of physical setback during your artistic career. Although this can seem disheartening, there are ways to mitigate problems before they escalate, and to prevent issues from arising in the first place. Physical therapy for dancers, though often thought of as a solution after an injury has occurred, can be a wonderful source of preventative care. To gain more insight on just how dancers can reap the benefits of physical therapy, I spoke with Robert Tsai, a physical therapist and founder of DANCE|PREHAB.

For dancers, injuries are daunting. Many do not seek care for a multitude of reasons. Firstly, there’s the fear of losing income. When a dancer is injured, they might be replaced, and they likely won’t get paid if they can’t work. Dance artists are notorious for dancing through pain, even if it may not be in their best interests long-term. There’s also the secondary fear of the price. According to the American Medical Association, health care costs are on the rise in the United States, and the financial burden associated with seeking medical care might be prohibitively high. Finally, there is the tertiary fear that their injury will not be taken seriously by the medical establishment. Dance artists are used to medical professionals misunderstanding their careers. Although dancers might joke among themselves that “the doctor just told me to stop,” this is a very real scenario. They are often left without viable solutions to their problems since many dancers are unable and unwilling to completely stop dancing for a multitude of reasons.

The idea of “no pain, no gain” is wildly unhelpful, and dancers should be encouraged to look after themselves and take it slow.

Tsai, being aware of these concerns, acknowledges the uphill battle that many dancers face when it comes to their needs, and highlights the special place that former professional dancers like himself can occupy within the community. “I am not the first physical therapist for the majority of people that I see,” he says, “typically, they’ve gone somewhere else and felt that they weren’t supported or understood…Besides the physical side of recognizing movement demand, there’s also the social and cultural side. We know what you have to get back to.” Thankfully, the fields of dance medicine and dance science are expanding now, with more and more professionals like Tsai coming onto the scene. Now, when a dancer Googles “dance physical therapy near me,” there are more options for experts who are better equipped than a regular physical therapist to meet the specific needs a dance artist will require.

Of course, most dancers are prone to type that Google query only when healing from an acute injury. These are the horrific moments that can haunt someone–the broken leg, the sprained ankle, the torn meniscus, or the ruptured Achilles tendon. After the event, the individual needs to take the time to heal and then rebuild. Physical therapy during the rehabilitation period will help the dancer to come back stronger, rather than rushing back into rehearsals and reinjuring themselves. The idea of “no pain, no gain” is wildly unhelpful, and dancers should be encouraged to look after themselves and take it slow. “Pain is our body’s way of telling us to pay attention,” notes Tsai, “if we don’t make time for our bodies at that moment, our bodies will force us to make time for it later. That might mean sitting out for longer or even backing off of dance completely.”

Aside from the possibility of sudden traumas to the body, many dance artists also face chronic pain. This can arise for multiple reasons, like repetitive motions, poor alignment, or an underlying injury that has never been addressed. Think of tendonitis or that nagging click in the hip that just won’t go away. When it comes to seeking out care for chronic pain, Tsai applies the Rule of Threes: “If it’s more than 3 out of 10 pain, you’ve had this pain for more than three days in a row, or there have been three classes that you’ve had to modify something. At that point, you should get it checked out.” Seeking care from a physical therapist can potentially help dancers reach the root of their chronic pain and address it. Tsai also highlights the possibility of a neurological component, “There’s a lot of dimensions to chronicity…our movement centers and our pain centers are very closely related in our brain. You can have healed tissues and your brain will still fire off pain signals because of the close relationship between movement and pain…If we [physical therapists] can rule out that nothing is happening physically, and that your body is just uncomfortable with these movements, a physical therapist can help you ease back into pain-free movement.”

Yet, even if a dancer isn’t in any pain right now, the benefits of physical therapy from a professional like Tsai will still be incredibly helpful. Preventative care is mostly about identifying potential weaknesses within the body and building a more physically resilient facility through strength training. “When we talk about strength training for dancers, what we’re talking about is progressive overload,” says Tsai. “This just means you’re doing things that require more effort and more demand than what you typically do. Unfortunately, dance movement and dance training do not lend themselves to building robustness and raising your physiological baseline.” Working with a physical therapist can help dancers truly improve their strength, balance, and proprioception in a way that dance classes never will. This can make dancers less prone to injury in both the short and the long run.

Furthermore, if a dancer has suffered a previous injury, continuing to work with a physical therapist can help them to develop some preventative care and practices that can keep a recurring injury at bay. If that isn’t possible, Tsai recommends building small habits into your daily life that can offset the older injury and keep the body strong. He uses the example of standing on one foot while waiting in line for dancers who have prior ankle sprains. Basically, dance artists should look to different kinds of exercises to help maintain and increase their physical abilities. Dance class alone will not provide it, and a physical therapist can help them to build the kinds of exercise routines that will serve them the best.

Aside from simply working with a physical therapist, Tsai stresses the importance of working with one who is a good fit for that individual. “When you’re going to see a provider, make sure you take the time and have the confidence to advocate for yourself…Are you getting the attention you need? And more importantly, are you getting the attention you deserve?” he asks. In order to utilize a physical therapist to their highest potential, dance artists have to feel comfortable in the relationship. As Tsai says, “You have to be able to speak up for yourself throughout the process of rehabilitation. Make sure you’re working with the right person for you.”

As amazing as it would be for every dance artist to have easy access to physical therapy, this is unfortunately not the present reality. The largest barrier for many is likely financial. Health insurance is expensive, and there are no guarantees that the artist’s plan will cover physical therapy services. Even if they do, it can be a headache to prove to insurance companies that physical therapy for dancers is necessary in the first place. More likely, the dancer will wind up paying out of pocket, and the cost can greatly diminish the time they’re able to spend with their physical therapist. Tsai suggests asking if your practitioner can superbill. “They’ll have to pay the cash rate, but then I’ll give my clients an itemized list of everything I did which they can submit to their insurance company for partial or even full reimbursement,” he shares.

Working with a physical therapist can help dancers truly improve their strength, balance, and proprioception in a way that dance classes never will.

Of course, even with work arounds like superbilling, physical therapy can still be hard to come by. Tsai recommends that dancers get to know their bodies–both strengths and weaknesses–on a deep level. That way, they can craft a warm-up that is designed to address whatever they may need to perform at their highest level. Tsai suggests that it should last about fifteen minutes and that dancers should consider their entire bodies. As he says, “Generally speaking, everyone can use the same types of movements, but there are some things that may need some more TLC, depending on the individual…I’ll tell dancers to not forget about their ribs, or maybe incorporate breathwork in different positions.”

For a more long-term solution, he is hopeful that his work with younger students will raise awareness of the importance of physical therapy within the community. “Instead of going top-down…let’s look at how we can get this knowledge to people earlier in life. I teach my kids things that they’ll need to know if they were to seek physical therapy in the future.” By giving his students clear instructions on basic exercises like how to squat and hinge, Tsai is preparing future generations of dancers for an easier recovery path as well as establishing a positive relationship with exercises and movements that are not purely dance-based.

In the end, unlike the visual artist or the musician who can put down their paint brush or instrument at the end of the day and walk away, a dance artist’s tool of expression is their body. There is no escaping it. Therefore, it is in their best interest as an artist to keep it strong, healthy, and injury-free. Physical therapy is preventative, not just rehabilitative care.

Robert Tsai is a Doctor of Physical Therapy based out of Orange County, CA. He works with all levels of performing artists through DANCE|PREHAB Physical Therapy.