Fond of dancing since early childhood, Grace fell in love with the art form and became a serious student of it as a seventh grader at the Academy of Notre Dame de Nemur, a school in the Philadelphia suburbs with an extensive dance program. She was a freshman when her chronic foot pain started.

Now 15 and a sophomore, Grace dances five days a week, performing with Notre Dame’s Upper School Dance Company and at a local dance studio as well. Last summer, she qualified for the Pennsylvania Ballet’s prestigious five-week intensive course.

“The studio is like a second home for me,” Grace says. During most of the year, she spends about 15 hours a week dancing.

Increased training time and an increase in pain

Each year, her studio time increases as December approaches. The holiday season is awhirl with activity for Grace, with annual performances of The Nutcracker Suite — Grace plays several roles in the classic ballet — as well as competitive performances in other styles of dance. Rehearsals for these performances can last until nearly 10 p.m.

Grace loves the excitement of that time of year, but more hours mean an increased risk of injury, and during her first winter in high school, Grace began experiencing persistent pain in her quadriceps so severe that it threatened to sideline her.

“My quads were strained to the point that my knees gave out when I was just walking,” Grace says.

Luckily, Grace’s dad, Theodore Ganley, MD, happens to be the orthopaedic surgeon who leads CHOP’s Center for Sports Medicine and Performance. He knew just what to do.

Getting connected with the right dance medicine specialists

“The clinicians at our Sports Medicine and Performance Center’s Dance Medicine Program have undergone training focusing specifically on understanding and treating dance-related injuries,” Dr. Ganley says. “It’s an extraordinary team, and I knew Grace was in capable hands there.”

Getting Dancers Back on Their Feet

After an office visit to Naomi Brown, MD, Grace started physical therapy at the Sports Medicine and Performance Center with Kristin Goldstein, PT, DPT, a physical therapist who specializes in dance medicine.

“Grace had strained her quad muscle over the course of a few days, during a time of intense rehearsals,” Goldstein says. “There was a competition coming up and a performance that weekend, so we looked at how we could manage the injury, what she would be able to do in her performance and how to get her ready for that.”

Goldstein advised a couple of days of rest so that Grace could heal sufficiently to participate in her performance.

“We also talked about ways she might be able to modify some of her techniques and moves so that if the leg wasn’t feeling 100 percent, she might be able to land differently or do something with the good leg instead,” she says.

To Grace’s delight, she was able to return to dancing in time for her performance.

Reducing injury risk with physical therapy

The longer-lasting benefit of the sessions came from exercises and techniques designed to prevent injuries — practices Grace has taken with her to the studio and the classroom.

In addition to the quad injury, Grace has chronic problems with her heels: Achilles tendonitis, posterior tibial tendonitis and Sever’s disease, which affects foot bones that are still growing. All of these can be characterized as repetitive stress or overuse injuries, and stretching and strengthening exercises are key to keeping them at bay.

“I don’t like taking time off, so I try to do as much as I can to prevent injuries,” Grace says.

Grace’s classmates benefited from her experience as well, when CHOP’s dance-specialist physical therapists visited her school to give a presentation to her classmates.

“We enjoy the injury-prevention aspect of the work, and helping the dancers — making sure they’re ready to start pointe work or identifying things that could lead to injuries down the road,” says Goldstein.

“There are certain muscle groups that need to be strong and able to move in the right way. If we can show them skills and techniques that help them better utilize certain muscle groups, they won’t go down the path of overusing the wrong muscle groups or irritating certain areas or joints,” she adds.

Recently, Grace suffered a more acute injury while dancing in dress shoes when her foot slipped out from under her.

“She caught herself,” Dr. Ganley says, “but she got a quad strain. It wasn’t terribly severe; it didn’t require surgery, but the dance-medicine therapists helped her recover quickly.”

“The exercises they taught her don’t just help with the injured quad muscle,” he says. “The area of injury is connected to an entire kinetic chain that’s linked in function. Physical therapy has helped her with core strengthening and hip strengthening and the entire extremity — both extremities!”

Understanding a dancer’s unique needs

The success of physical therapy in the long term depends on the patient’s willingness to continue doing exercises that prevent injury. “Physical therapy isn’t a place; it’s an action,” says Dr. Ganley.

Part of the strength of the Center for Sports Medicine and Performance is that its dedication to enhancing the performance of highly accomplished young athletes helps keep patients on track with exercises. “Kids tend to focus more on the sports part than on the medicine part,” he notes. “It’s important to them that doing the therapy improves their performance as well as treating their injuries.”

Goldstein concurs: “Dancers tend to be in tune with their bodies, but we are dealing with adolescents, so there are a lot of things going on in their life. They’re growing, they’re starting high school, and there’s a lot of pressure to perform.”

Dancers very much appreciate being treated by physicians and therapists who specialize in dance medicine, Goldstein says. When they see the Center’s ballet barre and other specialized equipment, “They really light up! It’s important to them that we understand what they’re trying to do.”

Grace says that physical therapy in CHOP’s Dance Medicine Program has helped her develop healthier practices regarding dance.

“Ballerinas tend to push through the pain, which is not ideal,” she says. “Now, if something’s really bothering me, I go to physical therapy, and I might take a couple of classes off. If I ignore injuries and don’t take care of my body, it ultimately slows my growth as a dancer.”