Injury Prevention vs Injury Reduction

by Mark Archer, Sports and Dance Physiotherapist

Physiotherapy at Trinity Laban Conservatoire of Music and Dance. Photo: JK Photography.

As a physiotherapist working with dancers, I encounter a lot of injury. As well as managing the recovery phases of injuries, I also implement strength and conditioning programmes and psychological profiling to reduce the incidence of injury in the first instance. Working with the ‘before, during and after’ of injury in this way, however, has led me to make some important distinctions.

“Injury can carry negative associations – embarrassment, weakness, vulnerability”

To injure or not to injure? It may seem like an innocent semantic quibble, but using the term ‘reduction’ rather than ‘prevention’ is key to how my approach to injury has shifted. In response to research that shows that a huge percentage of dancers experience injury every year, a lot of time, money and resources have been poured into injury prevention initiatives. Screening, assessment, education, physical conditioning and psychological tools all form part of strategies to prevent injury.

All of this has a valuable role to play in a dancer’s self-care, but it rests on a deeper held belief that injury is actually avoidable, and that by implementing A, B and C, we can predictably prevent D. I want to remove this belief and suggest that the term injury ‘prevention’ can reinforce invisible pressures on dancers to maintain a model of health that is actually impossible to achieve.

‘Prevention’ sets up a polarised view of health versus injury. We already know that injury can carry negative associations for dancers – embarrassment, weakness, vulnerability. Does the word ‘prevention’ unconsciously reinforce a sense of shame around injury, heightening the pressure to ‘push on through’? And as a clinician, what do I say to the client who has followed my ‘prevention’ programme to the letter and still comes back to me injured?

Sometimes, however prepared you are, things go wrong. Can we find a way of talking about injury that accepts this uncertainty?

Of course, we want to optimise a dancer’s opportunity to stay fit and free from pain. But injury is a reality. I don’t suggest that we stop implementing ‘pre-habilitation’ or that prevention programmes are naively invested, only that we develop a more pragmatic acceptance of our vulnerability. We’re not bullet-proof; we‘re not tanks. Any ‘prevention’ strategy that suggests otherwise fails to support us with kindness when something does go wrong.

So, back to the semantic quibble. For me, injury ‘reduction’ is a more accepting and realistic term referring to the management of perceptions and expectations around injury. Acceptance is hugely needed, yet surprisingly absent, within the dance population. Acceptance is needed on a personal level, particularly to counter negative self-talk (such as “I don’t get injured”, “I don’t have time/ can’t afford to be injured” and “everyone’s relying on me”), as well as on a collective and organisational level. The impact of injury is managed considerably better when everyone is accepting of and adaptable to injury status.

Armed with a pragmatic notion of reduction rather than the impossible task of prevention, I think we’re better equipped as dancers, teachers and clinicians to deal with the curve balls that life sometimes throws at us.

Originally published in Dance UK  magazine, Issue 88 – Autumn 2014