CUHK Dance Medicine 中大舞蹈醫學 • Feb 17, 2020
Low back pain in dancers (Part I) 舞者的腰背疼痛 （第一部分）
Updated: Mar 24
Low back pain is common, with reported lifetime prevalence up to 50-80% in various studies. Dancers are not immune to low back pain despite their relatively stronger physique. In fact, they are at risk of certain types of low back pain given the high physical demand on spinal motions. There are numerous causes of low back pain in dancers, ranging from simple muscle strains to serious nerve or spinal cord compression. To better understand low back pain in dancers, we discuss some causes of low back pain and their management using a 3P approach (Presentation, Pathology, Prevention, and treatment)
Soft tissue: Muscle strain/sprain and muscle imbalance
Presentation:
An acute onset of localized tenderness over paraspinal muscles. The pain usually increases with motion but can be improved by stretching, rest and massage. On-and-off back pain with a flare-up, especially with improper postures or exertion (such as during showcases or competitions).
Pathology:
It is caused by excessive stress on lower back soft tissues, especially at the extreme lower back closed to buttocks. Since many dance forms encourage a hyperlordotic (arched back) and anteriorly tilted hip posture, it increases the stress on the lower back. Some dancers may experience pain because of the underlying lower cross syndrome, which is characterized by tight back extensors (erector spinae) and hip flexors (iliopsoas), as well as weak abdominal muscles (rectus) and hip extensors (gluteus). This muscle imbalance combined with training behaviors can or overload certain muscles and reduce the flexibility of the lower back.
Prevention and treatment:
In addition to rest, massage and medications (oral and topical) that can help relieve the muscle tightness, a more important aspect is to correct the underlying muscle imbalance. To prevent further muscle strain/ sprain, stretching of tight muscle and muscle reconditioning targeting at abdominal and gluteus muscles are essential as well.
Intervertebral discs: Discogenic back pain
Presentation:
Chronic low back pain that is axial in nature, and worsens with activities that increase the disc pressure (e.g. sitting/ bending forward, coughing/squeezing and straining).
Pathology:
An intervertebral disc is the shock absorber located between adjacent vertebrae. Repetitive stress and loading would lead to wear and tear of disc fibres, resulting in disc-related back pain. Badly executed dance moves that bring sudden or unaccustomed loading to the spine, alongside weak core muscles, may cause accelerated disc degeneration.
Prevention and treatment:
For short term treatment, medications and passive physiotherapy (e.g., therapeutic ultrasound, transcutaneous nerve stimulation (TENS), and massage) can help to relieve discogenic back pain. Braces/orthoses are sometimes used to help support the back temporarily and to limit motions that may induce pain in the acute phase. Nevertheless, long term usage of braces may cause reliance and further weakening of core muscles. The ultimate treatment for discogenic back pain is core muscle strengthening because strong abdominal and low back muscles can unload intervertebral discs, and lower the risk of early disc degeneration, discogenic back pain, and its recurrence.
Soft tissue: Muscle strain/sprain and muscle imbalance
Presentation:
An acute onset of localized tenderness over paraspinal muscles. The pain usually increases with motion but can be improved by stretching, rest and massage. On-and-off back pain with a flare-up, especially with improper postures or exertion (such as during showcases or competitions).
Pathology:
It is caused by excessive stress on lower back soft tissues, especially at the extreme lower back closed to buttocks. Since many dance forms encourage a hyperlordotic (arched back) and anteriorly tilted hip posture, it increases the stress on the lower back. Some dancers may experience pain because of the underlying lower cross syndrome, which is characterized by tight back extensors (erector spinae) and hip flexors (iliopsoas), as well as weak abdominal muscles (rectus) and hip extensors (gluteus). This muscle imbalance combined with training behaviors can or overload certain muscles and reduce the flexibility of the lower back.
Prevention and treatment:
In addition to rest, massage and medications (oral and topical) that can help relieve the muscle tightness, a more important aspect is to correct the underlying muscle imbalance. To prevent further muscle strain/ sprain, stretching of tight muscle and muscle reconditioning targeting at abdominal and gluteus muscles are essential as well.
Intervertebral discs: Discogenic back pain
Presentation:
Chronic low back pain that is axial in nature, and worsens with activities that increase the disc pressure (e.g. sitting/ bending forward, coughing/squeezing and straining).
Pathology:
An intervertebral disc is the shock absorber located between adjacent vertebrae. Repetitive stress and loading would lead to wear and tear of disc fibres, resulting in disc-related back pain. Badly executed dance moves that bring sudden or unaccustomed loading to the spine, alongside weak core muscles, may cause accelerated disc degeneration.
Prevention and treatment:
For short term treatment, medications and passive physiotherapy (e.g., therapeutic ultrasound, transcutaneous nerve stimulation (TENS), and massage) can help to relieve discogenic back pain. Braces/orthoses are sometimes used to help support the back temporarily and to limit motions that may induce pain in the acute phase. Nevertheless, long term usage of braces may cause reliance and further weakening of core muscles. The ultimate treatment for discogenic back pain is core muscle strengthening because strong abdominal and low back muscles can unload intervertebral discs, and lower the risk of early disc degeneration, discogenic back pain, and its recurrence.
根據各種研究指出，高達50-80%的人（終生盛行率）一生中曾罹患下腰背疼痛，可見這是個很常見的病患。儘管舞者的體格相對強壯，但亦不代表完全不受下腰背痛的影響。事實上，舞者因著對脊椎動作的高度要求，有罹患某幾類下腰背痛的風險。然而，從簡單的肌肉拉傷到嚴重的神經或脊髓壓迫—舞者的腰背疼痛可以有多種原因。為了更全面地了解舞者的腰背疼痛，我們將從解剖學和3P的方向（表徵、病理、預防及治療）對其進行分析。
軟組織： 肌肉勞損／ 扭傷和肌肉失衡
表徵：
脊椎旁肌肉局部壓痛的急性發作。運動會令疼痛加劇，而伸展運動、休息和按摩可紓緩痛楚。斷斷續續的背痛尤其在姿勢和用力不當時加劇 (例如：在表演或比賽中)。
病理：
因下背部（尤其在末端位置）的軟組織承受過大壓力引起。由於許多舞種中都鼓勵舞者使用脊柱前凸過度(向後拱)和髖關節前傾的姿勢，繼而增加舞者下背部的壓力。 另外有些舞者可能曾經體驗過下背痛，這也歸因於潛在的下交叉症候群，其特徵是後背伸肌(豎脊肌) 和髖屈肌(髂腰肌)繃緊，以及腹肌(直腸)和髖伸肌(臀肌) 無力。這種長期的肌肉失衡加上訓練習慣或超負荷會導致下背部缺乏柔韌性。
預防及治療：
除了透過休息、按摩和藥物治療(口服及外用藥物) 幫助緩解肌肉繃緊外，更重要的是糾正潛在的肌肉失衡。為了防止進一步的肌肉拉傷/ 扭傷，伸展緊繃的肌肉和針對調節腹肌和臀肌也是必不可少的。
椎間盤：椎間盤源性背痛
表徵：
慢性腰背痛在本質上是軸向性的，並會隨著增加椎間盤壓力的活動（如坐著/向前彎曲，咳嗽/擠壓和拉扯）而加劇。
病理：
椎間盤是位於每個相鄰椎骨之間的減震器。由於反覆受壓和負載，它的纖維可能會磨損，導致椎間盤背痛。不當的舞步會為脊椎帶來突然或不正常的負重，再加上脆弱的核心肌肉，可能會加快椎間盤退化。
預防及治療：
對於短期治療，藥物和被動式物理治療（例如治療用超聲波、經皮神經刺激（TENS）和按摩）可以幫助減輕椎間盤源性背痛。支架/ 矯形器可以用於暫時支撐背部，並預防引起急性期疼痛的微動。但是，長期使用支架會引起依賴，並進一步削弱核心肌肉。椎間盤源性腰痛的根本治療方法是強化核心肌肉—強壯的腹部和下背部肌肉可以減輕椎間盤的受壓，並減低引起早期椎間盆退化和椎間盤源性背痛的機會及它的復發。
軟組織： 肌肉勞損／ 扭傷和肌肉失衡
表徵：
脊椎旁肌肉局部壓痛的急性發作。運動會令疼痛加劇，而伸展運動、休息和按摩可紓緩痛楚。斷斷續續的背痛尤其在姿勢和用力不當時加劇 (例如：在表演或比賽中)。
病理：
因下背部（尤其在末端位置）的軟組織承受過大壓力引起。由於許多舞種中都鼓勵舞者使用脊柱前凸過度(向後拱)和髖關節前傾的姿勢，繼而增加舞者下背部的壓力。 另外有些舞者可能曾經體驗過下背痛，這也歸因於潛在的下交叉症候群，其特徵是後背伸肌(豎脊肌) 和髖屈肌(髂腰肌)繃緊，以及腹肌(直腸)和髖伸肌(臀肌) 無力。這種長期的肌肉失衡加上訓練習慣或超負荷會導致下背部缺乏柔韌性。
預防及治療：
除了透過休息、按摩和藥物治療(口服及外用藥物) 幫助緩解肌肉繃緊外，更重要的是糾正潛在的肌肉失衡。為了防止進一步的肌肉拉傷/ 扭傷，伸展緊繃的肌肉和針對調節腹肌和臀肌也是必不可少的。
椎間盤：椎間盤源性背痛
表徵：
慢性腰背痛在本質上是軸向性的，並會隨著增加椎間盤壓力的活動（如坐著/向前彎曲，咳嗽/擠壓和拉扯）而加劇。
病理：
椎間盤是位於每個相鄰椎骨之間的減震器。由於反覆受壓和負載，它的纖維可能會磨損，導致椎間盤背痛。不當的舞步會為脊椎帶來突然或不正常的負重，再加上脆弱的核心肌肉，可能會加快椎間盤退化。
預防及治療：
對於短期治療，藥物和被動式物理治療（例如治療用超聲波、經皮神經刺激（TENS）和按摩）可以幫助減輕椎間盤源性背痛。支架/ 矯形器可以用於暫時支撐背部，並預防引起急性期疼痛的微動。但是，長期使用支架會引起依賴，並進一步削弱核心肌肉。椎間盤源性腰痛的根本治療方法是強化核心肌肉—強壯的腹部和下背部肌肉可以減輕椎間盤的受壓，並減低引起早期椎間盆退化和椎間盤源性背痛的機會及它的復發。
Dept of Orthopaedics and Traumatology, Faculty of Medicine CUHK
