The worst nightmare of a dancer's life isn't about forgetting the steps in the middle of the performance.
It is the anger, frustration and low self-esteem, and the fact that you suddenly become an observer and not a participant. When familiar faces see you limping and say “Why are you limping?” or “You are a dancer, this shouldn’t have happened to you!” or worst still- “How are you going to teach?”
It is a challenging phase when the thought of limping, not dancing and feeling miserable because of chronic pain causes a dancer's inner light to fade. It not only affects dancers physically but messes up their natural makeup of being a fun, loving life, joyful, happy, confident and dancing soul.
Ask any dancer, and they would say the pain has been an integral part of their dancing. Managing pain is easier when you are younger, but as you age, your body takes longer periods of rest for full recovery, and pain becomes routine.
How Does It All Begin?
For most dancers, it starts with slight pain, which escalates to excruciating pain, and in severe cases, instabilities in one or both the legs.
Despite receiving the diagnosis of severe arthritis, the myths surrounding risks related to surgery and recovery time of hip replacement or knee surgery pushes them to seek alternative solutions like cortisone treatments, chiropractic therapy, and acupuncture. Deep tissue massages to relax abductors, inner-thigh muscles and lower legs, combined with regular stretching routine might provide some relief, but it is only temporary.
As they age, their recovery time after teaching five to 8 ballet classes a week goes up, and sadly, with pain and fatigue, the ability to demonstrate simple ballet steps starts decreasing.
The legs and lower bodies of most dancers bear all the brunt of the overuse and sometimes abuse they are subjected to. Despite intense pain in hip joints or knees, many dancers postpone the decision to seek a medical opinion till they "retire" or "till the end of the season," which goes on till they can manage.
The pain in joints could be due to an injury or a genetic condition. While you can do as much as you can to prevent injuries, there is little you can do if the source of pain is genetic and demands a corrective action or threatens your dance career.
Surgery- A Choice or a Last Resort?
Although surgery remains the last resort- with new medical breakthroughs that work better and last longer, dancers can continue performing for several years after getting a replacement.
Studies in 2011 and a subsequent follow-up study by the researchers in 2014 pointed out that with the help of enhanced recovery programs, the mortality and recovery rates of more than 4500 patients in Britain recovered faster had lesser chances of mortality owing to surgery.
Enhanced Recovery (ER) programs are customized protocols designed for patients to use strategies like pre and postoperative diet counseling, medication, effective use of analgesics and postoperative care, all contributing to a reduction in surgical stress response as well as facilitating earlier patient mobilization and returning to oral fluids and solids intake. (Source)
Recuperation from surgery related to any degenerative joint disease like OA or any severe injury owing to wear and tear on the cartilage cushion between the joints that leads to pain, swelling and stiffness is faster, and hip replacement of knee surgery no longer spells and an automatic end to a dance career.
Are You The Right Candidate for Surgery?
Many young dancers, who have pain often get told “you are too young for surgery” by their doctors even when they are in their 40s or 50s and are miserable.
But before you think you can go under the knife, do have an honest and open conversation with your surgeon. Thought today's implant could not only last longer, and there is no reason to believe they will ever fail, you may need a revision in the future, and a joint replacement 20 or 30 years down the line shouldn't be ruled out.
Despite the common stereotype about hip replacement or knee surgery patients, there is no “right age” to get one. More and more dancers in their middle ages are finding themselves facing factors that necessitate them, and these operations are at higher rates than ever before.
Today's patients are relatively young, active and motivated to continue with their pain-free lives, and growing numbers of orthopedic surgeons are seeing and operating the dance teachers, students, and choreographers who realize that you are never too young or too old to undergo total hip or knee arthroplasty.
How Does The Recovery Process Begin?
The immune, nervous and endocrine systems of our body perceive a joint replacement surgery as an open fracture. To “fix it” they create an intense biological response which induces patient to rest thereby ensuring unhindered regeneration of damaged tissue.
If the patient remains immobile and is stressed out and on a lot of drugs, it can cause an inflammatory reaction, and even hormonal and nervous system changes. The fact is, the only thing that needs to heal is the skin, and there is no need to wait for the skin to recover for the joint to function adequately.
Under the enhanced recovery approach, patients who used to be confined to hospital beds for up to two weeks and more are getting sent home within days. This is made possible by reducing the “biological burden” on the body and preparing the patient physically and emotionally for the surgery.
If you are a smoker, you will be encouraged to kick the habit or at least reduce by half the number which alone minimizes the time for skin wound to recover. Patients with anemia are asked to take iron to strengthen the body, and dancers, who already have strong leg muscles, are even encouraged to take up some form of exercise to keep them stronger before surgery is performed.
People with diabetes have to improve their sugar balance to improve surgery outcomes and relieve complications.
How Fast Can You Resume Dancing Post Surgery?
Resuming normal activities post joint replacement surgery is highly dependent on the individual patient. Within the first few most difficult weeks of operation, the focus is on pain and swelling control, and once these improve, patients can see results regarding their range of motion and strength.
To gain range of motion, for example, patients are encouraged to take up biking, and then come strength training, workouts and physical therapy to strengthen the operated joint. Dancers can return to activities like walking, swimming, riding a bike by 6 weeks after a knee replacement surgery.
Surgeons today are taking the minimally invasive (MIS) anterior approach for total hip replacement. Unlike the traditional posterior (back) or lateral (side), the anterior (front) approach allows access to the hip joint without cutting through significant muscles or tendons, enabling a quicker return to regular activity.
Dancers can expect to return home the day of the surgery and begin teaching again in four to six weeks.
Questions to Ask Before Your Surgery
1. Do you need a joint replacement?
Most probably not, although surgery is quite common among dancers, those who end up needing one typically start with some abnormality of the joint like a shallow hip socket which might lead to excessive load and wear.
2. Aren’t these surgeries meant for really old people?
Not anymore, the implants that used to be made with plastic degraded over time, lasting only about 12-15 years, but today's replacements last more than 30 years, making them a reasonable option for a younger age group.
3. What are other things that I should care about?
Ask a lot of questions.
Talk about dual mobility hip replacement which potentially allows a greater and safer range of motion and has a lower dislocation rate after surgery. Also talk about the anterior approach to surgery, which has particular benefits for dancers.
4. How does the recovery phase look like?
You would need physical therapy for about 3 months after surgery –for at least 2 to 3 times a week. Post that, once a week for another 3 months is advised.
The leg may get stiff, so the muscles need to be freed up. There is a lot of work done on soft-tissue, strengthening, conditioning and also stabilization of the core.
Give yourself a full one year to full recovery so you could recover from residual injury and compensatory patterns you developed while you were in pain.
5. Does it change your dancing?
Yes, and No.
After 3-6 months, most dancers get back to almost full range of their motion. Although you may notice a reduction in your turnout, dancing on a replaced hip will not make you feel like a 20-year pain-free self. It may not feel quite the same as dancing on a natural hip joint and repetitive, high-impact movements like excessive jumping can still wear down even the best hip implant.
But having suffered years of extreme pain, swelling and discomfort, being able to dance pain-free will sound like a happy trade-off. You will feel the freedom that you didn't have in a long time.
You will be able to get back to teaching dancing with a new “hip” attitude towards life, skills and future adventures! With perseverance and luck, your replacement and dance could finally find a match!
This article does not promote or advocate any surgical or medical procedure, nor it is scientific medical advice. Reader’s discretion and consultation with a medical practitioner are strongly recommended.