Many of the common mechanisms of injury to the bony ribs can occur in the daily training of professional dancers and are not limited to contact sporting athletes. Partnering in dance can create the forces needed to stress the bony and cartilaginous components of the rib cage and and result in contusion type injuries. Choreography can include complicated lifts where the hand placement of the one dancer on another’s trunk can create compression and shear forces from multiple angles on the ribs.
In our experience, repetitive lifting maneuvers can lead to stress injuries to the ribs, and in a few cases the costal cartilage of the false ribs (ribs 8 -10) can also become irritated and mimic signs and symptoms of bony injuries or that of an oblique muscle strain.
Signs and symptoms of rib/costal cartilage injury include reports of a mechanism or description of a rib being compressed when partnering, a rib feeling pushed ‘out of place’, or dancer may complain of pain with breathing. The dancer may also have pain with active range of motion of the trunk or limbs, and tenderness to palpation to the anterior, lateral/posterolateral borders of the rib or costal cartilage. Trunk motion may be limited/splinted either with an immediate onset or the day after.
The treatment is based on clinical presentation and can range from a couple days off with avoidance of contact pressure (partnering) to the rib cage with return to modified dance activity – to weeks or months of rest and again gradual return to activity. The coordination between MD and Physical Therapist or rehab team as well as consideration of the dancers rehearsal and performance schedule is beneficial and necessary to establishing return to dancing.
It is important to re-establish the ability of the thoracic cage to move in all dimensions as well as making sure that all aspects of shoulder girdle coordination and proprioception are restored, i.e. assessing the dancer’s ability to move the shoulder girdle independent of the rib cage.
While there is a shortage of research on rib injuries in the dancing population, we hope this sheds light into the considerations and differential diagnosis of those dancers complaining of trunk and flank pain.
McAdams TR, MD, Deimel JF,MD, Ferguson J, ATC. Chondral Rib Fractures in Professional American Football: Two Cases and Current Practice Patterns Among NFL Team Physicians. The Orthopedic Journal of Sports Medicine 4(2) 2016.
Bar-Sever Z, Connolly LP, Treves ST. Stress Changes in the Ribs Associated With Ballet Dancing. Clin Nucl Med. 1997 Apr;22(4):263-4.