Physical Therapy, Post Rehab & Movement Analysis for Dancers & Athletes with Overuse Injuries

Physical Therapy, Post Rehab & Movement Analysis for Dancers & Athletes with Overuse Injuries

Today we are talking to Leah Bueno** about what exactly dance movement analysis is and how it can help us with injury risk management for performance athletes. 

Welcome to Beyond the StEPS

We learned last time that what you do is clearly different than a PT and you’re very good about making that distinction. For our friends new to BTS, briefly talk through the differences.

Leah: Well, I always like to describe myself as the bookend to injuries. When working with a dancer who has a current injury, it usually involves a co-management system. However, it's important to recognize that most dance injuries are overuse injuries that develop over time, sometimes months or years, without the dancer realizing they're accumulating small micro traumas. While it's crucial to address the current injury and ensure healthy tissue for a safe return to dance, many people overlook the post-rehab phase. This phase involves analyzing movement patterns to determine the root cause of the injury and preventing it from recurring. As a specialist in movement analysis, this is where I come in, especially when dealing with recurring injuries. It's essential to identify why the dancer is experiencing the injury multiple times, as ongoing injury can be frustrating and disrupt participation in dance or other activities.

If we partner with a trained Dance Movement analyst to work with our performance athletes, what kind of knowledge and skills can we expect to acquire through a Dance Movement analysis course?

Leah: There's so much to explore when it comes to movement analysis. While the concept of a movement analyst isn't new, it's not as widely utilized in dance as it is in other sports. For instance, if you're dealing with an injury, you might visit a physical therapist or another movement therapist who will conduct a gait analysis to assess how you walk and what's going on with your foot when you're walking. A lot happens when you walk, including heel striking, foot pronation, thigh turning, and pelvis rotating. If there's a problem in any of these areas, it can lead to injury or dysfunction, affecting performance. In sports like running and baseball pitching, movement analysis is conducted meticulously, examining every tiny detail. However, this level of analysis historically hasn't been applied to dance. I've had the privilege of learning from incredible movement analysis experts worldwide and have incorporated their teachings to bring this science to the dance industry. While it's frustrating to see how far behind dance is compared to other sports in utilizing movement analysis, I love this field and its potential to improve performance and prevent injuries. We need to pick up the pace and evolve the industry faster to catch up with other athletics. It's a recurring theme we explore in the show, acknowledging that while movement analysis is a newer field, the industry's evolution has been slow, which needs to change.

Why do you think dance has not utilized movement analysis as much as other sports?

Leah: In the dance community, there is a tendency to get stuck in traditions, especially in ballet, where people believe that if something has worked in the past, it should continue to work. In contrast, in more athletic sports, the athletes are often million-dollar investments, and there is a greater incentive to take care of them and prevent injuries. Additionally, dance is usually performed as an ensemble, so if one person is injured, there is often someone else who can step in and take their place, making it easier to overlook injuries. Ultimately, the issue comes down to finances.

Have you noticed if people, even those entrenched in traditional dance practices, are open to learning more about movement analysis through your training work?

Leah: I believe that there are two types of people in the dance community: those who are eager to learn more and expand their knowledge, and those who are stuck in their traditional ways. The educators who fall into the first category are truly impressive as they seek out multiple courses and continually research and read to better themselves. However, I have come to realize that I cannot change the minds of those who fall into the second category, as they are set in their ways and have always done things a certain way. Therefore, I focus my efforts on those who are open to learning and shifting their mindset. Overall, there is a significant shift in the dance community towards working with dancers in a healthier way, and I am glad to be a part of it.

How is dance movement analysis different from traditional methods of evaluation used to diagnose and prescribe?

Leah: Mastering the skill of Dance Movement Analysis takes time and practice. In my post-rehab training, I learned the importance of not chasing pain as it can often be a symptom of a larger issue. When conducting a training, I follow a step-by-step process, starting with identifying an observed problem and creating a hypothesis based on what I see. For example, if a dancer cannot turn out, I may suspect rib rotation, which affects the pelvis and hip. I then look above and below the area of concern to test my hypothesis and see if it makes a lasting change. It can be challenging, but with experience, recognizing patterns becomes easier. It's essential to note that you don't have to be a performer to make an impact in the dance space. Drawing on your knowledge and skills, such as Pilates, you can apply Dance Movement Analysis to diagnose and prescribe solutions for movement issues, ultimately changing the game for dancers.

Injury risk management can be frustrating because the goal is to prevent something from happening before we can feel it and before it can wreak havoc on our bodies and careers. We run into this with Apolla more than we like and it’s hard because if you can’t see the pain or feel the pain…it doesn’t exist. I’ll worry about that later. But later is too late if the injury occurs. Why is it so important for performance athletes to come up with their own risk management routine before it becomes an issue?

Leah: This is a great and challenging question. You are absolutely correct in noting that many dance injuries are cumulative. I often hear people say that they don't understand why they are experiencing pain now when they have been dancing all year. Unfortunately, these micro-traumas add up over time and can cause pain at the worst possible moment, such as during a competition or performance. To use an analogy I love, if you have a candy bar for dinner one night, it's not a big deal. But if you have one every night, it will eventually catch up with you and cause problems. Pain can lead to time lost in the studio, which is why it's so important for dancers and educators to be proactive in identifying and addressing potential issues early on. Ideally, every studio would conduct a beginning-of-the-year screening to assess alignment issues and muscular mobility imbalances. While we can't always predict where pain will show up, we can identify warning signs and take action to prevent or mitigate injury.

Wouldn't it be fantastic for coaches if there were standardization or certification requirements for teaching dance? We now have so much more knowledge than we did just five or ten years ago, and this could provide a system of checks and balances to identify potential problems with class structure or exercises that may be contributing to injury. Moving away from injury prevention, there is a new focus on injury risk management, which acknowledges the reality that dancers use their bodies repetitively on a daily basis, making injuries a possibility. While injury prevention aims to completely avoid injury, injury risk management seeks to reduce the risk of injury and mitigate the effects if an injury does occur due to repetitive movements, strain, inflammation, and other dance-related stresses on the body. How does this shift affect the long-term impact of injuries and the severity of their effects on dancers?

Leah: While it's not possible to completely eliminate the risk of injury, we can focus on identifying the repetitive motions involved in a particular dance style, such as lifting your leg repeatedly or doing a high volume of releves. By strengthening the opposing movements, like lifting the leg forward and back, we can balance the body and reduce stress on the joints. These overused injuries may not be dangerous, but they can be very irritating, and if left unaddressed, they could potentially lead to more severe issues, like tendon ruptures. Therefore, it's essential to minimize stress on the body as much as possible. I often have discussions with parents who are concerned about their child getting injured while dancing. While it's true that dance can cause injury, I don't believe that dance inherently hurts people. Rather, it's important to focus on injury risk management. For instance, when a child gets their driver's license and starts driving a car, there is always a risk involved. However, we can take steps to minimize that risk and make driving as safe as possible. Similarly, in dance, there are measures we can take to reduce the risk of injury and make it as safe as possible.

I'm not sure if you've had the same experience with your students, but in my experience of teaching and directing, I've noticed that many injuries occur outside of the studio. Despite learning how to move their bodies in the studio, students can still have accidents outside, such as stepping on something or tripping over a pothole. It's frustrating when these incidents happen, especially at inconvenient times. This year, I've heard of two incidents where students fell off desks, and it's just unbelievable. To minimize the risk of injury, I have prohibited trampolines and ice skating.

Leah: I agree with you on that. While we can't completely protect dancers from all possible injuries outside of the studio, it's important to be mindful of their physical condition and any areas where they may be more vulnerable. For example, if a dancer is working on improving their ankle mobility, their ankle may become more mobile but also less stable compared to someone who hasn't been working on mobility exercises. So, if they then step off a curb or encounter an uneven surface, they may be more prone to injury. So, it's important to take into account the specific needs and vulnerabilities of each dancer when considering injury risk management.

Understood. I agree that dancers use their joints in unique ways that differ from typical individuals, and injury risk management should be personalized for each performance athlete. In terms of Dance Movement analysis, would the diagnosis vary based on factors such as a dancer's mobility in different areas, their goals, or their physical build?

Leah: To break it down, there are two main points to consider. Firstly, injury risk management varies depending on the type of dance being performed. Ballet dancers, break dancers, and Irish dancers all have different risks associated with their dance style. Therefore, it's crucial to evaluate the repetitive motions involved in each dance and balance them out. Secondly, every person's body is unique, and their strengths and weaknesses will differ. While there may be some exercises that are generally beneficial, it's essential to assess each person individually and determine their specific needs. Feet, for example, come in many different shapes and sizes, and each dancer will have different mobility and strength requirements.

So, how do you approach individualized injury risk management in a class setting? Let's say you have 40 dancers and you want to assess their unique needs. Do you have any tips on how to handle this? It seems like a big challenge.

Leah: Dance educators truly deserve recognition as heroes in our field. It's a challenging job, especially when you have a class of 40 dancers, and we do our best to address individual needs. In my program, I emphasize the importance of assessment because it's a question that comes up often - "what do I do?" Having a good understanding of assessment will improve your eye for movement. Dance teachers already have a great eye for movement, but often lack formal training in anatomy and kinesiology. All we have to rely on is what we felt in our own bodies as dancers, so when we see something unusual, we try to fix it with everything in our toolbox. The more knowledge we have, the better we can identify issues and make quick corrections to fix them.

However, we must be cautious not to burden individuals who are not qualified to make such observations. What if they misinterpret the situation and it leads to further complications? This is why it's important to connect with healthcare providers in the community and ensure they have virtual options available, as you offer. It's crucial to relieve dance educators of the expectation that they have to take on all responsibilities because the reality is that they are not qualified for it, and that's okay. There's a growing pressure to take on this role, but we need to shift towards the idea that there are other professionals who can help, and it's important to know who they are.

Leah: Maintaining your scope of practice is crucial, and this applies to dance teachers as well. Dancers often turn to their teachers as the first line of defense, but it's important to recognize when something is beyond their expertise. For example, Josephine Lee, a point shoe fitter, may refer clients to me because she knows there's an issue but doesn't know what it is specifically. Similarly, dance teachers can identify patterns of movement issues or pain in their students, and then refer them to the appropriate professionals. It's all about having a network of trusted providers and knowing when to refer someone to them.

Currently, it appears that individual teachers are the ones taking the initiative to learn about Dance Movement Analysis. However, do you think that there will be a shift towards organizations such as companies, colleges, and dance programs incorporating it into their programs?

Leah: The ideal scenario would be to have dance organizations integrate Dance Movement Analysis into their programs. While there is a growing trend towards wellness, it is not currently the same as with sports teams who have dedicated athletic trainers to handle such matters. This could be due to differences in organizational structure. In my experience, dance teachers are often left to handle these responsibilities on their own. Therefore, I believe it would be great to see a shift where dance organizations prioritize educating their staff on various aspects of wellness.

Not only should teachers be educated on how to diagnose, treat, and handle injuries, but they should also know the protocol for when something goes wrong. This includes who to call, who to send the student to, and when to pull them from practice or competition. Having a protocol in place takes the pressure off the teacher and avoids disappointment from parents and students. Furthermore, it is essential to have trainers for young dancers, especially in commercial and competitive dance, precision dance, and competitive cheer, where so much weight is put on them. Unfortunately, many of these teams do not have access to trainers, unlike youth football and basketball teams. As a result, dancers often sustain injuries that can end their careers and affect their mobility for the rest of their lives.

Leah: I had a conversation with a female athletic trainer a few months ago who wanted to start working as a collegiate athletic trainer. She was currently working with one of the male sports teams and wanted to introduce her services to the female cheerleaders as well. However, the institution didn't perceive the cheerleaders as being at enough of a risk to see the value in her services. I think this highlights the need to educate those in charge about the fact that dancers are athletes too and require proper care and attention.

In other words, the decision-makers may not see the value of bringing in a trainer for cheerleaders because they don't generate enough revenue. However, this mindset fails to recognize the role that dancers play in the overall picture. Dancers are integral to creating the visual image and enhancing the performance, and this aspect should not be overlooked.

Leah: Yes, I completely agree. The Australian Ballet sets the gold standard with their exceptional medical staff and abundant resources. Whenever I talk about it, I always joke with my husband that if he can't find me one day, he should check Australia first. Compared to the US, European countries are way ahead in training dance educators in holistic teaching methods.

I'm going on a tangent now, but I think it's an important point. We've been discussing how money seems to be the primary motivator for providing support at a higher level. In my opinion, how do we get people to value the art and its benefits as much as they value money? This is a challenge because the importance of something that doesn't generate as much revenue is difficult to assign. However, during the pandemic, dance companies saved many people by putting on virtual shows, and Broadway shows were aired on TV, which is unprecedented. We need to figure out how to assign value to the arts beyond their revenue-generating potential. If we had an answer to this, we might be able to solve some of the world's issues.

Leah: Yes, I agree. I think it's important to share our love for dance with others and those of us who are able to should give our time and resources. For example, I volunteer my time for a professional dance company in Sacramento because I care deeply about the dancers. Instead of waiting for someone to pay me what I deserve, I choose to do what I can to support the art form.

As for a real-life example of using Dance Movement Analysis in the studio, let me give you one. Let's say you're teaching a group of students a complex dance routine that involves a lot of turns. However, you notice that one student is consistently losing their balance and struggling to execute the turns correctly. By applying Dance Movement Analysis, you could identify specific areas of weakness in their technique, such as insufficient core stability or improper weight distribution. Based on this analysis, you could then provide targeted feedback and exercises to help that student improve their technique and execute the turns more effectively. This approach would not only benefit the struggling student, but it would also enhance the overall quality of the dance routine being taught.

I have a dancer whose arm placement is quite peculiar. It appears as if her arm is turned backwards when she extends it. Even though she seems to have hyperextension, when she relaxes her arm, it turns inward. It's a bit challenging to explain, but you get the picture. It's difficult to find the middle ground between the two positions. I usually guide her to relax and then straighten her arm while engaging her back muscles, but it's still a work in progress.

Leah: Firstly, it's important to have an understanding of what a neutral joint looks like. Your arm is attached to your elbow, which is attached to your shoulder blade, which is attached to your rib and spine. When observing a problem, it's essential to have a good vocabulary of anatomy. This way, you can describe what's happening in more detail. For example, instead of saying, "your arm is on backwards," you can say, "you're externally rotating your shoulder too much, and your elbow is hyperextending."

Knowing what muscles create a neutral joint is crucial. If you can identify that, you can start to make corrections. However, if correcting the observed problem isn't working, then it's essential to look above and below. For instance, is their arm on backwards because they're thrusting their ribs forward, pinching their shoulder blades, or jutting their head forward? There could be many reasons why the observed problem is happening, and that's where the assessment comes in.

Leah, I understand the importance of language, but I've also witnessed students having a breakthrough moment when they finally achieve the correct position and can remember the feeling in their muscles. Is it also about guiding them to find that position and then having them hold it while looking in the mirror to help them remember the feeling and imprint it in their brain? I don't want to manipulate their body, but how can we help them achieve that breakthrough moment?

Leah: Yes, that process is called motor control. It's important for you to have a clear goal in mind and guide the dancer towards achieving it. When they finally reach that position, it's important to reinforce it so that they can remember the feeling and continue to improve. Without finding that position, they won't have that "aha" moment, so it's crucial to guide them towards it.

Let's move on to the homework segment. Could you suggest one action step for our audience to take in this area before the next Friday show? And for our viewers, please remember to like, share and comment to let us know your thoughts.

Leah: Don't feel overwhelmed, but rather get curious about dance science. It can be challenging to understand everything about the body, and even I spend my vacations reading anatomy books. However, if you let the overwhelm take over, you might not even start. Therefore, I suggest that you read a book or listen to a podcast about something in the body that interests you. This knowledge will gradually build up over time. I recommend starting with the Anatomy of Movement book or the Dance Anatomy book, both of which have images and are beginner-friendly. Additionally, there's a fantastic podcast called The Dance Docs. Remember, most of my knowledge comes from sources outside the dance world because movement is universal. So, find something that interests you and start there.

Leah's website,, offers a Dance Movement Analysis course. Leah, could you please explain a bit about the structure of the course and how it works?

Leah's Dance Movement Analysis course is a fully online program that starts once a year on March 5th. The course includes pre-recorded videos and content that covers anatomy and assessment, as well as three live coaching sessions where participants can ask questions specific to their field. The course is a great resource for dance specialists, Pilates instructors, gyrotonics instructors, ballet technique instructors, and others. The program runs for three months, and participants have a year to complete it at their own pace. It is packed with information about Dance Movement.

Leah: You can contact me through my website, I offer both in-person sessions and online consultations. Most of my online clients already have a healthcare provider they work with in person, but for those who don't have access to a dance specialist in their area, I can assist with their return to dance or help them address any movement restrictions or dysfunctions that may be causing pain or hindering their performance. In cases where no one else can figure out what's going on, I perform an assessment to identify the root cause of the issue.

Leah, many providers and PDS we talk to have state lines restrictions, which means they can only operate in the state they're licensed in. However, as you're not a medical provider, you can work with anyone, anywhere.

Leah:  To get in touch with me, you can send me an email through my website, using my professional email: You can also find me on Instagram under the handle @leahbueno.pilatesrehab and on Facebook under my business name, Performance Pilates and Rehab. Don't hesitate to reach out to me via direct message or email. I am always here to help.


Dance Movement Analyst Course: Starts 3.5 and only once per year!


Book “The Anatomy of Movement”

Podcast - “The Dance Docs”

Bendy Bodies Podcast and Hypermobility MD

**Leah Bueno is a Post-Rehabilitation Dance Specialist and Instructor Trainer for STOTT Pilates. Leah is a former professional dancer and has been working as an educator for 20+ years. Currently she uses a combination of Pilates and Movement Coaching to help dancers understand the source of their chronic injuries and optimize performance in a safe/effective way. In addition to her work with dancers she also provides continuing education for Dance Professionals in order to help instructors bring the latest information in science to the studio


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