A small niggle turned into a big worry for Ms Adelene Stanley when she could not lift her legs above 90 degrees - something a nimble dancer like her can do easily.
"It was odd. Usually, I just kick and my leg goes high," said the 21-year-old of the incident, which happened in 2013.
The problem was traced to a displaced disc in her lower back that she suffered during her final year at Rambert School of Ballet and Contemporary Dance in Britain.
She believed it occurred because she had not stretched properly before dance class, which sometimes lasted from 8am to 8pm.
But she persisted with training, though her back flexibility and range of motion were limited.
TAKING NO RISKS
If not, I will get rheumatism when I'm 30 and I will need a walking stick when I'm 40.
MS JOY WANG, 24, a dancer at Frontier Danceland, on preferring to sit out on a performance if she has an injury.
NO PAIN, NO GAIN
There will be a lot of backlash if you pull out and there is a need to find a replacement. Many dancers will just push through the pain.
MS JASMINE LEE , 29, an O School dance artist, on why many dancers set aside their injury concerns andcarry on training or performing.
Ms Stanley, who is now with local dance company Frontier Danceland, recalled how she was worried about being taken out of an important graduation show as it would have affected her job prospects.
She is one of many dancers who press on with their physically demanding craft despite the risks to their body from injuries.
A study on injury patterns among 365 dancers in Singapore found that about six in 10 (58 per cent) dancers did not seek medical attention when they got hurt.
Compared to other studies, the proportion of dancers who sought medical treatment was low, wrote Dr Jason Chia, the author of the study. He heads the sports medicine and surgery clinic at Tan Tock Seng Hospital.
Dr Chia, who does contemporary dance and ballet, said: "Injuries should be diagnosed properly. Some injuries can recur when not treated adequately."
Participants of the study were a mix of professional, semi-professional and recreational dancers. The study was published in the February edition of local medical journal The Annals.
Foot and ankle injuries were the most common. More than half of the dancers, or 54%, surveyed had suffered from them. Knee injuries were a close second at 49 per cent, followed by back injuries, which had affected 34 per cent of the dancers, the study found.
Fifty-three per cent of the participants had dance-related injuries and most of them had one to two recurrent injuries.
Professional dancers acknowledge the link between repetitive dance moves and injuries. Ballerinas often have to go en pointe, where their body weight is supported on the tips of their toes. This strains the ligaments, said Ms Stanley.
Dancers who did not seek medical attention when they got hurt, in the survey on injury patterns of 365 dancers in Singapore
Dancers who had foot and ankle injuries
Dancers who had knee injuries
Dancers who had back injuries
Meanwhile, male ballet dancers can suffer constant lower back strain from lifting their female partners in dance duets.
The repetitive movements of the foot and ankle that are required in dance forms like ballet also pose a risk, said the study.
As for modern dance, practi- tioners often have to do deep lunges and leg swings, said Ms Chia Poh Hian, 24, of T.H.E Dance Company. These moves can affect the knees, hips and spine, she added.
The consensus among professional dancers is that breakdancers are more prone to serious injuries due to the acrobatic jumps, flips, back bends and knee drops they do.
Over-training is another risk factor, with 12 per cent of the dancers surveyed saying they did not have a rest day from dance.
Often, it is not a lack of awareness that sees dancers set aside their injury concerns. The pressure and desire to perform often override such issues, they said.
The survey found that one in four of the injured dancers chose to ignore the injury, while nearly one-third of them simply abstained from dance to recover.
Ms Jasmine Lee, 29, an O School dance artist, said: "There will be a lot of backlash if you pull out and there is a need to find a replacement. Many professional dancers will just push through the pain."
Ms Stanley recalled how a fellow dancer went ahead with a performance despite a serious ankle injury.
She added: "During the intermission, a physiotherapist gave her a painkiller injection and she went back on stage afterwards."
However, there are others who prefer not to take such a risk.
Ms Joy Wang, 24, who is with Frontier Danceland, said she would rather sit out and rest, lest she aggravates her injury.
"If not, I will get rheumatism when I'm 30 and I will need a walking stick when I'm 40," she said, jokingly.
GETTING MEDICAL HELP
While most people would go to doctors for medical help, the study found this was not so for dancers.
It showed that injured dancers often turned to physiotherapists (33 per cent) or traditional medical professionals (31 per cent). The latter includes traditional Chinese medicine practitioners.
About 20 per cent of them visited specialists such as orthopaedic surgeons. Only 16 per cent chose to go to a primary care physician.
Ms Wang said that when she gets hurt, she would consult physiotherapists or osteopaths, who are practitioners of alternative medicine which emphasises massages.
She said primary care physicians usually do not understand the demands imposed on dancers.
Ms Lee agreed, saying: "They'd tell me to monitor for a few weeks, then go for a magnetic resonance imaging (MRI) scan. I can't wait so long, dance is a year-round thing."
She goes for acupuncture treatment which, she said, "doesn't really help in the long run". But it is useful as "a quick fix".
With many dancers seeking alter- native treatment, Dr Chia said healthcare professionals could take this into account when devising measures to improve the medical care of dancers.
He suggested "dance screening". This is an assessment of the dancer's physique, such as straightness of the spine, degree of hip rotation, and back and leg flexibility. It is typically done before a person joins a dance school or company.
Dance screenings are not a common practice in Singapore.
But Ms Chia said screening will help dancers be more aware of their body mechanics as well as identify the parts that need strengthening.
Ms Elaine Heng, 28, a company artist with Singapore Dance Theatre, hopes healthcare professionals can tailor exercises, as well as fitness and rehabilitation programmes for dancers, based on the dance-screening results.
Dancers can benefit from doing proper physical conditioning to prime their bodies better. The study said the relatively low rates of aerobic and strength training might suggest a lack of recognition of comprehensive physical conditioning in injury prevention.
Though Ms Chia incorporates flexibility and strength training into her routine, she would have to do aerobic training outside of her work hours to build up the stamina required for full-length dance pieces.
"It's difficult to find a balance between resting the body and more training sessions," she added.
Ultimately, Ms Wang believes that dance places the body in unnatural positions, bringing it "one step closer to injuries".
But Ms Chia is more optimistic, saying the key to avoiding injuries is to "figure out how to do things within one's bodily constraints".
She said: "It's all about being master of your body."
WARM UP, COOL DOWN
Before a dance session, it is crucial to get the heart rate up.
Ms Jasmine Lee, 29, an O School dance artist, said high-intensity interval training is one option.
It alternates between bursts of intensive exercises - jumping jacks, push-ups and crunches - and short periods of rest.
Dr Jason Chia, who heads the Sports Medicine and Surgery Clinic at Tan Tock Seng Hospital, advocates core training, which targets the torso. A strong core gives dancers more body control and stability.
Singapore Dance Theatre artist Elaine Heng, 28, tailors her warm-up sessions to the dance sequence. If it features leg extensions, she would do more back- strengthening exercises.
To cool down, she does calf, quad, hip flexor, hamstring and glute stretches.
Dr Chia said physical conditioning should include aerobic, flexibility and strength training.
Most dancers practise the RICE - rest, ice, compression, elevation - method.
When Singapore Dance Theatre artist May Yen Cheah, 32, sprained her ankle, she visited her physiotherapist "to learn how to do simple things like walk, hop and jump".
Applying ice or a compression band, and elevating the injured area to above the heart level can help minimise pain and swelling.
Many dancers take up yoga and pilates to develop flexibility and strength.
Running and swimming build up stamina. Dancers prefer swimming as running can cause wear and tear to the knee cartilage.