Fly High Again: Shine After Anterior Cruciate Ligament (ACL) Reconstruction Surgery
Henry Lam - President of HKADMS & Registered Physiotherapist (HK)
Translation: Chloe Mo - Registered Physiotherapist (HK)
Interviewee: Xiao-wan Liu, Dancer of the theme parks in Hong Kong
21 June 2020
Dancing since young, dreaming to shine on stage is a story of a typical dance girl. However, an accident merely put her dream at stake.
The 27-year-old Xiao-wan is a stage dancer. She was weak when from a young age. Concerning that poor health might affect her growth, her mother sent her to dance classes at the age of 4. Xiao-wan later studied in Diploma in Dance at Nanyang Academy of Fine Arts (NAFA), Singapore After her graduation, she joined one of the theme parks in Hong Kong as a dancer, which marked the start of her professional career in dancing. Unfortunately, after the first few months into her dance career, she met a dancer’s biggest enemy – injuring her leg. During one of her performances, she landed on the ground with her right knee twisted outward to 90 degrees in flexion after she completed a lifting act. Although her knee returned to a normal position later, she could not stand up. A girl who dreamed to shine on stage fell to the center of the stage hopelessly.
After the injury, Xiao-wan was in depression and frustration. She searched similar cases and information on the internet, which only made her worry more about her situation. She limped for a week after the injury. Even though she was able to walk normally after two weeks, her right leg often buckled, especially when she stood on her right leg alone. Given that she studied anatomy in college and knew that there are four ligaments in the knee, it made her concern more. The cruciate ligaments connect the thigh to the lower leg, and provide stability to the knee during sudden stop and twisting. These ligaments will not recover by themselves after rupture because of the poor blood supply.
The fear of not being able to perform again; crushing disappointment of not being able to meet the expectations anymore; feeling loss with the thought of life without dancing. An orthopaedic surgeon told her that an operation was needed, but she was clueless of the operation. The day after the operation, she started to do some leg- lifting exercise, followed by two to three physiotherapy sessions per week and repeated exercise. The exercises targeted at restoring the knee’s range of motion at first; and with the goal to touch her right hip with the right heel, she worked hard to gradually regain her knee range every day. At the same time, she had to strengthen those weakened leg muscles.
For a while, she felt that the knee bending range was not ideal and felt numbness when her right knee touched the floor. She started yoga practices after 1 year of operation, she made good progress. She thought that it was important to adjust her mentality. Progress should be measured in weeks and compared to her improvement with the previous week.
Before going back to the stage, she tried to handle it with a calm demeanor. Remembering the unfamiliar feeling when she was first on stage, she slowly adapted and tried to live in the moment. Now she practices yoga every day with some exercises targeting specific muscles. She feels that exercise and dancing are in a complementary relationship. Dancing is the way to express herself with body movements. Sometimes, movements in choreography put great physical stress on human normal body structures, which may lead to an imbalance in the long run. Exercise can restore the damage caused by excessive dancing practice, and thereby, extending a dancer’s dancing career. She now learns to pay more attention to her own posture to avoid injuring herself again.
Words from an expert:
Henry is a registered physiotherapist. He suggested that when a dancer moves at a high speed and lands on one leg unstably with pivoting, the range and speed of the lower leg may differ from the thigh, which may increase the risk of anterior cruciate ligament sprain or rupture. This risk is heightened especially when the knee is slightly bent, and shifted to the inner side and internally rotated. Dancers may need to undergo an anterior cruciate ligament reconstruction operation if the ligament is partially or completely torn. A dancer usually takes 6-9 months to return on stage after the operation.
作者：林漢威先生 - 香港舞蹈醫學與科學學會主席、香港註冊物理治療師
中文翻譯：巫柔潔 - 香港註冊物理治療師
受訪者：劉曉婉小姐 - 香港的主題樂園舞蹈員
曉婉現在 27 歲，是一位舞台舞者。小時候她身體不強壯，媽媽為了讓她鍛煉身 體，所以在她 4 歲時送她學跳舞。大學時她隻身到新加坡就讀南洋藝術學院的舞蹈文憑。畢業後加入香港其中一個主題樂園，展開跳舞的職業之路，一切看 似順利。豈料天意弄人，在曉婉初踏職業之路的數個月，她遇上舞者最大的敵 人-傷患。在一次表演中，托舉後雙腳落地的一瞬間，在雙膝彎曲的情況下，右膝向外扭至 90 度，雖然膝蓋隨即返回正常位置，但卻無法站立，一個夢想在台 上發熱發亮的女孩，倒在舞台中心。
受傷後心情低落，曉婉在網絡上查看一些資料，越看越怕，抱頭直哭，受傷後 的一星期走路都是一瘸一拐的。兩星期後，走路雖然恢復正常，但時常出現腳 軟的情況，特別是單腿站立的時候。大學時學過解剖學，知道膝蓋有四條韌 帶，十字韌帶連接大腿與小腿。急停，轉身，都是需要韌帶來穩定。而且韌帶斷裂後不會自行恢復。
害怕，不能再上舞台;失望，不能再與觀眾見面;徬徨，不再跳舞可以做甚麼? 骨科醫生告訴她要做手術，但自己對手術的內容一知半解。手術第二天便開始做抬腿運動，之後是一周兩至三次的物理治療，重複的練習。首先要恢復膝蓋 的活動範圍，每天彎多一點，目標是腳跟碰到臀部。同時間要鍛鍊腿部萎縮了 的肌肉。有段時間感覺膝蓋彎曲幅度不理想及膝蓋碰硬地板時有麻麻的感覺。 在手術後一年嘗試練習瑜伽，感覺進展不錯。她覺得重要是調整自己的心態， 進展應以周為單位，試試對比上週的自己是不是很有進展。
對於重踏舞台，她以平常心面對，記得頭一個星期在台上感覺陌生，慢慢適應 後，不會去回想自己在舞台發生過什麼事情，反而更享受當下。現在她每天練 習瑜伽，加以一些針對性的肌肉練習。開始覺得運動和跳舞是一種輔助關係。 跳舞是通過肢作表達自己，有時在編舞上的動作或移動有違人體正常構造，但 舞者長期都需要用身體，久而久之導致不平衡，所以運動可以平衡舞蹈帶來的 勞損，也可以延續舞蹈生命。她現在學懂更注意自己的姿勢，從而避免再次受傷。
Henry 是註冊物理治療師，他說舞者在高速的動作，單腳跳躍落地不穩或旋轉 (Pivot)時，小腿沒有跟隨大腿旋轉的幅度或速度，特別是膝關節微曲、內彎及 內旋，有機會導致拉傷或撕裂十字韌帶，視乎撕裂程度，在局部或完全撕裂 下，舞者需耍接受前十字韌帶重組手術。一般情況下，舞耆在手術後 6-9 個月 可重踏舞台。
Meuffels, Duncan E., and Jan AN Verhaar. "Anterior cruciate ligament injury in professional dancers." Acta orthopaedica 79.4 (2008): 515-518.
Liederbach, Marijeanne, Faye E. Dilgen, and Donald J. Rose. "Incidence of anterior cruciate ligament injuries among elite ballet and modern dancers: a 5-year prospective study." The American journal of sports medicine 36.9 (2008): 1779-1788.
This article was accomplished by the author in his/her personal capacity. The opinions expressed in this article do not reflect the view of the official statement of CUHK and HKADMS. It is intended for informational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always consult with an appropriate professional for specific advice related to your situation.