Within just three weeks this summer, Nanjing Drum Tower Hospital in eastern Jiangsu Province received five children with spinal injuries caused by dancing.

Treating children's spinal injuries and deformities caused by movements such as backbends and somersaults has become a global challenge over the past two decades, according to Liu Zhen, associate chief of the hospital's spinal surgery department.

An 11-year-old girl, one of the five, became paralyzed from the waist down at the age of 5 after practicing backbends in a dance class. Over the next six years, she also developed scoliosis, a sideways curvature of the spine.

"This is a common complication of paralysis," Liu told Chengdu Economic Daily. "Children with this kind of paralysis [resulting from sports-related spinal cord injury] will usually be wheelchair-bound for the rest of their lives."

The culprit

Given there is currently no effective treatment for this type of paralysis, prevention is the only cure. But data from a team of medical professors in Shanghai shows that the number of very young victims of sports-related spinal cord injuries has risen sharply in recent years.

Guo Xiaodong, a professor at the city's Union Hospital affiliated to the Tongji Medical School of Huazhong University of Science and Technology, leads a research on the issue. His team's statistics show that since 2005, more than 1,000 children in China have been paralyzed after doing backbends, making it a leading cause of spinal cord injury in children in the country.

From 1992 to 2002, children with spinal cord injuries caused by backbends accounted for only 4 percent of all cases. However, from 2015 to 2019, this percentage increased to 33.9 percent and has continued to increase since.

Experienced in treating children with such paralysis, Guo told Xinhua News Agency that the complications also include severe osteoporosis, a condition that causes bones to become weak and brittle, recurrent urethral infections, bedsores and psychological disorders.

But how can movements like backbends and somersaults potentially have such severe consequences?

The spinal cord is stretched when bending backward, Guo explained. Children's spines are flexible, and the vertebrae can realign themselves after relative displacement, but it is usually difficult for the spinal cord to adapt to the excessive stretching that is caused by significant changes in posture. Eventually, these substantial postural changes are more likely to lead to spinal injuries.

However, it is still common for dance training schools to include moves like the backbend as basic movements and as part of the routine practice for children. Many teachers, and parents, are not aware of the dire consequences these exercises may have.

But in the authoritative Chinese dance grading textbooks published by Beijing Dance Academy, the backbend is not included for grading children's dance.

"It is not recommended that dance instructors apply external pressure to a child's lower back, which especially goes for children between the ages of 4 and 6, the age group most prone to dance-related injuries," Dong Daier, an instructor at Beijing Dance Academy, said in a video she uploaded to Douyin, China's TikTok.

"Risky moves, including the backbend, are not meant for beginners and experienced teachers should know that; it's a matter of common sense," Dong said. "Flexibility training should be built up over time, with shorter practice times and lower intensity in the initial stages."

Some unqualified dance training schools simply don't follow standardized training requirements, Dong concluded, adding this, from her perspective, was the main cause of the tragedies.

Bending over backwards

On July 21, the Ministry of Education and the China Consumers Association jointly issued a warning to parents to be wary of their choice of dance classes for their offspring. In particular, it warned parents to be highly aware of the risks of injury, and even paralysis, which may result from movements such as backbends in children's dance training.

"We don't recommend children under the age of 8 to practice the backbend," Sun Haolin, an orthopedist at Beijing-based Peking University First Hospital, explained. "Unsuitable dance movements have become a major cause of spinal cord injuries among children in China."

He recommended parents get their children checked out before letting them practice backbends. "Children with underlying spinal defects, such as spinal dysraphism, a group of disorders of the spine in which the posterior bony and neuronal tissues fail to fuse, and tethered cord syndrome, a group of neurological disorders that relate to malformations of the spinal cord, should avoid practicing backbends. In addition, children should have an adequate warm-up prior to the performance of movements such as backbends," he said.

Dong emphasized children should always practice dance movements under professional supervision. Children under the age of 10 should focus more on cultivating interest and artistic sense in practicing dance, and should not practice difficult movements such as backbends, or any moves involving excessive spinal extension, splits, or somersaults at an early age.

"And I won't give a specific age that would be fine for children to start doing these moves," Dong added. "If a child shows a strong interest and unique talent in dance, it is recommended that they undergo formal and regular dance training after their skeletal development is mature. Experienced and qualified teachers will tell you the same thing."

A netizen named Yanting commented on a video about dance-related spinal cord injury and paralysis on Douyin, saying that she is now in her early 20s and still suffers from lower back pain caused by being forced to practice backbends in dance class at the age of 7.

"It was like a competition among the parents," she wrote. "When some of the other children could do a backbend in class, my mother would push me to practice more and say I should easily be able to literally bend over backwards given children are more flexible."

"It is a matter of awareness," Dong said. "We should help more parents to learn about the risks these movements can hold for their children."

Professor Guo revealed there is a period of time known as the "golden hours" immediately after a traumatic injury, during which there is the highest likelihood that prompt medical and surgical treatment will prevent serious injury, or even death, for children who are unfortunately injured due to improper practice. If a child feels discomfort after doing a backbend, it is crucial to seek medical help within eight hours to minimize injury to the spinal cord.

If a child feels physically uncomfortable while practicing backbends, they should stop immediately and lie down to rest. If the child feels better after resting for a while, they should continue to rest, but standing up and walking are not recommended. "If the child doesn't feel better after an hour, they should be taken to a hospital, but the child should lie flat on a board or a stretcher and avoid being carried or held while being taken to the hospital," Guo said. 

(Print Edition Title: Striking a Cord)

Copyedited by Elsbeth van Paridon

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