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Injuries Associated with Scottish Highland Dancing: A Case Series

Stacey Isidro, Dr. Tracey Isidro, Dr. John Cianca

University of Rochester School of Medicine and Dentistry

Introduction: Scottish Highland dancing is a traditional dance performed in solo competition by jumping on one plantarflexed foot without heel contact. The USA competitive Highland dance community is relatively small with 66 competitors in the 2017 Inter-Regional Championships. Championship-level dancing demands training approximately 3-4 hours daily, which may increase injury risk. Currently there is little literature about Highland dancing and associated injuries.

Methods/Case Description: We present a case series of 6 competitive level Scottish Highland female dancers from a local area with a mean age of 18.17 years (range=15-29) and BMI of 19.81 kg/m2 (range=16.83-22.46). All had symptoms of varying length with dancing prior to evaluation. Case 1 had posterior lower leg pain initially thought to be Achilles tendinopathy and revised to a gastrocsoleus strain. Case 2 had posterior ankle pain and tenderness over the posterior tibialis tendon in the medial tibia. Case 3 had pain from an acute back extension injury and L5 tenderness on examination. MRI was normal and did not reveal bony injuries. Case 4 had infrapatellar pain exacerbated with jumping and tenderness along the proximal tibialis anterior made worse with ankle dorsiflexion. Ultrasound revealed an area of hypoechoity within the left anterior tibial tendon. Case 5 had ankle tenderness after landing a jump while dancing, which was confirmed with ultrasound as localizing to the left anterior talofibular ligament. Case 6 had worsening left great toe pain that progressed to an intra-articular fracture verified by MRI.

Results: Several diagnoses were reached including right plantaris tendon tear confirmed with ultrasound, posterior tibial and Achilles tendinopathy, hyperextension lumbar stress injury, anterior tibialis strain, grade 2 left lateral ankle sprain, 1st metatarsophalangeal avulsion fracture treated with surgical stabilization, and stress fracture in the 3rd and 4th toes.

Conclusions: Treatment included rest, cast boot, physical therapy, and recommendation against competing due to the extent of damage. According to Henderson et al, Highland dancers are at increased risk of pain and injury. This case series documents 4 overuse and 2 acute injuries in the lower extremities and back. These are a result of frequent high-intensity practices that incorporate continuous jumping, which is an integral part of Scottish Highland dancing.

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