By Dinah Hampson | Sport & Dance Physiotherapist | Pivot Dancer Contributor
For Apolla Performance – The Muse Blog
Bruises are a normal part of a dancer’s life—most of us collect them the way some people collect souvenirs. But when a bruise appears without a clear cause or shows up a day or two after a strange sensation, dancers can jump to the worst-case scenario.
So let’s break this down clearly, scientifically, and reassuringly.
What Exactly Is a Bruise?
A bruise is the visible result of bleeding under the skin. When tiny blood vessels (capillaries) break, blood leaks into the surrounding tissues. The body clears it out over several days, which is why the colour of a bruise shifts from red → purple → blue → green → yellow.
The medical term for this is ecchymosis (eh-kee-MO-sis).
Simple definition for dancers:
Ecchymosis = leaked blood spreading under the skin after a small vessel breaks.
This spreading is what makes some bruises look large, even when the actual injury was tiny.
Why Do Some Bruises Show Up Days Later?
This is one of the most confusing experiences for dancers.
A dancer can feel a “pop,” “snap,” or sudden pinch during rehearsal, look at their ankle, see nothing…
…then two days later wake up with a dramatic purple bruise.
This delay can happen for several reasons:
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Gravity pulls the leaked blood downward, so bruising may appear below the actual injury site.
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Swelling takes time to accumulate, especially around the ankle and foot where tissue planes are thin.
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The vessel that tore may be very small, so the bruise grows slowly before it becomes visible.
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Muscle contraction continues to move the fluid, pulling it into a more visible area.
Delayed bruising does not always mean a serious injury.
A Real-Life Example: Samantha Sacks, New York Theatre Ballet, professional ballet dancer.
Samantha felt a sharp jolt of pain in her ankle while walking from dressing room to stage. She had no pain while dancing, minimal immediate swelling, and no pain that stopped her from walking.
Forty-eight hours later, this bruise appeared:
Understandably, that raised concern. She immediately sought a clinical assessment.
What the assessment found:
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No ligament tear – her ankle felt stable
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No tendon rupture – she had full and pain-free strength on resisted ankle and foot movements
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No fracture – no pain weight bearing
In other words: the bruise looked dramatic, but the cause was minor.
This is the perfect example of ecchymosis from a small vascular injury rather than a major structural injury.
So When Is a Bruise a Sign of Something More Serious?
A bruise alone doesn’t necessarily mean you’ve injured a structure. But you should seek clinical evaluation if you also notice:
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Significant swelling within the first hour
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Difficulty weight-bearing
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Sharp or localized pain
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A feeling of instability (“giving way”)
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Numbness or tingling
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A visible change in foot shape or arch
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Pain that increases rather than settles after 48 hours
These may indicate a ligament sprain, tendon strain, or a fracture.
How This Dancer Returned Safely to the Stage
Treatment included compression (thank you Apolla for great compression socks), elevation, activity modification and after being medically cleared, she followed the Pivot Dancer “Return to Jump Protocol”. The protocol is a structured progression of strengthening, mobility, neuromuscular control, and graded loading.
This included:
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Basic foot intrinsics
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Strength and loading progressions
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Balance and proprioception
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Plyometric phases
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Jump landing mechanics
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Rehearsal-specific readiness testing
By following the protocol and listening to her body, she returned to performance confidently and safely.
Key Takeaways for Dancers
✔ A bruise is simply blood under the skin—ecchymosis.
✔ Delayed bruising is common and not automatically a sign of major injury.
✔ A proper assessment helps rule out structural issues.
✔ PEACE & LOVE for acute injury
✔ A safe, structured return-to-dance plan protects your long-term performance.
✔ Your body often gives you clues—don’t ignore them, but don’t panic either.
Bruises may be part of dance life, but they don’t have to derail your training or performances. With good information, proper care, and smart progression, dancers can keep moving with confidence.
Submitted by Dinah Hampson, Physical Therapist
Photos and story shared by Samantha Sacks, professional dancer, NYC.
