Upper Neck Injuries - From Young Dancers to Formula One Drivers
Recently, I sat watching my daughter perform at the end of a week-long summer dance camp. As an osteopath, I probably watch movement slightly differently to most parents, and something caught my attention.
There was an enormous amount of movement through the head and neck.
Head flicks, rapid turns, looking upwards, dropping the head forwards and sweeping it from side to side were all incorporated into the choreography. Of course, this is part of dance. The head and neck contribute to expression, timing and the overall line of a movement, and I certainly wouldn't want children to dance rigidly with their heads held still.
However, having recently seen several young dancers in clinic with pain and restriction around the upper neck, I found myself watching these movements from a rather different perspective.
A child's neck isn't simply a smaller adult neck
We often hear that the human head weighs around 4–5 kg in an adult. In children, the absolute weight will of course be less, but their head is proportionally larger in relation to the rest of their body.
Their cervical spine is also still developing.
Children have greater ligamentous laxity, less-developed supporting musculature and differences in the orientation and maturity of their cervical joints compared with adults. In younger children, the effective fulcrum of cervical movement also sits higher in the neck, around C2–C3, gradually moving towards the lower cervical spine as they mature.[1]
This doesn't mean children's necks are inherently fragile. Children are remarkably adaptable and their bodies are designed to run, jump, tumble and move.
It does, however, mean that we shouldn't automatically think of a young dancer as simply a miniature adult dancer.
What is happening at the top of the neck?
The anatomy of the upper cervical spine is particularly interesting.
At the top sits the occiput, forming the base of the skull, followed by the first cervical vertebra, the atlas (C1), and the second, the axis (C2).
These joints are designed for considerable mobility. The relationship between C1 and C2 provides a significant proportion of our ability to rotate the head, while the joints between the skull and C1 contribute to the nodding movements of flexion and extension.
That mobility needs to be controlled.
When we move our head slowly, the muscles surrounding the cervical spine guide and control the movement. During dance, however, the movement can be much more dynamic. A dancer may rapidly accelerate their head in one direction, stop it, change direction and then immediately move into another position, often while the rest of their body is simultaneously turning, jumping or travelling.
It was this repeated acceleration and deceleration that really struck me while watching the performance.
A head flick may look effortless from the audience, but the muscles, joints and ligaments of the neck still have to control the mass of the head throughout that movement.
Formula One gives us an exaggerated example
Formula One provides a useful, although deliberately extreme, comparison.
Formula One drivers undergo specific neck conditioning because their neck muscles have to control the head during substantial acceleration, braking and cornering forces. Research examining elite racing drivers has found Formula One and IndyCar drivers to have particularly high levels of isometric neck strength compared with drivers competing in some other categories.[2]
A 2026 review of the physiological demands of Formula One similarly identified increased neck strength as one of the sport-specific adaptations seen in drivers, with neck strengthening routinely used to prepare them for the forces involved.[3]
Clearly, a child performing a dance routine isn't experiencing anything approaching the forces of Formula One racing.
The comparison simply demonstrates an important biomechanical principle: once we start accelerating and decelerating the head quickly, controlling it becomes considerably more demanding.
Watching repeated head flicks during the dance performance made me think about exactly that principle, but in a much younger and still-developing body.
What does the research tell us about dancers?
There is currently very little research specifically measuring the forces passing through a child's cervical spine during common dance movements such as head flicks. I think that is important to acknowledge.
However, we do know that musculoskeletal injuries are common amongst young dancers.
A UK study involving 806 talented dancers aged between 10 and 18 found that 347 reported an injury. The researchers also found associations between dance exposure and injury, concluding that the intensity and amount of training should be considered when trying to reduce injury risk.[4]
A larger study of 1,336 non-professional female dancers aged 8–16 found that 42.6% had an injury identified, with injury prevalence increasing with age and dance exposure.[5]
There is also some research specifically involving the cervical spine.
A study examining breakdancers who regularly performed headspins found considerably more cervical complaints amongst the dancers compared with controls, including greater neck pain and altered cervical biomechanics.[6] Headspinning is obviously very different from the movements performed in most children's dance classes, but it provides another example of how dance-specific loading can affect the cervical spine.
Perhaps more relevant is a published case series examining dance-related concussion in dancers aged 12–20. Most of the concussions followed falls, partnering incidents or direct blows, but one dancer developed symptoms following repeated whipping movements of the head and neck during choreography.[7]
That does not mean that head flicking causes concussion, nor does it mean that these movements should be removed from children's dance.
It does tell us that repetitive choreographed movement of the head and neck can be clinically relevant and deserves consideration when a dancer presents with symptoms.
Professional dancers have something most children don't
There is another difference that I think is important.
At professional level, dancers are increasingly treated like the elite athletes they are.
Major dance companies can have multidisciplinary healthcare teams supporting their dancers. The Royal Ballet, for example, has a dedicated Ballet Healthcare team. Its physiotherapists assess and diagnose musculoskeletal problems, provide treatment, plan rehabilitation and work alongside other healthcare professionals, while strength and conditioning coaches provide physical preparation, recovery, monitoring and rehabilitation support.[8,9]
In other words, if a professional dancer develops a problem, there may be a whole team around them looking not only at the painful area but also at why it happened, how their training needs to change and how they can safely return to full performance.
Most children dancing recreationally don't have anything resembling that level of support.
They may attend dance several times a week, practise at home, take part in competitions and then suddenly increase their hours considerably during rehearsals, summer schools or the build-up to a performance. Yet if their neck starts hurting, there isn't necessarily a physiotherapist or rehabilitation specialist watching them train.
Some will be fortunate enough to have parents who seek private treatment. Others may mention that their neck hurts and simply carry on.
That is where I think parents, dance teachers and healthcare practitioners can make a difference.
What I'm seeing in clinic
The young dancers I see aren't generally coming in following a dramatic neck injury.
More commonly, the story is subtle.
They may complain that the top of their neck feels sore, that turning their head one way feels uncomfortable, or that they have started developing headaches. Sometimes there is tenderness around the small muscles underneath the base of the skull or a noticeable restriction in cervical movement.
When I start asking about their dancing, there can be a recent increase in training, a new routine, repeated rehearsals or particular movements that reproduce their symptoms.
And because young dancers are often extremely motivated, they may simply continue dancing.
Pain doesn't necessarily mean a child needs to stop dancing completely, but recurring pain is information from the body that is worth listening to.
What should parents look out for?
A little muscular aching after an unusually demanding week isn't necessarily concerning. What I would pay more attention to is a pattern.
Neck pain that repeatedly appears after dance, a noticeable reduction in the child's ability to turn or tilt their head, headaches associated with dancing, pain around the base of the skull, or symptoms that remain into the following day are all worth investigating.
Parents might also notice their child repeatedly rubbing, stretching or trying to 'click' their neck after classes.
Symptoms following a fall, collision or direct head injury need to be considered differently. Significant headache, dizziness, nausea, visual disturbance, altered balance, weakness, numbness or neurological symptoms require appropriate medical assessment rather than simply assuming the problem is muscular.
Protecting young dancers doesn't mean stopping them dancing
I don't want the message from this article to be that head movements are dangerous or that children shouldn't perform them.
Dance is an excellent activity for children. It develops coordination, strength, balance, confidence, musicality, fitness and body awareness.
Instead, I think we need to recognise young dancers for what they are: young athletes whose bodies are still developing.
That means thinking about how quickly training increases, particularly around performances and intensive dance weeks. It means teaching control rather than simply encouraging a child to throw their head further or faster for dramatic effect. It means developing appropriate strength through the neck, shoulders and upper back and allowing adequate recovery between demanding sessions.
Most importantly, it means creating an environment where a child can say something hurts without feeling that they are being difficult or letting their dance teacher or team down.
Treat the dancer, not just the painful neck
When a young dancer presents to me with neck pain, I'm interested in considerably more than simply finding the painful joint.
I want to know how much they are dancing, whether that has recently increased, what styles they perform and whether particular movements reproduce their symptoms.
I'll assess cervical movement, but I'll also consider the thoracic spine, shoulders, scapular control, muscular strength and how the child coordinates their head and neck with the rest of their body.
Treatment can be useful where appropriate, but rehabilitation and managing the load that contributed to the problem are equally important. Making a painful neck feel better and then sending a child straight back to exactly the same amount of repetitive movement doesn't address the whole picture.
Watching my daughter's performance reminded me just how physically demanding dance can be, even when it looks effortless from the audience.
The head and neck are part of the artistry of dance, and they should remain so. But when a developing neck is repeatedly asked to accelerate, decelerate, rotate and control the head through increasingly complex choreography, it deserves some consideration too.
Perhaps one of the simplest things we can do is recognise that when a young dancer repeatedly says their neck hurts, it isn't necessarily something they should simply be expected to dance through.
References
Kreykes NS, Letton RW. Current issues in the diagnosis of paediatric cervical spine injury. Seminars in Pediatric Surgery. 2010;19(4):257–264. doi:10.1053/j.sempedsurg.2010.06.003.
McKnight PJ, Bennett LA, Malvern JJ, Ferguson DP. VO₂peak, body composition, and neck strength of elite motor racing drivers. Medicine & Science in Sports & Exercise. 2019;51(12):2563–2569. doi:10.1249/MSS.0000000000001961.
Physiological and health demands of Formula 1 motor racing: a comprehensive review with driver performance coach insight. British Journal of Sports Medicine. 2026. doi:10.1136/bjsports-2025-110977.
Steinberg N, Aujla I, Zeev A, Redding E. Injuries among talented young dancers: findings from the U.K. Centres for Advanced Training. International Journal of Sports Medicine. 2014;35(3):238–244. doi:10.1055/s-0033-1349843.
Steinberg N, Siev-Ner I, Peleg S, Dar G, Masharawi Y, Zeev A, Hershkovitz I. Injury patterns in young, non-professional dancers. Journal of Sports Sciences. 2011;29(1):47–54. doi:10.1080/02640414.2010.521167.
Kauther MD, Piotrowski M, Hussmann B, Lendemans S, Wedemeyer C, Jaeger M. Cervical biomechanics and neck pain of "head-spinning" breakdancers. International Journal of Sports Medicine. 2014;35(5):412–417. doi:10.1055/s-0033-1353167.
Stein CJ, Kinney SA, McCrystal T, Carew EA, Bottino NM, Meehan WP III, Micheli LJ. Dance-related concussion: a case series. Journal of Dance Medicine & Science. 2014;18(2):53–61. doi:10.12678/1089-313X.18.2.53.
The Royal Ballet. Company Physiotherapist: Job Description – Ballet Healthcare. Royal Opera House. Describes physiotherapy assessment, treatment, rehabilitation, injury prevention and multidisciplinary healthcare provision for Royal Ballet dancers.
The Royal Ballet. Strength and Conditioning Coach: Job Description – Ballet Healthcare. Royal Opera House. Describes strength and conditioning, recovery, monitoring, physical performance and rehabilitation provision within the company's multidisciplinary healthcare team.