For six years now, Li Huan has worked at a school cafeteria to keep her 12-year-old daughter Qingqing in class. Though deep in debt, there’s more at stake than money: Paralyzed and wheelchair-bound after an accident in dance class, Qingqing relies entirely on her mother for mobility.

“This job pays just 1,000 yuan ($140), far less than what we spend on medical expenses,” Li, 37, from Wuhan in China’s central Hubei province, tells Sixth Tone. “I’m just happy the school agreed to employ me.”

Away from the cafeteria, she maneuvers Qingqing’s wheelchair through narrow hallways, up steep staircases, and past crowds of students from class to class. At home, Li juggles medical expenses and a legal battle for compensation against the dance institute.

The relentless routine began in 2017, when Qingqing was 5. At the time, she, like millions of other girls her age, was enrolled in Chinese folk dance classes to boost physical fitness and flexibility.

But a routine dance move — the backbend, where the dancer bends backward to touch the floor with both hands — commonly perceived as safe and fundamental, went devastatingly wrong.

Qingqing fell while practicing the move, severely injuring her spinal cord and leaving her paralyzed from the chest down. Doctors say she may never walk again. “At the time, I’d never imagined a simple dance move or bending over would end like this. It happened so suddenly,” says Li.

Across China, research in recent years from multiple hospitals indicates a disturbing rise in similar cases, where young girls suffer severe spinal injuries from routine dance moves, particularly the backbend.

Between 2015 and 2019, data analyzed by the Chinese Orthopaedic Association, along with multiple hospitals, found that spinal cord injuries caused by the backbend accounted for 33.9% of all pediatric spinal injuries — up from only 4% between 1992 and 2002.

Similarly, the Spinal Cord Injury Rehabilitation Department at Beijing Boai Hospital, after a retrospective analysis of children under 14 years old treated for spinal cord injuries, found a significant increase in injuries related to backbends in dance. Domestic media reports indicate that since 2005, over 1,000 children have been paralyzed.

The increase coincides with the rapid expansion of the dance training industry before the pandemic, amid unregulated dance classes, unqualified teachers, and inconsistent guidelines.

The research also triggered widespread attention on social media, prompting several dance schools to stop teaching the move following demands from parents.

Last November, China’s Ministry of Education even issued a reminder urging that children should not engage in excessive flexibility training prematurely. It specifically warned that children under 10 should be cautious about practicing maneuvers like the backbend.

However, with hospitals continuing to report new cases of paralysis in children related to dance activities, doctors and senior dance instructors have called for more professional assessments and risk education before allowing children to practice backbend training.

Speaking with Sixth Tone, Dr. Guo Xiaodong, director of Orthopedics at Wuhan Union Hospital, says, “While we also need more collaboration in treating and preventing these injuries, it is crucial to ensure broader awareness and stricter regulation of dance training.”

Midnight trauma

Before the risk of spinal injuries and unqualified dance teachers sparked widespread debate across the country, many Chinese parents, like Li, chose dance classes for their children based on convenience and informal recommendations.

According to Li, she saw it simply as a beneficial after-school activity once a week, and selected a dance institution at random among dozens located in one building complex in Wuhan.

“The teacher was young and seemed nice, and it focused more on amateur training, not aiming to be professional. Comparatively easier, you could say,” says Li.

Such was her perception of dance classes as a harmless activity, that when informed of Qingqing’s accident during a backbend, Li wasn’t immediately concerned.

“They told me she fell and started crying. Qingqing was allowed to rest, but then continued to dance,” recalls Li. “When I picked her up, she mentioned feeling uncomfortable, but we all believed it was nothing serious.”

But by bedtime at around 11 p.m., Qingqing’s discomfort had escalated to the point that she couldn’t sleep. On rushing her to the nearest children’s hospital, doctors confirmed the worst: Qingqing was in extreme danger of paralysis and needed urgent surgery.

“I was in shock. All I could do was follow what the doctors recommended,” says Li.

Given the complexity of the surgery and the lack of specialists at the local hospital, they transferred to Wuhan Union Hospital. The prognosis there was grim.

“They weren’t sure if the surgery would help. But as long as there was hope, I had to take that chance,” says Li, adding that the surgery went without incident. But the damage to Qingqing’s spine was irreversible.

Over the following months and years, the hospital became their second home, filled with ongoing recovery treatments including physiotherapy and exercise. Due to her paralysis and resulting incontinence, Qingqing frequently suffered infections and fevers.

Even at home, Li had to be ready for unexpected trips to the hospital. “I don’t know how I got through that first year,” rues Li.

The backbend

Qingqing’s condition is classified as pediatric acute hyperextension spinal cord injury (PAHSCI). According to Dr. Guo at the Wuhan Union Hospital, this spinal injury, which is an acute, non-fracture dislocation injury in the chest and lower back region, often results from repeated or prolonged hyperextension of the spine.

Approximately 70% of patients with PAHSCI sustain complete injuries, for which there are currently no effective treatments. So often is PAHSCI associated with the backbend maneuver in dance, that it is commonly referred to in China as “backbend paralysis.”

Children with such injuries often only have a four-hour “golden” window for effective treatment. Initial symptoms might include mild lower back and leg pain or an abnormal sensation, with paralysis typically developing about four hours after the injury.

“During this golden period, 90.9% of patients are still engaged in physical activity, increasing the risk of secondary injuries and missing the optimal treatment window,” says Dr. Guo.

The spinal cord, a bundle of nerves connecting the brain to the body, is protected and supported by the spine’s ring-shaped vertebrae. And while the spine itself can endure significant stretching, the spinal cord is far less flexible and more susceptible to injury.

According to Dr. Guo, the risk of spinal injuries is notably higher in children. “For instance, a newborn’s spine can be stretched and lengthened by up to two inches without rupturing,” he explains. “However, the spinal cord can only withstand about a quarter inch.”

“Continuous or repetitive bending movements, as well as movements that repeatedly overextend the spine, are particularly dangerous and can easily lead to spinal cord injuries.”

Dr. Guo also led one of the studies that brought to light the alarming rise in pediatric spinal injuries. His data shows that just two hospitals, Union Hospital Tongji Medical College Huazhong University of Science and Technology and Wuhan Children’s Hospital, recorded 44 dance-related PAHSCI cases between September 2010 and September 2020.

“Collecting comprehensive data, analyzing it, and preparing detailed publications is a lengthy process. Although our latest published study includes data only up until 2020, we continue to collect and analyze newer data to keep our findings current and relevant,” says Dr. Guo.

Despite the studies, and the widespread debate that they triggered, both hospitals continue to see new cases annually. “In the past two years, we have treated approximately three children annually with PAHSCI,” he says.

Similar cases are occurring nationwide. Last August, domestic media reported that within just three weeks, the Nanjing Drum Tower Hospital in eastern China diagnosed five children with backbend paralysis, leading to spinal deformities.

The continuing rise in spinal cord injuries among children stems from the popularity of dance among parents to boost their children’s physical fitness and competitive edge in school entrance exams, despite the risks.

According to the business database Qichacha, more than 80% of businesses related to dance were established prior to 2020.

Its appeal grew in the wake of policies allowing children to earn extra points on school entrance exams by demonstrating specialties, particularly in dance or music. But by 2020, the Ministry of Education phased out the policy, opting instead to promote a broader assessment of students’ overall abilities.

But by then, thousands of dance institutions were firmly established across the country. “It’s a problem unique to contemporary China,” says Dr. Guo.

Within the industry, the backbend has long been a fundamental part of traditional dance education. “For anyone looking to go professional, mastering the backbend is crucial,” explains Zhu Dandan, a seasoned dance instructor from Nanjing, adding that the move is also significant in Chinese folk dance to develop waist flexibility.

Zhu, who began practicing the backbend at around 4 years old, stresses the importance of starting slow. “We typically start by teaching children to kneel and lean backward, gradually progressing to more complex movements,” she says.

According to her, training children aged 4-5 takes about a year. “It’s not just about nailing the move, but practicing it safely.”

Gao Jun, 44, who manages a dance training institution in Shanghai, agrees. “Today, most children attend just one and a half hours of class per week. Without additional practice, they lack the necessary muscle strength for professional training, making the backbend too risky and inefficient,” she says.

Given the recent public outcry over the alarming data and reports detailing spinal injuries and paralysis among young dancers, Gao has decided to stop teaching the backbend.

“As the risks have become clearer and parental concerns have grown, it no longer made sense to include such a demanding maneuver that could potentially harm the children,” says Gao.

Adding that several other institutions, particularly those in Shanghai, have also discontinued teaching this gesture, she says: “For normal practice, we focus on simpler waist and chest movements. Standing backbends are unnecessary unless aiming for professional levels.”

According to both Zhu and Gao, the qualifications of many dance instructors and the rigor of the curricula are inconsistent and often not standardized. “Also, textbooks for grading exams primarily focus on dance, with few resources dedicated to fundamental skills. Therefore, teaching fundamental skills must be tailored to each child’s individual circumstances,” says Zhu.

Gao says the difference in children’s physical conditions poses additional challenges for standardizing a curriculum. “Professional qualifications of the teacher and reviewing the curriculum are critical, but there’s no comprehensive supervision to enforce these standards across all dance institutions,” she explains.

She also underscored the crucial need to standardize teaching qualifications to a unified industry standard. “For instance, only teachers who have graduated from professional institutions should be allowed to teach. Even when dealing with amateur children, we must ensure that the correct techniques are taught,” Gao says.

Uncertain future

Back in Wuhan, as Qingqing prepares for middle school, her family faces an uncertain future due to escalating financial burdens. They have spent more than 300,000 yuan on her medical care, leaving them deeply in debt.

“We hesitate to take her little brother to the hospital if he has a cold or fever, and just deal with it at home instead. That way we can save some funds for (Qingqing’s) treatments,” says Qingqing’s mother, Li. Her father, a daily-wage electrician, ekes out a living installing security equipment, speakers, and monitors.

An upcoming surgery requires the insertion of steel pins into Qingqing’s back to correct her spine, and is expected to cost over 100,000 yuan — an amount far beyond their means. “A subsistence allowance we recently applied for might cover around 60% of the surgery fee, but we will have to borrow the rest,” says Li.

In 2019, the family felt buoyed after winning a legal victory. A Wuhan court ordered the dance studio where Qingqing suffered the injury to pay the family 2 million yuan in compensation.

But they have yet to see any of that money. “We were told that the company was essentially a shell and had no funds available to pay the compensation,” says Li.

With Qingqing moving to a middle school in another part of Wuhan this summer, Li no longer needs to work at the elementary school cafeteria. She’s also seeking another lawyer to help pursue the unpaid compensation.

“I can only do my best to make her feel the same as other children and grow up happily and healthy,” says Li. “I just hope there’s more focus on regulating dance institutions and more awareness about lower spinal injuries so that people can better understand the risks.”

Additional reporting: Lü Xiaoxi, editor: Apurva.

(Header image: Students practice the backbend at a primary school in Jinan, Shandong province, 2017. VCG)