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Treating the Whole Dancer

Unique qualities to consider during rehabilitation of the dancer population
by

Laura Pempkowski

on 21 July 2014

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Transcript of Treating the Whole Dancer

Treating the Whole Dancer
Unique qualities of the dancer population to consider during physical therapy rehabilitation
Dancers go to physical therapists first for medical treatment. It is important that physical therapists are aware of the specific needs and conditions of their dancer clientele.
In a 2011
survey of dancers,
80%
said they
sustained an
injury within
the last year.
This suggests a high likelihood
that any physical therapist will
encounter a patient who is a dancer
at some point in his or her career.
mental health
nutrition
hormones
"
Harmonious passion
" for dance is correlated with
less suffering
and
better coping skills
during periods of injury.

"
Obsessive passion
" has been linked with
prolonged suffering
.

If an unhealthy obsession is sensed, be mindful of:

Increased physical pain
Emotional frustration
Animosity towards injury & the rehabilitation process
Stress
Sources:
Anxiety of performing
Frustration of quickly learning lots of choreography
Striving for aesthetically and athletically perfected bodies
Verbal scrutiny from choreographers and teachers
Physical exhaustion from long, daily rehearsals
Stress has been
proven to cause an increased risk of injury
due to:

Tight muscles
Poor sleep
Problems concentrating
Burnout
Encourage your patients to practice stress- relieving techniques, such as:

Cross training
Involvement with non-dance social groups
Adequate sleep
Meditation
Symptoms:
Low BMD
Nausea
Swollen breasts
Headaches
Vision problems
Polydipsia
Goiter
Hyperpigmentation
hips
Ideal 90 degrees of hip ER necessary to achieve the five ballet positions, while simultaneously "avoiding compensations at joints above and below the hip."
This extreme turn out alters biomechanics and kinesiology, impacting gait and the normal kinetic chain.
Young female dancers in puberty and adolescence experience physiological changes in additional to coping with:
Dancers are at high risk of
developing eating disorders due to:

Packed schedules
Technical ability demands
Competition
Emphasis on body shape and size
Hours in front of a mirror
Ask your patient about their daily consumption of:
Calcium (1000-1300 mg/day)
Vitamin D

Assess risk of:
Osteopenia
Osteoporosis
Arthritis
Fractures
Bone health
knees
ankles & feet
Changes in gait
Initial contact
Toes strike first & excessive pronation
Loading response
Often skipped by keeping knee fully extended
Excessive hip ADD & IR
Hyperpronation at ankle
Midstance
Motion is compensated by STJ (normally occurs at talocrural joint)
Terminal stance
Premature weight transfer to medial forefoot
Cause of hallux valgus/bunions
Predispose 2nd metatarsal to stress FX


Piriformis syndrome
Labral tears
Femoroacetabular impingement
Iliopsoas tendonitis
Tight ITB
Femoral neck stress FX
Bursitis
Avulsion injuries
Snapping or clicking
The straight lines of ballet legs require severe knee extension. Dancers often have:

Genu recurvatum
Patellofemoral pain
Tight hamstrings
By Laura Pempkowski
Passion
Eating Disorders
Delayed menarche & amenorrhea
PT & the big picture
Stress
Malnutrition
Hormone imbalance

Can lead to:
Poor bone health
Increased risk of injury
Diet
International Association of Dance Medicine Science (IADMS) recommends a daily diet of:

Rigorous training
Perceived pressure of young social life
Competition of performance casting
Body hyper-awareness
Demands of school
Other jobs/work
Causes:
Low body fat
High levels of stress
Strenuous training
Malnutrition

Female
athletic triad
Hydration
Advise one cup of water every 15 minutes during rehearsal and PT sessions
Turnout
Turnout muscles
Factors that increase turnout
Femoral retroversion
Less forward-facing acetabulum
Longer & more concave femoral neck
Y ligament elasticity
Dynamic stability of hip muscles

Hip exercises
Lunges
Hamstring stretch
Supine on floor, buttocks and legs (turned out) on wall, abduct both legs
Reverse piriformis stretch
Foam roller for ITB
Pilates reformer

Q angle
Greater turnout increases the Q angle, which can lead to increased knee pain.
Common knee injuries
Common hip injuries
Patellar dislocation
Plica syndrome
Arthritis
ITB syndrome
ACL/MCL sprain or rupture
Knee treatments
Viscosupplementation
Surgery
Muscle strengthening
Kinesio taping
Kinesio tape provides "neuromuscular input... speed[s] healing... improves lymphatic drainage...reduce swelling... It allows you to perform while still protecting yourself."
Knee exercises
Wall slides
Squats
Walking lunges
Lateral step-ups
Ankle ROM
Ballet dancers typically have 90-100 degrees of ankle plantarflexion.
En Pointe
Ankle injuries
Sprains
Osteochondritis dissectans
Bone spurs
Posterior and anterior impingement
Triceps surae tightness
Ankle treatment
Balance and strengthening exercises with:
Bosu
BAPS
Foam
Air cushions
Pilates reformer

Sometimes surgery is necessary for reduction or ligamentous repair
Dancer feet
Forced turnout can cause pes planus, which can lead to:
Posteromedial shin splints
Flexor hallucis tenosynovitis
Plantar fasciitis
Common foot injuries
Tarsal tunnel syndrome
Morton's neuroma
Hallux rigidis
Morton's toe
Sesamoiditis
Turf toe
Bunions

Assessing pointe readiness
Traditional factors:
Age
(9-13)
Training years
(3-4 minimum)
Ankle plantarflexion ROM
(10-20 degrees more than "age-matched non-dancers")




Modern factors
LE strength (trunk/pelvis stabilization)

Can be compensated by:
"
Winging
" or eversion
"
Sickling
" or inversion

The Pilates reformer is a great tool to help train dancers because it allows for:
Maximal ROM
Eccentric control
Proprioception training
Gravity eliminated alternative
References
1. Nordin-Bates S, Walker IJ, Baker J, et al. Injury, imagery, and self-esteem in dance: Healthy minds in injured bodies? Journal of Dance Medicine & Science. 2011;15(2):76-85.

2. Rip B, Fortin S, Vallerand RJ. The relationship between passion and injury in dance students. Journal of Dance Medicine & Science. 2006;10(1):14-20.

3. Peterson JR. _Dance Medicine Head to Toe A Dancer’s Guide to Health_. Hightstown: Princeton Book Company; 2011.

4. Nutrition fact sheet: fueling the dancer. International Association of Dance Medicine Science. 2005. Available at: http://www.iadms.org/displaycommon.cfm?an=1&subarticlenbr=2. Accessed October 18, 2012.

5. Ehrlich SD. Amenorrhea. University of Maryland Medical Center. 2011. Available at: http://www.umm.edu/altmed/articles/amenorrhea-000006.htm Accessed October 13, 2012.

6. Gupta A, Fernihough B, Bailey G, Bombeck P, Clarke A, Hopper D. An evolution of differences in hip external rotation strength and range of motion between female dancers and non-dancers. British Journal of Sports Medicine [serial online]. December 2004;38(6):778-783. Available from: SPORTDiscus with Full Text, Ipswich, MA. Accessed October 12, 2012.

7. Wilmerding V, Krasnow D. Turnout for dancers; hip anatomy and factors affecting turnout. International Association of Dance Medicine Science. 2011. Available at: http://www.iadms.org/displaycommon.cfm?an=1&subarticlenbr=324. Accessed October 19, 2012.

8. Insight: ballet glossary – positions of the feet. RoyalOperaHouse. YouTube. Available at: http://www.youtube.com/watch?v=1fSa3ESmA1s. Accessed October 12, 2012.

9. Clippinger KS. _Dance Anatomy and Kinesiology_. Champaign: Human Kinetics; 2007.

10. Negus, V, Hopper, D, Briffa, NK: Associations between turnout and lower extremity injuries in classical ballet dancers. Journal of Orthopaedic & Sports Physical Therapy. 2005 May;35(5):307-18.

11. Pilates Rehabilitation: EP4: Working with the Hip. Balanced Body Pilates. YouTube. Available at: http://www.youtube.com/watch?v=-2Pg9U3E36k. Accessed October 20, 2012.

12. Ahonen J. Gait development in young ballet dancers. Rudolf Nuveyeu Foundation Medical Website. 2000. Available at: http://www.nureyev-medical.org/articles/gait-development-in-young-ballet-dancers Accessed October 14, 2012.

13. Wozny N. Stuck on it. Dance Magazine. Available at: http://www.dancemagazine.com/issues/july-2009/Stuck-on-it. Accessed October 19, 2012.

14. Alycia Fong Y, Hiller C, Smith R, Vanwanseele B. Effect of footwear on dancers a systematic review. Journal of Dance Medicine & Science [serial online]. May 2011;15(2):86-92. Available from SPORTDiscus with Full Text, Ipswich, MA. Accessed October 20, 2012.

15. Ewalt K. Bandaging and taping considerations for the dancer. Journal of Dance Medicine & Science [serial online]. August 2012;14(3):103-113. Available from: SPORTDiscus with Full Text. Ipswich, MA. Accessed October 20, 2012.

16. Pilates Rehabilitation: EP25: Working with Dancers Feet. Balanced Body Pilates. YouTube. Available at: http://www.youtube.com/watch?v=-EGWUQxQfLw. Accessed October 20, 2012.

17. Pilates Rehabilitation: EP20: Pelvic Stability. Balanced Body Pilates. YouTube.Availabl at: http://www.youtube.com/watch?v=I4Zecg7XhW0. Accssed Octobe4 20, 2012
Referenced Images

1.Indulgy. Dancer silhouette. Flickr.com. Available at: http://indulgy.com/post/xRQJrkHHU1/dance-and-strength. Accessed October October 11, 2012.

2.Nordin-Bates S, Walker IJ, Baker J, et al. Graph. Injury, imagery, and self-esteem in dance: Healthy minds in injured bodies? Journal of Dance Medicine & Science. 2011;15(2):76-85.

3.Hydration photograph. Available at: http://www.visualphotos.com/image/2x4397010/a_female_ballet_dancer_drinking_a_glass_of_water. Accessed October 20, 2012.

4.What is the triad? Female athlete triad coalition and international consortium. Available at: http://www.femaleathletetriad.org/for-athletes-coaches/what-is-the-triad/. Accessed October 16, 2012.

5.From plies to pirouettes. Turnout tips. Available at: http://pliestopirouettes.blogspot.com/2010/07/mondays-blog-brag-survival-guide-for.html. Accessed October 19, 2012.

6.Wilmerding V, Krasnow D. Turnout muscles. Turnout for dancers; hip anatomy and factors affecting turnout. International Association of Dance Medicine Science. 2011. Available at: http://www.iadms.org/displaycommon.cfm?an=1&subarticlenbr=324. Accessed October 19, 2012

7.Wilmerding V, Krasnow D. Anteversion. Turnout for dancers; hip anatomy and factors affecting turnout. International Association of Dance Medicine Science. 2011. Available at: http://www.iadms.org/displaycommon.cfm?an=1&subarticlenbr=324. Accessed October 19, 2012.

8.High insteps, high arches: ballet feet. Wandering Apricot. Available at: http://apricot.wordpress.com/2009/03/31/high-insteps-high-arches-ballet-feet/. Accessed October 2012.

9.Dancing with Kinesio tape. Full range therapy supplies. Available at: http://frtherapysupplies.com/latest-news/. Accessed October 20, 2012.

10.Goh CH. X-Ray of the foot en pointe in the Diamond pointe shoe. 2005. Available at: http://www.chanhongoh.com/diamond_pointe.shtml. Accessed October 12, 2012.

11.Chao N. So you think you can dance? Marie Claire. Available at: http://www.marieclaire.com/health-fitness/advice/becoming-a-ballerina. Accessed October 21, 2012.
Indulgy. Dancer silhouette. Flickr.com. Available at: http://indulgy.com/post/xRQJrkHHU1/dance-and-strength. Accessed October October 11, 2012.
Nordin-Bates S, Walker IJ, Baker J, et al. Graph. Injury, imagery, and self-esteem in dance: Healthy minds in injured bodies? Journal of Dance Medicine & Science. 2011;15(2):76-85.
Hydration photograph. Available at: http://www.visualphotos.com/image/2x4397010/a_female_ballet_dancer_drinking_a_glass_of_water. Accessed October 20, 2012.
What is the triad? Female athlete triad coalition and international consortium. Available at: http://www.femaleathletetriad.org/for-athletes-coaches/what-is-the-triad/. Accessed October 16, 2012.
From plies to pirouettes. Turnout tips. Available at: http://pliestopirouettes.blogspot.com/2010/07/mondays-blog-brag-survival-guide-for.html. Accessed October 19, 2012.
Wilmerding V, Krasnow D. Turnout muscles. Turnout for dancers; hip anatomy and factors affecting turnout. International Association of Dance Medicine Science. 2011. Available at: http://www.iadms.org/displaycommon.cfm?an=1&subarticlenbr=324. Accessed October 19, 2012.
Wilmerding V, Krasnow D. Turnout muscles. Turnout for dancers; hip anatomy and factors affecting turnout. International Association of Dance Medicine Science. 2011. Available at: http://www.iadms.org/displaycommon.cfm?an=1&subarticlenbr=324. Accessed October 19, 2012.
High insteps, high arches: ballet feet. Wandering Apricot. Available at: http://apricot.wordpress.com/2009/03/31/high-insteps-high-arches-ballet-feet/. Accessed October 2012.
Dancing with Kinesio tape. Full range therapy supplies. Available at: http://frtherapysupplies.com/latest-news/. Accessed October 20, 2012.
Goh CH. X-Ray of the foot en pointe in the Diamond pointe shoe. 2005. Available at: http://www.chanhongoh.com/diamond_pointe.shtml. Accessed October 12, 2012.
Chao N. So you think you can dance? Marie Claire. Available at: http://www.marieclaire.com/health-fitness/advice/becoming-a-ballerina. Accessed October 21, 2012.
For more information on dance medicine and science, you can visit:

http://www.iadms.org/
or
http://hjd.med.nyu.edu/harkness/

Thank you
Full transcript