Download - Dance presentation.101
Residency Presentation
Rex & Me
Rex = 10 Months
Rex = Tricks“Sit!”
“Down!”
“Paw!”
“Bang!”
Rex: “Good Luck!”
One of my tricks...
Overview of Dance Medicine
Objectives
1.) Understand the physical and psychological needs of the dance population.
2.) Identify common dance injuries and their implications.
3.) Utilize proper physical therapy interventions to treat dance injuries.
So You Think You Can Dance?(Not just a TV show)
Potts & Irrgang, 2001
“Dancers are a unique subset of the sports medicine patient population since they must combine aspects of art and science. No Physical activity calls for greater
physical versatility than dance. From explosive bursts of speed punctuated by bravura jumping to infinitesimally exquisite precision and control creating the illusion of
gravity defying lightness, from seemingly supra-human flexibility and balance to the strength necessary to carry one another, dancers are athletes as much as they are
artists.”
Subjective History & Risk Factors to Consider
Dance Medicine
• Dancer vs. typical patient =
Extreme ROM
Anatomic Alignment
• Perfect feet?– Pes Cavus– Pes Planus• Femino 2000 “supple and rigid”
• Hip anteversion vs. retroversion
Environment
• Raked Stage
• Sprung Floor
• Non-Sprung Floor
Footwear
• Men and Women ballet slippers give poor shock absorption.
• Need for dexterity
• Pointe shoes– Readiness?– 12x BW
Internal Environment
• Illness– Increased risk of injury
• Nutrition– Female athlete triad
• Gamboa 2008“...amenorrheic for > 6 mo. Were 93% more likely to sustain a stress
fracture”
• Bolin 2001“...dancers with a stress fx were more likely to consume <75% of
Recommended daily allowance (RDA).”
Training
• Change in training– 2-4 hrs. per
afternoon vs.– 6 hrs. per day
• Injuries occur when fatigued
Injury Occurence
Fitness
• Importance of cross training
• On and Off Season
Principles of Rehabilitation of LowerExtremity Injuries in Dancers
Potts & IrrgangJournal of Dance Medicine and Science
2001: 51-60
“Class work is inadequate for increasing the physiologic capacities of strength, power, and endurance that are
required by accomplished dancers.”
PT Magazine November 2008
Demonstration
• Technique
– Alignment, Alignment, Alignment!
Demonstration
• Releve• 1st Position (turnout)• 1st Position & Plie• Grand Plie• Developpe• Arabesque
Spine
Evaluation
• Look at: Arabesque and arching• Mechanism of injury.– Pull vs. Repetitive
• Inappropriate use of trunk or hip extension
• Poor lifting (males and females)• Weak Core
Treatment
• Educate on proper lifting technique• Educate patient on proper arching
technique– “Not bend back but feel lifted up and then
extend”• Core strengthening*
Differential Dx
• Imaging to rule out Spondylolysis
Hip
Evaluation
• Look at : Developpe• “Snapping Hip” (not an issue if not
painful)• Poor flexion• Overuse of Hip Abductors• Advantage of retroversion
Treatment
• Stretching of lateral structures– ITB (Winslow & Yoder, 1995)
• Correlation between tight ITB and tibial ER
• May need to look up or down the chain• Cautious with stretching IR and Flex. May be
causing impingement (increase pain)– Neutral may be enough
• Soft tissue work
Differential Dx
• Impingement
– Labral tear– CAM– Pincer
Knee
Evaluation
• Look at: Turnout & Plie• “Screwing the knee” mechanism and
poor technique• Hip ER (most likely weak)• Knee alignment in Plie should be over
2nd toe
Treatment
• Educate• Strengthen hip ER– Spin Disc or frictionless surface practice
turnout– Plie with theraband
• Correct alignment
Differential Diagnosis
• Meniscal tears• Stress fracture – Dreaded black
line• ACL– AJSM 2008
Liederbach, et al
Incidence of Anterior Cruciate Ligament Injuries Among Elite
Ballet and Modern DancersLiederbach, Dilgen, Rose
American Journal of Sports Medicine2008: 36; 1779-1788
Liederbach, 2008
• Looked at the incidence of ACL tears in dance over 5 years
• 298 Dancers– Male and Female– Modern and Ballet
• ACL tear per Exposure as defined by NCAA
Liederbach, 2008
Liederbach, 2008• Results – .009 per 1000 exposures
• Conclusion: “Dancers experience far fewer ACL injuries than in sports may be due to proprioceptive training as protective mechanism.”
Foot and Ankle
Evaluation
• Look at: Turnout, Plie, Releve• “Sickling” = BAD• Where is the pain?
– Medial vs. Lateral• FHL, Peroneals, Achilles• 1st MTP Joint DF ROM
– Rigid? Compensate, may start sickling• Jumping
– “Double Heel Strike” = Shin Splints• Gans, PT Journal, 1985
• Ankle sprains most common injury in dance
Gamboa, 2008
• Foot & Ankle Injury Incidence over 5 years
Liederbach, 2008
• Foot & Ankle Injury over 5 years
Treatment
• STM• Correct alignment• Modalities as needed and appropriate• Restrictions on jumping
Differential Dx
• Os Trigonum
Associations between turnout and Lower Extremity Injuries in Classsical Ballet Dancers
Negus, Hopper, BriffaJOSPT 2005: 35; 307-318
Negus, 2005
• 29 Dancers• Measured static Hip ER ROM• Measured Functional Hip ER ROM• Correlation between turnout and injury
Turnout
Negus, 2005
• Results:– No correlation with static hip ER ROM– Correlation found between non-traumatic
injury and functional hip ER ROM
• Conclusion: – “Measurement of hip ER ROM is insufficient
on its own.”
Shoulder
• Males – Increased lifting
of partners
• Style of dance, type of choreography
Evaluation
• Type of dance– WBing? Lifting?
• Proper lifting technique
• Typical UE evaluation
Who's tougher?
Treatment
• RTC Strengthening
• Correct lifting technique– Legs -> Trunk -> UE– Prevent hyperlordosis
• Core strengthening
Differential Dx
• Instability– 90% success non-operative
Injury Patterns in Elite Preprofessional Ballet Dancers and the Utility of Screening Programs to
Identify Risk Characteristics
Gamboa, Roberts, Maring, FergusJOSPT 2008: 38; 126-136
Gamboa, 2008
• Can you identify those that will be injured?• 5 Year study• Analyzed Several categories– Demographics & Medical Hx– Posture– Strength & Flexibility– Orthopedic testing (ROM)– Dance Technique Function
Gamboa, 2008
• Results:– Demographics & Medical Hx
• Hx of LBP
– Posture• Right foot pronation
– Orthopedic Testing• Insufficient Plantar Flexion (right)
• Conclusion:– Difficult to find screening to predict, prevent and
manage injuries, but medical hx may be sufficient
Summary
• Many injuries result from muscle imbalance and/or improper alignment
• Look at dancers unique movement patterns• Environment may need to be adjusted and
restrictions placed• “Proximal Stability leads to Distal Mobility”– Todd S. Ellenbecher
SummarySo You Still Think You Can Dance?
(Not just a TV show)
Thank You!
Questions?