Category Archives: Sports Injuries

ACL Injury Risks

Whether you are a conditioned athlete, fitness enthusiast or weekend warrior, the last injury you would like to be diagnosed with is a torn ACL (Anterior Cruciate Ligament). It is one of four major ligaments of the knee and its main purpose is to prevent forward translation of the tibia (leg) on the femur (thigh).

Recovery from this surgery is a long and arduous task, which can be as mentally taxing as well as physical. The process can take 6-12 months depending on your activity of choice post-surgery.

There are multiple ways that the ACL can be compromised. Most ACL injuries are common in sports that require a sudden change in direction. An underlying issue that could predispose an individual to an ACL injury is alignment and deconditioned hips. Hip strength and mobility is crucial to the health of your lower body. Hips and ankles are two of the most mobile joints in the body, the knee is not. So, being that the knee is in between the two it can be stressed at different times especially if the hip and ankles are misaligned.

ACL injuries

ACL tears are more likely in female athletes versus male athletes. There are many reasons for this—hormonal changes, wider pelvis, increased Q angle (angle of pelvis to knee), and a greater discrepancy in strength.

Valgus knee alignment upon landing (knees closer together than hips and feet) is another circumstance that can result in an ACL tear. This can be tested by having the athlete perform a simple squat (no weight). If the knees collapse inward as the depth increases this would be a red flag. Also, twisting motions can result in injury.

So, make sure to incorporate hip strengthening and mobility into your workouts to reduce the risk.

 

by Rocco Ferraiolo PTA, USAW-L1SP, NASM-CPT,PES

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Why Does Technique Matter?

Dance Technique

Sometimes technique can seem a little boring, or maybe even pointless. Why spend more than half a class at barre or warm up before getting to the “interesting” combinations? Why do some studios require ballet technique classes in order to participate in competition, jazz, or other “unrelated” teams/companies? What is the number one way to prevent dance injuries? The answer to all these questions lies in the basics of dance technique and its importance to all dancers.

Technique does not refer to having a “perfect” or 180 – degree turn out. It does not mean that each bâtiment à la seconde grazes your ear. While good technique may lead to these attributes, it is not the goal of good technique. Having good technique involves learning and working with your body’s unique capabilities to maximize your full potential as a dancer.

Turnout is one of the primary areas where technique plays a large role. Each dancer has a certain amount of turnout, and learning to use that turnout appropriately is the key to both longevity and quality of movement. There are many professional dancers who never achieve 180-degrees of turnout, or anywhere near that level, yet lead highly successful dance careers. The most important aspect is working hard to maximize each dancer’s turnout out, but without “cranking” or forcing their turnout beyond their body’s unique anatomical abilities. Most teachers use a “knees over toes” (knees over the 1st and 2nd toe) rule of thumb to ensure their dancers are not over working their turnout. Forcing turnout leads to dance injuries in the foot, ankle, knee, hip, and back, which, in turn, have the potential to shorten a dance career.

Another area of technique is core control. This is not always the term used in dance class, but you’ve heard it in different ways. Dancers are told to “pull up” or “not sink” into their hips. These terms refer to controlling the core, or the area encompassing your hip, stomach, and back muscles. Many dance teachers refer to this as your “center” – and for good reason! This area is the center of your body, your turning focus, and your balancing point. Without strength and control of your core, or center, your dance movements will lose a mature and grounded quality. Additionally, it will be more difficult to perform higher level choreography that requires increased strength. Of course, lack of core strength can also lead to dance injuries and create a longer recovery time from an injury.

Breathing may not inherently seem like an aspect of technique, but working with your breath in dance brings your technique together. Many health practitioners include the breathing muscles with the core. This is because the primary muscles that control your breath are located in your stomach and chest. Once you have pulled up, turned out, stomach and chest in, shoulders down, arms out, head turned, somehow you are now supposed to dance! Breath control can help release some of this tension and allow the muscles to move through the space, rather than gripping or forcing the movement. Dance is a balance between strength and elegance, control and release, power and grace. Learning, controlling, releasing, and using your breath helps bridge these dynamics in your movement.

Dancers who use proper technique will find themselves not only advancing in classes, companies, and roles, but will also decrease their risk of dance injury. As many dancers train with new teachers and studios for summer intensives, it is crucial to remember your technique basics and expand your training horizons. But above all, technique is about giving you the building blocks to enjoy your art form, so work hard and have fun!

 

by: Dr. Kathleen L. Davenport, M.D.

The Price of Pointe

The Price of Pointe

I am writing this article at the request of one of my “dance moms.” She mentioned that she did not have a clear idea of everything involved with her daughter starting pointe. Like many dance parents, she learned how to navigate this step in her daughter’s dancing through other parents, teachers, dance stores, and blogs. While all these resources are essential to the dance community, she asked if I could write an article from my experience, while including her insight from a parent perspective. My dance parents are some of the most generous people with sharing their insights, tips, and struggles, so it is with a special thanks to them that I write this article.

[As an aside, I have written this article using “she” to refer to the dancer en pointe with continuing the gender trend that women and girls are frequently placed en pointe, whereas this is not as common for male dancers. However, male dancers do participate in pointe work, as it builds balance and strength, and this article is equally applicable to their pointe process.]

Know before you go

Before you make your shoe fitting appointment, make sure the teacher and/or studio has cleared your daughter to advance en pointe. Each studio/teacher has different requirements for advancement, so just because a dancer was en pointe at one studio, does not necessarily mean she will be placed en pointe at another studio. Additionally, there may be many steps, such as a doctor’s evaluation, prior to your studio allowing her to progress to pointe.

Also, studios have different ideas about specific pointe shoes. Some teachers prefer certain brands, shank hardness, etc. Other teachers have no preference as long as the shoe fits well. Make sure you have asked ahead of time, as some stores will not allow you to return the shoe if the teacher does not approve.

If the shoe fits…

A pointe shoe fitting takes about an hour. This may be longer or shorter depending on the dancer’s foot shape, experience, and strength. A pointe shoe fitting is often made by appointment only, so call the dance store and plan ahead accordingly. Pointe shoes should be re-fitted a minimum of every 6 months while the dancer is still growing and every 2 years after growth has completed.

A pair of pointe shoes typically costs around $60-$100 per pair, not including the ribbons, toe pads, etc. New shoes need to be purchased whenever the old pair has worn out (known as “dead” as in, “Dad, I need new shoes because these are dead!”). The timing on new shoes is entirely dependent on how much she is dancing, the strength of her foot, and how well she cares for her shoes (see below). If she is just starting en pointe, the shoes may last several months since her foot is not as strong yet and she is likely not en pointe for much time. However, as she advances, new pointe shoes will need to be purchased more often. Some professional dancers will require a new pair of shoes for each performance. I cannot stress how important it is to avoid dancing on a dead pair of pointe shoes. Injuries, such as stress fractures, are more common while dancing in an unsupportive shoe, and can take a long time for recovery.

Shoe Care

Now that you have the shoe, how do you care for it? Dancers should be responsible for sewing their own ribbons. It should be the dancer’s expectation that if she is mature enough to be placed en pointe, that she is also ready for the responsibility of sewing her own ribbons. Most dancers sew ribbons on in a square with an “X” through the square to avoid the ribbons fraying, but there are many ways to sew ribbons on. Many dancers either place an anti-fraying material on the end of the ribbon or burn the ends (obviously, with parent supervision) to prevent fraying.

After dancing, it is normal for the feet to sweat and the shoe to become sweaty as well. It is important to allow the shoe to dry completely before wearing again. This will help the shoe last longer and remain strong to support the foot. In the Florida humidity, drying can take longer. Therefore, dancers may have two pairs of the same shoe and alternate pairs between days.

Similarly, pointe shoes should not be left in the Florida heat for any length of time. The Florida heat can wear them out more quickly and cause them to be less supportive, so pay attention to the dance bag being left in the car.

Final Thoughts

Pointe work can be rewarding and fun, but it’s not for every dancer. The price of pointe can be high, and it is important to remember that a dancer can advance her career, including as a professional, without ever going en pointe. Follow your dreams, in whatever shoes (or lack thereof!) you need to get there.

 

by: Dr. Kathleen L. Davenport, M.D.

Dance Injury Prevention

Dance Injury Prevention

As a dance medicine specialist, I have treated many dance injuries in Seattle, New York City, and Florida. I have recently moved to Boynton Beach to treat dancers in South Florida and to be one of the company physicians for Miami City Ballet. Preventing serious dance injuries is important to keeping your body ready to meet the demands of your art. Some injuries happen quickly, but most dance injuries have been happening over a longer period of time and are overuse injuries. Therefore, preventing these injuries cannot happen overnight. It is about taking care of your body so it will take care of you in return.

What goes in the body. Nutrition is important in injury prevention. Dancers spend long hours at the studio. Eating calories wherever we can doesn’t always add up. Your energy balance is crucial in keeping healthy and injury free. You burn a lot of calories in your dance training and you need to replace those with good nutrition. Getting out of balance can result in injury to your bones and muscles, not to mention making it harder and taking longer to come back from an injury. Also, not having enough calories can negatively impact your dancing and artistry. Some quick, healthy foods to throw in your dance bag are nuts, dried fruit, and vegetable sticks.

Cross training. Even though you spend many hours a day in dance class; you can still have weakness in some muscles. You need to train like you perform for dance specific physical conditioning. However, core strengthening is also very important to protecting your body from injury and for improving your dancing. Try planks, bridges, and even some push-ups for your cross training. Some teachers add conditioning exercises between barre and center. Many dancers add these exercises to their warm up. Also, dance class does not necessarily build aerobic fitness, cardiovascular health, or endurance. In order to improve their performances, dancers often add swimming or elliptical work outs to build their endurance.

The “R” word. “Rest” can sound like a dirty word to dancers. However, your body needs time to recuperate from the demands of an intensive dance schedule. Sometimes the body is just not ready to keep up with the demands of an intensive dance schedule. Saying “no” to some activities might be necessary to keep you healthy and dancing longer. Dropping a class or reexamining the schedule can help prevent fatigue, burnout, and injury. While these choices may be difficult, it can keep you dancing healthier for longer, which is the ultimate goal. Dancing is supposed to be fun!

Warm up. Get your blood and body moving. Sometimes this means walking around in the studio or doing some gentle jumps or leg swings. Start slowly and gently and give yourself appropriate time for warm up before class, rehearsal, performances, and auditions. Some dancers need stretching in their warm up, but others need more strengthening. If you are naturally very flexible, you may not need extra stretching in your warm up. Once you are a little warmer, active stretching, like battements and lunges, can be helpful. Additionally, make sure to warm up your plié (starting in demi-plié), and feet (rolling through the feet and progressing towards gentle small jumps).

Technique. Proper technique is essential to prevent dance injuries. Of course, using proper technique also helps advance your dancing. Sometimes dancers feel they are in a class that is too easy for them and they want to be promoted. If this happens, focus on perfecting your technique. Dancers can learn from any teacher in any class, so make the most of whichever class you are in. If you do have a dance injury, reexamining your technique and focusing on improving it can also bring you back stronger from your injury. Dance is about discovering how your body fits with movement. Your body is unique and is not like anyone else’s, so focus on your own body and your strengths instead of comparing your dancing (especially turnout or extension) to someone else.

Injuries happen. Dance is demanding and even if you do everything possible, you may still get injured. If that happens, be sure to take care of the injury. There are some aches and pains that you can keep dancing through, but a real injury needs to be discussed with a health provider who understands dance or sports injuries. A good rule of thumb is any injury where you cannot participate in dance class, or you have to modify a lot of class, should probably be seen by a health care provider. This doesn’t always mean you have to stop dancing, but you do need to make a rehabilitation plan with your dance medicine specialist. An untreated injury can become a chronic problem and can prevent you from dancing to your full potential and even lead to further injury. Make sure you are giving your body the best opportunity to keep you dancing for your entire life. Dance healthy, dance happy!

 

by: Dr. Kathleen L. Davenport, M.D.

Specialization in Young Athletes May Not be a Good Idea

Assorted sports equipment on blackAll of our athletic families, or those that show an interest in sports, would like our youth to become the next LeBron James, Aaron Rodgers, Derek Jeter or for the young women they could perform like Britney Griner, Kerrie Walsh, or Lindsey Vonn. The reality is this…DO NOT over do one sport early in their development. Specialization or sport specific training too soon can hinder their growth not only in sports but general health.

Sports all contain their own set of movement patterns which can lead to overuse injuries to their under-developed structures and soft tissue, not to mention one sport does not fully engage the young athlete’s nervous system. By letting them participate in multiple sports or activities, this will help prevent wear and tear at an early age and stimulate their nervous system, thus helping to prevent injuries. Having your child participate in a training program is a great idea but it does not, and should not be too specific to one sport. It should be to develop an overall athletic base, and prevent injury.

Finally, LET KIDS BE KIDS! Do not let them focus on one sport or activity. Let them explore their boundaries and let’s face it, if sports are your kid’s thing, playing multiple sports will benefit them when they decide on the one they enjoy most.

 

By: Rocco Ferraiolo PTA, NASM certified, USA-L1SP

Platelet Rich Plasma (PRP)

ID-100188360What is PRP?

Platelet Rich Plasma (PRP) has gained in popularity and usage in recent years and more research has been done on how helpful this treatment may be. When an injury happens in the body, platelets rush to that area to heal the injury. These cells contain many enzymes which play an important role in healing. PRP involves taking a sample of blood and separating out the platelets. Then, your doctor injects the platelets into the tendon or joint. These cells restart the body’s normal inflammatory healing process in the area of injury.

 

Does it work?

Currently, research shows PRP may be beneficial for musculoskeletal injuries. These may include issues at the shoulder, elbow, hip, knee, and ankle. Most of the PRP research is on tendon injuries, but there have also been studies showing PRP may be beneficial in osteoarthritis as well. The studies show that PRP is a safe procedure with a low risk of adverse events. Since it’s your own cells, the risks are minimal. However, there are always risks and side effects with every procedure and you should talk with your doctor about these before considering PRP.

 

What does the procedure involve?

A PRP injection starts with a visit to your Preferred Orthopedics of the Palm Beaches doctor to discuss your area of pain and treatment options. PRP may or may not be recommended for you.  If you and your doctor decide to continue with PRP you will schedule a separate appointment. You will have blood drawn, which will then be placed in a machine and the platelets removed. Your area of pain will be injected with the platelets, sometimes using an ultrasound machine for guidance. The injection usually causes some discomfort. After the injection, you may be asked to immobilize the area and then to undergo a physical therapy protocol. This will depend on where you had the injection and your treatment plan with your doctor.

 

Written by Kathleen L. Davenport, MD

 

 

Photo courtesy of dream designs/ FreeDigitalPhotos.net

Dealing with Shin Splints

Shin splints is a common term for an irritation of the tibia bone on the medial side of the lower leg. The medical term for this is medial tibial stress syndrome (MTSS). It is commonly seen in athletes, dancers and military personnel who have a higher incidence of running and jumping activities. Running and jumping activity place increase stress on the muscles, tendons and periosteum (lining of the bones) of the lower leg. MTSS can share symptoms with another more serious condition called anterior compartment syndrome. This is where the fascia, which encapsulates and separates muscles, swells. This causes increased pressure that presses on vascular structures and limits blood flow to the lower leg causing intense pain, weakness and color changes in the leg.

MTSS is usually diagnosed through a detailed physical evaluation and subjective medical history.  Tenderness to palpate the bone and muscle of the front of the leg is usually found to directly follow, or be present during, a specific physical activity. Imaging studies such as CT scans or MRI’s will be utilized to rule out stress fractures of the bone or show edema within the periosteum. Edema is sometimes found as the muscles and tendons that attach to the bone stress the periosteum. This can be caused by muscle imbalances of the lower leg or repetitive downward pressure of pointing the toes during activity. Decreased arch support with improper footwear can also lead to increased stress on the muscles that control the ankle leading to pain and swelling in the anterior lower leg.

The best treatment for shin splints is an immediate period of rest, ice and the initiation of non-steroidal anti inflammatory medication. After the pain has completely resolved, a rehabilitation program to build up strength in the lower legs should be utilized along with wearing appropriate footwear with good arch support. Orthotics may be utilized to increase arch support if deemed necessary by your physical therapist or MD. Low level aerobic activity should be introduced and completed without pain before return to any vigorous activity or sport. For those that are returning to running or pounding activities, you should try to avoid harsh or rough terrain. Possibly running on a softer track may be a better option before running on hard pavement. Finally, appropriate rest time intervals between activities will be important to a full return without pain.