Thursday, 28 January 2016

How to Maintain and Prevent Dance Injuries


My name is Imogen; I'm a Certified Athletic Therapist in Cambridge, ON and owner of Hespeler Village Athletic Therapy. My area of expertise is with dancers and their injuries. During my childhood and teenage years, I was a competitive dancer which has given me the insight and experience to better help my dance clients. I'm so excited to talk about dance injuries because it allows me to bring my two passions—dance and Athletic Therapy--together into one topic! I hope you enjoy reading it as much as I enjoyed writing it!  But, please be aware that it's kind of a long one.

When you think of athletes, dancers probably don't pop into your mind. This is unfortunate, because dancers are athletes who pour their mind, body, and soul into a passion for their sport, not unlike football, hockey, or rugby players. If young dancers are at a high level, they can be at the studio upwards of 4 hours per day, and professional dancers spend even more time in the studio!

For young dancers, their time spent dancing is outside of the hours spent in school and on homework, they may even have a part time job to work around. Can you imagine the physical and mental toll this can put on their body? For this reason, a major factor in dance injuries is fatigue. These athletes are so passionate about perfecting their jumps, turnout, or pirouettes that they don't take the needed time off for recovery. In the grand scheme of things, this is not the best way to improve your performance. But we'll come back to this in a few minutes.

Now, we all know that dancers are known for being extremely flexible and graceful, but a common misconception is that they aren't "real athletes". Dance takes an incredible amount of strength, control, agility, and balance, which often brings along the typical types of injuries you'd see in sports. The most common injuries seen in dancers include:

  • Muscle spasm
  • Strains/sprains in the lower extremity and back
  • Overuse injuries such as tendonosis
  • Chronic fatigue

Typically, when dancers sustain these injuries, they tend to “dance through the pain” rather than going to their local Athletic Therapist for an appropriate dance specific rehab program—shameless self promotion! In some instances, the dancers seek help from a therapist who doesn't specialize in dance. This can lead to frustration and a non-committal attitude to their rehab program because they feel misunderstood and don't see the relevance in the exercises or advice given--I'm speaking from first hand experience here. For this reason, it is my opinion that the most important step in treating and maintaining your dance injuries is to seek help from an appropriate medical professional that knows and understands the demands of dance.

The second most important piece of injury prevention advice I can give is for every dancer to ensure that he/she has a very strong core. I don't mean the “hey, check out my six pack” type of “core” that you may be thinking of. I mean the deep deep muscles that stabilize your spine and keep everything in control, so all of your other muscles can do their jobs.

Do you know what I'm talking about? If not, don't worry, I'm going to tell you!

Your core is comprised of some very deep muscles that attach to your spine and are within your abdominal cavity. See how this can be confused with that awesome six pack you've got going on?

If you were to look even deeper, under that six pack, you'd find a broad flat muscle that wraps around you like a weight lifter's belt, called transverse abdominus. This is what most people are talking about when they say “core.” 

But wait! There's more to it than that! You also have to consider the small group of muscles that run up and down each side of your spine on the back side, called multifidus. They control the rotational stability between individual vertebrae and assist in extension of the spine. Then there is the pelvic floor and diaphragm which create the “floor” and “roof” of the entire functional unit we like to call your core. If you picture these muscles contracting together, they theoretically create a small, dense cylindrical shape within your abdominal cavity which is your “core.”

Now, consider this example: dancers require excellent strength in their hip flexors and surrounding muscles to lift their nice straight leg, with a beautifully pointed foot, high up in front of them and gracefully hold it there for what seems like an eternity. But let's pretend this particular dancer has a weak core and is struggling to hold her leg for a few seconds at an eye-soring level of just above 90 degrees—oh my!

Part of the struggle here is because her core muscles are not working with her in this position to stabilize her spine so her hip flexors can do their job. In a lot of cases, the hip flexor (specifically psoas major in this case) is left to split it's task between stabilizing the lumbar spine that it's attached to and lifting the leg into forward flexion. Since this muscle's main job is to bring the leg into hip flexion, it really struggles when you ask it to do both.

Maintaining a strong core is so so SO important for dancers to be able to do the movements required of them. I've also been reading up about how a weak core can cause chronic neck tightness in dancers (and other athletes), so check out my website for a blog on this soon!

If you want a more in depth explanation of how important your core is, read my blog post about it!

Another important aspect of maintenance for dancers is ensuring proper breaks from dance. See? I told you we'd come back to this. You probably thought I forgot, didn't you?

“Take breaks from dance” is meant in two ways, full out rest OR do something else for a while. Yes, you should schedule down time into your busy schedule! Everyone should, it's good for your mental health and gives your body some time to recover from the demands you place on it.

Taking a break from dance doesn't always have to mean complete rest and doesn't mean it needs to be for an extended time! Cross training is an important aspect for any athlete and is equally important for dancers. 

In the studio, a dancer works a lot on technique, plyometrics, and agility but there isn't much strength or cardiovascular training. For this reason, it is very important that dancers build in time for cross training, which also gives them a little break from too much dancing—yeah right, there's no such thing, right? Wrong! Build “dance breaks” into your schedule, it will help you to stay fresh, strong, and avoid over training.

There have been many research articles suggesting that strength training is quite helpful with injury prevention for dancers, and if it's done properly there will be no major muscle bulking, which is what every dancer is trying to avoid. In fact, it helps to ensure that every muscle is working to it's full capacity, therefore you can jump higher, lift higher, dance longer, and look great while you're doing it! 

I've also been reading that the Fartlek Interval Training method is the most highly recommended method for dancers looking to work on their cardio endurance—you should all want to do this, it will help your performance immensely! Think about it. Try and schedule some cross training into your life and you'll see the positive effects on your performance both in class and on stage. Maybe you'll even finally get that solo you've been working so hard for!

Also, please consider your ankles when strengthening! If you're planning on starting pointe or already are en pointe, keep working on that ankle strength! And I don't mean just sitting on the floor with a theraband pointing and dorsiflexing your ankle. You need weight bearing, functional, ballet specific movements to be strong enough to be successful! Ask your teacher for advice, or you could ask your local, friendly, Athletic Therapist--there it is again ;)--for some dance specific training exercises to get you started.

The last thing I'll mention is that you NEED to take care of your feet! Just like musicians have to take care of their hands, dancers need to care for their feet! This means:

  • Keep your toe nails short and cut straight across—a curved cut can leave you prone to ingrown nails and nobody wants that
  • Don't wear coloured nail polish on your toes all of the time—you won't be able to easily see if you're having any of the typical dancers foot problems
  • Look after your calluses, they aren't all bad—don't file them off unless they are becoming too big and cumbersome/painful and interfering with your dancing. They protect you from unnecessary blisters and abrasions
  • Be sure to keep your blisters clean and covered—there are products and methods that can help reduce friction on a blister or blister prone area. Ask your dance teachers for advice, they know what you're going through!
  • If you find that you are getting blisters often, even after your shoes are broken in, consider going back to the store and being refitted. Chances are, your shoes aren't right for you. Maybe you need a different shape/size/style

I know I've thrown a lot of information at you in this post but here is a recap of the main take-home messages:
  1. Seek professional medical advice from a therapist who has got a lot of experience with dancers and preferably has first hand experience dancing at a high level
  2. CORE STRENGTH—I can't stress this enough. It will improve your dancing noticeably and help you to be less prone to injury.
  3. Schedule “dance breaks” into your week and try cross training sometimes too. It will help your performance immensely!
  4. Strength training is important. You should all be doing it, no exceptions.
  5. Take care of your instruments—YOUR FEET!
  6. Most importantly, HAVE FUN!  Dance is meant to be a fun, educating, and worthwhile experience.  Don't try so hard that it becomes less fun for you.  Take advice from your teachers, appreciate what they're telling you, and try to apply it to your own dancing.
"Great dancers are not great because of their technique.  They are great because of their passion" --Martha Graham

Thursday, 7 January 2016

Watching "Concussion" (the 2015 movie) as an Athletic Therapist

Like dozens of other Athletic Therapists and sports medicine professionals, I was counting down until the new Will Smith movie 'Concussion' was released in December 2015. I was a mix of anxious and excited to see it, wondering if it would be scientifically accurate, or if the facts would get caught up in the drama (also excited to see if Will Smith could pull off the accent... I think he did a good job.

I was most anxious that parents would have a knee-jerk reaction to pull their kids from collision sports and take the information about Chronic Traumatic Encephalopathy out of context. I expressed this fear to a therapist friend and she reminded me that some fear is a good thing. Parents and children need to fear the consequences of repeat head trauma, the same way we need to fear the consequences of inactivity, and the consequences of poor nutrition. 

CTE is a chronic condition. It results from numerous blows to the head, including concussive events and blows that are being called sub-concussive events. What's scary is that these sub-concussive events don't always produce symptoms, but they can contribute to the damage. It takes YEARS of these blows to produce CTE, starting from a young age. 

I like to think of it as a point system. We all start out with a certain number of points. Every time you have a concussive or sub-concussive event, you loose some. When you properly manage your concussion (take time off, get evaluated, step-wise return to play etc) you get some points back. Taking time off from contact sport gets you some points back too. Problem is that we have no idea how many points everyone starts out with, how many points a concussion is worth, or how many points you have to loose to be at risk for CTE. There's a lot of uncertainty around how the brain works, or doesn't work, but if you loose enough of these unknown points, then it's game over for you. 

So what do you do in youth sport to prevent CTE? Unfortunately we have not figured out how to prevent a concussion. Helmets prevent skull and face injuries, but don't actually protect the brain that well. Even abstaining from contact sport doesn't prevent concussions, there's an increasing number of reported head and brain injuries resulting from activities of daily living! But we can maximize the chances of the brain healing, and minimize the chances of other conditions such as CTE or Second Impact Syndrome. Here's some advise that I would give to any youth contact or high risk sport participant.

1) Always report to a coach or athletic therapist if you have symptoms. 
You can check out the list of possible symptoms in the Consensus Statement for Concussions, but it includes feeling foggy, ringing in the ears, headaches, dizziness, and a general feeling of unrest or not feeling right. The symptoms are very broad because the brain is very complex. One symptom counts though, you don't need to have multiples to suspect a concussive event. 

2) Report major hits to a coach or athletic therapist, even if you don't have symptoms! 
Sometimes if an impact is big enough, its a smart idea to to take a break for a day (or seven), just in case the symptoms develop within the next 24-48 hours. The hit may also have produced a sub-concussive event which they're saying is just as dangerous. 

3) Report if you were hit in a different sport or activity! 
The slate isn't wiped clean between sports. If you sustained a blow to the head in Lacrosse practice, and were removed from play, you probably shouldn't be playing in a football game the next day. 

4) Consider only participating in one risky activity at a time.
Most coaches have been trained on how much hitting is too much (to the best of our knowledge right now). For instance, most football teams will only have full contact practices 1-2 times per week. If you participated in more then one sport (i.e. ice hockey and wrestling) at the same time, then you may be experiencing too many blows to the head, and using up too many 'points'. It's also difficult to monitor injuries unless your coaches and therapists are talking to each other! 

5) Seek the advise of a trained professional.
Having a baseline on file is very helpful, but only if it's used! It's also only helpful if the person discussing your return-to-play decision with you is knowledgeable about concussions in sport. Even if you have not been formally diagnosed with a concussion, you can still participate in a step wise return to sport protocol, and undergo concussion rule-out testing to ensure that your brain is fully healed (and you've earned back your 'points') before returning to your activity. 

This list of course isn't exhaustive, but it's a good place to start for active teens and their parents. It is a good thing to be aware of the consequences of contact sport and have a small amount of fear of blows to the head and concussions.

If you have any questions at all about concussion management and risk mitigation surrounding contact sport, get in touch with your Athletic Therapist. They can help point you towards valid literature and help weed through the information available on the internet. 

Sunday, 3 January 2016

Opening a Clinic: My Promise to my Clients

When I was in school, learning how to become an Athletic Therapist, we were required to do a project for business class. The assignment was to take an investment of one hundred thousand dollars, and create a sustainable business. The goal was to end up with a business model that would make as much profit as possible, with as little work as possible, in a little time as possible. There was very little emphases put on quality of product (in this case quality of healthcare), or the personal relationship that would be nurtured with each client.

This is when I started to think about what my perfect clinic would be. I started to create a bucket list of requirements that I would meet should I ever own a clinic. At this point it was all very abstract and hypothetical, but one thing stood out as very important:

Every client of any business that I would ever own would be treated as an individual, with individual needs, individual goals, and with individual treatment time. 

Let me explain a little bit about why this is so important to me as an Athletic Therapist. 

In so many clinics, there is a demand to treat several patients at once. A therapist, weather they are a chiropractor, physiotherapist, athletic therapist or kinesiologist is expected by his or her boss to treat three or four patients at the same time. The idea behind this is that each patient is in the clinic for an hour (working independently for most of it) and leaves feeling as though they gained an hour worth of treatment. Meanwhile the business gains 4x the profit, and on paper is 4x as successful.

Now this model has been shown in some circumstances to improve the quality of treatment for some kinds of injuries. For instance, if a patient suffers a major injury, such as an ACL tear or a disk injury, then completing his or her rehab side by side with a similar patient sometimes encourages an environment of competition. Both patients draw from each other and healing may occur more quickly. Humans become social in their times of need. This occurs in very select types of injuries, and in select types of people though. 

In my frank opinion, treatment is more effective during a one on one appointment with your therapist. It's more effective when your therapists attention is undivided. Your therapist is better able to apply their skills when they have the time to truly reassess your condition during every visit, to truly listen to what's working and what's not working. Even if the majority of your treatment is exercise and activity based, your therapist can learn so much by watching how well you're doing, and improve the quality of the exercises with cues and suggestions.

So as I worked in several clinics as a student, and then as a certified therapist, I began to develop a list of promises that I would make to my patients should I ever open my own clinic. So now, as I re-launch my little clinic as Guelph Performance Therapy, these are the promises that I make to you, my client. 

1) I promise to never double book. I will never compromise your treatment time by dividing my attention between you and another client.

2) I promise to give you choice in your treatment. I will guide you to the best course of action, but ultimately the decision to participate in any treatment technique is yours.

3) I promise to recommend visits based on your best chance for healing, not based on my convenience, and definitely not based on business growth.

4) I promise to never give the exact same treatment to any two patients. When you combine an infinite number of body types, with an infinite number of mechanisms of injury, there is no possible way that two individuals will need the same combination of treatment techniques. I will build your treatment and exercise programs specifically for you.

5) I promise to never give any client the same treatment twice. In the same way that no two patients are the same, it is also true that no patient is the same on two different days.

6) I promise to listen, to answer questions, and provide guidance in any way that I am able to do, and never to pretend to have knowledge that I don't.

7) I promise that if you ever have a question that I can't answer, or an injury that I cannot treat, that I will find an answer or send you to someone who can help you more. I understand that no one therapist can be the best treatment option for every injury. 

7) I promise that I won't forget these promises when my business grows. I will ensure that any therapist or support staff that I invite to join Guelph Performance Therapy will share these same values. I promise that I won't forget where I started, and I won't forget how I felt as a patient, a student, or an employee when I am a therapist, a clinic owner and an employer.