Program Outline. What Are the Performance Sports? Health Benefits of Performance Sports

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1 Performance Sport Athletes: Caring for Gymnasts, Dancers & Skaters Program Outline General Issues of Performance Sports Athletes Medical Issues of Performance Sports Athletes Orthopedic Issues of Performance Sports Athletes Dance Injury Prevention (Preparticipation Screening) Jordan D. Metzl, M.D. What Are the Performance Sports? Ballet Gymnastics Figure Skating Grace Athleticism Thinness Precision Perfectionism Health Benefits of Performance Sports Psychological Social Bone density Weight control Athleticism 1

2 History of Ballet Dance Originated in renaissance Italy Brought to France by Catherine De Medici ( ) Flourished under Louis XIV at Versailles Positions in ballet derived from foot positions in fencing 5 Foot Positions of Ballet Dance First heels together, 90 degrees Second heels shoulder width Third 90 degree alignment of foot Fourth turn out with foot in between Fifth need maximum ER to close in 5 th Level of Dancer Weekend After school Pre-professional school Company 2

3 Specialization and Dance What are goals/objectives? In order to be good, need to start early? Exclusion of other sports? Varied types of dance? Performance Enhancement? Drugs? Extra edge? Weight issues Influence and politics Boston ballet experience (Heidi Gunther) Medical Issues of Female Athletes Medical Issues Bone Female Athlete Triad Anorexia Nutritional Amenorrhea Hormonal Osteopenia Future bone health? Medical of the female athlete Adolescent Sexual Skeletal Physiologic Psychological Sexual in Dancers Menarche 2-3 years later than controls Primary amenorrhea Absence of menses by age 16 Progression of sexual development correlated with rest Female Athlete Triad Amenorrhea Primary Secondary Anorexia Anorexia athletica Osteoporosis Osteopenia 3

4 Anorexia Athletica Axis of Rotation Absolute Criteria Weight loss >5% Absence of medical illness Excessive fear of obesity Caloric restriction Relative criteria Primary amenorrhea GI complaints Compulsive exercise Disordered body image Sense of center Vital to performance sport athletes Changes dramatically during SMR IV-V Most frequent time of disordered eating issues Culture of Disordered Eating Adolescent BMD in Dancers Oligo/amenorrheic dancers BMD as compared to controls with similar profiles No significant difference in control group vs. dancer group Value of weight loading exercise, menstrual history Bone Mineral Density Differences between Adolescent Dancers and Nonexercising Adolescent Females To WW, et al. J Pediatr Adolesc Gynecol Oct;18(5): adolescent female dancers (17-19 yrs old) vs. 35 adolescent controls DEXA of both groups BMD values much greater for dancers compared to eumenorrheic controls Ward's triangle g/cm(2) vs , P = 0.003; trochanter g/cm(2) vs ; P < 0.001) were significantly higher in the eumenorrhoeic dancers as compared to controls Psychological Adolescent Sexual Skeletal Physiologic Psychological 4

5 Psychological Considerations Only 23% of female and 33% of male professional dancers are satisfied with their bodies Adolescent dancers who begin puberty on time (12.9 years) have a lower body image than their peers Issues to Consider When Counseling for Healthy Bones Body Habitus Disordered eating, anorexia athletica, anorexia nervosa Lifestyle smoking, drinking, caffeine ingestion Diet calcium, calories (calcium counting sheet) Heredity Sex Hormone Levels Previous Bone Injury (Dexa?) Keeping Dancers Medically Healthy Orthopedic Issues in Dancers Preventive education Recognition of disordered eating, altered body image Making sure that health care team and teaching institution are on same page Common Orthopedic Issues in Dancers Scoliosis Overuse Injury Bone Sesamoid Tibial Femoral Tendon Ankle Iliopsoas Apophyseal Acute Traumatic Injury Romeo and Julliet 15% of dancers Most common type is adolescent idiopathic Girls>Boys Skeletal delay? Scoliosis 5

6 Forward Flexion Test Injuries in Dancers Is the School on Board? Which Body Type Is Favored? Flexibility Natural turnout Normal Femoral anteroversion is 15 degrees External tibial torsion Roughly 60% above knee, 40% below knee (turnout) Foot Type ROM at 1 st MTP The Ballet Pointe Shoe Correct age to go en pointe? Beginning Stage Dancer 8-12 years of age Pre-pointe Middle Stage Dancer years of age Major health issues Apprentice Stage Dancer 16-older Pre-professional stage 6

7 Posterior Ankle Pain Common Injuries in Dancers 14 year old dancer Pain in posterior ankle Pain with pointe Pain with releve Posterior ankle impingement Os Trigonum Mechanical Factors Mechanical factors causing posterior impingement (FHL) Hip Pain in Dancers The Snapping Hip Syndrome 12 year old dancer Snapping hip Noise with hip flexion? Pain 7

8 Iliopsoas Tendonitis Common fem vessels IPM Injection Site Needle tip IP acet IPM=iliopsoas muscle IP= iliopsoas tendon Bone Overuse Injury 15 year old ballet dancer Pain with dance Having trouble with all activities, particularly landing jumps Pediatric Bone Health Children attain 90% of peak bone mass by 18 years of age Bone density increases by 6-8% per year in teens Multiple factors determine adult bone health 8

9 Bone Injury in the Female Athlete Activity Bone Density Biomechanics Injuries in dance company: effect of comprehensive management on injury incidence Bronner S et al. Am J Sports Med May-Jun;31(3): year injury data in professional company 3 years without intervention, 2 years with intervention of screening program Roughly 60% decrease in injury rate with preventive screening program Dance Medicine Physical Therapy Pilates Method Born early 1900 s, Germany Rickets, weak body Art of centrology WW I orderly in hospital treated disabled soldiers Reformer Core muscle strength Trunk stability Injury prevention 9

10 Conclusions Dance is great for health! Medical and orthopedic issues Parents, teachers can take an active role in health prevention! Don t dance through the pain 10