An overview of injuries to the ballet dancer. Kathleen Nachazel, LAT, ATC UPMC Sports Medicine Athletic Training and Development

Size: px

Start display at page:

Download "An overview of injuries to the ballet dancer. Kathleen Nachazel, LAT, ATC UPMC Sports Medicine Athletic Training and Development"

Amberlynn Morrison
5 years ago
Views:

1 An overview of injuries to the ballet dancer Kathleen Nachazel, LAT, ATC UPMC Sports Medicine Athletic Training and Development

2 My background Undergraduate Degree Ohio University 1987 Medical College of Ohio Springfield High School UPMC Sports Medicine August 1992 to present

3 Medical Coverage for PBT In studio for rehearsals All performances Team coverage at studio Athletic Trainer (me) 1 day a week for 3 hrs PT 2 days a week for 2 hrs. On-call MD with weekly onsite visits Annual pre/early season screenings During paid time for dancers

4 Day in the life of a ballerina 9:45

5 Apprentice Corps de Ballet Soloist Principal PBT staffing

6 Basic Ballet Foot Positions

7 First Position Second Position Fourth Position

8 Fourth Position side view Fifth Position Fifth Position side view

9 Positions of the Arms

10 First Position Second Position

11 Third Position Fourth Position

12 Fifth Position

13 MOVEMENTS IN DANCE Plié Releve

14 Saute: to jump

16 Preventing Injuries Maintain conditioning once rehearsals set in Pay attention to recovery time once exhaustion from many performances set in According to Marijeanne Liederback of Harkness Center for Dance Injuries, the 3 rd week of training/performances is when fatigue takes over

17 Intrinsic Causes of Injury Insufficient flexibility, range of motion strength Strength and/or flexibility imbalances Insufficient cardiovascular conditioning Poor technique Prior history of injury Nutritional deficiencies

18 Extrinsic Causes of Injury Incorrect shoe fit Floor surface Cold studios Difficult choreography Insufficient warm-up

19 If good technique is developed and maintained, the chance of sustaining a dance injury is minimized. Minor technical faults can produce major problems for the dancer, either in the actual treatment of the injury, or more often in the prevention of recurrences of the injury.

20 Common Technique Mistakes Progression to the next level of dance too soon Cheating your turnout Whacking your leg up Sickling and Winging Lack of plié when jumping

21 Cheating Your Turnout Using friction between your feet and the floor instead of the muscles in your hips to achieve your position Can cause injuries all they way up the chain

22 If your knees don t line up with your 2nd toe when you plié you are cheating your turn out Cheating your turnout

23 Whacking your leg up

24 Sickling Compensation for lack of full mobility Instead of a straight line from the hip thru the leg to the midfoot, the foot is turned inward.

25 Sickling in demi-plie Demi-plie

26 Instead of a straight line from the hip thru the leg to the mid foot, the foot is turned outward Winging

27 Lack of plie The heel does not reach the ground resulting in knee and foot pain

28 Improper landing a jump

29 Ballet specific evaluation Hips External and internal rotation Q angle Antiversion and retroversion Short/ long leg Hip extension and flexion

30 Ballet specific evaluation Knees Patellar position Medial, later, inferior, superior Flexed or hyperextended Genu varum-bow legged Genu valgum- knocked knees

31 Ballet specific evaluation Ankle Weight forward of plum line Weight behind plum line Subtalar neutral Restricted plie or releve Tendinitis around the malleolus

32 Ballet specific evaluation Foot Mid tarsal joints (arch) Pronated or supinated Metatarsals and toes Dropped metatarsal head Bunion Claw or hammer toes

33 Most common injuries Overuse Lower Extremity Low Back Hip Lower Leg Ankle Foot

34 Low Back Individuals with long-standing hip pathology often have a history of low-back pain or SI Joint dysfunction. Weakness of the muscles that stabilize the lumbopelvic complex is often observed

35 Back injuries whacking your back

$Stress fracture of the spine creating a forward$ deformity Pain with activity with WB positions

36 Stress fracture of the spine creating a forward slippage of the vertebra S/S: Step off deformity Pain with activity with WB positions Point tender lateral to the spinous process Spondylolysis

$Spondylolisthesis Stress fracture of the$ (spinal column) Due to repetitive stress

37 Spondylolisthesis Stress fracture of the pars interarticularis of the vertebrae (spinal column) Due to repetitive stress Persistent back pain that increases with hyperextension

38 Hip Injuries Hip Flexor Labral Tear IT band i.e.. snapping hip Bursitis

39 Hip Flexor and Iliotibial Band Tendinosis (Snapping Hip) Snapping or Clicking Contributing factors: Poor turn out / rolling Trunk, hip weakness Underlying ligament instability Hip inflexibility

40 Labral tear Caused by impact or shear injury Sudden onset deep lateral and deep groin pain Contributing factors: Ligamentous laxity, tight hip flexors Poor turn out Trunk weakness

41 Foot and ankle Inversion ankle sprain Anterior/ Posterior Ankle Impingement Tendinosis Flexor hallucis tendinitis Achilles tendinitis 5 th metatarsal fracture

42 Anterior Ankle Impingement Bone spur formation in the anterior ankle or soft tissue impingement Causes repeated hyper dorsi forced position Check winging and sickling Abnormal motion through the mortise Male dancers- pain with landing from jumps Lack eccentric strength and motion

43 Anterior Ankle Impingement Treatment Evaluate underlying instability Stretching in plantar flexion Global ankle strengthening Functional training Mobilization Eccentric strengthening

44 Posterior Ankle Impingement Causes With or without an accessory bone of the foot. Extreme plantar flexion of releve en pointe in the ballet dancer Retro calcaneal bursitis

45 Posterior Ankle Impingement Treatment Mobilization of the talus Release of calf Strengthen anterior leg muscles

46 Posterior Tibialis Tendinosis Tender over medial ankle, possible midfoot (arch) Lateral pain upon progression of injury Pain with resisted internal rotation Single leg heel raise strength greatly reduced

47 Peroneal Tendinosis Lateral ankle sprain which worsens with activity May complain of snapping or popping Pain on palpation along lateral ankle Pain with inversion Weak eversion

48 Flexor Hallucis Longus Disorders Tender over medial ankle Crepitus upon progression of injury Catching of the great toe Pain with plantar/ dorsi flexion Causes Repetitive stress Tight gastrocnemius

$Dancer s Fracture (Acute fracture of 5 th metatarsal) Spiral fracture through the shaft of the 5 th (baby) toe Sudden$

49 Dancer s Fracture (Acute fracture of 5 th metatarsal) Spiral fracture through the shaft of the 5 th (baby) toe Sudden severe pain after rolling onto lateral foot Contributing factors Ankle instability Weakness Poor balance Floor surface/ shoes

50 Dancer s Fracture Treatment Treatment: Immobilization Surgery occasionally necessary Complete rehabilitation before return to dance Address underlying weakness and technical problems

$Metatarsal Stress fractures 2 nd metatarsal fx common in dancers Localized pain associated with activity$

51 Metatarsal Stress fractures 2 nd metatarsal fx common in dancers Localized pain associated with activity Contributing factors: Sudden change in training Intrinsic foot weakness Toe length discrepancies Hard surface, poor shoe fit

52 Treatment Mobilization of the talus Release of the calf muscle Strengthening of the anterior leg muscles Ice Retraining of the pointe in tendu

53 Other foot injuries Plantar fascitis Bunions Cuboid dislocation/subluxation

54 Cuboid Dislocation Causes Lateral midfoot pain Inability to work through the foot Reduced plantar flexion Dropped fourth metatarsal head

55 Manual Reduction

56 Taping

57 Improving turnout Stretching Hip flexors Butterfly and pretzel stretches Hip Strengthening External Rotators, Adductors, Abductors Practice!

58 Additional Tools: Standing Firm Rotational Discs Improving turnout

59 Rehabilitation Consistent with rehab of elite athletes Re-balance the soft tissue structures Correct improper technique Balance/proprioception Core strengthening

60 Dance Specific Rehabilitation Pool exercises Corrective conditioning class Basic rehabilitation barre Reformer footwork Manual therapy Flexibility exercise Strengthening exercises

61 Return to Dance Progression to full dance with rehab classes and modification of activity. Consider occupational stresses and the psyche of the athlete Nutritional considerations

62 Modified doming exercises

63 Core Strength

64 Foam roller

65 Trigger points

66 Summary Injuries are very common in dance Early recognition and treatment promotes early, safe return to dance Treatment (even of minor injuries) always includes rehabilitation and technique evaluation

67 Bonus round Job opportunities Educational opportunities Networking opportunities

68 Job opportunities Performing Arts Medicine Resources Linkedin Performing Arts Athletic Training This group is designed to connect healthcare professionals working or interested in working in the performing arts. This website will provide an avenue for interested professionals to connect and network among others in this exciting field.

69 Educational opportunities International Association for Dance Medicine & Science (IADMS) Harkness Center for Dance Injuries NATA Emerging settings ES php

70 Networking opportunities NATA EATA Performing Arts Athletic Training Society (PAATS) Facebook: NATA Committee on Practice Advancement

71 Manual therapy practice Active Release Technique Trigger point release Cross fiber massage Hip glides Psoas release Mobilization of the talus

Balanced Body Movement Principles

Balanced Body Movement Principles How the Body Works and How to Train it. Module 3: Lower Body Strength and Power Developing Strength, Endurance and Power The lower body is our primary source of strength,