Sports injuries are injuries that occur in athletic activities. They can result from acute trauma, or from overuse of a particular body part

Stretching Aerobics

POSTURAL STABILITY IN DANCERS AFTER INJURY

Dancer in ActionBallet dancers are widely known for their superior body control in various challenging body positions.  In fact it has been found in recent studies that ballet dancers have better postural control when compared to other elite athletes. However, what has not been examined is the effect of injury on postural balance in dancers.  A recent study in The American Journal of Sports Medicine by Lin, et al, addresses this vary issue.

Postural balance requires a combination of several different sensory inputs: visual, vestibular (inner ear), and somatosensory (from the skin, joints, muscles, etc). Somatosensory input gives the brain information about where the body is in space; this is called proprioception.  These sensors can be damaged with ligamentous and muscular injuries such as ankle sprains and in turn lead to a deficit in proprioception.  Proprioceptive deficits can put a dancer at more risk for re-injury or new injury.

The recent study by Lin was the first study that evaluated stability in dancers in ballet specific postures following an injury. Three different groups were studied: healthy dancers, injured dancers (with sprained ankles), and health non-dancers.  Postural stability was evaluated on a balance sensor that monitors subtle deviations in stability.  This was done with the eyes open and then again with the eyes closed to further stress the proprioceptive component of balance.  As expected the injured dancers had decreased control not only in ballet specific positions but also in a simple single leg standing position when compared to healthy dancers. Surprisingly the injured dancers had worse stability control than the non-dancers.  Many dancers, and other athletes, that I have treated often assume that a skill such as balancing will come back without training, however this is not the case, and as the study indicated it regresses to the point that is worse than untrained people.Ankle

The postural deficits were most notable in side to side control with single leg standing and front to back control with first and fifth position.  Compensation was noted at the knee and hip joints in an attempt to make up for the injured ankle.  The en pointe position crated the most stability issues; injured dancers were inferior in all directions of stability.  With lateral ankle sprains the most commonly damaged ligament is the anterior talofibular ligament. This ligament is stressed maximally when the ankle is plantar flexed, such as during en pointe positions.  It is not surprising that when this ligament is damaged the proprioception during pointe is significantly disturbed.

This study brings to light the importance of a thorough rehabilitation program that includes proprioceptive training in ballet specific positions.  Typically a sprained ankle takes 6-8 weeks to recover.  During this time it is critical to begin proprioceptive training to ensure that the balance deficits do not lead to further injury.  Additionally if a dancer has a past injury of ankle sprain without proper rehabilitation it is likely that postural stability still remains and there is an increased risk to further injury.  If this is the case, dancers should begin a 3-4 week proprioceptive training plan that includes ballet specific posture.

Dance injuries and rehabilitation are unique and should be managed by a healthcare practitioner that is experienced with the subtleties of dance medicine.  Proprioception training for ballet typically includes balance exercises on an unstable surface such as a Bosu ball or stability disc.  These exercises should be done in normal stance position as well as ballet specific positions.  Whole body vibration may additionally add value as a proprioceptive trainer especially early during rehab when range of motion is limited.  KinesioTape or RockTape are also good taping methods that help protect the joint and provide increased proprioception when applied properly. Keep in mind that a training plan should be designed specifically for each injury and you should not attempt to manage the injury without the supervision of an experienced healthcare practitioner.

Glabrum - Picture of Shoulder

Labral tears of the shoulder: surgery or not?

 

At the recent American Orthopaedic Society for Sports Medicine, a comparison of non-surgical treatment and surgical treatment for SLAP labral tears of the shoulder in baseball players was presented. The labrum is a cartilage structure that makes the Glabrum - Labral Shoulder Tearsocket of the shoulder deeper and helps hold the upper arm. SLAP tears are a specific type of labral injury that is mainly caused by repetitive throwing.   Although surgical repair of SLAP tears is common, little is known about the effectiveness of nonsurgical pain relief and the effects of surgery on performance.

Return to play

Return to same level of play

Surgery

48%

7%

Non-Surgery

40%

22%

 

 

 

The return to play rate in SLAP injuries is low, typically reported at less than 50%. In this study the return to play rate for those that underwent surgery was 48% while those that underwent rehabilitation was only slightly lower at 40%. The most interesting finding in this study however was that the group that had surgery rarely, only 7% of the time, returned to the level of play that they had previously attained. The non-surgery group in comparison returned to the same level of play 22% of the time.

John E. Kuhn, MD, associate professor of orthopedic surgery and rehabilitation and chief of shoulder surgery at Vanderbilt University Medical Center in Nashville, Tennessee described the findings as “very significant” and summed up the findings:

“A lot of these throwing athletes can be treated non-operatively,” Dr. Kuhn said. “They had very good success with rehabilitation.  That suggests that patients can throw with SLAP tears, and that not every SLAP tear needs to be repaired,” he said. “Many can be rehabilitated; the sources of pain or disability may not even be the SLAP lesion itself,” he added. The research suggests that surgery in this patient population really should be a career-salvaging option, he explained. “It really shouldn’t be something you throw at somebody quickly or early. Rehab them, do everything you can to prevent surgery,” he concluded.

Another take home message from these findings that should be discussed further is the importance of avoiding shoulder injuries from throwing.  As stated the percentage of those injured with SLAP tears that return to play is less than 50%.  The best advice then logically is to avoid getting a SLAP tear altogether.  Unfortunately, there is no sure fire way to avoid getting a tear if you are a pitcher. However what can be done is limiting the risk factors for injury.  Risk factors for throwing injuries include a decrease in shoulder internal rotation, poor scapular control, and high pitching load.  These risk factors should be screened for and proper preventative exercises should be built into any strength and conditioning program for baseball players, especially pitchers. Non surgical treatment in these cases included rehabilitation that focused on stretching the posterior capsule of the shoulder to increase internal rotation and training the scapular muscles to hold the scapula in a stable position during the wind-up and cocking phase of the throwing motion. These exercises should also be at the core of any preventative arm care program for baseball players. Manual therapy, including myofascial release and Graston treatment can also be beneficial to aid in increasing range of motion.  These preventative strategies should be overseen by a healthcare provider knowledgeable in baseball injuries.

If you would like more information about how to recover from or prevent shoulder injuries contact our office today.

Another article outlining preventative exercises is coming soon…

-Dr. Kevin Rose, DC

 

 References

Yin, S.”SLAP Tears Often Treated Successfully without Surgery”. Medscape Medical News, July 7 2012.

Wilk et al. Passive range of motion characteristics in the overhead baseball pitcher and their implications for rehabilitation.  Clin Orthop Relat Res. 2012 Jun;470(6):1586-94.

Wilk et al. Shoulder injuries in te overhead athlete.  J Orthop Sports Phys Ther. 2009 Feb;39(2):38-54.

 

 

 

Ankle Kinesio Tape

Kinesiology Tape for Dancers

Many dance medicine specialists and dancers have begun to use Kinesiotape as a staple to manage their injuries.  Developed Ankle Kinesio Tapemore than 25 years ago in Japan by chiropractor Dr. Kenzo Kase, the Kinesiotape method drew worldwide interest when the U.S. Olympic volleyball player Kerri Walsh wore the tape to support her shoulder during the 2008 Games in Beijing. Now many elite athletes, including dancers use Kinesiotape.  Unlike traditional athletic tape, the latex-free Kinesio stretches easily, and permits greater range of motion, making it popular with dancers. It allows the dancer to perform while still protecting them from further injury. “The old way of taping was stiff and tried to support ligaments, but we have learned it gave less support than we suspected,” says Dr. Rebecca Clearman, M.D, “Kinesiotape, on the other hand, helps dancers self-correct. (For instance) if a dancer is hyper-extending, it can serve as a reminder at the end of the range to not go as far.”

Kinesiotape can be used to stimulate or relax a muscle, depending on the direction of the recoil of the stretched tap. Whether relaxing or activating, the tape gets placed along the line of the muscle. For activating, the direction of the tape goes from muscle origin to insertion. The tape’s degree of stretch determines the strength of the recoil action, so each application can be tailored to a dancer’s needs.

It’s like a brace, but better, because of it allows greater range of motion and also provides proprioceptive input (joint balance). Kinesiotape comes in a variety of brands and can be purchased by the consumer, however initially the tape should be applied by a dance medicine professional with knowledge of dance mechanics.  After several sessions the injured dancer can learn to put the tape on properly by himself/herself.

Kinesiotape is not a magic bullet. Proper diagnosis of the injury by a qualified healthcare professional is always the first step and during recovery, proper rehabilitation and correction of biomechanical errors are keys.

-Dr. Rose is a San Diego Chiropractor and a Certified Chiropractic Sports Practitioner®.  He is a member of the International Association of Dance Medicine and Sciences and has experience with ballet dancers from youth to professional.

Preventing Throwing Injuries in Youth Baseball

 More and more young baseball players, especially pitchers, are coming down with “Little League elbow,” or “Little League shoulder.” Don’t let the names fool you; these are real medical diagnoses with real consequences.  Among pitchers under 12-years-old, as many as 45 percent complain of chronic elbow pain, according to several published studies. At the high school level, nearly six in every 10 pitchers suffer chronic elbow pain.  Most will heal with a combination of rehabilitation and prolonged rest while some will require surgery.

How to prevent throwing injuries

Limit the number of pitches

A broad recommendation is that pitchers base their number of pitches each week by multiplying their age by 10, so an 8-year-old would limit his pitches to 80 per week. A 12-year-old would throw no more than 120.

The American Academy of Orthopaedic Surgeons (AAOS) recommends limiting the number of pitches per game to 60 to 100, with no more than 30 to 40 in a single practice session, adding that innings pitched should be limited to about four per week, with a minimum of three days rest between starts.

Warm Up

Research studies have shown that cold muscles are more prone to injury.  The AAOS suggests an active full body warm up followed by slow, gentle stretching, holding each stretch for 30 seconds.  A knowledgeable coach or trainer should be able to guide your athlete in this area.

Throw Correctly and Master the Basics

Poor throwing motions put undue stress on the elbow and shoulder.  It is especially important that between the ages of 8 and 14 players receive skilled instruction in proper throwing mechanics.  Pitching lessons should focus on gaining control, increasing velocity and developing a command of the strike zone.

Recognize the warning signs

One of the most important factors to preventing the development of serious injuries is early identification and treatment. Young players often ignore pain or are encouraged to play through it.  This way of thinking can be extremely harmful and lead to more serious complications that may not heal without aggressive treatment and possible surgery.  However, if caught early, most youth throwing injuries can be relieved with a combination of therapy, rest, and rehabilitative exercises.

Early signs of injury include decrease in ability to throw the ball as fast or as accurately, loss of enjoyment in playing baseball, elbow or shoulder pain with or after throwing.   If any of these signs are present, the player should be evaluated by a healthcare professional.  More significant signs include prolonged persistent pain after throwing, swelling at the elbow, and difficulty straightening the elbow.

Any persistent pain, loss of motion or joint should keep a player on the sidelines until the symptoms disappear or a doctor clears the players. Be sure to consult a health care professional familiar with the intricacies of baseball injuries if any of these signs are present.

-Dr. Kevin Rose, DC, CCSP®

 

Dr. Rose is a Certified Chiropractic Sports Practitioner® located in San Diego.  As a former professional baseball player, having played three seasons in the minor leagues, Dr. Rose understands the unique characteristics of baseball injuries first hand. 

 

Stretching Aerobics

Preventing Dance Injuries

The Dancer in Actionphysical demands placed on the bodies of dancers have been shown to make them just as susceptible to injury as football players.  For this reason, more emphasis should be placed on creating awareness of risk and preventing injuries in dancers.  Most dancers begin dancing at a young age, the repetitive practice of movements that require extreme flexibility, strength, and endurance make them prime candidates for overuse injuries.  In fact, there is little doubt that the vast majority of injuries are the result of overuse rather than trauma. These injuries tend to occur at the foot, ankle, lower leg, low back, and hip. These injuries show up with greater frequency in dancers as they age, so it is extremely important to emphasize what the young dancer can do to prevent future injuries.

 

WHAT CAUSES DANCE INJURIES?

Dancers are exposed to a wide range of risk factors for injury. The most common issues that cause dance injuries include:

  • Type of dance and frequency of classes, rehearsals, and performances
  • Duration of training
  • Environmental conditions such as hard floors and cold studio
  • Equipment used, especially shoes
  • Individual dancer’s body alignment
  • Prior history of injury
  • Nutritional deficiencies

How to Prevent Dance Injuries

Getting and keeping dancers free of injury in a fun environment is key to helping them enjoy a lifetime of physical activity and dance. With a few simple steps, and some teamwork among parents, teachers and health professionals, dancers can keep on their toes and in the studio with a healthy body.

Key Points

Dancers should remember a few key things to prevent injury:

  • Wear properly fitting clothing and shoes
  • Drink plenty of fluids
  • Resist the temptation to dance through pain
  • Pay close attention to correct technique
  • Be mindful of the limits of your body and do not push too fast too soon
  • Perform proper warm-up and cool-down

Parental Oversight

Parents play a large role in injury prevention. First, they must be careful not to encourage their children to advance to higher levels of training at an unsafe rate. Specific to ballet, parents should ensure that the decision to begin pointe training is not made before the child’s feet and ankles develop enough strength. Age 12 is the generally accepted lower limit, but strength and maturity are more important than age.

Proper Instruction

The first line-of-defense to prevent injuries may be dance instructors. From the onset of instruction teachers should establish a class environment where students are not afraid to share that they are injured and need a break. Students should also be consistently instructed on the importance of warm-ups and cool-downs, proper equipment, and at what point, whether by age or maturity, it is appropriate to move on to the next level of dance.

Health Care and Screening

Health professionals play a significant role not only in treating and rehabilitating the injuries dancers incur, but also in preventing them. Dancers respond well to providers who respect both the aesthetics and intensity of dance. Experienced providers can initiate and facilitate screening sessions for dancers to help identify potential problems and prevent future injuries. They should be considered a natural part of a dancer’s career and sources of insight into staying healthy. A dancer should return after an injury only when clearance is granted by a health care professional.

REFERENCES

Clippinger, K. Dance Anatomy and Kinesiology. Champaign, IL: Human Kinetics, 2007.

Howse, J. Dance Technique and Injury Prevention. 3rd ed. London: A & C Black, 2000.

Solomon, R, J. Solomon, and SC Minton. Preventing Dance Injuries. 2nd ed. Champaign, IL: Human Kinetics, 2005.

www.stopsportinjuries.org