1
Q
Two most common injuries categories
A
- performance anxiety PA
- Performance- Related Musculoskeletal disorders PRMDs
2
Q
Performance Anxiety PA
A
- Beta blockers fro physical symptoms
- Psychotherapy (cognitive-behavioral therapy)
3
Q
Performance -Related Musculoskeletal Disorders
A
- chronic repetitive motion
- chronic pain
- risks: Previous injuries; female gender, instrument, sudden increase in practice, stress (PA),
4
Q
Foot and ankle dance morphology requirements
A
- 90 deg ER at each LE
- 90 deg PF
- 90-100 deg DF of the 1st MTP
5
Q
Foot shape
- “normal”
A
- navicular, medial cuneiform, 1st met in line with the head and neck of the talus
- 1st MTP PF= DF
6
Q
Foot shape
pes cavus
A
- high arch, rigid
- dancers can get plantar fasciitis , stress fx, ankle sprain, anterior impingement
7
Q
Foot Shape
pes planus
A
- medial longitudinal arch drop common in dancers, hypermobile foot (functional vs. actual)
8
Q
Common acute injuries in dancers
A
- 5th met fx: sickling
- Lateral ankle sprain: sickling; Cuboid subluxation; Spiral fx of 5th
- Achilles tendon rupture; Weekend warrior males
9
Q
Overuse injuries in dancers:
Plantar fasciitis
A
- high arch, male, stiff calf, excess pronation
10
Q
Overuse injuries in dancers:
achilles tendinopathy
A
- poor g/s flexibility, M, raked floor, after vacation
11
Q
Overuse injuries in dancers:
1st MTP impingement
A
- excessive 1st MTP DF,or “going over” MTP PF en pointe
- feel it in soft shoes, leads to hallux limitus then hallux rigidus
12
Q
Overuse injuries in dancers:
-hallux valgus
A
- F>M
- hypermobile winging feet, femoral IR
13
Q
Overuse injuries in dancers:
-dropped 2nd/3rd metatarsal
A
- excessive MTP DF in releves, excessive PF en pointe, hypermobile
14
Q
Overuse injuries in dancers:
- sesamoid issues, sesamoiditis
A
- contusions, stress fx, chondromalacia, simple fx
- osteonecrosis,sprains
15
Q
Overuse injuries in dancers:
- interdigital neuritis/neuroma
A
- plantar divisions of the posterior tibial nerve
- grande -plies, rleeves: extreme DF of teh MTPs, nerve compressed over teh met heads
- hypermobile: pronated foot flattens the transverse Met arch
- hypomobile: hallux rigidus moves pressure to other MTPs
- mortons Neuroma
16
Q
Overuse injuries in dancers:
-chonic ankle stability
A
- prior inversion sprains (ATFL, CFL)
- hypermobility
- subtalar instability
- ant distal fibula position make a loose ATFL decr position sense in neutral
- TC ant aglide 2/2 PF stiff post capsule
17
Q
Overuse injuries in dancers:
-anterior impingement
A
- pes cavus foot, rigid foot, pronation due to ligamentous laxity, poor calf eccentric control, calf stiffness, osteophyte development, excessive DF landing a high jump
18
Q
Wall test
A
- motor control of abs and extensibility of thoracolumbar and TFL
- back to wall, plie 15 deg, heels 3” from wall, hold 10 sec, straighten and hold 10 sec, repeat with arms overhead
- back stays on wall 10 reps
19
Q
Hip rotation control test
A
- single limb parallel to lateral rotation 10-15 deg slowly, then do medial rotation
20
Q
lumbar provocation test
A
- stork position extend and SB
21
Q
Dancer hip range
A
- anteversion is same as non-dancers
- 10 deg more ER in dancers. avg 50 deg
- ballet and modern need more total ER: 70-90 deg, ext: 20deg
22
Q
Dance positions and what to look for
plie
A
- keep same ER the whole tome no ant pelvic tilt, no excess paraspinal use no incr tibial ER in plie
23
Q
Dance positions and what to look for:
Tendu derriere and; arabesque
A
look at the standing hop for loss of ER/ABd, gesture leg timing of ant pelvic tilt, lumbar and thoracic extension and rotation
24
Q
Dance positions what to look for
developpe
A
- gesture leg needs HS and adductor length, activation of LR, need a good psoas! Watch for TFL and rectus Femoris recruitment, try to inhibit activation
25
standing drop leg test
- functional leg hold and let go at the barre
| - if leg drops strengthen via: long sit psoas, chair knee flexed psoas, sidelying developpe
26
iliopsoas syndrome
- tight and weak, long and weak
- overuse
- poor motor control of trunk, hip and pelvis
- end-range compensations of QL, TFL, RF
- -Treat: limit hip flexion in class to under 90 deg, address femoral-acetabular rhythm, manual release of psoas, recruitment in supine, sidelying, seated short, seated long, standing
27
Snapping hip
| -- coxa saltans
- 90% of dancers
- ilopsoas on iliopectineal eminence (main one), femoral head, or lesser troch
- ITB or gmax over gr troch
- HS at ischial tub
- osteochondral fx, labrla tears, loose bodies, synovial chondromatosis
- --Test: snapping hip test, obers, demo of the snap, post hip glide, supine PROM log roll test
28
trochanteric bursitis
overuse, over-recruitment, short TFL, ballet dancer doing parallel work
- LLD, Q-angle, pronated feet, lumbopelvic malalignment
- --Treat: control inflammation, repattern movement, provide alt. stance in parallel if tibial torsion exists
29
anterior hip impingement busitis or capsulitis
- cam, pincer, iliopsoas, OA, stiff posterior capsule, synovitis, capsulitis
- check: hip flexion, flexion/adduction, posterior glide, inferior glide, medial glide, T12-L5, scour, quadrant
30
acetabular labral tear
- dislocation, sublaxation
- repetive microtrauma and degeneration
- structural: hip dysplasia, FAI from CAM, pincer
treat: hip stability, trunk control, NWB exs for acute
31
test to provoke ant tear
- FABER to ext, IR ADD
32
test to provoke post tear
- EXt, ABd ER to flex, ADD IR
33
hamstring strain
- dancers need > 110 deg
- overuse HS trying to post tilt the pelvis with abs
- lower abs are weak, so HS is used more
- overstretching
- poor recruitment
34
treat for hamstring strain
- control inflammation, re-pattering and strengthening, STM, stretch, neurodynamics, tape, isometric, isotonic, modified dance in PT aim for HS 110-120 deg
35
Stress fratures
- aacetabulum, intertroch, shaft, ASIS, spine apophysis, femoral neck, slipped femoral epiphysis, lesser troch
- test palpation, hop test, hx of gradual onset
36
tx of stress fracture
--tx: activation of deep rotators vs glute max.
- deep rotators will lift the pelvis on a fixed femur, or distract the femur on a fixed pelvis vs. gmax will compress teh hip joint
37
what dance movements will trigger patellofemoral pain syndrome
- pain with demi-plie, jump landing, flexion-to-extension with the gesture leg
- usually younger dancers
38
what dance movements will trigger meniscal pain
- twisting in demi or grande plie, landing a jump in a deep plie
39
Modern dancers injuries
- #1 cause of injury is faulty techniques: due to fatigue, and decr in power
40
noise induced hearing loss
- affected by noise level: 85 dB and> leads to permanent hearing loss
- NIHL leads to tinnitus and pitch perception problems
- affected by stress -> incr cortisol, glutamate -> decr neuroprotectant of hair cells in chochlea
- affected by exposure time
41
What can we do about floors?
- Raked: makes performers shift their weight back --> stiff hamstrings, LBP lifting
- Hard: increase GRF
- sprung: decr GRF
- Sticky: increases torsion
- Slippery increases falls
42
how can costumes affect the dancers
- headdress elevates the COG
- incr IAP for high sopranos
- if she can't expand the chest,she may get a bladder prolapse
43
NOTE to self: look at lectures slides for performers/dancers
Too many pictures and exercises to write flashcards
Special Topics
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Decks in class (9)
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