A Guide To Diagnosing And Treating Common Dance Injuries

Start Page: 48
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Author(s): 
Lisa M. Schoene, DPM, ATC, FACFAS

Keys To Making The Proper Diagnosis

As a podiatric physician, it is crucial to understand that the foot can affect the knee, hip, core musculature and spine. Unless a dermatology condition is the chief complaint, it is important to evaluate the whole lower extremity.

   The dancer should be in tights or shorts for the best visualization while testing. Evaluate flexibility and strength for symmetry, and do a complete biomechanical exam to detect any intrinsic biomechanical factors. Address and correct any deviations visible in the exams. Dancers can benefit from foot orthotics in their street shoes if they have abnormal pronation. Some dancers may walk externally rotated due to habits they develop in class. Encourage dancers to walk with a normal angle of gait in order to offload the hip rotators.

   Since dancers have to be experts in stabilizing the whole lower extremity while utilizing the upper extremity in unison, it is important to test dancers in the movements they have to perform. It is known that a typical ballet class will include over 200 jumps in upward of 10 to 12 times body weight.

   Testing balance is also very important. It appears that balance and skill level may suddenly change during adolescent years. These changes can be due to growth spurts, which create changes in sensorimotor adaptations, but these issues will reverse in time. Dance-related tests will help the practitioner see weaknesses that will be more relatable to the actual activity.

   Standing X-rays are essential to evaluate for both injury and the alignment of the foot. X-rays that capture the dancer inside the ballet slipper or pointe shoe can also aid in the evaluation of injuries. With the aid of extra radiology testing, one can confirm the diagnosis. Subsequent decisions to pull a dancer out of rehearsals or a performance can allow the artistic staff to make other arrangements for a replacement.

   I prefer obtaining a diagnostic ultrasound at an outside facility. Real time functional evaluation can reveal the strain or shear of the tissues. With an experienced physician technician, this modality picks up extreme detail and can show the very fine collagen alignment of the soft tissues. If bony structures are involved, magnetic resonance imaging (MRI) or computed tomography (CT) are the best choices. It is important to have a radiology facility on hand that offers cash pricing for exams so the dancer without health insurance benefits can afford the test.

What You Should Know About Treating Dance Injuries

Utilizing a variety of modalities all at once is the best choice. One should favor conservative treatment over surgical. Treating the acute nature of the problem along with the biomechanical aspects has to happen simultaneously.

   In addition to traditional heat or cold therapies as well as functional and postural strengthening methods for the hip and foot, various physical therapy modalities can help treat acute issues and more chronic disorders quickly and inexpensively. Massage therapy is an excellent modality for muscle injury as it helps improve blood flow, increases range of motion, releases deep congestion and aids in chronic scar tissue repair.

   I limit nonsteroidal anti-inflammatory drug (NSAID) prescription but utilize holistic homeopathic medications via injection, topicals and oral methods to reduce acute pathology when corticosteroid injections or NSAIDs are contraindicated. Holistic treatments may include acupuncture and nutrition counseling. Other treatments such as strapping, padding and taping can augment the treatment plan.

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