Tag Archives: pre-pointe assessment

Kids and Sport: When to see a Physiotherapist

 

 

Often parents are unsure when to seek the opinion of a Physiotherapist in dealing with their active kids. Now more than ever, kids and adolescents are getting involved in organised sports, with a multitude of social and health benefits to be gained from their participation. It is not unusual to see kids that are actively competing in several different sports every week, often with once- or twice-daily training sessions and multiple weekend games or competitions. Combine this activity with the demands of growing on a young body and you find the balance is a delicate one: get it right, and the child thrives; push too hard, and it doesn’t take long before niggles and burnout can arise.

Research tells us that sport is the main cause of injury in adolescents (Brukner, 2008). The number of under-15’s seeking medical attention for sporting injuries increased by 60% between 2004 and 2010. This can be attributed to an increase in kids’ participation in organised sports, improved diligence by parents in seeking medical care for their children’s sporting injuries, and higher levels of competitiveness (or skill) in children of younger ages.

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INJURY MANAGEMENT:

We often get asked when is an appropriate time to see a Physiotherapist with respect to a child’s injury or pain. Growing children who are active will often get transient aches and pains that are normal – when these last only a few days and are mild in nature, ie do not stop the child from participating in any activities, then these can be managed without significant interventions. Often rest or a few days off sport will help in these cases. If, however, a child has any of the following, you should seek out a Physiotherapist for diagnosis and treatment:

  • Pain that lasts longer than a few days;
  • Pain that is increasing or sharp in nature;
  • Pain that gets worse with activity – ie it does not “warm up”;
  • Pain that is stopping them from participating;
  • If they are limping/modifying their activity;
  • Pain that is affecting their sleep;
  • Pain that is mild but recurrent in nature;
  • Redness or swelling around the painful area.

A Physiotherapist will be able to diagnose the injury, develop a treatment plan, and work on prevention strategies so that the injury is less likely to reoccur. If scans are required to assist diagnosis, these can be ordered through the Physiotherapist. The earlier treatment is sought, the easier the injury will be to treat and as a general rule, the less treatment sessions that will be required. Don’t feel like your child needs to be in severe pain or unable to participate before you book an appointment – a good Physio will be able to find their diagnosis no matter how “mild” you may think their symptoms are. Keeping a child active and involved in their sports is always a priority and this is much more likely to happen if the injury is seen to at an earlier stage of its progression.

The wonderful thing about children and adolescents is that their bodies have a marvellous capacity to repair and respond to increased training loads (otherwise known as: “kids bounce”). Generally, we can use the same principle in treating injuries that arise: in the majority of cases, kids can continue participating in their chosen sport(s), albeit with a few modifications to unload the injured area and allow it to heal. They are a beautiful example of what we also see in adult athletes: that when we are able to keep the body active through injury, in a safe and supervised way, the body heals faster and is able to bounce back stronger than it was before the injury. Our bodies like to move, and they respond favourably to the increased circulation, muscle mass, and the hormonal response that comes with exercise.

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INJURY PREVENTION:

Physios also play an important role in injury screening and prevention. This has been the case for a long time in sports such as ballet and swimming, where the unique demands of the sport (eg extra flexibility through the shoulders in swimmers, or characteristics of the feet in dancers) mean that the injury risk is higher if the child is not well-prepared and well-suited to the sport (Gamboa, 2008). Typically with these sports we do a Musculoskeletal Screening on young athletes at the start of every year, to flag any strength, growth or flexibility issues and to develop an exercise program to reduce the risk of injury. This process usually requires a one-off musculoskeletal assessment, followed by 1-2 sessions to supervise the implemented intervention and reassess any high-risk measures.   Such programs have been shown to be effective in reducing injury risk (Eils, 2010), and as an added bonus these kids tend to see an improvement in technique and efficiency due to their improved preparedness. Of course, not all injuries can be avoided; traumatic injuries such as those typically seen in contact sports are difficult to prevent, while overuse or growth-related injuries tend to be decreased with the use of screening programs (Emery, 2003). Good candidates for musculoskeletal screening include:

  • Dancers, especially those about to go en pointe;
  • Children and adolescents swimming more than 3 x week;
  • Children who are going through an aggressive growth spurt, or who are likely to be particularly tall;
  • Children with a family history of growth- or overuse-injuries eg older siblings or parents had ongoing knee and ankle pain during growth spurts;
  • Children and Adolescents involved in more than 6 hours of organised sport/training per week;
  • Children and adolescents with a history of recurrent injuries or niggles.

 

 

WHEN NOT TO SEE A PHYSIO:

The following conditions require urgent medical attention and should be assessed by a doctor (usually at a hospital or via ambulance) immediately:

  • Concussion or head trauma;
  • Suspected acute fractures – eg the child has sustained a trauma and is unable to bear weight or move the affected limb;
  • Pains that also involve rashes, fevers, headaches and other systemic symptoms;
  • Traumatic joint injuries eg shoulder and knee dislocations (these will require Physio, however need to be assessed in the acute phase to clear fractures and to get an assessment from an orthopaedic specialist);
  • Pain that is causing vomiting or nausea.

The key point to remember is that early treatment results in less time away from sport, and generally less treatment. Physiotherapists work very closely with other allied health professionals as well as doctors and specialists, ensuring that any patient that requires referral on will be obtaining the best possible care and follow-up.

For more information and advice, contact your local Physiotherapist.

 

Happy Training!

 

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REFERENCES

  • Brukner, P., Kahn, K. Clinical Sports Medicine. Revised Second Edition. (2008). McGraw-Hill Australia Pty Ltd.
  • Eils, E., Schroder, R., Schroder, M., Gerss, J., Rosenbaum, D. Multistation proprioceptive exercise program prevents ankle injuries in basketball. Med Sci Sports Exerc 2010; 42:2098-2105
  • Emery, C.A. Risk Factors for injury in child and adolescent sport: A systematic review of the literature. Clin J Sports Med 2003; 13:256-268
  • FIFA 11+ Webpage: http://f-marc.com/11plus/home/
  • Gamboa, J., Roberts, L., Maring, J., Fergus, A. Injury patterns in elite preprofessional ballet dancers and the utility of screening programs to identify risk characteristics. J of Ortho & Sports Phys Therapy 2008; 38(3) 126-136

Pointers for Preventing Injuries ‘en Pointe’

pointe-shoesEvery budding ballerina dreams of the day she can one day transition into pointe shoes and dance up on her toes; indeed, many years of foundation training and development go into preparing a young dancer for this exciting stage in her dancing life.  However, along with the excitement comes much more demand on the body and a higher risk of injury.  Even with optimal technique, dancers who wear pointe shoes are bound to experience wear and tear on their feet.  In adolescents, overuse can also be a very common problem – we see a sharp increase in dance injuries as students build up their hours leading into exams and eisteddfods (typically in the middle of the year), and then towards concert time at the end of the year.  Dr Justin Howse, former orthopaedic surgeon to the Royal Ballet School, states that “no dance-related injury is an act of God”.  Variables such as the time spent dancing per day/week/month; experience level; anatomical limitations; technical knowledge; quality of teaching and quality of shoe fitting; history of previous injury; surfaces on which dancing is performed; and strength and conditioning level are among the factors that determine the likelihood of sustaining a pointe-related injury.

 

The following is a list of pointers to help prevent unnecessary pointe-related injuries:

 

 

– Get your pointe shoes fitted by someone with a lot of experience, and especially with fitting beginners if you are just starting en pointe.  Even if you have to travel to do this, it is worth the investment compared to having to see a physio and have a lot of time off later when injured.

 

Take your time getting onto pointe.  There is no “right” age to start – every body and dancer is different.  A dancer is ready when they have done most of their growing, have very good technique, flexibility and strength, and when their teacher feels it is time.  For most dancers this is between 12-14 years of age.  Going on pointe too early can cause a host of injuries and developmental issues in the feet – some irreversible.  Not to mention the cost of replacing pointe shoes every few months during a big growth spurt!

 

– Get a pre-pointe musculoskeletal assessment from someone qualified in assessing dancers.  This is usually a physio with a special interest in dance.  These assessments pick up any potential areas of weakness before they have a chance to cause you problems en pointe.

 

– These days there are a host of padding and toe spacing options to fit inside your shoes, but you do not need to have every single one of them.  I often see young dancers coming in with shoes full of bits and pieces and as a result, they lose the ability to control the end of the shoe well.  Experiment with padding and spacers, and do what feels best for you.

 

– Do not wear ribbons that are too tight – this cuts off circulation and can hide shoe-fitting problems.

 

– Ensure that you tie ribbon knots on the inside of the ankle, not over the back of the ankle, which can apply undue pressure to the achilles tendon.

 

– Be aware of how feet are used when they are not dancing.  Many a foot injury has been blamed on pointe shoes when the dancer is not wearing supportive shoes such as joggers at school or when walking on concrete etc.

 

– If you are having trouble with centre and balance work en pointe, look for weaknesses in muscles higher up the chain – it could be a lack in hip or core strength.

 

 

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– If you have very good muscle strength and still have troubles with single-leg pointe work, consider changing to a pointe shoe with a square box instead of a round one.

 

– Look at the whole body en pointe when trying on shoes.  Observe how the shoe affects the alignment of the rest of the body.  Beware of shoes that thrust the hips forwards.

 

– Never skimp on warming up and stretching.  When the body is not warm enough, or does not have sufficient flexibility to perform a particular technique, something else will pull or strain in order to achieve the desired result.

 

– Whenever possible, take a regular class before a full pointe class.  This will assist in warming up the body and help to decrease the risk of tendinopathy from pointe work.

 

– Don’t be “lazy” en pointe.  If you are wearing pointe shoes, you must have warmed up, be switched on, and aware of your body.  Never mark out dances or go ‘half up’ on pointe because you can’t be bothered in rehearsal – this is where some of the worst injuries occur.  If you are marking out or fatigued, swap into your demi-pointes.

 

– Check the wear pattern on the heel of your pointe shoes.  If there is evidence of foot contact a half inch or longer on the satin at the heel of the shoe, the size may be too short.

 

– A shorter shoe may create a better line and make the instep look higher, but it can also cause a tendinopathy or a bone spur at the back of the foot.  Short shoes also prevent the arch from expanding.  Once the elasticity of the arch is lost, the ability to jump is lost, as is the ability to perform deep pliés.

 

– Conversely, shoes that are too big lessen control over movements.  A shoe that fits correctly allows full flexion and full ability to spread the arch, as well as control the foot and ankle.  A large shoe can cause sprained ankles, overstretched tendons, and overdevelopment of muscles that are straining to hang on to the shoe.

 

– Pointe work is not just about the feet.  Remember to strengthen all muscles around the joints, from the foot to the knee to the hip to the spine; only then will you be able to accomplish your maximum range of motion with beautiful control.

 

– Many dancers stretch but forget to strengthen the deep stability muscles, especially around the hip and the foot.  Working particularly on the instep and the forefoot will decrease the risk of ankle injuries.

 

– When increasing your dance load or when going through a growth spurt, ice the feet at the end of the day.  Muscles swell as you dance, and ice assists in constricting the blood vessels and decreasing swelling and aches.  Also pay careful attention to calf length, and stretch more frequently (2-3 times a day).

 

– Ensure that you don’t allow the skin on the feet to become dry and cracked.  If this is a problem for you, get into the routine of massaging your feet and toes with Vaseline or a good quality moisturizer at night.

 

– Finally, be especially aware of your form when fatigue sets in.  Studies have shown that the majority of ballet injuries occur between 4-6pm, rather than during morning classes.  Physical and mental fatigue can lead to increased injury risk.

 

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It is important for dancers to learn about the anatomy of their bodies, and what they are designed to do, as they get older and more experienced with dance.  When dancers go onto pointe is a great time to start learning about their feet and how to look after their bodies ongoingly.  Often a dancer can carry minor weaknesses for a long time without realising that anything is wrong, until a growth spurt or extra rehearsal load comes along and tips their body over the edge.  Unfortunately this usually happens right before exams or concert time!

 

Thankfully, many of these injuries can be prevented or at least better managed if the dancer has been looking after their body and knows their body well – it’s strengths as well as its weaknesses.  If you are unsure about when is the right time to go onto pointe, whether your body is ready, and how to best transition without the fear of injuries, a dance Physio can assess your body and then work with you and your dance teacher to ensure that you are as ready as you can possibly be.  The end goal should always be facilitating the young dancer to achieve their full potential in the safest and most enjoyable way possible.

 

– Kristy Shannon

Physiotherapist and Exercise Physiologist