Get to know the terminology, lifestyle & culture. Many dance physios have a background in performing, but not all. However, knowing the difference between ‘fosse walks’ & a grande jeté en tournant will help you understand/manage dance injuries & importantly gain performers’ trust
Be great at manual therapy, massage & taping, but don’t mis-sell them ☝🏼 Performers often need those quick fixes (as much as the imp. fundamentals). Being able to provide immediate (if short lived) symptom modification is invaluable - keeping professionals on stage & being paid
If you work in a company you’ll need to know the hierarchy & set up. The company manager will be your go-to for comms & supply requests. Know the difference between a swing & understudy & what that means to the performer. Know the choreography, costume demands, puppets & props!
If you work with freelancers, remember the stress they’re under. Little security from job to job & probably holding down 2-3 other (non dance) jobs to make it all work. Empower, educate & make it count. Direct them to the brilliant NHS dance clinics! nidms.co.uk/nhs-dance-inju…
Be familiar with RED-S/bone stress, hypermobility, hip, knee, foot & ankle. The upper limb is often injured during floor or partner work and especially in styles such as Breaking 💪🏼 Know when & where to refer for mental health or nutritional support - you’ll need your MDT 🧠🥑
Understand why dancers stretch endlessly (culture, aesthetics, hypermobility making them ‘feel tight’). Know the evidence and how to argue it to get them to use their time wisely - weighted eccentrics, controlled end-range work, strength & proprioception e.g. clockface training👇🏼
Get ready to start pushing cardiovascular fitness! Dancers aren’t fit. Evidence has shown that their VO2 max often isn’t much higher than that of a sedentary person. See my blog here for details about how to train the CR system for ‘show fitness’…🩰🚴🏻♀️🫀🫁 blogs.bmj.com/bmjopensem/202…
Dancers are great at doing yoga & Pilates. Selling cross-training like this isn’t difficult. But, evidence is pointing more in the direction of resistance/strength training for injury reduction. Getting buy-in for this can be trickier. Empower dancers to think like athletes! 🩰🏋🏼♀️
How do I get the job? Network & use social media - most jobs are advertised there/by word of mouth. Take every opportunity you can. Shadow, follow, & volunteer! Build experience & exposure, and ooze enthusiasm. It’s an amazing world to be part of and hugely inspirational 🤩🎭🩰
Ankle sprain rehabilitation…
Reducing visual dependence 🎢
Balance is controlled by these systems:
Visual 👀
Vestibular 👂🏼
Proprioceptive 🦶🏼
Thread 🧵 inspired by @angiejphysio 1/6
When I teach the balance section during my foot and ankle courses, I ask which system is being trained during foam cushion/bosu ball single leg standing. Almost 100% of the time people answer
'proprioception’🦶🏼
2/6
In fact this environmental challenge causes the brain to have to compensate for LOST proprioception (because the foot/ankle has no stable point of reference) & the systems that are trained are the visual & vestibular ones - the opposite of what most people think it does...
3/6
A thread on anxiety, coping and injuries in dance… 🧵🧠🩰 1/9
This study found that
biopsychosocial factors were more important in injuries than strength, flexibility or balance…
And highlighted the importance of biopsychosocial assessment in addition to physical screening 🧠🍀
Consent to share ✅
Interesting case of bilateral foot pain which seems to be driven by FHL and tibialis posterior (possibly a knot of Henry issue as well)… 🤔
Working with @DrJN_SportsMed on this case 🤓
Thread 🧵
1/6
Most cases of FHL pain seem to be driven by ‘overuse’ of the extrinsic (FHL) over the intrinsic (flexor hallucis brevis (FHB)). On testing, these patients claw their toes when asked to flex them against resistance. In this case, it’s the exact opposite - see video… 🎬🦶🏼
2/6
The main aggravator of this patient’s symptoms is running. My theory; Where his FHL is required to produce force for propulsion, it’s not able to tolerate the load and becomes symptomatic. There appears to be an ‘imbalance’ in the 1st toe flexor group (controversial)! 👀
3/6
The sesamoids live within the FHB’s distal tendons & articulate with the head of the 1st metatarsal, acting as a fulcrum to increase the leverage of FHB/FHL. But is all ‘sesamoid’ pain actually the sesamoids?
Certain cases of sesamoiditis seem to manifest more as FHB tendinopathy. The pain presents proximally to the sesamoids & is irritated by FHB activation (see pic below of 1st toe flexion), or passive toe extension rather, than pressure through the met head e.g. calf raises 2/5
Treatment can differ slightly - you may want to focus more on muscle-tendon loading exercises rather than just off-loading in cases where FHB tendinopathy is suspected. For example 1st toe flexion with band or rises with toes extended to 30 degs 👇🏼 3/5
Anterior Draw Test was positive, suggesting damage to the ATFL fibres, but Talar Tilt test (CFL) was normal = Grade 2 lateral ankle sprain. There’s still no consensus on the best classification system 👇🏼
Bifurcate lig. attaches the calc to the cuboid/navicular. The mechanism of injury was plantarflexion > inversion which explains the injured ATFL, but a relatively intact CFL. This MOI will sometimes = anterior process of calc #. In this case it was only a bifurcate sprain
75 yr old M. Keen golfer and very fit. 3-4 months of left medial foot pain.
Agg: Barefoot. Ease: Rest/insoles.
History of standing on broken bottle in river age 13 - lacerated plantar aspect of left foot 🦶🏼
1/7
Reduced inversion of L calcaneus noticeable with heel raise - suggesting poorly functioning tib. post. It improved as we practised it. Swelling/redness posterior to medial malleolus and down into navicular. Very tender navicular tuberosity and very weak/painful resisted IV.
2/7
🔹Positive Silfverskiold Test
Indicates tight gastroc. This can exacerbate PTTD signs & symptoms. Reduced ankle DF can lead to increased mechanical demand on the tendons and decreased efficiency of the calf complex
🔹Paper grip +ve on left
🔹Reduced FHL strength on left