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 🤩🎭🩰
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
‘And my bunion is better’ is often what dancers say after rehab for a different foot/ankle issue that has indirectly addressed their hallux valgus. This dancer’s primary concern was bilateral HV… Worse at end of day.
3 exercises for hallux valgus 🦶🏼
A thread 🧵
1/4
Warm up:
A combination of Piano Toes (flexion) + ‘Paper’ from ‘Rock Paper Scissors’ (abduction). To spread the toes it helps to do it with your hands at the same time. This was a first attempt - It takes practise. About 10-15 reps x 2 of each to wake up the feet!
2/4
1st MTPJ flexion with band:
Important not to try and pull the toe into abduction with the band or you’ll end up working adduction with resistance (the opposite of what you want)! Cue: Spread & pull down. Hold for 5-10 secs & repeat until felt in MLA 🦶🏼
What initial exercises would you give a patient who was reporting ‘weak ankles’ and most importantly, why?
Thread…🧵🪡 1/8
Female dancer in 8 shows a week. Ankles feel ‘tired’ & ‘achy’ by end of day. No specific pain. Requested exercises to help 🙌🏼
Hx of ankle sprains
Very mobile ST joints
Poor functional endurance IV/EV
⬇️ balance: hip airplane
SLHR: 11 - VERY low
Overuses FDL for SLHR: clawing
2/8
Dancers often resist IV/EV isometrically without issues but when you ask them to use the foot in a more functional way they struggle. Use this exercise as an assessment - any shaking or difficulty maintaining a neutral position = a sign they should include it in their HEP👇🏼 3/8
Balance Assessment in Dancers 🩰
Mini thread 🧵
Are tests specific enough and are they validated to be part of a return to dance criteria? 🤔
🔸Pirouette test 🌀
🔸Hip airplane 🛩
🔸Force plates 💪🏼
🔸SEBT (+ variations) ☮️
🔸Single leg stand 🦩
1/4
Pirouette & hip airplane are the most specific, but quite subjective in how they’re scored. SEBT & SLS are overly static. Force plates are unavailable at most dance facilities and don’t replicate a dance environment eg noise-free/no dynamic movement 🤔 2/4 pubmed.ncbi.nlm.nih.gov/34517937/
A combination of the pirouette test, sauté test (dance version of a continuous hop test) & hip airplane has been used to Ax readiness for pointe work 🩰 This could potentially be extrapolated for use with dancers returning to dance following injury 👍🏼 3/4 pubmed.ncbi.nlm.nih.gov/21067685/
The collective minds of #medtwitter helped me compile this list of resources for Pts. I’ve aimed it primarily at dancers 💃 but there’s lots of crossover with other sports 🎿🏄🏻♂️