Wednesday, April 15, 2015

Dance medicine a growing specialty at Children’s of Alabama

By: Dr. Reed Estes is the Chief of UAB Sports Medicine at Children’s of Alabama and an Assistant Professor at UAB. He treats young athletes, and has developed a growing specialty in dance medicine. He has worked with performers in the Boston Ballet and many other professional and amateur dance companies.

Dance, like any other physical activity, produces its share of injuries, particularly in children and teenagers. There are sprains, strains, broken bones, bumps and bruises. The more serious injuries often require specialized care and rehabilitation aimed at getting dancers back on their feet and toes. It’s important to understand when and why this specialized care is needed.

Dance injuries account for a steadily increasing volume of my sports medicine practice at Children’s of Alabama. We provide and coordinate care across the many specialties at Children’s, and we work closely with Agile Physical Therapy, which greatly enhances our ability to serve dancers. We conduct clinics at dance studios, and see patients from throughout the southeastern U.S.

Dance injuries are fairly common. On average, 23 children are treated every day in U.S. emergency rooms for some type of dance-related injury, according to a recent study published in the Journal of Physical Activity and Health. That same study also found that the number of serious, dance-related injuries increased 37 percent from 1991 to 2007, climbing from 6,175 to 8,477 annually.

Some dancers come to us just to be checked when approaching a new, more difficult level of performance, such as beginning pre-pointe participation with ballet. Others have been injured, and come to us for specialized care. We understand the mentality of dancers and the things they need to prepare for. It’s considerably different than the way we treat our football players or soccer players.

For example, when a football player tears his anterior cruciate ligament, or ACL, we focus rehabilitation on strengthening his core movements to get him back on the field, specifically to the demands required of a contact athlete. In dance, there are different requirements. A dancer must not only be limber and able to accomplish difficult tasks in an aesthetically pleasing manner, but also maintain full stamina. Rehabilitation for a dancer focuses on that.

Not all injuries require a dance medicine specialist. I tell patients and families to watch for pain that is ongoing, persistent and may be causing disability. Pain that is present with one particular activity, every time it occurs, may indicate a need for medical intervention. Likewise, pain that progresses with a decreasing level of activity often poses a warning sign.

Of course, the best medicine is prevention, and there are things that parents can do with a child who is a dancer. Watch for fatigue, monitor dietary habits, ensure that sleep is sufficient and know when a child or teenager is under stress with projects at school. Understand how that affects them when they are in the dance studio, when they are under duress and fatigued. Young dancers tend to eat poorly and not get enough sleep before performances when life becomes stressful. There’s only so much time in the day to practice and do homework.

Many times, teenage dancers will remain silent when they are injured. There is often a fear that their instructor may be upset with them, their classmates may lose faith in them, or they may lose their roles in performances. Oftentimes, it requires the parent watching closely and saying, “I noticed my daughter was icing down her ankle or rubbing down her knee.” Parents should be mindful of those things.

Also, we encourage parents to watch for the level of pain after dance. We usually advise that a low level of pain is acceptable some of the time. That’s a 4 or 5 out of 10, on occasion, and is often a symptom of soreness, as opposed to something that is more persistent.

Remember, most sports are seasonal, but dance is a year-round pursuit with little downtime. Thus, my mentality has to change when treating a dancer.

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