The importance of Vitamin D for the dancer

It’s pretty standard that a sunny day brings out a good mood in all. I just love opening the curtains wide and letting the sun’s rays flood the house and jump at the chance of visiting the beach in some shorts to catch some colour. Well it turns out that the sunshine isn’t just good for our moods, but also building a healthy body…

With limited hours being spent in natural sunlight due to many hours being spent inside from classes or rehearsal, dancers are at a greater risk of Vitamin D deficiency. A 2013 study by Wyon et al. found dancers to have insufficient levels of vitamin D, especially within the winter months.

Vitamin D is a vital nutrient for maintaining strong bones and helping the body to absorb calcium. Calcium is vital for growth, immune function, blood pressure, muscle mass and strength. So it is no coincidence that research has found vitamin D supplementation to be beneficial in increasing vertical jump height and isometric muscle strength, whilst also reducing injury rates within elite ballet dancers.

It is believed that due to the high levels of stress which is placed on dancer’s bones and muscles, a vitamin d deficiency can cause greater harm on their bodies, than others who train at a less intensive level. A stress fracture is a common injury within the dancing population, and although it may be caused by poor programming, technical or biomechanical factors, it could also be linked to a vitamin D deficiency.

Dr Wolman (National Institute of Dance Medicine and Science) recommends that dancers need about 1000 IU of vitamin D3 a day, however for the deficient dancer higher levels may be needed. If you are worried about your Vitamin D levels, contact your Dr who can perform a simple blood test to calculate your levels.

Vitamin D can be found in natural sources of food such as salmon, tuna, eggs, cheese and milk. You might, therefore wish to contact a registered dietician who can advise you further.

Concussion

A ‘complex pathophysiological process affecting the brain, induced by biomechanical forces’ – Kuhn and Solomon, 2015

What?

Concussion, also known as minor traumatic brain injury (TBI), is 'the sudden but short-lived loss of mental function that occurs after a blow or other injury to the head' (NHS, 2014). Clinical signs and symptoms encompass emotional, cognitive and physical areas.

Injury to the brain is caused by a sudden acceleration or deceleration caused though a knock to the head.

This indirect force produces a violent jarring of the brain within the skull. Unlike what we often think, the brain is not fixed within the skull, it is suspended, the two do not move as one. Imagine an apple within a Tupperware box. A violent knock to this box will cause the apple to bash against the walls of the plastic box and become bruised. Such damage occurs to the brain within the skull.

The brain balances a series of electrochemical events in billions of brain cells. However when the brain is shaken or jarred soft tissue damage occurs causing brain function to be temporarily disrupted. This is when we might spot clinical changes within the individual.

Signs and symptoms 

·    periods of memory loss/the inability to recall

·    Disturbances in vision/seeing double/seeing stars/blurred vision

·    A period of confusion

·    Headaches

·    Gait disturbance

·    Unsustainable sleeping patterns

·    Vomiting

·    Blank expression

·    Delay in answering

·    Drowsiness

·    Tonal changes

·    May or may not loose consciousness (in fact only 10% of concussed individuals loose consciousness

These symptoms may occur immediately following impact to the head, or can develop hours, days or weeks later. If any of the symptoms becomes problematic or persistent, further assessment should be made by a GP.

Between 1.6 and 3.6 million individuals are affected by sports related concussions each year in the United States. Within the 2011-2012 National Hockey League season 4,878 concussions were reported per 100 games. This sport has seen a steady rise greater than tenfold in the concussion rate between the 1986-1987 season and 2011-2012 season.

Why is the incident rate increasing so dramatically?

·    Increase in player size? Athletes are now heavier, taller and stronger than previous years, meaning there is more force travelling through each hit. Within the NHL player height has increased by 1 inch and an average weight by 10 pounds.

·    Greater recognition and reporting?

·    Player position - concussion is also seen more commonly within some playing positions than others. For example, within the National Football League, research has seen concussions to occur more frequently in wide receivers, tight ends and defensive backs.

Mechanism of injury

Within sport, possible causes of concussion include

·         head to head contact

·         Knee to head contact

·         Ball to head contact

·         Head to ground contact

·         Fighting - within the NHL, 9% of concussions are due to fights between players.

·         Additionally, the NHL has recognised concussion rates to be higher when the individual is unaware, unexpecting and unprepared for a hit.

 

Management

Even a minor blow to the head may leave an individual concussed. Someone who has a concussion may not necessarily be aware of it, or they may not admit it due to a fear of being taken out of the game. Symptoms of concussion can often be delayed, therefore it is important to continuously assess the player. I suggest an on-pitch assessment, side-line assessment and medical room assessment for constant watch of any deterioration of health.

Immediate Pitch assessment should be actioned, followed by a side-line and medical room assessment to watch for any deterioration in symptoms.

IF IN DOUBT, SIT THEM OUT. Continuing to play may increase the players risk of more severe, and/or longer lasting concussion symptoms and an increase in a risk of other injuries. The SCAT3 form can used to evaluate the level of injury.

Should the player show signs of a more serious head injury, an immediate action of emergency care should be taken, i.e. CPR, phoning 999 for an ambulance.

These symtoms include:

·         Remaining unconscious after the initial injury

·         Lack of coordination or balance

·         Seizure or fit

·         Repeated vomiting or nausea

·         Slurred speech

·         Prolonged vision problems

·         Weakness in extremities

·         Fluid/blood leaking from the ears or nose

·         A persistent headache

·         Sudden deafness

·         Difficulty staying awake

Return to play protocol

The RFU have put together a Graduated Return to Play protocol which can be viewed here … http://www.englandrugby.com/mm/Document/MyRugby/Headcase/01/30/49/33/returntoplayafterconcussion_Neutral.pdf

My own experience of dealing with concussion over the past 4 years has changed. 4 years ago, it was difficult to get a player to take a concussion injury seriously and they were often encouraged to stay on the pitch despite my advice. However most recently, in light of new research and guidelines, this is changing and if I tell a player they can’t go back on, they don’t and my advice is fully supported by the coaches. I believe there still needs to be better education across all sports with regards to concussion but I have seen attitudes beginning to change. This can only be for the better.

-E

Recommended Sites

·         http://www.englandrugby.com/my-rugby/players/player-health/concussion-headcase/

·         https://www.headway.org.uk/about-brain-injury/individuals/types-of-brain-injury/traumatic-brain-injury/

·         http://playerwelfare.worldrugby.org/concussion

My Past Dance Injuries

In a past post I mentioned I had suffered from a dance related injury. This injury was greatly overlooked and could have been prevented had I taken supplementary classes. I suffered from Chondromalacia Patella. This is roughening of the articulate cartilage on the underside of the patella. This cartilage can become soft and wear away, causing anterior knee pain. Luckily I was not at this stage and was able to rehabilitate. Chondromalacia Patella is caused by the incorrect tracking of the patella due to a muscle imbalance within the quadriceps. Through my dance training I had become dominant in my vastus lateralis which pulled my patella laterally out of its groove, causing pain with active movement. Through simple Pilates and strength training exercises, by the guidance of my Sports Therapist I was able to strengthen my Vastus Medialis and glutes to correct the problem.

Source - Google

Here are a few of the exercises I used to perform -

Single Leg Bridge

1.       Lie on your back with your knees bent to 90 degrees with your feet on the floor. Arms palm up at your side.

2.       Draw in your abdominal muscles, maintaining this throughout the exercise.

3.       Squeeze your glutes together and slowly raise your bum off the floor until your torso is in line with your thighs. Lift off one leg so that it is in-line with the other thigh. Ensure the hips stay level.

4.       Hold for 10 seconds and lower.

5.       Repeat 10 times on each leg.

Glute band walk

1.       Place the band above the knees.

2.       Keeping the glutes squeezed and the knees pushed out, walk side to side (crab walks) and forwards and backwards (monster walks).

3.       Ensure walks are slow and controlled.

Swiss ball squats

1.       Stand with your back facing the wall. Place a swiss ball at the lower back between you and the wall. Place feet slightly in front of the body.

2.       Hold a light medicine ball between your knees.

3.       Lower yourself until your legs are at 90degrees.

4.       Hold for 10 seconds and squeeze the ball.

5.       Drive up out of the squat to the starting position.

6.       Repeat 3 sets of 12 reps.

Please remember everyone’s injuries are different, therefore each may require different treatment. What worked for me may not work for you. However, these exercises are good, simple strengthening exercises which can be incorporated into your supplementary training regime to help prevent muscle imbalances.

If you have any questions, don’t hesitate to get in touch!

-E

6 things I love about working as a Sports Therapist

1.       Educating and aiming to protect players from further damage

I love treating people, but it gives greater satisfaction when I can educate my clients to enable them to take steps to improve their health on their own.

2.       The people you meet

I have met some wonderful people throughout my time working and look forward to meeting many more interesting people. I absolutely love listening to old stories told by client’s and learning different things from each of them.

3.       Helping others

I like to help people. I always have and I always will. Seeing a client improve or having one tell you they are now pain free makes my day!

4.       The places you travel

Despite waking up at 4.30am for some away games and the eventful University American Football journeys I have been on, I love visiting new places. It's just another mini adventure for me! I even love those freezing cold snowy days on the side-lines when I can't feel my toes or fingers. Being outside and able to watch sport is an ideal weekend activity for me, so combined with doing the job I love, it is a winning combination!

5.       Family and friends

At all the clubs/teams I have been involved in, I have been welcomed and made to feel as part of one big family. With my first team (Teesside University Cougars), it felt like I had 30 big brothers who would look after me. I have made some lifelong friends (young and old) while being part of these teams and am forever grateful for their support promoting me and my work. 

6.       Continuous learning

In this job, you never truly leave education. To hold onto my professional insurance and membership, it is a requirement to continue my professional development. However, as you might be aware within this job, you will constantly be returning to books and journal publications to seek new ways of treatments or to investigate further into an injury. I absolutely love this, as since leaving university I miss the deadlines, which I guess it is part of the reason I write this blog. Yey to learning!

-          E