Everyday care for the dancer’s feet

The foot and ankle are a vulnerable area for the dancer, accounting for 65% of all injuries within professional dancers and 53.4% within elite pre-professional dance students. Dancers are constantly on their feet and despite the effortless look, there is no doubt that this art puts incredible strain on the lower limbs. 

A combination of flexibility, stability and dynamic strength are required at the ankle and foot for a healthy dancer’s foot. However, despite the intense training, injuries in this area are highly common.

Foot injuries can be caused by a number of factors including;

•             ill-fitting shoes,

•             an increase of training intensity too quickly,

•             poor dance technique,

•             over training

Chronic injuries at the foot, due to overtraining, are more common than acute injuries.

Below are some tips of how you can take care of your feet each day, with an aim to prevent injury.

Everyday care

Remove the waddle

As a dancer it is very important to look after your feet when outside of the studio. Dancers often adopt the dancers “waddle” out of habit due to their turnout training. However, mechanically, the feet are not designed to be turned outwards, therefore it is important to note when walking and jogging to place your feet in parallel.

Rest and recover

Additionally, allowing your feet to rest and recover is highly important and beneficial, in order to help prevent injuries due to overtraining. Possible ways of doing this is by soaking the feet, simply taking the weight off your feet or having a massage in the arch of the foot and Achilles tendon insertion.

Wear the correct footwear

When buying shoes, ensure you wear properly fitted shoes. Not only dance shoes, but any casual pumps too. After a long day training you do not want to put extra strain on your feet. I would suggest purchasing a well-fitting pair of running trainers for these occasions.

Prepare your feet

In the morning you might feel stiffness in the foot and ankle. Why not prepare the feet first thing? Even before class? This will feel like a breath of fresh air and help enhance movement quality.

Try this plantar fascia roll.

1.            Using a hockey ball, roll deeply into the plantar fascia on the foot for 2-3 minutes. Ensure you cover the whole underside of the foot.

2.            Repeat on the other foot.

You'll feel like you're walking on air!

Strengthening the ankle and foot is highly important in order to prevent fatigue, a leading cause in injury. View my article on improving ankle strength here and warming up the ankle and foot here.

Look after blisters

Blisters are a common complaint for ballet dancers caused by moisture and repeated friction from (most commonly) pointe shoes. Taping susceptible areas of the feet can help prevent blisters yet don’t work 100% of the time.

When blisters come up it is unadvisable to burst blisters. Doing so could lead to infection. It is best to leave the blister to heal in the open air, however dance class schedules and pain can restrict this. Therefore you can drain a blister using a sterilised needle to ‘pop’ the blister. It is important to keep the roof of the blister intact to allow as cover which will help avoid infection. It is then best to cover this area with a clean dressing.  

Avoid bunions

Toe spacers or improvised toe spaces help to improve the alignment of the big toe. I would recommend fixing these in place before class with a bit of tape.

If you suffer from bunions then seek a good pointe shoe fitter who can offer you a shoe with the correct support and angling to remove pressure from the bunion.

At the end of the day have an ice pack to hand to sooth any bunion pain.

Do you have any rituals you go through each day to look after your feet? Let me know below!

 Photo credit: Rennison-Rae Photography

Dealing with a severe ankle sprain

Four weeks yesterday I seriously sprained my ankle. Trust me to do such a thing whilst trying to perform an exercise to build reaction and strength in the muscles surrounding the ankle joint! *face palm* It was totally my fault and not something I will do again!

Having had a very exciting meeting I wasn’t keeping track of the time and consequently had to race (within the speed limits) to reach that evenings rugby clinic. Still buzzing from the meeting and disappointed at myself for not keeping track of the time I wasn’t focused sufficiently to perform a complex exercise (I got caught up in a 12-inch hurdle whilst performing lateral ankle hops.) You live and learn eh! Good thing I wasn’t coaching a large group at the time!

At first I was in so much pain and worried as I couldn’t move my foot. (I hadn’t sprained my ankle since I was in primary school so the pain felt very alien). Thankfully my boyfriend Richard was there training with me and able to calm me down and carry me back inside. Having had a great number of injuries himself, Richard took on the role of therapist and could assess my ankle without much prompting from me (A sports therapist in the making perhaps?)! The injury didn’t seem too severe in that nothing was broken but instead a lot of soft tissue damage had been done. I’d fallen into a plantarflexion/inversion position so a lot of anterior structures had been damaged. I placed it at a severe grade 2 injury, and hobbled my way home for immediate treatment.

Immediate swelling

Over the next few hours/days the ankle swelled up quite significantly and bruising of a beautiful violet blue developed! I used the R.I.C.E protocol of rest, ice, compression and elevation for a good 10 days straight, and tried to keep off my feet as much as possible. This admittedly wasn’t as much as I ideally would have since my parents were visiting and I wished to show them around rather than be stuck indoors, but I survived!

Richard applying Kinesio Tape

Rest, Ice, Compression, Elevation

The swelling was pretty significant!

In addition to using a crepe bandage with horse-shoe padding to encourage a greater decrease in swelling, I used Kinesio Tape to help lymphatic drainage. Again Richard put his therapist skills to good use! The effects of this tape were most evident in the bruising, where on removal you could see where the tape had once laid (small thin .5cm lines no longer the colour of the bruising).

I had some beautiful bruising!

In the weeks prior to this injury, training had been going well and so this caused me the most frustration. However I have managed to adjust my training accordingly. For the first week I laid off training legs completely, only concentrating on my upper body – fun and frustrating at the same time. Slowly but surely I have gradually been working the ankle through proprioceptive work on the ground and then on un-even surfaces. At 14 days the ankle was still too painful to perform general resistance work with therabands so I stopped and moved on. Listening to your body following an injury is key to progress and not regress. I have finally managed to get back squatting by performing front squats as this doesn’t cause any pain at the ankle. Back squats however are another matter. I tried this exercise first, but found that my ankle was uncomfortable and consequently changed my form. I wasn’t having that! So I tried loading from the front i.e. front squats. Flexible training at its best!

Rehabilitation begins!

Thank you to Chris Rennison-Rae for allowing me to change the nature of our recent shoots due to the injury. Dancing on pointe and jumping around are not ideal with a poorly ankle! And I think the alternative photos turned out quite nicely!

You can see my swollen ankle if you look closely!

Four weeks in and the swelling has almost disappeared but what remains seems to be within the joint itself. Actively placing the foot in demi-point and pointing the toes/ankle is now possible. I am also able to jog without pain but springing off one foot is not yet comfortable. With swelling still present in the joint I am continuing to follow the R.I.C.E protocol and hope that I can up my rehabilitation soon. I expect it to take another 2 weeks to fully recover. Then I think I might try my hand at some running along our beautiful coastline.  

 - E

The secret tool to rehabilitation

 Support

 The often forgotten essential tool of rehabilitation.

Having recently read an online article by ballet dancer Rebecca King, it made me reflect on my own experience of providing support within the rehabilitation of clients.

Too many times within grassroots have I experienced players being put down by their coaches and fellow team mates through missing games due to serious injuries. This mocking is often because they’re not ‘putting their body on the line’ for the team anymore, which is primarily due to the fact that they’ve done this one too many times and their body has finally given up. What angers me the most is that no credit and understanding is given to these players who are working their boots off to get back onto the field and it is then left to me as their rehabilitator to not allow this player to become despondent. Not only is this destructive to the team environment but it is harmful to athletes mental and physical wellbeing. If it was me, I know I certainly wouldn’t want to return to a team with an attitude like this.

As a therapist, our role is not to simply drill out numerous exercises for our athlete, but to also ensure a good mental state and preparedness listening and advising our clients when they have concerns. Thus I try to ensure all my sessions are run with light-heartedness, good-humour and in a safe environment, where they can feel relaxed and open to talk. From doing this, my athletes work hard to please both themselves and me.            

Support from the team and staff are not the only places this care should be coming from, support from both friends and family are key. This allows for good psychological health within and away from sport and can aid to a better recovery.

Let me know your thoughts on this area! Have you experienced a lack of support from your team and how did you overcome it?

- E

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

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

The misconception of helmets

Photography by Micheal Oakes

The topic of concussion is something I have been interested in since working with rugby league, rugby union and American Football teams. Having read the book ‘Concussion’ by Jeanne Marie Laskas (a brilliant but worrying story) it just highlights the mistaken views of players within these sports.

I constantly have players telling me they are risk free from concussion, due to wearing helmets or scrum caps. I am able to educate my own player s that this is not the case. However it can be very frustrating for professional sport medics like myself when others believe they do offer complete protection, and then act in a reckless fashion with their heads. What really needs to be understood is the mechanism of concussion (see my next post).

Photography by Micheal Oakes

HELMETS DO NOT PREVENT CONCUSSION!

American football has one of the highest incidences of traumatic brain injury than all major sports, including rugby union, rugby league and ice hockey. ‘But they wear helmets’ you might be thinking, ‘this protect them from concussion’. WRONG!

A helmet does not protect the skull from concussion. A helmet can help to protect the skull from fracture and lacerations.

However, steps are being taken to look at reducing the trauma to the brain. Riddell an American Football helmet manufacturer, is designing helmets to aim to minimise the impact of a hit by diffusing the energy of the hit throughout the helmet, and also using sensors inside the helmet to alert side-line officials of possible concussions. This is all well and good within the NFL, but at grass-roots levels, there is no way this level of technology can be paid for.

Take a look at how these two helmets have changed over the years…

The oldest of the two helmets (aged at roughly 18 years old) is constructed of hard foam and a blow-up rubber inner tube.

The newest helmet (1 year old) is constructed of a compression liner which acts a suspension system to keep the head secure while the shell moves independently. (https://www.youtube.com/watch?v=2-T1g_-dSo4).

It’s not perfect, but it’s the start of ongoing improvements.

The rubber inner-tube

The old Shutt VRS4

The Xenith Epic

The vastly different insides of new American Football helmets.

Please remember that safety comes first! Don’t be reckless with your head, it’s the most important part of you!