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Maintaining the best results requires knowledge and expertise. Our athletes train and so do we, through our professional development program. Meaning that when a practitioner the treats you, they have the most advanced injury care knowledge. Read about what our practitioners are thinking in the injury blogs below.
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The Perfect Pointe
When is the right time for a ballet dance student to progress to pointe work? Many students wonder at what age they might get their first pair of pointe shoes.
The dancer must first undertake a detailed assessment with a podiatrist or physiotherapist experienced in performing pre-pointe assessments. It is important to determine a dancer’s readiness in order to avoid potential injuries and the development of bad habits.
Dancing en pointe requires significant strength, athleticism and discipline. Beginning too young or when the body is not strong enough can be detrimental in the long term.
The en pointe position places significant pressure on the bones and soft tissues of the foot and ankle, up to ten times the dancers body weight on her toes and feet. Some bones in the feet are still growing until age 16 or even 25 years of age. And damage can occur in the growth plates causing malformed bones if a dancer is not strong enough. Damage can also occur to other joints such as the knees and hips; which may not become apparent until years later.
Many dancers begin pointe work at approximately 12 to 14 years of age; although age alone is not an adequate predictor of growth and maturity. When deciding if a student is ready to begin pointe work the practitioner will consider the number of years and hours per week the dancer undertakes. The practitioner will perform a detailed assessment which includes tests of strength, flexibility, neuromuscular control, balance, alignment and ballet technique. The body as a whole will be evaluated, not just the foot and ankle. The dancer must be able to perform all tests maintaining balance, control and alignment to be considered ready.
It must be recognised that pointe work is the end result of slow and gradual training of the whole body, back, hips, leg and feet in perfect balance and alignment. This will naturally occur at different ages for different dancers and should not be rushed. Practitioners will also expect a good attitude and work ethic which is required to dance at an advanced level.
Podiatrists Gen and Sarah at CSSM enjoy the opportunity to work with dancers; both for undertaking a pre-pointe assessment and in the prevention and management of injuries associated with dance.
Richardson M, Liederbach M, Sandow E. Functional Criteria for Assessing Pointe Readiness. J Dance Med Sci. 2010; 14 (3): 82-88. Weiss et al. When Can I Start Pointe Work? Guidelines for Initiating Pointe Training. Journal of Dance Medicine and Science. 2009; 13(3)). IADMS
The excitement is building in the lead up to the 2016 AFL grand final. But we should spare a thought for the players who have been recently injured and will be watching from the sidelines like the rest of us.
Sports injuries can affect a variety of tissues including muscles, ligaments, tendons and bones. Interestingly, it is estimated that greater than 60% of all sports injuries occur to the lower limb.
For our top four AFL teams this year, of the players who are excluded due to injury, 67% are suffering a lower limb injury and 6% have an injury specifically affecting the foot.
Due to the fact that feet carry all our body weight, foot injuries unfortunately can take extended periods to fully heal and returning to sport too soon can be detrimental long term.
Sydney Swans defender Michael Talia has a partial tear to the LisFranc ligament with bone displacement which may take a least three months to heal. Sam Reid also from the Swans has an achilles injury which should be ok in a few weeks.
Marcus Adams from the Western Bulldogs will be in a moon boot for at least two weeks after spraining his midfoot.
A Lisfranc injury sustained by forward Jarrod Pickett from GWS may take up to six months to heal. Jarrod will need surgery and then rehab before returning to full fitness. Midfielder Jack Steele also from GWS has sustained a foot injury during training which has prematurely ended his season.
Cory Gregson from Geelong has a stress fracture in the navicular for which he has had surgery and will take about 10 weeks to heal.
We wish all these players the best for their recovery.
You don't have to be an athlete to suffer a sports injury. At Camberwell Sports and Spinal Medicine we treat all types of sports injuries for both professionals and amateurs. It is estimated that in Australia, one million sports injuries occur each year. It is important to realise that up to 50% are preventable. Prevention can begin with the right advice regarding footwear, technique, training frequency, intensity and duration. Regular check-ups are recommended to alter training appropriately and address injuries when they occur.
Sport injuries can result in time spent off work or school as well as significant medical costs which sometimes involve hospitalisation. Visit CSSM today to book in your running gait assessment to optimise your gait, have your footwear and training regime assessed.
Caroline Finch, leading sports epidemiologist. Injury prevention and the promotion of physical activity: what is the nexus?, Caroline Finch and Neville Owen, Sports injury Prevention Research Unit, School of Health Sciences, Deakin University and Faculty of Health and Behavioural Sciences, University of Wollongong NSW. HAZARD, Edition number 8, Autumn 1991, Victorian Injury Surveillance and Applied Research System (VISAR), p.1
The TGA (Therapeutic Goods Administrator), Australia’s drug regulator has issued a warning to women about the use of anti-inflammatories during pregnancy.
Whilst pregnant women should always speak to their health professional before taking any medication, many women consider anti-inflammatories “harmless” like other drugs such as paracetamol. Anti-inflammatories are marketed as a common remedy for headaches, period pain and other general pains; and many women may take them before they are even aware that they might be pregnant.
Taking anti-inflammatories during early pregnancy has been linked with increased risk of miscarriage.
The TGA is warning all women thinking of conceiving to avoid these popular drugs including Voltaren, Naprosyn and Nurofen; and are in discussion with drug companies to make sure they display obvious warnings on the packaging. The TGA has stated “The data suggests that the risk is greatest when the medicine is taken close to the time of conception."
American researchers interviewed more than 1000 recently pregnant women and found that use of NSAIDs increased the risk of miscarriage by 80 per cent.
There are many studies relating to the use of non-steroidal anti-inflammtory drugs (NSAID) during pregnancy. Antonucci et al outline “Increased risks of miscarriage and malformations are associated with NSAID use in early pregnancy. Conversely, exposure to NSAIDs after 30 weeks' gestation is associated with an increased risk of premature closure of the fetal ductus arteriosus” (part of the developing heart). “Fetal and neonatal adverse effects affecting the brain, kidney, lung, skeleton, gastrointestinal tract and cardiovascular system have also been reported after prenatal exposure to NSAIDs.”
A study by Wiley et al identified “Many pregnant women get prescriptions for NSAIDs during their first trimester, and even more--up to 15 percent--take over-the-counter versions of these drugs.”
The current advice from the TGA is “If you are pregnant, think you may be pregnant or are trying to become pregnant, consult a health professional before using these products and consider using an alternative medicine.”
“TGA pregnancy warning for popular over-the-counter painkillers” The Age Newspaper. October 11, 2016.
Use of non-steroidal anti-inflammatory drugs in pregnancy: impact on the fetus and newborn. NCBI. Antonucci et al. May 2012
First Trimester Use Of NSAIDs Is Associated With Cardiac Abnormalities In Babies. Wiley, John et al. Science Daily. August 25, 2006
Hawthorn football player James Frawley is out for 8 weeks with a Turf Toe Injury. So, what is turf toe and why does it take so long to heal?
Turf toe is a sprain of the 1st MPJ or the joint where the big toe attaches to the foot. It usually occurs when the big toe is hyperextended or forced upwards. This can occur as the toes push off the ground but can also result from another person stepping on the toes as the foot is moving. Turf toe can be classified as grade 1, 2 or 3 which indicate severity. In the worst cases, the ligament under the toe is torn. Pain is felt each time the toes bend, which is obviously difficult to avoid as this occurs with each step we take. Foot injuries are therefore difficult and can take long periods to heal properly for this very reason. It is very difficult to rest a foot completely unless a plaster cast or a cam boot walker is used.
If a turf toe injury is suspected, treatment should initially involve rest, ice and elevation. Consultation with a podiatrist will ascertain the extent of the injury and guide further treatment. A variety of treatments may be implemented ranging from taping; which can be very effective, right through to surgery in some cases.
If correct treatment is not undertaken there can be a permanent loss of flexibility at this joint. This will cause altered biomechanics and most likely predispose this joint to arthritis and pain in the long term. Correct diagnosis, treatment and adequate rest from sport will reduce the likelihood of long term complications.
We wish James Frawley a speedy recovery.
Clinical Sports Medicines Brukner and Khan 4th edition 2012 McGraw-Hill Education
Podiatry Today: http://www.podiatrytoday.com/article/9063