Dance Injuries and Conditioning - Lesson 7 - 2012
Dance Injuries and Conditioning - Lesson 7 - 2012
Iliopsoas
Tendinitis
In addition to relative rest (avoidance of activities that stress the iliopsoas muscle), a gentle stretching regimen can assist in reduction of spasm in the iliopsoas complex. Note that stretching must not immediately follow icing, when the sensitivity to pain is lessened, because a potential to overstretch exists. A gentle stretch for the iliopsoas muscle is demonstrated in the image below. Hold the stretch for a count of 20 seconds, relax for 30 seconds, and repeat the stretch 5 times. Caution patients to not hold their breath while maintaining a pain-free stretch.
Medical Issues/Complications
The average time from onset of symptoms to diagnosis typically ranges from months to years; therefore, most patients may present in the subacute or chronic phases of the condition. Despite this, medical treatment during the acute phase consists of relative rest and avoidance of activities that cause pain. Rarely, crutches may be necessary if sufficient pain is associated with ambulation or activities of daily living. The application of ice for 20 minutes every 1-2 hours for the first 1-3 days is recommended in addition to a short course (eg, 5-14 d) of nonsteroidal anti-inflammatory drugs (NSAIDs) in order to potentially limit inflammation and assist with analgesia
References
Garry, Joseph P. Iliopsoas Tendinitis Treatment & Management. Medscape. http://emedicine.medscape.com/article/90993-treatment
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Periformis
Piriformis Syndrome
Piriformis syndrome is an uncommon neuromuscular disorder that is caused when the piriformis muscle compresses the sciatic nerve. The piriformis muscle is a flat, band-like muscle located in the buttocks near the top of the hip joint. This muscle is important in lower body movement because it stabilizes the hip joint and lifts and rotates the thigh away from the body. This enables us to walk, shift our weight from one foot to another, and maintain balance. It is also used in sports that involve lifting and rotating the thighs -- in short, in almost every motion of the hips and legs.
The sciatic nerve is a thick and long nerve in the body. It passes alongside or goes through the piriformis muscle, goes down the back of the leg, and eventually branches off into smaller nerves that end in the feet. Nerve compression can be caused by spasm of the piriformis muscle.
Pain Management Quality of Life Scale for Pain
If you feel chronic pain, it's probably taking a toll on your quality of life. That's true whether your pain is due to cancer, shingles, arthritis, injury, or any other cause. A quality of life scale is one tool that can help your doctor assess your pain. This same scale can help you and your doctor monitor improvement, deterioration, or treatment-related complications.
Periformis Syndrome Signs and Symptoms
Piriformis syndrome usually starts with pain, tingling, or numbness in the buttocks. Pain can be severe and extend down the length of the sciatic nerve (called sciatica). The pain is due to the piriformis muscle compressing the sciatic nerve, such as while sitting on a car seat or running. Pain may also be triggered while climbing stairs, applying firm pressure directly over the piriformis muscle, or sitting for long periods of time. Most cases of sciatica, however, are not due to piriformis syndrome.
Periformis Syndrome Diagnosis
There is no definitive test for piriformis syndrome. In many cases, there is a history of trauma to the area, repetitive, vigorous activity such as long-distance running, or prolonged sitting. Diagnosis of piriformis syndrome is made by the patient’s report of symptoms and by physical exam using a variety of movements to elicit pain to the piriformis muscle. In some cases, a contracted piriformis muscle can be found on physical exam.
Because symptoms can be similar in other conditions, radiologic tests such as MRIs may be required to rule out other causes of sciatic nerve compression, such as a herniated disc.
Periformis Syndrome Treatment
If pain is caused by sitting or certain activities, try to avoid positions that trigger pain. Rest, ice, and heat may help relieve symptoms. A doctor or physical therapist can suggest a program of exercises and stretches to help reduce sciatic nerve compression. Some health care providers may recommend anti-inflammatory medications, muscle relaxants, or injections with a corticosteroid or anesthetic. Other therapies such as iontophoresis, which uses a mild electric current, and injection with botulinum toxin may be used. Surgery may be recommended as a last resort.
Prevention of Periformis Syndrome
Since piriformis syndrome is usually caused by sports or movement that repeatedly stresses the piriformis muscle, such as running or lunging, prevention is often related to good form. Avoid running or exercising on hills or uneven surfaces. Warm up properly before activity and increase intensity gradually. Use good posture while running, walking, or exercising. If pain occurs, stop the activity and rest until pain subsides. See a doctor as needed.
Research into Periformis Syndrome
Traditional treatment for piriformis syndrome has included stretching, physical therapy, and corticosteroids in some cases. Research suggests a benefit in the use of botulinum toxin (Botox) for piriformis syndrome. Using the paralytic properties of the toxin, injections relieve muscle tightness and sciatic nerve compression to treat pain. Some studies have found Botox to be more effective than corticosteroids.
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Sciatica
Sciatica is a common type of pain affecting the sciatic nerve, a large nerve extending from the lower back down the back of each leg.
What Are the Symptoms of Sciatica?
Common symptoms of sciatica include:
• Pain in the rear or leg that is worse when sitting
• Burning or tingling down the leg
• Weakness, numbness, or difficulty moving the leg or foot
• A constant pain on one side of the rear
• A shooting pain that makes it difficult to stand up
Sciatica usually affects only one side of the lower body. Often, the pain extends from the lower back all the way through the back of the thigh and down through the leg. Depending on where the sciatic nerve is affected, the pain may also extend to the foot or toes.
For some people, the pain from sciatica can be severe and debilitating. For others, the sciatica pain might be infrequent and irritating, but has the potential to get worse.
Seek immediate medical attention with any symptoms of progressive lower extremity weakness and/or loss of bladder or bowel control.
What Causes Sciatica?
Sciatica is caused by irritation of the root(s) of the lower lumbar and lumbosacral spine.
Additional common causes of sciatica include:
• Lumbar spinal stenosis (narrowing of the spinal canal in the lower back)
• Degenerative disc disease (breakdown of discs, which act as cushions between the vertebrae)
• Spondylolisthesis (a condition in which one vertebra slips forward over another one)
Pregnancy
Other things that may make your back pain worse include being overweight, not exercising regularly, wearing high heels, or sleeping on a mattress that is too soft.
References
Pain Management and Sciatica. 12 Feb 2012. 25 March 2012. http://www.webmd.com/back- pain/guide/sciatica-symptoms
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Lower back
Slide show: A Visual Guide to Back Pain. 25 March 2012. http://www.webmd.com/pain- management/ss/slideshow-low-back-pain-overview
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Joints
Shoulder Dislocation
If your shoulder is wrenched upward and backward, you may dislocate it out of its socket. This condition is both painful and incapacitating. The force required is often that of a fall or a collision with another person or object (both of which can occur during many sports).
Most shoulder dislocations happen at the lower front of the shoulder, because of the particular anatomy of the shoulder joint. The bones of the shoulder are the socket of the shoulder blade (scapula) and the ball at the upper end of the arm bone (humerus). The socket on the shoulder blade is fairly shallow, but a lip or rim of cartilage makes it deeper. The joint is supported on all sides by ligaments called the joint capsule, and the whole thing is covered by the rotator cuff. The rotator cuff is made up of four tendons attached to muscles that start on the scapula and end on the upper humerus. They reinforce the shoulder joint from above, in front, and in back, which makes the weakest point in the rotator cuff in the lower front.
Subluxation refers to a partial dislocation. A subluxation occurs when the two joint (articular) surfaces have lost their usual contact. A 50% subluxation means the normally opposing articular surfaces have lost half their usual contact and the joint is partially dislocated. A 100% subluxation means the articular surfaces have lost all of their contact. A dislocation is the same as a 100% subluxation.
The shoulders are the most common joint in the body to dislocate. The arm is moved away from the body (abducted) and externally rotated (turning the forearm, palm side up). The joint gives way, and the humeral head, or the ball of the joint, is ripped out of the socket. The structures that hold the shoulder together are torn, including the joint capsule, cartilage, and the ligaments of the rotator cuff.
People with this injury appear in the ER in a fair amount of pain, and pain control is the first priority. The usual sequence of events begins with drugs to help with the pain, a quick exam by the doctor, followed by x-rays to make sure no bones are broken. Then the dislocated shoulder can be reduced; and most people prefer to be aggressively sedated for the procedure.
Treatment
People with this injury appear in the ER in a fair amount of pain, and pain control is the first priority. The usual sequence of events begins with drugs to help with the pain, a quick exam by the doctor, followed by x-rays to make sure no bones are broken. Then the dislocated shoulder can be reduced; and most people prefer to be aggressively sedated for the procedure. After the shoulder is back in place and another x-ray confirms this, the patient is allowed to wake up and go home using a sling or shoulder immobilizer.
Since the joint has been damaged and is unstable, the shoulder immobilizer will need to be worn for a few weeks. At the same time, the physical therapist and orthopedic surgeon may decide to do range of motion exercises to balance the achievement of joint stability, while minimizing the loss of function. A solid shoulder that doesn't move can limit an individual's mobility and lifestyle dramatically.
Unfortunately, in young people and athletes, the re-dislocation rate is high (up to 90%), and the nonsurgical approach that can work for the older person may not work as well for somebody who wants to use the arm aggressively. The conservative, nonsurgical approach can take more than three months until return to full activity can be expected.
References:
Wedro, Benjamin C. Shoulder Dislocation: A Painful Injury. 29 Nov 2007. 25 March2012. http://www.emedicinehealth.com/script/main/art.asp?articlekey=85530
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