Dance Injuries and Conditioning - Journal/Chapter 11:The Report - SAMPLE - 2012

Dance Injuries and Conditioning - Journal/Chapter 11:The Report - SAMPLE - 2012

Chapter 11

The Report:

I met J.N. in September 2011 at the Praise Academy of Dance Trinidad and Tobago. She came to the Academy based on recommendation by her Therapist, who advised that dancing might help with relieving the pain that stemmed from a hamstring injured occurred. Due to the injury J. had some restriction in movement especially to bend over from the waist to touch the floor. She usually experience intense pain whenever the hamstring muscle is stretched due to the lengthening of it whether standing up or on the floor. J. was often seen wincing in pain while performing simple exercises during the beginner’s modern dance class.

Based on her height and weight ratio, J. could be considered over weight for her short stature. She is noted to be a curvature woman as well as she has a curvature of the spine in the lumbar and thoracic regions. From the pelvic tilt alignment exercise on the wall, it was observed that she had an excessive anterior pelvic tilt along with an excessive curvature of the thoracic vertebrae of the spine which is rounded at the shoulders causing it to rotate forward. The Cervical region of the spine seemed short due to the lack of lengthening of the neck area from the shoulder to the ear. Due to the excessive anterior pelvic tilt, this meant that the lengthened hamstring, abdominals and gluteus muscles are weak while the erector spinae and hip flexors are shortened as well as tight. Therefore her postural could further cause tension in her hamstring injury.

For the first three months, it was a matter of gaining J.'s trust during the dance session as well as before and after class. During those times she was able to open up about her sociological, physiological, psychological and spiritual situations. This allowed me to get a greater perspective on her daily life style which could be contributing factors to her injury. It should be noted that during these months, she participated in the regular exercises that the other dancers were doing however she was advised that she should not add undue stress. Once she feel any strain in the area, she was advised that she had reached her maximum stretch and not to try to go beyond that. However this was an area that she needed reconditioning or re-patterning in her mindset as she was often found over doing it to measure up with the other students. She was often reminded that each person has to work towards his or her limits and to work around the injury. Some of the exercises that were part of the routine were planks, sit ups, contract and release of the hips while in the butterfly position, launches, push ups and most important, breathing exercises. J. had noted that there were some improvements in her ability to dance, however she was still experiencing some pain. Still was proof that she was on the road to recovery.

For the first two months of the year 2012, emphasis was placed on strengthening the core, interior and hamstring muscles of the leg with the use of balls and therapeutic bands or fabric. Imagery was eventually used as it was noted that most of the dancers had an imbalanced alignment and also have a very stressful lifestyle. The focus was breathing through the movement while performing the exercises as many times dancers tend to forget to breathe. Therefore a series of breathing exercises were incorporated as part of the routine which have very positive effects such as relaxation of the muscle and mental capacity.

J. along with the other dancers was encouraged to use the exercises from the class during the week in order to increase and measure progress as it doing it once per week for at least one hour and fifteen minutes is not enough. They were encouraged to do so via emails sent at least once a week to provide the necessary support. It was still a challenge for them especially J. as it is a matter of changing mindsets as they are still overwhelmed by their other commitments. In addition to the exercises done during the first three months upon meeting J., the following exercises were added namely

• The squeezing a ball between bent knees while lying in a supine position as the feet and palms of the hand is flat on the floor. This will strengthen the interior muscles of the leg as well as the core muscles.

• Still in the supine position, both feet are off the floor with the ball still between the knees. The arms are spread eagle on the floor as the palms face flat. The knees are lowered to the floor on one side of the body while the head turns in the opposite direction.

• Further to this exercise, the legs are stretched in the air while the leg lowering exercise is performed ensuring that not to create the arch in the lower back. Care must be taken the moment the arch is felt the legs are stopped lowering and returned to the upright position.

• Returning the feet to the floor, knees bent, and the fabric was held firmly between both hands as they extend behind the head on the floor. Using the abdominal muscles while inhaling, the upper part of the body was lifted off the floor as the arms accompanied the upright movement of the body. All this was done on exhalation until the spine was straight. The body returns to the floor upon inhalation.

• In a prone position, the fabric is wrapped around the ankle. A leg curl was performed by lifting from the lower leg up to the knee was gently pulling the fabric while the thigh region was kept on the floor. The stretch should have been felt on the rectus femoris muscles in the flexion position. When the leg extends the hamstring muscles will lengthen.

• In a prone position, the soles of the feet were placed together off the floor as the hips were pressed to the floor just encouraging the pelvic to open.

In addition to these exercises, J. was encouraged to apply heat to the hamstring muscles before performing the exercises in order to increase and maintain flexibility. After one week, she did report that she felt some relief in the tension experienced in the hamstring area with the use of the tension band. However she did experience pain from coccyx to the front of the lower abdominal muscles.

A successful progress report occurred on Saturday 25th February 2012 at one of the dance sessions when the alignment technique was adopted. Note that all the mentioned exercises were performed at one of the dance sessions held Praise Academy of Dance Trinidad and Tobago beginners modern dance with other dancers, however with reference to this report, the attention will be based on J., the client.

Standing in a modern dance stance in a circle with eyes closed, the client was encouraged to focus on the breathing pattern upon inhalation and exhalation through the nose. Deeper breathing was advised as words of self awareness of the environment were articulated. This was followed by words of self evaluation and affirmation of the body and its purpose was declared. With eyes still closed, the alignment checklist along with imagery was used to achieve proper alignment. The Skinner Release Technique was incorporated however the client did indicate that she felt tension in the arms even though there were none in the other parts of the body. To check for dynamic alignment, the client walked around the room at different speed, levels and directions which began slowly with one dynamic added at a time. This was to encourage the client to maintain alignment in motion as well as allow natural movement of the body.

Lying on the floor in a supine position with legs in the air, the leg lowering test was performed in order to check the strength of the core as well as the extent of the arch in the lumbar region of the spine. While lowering the leg to the floor, the client was encouraged to stop the moment the back felt it was developing an arch. The exercise was repeated at least four more times before the legs were placed on the floor. With knees bent and feet flat on the floor as they were hip width apart, the arms were placed at the side of the body with palms facing down. The five series of alignment exercises for the neck, abdomen, pelvic, shoulder girdle and chest were performed. The client was amazed to note the elimination of the arch and the inability to pass the hand under the lower back which was visible before the exercises were performed. The wall test was next which was accompanied by exercise six of the alignment series. Even though the client experienced some pain as she slid down the wall, she was able to complete the exercise appropriately. Some exercises were performed at the barré which were iterated in centre work which as to test the pedagogy of the myth and reality with regards to ballet. These exercises included demi and grand plies, tendus, relevé and grand battement. The imbalance of the alignment was noticed while performing at the barré, however when the client was told to concentrate on the alignment achieved at the beginning of the session as well as ensuring that the core muscles were contracted, the improvement in executing the perform the sequence of movements was observed. This was only achieved when the client constantly check her alignment from the check list used earlier especially in movement. Upon completion of the session, the client was instructed to resume the breathing exercise which should be maintained as the body rolled down on eight counts ensuring to use the entire spine, i.e. the cervical, thoracic, lumbar and sacrum. In that position, the knees were bent then straighten at least four times before the client was told to just allow the head and the arms to hang as if a rag doll. Then upon the count of eight, the body was returned in an upright position with the head being the last to come up.

The client was elated to report that for the first time after such a long period of time that she was able to bend over and touch the floor without experiencing any pain as there weren’t any tension in the hamstring muscle. She also reported that her therapist has been measuring her progress and was amazed by the improvement. The therapist had told her that she was getting a two for one deal as the dancer had explained to her that even though I am not a therapist I surely acted like one.

The progress made even though it was small it was a hurdle achieved. As follow up treatment, the client will have to repeat the above exercises on a regular basis in order to monitor progress which could only happen based on her willingness to perform them on her own. At the dance session held with the client on the 17th March, 2012, the client had indicated that she was involved with extensive dance rehearsal for an event however she was experience pain in her shine. Through leading questions it was discovered that the surface area that the rehearsals were held was concrete and the choreography of the dance entailed lots of jumps. I advised her that it was possible that she might be developing shin splints due to jumping on the incorrect surface as concrete don’t absorb shock that occurred from jump. The best surface was wood which has the necessary track back spring in it. She was advised to refrain from jumping on the surface and/or change the choreography if she wants to preserve her body especially her ankles, knees, pelvic and spine that relates to her alignment thus her posture. As part of preservation she was reminded that should take into consideration the progress she was having with regards to the repair and conditioning of her hamstring muscle as well as not to cause her dancers to become susceptible to injury in the near or distant future. This recommendation was supported by the scientific article on shin splints from the Botanica Medicine website on Integrative Fascial Release which was a collaborative effort written by physicians. The symptoms that she received mirrors those in the article hence for the deduction of it being the onset of shin splints and the recommended treatment was taken from the article as well.

The client did not attend the next dance session due to a heavy flow of her menstruation, which should was also considered in her evaluation and treatment. From her history, the fact that her womb dropped, the evidence of an excessive anterior pelvic tilt, the fact that she had injury to her spine and hamstring as well as the factors surrounding her psoas muscles which don’t always be supple could explain the excessive flow of blood and the menstrual cramps.

Some recommended exercises were gathered from the Inhuman Experimental website to correct the excessive anterior pelvic tilt. This will in turn the strengthening of the hamstring and abdominal and gluteus muscles as well as stretch the spinal erectors and hip flexors. These exercises which were recommended to Jillian in the last session held on Saturday 31st March 2012, which entailed the following activities that were based on using body weight which is a good place to start.

• Exercise 1: Glute bridge

This exercise, also known as supine hip extension or pelvic lift strengthens both the glutes and the hamstrings. Here's the basic way to do it:

One variation of the exercise is to straighten one leg so that only one foot is on the ground, hold for a while and then do the same with the other leg.

• Exercise 2: Front and side plank

Plank exercises are good for making the abdominal muscles stronger. In contrast to sit-ups, which mainly affect the superficial muscles, planks target the deeper muscles. In addition to the usual front plank where both feet and elbows are on the ground, you can do side planks:

This exercise can also be made more difficult by lifting one of the legs up and holding for at least 30 seconds.

• Exercise 3: Lunge stretch

The lunge stretch exercise stretches the hip flexors. It's also called by various other names like hip flexor lunge, lunging hip flexor stretch, psoas stretch, etc. Depending on who you ask, you may get a different answer as to how to perform the exercise, but here's one way:

This exercise can also be done as a forward lunge, in which you begin from a standing position and then lunge forward and drop your hips towards the floor. Performed this way, you'll target glutes and hamstrings more than the hip flexors, unless you also do the stretch.

• Exercise 4: Lower back stretch

The lower back stretch is an exercise that stretches the erector spinae. It's also known as all fours back stretch, back arch stretch, cat pose stretch, and various other names. Here's how to do it:

You can alternate between the two arches but keep in mind that it's the upward arch that stretches the erector spinae.

• Exercise 5: Supine pelvic tilt

Finally, here's an exercise imitating what you want to happen through all your hard work. Like planks, the supine pelvic tilt mainly targets the deeper abdominal muscles. Here's a good example of how to do it (nevermind the Swedish subtitles):

The exercise itself is very subtle, but it gives a good idea of what you're trying to achieve. You can alternate between short reps and holding the tilt for a longer period.

As for her the problems she has been experiencing during sex, she was advised to practice relaxing before either through breathing exercises or have a warm bath which should include bath oils prior to allow the muscles to become flexible as well. She indicated that she usually not away [?] when the sex would occur which she was advised to make it a daily routine which would be beneficial in the long run. As for the pain experience in her lower back, a contour pillow was recommended for the lumbar region of the spine. The client was also recommended to continue using the heat pad on the hamstring muscles, not only when the pain is bad which she was doing but as a regiment as well. To ensure that she warm up properly before engaging any physical activities especially dance.

A progress report from the client has not been received as from since the last session held on the 31st March 2012, a follow session was not scheduled by her. A report of the exercises that was given by her therapist for the hamstring injury was supposed to be emailed which was not received. Also monitoring of her exercises and progress report were to be conducted via Skype however upon several attempts to contact, the client was unreachable. The client however did informed prior that she would have been engaged in church related activities for approximately two weeks after the last session.

With regards for the shin splints further recommendation for follow up treatment was taken from the scientific article which includes:

• At least one week of rest.

• Ice packs

• A light elastic bandage to help minimize the pain

• An over-the-counter anti-inflammatory creams.

• Avoid stressful activities until relief has been felt

• Return to activities gradually.

• Should flare ups, a two to four weeks restriction from dancing especially jumping would be recommended.

• Low impact cross training on bicycles or treadmills will be advised.

Footnote:

Information was source from the following websites:

• Inhuman Experiment: Practical ideas for extending lifespan; Experimenting to live longer and healthier

http://inhumanexperiment.blogspot.com/2009/11/5-simple-exercises-for-correcting.html

• Psoas. 2 April 2012. http://www.vlmassage.com/psoas.html

• Botanica Medicines: Integrative Fascial Release - http://www.fascialrelease.com/