ACUTE INJURIES

These are usually obvious because they come about as a result of an incident. Landing wrong from a jump. Falling from a lift. Slipping while crossing the stage. Severe injuries like broken bones obviously need immediate attention and a visit to the doctor. For most common ailments…

First aid suggests the R.I.C.E method (rest, ice, compression, and elevation) for strains, sprains, swelling, etc.

In addition, staying hydrated and eating well promotes healing.

OVERUSE/CHRONIC INJURIES

WITH OVER 600 MUSCLES, 206 bones and countless nerves, ligaments, and tendons in the body, it's almost impossible for dancers to escape getting injured. Acute injuries, such as a sudden sprain or muscle pull, seem to happen out of the blue. One minute you're dancing, the next minute you've hit the floor. Chronic problems, like tendonitis, develop from repetitive stress over time.

Overuse or chronic injuries are sometimes triggered by an event that is allowed to persist without proper rest or rehabilitation. These can include inflammation of tendons, joints and muscles. However, often they are be caused or aggravated by other circumstances:

  • growth spurts
  • imbalance between strength and flexibility
  • inadequate warm-up
  • excessive activity (for example, increased intensity, duration, or frequency of training)
  • improper technique
  • unsuitable floors
SIGNALS OF CHRONIC PAIN

Four signals of chronic pain:

  • Pain that gets progressively worse during working out.
  • Pain that comes after you work out and the next day comes back after less working.
  • Pain that is accompanied by a certain movement (e.g. arabesque).
  • No real sense of “pain” but a definite restriction of movement.

It is normal to have temporary muscle soreness after a challenging class or when working in a new way. Anything that persists, particularly in the ways mentioned above, should be discussed with a physician or dance/athelete specialist. This should be done sooner, rather than later.

Iliacus tendonitis (hip)

“I have pain in the front of my hip, near my groin.”

Diagnosed most often in younger dancers, iliacus tendinitis affects the iliacus muscle, at the lower portion of the iliopsoas muscle at the front of the hip. This can also be referred to as iliopsoas syndrome.

Causes - Iliacus tendonitis often results from overuse during dance activities. It can affect modern dancers more often, due to the increased emphasis on hip flexion and internal rotation. Pain is most often felt in front of the hip, often in the groin. Pain and often crepitus is felt on palpation over the iliacus muscle.

Treatment - Conservative measures are normally sufficient in dealing with the pain associated with iliacus tendonitis. A dancer may need to reduce their rehearsal regimen until symptoms decrease. Anti-inflammatory medication can assist with reducing swelling along the tendon. An assessment by a physical therapist or athletic trainer can assist with soft tissue management and correcting muscular or structural imbalances that may also be present.

Achilles Tendinitis

“My heel and lower calf hurt, particularly while running or jumping.”

Tendinitis can occur in any of the tendons about the ankle, including the flexor hallucis longus tendon (the dancer’s tendon), the peroneus brevis tendon, and the peroneus longus tendon. It most commonly occurs, however, in the body’s longest tendon—the Achilles tendon. Able to withstand forces equal to and greater than 1000 pounds, this tendon connects the calf muscles to the heel bone (calcaneus) and is responsible for plantar flexion of the foot to achieve releve and performing jumps. Due to its’ heavy workload in the dancing population, it is prone to inflammation (tendinitis). It unfortunately is also the most frequently ruptured tendon in dancers and non-dancers alike.

Causes - Most cases of Achilles tendonitis are due to overtraining of the dancer, particularly heavy training during a short period of time. Other contributing factors for Achilles inflammation would be:

• Returning to dance after a long period of rest

• A natural lack of flexibility in the calf muscles

• Dancing on a hard surface or a non-sprung floor.

Aside from pain over the area of the Achilles, dancers with Achilles tendonitis can also notice:

• Mild pain after dancing that worsens

• Tenderness in the morning located ” above tendon attachment to heel bone

• Stiffness that fades once tendon is sufficiently warm

• Swelling and inflammation

Treatment - As with all overuse injuries, the sooner the injury is addressed, the more positive the outcome. Rest and ice are immediate treatments for conditions that do not allow for any pain free activity. Active stretching of the Achilles is helpful. However, dancers need to exercise caution with stretching the Achilles beyond the point of comfort. Strengthening exercises should be introduced gradually. For chronic conditions, the use of an overnight splint to assist with dorsiflexion range of motion can be helpful. Orthotic prescription can be helpful to correct any structural imbalances in the foot. However, if a dancer has no correctable faults, orthotics may not assist with symptom relief.

A Note on Anti-Inflammatory Drugs

These are often overused in the dance community. Sometimes a doctor will recommend them and they can help bring down swelling. However, they are misused when taken to “get through a class” or otherwise mask pain.

REINJURY

Dancers often re-injure themselves when they return too quickly to activity. Temporary muscle soreness can sometimes improve with a return to class. However, if moving makes it feel worse, the body may need more rehabilitation time and/or medical attention.

After an injury, always ease back into activity. It is better to be safe than sorry. Dancers don’t like to hear this when they are eager to get back or feel pressure to return to class but, remember that temporary setbacks are just that – temporary, and not worth permanently injuring oneself.

“An ounce of prevention is worth a pound of cure.”

Prevention

Of course, preventing injury in the first place is ideal. Although sometimes this is not entirely possible there is a lot a parents can do to keep their dance students injury-free.

  • Find a studio that is committed to safety
  • What is your studio’s philosophy?
  • Is there proper flooring (i.e. – something sprung or with some “give”)?
  • Find a studio that is committed to quality instruction
  • Do the students spend a reasonable portion of their class warming-up (not stretching but individual body-part and full-body exercises that encourage blood flow)?
  • Are students encouraged to master foundational basics before moving on?
  • Do students receive individual attention and feedback from their teachers?
  • Etc…
  • Encourage dancers to stay hydrated
  • How much water is really necessary is debated, however, there are many active dancers that probably do not drink enough water.
  • Encourage healthy, balanced nutrition
Some other things you can do
  • Encourage rest and proper sleep habits
  • Encourage a positive outlook
  • Remove the stress and pressure to “work through” or “push on” through injury
  • Try cross-training with other activities (not to load extra onto already tired kids but to promote balance in the body; you might even speak to your child’s teacher or studio owner about alternatives within the studio)
What is shock?

The most important distinction to make between the different forms of shock, is between psychological (or mental) shock and physiological (or circulatory) shock:

Psychological shock can occur after a physically or emotionally traumatic experience but it effects your state of mind (although this can give you symptoms such as palpitations and feeling faint, it doesn’t usually lead to serious physical collapse).

Physiological shock is a dramatic reduction in blood flow that, if left untreated, can lead to collapse, coma and even death.

Symptoms

The most common symptoms of shock include:

A fast, weak pulse

Low blood pressure.

Feeling faint, weak or nauseous.

Dizziness.

Cold, clammy skin.

Rapid, shallow breathing.

Blue lips.

Causes and risk factors

There are various types of shock with varying causes.

Physiological shock:

This type of shock can be caused by:

Severe bleeding.

Pulmonary embolus (a blood clot in the lungs).

Severe vomiting and diarrhoea.

Spinal injury.

Poisoning.

There are also specific types of physiological shock, with very particular symptoms.

SYSTEMIC PROBLEMS
Low Blood Sugar Problems

Low blood sugar problems can be caused when food intake, exercise and diabetes medication are imbalanced. This condition can be mild to severe. To prevent low blood sugar problems, eat meals at regular times. Skipping meals, fasting or crash dieting will cause your blood sugar level to plummet. Exercise is an essential part of your treatment plan but if you overdo it, it will also result to a rapid drop in your sugar level so before you exercise it is important to check your blood sugar first. If your blood sugar level is lower than 5.0 mmol/L prior to exercise, bring with you a quick source of glucose such as hard candies, fruit juice or glucose tablets.

The common manifestations of mild low blood sugar problems are trembling, heart palpitations, sweating, anxiety, sudden and/or frequent hunger, tingling, and nausea. People with moderate low blood sugar problems may also experience the symptoms just described as well as feeling confused, weak, drowsy, dizzy, exhausted, and unable to concentrate. They may also sometimes experience headaches, speech difficulty and blurred vision.

Severe low blood sugar problems will have the same symptoms as above but only more intense and usually require assistance from others for treatment. To treat both mild and moderate low blood sugar problems, the following may be given to the patient: three glucose tablets, five dextrose tablets, ¾ cup of fruit juice, six LifeSavers, and four teaspoons of sugar. If the blood sugar level stays below 4.0 mmol/L after 15 minutes then repeat the treatment.

To treat severe low blood sugar problems if the person is conscious, give the same items listed above for mild and moderate cases except increase the glucose tablets to four, the dextrose tablets to 7, the fruit juice to a cup, the LifeSavers to 8 pieces, and the sugar to 5 teaspoons. Repeat the process until blood sugar increases to 4.0 mmol/L. If, however, the person is already unconscious contact emergency services immediately. Severe cases may be treated with injections of glucagons.

If you are taking acarbose as your only diabetes medication or in conjunction with insulin or other pills for diabetes, you must treat your low blood sugar problems with glucose tablets or milk, if the tablets are not available, because sweetened foods will not be able to raise your blood sugar level.

After the treatment of low blood sugar problems, the person must have a snack if the next meal is more than an hour away. The patient may eat 1 slice of bread slice with a slice of cheese or meat or 1 tablespoon of peanut butter. It is essential to consult and approve any treatments with a physician or a qualified professional.

Sodium Deficiency

The body loses sodium every day. It escapes the body by way of the urine and also via sweat, which is why a considerable amount is lost on hot days and after a strenuous exercise session. Because so many foods contain sodium, sodium deficiency is rare. However, a serious loss of sodium can result from excessive vomiting and/or diarrhea. Diuretics, such as those that are prescribed to help lower blood pressure, can also deplete sodium levels.

Symptoms of a sodium deficiency that is combined with a loss of water most often include muscle cramps and weakness, dizziness, an inability to concentrate, memory impairment and nausea. If the deficiency becomes serious, the circulatory system can collapse and the body can go into shock.

A deficiency in sodium alone can allow water to enter the cells causing the cells to become swollen. Water intoxication may result. Symptoms include fatigue, apathy, muscle twitching and anorexia.

Sodium is an electrolyte meaning that it, along with chloride and potassium, helps control the electrical charges that occur between cells. These electrical charges are used by cells to communicate with one another. The electrical charges are also what give our five senses the ability to see, smell, touch, hear and taste.

Approximately 30% of the sodium mineral inside the body is stored in the bones and the balance is found in body fluids. Sodium is a main component of blood plasma and approximately 60% is contained in the fluids that surround cells. About 10% of the body's sodium is stored inside the cells. This division helps maintain a proper balance of water inside as well as outside these cells.

Its presence in the circulatory system helps the body keep blood pressure and the overall volume of blood flow within normal ranges. Sodium helps keep the blood from clotting, which can be a very dangerous situation. In the blood, sodium together with potassium helps maintain the blood's delicate pH balance. Sodium also helps carry important nutrients to the cells.

In the digestive system, sodium assists in the process of metabolizing foods into energy. It protects the stomach lining by preventing the acids inside the stomach from burning it.

Sodium Sources

High quantities of sodium are in most processed and preserved foods. Potato chips and pretzels, hot dogs, ham and bacon, tomato sauces, ketchup, lunch meats and canned soups are good examples. Lower levels of sodium also occur naturally in many foods including meat, chicken, eggs, nuts, seafood, fish, carrots, beets, artichokes, cauliflower, celery and even milk. Since so many of the foods we eat already contain salt, it isn't necessary to add more prior to consumption.

What is iron deficiency?

Iron deficiency is a condition resulting from too little iron in the body. Iron deficiency is the most common nutritional deficiency and the leading cause of anemia in the world. In the USA, despite food fortification, iron deficiency is on the rise in certain populations. Iron deficiency at critical times of growth and development can result in premature births, low birth weight babies, delayed growth and development, delayed normal infant activity and movement; iron deficiency can result in poor memory or poor cognitive skills (mental function) resulting in poor performance in school, work, military or in recreation. Lower IQs have been linked to iron deficiency occurring during critical periods of growth.

Signs and symptoms of iron deficiency

A person who is iron deficient may also be anemic and therefore have one or more symptoms of anemia—chronic fatigue, weakness, dizziness, headaches, depression, sore tongue, sensitivity to cold (low body temp), shortness of breath doing simple tasks (climbing stairs, walking short distances, doing housework), restless legs syndrome and loss of interest in work, recreation, relationships and intimacy.

Causes iron deficiency

Iron deficiency can be the result of numerous and multiple causes, which fall into two broad categories: an increased need for iron and a decreased intake or absorption of iron.

Increased demand: Iron deficiency can occur during rapid periods of growth; for this reason nature makes certain that a developing fetus, newborn and infant up the age of about six months has an ample supply of iron. These conditions also can result in iron deficiency: blood loss from heavy menstruation, pregnancy, frequent or excessive blood donation, fibroids, digestive tract disease (including infections), surgery or accidents; medications, supplements or substances that cause bleeding such as pain relievers with aspirin; poisoning from lead, toxic chemicals or alcohol abuse.

Decreased intake or absorption

Diets that do not include heme iron, the form of iron in red meat, which is absorbed more efficiently than non-heme iron found in plants and dietary supplements. or sufficient iron or other nutrients such as vitamin C, B12, folate or zinc. Consuming foods, substances or medications that interfere with the absorption of iron such as: taking antacids, proton pump inhibitors (to treat acid reflux), calcium supplements, dairy products, coffee, tea, chocolate, eggs, and fiber. Or diseases and conditions that lower iron absorption, such as: not enough stomach acid, lack of intrinsic factor (hormone needed to absorb vitamin B12); celiac disease, inflammatory conditions such as Crohn’s disease, autoimmune disease and hormone imbalances.

Most at risk for iron deficiency

Women, children and the elderly are most at risk. African American and Hispanic women and their young children are prone to iron deficiency, possibly because of diet or perhaps different hemoglobin needs. Men are rarely iron deficient; when they are it is generally due to blood loss from the digestive tract, diseases that affect iron absorption (such as celiac’s) disease or alcohol abuse.