Books: Anybody's Sports Medicine

[tendumom]

I was at the local library yesterday perusing the new non fiction shelf and found a great book. Anybody's Sports Medicine by James G. Garrick, M.D. and Peter Radetsky, Ph.D. As I was leafing thru I even found an entire chapter on ballet in the appendix. It is a fabulous book oganized around the parts of the body, their most common sports injuries and the way to treat them. Under $14 at Amazon, I have ordered one for our studio and one for me.

 

There is one very interesting discussion in the ballet section about rapid growth spurts. According to the authors, gymnastics academies track growth rates and when they see their students shooting up they begin a specific program of stretches designed to stretch areas most involved with muscle tightness that are suceptible to injury eg quads,hams (tightness here contributes to back injury) and calf muscles. They suggest that parents of ballet students do the same. Although the authors admit that ballet "is better equipped than other activities to handle this risk" they still advise additional stretching. In our studio, the girls who have been nursing the most injuries are the tallest girls. This really got me thinking. I wonder if any ballet schools have implemented such a regime? It seems to make sense to me.

[vagansmom]

Oh, you're bringing up a big concern of mine! I remember reading some articles on Russian ballet schools years ago and how, when a dancer was experiencing a growth spurt, they'd modify his/her schedule during that time. Dancers grumbled about it but the teachers' concerns for injury prevention prevailed. At most ballet schools in America, dancers' regimens increase around that time, rather than decrease. I'd love to see, at the very least, an exercise regimen to be done during class time, or just before, (but mandatory) for dancers approaching and during puberty. I know that at my daughter's studio, there's always at least a couple dancers that age with knee problems. My own daughter was one of them at the beginning of her growth spurt. four years ago. The PT explained to us that it's most common among girls 10-13, esp. slender girls. He sees it in ballet, track, and gymnastics. First, the bones are lengthening so fast that the soft tissue (muscles, ligaments, tendons) can't keep up. Also the inner thigh muscles in ballet aren't as well-developed as the outer ones, so the kneecap gets tilted from teh pressure on one side, and then the problems begin. My daughter's kneecap did that and it took a daily regimen of exercises to build the inner thighs before it improved (about three weeks). To this day, she does those exercises as a preventive. Recently she experienced some tendonitis in her knee and it turned out to be due to her quad muscles being so strong that she was losing flexibility, thus a shortened quad tendon developed. Once again, daily stretching exercises for her quads have solved the problem easily. But I see so many parents not taking their dancers to a PT at the first sign of trouble and those dancers end up with chronic problems. I really wish it would be addressed on a daily basis within the ballet studio where, in my opinion, it belongs.

[tendumom]

It sounds as though you have connected with a very knowledgeable PT. We have a couple in our area who treat dancers and I'm thinking about contacting them to see what they think of this preventive stretching idea and what stretches would be useful. Perhaps with some legwork, I can get our ballet staff and AD interested in incorporating a "mandatory" stretch in classes.

 

Vagansmom, I have a question re your daughter's knee issue. My 12 year old periodically has pain around the outer side of one or both knee caps. Her instructor thinks it is because she pushes back into them vs pulling up and has been working with her in that regard. It has seemed to help, yet I wonder if it is also because of this muscle imbalance you mention. Where was the pain in your daughter's knees?

[vagansmom]

When it was caused by a kneecap that had tilted slightly out of place 4 years ago, the pain was just above the kneecap. It also swelled out. I was upset because she was just 11 years old and I worried that it would become a chronic problem. She had electro-stim and ultrasound as well as exercises for 3 weeks. The swelling disappeared within 24 hours and she's not had trouble again till 10 days ago. This time the pain was in the center of the kneecap. Xrays showed the tilt but an orthopedic dr. whose specialty is ballet said it wasn't more than he usually sees among dancers and that continuing the stretches she's been doing for years should control it. He said it had nothing to do with her present pain. He discovered her quad tendon is shortened by having her lie on her stomach. He then had her bend her knee back as far as she could. It wouldn't go all the way back and she felt the pain in her kneecap. He said she'd lost about 15% flexibility in her quad tendon due to the quad muscles being too strong. She's done quad stretches daily since then and she can already in just these 10 days get her leg all the way back. The pain disappeared within 2 days. She says she feels the stretch in her knee but it's not a painful feeling. Her quads are much more flexible now. I hope by describing exactly what happened both times, you'll be able to figure out if your daughter's problem is similar or not. I'm really passionate about getting these little things taken care of professionally immediately because I've seen too many kids end up with chronic pain or recurrent swelling. My daughter's injuries have never lasted as long as anyone else's in her group of dancers, but she's the only one who gets to a PT immediately. She's had fewer injuries too because she's been very good about doing the stretches the PT gave her.

[Guest sneds]

A bit off topic, but a ballet connection...

 

Peter Radetsky, one of the authors, is the father of ABT dancer Sascha Radetsky.

 

 

Kate

[Guest sneds]

Sorry to post again..should have read all the posts before adding my .02

 

I find it interesting that the book spends time on growth spurts, because Sascha Radetsky(son of one of the authors) went through a growth spurt while he was studying at the Bolshoi Academy. Indeed, he was put on a modified schedule until the spurt was over.

 

Also, the knee problem you are referring to is patello-femoral syndrome. It's much more common in women because women's wider hips create a greater femur-to-kneecap angle. People (like me) with shallower femoral/patellar grooves are more prone to the problem as well.

 

I was diagnosed after having knee pain while running in college. In my case stronger quads were also an issue, as well as inflexible hamstrings. My pain is less localized and more general and achy. The orthopedic doctor gave me ultrasound to take the initial swelling down, and then exercises and anti-inflammatories for the long term. It's been more of am problem lately because of my ice- skating and the fact that I am not as rigourous about doing my exercise now.

 

I wish they'd diagnosed me earlier because I'm sure I've done some damage to my cartilage that could have been avoided.

 

Kate

[Guest BAM]

My daughter has only been injured once (I am now knocking on wood!), and she pulled a hamstring during the end of the session performance at her second summer intensive-she was in the middle of a growth spurt, pre-puberty and as skinny as the proverbial rail. She was also in the middle of a growth spurt. The director said it wasn't uncommon for someone of her age/body type--at first I was suspicious they were just trying to make sure it didn't look like their fault, but the more I thought about it, the more it made sense. They said the bones grow so fast that the muscles and tendons can't keep up, and they haven't stretched enough. Something to keep in mind if you have a younger dancer! Every studio should probably have a copy of that chapter.

[Guest samba38]

Great advice here on stretching. my kiddo's hip is hurting and, no surprise, it came after she grew 1.5 inches in three months this fall. Her physical therapist has ordered up weekly floor barre plus a conditioning class plus extra stretching. Here's the rub -- how can kiddos zoom from school to ballet class with about 30 seconds to spare and warm up adequately? Our wise teacher encourages the kiddos to warm up before class but few can get there more than a nanosecond before barre. Next year I hope her schedule will allow a little more lead-in time.

[tendumom]

Okay, I think I know what a floor barre class entails. What is a conditioning class and where do your find it? I love living in a more "rural" area, but I am envious of those of you who have such a variety of useful resources. We don't even have a place to access a floor barre class.

[Guest samba38]

Actually, i'm having trouble finding a conditioning class and I've got a call in to the PT to get advice. We may hav eto make do with videos but kiddo is a social creature and I don't think she'll get the encouragement to stick with something doing it alone in the living room.

[tendumom]

Good luck! Let us know what happens.

[Guest checkwriter]

Thanks for the tip, tendumom. I bought the book from bn.com and looked through it over the weekend. A great section focusing on ballet, and some interesting commentary from one of the authors, a sports medicine specialist who works with the SF Ballet.