Essential Dance Medicine

184 Pages·2009·2.944 MB·English

by  Ana Bracilovic (auth.)

Musculoskeletal Medicine
SeriesEditors
GrantCooper,M.D.
PrincetonSpineandJointCenter,Princeton,NewJersey,USA
JosephE.Herrera,D.O.
MountSinaiMedicalCenter,NewYork,NY,USA
For furthervolumes:
http://www.springer.com/series/7656
Ana Bracilovic´, M.D.
Essential Dance Medicine
Foreword by Donald J. Rose, M.D.
AnaBracilovic´,M.D.
PrincetonSpineandJointCenter
601EwingSt.,SuiteA-1
Princeton,NJ08540
USA
[email protected]
ISBN978-1-934115-67-1 e-ISBN978-1-59745-546-6
DOI10.1007/978-1-59745-546-6
LibraryofCongressControlNumber:2009921122
#HumanaPress,apartofSpringerScienceþBusinessMedia,LLC2009
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Foreword
Dancersareunique,combiningartistryandtremendousathleticskills.Asa
result, many of the musculoskeletal injuries sustained by dancers are
unique. Recognition and subsequent management of these injuries there-
forerequiresaspecialsetofclinicalskills,oftendifferentfromthoseusedto
treatotherathleticpopulations.
Therehavebeengreatimprovementsintherecentpastinthediagnosis
andmanagementofmusculoskeletalinjuriesofdancers,whichhavetaken
advantage of recent advances in radiology (e.g., magnetic resonance ima-
ging),surgery(e.g.,arthroscopictechniques),andrehabilitation.
DoctorBracilovicprovidesanup-to-dateinsightforalllevelsofhealth-
care practitioners into the recognition, background, and management of
manyofthecommonmusculoskeletalinjuriessustainedbydancers.Thisis
achieved in an easily digestible form, as a typical case presentation, diag-
nosis, scientific background and management of the injury, grouped by
anatomic site. She approaches the text through her unique perspective as
adancer,anengineer,aresearcher,andaphysicianspecializinginphysical
medicineandrehabilitation.
It should also be mentioned that this text is not intended to be an all-
inclusivecompendiumofthemusculoskeletalevaluationandmanagement
oftheinjureddancer.Suchknowledgecanonlybeachievedbyhealthcare
practitionerscombiningallavailablevalidknowledgewiththeirownexperi-
enceinthemanagementofdancers,recognizingtheiroftenuniquepsycho-
logical needs, and sharing their expertise and experience with others
interested in benefiting this often underserved patient population. It is
hopedthatthistextprovidesavaluablereferenceandstimulustowardthis
end.
Director,HarknessCenterforDanceInjuries DonaldJ.Rose,M.D.
NYUHospitalforJointDiseases
ClinicalAssociateProfessor
NewYorkUniversitySchoolofMedicine
vii
Preface
WhenIwas8yearsold,Iaccompaniedmyfathertokarateclasses.Iliked
thesenseiandenjoyedmemorizingthekatas.Withinafewmonths,Iearned
my yellow belt. Advancing in karate meant learning the ‘‘martial’’ part of
martialartsandmoreadvancedfightingmaneuvers.Whenmymothercame
toclassonedayandwatchedmekick,punch,andgethurledtotheground,
shefearedIwouldgethurt.Onceaseriousstudentofballetwithgreatlove
for the art, she offered to enroll me in ballet classes. Ballet was a magical
world of graceful, safe, and elegant movements accompanied by classical
musicthatIhadbeenplayingonthepianosinceIwas5.Ibecamesmitten
withdancingandbeganperforminginrecitalsandcompetitions.
Inhighschool,mygoalwastobecomeabrainsurgeon,whilemypassion
was dance. As an undergraduate, I remember spending hours in the
bioengineeringlaboratorydissectingfrogs’spinalcordsandracingacross
campus to reach the studio in time for rehearsals. As artistic director of
a university dance company, I loved performing, feeling the excitement
of my fellow company members on stage and together experiencing the
rushofsheeradrenalinandphysicalexpression.Dancepiecesweretome
three-dimensional works of art, displaying beauty, athleticism, emotion,
narration,andimagination.
Inmedicalschool,Iwasabletocombinemyfascinationwiththehuman
body and its ability to display wide ranges of expression in choreography.
Danceandmedicineshareacommonbaseinhumananatomy,kinesiology,
and biomechanics. Dance demonstrates the body’s incredible capacity for
simultaneousstrengthandgrace, agilityandbalance, stillness andfluidity.
Medicine demonstrates its contrasts of health and pathology, ability and
disability,autonomyandsubmissiontodisease.Dancedisplaystheultimate
beautyofthebody,medicineitsnadir,andthepotentialtohealandreturn
tooptimalfunction.
Incontrasttotheapparentetherealnessandeaseofmovementthatballet
dance evokes, the physical demands of common ballet positions and the
underlyingprinciplesofdesiredexaggeratedlowerextremityexternalrota-
tionareentirelyunnatural.Addedtotherequirementsofdancingliterally
ix
x Preface
onthetoesinpointeshoes,thesepositionsandattributesareverydifficultto
attain.Theeffortlessnessofballetisanimpressiveillusion.
Myintentinwritingthisbookistohelpmedicalprofessionalslearnthe
presentations, differential diagnoses and available treatment options for
common dance injuries. Too often, the career of a dancer is short lived
and curtailed by poor injury prevention, improper dance technique, or
nonspecifictreatment.Evenmorefrequently,ifandwhenthedancerarrives
at a doctor’s office, the injury is in an advanced stage. It can often cost a
professional dancer their career, and an amateur dancer their role in a
performance.Thesetendencieshavefosteredacultureofinadequateedu-
cationofallpartiesinvolved,fromdancer,toteacher,tocompanydirector
tomedicalprofessional.Asmembersofadancefamily,wehavetherespon-
sibilityanddesiretomakethecareersofamateurandprofessionaldancers
healthy,long,andenjoyable.Ihopethisbookhelpsaccomplishthatgoal.
AnaBracilovic´,MD
NewYork,2008
Acknowledgments
TomyhusbandGrant—mysoulmate,inspiration,and MSA. Myparents
LjubicaandDragomir—myearth,air,water,andsunshine. Mybrother
Viktor—myrolemodelofintegrityandlove. Myparents-in-lawBarbara
and Joel—my support and good humor. Donald J. Rose MD—for his
mentoring and enormous help with editing. Boni Rietveld MD, Elly
Trepman MD, William Hamilton MD, Laurie Abramson, Lisa de Ravel,
Risa Kaplowitz, and Mary Pat Robertson, PhD. The publishers of
Humana Press – Springer for making this book possible. The beautiful
membersofPrincetonBalletSchool,PrincetonDance,andTheaterStudio,
my family, and colleagues who volunteered their time and creativity with
thisproject:JillianBrinberg,ChristopherCostantini,RachelAnneCostin,
JillianDavis,LaurenElsonMD,Allison,Emma,RobinandJohnFleming,
Francesca Forcella, Gretchen LaMotte, Aditi Menon MD, Drew Nelson,
andAbigailWohl.
Thankyou.
xi
Contents
1 FootInjuries ............................................ 1
2 AnkleInjuries ........................................... 43
3 KneeandShinInjuries.................................... 63
4 HipInjuries ............................................. 89
5 SpineInjuries............................................ 111
6 ShoulderInjuries......................................... 133
7 Elbow,Wrist,andHandInjuries............................ 149
8 DanceGlossary.......................................... 159
Index...................................................... 169
xiii