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Dancer Injuries

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121. Safe Travels – or Tampere and back again (and everything in between)

Safe Travels – or Tampere and back again (and everything in between) Safe Travels – or Tampere and back again (and everything in between) | Injury Prevention: Editor's Blog by [SB] Our guest blogger is Russ Milner – reporting on his experiences at the recent Safety conference (follow him on Twitter ) [RM] I was fortunate enough to win the inaugural Travel Subsidy to support my attendance at . As delighted as I was to receive this news, I soon realised that arranging the various approvals (...) ”, to the locals) 20 metres behind a colleague from Perth. It’s a small world after all. An interesting series of presentations and group discussions quickly revealed that across the globe, many issues and challenges are shared by injury prevention and safety promotion (IPSP) practitioners. It was comforting to realise that we’re all in this together, yet concerning that we haven’t found a way to solve the problems altogether. I mustered the courage to take the roving microphone in this session and reflect

2016 Injury Prevention: Editor's Blog

122. Crossingtheline Summit – Let’s Talk About Athlete Retirement

and psychological advice. Battle Wounds My input was to host a panel discussing ‘battle wounds’. A particular interest of mine is that athletes are a vulnerable group of patients, sometimes because of their celebrity status but often because they have become a commodity that can be replaced when it’s broken. Brendan de Gallai (ex-lead dancer with Riverdance) discussed the fear of injury as a dancer. “You would be replaced by the understudy who might do a better job than you for one night as they are fresh (...) rush to operate sometimes and we have quite a patriarchal approach. Hands up, I have done this myself. When we give a patient bad news, we have been provided with training. Palliative care and certain areas of medicine are excellent at this. Yet when we tell an athlete that they must retire because of injury, we have a limited body of knowledge to guide us. The athlete is about to have the very thing that defines them as a person removed and will experience a ‘kind of death’ yet we are somewhat

2016 British Journal of Sports Medicine Blog

123. Hamstring Rehabilitation: Criteria based progression protocol and clinical predictors for return to play

measurement to keep track of the progression. In our experience, nearly all of the hamstring injuries were due to running. If you see dancers (and maybe martial artists) you probably need to take our advice with a grain of salt. We agree with Askling that stretch type injuries are a different beast, but we can’t help you there as we really hardly ever see these. However for our patients, all rehab protocols must include running. Specifically, running as close as you can get to what would be required (...) strain injury rehabilitation. Not wanting to be left out, we developed a hamstring rehabilitation protocol at the , based on available literature and clinical experience (that magic combination that doesn’t always like each other, but oh how sweet when they do). Our initial assessment and treatment includes elements that will form part of most protocols. So I will focus on three critical elements that we were able to identify: The most important measurement is strength, especially outer range

2015 British Journal of Sports Medicine Blog

124. Performing Arts Medicine: How can it add to one’s clinical practice?

of Injury & Illness in Sport: Posters: Epidemiology of injuries among elite pre-professional ballet students. Br J Sports Med 2011;45:4 347 D Hamilton, P Aronsen, J H Løken, I M Berg, R Skotheim, D Hopper, A Clarke, N K Briffa. Dance training intensity at 11–14 years is associated with femoral torsion in classical ballet dancers. Br J Sports Med 2006;40:4 299-303 Nolet, R. Virtuoso hands. Clin Rheumatol (2013) 32:435–438 ************************************8 Dr Farrah Jawad is currently a ST5 doctor (...) , and are subject to acute and chronic injury and illness just like athletes. As a part-time PAM MSc student whilst continuing with my full-time Sport and Exercise Medicine training, I have been learning about these issues pertaining to the performing artist in lectures and in seminars. Last term we had a seminar with David Hockings, Principal Percussionist with the BBC Symphony Orchestra and Head of Percussion at the Royal College of Music, who talked to us about the challenges musicians can face, often

2015 British Journal of Sports Medicine Blog

125. Highlights from the Sixth London School of Sport and Exercise Medicine Conference – Sport and Exercise for All

has been involved with Dance Medicine at a high level since the late 1980s, and has a great wealth of experience in the field. He highlighted the injury pattern and predisposing factors that are specific to an aesthetic athlete such as a dancer. Mental health in sport Dr Justin Yeoh, an ST6 in SEM who is an experienced physician in the world of football, delivered perspectives from his own experience on mental health in sport, with a particular emphasis on depression. He highlighted how common yet (...) by Holborn Bars, March 11, 2015) certainly lived up to high expectations. 145 candidates from diverse backgrounds attended the expert presentations on key issues including: physical activity for the old, young, elite and the less athletic. Below, we summarize highlights from the day. Tales from the Ballet: common problems encountered with performing athletes and dancers In the morning, we heard from Dr Roger Wolman, Consultant Rheumatologist and Sports Physician, about ‘Tales from the Ballet’. Dr Wolman

2015 British Journal of Sports Medicine Blog

126. The delegate view of 6th London School of SEM Conference– What lessons were learnt?

of the important lessons learnt by those in attendance, and add in some links to related BJSM material. Tales from the ballet: common problems encountered with performing athletes and dancers – Dr Roger Wolman Dancers are often lumped as a single group, however movement patterns vary significantly between forms of dance Injury risk factors – Poor nutrition. The movements desired by dance coaches require demanding biomechanics. Aesthetic requirements of low body weight and knee hyper-flexion Demands – Highly (...) competitive environment means that dancers do not reveal injuries for fear of being held back. Tours are often long, with inadequate rest Support – Limited financial resources, therefore there is inadequate medical and scientific support. The first NHS specialist dance injury clinics were set up in 2012. There is often an on-going battle between dance teachers and sports therapists and a balance must be met to ensure protection of athlete’s health and performance capability Mental health in sport – Dr

2015 British Journal of Sports Medicine Blog

127. The American Dream? Lessons from an elective in Orthopaedics & Sports medicine

at Boston Children’s Hospital; 2) The Hospital for Special Surgery (HSS), Cornell University; and finally 3) The Cleveland Clinic Sports Health. My few-month stint resulted in travelling to 3 USA states, 2 Ivy League institutions, 2 #1 ranked Orthopaedic programs (paediatrics and adults) and working with sports doctors and athletes from professional and college teams for hockey, basketball, baseball, football and rrestling, as well as dancers and ballet companies. It really was that busy (...) . For example, baseball is a great arena to study the ‘Throwing Shoulder’ and American football has injury profiles similar to rugby. Overall, if you plan ahead, put yourself out there and dive into it! Make your elective, the trip of your lifetime. David Bui is a final year medical student at the University of New South Wales, Sydney Australia. He is the current President of the University of New South Wales Sports Medicine Society Twitter: ( ) Dr. Liam West BSc (Hons) MBBCh PGCert SEM ( ) is a graduate

2015 British Journal of Sports Medicine Blog

128. Highlights from the Female Athlete, BASEM Spring Conference 2015

the importance of energy availability for optimal health and performance but presents a more comprehensive approach than the triad’s limited triangular view. Risk factors for developing relative energy deficiency include; restrictive eating, injuries and illness, specialisation, decline in performance level, casual misinformed comments by coaches on physical appearance. Risk of developing RED-S can be minimised by: educational programs for athletes and coaches, re-emphasising weight as a performance (...) in amenorrhoeic athletes. Vitamin D deficiency is an independent risk factor for stress fractures. Treatment options for low bone mineral density include; calcium and vitamin D supplements, impact exercise, addressing contributory lifestyle factors. Ballet: The Vitamin D and Bone Mineral Density Story – Professor Matthew Wyon Ballet dancers undertake rigorous training; 38 hours per week at least. They are considered prime candidates for developing the female athlete triad. The research examining

2015 British Journal of Sports Medicine Blog

129. Ankle Stability and Movement Coordination Impairments

ankle sprain, (2) do not use an external support, (3) do not properly warm up with static stretching and dynamic move- ment before activity, (4) do not have normal ankle dorsi?ex- ion range of motion, and (5) do not participate in a balance/ proprioceptive prevention program when there is a history of a previous injury. (Recommendation based on moderate evidence.) RISK FACTORS – ANKLE INSTABILITY: Clinicians should recog- nize the increased risk for developing ankle instability in pa- tients who (1 (...) a discriminative instrument, such as the Cumberland Ankle Instability Tool, to assist in identifying the presence and severity of ankle instability associated with the ICD category of disorder of ligament, instability second- ary to old ligament injury, ankle and foot (M24.27), and the associated ICF impairment-based category of ankle stability (b7150 stability of a single joint) and movement coordination impairments (b7601 control of complex voluntary move- ments). (Recommendation based on moderate evidence

2013 The Orthopaedic Section of the American Physical Therapy Association (APTA), Inc.

130. Peroneal Mononeuropathy (Diagnosis)

Peroneal mononeuropathy is uncommon in children but has been reported in all age groups. Profession Dancers are also prone to superficial and deep peroneal nerve entrapments. [ ] Previous Next: Prognosis Common peroneal nerve decompression is a useful procedure to improve sensation and strength as well as to decrease pain. [ ] A retrospective study evaluated electrodiagnostic prognostic factors after peroneal nerve injury in 39 subjects. Outcome was associated with compound muscle action potential (...) , Selected Topics in Outpatient Neurology):487-511. . Bregman PJ, Schuenke M. Current Diagnosis and Treatment of Superficial Fibular Nerve Injuries and Entrapment. Clin Podiatr Med Surg . 2016 Apr. 33 (2):243-54. . Tzika M, Paraskevas G, Natsis K. Entrapment of the superficial peroneal nerve: an anatomical insight. J Am Podiatr Med Assoc . 2015 Mar. 105 (2):150-9. . Kennedy JG, Baxter DE. Nerve disorders in dancers. Clin Sports Med . 2008 Apr. 27 (2):329-34. . Humphreys DB, Novak CB, Mackinnon SE

2014 eMedicine.com

131. Lumbosacral Radiculopathy (Diagnosis)

at multiple levels. Herniation of the intervertebral disc can cause impingement of the above neuronal structures, thus causing pain. The presence of disc material in the epidural space is thought to initially result in direct toxic injury to the nerve root by chemical mediation and then exacerbation of the ensuing intraneural and extraneural swelling, which results in venous congestion and conduction block. Notably, the size of the disc herniation has not been found to be related to the severity (...) with the upright position. Because each intervertebral disc is a fluid system, hydraulic pressure is generated whenever a load is placed on the axial skeleton. The hydraulic pressure mechanisms then multiply the force on the annulus fibrosus of the intervertebral disc to make it 3-5 times that which is exerted on the axial skeleton. Previous Next: Sport-Specific Biomechanics Dancers are prone to both acute and chronic back problems, including lumbosacral radiculopathy, which develop secondary

2014 eMedicine.com

132. Low Energy Availability in the Female Athlete (Diagnosis)

meals that are less energy dense may be an important means of avoiding low energy availability conditions and thus preventing the female athlete triad [ ] Musculoskeletal history A careful review of past and current musculoskeletal injuries in the female athlete should be conducted. There should be a focus on all stress fractures, as well as on other fractures. There is an increase in risk of stress fractures in females with a chronic energy deficit. Any injury that results in loss of training (...) should be considered if a patient's reproductive function is not restored with a trial of increased energy intake or if the findings on history and physical exam suggest other causes of . If the patient has signs of hyperandrogenism ( ), free and total testosterone can be tested to assess for androgen excess. [ ] In a 2016 study by Łagowska et al, nutritional status and dietary habits were analyzed in relation to testosterone levels in female athletes and ballet dancers with menstrual disorders

2014 eMedicine.com

133. Metatarsal Stress Fracture (Diagnosis)

. This type of injury is seen in runners of all levels, as well as ballet dancers and gymnasts and patients with rheumatoid arthritis (RA), metabolic bone disease, and neuropathic conditions. [ , , ] Metatarsal stress fractures are also seen with increasing frequency in patients who engage in aerobics activities, particularly high-impact aerobics. Next: Epidemiology Frequency United States The incidence of stress fractures in the general population is unknown, as virtually all literature on the subject (...) is derived from a military population or advanced-level athletes. Stress fractures are estimated to constitute up to 16% of all injuries that are related to athletic participation; running is the cause in most of these cases. Most stress fractures (95%) involve the lower extremities, particularly the metatarsals. A study by Waterman et al reported the incidence rate for lower extremity stress fractures in the US military (not adjusted for sex, race, age, rank, and service branch), including

2014 eMedicine.com

134. Iliopsoas Tendinitis (Diagnosis)

(4):271-83. . Khan K, Cook JL, Maffulli N. Tendinopathy in the active person: Separating fact from fiction to improve clinical management. Am J Med Sports . 2000. 2(2):89-99. Lachiewicz PF, Kauk JR. Anterior iliopsoas impingement and tendinitis after total hip arthroplasty. J Am Acad Orthop Surg . 2009 Jun. 17(6):337-44. . Reid DC. Prevention of hip and knee injuries in ballet dancers. Sports Med . 1988 Nov. 6(5):295-307. . Renström P, Peterson L. Groin injuries in athletes. Br J Sports Med (...) : Jan 16, 2019 Author: Joseph P Garry, MD, FACSM, FAAFP; Chief Editor: Sherwin SW Ho, MD Share Email Print Feedback Close Sections Sections Iliopsoas Tendinitis Overview Background Hip and pelvis injuries represent 2-5% of all sports injuries. Among these injuries, groin pain is the most common finding. The most common sports-related injuries in the hip, pelvis, and thigh area are musculotendinous, (eg, quadriceps strain, adductor tendinitis) and, less commonly, iliopsoas tendinitis. Iliopsoas

2014 eMedicine.com

135. Metatarsal Stress Fracture (Overview)

. This type of injury is seen in runners of all levels, as well as ballet dancers and gymnasts and patients with rheumatoid arthritis (RA), metabolic bone disease, and neuropathic conditions. [ , , ] Metatarsal stress fractures are also seen with increasing frequency in patients who engage in aerobics activities, particularly high-impact aerobics. Next: Epidemiology Frequency United States The incidence of stress fractures in the general population is unknown, as virtually all literature on the subject (...) is derived from a military population or advanced-level athletes. Stress fractures are estimated to constitute up to 16% of all injuries that are related to athletic participation; running is the cause in most of these cases. Most stress fractures (95%) involve the lower extremities, particularly the metatarsals. A study by Waterman et al reported the incidence rate for lower extremity stress fractures in the US military (not adjusted for sex, race, age, rank, and service branch), including

2014 eMedicine.com

136. Corns (Treatment)

in General Medicine . 7th ed. New York, NY: McGraw-Hill; 2008. 97. Kennedy CTC, Burd DAR. Mechanical and Thermal Injury. Burns T, Breathnach SM, Cox N, Griffiths CE, eds. Rook's Textbook of Dermatology . 7th ed. London, England: Blackwell Science; 2004. 22. Viegas SF, Torres FG. Cherry pitter's thumb. Case report and review of the literature. Orthop Rev . 1989 Mar. 18 (3):336-8. . Villano PA, Ruocco V, Pisani M. The cameo engraver's corn. Int J Dermatol . 1990 Jul-Aug. 29 (6):424-5. . Scott MJ Jr, Scott (...) arterial disease. A case report. J Am Podiatr Med Assoc . 1985 Nov. 75 (11):616-8. . Coughlin MJ. Common causes of pain in the forefoot in adults. J Bone Joint Surg Br . 2000 Aug. 82(6):781-90. . Verbov JL, Monk CJ. Talar callosity--a little-recognized common entity. Clin Exp Dermatol . 1991 Mar. 16 (2):118-20. . Oztekin HH, Boya H, Nalcakan M, Ozcan O. Second-toe length and forefoot disorders in ballet and folk dancers. J Am Podiatr Med Assoc . 2007 Sep-Oct. 97 (5):385-8. . Baccouche D, Mokni M, Ben

2014 eMedicine.com

137. Stress Fracture (Overview)

> Physical Medicine and Rehabilitation for Stress Fractures Updated: Nov 29, 2017 Author: Stephen Kishner, MD, MHA; Chief Editor: Consuelo T Lorenzo, MD Share Email Print Feedback Close Sections Sections Physical Medicine and Rehabilitation for Stress Fractures Overview Background There are 2 common stress injuries to bone: (1) insufficiency fractures, which occur typically when osteoporotic bone is subjected to normal stress, and (2) stress fractures, which can occur when normal bone is subjected (...) to abnormal activity. [ ] Stress fractures are overuse injuries of bone. These fractures, which may be nascent or complete, result from repetitive subthreshold loading that, over time, exceeds the bone's intrinsic ability to repair itself. Briefhaupt originally described stress fractures in military recruits in 1855. Our present understanding of the pathophysiology of stress fractures and of bone's response to loading has been advanced by numerous studies investigating the epidemiology of stress fractures

2014 eMedicine.com

138. Snapping Hip Syndrome (Overview)

DM, Wiseman DA. Iliopsoas bursitis and tendinitis. A review. Sports Med . 1998 Apr. 25(4):271-83. . Reid DC. Prevention of hip and knee injuries in ballet dancers. Sports Med . 1988 Nov. 6(5):295-307. . Jacobsen JS, Thorborg K, Soballe K, Ulrich-Vinther M. Eccentric hip abductor weakness in patients with symptomatic external snapping hip. Scand J Med & Sci in Sports . 2012. 22:e140-e146. Tatu L, Parratte B, Vuillier F, Diop M, Monnier G. Descriptive anatomy of the femoral portion of the iliopsoas (...) No data are available on the prevalence or incidence of snapping hip syndrome. The syndrome occurs most often in individuals aged 15-40 years and affects females slightly more often than males. [ ] In one clinic, the rate of some form of snapping hip syndrome in female ballet dancers with hip complaints was 43.8%, and approximately 30% noted pain with this condition. [ ] Previous Next: Functional Anatomy The pelvis is the link between the trunk and the lower extremities. The ball-and-socket joint

2014 eMedicine.com

139. Clavus (Overview)

a normal physiological response—proliferation of the stratum corneum. One of the primary roles of the stratum corneum is to provide a barrier to mechanical injury. Any insult compromising this barrier causes homeostatic changes and the release of cytokines into the epidermis, stimulating an increase in synthesis of the stratum corneum. When the insult is chronic and the mechanical defect is not repaired, hyperplasia and inflammation are common. [ ] With corns, external mechanical forces are focused (...) Tethered spinal cord syndrome [ ] Vascular occlusion syndromes [ ] (ie, verruca vulgaris) [ ] Faulty mechanics play a role. Irregular distribution of pressure and repetitive motion injury (especially in athletes) are believed to be the main inciting causes; however, inappropriately shaped or constrictive footwear in the presence of bony prominences (eg, talar bone prominences [ ] ) may exacerbate corn formation. Furthermore, some disorders may alter the shape or sensation of the soles of the feet. Bony

2014 eMedicine.com

140. Female Athlete Triad (Overview)

history, dietary concerns/restrictions, and a bone health history. [ ] Simple inquiries such as these may reveal the first warning signs of an athlete at risk or suffering from the female athlete triad. A study that categorized athletes into low-, moderate-, and high-risk groups for bone stress injuries using the Female Athlete Triad Cumulative Risk Assessment score found that moderate-risk athletes were twice as likely to sustain a bone stress injury when compared to the low-risk group and high-risk (...) were 4 times as likely. The study also found that bone stress injuries were most common in cross-country runners. [ ] Previous Next: Prognosis For many athletes, the long-term prognosis is good. Few athletes with the female athlete triad are admitted to the hospital for inpatient treatment, and few die from their disease. However, significant long-term morbidity may affect these women later in life. The diagnosis of the female athlete triad was established in the early 1990s, although this set

2014 eMedicine.com

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