Category: Uncategorized

Posted on

What does my MRI for low back pain mean?

What does my MRI for low back pain mean?

Has a friend ever told you: “The MRI says that I have a herniated disc”?

You’ve probably heard that at least a dozen times.

As a physical therapist in Miami, I know I’ve heard it from nearly everyone I treat with low back pain and has had an MRI.

Athletes, non-athletes. Old. Young. Doesn’t matter.

And it does not mean much of anything. Well… doesn’t mean much when it comes to experiencing pain.

Do you know why?

Because there has been little to no evidence that those images can tell you how well you move or how much pain you have.

Take a look at these MRIs

This is what a normal lumbar spine (lower back) MRI looks like.

Nice, evenly spaced discs, solid (yellow) spinal cord with nothing touching it, bright white spinal fluid alllllll the way down the spine.

Now take a look at the MRI below…

Do you see where that nice fat white spinal cord & fluid is cut in half??

It looks like the Angel Falls in Venezuela!

This is an example of a Grade 4 spondylolisthesis.

You would be very reasonable to think that this 32 year old pregnant woman had IMMENSE amount of back pain-

…that she might be confined to a wheel chair for the rest of her life

…couldn’t sit

…stand

…walk

…jump

…not be able to play in the park with her child

…And definitely NOT play sports or compete as an athlete

But guess what?

She had absolutely NO symptoms!!

And this was from a fall 2 years prior to the MRI!!

Thats right, she goes about her life without pain, numbness, tingling or weakness.

AND she’s carrying another human inside of her!!

I am NOT making this up. Click this link to access the article

(She just needed a C-section when delivering to avoid complications)

That same review study in the link above and this study also discuss the following:

Of 60-80 year olds:
99% had at least one degenerative or bulging disc

Of 60 year olds:
36% had herniated discs
21% had spinal stenosis
>90% had degenerated or bulging discs

Of 20-39 year olds:
35% had at least one degenerative or bulging disc

AND THEY WERE ALL PAINFREE WHEN THEY TOOK THE MRI!

Another report shows that 84% of study participants had no change or an improvement in imaging after they developed back pain!

Take a look at a paper written in 2011 about the use of MRIs for diagnosis from a physical therapist perspective.

The authors found that the MRI results might make a patients perception of pain WORSE by increasing their fear of movement. This may result in weakening tendons, ligaments, muscles & even bone- driving them further down the rabbit hole with increasing their risk of other injuries.

Plan on having surgery after finding out what the MRI shows? Check out what these folks found:

“…use of MRI versus a lumbar radiograph early in the course of an episode of LBP resulted in a 3-fold increase in surgical rates, with no improvements in outcomes in the subsequent year.”

This is not to say that surgery should not be performed at all. Only that surgeries based on taking MRIs early in the pain experience provided no additional benefit.

In other words, unnecessary surgery.

I get it…

By now you might be a little hesitant, maybe even confused about what your next step should be.

 

I am here to assure you that despite what your MRI or x-ray shows, you and your body are more resilient & stronger than you think.

You just need to find the right path to take.

Learn techniques to alleviate pain with movement.

Exercise to maintain a healthy body.

Rethink your perceptions about what pain truly is and how your life is changed by it.

Absolutely. 110% you should not read this blog and make a decision for yourself without first having consulted with a medical professional. You need to consult with a qualified health care practitioner, probably a few.

Keep the team diverse.

Speak to medical doctors, athletic trainers, physical therapists, chiropractors, massage therapists. Maybe even a sports/performance psychologist if you are fearful of returning to sport or activity.

Developing a plan that you are comfortable with, after you have spoken with family, friends and professionals, is the best option.

BACK

Dr. Abate Physical Therapy - Created by Do.Websaits 2023

Posted on

MRI, Physical therapy and back pain… what can we do?

MRI, Physical therapy and back pain... what can we do?

To better answer WHEN would be a good time to have an MRI, we need to understand a little background info.

First

Good, I’m glad we got that out of the way…

Second

Here are the guidelines published by the American College of Physicians (ACP) and the American Pain Society (APS) for when it is appropriate to get an MRI.

These two organizations suggest MRIs should:

  1. Not be obtained on a routine basis for non-specific low back pain
  2. Be taken for severe or progressive neurological complications, or when a severe underlying condition is suspected
  3. Be taken if spinal stenosis or radicular signs and symptoms are observed, only if they are candidates for surgery

Non-specific low back pain: low back pain that is not due to a specific cause like a tumor, fracture, arthritis, herniated disc etc…

Neurological complications: numbness, tingling, altered sensation, weakness, muscular wasting or atrophy, abnormal reflexes

Spinal stenosis: narrowing of the spinal canal; can be due to herniated disc, fracture, bone spur

Radicular signs and symptoms: numbness, tingling in the buttocks, legs or feet

Third

In most situations conservative treatment is appropriate and is the best option.

Conservative treatment includes massage, chiropractic, physical therapy, exercise and even meditation.

If you do choose to seek non-surgical and non-medication based treatment, MRIs should be considered if the following are true:

  1. Your low back pain fails to improve with physical therapy over the course of 1 month of treatment
  2. You have shows signs and symptoms of cauda equine syndrome (numbness in the groin area, see picture below) or a bacterial infection

Bacterial infections are often accompanied by a fever. So if you’ve been feverish for a month, have back pain and haven’t seen a doctor about that…

Go see one now!

Cauda equina syndrome is a life-threatening condition. If you show these signs and symptoms you should seek immediate medical attention.

NOTE TO THE READER: THIS BLOG POST DOES NOT OFFER ANY MEDICAL ADVICE.

IT IS FOR INFORMATIONAL PURPOSES ONLY.

YOUR SPECIFIC CASE NEEDS TO BE DISCUSSED WITH A QUALIFIED HEALTH CARE PROFESSIONAL.

Fourth

If you have been treated by a chiropractor, massage therapist, physical therapist, have been exercising & following their advice AND you have not significantly improved for the past month, then it might be a good idea to consider seeking additional imaging or someone else to help.

For example, you’ve been up and down with the recovery but nothing seems to quite “stick” to improve how you feel.

Are you interested in learning more about MRIs and low back pain?

And maybe finding a solution to your back pain so you can enjoy beautiful Miami?

I want to share a story about two gentlemen:

The first patient: a 62 year old with two hip replacements, significant lumbar degenerative disc changes at multiple levels, osteophyte formation, and a retrolisthesis of L1-2 and L2-3.

The second patient: a 32 year old mechanic with a history of chronic low back pain, took off of work on disability with an MRI that was “relatively unremarkable” with some degenerative disc disease of L4-5 and L5-S1 and mild disc protrusion at L4-5.

No nerve impingement. No hip replacement surgery. No additional bony outgrowth.

Who would you think had more pain, the first or second man?

 

Mr. 62-year-old had one single episode of back pain 8 years after his bilateral hip replacement-

…after canoeing and hiking for 2 WEEKS STRAIGHT!!

And he “WORKED THROUGH” the pain with stretching and ibuprofen while on his backpacking trip.

When he returned home, he had 9 sessions of physical therapy and then went on to backpack for another 2 weeks in the United States Continental Divide and had “0” back pain.

Superhuman?

Probably not.

Despite the growing field of research in injury assessment and risk management, there are quite a few unanswered questions. Standardization of measurements, sport-specific assessments, and more robust association in findings would help clear up many of these questions.  

Practical application and programming for athletes and careers that require high fitness levels should also be discussed within the research community. Perhaps guidelines may help coaches develop pre-season injury assessments and provide strength and conditioning programs that are athlete-specific, essentially reducing the number of athletes sitting on the sidelines due to injury.

If you are an athlete or coach in Miami, FL and find this topic interesting, or want more information, reach out to our office for assistance.

BACK

Dr. Abate Physical Therapy - Created by Do.Websaits 2023

Posted on

Why do I have low back pain?

Why do I have low back pain?

Hey fellow athletes,

Lets review a handful of the most important things to rule out when you have low back pain.

Basically, this is the list that you look up on WebMD, and what it most likely is NOT.

So here is a list of some conditions that are life-threatening or potentially debilitating related to low back pain.

This article is about why you may be at increased risk for the conditions listed.

  1. Back related tumor: you are significantly more likely to have cancer-related low back pain if you have a personal history of being diagnosed with cancer.
  2. Cauda equina syndrome: if you are retaining urine, experience saddle anesthesia (see this post), or numbness/tingling of the lower legs or feet.
  3. Back-related infection: if you are feverish and have low back pain, potential issues include tuberculosis osteomyelitis, pyogenic osteomyelitis or spinal epidural abscess.
  4. Spinal compression fracture: if you have been in a major trauma including car accident, fall from a high height or direct blow to the spine.
  5. Abdominal aneurysm: if you have a history of smoking

If you said “yes” to any one of those things, and have not spoken to a medical doctor, please do so now.

Other than that, the vast majority of “non-specific low back pain” will fall into a a bucket of bulging or herniated discs, osteophyte formation, nerve impingement, annular tears, sprains or strains, degenerative disc, facet joint dysfunction, sacroiliac dysfunction, spinal stenosis, spondylolisthesis, osteoarthritis or a deformity.

Thats a long list…

A variety of tools help diagnose your cause of low back pain. X-rays, MRIs, CT scans or blood tests.

Physical therapists, massage therapists and chiropractors also have a different “lens” they use to evaluate a patient.

Some may diagnose muscles as being “tight”, having “knots” or “tense”. Others might diagnose based on movement like sacroiliac dysfunction or pelvic asymmetry. Some may say that “the spine is not aligned”, “misaligned”, or “out of place”.

Here is a reminder of what you need to know, with whatever you have been diagnosed with:

Go ahead, click that “Okay” button!

The human body is extremely intelligent and has some of the most resilient hardware manufactured in the furnace of a star.

With proper guidance there are few reasons why you shouldn’t return to doing the things you love in life.

Not every person has the same response with treatment. There are just too many factors to take into consideration…

Your personal history, your family history, how active or inactive you are, injuries, nutrition etc… Its usually not a good idea to compare your specific injury to someone else.

Do you live in the Miami area and want to find out more about your back pain and treatment options?

Are you fearful of surgery or taking medications for the rest of your life with terrible side effects?

BACK

Dr. Abate Physical Therapy - Created by Do.Websaits 2023

Posted on

Injured? Nutrition and exercise may be the best option

Injured? Nutrition and exercise may be the best option

Dealing with injuries can be very frustrating, especially as an athlete.

I often find athletes quite distressed when trying to resolve their pain and get back to their previous performance. They often receive conflicting information from friends, coaches and online gurus (like WebMD, where everything is suspicious of cancer or other life-threatening disease).

On top of that, rest and avoidance of aggravating movements might not resolve the pain as quickly as they like.

Seeking medical treatment for prescription drugs, taking over the counter medication like ibuprofen, wearing braces, taping it up or using topical ointments can help the edge a bit. However, these approaches often miss a large part of a successful recovery.

It’s important to understand the tradeoffs of each approach.

Here is a birds-eye view of the most common treatments and their tradeoffs.

Medication

Medicine has been used by humans for thousands of years. Since ancient times, herbs, oils or plants either in whole form or concentrated for a specific molecule are administered for the benefits of reducing swelling, improving blood flow and pain relief. Drawbacks include unwanted side-effects such as organ damage, dizziness, diarrhea, headaches, insomnia and in some cases, death.

Injections

Injections are concentrated forms of medicine that usually contain very strong anti-inflammatories & pain reducers. The benefits, like medicine, include relief from pain and reduction in swelling, blocking of nerve signals that send pain. The cons are similar to medicine as well.

Nutrition

Proper food choices have been a source of pain relief for thousands of years. The focus should be on consuming anti-inflammatory foods, avoiding pro-inflammatory foods or specific nutrients for building blocks of tissue healing. There are generally no drawbacks except for caution with specific foods that interact with medications (speak to your medical doctor about that).

Exercise

Movement can also be a form of pain relief. The benefits far outweigh the risks if the program is prescribed appropriately. These include improved blood flow, muscular strength, tissue healing and overcoming the fear of movement. Continuing to exercise body parts that are not injured, or movements that do not aggravate injury, can dramatically improve time for return to sport.

Rest

I hear this almost every day. An athlete tells me that they are “just resting, and not doing anything.” This might be good for a very short time (like a day or two at most), to relieve swelling, pain and maybe overcome fear of movement. However, complete rest more than a week causes the muscles, tendons, ligaments, bones and joints to deteriorate. While it might not appear to be detrimental at first, many hours of exercise are thrown out the window in even that short period of time.

So what additional benefits can exercise offer that medication, injections and rest cannot?

Medicine and injections help relieve pain, reduce swelling and might help you overcome fear of movement. However, they fall short in the tissue strengthening department. In fact, cortisone shots in particular have been shown to make tendons even weaker. This can cause a false sense of security, possibly an earlier return to sports, but a greater risk of reinjury due to a weakened tendon and ligaments.

Exercise, on the other hand, has such a strong track record and and long list of positive outcomes that Dr. Robert Butler, the founder of the National Institute of Aging said this:

“If exercise could be packed into a pill, it would be the single most widely prescribed and beneficial medicine in the nation.”

Lets talk more about exercise

The technique with prescribing the proper exercise regarding frequency, intensity, time and type, has many layers. 

The first step would be to take a history of when your injury happened, how it happened, why it happened and what activities are limited because of your pain.

Next would be to have a look at how well you move- if you have pain with movement, loss of movement or fear of movement.

What does the range of motion look like? Compare that to the other side (if its your shoulder or leg).

How about strength? Is the injured limb strong or weak?

What about more sport-specific movements? Think back to the last time you trained or worked out. Which movements in particular did you not feel comfortable performing?

Which part of the movement did you avoid or “work around” in order to complete it. This may help you better explain to your therapist or coach what is happening & how to approach resolving the pain.

Thirdly, properly identifying the type of tissue is injured.

Bones, tendons, ligaments, muscle and joints all respond to specific stresses.

Once the correct tissue is identified, a program can be designed to address the issues that were identified. Correct loading of joints, muscle recruitment, balance and coordination should all be considered.

Being able to figure out which structures are injured will help determine which exercises are appropriate for your specific condition. The number of sets, reps, intensity, frequency and any necessary adjustments require a skillful eye to keep you moving in the right direction.

This is where the art and science of understanding the human body from its cells to social interaction are integrated to ensure that the athlete has a comprehensive and individually designed approach.

If you are unsure of what your next step should be, speak to a trusted health care provider. If you’re in the Miami area, you can always reach out to me, I would love to help.

BACK

Dr. Abate Physical Therapy - Created by Do.Websaits 2023

Posted on

Ban combat sports!

Ban combat sports!

In this article I discuss a question that most have already come to a conclusion on:

Should combat sports be banned?

With viewership of sporting events like UFC and boxing on the rise, many people including psychologist, sociologists and the medical community, have spoken out against combat sports.

With viewership of sporting events like UFC and boxing on the rise, many people including psychologist, sociologists and the medical community, have spoken out against combat sports.

With viewership of sporting events like UFC and boxing on the rise, many people including psychologist, sociologists and the medical community, have spoken out against combat sports.

 

Those who call to ban martial arts or combat sports can usually be divided into one of three groups, or all of them:

1 - VIOLENCE IS BAD!

Violence or aggressive behavior is morally wrong and should be discouraged.

2 - EVERYONE WILL BE SMASHING SKULLS IN THE STREETS!

Street violence will rise as a result of poorly regulated or sanctioned events. In other words, those watching will take it upon themselves to determine what is socially appropriate.

3 - ITS WORSE THAN DRUGS!

Life-threatening injuries or long-term disabilities will lead to a poor quality of life for athletes.

Lets take a closer look at these three objections.

1: Morality

“It does not matter if they are mutually consenting adults or if paramedics and medical doctors are always at the ringside. Nothing should ever override the most basic and universal moral principle that involves respecting and caring for others as human beings. I truly understand that there are individuals who may wish to test their skills under more realistic conditioning (something more analogous to real self-defense or battle situations), but this does not make it morally acceptable in a civilized world. There are many other ways to be physically challenged… mountaineering, white water rafting… for the well-being of others.”

Janel Gauthier. Ethical and Social Issues in Combat Sports, Chapter 5. Combat Sports Medicine. 2009.

First off, what the hell? Stay in your lane Janel. Going toe to toe with an opponent is the ultimate test of skill, guts and brains. Fighting is the oldest human sport, unless you can count those who RUN from a fight, then track would be the oldest sport.

In any case, if athletes understand ALL risk that is involved, then they should be free to do as they choose.

The risk of developing CTE (chronic traumatic encephalopathy) has reduced considerably when professional associations such as the AIBA (International Boxing Association), UFC (Ultimate Fighting Championship), USMTA (United  States Muay Thai Association), NCAA Wrestling Rules of the Game or the IBJJF (International Brazilian Jiu Jitsu Federation) developed a standardized set of rules and regulations that fighters, promoters, medical associations, coaches, trainers etc… must abide by in order to compete in their league or under the association.

These include weight classes, use of protective equipment, length of bouts, number of bouts over a given time span, pre- and post-competition medical clearance, and even the size of the competing area (mat, cage, ring).

All of these rules have dramatically reduced overall injury rates, injury severity, and the health of the fighter. Basically these organizations all met up and thought: “We want to see people enjoy a healthier fighting career… how can we do that?”

The use of protective equipment, such as helmets, has been a hot debate lately. Some athletes, coaches and even medical professionals are under the impression that the use of head gear (not wrestling head gear to prevent the old fashioned Badge of Honor: cauliflower ear) in striking sports like boxing or Muay Thai, prevents concussions or brain trauma.

While some research suggests that this is so, the evidence is conflicting and difficult to sift through.

Head gear has been demonstrated to reduce the frequency and severity of facial lacerations, which is a large part of competitors being disqualified from competing. I could throw out stats and figures, but it essentially boils down to this:

 

The majority of “contact” hours an athlete occurs during training. You train for 2-3 hours a day, five to six hours a day.  This includes technical, tactical as well as strength & conditioning. Then comes competition and you might fight for a 6 minute match (wrestling) or up to 25 minutes (professional MMA).

When training, there is rarely a medical professional on staff (unless you’re a professional with a well-endowed team), assessing fighters injuries.

Medical assessment is typically only available at the fight itself where they review past medical history & ask a few questions. Or maybe as a follow up if you experienced a significant enough trauma and you were referred for further testing after the fight.

So it would make sense (and its been demonstrated in the literature) that fighters may suffer a concussion while training, not report it, continue to train, then suffer the consequences of second impact syndrome or over the length of their career, CTE. This is well known to be the case with Muhammed Ali (bless his soul) and his vicious sparring sessions.

If you suffer a concussion during a competition, the medical staff will most likely have you follow up with more advanced care and you may be prevented from competing again for a period of 30-60 days. This does not full address the issue, but it makes the fighters health a priority.

Mouth pieces do nothing to prevent concussions.- only dental trauma.

2: Morality

“In general, the more persons watch media violence, the more aggressively they behave. Exposure to television violence does have an effect on violent behavior in some viewers, and that effect may be long lasting.”

Janel Gauthier. Ethical and Social Issues in Combat Sports, Chapter 5. Combat Sports Medicine. 2009.

While I do not necessarily disagree with Janel’s suggestion that some viewers may be more likely to behave violently when watching violent film. It has been my personal experience from speaking to dozens of fighters across the combat sports spectrum, that martial arts have a positive influence on discipline and respect. 

Although there may be a few “bad seeds” out there (what profession doesn’t?), this is largely controlled by the years or decades of dedication and commitment it takes to earn a black belt or open up a prestigious school. Those athletes who do harm to weaker people often know what its like to “get a piece of humble pie” as my training parter Marty Davila so cleverly pointed out. So, essentially, getting your teeth kicked in or choked out by someone who might be smaller than you when training, is a motivating force to NOT do so.

All in all, the benefits of learning a skill set for fighting or self-defense far outweigh any risks associated with a handful of scumbags starting street fights.

3. The Individual

“The understanding that there is an inherent risk of being injured participating in any sport needs no formal research. However, it seems that some are concerned with the role that combat sports has an intent to do as much damage to the competitor as possible. This is in contrast to other sports where points or grades are awarded based on skill (like basketball or soccer) that does not require one to injure their opponent to win.”

Janel Gauthier. Ethical and Social Issues in Combat Sports, Chapter 5. Combat Sports Medicine. 2009.

Yes, combat sport athletes rely on operating at a level that will incapacitate their opponent- punch, kick or tap.

Or in BJJ- tap, snap or nap.

It is not basketball. It is not soccer.

Competitions even offer a greater reward for submission or fight of the night. This likely heightens the element of aggression.

Not too much else to say here. If you don’t like it, don’t compete. Or watch it. Or let your children watch it until they understand what it is thats going on.

 

My contention with the individual morality of doing harm to another falls to the  common denominator that there will always be evil people in this world who mean to do you harm. If there is no opportunity for healthy-minded individuals to defend themselves or others via the participation in combat sports, then social Darwinism will result in the common “winner”: evil people.

 

Making a sport of it encourages an environment that differentiates things that work and things that do not work. Look at this absolutely INSANE video of how to defend against rape.

BACK

Dr. Abate Physical Therapy - Created by Do.Websaits 2023

Posted on

The Psychology of Dance Injuries

The Psychology of Dance Injuries

To survive and ascend, a dancer must be self-analytical and self-critical virtually to a fault. For dancers, dance is more than an art; it is an all-consuming lifestyle. The aesthetic, the technique, the teachers, and perhaps most importantly, the dancer must constantly push to exceed, to overcome, to persist and to persevere. The love of dance and desire to dance are intrinsic to dancers of all levels and talent. Many have sacrificed so much just to have those few moments of pure movement where the physical price was no measure of the artistic reward.

The Role of The Individual

Athletes may initially respond to a recent injury with a negative outlook- the fear of losing their spot in the cast, the frustration of not being able to perform as well as they wish or feeling pressure from choreographers and cast members. This can effect the healing process.

If the problem lingers around for long enough, the chronic pain may be ignored, resulting in severe damage and maybe psychological distress.

Personality types, understanding of anatomy or an injury, coping skills and social support all play a dynamic role in the rehabilitation process. Often, the athletic culture of “pushing past the pain” or perhaps outright ignoring it may result in a “disruption of self”. This can have profound effects on the performers psyche, and ultimately, their capacity to perform.

When we speak of injuries in athletics, performers in particular tend to have a high level of fear of being replaced, losing potential income and often distrust traditional health care practitioners.

Takeaway: consider the individual, not just an “injury”

Old vs. New Thinking

An old way of understanding coping skills when injured is Kubler-Ross’ 5 stage theory: shock/denial, anger, bargaining, depression, acceptance. We’ve moved away from this linear model and focus instead on the circumstances surround the the athlete.

Personality type, locus of control (who is responsible for this injury?), hardiness (mental toughness), achievement motivation (how far are you willing to go?), external stressors (rehearsal process, finances) and coping resources (social support) must be considered.

The initial response is often a cognitive appraisal of the injury- what am I dealing with, what can I do, what can I not do?

Secondly to an emotional response- am I optimistic or pessimistic?

And finally a behavioral response- what actions need to be taken to resolved this issue?

First time injuries tend to be more stressful. Pessimism, fear and frustration often accompany even seemingly minor injuries.

Injury “veterans” have a bit of a different outlook- they may have a better understanding of their injury, how it will affect their performance and the steps needed to address their predicament. They tend to be less anxious & are able to “wrap their head around” the injury to continue on with dancing, albeit modified.

Athletes that sustain a more severe injury might experience greater levels of fatigue. This is perhaps due to the intense psychological effort spent on the injury- what it means to the performer, how their peers are affected by it and what it means to their dance career.

Like learning a new show or beginning a new exercise program, goal setting, taking the time to relax and positive self-talk can have a strong influence on the recovery process.

Respecting the constraints of human anatomy, tissue healing & the body to adapt and overcome all types of stress (physical, emotional, social) is the cornerstone for recovery. Having realistic expectations can be helpful to the athlete and support team.

Takeaway: a team approach to individual treatment must take into account all life factors

Psychological Impact of Dance Injury

A few studies have demonstrated that many dancers do not report their injuries to medical doctors. Nearly every dancer will experience at least one injury in their career, and about 2.5 on average. Lack of reporting was described as dancers not being confident in a medical doctors appreciation of dance culture; not understanding the performance curriculum, where taking 2 weeks may spell career suicide; lack of knowledge about what it is that dancers go through on a daily basis; and the physical demands of their chosen career.

The vast majority are overuse injuries, meaning the performer did too much too soon without adequate rest.

In the athletic community itself there seems to be a culture of tolerance which encourages dancers to push through the pain. If physical pain is not addressed, this may lead to psychological and emotional pain.

It is one thing to be gritty- to persevere through pain with proper support, and another to fail to address pain that can cripple.

Takeaway: athletes suffer from injuries, be proactive in treatment

Emotional Reactions

Dancers may initially respond to injuries with fear, distress, anger & depression. This may be due to the relationships that surround the dance community: choreographers, parents and fellow cast members.

Injuries do not only affect the performer themselves- but this network of individuals that comprise the team.

Takeaway: everyone around the athlete is affected

Role of Pain

Dance releases a large amount of feel-good hormones in the body, suppressing the sensation of pain. Think of a time when you (or a cast member) were performing and fell. You  (they) might not have experienced any pain at that moment, but when the adrenaline wore off an hour or so later, it came on like a tidal wave.

This natural pain-blocker is a good thing, but it can sometimes blunt the effect of properly dealing with injury. An understanding of pain & how our bodies react is important because it allows for an avenue of better coping skills. Dancers in particular have very specific injuries that are very prevalent in the performance community but not elsewhere. Pinching hip pain, clicking knees and aching ankles are just three of the very many injuries I treat as a physical therapist. Many dancers might choose to “just deal with it” because there are often 3 or 4 other performers in their cast that have these symptoms as well.

However, no two people, and thus injuries, are the same. A proper understanding of anatomy and the recovery process can be worlds of a difference between performers.

Takeaway: pain is more than just tissue damage and swelling (biology), it also includes mental attitudes (psychology) and peer support (society)

Want to learn more about pain? Read my article What is pain? 

For dancers, their work is their dancing: it is a way of life that defines who the dancer is. Any barrier to self-expression and movement may be a threat to the dancers identity. Identity is the most examined personal factor in recovery from athletic injury. The more narrowly defined the sense of self, the more threatened the athlete will be by any challenge to identity. In the case of injury, the more an athletes self-self-identity is linked to his or her role as athlete, the more likely reactions to injury will be negative. A period of “restoring the self” after injury is a cornerstone of recovering from an injury.

Psychological Issues with Treatment

Even when dancers receive medical treatment, their fears and frustrations might not be addressed. Medical advice offered to performers is often: “take medicine and take two weeks off, then come and see me”.  What might not be understood on the medical side are the myriad of consequences this can have. Dancers usually don’t have the luxury of taking 2 weeks off. There is no “off-season” when learning a new show.

Seeking medical advice from a practitioner that understands the demands of the performer can help steer appropriate treatment, bolster confidence, and improve relations with the dance community as a whole.

Takeaway: Not all medical professionals are the same, seek someone who understands you and the injury you’re suffering from

Stress, Injury & Social Support

Negative life stressors (family, relationships) can impact the onset & duration of injury as well as the number and severity of injuries in dance. In one study 24% of dancers accounted for nearly 50% of all the injuries sustained. They found that high social stress & low social support may increase risk and severity of injury. Even minor daily “hassles” can compound the effects of injury.

On the flip side, strong social support form peers, educators, dance companies, friends, choreographers, medical staff & family can facilitate a successful recovery.

Keeping the athlete active by offering an opportunity to help with choreography, record the performance or encouraging them in exercises can make a world of a difference. Acknowledging the emotional distress of “losing yourself” when injured can place the community on the “right side” of the athlete.

Takeaway: Support the athlete by acknowledging their point of view

Culture of Injury, Tolerance & Pain

While pain & injury may be a common occurrence in most athletes’ lives, the belief that outright ignoring an injury might not be the best approach.

Dancers in particular are very aware of their body image, weight and food intake. Inappropriate behaviors including eating less food to make up for lost time exercising or overtraining non-injured body parts may consume the athlete.

It is important to recognize these changes and address them accordingly. These behaviors can have a negative, spiraling effect on injury recovery. Improper nutrition and increasing the risk of additional injury.

Takeaway: injuries are often a part of an athletes career, attendance to influencing factors can make or break an athlete

Moving Forward

There are many things that have not been written about in this article. Some things that health care providers always want to know more about so we can extend our hand to the dance community and provide the best possible treatment include the following:

  • Personal experiences of dance injury
  • Personality traits & experience of dance injury
  • The bodies response to stress throughout the injury process
  • Coping styles & strategies
  • The dancers perception of pain & recovery
  • How emotional reactions differ between acute & overuse injuries
  • Proper social support
  • Dance culture of injury/pain/tolerance
  • Eating behaviors associated w/ injury
  • Education & intervention strategies

BACK

Dr. Abate Physical Therapy - Created by Do.Websaits 2023

Posted on

Overtraining syndrome in dancers

Overtraining syndrome in dancers

Overtraining Syndrome (OTS) is more than just feeling blue & wanting to take a day off. It is a sort of all-encompassing entity that blurs your vision (metaphorically speaking, if you have blurry vision you should get that checked out) and can take muuuuuuch longer to recover.

Before we dive into OTS, lets talk about your training schedule.

When training, whether that is rehearsing or exercising, there are a few things that need to be accounted for.

This usually includes the FITT principles

Frequency: how often you train (body part, days of the week/month/year)

Intensity: how much effort are you putting into the training

Time: how much time per session, measured over a day to weeks

Type: are you performing power training? Super slow training? Cardio?

What are you doing in rehearsals? Lounging around or non-stop partner work?

Write some of these elements in your calendar. Next to that write how you are generally feeling: full energy throughout the day, unstoppable, lethargic, irritable etc…

Get a general idea of how much work you’re putting in and how your body responds to that specific training. Cookie-cutter programs are garbage. Everyone starts at a different level of exercise capacity & everyone responds differently to exercise. There is no “one-size-fits-all” program. Yes, most people may respond to HIIT fairly well, but there will always be outliers.

Anywho…

If you notice that you are under the weather (but not physically sick)- you don’t feel like you’re getting as much out of your workout as before, you’re strength/cardio isn’t improving or maybe your just want to sit in bed and eat pizza and donuts- every day of the week, then you might be edging towards overtraining.

While there is not specific blood or psychological test that says “Yep! You have the overtraining syndrome”, there are general markers of individual emotional & physical states that suggest you might need some (modified) time off.

Lets take a look at some “triggers”:

-Increased training load without recovery

-Monotony of training

-Excessive number of competitions

-Sleep disturbances

-Stressors including personal life (family, relationships) and occupation

-Previous illness

-Altitude exposure

-Heat injury episode

-Severe “bonk”

As you can see, severe “bonk”-ing is not exactly PhD material. But you get the idea…

Symptoms may include:

-Fatigue

-Depression

-Bradycardia/tachycardia (abnormally slow/fast heart rate)

-Loss of motivation

-Insomnia

-Irritability

-Agitation/anxiety

-Hypertension

-Restlessness

-Anorexia

-Weight loss

-Poor of mental concentration

-Heavy/sore/stiff muscles

This fuzzy picture demonstrates what we in the science community attribute to “training threshold”. Generally speaking, over the course of your phenomenal career, you should be getting better. Stronger muscles, more flexible joints, better technique etc…

Proper rest (HIIIIIIIIGHLY individualized) can make or break an athlete. Whats that line for you? I don’t know.

It is the EXCESSIVE that can create the extra “wear and tear” over an athletes career. We’re all athletes reading this, so I think its safe to say that nearly everyone reading this will experience some sort of injury at some point in their career.

Heres a little less fuzzy picture:

Generally speaking, the more intense (physically, emotionally, psychologically) an exercise or dance session, the greater the risk of developing overtraining syndrome. Again, we’re all humans with different attributes, so there is no “Well Jax can do X, Y & Z, why can’t I?” Thats because you’re two completely different humans. Unless its your twin… Then I’d be writing a bit differently…

A typical workout or rehearsal session should take a day or so to recover. Once you start to see your performance sliding, it might be a good idea to evaluate your status.

Here are a few things you should log r.i.g.h.t. n.o.w.

Resting heart rate: morning, night & after training

Commitment level: are you diehard? Or would you rather Netflix and coma?

Energy level: is your gas tank full? Or do you need to take a nap because you’re exhausted from binge watching some new Netflix show?

Here are a few tips to prevent the onset of Overtraining Syndrome

Prevention Strategies

-Periodization

-Tapering for competition

-Adjust training volume and intensity based on performance & mood

-Ensure adequate nutrition during exercise

-Adequate sleep

-Promoting mental toughness or resilience as a buffer

-Rest >6 hours between exercise bouts

-Abstain from training after infection, heat stroke, periods of high stress

-Avoid extreme environmental conditions

-Utilize Profile of Mood States and alter training load accordingly

 

I hope you enjoyed this article. Feel free to reach out if you wish to know more.

Keep in mind that I’m a physical therapist in the Miami area and have a few years helping out amazing dancers, singers, acrobats, breakdancers, aerialists & even professional handstanders recover from injury of the back, knees, shoulders and hips!

I love what I do and do what I love

I just might be able to help you!

BACK

Dr. Abate Physical Therapy - Created by Do.Websaits 2023

Posted on

Dance Fitness

Dance Fitness

Background

While helping professional dancers recover from injury I have heard and seen quite a lot of things. I know from experience that dancers are passionate about their career and sacrifice many hours rehearsing and watching video of their performance. 

Very few of those athletes spend additional time supplementing their performance in dance with improving their performance with strength and conditioning.  I get it- besides those arduous hours in the studios, there is a taboo culture in the dance world that exercising will result in big bulky muscles. And thats not aesthetically pleasing. 

At least thats one thing they told Misty Copeland- check out her commercial with Under Armour “I Will What I Want”. She received a letter denying her acceptance, stating “you could be a professional dancer in Vegas”. While there is absolutely NOTHING wrong with being a dancer in Vegas, I am only using this as a reference to demonstrate that the perception of dance culture regarding specific body types is not always “right”. Misty was accepted on June 30, 2015 as ABT principal dancer and was named “100 Most Influential People in the World” by Time magazine. Again, I’m not saying Misty’s exercise routine catapulted her to stardom, but this only serves its purpose that a belief in a certain body type is either on its way out, or not accurately represented in the dance community.

Moving on. 

I have seen plenty of talented and passionate dancers who were exceptionally weak when they progressed to the performance-specific strength training phase of rehabilitation. One dancer in particular could perform the hip adductor machine with 120# for about 8-10 reps with proper form. But could not perform even 60# hip abductor for 3 repetitions! Those are seriously imbalanced & weak muscles! Not only did this hip weakness most likely result in her dance injuries of the hips and knees, but she was missing out on being a better performer. 

Muscles produce movement. The stronger the muscles, the bigger the movement. However, muscles do not have to be BIG in order to leap high or pop off the floor quickly. They just need to move very efficiently. I think it is crazy that dancers go through their career without a solid strength training program to prevent injuries and improve their performance. 

So let’s talk about it.

What is fitness? 

The dancers’ body is their instrument. It is a means of artistic expression. Like a musician cleaning and tuning their violin or drum, so too, must the dancer take time to attend to the “tuning” of their body. Everything vibrates- electrical signals from your brain send signals to muscles and tell them to fire off. Keep that system vibrating at a frequency that resonates with the music. 

The more fit you are the less likely you are to suffer from injury, the better you will perform and you will enjoy a long and successful career. 

Attending to your body can be classified as follows:

  1. Poor: dance only, no attendance to psychological or physical needs outside of rehearsal
  2. Fair: may take care of some issues as they arise
  3. Good: “well” both psychologically & physically
  4. Excellent: proactive steps to take care of self; exercises to strengthen the body, practices meditation or mindfulness to strengthen the mind
  5. Elite: seeks out professional help in all aspects of dance life. Dance

What is important is not so much where you feel you line up now on this scale, but where you see yourself in the future. Maybe not even as a dancer, just as a human. Technology allows us to get in touch with those who can help us get to the next level in a near instant. Are you an Australian who found an awesome trainer in Miami? Sign up for their online class or maybe see if you can schedule a FaceTime or Skype session. Get in touch, pick their brains.

So what types of exercise should dancers engage in? First, let’s talk about what type of exercises are out there and the benefits & tradeoffs of each. 

Aerobic/Cardio

Aerobic work is defined as any activity lasting more than a few minutes without  time to rest. The heart rate is elevated to pump blood to muscles and lungs & your breathing rate increases. 

Mode of exercise: running, elliptical, bike riding, swimming

Benefits: improved endurance of muscles, heart & lungs

Tradeoff: does not address muscle power, or ability to generate force in a short period of time (like leaping, jumping from a kneeling position)

Muscle Endurance

Muscle endurance can be defined as the ability of a muscle or groups of muscles to produce constant tension over a prolonged period of time. It does not necessarily have a cardio component. For example, performing squats or lunges for 1-2 minutes and then resting in between sets. Your heart rate might not be significantly elevated at the end of the set, although that would be a good bench mark for how fit you are. The goal here would be to bring that muscle to fatigue or failure at the end of the set. 

Mode of training: dumbbells, machines, body weight

Benefits: can track progress with reps, sets & weight lifted; dynamic range

Tradeoff: access to equipment; proper form & quality program; does not address muscle power

Muscle Strength

I’ll try not to get too technical here. Strength can be defined as the ability of the muscle to perform repeated contractions without fatigue against a given resistance. That sounds kind of mouthy. But think of it as the body overcoming a good deal of weight, but is not dependent on how quickly you can move that weight. A good rule of thumb for strength training is high volume (lots of reps, lots of weight).

Mode of training: dumbbells, machines, body weight

Benefits: can track progress with reps, sets & weight lifted; variability in types of workout can be specific to your type of dance

Tradeoff: access to equipment; proper form & quality program; does not address muscle power

Muscle Power 

Easiest way to think of power is: how much weight can you move in the shortest amount of time? Whether this is your body weight (like jumping) or an external weight (or person, like partner work), how fast your muscles contract and how much force they develop in the shortest amount of time. 

Mode of training: dumbbells, machines, body weight

Benefits: can track progress with reps, sets & weight lifted; dynamic range

Tradeoffs: require a great deal of muscle strength, balance & coordination; proper programming can place you head and shoulders above the competition 

Flexibility 

The flexibility of your body is dependent on ligaments and muscles. Using the full range of motion available can help performance by appearing fluid & long. There  are a handful of ways to stretch, but some things should be avoided. If you experience “pinching” type pain in the front of the hip or shoulder when stretching, you should stop. Yes, stretching needs to be uncomfortable if you plan on improving the length of ligaments and muscles, but there are some types of pain that are unnecessary and harmful. 

Mode of training: your body, sometimes a partner or use of elastic bands

Benefits: maintain a supple body

Tradeoffs: too much stretching can cause instability in the joint if proper strength training is a part of the program. This can cause significant injuries that limit performance.

Balance/Coordination 

There is moderate evidence that demonstrates a 2.5x increased injury risk in ankle sprain injuries in athletes that have poor single leg balance. 

Rest

The human body needs rest, both physical and psychological. Stress is a good thing, especially if approached the right way. However, similarl amounts of stress for one person can “make” them but “break” another. It is important to be in tune with your body and identify how well you’re responding to any given type of exercise or rehearsal process. Check out my article on “Overtraining” to fill in the gaps.

Mode: a bed in a quiet, dark space

Benefits: consolidate memory, allow muscles and brain to recover

Tradeoffs: … I really can’t think of any!

Why do dancers need to exercise outside of rehearsals? 

In my experience with elite dancers from all over the world, I have yet to meet a performer who did not benefit from an individualized program I designed. They return to dance stronger, more flexible, have more energy throughout the day and almost always report feeling “as if they can dance forever”. 

Who doesn’t want to dance longer, jump higher or look leaner when performing? 

Here are a few ways to test yourself:

Cardio:

Heart rate response to exercise

Assessment: walk or jog on the treadmill at a specific incline and pace (example: 3.0% incline, 4.0 mph) for a specific time (5 minutes). Record your heart rate after the 5 minutes.

Reassessment: repeat the sequence above. 

Lower heart rate? Excellent. 

Higher heart rate? Things to consider: time of day; last meal consumed; stress level; most recent day of exercise ; poor program design

Power:

Jump height or jump distance

Assessment: find a wall or clear floor; jump as high as you can and touch the wall with a sticker, mark off distance jumped on the floor

Reassessment: repeat the sequence above

Higher/longer distance? Excellent.

Not so much better? Things to consider: time of day; last meal consumed; stress level; most recent day of exercise; poor program design

Flexibility:

Sit and reach test

Assessment: sit with legs straight in front of you, bend forward to touch toes

Make sure you are not flexing or “hinging” from one spot on your body, allow an equal contribution of lower back & hips to produce the length

Reassessment: repeat above sequence

Improved flexibility? Excellent. 

Not much better? Poor program design; possible injury

Balance/coordination:

Step down test

Assessment: with a mirror in front of you, step down from the bottom step on the stairs. Do you see the knee that remains on the step “cave in” or “collapse”? 

Yes? You need to work on that

No? Good coordination of hip muscles

I hope you enjoyed reading this article. As a physical therapist in Miami helping dancers recover from all types of injuries I am passionate about providing the best & most relevant information. 

Dance injuries do not need to be career ending. Strength training to prevent dance injury can place you head and shoulders above the competition, improve your performance & reduce your risk of injury. If you need help designing a program, feel free to reach out. I’m here to help.

BACK

Dr. Abate Physical Therapy - Created by Do.Websaits 2023

Posted on

Back Strengthening for Dancers

Back Strengthening for Dancers

Background

    • Myth: strength training compromises dance aesthetics
    • Fact: strength improves dance aesthetics (ROM, perceived effort of movement)
    • Performing repetitive movements may lead to compensatory patterns, causing weakness & muscular imbalance
    • Strength training
    • Movement performed with control through full ROM
    • Progressive overload: gradually increase resistance/reps, duration or speed
    • Variety is essential; Same program = same results
    • 6-10 week back strength training program maintained strength gains for 1 year after
    • Improved performance (greater ROM, less fatigue, more “fluid” movements), less chance of developing back pain, correct imbalances

As a physical therapist and strength training coach for dancers are Royal Caribbean and Celebrity Cruises I often hear from dancers that they don’t workout at the gym because

1. They do “enough” in rehearsals and

2. They don’t want to become “bulky”.

I definitely agree that the performers I treat for dance injuries at Royal Caribbean and Celebrity spend a considerable time rehearsing. On average, about 6-8 hours a day for 6 days a week… For at least 1 1/2 months and at most 3 months (longer shows, longer rehearsal process for dancers).

However, if you only train to dance at that level in rehearsals, you can only perform up to that level. Never above. Why? Because you are not training your muscles or heart to exceed those expectations. This is why strength training outside of rehearsals or technique training is so important. 

The below graph demonstrates the difference in level of intensity between rehearsing, performing and strength training. The intensity of rehearsing is often significantly less than the intensity of performing. The difference between these intensities is often the “gray zone” for injury. If you train below the level of your performance, the body will not be capable of handling that much stress.

By engaging in planned & strategic strength training program, we are developing our muscles, heart and brain to execute above what is required to perform.

Performing will be a breeze.

The second issue, “bulkiness” is a combination of

1. Most likely never receiving proper instruction in strength training for dancers (very common in my experience over the past years) and

2. Not understanding how the body works. 

Don’t get me wrong- dancers especially have a unique appreciation for aesthetics & looking really good when moving. Its just the science thats lacking. 

I hope to clear these two misconceptions up.

In an article by Tom Welsh of FSU, “Back Strengthening for Dancers”, he describes how a back strengthening program not only improved back strength (surprise, surprise!), but also improved the range of motion with an arabesque and reduced the risk of lower back injury. 

These gains were maintained for a year after the 6-10 week program was implemented. 

One very important issue Dr. Welsh brought up in the article is “Strength is an explicit element in some athletic endeavors, but it remains a hidden ability in dancers.” 

Well, thats just a nice way of saying that most dancers lack a solid strength training program, for whatever reason.

He later describes what I find very often in dancers, that additional training will result in a loss of beauty and aesthetic appearance in dance. While this is not only a myth, the complete opposite is true!

Prescribing a proper strength training program doesn’t have to be rocket science. But certain principles, once understood, can be easily applied to dancers of all types, ages & experience. 

Other challenges include accommodating time schedules, muscle fatigue or soreness, and program design that includes proper periodization (scheduling) to progress the training while simultaneously reducing the risk of injury.

With the help of a strength training coach (Hey thats me!) who understands a dancers ambition, goals and athletic drive, the proper program can push you, the competitive dancer, to new heights (literally). 

Here are IADMS recommendations for strength training:

IADMS Education Committee Recommendations for Strength Training 

  • Choose an exercise that focuses effort on the muscles you want to strengthen.
  • Use perfect alignment; stop if you begin to compensate.
  • Add enough resistance so you can complete the movement almost 8 times without compensating.
  • Move with control through the full range of motion.
  • Gradually increase repetitions until you can do 12 without compensating.
  • When doing 12 repetitions is easy, increase the resistance by a small amount (~5%) and do as many repetitions as you can without compensating (~8 reps).
  • Repeat the pattern of increasing repetitions, then adding a small amount of resistance until you have a little more strength than you think you need.
  • Perform the exercise two or three times a week to increase strength.
  • Perform the exercise at least once a week to maintain strength.
  • Increase repetitions to 20 or more (without compensation) to build endurance.
  • Consult a fitness trainer for help if you want to build power.

BACK

Dr. Abate Physical Therapy - Created by Do.Websaits 2023

Posted on

Blurred Lines: Aerial Dance & Aerial Circus

Blurred Lines: Aerial Dance & Aerial Circus

  1. Similarities and differences between aerial dance and aerial circus. 
  2. Brief history of aerial dance and aerial circus
  3. “Blurring” of aerial form

The table below identifies the differences between aerial dance and aerial circus. The primary differences are use of an apparatus, movement quality, gender roles, intent and location of the performance.  The main divergence is the intent of the performer and participation (or non-participation) from the audience. 

Movement vocabulary of aerial dance focuses almost exclusively on constantly flowing transitions. The choreographers craft and intention in creating dance was to focus attention on the process of movement exploration to capture aerial dance aesthetic. Stephanie Evanitsy and Terry Sendgraff pioneered aerial dance with their company Multigravitational Aerodance Group  in the late 1960s in New York City under the guidance of Alwin Nikolai. The duo investigated the human element in relation to changes in time, space and light. They used bungee cords, ropes and the inner tube of tractors to create the vertical environment they desired. Trisha Brown had also explored the use of props and suspension equipment at the Judson Dance Theater with “Man Walking Down the Side of a Building” in 1970. The next year Brown had left pursuing aerial work, having “plumbed the possibilities of control imposed by equipment”. Sendgraff continued to teach and explore with Motivity trapezes, stilts and bungee cords. This determination coined her as the “mother of aerial dance”. Sendgraff, a vocal feminist, celebrates women’s connectedness with the use of stilts and clashing cymbals at the 1992 Women Walking Tall festival in Michigan. The downplay of specific “tricks” and the emphasis on transitional movement from floor to air is paramount to the craft and intention of creating an aerial dance. 

Aerial circus is differentiated from aerial dance in that the structure and sequence of tricks build in intensity and virtuosity. This engages the audience, evoking a response such as an applause. The allure of aerial circus is predicated on engaging the audience with dangerous and provocative acts. 

 

Blurring of form between aerial circus and dance can be seen through shows such as Cirque du Soleil, Circo Zero, and “Woman in the Moon”. The blurred elements include a building up of theatrical tension in addition to inclusion of a narrative, transitional movements from the floor to the air that expand from “tricking”, use of make-up, costumes and various apparatus’ as well as the interaction of traditional male-female roles on stage. 

Conclusion:

A recent “blurring of form” between aerial circus and aerial dance has occurred within the recent contemporary performance world. The use of various apparatus’, narratives, costumes and intent has created a unique environment for the performing artist to develop professionally. 

BACK

Dr. Abate Physical Therapy - Created by Do.Websaits 2023