Monday, March 27, 2017

The Dancer–Physical Therapist Relationship

The Dancer–Physical Therapist Relationship

Often when treating athletes who are on the competitive level, compliance becomes an issue. As a dancer myself for the past 15 years, non-compliance is an ongoing issue that is often misunderstood by not only the physical therapist, but also other medical providers. An article published in the Journal of Dance Medicine & Science discusses the reasoning behind this misunderstanding and provides opportunities of how we as physical therapists can improve dancer compliance and return our dancers to the studio with success. 

The dancer often brushes the consequences of continuing to dance aside due to inability to relate to their health care provider. Dancers fear being told to stop dancing completely in order to heal their injury. What dancers really needs is an explanation of their injury, how it was caused, and what they can do to modify their current dance practice to avoid re-injury.1 Dancers report that they are willing to alter techniques in the short term, but not long term and would rather decrease their dance intensity level than the frequency of practice.1 This is where we as physical therapists can make a difference. Physical therapists (PTs) are rated highest by dancers for the quality of information given during therapy when compared with family physicians, sports medicine physicians, chiropractors, or massage therapists.2

By providing opportunities to educate dancers using their terminology and offer alternative ways to practice that are safe will allow dancers will improve the dancer-physical therapist relationship. Alternative exercise such as mental imagery, floor barre that minimizing full weight bearing, marking choreography either upper or lower extremities, or Pilates and yoga can help with a faster recovery. Specific questions such as: "What corrections do you get in class?" "What about your dancing are you unsatisfied with, and what are you working on?" "What specific motions make the symptom act up?" will show you as the physical therapist has a similar goal of returning your patient back to their sport.1

Treating only their symptoms does not address the issue for their overuse problems. Compensatory patterns and muscle imbalances should be evaluated and impairments should be treated after analyzing specific dance movements that the dancer usually preforms and caused the injury.1 Dance floor type, costumes, schedule, frequency of dance class, partner work, and personality should also be considered.1

Communication is key when treating dancers.  By listening, observing, and providing the education to dancers, they will be back to their sport in no time.

Catie Grumbein, DPT is one of our newest PTs at PTW! To schedule an evaluation call 215-855-9871 today!

1) Sabo, Megin. "Physical Therapy Rehabilitation Strategies for Dancers: A Qualitative Study." Journal of Dance Medicine & Science, vol. 17, no. 1, Feb. 2013, pp. 11-17.

2) Ruanne L, Krasnow D, Thomas M. Communication between medical practioners and dancers. J Dance MedSci. 2008;12(2):47-53. 

Thursday, March 2, 2017

Marijuana and Physical Therapy

Chronic Pain negatively affects

Last weekend, I had a previous patient tell me about their experiences with chronic pain, including their legal use of medical marijuana. 

It made me realize how uninformed I am about the effects of cannabis.  Since patients will ask their family doctor, Physical Therapist, Orthopedic doctor, and other healthcare providers about appropriateness, I thought it be best to deeper understand some facts.

Here are some facts;
  • Marijuana has been used for medicinal purposes for more than 4000 years.
  • It was used extensively in the United States for medical treatment well into the 20th century
  • In 1937, the US government put severe legal restrictions on the use, consequently reducing the use and availability
  • In 1970, it was declared a controlled substance, further restricting the use and limiting research on the analgesic effects

Lately, there has been a change in the medical thoughts on the substance due to the positive reduction of pain and other disorders with the use of cannabis.   Currently, medical marijuana is permitted in 1/2 of the states.  In addition, there are areas of our Physical Therapy practice that are sure to be affected for folks with chronic pain, hyperexciteability, inflammation, neurotic pain. 

A few key facts;

What conditions have been treated with medical marijuana with positive effects?
  • Glaucoma
  • Psychosis and anxiety
  • Seizure disorders
  • Tourette syndrome
  • Cancer related pain
  • Fibromylagia
  • Neuropaathic pain
  • Spasticity with multiple sclerosis
  • Rheumatoid and osteoarthritis
  • Chronic musculoskeletal pain

Adverse effects that could effect Physical Therapy

Short term impairments in cognition, memory, alertness, balance, and coordination, possibly affecting;
  • The ability to drive
  • The risk of falls
  • Workplace or school tasks

Although Medical Marijuana is not fully legal yet in our state, it appears it is soon to come.  I have a lot of reading still to do.

At The Physical Therapy & Wellness Institute,  Chronic Pain Physical Therapy programs are always aimed at reducing pain with education, manual skills, or modalities, and the use of cannabis may soon complement our work.

More discussions with the family and chronic pain doctors are a sure bet in my practice, to help me answer my patients when the time comes!

Robert Babb, PT
Physical Therapist at The Physical Therapy & Wellness Institute with locations in Lansdale, Quakertown, Montgomeryville, West Norriton, Glenside, Harleysville, and Souderton, PA