Using RICE to Treat Your Acute Injury

In the sports medicine world, “RICE” is a well-known self-treatment for acute soft-tissue injuries. RICE stands for Rest, Ice, Compression, and Elevation. Like most things in life (especially performing arts medicine), RICE should be used in moderation, as too much of even just one of the segments can hinder healing and potentially cause additional tissue damage. The exact length of each segment depends on the severity, location, and stage of healing of your injury.

The best time to apply all four components of RICE is several hours after a severe acute injury before you have the injury evaluated by a medical professional. Unless you are specifically told to do so by a medical professional, you shouldn’t need to apply RICE more than 3-5 days following a severe acute injury (assuming you don’t re-injure yourself).

A Cold or the Flu? Use These 8 Symptoms to Find Out

It’s the holiday season, but, unfortunately, it’s also cold and flu season. You can take steps to prevent getting a cold or the flu by washing your hands frequently with warm soapy water, avoiding contact with infected people and contaminated surfaces, and getting a flu vaccine. However, sometimes these steps aren’t enough.

Colds can happen at any time throughout the year, whereas flu outbreaks tend to be seasonal. In the United States, seasonal flu activity generally peaks between late December and early March. In order for the flu vaccine to be effective, it needs to be administered early enough for the body to react to it and produce protective antibodies before being exposed to the virus. These antibodies develop within two weeks of receiving a flu vaccine (so get your vaccine now, if you haven’t already!).

Why Medical Professionals Insist on Making You Describe Your Pain

Pain is your body’s way of telling you that something is wrong. It’s a protective mechanism (pain causing a recoil or limp prevents you from further injuring your already compromised body part). Not only does pain indicate that there is a problem, but it can also give you clues as to the extent and location of the injury and which type(s) of tissue are damaged.

6 Stretches for Instrumentalists

This article continues a series examining upper body stretches for specific types of performing artists. The grouping of stretches presented in this article is targeted toward musicians who play while seated with their arms elevated. Future articles in this series will identify key upper body stretches for dancers and musicians who play with their arms lower than the musicians addressed here.

Ten Keys to Making it through Thanksgiving without Feeling More Stuffed than the Turkey

Thanksgiving is a great holiday to get together with family and friends and remember all of the great things and people we have in our lives. Unfortunately, it also has a reputation of offering way more food than anyone could possibly eat without exploding. Survive the multitude of heavy sides, savory entrees, and mouth-watering desserts by following the following tips.

Yoga for Performing Artists: 7 Ideal Poses for Dancers

This is the second article in a series designed to help you identify a handful of yoga positions that will be most beneficial to your particular performance genre. The first article was for marching band members.  This article focuses on dancers.  Check back for future articles for instrumentalists (not marching) and stage crew.

Practicing yoga offers performers many significant benefits, including lowering stress levels, promoting physical and mental relaxation, improving balance, and maintaining or improving flexibility. All of these things can help keep your immune system functioning optimally, maintain a healthy body weight, and reduce the likelihood of falls that can cause injuries. Additionally, regular yoga practice can improve body awareness, which can improve precision of movement, improve aesthetic qualities of performance and movement, lower unnecessary muscular tension, and improve posture.

10 Keys to Saving your Back...and Your Performing Career

This is the second article in a series examining low back pain and injury in the performing arts.

Nearly all people, active or otherwise, will experience back pain at some point in their lives. Most often, back pain is caused by a combination of poor posture and bad mechanics, specifically lifting technique. Adhering to the rules of lifting can save you a great deal of pain and disability – and may even keep you from missing rehearsals and performances due to back pain.

Your Guide to Pain Medicine

Pain is the most common reason people seek medical attention, so it’s no surprise that there are so many different medicines designed to reduce or eliminate pain. Pain signals are sent to the brain through the body’s nerves after pain receptors on the nerve endings have been activated by chemical, mechanical, or thermal damage to tissue cells. Medication and therapeutic treatments aimed at reducing pain work through a variety of mechanisms, including removing/limiting the irritants that contribute to pain, raising the threshold of the nerve endings to delay pain signal transmission (you have to be in more pain before your nerves decide that it’s important enough to tell your brain about it), or preventing or removing the swelling that increases mechanical pressure on nerve endings.

Pain medicine covers a wide range of types of medication, including counterirritants, local anesthetics, analgesics (narcotic and non-narcotic), anti-inflammatories (including steroid-based and non-steroid-based), and antipyretics. This article only addresses oral medication (pills) that is available over the counter (OTC) (as opposed to prescription medications), focusing primarily on analgesics and anti-inflammatories.

Shoulder Injuries in the Performing Arts: "Stingers"

This is the third and final article in a series on shoulder injuries in the performing arts. This series of articles addresses fairly damaging acute shoulder injuries. Unless otherwise noted, these injuries are substantial enough that they should not be self-treated until after you've seen a medical professional who has instructed you to do so. These traumatic shoulder injuries should be treated as emergencies, since there is a high risk of significant complications if they are improperly or incompletely cared for (these complications can include nerve damage, internal bleeding, and nonunion fractures).

What to Look for on a Nutrition Label

Eating nutritious, well-balanced meals is important because the food you eat is your body’s fuel. Giving your body what it needs can keep you healthy, help you achieve or maintain your target weight, improve your physical and mental performance, and improve your mood. But eating well can be very challenging. There are many factors that can get in the way – cost, time available for meal preparation, food allergies and preferences, daily schedule – but one factor that prevents many people from eating as well as they’d like is a lack of awareness of how to use a food item’s nutrition label and ingredients list to help make informed decisions.

Interpreting nutrition labels and ingredients lists can be intimidating, but it is incredibly helpful when comparing similar foods or identifying the nutritional value of your current diet.

6 Upper Body Stretches All Marchers Should Be Doing

This article opens a series examining upper body stretches for specific types of performing artists. The grouping of stretches presented in this article is targeted toward musicians who stand when they play and for members of the marching band. Future articles in this series will identify key upper body stretches for dancers and seated musicians.

How You are Giving Yourself Low Back Pain

This is the opening article in a series examining low back pain and injury in the performing arts.

Low back pain is one of the most common – and potentially debilitating – musculoskeletal problems. In performing artists, thankfully, most instances of low back pain do not involve serious injury. However, this does not mean that low back pain can be ignored when it does occur.

7 Steps to Ensure Your Voice Survives the Royals' Postseason

After the Chiefs’ domination in Monday Night Football at Arrowhead and the Royals’ first postseason win in 29 years last night, more than a few Kansas Citians are likely to have vocal trauma and maybe a hoarse voice this week.

The vocal cords are bands of connective tissue that run across the trachea (“windpipe”) and vibrate when air is forcefully exhaled past them. Vocal pitch is controlled by contractions of tiny muscles attached to the ends of the vocal cords which tighten and flatten the vocal cords. When you scream or yell as loudly as you can and/or for an extended period of time, the vocal cords are exposed to a large amount of vibration, which can cause friction and irritation, leading to inflammation, swelling, damage, and pain.

The Body's 5 Distinctive Reactions to an Acute Injury

When an injury happens, the body has a set reaction called the inflammatory response, which is the first step in the body’s healing process. Swelling is a key component to the inflammatory response, but there are four other characteristic signs of inflammation, too: redness, heat in the affected area, pain, and dysfunction.

Yoga for Performing Artists: 9 Fantastic Daily Yoga Poses for Marchers

This is the first in a series of articles designed to help you identify a handful of yoga positions that will be most beneficial to your particular performance genre. This article focuses on marchers. Check back for future articles for dancers, instrumentalists (not marching), and stage crew.

Practicing yoga offers performers many significant benefits, including lowering stress levels, promoting physical and mental relaxation, improving balance, and maintaining or improving flexibility. All of these things can help keep your immune system functioning optimally, maintain a healthy body weight, and reduce the likelihood of falls that can cause injuries. Additionally, regular yoga practice can improve body awareness, which can improve precision of movement, improve aesthetic qualities of performance and movement, lower unnecessary muscular tension, and improve posture.

Shoulder Injuries in the Performing Arts: "Separations"

This is the second article in a series on shoulder injuries in the performing arts. This series of articles will address fairly damaging acute shoulder injuries. Unless otherwise noted, these injuries are substantial enough that they should not be self-treated until after you've seen a medical professional who has instructed you to do so. These traumatic shoulder injuries should be treated as emergencies, since there is a high risk of significant complications if they are improperly or incompletely cared for (these complications can include nerve damage, internal bleeding, and nonunion fractures). Some of the injuries discussed in this series can be caused by accidental falls or collisions, but these articles will focus on other mechanisms of injury.

Clothes that Burn Calories?

Some companies that sell exercise clothes make a lot of claims about the abilities of these clothes nowadays. According to ads, these clothes soak up sweat, keep you cool, improve your body’s functioning, and now, help you burn more calories.  With all these "specialized" clothes, shopping for exercise clothes can be overwhelming and confusing.

Not only are many of these claims unproven, but not all of the “perks” advertised by these companies are actually desirable for exercise clothes (or even good for you). If you are considering purchasing one or more of these types of special exercise clothes, make sure you research how the clothes go about achieving their claim-to-fame (if they do). Some clothes actually end up interfering with your body’s natural cooling processes, which can put you at risk of overheating while exercising.

Foot Care for Marchers

Marching band can be a great deal of fun, but it can also put your body at risk of developing injuries. Old, worn-out, or improperly-sized shoes, sweaty feet, standing for long hours, and a whole lot of marching can lead to a host of problems, including blisters, plantar fasciitis, ingrown toenails, skin or nail infections, and foot, ankle, lower leg, knee, hip, or even back pain. It isn’t just the shoes or the long hours that can take their toll; even the surfaces that bands typically march on can have negative consequences for your body: clumps of grass on football fields, curbs at parades, angled or uneven surfaces – even standing or marching on the bleachers/stairs.

2014 National Athletic Trainers' Association Clinical Symposia & AT Expo

Last week, Behind the Scenes Medical Consulting's owner, Laura Mertz, attended the National Athletic Trainers’ Association Clinical Symposia & AT Expo for four days in Indianapolis. Here, she shares some of her experiences and observations at this year’s convention.

As I have done every year of my career, I attended the Performing Arts Medicine pre-conference half-day session at the National Athletic Trainers’ Association (NATA) conference. This year focused on connecting with performing artists and arts organizations who may not know that performing arts medicine exists. Presenters included the athletic trainers at Ohio University, Dean College (MA), the University of North Carolina School of the Arts, and the hospital outreach organization that provides medical services to Cincinnati Ballet. In addition to the invaluable information this session consistently provides, one great benefit of attending this seminar is re-connecting with friends and colleagues from around the country, including the athletic trainers at Ohio University, Cincinnati Ballet, Indiana University, Radio City Rockettes, Louisville Ballet, and La Rêve – The Dream at Wynn Las Vegas.

"Dancer's Tendinitis"

Some injuries are so commonly seen in dancers – especially when compared to their incidence in non-dancers – that they earn a dance-specific nickname: Dancer’s Fracture, Dancer’s Tendinitis, Dancer’s Hip.

Dancer’s Tendinitis refers to Flexor Hallucis Longus tendinopathy (That’s quite a mouthful! No wonder it’s referred to as dancer’s tendinitis!).  The Flexor Hallucis Longus (FHL) muscle is located in the lower leg and its tendon runs down into the foot, attaching to the bottom of the big toe. As the name implies, it is responsible for flexing (pointing) the big toe. Tendinopathy simply means “an injury or disease related to a tendon,” making it a good term to use when discussing tendon-related conditions without worrying about what specific aspect of the tendon is injured (the actual tendon vs. the sheath of connective tissue surrounding it) or for how long it’s been injured (tendinitis vs. tendinosis – acute vs. chronic).

Shoulder Injuries in the Performing Arts: Dislocations

With the video and witness reports circulating about Mark Ballas's injury during DWTS rehearsal, this is a good time to review the differences between the most common acute shoulder injuries.  This is the first in a series on shoulder injuries in the performing arts.

This series of articles will address fairly damaging acute shoulder injuries.  Unless otherwise noted, these injuries are substantial enough that they should not be self-treated until after you've seen a medical professional who has instructed you to do so.  These traumatic shoulder injuries should be treated as emergencies, since there is a high risk of significant complications if they are improperly or incompletely cared for (these complications can include nerve damage, internal bleeding, and nonunion fractures).  Some of the injuries discussed in this series can be caused by falls or collisions, but these articles will focus on other mechanisms of injury.

Performer’s Perspective: The Two-Year Injury Saga that Nearly Ended All of My Activities

Laura Mertz

Violinist

Age at time of injury: 14-16 years old

Site of injury: shoulders and upper back

Laura is a performing arts medicine specialist and the owner of Behind the Scenes Medical Consulting. Her first experience with debilitating playing-related pain came as a 16-year-old violinist. Here, she details her injury and how she eventually overcame it – with the help of the friendly person working at KC Strings on the day she came in to correct her playing ergonomics.

Four Ways You Can Improve Your Health and Performance by Sleeping

Did you know that sleep is a critical component to maintaining your weight, staying healthy, and preventing injuries? Not only does sleep help you avoid overuse or fatigue-related injuries, it also gives your performance a boost by allowing your body to recover more completely from the previous day’s activities. There are many factors that go into getting enough and the right kind of sleep.

Pain on the Bottom of Your Foot: Plantar Fasciitis

Fascia is connective tissue that runs throughout the entire body, connecting, surrounding, and supporting muscles, tendons, and nerves. It also separates the skin and subcutaneous fat (body fat that’s just under the skin) from the underlying muscles and other soft tissues. Like all other connective tissue in the body, the fascia can develop adhesions, become inflamed, tear, or be subjected to some other kind of injury. Due to its interconnected nature, movement restrictions, tightness, or pain in the fascia in one region of the body can affect other parts of the body.

One place in the body that is particularly susceptible to irritation, chronic inflammation, dysfunction, and pain is the plantar fascia, located on the soles of the feet. Plantar fascia runs from the bottom of the heel to the ball of the foot. This fascia supports the foot’s main arch and stabilizes the foot during pushing-off (like during running and jumping). When this tissue becomes inflamed, the condition is called plantar fasciitis.

Exercising Doesn't Have to Hurt! Dealing with Muscle Soreness

Anyone who has exercised or participated in physical activity likely has experienced soreness associated with these activities at one point. Colloquially, “soreness” may be rather vague and used to describe a variety of sensations and conditions. So the physical fitness and medical fields use the term delayed-onset muscle soreness (DOMS) to describe the residual muscular pain or discomfort following unusual or excessive muscle use. As the name indicates, the soreness usually sets in anywhere from 1-5 days after exercise.

Stress Fractures

A stress fracture is a bone injury that occurs at a spot in the bone that is exposed to high or repetitive forces. These forces either come from external sources (like impact with the ground when you walk, run, or jump) or from internal sources (like muscles/tendons pulling on the bone). Specific spots of bones may be more susceptible to stress fractures than others due to mechanics/form while performing specific tasks or due to cyclical weaknesses that occur naturally as a part of the bone’s remodeling process.

Resting from Activity

Many injuries need time off from physical activity to heal. However, this does not always mean completely stopping all activities and losing conditioning simply due to an injury.

Orthotics

When the foot’s natural structure is compromised or the foot functions improperly, pain and injury can occur either in the foot itself or elsewhere in the body (usually in the knee, hip, or lower back). This pain and injury can be corrected – or even avoided – through the proper use of orthotics.

The orthotic accommodates for or corrects specific structural or mechanical problems, bringing the lower body into alignment and allowing for efficient joint mechanics and correct force transmission.

Building Bone Safely

Bone injuries can be debilitating to the performing artist, but understanding how bone tissue grows, remodels, and heals can help direct preventative measures aimed at reducing the occurrence of injuries such as stress fractures.

Workouts at the Pool

Pool workouts are a great way to cross-train. But what do you do during a “pool workout”? Much like land-based workouts at the gym, you can do practically whatever you’d like. Exercising in the pool can improve your endurance, your sprinting ability (from a cardiovascular standpoint), your sprint endurance, or even your muscular strength and tone.

Hamstring Strains

The hamstring muscle group is located on the back of the thigh, running from the ischial tuberosity (the “butt bone”) to either side of the front of the tibia (shin bone), just below the knee joint. There are three muscles that make up the hamstrings muscle group (on each side) – the biceps femoris, semitendinosis, and semimembranosis. For the purposes of this article, “hamstrings” indicates all three of these muscles collectively. The hamstrings are 2-joint muscles, crossing and affecting movement at both the hip and knee joints.

Primary functions of the hamstrings are to:

• flex the knee (bend the knee by bringing the heel up toward the butt)
• extend the hip (bringing your leg backwards)
• control lowering the trunk when bending forward
• decelerate leg swing during walking and running

Hydrate Throughout the Day

So, you already know what dehydration can do to your body and your performance. You also know that you need to hydrate throughout the day in order to replenish what you lost the previous day and to prepare yourself for the coming day’s activities. However, you may not know what proper hydration is or how to hydrate before, during, and after rehearsals, workouts, and performances.

Fitness in Dance

Despite the fact that dance requires just as much athletic ability and effort as most sports, dancers are not as physically fit or healthy as most athletes of a comparable age and skill level. (This is even supported by dance research.) For the most part, dancers have a lower level of fitness because they do not overtax their system (essential for building muscle and improving cardiovascular conditioning) during class and most rehearsals. A dancer who does not exercise outside of class and rehearsal will not be adequately prepared for the physical demands of performance.

What Dehydration does to Your Body

Practically everyone knows that it is important to stay hydrated while exercising in heat. But, did you know that dehydration is just as likely during physical activity in normal temperatures, cold weather, and even indoors?

Four Great Reasons to do Pool Workouts

Performers often struggle with finding new and/or different ways to exercise without increasing their risk of developing an overuse injury.  Pool workouts offer an excellent alternative to working out in a gym with cardio equipment and weight training.

Here are 4 benefits to exercising in the pool:

The Best Foods for When You're Sick

One of the worst things about being sick to the point of throwing up or having diarrhea (or, heaven forbid: both) – aside from vomiting and having diarrhea, of course – is that the cycle can be very difficult to break. If you can’t keep food inside your body long enough to benefit from the nourishment it can provide, your body won’t have the fuel it needs to help fight off what’s ailing you. Saltines and Sprite may help you feel like you’re “settling your stomach,” but they won’t give your body the nutrition it needs to restore your health.

It sounds really gross, but a general rule to follow when you’re having bowel problems like diarrhea and a good way to help your body get back to normal is to eat food that has about the same consistency as what’s coming out of you. This allows your gastrointestinal (GI) system to take baby steps toward getting healthy instead of being overtaxed by trying to breakdown the regular food you eat. One of the best ways to follow this advice and get some nutrients in the process is to follow the BRAT diet. And, no, we’re not talking about going to Octoberfest to have as many wursts as you can.

How Fatigue Leads to Injury

A number of studies have found a link between fatigue and a higher incidence of injury. Injuries are more likely to happen at the end of the activity session (rehearsal, performance), at the end of the week, and at the end of the season. An important thing to keep in mind is that “fatigue” can refer to physical or mental/emotional fatigue – and both types can have a negative impact on your body and your performance.

Anaerobic and Aerobic Metabolism and Exercise

There are two types of metabolic systems used within the body to create energy for muscle contractions: anaerobic metabolism and aerobic metabolism. These metabolic systems are used to identify types of conditioning exercises, basing the classification of the exercise on the metabolic pathway supplying the majority amount of energy.

The most important difference between these two systems is the need for and use of oxygen to create energy. Anaerobic metabolism creates and uses energy without oxygen while aerobic metabolism, which converts glucose and fats into energy, must use oxygen.

New Year's Resolutions: Some Things to Remember for All Goals

With the New Year, it’s tradition to set some resolutions. And while many people know that “eat better” or “sleep more” aren’t complete goals, it can be difficult to set good, solid goals, especially when you have the entire year to attempt them.

While “quit smoking” is certainly a laudable desire, it isn’t necessarily a good goal to set. The appropriate way to go about quitting smoking (or other similarly ambiguous plans) is to create in-depth goals that focus on the steps necessary to achieve the desired result.