Concussions in the Performing Arts

March is National Brain Injury Awareness Month

The most common brain injury suffered by athletes and performers is a concussion. A concussion is a traumatic injury to the brain, and it comes with a plethora of symptoms that can affect nearly all of the systems in the body. Even with prompt and proper care and recovery, suffering a concussion can result in permanent or life-threatening consequences.

When people think of activity-related concussions, they typically think of high-impact sports like football, hockey, or boxing, but performing artists are at risk of suffering concussions, too. Most commonly, activity-related concussions are caused by collisions, falls, or blunt trauma to the head (getting hit in the head or hitting the head on something). In the performing arts, concussions are almost always caused by accidents or mistakes while executing choreographed movements.

How to Care for Your "Shin Splints" and Avoid Them in the Future

Pain in the shins, often referred to as “shin splints,” can be debilitating. But what exactly are “shin splints”? Medically speaking, “shin splints” don’t exist – the phrase is not a medical diagnosis.

The term is actually a catchall for any number of conditions that cause pain and inflammation in the lower leg, including tendinitis, muscle strains, stress fractures in the lower leg, medial tibial stress syndrome (MTSS), recurrent chronic anterior compartment syndrome, and inflammation of the connective tissue around and between the bones in the lower leg (called periosteitis and inflammation of the interosseous membrane, respectively).

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).

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.

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.

"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.

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.

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.

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

Tendinitis

One of the most common injuries suffered by performers of all types is tendinitis. But what exactly is it? Quite simply, the suffix “-itis” means “inflammation of,” so tendinitis is an inflammation of the tendon. To be more precise, tendinitis is an overuse injury affecting a muscle’s tendon and the musculotendinous junction (the part where the muscle fibers join with the tendon fibers). [A side note: tendinitis and tendonitis are both correct spellings.]

Meniscus Injuries

Within the knee, there are two fibrocartilaginous crescents that sit on top of the tibia (the shin bone). These are the menisci. Their outer rims are thicker than their inner borders. They help to create a sort of seat on top of the tibia for the condyles of the femur. The medial meniscus is C-shaped while the lateral meniscus forms more of an “O”.

High Ankle Sprains

In the lower leg, the two bones, the tibia and fibula, meet twice: once near the knee and once just above the ankle joint. The distal tibiofibular joint (the one just above the ankle joint) has ligaments that connect the two bones in the front and back of the joint. These ligaments blend together with the connective tissue that runs between the two bones throughout the lower leg (called the syndesmosis or the syndesmotic ligament). Injuries to the distal tibiofibular ligaments are referred to as “high” ankle sprains due to their location in relationship to the rest of the ankle joint. Syndesmosis sprains often occur with high ankle sprains either at the same time that the high ankle sprain occurs or shortly afterward due to the syndesmosis having to absorb higher forces than usual after the tibiofibular ligaments are sprained.

Patellofemoral Pain Syndrome: Symptoms and Treatment

Patellofemoral Pain Syndrome (hereafter referred to as PFS) has many causes and can really be a hassle to deal with if you don’t recognize the symptoms early.

Causes of Patellofemoral Pain Syndrome

The knee joint is actually a combination of two joints: the tibiofemoral joint (the hinge joint that most people think of when talking about the knee joint) and the patellofemoral joint (which isn’t so much a joint as it is a place where bones slide past each other). This article is going to focus only on the patellofemoral joint. This term describes the gliding articulation of the patella (kneecap) with the trochlear groove of the femur (thigh bone).

The patella glides up and down in the groove in the femur during knee flexion and extension. This groove helps facilitate keeping the patella lined up with the midline of the leg.

Lateral Ankle Sprains

The body’s joints get their static and dynamic stability through a combination of bony architecture, tightness and orientation of ligamentous structures (ligaments and the joint capsule), and muscular contractions. The amount of a joint’s stabilizing forces coming from each of these factors at any given time is dependent on the specific joint and the current position of that joint. Joints are most stable when the majority of the joint’s stability comes from the bony architecture, and they are often least stable when the ligamentous structures are left to contribute the most to the joint’s stability.

The ankle joint is most stable in a combined position of dorsiflexion (lift up your toes and front of your feet so you can walk only on your heels) and eversion (try to “aim” the soles of your feet as far away from each other as you can without rotating your legs) and least stable in a combined position of plantarflexion (point your feet and toes) and inversion (soles of the feet turned toward each other).

Is it a Sprain or a Strain? (part 2)

Find out the specifics of sprains and strains in this 2-part article

Part 2: Strains

There is a plethora of information surrounding sprains and strains. As a result, the information presented here has been split into 2 articles. This is part 2 – be sure to check out Part 1: Sprains.

What is a Strain?

When a muscle, tendon (what attaches muscles to bones), or its associated fascia is torn or suffers a stretching-based injury, it is called a strain. A tendon’s collagen fibers, which are what allow the tendon to become taut when its muscle pulls on it, break after a 6%-8% increase in length. However, a tendon is usually twice as strong as its associated muscle, so when a musculotendinous unit is strained, the injury is usually located within the center of the muscle (referred to as the muscle belly) or at the spot where the muscle fibers blend into the tendon (called the musculotendinous junction).