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When can I start pointe work? Guidelines for initiating pointe training

Weiss, David S; Rist, Rachel Anne; Grossman, Gayanne
The initiation of pointe training for dance students should be determined after careful evaluation of a number of factors. These include: the dance student's stage of physical development; the quality of her (or his) trunk, abdominal and pelvic control ('core' stability); the alignment of her legs (hip-knee-ankle-foot); the strength and flexibility of her feet and ankles; and the duration and frequency of her dance training. For students who meet the requirements related to all of these factors, began ballet training at age eight or later, and who are taking ballet class at least twice per week, pointe work should be initiated in the fourth year of training. Students with poor core stability or hypermobility of the feet and ankles may require additional strengthening to allow them to safely begin pointe training. For those who are only taking ballet classes once per week, or who are not truly pre-professional, pointe training should be discouraged. No student with insufficient ankle and foot plantar flexion range of motion or with poor lower extremity alignment should be allowed to do pointe work
PMID: 19754985
ISSN: 1089-313x
CID: 102409

Injuries in professional modern dancers: incidence, risk factors, and management

Shah, Selina; Weiss, David S; Burchette, Raoul J
Modern (or contemporary) dance has become increasingly popular, yet little has been reported with respect to modern dance injuries and their consequences. The purpose of this study is to define the incidence, risk factors, and management of musculoskeletal injuries in professional modern dancers. A total of 184 dancers in the United States completed an anonymous 17-page questionnaire on their injuries, including extensive details regarding the two most severe injuries that had occurred in the prior 12 months. According to their self-reports, a total of 82% of the dancers had suffered between one and seven injuries. The foot and ankle (40%) was the most common site of injury, followed by the lower back (17%) and the knee (16%). The rate of injuries was 0.59 per 1,000 hours of class and rehearsal. Injured male dancers returned to full dancing after a median of 21 days, while females returned after a median of 18 days. Most dancers missed no performances due to injury. Of the medical consultations sought by dancers for their injuries, 47% were made to physicians, 41% to physical therapists, and 34% to chiropractors. The majority of dancers adhered to the advice given them by consultants (87% of males and 78% of females for the most severe injury). While the majority of injuries were considered work-related (61% of the most severe injury and 69% of the second most severe), few were covered by Workers' Compensation insurance (12% and 5% respectively). These professional modern dancers suffer from a rate of injury similar to other groups of professional dancers. Most dancers return to a partial level of dancing several weeks before attempting full-capacity dancing.
PMID: 22390950
ISSN: 1089-313x
CID: 178958

Early knee changes in dancers identified by ultra-high-field 7 T MRI

Chang, G; Diamond, M; Nevsky, G; Regatte, R R; Weiss, D S
We aimed to determine whether a unique, ultra-high-field 7 T magnetic resonance imaging (MRI) scanner could detect occult cartilage and meniscal injuries in asymptomatic female dancers. This study had Institutional Review Board approval. We recruited eight pre-professional female dancers and nine non-athletic, female controls. We scanned the dominant knee on a 7 T MRI scanner using a three-dimensional fast low-angle shot sequence and a proton density, fast spin-echo sequence to evaluate cartilage and menisci, respectively. Two radiologists scored cartilage (International Cartilage Repair Society classification) and meniscal (Stoller classification) lesions. We applied two-tailed z- and t-tests to determine statistical significance. There were no cartilage lesions in dancers or controls. For the medial meniscus, the dancers demonstrated higher mean MRI score (2.38 +/- 0.61 vs 1.0 +/- 0.97, P < 0.0001) and higher frequency of mean grade 2 lesions (88% vs 11%, P < 0.01) compared with the controls. For the lateral meniscus, there was no difference in score (0.5 +/- 0.81 vs 0.5 +/- 0.78, P = 0.78) in dancers compared with the control groups. Asymptomatic dancers demonstrate occult medial meniscal lesions. Because this has been described in early osteoarthritis, close surveillance of dancers' knee symptoms and function with appropriate activity modification may help maintain their long-term knee health.
PMID: 23346987
ISSN: 0905-7188
CID: 212562

Pain Influences Neuropsychological Performance Following Electrical Injury: A Cross-Sectional Study

Dorociak, Katherine E; Soble, Jason R; Rupert, Patricia A; Fink, Joseph W; Lee, Raphael C; Anitescu, Magdalena; Weiss, David; Cooke, Gerald; Resch, Zachary J; Pliskin, Neil H
OBJECTIVE:Electrical injury (EI) is a significant, multifaceted trauma often with multi-domain cognitive sequelae, even when the expected current path does not pass through the brain. Chronic pain (CP) research suggests pain may affect cognition directly and indirectly by influencing emotional distress which then impacts cognitive functioning. As chronic pain may be critical to understanding EI-related cognitive difficulties, the aims of the current study were: examine the direct and indirect effects of pain on cognition following EI and compare the relationship between pain and cognition in EI and CP populations. METHOD: RESULTS:Higher pain levels were associated with poorer attention/processing speed and executive functioning performance among patients with EI. Depression was significantly correlated with pain and mediated the relationship between pain and attention/processing speed in patients with EI. When comparing the patients with EI and CP, the relationship between pain and cognition was similar for both clinical groups. CONCLUSIONS:Findings indicate that pain impacts mood and cognition in patients with EI, and the influence of pain and its effect on cognition should be considered in the assessment and treatment of patients who have experienced an electrical injury.
PMID: 35039108
ISSN: 1469-7661
CID: 5557112

Dancing on broadway with irregular periods and a femoral neck stress fracture [Meeting Abstract]

Fink, D; Weiss, D; Turner, R; Liederbach, M
The female athlete triad/ hypothalamic amenorrhea and polycystic ovarian syndrome (PCOS) are both common causes of irregular periods in young women. A 26-year-old woman presented with right hip pain after performing for 2 months in her first Broadway show. She was diagnosed with a left inferior (compression) femoral neck stress fracture by MRI scan. Because she had no history of fracture but had irregular periods, she was sent to endocrinology for evaluation. Her menarche was at 13-years-old. She had irregular periods throughout high school and she reported missing approximately 2-3 menstrual cycles a year. She took isotretinoin (Accutane) for acne in college and reported excess body hair, but was never worked up for PCOS. She denied weight changes and any eating disorder. Her food journal revealed an average intake of 1395 kcal per day with restriction of carbohydrates. Her food intake did not increase during periods of intense activity because of not taking time to plan ahead for meals and not wanting to eat before performing. Her weight was 98 pounds with a BMI of 19.83 kg/m2. Her exam showed mild hirsutism (Ferriman-Gallwey score of 12) and cystic acne. Her blood work was unremarkable except her total testosterone was 40 ng/dL (nl: 9-55) and her dehydroepiandrosterone sulfate (DHEAS) was elevated at 428 ug/dL (nl: 65-380). Her bone density revealed an AP spine Z-score of-3.0, left femoral neck Z-score of-2.6, and right femoral neck Z-score of-2.9, all consistent with low bone mass for age. Her irregular periods provided a clue for underlying hormonal dysfunction and eating patterns that resulted in her low bone mass and fracture. While she did not have an overt eating disorder with anorexia or bulimia, long term exposure to restrictive eating patterns led to poor bone health and affected her accrual of peak bone mass. Her case also highlights that biochemical and physical evidence of elevated androgen levels often seen in PCOS may occur simultaneous with the female athlete triad and these symptoms may lead to challenges in the appropriate diagnosis
ISSN: 1523-4681
CID: 3831972

Iontophoresis successfully delivers dexamethasone sodium phosphate to dermis as measured by microdialysis

Joshi, Abhay; Stagni, Grazia; Cleary, Ann; Patel, Komal; Weiss, David S; Hagins, Marshall
Despite its widespread and long term use, the effectiveness of iontophoresis to increase the delivery of dexamethasone sodium phosphate (DSP) remains controversial. The goal of this study was to quantitatively compare the DSP concentrations in dermis' dialysates in two delivery scenarios: with and without iontophoresis. Interstitial fluid concentrations were measured by cutaneous microdialysis. Passive and active iontophoresis were applied simultaneously on the skin of the forearm in eight healthy adult participants using each participant as his/her own control. The iontophoresis apparatus and procedures were identical to those used in common clinical practice. Iontophoresis electrodes were loaded with 2 mL of 4.4 mg/mL of preservative-free DSP solution. Electric current (4 mA) was applied for 20 min. Dialysate samples were collected for 2 h and analyzed for DSP and its active metabolite dexamethasone (DXM). Seven out of eight iontophoresis sites contained quantifiable levels of DSP and DXM, whereas none of the samples collected at the passive site contained either form of the drug. In conclusion, this study demonstrates that iontophoresis significantly (p < 0.0001) increases delivery of DSP to the dermis compared with passive delivery of the same, and that microdialysis can be used to monitor DSP delivery and DXM formation in skin. (c) 2013 Wiley Periodicals, Inc. and the American Pharmacists Association J Pharm Sci 103:191-196, 2014.
PMID: 24338751
ISSN: 0022-3549
CID: 746482

Micro-finite element analysis applied to high-resolution MRI reveals improved bone mechanical competence in the distal femur of female pre-professional dancers

Chang, G; Rajapakse, C S; Diamond, M; Honig, S; Recht, M P; Weiss, D S; Regatte, R R
Micro-finite element analysis applied to high-resolution (0.234-mm length scale) MRI reveals greater whole and cancellous bone stiffness, but not greater cortical bone stiffness, in the distal femur of female dancers compared to controls. Greater whole bone stiffness appears to be mediated by cancellous, rather than cortical bone adaptation. INTRODUCTION: The purpose of this study was to compare bone mechanical competence (stiffness) in the distal femur of female dancers compared to healthy, relatively inactive female controls. METHODS: This study had institutional review board approval. We recruited nine female modern dancers (25.7 +/- 5.8 years, 1.63 +/- 0.06 m, 57.1 +/- 4.6 kg) and ten relatively inactive, healthy female controls matched for age, height, and weight (32.1 +/- 4.8 years, 1.6 +/- 0.04 m, 55.8 +/- 5.9 kg). We scanned the distal femur using a 7-T MRI scanner and a three-dimensional fast low-angle shot sequence (TR/TE = 31 ms/5.1 ms, 0.234 mm x 0.234 mm x 1 mm, 80 slices). We applied micro-finite element analysis to 10-mm-thick volumes of interest at the distal femoral diaphysis, metaphysis, and epiphysis to compute stiffness and cross-sectional area of whole, cortical, and cancellous bone, as well as cortical thickness. We applied two-tailed t-tests and ANCOVA to compare groups. RESULTS: Dancers demonstrated greater whole and cancellous bone stiffness and cross-sectional area at all locations (p < 0.05). Cortical bone stiffness, cross-sectional area, and thickness did not differ between groups (>0.08). At all locations, the percent of intact whole bone stiffness for cortical bone alone was lower in dancers (p < 0.05). Adjustment for cancellous bone cross-sectional area eliminated significant differences in whole bone stiffness between groups (p > 0.07), but adjustment for cortical bone cross-sectional area did not (p < 0.03). CONCLUSIONS: Modern dancers have greater whole and cancellous bone stiffness in the distal femur compared to controls. Elevated whole bone stiffness in dancers may be mediated via cancellous, rather than cortical bone adaptation.
PMID: 22893356
ISSN: 0937-941x
CID: 176417

A profile of the demographics and training characteristics of professional modern dancers

Weiss, David S; Shah, Selina; Burchette, Raoul J
Modern dancers are a unique group of artists, performing a diverse repertoire in dance companies of various sizes. In this study, 184 professional modern dancers in the United States (males N=49, females N=135), including members of large and small companies as well as freelance dancers, were surveyed regarding their demographics and training characteristics. The mean age of the dancers was 30.1 +/- 7.3 years, and they had danced professionally for 8.9 +/- 7.2 years. The average Body Mass Index (BMI) was 23.6 +/- 2.4 for males and 20.5 +/- 1.7 for females. Females had started taking dance class earlier (age 6.5 +/- 4.2 years) as compared to males (age 15.6 +/- 6.2 years). Females were more likely to have begun their training in ballet, while males more often began with modern classes (55% and 51% respectively, p < 0.0001). The professional modern dancers surveyed spent 8.3 +/- 6.0 hours in class and 17.2 +/- 12.6 hours in rehearsal each week. Eighty percent took modern technique class and 67% reported that they took ballet technique class. The dancers who specified what modern technique they studied (N=84) reported between two and four different techniques. The dancers also participated in a multitude of additional exercise regimens for a total of 8.2 +/- 6.6 hours per week, with the most common types being Pilates, yoga, and upper body weightlifting. The dancers wore many different types of footwear, depending on the style of dance being performed. For modern dance alone, dancers wore 12 different types of footwear. Reflecting the diversity of the dancers and companies surveyed, females reported performing for 23.3 +/- 14.0 weeks (range: 2-52 weeks) per year; males reported performing 20.4 +/- 13.9 weeks (range: 1-40) per year. Only 18% of the dancers did not have any health insurance, with 54% having some type of insurance provided by their employer. However, 23% of the dancers purchased their own insurance, and 22% had insurance provided by their families. Only 16% of dancers reported that they had Workers' Compensation coverage, despite the fact that they were all professionals, including many employed by major modern dance companies across the United States. It is concluded that understanding the training profile of the professional modern dancer should assist healthcare providers in supplying appropriate medical care for these performers
PMID: 19618577
ISSN: 1089-313x
CID: 101130

Grip lock injuries to the forearm in male gymnasts

Samuelson M; Reider B; Weiss D
We performed an epidemiologic survey to estimate the number of grip lock injuries occurring among male high school and college gymnasts. These injuries occur when dowel grips used by the gymnast become locked on the bar as the gymnast's momentum carries him through the skill being performed. We also questioned injured gymnasts to obtain details of their injuries. Thirty-eight high school coaches reported 17 injuries and 32 college coaches reported 21 injuries for a 10-year period; 36% of the coaches responding reported at least one such injury in their program. Of the 23 injured gymnasts who returned detailed questionnaires, 20 had sustained fractures and 9 required surgery. The distal forearm or wrist were the areas injured most often. Fourteen gymnasts had residual pain, seven had functional limitations, and eight had limited motion in the wrist. Fifteen of the 23 athletes were using a cubital (hyperpronated) grip at the time of injury and 19 were using dowel grips. Among the reasons cited for the injury, 18 gymnasts thought that their grips were either too large, worn, or stretched; 8 said the grips slid up their wrists, and 7 cited technical errors
PMID: 8638747
ISSN: 0363-5465
CID: 20793

Rehabilitation of dance injuries to the shoulder, lumbar spine, pelvis, and

Weiss DS; Zlatkowski M
ISSN: 1059-1516
CID: 20819