There is limited research on dance injuries outside of ballet. Most dance injuries are of the lower extremity and back (except the wrist and hand, which is most involved in break dancing). Risk factors for injury include dancing on hard surfaces; shoe wear; and increased hours of training per day; years of dance; and performance level. Most injuries are soft tissue (non-bone) overuse injuries, although there are some unique injury patterns (such as posterior ankle pain with repetitive activities on the toes or ball of the foot, or the ‘dancer’s fracture’ of the outside of the foot).

Medical problems of dancers include eating disorders, menstrual disorders, decreased bone density and burnout.

At ThedaCare Orthopedics Plus we are well positioned to evaluate and treat dance injuries, and work with your primary provider’s office when necessary regarding dancer-specific medical problems.

Dr. Erica Kroncke is a licensed medical physician with added certification in primary care sports medicine. A graduate of the Medical College of Wisconsin in Milwaukee, Dr. Kroncke enjoys helping patients reach their full potential and enjoys working with them on improving their health and well-being. She has completed several research projects including safety equipment in extreme sports and the correlation with high risk behaviors in adolescents. As a former high school and college athlete, she uses her experiences to help athletes of all ages and abilities become as healthy as possible. For more information  call 920-831-5050.

One of the best ways to stay motivated is to find a “workout buddy.” If you make plans to meet with someone at a set time and day, you make more of an effort to make it happen. You can motivate each other to stay fit. My workout buddy is my husband. He motivates me to exercise on days where if he were not there, I wouldn’t. I then turn around and become the motivator on days where he just is not feeling energetic. Sure, there are days where we help each other make some really good excuses not to exercise. But, more often than not, we help each other workout more than we would without the support person.

You should also wake up early and workout before going in to work. This does not work for everyone’s schedules, but if you can wake up an hour earlier and get your workout done at the start of the day, there are benefits. You feel more energized during the day, there are typically fewer conflicts or time demands at this time of day, and you free up time later in the day for other activities.

I recommend you vary your workout routine. Keep exercising exciting and fun by not doing the same routine every day. I often recommend alternating high impact activities (such as running, tennis, basketball) with lower impact activities (such as elliptical use, swimming, exercise bike) to help maintain joint health. Too much high impact activity can increase your risk of many orthopedic complaints such as shin splints, stress fractures, tendonitis, etc.

Go ahead and join a gym. Once you are at the gym, other distractions are limited. Many places of employment are also offering access to an exercise facility on site. This is optimal because you can use the facility even before you leave work and get home where, as we all know, there are many distractions.

Many people I know are also utilizing applications on their smart phones as a motivator. Some applications track running routes, showing how far you ran, how fast, elevation changes, etc. and map your route out on your phone. Your workout history is saved and can even be posted on social web sites such as Facebook. That way, you can even have a “workout buddy” that is not in the same city. You can post workouts to each other to help motivate one another. This does not have to be all running related. Some smart phone applications can be used to log different activities such as hiking, walking, canoeing, really anything. There are also web sites available where you can log your workouts and post them to others; this is not a motivator limited only to those with smart phone access.

I volunteered at the Fox Cities Marathon this year and saw many people wearing shirts that asked “what moves you?” and left an area for them to write in their own reasons. Many wrote in the names of family members. Improving your health is a great way to show loved ones you care. There were many other reasons people had for becoming more active. With the approaching cooler weather and shorter daylight hours, the question remains: what motivates you to remain physically active?

Anne Schultz received her bachelor’s degree in biomedical sciences and her master’s degree in physician assistant studies from Marquette University. She is a member of the American Academy of Physician Assistants. As a physician assistant, Anne provides diagnostic, therapeutic and preventative healthcare services to patients under the guidance of a physician. When working with patients, Anne said, “educating patients about their condition and treatment options is essential to achieve the best results.”

• Keep walking after you finish the race. During the race, blood has been redirected to the working muscles in your legs and away from your internal organs. It’s important to continue walking after you finish your race for about 20 minutes to allow the body to re-equilibrate your blood supply. Otherwise, you may feel nauseous (not enough blood flow to the stomach) or dizzy and weak (not enough blood flow to the brain).
• Replenish your body’s fluids. Begin drinking fluids slowly at the finish line as soon as your body is able to tolerate it without feeling nauseous. Sports drinks containing electrolytes and sodium are best to replace the fluid and salt your body has lost during the race. Keep track of urination color and frequency after the race to monitor your hydration status.
• Slowly add food to restore energy. Begin eating solid food when your stomach feels like it can handle it. Good sources of energy including sodium and potassium are bananas, pretzels, bagels, energy bars and other easily digested high-carbohydrate foods. Studies have shown that your muscles are primed to take in and recharge their energy supply most efficiently in the first few hours after the race. Eat slowly, and be aware of any nausea to avoid throw up.
• Take a lukewarm or cool shower. Avoid hot showers until you are completely rehydrated, because they can dilate your blood vessels and cause you to get dizzy and pass out. Avoid hot tubs because they will worsen the swelling and inflammation in the muscles and joints.
  
• Avoid pain relievers. We recommend avoiding aspirin, ibuprofen (Advil, Motrin), and naproxen (Aleve) until you are rehydrated as indicated by passing light yellow or colorless urine. These products can be harmful to the kidneys if taken when the kidneys are stressed by dehydration and prolonged exercise.
• Ice up for sore muscles. For sore muscles and joints, we recommend applying ice or cold packs for 20 minutes three to four times per day for the first two days post-race. Remember not to apply ice directly to your skin. Gentle stretching for the calves, quads, hamstrings, IT bands, glutes and low back can begin right away.
• Take good care of your skin. Skin care is important to limit damage and prevent infection. For scrapes, chafe, and open blisters, wash twice daily with soap and water, applying antibiotic ointment and covering with bandage for the first few days is best. For larger blisters that have not been broken, apply cold packs and consider carefully draining them. If you choose to drain them, we recommend washing with soap and water, then wiping with alcohol, letting the alcohol dry, and then popping them with a sterile needle near the edge of the blister. Take care of the popped blister as noted above and watch carefully for any sign of infection. If you see redness or pus develop, seek medical attention.
  

Megan Check received her bachelor’s degree in psychology with a child and youth emphasis from the University of Wisconsin-LaCrosse and a master’s degree in occupational therapy from UW-Madison. She is a registered occupational therapist and licensed in the state of Wisconsin. For more information visit: www.thedacareorthoplus.org or call 920-831-5050.

“If you have asthma, make sure you stay true to your controller therapy,” Dr. Maguire said. “Consider taking one-to-two puffs of your albuterol or rescue inhaler before the race.”

Runners, especially asthmatics, should have a “low threshold to stop their race” if they have a shortness of breath, he added.

In addition, those with heart disease should check with their primary care doctor if a race is even appropriate with air quality risks.

However, Dr. Maguire has consulted with the race medical director, Dr. Erica Kroncke, with ThedaCare Orthopedics Plus, and they want to reassure participants and their families that medical stations have respiratory medications – including oxygen – if they are needed.

“I wish all runners good luck this weekend!” Dr. Maguire added.

Fast forward five years and I’m waking up in the emergency room after a major grand mal seizure that almost took my life, not even able to remember my name. An MRI and CAT scan confirmed a large brain defect and further tests confirmed an epilepsy diagnosis. Without heavy doses of medication I was at risk for another seizure. I lost my short term memory, balance and depth perception, my driver’s license for three months, and something as simple as putting an outfit together became completely overwhelming.

Recovering from the seizure and adjusting to the medications, with nasty side effects, left me depressed and purposeless for seven months.  It wasn’t until I read a running article stating that less than one percent of the population would ever attempt an ultramarathon that I started to break out of my rut. I found I really wanted to be part of that percentile, so I signed up for the Fox Cities Half Marathon and finished it 31 days later. After I completed the Miami Marathon that following January I started researching and training for my first ultra, the Ice Age 50k.

My medication has prevented me from having any more grand mal seizures but it hasn’t stopped me from having mini seizures called auras, which I’d been unknowingly having for years even before my big seizure and still have on a regular basis. They last only a minute or two and have no physical side effects other than to leave me disoriented, emotional, and extremely tired when they’re over. I made the mistake of never telling anyone about them all those years because I couldn’t put my symptoms into words until it was too late.

After finishing that 50k I felt like I could do just about anything again, so I signed up for the North Face Endurance 50-miler and put it on my bucket list. Several months of 50-60 mile weeks and back to back long runs later, I was on my way to another personal victory.  The stress of running all those miles and dehydration triggered several auras in a row, forcing EMTs to pull me from the course at mile 40, totally devastated.

However, I was determined not to let a seizure disorder control my life and on September 18th of last year I crossed the finish line of the 50-mile course in 10 hours and 20 minutes with my incredible boyfriend by my side and my mom waiting at the finish line. Another check off my bucket list! Never did I think I’d hit such a valley after being on such a high, but I believe everything happens for a reason and purpose. My dad taught me that you can’t always control your circumstance but you can always control your attitude towards them. Having epilepsy reminds me of the importance of taking care of myself and running has helped bring balance to my life again. For as long as I’m physically able to, I will continue pursuing new running goals and always moving forward.

What are some of the signs that my body is being over-trained? How do I know when I NEED a day off??

Runner’s World had a great article in the June 2011 issue. To summarize, they recommend paying attention to ten markers. If you say “yes” to three or more of the markers, you should strongly consider taking a day off.

1. You are losing weight.
2. Your heart rate is elevated. This is a sign of stress.
3. You aren’t sleeping well or aren’t sleeping enough. Sleep is necessary to help rebuild the muscle fibers you disrupt with a good workout.
4. Your urine is dark yellow in color. A sign of dehydration. You need to drink water.
5. You feel run down. Be honest with yourself on this one.
6. You are in a bad mood.
7. You feel sick.
8. You have pain or an injury.
9. You had a bad workout or multiple workouts.
10. Your oxygen levels are low (as measured by a pulse oximeter). Most people will not be able to monitor their oxygen levels and thus this marker will likely not apply.

Visit Runner’s World and click on the article “10 Signs That You Need a Rest Day” for more details.   Ultimately, you need to listen to your body and give it the rest it deserves when it needs it.

Modified from Runner’s World

Amy Flick is a graduate of Marquette University, Milwaukee, Wisconsin. She obtained her Bachelor of Arts in Psychology and a Master of Physical Therapy. She is an Orthopedic Certified Specialist and a member of the American Physical Therapy Association. For more information visit: www.thedacareorthoplus.org or call 920-831-5050.

Hydration is the No. 1 intervention in providing performing-enhancing effects when running.  When exercise or any event lasts more than 60-90 minutes, fueling is crucial to keep energy levels high and not deplete the glycogen stores in the muscles. Sweating increases electrolyte loss, which can cause up to a ten percent loss of contractile strength and an eight percent loss of speed while training. Hydration is important before, during, and after competition.  Luckily, fluid can be consumed in various forms, such as fruits and veggies, milk and smoothies, fruit juice, sports drinks, water and soups.

Fluid recommendations for prior to exercise include:

• Drink approx 7 ml/kg of body weight two hours before exercise
• If weather will promote profuse sweating, drink an additional 3-4 ml/kg of body weight within 20 minutes of exercise

Fluid recommendations during competition include:

• Start drinking early and often
• Drink 4-8 oz every 15 min. per hour of exercise
• Practice with hydration during training so your body can adapt to the water demand
• If event or training is more than 60 min., sports drinks should be used to accommodate the sodium loss

Fluid recommendations after competition include:

• For every pound of weight lost, replace with three cups of water or sports drink
• If urine is a dark yellow, that is an indication that you need more water

Hydration packs are also an option for use when training and during competition to ensure you have adequate fluid intake throughout the run.  Options include a belt with water bottles, a handheld water bottle, or a backpack hydration system for example.

Fueling

When exercising for greater than 60-90 minutes, a snack is necessary for energy stores. This snack should be about 200-300 calories. It should be eaten at least an hour prior to exercise and could include such foods as:

• Yogurt, milk, cheese
• Bananas, apples, pears, grapefruit
• Oatmeal, bran muffins
• Bean soups, lentils
• Energy bars

Post workout foods for recovery should be consumed with training lasting greater than 45 minutes. The optimal time for replenishment after exercise is 30-60 minutes post workout.  Options for replacing glycogen stores include:

• Bagels, rice cakes, graham crackers, popcorn
• Cranberry, apple, orange juice Baked potato, couscous, rice
• Raisins, watermelon, banana, orange
• High fiber/low sugar dry cereal
• DON’T FORGET TO ADD PROTEIN WITH THESE OPTIONS!!

During competition or training, use of gels, shot blocks or sports beans can be used for additional energy stores with exercise lasting 60-90 minutes.  It is very crucial to consume at least 8-10 oz of water with these gel options to avoid stomach cramping.

Below is a chart with examples for proper fueling during various exercise durations

Becky Czechanski received her bachelor’s degree in exercise physiology and her doctorate degree in physical therapy from Concordia University in Milwaukee. She is also a certified strength and conditioning specialist.

1. How long have you been a physical therapist? 32 years, since October 1979.
2. How long have you been a runner? 38 years. I started my sophomore year of high school.
3. How long have you been barefoot running? I’ve been doing it in earnest for the past three years. Prior to that I “dabbled” in it just kind of intuitively because I knew it felt good and seemed to have a positive influence of my legs. I would do it back then (15 or more years ago) after doing speed work on a track. I would finish the workout running a mile or so barefoot on the grass just on the inside of the track.
4. Why did you start? I began running seriously three years ago because of a long standing hamstring and heel pain as a result of being in a cast for six weeks for a major knee surgery in 1982. I also had surgery on my right knee in 2006 for a cartilage problem after which I was I was told to seriously consider not running at all due to risk of progressive arthritis. It was around that time I read an excerpt of Chris McDougall’s book “Born to Run,” and as soon as I read it, I knew it was for me.
5. Do you wear shoes for barefoot running, if so which ones? Do you go purely barefoot? Right now my runs are generally 3.5 – 4.5 miles in length. I generally am doing the majority of true barefoot running on grass such as at Plamann Park in Appleton or another smaller park closer to my house. For pavement or concrete or gravel or rocky trails (such as through the Thrivent complex), I use very flimsy, light Vibram 5-Fingers, which are like thin rubber-soled gloves for the feet. This summer I plan on also running on trails through Bubolz Preserve using the Vibrams. For races, I use some of the new breed of minimalist running shoes such as Nike Free or currently Saucony Kinvara, which are basically stripped-down racing flats.
6. Do you run with shoes as well? I personally am forever done with conventional cushioned or stability-oriented running footwear.
7. How far do you run barefoot? Would you run a half-marathon or marathon barefoot? In order to conserve my knees, I am keeping my mileage low at the present time. If I continue to be successful in reducing the effects of previous chronic running injuries, I hope to play with some increasing mileage if the knees allow. I would love to be able to do a half marathon in the Vibrams. It is becoming more and more common to see people do so.
8. What are the benefits of barefoot running? Are you faster, stronger, what specific muscles do you work? There is a fair amount of research being undertaken in this field. The theory is that encasing our feet in all this cushioning that we think is preventing injury is actually contributing to even more injury. The intrinsic muscles of the feet are atrophied due to disuse because of lack of appropriate contact with the ground. The shoes themselves promote a heel-strike running gait which causes stresses and strains up the kinetic chain and can actually lead to more injury. Running barefoot (or in true minimalist footwear) results in an immediate change in running style to a more mid-foot to fore-foot type contact with the ground, which is much more natural and more joint- and soft tissue-friendly. The intrinsic musculature of the feet “wakes up” and get stronger and the more mid-foot type of contact with the ground is less stressful on the knees.
9. How long did it take you to get used of barefoot running? A long time!! Actually many months. I’m not there yet. I’m determined to ease into it over a period of years if need be to avoid getting injured. It takes a long time and has to be incorporated very slowly. In my own personal case it is worth the effort. Hamstring and plantar fascia symptoms of the past are getting noticeably better and my “meniscus-challenged” other knee is holding up well thus far.
10. Enquiring minds want to know: what do you do about stones? Glass? Nails? It does force you to pay close attention to what’s in front of you!! But also that is the driving force behind the Vibrams and other minimalist footwear to offer a degree of protection form the dangers to the skin and yet to not totally get away from the barefoot experience and benefits. There is a definite difference in the experience of running totally barefoot and using even flimsy shoes, but one has to use some common sense and draw the line somewhere. I go totally barefoot on grass and will wear Vibrams when on concrete, pavement or rocks.
11. Does it hurt to run barefoot? It hurts if you’re doing it wrong, but what most people find is that when you take your shoes off and run, your body almost automatically changes to a more normal foot strike so it doesn’t hurt. If you’re running barefoot and trying to land heel first, it does hurt.
12. Do you run races barefoot? Not yet, but it is a possibility for the future
13. Is barefoot running really good for you? I know it is for me, and also apparently for an ever-increasing group of folks. Is it good for everyone? We’ll see, but I would suspect there will always be people whose foot structure will always do better with shoes. I think most runners would benefit from at least a few miles of barefoot running to strengthen the feet such as the way I started on grass on the inside of a track.
14. What does your podiatrist say about the calluses? Do you pumice more often? I have actually found that with running barefoot my calluses are actually better. We’ll see what happens as I put more barefoot miles on actual pavement or concrete but I doubt at this point they will get any worse.
15. Would you recommend others try barefoot running? Why or why not? If a runner has a significant history of chronic injuries such as I did, I would say you have nothing to lose and a lot to gain by at least incorporating a few low intensity, easy miles per week on a grassy surface and see what happens. It is my true belief that if you do it right and give it a fair shot, most runners will be pleasantly surprised.

Teresa L. Iattoni received her bachelor’s degree in anatomy and physiology and a master’s degree in physical therapy from Andrews University in Berrien Springs, Mich. She holds basic and advanced certification in Leduc Method Lymphedema Management and is also Lebed certified.

Tim Hatlestad received his bachelor’s degree in physical therapy from the University of Wisconsin-LaCrosse. He has also taken courses in manual therapy and exercise rehabilitation, including attending the Michigan State University Osteopathic School Continuing Education series. For more information visit: www.thedacareorthoplus.org or call 920-831-5050.

LOW PLANK: Lay face down. Lift your upper body and hips off of the floor and support your weight on your elbows and your toes. Tighten your abdominal muscles and your buttocks. Your body should be in a straight line. Hold this position for 30 seconds. Repeat 3-5 times.

SIDE PLANK: Lay on your side supporting your body weight on your elbow and your feet. Lift your body so your hips are in a straight line with your head and feet. The top arm can extend toward the ceiling or rest on your side. Hold this position for 30 seconds. Repeat 3-5 times.

INCHWORM: Stand with your feet on the ground and your hands on the ground in front of you. Walk your hands away from your feet until your body is parallel to the ground. Do one push up. Walk your feet in toward your hands to return to the starting position. Repeat 10 times.

HOT FOOTED LIZARD: Lie face down supporting your body weight on your hands and feet. Keep your elbows straight. Spread your hands and feet wide. Maintaining a stable body, try to touch one hand to the opposite foot. Repeat on the other side. Repeat this exercise 10 times on each side. Repeat for 2 sets.

Amy Flick is a graduate of Marquette University, Milwaukee, Wisconsin. She obtained her Bachelor of Arts in Psychology and a Master of Physical Therapy. She is an Orthopedic Certified Specialist and a member of the American Physical Therapy Association. For more information visit: www.thedacareorthoplus.org or call 920-831-5050.

BAND WALKING: Stand with a resistance band tied around your ankles. When performing the exercises listed below, maintain tension on the band throughout the exercise.

SIDE STEPPING: Step to the side against the tension of the band. Repeat 10-20 steps to the right and then 10-20 steps to the left.

FORWARD AND BACKWARD STEPPING: Stand with your feet at least shoulder width apart. The band should be on tension. Take a step forward with one leg, keeping the feet wide. Repeat with the opposite leg. Continue to walk forward for 10-20 steps. Return to your starting position by walking backward.

BRAIDING: Stand with your feet hip width apart and tension on the band. Cross your right leg behind your left leg, maintaining the tension on the band. Step your right leg out to the side. Cross your left leg in front of your right leg. Step your right leg out to the side. Repeat this sequence alternating crossing the leg in front and then behind for 10-20 steps. Repeat in the opposite direction for 10-20 steps to return to your starting position.

SQUATS: Stand with your feet just wider than your hips. Your toes, knees, and hip should all point straight ahead. As you bend your knees to squat, keep your toes, knees, and hips pointing straight ahead. Do not let your knees come together. Your knees should not go past your toes. Keep your chest tall and your buttocks down. Repeat 10-20 times and perform three sets.

STATIONARY LUNGES: Stand with your feet staggered and hip width apart. Your toes, knees, and hips should all point straight ahead. Seventy-five percent of your body weight should be over the front leg. Lower your body so that your front thigh becomes almost parallel to the floor. Your knee should not go past your toes and your knee should not fall inward. Return to standing. Repeat 10-20 times. Switch legs. Perform up to three sets.

Amy Flick is a graduate of Marquette University, Milwaukee, Wisconsin. She obtained her Bachelor of Arts in Psychology and a Master of Physical Therapy. She is an Orthopedic Certified Specialist and a member of the American Physical Therapy Association. For more information visit: www.thedacareorthoplus.org or call 920-831-5050.