Inside Pediatrics Winter 2015

Dance is different from most sports. Instead of speed and power, it requires flexibility, control and grace. This is why Reed Estes, M.D., Chief of UAB Sports Medicine at Children’s of Alabama, has developed a growing specialty in dance medicine. Estes received his bachelor’s degree from The University of Texas at Austin and his medical degree from The University of Texas at San Antonio Medical School. He then completed his orthopedic residency at the University of Alabama at Birmingham (UAB) and a pediatric sports medicine fellowship through Harvard Medical School at Boston Children’s Hospital. An athlete himself, Estes has always been interested in the types of injuries and medicine associated with sports, but that interest evolved to include dance during his fellowship at Boston Children’s. The dance medicine program there showed Estes a different side of sports medicine and gave him the opportunity work with several dance companies, including the Boston Ballet. While at Boston Children’s, Estes learned that dancers require a different approach to care and treatment. Dance medicine focuses on the prevention and rehabilitation of dance-related injuries by applying specialized care to the individual body, technique and lifestyle of a dancer. For example, most sports are seasonal, while dance is year-round—there is no off-season—so treatment must be adjusted accordingly. Other factors to consider are age, gender, mobility, prior injury history, muscular strength, cardiovascular fitness and the individual’s personal dance style. External factors that come into play in dance include lighting, staging, type of flooring, costumes and shoes. Many dancers who come to Estes for care have been managed well in general, but not properly for dance because of the

Dancers must be limber and able to perform difficult combinations of elements while also being aesthetically pleasing and maintaining full stamina. Dance rehabilitation focuses on that. “If injury has already occurred in a dancer, there are often different requirements than those for treating a different kind of athlete,” Estes said. Estes employs a multidisciplinary approach to the care and treatment of his dance patients by partnering with sports medicine experts who are also dancers themselves, including athletic trainer Megan Steirer. The program also works with Agile Physical Therapy, which employs a former Alabama Ballet dancer and has an excellent dance clinic. These partnerships enhance the program’s ability to serve dancers from across the Southeast that come seeking treatment. Under Estes, the dance medicine program at Children’s works to make sure that dancers receive the specialized care they need to perform with both grace and stamina. More information is available at www.childrensal.org/dancemedicine. Pediatric sports medicine physician and orthopedic surgeon Reed Estes, M.D., has created one of the few dance medicine programs in the U.S. at Children’s. Most of his dance patients seek treatment for injuries that commonly occur when they go en pointe in ballet.

specialized technique and movement involved. “Dance is unique because it is nothing like football or soccer,” Estes said. “It takes doctors who are genuinely interested in dance and know the dance language to care for the dancers properly. They have to understand the unique demands and nuances of movement involved in dancing.” According to Estes, foot and ankle injuries account for nearly half of injuries in dancers and typically include sprains, fractures and ligament tears or strains. About two-thirds are the result of overuse and are related to cumulative microtrauma rather than a single incident. The cumulative nature of the injuries is most often related to chronic positioning faults in combination with muscular imbalance and strength deficits. Growth spurts put young dancers at increased risk of injury because as the proportion of limb-to-torso length and body mass change, fluctuations in coordination and balance often result, along with a decrease in strength and flexibility. Dancers are also more prone to injuries when fatigued or under high stress. Of all the forms of dance, ballet has the highest risk of injury. Many of his patients seek treatment around ages 12 to 14, when they are transitioning to a higher level of dance, usually dancing en pointe. “The rite of passage in which ballet dancers begin dancing on the tips of their toes is a little like the curveball in youth baseball,” Estes said. “Start doing it too soon, and trouble is likely to follow.” Increasing treatment options and general awareness have improved the prognosis of most dance-related injuries. The first line of defense is awareness and preventing significant injuries before they happen. “While most dancers will suffer at least one major injury in their career, most are manageable,” Estes said. “It’s rare to see injuries beyond anything we can care for.”

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