225: Dr. Claire Hiller: Rehabilitation for Dancers

On this week's episode of the Healthy Wealthy and Smart Podcast, I welcome Dr. Claire Hiller to the show to introduce us to dance medicine and how physiotherapists can break into the industry. Dr. Hiller is a physiotherapist specializing in dance injuries and her current research interests at the University of Sydney include further development of the Cumberland Ankle Instability Tool, prevalence and impact of chronic ankle problems, predictors of chronic ankle instability, dancers' lower limb injuries, and dance footwear.   In this episode, we discuss: -Common injuries of the spine, knee, and ankle seen in dancers -In-depth analysis of the lateral ankle sprain vs the high ankle sprain and differential diagnosis -Pre-pointe assessments and when to give your dancer the green light -How a medical professional can effectively collaborate with dancer, dance teacher, and parent -And so much more!   Dr. Hiller encourages physical therapists to pursue their interest in dance medicine by taking continuing education courses regardless of their current background. She states, "Physical therapists and other allied healthcare professionals are trained to watch people move… Dancers are very forgiving, if you even show a glimmer of the fact that you have an understanding of just the basics that go into dance, and you know what to look for and how to look for it, and you understand the body and how it moves and how it all connects, then you can be just as good if that's the field you want to go into."   In dancers, lateral ankle sprains usually don't occur in isolation and a full ankle assessment is necessary for a realistic prognosis back to sport. From her experience, Dr. Hiller has found, "Dancers will often do something at the base of the outer part of their foot. Dancers can also have a high ankle sprain component again because they are coming down from a [demi-pointe position] and that's often missed. People will go back far too soon if they have that. It's a really important injury to stay longer off than even your lateral ankle sprain."   Dr. Hiller believes that parents should be tuned into their child's complaints of pain and advocate early on for preventative care. "Some ways of training is you power on through everything. The life of a dancer is to live with pain, to be able to cope with pain. When you have pain, it is nothing unless you're laid out on the floor and can hardly move. If your child is complaining of pain, and their consistently complaining of pain, don't wait till they are nagging you that they're having pain. Listen to them when they start to say they have pain in my back, pain on the side of my knee, pain in my ankle, pain in my foot."   Physical therapists have the training to facilitate a safe progression to pointe. Dr. Hiller illustrates this role, "A pre-pointe assessment is about whether your child is actually ready for that step of putting your pointe shoes on. It's not just about being able to put the pointe shoes on and balance, you've got to be able to have the strength and the control at a certain level before you can safely get up on your pointe shoes. And not just safely, once you get up there and actually be able to do something and enjoy it."   For more about Dr. Hiller: Dr. Hiller has been awarded a Postdoctoral Fellowship at the University of Sydney to study ankle sprain and instability. Her current works aims to build on her doctoral studies which included: the development of the Cumberland Ankle Instability Tool (CAIT), an objective measure of functional ankle instability; finding bilateral changes following unilateral ankle sprain; and proposing a modified model of chronic ankle instability. Dr. Hiller is also a practicing physiotherapist with a special interest in dance injuries. She has been involved in convening specialist interest days at the International Association of Dance Medicine and Science Annual Meetings and recently co-convened the 4th International Ankle Symposium.   Current research interests include: further development of the CAIT, prevalence and impact of chronic ankle problems, predictors of chronic ankle instability, dancers' lower limb injuries, and dance footwear.   Resources discussed in this show: International Association for Dance Medicine and Science Harkness Center for Dance Injuries Dance Movement Therapy Association of Australasia  National Institute of Dance Medicine and Science (NIDMS) Ausdance Healthy Dancer Canada - The Dance Health Alliance of Canada Performing Arts Medicine Association (PAMA)   Articles mentioned in today's podcast: 1) Liederbach MJ et al (2008) Incidence of anterior cruciate ligament injuries among elite ballet and modern dancers. American Journal of Sports Medicine 36: 1779-1788 2)Sman AD et al (2015) Diagnostic accuracy of clinical tests for ankle syndesmosis injury British Journal of Sports Medicine 49:323-329  3) The Hazards of Ankle Sprains NYT July 25th 2016   Dr. Hiller invites you to reach out via email ([email protected]) and connect with researchers, clinicians and students interested in dance related research at Dance Research Collaborative!   Thanks for listening and subscribing to the podcast! Make sure to connect with me on twitter to stay updated on all of the latest! Show your support for the show by leaving a rating and review on iTunes!   Have a great week and stay Healthy Wealthy and Smart!   Xo Karen   P.S. Do you want to be a stand out podcast guest? Make sure to grab the tools from the FREE eBook on the home page! Check out my latest blog post on Managing Expectations: It Shouldn't be That Difficult!