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Managing tendinopathy in dancers and dance students

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What is a tendon?
A tendon connects muscle to bone and is designed to absorb force. They act as a spring that stores energy that allows a dancer to produce and absorb force, such as jumping higher. Tendons are made up of flat cells called tenocytes that lie in rows between collagen fibres. There is minimal blood and nerve supply in the normal tendon.


Tendons response to load
Like bones and muscles, tendons adapt to the load that is placed on them. Activities such as jumping and running are called plyometric activities and maximally load a tendon. This is due to the energy storage and quick release in the tendon (similar to if you flick a rubber band across the room). There are high load and low load activity types tendons go through.
Examples of high load activities in ballet would be petite and grand allegro (bigger jumps and greater distances traveled) as opposed to low loads such as barre work and adagio. Tendons have a specific capacity they can withstand in terms of load. The normal response to an increase in load, is to become stiffer. If the tendon is being loaded gradually with sufficient recovery time, it will be able to adapt to the demand being placed on it and it will be able to cope. If there is too much of an increase too quickly, and/or insufficient recovery time is being given, it will go through changes at the deep cellular level that are considered pathological changes.

Tendon changes
Reactive tendinopathy
This usually occurs with a sudden change in activity such as returning to a normal dance load after holidays or returning from injury, or increasing rehearsal and class hours for an upcoming performance. The response of the tendon in this stage is to draw water into the cells in order to thicken it by increasing the surface area so it’s able to withstand the new added forces. At this stage whilst it is technically swollen, there is generally no evidence of inflammation.

The tendon is able to recover in this stage which normally takes approximately 3 days which is done by reducing the load. If the load is not reduced, however, it will progress towards dysrepair (failed healing).

Dysrepair
Proteins continue to increase in the tendon which can cause gradual separation of the tendon fibres and disorganization of the collagen. New blood vessels and nerves also begin to grow in the tendon during this phase and depending on load management and modification, the tendon can still heal.

Degenerative tendinopathy
If the tendon is continuously overloaded and unable to repair itself, it will then progress into degenerative tendinopathy. In this stage, the tissues have begun to break down and there is apparent cell death which is unlikely to be reversible. If there is still healthy tissue surrounding the damaged cells, it can be strengthened and the dancer can return to full work load without pain. If the tendon is continuously loaded, it can result in a rupture which will need surgery.


FUN FACT!

If a tendon is “unloaded” (where it is braced or placed in a cast) it can have a similar effect as if it was overloaded. This is because the tendon is unable to be strengthened, so the healthy tissue becomes weak. Additionally, once the pain has settled and the dancer goes back to training because the healthy tissue is now weaker, the tendon’s baseline strength has been
diminished and can be now overloaded much more easily. It is important to gradually strengthen and load the tendon to improve its capacity.

How do we manage and modify load appropriately?


Generally, tendons don’t like change and like consistent load. They respond well to strength training, particularly heavy, slow resistance training and don’t respond well to a sudden increase in jumping, running, and quick changes of direction.

  • Slowly increase jumping, running and changes of direction in new choreography seasons and allow several days of recovery in between. This applies to students (particularly young students) who are progressing through levels and participating in workshops or intensives.
  • Gradually increasing and decreasing activity should be applied at the start and end of term.
  • A strengthening program should always be maintained to keep baseline tendon capacity at its highest.
  • A dancer should never completely rest with tendon problems, they should have relative rest. This means avoiding provocative activities such as jumping but should participate in class as much as possible or participate in strength training as the injury allows.

But as always, it’s best to book in to see a physiotherapist for assessment and appropriate management.

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Helen Shang
Helen Shang
08:07 11 Mar 21
After Oscar left the company, the staff there not really care patient, so disappoint
Howard Pink
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Dr Louis is the best! He fixed me so many times. Highly recommend!
B A
B A
01:39 22 Jan 21
Hopefully I'm never injured again, but if I am, Jay at BodyFocus will be my first point of contact. He helped immensely... with a nagging & long term Shoulder & Lower Back injury.I highly recommend him to anyone in need of a quality Physio.read more
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NICHOLAS ABI ESBER
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I would highly recommend this Physio clinic as they prove to give results to their clients especially Jay!
rupsikha baruah
rupsikha baruah
11:26 25 Feb 20
Friendly staff. Lvl 8 in Rhodes Shopping Centre..accessible via lift. You have to pay..check for discounts.
Fahad Alotaibi
Fahad Alotaibi
00:10 28 Nov 19
Excellent service with dr Louis. Have really back pain due to having a bad massage previously. So he really... helped.Thanksread more
Mellissa Admin
Mellissa Admin
01:01 11 Sep 19
I work in the local area and have found Bodyfocus to be amazing and would highly recommend. I had the pleasure of... having Sarah as my physio and she was friendly, knowledgeable and professional. She explained my injuries to me in easy to understand language and was able to get me back on my feet quickly. Every interaction with staff at Bodyfocus has been extremely positive and helpful. Would not go anywhere else now for physio.read more
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Vanessa reinmuth
06:48 07 Sep 19
Would recommend this place in a heartbeat! The service and care provided is second to none. In particular, I'd like to... call out Lauren who has been nothing but amazing, supportive and genuinely interested in how I'm progressing. I injured my hip and initially went to a physiotherapist closer to where I live, but my condition didn't get any better, so I decided to come over to Rhodes and give Bodyfocus a try - right after the first session I felt an instant relief. That was a few weeks ago and my mobility has been steadily increasing, while the pain has become so much better. Lauren also motivated me to exercise and I actually enjoy it. Overall, it's just been a fantastic experience.read more
Yuyan Cai
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00:43 04 Sep 19
Highly recommend Sarah. Her attitude and knowledge has made my recovery a quick and easy process. She has a great... understanding of how the body works and teaches you the process to live life to the fullest.Do not hesitate to reach out and connect with this amazing physio!read more
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Lucy-May Pitt
Physiotherapist

Bachelor of Physiotherapy (Charles Sturt University)

Lucy is a passionate physiotherapist who graduated from Charles Sturt University Albury- Wodonga

With a background as a professional ballerina in both Australia and the UK, Lucy has gained an in-depth understanding of the demands that sport can put on the body and the physical and mental requirements to become a successful athlete. Unfortunately Lucy’s career was cut short due to injury, which is what inspired her to become a Physiotherapist. She is passionate about injury recovery and prevention and works with her patients to keep them as active as possible while they heal. 

With an interest in sports, Lucy was the Head Sports Trainer with an O&M league AFL team in Albury for 

2 seasons where she worked with the team on injury prevention and attended to the players injuries on

 the field. She also has experience in Women’s Health and Vestibular conditions as well as inpatient

 rehabilitation in hospitals. 

Lucy uses a combination of hands on therapy, taping, mobilisations and dry needling techniques to

 accompany her exercise based approach. She also has experience teaching both mat based and 

reformer pilates and believes it is an excellent way to aid in injury prevention. 


Having recently moved to Sydney, Lucy is on the hunt for the best hiking locations! In her spare time, 

you can find her at the gym exploring Sydney with friends of getting stuck in a good book

 

Lucy has completed advanced training in: 

  • Sports trainer level 1 
  • Trigger point Dry Needling 
 

Sabina Bireroglu

BHlthSc/ MPodMed Podiatrist

Sabina has completed a Bachelor of Health Science/Mastering in Podiatric Medicine at University of Western Sydney. She has experienced working in different treatment settings including private practice, hospitals and mobile care. One experience in which takes forefront in her experiences is working in Ireland at Merlin Park Hospital.

She incorporates evidence based treatment plans in all scopes of podiatry including the general and chronic foot, injuries and pain, nail surgery, biomechanics and paediatrics. Outside of the clinic environment Sabina enjoys running, playing netball and playing the violin.

Dr Louis Darmizin

Chiropractor

From early childhood, Louis was exposed to Chiropractic due to his scoliosis and constant back pain. Being only 10 years of age, he was unable to participate in social and sports activities in fear of being in pain. Upon seeing the benefits of Chiropractic for his back, Louis focused his life on helping others achieving a pain free and healthy lifestyle.

Louis graduated with a Bachelor and Masters of Chiropractic Science from Macquarie University. After practicing in the best clinics in Sydney, he is now the founder of Dynamic Spine Clinic. He is a very passionate and motivated practitioner that makes your problems his own.

Louis has a extensive knowledge in posture and back related injuries. He combines his treatment with soft tissue therapy, acupuncture, rehabilitation and lifestyle advice. His treatments are individualized to suit each patient in order to achieve the best outcome possible.

Louis has a passion for soccer, tennis and rugby. He also earned local, regional and state level competition titles as a squad swimmer.

His goal is to inspire, educate and encourage his patients to reach a happy and enjoyable lifestyle. He believes that Chiropractic care is an essential tool to maintain wellness, improve posture, eliminate pain and stress.

Sarah D’arcy

Physiotherapist - General & Women's Health Physiotherapy

Sarah is a passionate physiotherapist who graduated with distinction from Charles Sturt University, Orange, NSW. Sarah has worked within the public health system and has experience in orthopaedic, fracture clinic, medical, respiratory, musculoskeletal, rehabilitation, hydrotherapy, emergency department, intensive care and women’s health physiotherapy.

Sarah has an interest in all areas of musculoskeletal physiotherapy and is always looking for opportunities to expand her knowledge to grow as a clinician. Sarah is highly ambitious and applies herself in all areas of work and life. She is driven by her desire to become a go-to physiotherapist by providing the best evidenced-based care to all of her clients to achieve positive outcomes. Sarah enjoys staying active, being outdoors, and socialising. Sarah enjoys new experiences and is always willing to try new things. Sarah believes you can achieve anything if you put your mind to it and are willing to put in the effort.

Sarah has completed training in comprehensive assessment and treatment of the pelvic floor. This includes complete subjective and objective (including internal examinations) of pelvic floor problems, such as:

  • Bladder and bowel issues
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  • Pregnancy related back pain
  • Pre and postnatal exercise
  • ProlapseTears during child birth

Sarah consults from our Rhodes clinic.

WILSON HUI

APA TITLED MUSCULOSKELETAL PHYSIOTHERAPIST

Wilson graduated from University of Sydney as a physiotherapist and he has always been keen on learning new things so that he can do what is best for patients. On top of ongoing professional development, he completed a Master in Musculoskeletal Physiotherapy from University of Melbourne to gain further knowledge.

Wilson has worked in various private practices in the past and managed a variety of clienteles, from acute musculoskeletal and sports injuries to pre/post-op rehabilitation, and from injury prevention to performance enhancement. He has also done a range of sports coverage as a physiotherapist, such as City2Surf and Sydney Half Marathon etc.

Wilson has done extensive training and obtained certifications in multiple techniques and areas, below are some examples but not limited to:

  • Dry Needling
  • Mulligan’s Concepts
  • McKenzie Method of Mechanical Diagnosis and Therapy
  • Kinesio Taping
  • Sports Level 1 and 2

When Wilson is not working and not injured (if injured, rest and doing own rehab), he plays competitive table tennis. He is also a recreational road and trail runner.

Wilson can speak Cantonese and Mandarin.

Jay Kasthuriarachchi Senior Physiotherapist

APA Sports and Exercise Physiotherapist
Masters of Sports Physiotherapy (La Trobe)

Jay is a relaxed yet attentive and thorough physiotherapist whose passion lies in sports and musculoskeletal physiotherapy. He has worked in private practices in North Sydney and Richmond, as well as doing sports coverage work over a variety of sports including Gridiron, Football (Soccer), Rugby Union, Rugby League, AFL and is currently the lead physiotherapist of the West Tigers Under 21’s (Jersey Flegg). This opportunity has allowed him to spend time with the NRL squad, assisting with the rehab of their injured 1st grade players. He was also recently part of the medical team working at the GoldCoast Commonwealth Games in April 2018.

Jay has recently completed his postgraduate qualifications in Sports Physiotherapy at La Trobe University. This course allowed him to learn of senior physiotherapists at the GWS Giants, and Rugby Australia, learning their rehab techniques and long term injury prevention strategies. Jay is extremely knowledgeable and skillful with the ability to lead you to excellent results. He will find out why you cannot perform at your peak and develop a treatment plan that addresses your goals.

Jay also has had experience playing cricket, having played 1st grade cricket for the North-West Sydney Hurricanes in the Sydney Shires Competition and understands the frustration that “weekend warrior” athletes have with missing out on playing sports due to an injury.

He has completed advanced training in:

  • Advanced Hip and Groin
  • Sports Level 2 (APA)
  • Trigger Point Dry Needling
  • Strength and Conditioning Coach Level 2