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| HEALTH & FITNESS |
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When dance gives you pain Low chloride levels up risk of death
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When dance gives you pain Dance is a type of performing art that requires special physical movements of different body parts. The professional dancers require well-developed muscles and a slim and flexible body, which is a blend of high stamina of an athlete and a high flexibility of a gymnast. The training of the elite dancers usually starts at around eight years of age. This can put intense physical and emotional demands on the dancers during the early years of their life. In the last two to three decades, a sharp rise has been noticed in the medical problems of dancers. It is mainly due to higher number of problems being reported as well as a higher incidence due to dance being practised as a profession and a race for success resulting in high level of competitiveness. It has been observed that of the 61 common sports, only American football is more physically demanding than ballet dance. The injury rate amongst elite dancers has been assessed to be 70 per cent to 90 per cent, while almost 60 per cent dancers may have been disabled due to dance injuries. In a study of 1,233 aerobic dancers, 43.3 per cent of students and 75.9 per cent of instructors reported dance injuries. For every 100 hours of dance, 1.01 injuries occurred. The science of dealing with dance injuries has evolved in the recent years as a sub-specialty under the ambit of the broader specialty of sports injuries. Apart from the injuries, dancers are prone to some specific medical problems which are quite similar to that of sportspersons. Why these occur In more than 50 per cent cases the injuries are caused by lack of warm-up, faulty technique, an unconditioned body and intensive fatigue. The extrinsic causes include inappropriate dance floor and extremes of environmental temperature. A carpeted concrete floor has been associated with more injuries than a wood-over-airspace floor. The dancers often suffer from overuse injuries. In order to stay in the competition, the dancers tend to over perform or practice excessively and conceal initial minor symptoms leading to chronic injuries. Joint laxity and hyper-mobility are considered to be the great assets for all dancers but these two assets also make the dancers, more prone to injuries. Dancing for the purpose of recreation in social functions, especially under the effect of alcohol, has at times resulted in serious knee injuries requiring surgery. Pattern of problems About 50 per cent of the dance injuries pertain to foot, ankle, knee and thigh. Ankle sprain and stress fracture are common injuries experienced by dancers. Resumption of the dance practice without compete cure of the ankle sprains and stress fractures often results in chronic problems. In classical ballet dance, the need to dance enpointe (dancing on tip of toes), wearing pointed shoes with the rigid toe box, practice of turnouts (extreme outsiderotation of the legs) and plié (bending down with hips turned out), with repetitive jumps and landing, places special stress on the lower extremities resulting in over 60 per cent of ballet injuries involving the lower extremity. In folk dances, dynamic overload and repetitive excessive use often result in shin splints and stress fractures of the tibia (leg bone), metatarsals (foot bones), femoral neck (hip joint) and lower fibula (near ankle joint). Dancers dancing more than five hours a day have a higher risk of sustaining a stress fracture. The dances that require sitting, kneeling or lying on the floor and throwing the body across the floor during a performance are more prone to 'floor burns' (abrasion) which occur due to friction and contusions between bony prominences and the floor. Dancing barefoot also predisposes to plantar callosities, fissures and lacerations. Modern dancers are also at risk of knee injuries from patella-femoral compression during floor work, as well as ligament or meniscal injuries during sudden twists and turns. Common woes
Management
First aid
"RICE" therapy is the best form of first aid for all the dance injuries at the site of injury before the medical aid becomes available. Pain and inflammation can be reduced using a non-steroidal anti-inflammatory drug (NSAID). During the rehabilitating period, range of motion and strength should be restored before resuming the dance practice. A limited range of motion and weakened extremity predisposes the dancer to a second injury even if the initial one has apparently healed. Surgery should be avoided as far as possible. However, the injuries requiring surgery should not be delayed with a wishful thinking of healing with non surgical measures. A special dance clinic significantly facilitates early effective management. A team of a sports therapist and an orthopaedic surgeon trained in sports injuries is the recommendation for every dance school. Professor, Orthopaedics, Government Medical College Hospital, Chandigarh
Other medical problems
Eating disorders The aesthetic requirement of dance often calls for a slim figure. A good ballet dancer usually weighs 12-15 per cent below the ideal weight. Ballet dancers often indulge in aggressive dieting. In a study on adult female ballet dancers, the incidences of deficiency of vitamins A, B and C and iron, calcium and zinc were about 40 per cent and 60 per cent, respectively. Dieting and nutritional deficiency contributes to delayed menarche, menstrual irregularities, hypo-oestrogenaemia and subsequent osteoporosis. The combination of intense exercise, low-body weight and body fat, dietary restrictions and the psychological stress of performance and training contributes to menstrual dysfunction in dancers. In a comparative survey of collegiate dance students, the overall incidence of amenorrhoea (stoppage of menstruation) was 13 per cent and of oligomenorrhoea (decreased menstruation) was 15 per cent. It has been postulated that 17 per cent of body fat weight is required for menarche, and 22 per cent of body fat is required for resumption of menses after secondary amenorrhoea caused by weight loss. Osteoporosis Osteopenia and osteoporosis are well documented in dancers although dance as an exercise is supposed to have a protective effect in preventing osteoporosis. The dancers are at special risk for osteopenia, due to low body weight, nutritional deficiency and menstrual disorders and resultant hypogonadism. Psychological problems Dance practice demands obedience, perseverance and a total dedication. Low weight requirement is an important source of psychological stress among dancers. Open criticism of injured dancers and a psychological pressure of mentors and choreographers to resume dancing before restoration of healthy body from injuries often exacerbate the problem. Serious injuries, fear of fall from top position or anticipated retirement in professional dancers have been related to depression, substance abuse and suicidal tendencies.
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Low chloride levels up risk of death
London: Low levels of chloride are associated with higher mortality rate and cardiovascular disease in people, according to a new study led by an Indian-origin physician. A study by researchers at the University of Glasgow has revealed that low chloride levels in the blood is an independent indicator of mortality risk in people with hypertension. The role of chloride in hypertension has received little attention from scientists hitherto. After analysing data from almost 13,000 patients with high blood pressure, followed up over 35 years, the researchers found that low levels of chloride were associated with a higher risk of death and cardiovascular disease. The group with the lowest level of chloride in their blood had a 20 per cent higher mortality rate compared to the other subjects. The results are published in the journal Hypertension. Dr Sandosh Padmanabhan of the Institute of Cardiovascular and Medical Sciences, said in a statement today, "Sodium is cast as the villain for the central role it plays in increasing the risk of high blood pressure, with chloride little more than a silent extra in the background." However, our study has put the spotlight on this under-studied chemical to reveal an association between low levels of chloride serum in the blood and a higher mortality rate, and surprisingly this is in the opposite direction to the risks associated with high sodium. It is likely that chloride plays an important part in the physiology of the body and we need to investigate this further. Chloride is already measured as part of routine clinical screening and so monitoring of chloride levels could easily be incorporated into clinical practice to identify individuals at high risk. Dr Padmanabhan said, "The results we see from this study are confounding against the knowledge that excess salt is a bad thing, yet higher levels of chloride in the blood seems to be an independent factor that is associated with lower mortality and cardiovascular risk." We seem to have entered a grey area here that requires further investigation. It is too early to draw any conclusions about relating this finding to salt intake and diet. — PTI |
Health Notes
Menstrual dysfunction
Too much salt in the diet and specifically sodium is widely acknowledged as a major risk factor for high blood pressure, however scientists have found that salt's other overlooked constituent chloride might also play an important role.