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Exercise enhances creativity independently of mood.

OBJECTIVES: It has been widely accepted in the literature that various forms of physical exercise, even in a single session, enhance positive mood. It has also been shown that physical exercise may sometimes enhance creative thinking, but the evidence is inconclusive. Positive moods can favour creative thinking, but the opposite has also been reported and these relations are unclear. There is a large anecdotal literature suggesting that creative people sometimes use bodily movement to help overcome "blocks". The aim of this study was to establish whether post-exercise creative thinking was attributable to improved mood. METHODS: The responses of 63 participants to an exercise (aerobic workout or aerobic dance) and a "neutral" video watching condition were compared. Mood was measured using an adjective list, and creative thinking was tested by three measures of the Torrance test. RESULTS: Analysis of variance showed a large and significant increase in positive mood after exercise (P < 0.001) and a significant decrease in positive mood after video watching (P < 0.001). A significant increase between the creative thinking scores of the two conditions was found on the flexibility (variety of responses) measure (P < 0.05). A multifactorial analysis of all data failed to show a significant covariance of creative thinking with the two measures of mood (P > 0.05). CONCLUSIONS: These results suggest that mood and creativity were improved by physical exercise independently of each other.

Adult↗

Sport and active recreation injuries in Australia: evidence from emergency department presentations.

OBJECTIVE: Despite the rise in specialist clinical services for the management of sports and active recreation injury, many patients attend hospital emergency departments for treatment. The purpose of this study was to describe sports injury cases presented to selected hospital emergency departments around Australia for the period 1989-1993. METHODS: Routinely collected emergency department injury presentation data from the Australian National Injury Surveillance Unit were examined. Data on 98,040 sports and active recreation emergency department presentations were analysed. Sports and active recreation activities were ranked according to frequency of presentation. Relative proportions of injury type and body region injured were determined. Data are presented separately for children (<15 years of age) and adults (>15 years of age). RESULTS: Among the 10 activities that most commonly led to a sports or active recreation injury presentation for all ages were cycling, Australian football, basketball, soccer, cricket, netball, and rugby. For children, injuries were also commonly associated with roller skating/blading, skateboarding, and trampolining. Hockey, martial arts, and dancing injuries were frequent in adults. Most sporting injuries occurred during organised competition or practice whereas the active recreation injuries occurred in a variety of settings. Fractures, strains, and sprains, particularly to the lower and upper extremities, were common types of injury. CONCLUSION: The rich, but nevertheless limited, information available about sports and active recreation injuries from data collected in emergency departments indicates that these activities are a common context for injury at the community level in Australia.

Adolescent↗

Fracture of lateral process of the talus presenting as ankle pain.

The case is presented of a 27 year old woman with lateral ankle pain after an inversion injury sustained while dancing. Although initial radiographs failed to identify the fracture, radiographs of the ankle at six weeks showed an unsuspected fracture of the lateral process of the talus. The fracture was treated with cast immobilisation for six weeks and the patient is currently undergoing aggressive physiotherapy. A literature review revealed that fractures of the lateral process of the talus are frequently overlooked and should be considered in the differential diagnosis of patients with acute and chronic ankle pain as an early diagnosis and treatment prevent long term complications.

Adult↗

Movement therapy with geriatric patients in a convalescent home.

After several weeks of orientation with staff, the author, a registered dance therapist, established a movement therapy group for long-term geriatric patients in a convalescent home. The purpose was to promote socialization and expression of feelings, partly by recognizing even the most minimal participation in the group. Many patients were severely depressed and disoriented; most were in wheel chairs. Three months later a second group, functioning at a higher level, was formed. During the first six months, patients showed increases in verbalization and spontaneous expression of feelings, in interaction, and in assertiveness.

Aged↗

Becoming multicultural dancers: the pastoral practitioner in a multicultural society.

Uses a dance metaphor in describing pastoral practice. Describes multicultural realities of the United States and argues for the multicultural competencies in the practice of ministry. Details three challenges to overcome: 1) unintentional racism, 2) making visible the invisibility of monoculturalism and "Whiteness," and 3) embracing the complexity of multicultural lived realities.

Cultural Diversity↗

Neurapraxia of the femoral nerve in a modern dancer.

We have presented a case of an acute onset femoral nerve neurapraxia in a pure modern dancer. Repeated mild stretching of the femoral nerve during an established dance routine over a period of several months is implicated as the etiology. The thigh muscles quickly weakened, but regained strength within 3 months. Electromyographic evidence of specific femoral nerve injury initially was negative, but was evident 6 weeks following injury. Overuse syndrome in dancers can cause rapid loss of strength. Other conditions such as herniated intervertebral disc, acute hemorrhage, trauma, iliopsoas rupture, and acute stretching must be ruled out. Complete recovery was the natural outcome.

Athletic Injuries↗

Proprioception in classical ballet dancers. A prospective study of the influence of an ankle sprain on proprioception in the ankle joint.

We studied prospectively the influence of ankle sprains on proprioception as measured by recording the postural sway of classical ballet dancers. Excellent balance and coordination are important for classical ballet dancers, and postural stability requires adequate proprioception from the ankle joint. Fifty-three professional dancers from the Royal Swedish Ballet, Stockholm, and 23 nonathletes, the control group, participated in the investigation. Postural sway was recorded and analyzed with a stabilimeter using a specially designed, portable, computer-assisted force plate. Six dancers sustained ankle sprains during followup. The recordings were obtained of these dancers before and after the injuries. The stabilometry results differed among the male and female dancers and the control group as follows: 1) the male dancers demonstrated a smaller total area of sway, and 2) both the male and female dancers had a smaller mean sway on the left foot than on the right (no mean difference in sway was found between the left and right foot in the control group). In comparison with the condition before injury and with the uninjured foot, the postural stability of the dancer was impaired for several weeks after the ankle sprain. Postural stability gradually improved during rehabilitation and improvement still occurred several weeks after professional dancing had resumed.

Adult↗

A comparative mechanical analysis of the pointe shoe toe box. An in vitro study.

Dancing en pointe requires the ballerina to stand on her toes, which are protected only by the pointe shoe toe box. This protection diminishes when the toe box loses its structural integrity. The objectives of this study were 1) to quantify the comparative structural static and fatigue properties of the pointe shoe toe box, and 2) to evaluate the preferred shoe characteristics as determined by a survey of local dancers. Five different pointe shoes (Capezio, Freed, Gaynor Minden, Leo's, and Grishko) were evaluated to quantify the static stiffness, static strength, and fatigue properties (cycles to failure) of the shoes. Under axial loading conditions, the Leo's shoe demonstrated the highest stiffness level, and the Freed shoe exhibited the least strength. Under vertical loading conditions, the Leo's and Freed shoes demonstrated the highest stiffness levels, and the Gaynor Minden and Freed shoes exhibited the highest strength. Fatigue testing highlighted the greatest differences among the five shoes, with the Gaynor Minden demonstrating the highest fatigue life. Dancers rated the top five shoe characteristics, in order of importance, as fit, comfort, box/platform shape, vamp shape, and durability and indicated that the "best" shoe is one that "feels right" and permits artistic maneuvers, not necessarily the strongest or most durable shoe.

Adult↗

Subtalar subluxation in ballet dancers.

Ankle injuries frequently occur in dancers. Among these injuries, only a few cases of talar subluxation have been reported in the literature. In our series, we diagnosed and treated 25 subtalar subluxations over a 1-year period in the Ballet Béjart Lausanne company. The subluxations occurred after a grand plie on pointes or at the landing of a jump on demi-pointes, without any mechanism of ankle sprain. The dancer usually noted a sudden and sharp pain in the talonavicular joint and hindfoot with a feeling of "forward displacement" of the foot. At palpation, the talonavicular ligament, the anterior talofibular ligament, and the posteromedial part of the subtalar joint were painful. A limitation of the ankle extension and a clear hypomobility of the subtalar joint were noted. Under the effect of shearing forces on the midtarsal joint, a posteromedial subtalar subluxation occurred. Treatment consisted of a manipulation that reduced the subluxation. Continuous taping, which locks the talonavicular joint in the anterior direction, was recommended for 6 weeks. Dancing could be resumed in a swimming pool after 2 weeks, and on the ground after 3 to 4 weeks. We found that subluxation could recur, and that it could eventually become chronic.

Adult↗

Toe flexor forces in dancers and non-dancers.

Toe flexor force (hallux and second toe) was determined in the right and left feet of 24 dancers and 29 non-dancers (sitting and standing positions) using a commercially-available pressure sensor connected to a voltmeter. For the hallux and second toe combined (all trials combined), average toe flexor force was slightly greater for dancers than non-dancers (dancers, 7 +/- 4 N; non-dancers, 6 +/- 4 N; P<0.049). For dancers and non-dancers combined (all trials), the average toe flexor force of the hallux was more than twice that of the second toe (hallux, 9 +/- 4 N; 2nd toe, 4 +/- 1 N; P<0.0001); average toe flexor force was slightly greater in standing than sitting positions (standing, 7 +/- 4 N; sitting, 6 +/- 3 N; P<0.0001); and the average toe flexor force was slightly greater for the right than left foot (right, 7 +/- 4 N; left, 6 +/- 4 N; P<0.012). The average toe flexor force was greatest for the first repetition and slightly decreased for the second and third repetitions (first repetition, 7 +/- 4 N; second and third repetitions each, 6 +/- 4 N; P<0.0013). Toe flexor force measurement may potentially be applicable to clinical practice as a guide to rehabilitation after injury or as a screening parameter for readiness to advance dance or other athletic training, performance, or competition.

Adult↗

Stability of Lisfranc joints in ballet pointe position.

BACKGROUND: Ballerinas develop stress fractures at the second metatarsal base associated with dancing en pointe. The purpose of this study was to evaluate the relative importance of the pointe shoe and the tarsometatarsal ligaments in Lisfranc joint stability en pointe. METHODS: Eleven cadaver feet were dressed with pointe shoes, loaded in foot flat with ligaments intact, and loaded en pointe before and after sequential sectioning of the dorsal, interosseous, and plantar ligaments between the first and second metatarsals and cuneiforms. Relative motion between the first and second metatarsals and cuneiforms was determined radiographically. RESULTS: No significant displacement of the Lisfranc joints occurred when the shod foot with intact ligaments was loaded in the foot flat or en pointe positions. Serial sectioning of the ligaments from dorsal to plantar in the shod foot en pointe demonstrated no change in alignment after the dorsal and interosseous ligaments were cut, but a significant change in alignment between the second metatarsal and second cuneiform was noted after the plantar ligament was cut (p < 0.0001). Removal of the pointe shoe after cutting the ligaments and applying a minimal (1 to 2 kg) load resulted in complete subluxation and diastasis through the first-second intermetatarsal and intercuneiform region. Replacing the shoe improved alignment en pointe with similar loading. CONCLUSIONS: Both the pointe shoe and Lisfranc ligaments are important for Lisfranc region stability in feet en pointe. The plantar ligaments are major stabilizers of the Lisfranc region in the loaded, shod foot en pointe. Selection of a pointe shoe with adequate support may limit susceptibility to stress fracture of the second metatarsal base in ballerinas.

Cadaver↗

Posterior block of the ankle joint in dancers.

The presence of a bony block at the back of the ankle should be recognized as occurring in patterns of symptoms which are not themselves directly related to the ankle joint. When careful examination and observation of the patient indicates that the source of the trouble is in fact at the back of the ankle joint and it has been determined that there is some extra bone at this site, then surgical treatment will give excellent results. It must be emphasized that the presence of an os trigonum or other bony prominence does not mean that it is the source of recurrent symptoms. Surgery should certainly be delayed until all conservative measures have failed to relieve the symptoms or prevented them from recurring constantly. Frequently, strengthening of the forefoot and other relevant areas in the lower limb is sufficient to alleviate symptoms and allow the patient to continue to dance fully.

Achilles Tendon↗

Forefoot conditions in dancers: part I.

The conditions occurring in the dancer's forefoot can be divided into five categories. The three categories presented in Part I of our study include those conditions occurring from poor training, those from chronic forefoot stresses, and those of static deformity. Five hundred dancers were observed for both symptomatic and asymptomatic forefoot conditions. It is most important that a young dancer have at least three years training before dancing en pointe. Many skeletal changes in a dancer's foot occur from use and should not be interpreted as injuries. Static forefoot deformities tend to appear in dancers at a younger age than the general population but seldom require corrective surgery.

Adolescent↗

Forefoot conditions in dancers: part II.

Conditions in the dancer's forefoot can be divided into five categories. Part II of our study presents two categories: acute conditions of the forefoot and conditions which masquerade as forefoot problems. Five hundred dancers were studied. Of those, some had conditions including muscle spasm, soft tissue trauma, fractures, dislocations, and abscesses, and were treated accordingly. The general health of the dancer was an important factor in treatment as well as difficulty in diagnosing the injury. Prolonged periods of healing were expected but did not prevent the return to dance class and rehearsal. The highly motivated, goal-oriented dancer often did not complain of systemic disease or pain and this prevented diagnosis until triggering tendons or muscle paralysis made it obvious. Such a sequence gave rise to prolonged convalescence or termination of the dancer's career.

Abscess↗

Pressures on the foot in pointe shoes.

This study was designed to determine the relative pressures on the first and second toes and first MTP joint when dancing en pointe, in addition to the variation of these pressures as a function of toe length, foot position, and padding. The first ray always bore the most pressure. Pressures on the second toe varied as a function of toe length and padding. Relevé in the everted position markedly increased first MTP joint pressures. Further research is required to determine whether properly designed padding and positioning of the foot en pointe could decrease the incidence of toe problems in the ballet dancer.

Adolescent↗

Hallux valgus in ballet dancers: a myth?

Among dancers it is widely believed that ballet dancing induces hallux valgus. Revision of radiographs of 63 active and 38 retired dancers of both sexes showed no increase in the valgus angulation of the hallux compared with that of nondancers.

Adolescent↗

The foot in ballet dancers: the importance of second toe length.

Ballet dancers are prone to foot injuries. Our hypothesis was that the length of the second toe in relation to the big toe affected the distribution of stresses on the foot, correlating with calluses, injuries, and pain. Fifty-nine ballet dancers were examined for second toe length with respect to great toe, calluses, and metatarsophalangeal inflammation. Daily foot pain, limitation of work hours because of this, injuries, age, sex, and rank in the company were considered. The dancers' feet had an incidence of shorter, equal, or longer second toes which was comparable to a non-ballet-dancing cohort (N = 60). In female dancers (N = 34), total callus counts and pain scores were significantly lower in the group with shorter second toes versus those with equal or longer second toes. Counts were unrelated to age or rank. Longer second toes were related to hallux rigidus. Limitation of practice hours, ankle sprains, and foot/ankle fractures and sprains were comparable across the groups. The male dancers (N = 25) had significantly fewer calluses than did the women, but had equal pain scores and number of injuries. There were no significant differences among the males in total callus counts, pain scores, limitation of practice hours, or injuries between groups based on toe length, age, or rank. We conclude that there is no significantly more ideal pattern of toe lengths for male ballet dancers, but females with shorter second toes have fewer calluses and less daily foot pain. Those with a longer second toe had a higher incidence of hallux rigidus and correspondingly increased pain scores.

Adult↗

Stress fractures at the base of the second metatarsal in ballet dancers.

Stress fractures are a frequent injury in ballet companies and the most common location is at the base of the second metatarsal. While previous reports have focused on risk factors for this injury (overtraining, delayed menarche, poor nutrition), there is no published series describing the natural history and outcome following this fracture. We reviewed the office records of the senior author and identified 51 professional dancers (64 fractures) who sustained a stress fracture at the base of the second metatarsal. History of a previous stress fracture in the lower extremity was seen in 19 patients and delayed menarche in the women was common. The clinical presentation was insidious onset of midfoot pain an average of 2.5 weeks prior to seeking medical care. The initial radiographs of the foot were positive in 19 patients, questionable in 3 patients, and negative in 42 patients. The usual location of the fracture was at the proximal metaphyseal-diaphyseal junction (three fractures extended into the tarsometatarsal joint). Treatment consisted of a short leg walking cast for 6 patients, and a wooden shoe and symptomatic treatment for the remainder. At follow-up, 14% of patients still had occasional pain or stiffness in the midfoot with dancing. The patients returned to performance at an average of 6.2 weeks following diagnosis. No patients required bone grafting for persistent symptoms. There were eight refractures (at the same site) occurring an average of 4.3 years, all of which healed with conservative care. Stress fractures at the base of the second metatarsal are common in ballet dancers and can usually be treated with symptomatically. The results of this study are discussed in terms of risk factors, the use of a posterior-anterior view of the foot to eliminate overlap at Lisfranc's joint, and our present treatment regimen.

Adolescent↗