Dance Rehabilitation

Dance Rehabilitation

Dance & Chiropractic

Dance is an art form based on proper body alignment to perform beautiful feats of agility and strength.  Chiropractic is a healthcare system based on proper body alignment to promote optimal health and body performance.

Chiropractors are specifically trained  and educated in applying biomechanical treatments that will effect the body's neurology to improve a dancer’s abilities.

The rigors of dance cause alterations in joint alignments, whether the joint is in your foot or in your spine.  These alterations prevent proper joint motion and may cause injury and muscle tightness.

Joint alterations will also effect a dancer’s ability to create the proper lines of technique and over time, if left untreated, will lead to undesirable dance habits.

Dance Chiropractor

It is important for a dancer to find a chiropractor who specializes in Dance Injury.  Dancers need more than adjustments; they need a doctor who fully understands how to treat dance injuries and most importantly how to properly return dancers back to dance (as soon as possible). 

In addition to returning the dancer to the stage, the chiropractor must correct alterations in the dancer’s techniques to prevent future re-injuries.

When dancing with pain, dancers' bodies will automatically alter their lines to avoid the pain.  The longer this continues, the more the altered lines are neurologically ingrained and incorrectly assumed as dancers' normal lines of techniques.  Improper dance lines will lead to further injuries.  In fact, most dance injuries stem from altered dance lines.

Dance Specific Rehabilitation

If a dancer’s lines of technique have been altered, it is imperative for the dancer to be treated with Dance Specific Rehabilitation.   Dance Specific Rehabilitation should not be based in strength training as strength training will cause unnecessary overuse, fatigue and lead to more injuries.

Dance Specific Rehabilitation involves advance neuromuscular control training and movement training to reconnect the dancer’s body with the lost lines of techniques.

Dr. Giangiulio's years of experience have lead to the creation of the four Dance Specific Rehabilitation Programs that reconnect the dancer with the foundations of dance.  If a dancer has problems in any one of these four areas, the dancer will have altered lines and a high chance of injury.

Benefits of Chiropractic Care for Kids

Benefits of Chiropractic Care for Kids

An increase in chronic childhood disease is part of the reason parents today seek alternative health care for kids. Chiropractic care is an effective and affordable program by licensed providers that addresses children's health conditions associated with the nervous and musculoskeletal systems. Gentle, noninvasive and drug free, chiropractic adjustments treat, resolve and prevent a wide range of health problems. Recent research by the International Chiropractic Pediatric Association (ICPA) found spinal manipulative therapy safe and successful in treating children of all ages.

Acute Conditions

Acute conditions may result from birth trauma, sports mishaps and accidental injury. Chiropractic care benefits children by correcting the spinal alignment to improve their overall health. When vertebral joints are misaligned during birth or from a blow or fall, muscle tissue and nerves may also be affected. Spinal adjustment frees joints, restores motion and relieves nerve pressure, which may be the cause of additional ailments. Parents report successful treatment of children's health issues such as acute earache, upper respiratory infection, muscle pain, neck pain and accident trauma. Spinal manipulation for children as young as newborn babies is an alternative treatment for the discomfort of colic and other digestive disorders as well.

Chronic Conditions

Parents surveyed by the ICPA reported behavioral improvement for kids who saw a chiropractor, as well as improved sleep and stronger immune systems. Although scientific evidence in these areas is still inconclusive, the growing number of those seeking children's health care from chiropractors (up 8.5% since 1991, according to the American Chiropractic Association) is a positive endorsement of its benefits. Chiropractic America reports that natural, drug-free chiropractic care is sometimes more effective than traditional medical approaches for chronic earache, scoliosis and neck pain. Headaches and sleep disorders of nonspecific causes respond well to spinal adjustments, which affect and repair interrupted neural pathways. Asthma and allergy symptoms and patterns of attention-deficit hyperactivity disorder (ADHD) may also be treatable with chiropractic.

Prevention

Success in these areas has implications for chiropracticcare's preventive capacity. Periodic ongoing adjustments at a young age may help stave off the above ailments before they begin. Proper spinal alignment now may delay or prevent degenerative bone or joint disease, such as osteoporosis and osteoarthritis. In addition to maintaining children's health, regular visits to the chiropractor also instill the value of proactive health care in kids. They'll be more likely to monitor and manage their health as they grow up and less likely to be afraid or in denial of any health problems. Encouraging good lifelong health habits is one of chiropractic's best benefits for kids.

The Role of Radiologic Imaging in the Orthopedic Impairment Evaluation

The Role of Radiologic Imaging in the

Orthopedic Impairment Evaluation

During the course of the evaluation of patients who have acute, sub acute, or chronic injuries that limit their occupational capacity or activities of daily living (ADL), a clinician will frequently order diagnostic tests to determine if there is objective evidence of tissue dysfunction. Because injuries to the musculoskeletal system are a frequent cause of impairment, it is important for the clinician working with these patients to understand the efficacy of the diagnostic tests that are available to assess these clinical problems. Radiological imaging studies have been heavily utilized to document objective pathologic changes in the musculoskeletal system, but to use these tests effectively it is necessary to understand their strengths and limitations. The efficacy of these tests is not only affected by the quality of the study but by the expertise of the individual who interprets the examination. The additional data provided by these tests only become useful clinical information when integrated with the patient’s history, physical examination, and other diagnostic tests.    

               The radiologic studies that are frequently ordered in the evaluation of the musculoskeletal disability include standard plain films, magnetic resonance imaging (MRI), radionuclide studies, ultrasound (US), and computed tomography (CT). This chapter will focus on the application of plain films, MRI, US, and CT have played a major role in the detection of osseous abnormalities in the body, whereas MRI has been particularly useful in the assessment of soft tissue injury (eg, cartilage, muscles, tendons, and ligaments). In addition, MRI is particularly sensitive to detect abnormalities of cancellous bone. The application of US is limited to the assessment of superficial soft tissue structures. A basic understanding of the physics and the technical factors involved in these different modalities is needed in order to facilitate the selection of the appropriate imaging modality for different diagnostic problems.

The Economic Burden of WAD

THE ECONOMIC BURDEN OF WAD

Little is known about the individual and societal economic burden of WAD. For instance, little is known about the prevalence of long-lasting work disability due to WAD, which probably the most costly part. This burden is probably largely dependent on the legislation in different countries. In 2002, an independent and temporary Commission on whiplash-related injuries was informed in Sweden, initiated by the four largest motor vehicle insurers. The mandate of the 3-year commission was an examination of the problems of WAD from road safety, medical care, insurance and societal aspects. One of the conclusions of the final report was that the yearly cost for society and for the insurance industry was approximately SEK 1.5 billion (US$201million), while projected costs (i.e. what new cases of WAD arising in a particular year will cost society and insurers by the time the person reaches retirement age) amounted to SEK 4.6 billion (US$648 million). These calculations were based on an annual incidence of 30,000 WAD cases (324 per 100,000 inhabitants) in the year 2002. Since the report’s publication, the number of WAD cases have decreased dramatically to about 16,000 claims in 2008 (173 per 100,000 inhabitants), which, of course, has an impact on the overall costs.

Comparable data has not been found, but there is some evidence from a study that addressed the incidence of WAD in 10 European countries. The administrative data suggests that the total claims cost in Switzerland was 500 million Swiss francs (US$467 million). Switzerland’s population is 80% that of Sweden. Expenditures in addition to the claims cost was not reported in that study. 

WAD and Widespread Pain

WAD and Widespread Pain

One important aspect about the course of recovery from WAD is whether the neck injury is a trigger for subsequent widespread body pain. This has been suggested from cross-sectional studies, but knowing whether widespread pain came before the neck injury remains unclear from this type of study design. A potential aetiological explanation is a neurophysiological disturbance in the peripheral and central nervous system, which, in some stances, leads to an increased sensitivity to pain in other ‘uninjured’ areas. Another possible explanation for widespread pain is that new tissue damage may result from an altered pattern of movement in the body due to the neck pain. The exact aetiology of widespread pain is that new tissue damage may result from an altered pattern of movement in the body due to the neck pain. The exact aetiology of widespread pain is probably complex and multifactorial, but there are no indications that it would be specific to WAD. It can also occur after surgical intervention or any tissue damage. In addition, large prospective studies on pain of other aetiology have demonstrated that psychosocial factors at work, repetitive strains or other physical strains at work, awareness of symptoms and illness behavior may increase the risk of development of widespread pain. Thus, it seems that biological as well as psychological and social factors contribute to the development of widespread pain.

Prospective studies on WAD and its association with widespread pain are sparse and the evidence is not clear. The results from one study suggest a relationship between the onset of neck pain or other associated symptoms as well as self-perceived injury severity, after an MVC, and subsequent widespread pain. However, age, gender, health behavior and somatic symptoms prior to collision were at least as important. Another study investigated the incidence of onset of more extensive pain during 12 months of follow- up of WAD claimants, and associated factors with such an outcome. In that study, a less conservative definition of widespread pain was used and probably have resulted in higher incidences. The main conclusions were that widespread pain was common over a 12-month period (21%), but most improved over the follow- up period. Female gender, poor prior health, greater initial symptomatology (including pain intensity) and more depressive symptoms were associated with the development of extensive pain. The authors also found that local neck/ back pain, raising the question of the potential cause of widespread pain in other studies.

Specificity of Association and Apportionment

Specificity of Association and Apportionment

Most medical conditions are multifactor in etiology; ie, they are reflective of more than one physiologic or environmental process. Evaluation of the results of epidemiologic studies via regression analysis (which weighs the contribution of various factors both individually and the combination on a given event or events) provides data that can be applied when reaching conclusions regarding the degree to which one would expect a given factor to contribute to the medical condition under evaluation but never can provide definitive answers regarding apportionment.

               It is impossible to accurately evaluate to what extent a given factor or exposure was the contributing cause in a multifactorial disease process. Likewise, in certain situations (such as heart disease), the genetic predisposition of the affected individual is a considerable, if not primary, determinant of causality. Assessing the specificity of association is consequently often the most difficult aspect of causality analysis.

               There is a great deal of legal terminology focused on establishing, and labeling, the degree to which an event or injury has led to a particular outcome. The legal determination of causality uses, but does not necessarily rely upon, the medical evidence that supports or refutes a casual relationship between a given event and outcome. Furthermore, it is often societal decision, and not scientifically required to reach conclusions about the presence or absence of a casual relationship. Using the legal definitions of causality, a relationship between an event and a given outcome is classified as “probably” or “possible.” It is probable if the chance of them being related is greater than 50%. It is possible if the chance of a relationship is deemed to be less than 50%. The skill of the attorneys arguing the case, the credibility of the claimant and his or her physician, the ability of the medical expert to present the medical information regarding causality, and the existence of case law (which may have established the de facto existence of a casual relationship unless definitively proven otherwise) all influence the ultimate determination. Statements are often made regarding the probability or possibility of a causal relationship between an event and an outcome in the absence of an objective epidemiologic or biologic rationale for the determination. While the Supreme Court, in Daubert case, held that testimony must be grounded in the methods and procedures of science and based on more than simply subjective belief or unsupported speculation to be held as relevant and reliable, this standard is not routinely used in many jurisdictions. Thus the use of the legal terminology alone can imply a degree of certainty that may be completely unfounded. 

Spinal Dysfunction

Spinal Dysfunction

Lumbosacral Spine

Because back pain is the second leading cause of work absenteeism and the number one cause of Workers’ Compensation claims, it is important to understand the appropriate role of radiologic imaging in the assessment of spinal dysfunction. The goal of any imaging study is to define accurately the path morphologic changes in a specific tissue, organ, or part of the body. Objective categorization of pathologic changes facilitates the interpretation and communication of abnormalities detected on a test, and these same criteria can be used on follow-up evaluation to assess the effects of different forms of therapy (eg, surgical intervention or non-operative rehabilitation). The reproducibility and the reliability of all objective diagnostic criteria must be rigorously evaluated in prospective blinded studies prior to their implementation.

               Patients with neck or low-back pain (LBP) are a challenge to the physician who desires a precise patho-anatomic diagnosis prior to the initiation of therapy. Back pain and neural dysfunction are a frequent symptom complex for many processes afflicting the lumbar spine and Paraspinal tissues. For this reason, a clinical assessing a patient after a work-related injury must consider and exclude a large number of potential causes to explain a patient’s symptoms. Fortunately, most episodes of back pain are self-limited, and diagnostic tests are needed. However, if pain persists or becomes worse, it is usually necessary to order a diagnostic test to provide the additional clinical information needed to choose rationally the appropriate therapeutic modality. Prior to ordering any diagnostic test, a clinician must determine how the information provided by the test will affect patient management and mentally compare projected test costs and expected benefits. The more precise the information provided by a diagnostic test, the greater will be its impact on directing patient care. The value of different tests depends on their sensitivity, specificity, accuracy, risk, cost, and availability.

Persistent Pain as a Disease Entity

Persistent Pain as a Disease Entity

Persistent pain is a major health problem, with between 18% and 50% of the population reporting continuous pain for at least 3 of the last 6 months. Chronic pain has been linked with significant disability. Although pain has been traditionally regarded as a symptom that serves as a warning signal of an underlying disease process, there is accumulating evidence that persistent pain should be considered a disease entity in its own right. Indeed, permanent changes in the responsiveness of both the peripheral and centralnervous systems can persist even after all tissue healing has ensued; thus, persistent pain can become a self-perpetuating condition. The individual is signs of original inciting disease process that initiated the pain. This results in a multitude of consequences that can lead to significant impairment for the individual affected, including physical impairment, mood dysfunction, and social disruption. This is in keeping with the earlier biopsychosocial perspective of CPS.

How Much Weight Should Be Given To Pain in Impairment Ratings?

How Much Weight Should Be Given To Pain in Impairment Ratings?

Whether or not to include PRI in the Guides can be frames as a qualitative yes or no question. However, it is more fruitful to from the issue in quantitative terms by asking the following question: How much weight should be given to pain in impairment ratings? Opponents of PRI, in effect, argue that pain (and other subjective factors) should be given zero weight, so that impairment ratings reflect only objective factors. Many proponents of including PRI in the Guides argue not only that pain should considered in impairments ratings but also that a PRI system should permit patients with severe pain to receive impairment awards with high WPI percentages. An impairment rating system could make a “cautious foray into the difficult waters” of PRI assessment by permitting awards to be made for PRI, but capping these awards at a modest level. This describes the strategy used in the Guides’ Fifth Edition, in which PRI capped at 3% WPI. In the absence of persuasive empirical research on the extent to which pain affects the ability of people with medical conditions to function or the measurement problems that arise when PRI is assessed, any dcision about caps for PRI will be perceived as arbitrary.