The clinic is located in the Bellbird medical precinct of Blackburn South. It originally started back in the early 1970’s as Bellbird Physiotherapy and has been servicing the eastern suburbs of Melbourne for over 40 years. We have been providing excellent physiotherapy services to the local community ever since, and we are proud of our strong history here.
Like the physiotherapy profession our clinic has evolved over the last 40 years. The clinic changed names in 2005 to Bellbird Sports & Spinal, to reflect the expertise of our practitioners in sports and spinal injuries as well as all of our services Physiotherapy, Clinical Pilates, Myotherapy and Hydrotherapy.
Bellbird Sports & Spinal offers a wide range of services including Sports and Musculoskeletal Physiotherapy, Clinical Pilates, Myotherapy, Hydrotherapy and Babyswim classes. We have the experience and expertise in all of these services to allow us to manage a wide range of injuries, conditions and ailments; our ultimate goal is your optimal well being. If you wish to return to a physically demanding job, or return to sport or a leisure activity, we can help you recover the strength, flexibility and confidence in your physical ability to achieve these goals.
We pride ourselves in our ability to deliver the best quality, evidence based health care. Our practitioners are committed to ongoing professional development and using cutting edge technologies to allow for accurate diagnosis, faster recovery and efficient injury management.
Our experienced practitioners work regularly with all age groups and fitness levels and can easily tailor your treatment and rehabilitation to meet your goals.
Andrew Cobb from Bellbird Sports & Spinal
What are your thoughts on dancers stretching in second split with one foot raised on a block or both feet raised on a block?
Is this extreme hip range actually required by this dancer? Is this type of stretching and flexibility likely to improve their dancing (considering they can already do splits in second)? Is this type of stretching likely to increase their risk of injury?
As you can imagine there isn’t one answer to this question that suits all dancers, much like there isn’t one pointe shoe for all dancers. Also the training techniques used by professional dancers should be different to those adopted by young dancers due to the extra years of conditioning.
If a dancer can easily get down into second split without any sensation of stretching in their hip or associated muscles they are probably suitable to place a foot up on a block. Some dancers with hypermobile hips will also safely be able to perform this type of stretch without risking injury but there are many that are already pushing the boundaries set by their own anatomical hip joint shapes and pushing further into this range will undoubtedly cause an injury.
If the extra flexibility gained by doing this stretch isn’t supplemented with extra strength in that exact hip range of movement then the extra hip range is likely to increase their risk of injury.
Please be careful when attempting this type of stretch, as one size doesn’t fit all.
Can you talk to us about some of the more common problems dancers sustain in their lumbar spines and pelvis region?
Hypermobility versus Instability – Hypermobility is an attribute all dancers need a certain degree of. Hypermobility means that a joint can move further into range than is considered normal in the general population. For example if a dancer didn’t have some hypermobility they wouldn’t be able to do the splits. Hypermobility is very different to instability. Instability relates to a loss of control or stability of a joint or multiple joints. The joints stability is the combination of both passive and active components. The passive stability of the joint comes from the structure and shape of the bones and the tension of the ligaments, whereas the active stability comes from the strength of the surrounding muscles and the neural and proprioceptive control of the joint. A hypermobile dance may possess less passive stability, i.e. a joint shape that allows more movement, but they compensate for this with increased active stability, i.e. better strength and proprioceptive control.
When a patient presents with both hypermobility and instability this is a more difficult presentation to rehabilitate. Hypermobility increases your risk of injury and length of recovery but isn’t the cause of the injury, ultimately a lack of strength or endurance is usually what results in the injury of the hypermobile joint.
When a dancer presents with lumbar or pelvic instability, the important thing to remember is that the injury isn’t the instability. The pain is quite often the cause of the instability and is most likely coming from injuries to the zygapophyseal (facet) joints, the intervertebral discs or other local structures.
The fundamental solution to prevent a hypermobile dancer from injury but also rehabilitate one with an instability related injury is quite simple, the dancer needs to build stronger muscles with better proprioception and this will reduce their symptoms and ultimately allow them to return to dancing.
Scoliosis is another common complaint in female dancers. Scoliosis is defined as a sideways bend and rotation of the spine off its usual axis. It is much more common in females and the angle of bend needs to be greater than 10o to be called a scoliosis. Scoliosis can change overtime and is not considered an injury but still needs to be monitored.
Zygapophyseal (Facet) joints are another commonly treated spinal injury in dancers. The purpose of the facet joint is to control the direction and degree of movement at each vertebral level. The alignment of the lumbar facets joints allow flexion and extension but limit rotation, whereas the ones in the thoracic spine allow rotation but limit flexion and extension.
A facet joint can be strained when the joint is stretched further than designed resulting in ligament damage, similar to an ankle sprain. The other common facet joints injury is impingement, when a joint is jammed up excessively under force.
The last common lumbar spine injury in dancers is an intervertebral disc injury, the most common being a disc bulge, however disc tears and disc herniation’s can occur in older dancers. The disc sits between two vertebrae and is a made up of two parts, the outer fibrocartilage and the inner nucleus. The disc is a strong flexible joint which is what allows our spine to move. In a disc bulge the disc pushes backwards towards the spinal cord or exiting nerves and can potentially touch these nerves. If the nerves touch the disc bulge there is usually referred pain down the leg commonly called sciatica.
Common hip complaints in dancers:
Femoroacetabular Impingement (FAI) occurs when the femur (thigh bone) hits or rubs up on the acetabulum (hip socket) causing damage and inflammation of the hip joint. There is usually a boney anomaly of the femur or the acetabulum (sometimes both) that result in the condition. The dancer would usually experience pain with high hip movements forwards or to the side.
Labral tears often occur as a result of FAI but can occur due to an injury, especially in dancers. The labrum is a rim of fibrocartilage that sits on the edge of the acetabulum, which deepens the socket and acts like a suction cup to hold the femur in the socket. Once the labrum is torn the hip quite often becomes “clicky” and sometimes painful. This loss of suction results in extra-unwanted movement in the hip joint. If the labral tear is small most dancers can compensate for this loss of passive stability by strengthening their hip muscles, allowing them to successfully return to dancing despite the labrum never truly healing due to its poor blood supply. In large labral tears the current recommendation is to have arthroscopic surgery to reattach the torn labrum and restore the joints stability.
Muscular strains and tears around the hip joint are also quite common in dancers. The three most common muscles injured around the hip are the hamstrings, iliopsoas (hip flexors) and rectus femoris (center part of the quadriceps). These injuries almost always fully recover with appropriate treatment however there is a high reoccurrence rate if the strength and flexibility aren’t returned to a level at or above the pre injury level.
Are you able to say if these injuries have a common cause?
All sports have similar underlying causes that result in injuries; the obvious and easily managed things are often overlooked when trying to find the cause. The causes of most injuries are:
Fatigue – with many amateur dancers training over 10 hours per week and professionals easily over 30 hours, fatigue has a huge role to play. When people are tired they don’t concentrate as much, stumble more and make more mistakes increasing their risk of injury. There are a few simple solutions here, identify the signs of fatigue, get more rest/sleep, spend more time preparing your endurance for upcoming performances, eat snacks and drink water throughout long rehearsal days.
Overuse – dancers are prone to overuse related injuries, be it practicing the same move over and over and over or just the number of hours en pointe. This repetition of the same move loads the bones, joints and muscles in the exact same way and eventually leads to structural fatigue and injury.
Previous Injury – once a dancer has injured a joint or muscle this increases their likelihood of further injury not only to that area but the structures above and below the injury. The easiest way to prevent this from reoccurring is to continue working on rehabilitation months if not years after the injury to ensure you have regained your full strength, stability, proprioception and function.
Joint Stiffness – the majority of dancing requires extremes in joint range of motion. If a joint is asked to go beyond its available range of movement it will very quickly become injured. Knowing your own joint limitations is essential but also regularly working to improve your flexibility can actually let you achieve these ranges.
Decreased Stability, Balance & Proprioception – when a joint loses stability through injury the balance feedback sensors in the joint are quite often also injured. If these sensors aren’t sending information back to the brain telling it where the joint is, the brain cannot adequately protect and control the joint.
Muscular Weakness – when a muscle is weak it struggles to absorb force as efficiently as a stronger muscle would but it also fatigues quicker. If the force applied to a muscle is greater than what it can stand the muscle will tear. If you think of all the brilliant dancers you’ve ever seen, they all have one thing in common, their strength. Strong dancers hurt themselves less often as they can produce and absorb more force ultimately protecting their joints for longer.
Poor Technique – when a skill is performed incorrectly it is more likely to injure a dancer, a perfect example is a pirouette. If the pirouette technique is performed poorly the dancer is more likely to fall out of the turn and land awkwardly spraining an ankle.
Anatomical Factors – some people have anatomical changes that make them more prone to certain injuries, i.e. internally rotated hips and flat feet mean you are more likely to get knee pain. Having someone identify these anatomical differences and advise you on stretches or exercises to account for them can help prevent injuries.
Please remember that it is extremely rare for an injury to stop a dancer from all aspects or training and maintaining fitness. Please ask your health professionals what you can do while you are recovering. Apart from the obvious rehabilitation exercises to overcome the injury, ask if you can you also do:
– Clinical Pilates
– Floor barre
– Exercise bike
– Upper body strength exercises
– Core exercises
– Mark class at the back, either standing or seated
Andrew Cobb: Andrew is an APA Sports Physiotherapist and Clinical Pilates instructor with over 15 years clinical experience. He is an active member of the Australian Physiotherapy Association and Sports Medicine Australia.