The Dancer: An Orthotic Case Study

By Dr. Ryan Zullo, DC

HealthFirst Chiropractic of Westerville

Dr. Ryan Zullo, DC

“My legs don’t feel even.”
“I feel like I am always leaning to one side.”
“The bottoms of my feet hurt while I am standing at work.”
“My back always hurts after dancing.”
Those were just some of the complaints that were mentioned by a 17 year-old female patient recently after I asked, “What brings you in today?”

Her mother, who is also a patient of the office, had mentioned to me at a previous appointment that her daughter continues to complain of low back and foot pain. I suggested that she make an appointment for her to see if we could possibly help. She laughed and said, "It's probably a result of bad posture from all of the texting she does!” And although there is some truth to that statement (the increase of adolescents in our office complaining of neck and back pain from what I believe to be from the prolonged time playing video games, or on their computer/phone, is quite concerning), I felt like there was a deeper issue here that was causing the symptoms to be present on nearly a daily basis.

Fast-forward to the initial appointment and it didn’t take me long to find out what I believe was to be the real cause of her reoccurring symptoms. You have probably experienced this far too often as well in your office. You go through the patients’ paperwork and it’s either not filled out completely or there are only one word answers to important questions. That was the case here; there wasn't anything in particular that suggests it would be the primary cause of the present symptomology -- no major traumas, no falls or car accidents. So what is going on?

This is where a thorough history, one where using questions that generate good responses from the patient, is critical. Within just a few minutes of being in the consultation room, she had opened up and shared with me that ever since she was a little girl she had danced in some way. First it was ballet, then she tried tap dancing, and then she transitioned to Irish Dancing, something she's been doing at a very high level for the past 11 years. Practicing multiple times a week, she went on to say that she’s literally had thousands of hours where she was applying extra stress to her entire body in the form of dancing.

When asked about any recent trauma, she stated “No” but was quick to tell me about the multiple stress fractures that she’s endured in both of her feet, the broken toes that she’s taped up and submerged in ice baths, as well as the multiple sprained ankles and the continuous pain she endures in the balls of her feet from the amount of hours she is standing as a hostess when she’s not in school or at dance practice.

A Chiropractic examination revealed that pelvic unleveling caused the all-too-common "short leg." Range of motion was considered to be within normal limits, but there was tenderness when palpating lumbar and pelvic specific musculature including her lumbar paraspinals, quadratus lumborum, gluteal muscles, IT band, hamstrings, quadriceps, and Psoas muscles bilaterally. Arches in her feet were maintained, but mobilization of her tarsals/metatarsals caused pinpoint pain and discomfort bilaterally. Due to what was revealed during the consultation and examination, x-rays of her spine, pelvis and feet were taken to rule out any underlying trauma.

Once the examination was complete I explained that I wanted to take some time to review all of the information, and when they return I will go over the x-ray findings, as well as recommending a program of care to not only get her out of pain and discomfort as soon as possible, but to make sure symptoms don’t re-occur.

She scheduled her next appointment and when I reviewed all of her exam findings in the meantime, I knew I had an opportunity to really help her and change her life. Taking pain meds to reduce the swelling or muscle relaxers to decrease spinal tension are considered Band-Aids and fail to address the true cause of the symptoms. I was confident that we could help her, but because of the chronicity of her symptoms, how long would it take before we started to see results? I certainly didn't want to throw everything against the wall just to see what stuck; I wanted to be very specific with recommending things that would not only reduce the pain and discomfort she is currently experiencing, but help her from possibly re-injuring herself in the future and/or allowing her to be susceptible to arthritic changes as her skeletal system matures.

My recommendation included a program of care that had her being seen 3x/week for the first 2 weeks, 2x/week for 4 weeks, followed by 1x/week for 4 weeks in order to address the issues in not only her spine and pelvis, but her feet and ankles as well. I also recommended a pair of Powerstep insoles to maintain the arches of her feet and promote proper foot mechanics due to the unfortunate long period of time without such assistance.

Upon hearing this, she and her mom instantly said, "Let's do it." They were clearly excited to get out of this pain-induced rut that she had been stuck in for most of her young life. Chiropractic adjustments with the associated therapy (intersegmental traction, electric stimulation, vibration plate, etc.), education about body awareness and proper posture, and the addition of putting her insoles into her shoes were all things that were recommended and performed that day.

Fast-forward a couple of weeks, and just 6 visits later, she was reporting things to us like, “My legs actually feel even.” “I actually feel balanced and not like I’m leaning to one side.” “The bottoms of my feet don't hurt as much while I’m standing for work.” “My back is usually a little stiff or fatigued after dancing, but it doesn't hurt like it used to." As she continued to make her appointments and make positive change, she went on to say that she has more "body awareness," meaning she can tell if her posture isn't as good as it should be while at school, work, or even while performing. She is so excited for the life changes that she has made up until this point, and will continue to make, as she does her part by wearing appropriate footwear with her insoles, makes sure she performs her at-home stretching/exercises and continues to make her Chiropractic appointments in order to maintain what she’s worked so hard to achieve.

This is just proof that as a Chiropractic Physician you have to recommend what you think is best for the patient. Try to avoid the "Well, I feel like a salesman," or "They can't afford the insoles," or "She's young so she probably won't even wear the orthotics" mentality. Patients will most likely sense your confidence and thoroughly appreciate the honesty which just makes things that much better when they are spreading the good word about you and your practice to their friends and family.

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