Make It Subtle

The show must go on! For so many performers and athletes, sitting on the sidelines isn’t an option. Kinesiology taping can be a beneficial treatment modality to help minimize time off when combined with progressive reloading. A 2018 case study demonstrated successful conservative management of FHL tenosynovitis with care including kinesiology taping, manual therapy, rehabilitative exercise, and laser therapy. The patient was able to continue two hours of dance training per day within the first two months of treatment, and gradually build back to 6 hours per day without re-aggravation of the condition.

Figure 2 Kinesiology tape application to the FHL. The ankle was dorsiflexed and pronated with no stretch in the tape as it was applied. This application provided a “lifting” of the skin as the patient assumes a plantarflexed ankle position.

When working with performers, presentation matters. While neon colored kinesiology tape may be permissible for other athletes, dancers may need to prioritize appearance. Enter KTape MySkin. This simple design change allows for all athletes to receive the support and care they need to perform at their highest potential.

Dance medicine providers or teams can order a mixed box to ensure that each performer has a color that matches their skin tone, allowing the audience to focus on the dancer rather than their injury.

To learn more, check out this article: 

1. Wentzell M. Conservative management of a chronic recurrent flexor hallucis longus stenosing tenosynovitis in a pre-professional ballet dancer: a case report. J Can Chiropr Assoc. 2018;62(2):111-116.

The Future of Disc Pathology Treatments

NSAIDs and rehabilitative care are the first line of treatment for the majority of low back pain patients. When appropriate, epidural injections can be utilized to reduce inflammation and allow for improved tolerance for exercise. Surgery is considered with severe disc herniations or when conservative care fails.

Given the prevalence of disc injuries, science is constantly searching for new strategies to treat patients. In recent years, there has been research in the potential for replacing and re-growing intervertebral discs! Two of these novel methods are stem cell therapy and gene therapy.  

Stem Cell Therapy

Currently, the best surgical strategy for severe disc injuries is either spinal fusions or disc removal. Both result in decreased function, and can have long term effects on joint health. Stem cell therapy aims to provide an alternative solution, either surgically or through injections. Cells from bone marrow tissue and adipose tissue have show the ability to develop into a structure very similar to the nucleus pulposus. Research hypothesizes that these cells can be used to grow vertebral discs in a lab, or be injected to support disc regeneration.

In a 2019 systematic review by Meisel et al, the team of researchers looked at stem cell therapy for the treatment of disc degeneration. They found the strength of the current evidence to be poor due to the low number of studies and that all reviewed studies were small and primarily case series. It was recommended that larger, more robust studies be performed to accurately evaluate this potential new treatment. 

Gene Therapy

Researchers argue that it is almost impossible to stop the progression of degeneration once it’s be diagnosed. Disc tissue lacks the regenerative properties that other cells in our bodies possess, and their low supply of oxygen and nutrition further challenges cell survival. Injecting genetic material in to very specific cells can alter this pattern, and help extend the life of spinal discs. There are several methods for this process, however RNA interference stands out as the best possible strategy currently.

A 2020 paper by Takeoka et al. proposes in depth the potential for gene therapy as a treatment strategy for degenerative disc disease. Despite listed obstacles, they assert “the amount of research is increasing and broadening, and so it is not unrealistic to expect a breakthrough from these studies over the coming few years.”

Both cutting edge procedures are still in the early stages of development, but show promise. However, medication nor surgery will never be the sole solution. It’s essential to assess your movement patterns, and address any strength imbalances or weakness.

To learn more, check out these articles:

1. Meisel HJ, Agarwal N, Hsieh PC, et al. Cell Therapy for Treatment of Intervertebral Disc Degeneration: A Systematic Review. Global Spine J. 2019;9(1 Suppl):39S‐52S. doi:10.1177/2192568219829024

2. Takeoka Y, Yurube T, Nishida K. Gene Therapy Approach for Intervertebral Disc Degeneration: An Update. Neurospine. 2020;17(1):3‐14. doi:10.14245/ns.2040042.021

Jump Into Prenatal Fitness

The literature has shown exercise can decrease pain, improve function, and limit time off work due to pregnancy-related back and pelvic pain. In general, strengthening routines should focus on muscles of the back, core and pelvic floor. Bonus circuits can also include upper body strengthening in preparation to lifting and carrying your bundle of joy. Depending on your experience with exercise, you can choose between independent sweat sessions, or working one-on-one with a coach. Prenatal group exercise classes are recommended for individuals who find themselves needing modifications for greater than 50% of the class. But what if you feel too pregnant to exercise?

Enter water aerobics.  While the class may conjure images of senior citizens in shower caps, aquatic therapy is frequently used with patients who are pregnant. Being in the water up to chest level takes off 70% of your body weight. This can be extremely helpful for soon-to-be moms who are having painful back and pelvic girdle issues, allowing for exercise until they can tolerate more land therapy.

A 2016 systematic review of literature, found strong evidence demonstrating benefit of combined aquatic and resistance for maternal cardiorespiratory fitness and prevention of urinary incontinence. Additionally, a 2011 study found that aquatic therapy is effective in reducing peripheral edema (swelling in the ankles and feet). 

Depending on your community, access to a pool may vary. Some health clubs and specialty physical therapy clinics offer individual and group classes depending on local health regulations. Your OB-GYN can be a great resource for other options. Just be sure to double-check with your primary medical team before jumping in the nearest lake!