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10 Jun 2010

 

What to Do When A Skater Is Injured
Part one
Lauren Downes MSPT
 
This article will discuss various figure skating injuries and recommendations for a skaters’ activity level while injured. Please note that these are general guidelines, as each skater’s injury may affect him or her differently than another skater. Many injuries require a consultation with a physician and/or a physical therapist. After reading this article, you will have increased awareness of how to limit your skater’s activity level and how to avoid further injury.
 
1)Spinal Stress Fracture: A stress fracture in the lumbar spine needs time to heal. The number one thing a skater needs to avoid is jumping, and a physician will set a time frame for a return to jumping. After an initial evaluation, a physician will most likely schedule a follow-up x-ray or bone scan to determine if a fracture has healed. If the skater does not experience pain with basic skating, he or she may be allowed to complete all moves that do not create impact on the spine. In regards to spins, all laybacks, catch foot camels, and biellmans should be avoided at all cost until the fracture is fully healed. A skater should use this rest time to improve skating skills, work on program endurance, perfect footwork sequences, and improve overall conditioning. Even though it delays improvement of jumps, it can occasionally be a blessing to give the body a rest. When a skater is cleared to return to jumping, a physician or therapist may recommend a gradually return to jumping. A skater may be allowed to complete a certain number of single jumps per session for the first week or two, then progress to a limited number of doubles per session after that time frame. A release to full jumping may take weeks, yet it is important to follow a medical professional’s instructions.
 
2)Ankle Sprain:  There are three degrees of ankle sprains: grades one through three, with grade three being the most severe. The length of time for rehab is dependent on the skater’s mechanism and grade of injury. A grade one ankle sprain may heal within two to three weeks, and a grade three ankle sprain may take 2-3 months to heal. Luckily, skaters are supported in a stiff boot, and return to sport is typically much easier for a skater than a soccer or basketball player, because those sports involve excessive cutting and pivoting of the foot. There are various ligaments in the ankle, and each serves a different purpose and resists a certain motion. The most commonly sprained is the anterior talofibular ligament, which checks the turning in motion of the ankle. 
 
If a grade one sprain occurs, a physician may recommend a few weeks off from skating. Upon return, it is beneficial for the skater to learn how to tape the ankle to increase stability in the skate. A traditional taping technique will fit into the skate without too much restriction or discomfort. To view a good video of taping for an inversion ankle sprain, go to: www.youtube.com/watch?v=9IQQ73Fn0G8A skater should spend the first few sessions stroking, completing warmup drills, and trying to get comfortable during deeper edgework. Footwork sequences that involve changes in direction may irritate the ankle, and should avoided until the skater is comfortable. Next, try spinning that does not involve a significant amount of knee bend (no sit spins or sit variations!). After a few day, if the skater feels that he or she can complete jumping pain free, the skater can start doing single jumps on a limited basis. The number of jumps should be limited at first, and then gradually increased. Once a skater can complete his or her normal jumping routine (whether it be singles, doubles, or triples), the skater can be slowly weaned from taping.
 
A higher grade ankle sprain should be treated with caution, as a quick return to skating will possibly cause damage to the ligament further down the road. In therapy, a skater should not be allowed to return to skating until he or she can fperorm single leg plyometric jumping exercises and demanding agility drills pain free. That is the guideline that my patients follow, and it has worked well.
 
3) Patellofemoral Syndrome (Anterior Knee Pain): Patellofemoral Syndrome causes pain around various parts of the kneecap, and is typically present with jumping, going down stairs, and sitting for long time periods. It is most commonly found in teenagers between the ages 12-17, but may be found in adults as well. The pain typically is sharp in nature. This injury can be tricky, as it can be caused by several factors, including flexibility imbalances, strength imbalances, improper tracking of the kneecap, or a recent growth spurt. In severe cases, a physician may recommend a layoff of a few weeks from skating. Therapy during this time will focus on strengthening certain muscles in the hip and knee region, stretching or massaging tight muscles, and helping the tracking of the kneecap. During rehabilitation, if a skater is allowed to skate, a therapist may teach the skater how to tape the kneecap, or use a brace such as the ’patellar tracker.’ These aids help guide the kneecap in the right direction to avoid compression under the kneecap. A skater may be allowed to skate, but not jump or complete sit spins and stroking with deep knee bend. If the skater responds well to bracing, it may be beneficial to use the brace for several months. During this time, as mentioned in the stress fracture section, a skater can work on perfecting other elements. It is a good time to perfect moves in the field. As with the previously mentioned injuries, a skater should gradually return to jumping, increasing the number of jumps per session as he or she gets more comfortable.   It is important to note that ignoring symptoms of patellofemoral syndrome may cause a breakdown of the cartilage behind the kneecap; therefore, it should be treated with physical therapy.
 
4) Hamstring Strain:   The hamstring muscle extends from the bottom of the pelvis to the knee joint, in the posterior thigh. Females can easily strain the hamstring, as there is usually a 2:1 ratio of quadriceps to hamstring strength. Strains occur when a muscle becomes overloaded or is not properly stretched or warmed up. Treatment of a strain immediately involves ice and massage, and heat should not be applied for the first several days. Once the initial pain reaction and inflammation subside, and a skater feels tightness more than pain, heat may be applied. If the strain is minor, a skater may be able to take 5-7 days off and return to skating quickly without pain. If the muscle is treated with massage and therapy in this time period, the skater may be able to return to jumping fairly quickly. If the strain is fairly significant, a skater’s activity may be restricted for a week or two. Therapy will consist of modalities such as ultrasound and electric stimulation, massage, and eventual return to stretching and strengthening. Some skaters may barely feel pain during jumping within a few weeks, and may have residual pain with sit spins, pancakes, spirals, and catch foot camels. Gradually return to these elements as a skater feels more comfortable with them.
 
With any injury, it is important not to push a skater too quickly. Pushing through an injury while a muscle or ligament is not fully healed may cause months of unnecessary pain and possible problems in the future. Even though a skater may initially miss more training time, resting and following guidelines will benefit the skater, coach, and parent in the long run.