Tendon structure, clinical tests, and pain during-loading in young female competitive gymnasts.

To examine the relationship between Achilles-tendon (AT) and patellar-tendon (PT) structure, clinical-examination and tendon pain in young gymnasts; and, to explore the associations between these factors and age, maturation, and training-load. Two hundred and seventy-four female gymnasts (aged 12.1±1.9 yrs) were assessed for anthropometric measures, pubertal-stage, and training-load. They had clinical-tests (pain-on-palpation for AT and pain-on-palpation and Royal-London Hospital-Test for PT), were asked about tendon-pain during-loading and were assessed for tendon-structure. Gymnasts with positive clinical-tests (with and without pain during-loading) presented a significantly higher prevalence of disorganized AT and PT compared to gymnasts with negative clinical-tests (with and without pain during-loading) (p<0.05). A significant pubertyXpositive clinical-test interaction was found for disorganized PT structure, whereby a disorganized structure was more prevalent among post-pubertal gymnasts with positive clinical-tests compared to pre-pubertal participants with negative clinical-tests (F(1, 263)=9.436, p=0.002). In gymnasts with positive clinical-tests, significant correlations were found between disorganized AT and PT structures and age, and training-load (p<0.05). An increased prevalence of disorganized tendon structure (regardless of pain during-loading) was seen in participants with positive clinical-tests. This disorganized tendon-structure was found to be significantly related to increased age, post-pubertal stage, and higher training hours in gymnasts with positive clinical-tests.

Forward step down test - clinical rating is correlated with joint angles of the pelvis and hip: an observational study.

BACKGROUND: Clinical methods for assessing quality of movement and functional tests are important to clinicians. Typical deviations from normal kinematics during the clinical test of Forward Step Down Test (FSDT) are pelvic tilt and hip adduction which are associated with the risk of knee pain. OBJECTIVES: (1) to examine the correlation between clinical assessment of the FSDT and joint angle measurements of pelvis, hip, knee and ankle joints in males and females; (2) to examine the differences in joint angles between individuals rated as good, fair or poor in a FSDT performance test. METHODS: Ninety-two healthy individuals performing FSDT were video-taped with two-dimensional digital video cameras. The clinical assessment of the FSDT was rated by two experienced physical therapists as good, fair, or poor based on a Crossley et al. (2011) validated scale. Measurements of pelvic drop, hip adduction and knee valgus were taken using Image J software. RESULTS: Out of 177 lower limbs, 74 (37 in each limb) were clinically rated as "good/fair" (41.80%) while 103 (52 in the dominant leg and 51 in the non-dominant leg) were rated as "poor" (58.19%). No significant differences were observed between dominant and non-dominant legs or between males and females in clinical rating of the FSDT. Pelvic drop angle was significantly higher and hip adduction angle was significantly lower for "poor" clinical rating compared to "good/fair" in both dominant and non-dominant legs (p < 0.001) in males and females. Females demonstrated higher pelvic drop, lower hip adduction and higher knee valgus angles compared with males (p < 0.05). CONCLUSIONS: This study showed that the clinical rating of FSDT is correlated with joint angle measurements suggesting that this assessment can be utilized in clinical practice. Individuals with poor quality performance of FSDT showed higher pelvic drop and hip adduction movement. Further studies examining different populations with diverse disorders or pathologies are essential.

On the job training in the dissection room: from physical therapy graduates to junior anatomy instructors.

BACKGROUND:  The training of near-peer (NP) teachers and junior faculty instructors received major attention as a possible solution for the shortage of experienced anatomy instructors in faculties of medicine and health professions. Several studies described the training of NP teachers and junior instructors (≤ 2 years of teaching experience) using various methods. However, few publications include On the Job Training (OJT), which enables reflection and performance evaluation and encourages professionals to cope with their blind spots. Previous publications describing OJT did not include formal observation of the NP teacher or junior instructor. Therefore, this study aimed to present a novel approach to OJT inclusion during prosection laboratories based on the Lewinian experiential model. METHODS:  Eight physical therapy (PT) graduates were recruited as junior anatomy instructors into the prosection laboratories. All participated in a unique training program during two consecutive academic years (2017, 2018) and received OJT during the teaching sessions. Two questionnaires were filled out to evaluate the educational impact of the training program. Eighty-three first-year PT students participated in prosection laboratories in anatomy taught by junior instructors, and filled out a questionnaire evaluating the performance of both junior and senior instructors. In addition, we compared the final grades in anatomy obtained by students taught by senior instructors to the grades of those taught by junior instructors. RESULTS:  Each junior anatomy instructor participated in four OJT sessions. Based on self-reported measures, all professional and didactic aspects of the training program received a median score of 4.5 or higher on a five-point Likert scale. Students obtained similar grades in anatomy when taught by junior instructors compared with senior ones, and were similarly satisfied from the teaching performance of both senior and junior anatomy instructors. CONCLUSIONS:  OJT is applicable in a small-sized PT program facing a shortage of anatomy instructors. Including junior anatomy instructors in prosection laboratories for PT students is a viable solution to the shortage of experienced anatomy instructors. Further study, involving a larger cohort with a longer follow up will strengthen the preliminary results presented here.

New methods for sex estimation using sternum and rib morphology.

Sex estimation of skeletal remains is of great importance in the fields of physical and forensic anthropology. Since skeletons are often incomplete, it is essential to estimate sex from as many skeletal remains as possible. The aim of this study was to establish new methods for estimating sex using the morphology of the sternum and the fifth to ninth ribs. We considered two conditions of skeletal preservation: All skeletal elements measured are available, or only a single element is available. Traditional or virtual measurements were carried out on three samples: (1) A skeletal sample from the Hamann-Todd Human osteological collection, Cleveland Museum of Natural History, USA (N = 413), was used to create prediction equations for sex estimation. (2) A recent, CT-based sample from Israel (N = 33) was used to cross-validate the accuracy of the prediction equations. (3) A skeletal sample from the Anthropological Collection at Tel Aviv University (N = 15) was used to test the validity of the virtual measurements. Reliability and validity analyses were carried out via intraclass correlation coefficient analysis. Prediction equations for sex were created using logistic regression. The measurements were found to be highly reliable and valid. Success rates for sex estimation were high (> 80%) and correspond well between the skeletal and recent samples, especially for the left sixth, left eigth, and left ninth ribs. To conclude, measurements of the sternum and ribs are valuable for estimating sex and can be carried out using either traditional or virtual tools. Of all the skeletal elements examined in this study, the sternum, left sixth, left eighth, and left ninth ribs were found to be the most reliable skeletal elements for estimating the sex of an individual.

Extrinsic and intrinsic risk factors associated with injuries in young dancers aged 8-16 years.

In the present study, we tried to determine the association between joint ranges of motion, anatomical anomalies, body structure, dance discipline, and injuries in young female recreational dancers. A group of 1336 non-professional female dancers (age 8-16 years), were screened. The risk factors considered for injuries were: range of motion, body structure, anatomical anomalies, dance technique, and dance discipline. Sixty-one different types of injuries and symptoms were identified and later classified into four major categories: knee injuries, foot or ankle tendinopathy, back injuries, and non-categorized injuries. We found that 569 (42.6%) out of the 1336 screened dancers, were injured.The following factors were found to be associated with injuries (P < 0.05): (a) range of motion (e.g. dancers with hyper hip abduction are more prone to foot or ankle tendinopathies than dancers with hypo range of motion; (b) anatomical anomalies (scoliotic dancers manifested a higher rate of injuries than non-scoliotic dancers); (c) dance technique (dancers with incorrect technique of rolling-in were found to have more injuries than dancers with correct technique); (d) dance discipline (an association between time of practice en pointe and injury was observed); and (e) early age of onset of menarche decreased risk for an injury. No association between body structure and injury was found. Injuries among recreational dancers should not be overlooked, and therefore precautionary steps should be taken to reduce the risk of injury, such as screening for joint range of motion and anatomical anomalies. Certain dance positions (e.g. en pointe) should be practised only when the dancer has already acquired certain physical skills, and these practices should be time controlled.

Injury patterns in young, non-professional dancers.

The aim of the present study was to assess the prevalence and types of injuries in 1336 young, non-professional female dancers (age 8-16 years) who participated in a descriptive mixed (cross-sectional/ longitudinal) cohort study. Previous and current injuries were diagnosed and later classified into seven major categories. Our results show that 569 (42.6%) of the dancers examined manifested an injury. Advanced age and increased exposure to dance yielded an equivalent increase in the prevalence of injured girls: from 1 of 10 girls in the 8-year-old age cohort (mean = 1.05 per 1000 h) to 1 of 3 girls in the 14-year-old age cohort (mean = 1.25 per 1000 h). Time elapsing between first and second injuries decreased with age. Among the youngest group of dancers (8-9 years) the most common injury was tendonitis (41%), while in adolescent dancers (14-16 years) knee injuries became the leading cause of complaints (33%). We conclude that young, non-professional dancers are at high risk of injury. Dancers who had been injured in the past were at higher risk for re-injury. Tendonitis in the foot or ankle joint was a common injury among the youngest dancers, while knee injuries were common among adolescent dancers. A routine screening of this dancer population by an expert in dance medicine will reduce the risk for an injury.

Paratenonitis of the foot and ankle in young female dancers.

BACKGROUND: In their pursuit of excellence, dancers continually face the risk of injuries, such as paratenonitis. This attests to the strong need for preventive action, which is possible only if major risk factors are identified. The aim of the present descriptive study was to determine the association between risk factors and paratenonitis in young recreational female dancers. METHODS: One thousand eighty-two non-professional female dancers, aged 8 to 16 years, were screened. The risk factors considered for paratenonitis were: joint range of motion (ROM), body structure, anatomic anomalies, dance technique, and dance discipline. All dancers were clinically examined for current ankle/foot paratenonitis. RESULTS: Ninety-three dancers (8.6%) manifested a paratenonitis at the ankle or foot joints. ROM such as hyper ankle plantarflexion and hyper hip external rotation, false dance technique, and hours of practice per week were found to be associated with increased rate of injury. Regression analysis indicated that dancers with paratenonitis had greater hip external rotation ROM compared to dancers without paratenonitis. No association with injury was found with age of onset of menarche, body structure, and anatomic anomalies such as scoliosis. CONCLUSION: Precautionary steps, such as screening for joint ROM and dance technique, may reduce the risk of dance injury. Furthermore, our results led to a very significant justification of the dance maxim ``don't force your natural joint ROM and especially your `turnout' position,'' as it could increase your chance to develop paratenonitis.

Morphology and function of the lumbar spine of the Kebara 2 Neandertal.

The morphology of the lumbar spine is crucial for upright posture and bipedal walking in hominids. The excellent preservation of the lumbar spine of Kebara 2 provides us a rare opportunity to observe a complete spine and explore its functionally relevant morphology. The lumbar spine of Kebara 2 is analyzed and compared with the lumbar spines of modern humans and late Pleistocene hominids. Although no size differences between the vertebral bodies and pedicles of Kebara 2 and modern humans are found, significant differences in the size and orientation of the transverse processes (L(1)-L(4)), and the laminae (L(5), S(1)) are demonstrated. The similarity in the size of the vertebral bodies and pedicles of Kebara 2 and modern humans suggests similarity in axial load transmission along the lumbar spine. The laterally projected (L(2)-L(4)) and the cranially oriented (L(1), L(3)) transverse processes of Kebara 2 show an advantage for lateral flexion of the lumbar spine compared with modern humans. The characteristic morphology of the lumbar spine of Kebara 2 might be related to the wide span of its pelvic bones.

Schmorl's nodes distribution in the human spine and its possible etiology.

Although Schmorl's nodes (SNs) are a common phenomenon in the normal adult population, their prevalence is controversial and etiology still debatable. The objective was to establish the spatial distribution of SNs along the spine in order to reveal its pathophysiology. In this study, we examined 240 human skeleton spines (T4-L5) (from the Hamann-Todd Osteological Collection) for the presence and location of SNs. To determine the exact position of SNs, each vertebral body surface was divided into 13 zones and 3 areas (anterior, middle, posterior). Our results show that SNs appeared more frequently in the T7-L1 region. The total number of SNs found in our sample was 511: 193 (37.7%) were located on the superior surface and 318 (62.3%) on the inferior surface of the vertebral body. SNs were more commonly found in the middle part of the vertebral body (63.7%). No association was found between the SNs location along the spine and gender, ethnicity and age. This study suggests that the frequency distribution of SNs varies with vertebra location and surface. The results do not lend support to the traumatic or disease explanation of the phenomenon. SNs occurrences are probably associated with the vertebra development process during early life, the nucleus pulposus pressing the weakest part of the end plate in addition to the various strains on the vertebrae and the intervertebral disc along the spine during spinal movements (especially torsional movements).

A morphological adaptation of the thoracic and lumbar vertebrae to lumbar hyperlordosis in young and adult females.

The lumbar shape in females is thought to be unique, compensating for lumbar hyperlordosis. Yet, the morphological adaptation of various vertebral parameters in the thoracic and lumbar spine to this unique posture in young and adult females has only been partially addressed in the literature. Our aim was to investigate the gender association to vertebral shape in the thoracic and lumbar spine as a possible adaptation to lumbar hyperlordosis in young and adult females. A three-dimensional digitizer was used to measure the vertebral body sagittal wedging, relative spinous process thickness, and relative interfacet width at the T1-L5 level. Two hundred and forty complete, non-pathological skeletons of adults and 32 skeletons of young individuals were assessed. Three major results were found to be independent of age and ethnicity: (a) VB sagittal wedging in females was significantly less kyphotic than males from T9 to L2 (T11 excluded) with a cumulative mean difference of 8.8 degrees ; (b) females had a significantly relatively thinner lumbar spinous processes and (c) females had a relatively wider superior interfacet distance (T9-T10 and L1-L4) than males. We conclude that the combination of less kyphotic VB wedging in the lower thoracic and upper lumbar vertebrae, relatively greater interspinous space and larger interfacet width in the lumbar spine in females are key architectural elements in the lumbar hyperlordosis in females and may compensate for the bipedal obstetric load during pregnancy.

Weight Stigmatization among Physical Therapy Students and Registered Physical Therapists.

INTRODUCTION: Weight stigmatization is reflected in anti-fat attitudes and stereotypical perceptions of people who are overweight; it has been demonstrated to be prevalent in many segments of society across multiple countries. Studies examining the prevalence of weight stigmatization use different research tools, which can hinder inter-study comparisons. There is also evidence indicating weight stigmatization among registered physical therapists, although its magnitude differs between studies. Limited information exists regarding the attitudes and beliefs of physical therapy (PT) students toward individuals with obesity. Examining weight stigmatization among PT students is particularly important for developing appropriate educational interventions that may influence the professional lives of future physical therapists. OBJECTIVE: This study aims to characterize and compare the stigmatizing attitudes and beliefs of PT students and certified physical therapists regarding people with obesity in Israel. Its secondary objective is to translate three weight stigmatization questionnaires into Hebrew and determine their psychometric properties. METHODS: A cross-sectional, anonymous, and computerized self-report survey was completed by 285 certified physical therapists (average age 39.6 ± 10.1 years) and 115 PT students (average age 26.4 ± 4.9 years). The study used three validated weight stigma questionnaires employed in earlier studies to determine different aspects of weight stigmatization: the Fat Phobia Scale (short form; FPS), Anti-Fat Attitudes (AFA) questionnaire, and Beliefs about Obese People (BAOP). These questionnaires were translated into Hebrew and their psychometric properties ascertained. RESULTS: Similar to the original English versions, the translated versions of the three questionnaires demonstrated good internal consistency (Cronbach's α values of FPS = 0.77; AFA = 0.75; BOAP = 0.59). The three questionnaires showed a low correlation. No significant difference was noted in the FPS and AFA scores between groups, reflecting that both demonstrated average weight stigmatization (FBS in both groups: average score of 3.6 out of 5; AFA therapists: 3.3 ± 1.2, students: 3.0 ± 1.2 out of 9). However, significant between-group differences were observed for BOAP, which examines beliefs regarding individuals' control over their weight (therapists: 16.4 ± 5.6, students: 18.0 ± 5.7 out of 48; p < 0.01). CONCLUSION: Student and certified physical therapists demonstrate average levels of weight stigmatization, as reflected in the FPS and AFA scores. Nevertheless, compared to certified physical therapists, physical therapist students believe more strongly that obesity cannot be controlled by the individual. The students' beliefs could affect their clinical judgment and behavior as health care professionals in the future. Therefore, anti-fat attitudes and stereotypical perceptions should be addressed and remediated early using educational interventions during the study period.

Polyphenol oxidase can cross thylakoids by both the Tat and the Sec-dependent pathways: a putative role for two stromal processing sites.

Polyphenol oxidase (PPO; EC 1.10.3.2 or EC 1.14.18.1), a thylakoid-lumen protein encoded by a nuclear gene, plays a role in the defense of plants against both herbivores and pathogens. Although previously reported to be a Tat (twin-arginine-dependent translocation) protein, the import of PPO by isolated chloroplasts was inhibited by azide, a diagnostic inhibitor of the Sec-dependent pathway. Import of PPO inhibited thylakoid translocation of a Tat protein and did not affect translocation of Sec-dependent proteins. In contrast, a pre-accumulated iPPO competed with Sec-dependent but not with Tat proteins. A previously reported second processing step in the stroma removes a twin-Arg that is part of a 'Sec-avoidance' motif in the thylakoid targeting domain of PPO. When the second processing site was mutated, the import of the resulting precursor showed Sec-dependent characteristics. The PPO transit peptide could drive thylakoid translocation of a Tat protein in the dark. Azide inhibited the secretion of a PPO intermediate that lacks a twin-Arg to the periplasm of Escherichia coli, but had no effect on the export of the intermediate containing the twin-Arg. PPO is synthesized in plants in response to wound and pathogen-related signals and it is possible that when the Tat pathway is unable to translocate adequate amounts of newly synthesized PPO, translocation is diverted to the Sec-dependent pathway by processing the intermediate at the second site and removing the twin-Arg.

Growth and development of female dancers aged 8-16 years.

Little data are available on the growth and development of young female dancers. The objective of this study was to determine whether the body structure and adipose tissue distribution of dancers aged 8-16 years differ from that of non-dancer girls. Our cross-sectional study included a group of 1,482 female dancers, aged 8-16 years, and a control group of 226 female non-dancers of similar age cohorts. Fourteen anthropometric measurements were recorded and 15 indices calculated. In none of the linear anthropometric measures, were significant differences found between the two groups. The only significant difference relates to the extent and distribution of adipose tissue: At age 8, both groups show similar weight while at age 13 non-dancers are significantly heavier than dancers (48.4 +/- 9.8 kg for non-dancers and 40.6 +/- 8.7 kg for dancers). At age 15, weight differences between the two groups decrease to only 2 kg. The differences in weight are also expressed in skinfold thickness and chest circumference. Patterns of adipose tissue distribution differ between the two groups. Mean age at menarche was 13.1 years among dancers and 12.3 years in non-dancers. In conclusion, musculoskeletal development was found to be very similar in dancers and non-dancers. The specific body type reported for professional dancers is more likely acquired via "teacher's selection" and not training programs. Parents should not dread the possibility that dance training will delay the growth or reduce the height of their daughters.

Vertebral body shape variation in the thoracic and lumbar spine: characterization of its asymmetry and wedging.

This study was designed to characterize the vertebral body (VB) shape, focusing on vertebral wedging, along the thoracic and lumbar spine, and to look for shape variations with relation to gender, age, and ethnicity. All thoracic and lumbar (T1-L5) dissected vertebrae of 240 individuals were measured and analyzed by age, gender, and ethnicity. A 3D digitizer was used to measure all VB lengths, heights, and widths, and their ratios were calculated. This study showed that the VB size was independent of age or ethnicity. VB left lateral wedging was found in most vertebrae of most individuals, yet systematically was absent in six vertebrae (T4, T8-T9, T11, L3-L4) with a greater tendency in females than males ( approximately 92% vs. 86%). The VB was anteriorly wedged from T1 through L2 (peak at T7), nonwedged at L3, and posteriorly wedged at L4-L5 (peak at L5). VB width decreased from T1 to T4 and then increased toward L4-L5, so that the spinal configuration in the coronal plane resembled two pyramids of opposite directions, sharing an apex at T4. The inferior VB width was significantly greater than the superior width of both the same vertebra and the adjacent lower vertebra, indicating a trapezoidal shape of the VB and an inverted trapezoidal shape of the intervertebral space. In conclusion, these findings indicate that the human vertebra, in its normal condition, maintains its external dimensions with age, independent of gender or ethnic origin. Clinical and surgical implications of the unique thoracolumbar architecture are discussed.

Differential effect of supraspinal modulation on the nociceptive withdrawal reflex and pain sensation.

OBJECTIVE: To study whether the nociceptive withdrawal reflex (WR) and pain sensation are differentially affected by supraspinal modulation and to determine the nature of this modulation. METHODS: The WR and pain sensation elicited by electrical stimulation were measured in complete spinal cord injury (SCI) subjects and in intact controls under two different experimental conditions; "facilitation" and "neutral" control. RESULTS: Pain sensation was the same under both conditions, whereas the characteristics of the WR were highly dependent on them. In intact body regions the WR threshold was similar to pain threshold under facilitation but was near pain tolerance in neutral conditions. Furthermore, WR was elicited in 100% of trials under facilitation but only in 57% of trials in neutral conditions. Thresholds of WR in paralyzed regions were significantly higher than in intact regions (p<0.001). The former showed a clear stimulus-response relationship as did pain sensation whereas the WR in intact regions did not. CONCLUSIONS: The WR and pain sensation are differentially affected by supraspinal modulation. The WR is subject to both excitatory and inhibitory influences, depending on the instructions subjects receive. SIGNIFICANCE: The experimental setup and subjects' mental state should be considered when interpreting changes in the WR. Extreme caution should be employed when utilizing reflexive indices as a measure of pain. Verbal report seems a more suitable tool to evaluate pain since it is relatively stable with repeated measurements and in accordance with stimulation intensity.

Range of joint movement in female dancers and nondancers aged 8 to 16 years: anatomical and clinical implications.

BACKGROUND: Little data are available on changes that occur with age in joint range of motion in dancers and nondancers. HYPOTHESIS: In dancers, joint range of motion will increase with age, whereas it will decrease in nondancers, independent of the joint studied. STUDY DESIGN: Cross-sectional study; Level of evidence, 3. METHODS: The study population included 1320 female dancers, aged 8 to 16 years, who participated in different types of dancing classes (classical ballet, modern dance, jazz, etc) and 226 nondancers of similar age. Range of motion was measured for the hip, knee, ankle, foot, and spinal joints. RESULTS: The pattern of differences in range of motion with age varied in different joints and types of movement. (1) For combined ankle and foot plantar flexion (pointe), ankle plantar flexion, and hip external rotation, there was no change in range of motion in dancers, whereas range of motion diminished with age in the nondancers. (2) For ankle dorsiflexion, neither group showed any change with age, and range of motion was significantly greater in the nondancer group. (3) For knee flexion, hip flexion, and hip internal rotation, range of motion decreased with age in both groups. (4) For hip abduction, range of motion decreased with age in dancers and remained constant in the nondancers. (5) For hip extension, range of motion increased in both groups. (6) For lower back and hamstrings, range of motion increased among dancers with age and remained constant among nondancers. CONCLUSION: Dancers and teachers should realize that passive joint range of motion is unlikely to improve with age. Therefore, the major goal of a dancing program should focus on exercises that retain the natural flexibility of the dancers' joints rather than trying to improve them.

Sacral orientation and Scheuermann's kyphosis.

To examine whether the association between spinal alignment and sacral anatomical orientation (SAO) can be detected in skeletal populations, by comparing SAO values in individuals with a typical SD to individuals with normal spinal alignment. 2025 skeletons were screened for Scheuermann's disease. Scheuermann's kyphosis was established by the presence of apophyseal abnormalities associated with more than 5° of anterior wedging in each of three adjacent vertebrae. SAO was measured as the angle created between the intersection of a line running parallel to the superior surface of the sacrum and a line running between the anterior superior iliac spine and the anterior-superior edge of the symphysis pubis (PUBIS). SAO was measured on 185 individuals with normal spines and 183 individuals with Scheuermann's kyphosis. Out of 2025 skeletons, 183 (9 %) were diagnosed with Scheuermann's kyphosis. The sacrum was significantly more horizontally oriented in individuals with Scheuermann's kyphosis compared with the control (SAO: 44.44 ± 9.7° vs. 50 ± 9.9°, p < 0.001). Alteration in spinal biomechanics due to a horizontally orientated sacrum may be an important contributing factor for the development of Scheuermann's kyphosis.

Morphological characteristics of the young scoliotic dancer.

BACKGROUND: The literature lacks important data about the relationship between scoliosis and growth process, scoliosis and intensive exercise, scoliosis and morphological characteristics, and scoliosis and injuries, among young dancers. OBJECTIVE: The aims of the present study were to determine the extent to which dance experience, body structure, anatomical anomalies and injuries are associated with scoliosis, and to identify variables able to discriminate between scoliotic and non-scoliotic female dancers at time of screening. DESIGN: Cross-sectional cohort study. METHODS: One thousand two hundred and eighty-eight non-professional female dancers, aged 8-16 years, were screened for the current study. We determined their morphometrical profile (height, weight, BMI), dance discipline (as hours of practice per week), manifestation of anatomical anomalies, and existing injuries. All dancers were clinically examined for presence of scoliosis. RESULTS: Three hundred and seven of the 1288 dancers (23.8%) were diagnosed as having scoliosis. Dance experience and body structure were similar for dancers with or without scoliosis. Scoliotic dancers presented a significantly higher prevalence of anatomical anomalies (such as genu varum, and hallux valgus). Back injuries were more common among scoliotic dancers compared to non-scoliotic dancers. CONCLUSION: Screening and identifying the young scoliotic dancers prior to their advancing to higher levels of exercise is recommended. The scoliotic dancers should realize that there might be a connection between the presence of scoliosis and increased incidence of anatomical anomalies and back pain, hence, it should be suggested they seek help with an adequate assessment and exercise rehabilitation program.

Injuries in female dancers aged 8 to 16 years.

CONTEXT: Most studies of injured dancers have been carried out on professional adult dancers; data on young, nonprofessional injured dancers are sparse. OBJECTIVE: To identify the types of injuries sustained by recreational dancers and to examine their association with age, joint range of motion, body structure, age at menarche, presence of anatomic anomalies, and physical burden (i.e., practice hours en pointe). DESIGN: Descriptive epidemiology study. SETTING: The Israel Performing Arts Medicine Center, Tel Aviv. PATIENTS OR OTHER PARTICIPANTS: A total of 569 injured female dancers, aged 8 to 16 years. MAIN OUTCOME MEASURE(S): Dependent variables were 61 types of current injuries that were later classified into 4 major categories: knee injuries, foot and ankle tendinopathy, back injuries, and other injuries. Independent variables were age, joint range of motion, body size and shape, age at menarche, anatomic anomalies, and dance discipline (e.g., hours of practice per week en pointe). RESULTS: At least 1 previous injury had been sustained by 42.4% of the dancers. The most common injuries involved the knee (40.4%), followed by other injuries (23.4%). The relative frequency of back injuries and tendinopathy decreased with age, whereas knee injuries increased. Types of injuries were significantly associated with ankle plantar flexion, hip external rotation, hip abduction, and knee flexion. Multinomial regression analysis revealed only 3 predictive variables (with other as baseline), all for back injury: scoliosis, age, and hip external rotation. CONCLUSIONS: Joint range of motion and scoliosis may signal the potential for future injury. Young dancers (less than 10 years of age) should not be exposed to overload (especially of the back) or extensive stretching exercises.

The epiphyseal ring: a long forgotten anatomical structure with significant physiological function.

STUDY DESIGN: A descriptive study of the epiphyseal ring's structural design along the thoracolumbar spine. OBJECTIVE: To characterize and analyze the shape and size of the epiphyseal ring, to better understand its function. SUMMARY OF BACKGROUND DATA: The literature is lacking in metrical data pertaining to the epiphyseal ring that is usually described as a narrow bony labrum on which the external fibers of the anulus fibrosus are anchored. Most researchers express doubts as to whether the term epiphysis is justified in this case. METHODS: The sample studied included 240 human skeletons (vertebrae T4-L5) from a normal adult population (divided by sex, ethnicity, and age). Measurements of the vertebral body and epiphyseal ring were taken using a digital caliper at four different locations: anterior, posterior, right, left. In addition, each vertebral surface was photographed and the epiphyseal ring area measured (using image analyzer software Image J). RESULTS: We found that relative to vertebral body size throughout the thoracolumbar spine, the anterior section of the ring was the widest and the posterior section the narrowest. The lateral parts presented intermediate values. Relative to the discal area, the epiphyseal ring area gradually decreased from T7 to T12 and increased from T12 to L4. The area of the inferior ring was always larger than the superior ring (significant only for lumbar vertebrae), regardless of sex, ethnicity, and age. CONCLUSION: The epiphyseal ring varies largely in size and shape along the thoracolumbar spine. Much of its metrical properties are dictated by the applied mechanical stress regime during various movements, and/or the general anatomic structure of the spine.