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At the end of term, dd tripped on the stairs at school and injured her ankle.  It was strapped up well and she was on crutches for a few days.  The pain reduced but it was still very bruised and swollen.

 

Now she's home for Easter and I want to make sure it's healed properly before she starts dancing again next term.  The school nurse thought it was probably sprained but could have been a torn ligament.

 

It does seem improved but there is still some swelling/bruising.  I did think about taking her to my excellent osteopath to get it checked but would a sports physio be better?  

 

Any advice please?

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9 minutes ago, Lemongirl said:

At the end of term, dd tripped on the stairs at school and injured her ankle.  It was strapped up well and she was on crutches for a few days.  The pain reduced but it was still very bruised and swollen.

 

Now she's home for Easter and I want to make sure it's healed properly before she starts dancing again next term.  The school nurse thought it was probably sprained but could have been a torn ligament.

 

It does seem improved but there is still some swelling/bruising.  I did think about taking her to my excellent osteopath to get it checked but would a sports physio be better?  

 

Any advice please?


Physio or a sports medicine  doc 

decent Osteopath  might well be able to confirm / deny a diagnosis  it;s not  core Osteo stuff ...   at least the  dreded chiroquack  word hasn;t been mentioned 

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A physio with a special interest in dance would be best I think. My dd has had a recent ankle injury too and finding a physio who actually understood what she was aiming for, both short and long term, has been invaluable. It was really helpful that the physio understood exactly what the physical demands of the classes were too and she tailored her advice and exercises to fit. 

 

It might be worth contacting a local-ish CAT programme and asking if they know of any physios? Or one of the big schools if you’re near them? Or people on here will know, if you can give a region/area?

Edited by Farawaydancer
To add further info - posted too soon!
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Thanks, I am in NW London/Middlesex/Herts so if anyone can recommend someone in that area that would be great.

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Not really any need too be honest - a physio will possibly confirm a diagnosis but a diagnosis is only a guide for treatment. If there is ligament damage the treatment will be a period of rest with non-weight bearing mobility work. In other words,  keep off it but keep it moving. Suitable exercises include writing out the alphabet with the foot, moving the foot gently up and down, and side to side. If walking is not painful then some walking will help to keep it moving. Avoid the temptation to push the ankle to end-of-range movements while weight bearing such as pliés or rises. 

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On 29/03/2018 at 12:23, Lemongirl said:

At the end of term, dd tripped on the stairs at school and injured her ankle.  It was strapped up well and she was on crutches for a few days.  The pain reduced but it was still very bruised and swollen.

 

Now she's home for Easter and I want to make sure it's healed properly before she starts dancing again next term.  The school nurse thought it was probably sprained but could have been a torn ligament.

 

It does seem improved but there is still some swelling/bruising.  I did think about taking her to my excellent osteopath to get it checked but would a sports physio be better?  

 

Any advice please?

I'm not too sure on the time frame of the injury sustained but visble bruising can take up to 6 weeks to disappear completely, depending on the severity. This timeframe will also include recovery form a sprain. Try not to rush things just because it is the holidays as tempting as it may well be. 

If it really is just a matter of days and the ankle is still swollen a quick visit to A & E should at least confirm the diagnosis. I'm not one to encouage those to go to A &E several days after an accident but in some circumstances it may be necessary. Many might say see your GP but as it was an accident resulting in a injury that may need a X-ray or scan a GP can't do that. 

 

It is important to receive an a confirmed diagnosis before embarking on any kind of treatment/therapy. 

 

Does your DD have Private Medical Insurance? All the companies hold a detailed list of all recognised therapists in your area. If not, BUPA and possibly other private medical providers often offer the services for the non-policy holders. Defintely worth considering for the future if you haven't already. If only just to avoid the dreaded NHS waiting lists. As well as choosing your own day and times for appointments. 

 

Good Luck 

 

 

 

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1 hour ago, taxi4ballet said:

I really would suggest an x-ray to rule out an avulsion fracture.

Sound advice.

I have seen far too many potential careers ruined because xrays were not carried out early enough . I have known young dancers struggle on with inappropriate treatment which would have been avoided if more thorough examination had been done in the first place. Not all xrays will pick up problems I know but I do think better safe than sorry. One ex student of mine was left nearly paralysed , something that would had been avoided had an xray been done in time.

 

You should not need any medical knowledge to apply this common sense!!

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Posts on this thread is hidden while it is under review for being thought to contravene the Acceptable Use Policy and/or forum moderation policy.

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On 31/03/2018 at 08:51, balletbean said:

I'm not too sure on the time frame of the injury sustained but visble bruising can take up to 6 weeks to disappear completely, depending on the severity. This timeframe will also include recovery form a sprain. Try not to rush things just because it is the holidays as tempting as it may well be. 

If it really is just a matter of days and the ankle is still swollen a quick visit to A & E should at least confirm the diagnosis. I'm not one to encouage those to go to A &E several days after an accident but in some circumstances it may be necessary. Many might say see your GP but as it was an accident resulting in a injury that may need a X-ray or scan a GP can't do that.

 

And if it doesn't seem to be responding as expected, it may be a good idea to have a second look taken.  A friend who was knocked down by a bike last summer spent several months in a "boot" with a very swollen and painful foot, having been told at the local hospital that it was just soft tissue damage or something like that.  It was only a couple of months ago that she was finally referred to a specialist who took one look and diagnosed a couple of torn ligaments.  Result?  Immediate plaster, but possible surgery needed if the ligaments haven't mended properly, which is quite conceivable given the time elapsed since the initial injury.

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An ankle injury is not to be under estimated, it can take many months to heal and require lots of strength and conditioning work on the whole body before returning fully to dance. The recovery can also be two steps forward and one step back. It cannot be rushed.

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Whilst there is no problem with people giving examples of their own experiences, I should remind members that we must not give medical advice as such. 

 

Lemongirl, please seek medical advice, whether that's from a dance physio, or a doctor who specialises in dance injuries. Feel free to ask on the board for recommendations of practitioners. 

 

Most children at vocational schools have private health insurance (I know we had to have it) - if you have, please get wheels in motion to see someone.

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Thank you very much, very helpful advice.  I have arranged for dd to see the dance physio recommended to me, she is going tonight.  But now I am wondering if I should have taken her for an x-ray first?  Or should I discuss this with the physio?

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24 minutes ago, Lemongirl said:

Thank you very much, very helpful advice.  I have arranged for dd to see the dance physio recommended to me, she is going tonight.  But now I am wondering if I should have taken her for an x-ray first?  Or should I discuss this with the physio?

 

an X-ray , like any investigation  answers a clinical question. 

the clinical  question  to be answered with an X-ray from  Minor injuries / Urgent care is  " in this patient who  is Ottowa Ankle rule  positive , do they have a bony injury  to the foot  and /or ankle"   foot and/or ankle depending on  exact findings of a clinical exam .

where someone has been seen  by a specialist Health  professional the question may be different  and the imaging request may  be different 

any  X-ray  request in the UK  has to be justified  under the Ionising Radiation (Medical Exposure) Regulations 2000

https://www.gov.uk/government/publications/the-ionising-radiation-medical-exposure-regulations-2000

https://en.wikipedia.org/wiki/Ottawa_ankle_rules

Edited by Nicola H
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1 hour ago, Nicola H said:

 

an X-ray , like any investigation  answers a clinical question. 

the clinical  question  to be answered with an X-ray from  Minor injuries / Urgent care is  " in this patient who  is Ottowa Ankle rule  positive , do they have a bony injury  to the foot  and /or ankle"   foot and/or ankle depending on  exact findings of a clinical exam .

where someone has been seen  by a specialist Health  professional the question may be different  and the imaging request may  be different 

Specialist health professionals sometimes get it wrong, and don't suggest an x-ray when they should have done.  A misdiagnosis can cost a dancer their career.

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I suffered with ankle problems when I played physical sports, and when I look back, a lot of the pain and suffering was unnecessary, due to coming back too soon. Without doubt I would get an x-ray, and preferably a scan too, this will show any soft tissue damage, which could be worse than a fracture in the long run. When asked for advice I always told players to give it another week at least, when they thought they were fit to play.

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51 minutes ago, taxi4ballet said:

Specialist health professionals sometimes get it wrong, and don't suggest an x-ray when they should have done.  A misdiagnosis can cost a dancer their career.

I think what Nicola H was trying to get at is that plain X rays might not be the best imaging rather than that no imaging is needed.

A&E staff have specific criteria to follow in determining whether an ankle injury needs an X ray, but they aren't generally looking at injuries from the perspective of a would be professional dancer/ elite athlete. 

An expert opinion from a dance or sports specific health care professional would perhaps be best first, as they are more likely to recommend the right imaging. Admittedly that may not be easy to come by of course - there may be no option other than A&E in some areas. But either way, the decision about investigations has to be made by someone who can request them, and that decision is made on the basis of history and examination. So the key thing is to find the best  "someone" you can.

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2 hours ago, taxi4ballet said:

Specialist health professionals sometimes get it wrong, and don't suggest an x-ray when they should have done.  A misdiagnosis can cost a dancer their career.

The next step after an x-ray and/or scan is to ensure they are reviewed by qualified and knowledgeable staff. Seek 2nd opinion if not completely satisfied. That’s where private medical insurance can come into their own. No disrespect to many highly qualified Registrars out there but there’s no one better person than a Consultant who specialises in a particular field.

Not just for this post but for any injury or even long ongoing illness that can result in an unnecessary delay/pain in a dancers  recovery or even worse put paid to their career. 😕

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8 hours ago, Pups_mum said:

I think what Nicola H was trying to get at is that plain X rays might not be the best imaging rather than that no imaging is needed.

A&E staff have specific criteria to follow in determining whether an ankle injury needs an X ray, but they aren't generally looking at injuries from the perspective of a would be professional dancer/ elite athlete. 

An expert opinion from a dance or sports specific health care professional would perhaps be best first, as they are more likely to recommend the right imaging. Admittedly that may not be easy to come by of course - there may be no option other than A&E in some areas. But either way, the decision about investigations has to be made by someone who can request them, and that decision is made on the basis of history and examination. So the key thing is to find the best  "someone" you can.


 Imaging on demand  does not  exist in the UK because of IR(ME)R  , the  various Ottawa  rules  around x-rays /  scans  came about  because Canadian  radiologists and  Emergency Dept Doctors , concerned at the  rise in ' because we can' imaging  in the fee for item of service US   and their courts  rather  slack attitude to   evidence base  over   medical practice  , and seeing  these ideas come across their border wanted to   have an evidence based test  with  good specificity and sensitivity  to screen who needs a dose of radiation. 

a relevant  specialist examination   will determine  whether imaging is needed and what is be best modality   plain film XR / ultrasound / CT / MR  

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My brother-in-law is a consultant specialist in medical imaging.

 

You can't just rock up at the x-ray department at a hospital and demand an x-ray, obviously. Nobody in their right mind would expect to be able to do that.

 

If you turn up at A&E in the UK with an injury you will be assessed and sent to the imaging dept if required. In our experience, if you explain that you are a vocational dancer, then they will err on the side of caution, send you for an x-ray and will even call a consultant down for a second opinion on the x-ray just to be on the safe side.

 

They are generally far more helpful that your average GP who doesn't believe in early intervention for dance-related injuries (they don't seem to quite 'get' it), and will tell you to go away, rest and take paracetamol, and return in a week's time.

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Just a thought to add regarding diagnostic imaging - not every issue that is symptomatic will be shown on an image. MRI scans, CT scans, x-rays etc are not 100% reliable. In fact, studies have been done recently where PAIN FREE individuals have had diagnostic images taken (for research purposes) and lots have had what would be considered as 'clinically significant' findings showing up on their images! 

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2 hours ago, drdance said:

Just a thought to add regarding diagnostic imaging - not every issue that is symptomatic will be shown on an image. MRI scans, CT scans, x-rays etc are not 100% reliable. In fact, studies have been done recently where PAIN FREE individuals have had diagnostic images taken (for research purposes) and lots have had what would be considered as 'clinically significant' findings showing up on their images! 

Agree, in fact I have an elderly relative who had a scan a couple of weeks ago which showed up a hitherto unknown and symptom-free spinal injury. They had the scan for something else entirely.

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On 3/29/2018 at 12:23, Lemongirl said:

At the end of term, dd tripped on the stairs at school and injured her ankle.  It was strapped up well and she was on crutches for a few days.  The pain reduced but it was still very bruised and swollen.

 

Now she's home for Easter and I want to make sure it's healed properly before she starts dancing again next term.  The school nurse thought it was probably sprained but could have been a torn ligament.

 

It does seem improved but there is still some swelling/bruising.  I did think about taking her to my excellent osteopath to get it checked but would a sports physio be better?  

 

Any advice please?

 

In addition to my post regarding the debate re imaging - I'm not saying don't get an x-ray or scan, but as the OP stated, her DD was seen by the school nurse who would've sent her for any diagnostic imaging that was necessary. It's important not to get carried away with the fear surrounding injuries. I know that historically dancers have injuries that are poorly diagnosed and therefore treatment hasn't been appropriate but in this case Lemongirl has stated that her DD was seen promptly by a medical professional (who has, no doubt seen a lot of these in their time) and did their job by strapping up the ankle and giving crutches. I stand by my earlier advice - trust the nurse who saw the injury initially, give it plenty of time to heal whilst keeping it moving, and worry about physio if it's still hurting after a week or so. I am assuming that there is a physio connected to the school?

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10 minutes ago, drdance said:

 

In addition to my post regarding the debate re imaging - I'm not saying don't get an x-ray or scan, but as the OP stated, her DD was seen by the school nurse who would've sent her for any diagnostic imaging that was necessary. It's important not to get carried away with the fear surrounding injuries. I know that historically dancers have injuries that are poorly diagnosed and therefore treatment hasn't been appropriate but in this case Lemongirl has stated that her DD was seen promptly by a medical professional (who has, no doubt seen a lot of these in their time) and did their job by strapping up the ankle and giving crutches. I stand by my earlier advice - trust the nurse who saw the injury initially, give it plenty of time to heal whilst keeping it moving, and worry about physio if it's still hurting after a week or so. I am assuming that there is a physio connected to the school?

 

The medical professional who saw my dd straight after her injury did not send her for an x-ray. She saw them again and again (and others) in the weeks that followed. They said there was nothing broken. They got it spectacularly wrong. 

 

Please folks, if you have any doubts whatsoever, get another opinion, and if necessary demand a referral to a specialist. I only wish we had insisted on a referral far sooner than we eventually did.

 

We trusted them. One of the biggest mistakes I have ever made. DD's dance career is over because of it. 

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Sadly, just because a school has a Nurse or Physio attached to it, this doesn't automatically make those medical staff infallible.  If in any doubt at all, I always take my daughter to one of our own two Physios; one locally and one in London who is always our first stop.  Even another Physio at the same local practice has missed an injury that the senior Physio picked up.   

It would be lovely to be able to to say "trust the staff at school" but unfortunately it doesn't always work like that. 

 

Anyway, any news, Lemongirl? 

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1 hour ago, taxi4ballet said:

 

The medical professional who saw my dd straight after her injury did not send her for an x-ray. She saw them again and again (and others) in the weeks that followed. They said there was nothing broken. They got it spectacularly wrong. 

 

Please folks, if you have any doubts whatsoever, get another opinion, and if necessary demand a referral to a specialist. I only wish we had insisted on a referral far sooner than we eventually did.

 

We trusted them. One of the biggest mistakes I have ever made. DD's dance career is over because of it. 

OMG taxi that is truly awful. 

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This is absolutely dreadful, Taxi. If you can’t trust the medical staff at a vocational school, who can you trust? I am so very sorry.

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5 hours ago, taxi4ballet said:

 

The medical professional who saw my dd straight after her injury did not send her for an x-ray. She saw them again and again (and others) in the weeks that followed. They said there was nothing broken. They got it spectacularly wrong. 

 

Please folks, if you have any doubts whatsoever, get another opinion, and if necessary demand a referral to a specialist. I only wish we had insisted on a referral far sooner than we eventually did.

 

We trusted them. One of the biggest mistakes I have ever made. DD's dance career is over because of it. 

 

So, so sorry to read this! 

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