Dancers at the National Ballet of Canada begin each day the same way. They gather for a 75-minute ballet class to develop and refine techniques they have been working on since their introduction to ballet. Every dancer has performed each movement thousands of times with a precision and level of conscious awareness seldom seen with other athletes or performers.
Neurofunctional acupuncture – the insertion of fine solid needles into innervated areas of the body for therapeutic purposes – is the perfect complement to ballet, where development of the nervous system in a dancer’s technical foundation is of the utmost priority.
Ten days before the start of the 2010 Winter Olympics in Vancouver, a National Ballet dancer preparing to perform at the Games landed poorly from a jump, severely rolling her right ankle. The physician diagnosed the injury as a second- to third-degree lateral ankle sprain and suggested she be off work for two or three weeks. While this dancer wasn’t competing for gold medals, she had been scheduled for more than a year to dance at the Olympics and the thought of not participating was disheartening.
I first saw the dancer six hours after the injury. She was on crutches, bound with ice and in a great deal of pain. She still had the ability to plantar flex about 20 degrees, but other movements surrounding the ankle were nonexistent. She also had an edema that reached mid-shin.
Treatment Protocol
1. Decrease excessive activity centrally and locally
No matter where the injury, there will always be an acute response with an increase in sympathetic nervous system activity. Increased sympathetic tone will result in a host of physiologic changes, including increased heart rate and increased glucose metabolism in muscle. Central stabilization of the sympathetic nervous system was achieved by stimulating insertion sites on the head and ear as well as distal neurovascular bundles in the upper extremity. Local stabilization was achieved initially by stimulating distal neurovascular networks on the contralateral lower extremity and ankle.
2. Decrease nociception from the injured area
The nociceptive information into the dorsal horn must be decreased in an acute situation. The dancer did much of this herself when she was not receiving treatment. She constantly iced and elevated her ankle, used a jobes pump with light compression, and took an anti-inflammatory prescribed by the sports medicine physician.
3. Decrease spinal processing of nociceptive signals
Decreasing the nociceptive signalling taking place at the spinal cord is of the utmost importance when attempting to quickly restore function. Initially, because the injury was acute, the strategy was to stimulate peripheral neurovascular bundles both proximal and distal to the injury site. With each passing day, the goal was to get closer to the injury while increasing the non-noxious signals being sent to the spinal cord and while working on contralateral stimulation of the affected tissue and corresponding area.
The day after the injury, the dancer received two treatments. One session was devoted to stimulation of the posterior rami at spinal levels neurologically relevant to the problem. This was done with bilateral needle insertions into the paravertebral musculature at segmental somatic as well as reflex vascular levels of the preganglionic neurons that supplied the injured area. Electrical stimulation of 2Hz for 20 minutes was also added to increase the neuromodulatory effect.
4. Decrease central processing of nociceptive signals
By the fourth day the dancer was feeling much better and treatment was becoming more local around the sinus tarsus and some of the peripheral nerves without stimulating a noxious response. Central processing of nociception was still addressed by targeting distal extremity points, as well as head and ear points. 2Hz of electrical stimulation was used to release endorphins and decrease nociception centrally.
5. Increase strength and function
Restoring strength and function is of the utmost importance. This was done by stimulating healthy surrounding tissue, relevant local nerves, various myotendinous units and intra-articular insertions within both the talocrural and talocalcaneal joints. Soft tissue work was also added bilaterally to clean the peripheral nervous system and encourage lymphatic drainage.
Result
The dancer flew to Vancouver three days before the show. At this point she was performing barre exercises at the beginning of ballet class, as well as propioceptive training, muscle activation and motor pattern drills, core exercises and cardiovascular conditioning on an exercise bike. While in Vancouver, the same strategies were implemented and she continued to regain strength, function and the confidence needed to perform on stage at the Olympic Games in front of thousands of people. The quality of the dancer’s neuromuscular system in combination with neurofunctional acupuncture was instrumental in allowing her to experience this once-in-a-lifetime opportunity.
