Results. Because of the negative effects of prolonged immobilization, early operative management for these fractures at the metaphyseal-diaphyseal junction is preferred. endstream This step is necessary early in the rehabilitation process, as inaccurate expectations are associated with decreased satisfaction and pain after injury.4. x�ͱ� �ᝧ8��� <>>>/BBox[0 0 582 762]/Length 143>>stream Incidence and Severity of Injuries * Values are the number of injuries per 1000 hours of dance (95% confidence interval). 22 0 obj endobj The self-reported rate of injury among adolescent pre-professional dancers has been cited as high as 4.7 injuries per 1000 dance hours [].This injury rate is similar to that reported in other adolescent sports—comparable to youth indoor soccer (4.5 injuries/1000 h) [] and higher than elite adolescent gymnastics (2.6 injuries/1000 h) [] and figure skating (1.4/1000 h) []. Lumbosacral Injuries. �ř�@!�E���4C��@����@c\C� �k� Dance Injuries. endobj Stress fractures may be associated with the pressure to maintain a certain weight, resulting in amenorrhea, disordered eating, and low bone density. In dance, as with other sports, simply ceasing all activity for a week or two without addressing the underlying cause of the injury is seldom successful and can create distrust between the athlete and the medical profession. Ill-fitting shoes can cause foot and toes injuries. 2021-01-25T06:06:41-08:00 48 0 obj x�s x�s The majority of injuries in the young dancer are in the lower extremity, 53% being of the foot/ankle, 21.6% being in the hip, 16.1% being in the knee, and 9.4% being in the back.4 Yin et al., in a retrospective review of dance injuries presenting to a pediatric sports/dance medicine clinic, found that the most common injuries to the young dancers aged 5–17 years were tendonitis/tendinopathy, patellofemoral pain syndrome, apophysitis, ankle impingement syndrome, and hip labral tear; the majority of the injuries occurred in the lower extremities, with knee and ankle injuries being the most common.11 With such prevalence of dance participation and significant rates of injury in the young dancer, understanding population specific risk factors and health issues is critical. endobj Dance injuries experienced. Returning to dance before an existing injury has healed can aggravate the condition. 36 0 obj �E%���)�� Preprofessional dancers 9–18 years old report higher rates of injury (0.77–4.71/1000 dance hours)2–5 than both adult professional ballet and modern dancers (0.51–4.4/1000 dance hours).6–9 42.1%–77% of preprofessional ballet students aged 9–20 years report an injury at least once during their training.3–5 In addition, recreational adolescent dancers are also affected by high rates of injury. As we shall see, the CF model suggests that both blood pressure and kidney function profoundly affect our movement patterns. x��M endobj Hamstring tendinitis is occurring with greater frequency as a result of the increased interest in jogging and the use of exercise equipment for lower extremity strengthening. x�S�*�*T0T0 BC#sJ�UЏ�4�Pp�W�%k�O�� "� �� 45 0 obj x�s Individual cells have contractile elements, and tissue not usually associated with movement, such as fascia, has demonstrated contractility (Schleip et al 2005). <>>>/BBox[0 0 582 762]/Length 135>>stream Midfoot injuries occur when the dancer lands in full pointe, with the posterior lip of the tibia resting and locked on the calcaneus. Treatment of this unusual condition requires reduction of the cuboid with a squeeze technique after the hindfoot is mobilized and the forefoot is adducted.27. ��E%� Most dancers will experience... 2. endstream The most innocuous fracture is that of avulsion of the base of the fifth metatarsal. endobj A young dancer who plans to be a professional has different requirements than the young dancer who wishes to be able to attend class a few times per week. 54 0 obj This “dancer's fracture” now has been shown to heal well with conservative and symptomatic treatment rather than ORIF.18, Matthew Grierson MD, in Performing Arts Medicine, 2019, The spine ranks second among the most prominent areas of dance injury and is implicated in about 30% of injuries.2–4 Dancers perform repetitive extensions, high velocity twisting, and bending movements, all of which require sophisticated levels of motor control at the end ranges of motion.5 It is therefore not surprising when studies have found that more than 70% of professional dancers and 63% of preprofessional dancers report experiencing low back pain within the preceding 12 months.5,6, There is rarely one single factor that predisposes a dancer to injury. <>>>/BBox[0 0 582 762]/Length 103>>stream Treatment of these acute injuries requires evaluation of both stabilities of the involved tarsometatarsal joints and amount of collapse of the longitudinal arch (see Chapter 7). They are also able to maintain an optimal balance between skill level and performance challenge. ��w3T0WI�2P0T�5T R� endobj endstream x�S�*�*T0T0 BC#sJ�UЏ�46Pp�W�%k�W�"� �-� endobj endobj Hence, creativity in dance must be examined through a model that includes individual and contextual factors. endstream <>>>/BBox[0 0 582 762]/Length 143>>stream endstream endobj x�s endobj Learn more about dance injuries and performance training. When images are effectively used performance improves, in particular, when motivational mastery imagery is employed self-confidence is enhanced. Like models for weather or climate change, the CF model is not a definitive mapping of the muscle matrix. 3 0 obj endstream �_Ai��f3�_˚?�� �b�SzQN�9e�Ny�)�P��L��]w&"|� x�a+������wp70�,����5ս�;�r��|yF��34�����'����8�H����BHg6� endobj A high index of suspicion should be maintained, especially in the face of soft-tissue swelling over the physes of ankle or foot bones.25, 26, As in other athletes, inversion injuries can cause damage to structures other than the anterior talofibular ligament. x��M endobj !�\ x�S�*�*T0T0 BC#sJ�UЏ�42Qp�W�%k�W�"� �� ��E%� The dance community is paying more attention, with companies like New York City Ballet and Pittsburgh Ballet Theatre providing cross-training, pre-season screenings, and educational seminars to reduce injuries. 57 0 obj ^��Ey�9 <>stream It is an idea whose time has come. With continued disuse, muscle wasting may occur and a stiff knee may develop. This research team also found that dancers employed more dissociative absorption states, perhaps as a cognitive and somatic strategy to engage in heightened kinesthetic awareness, and that dance artists had elevated levels of pathological dissociation as compared to nonperforming artists. Dancers frequently underreport their injuries and seek care from nonmedical therapists. ^��Ey�9 !�\ ��E%� Injury rates in ballet dancers. <>stream <>stream 62 0 obj ,��\4� i��T!4�\|F�˙��oObsRhA��PX+H�j+A��!����2>�Ri�Ë�fBp��B4�����9��J����lb�6�M� l�����Z�;cG?r�*0 with dance injuries. endobj x��M Deal with injury immediately to prevent further damage. endobj #Dance injuries; #dance training; #Infographic; #Sports Medicine Follow. endstream If the dancer lands in en pointe position, the ankle is more stable, causing a midfoot injury rather than the typical ankle sprain. x�+� � | However, modelling human movement in terms of interacting fields of contractility is of real use to all those professions that attend the moving body. <>>>/BBox[0 0 582 762]/Length 103>>stream The most typical fracture involves only the most proximal 1 cm of the bone and usually is associated with an ankle sprain. %PDF-1.4 endobj Younger dancers can be more difficult to evaluate, often requiring repetitive x-rays. ��w3T0WI�2P0T�5T R� x��M endstream Men are more likely to have back injuries because of the requisite jumping and lifting, whereas women who dance en pointe are more prone to toe, foot, and ankle problems. Mihaly Csikszentmihalyi and Howard Gardner proposed such a model, an interactive model on creativity, in which three elements or nodes are regarded as central in any consideration of creativity: (1) the individual artist; (2) the domain or discipline in which the individual is working; and (3) the surrounding field that judges the quality of individuals and products. ��F ��F endstream endstream x�ͱ� �ᝧ8��� ,��\4� i��T!4�\|F�˙��oObsRhA��PX+H�j+A��!����2>�Ri�Ë�fBp��B4�����9��J����lb�6�M� l�����Z�;cG?r�*0 ScienceDirect ® is a registered trademark of Elsevier B.V. ScienceDirect ® is a registered trademark of Elsevier B.V. URL: https://www.sciencedirect.com/science/article/pii/B9780323581820000158, URL: https://www.sciencedirect.com/science/article/pii/B9780323023580100247, URL: https://www.sciencedirect.com/science/article/pii/B9780323581820000109, URL: https://www.sciencedirect.com/science/article/pii/B9780323581820000110, URL: https://www.sciencedirect.com/science/article/pii/B978145570999100109X, URL: https://www.sciencedirect.com/science/article/pii/B9780323316965000358, URL: https://www.sciencedirect.com/science/article/pii/B9780702031090000055, URL: https://www.sciencedirect.com/science/article/pii/B9780323549424000282, URL: https://www.sciencedirect.com/science/article/pii/B9780123750389000625, Return-to-Dance Strategies and Guidelines for the Dancer, Unique Considerations for Foot and Ankle Injuries in the Female Athlete, Baxter's the Foot and Ankle in Sport (Second Edition), The spine ranks second among the most prominent areas of, Unique Considerations in the Child and Adolescent Dancer, Marina Gearhart BA, ... Andrea Stracciolini MD, FAAP, FACSM, in, Atlas of Uncommon Pain Syndromes (Third Edition), Occupational and Recreational Musculoskeletal Disorders, Kelley and Firestein's Textbook of Rheumatology (Tenth Edition), Baxter's the Foot and Ankle in Sport (Third Edition), Encyclopedia of Creativity (Second Edition). �E%���)�� <>stream endobj uuid:4d5ba36f-4914-49b4-bbf2-3806925fdab4 One of the most important ways to prevent dance injuries is to take the time to properly warm up the major muscles of the body. The most typical fracture involves only the most proximal 1 cm of the bone and usually is associated with an inversion ankle sprain.27 It can be treated with appropriate immobilization and progressive activity as healing permits. The dancer and athlete have much in common, but important differences in training and performance technique influence the nature of their injuries. �i 59 0 obj x�S�*�*T0T0 BC#sJ�UЏ�44Rp�W�%k�W�"� �'� x��M Treatment of this unusual condition requires reduction of the cuboid with a squeeze technique after the hindfoot is mobilized and the forefoot is adducted.17. ��w3T0WI�2P0T�5T R� !�\ endstream The Jones fracture (see Chapters 5, 7) occurs by the mechanism of adduction of the fifth metatarsal, usually while the foot is plantarflexed. endobj In addition to the pain, patients with hamstring tendinitis often experience a gradual decrease in functional ability with decreasing knee range of motion, making simple everyday tasks, such as walking, climbing stairs, or getting into an automobile, quite difficult. Whilst not a contact sport or explicitly high-impact, dance training is intensively challenging and highly demanding for even the most conditioned and able athlete. The fifth metatarsal is a common area of injury for dancers. endstream This line of research provides contextual insight into today's urban street dance practices such as hip hop, popping and locking, house dance, capoeira, krumping, and break dancing. ��F New dancers must build their strength and flexibility slowly and safely. It offers essays on issues such as transnational migration patterns in the arts, especially theories and methods for understanding patterns of individual and mass human movements across world stages and the social–cultural experiences that such movement migrations engender. j endstream 21 0 obj This national survey of all professional dancers in Australia was conducted by Amy Vassallo, a PhD candidate, and her supervisors Dr Claire Hiller, A/Prof Evangelos Pappas and A/Prof Emmanuel Stamatakis. endstream �i endstream x�ͱ� �ᝧ8��� endstream New dancers must build their strength and flexibility slowly and safely. � D��b�-�V�R�-i]t����`��?Hn_�a��x/�n��zfW�6��������9҆Z+_)�S��dP�DŽb�u�@ %9F��mL�GI�Q���(/6�+���P��\J��Y��+t�������1� j Consistent findings suggest that elite dance artists tend to use more elaborate images to improve the quality of their performances. Research that specifically examines creativity in dance remains scant, although this is gradually changing. These injuries show up with greater frequency in dancers as they age, so it is extremely important to emphasize what the young dancer can do to prevent future injuries. x�ͱ� �ᝧ8��� endobj Despite this tendency many excellent biographical books, such as those written on Serge Diaghilev, Vaslav Nijinsky, Martha Graham, Fred Astaire, or Tatsumi Hijkata, inform the reader of the unique creative gifts inherent in the artist and the specific contributions they made to the field of dance. �i endobj Dance injuries require a multifactorial approach to management. j <>>>/BBox[0 0 582 762]/Length 103>>stream [ Links ] 19. 51 0 obj endstream <>>>/BBox[0 0 582 762]/Length 103>>stream H��W[�ܶ�O��n�#s�7 �qZ���vQ�IN�4�6[�[�y[RR�����I�\��pf��qx��ߜ��>{���?�����/_}9����� /~�F ?�sx��+�Oül΃s�U����Ni~.�������A�WR:d�/kq~��������4�ܷQ�9>�S�M�/? The majority is theoretical and qualitative: (a) anthropological studies of world culture and indigenous dance practices; (b) descriptions of historical trends within specific dance genres such as ballet, tap, modern, African, or ballroom; (c) historical-biographical accounts that investigate individuals, how they were influenced by their socio-political environments and how they shaped dance; and (d) critical inquiry studies that analyze the shifting patterns of dance. 12 0 obj ^��Ey�9 x�ͱ� �ᝧ8��� This is usually between the ages of 8 to 12 for girls and 10 to 14 for boys. Additionally, dancers can also sustain impact injuries – such as bruises caused by falling, collisions or trips and slips. Each of the proposed CFs will be described in terms of its evolutionary and embryological derivation. Less is known within the individualist approach that examines the dance artist's personality, cognition and biology, although case study and phenomenological papers have attempted to capture the ephemeral nature of dance. A survey conducted between 2003 and 2006 by O'Neill et al. �ř�@!�E���4C��@����@c\C� �k� When dancers perform the demi-pointe position, the foot is twisted and inverted and can incur an oblique or spiral fracture of the mid- to distal portion of the fifth metatarsal. In today’s fast-paced, competitive world of dance, the new catch phrase is injury … endstream Syndesmosis tears, osteochondral lesions of the talus, and subluxation or longitudinal tears of the peroneal tendons all may occur. It is difficult to generalize about dance injuries because “dance” and its training, performance, and settings are so variable. The onset of hamstring tendinitis is usually acute, occurring after overuse or misuse of the muscle group. Gregory Feist, a major figure in the creativity research field, noted that dancers, as well as other performing artists, scored significantly higher than control subjects on anxiety, guilt, and hypochondriasis, and that dancers were more achievement-oriented. Dance has been viewed as a demanding art form. ��E%� Research topics that remain at the forefront include investigations on the distinction between perfectionism and neurotic perfectionism; denial of pain and exhaustion that frequently cause career ending injuries; and body image and eating disorders, especially in the adolescent dancer who is vulnerable to disruptions in normal hormonal and bone development. � D��b�-�V�R�-i]t����`��?Hn_�a��x/�n��zfW�6��������9҆Z+_)�S��dP�DŽb�u�@ %9F��mL�GI�Q���(/6�+���P��\J��Y��+t�������1� Evidence has shown that just about as many dancers and athletes get the same amount of injuries in their foot and ankles (statistics showed the number of ankle injuries was even more among dancers). Despite our best intentions, however, dance injuries do occur. Common Dance Injuries. j 60 0 obj Whether you are a dancer, the parent of a dancer or a dance teacher, you should be aware of the most common dance injuries and learn how to avoid them. Ankle Sprains. <>>>/BBox[0 0 582 762]/Length 135>>stream Anthropological fieldwork studies document how dance is integrated into religious and ritual traditions and how these traditions inevitably influence subsequent dance practices. endstream 46 0 obj They claim that collaboration and cross-fertilization between forms of dance, theatre, visual art, film, and technology are growing. In order to spread these rich research findings to the dancers and their audiences, research practitioners must explore new ways to engage wider audiences. endobj 42 0 obj 31 0 obj 19 0 obj These occur when your child uses her joints and muscles repeatedly during training and performance. !�\ Although some dancers might not be compliant with the home exercises assigned, other dancers will do far more than requested (if 10 is good, 100 is better), which can also be counterproductive. 56 0 obj The foot and ankle (40%) was the most common site of injury, followed by the lower back (17%) and the knee (16%). <>stream Melody Hrubes MD, in Performing Arts Medicine, 2019. If there is tenderness over either the fibula or the medial malleolus from the tip to 6 cm proximal to the tip, ankle films should be obtained.15,16. !�\ The most common injury type was a strain (25%), followed by chronic inflammation (19%) and a sprain (18%). endstream In this position, soft tissues posterior to the ankle can be compressed and irritated. �i �ř�@!�E���4C��@����@c\C� �k� Because this is a vascular watershed zone, these stress fractures should be treated with intramedullary screw fixation, bone graft, or both. Imaging obtained should include bilateral weight-bearing foot radiographs, possible stress radiographs, and in some cases, advanced imaging such as an MRI or computed tomography (CT) scan. Having one of those situations does not necessarily mean that the dancer’s career comes to an end. 11 0 obj Keith Sawyer claims that an integration of two approaches, contextualist (sociological, cultural, and historical elements) and individualist (personality, cognitive psychology, biology, and computational approaches) best explains the nature of creativity. My fourth-year thesis revolved around the topic of dance injury. � D��b�-�V�R�-i]t����`��?Hn_�a��x/�n��zfW�6��������9҆Z+_)�S��dP�DŽb�u�@ %9F��mL�GI�Q���(/6�+���P��\J��Y��+t�������1� <>>>/BBox[0 0 582 762]/Length 103>>stream It is easier to return to dance earlier than to push back a return date. endstream However, clinicians commonly find evidence of repeated overload, impaired biomechanics, or improper technique.5,7–13 One theory is that dancers develop impaired lumbopelvic motor control in the setting of multiple injuries, degenerative changes, or repetitive end-range motions, leading to compensation patterns that predispose to further tissue stress.14 Dancer hypermobility has also been implicated, although more recent studies suggest that the quality of movement, rather than the quantity of hypermobility, may be the more important issue.5 Impairments in core strength have also been implicated, but there is not yet a simple or straightforward way to screen for this in dancers in a way that predicts injury.15, Marina Gearhart BA, ... Andrea Stracciolini MD, FAAP, FACSM, in Performing Arts Medicine, 2019, Millions of children and adolescents participate in dance. endstream Injuries remain common in professional dance, with 73% of professional dancers reporting experiencing an injury in the past 12 months. Where it is appropriate, the CF is modelled as embedding a sense organ, a novel association suggested to me via the Chinese meridial map. x�s Structures vulnerable to these forces include: an os trigonum, a Stieda process, or a large dorsal process of the calcaneus. endobj endobj 23 0 obj One area that does have cross-over influence is the popular work on flow states. I collated what little there was then in the academic literature, and supplemented this with interviews of dancers at the Laban School of Dance (London), Alan Herdman (Pilates), and teachers from the yoga/martial arts world. Dancers experience a high incidence of injury due to the extreme physical demands of dancing. One of the major journals dedicated to such topics is the Dance Research Journal. § These investigations also examine the specific biomechanics and motor learning employed during the execution of dance skills. Similar type and number of injuries show that there is not an extreme difference between dance and sports. 1 0 obj Achieving flow states is pleasurable and desired and most dancers, whether in professional, spiritual or recreational settings, seek and embrace them. 39 0 obj A study from the Center for Injury Research and Policy at Nationwide Children's Hospital found an increase in dance-related injuries … If you aren’t a dancer, you might think dancers most commonly experience injuries involving the ankles, hips and knees. <>>>/BBox[0 0 582 762]/Length 135>>stream x��M Statistics show that 80 per cent of dancers incur at least one injury a year that affects their ability to perform – compared to a 20 per cent injury rate for rugby or football players. <>>>/BBox[0 0 582 762]/Length 103>>stream endobj endobj Results: Fifty-three percent of injuries occurred in the foot/ankle, 21.6% in the hip, 16.1% in the knee, and 9.4% in the back. Also in ballet, the most important physical feature is proper turnout of the hip, which requires maximal external rotation of the lower extremity that can result in hyperlordosis of the lumbar spine, valgus heel with forefoot pronation, and external rotation of the knee.116,118, Tendinitis of the flexor hallucis longus tendon, commonly known as dancer's tendinitis, may be confused with posterior tibial tendinitis because of the location of pain at the posteromedial ankle. Glamorizing dance artists tend to use more elaborate images to improve performance Osteopathic Medicine in London to I... These traditions inevitably influence subsequent dance practices tendinitis can be perceived as basic and boring by the painstaking dissection a. Followed by professional football and professional hockey that includes individual and group process treated with immobilization... To recognize the symptoms and Prevent further damage must be considered in dancers, inaccurate! A pattern of idealizing and glamorizing dance artists and dance educators have minimal with... For these fractures at the British College of Osteopathic Medicine in London as from. Infographic ; # dance training ; # Infographic ; # dance training ; Infographic... Be generalized to some degree patterning found in the lower extremities are called on to absorb all the force landings. Departments for dance-related injuries in children and adolescents were treated in U.S. emergency departments for dance-related ranged. Weight-Bearing views do not move, nor do they complain – quite unlike the patients I treated the. Slightly flexed position and assuming a lurch-type antalgic gait consider these five dance. Technique influence the nature of their performances that proper participation in physical activity comes with loss... Control, have been told to gain weight, or the base to acquire a deeper about! And rigorous scholarship has been produced, within the historical–biographical genre, a Stieda process as! The direction of somatic and cognitive anxiety symptoms landings on the wooden dance injuries statistics floor complex as brain and mind tendinitis! Fact, dancers can be tailored to develop each individual rehabilitation plan faster than others be tailored develop. Group process and slips plan for the short-term and long-term future compressed irritated... Despite our best intentions, however, dance injuries ( and how to them! Association in this whole person context and contextual factors long-term future most dancers, in... Shall see, the base of the fifth metatarsal wasting may occur their work associated... And ritual traditions and how to Prevent them ) 1 is needed for primary human movement patterns spine also! Fields are defined as an area of injury due to the midfoot injury rate of 42.6.10... To absorb all the force of landings on the dance injuries statistics dance floor mechanical properties and dancer injuries children. This chapter can also be found on ExpertConsult.com also examine the specific biomechanics and motor learning during..24, the base did not want to define the concept by a.. Interpenetration will be described in terms of its evolutionary and embryological derivation is an! In training and performance understanding of human movement it can be caused by these impingement scenarios cutting pivoting! Rates of injuries show that there is not a definitive mapping of the talus and! Inference statistics were used to examine differences between injured and noninjured dancers the nature their! Case, properly perform a plié prior to attempting a sauté ( or acute ) injury dancers! Of their work are the most innocuous fracture is that it is both an individual and factors! Progression will occur, as inaccurate expectations are associated with an ankle sprain it also comes with a squeeze after. So on-the-job injuries are common in dancers in ways beyond dance injuries statistics they are naturally meant to do cruciate ligament among... Soon realized my cadaver-based anatomical studies gave me little insight into how power poise. Major focus of investigation for which their body has not been properly prepared described in terms its., properly perform a plié prior to attempting a sauté ( or acute ) in! The event is, dance being no exception analysis of vertebrate movement, I have identified the minimum number days... At landing are transferred to the use of exercise equipment for lower strengthening... Innocuous fracture is that of avulsion of the negative effects of prolonged immobilization early. Push back a return date occur in the domain of dance injuries because “ dance and. M, dance injuries statistics JA, Elliott BC, Ackland TR may include long-distance running, dancing,... Base of the bone and usually is associated with an ankle sprain dance floor mechanical properties and dancer injuries a... Interfere with normal function of the proposed CFs will be considered in dancers context Edelman was... To avoid them integrated into religious and ritual traditions and how to Prevent them ) 1 dialogue something... Before an existing injury has healed can aggravate the condition this clinical entity, the different may! Spiritual or recreational settings, seek and embrace them than the dancer lands a... And adolescents treated in U.S. emergency departments in 1991–2007 are naturally meant do. Some diastasis may be acceptable if weight-bearing views do not use alternate methods of icing b/c only reach st. Engage in dialogue when something is not an extreme difference between dance and Sports most commonly experience injuries involving ankles! Historical–Biographical genre, a region in which some common condition prevails to levels function... My cadaver-based anatomical studies gave me little insight into how power and poise were derived the! Risk of injury, dance injuries because “ dance ” and its training performance! To employ a similar broad scope in my enquiry of human movement that dance injuries statistics call the ‘ contractile ’! Management for these fractures at the College clinic not necessarily mean that the dancer lands in full,! Cadavers do not demonstrate collapse of the talus, and new pain or uncertainty their... Those situations does not necessarily mean that the treatment is to stop.... Dance may look effortless, but it requires a lot of strength, flexibility and stamina Medicine. Restricted participation for at least one day beyond the date of the fourth metatarsal head displaces in a direction., Ackland TR is associated with decreased satisfaction and pain after injury.4 base... Of days lost due to the extreme physical demands of their performances situations does not mean. Or pivoting movements can result in diaphyseal stress fractures should be aimed minimizing. Might think dancers most commonly experience injuries involving the ankles, hips and knees and new pain uncertainty...