Reducing Risk of Ankle Injury Among Ballet Dancers

Research Proposal

KINE4565 Epidemiology of Injury Prevention

Instructor: Professor Theresa Kim

Names: Liliana Ferreira and Jessica Cunha

Student Numbers: 209361411( L.F) and 210561611(J.C)

Due Date: April 3, 2014

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Summary

An ankle joint is like a metal coat hanger in the way that if you were to bend the metal

coat hanger, in the same spot over and over again it would eventually break from overuse. The

ankle is the same way in the fact that if a person, such as a ballet dancer, were to constantly

move their ankles the same way for hours on end, it would eventually get damaged or injured

from the amount of strain being put on a single joint. According to Allen, Nevill, Brooks,

Koudtedakis and Wyon (2012), overuse injuries are the most common types of injuries in ballet

dancers compared to traumatic injuries possibly because of the constant repetitive movements

involved in ballet. Another common injury that ballet dancers tend to encounter is ankle sprains

particularly lateral ankle sprains which can lead to more problems in the future (Ritter & Moore,

2008) and it has been stated that many ballet dancers endure at least one injury per year

(Twitchett et al., 2010).

There are studies that have been done on ballet dancers and ankle injuries that are

descriptive studies and look at the frequency and the types of injuries (Reynolds, Kerchief &

Boyce, 2013). This study would look at ballet dancers and try to find a way to help reduce the

risk of injury by using demi pointe ballet shoes, ankle exercises and ankle tape. In order to do

this, a one year randomized control study design would be used and will include 150 female

subjects from the age of eleven to thirteen from the greater Toronto area. They will train three

times a week for an hour and a half at the York University dance studios in order to avoid

confounding variables. They have a clinic on campus which will be of assistance if any injuries

do occur throughout training. There will be two phases of the study, the first one being the Pre-

Pointe phase where participants will not be using the pointe shoes and the Pointe Phase where

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the participants will be using the Pointe shoes. The same type of skills and the same instructor

will be used in both phases to again avoid confounding variables.

Introduction

Prospective Studies

Many prospective studies have been done on ballet dancers and the types of injuries that

they endure. A study that looked at injury prevalence in ballet, jazz and modern dancers noted

that most ballet dancers dance for nine hours a week and even though ballet dancers had the

lowest number of injuries, most of their injuries were in the lower extremity particularly the

ankle (Reynolds et al., 2013). The reason as to why ballet dancers had less injuries overall

compared to the other types of dancers could be because the ballet dancers had less years of

experience than the other dancers and they hypothesized that the more years of experience you

have, the more likely you are to endure an injury (Reynolds et al., 2013). If the dancers had the

same years of experience, they might have endured the same amount or more injuries as the

other dancers. This study had a small amount of participants with only twenty ballet dancers

making it hard to generalize to other ballet dancers and they used mailed out surveys to gather

their information making the evidence not as reliable (Reynolds et al., 2013).

Another prospective study called The Effect of a Comprehensive Injury Audit Program on

Injury Incidence in Ballet: A 3-Year Prospective Study, looked at professional ballet dancers over

a three year period noted that females endured three hundred and twenty three injuries within

those three years (Allen, Nevill, Brooks, Koudtedakis and Wyon, 2013). Although the article did

not mention where the injuries occurred, they mentioned that the highest amount of injuries

occurred within the first year and slowly declined in the second and third year, but the amount of

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overuse injuries remained steady throughout the three years. All of these statistics were found to

be significant with a p<0.001 and with a confidence interval of 95% (Allen et al., 2013). A

limitation of the article was the fact that they could not use a randomized control study design

due to the reality that they looked at all injury types and not a specific one but they were able to

demonstrate that using a in-house medical team helps in reducing the occurrence of injuries

(Allen et al., 2013).

Another research article that looked at rates and risks in pre-professional ballet dancers

was Injuries in pre-professional ballet dancers: Incidence, characteristics and consequences

(Ekegren, Quested & Brodrick, 2013). This study also concluded that overuse injuries were the

most common types of injuries and that 77% of the injuries were located in the lower extremity

33% affecting the ankle. This was a significant statistic with a p<0.05, a confidence interval of

95% and a rate ratio of 1.0 (Ekegren et al., 2013). Many of these injuries can be implied to the

fact that many ballet dancers spend a lot of time dancing causing continuous stress to their lower

limbs and that is why we do not see as many upper limb injuries (Ekegren et al., 2013).

An article that looked specifically at modern dancers noted that many dancers sometimes

do not get medical help, especially if it is a minor injury for certain reasons such as no insurance

or because dancers believe that doctors do not understand the demands of dance training

(Weigert & Erickson, 2007). They mentioned that these minor injuries can easily become more

serious injuries if they go untreated (Weigert & Erickson, 2007). This supports the idea that it is

important to have a clinic or health professional available when doing studies in order to make

sure that all the information is collected and that the dancers get treated right away so they can

avoid more serious problems in the future.

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Cross-sectional Studies

Few cross-sectional studies have been done on ballet dancers but one in particular looked

at dance floors and how they affected injury rates in ballet dancers (Hopper et al., 2013). They

found that many of these ballet dancers were dancing on floors that did not comply with the

European Sport Surface Standards and that the majority of injuries occurred on the floor that had

a high variability of force reduction magnitudes (Hopper et al., 2013). Meaning that a single

dance floor that a dancer would be dancing on would have different force reduction magnitudes

throughout, making the floor uneven in the way it absorbs the impact of the jump. This floor had

a significant difference (p<0.05) in the fact that it had a higher weekly injury rate than the other

ones that did not have a great variability (Hopper et al., 2013). This is important to note in order

to make sure that the floor does not act as a confounding variable which can skew the results of a

study.

A large study that was done on five hundred dancers from all different types of dance

styles was Investigation of Risk Factors and Characteristics of Dance Injuries (Campoy et al.,

2011). They looked at the characteristics and injuries that had occurred to these dancers within

the twelve months and found that a hundred and ninety-seven classical ballet dancers had

endured an injury within those twelve months which was seventy-six percent of the total

classical ballet dancers questioned (Campoy et al., 2011). When compared to non-injured

classical ballet dancers there was a significant difference with a p<0.05 and that the injuries

occurred predominantly at the ankle and foot which was caused mainly by dynamic overload and

excessive use of the ankle and foot (Campoy et al., 2011). The strength of the data can be

cautious as the information collected was by a questionnaire at a festival and there could be

recall bias involved.

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Other Designs

An interesting article called Musculoskeletal injuries in young ballet dancers concluded

that the most frequent region that was injured was the foot and lower leg with a p<0.05 and the

most common type of injury was ankle sprains (Leanderson et al., 2011). As the studies

mentioned above have also stated, this article mentions that the cause of most injuries is the fact

that the joint is overused to the point that it causes damage. Since this was a retrospective study,

it looked at old medical records from 1988 to 1995 so the information is not very recent

(Leanderson et al., 2011). This could be a problem because health care has changed a lot since

1995 which could have an effect on the results presented from this study.

An article that looked at footwear in classical ballet mentioned that a dancer’s foot is

more at risk during adolescence when the dancer’s foot is still growing and by wearing demi

pointe before using pointe shoes may relieve some of the pressure on the foot which may help

reduce the possibility of an injury occurring (Pearson & Whitaker, 2012). They found that a

dancer was more likely to sustain an ankle injury if they did not use demi pointe shoes before

using the pointe shoe and that a combination of both shoes was the best results however; there

was no significant result when comparing pressure differences between the two shoes (Pearson

& Whitaker, 2012). They collected their information about injury and use of shoes from a

questionnaire and there could have been some recall bias which would skew the results. Certain

things that the article did not look were the effects of ankle tape and the aid of ankle exercises

which could also assist in reducing the risk of ankle injuries in ballet dancers.

After reviewing these journal articles one can conclude that almost all of them have one

main thing in common which is that ballet dancers tend to suffer lower limb injuries that pertain

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to the ankle and foot which could be the result of the constant hours and pressure that they are

constantly putting on their ankles. Getting medical help right away even for minor injuries and

dancing on the right type of dance floor is critical to reduce the risk of an initial injury and to

prevent a dancer from reinjuring themselves. Wearing the right type of shoes with proper

pressure distribution can help with this.

Rationale

Since little research has been done in looking at preventative ways in order to reduce the

risk of injury in ballet dancers this is a field that requires more research. As mentioned above

ballet dancers are more than likely to endure at least one injury in a year (Twitchett et al., 2010).

If there is a way we can reduce the amount of injuries that a ballet dancer endures, we can not

only save money in health care from rehabilitating them, but we can also help them progress in

their careers as they would not have to waste time in rehabilitation and would be able to spend

more time in practicing their dancing. When looking at the Haddon Matrix the study would fit

into the pre-event and post-event involving the agent with the aid of ankle exercise. It would also

fit into the host during the event because of the different types of ballet shoes and the ankle tape

while the dancers are dancing.

Objective

To determine if the risk of ankle injury reduces in ballerina’s who use pointe shoes with just the

aid of ankle exercises, ballerina’s who used demi pointe shoes prior to pointe shoes and

ballerina’s who use ankle tape while practicing in pointe shoes.

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Methods/ Materials

Study Design

This study is a 1 year Randomized Control Trial that focusses only on female ballet dancers.

-Control group vs. Demi-pointe Group vs. Ankle Taped Group

This particular study design was chosen as it is not only unique compared to the other research

articles examined which focused more on cross-sectional, prospective and retrospective designs,

but we also wanted to try and focus on limiting as many confounding variables as possible.

Target Population

Ballet Dancers in Toronto and the Greater Toronto Area (GTA)

Age: 11-13 years of age. This is typically the age in which pointe shoes are introduced to

the ballet dancers. (The Pointe of Pointe Shoes, n.d)

Gender: Females. Typically females are the ones who wear and train in pointe shoes

much more often than males who generally use it for comedic affect during their

performance. (The Point of Pointe Shoes, n.d)

Skill Level: Intermediate Level, equivalent to the Royal Academy of Dance (RAD). This

intermediate foundation- Advanced 2 Level- develops technique further, as well as music

and performance skills, and also introduces pointe shoe work. (Rad Vocational Ballet

(Intermediate Foundation), n.d)

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Inclusion:

Any female ballet dancer who is in the Intermediate Level or equivalent to that of the

Royal Academy of Dance that fits the age requirement.

Female ballet dancers who are a part of a dance company or a dance class

Ballet dancers who may be practicing another type of dance outside of ballet

Exclusion:

Ballet dancers who have had previous lower body injuries prior to the study as it may

affect the findings.

Ballet dancers who have had previous exposure to pointe shoes

Male danseurs

Setting

This study will be taking place at York University; in one of the three dance studios they have

offered which are the three additional rehearsal studios E, G and H. This was done because York

University is in a central area between downtown Toronto and those living in the Greater

Toronto Area. Having it at York University will also ensure that the dancers practice on the same

type of floors in order to avoid confounding variables. There is also a sports medicine clinic on

site called Athlete’s Care which houses a physiotherapist named Vicki Hawkins, whom the

dancers can choose to see if they endure an injury at some point during the study. (Facilities and

Equipment, n.d)

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Recruitment

The recruitment process will be carried out by the 5 undergraduate volunteers from York

University.

Posters and General Information emailed to all ballet/ dance schools/companies.

Posters posted in ballet shoe stores

Posters in ballet apparel stores

Online advertisement on Ballet Blogs/ Ballet pages on Facebook

Pamphlets put into the programs at ballet performances

o Those who expressed interest were then sent information packages which outlined

what the study entailed as well as explanations regarding ankle injuries and their

severity. A consent form was also included in the package to be signed by the

parents. The forms had to have been sealed in the pre-stamped addressed

envelope.

In order to encourage participation, participants who were from dance companies were given a

credit that could be used towards their graduation credits. Those who are not a part of particular

dance companies and practiced ballet for more recreational purposes received a certificate that

honoured their help in the research study.

Testing Procedures

Number of Participants: After performing an a priori power analysis we decided to have 150

participants in total for this research study. Of the 150 participants, 50 participants were divided

into each of the three groups that were going to be assessed.

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The three groups are:

Control Group: This group will be doing the skills without the use of any aids;

instead they will be doing some ankle exercises, provided by physiotherapist

Vicki Hawkins, to strengthen them.

Demi Pointe Group: This group will be wearing demi pointe shoes prior to

wearing pointe shoes; each participant will be fitted. Since the idea of using the

demi pointe shoe prior to the pointe shoe is to strengthen the ankle, the demi

pointe group will be participating in their own exercises.

Ankle Tape Group: This group will be wearing ankle tape, which will be put on

by physiotherapist Vicki Hawkins, once pointe shoes are introduced. Prior to

pointe shoes they will also be working on strength conditioning exercises.

Duration of Training: Participants will train 3 times per week, for an hour and a half until the

end of the study. This is the average training time offered by different ballet schools across

Toronto and the Greater Toronto Area for this specific level. (See Appendix 1 for training

schedule)

Allocation of Groups: Group allocation was computer generated; participants received a

number between 1 and 6. Groups 1 and 4 were in the control group, Groups 2 and 5 were in the

Demi pointe group and Groups 3 and 6 were in the Ankle Taping group. The reason for this

division was to ensure that class sizes were kept small (25 participants per class). The different

groups, for example Groups 1 and 4 were held after one another so that the students are unaware

of what the other groups are doing.

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Period Phases: There will be 2 periods during the year considered pre-pointe and pointe. During

this time, the same ballet skills will be taught to each group by the same ballet instructor.

Pre-Pointe Phase: This is the period before pointe shoes are introduced. All of the

participants in each of the groups will be practicing the same skills that they

would in a normal class leading up to pointe shoes. The idea of this is to give all

the groups the same strengthening and technical opportunity prior to starting with

pointe shoes. This period will last for the first 3 months of the study.

Pointe Phase: This is the period in which pointe shoes will be introduced to the

participants to train in. This period will last for the remainder of the 9 months of

the study.

Outcome Assessment:

Participants, who become injured only during the practice, will fill out two questionnaires. The

first will be an Injury Report Form (Appendix 2) which asks questions about the nature of the

injury, its location, as well as type when the injury first occurred. The second questionnaire is a

Self Estimated Functional Inability because of Pain (SEFIP) questionnaire (Appendix 3) which is

a questionnaire developed to measure musculoskeletal pain and function in dancers. Because it is

self-estimated we are able to compare the results with the type and severity of the injury to see a

dancer’s pain tolerance. Those participants who do become injured can also see the registered

physiotherapist, Vicki Hawkins, who will assess their injuries, or the participants may choose to

see someone else of their choice. No matter whom they choose to see, they will need to have the

medical practitioner complete the Medical Practitioner Form (Appendix 4) which outlines their

diagnosis, treatment plan and expected to return date. This information again will tell us the

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severity of the injury according to a medical practitioner. We also ask for this to ensure that the

participants avoid injuring themselves further. Upon return from the injury, the dancers will have

to complete the Return from Injury Questionnaire (Appendix 5) which discusses what occurred

during the recovery period as well as other treatments they received during the recovery that

time. All of these forms will aid in examining, with much detail, the severity of the injury in

each the groups to see if there is a reduction in prevalence or even severity. These forms will be

collected and put into an envelope by the volunteer undergraduate student to then put into our

drop box.

Roles of the Volunteers:

There are 4 volunteers for this study, all of whom are undergraduate students either majoring in

Dance or Kinesiology. They aid in the collection of consent forms, as well as the questionnaires,

medical practitioner forms, and injury report forms that injured participants will have to fill out.

Prior to leaving the practice, they must ensure that all forms are completely filled out by the

participants, and that the identification number of the participant is correctly written from the

copy of the identification chart found in the binder provided to them which contains all

questionnaires, and required forms that must be filled out. They were also responsible for putting

all of the documents into their respective envelopes, which are labeled from G1 through 6.

Covariates: Age, years of experience prior to study, body mass index, height,

Ethics: To avoid ethical issues, we ensured that all of the groups who did not use demi pointe

shoes prior to wearing pointe shoes received the same strength conditioning exercises for their

ankles. Also due to the fact that we were examining adolescent children, we made sure that we

received consent forms from parents after they had read and understood what the study entailed.

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Also to maintain confidentiality of the participants, a study identification number will be used in

the database.

Implications:

From the studies we examined, one looked at the relationship between the use of demi pointe

shoes prior to the use of pointe shoes and their reduction in ankle injuries, but the sample was

fairly small. We also had not encountered any studies that examined the effects of ankle taping

on reducing the chances of sustaining an ankle injury. Although this study was a randomized

control trial where we controlled for certain confounding variables, this information found can

still be used by ballet companies/schools across Canada and even in other countries where ballet

is practiced as many of the skills in pointe shoes are the same. A key policy priority should

therefore be to plan for the long-term care of ballet dancers’ ankles, specifically in adolescents

where research has shown that the prevalence is high, whether through taping their ankles or

using demi pointe shoes prior to pointe shoes, helping to limit the occurrence and time spent off

practicing to recover. Also, using a tool such as the Self Estimated Function Inability because of

Pain questionnaire (SEFIP) can also help to identify not only which areas of the body are most

likely to get injured, but also the severity. This can ultimately assist both choreographers and

ballet instructors to anticipate these types of injuries and even change the routines and practices

to help minimize those area specific injuries from occurring.

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References

Allen, N., Nevill A. M., Brooks, H.M. J., Koutedakis, Y., & Wyon, A. M. (2012). Ballet Injuries:

Injury Incidence and Severity Over 1 Year. Journal of orthopaedic & sports physical

therapy, 42(9), 781-792.

Allen, N., Nevill A. M., Brooks, H.M. J., Koutedakis, Y., & Wyon, A. M. (2013). The Effect of a

Comprehensive Injury Audit Program on Injury Incidence in Ballet: A 3-Year

Prospective Study. Lippincott Williams & Wilkins, 23(5), 373-378.

Campoy, F.A.S., et al. (2011). Investigation of Risk Factors and Characteristics of

Dance Injuries. Lippincott Williams & Wilkins, 21(6), 493-498.

"Dance." Facilities & Equipment. York University, n.d. Web. 19 Mar. 2014.

http://dance.finearts.yorku.ca/for-students/facilities-equipment/.

Ekegren, C.L., Quested, R., & Broderick, A. (2013). Injuries in pre-professional ballet dancers:

Incidence, characteristics and consequences. Journal of Science and Medicine in Sport,

2013), http://dx.doi.org/10.1016/j.jsams.2013.07.013.

Hopper, L.S., Allen, N., Wyon, M., Alderson, J.A., Elliot, B.C., & Ackland, T.R. (2013). Dance

floor mechanical properties and dancer injuries in a touring

professional ballet company. Journal of Science and Medicine in Sport, 17(2014), 29-33.

Jacobs. C. L. (2010) Musculoskeletal Injury in Professional Dancers: Prevalence and Associated

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Factors. An International Cross-sectional Study. Retrieved from

http://hdl.handle.net/1807/24583

Leanderson, C., Leanderson, J., Wykman, A., Strender, L., Johansson, S., & Sundquist, K.

(2011). Musculoskeletal injuries in young ballet dancers. Sports Medicine, 19, 1531-

1535.

Pearson, S.J., & Whitaker, A.F. (2012). Footwear in Classical Ballet A Study of Pressure

Distribution and Related Foot Injury in the Adolescent Dancer. Journal of Dance

Medicine of Science, 16(2), 51-56.

"Pittsburgh Ballet Theatre." The Point of Pointe Shoes. Pittsburgh Ballet Theatre, n.d. Web. 19

Mar. 2014. http://www.pbt.org/community-engagement/point-pointe-shoes.

"RAD Vocational Ballet (Intermediate Foundation–Advanced 2)." - RAD. Royal Academy o

Dance, n.d. Web. 19 Mar. 2014. http://www.rad.org.uk/learn-to-dance/find-an

activity/vocational-graded-examinations-in-dance.

Reynolds, M., Kerchief, B., & Boyce, D. (2013). A Descriptive Study on Injury Prevalence

Among Female Ballet, Jazz, and Modern Dancers. Journal of Women’s Health Physical

Therapy, 37(2), 83-90.

Ritter, S., & Moore, M. (2008). The Relationship Between Lateral Ankle Sprain and Ankle

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Tendinitis in Ballet Dancers. Journal of Dance Medicine & Science, 12, 23-30.

Twitchett, E., Brodrick, A., Nevill, A.M., Koutedakis, Y., Angioi, M., & Wyon, M. (2010). Does

Physical Fitness Affect Injury Occurrence and Time Loss Due to Injury in Elite

Vocational Ballet Students?. Journal of Dance Medicine & Science, 14, 26-31.

Weigert, B.J., & Erickson, M. (2007). Incidence of Injuries in Female University-Level Modern

Dancers and the Effectiveness of a Screening Program in Altering Injury Patterns.

Medical Problems of Performing Artists, 52-57.

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Appendix 1- Time Schedule

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Time

Day of Week

9:00am-10:30am

10:30am- 12:00pm

5:00pm- 6:30pm

6:30pm-8:00pm

Monday Group 1 Studio E

Group 4 Studio E

Group 2 Studio G

Group 5 Studio G

Tuesday Group 3 Studio H

Group 6 Studio H

Wednesday Group 1

Studio E

Group 4

Studio E

Group 2

Studio G

Group 5

Studio G

Thursday Group 3 Studio H

Group 6 Studio H

Friday Group 1 Studio E

Group 4 Studio E

Group 2 Studio G

Group 5 Studio G

Saturday Group 3 Studio H

Group 6 Studio H

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Appendix 2- Injury Report Form

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Ballerina 2014-2015 Injury Report Form

Participant ID #:

Group Allocation:

On this form, please report any injury (new or recurrent) occurring during ballet practice

which requires medical attention and/or results in the inability to complete the session of

activity in which the injury occurred and/or requires you to miss at least seven days of

dancing activity. In completing this form, feel free to obtain the assistance of a parent or

instructor. Please remember if you do seek medical attention to please have the attending

medical practitioner (physician, nurse, physiotherapist, athletic therapist) complete the

Medical Practitioner Form

*Upon completion, please return this form to the designated undergraduate volunteer

*Please do not submit form until player has resumed regular activities and has completed the

Return from Injury Questionnaire form that is to be attached to this form.

Name:___________________

Age:_________

Date of Injury (Day/Month/Year): ________/________/________

Injury Status: (Please Circle One)

o New Injury o Recurrence of injury

What occurred at the time of the Injury? (I.e. Practicing certain skill (Be specific),

conditioning exercise, etc)

Were you able to return to the same practice in which you were injured? (Please Circle)

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o Yes o No

Injury Location (Check all that apply, circle affected side where applicable)

o Head

o Neck

o Shoulders (L / R)

o Collarbone (L / R)

o Upper Arm (L / R)

o Elbow (L / R)

o Forearm (L / R)

o Wrist (L / R)

o Hand (L / R)

o Mid Back

o Lower Back

o Hip (L / R)

o Groin (L / R)

o Upper Leg (Thigh) (L / R)

o Knee (L / R)

o Lower Leg (Calves) (L / R)

o Ankle (L / R)

o Foot (L / R)

o Toes (L / R)

o Other (Please Describe) :

Type of Injury (Check all that apply):

o Bruise

o Abrasion/ Scrape

o Blister

o Joint Swelling

o Joint/ Ligament sprain

o Dislocation

o Broken Bone

o Muscle strain

o Tendonitis

o Other (Please Describe) :

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Appendix 3- Self Estimated Functional Inability because of Pain Questionnaire

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Jacobs. C. L. (2010)

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Appendix 4- Medical Practitioner Form

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Medical Practitioner Form 2014-2015

To be filled out by the designated undergraduate volunteer

Participant ID #:

Group Allocation:

If you were seen by a physiotherapist, athletic therapist, physician, nurse or other medical

practitioner for this injury, please have them complete the following section.

*Upon completion, please return this form to the designated undergraduate volunteer

*Please do not submit form until player has resumed regular activities and has completed the Return from Injury Questionnaire form that is to be attached to this form

Dancer’s Name:_________________________

Date (Day/Month/Year): __________/_________/_________

Attending Medical Practitioner’s Name: _______________________________

Occupation (i.e. Family physician/ Specialist/ Therapist/etc):____________________________

Treatment Plan:

Expected/ Recommended Duration of Treatment:______________________

Is this dancer cleared to resume practice? (Please Circle) Yes No

If NO:

Expected Date of Clearance: ____________________________

Conditions of Clearance:

Does this dancer require medical follow up prior to clearance? (Please Circle) Yes No

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Appendix 5- Return from Injury Form

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Ballerina 2014-2015 Return from Injury Form

Participant ID #:

Group Allocation:

To be completed once the dancer has returned fully to practice and has finished all

injury-related care.

Total number of days you were unable to participate in your normal activities of daily

living: _________

Total number of days you were unable to participate in ballet practice: _________

Did you see any health care professional(s) for assessment or treatment of this injury? (If

yes, please check all that apply)

o Physician (Family) : Total # of visits______

o Physician (Specialist): Total # of Visits _______

Speciality: _________________

o Physiotherapist: Total # of Visits_______

o Athletic therapist: Total # of Visits________

o Massage Therapist:: Total # of Visits_______

o Other (Please Specify): _________________________ Total # of Visits________

Did you receive any other treatment for this injury? Yes No

(If yes, please check all that apply)

o Medications

o X-Rays

o MRI/CT

o Cast

o Other (Please Specify):