Young children learning to dance, dangerous "lowering the waist"
According to the survey, the number of spinal cord injuries caused by dance practice in some children is increasing. Guo Xiaodong, chief physician of the Department of Orthopedics, Tongji Medical College Affiliated to Huazhong University of Science and Technology, obtained preliminary statistics that nationwide, there may be more than 1,000 children due to dance practice. Injury to the spinal cord leads to paralysis.
Experts suggest that it is necessary to avoid the younger age of waist movement exercises.
Here are several pairs of deformed legs.
In more serious cases, the knees are everted, skinny and fleshless, a circle thinner than the small arms of ordinary people.
Slightly better, the flesh at the ankles is unusually thin, and the ankles hang down like dead leaves.
They were once healthy, full legs, capable of many difficult lifts, strides, folds, and presses.
However, during a dance practice, the spinal nerves that drive them were crushed and damaged, like a power outage, and they suddenly went numb, hurt, and then "drooped down like soft noodles."
Overnight, their owners, the children, went from dancers to paraplegics.
They can't stand up.
"In view of the fact that dance lower back movements have become the main cause of spinal cord injury in children, posing a serious threat to children's health and bringing a great burden to parents, relevant departments should pay attention to the management of dance training institutions, strengthen the standardized training of dance teachers, and focus on lower waist movements. Professional assessment should be carried out before training, risk education should be given to children's parents, and necessary preventive measures should be taken during the lower waist exercise training process." Doctors from the Spinal Cord Injury Rehabilitation Department of Beijing Boai Hospital wrote in a paper.
dance practice, spinal cord injury, paralysis
5 years and 8 months ago, Wang Xinyue's growth and development in Xiangtan, Hunan was smooth or even slightly ahead of schedule.
She gave birth at full term, with a birth weight of 6 catties. She was able to sit at 5 months old and walk at 10 months old.
She has always been an active child who likes to run and climb.
When she was four years old, her mother Yuan Ling instructed her to learn the piano. She "couldn't sit still" and couldn't practice a basic piece of music for a week.
Entirely with the mentality of giving it a try, Yuan Ling signed up for her dance training class, and she has been fascinated with dancing ever since.
At 8:00 a.m. on August 20, 2020, Wang Xinyue, who was 5 years and 8 months old, practiced dancing at home, performing horizontal forks, vertical forks and rocking boats in sequence, ending with a handstand.
Then she sat on the small bench and complained to Yuan Ling that her feet hurt. Yuan Ling thought it was a cramp and told her to sit and rest.
The situation is developing rapidly.
When Wang Xinyue went to the toilet, Yuan Ling found that she was "beating her feet"; seeing that she didn't come back, her husband went to the toilet to carry her out, her legs were swaying, "like soft noodles".
Yuan Ling pinched her leg, but she didn't feel the slightest bit.
She can't stand up.
Wang Xinyue was sent to the First People's Hospital of Xiangtan City for CT and MRI examinations.
During the inquiries, the doctor learned that the girl had a sudden abnormality after dancing practice, and immediately told Yuan Ling that the child might have suffered a spinal cord injury.
The family went to the Hunan Provincial Children's Hospital overnight, where they came to the exact same conclusion: because of the dance exercises, the spinal nerves of the fourth to waist 1 segment were compressed by edema, and the child lost the ability to exercise below the navel, which is paraplegia. , I'm afraid I can't walk for the rest of my life.
Dance practice, spinal cord injury, paralysis - Yuan Ling couldn't understand the connection for a time.
Confused, she began to record her daughter's medical process online.
She told reporters that a large number of families with similar illnesses rushed to her soon. "The private messages sent cannot be answered day and night." She found that her daughter's illness was not an isolated case.
About a year after Wang Xinyue was injured, on September 7, 2021, after dinner, eight-year-old Xiao Ru, who lives in Yangjiang, Guangdong, suddenly felt back pain.
The day before was Saturday, and she had just finished her weekly dance class.
The mother Liu Liping, who was off the night shift, thought she was looking at the tablet computer, which made her shoulders tense, so she rolled an egg on her back and coaxed her to sleep.
Early the next morning, Xiaoru's back pain got worse, and she burst into tears.
Near noon, her feet became weak, "it seemed like many ants were crawling." In an MRI taken at the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, Xiaoru showed two blood clots behind her thoracic spine.
Like Wang Xinyue, she was judged to be acutely paraplegic, losing her ability to move below the navel.
The doctor told Liu Liping that the blood clot behind the thoracic spine formed within a week, and it should have been caused by external force and spinal injury and bleeding.
Combined with the medical history, it can be basically judged that it is caused by dancing and practicing waist movements.
At 3 pm on October 28, 2018, Xu Hui, a native of Xinmi, Henan, received a call from a dance training teacher, saying that her four-year-old daughter Qiqi "touched her leg".
When the family arrived, Kiki couldn't leave.
The daughter later told Xu Hui that she "fallen" while practicing her lower back, and she suffered from stomach pain, leg pain, and leg numbness, which could not be relieved by sitting for a long time.
At seven o'clock in the evening, Qiqi was sent to the First Affiliated Hospital of Zhengzhou University, where she was diagnosed with a complete spinal cord injury caused by lower back dance.
In several medical papers, the characteristics of sick children such as Wang Xinyue, Xiaoru, and Qiqi have been surprisingly consistently summarized: 4 to 8 years old, girls, with a history of ethnic dance or Chinese dance waist movement exercises.
According to Feng Shubin, director of the Department of Neurology at Henan Provincial Children's Hospital, in the past five years, the hospital has received 16 cases of spinal cord injury caused by dance practice. When the admissions were the most frequent, there were three such patients in just one month.
According to preliminary statistics, Guo Xiaodong, chief physician of the Department of Orthopedics, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, nationwide, or more than 1,000 children have been paralyzed due to spinal cord injuries during dance practice.
He once told the media that if children who were misdiagnosed and abandoned were included, the actual number of cases may be larger.
Doctors from the Spinal Cord Injury Rehabilitation Department of Beijing Boai Hospital published a paper analyzing a total of 275 children with spinal cord injuries under the age of 14 admitted to our hospital from January 1989 to December 2014, and found that 63 of them were due to dance exercises. Hyperextension caused the injury; among 221 children with spinal cord injury under the age of 14 admitted from January 1, 2015 to December 31, 2019, the aforementioned injury type rose to 75.
"Sports injury is the main cause of injury for children with spinal cord injury hospitalized in the center in the past 12 years, and the incidence is increasing, with girls aged 4-7 years being the most common. Injury, the degree of damage is relatively serious." The related paper wrote.
Liu Genlin, chief physician of the Spinal Cord Injury Rehabilitation Department of Beijing Boai Hospital, said that since 2022, the department has received more than ten children with spinal cord injuries caused by dance exercises.
Nonstop, new patients arrive every month.
Spinal cord damaged like bean curd
Almost all children with spinal cord injury caused by dancing will not show abnormality in radiological examinations such as CT and X-ray, and there is no fracture or dislocation; only in MRI images, children often show "edema from the cervical spine to the lumbar spine." ".
After two or three weeks, the edema gradually subsided, but the original site was necrotic.
This is called a non-fracture-dislocation spinal cord injury, and it eventually results in paralysis of the patient.
This catastrophic blow stems from the special physiology of children.
Liu Genlin introduced that the human spinal cord is a soft texture like a tofu brain, surrounded by a hard dura mater, and outside the dura mater, it also surrounds the spinal canal.
Like a nesting doll, the spinal cord is protected layer by layer.
However, when the action of spinal hyperextension occurs, compared with adults, the spine of children is more likely to be displaced relative to the intervertebral disc, and the spine, dura and the central spinal cord are squeezed together. The former two can be restored with the help of ligaments. position, and the latter is like a rubber band that has been pulled beyond its limit, "can't come back." And bleeding, edema, etc. will occur.
A more concise explanation is that children's spinal cords can withstand far less stretch than the spine.
"The spine can withstand a 5.080cm stretch, and the spinal cord can only withstand a 0.635cm stretch." Once stretched too far, it will cause irreversible damage to the spinal cord.
A doctor once opened the child's spine during surgery, and found that the damaged spinal cord was like bean curd.
Such a hidden injury has the same edema symptoms as myelitis on medical imaging, so the misdiagnosis of the cause still exists.
Liu Genlin concluded that from January 1, 2002 to August 31, 2020, among the 120 children with spinal cord injury without fracture and dislocation admitted to the Department of Spinal Cord Injury Rehabilitation of Beijing Boai Hospital, 17 children were classified as acute at the time of initial diagnosis. Myelitis.
"In some local hospitals, the understanding of spinal cord injury without fracture and dislocation is still insufficient." In addition, some children seek medical treatment within 8 hours of the injury, and the spinal cord edema is still developing. MRI can not immediately show abnormalities, which will also affect Initial diagnosis.
In this context, taking a medical history has become a key qualitative method for diagnosing SCI without fracture-dislocation.
"The development of these diseases is highly similar - sudden abdominal pain, back pain, difficulty urinating, numbness and weakness of the lower limbs, most of which occur quickly after dance moves." Liu Genlin said, "As short as 5 minutes, it may be as long as possible. In about two days, the ability to stand will be lost."
Feng Shubin suggested that if a child has an accident while practicing dance, it is best to use a large dose of methylprednisolone for shock therapy within 8 hours. Children, they may be able to lift their legs, and children who can only lift their legs may be able to make their legs resist resistance.” Hormone shock therapy is widely used in hospitals around the world, and Wang Xinyue, Qiqi and Xiaoru have all received corresponding treatment.
Liu Genlin is inclined to a relatively pessimistic conclusion: at least in his observations, injection of hormones has no obvious effect. In other words, once a spinal cord injury without fracture and dislocation occurs, it is difficult to have an effective treatment.
Prognosis depends on the degree of injury - he has analyzed 31 children with incomplete spinal cord injury in the lower back that were admitted to the department from January 1, 2002 to August 31, 2020, of which 25 cases were 1 to 90 after injury. The ability to stand independently was restored within days.
In contrast, complete injury rarely recovers motor function.
A complete spinal cord injury, Liu Genlin said, means that the anus has no feedback on stimulation tests.
Among the cases he was exposed to, the rate of complete injury was as high as 75.8%.
After being injured, Wang Xinyue lived alone in the intensive care unit of Hunan Provincial Children's Hospital for eight days.
The doctor announced to them the slim chance of a cure and told them to buy a wheelchair for backup.
In fact, Wang Xinyue was the luckier one, and she was eventually diagnosed with incomplete spinal cord injury.
After a month of massage rehabilitation, she was able to stand on her own, and after half a month, she was able to drag her legs, limp, and walk at a very slow pace.
In the two years since then, she has continued to undergo rehabilitation training, and her mobility has continued to recover.
After receiving hormone therapy in the First Affiliated Hospital of Zhengzhou University ineffective, Qiqi followed her parents to Beijing and Xi'an for many years to seek medical treatment.
Xiaoru underwent surgery to remove the lump at the First Affiliated Hospital of Guangzhou University of Traditional Chinese Medicine, and six steel nails were driven into her back.
On a daily basis, she is stimulated by acupuncture and electrotherapy.
They have not been able to stand up yet.
The "normative" problem of amateur training courses
In the 1980s, Lu Yisheng, a famous dancer and former dean of the Beijing Dance Academy, first heard about the case of spinal cord injury caused by dance practice, and he heard about it intermittently for nearly 40 years.
In 2019, when he was writing an article on dance education, he did a related search on the Internet. "When I checked it, I was shocked that there were so many cases of spinal cord injury caused by dance all over the country." After reading some medical literature, he wrote " A letter to dance teachers across the country", stating that "dance is not equal to practice." "Young children should not be forced to move, press, and break when learning dance."
Lu Yisheng introduced that Chinese dance and folk dance pay attention to "dancing with hands and feet", and use the hands to drive the waist to dance. Therefore, from the perspective of professional aesthetics, the waist of the dancer should preferably be as soft as water.
However, the recruitment and compulsory training in the professional field often occurs after the child is 12 years old. At that time, the child's muscles and bone strength are fully developed, and the compulsory methods such as moving, pressing and breaking can be carried out under the premise of scientific warm-up.
In Lu Yisheng's impression, he had never heard of spinal cord injuries caused by dancing in professional colleges, but in amateur training classes, incidents of spinal cord injuries emerged one after another.
In fact, the Beijing Dance Academy has a clear amateur grading system for Chinese dance, with a total of 13 grades.
"Level 4 means that children start kneeling down when they are seven or eight years old, and Level 8 means that children don't start kneeling down until they are about ten years old. Therefore, younger and more difficult waist exercises are unnecessary and unscientific. Sex," explained Li Jia, a teacher who has taught Chinese dance for 12 years.
Li Jia said that in a standardized dance training institution, it is not allowed to "force" young children. "There is absolutely no need for external forces, and only the children's own physical quality can be used to perform movements. Children who are naturally softer may do so. Be more standard, and children who are not standard will not force it. Amateur dance training is not about blindly enduring hardships, but more importantly, the cultivation of beauty.” In addition, from the perspective of dance aesthetics, it is not “the softer the waist, the more beautiful it is.” The anti-human is better." In addition to soft opening, musicality, beauty, expressiveness, style rhythm, etc. are all part of the evaluation system.
"Most of the children with spinal cord injury (dance practice) come from private dance training institutions in underdeveloped economic and educational areas, and dance teachers often lack professional training." Doctors from the Spinal Cord Injury Rehabilitation Department of Beijing Boai Hospital once pointed out in the paper.
Another widely circulated saying is that dancers are more likely to open the soft opening of their bodies when they are young, and when they get older, their bodies become hard and unable to open.
Is this really the case?
Li Yiran, a former Hong Kong Ballet dancer, said that in the dance education system, there is no one-size-fits-all path. It is not said that a child does not practice soft opening at the age of five or six, and he does not practice until he is about ten years old." She gave an example, a famous Chinese ballet dancer, the 5th International Ballet Dance Competition Gold Award winner Tan Yuanyuan did not have any dance practice foundation before the age of ten.
So, what led to the younger age of waist movement exercises?
Lu Yisheng sees this as the result of the booming dance training market.
"The training competition is fierce, so everyone wants to be eager for success and show parents a visual result." Lv Yisheng said that in addition to the Beijing Dance Academy, the China Opera and Dance Theatre, and the China Dancers Association, there are also a variety of dance education on the market. mechanism.
Different institutions use different teaching materials, test content and test intensity.
In other words, the norms of amateur dance teaching have not been uniformly established.
Li Yiran also mentioned similar practical problems.
She recalled that when she practiced dancing in her childhood, she would be recognized and praised when her lower fork could reach 180 degrees.
Now, she heard that some training institutions require children to reach 240 degrees or even 260 degrees.
Dance practice, the dream of aesthetic education in the new era
Several families have relatively simple reasons for letting children practice dancing.
Yuan Ling hopes to properly cultivate her daughter's hobbies and hobbies. It happens that "nine out of ten girls of the same age are learning to dance." She hoped that her skinny daughter could also "eat more rice" by practicing dance; some girls in the village who were learning dance wore training clothes to play at Xu Hui's house, and Qiqi was greedy and proposed to Xu Hui to learn dance.
Yuan Ling often accompanies her daughter to dance classes. She has not found any "strong pressure" from the teacher, and she has never heard her daughter say that dancing is uncomfortable.
She said her daughter started learning waist movements about a year after she started dancing.
The other two mothers were not sure when their daughters started practicing waist exercises.
What is certain is that before the accident, several children had been practicing dance for three months to two years, and they had all learned the lower back movements.
Xiaoru once complained to Liu Liping several times, saying that she felt a little pain while leaning down on the railing by the wall of the dance classroom.
"Sometimes, teachers teach some difficult exercises too early, which is actually satisfying the vanity of some parents." Lu Yisheng said.
Because he often shares his dance teaching experience on social platforms, many dance teachers leave messages under Li Yiran's account.
A teacher confided to her that a student’s parents asked her if she taught her students the rug technique—a dance movement that involves rolling on the ground with hands supported, “The problem is that his child is only four or five years old, I said he can’t practice it, it’s too young. I’m gone, people turned around and left, thinking I’m incompetent.” Another teacher left a message saying that he accepted a new five-year-old student, whose parents claimed that the child started dancing at the age of three, and was in another institution at the age of four. I learned to stand down and said, "He said that I don't press my waist, nor my legs. I kept telling me to press her more, saying that the child is not afraid of pain."
"Spinal cord injury does not necessarily occur when a child does the waist movement for the first time," said Kang Haiqiong, an attending physician in the Department of Spinal Cord Injury Rehabilitation at Beijing Boai Hospital. "Some children may have practiced lower backs and handstands for months or years without incident. But one time I didn't do it well, I fell, or got down too fast, got up too fast, or pulled it, and I became paralyzed." For this reason, she does not recommend children to practice waist dance movements too early, "It is not professional. , just as a hobby, there is no need to take this risk."
Her colleague Liu Genlin observed that spinal cord injury caused by young children's dance practice is a "new disease" in the past two decades, especially the past ten years.
When he first started his career in the 1990s, most of the spinal cord injury patients he came into contact with were injuries caused by physical labor such as car accidents, falls, or coal miners. After 2000, the number of spinal cord injuries caused by dancing has skyrocketed. .
According to data from Beijing Boai Hospital, from 1992 to 2002, the number of children with spinal cord injury in the lower back accounted for 4% of the total number of children with spinal cord injury. It rose to 33.9% between 2019 and 2019.
"It can be regarded as a manifestation of social and economic development. Parents are willing to invest more and more in the cultivation of children's interests and aesthetic education." Liu Genlin said.
Until the injury made the dream of aesthetic education come to nothing, and the burden on the family became heavier.
Liu Liping said that she had spent more than 500,000 yuan for her daughter's treatment, she had run out of savings, and she still owed a foreign debt.
She tried to communicate with her child's dance institution, and the other party refunded her the remaining 1,000 yuan in tuition and donated 500 yuan to her.
Two months after the accident, Xu Hui took the dance agency to court on the grounds of disputes over the rights to life, health and body.
Under the appraisal of the relevant judicial appraisal institute, it was determined that there was a "direct causal relationship" between the daughter's "dance movement practice" and her lack of fracture and dislocation spinal cord injury and lower limb paraplegia.
In the end, the Xinmi City People's Court ruled that the dance organization should bear the main responsibility and compensate Xu Hui's family more than one million yuan.
Ge Bing of Beijing Yingke Law Firm analyzed that in cases of spinal cord injury caused by dance practice, the key point of judicial advancement is to "prove the causal relationship between dance and injury".
"You can cite the testimony of the people present, or the records of surveillance video, or the chat records of the agency notifying parents of the child's injury, but the most important thing is the identification result given by the judicial identification agency - this is evidence from the perspective of forensic science. Ge Bing said, "If the child is not injured in the training institution, then it is also critical whether she has practiced dance moves after returning home. If the child does not practice dance by herself after returning home, but is injured suddenly, then the injury is serious. The relationship with the dance organization will be larger; otherwise, the relationship will be smaller.”
Searching the two keywords "dance" and "spinal cord injury" on the Judgment Documents Network, a total of 172 documents were retrieved.
A slight difference is that Yuan Ling and his wife still kept friends with her daughter's dance teacher after her daughter's accident.
"This (the child's injury) is something that no one wants and no one can think of."
outside the disease
As the one who was diagnosed with incomplete spinal cord injury and "lucky in misfortune", 7-year-old Wang Xinyue has two years of rehabilitation training experience.
"It's like learning to walk again, but with more pain," said her father Wang Qiang.
Just like a baby, Wang Xinyue has to learn to turn over, then sit up, crawl, and walk while holding onto things... She needs to practice lifting her legs, hooking her ankles, and moving her toes every day. In the depressing part, "It felt like clenching a fist. It was clearly clenched to the end, and I had to continue to clench it hard - but the strength couldn't be released at all, and it felt like I couldn't exert any strength." Sweaty, and sometimes crying with discomfort.
The family spends four to six hours a day in rehabilitation training.
Wang Qiang played the role of an instructor. "There is absolutely nothing wrong with doing rehabilitation. If you don't want to practice, you will scold. If you scold it's useless, just slap it twice."
Under such intensity, Wang Xinyue's toenails were deformed, and the belly of her toes was full of calluses.
Her lower extremity consciousness has recovered by 70 to 80%, and she can control her bowels and bowels autonomously.
This summer, she was even able to trot.
It's just that she has a serious tendency to be inward no matter whether she is walking or running. She buckles her knees inward, always striding her right leg first, and then dragging her left leg over with great effort.
The speed is not fast, and it can't even catch up with her sister who just turned 4 years old.
She has slight muscle atrophy at the ankle, and her ankle is very thin, and her walking force is biased, gradually forming flat feet.
When her legs are stretched out to meet her torso, there is a huge gap of about 45 degrees.
Yuan Ling has mentioned many times that her daughter was a dark horse and a top student in the dance class. "I really like dancing." After the accident, Wang Qiang deleted all the photos of her daughter dancing.
Liu Liping envy Wang Xinyue's recovery from the bottom of her heart.
After a month and a half of rehabilitation training, the doctor tested her daughter Xiaoru's legs and steps with cotton swabs. She felt the scratching, which was equivalent to regaining a slight consciousness.
This made Liu Liping happy, but then progress was slow.
Nearly a year has passed, and Xiaoru can only swing slightly with her feet, but she cannot sit up, let alone stand.
She still can't control her constipation, wears more than a dozen diapers every day, and uses Kaisailu every other day.
In one year, UTIs flared up ten times.
Every morning, the first thing Xu Hui does when she wakes up is to catheterize her daughter Qiqi, then dress her, brush her hair, cook for her, and then do rehabilitation training, ride a rehabilitation bicycle, and practice crawling on the floor mat.
As a complete spinal cord injury, Kiki's body did not recover at all after the incident.
There is no feeling in the lower limbs, and Qiqi often bumps her legs into blue and purple pieces, but she doesn't notice it.
She hadn't walked for four years, her spine was bent, a prominent bone protruded from the left side of her waist, her leg muscles were severely atrophied, and her thighs were even thinner than the arms of her peers.
In addition, her knees were everted and her ankles were drooping. Xu Hui had to tie her legs all night while she slept to prevent the bones from developing further deformities.
Liu Genlin said that scoliosis, hip dislocation and knee valgus are all common complications of children with spinal cord injury without fracture-dislocation.
To understand their seriousness with the most straightforward logic is that the bones of the child will be deformed step by step, and the bones will become loose day by day until they are completely deformed, and there is no possibility of standing up again.
In his view, these complications are difficult to avoid. "Data from abroad have proved that the abnormal rate of hip joints in children with spinal cord injury under the age of 5 is 100%, and the rate for children under the age of 10 is 93%." The significance of doing rehabilitation training, To delay or stop the development of complications, he said.
Whether recovery is good or bad, several children crave warm temperatures.
When it's cold, their muscle tone is terrifyingly high, and their legs are rigid, tossing them around like sticks.
Their lower limbs also have different perceptions of temperature from ordinary people. When soaking their feet, they either do not feel hot water at all, or the water temperature of the left foot is just right, but the right foot feels hot.
In addition to disease, changes are quietly happening.
After the accident, Xu Hui suffered from severe insomnia and depression, and once thought of suicide.
Liu Liping lost 20 pounds in one month.
Yuan Ling closed her original piano training room and took care of her children at home, while Wang Qiang drove into five or six guardrails when her daughter was injured for more than a month, spraining her neck.
Children grow up day by day, and life has to continue. Their studies and social interaction constitute new worries for parents.
Wang Xinyue is used to calling herself an "abnormal person" with a little joking. Because of the inconvenience of participating in games, she was unable to make friends at school.
Xu Hui quit her job to accompany her daughter. The school was considerate and gave Xu Hui a small room beside the classroom.
My daughter is in a wheelchair all day, and gets into her room after class, and rarely wants to interact with her classmates.
Liu Liping is still distressed, wondering if she should send her daughter, who can't control her bowels, to school.
Two days ago, my daughter Xiaoru told Liu Liping that she dreamed that she could walk again.
Liu Liping comforted her and said that it will be soon.
Several parents who share adversity have reached a tacit agreement: they never reveal their true illness to their children, and they are used to "prevarication" day after day: you are only temporarily injured, and if you persist for a few days, you will be able to walk again and again. It's time to dance.
(Xu Hui and Wang Xinyue are pseudonyms in the text)
Beijing News reporter Feng Yuxin