Feature Let Her Roll! PTs help roller derby skaters compete in the rink. By Keith Loria | June 2019 As a member of the Beltway Betties of NOVA Roller Derby, Renee Mitchell skates under the name Missy Savage and has had some meaningful bouts as a blocker for her team. Skating 3 or 4 times a week and competing at a high level, however, has not come without its challenges. After all, roller derby involves full contact and high-intensity plyometrics with lots of hops, lateral motions, and quick reactions. [See "A Quick Look at Flat Track Roller Derby" on the facing page.] Plus, in roller derby the track is relatively small—typically 108 feet long and 75 feet wide—and the sport involves abrupt movements combined with forceful contact. This often leads to sudden falls and athletes sliding off the track. Players get hurt. "I've sprained my left ankle twice and my right ankle once," Mitchell says. "Most recently, I had a level 4 sprain that required time off and lots of healing. It led me to visit a physical therapist for the first time." She went to Jenna Justen, PT, MPT, with Blue Ridge Orthopedic & Spine Center in Warrenton, Virginia. Mitchell explained that she had hurt the ankle during practice—which often is just as intense as the derby itself. Although she was the first roller derby athlete Justen ever worked with, the physical therapist's (PT's) experience dealing with sports injuries prepared her for the visit. "Originally, I would not have suspected that ankle sprains would be an issue with roller derby because I was imagining a high roller skate boot," Justen says. "But, to my surprise, that is not the case. Roller derby skates are low, more like a regular tennis shoe, so ankle sprains are very much a reality in the sport." Justen's treatment workout for Mitchell consisted of 5-star balance exercises (with tape on the floor in the shape of a star, balance on 1 leg while bending the knee and ankle, and tap the other foot on each star point around the entire star as many times as possible); squats; heal raises off a platform; slow lunges; and 15 minutes on an electric bike, accentuating the flexing of the ankle as she peddled. "I was able to get back in the rink as quickly as I did because Jenna made sure I was doing my homework workouts, and she was honest with her feedback," Mitchell says. "She shared with me her knowledge of tendons and ligaments and why things feel a certain way. I was 'in the know' about my body and its healing process. That helped me stay on top of what I needed to do to get back onto the track. "We need people who have spent a lot of time learning about parts of the body, who can break it down for us as to why and how things are happening, and what we need to do to get back to top performance," she says. "Jenna was open to learning about the sport to better help me in my personal healing journey." A Safe and Inclusive Space Despite the risk of injury, many skaters return to the rink year after year, citing a fondness of the sport and the camaraderie of a group of strong women engaged in a fast-paced competition that fosters respect and builds confidence. "Roller derby is amazing because it teaches us to support and challenge each other—and that we're always stronger together," says "Gaymer Grrrl" of the DC Rollergirls, who was named "MVP Jammer" at several bouts last year. "On and off the track, we all work to make it a safe, inclusive space. Your body type and skill level don't matter. What matters is that you're willing to show up and put in the work." Grrrl recently sprained her ankle when her skate went onto its side, taking her foot with it. "I think seeing a PT not only helped with rehabilitation but made me a better skater," she said. "A PT can break down all the muscles you need to support your skating body and knows exactly how to make those muscles both strong and flexible." Jill McVey, PT, DPT, ATC, with Movement Systems Physical Therapy in Seattle, Washington, not only treats the roller derby participants, but also is one herself, skating under the name "Alex DeLarge" for the Rat City Rollergirls. "I saw my first roller derby bout in 2009, right after the movie Whip It [in which 'an indie-rock loving misfit finds a way of dealing with her small-town misery after she discovers a roller derby league'1] came out. There was a lot of public interest in the sport, particularly in the Pacific Northwest," she says. "Rat City was skating at Seattle's KeyArena, and I went to their league championship game. It was so intense and amazing to see such strong, empowered women play full contact and have thousands of people cheering in the stands. I swore that day that I, too, would skate with Rat City." The funny thing is, McVey had never skated before. She eventually learned and was drafted into the team Derby Liberation Front—and the fun began. However, as someone who had worked with athletes during her career, McVey noticed that many of the participants weren't properly coached or taught how to care for their bodies, as a professional athlete in a more mainstream sport would be. "There didn't seem to be any accepted canon for teaching specific skills or advancing new skaters quickly to being 'bout-ready,'" she says. "As I learned more about the sport's demands on the body, I started teaching a community class through my clinic to help skaters better self-manage their bodies, using evidence rather than asking coaches for help." This led to skaters being added to her caseload. Word of mouth spread throughout the region, and now McVey treats a sizable number of skaters of all skill levels and experience. "The 'shelf life' of a typical roller derby skater—not elite—is maybe 3 to 4 years, and I'd like to see that life extend," she says. "Promoting diversity of training and skating experiences can help reduce burnout in the sport and keep skaters interested and engaged rather than being overexposed." Common Conditions Because of the wear and tear derby participants put themselves through on the rink, common issues include knee injuries, ankle sprains, and broken bones. Brian Schiff, PT, supervisor and sports physical therapist with Raleigh Orthopedic, began working with the Carolina Rollergirls 8 years ago. Over that time he has become a trusted resource for the roller derby community in North Carolina's capital. Schiff is a board-certified clinical specialist in orthopaedic physical therapy. He explains that because skaters move counter-clockwise around the rink at all times, the repetitive movement can contribute to asymmetries and overuse injuries. In addition, skating around the track involves changing pressures under the foot as the skater performs a right front crossover. This is rather difficult to do correctly, he says, and often skaters develop impaired movement patterns. One of the most common injuries Schiff sees is a bimalleolar fracture, which typically requires surgery. When a patient comes to therapy after the surgery, Schiff's early focus is on joint mobilization, edema reduction, range of motion, strengthening, and transition back to full weight bearing. "Rehab allows patients to resolve pain, improve strength, eliminate muscle imbalances, and learn how to take better care of their bodies," Schiff says. "In many cases, they are able to move better, thereby leading to more efficient training and enhanced performance." Additionally, many roller derby athletes are quad-dominant—relying heavily on their quadriceps muscles for movements that should balance more evenly with force from hamstrings and glutes. Schiff says these athletes can benefit significantly from reeducation that optimizes muscle balance and helps reduce the already significant demands on the foot and ankle. Other common issues are bilateral posterior cruciate ligament tears, articular cartilage tears, and osteoarthritis—all conditions for which Alayna Wade (aka "Push-up Brawl")has received physical therapy. Wade has founded 2 roller derby leagues—Classic City Rollergirls of Athens, Georgia, and her current team, 10th Mountain Roller Dolls of Eagle, Colorado—and competed for almost a decade. Wade says her PT helped her learn to balance muscles in her glutes, hips, and legs. "Physical therapy also has helped me strengthen my core and pelvic floor muscles," she says. "I also found KT [kinesiology taping] helpful. Ultrasound and E-stim were also used." Another common injury is plantar displacement of the cuboid bone, which happens when skaters strap their feet extremely tightly into their skates. Most skates' laces can tighten very extremely the forefoot and midfoot, but few models optimally support the rear foot and ankle, report several PTs. So, it may not require much in the way of a pile-up, or a skater getting stepped on, to injure the midfoot. Initial treatment often focuses on restoring bone alignment through manual therapy and follow-up taping with a felt pad under the plantar aspect of the cuboid while the skater continues training and increases weight-bearing on the foot. Follow-up interventions typically include peroneal reeducation to restore more optimal midfoot muscle balance—if the peroneals present as inhibited, as they often do. The Art of Prevention A roller derby skater needs to be able to take high-impact hits and falls. That makes flexibility one of the most important attributes to preventing injury. Justen provides specific exercises to participants, including static and dynamic stretching for the lower extremity, and double- and single-limb dynamic balance activities. "I also have incorporated whole-body dynamic activities such as quickly getting up from tall kneeling while throwing a weighted ball," she says. "Since roller derby is not a full-time sport for most of its athletes, it is also important to train a skater to be able to optimally perform her regular work duties. For example, if a skater needs to be able to carry heavy boxes and climb ladders for work, then it also is very important to incorporate those specific activities into the program." Anterior cruciate ligament (ACL) tears can occur during skaters' attempts to weave in and out of traffic by jumping, cutting, and maneuvering on the track, which can be particularly dangerous. Niki Cash of Philly Roller Derby's Liberty Belles has learned this in her 8 seasons in the sport. "I've torn both my left and right ACL," she says. "The first was while I was stopping abruptly to avoid running into someone by doing a hockey stop and then ran into someone else who hit me in the opposite direction," Cash says. "The second time, I fell and my knee landed bent toward the inside. Then someone fell on my back." Among the exercises her PT gave her were flexing her quads, small squats, riding a stationary bike, using bands in various ways in different directions, balancing on a trampoline and catching a ball, and straight leg lifts and holds. "Performing preseason and in-season neuromuscular training [jump landings, targeted core and lower body strengthening, and proprioceptive exercises] at least 1 or 2 days per week helps reduce injury risk," Schiff says. "The exercises can be included as part of a warm-up prior to skating, as well." Schiff suggests that all roller derby skaters get a full assessment or movement screening prior to participation to uncover any asymmetry or imbalances that may increase injury risk. Using this information, a PT can help create a corrective exercise regimen and better direct training efforts to meet the needs of each skater. "I'm much healthier now, having gone through derby—though I certainly sustained a couple significant orthopedic injuries—because derby forced me to take on better health behaviors in order to improve my performance," McVey says. Help for All Skaters Roller derby skaters practice more, train more intensely, and deal with more physical contact than do those who skate purely for fun. Still, Schiff notes, injury-prevention measures and training tips apply, as well, to recreational skaters looking to stay healthy. "Balance, flexibility, and general stability all are goals for a skater at any level," Justen says. Management of elite-level skaters typically focuses on helping the skater get through the season with as little modification as possible, then rebalancing the skater in the offseason. "They need to be more intentional [than does a recreational skater] about scheduling rest, dialing in their eating, and making sure they aren't overtraining," McVey says. When applying this understanding of elite athletes to recreational skaters, McVey emphasizes a balance of activities. "I'll spend more time working with my recreational skaters to make sure they have a good setup with respect to their skates and safety gear," she says. "We'll talk more about cross training, off-skates training, and ways to vary their skating experiences to give them more opportunities for practice." McVey also helps them gain an appreciation for ways simply to have fun on skates—such as jam or dance skating, going to the skate park, long-distance outdoor skating, and skating at the roller rink. "Variable experiences on skates at least change the context for the athletes and help keep them more focused during practices by giving them a refreshing 'sorbet' from the normal derby schedule," she says. Keith Loria is a freelance writer. A Quick Look at Flat Track Roller DerbyEarly roller derby competitions featured banked tracks. As the sport has evolved, many changes have been introduced and nearly the same number abandoned, including a figure-8 track and an alligator pit.1The flat track is a relatively recent development. According to the Women's Flat Track Derby Association (WFTDA), "Flat track roller derby is a fast-paced contact team sport that requires speed, strategy, and athleticism. The flat track version of the sport evolved in 2001, and has quickly grown to encompass more than 400 leagues worldwide. This is in large part due to the ease of setting up a flat track—it can be done on any flat surface that is suitable for skating, such as skating rinks, basketball courts, parking lots, and even airplane hangars. This greatly reduces the capital needed to start up a roller derby league, and allows small groups of people to get a fledgling league off the ground."2WFTDA, the international governing body for women's flat track roller derby, adds, "The DIY spirit that drives the sport allows roller derby leagues to create their own unique identities and adapt their structures to reflect their local communities."2Among WFTDA rules and procedures: The game is played on a flat, oval track. Play is broken up into 2 30-minute periods, and, within those periods, into units of play called "jams," which last up to 2 minutes. There are 30 seconds between each jam.During a jam, each team fields up to 5 skaters. Four of these skaters are called "blockers" (together, the blockers are called the "pack"), and 1 is called a "jammer." The jammer wears a helmet cover with a star on it.The jammers from each team start each jam behind the pack, and they score a point for every opposing blocker they lap, each lap. Because they start behind the pack, they must get through the pack and then all the way around the track to be eligible to score points on opposing blockers.Roller derby is a full-contact sport; however, skaters cannot use their heads, elbows, forearms, hands, knees, lower legs, or feet to make contact to opponents, and they cannot make contact to opponents' heads, backs, knees, lower legs, or feet.Play that is unsafe or illegal may result in a skater being assessed a penalty, which is served by sitting in the penalty box for 30 seconds of jam time.The team with the most points at the end of the game wins.3Referenceshttps://wftda.org/history/. History of roller derby. Accessed March 17, 2019.https://wftda.org/faq/what-is-flat-track-roller-derby. Accessed February 21, 2019.https://rules.wftda.com/summary.html. Accessed February 21, 2019.About Those NamesMissy Savage? Gaymer Grrrl? Leannibal Lector?What's with roller derby athletes' names? As the Women's Flat Track Derby Association explains, "Skaters are 'normal' during the day. We work, we're moms, students, etc. Roller derby is our escape from day-to-day life and our opportunity to embrace a tougher, edgier side of ourselves. When you step into the rink, your derby alter ego takes over. Derby names are creative and fun and can either be tough or just plain funny."1There also can be a more serious reason to adopt a pseudonym. In an online posting a few years ago, roller derby player Day Glo Divine wrote: "I feel that people should be able to use a derby or real name without being forced or pressured to pick one or the other, and I don't really care what others choose. However, I will never use my real name for derby. Besides the philosophical implications of doing so, there are privacy and personal safety issues involved. Not all employers and professions are derby-friendly, and not all audience members are respectful of the idea that the sport is a 'safe place' for its participants. The last thing I need is for people like that to find out where I live or work; I've dealt with that before, and it's no fun."2Meanwhile, most of the team and league names include a casual reference to the team's location, though it helps to be familiar with city nicknames. For example, among the top-ranked teams from around the world in January 2019, were the Rat City Roller Derby (Seattle, Washington), Rose City Rollers (Portland, Oregon), Crime City Rollers (Malmo, Sweden), and Mad Rollin' Dolls (Madison, Wisconsin).3ReferencesWhat's Up With All those Roller Derby Names? https://wftda.org/faq/roller-derby-names. Accessed February 21, 2019.http://derbynewsnetwork.com/blogs/justice_feelgood_marshall/2008/12/killbox_retires_sort. Accessed February 21, 2019.WFTDA Rankings: January 31, 2019. https://wftda.com/rankings-january-31-2019/. Accessed February 21, 2019.