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Dental Hygiene and Sport (Part 1)

Sport and Oral Health - Archery - Running (Part 1).

Sports balance

Dental care Archery

Sports posture

(Article UFSB Congress Report - INSEP)

Finding balance: example of archery.

Dr Jean Luc Dartevelle

I am speaking today, as part of this conference, as a dentist from the UFSBD, but also from the INSEP , where I carry out both a sports care activity and a prevention activity.

The French archery center of INSEP has been offering osteopathy support to archers since 2003. This follow-up complements the follow-up in physiotherapy in order to increase the recovery capacity of archers and prevent possible injuries.

Specific work on the muscular chains has been put in place, as well as work in sophrology, podiatry and posturology . All these elements being linked to each other, dental questions quickly emerged.

Training aims to learn and automate postures, placements and all of the archer's actions which serve to prepare for the propulsion phase of the arrow, the objective being to always arrive at the same situation at the time of departure of the arrow, therefore to promote precision and regularity.

The search for perfect balance is a quest in the postural stability of the archer when releasing his arrow. Acquiring this stability remains a fundamental concept in the precision and reproducibility necessary for high-level performance.

The physical and mental qualities of the archer serve this objective. The archer's posture is a strong adaptation combining an asymmetrical static position with voluntary muscular action. This attitude must be constantly supported to avoid possible dysfunctions.

The high technicality of the procedure requires adopting an appropriate treatment methodology specific to each athlete, working in concert, if necessary, with other health professionals in a process global, structured and coordinated.

 Thus, the archers are surrounded by a physical trainer, a physiotherapist every day, a physiotherapist specializing in muscular chains once or twice a week, an osteopathic physiotherapist twice a week, a posturologist podiatrist twice a year, a sophrologist once or twice per week and a dental surgeon twice a year.

The investigation is twofold: the high-level athlete, who is a patient with classic problems to resolve, and the high-level archer, who undergoes specific constraints due to his posture, his sporting gesture and his training volume.

Current training for archers is twice daily with 200 to 400 arrows per day six days per week, aerobic work two to five times per week and muscle strengthening work two to five times a week as well.

The objectives of the dental surgeon's intervention are to help guarantee good muscular balance to allow an increase in training volume and promote better recovery.

Three areas of work were undertaken: occlusion work, intended for very slight mandibular deviations, makes it possible to eliminate interferences and should contribute to increasing body stability. Finding balance: the example of archery at INSEP.

Dr Jean-Luc DARTEVELLE Dental surgeon: during the phase of performing the procedure; the creation of a shooting splint to reduce muscular tension; finally, the creation of a mandibular repositioning splint causing muscular relaxation and balance.

Support was of course considered individually for each archer.

The means used by the manual therapist are post-urological tests and evaluations of the organization in an ascending, descending or mixed chain, the clinical palpatory examination to identify tensions and the use of the Stabilo metric force platform.

In the shooting position, the archer is static, asymmetrical, with voluntary muscular action.

Using the Stabilo metric platform will allow us to visualize the subject's ability to maintain good orthostatic balance.

The archer positions himself on the Stabilo metric force platform by placing his feet with the same spacing and angulation.

 The measurements are taken in the shooting position: a first without a splint and a second after injection of Mémosil 2 type fluid silicone between the two arches.

These measurements allow computerized recording of foot support with calculation of the center of pressure which can be assimilated to the center of gravity of the body.

The temporary splint in Mémosil allows the archer to easily place the mandible and maxilla in a comfortable, physiologically neutral position. With the gutter in place, we notice a shift in its center of gravity towards the frame of reference or barycenter of the support polygon.

The reduction in the recording surface testifies to the great stability of the archer in the shooting position.

  The collaboration between the osteopath and the dental surgeon allowed the adjustment of the craniofacial and occlusal system, as well as the adjustment of the gutters in the firing position.

In conclusion, archers show better balance management than a classic subject. Platform measurements show that it is possible to further optimize this capacity, by harmonizing the physiology as finely as possible, as well as with additional balancing using occlusal splints.

  • The results are an increase in training volumes of 20%.
  • Only one injury was recorded this year.
  • At the 2011 world championships, the men's team finished 2nd.
  •  A fourth place was achieved among the women individually.
  • Four podium finishes were recorded across four World Cup events.
  • Three men are in the top twenty in the world and one girl is ranked 7th.

Thus, maintaining the integrity of the manducatory system is one of the conditions for a high level of performance in athletes, particularly in those whose gestural activity is predominantly tonic.

Even if the physiology is harmonious, it is interesting to know that performance can be optimized by working on the creation and balancing of gutters specific to sporting activity.

The position of the manual therapist is central in this approach to the care of high-level athletes.

Multidisciplinary work is essential. Doctors and manual therapists must refer the athlete to the dental surgeon when the dysfunction falls within their competence and at the appropriate time in the treatment.

Discussions From the room: I am a high-level athlete. What is a repositioning gutter? In what case is it used? To solve what problems? Furthermore, I heard about a kind of mouthguard to ensure, as a preventive measure, a good position of the teeth in children. What exactly is it? What do you think?

Philippe BOISSONNET: Several athletes have used a mandibular repositioning splint. I am thinking in particular of the racing driver Jacques Villeneuve or the athlete Carl Lewis - before he started orthodontic treatment.

Carl Lewis' performance improved until the day he undertook this orthodontic treatment intended to remove this re-balancing splint.

 During the duration of the treatment, his performance declined, before returning to an excellent level during the Olympic Games in Seoul in 1988 .

In fact, the mandibular repositioning splint is a polycarbonate plate which allows the teeth to be aligned in the best position to respect the neuro-muscular balance of the set of muscles of the head and neck.

Flat muscle release trays have been used for a long time.

But it is possible to make a gutter in the right position straight away. We seek maximum dental contact.

The objective being to eliminate all parasitic muscle spasms to allow the athlete to recover in better conditions. I didn't really understand your question about children. Perhaps you are referring to a flexible device used during the development of teeth.

When an athlete already has a good occlusion, the splint does not add anything, except in specific examples such as archery where the splint can provide an advantage in terms of the stability of the archer.

A splint is only useful in the event of a problem, like soles at the podiatrist.

Jean-Luc DARTEVELLE: It is important to specify that it is appropriate to check the soles whenever a gutter is made or occlusion adjustments are made.

The insoles may no longer be suitable once the occlusion has been modified.

From the room: I am a private dental surgeon. The clinical cases presented focused on descending disorders. What is your opinion on ascending disorders?

Furthermore, have you assessed the psychological impact of the repositioning gutters?

Philippe BOISSONNET: The real ascending problems concern people who have malformations or trauma to the feet. In the vast majority of cases, athletes present with mixed disorders which must be treated as a priority at the dental level.

 But doctors very often start with the feet. Many people come to me to tell me that the insoles we made for them have not changed their problems.

From the room: How long did the dancer's treatment last?

Philippe BOISSONNET: This case dates from twenty years ago. The orthodontic treatment was intended to prepare for the surgical procedure, which took three weeks.

I saw this dancer again around 1996, after following my training in Lyon. I then began to refine the posture work.

From the room: During orthodontic treatment, did she continue to play sports?

Philippe BOISSONNET: Yes. However, she only had small disturbances, which she could compensate for. She was young. It is with time and training mass that disturbances appear.

From the audience: Doesn't this risk causing poor performance in an athlete who has become accustomed to his imbalance?

Philippe BOISSONNET: That’s a very good question. I remember being interested in the case of Marie-José Pérec. The analysis of her foal was very particular: she was neither a sprinter's foal nor a long-distance runner's foal. One day, Marie-José Pérec decided to have her teeth straightened.

It disturbed her more than anything else.

TO BE CONTINUED.

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