Weak Rélevé

I got your name from a dancer/friend when I asked her a question regarding a current ‘disability’ I have that affects my dance.

First, I am a sixty year old male with a history of osteoarthritis and two joint replacements (one hip, one knee).  I also social dance 5-6 nights a week……and I am actually a good dancer (mostly because of musicality and I am precise/gentle at leading)……I sometimes tease that I recently won an award for being ‘The Best Male Dancer in the Greater Seattle Metro Area over-60 and with TWO OR MORE Artificial Joints”  (small competitive class!).

My most recent issue:  foot/ankle surgery in late December09 to tie ruptured post-tibial tendon into adjacent tendon…..they also did a couple of calcaneus bone cuts and one inserted bone graft to facilitate better foot alignment… sounds pretty mucked up but I have been dancing consistently with ONE noticeable (to me) impediment:

I have trouble taking weight on the ball-of-foot of a pointed foot…..I can hold my weight well enough to get in a chaine turn (heel just kisses ground…..but does not collapse halfway thru)……but I can only hold the weight so far with heel is near the ground……I want to be able to absorb weight at point of max extension and execute a cushioned articulation (sorry I do not know the tech words better) down to my heel…….if I could do a MOON-WALK…..I think I would be fine.

Currently working wth a heavy rubber band at that max-extension to see if that will help……also raising to max extension two-legged and then trying to shift weight to injured foot for the down (eccentric?) movement.

Related, I tend to ‘claw’ my toes related to being up on ball of foot…..I think because my ‘long’ tendons are trying to compensate for ‘short’ tendon weakness……anyway dancing around on clawed toes for a few hours IS pretty
tiring…..

Overall, I am in great health, not overweight…..but if you have any ideas for rehab, I would REALLY appreciate it!      John

I’m curious, John, if you had your hip and knee surgery on the same side.  (and what side does the ankle surgery line up with?)  When there are too many injuries on one side I start to suspect a leg length difference:)

You’re doing the right stuff with the theraband to start to strengthen the calf muscles again, and I like the slow descent lowering from releve on the side that had the surgery.  If you are doing toe risers with clawed toes, though, (called rélevés in dance language) then you aren’t getting as much out of that exercise as you could.

This is what I would suggest.  Start working the bottom of the foot with a pinkie ball.  Stand and roll your foot on the ball to release as much tension on the bottom of the foot as you can.  It will feel tight – but good:)

Then I want you to stand on one foot and place the other one behind you as in the picture below.  You won’t have as wide of a position as the dancer demonstrates.  You are stretching the underside of the toes and know that you won’t really need to bend your knee much to get a good stretch. To get more stretch you bend your back knee.

An even simpler way to stretch the underside of your toes would be to stand with both feet in parallel and then slowly bend one knee, lifting the heel up slightly as you keep the toes straight and long.  Then switch feet.  You are in slow motion practicing a ‘moon walk’ variation but without traveling:)

When you practice your toe risers – only go as far as you can keep the toes straight.  The minute they start to claw – stop – stretch them out and lower back down.

Time will tell how much change you can give to this area.  After all… you are going to need to continue to train in order to keep your title of The Best Male Dancer in the Greater Seattle Metro Area over-60!

Best regards,

Deborah
“Education is the key to injury prevention”

Adult tibial torsion?

I recently viewed your video “tibial torsion audio” on youtube and was directed to your website thebodyseries.com; I was amazed to realize that the dancer in the video seemed to have the same problem as me, where she did not stand evenly on her legs, and in a demi pliet the knee turned inward in relation to the foot. I believe that my right leg has tibial torsion which is negatively impacting my ability to dance or workout. I was wondering if you knew of any doctor who specializes in diagnosing or treating adult tibial torsion, or could provide exercises to help correct this condition. I am a bit clueless, because this is the first time I have heard of someone with knowledge of the asymetry which affects others and me. Any help or direction you could provide would be invaluable and greatly appreciated.

Sincerely,
Josh

Unfortunately, Josh, you can’t undue the tibial torsion once you have it – but it doesn’t have to stop you from dancing. You do, however, need to focus first and foremost on keeping the weight even between the 3 points of the foot, the pads of the big toe, little toe, and heel. The knees will not be over the middle of the foot as we so often hear in dance class. For the dancer with tibial torsion if they pull the knees out to get them over the middle of the foot they are doing it by supinating the foot or overly using the sartorious muscle to pull the knees out to the side. Then you’ll have more problems than just pulling the knees out to the side!

The treatment? To simply balance out any muscular imbalances and keep the weight on the feet properly placed while working the turnout as well as you can from the hip – not the knees and feet.

Développés – how to strengthen

First of all I would like to thank you for the great website and your great blog!

I am a 19-year-old ballerina and have been doing ballet recreationally since I was 5. A couple of years ago I decided to take it more seriously and to train more hours. I have three questions and I would really appreciate it if you had the time to answer them. The first one is a rather short one: How can I prevent Achilles tendonitis, especially as I have noticed that I pop my ankle more often, which I didn’t use to do as much before (it doesn’t hurt).

The two remaining questions have to do with each other: As I have been training more now, I have been working on my développé, they aren’t that bad, but not really outstanding: I can do about 100 degrees but I really wish to get it higher. However it seems that it is not only the muscles that are making it harder to improve, but also a popping in the front of the hip when LOWERING my leg after a développé and sometimes when raising the leg, too. As I noticed that, I kept stretching the iliopsoas muscle before développés and battements, it got better but it still pops and keeps me from doing my best (although it doesn’t hurt, my leg feels like “not free”!).

Could it be another muscle that needs to be strengthened and stretched? How can I get rid of that popping and improve my développés at the same time?

Thanks a lot for taking the time to read my letter!
Liz

Great questions, Liz! Let’s start with the easier one first. If your ankle is popping more, that doesn’t necessarily mean that you are on your way to developing Achilles tendonitis – but it does make me wonder what’s happening in your standing alignment. Evaluate honestly if the weight is staying balanced between the front and back of the foot – are you over turning out at the feet in first position – and can you do a demi plié and keep the anterior tibialis tendon (the one at the front of the ankle) during the descent of the plié. Check those 3 areas and correct them as they may be creating some muscle imbalance.

Stretching is key for the Achilles tendon – and while most do the traditional lunge calf stretch, I prefer putting my foot over a thick book, and then stepping forward with the other leg to do a modified lunge. You don’t have to step very far forward to get a super stretch of the calf muscles. Also do this also with the back knee just barely bending to place the stretch down towards the tendon. Both variations are important.

Onto développés.

Many dancers aren’t aware of the importance of a strong iliopsoas to their extensions and développés. When you are lifting the leg to the front there is a point above 90 degrees where the quads are less effective and the iliopsoas becomes more important for a gorgeous high extension.

I’m posting a quicktime movie of an iliopsoas strengthening exercise. You will place a theraband around the thighs and then bring the knee towards the chest.. You can also do straight leg legs or développés. The more upright you are by moving from your elbows to your hands, the harder. Do these exercises with the leg slightly turned out leg. It is a challenging exercise but you will be quite happy with the results, I promise! Then stretch the iliopsoas afterwards. I’ll be curious if your ‘popping’ will get better after balancing out the strength to flexibility of the all important iliopsoas muscle.

This clip is taken from my new Essential Anatomy: A Multimedia Course for Dancers and Teachers

I’m putting it all together as we speak – and they will be ready to order (along with some very special bonuses) next week – for sure! I have put together over 3 hours of quicktime movie clips (along with an outline and study guide) that bring anatomy to life – talking and illustrating important muscles, concepts and what to do… in order to dance smart and teach smart. After clicking the link the movie will open up and take just a moment to load.

psoas strengther with theraband

Until next week!

Deborah

“Education is the key to injury prevention”

Too old for pointe?

What is your feeling about adults (20’s and beyond) dancing on pointe?  Some people (dancers and teachers) feel that adults cannot be successful on pointe, and that, indeed, it is risky because of their “advanced age”.

I have a group of 30-45 year olds who do quite well, thank you very much.  They are strong, take many classes a week, and cross train with Pilates, etc. outside of ballet class.  These ladies are doing double pirouettes, some of them are doing fouetté turns, hops on pointe, etc.  They love dancing on pointe.

Are there any studies you know of that link additional risks associated with pointe work due solely to age?

I’d love to see the topic of myths and misconceptions about older dancers dealt with on your site, as well as tips for dancing safely as the years go by.

Thanks so much!

Ruth

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Great questions! Margot Fonteyn danced the role of Juliet at age 43.  Did she do it in her bare feet?  I think not☺ She did it in pointe shoes.

As is the case with most physical activities – how you do it  – is more important than what age you do it at.  I remember hearing when I was growing up that running will hurt your knees.  (tell that to the 69 year old woman who took up running and did her first marathon shortly after)

I also grew up with the idea that all dancers will get ugly feet and arthritis the longer they danced.

Why?  Because the majority of my teachers talked about their aching feet, I saw their huge bunions, and listened to their complaints of how their hips hurt!

Not a very pretty picture of aging dancers, is it?

Alignment and muscle balance are keys to optimal functioning in any chosen physical activity.  Your group of 30 – 45 year old dancers sound like smart dancers by cross training outside of dance class and maintaining a good relationship between strength and flexibility.

In fact, I would venture a guess that the older dancer is even more particular about their training over the late teen, early 20’s ballet dancer who feels more invincible and much less concerned about the physical effects of poor training – especially if they have accepted myths such as bunions are inevitable.  (Which they aren’t – sorry for my bluntness)

If your older dancers are paying attention to their alignment and proper training and conditioning for pointe work they can work as long as they choose to – or until other challenges such as osteoporosis might crop up.  On the other hand, continuing to dance is a great way to decrease the chances of osteoporosis along with good nutrition.

If they begin to have problems associated with doing pointe work they’ll handle it the same way as a younger dancer.  By checking out their alignment and technique first and then correcting any muscle weaknesses (Lisa Howell’s, The Perfect Pointe book is a fantastic resource for teachers and dancers.  You can purchase it through my website .

There are other interesting aspects to challenging yourself as you age.  The Berlin Aging Study looked at men and women over the age of 70.  This research was looking at how people feel about aging and comparing that to their vitality and resiliency.   Your older dancers (although not truly very old) are engaging in an activity that makes them feel younger and better about themselves!

In unpublished research based on the Berlin Aging Study, they found that people who feel younger are less likely to die than
those who don’t, given the same level of chronological age and equivalent physical health.

“Feeling positive about getting older may well be associated with remaining active and experiencing better health in old age.” “Thus, studies on self-perceptions of aging can contribute to our understanding of potential indicators of resilience in older adults and the aging self.”   (http://www.sciencedaily.com/releases/2008/12/081202153521.htm)

Bottom line – continuing to dance is good for our bodies, mind and spirit!  Your dancers will know when to hang up their pointe shoes – and it doesn’t sound like it is quite yet!

Deborah

“Education is the key to injury prevention”

PS:  Remember any order this month will receive a FREE copy of Tune Up Your Turnout:  A Dancer’s Guide or if you order an ebook or downloadable product, I will see a FREE copy of the 440 page Dancing Smart:  Tips to Improve your Technique

Recovering from injury

I am a 15 year old ballet student who hopes to pursue a career in dance. Right now I have an achilles tendon injury that requires passive healing, a lot of physical therapy and may take many months to heal. I have been off of dance for about 2 months now, and I’m having a very hard time coping with this rest period. Going from 15 hours of ballet a week to none has put me in a kind of “dance withdrawal.”. I am trying to keep in shape, but there is really no physical activity that compares to ballet for me, and I have a hard time finding the motivation to go to the gym. Do you have any reconmendations for keeping in physical shape (flexibility, strength, balance, core work, etc.) and also in a good mental state during periods of injury rehabilitation?

Thank you so much, your blog is a wonderful resource.

-Jackie B.

I’m so sorry to hear about your Achilles tendon injury. It is especially rough for someone like you who is used to being so active. I know your ankle is being taken care of with going to physical therapy, so we’ll focus on the right of your body ‘s well being.

I’d like you to first focus on the perspective that this is a good cross training opportunity for you. How is your cardiovascular strength? What about your upper body? That is an area that many women could improve – especially in these days of extreme athleticism and using your arms for support in contemporary choreography.

Those 2 areas along with core work with theraband or foam roller could easily be focused on during your rehab – even without going to the gym☺ (I don’t like the gym atmosphere and also prefer working out at home) I like using the kettle bell for my cardio. It’s amazing how much you work within just a minute. It’s a weight that has a handle on top and you swing it for between a minute and 2 minutes (I started at 30 secs) and then rest, walking around for a few minutes in between. You are doing interval training with this. Cardiovascular health is about the ability of your body to recover from stress.

I found a kettle bell demo on youtube that is better than most – although I will say that I do not ‘snap’ my knees or suggest that my dancers do as she is showing on this video. Bring them to straight, using the gluts and engaging the abdominals as you straighten your legs – but do it without snapping. Here’s the youtube link so you know what I’m talking about.

This time off from dance is a great time to be focusing on virtual rehearsals – using visualization to set new pathways from the brain to the muscles.

I’d like to tell you a fascinating story about Marilyn King, who was a two-time Olympic athlete and later a coach at the University of California. Her story beautifully demonstrates the power of mental rehearsing. She made the 1972 pentathlon team and placed 13th in the 1976 Olympics. She was determined to do even better at the 1980 Olympics and gave herself all of 1979 to train for the trials that would happen in the spring of 1980.

In November 1979, she was in a head-on car accident and suffered a severe back injury. Her friends and physicians felt her chances for competing in the Olympics had come to an end. She spent four months in bed, a daunting setback for anyone training for a physical competition. During those long months, Marilyn was determined to continue training and working in the only way she could, which was in her head. She went through every event in her minds eye and watched endless hours of the world’s best pentathlon athletes competing. Sometimes she watched them frame-by-frame.

When she was able to walk again, she went to the track and continued to train by envisioning herself going through each event successfully.

When it came time for the trials, she was better enough to compete and put herself through five grueling events—without having months of physical preparation, as the rest of the athletes had. She described moving almost as if in a dream, as she had rehearsed it so many times in her head during the past months. She placed second in the trials and went to the Olympics that summer.

Inspiring story, yes? She had a strong desire, focused only on what she wanted – cultivated by an emotional attitude that supported success—and took the actions she knew would optimize her performance, physically training when she was able and mentally training when she was not.

Elite athletes have long known about the power of mental rehearsing. Musicians and dancers are beginning to be more aware of the body/brain connection to their performance.

Watch the videos of your favorite dancers, put music on and go through barre, or other warm-ups… in your mind’s eye – not in real time. Imagine how good you are going to feel when you are back in class – and feel that way now!

What I know about healing is those who are able to maintain a positive attitude, imagining the best coming out of the situation, rather than the worst, are often the ones who heal the quickest as well.

Hope that helps – and best wishes for a speedy recovery!

ankle sprain

I’m going to talk about balancing for ankle sprains in just a moment but first I want to announce that Effective Stretching: The Ultimate Guide is ready to ship! Its on sale from $45 to $29 just until December 31st – and you get free shipping as my holiday gift to you! (sorry… only for domestic orders) Check it out on the website – and order Effective Stretching which comes with a free pinkie ball and 2 smaller balls now!

I’m enjoying your dance smart messages so very much, and share them with the other dance teacher in my school. Recently a student of mine injured her ankle, and had it diagnosed as a bad sprain. She has now returned to dance class, but is, of course, finding it weak. Having not had any physical therapy, she has asked me for recommended exercises to help strengthen it.
Any suggestions? Thanks very much.
Shelley

Good question Shelley. It distresses me some that your student didn’t receive any physical therapy. I have seen many injuries that have been traced back to sprains that weren’t fully rehabbed. I’m assuming that your student can walk, stand, and slowly relevé without pain in her ankle. One of the first focuses would be to retrain the nervous system where center is at the ankle joint. This is done through balancing exercises. This one part is essential in the rehab process because the body immediately compensates after an injury such as a sprained ankle. If we don’t take the time to retrain the musculature around the joint through balancing, they will continue to act in the compensatory pattern.

Start by standing on one foot making sure you are not sinking into the hip. First begin in parallel, and then you can move into doing these turnout exercises in a slightly turned out position. Toss a ball from one hand to the other, balancing on the one leg, for one minute initially and working up to balancing and tossing the ball for three minutes. (When I was training gymnasts I would make them do this on the balance beam, so our dancers have it easy!)

When you get pretty good at balancing for three minutes in this way, challenge your nervous system by standing on a moveable surface such as a sofa cushion, your bed, or the middle of a small mini tramp.

Whatever feels tired first means one of two things, that muscle group is weak or tight, or both weak and tight. Just by virtue of doing the balancing exercises you will be strengthening and asking all the muscles to work to keep you in balance. If you get tired around the outside of the hips you should stretch that area after doing the balance exercises.

To work at strengthening the muscles around the joint your student may want to work with a wide strip of theraband and do pointing and flexing with her foot inside the theraband. She would also want to resist the theraband moving her foot into abduction which is a flagged foot, opposite of sickling her foot. To do that she would hold the theraband off to the left if she was working with her right foot and move her right foot away from the midline of the body.

You can do straight abduction, and also work the foot in a half circle shape going from flexion out to the side and into a Pointe, and then reversing the motion. [Whew, it is challenging to describe movement in words sometimes.] It is the peroneal muscles that are strained when you sprain your ankle for those of you who want to look it up in an anatomy book. She should move cautiously back into jumps and leaps and pointe work until she feels confident that her ankle is strong enough. Post sprain is a vulnerable time when it would be very easy for her to re-sprain the joint.

Happy December!

Deborah

“Education is the key to injury prevention”

Slow recovery…

Someone recommended I e-mail you, because we have been unable to get answers from doctors and physical therapists who know enough about ballet.

My daughter, stepped on a pencil a year ago. She is 14 and loves ballet. The pencil graphite lodged deep in the bottom of her foot. She was operated on by a good podiatrist. He had to cut through 3 layers of muscle and the plantar fascia was repaired. She seemed fine. She went back to ballet and was still doing fine. After a few months, she went slowly on pointe. She was fine until she started doing pointe for longer periods. At that point, her progress went way backwards to the point where it hurt to walk. We went to a great physical therapist and she got much better. She massaged it, iced it, put on ultra sound, had Ashley do exercises..etc.She is just getting back to ballet this month, but her foot is hurting again. It isn’t hurting as much as before, but it began to hurt after she was doing ballet classes again. She danced the first few classes for only 15 minutes. She was fine at that point. When she went up to 30 minutes, she began to have trouble. She is not on pointe. Ashley is still doing massage on the foot, putting ice on it, and doing stretches based on the physical therapist’s orders.

Her physical therapist and podiatrist are very good, but really don’t know about ballet. Any ideas on how to get her better and back to ballet? Your input would be greatly appreciated.

A concerned mom,
Joan

Joan – you’ve been very fortunate to have a good podiatrist and physical therapist. It is encouraging that she does respond very well with the physical therapy. I suspect that there was a compensation that occurred after surgery that hasn’t been fully addressed. When we injure something on one of our legs, whether that is a foot injury like your daughter had or a knee or hip issue – our body automatically compensates. It is quite amazing in that respect – we start to stand with more weight on the other leg, potentially start having a muscular imbalance between the two sides, and so on. It is so automatic that we don’t realize going back to class that there still may be some compensatory movement happening.

I would also question if there has been some fascial restriction above the level of the plantar fascia. I wrote a post about flexibility and fascia that you’ll want to read. I wonder if there is some fascial pull in the torso or pelvis that has not been dealt with yet. If there is a pelvic/torso shift or a rotation that is occurring it could be changing her muscle usage and ballet technique. While it is hard to assess these shifts yourself, have your daughter face a mirror and stand in a neutral position with her arms just hanging by her sides.

When you look at the figure below you can see she has a pelvic shift right, torso shift left (you always describe the direction from their point of view) Notice how she makes her shoulders look square, but when you look at the arms and how they hang there is more space between her left arm and pelvis, while her right arm touches her pelvis. She is not standing with equal weight on the two legs. If she turns out into first position she most likely will continue this imbalanced pattern.

There may be something like this that is going on with your daughter. Perhaps her dance teacher could meet with the two of you before or after class to look at her alignment markers. Is the middle of the ear over the middle of the shoulder, hip, knee and ankle from the side? From the front if you drop a plumb line from her nose does it fall evenly between the 2 feet? Are her hips, knees and ankles in alignment?

While everyone is asymmetrical, and I would expect to find some shifts, rotations, etc., it could be that her shifts are causing enough of an imbalance in class where she is not working evenly on her two feet. It might also be very useful to find a massage therapist that will look at your daughter’s standing alignment and based on what she sees, work to release the myofascial tensions. This will be different from a regular massage. He/she will slowly stretch and lengthen the fascia – not always a comfortable technique, but the results are well worth it.

Hope this gives her a few more suggestions for a speedy recovery. I’m rooting for her!

Warmly,

Deborah

“Education is the key to injury prevention”


sinking feet….. understanding corrections

I recently re-read your archived article from January 2006 on “sinking arches.” One of our students has high arches and is experiencing some pain in her instep, to the end that she has been crying, and one of her other teachers thinks it may be “falling” arches.

Are “sinking” arches and “falling” arches the same thing? Is there any more that you can you tell me about this particular issue with arches? I have high insteps also, but I never experienced any problem like this.

Thank you for your help.

Lisa

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A foot that is in neutral has equal weight on the pads of the big toe, little toe and heel. When the weight is evenly spaced like this it helps to maintain the arches of the feet.

When a foot is rolling in or ‘falling’ as some call it that is a pronated foot. This puts strain on the arch and the plantar fascia of the arch. This could be what’s happening to your dancer. I would evaluate by looking at the shape of her foot, and the shape of her Achilles tendon.

With pronation the Achilles tendon is bowed. You can see see that in the picture below left. In the picture below and on the right you can see how a very high arch can also create some problems. It is a less flexible foot and because of that there can be a pull on the plantar fascia on the bottom of the foot, and/or they can ultimately roll in or pronate like the picture on the left. Both of these scenarios can cause pain and should be checked out by a podiatrist or physician. Rolling on a pinkie ball or tennis ball can help relieve some tension but ultimately the weight of the body has to be redistributed accurately over the 3 points of the foot.

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Dear Deborah,

I was reading your latest blog, and I was thinking about two tools that ballet teachers often use to help their students understand what their bodies should be feeling and what they should look like. I noticed this in a recent class, with a very good teacher, and it reminded me of the many times I have heard this before. Now that I am more educated, I interpret it differently, and maybe you can confirm my change in thinking and even assist students and teachers with these two “tips”.

The first is to “tighten the knee”. The fleshy part of your quadriceps just above your knee cap should be pulled up tight. Teachers will point to this and poke it, until the student makes it “tight”.

When I was younger, I simply pushed the knee in the opposite direction (hyperextension). This achieved the external appearance the teacher was looking for, and so I thought I was on the right track. Unfortunately, as my quadriceps ballooned, I had no idea why. (other hip alignment issues helped this along) I felt like my teachers were just as frustrated with me as I was with my own body. I was only doing what they told me to do! If I had known that you could “tighten” that muscle in *two different ways* and achieve the same external result, it might have helped. Now I think of *lengthening the leg out of the hip socket* and surprise – the quadriceps “lifts”, but the feeling is much different. So now, I think I understand better what they were trying to tell me all along.

[Deb’s response: ‘Lifting’ the knee cap – or ‘tightening’ the knee both ask the quadriceps muscles to engage and contract. I have always disagreed with the idea it should be tight all the time – that only creates a bulkier muscle and fatigues it too. What you translated that correction into was wonderful. You lengthened the distance between the pelvis and the knee joint, consequently lengthening the quadriceps rather than just locking them, and it felt different. Excellent!]

The second is to “squeeze the butt”. Again, my backside ballooned a la J-Lo, and I had no idea why. So I squeezed harder, which made it worse. All the while my turnout was getting worse, not better. Only recently I understood that there are several gluteal muscles, and not all of them are engaging to assist the outward rotation of the hip. Some can actually get in the way. When I stand in first and tendu to second, and rotate the gesture leg in and out, and I focus on *relaxing* my “butt” and focus on the deep rotation of the femur, (along with the long legs I mentioned before) I find that I am more in tune with the actual rotator muscles and the gluteus maximus gets out of the way and lets my leg rotate! And my butt is much smaller (yay). And my teacher gets the physical reaction they were looking for, which is a “tight bottom”.

[Deb: Another good example that constant contraction builds bulk – and dancers don’t need to look like Mr. and Ms. Atlas! When you are standing in first and doing tendu to the side you will be be in slight flexion at the hip. Most dancers don’t have 180 degrees of turnout so if you follow the line of your first you will tendu on a diagonal forward. The main gluteal muscle does assist in rotating the leg when you are extending the hip. Meaning, it only helps when you are taking the leg behind you. Yea for finding the deep lateral rotators underneath the gluteals!]

So I am getting the same corrections, but interpreting them differently, and this has made all the difference.

Thanks in no small part to you. [Deb: Thank you for your kind words – and congrats on your new insights!]
Ginger

[Deb: Ginger came to the first summer conference on Analyzing Movement that was held at Oberlin College last June. I’m firming up the date for summer 2010 – will send details soon!]

Different sizes of pointe shoes

A dancer has asked me for help with her pointe shoes. One foot is much smaller than the other and she had been stuffing extra padding into the bigger shoe, but this caused her a lot of pain and lots of problems on pointe. She has found out that one foot is actually 1/2 size smaller than the other and ever since she purchased two pair of shoes (1/2 size difference, but the same exact brand) she has been doing much better. She’s now fine with her pointe shoes, not having any difficulties with pointe, but she asked me a question that I really can’t answer.

Will the 1/2 size difference in her pointe shoes cause any imbalance in her hips, or cause problems with her spine? Is she better off working in the exact same size pointe shoes and building up the inside of the bigger shoe? My gut feeling is that it is more important that the pointe shoes fit properly and that 1/2 size is not that big of a difference. I had this same exact issue with my pointe shoes and always bought my shoes in two different sizes, and although I’ve hung up my pointe shoes many years ago, I DO have problems with my spine and hips — that’s why I’m beginning to question whether or not this is actually a good idea. I did have a few definite injuries that caused my back and hip problems, but could I have weakened this area or caused an imbalance by wearing two different size pointe shoes?

I don’t want to advise this dancer incorrectly, so I’m really curious to know what your thoughts are on this subject. I do not know this dancer personally, so I do not have any other details about her. Generally speaking, what do you think? I’m really stumped!

Thank you in advance for your time and your help.

Lorie

Great question Lorie! I agree with your opinion that it is more important to wear pointe shoes that fit correctly instead of padding the larger shoe so you are wearing the same size.

I do not believe that wearing a half size different shoe is going to create problems for her at the hips and spine. You don’t spend that much time with the exception of sous sus and échappé being on both shoes. Typically, you are transferring from one foot to the other, or doing an exquisite balancing move on one foot.

Different sized feet are pretty normal, in fact. Having leg length difference is not unusual either, but greater the difference between leg lengths – the more influential on the pelvis and hip placement.

I have not personally seen shoe size be a leading factor in spine and pelvis issues. The fact that the dancer feels better with the 2 different size shoes is good feedback that she is on the right track.

High arched feet

Quick reminder to check the 2009 workshops listed on the website. I still have a few spots left for my ‘Analyze This! Train Your Eye for Dance’, being offered in June. Being able to look at the relationships in the body and translate that into effective training for your students is essential – and that will be the focus of the entire workshop!

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My 12 year old takes 13-14 classes a week at this rigorous studio, and is a member of the performing/competition company. She spends very little time on pointe due to her age, but focuses on ballet. She also has several jazz, lyrical and musical theater classes. Over the last several months, my daughter has developed more and more pain in the first metatarsal/phalangeal joint on the medial side. It first started as just soreness, and she worked to not get too far over her toes on rélevé, something she slips into sometimes. We have consulted with a podiatrist, who tells us that her very high arch is placing more load on this joint than average, especially in rélevé. His suggestion is to place a small pad right behind the joint (not under it) to help off-load the joint. Obviously, rest is called for as well due to the pain she’s experiencing. The medial side of the ball joint is sore to the touch, and sometimes so sore that she doesn’t want to even bend this joint. She is sitting out of many classes at the moment while we “tend to” this issue…icing, rest, anti-inflammatory topical cream, etc.

Do you have experience with this sort of overuse injury, especially in a very high-arched foot? Any pearl of wisdom or recommendation you have would be greatly appreciated. Thank you so much.

Sue

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I asked Sue to send me some pictures of her daughter’s feet – which she graciously did. Let’s take a look at them together. When I first looked at the picture of her feet from above I was struck by the difference between the two feet. I first see the bunions on both feet, left more than right. When you look at the way the two feet are placed she is more ‘on’ her right foot than left. See the angle at the ankles? The left foot is pronating slightly – which is probably why her bunion is larger on that foot.

Her toes are long and straight, and she has a somewhat narrow foot – with a very high arch – which used to be the favored foot of an aristocrat! (alas, it probably has to do more with the genes you got from your parents than nobility in your background)

When you look at her feet from the front you see the high arch, which so many dancers desire. (I imagine she has a beautiful pointe!) Comparing the 2 feet do you see the difference in the arches? The left one has less space between the foot and the floor – again showing the left foot in slight pronation. It is also showing up around the ankle, where you can see the outline of the tendon below the ankle bone. She again appears more ‘on’ her right foot than her left.

When I look at her rélevé, she has the wonderfully flat base to rise from. Looking at her heels, her right ankle/foot looks more pulled up out of the toes than her left one does. (I don’t know if both or just one foot is bothering, but if it is one I would bet money on the left foot being the foot that hurts more) I can’t tell from this angle where the her weight is centered and if it is shifting over the big toe instead of between the 2nd and 3rd toes.

So what to do with this pes cavus foot? (the medical term for the high arch, often slightly rigid food)

I would start by gently massaging the bottom of the foot, as well as gently massaging inbetween the toes, and the top of the foot. Depending on how tight or loose her calf muscles/hamstrings are – it may be useful to massage and release any excessive muscle tension all the way up the leg. With this type of foot the challenge is to keep the arches flexible instead of just plopping up on rélevé.

She is already pulling back, icing and focusing on deinflamming the foot – all the right things to be doing. I know taking time off during the dance year is challenging, but if the bunion area may almost have a bone bruise type of feel to it – and that is going to take some time to feel better.

She’ll need to really have her releve and first positions and how she is traveling on her feet looked at carefully – because somewhere there is a pattern of pronation with the bunion formation. (Sorry guys, I don’t buy into the genetic factor in bunions – although I do see similar postures in families based) I would also have her leg lengths evaluated because of the right/left asymmetry that is in all three pictures. That could be fueling the problem, and if I had to make a guess, I would guess the left leg being longer.

She’s 12 – so she is going through growth spurts – and her muscle balance needs to be checked. What is the strength versus flexibility in her legs? Is she sitting too much into her rélevé because of the high arch?

After she massages her feet for 5 – 10 minutes, gently but firmly, stand up and note how the feet feel. Any difference? After she ices – how do they feel? Whether or not the feet are responding to the care she is giving them will determine how ‘off class’ she may need to be.

An aside note – NO FLIP FLOPS! If she loves wearing sandals and closed shoes are too warm for where you live, she must find ones that strap onto her feet so if she lifted her foot up behind her they would not fall off – and her toes would be totally relaxed in the shoe. Flip flops are fine for walking from the car to the beach – but not as everyday shoewear. If she is doing all the right stuff – and still wearing flip flops – then her rehab time is going to be increased.

Let us know, Sue, how your daughter does with these suggestions.

Warmest regards,

Deborah