Shin Splints

Announcements
If you haven’t had a chance to listen to the mp3 file that was posted in the last newsletter, it’s still up.

Secondly, I wanted to let you know about another wonderful dance website called Dance Advantage. (http://danceadvantage.net) It’s written by Nichelle Strzepek and is filled with valuable information. Check it out! (I’m hoping soon to get a page on my website for links)

Lastly, I want to firm up the rest of 2009’s schedule and so if you are interested in having me come to your area to do an all day workshop, now is the time to email me at Deborah@thebodyseries.com! I realize if you are interested in a workshop before summer, most likely it would have to be on a Sunday. I’ll be in Chicago in July at CDMA, and am working on details to come to Denver, Colorado.

With finances the way they are with everyone, I wanted to figure out a way to make the very important info about the science of dance training available and affordable to everyone. So here is my outline.

We’ll meet from 9 – noon and then 1:30 – 4:30 with an open Q & A from 4:30 – 5pm.
The whole day would be $150, a half day $90. Generally, I gear my information towards the older dancer or teacher, but I would consider doing a workshop geared towards the 10 – 16 year old. There would need to be 20 participants so that I could make my minimum fee of $3000 – and I will take care of my housing and travel expenses. (of course the person setting it up wouldn’t be charged as they are offering space) I wouldn’t want more than 30 participants in any one workshop. Participants will walk away with valuable resource material to support what they have learned. (Sorry if talking about finances is tacky in a newsletter – but I always appreciate someone being honest and clear when they are proposing something, so that’s why I’m telling you the details before you indicate your interest.)

If you are in an area where the dance community is willing to drive up to a few hours to attend such an event – and there are enough interested dancers and dance teachers to make it happen – please let me know! (email me at Deborah@thebodyseries.com) I will help with advertising the event and location on my website and announcing it in my newsletters. (I’d also consider traveling to Europe – but you’d need to let me know asap you’re interested!)

Onto the question of the week from Hetty…

I am fifteen years old; I have been dancing for the past 10 years or so. I started with Ballet and I am now doing jazz and Modern. I dance about 8.25 hours per week plus 1.25 hr additional coaching on Saturdays for Grade seven ballet exam due in March.

Problem: My right shin hurts a lot. I Rest, Ice, Elevate and Compress and it goes away and comes back when I dance again. If I rub the calf muscle with sports balm the pain goes away.

Will massage help in this situation? I already checked with a sports doctor who recommended the RICE method.
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This is a great question that is pertinent to all dancers and physical movers, such as cheerleaders & runners. Shin splints is often given as the diagnosis when you feel pain at the front of the lower leg. As we have mentioned before pain is always a cause for concern, and you would want to seek out appropriate medical attention if the pain is not getting better with your self treatment program. The doctor needs to rule out more serious problems such as stress fractures, which can occur from shin splints that go untreated. So words to the wise, shin splints do not need to be a rite of passage for dancers!

There are several theories on what shin splints really are. A common definition is inflammation of the periostium, which is the sheath that surrounds the tibia (which is the shin bone.) You can also have small tears and/or inflammation in the anterior tibialis muscle, which is the muscle in the front/outside of the calf, which flexes the foot towards the shin. You may have a combination of both problems.

Typically in shin splints you feel pain from the ankle to about half way up the shin. The area may feel swollen and tender. A warning sign of a stress fracture is when the pain becomes sharper and more specific to one spot on the tibia. Please go get an x-ray, Hetty, if this is what your pain feels like.

There are multiple reasons why you might get shin splints. The easiest one to figure out is dancing on too hard of a surface. Sometimes shin splints come on with a sudden increase in training – for example, all of a sudden doing twice the number of jumps and leaps in each class. (I’ve seen a lot of girls get shin splints in December when they start increasing rehearsals for Nutcracker and their muscles and feet aren’t conditioned and ready for the increase in time spent in pointe shoes)

Another common reason for shin splints is from an imbalance between the muscles in the front and back of the leg. More often I see dancers who are tight in their posterior calf muscles (the gastrocnemius, soleus) and end up loading the front calf muscle, which tries to help deepen the flexion as we described prior. It is also possible to have some weakness in those same muscles that can create a strain situation when you do multiple jumps and leaps. The key is balance, always.

I want to mention one other common issue with shin splints and that is poor foot mechanics. If you have a tendency to pronate, or roll in on the arches of your feet, you will be at greater risk for developing shin splints. This is another very good reason to make sure turnout is being created at the hip, not at the ankle/foot. If the shin splints have this biomechanical basis an insert or orthotic in your shoe wear can be helpful in keeping you out of pronation.

So what can you do to if you think you have shin splints? First, pull back from your jumping and leaping until you don’t feel pain in your shin area. It’s very hard to stretch the anterior tibialis muscle, especially for dancers, who have a good point. Instead, take your pinkie ball and kneel on the ground placing the pinkie ball under the front of one calf. You are going to gently massage the muscle by rolling on the ball or pressing down onto the ball. This will help decrease the tension in the anterior tibialis, and often make an immediate difference in how your calf feels when you stand back up. Many dancers will also use the ball to massage the back of the calf, and then stretch afterwards.

You can stretch the back of the calf by doing the typical lunge stretches with your back leg straight, and then with a tiny bend at your knee, bringing the feeling of stretch down into the Achilles tendon. You could also stand with the ball of your feet on the bottom step, or a couple of books, and allow your heels to drop down keeping your knees straight, and then with your knees slightly bent.

Generally, physicians and physical therapists initial will suggest using ice on the painful areas, and at a later time go between icing and applying moist heat to the area. Of course it goes without saying that dancing without having your leg muscles properly warmed up will increase your potential for shin splints (as well as other injuries:)

Since you have been doing the RICE treatment, lets try more massage, perhaps with the pinkie ball, along with pulling back on jumping and leaping, and increasing your stretching. You want the synergy of all of those things at the same time for shin splints. If this helps decrease the soreness or pain, that’s wonderful! You’re on the right track! If it doesn’t seem to help, or if the pain is getting worse, then stop dancing and get yourself to the doctors. You need to rule out the possibility of a stress fracture.

Best wishes for a speedy recovery!

Deborah

“Education is the key to injury prevention”

Pointe preparation

I am 15 years old and I have read all of your newsletters dealing with the feet and ankles and they have helped so much. Although, I’m starting to have some new problems with my feet. I have noticed after performances and warm-ups my ankles and a muscle between my calf and the heel of my foot becomes very sore the next day. I do not know if it has to do with wrong use of extrinsic muscles or using too much pressure on my feet. I am about to start pointe soon and want to correct this problem before i dangerously injure my ankles even more. Please help me recover and prevent this issue.

Thank you, Sara

It sounds like you are talking about the Achilles tendon, Sara. The fact that you are feeling fatigue the next day is giving you information that either that muscle is too weak – or – too tight for what you are asking it to do. There are 2 muscles that make up the Achille’s tendon. They are the gastrocnemius muscle and the soleus muscle.

Gastroc-soleus copy

From the information you have given me it is challenging to know what exactly is going on with your calf muscles. Do you tire after jumping on one leg? How deep is your demi plié? Are you in a growth spurt? All of these things will influence your feet and calves.

What I would strongly suggest is that you ask your parents for Lisa Howell’s Perfect Pointe Book. Click here to read about it ….

http://dancesmart.prepointe.hop.clickbank.net/

Lisa is an incredible dance physiotherapist from Sydney, Australia who put together an course for dancers preparing to go onto pointe. This book will guide you through a series of exercises that are essential to master if you want to go on pointe. She has done such a good job with this book (you can easily download it from the internet) that I don’t need to create any products for pointe preparation – because Lisa has done such a good job with this one! Lisa definitely understands the science of dance training and I highly recommend this book.

Feet & Proper Posture

My ballet teacher has been helping me a lot with my feet because they are my weak spot. She said that I am too strong in the outer part of my feet, instead of being strong in the inside part. She said that I am more prone to injury because of this, and that this is incorrect.

I know this is true, especially because my feet are pretty close to flat. I “roll in” my ankle in class and outside of class when just walking around. I try not to roll in as best as I can. I was wondering if there are any exercises to help strengthen my inner part of my foot.

Thanks, Rachel
PS: I have a theraband.

Rachel, I’m not sure what you mean exactly with the stronger outer part versus inner part of your foot. When your foot rolls in it is called pronation and yes, there are definitely exercises you can do to help strengthen the muscles of the feet.

Your first focus is to bring your turnout in to where you feel equal weight between the pads of the big toe, little toe and heel. Check how you are standing when you are waiting in line at lunch – or standing and brushing your teeth. The habit of pronation probably occurs in your regular life as well as in ballet class.

Start with rolling for a moment or two on a tennis ball or pinkie ball to release and relax the foot muscles. Start by simply by ‘playing the piano’ with your toes. Keeping the pads of the toes on the floor, lift the toes up in the air and starting with your little toe, put it down on the ground, then the 4th toe, etc., with the big toe being the last. Now reverse and lift the big toe up, the 2nd toe next, and so on. You can use your hands to help do this exercise. If your feet start to cramp, stop and roll on the ball for a moment.

The next exercise is to practice pointing your feet by separating your toes as they begin to lengthen. You will start to cramp on this – and again – stop and roll on the ball before trying it again. You can do this exercise easily with putting the theraband around your toes and pressing gently against the theraband as you extend your toes.

Next tip – get rid of your flip-flops! Wear good supportive shoes with an arch support to help you keep from rolling in. Becoming aware of your rolling in or pronating is the first step in changing your feet – and I can’t emphasize enough the importance of standing with equal weight on the 3 points of the foot.

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I am a faithful reader of your newsletter and I found your book, Tune up your turn out a great help too. Now at 40, I am taking 3 classes a week, I feel that the largest improvement in my dancing would come from understanding of the muscular recruitment of proper posture.

I can’t seem to get hold of the right balance between my deep abdominals, hip flexors and extensors. I don’t know if I am tucking under or holding my center. The visual that I got from my teachers is that I should think belly button to the spine, or lengthen from the bottom of my spine, but I don’t find this very helpful. Should I really be aiming for a straight lower back devoid of its natural curve?

I naturally stand swayback, in a slight turnout with hyper extended knees. Standing in parallel feels really weird, as if my knees are about to knock, and correcting for the exaggerated lordotic curve I end up on bent legs with tight hip flexors and ribs fanning out. I am experimenting with different recruitments, but I am afraid of acquiring bad postural habits, and I certainly don’t need any more of those.

I know that you can’t possibly diagnose my posture by email, but I was hoping that you might have a few tips, or visual images I can try. I know a bit about musculoskeletal anatomy, so to me it would be more useful if someone could address the issue in those terms, as in get out of the quads, use more hip flexors, for example, but this is wishful thinking with the teachers I encountered here.

I would be grateful for your advice.

Zsuzsanna from Budapest, Hungary

Sounds like you have learned a lot over the past 6 years! First – check out whether or not your slight hyperextension is connected to your swayback. Very often it is – and when you bring your knees out of hyperextension, the pelvis comes out of its forward or anterior tilt.

Your lower back will not board straight – and I wouldn’t want you to work towards that – clearly as you describe it creates other problems. What if you shift your focus to the pelvic bowl? If you were lying down on your back with your knees bent and your lower back just resting on the floor I would want you to feel that the pubic bone and the two points on your pelvis that feel like they are sticking up are on a level plane. (Those are your ASIS, or anterior/superior iliac crests)

Note that if you flatten your lower back against the floor your ASIS are probably closer to the floor that your pubic bone, and when you arch your back your pubic bone is closer to the floor that your ASIS.

Now come back up to standing. In standing it is more challenging for me to have a sense of the ASIS and pubis relationship so I shift to thinking that my pubis is lifting gently towards my sternum above it. This helps me to maintain the correct torso/pelvis alignment without putting my thinking (and corrections) into my lower back.

I also imagine that the pelvis is a bowl and I keep a small amount of lift between the pubis and my belly button in order to keep the front of the bowl from spilling their abdominal contents out as they do when you go into a swayback.

Let me know how it goes with bringing your knees to neutral when standing (you can hyperextend when its in the air) and bringing the front of your pelvic bowl up.

Best wishes!

Deborah

“Education is the key to injury prevention”

Longer Leg & Plantar Fasciitis

Greetings!
I’m sending this from the beautiful TCU campus where I have been teaching an intensive course this week to the dance dept. There is nothing like teaching to a group of students who are eager and avid to learn all they can to improve their technique. And an extra perk is the Texas sun and warmth – It’s going to be hard to go back to Ohio weather!

Quick reminder that registration for Lisa Howell’s Perfect Pointe Workshops ends today. Register at http://theballetblog.com/index.php?option=com_content&task=blogcategory&id=67&Itemid=152

Onto the questions of the week!

Thanks for creating such a valuable resource. I attended your session at the Dance Teacher’s Conference in New York back in August and found your information so helpful. One of my legs is a little longer than the other. This does affect my ballet dancing, particularly my turnout and jumps, etc.. I’ve also noticed that the longer leg is a little more weak than the other. Are there any exercises I can do to help? I am new to your newsletter so please forgive me if you have already addressed this issue. Thanks, Jennifer

Jennifer, if your legs are structurally at different lengths it can influence your alignment. It’s tricky to decide whether or not you should insert a small heel lift in your soft slippers. Your spine needs to be looked at to evaluate it’s curves and response to the shorter leg. Sometimes the spinal curves become less when the pelvis is balanced by putting a heel lift in – other times it might make your spinal curves worse, in which case you would not correct the leg length difference. I would suggest you see a PT or sports physician who could do an assessment of your spine and leg length.

aThere are some common patterns with uneven leg length – some of which you have referred to. When you look at the picture on the left you see the dancer has a pelvic shift right, torso shift left. The common pattern is to stand on the long leg, because to stand with more weight on the short leg would require you bend the long leg. You can see her left leg is the shorter leg.

Typically you come down heavier on the short leg side on each and every step. Sometimes dancers prefer to stand on their short leg and use their longer leg as the gesture leg – although I have seen the opposite preference also. It certainly can influence the turnout too. More often I see the long leg side having more challenges with turnout. It is easy to understand that you’d prefer to stand on your long leg and put your shorter leg in front in fifth position.

The dancer in this photo improved her alignment by putting a lift under her left heel. It evened out her shoulder line as well as equalizing the amount of weight through both legs. She put a lift in her every day shoes – as well as in her soft slipper. For modern dancers sometimes it is enough to have a lift in your shoes – keeping the musculature working evening for the majority of the time, then dancing barefoot without a lift.

There aren’t any special exercises I would offer to you to even out the two sides, rather I would encourage you to have an evaluation to see if a lift would be useful, and then do your stretches and strengtheners in such a way that you are working to balance out the 2 sides. If you find the muscles around the right hip tighter, but weaker, then do more stretching and strengthening on that side. Don’t feel you need to do your workout exactly the same on both sides. It is very common to have one iliopsoas muscle tighter than the other and I tell people if you only have time to do one side – do your right side, as many times as you can throughout the day. Then as the two sides feel more even, you can reflect by stretching more evenly as well.

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I have a student who is complaining of her arches and ball of the foot hurting when she rolls up to pointe. She has fairly flat feet and either tight calves or short Achilles tendons – she does not have a very deep demi-plie. She also tends to roll onto the outside of her pointes. Any ideas as to what can be causing her pain (plantar fasciitis?)? Courtney

heelpa2You’ve hit upon some of the reasons in your question. Having overly tight calf muscles will pull on the plantar fascia, and encourage such standing patterns such as standing slightly forward onto the ball of the foot. That decreases the pull slightly, but over time, certainly doesn’t help to get a deeper plié.

You didn’t indicate where she felt her pain when she rolls up to point. Plantar fasciitis is most often felt on the underside of the foot. The diagram to the left illustrates this.

illustration_sesamoiditisIf she is feeling pain down towards the toes, perhaps she is rolling to the outside of her feet as a way to get away from the pain. It would be useful to send to her a good sport podiatrist who may be able to evaluate her feet and make sure she doesn’t have any problems such as a sesamoiditis.

Have sesamoiditis once myself I know how easy it is to simply rise a little bit more towards the little toe side to get away from the irritation and inflammation of the area underneath the big toe.

There are other reasons she might feel some discomfort only in relévé, but we won’t go into those now. My advise would be to have her get checked out and make sure there isn’t anything structural going on.

As far as deepening her demi plié, I would encourage her to do a lot of soleus stretching. Spend 1-3 minutes in the following stretch.

soleus stretchUntil next time!

Warm regards,

Deborah

“Education is the key to injury prevention”

Toeing – In

Happy Labor Day weekend! Many of you have already started back into the fall semester and others will start on Tuesday. I hope your fall is getting off to a splendid start!

Onto the question of the week….

I had the great fortune of attending your classes at the DTSC again this year. I was returning after having taken your class 5 years ago – after which I ran right out and purchased some pinky balls. Since that time, my father has taken up working out and has had many successes with that. He has had the occasional ache and pain however, to which I have recommended some of your ball-work. Although he listened, it wasn’t until the PT suggested something similar that he gave my suggestions some validity! I’m trying to get him to borrow my ballwork video that I purchased. 🙂

My question today is in regards to my daughter’s feet. At an early age, watching her on the sidelines and even in her own early dance classes – I took notice of something funky going on with her feet. Now, age 6, I have concern still. As she has taken some ballet technique and gymnastics classes – it has become more apparent that her feet appear to turn in while in action. She can stand in first, draw her leg up to passé and keep the knee back, heel forward as long as I remind her. When her movement is stationary or sustained she understands and tries to make corrections… yet when she is dancing her feet turn in..quite a bit. A simple leap – toes turn in, a small arabesque – turned in, on the uneven bars her teacher called me over before coming to the conference because when she circles the barre – her foot turns in. I’m beginning to notice it might be in her right foot more then the left. The pediatrician looked at her feet at the 5 yr. and 6 yr. visit and has determined she is turned in slightly – but it is mild. Although she may never be a professional dancer – it is difficult for me as a dance teacher to see her little feet so turned in when she dances. Should I be concerned or not? Is there anything I can have her do at home to help? What type of orthopedist should I be looking for to look at her feet? If her feet are mildly turned in – is there any concern I should have other then dance related?

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Lovely question! Turning in of the feet or pigeon-toed can come from three different areas – at the feet, the shin bone, or the hips. Let’s take a look at each one individually.

9052When the feet turn in at the feet it is called metatarsus adductus . This is where the bones of the feet turn in. Typically, this is caught before the child even begins walking and the doctor would have suggested massaging and stretching the feet as she grew. Since it was not caught when she was really young, I would rule out this cause for your daughter’s turning in of her feet.

We have talked about tibial torsion in other newsletters, more often we talk about external tibial torsion – but there is internal tibial torsion. In dancers I see more external tibial torsion which describes an outward rotation of the shin bone. I often find this in dancers who aren’t using their turnout from the hips, but rather are turning out from the knee down. Over time, that stress from standing in too much turnout creates a rotation at the bone that one might think is a good thing – but actually, it means that your knees and the feet won’t be lined up and leaves the dancer vulnerable to knee and ankle injuries.

202b.Par.0001.ImageInternal tibial torsion, which your daughter might have is where the shinbone rotates in making for a pigeon-toed walk. This isn’t unusual in toddlers and preschoolers, and often corrects itself as they become more active in running and walking – the 5-6 year old stage. Sometimes toeing in lasts into the school years, but usually isn’t a problem. In fact there are some sports that favor internal rotation, such as martial arts, soccer, and sometimes basketball.

If the toeing in was happening just from the shin you could sit your daughter on the edge of a table with her knees facing forward and you would see a clear inward rotation of the shin bone – as in the picture to the right.

When the turning in is coming from the hip it is called anteversion. The normal range of turnout and turn in at the hip is 45 degrees for both. When you have more turnout it is called retroversion, when you have more turn in it is called anteversion. This is a structural situation where it describes the angle of the neck of the femur to the shaft or long body of the femur or thigh bone. If you test your daughter’s range of motion at the hip by lying her on her stomach that might give you an idea if she has some natural anteversion.

W Sitting1A child with anteversion easily W sits – as shown in this picture. It will be interesting to find out what the relationship is between the two hips – are they even as far as their range, or is one more turned out or more turned in. This is very common, and while it isn’t a significant issue, you would want a young dancer to create her first position based on the lesser turned out leg, rather than the more turned out leg.

Watching the recent Olympics and especially the gymnastics competition, I was struck by how many of the gymnasts had a slight tendency to turn in their feet on the balance beam as well as on the floor routines. No one would ever say that their line wasn’t beautiful and elongated – even if it wasn’t as turned out as what the dance world would like.

All in all, I think I would take a look at these 3 areas on your daughter, see if you can get a better idea where her toeing in is coming from – and then encourage her to be as well-rounded and active in all ways as possible. At 5-6 years of age, I’m prone to suggest going light on the amount of turnout emphasis and focus on the alignment of the hip, knee and foot – which is what you are already doing. Since she can do that when she thinks about it – my intuition says she will improve her ability to automatically line her legs up as she gets older and better able to maintain that specific focus during class. Now you have a way to periodically assess her range of motion and know better where to focus her attention.

Below are pictures of what normal turnout would look like, a retroverted hip (excessive turnout) and an anteverted hip (more turn in than turnout)

Normal ext RotNormal amt. of turnout – 45 degrees

 

 

 

Retroversion t-oRetroversion – more than normal turnout (leg is resting on other thigh)
Anteversion: more than normal amt. of turn inOLYMPUS DIGITAL CAMERA

Until next time,

Be well,

Deborah

“Education is the key to injury prevention”

Creating Strong Foot Muscles

Hello!
Anyone besides me feeling the fast descent into fall? I remind myself to enjoy every moment of the sun and warmth during this busy time. I have a request. When I was recently in New York at the Dance Teacher Summer Conference (great workshops:) there were a few teachers who said they found good online sources for pinkie balls. If you have a source, or a website where you have found the pinkie balls – will you email me? I will post them in an upcoming newsletter. Sometimes they are hard to find – and since I’m one of the lucky ones whose local store carries them – I need your help to find out where you are purchasing them!

Onto the question of the week……

My name is Yekta, 22, and I’m a sociology student at the university of Toronto in Canada. I’m really interested in dance and I did Persian dance and ballet when I was in Elementary school. I restarted my ballet at the university from May. I have very good dance instructor because she really understood my hyper mobility particularly my hyper extended knees and she really does not push me to do lots of work. She gave me some kinds of exercises to strengthen my muscles, because, I have lots of problems in maintaining my balance in passe, arabesque and this kind of things although I’m very good at pointing my feet. I want to get your hints for making my feet muscles strong in order to maintain my balance well and less painfully. What shall I do right now? Regards, Yekta

You bring up a good point that sometimes dancers with extreme flexibility have to work harder in order to stabilize their movement. My suggestion to you would be to begin doing a lot of balance exercises. You will see definite improvement in both your balance and alignment.

bThe first exercise is a simple one – whenever standing in one place for a minute or so, lift up one foot and balance. Standing at the bathroom sink brushing your teeth, and waiting in line at the bank are examples of when you can get a quick practice session in. Make sure that when you are standing on one leg you are NOT hyperextending. I realize that it will feel as if you are standing with a slightly bent leg, but you want to make sure your hip, knee and ankle are in alignment. Standing and balancing will also strengthen some of the weaker muscles around the knee and ankle.

Then take your shoes off and try standing on your bed or a sofa cushion placed on the floor and toss a small ball between your hands for up to 3 minutes. If you don’t have a ball available do port de bras, including head movement. Standing on one leg and turning your head right and left will be hugely challenging for many people.

If you want to focus on improving strength as well as balance, practice doing small demi plies on one leg! These are baby demi plies – smaller than your normal demi plié. You should not feel any strain at your knees while doing them. If you do feel strain it means you are not in alignment. Always monitor your feet to make sure the weight is even between the pads of the big toe, little toe and heel.

Good luck!

Deborah

“Education is the key to injury prevention”

Pronated versus flat feet

Greetings!
It was so wonderful to meet some of you last weekend in New York at the Javitts Center! Yea to Dance Teacher magazine for putting on a wonderful conference! This Sunday I’ll be in Brockport, NY for the Dance Rochester workshop.

Onto the question of the week…

My daughter has danced for 10 years and had hoped to start pointe this year. Her teacher says she cannot start point due to the fact that she tends to roll her ankles inward, it seems as though she is flat footed. I took her to an orthopedic specialist who said it was a common problem and not severe enough to do anything about it. He said everyone is built differently and people should not be so critical! Is this a problem that should cause her to delay pointe classes or should we look for a new dance instructor?

Believe it or not – I’m going to side with the dance teacher. She caught your daughter pronating her feet, which is rolling in on the arches. That is a different situation from having flat feet. When you have flat feet it means there is no visual instep. Someone with flat feet can be a very strong dancer, they simply won’t look like they have as high of an arch as most people. This is a structural issue, not a functional. Asians and African Americans, for example, have more of a genetic tendency towards structural flat feet.

This image is of pronated feet – these are not flat – rather they are rolling in. If you look at flat feet from the back the heel and heel bone would be straight, not curved towards the floor.

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arch1From the side you can see that a flat foot has little or no space between the arch and the floor.

Pronated feet, on the other hand, means the weight is not being evenly divided on the foot and there is more weight on the inner border of the feet. If left unattended, that is a problem and concern for a dancer. You want to see the weight evenly divided between the pads of the big toe, little toe and heel.

Your doctor isn’t the first one who thinks that pronation is something the average youngster will grow out of. What they don’t understand is the challenge of turnout and standing in first position to pronation. The child who is primarily in sneakers (with an arch support) and running around or involved in sports is using their legs primarily in a parallel stance. I can’t tell you how many young dancers I have seen who begin pronating because they are over turning out their feet. Ballet is a wonderful activity – and I love dance – and – pronation is a problem that needs to be addressed as early as possible.

What I would suggest for your daughter, if she really wants to go on pointe this year – she is going to have to prove to the teacher she can stand in first position (or any other position for that matter) without rolling in her arches. It will take first and foremost awareness on her part of when she is rolling in.

If she is in the habit of wearing flip flops – she needs to temporarily stop. They are not good for growing feet with the exception of walking from the car to the beach. Speaking of beaches – walking on the sand barefoot is a wonderful strengthening for the feet and the calves!

She can practice balancing on one foot while tossing a ball back and forth between her hands – again – not allowing herself to roll in, and maintaining good alignment as she is doing so.

She can focus on strengthening the foot and calf muscles. You can find useful exercises in my Tune Up Your Turnout book – as well as in many other useful dance books. Lisa Howell has written a fantastic ebook called the Perfect Pointe Manual. You can check it out at www.theperfectpointebook.com/PerfectPointeBook/?hop=home2php&gclid=CJDJtNvyjZUCFRKLxwody1etfw

Your doctor isn’t stupid for not knowing how to guide you in this situation – I think he/she just doesn’t have the insight into the specific challenges for dancers. I remember taking my son to the doctors after he twisted his ankle pretty badly when he was 8. My doctor said I didn’t need to give him an anti-inflammatory or ice or do rehab – that he was active and would work his way out of it. I needed the doctor to rule out anything more significant – which is what you needed to do with your daughter. But after I got that information I went to work with icing and then doing some rehab with my son. Some fun things like each of us standing on one foot and tossing a ball back and forth to each other and slowly increasing the distance. It helped his joints relearn where center is because as soon as you have an injury or a dysfunctional pattern, the body compensates.

With continued guidance and some extra work on your daughter’s part – I’m sure she’ll be ready for pointe work in no time!

Warm regards,

Deborah

“Education is the key to injury prevention”

Sore Arches

Quick announcement: I’ll be in NYC for the Dance Teachers Summer Conference sponsored by Dance Teacher Magazine and MacFadden Performing Arts Media. I hope to see many of my loyal readers! The subject of my two classes will be, Conditioning the Body for Jumps and 10 Tips Towards Keeping Teachers in Top Shape. Hope to see you August 9-11!

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Recently I’ve been doing a lot of tendus and the like daily to increase the strength and stop my toes “crunching” while pointing. Over the past few days the tendon/muscle going from the top of my toe over the arch has become incredibly sore and “crunches’ when I flex and pointe. After some very brief research on the net, I found that this could be tendonitis. More research also points to a small bone fracture or something to do with the tissue. I was just wondering what you think this is and how to treat it?
Regards,
Jane

My recommendation would be to use the pinkie ball to see if releasing tension from the anterior tibialis muscle will release the discomfort on the top of your arch. That muscle contracts when you flex your foot and needs to stretch and lengthen when you are pointing.

You’ll want to gently kneel on the pinkie ball to massage the front, outside portion of your calf where the anterior Tibialis muscle is. After doing the front of the calf, take some time to massage the bottom of your foot by standing and rolling your foot over the ball. If you are practicing your tendus and lengthening the toes you are strengthening the intrinsic muscles of the foot – always a good idea! That, along with lengthening the front of the ankle is what creates a beautiful tendu.

If releasing the pull from the muscles around the ankle helps – super! If the top of your foot continues to feel sore, and you are hearing crunching or cracking noises – I would encourage you to go to the doctors and get some x-rays in order to rule out a stress fracture or other boney problem.

The doctor should also look carefully at your standing alignment to make sure your foot is not pronating, which so strongly affects the muscle balance around the foot.

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I am suffering from Plantar fasciitis…I am doing everything (ice, taking time off, walk with heels, massage, exercises for the feet and legs, hamstring and calf lengthening and ease) and there is no change. What do you recommend?

I was diagnosed by a foot doctor.
Lori

Lori, you are following the traditional protocols for plantar fasciitis, and since it is not getting better I would look at other potential factors. Is one foot or both bothering you? Did it start all of a sudden, or come on more gradually? Were there any precipitating events?

It appears that you are going to need to put on your detective’s cap to figure this one out. I would check for any imbalances between the two legs. Could there be a leg length driving this problem? Does one foot have a tendency to pronate more than the other? Do you have a difference in your turnout between the two legs? Are you able to walk more comfortably when your arch is taped up for pronation? Often, that will help ease the pull and strain to the plantar fascia, which will help it heal.

As far as immediately trying to release the strain – I would encourage you to find a practitioner who has been certified by Tom Meyers, who wrote Anatomy Trains, the best book on understanding the myofascial relationships in the body, in my humble opinion. Here is the link to his practitioner list. http://www.anatomytrains.com/kmi/practitioners

There are massage therapists who have studied other myofascial techniques that could also be useful. My focus would be on releasing the entire line of fascia that runs from the bottom of your foot all the way up the back of your leg, spine, neck, and finally ending on your head. It could be that other areas are feeding this posterior line of fascia and once they are released the weight and pull on the plantar fascia will be released.

Plantar fasciitis can be a very tenacious problem – I wish you the very best for a speedy recovery!

Warm regards,
Deborah

“Education is the key to injury prevention”

Painful Hips & Scheuermann’s Kyphosis

Greetings!
Hope everyone is enjoying their summer activities! Right to the questions for the week…

I have had an uncomfortable tightness and pain in my left hip area for about a year. My hips easily pop now. When doing anything that involves the left leg, it won’t go as high and feels like it wants to give out. I feel a little pain when stretching in side splits and leaning to the left and trying to stretch the leg in arabesque. I have seen two orthopedic surgeons with two opinions. One said it was a definite labral tear (no MRI) and the other said it was tight hip flexors. Is there a way to distinguish between the kinds of pain or area each would cause so I know how to fix this problem?
Thank you, Jaime

Jaime, I’m not sure how the definite labral tear was diagnosed without an MRI. Since the fix for a labral tear is surgery – I would certainly want that confirmed before going further.

Tight hip flexors are easy enough to address physically through stretching and massage work. If you stretch and release the hip flexors – do you feel a difference in the hip? It should be a pretty straight-forward even if it doesn’t hold for long. It takes time to truly change any tight muscle.

What I would suggest is doing the rehab for a tight hip flexor and if that isn’t helping think about getting an MRI done to more accurately assess the joint.

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I have just had a student diagnosed with Scheuermann’s Kyphosis, which I don’t know much about and am currently researching. Do you know anything about the condition and how it will affect the student’s ability to dance.

Her mother is concerned that the doctors will suggest that she give up dancing. I think that in the case of Kyphosis, dancing will help to keep the spine loose and help to control the progression?

Any help would be greatly appreciated, both by myself and my dancer!
Jane

Scheuermann’s kyphosis is an abnormal rounding of the upper back. Think of a very elderly person who is walking stooped over with just their head picking up. That would be a potential end point for someone with Scheuermann’s. With your student being young – hopefully without back pain and a mild curve – there is much they might do. I imagine they will give her a brace to keep her spinal alignment upright and put her in some type of physical therapy. Pilates on the equipment with a knowledgeable physical therapist is one such possibility. It’s quite possible that dance has been a very positive activity for her already! We know that spine health means maintaining your ability to flex, extend and rotate. I can’t think of a better activity that dance which involves all of those motions of the spine!

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My 12-year old daughter loves modern dance, but she often has pain in her right ankle and foot. Her right arch provides very little support so that she pronates when she walks. From the back her right foot and leg look very similar to the photo that accompanied your May 2 post. I would very much like to know what we should do now to: 1. Minimize her pain 2. Not injure her ankle/foot 3. Make sure that she does not have problems as she gets older. My family doctor grudgingly gave me a prescription for orthotics, but without better understanding of the problem (she has a terrible time turning out at all and could have issues higher up in her legs and hips), it seems foolish to just go for the orthotics. What would you suggest? I am based in central Pennsylvania. It strikes me as ironic that we have orthodontists who fixate on kid’s teeth, but I’m having a hard time finding someone who can help with my daughter’s feet and legs. Thanks for the wonderful newsletter!
Rebecca

It sure can be frustrating to find practitioners who understand what you are going through. Often I counsel my students to find the closest, largest dance studio and see where their dancers go. For you that might the Central Pennsylvania Youth Ballet.

Another way would be to poll the local soccer athletes and runners who they go to. Sports medicine physicians and therapists might not be dance savvy – but they are movement savvy.

As far as your questions you’re on the right track with first and foremost getting her some orthotics. This will accomplish a multitude of issues with correcting the pronation and giving the muscles around the ankle a chance to redevelop balance. In fact, I would have her practice balancing on one foot, while in her orthotics, tossing a ball back and forth between her hands to challenge herself. See if she can stay on one foot for between 1-3 minutes.

She’s 12 – so that means she is growing and moving into the sometimes awkward teenage years. Once you find a practitioner that is versed in sports or arts medicine have them keep checking her leg length. When there is one ankle or foot that hurts – I’m always suspicious that there is something going on above that is creating a weight imbalance – like a long leg or a pelvic/torso shift.

If the foot that hurts is on the side that she has less turnout – then she needs to decrease her first position until she is able to line up the ankle/knee/hip more accurately. She might want to read my Tune Up Your Turnout book for more exercises – and – to understand more appropriately how to create turnout at the hip.

Best wishes for a safe and speedy recovery!

Happy Solstice everyone!

Deborah

“Education is the key to injury prevention”

Painful Ankles, Cramping Arches, Strained Hamstring

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Recitals are around the corner, please remember to take care of yourself!

Onto the questions of the week:

Hi. The top of my left ankle is continually painful, in an aching sort of way. It must be some sort of tendon thing. I also have arthritis in the big toe on that foot. Any helpful suggestions?

My first suggestion is to do some daily work to release any muscle tightness from the front of the calf by kneeling on a pinkie ball and massaging the anterior Tibialis muscle which is on the outside of the shin bone.

Next, I would check out your alignment of that foot. Do you have a tendency to pronate? The reason why I ask is that when you pronate the big toe takes a hit, and often a bunion begins creating an ideal arthritic situation. If this is true, try taping your foot for pronation which will lift and support the bones in the arch of your foot. If it feels better to be in a running shoe with good support I would suggest not going barefoot and teaching in a shoe with an arch or taping your feet.

If the dull ache continues you’ll want to go to the physicians and get an x-ray to rule out a stress fracture or other boney problems, such as a spur. I just took my daughter in for this exact reason – and fortunately – it got ruled out temporarily – which gives me permission to work in these other ways. Although, that being said, if the ache doesn’t improve within a couple of more weeks I will have more x-rays done, because stress fractures are tricky and sometimes don’t show up right away.

Hoping it is an easy fix!

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First of all, thank you so much for the Amazing Turnout and Arabesque DVDs. They have been extremely useful!

My question for you is: I sometimes get cramps in the foot or both feet during class. The cramps concern the 2nd to 5th toes, making them completely frozen. Can you tell me if this is because of tight extensor digitorum longus or could it be more due to tight intrinsic foot muscles? I do proper warm-up and even use a golf ball to massage the tight spots on my soles before each class. I wonder what I am missing. Can you recommend a good stretch for that?
Thanks! Louisa

You are doing the right actions to release the plantar fascia and the intrinsic muscles of the foot. The act of cramping usually happens when there isn’t enough strength in the intrinsic muscles, they fatigue, and then cramp. (I’m making an assumption here that you eat well and do not have a chemical/nutritional imbalance in your body)

Sit in a chair or on the ground with your leg and foot straight and in front of you. You are going to watch your toes as you slowly lengthen through the ankle keeping the toes flexed and separated, before slowly continue to lengthen the toes while keeping them separated. At first this can be hard! Only pointe your foot as far as you can keep the toes lengthened. Once you have reached that point, gently wave your toes in the air. If you cramp during this exercise you know that you have to strengthen the foot muscles and that should cut down on the in class cramping. Of course, keep using the pinkie ball or golf ball to release any tension in the foot and calf. You can use the golf ball for the foot, but when working on the calf I would only use the pinkie ball.

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I’m 34 and I’ve been dancing (ballet) since I was young. I currently take 5-6 intensive ballet classes a week. Last July I pulled my right hamstring when a guest teacher pushed my leg into a higher penché. My hamstring in my supporting leg gave out. It was very painful for several weeks, but I danced through it, taking anti-inflammatories and going easy on my extensions. My physio gave me stretches and strengthening exercises and I had some massage work done.

Nearly 10 months later and I’m still having issues with it. I’m only now getting some flexibility back, but I don’t have nearly the same flexibility in that leg. Stretching after class or at home only seems to make things worse — I’m usually quite sore the next day.

The routine seems to go like this: My hamstring starts to feel better (ie. it doesn’t hurt); I take my extensions and splits a little further; I get sore; I back off until it feels better, etc. etc. It seems to be a chronic problem now.

I guess my question is: is stretching making things worse, or am I just stretching too much?? I’ve been told that inactivity will result in scar tissue (I sit all day at a computer at work) so I try to stretch for at least 15 minutes every day.

Thanks so much for your help!

My heart goes out to you. I have seen 2 other dancers whose hamstrings were torn by well-meaning but anatomy-ignorant teachers. Sometimes the damage is done before the dancer thinks to say ‘stop’! It is never appropriate to increase a dancer’s extension in this way. One of the other dancers was taken out for a full year from her professional career in Europe! She was lying on the ground stretching, and had a teacher lift the leg up into a hamstring stretch and press it towards her body. This dancer was very flexible, but her body did not have the time to adapt to someone else’s force and tore her hamstring. Enough said – never – stretch out someone’s hamstrings unless you are a physical therapist who has been trained to listen, feel and watch for the subtle cues from the muscles.

There are 2 suggestions I have for you. The first would be to have someone who is trained either by Tom Meyers (http://www.anatomytrains.com/kmi/practitioners) or a massage therapist that does myofascial release work. Rolfing is another name for another type of myofascial release work. They will work slowly, deeply, and along the entire posterior muscular line, as well as any other fascial lines they see are off. The whole body adjusts to trauma, and your hamstring tear was certainly a traumatic event. By releasing corresponding areas that tie into the fascia of the hamstrings you are treating the whole body rather than just the hamstrings. (An aside, Tom Meyers book, Anatomy Trains is wonderful!)

The second suggestion may seem a little more off the beaten track. It seems like common sense to acknowledge that our emotions have an influence on our physical body just as our thoughts do. Our thoughts and our emotions are integrally connected as thoughts create the chemicals of emotions.

I’m not going to go into a deep conversation about the field psychoneurophysiology, but I am going to suggest that you try working on the issue of this injury with EFT. EFT is a tapping technique that has been described as emotional acupuncture. If you go to
http://www.emofree.com you can first watch a very short video introduction to EFT, read the online manual, and search in the thousands of case reports where athletes and others have used EFT for performance enhancement as well as relief from physical ailments. Just typing in injuries in the search box will bring up 171 cases of where EFT was used for injuries.

I use EFT and while I don’t totally understand how and why it works I am all for any and all techniques that empower us to create change in our own lives.

Please send me an update on how you are doing.

To your good health!

Deborah

“Education is the key to injury prevention”