Troublesome Trigger Points

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Most everyone has experienced the uncomfortable sensations of a trigger point.  It’s that dull ache or sore spot in your muscles.  You think – if only I could stretch it out – and then go to town with stretching – but it doesn’t really help. 

Then you try taking ibuprofen or another anti-inflammatory drug – but it doesn’t decrease the discomfort by much.  Taking a hot shower or bath feels good and decreases the nagging pain – but doesn’t last as long as you like. 

You may have some pesky trigger points! Currently the more official way to describe them is as myofascial trigger points or myofascial pain syndrome if you have a bunch of trigger points influencing your body. 

One more thing – trigger point discomfort sneaks up on you.  You don’t yell ‘ouch’ and think – I have a new trigger point!  They often appear after muscle strains have healed but the area still feels stiff and sore.  You may or may not feel a lump or knot in the muscle.  The pain seems to come out of nowhere!  

They can be quite challenging to get rid of – but hopefully some of the following suggestions will be useful.  You’ll know by how your body responds – and of course – if you have continued pain or can’t seem to make any headway from your own efforts – please seek medical guidance. 

Here are a few suggestions for treating trigger points

Don’t chase the pain!  

It’s really tempting to focus right where it hurts.  Trigger points often refer pain into other areas and if you just work where it hurts, you might not be working where the problem is. 

Massage

There are many gifted massage therapists out there with varying abilities to work with myofascial pain syndromes.  One of the cool things I always loved about going to get a massage was becoming more aware of where I had muscle tension.  You may want to explore having a true myofascial session where the therapist works the fascial lines of the body.  

Even a whole body massage will wake up your sensory systems and you become more aware of hidden tension patterns.  Thomas Hanna coined a phrase called SMA (Sensory Motor Amnesia) and basically it means that your sensory connection to that area has decreased.

It wasn’t unusual that after working with a client who had a chronic condition to have them come back the next week and say something like “my knee feels better, but now my hip hurts”.  Good, I replied – let’s see if we can peel a few more layers off the onion!  Feedback is feedback – and if we can non-judgmentally work with our body it is amazing what information we can gleam over time.  

Be aware of your sleeping positions

If you are stiffest first thing in the morning – analyze your sleeping position.  Is your spine able to rest in neutral or are you curled up like a pretzel with one leg in passé while side bending towards it:). Mattresses that are too soft or too hard can also be a culprit.  There is no one ‘right’ mattress for everyone.  Depends on whether you are a side sleeper or back sleeper along with your pattern of hip flexor tightness, etc.  

Traveling was always interesting to me as I got to try out lots of different mattresses and always looked at what the brand and type was when I had a super duper night of sleep.  Pillows are important to me as well as I am a side sleeper and need my top arm and bent top leg on a pillow.  I have created pillows by folding up bath towels in hotels if I didn’t have enough to have on either side of me so I can easily flip from side to side.  Perhaps not the most romantic way to sleep – but my spine, shoulders and neck are so much happier.  

Pinkie balls and foam rollers

Both of these tools along with a wide variety of other balls such as lacrosse balls, tennis balls, etc. can be very useful for targeting trigger points.  The challenge is to go firmly and sometimes slowly enough that you can feel the tissue easing up.  I like to find a point of soreness and then hold… breathing and trying to release tension in the spot and also all around it.  

I’m sitting on the sofa right now and just finished a break with my backnobber, a S-shaped tool that I’ve had for decades.  I found a pesky spot in my right gluteal area… worked the area around it as well for a minute and then came back to ‘the spot’.  Then I spent probably 2-3 minutes just holding pressure on the spot until I felt it release.  Much better!  

Release or relief doesn’t always happen as quickly as it just did for me.  It might take days or even a few weeks to feel like you have made progress.  What I will tell you is that after releasing that spot stretching my turnout muscles immediately feels much deeper and easier.  

Heat

A hot bath or sauna can feel SO good!  I’ve known a few people who  like to stretch in  the bath and even use a lacrosse or other rubber balls to work the outside of the hips and back of the the pelvis while in the tub.  I’ve used the backnobber on my upper back for a few minutes while sitting in an infrared sauna and then just relaxed and came out feeling noodle-like.  Best of both worlds… release work and heat!  

Stretching

Stretching typically isn’t at the top of the list for trigger point relief although I like stretching after working with the pinkie ball or foam rolling.  The combination is a good one for me – but may not be for everyone.  

So there are some tips to try.  I’m sure there are more techniques and certainly other tools that are out there that can address trigger point discomfort.  Please share in the comments below if you have other suggestions!  

I’ve posted below a cool YouTube clip that has an explanation of what is going on in the muscle when you get a trigger point.  

And finally… I’ve started working on a 2 hour zoom/webinar on stretching. Stay tuned for more details!

To your success, 

Deborah 

New Perspective: Plantar Fasciitis

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We’re going to do a deep dive into plantar fasciitis over the next 2 newsletters.  I want to share some new perspectives which might help guide those with who have a chronic problem with their plantar fascia. 

Inflamed?

In its simplest definition, plantar fasciitis means inflammation of the thick sheath of fascia that is on the bottom of the foot.  ‘Itis’ means inflammation – and here is my first perspective shift gained from my research.  With the exception of perhaps the initial phase of symptoms, rarely is the plantar fascia inflamed in the normal way that we think of inflammation. 

Instead, the plantar fascia goes through a process of collagen degeneration and disorganization. (1) This is not to say that initially rolling your foot on a frozen water bottle might not help.  It may, especially in the early stages and for pain relief, which is one of the positive benefits of cold treatments.  

This collagen degeneration can be thought of as tissue fatigue in the arch due to excessive strain.  After all, we are on our feet all the time, and dancers, like runners, are constantly asking this fascia to act like a spring, keeping us light on our feet.  

Common causes you always hear about

There are commonly held beliefs about the causes of plantar fasciitis.  Pronation, bone spurs and tight calf muscles.  Let’s look more closely at these common challenges to the dancer.  

Pronation

Pronation as we know is when the foot rolls inward, collapsing the arch.  Flat-footedness may stretch the plantar fascia, making it hard to have the desired springiness, but pronation is not the same as being flat footed.  (pet bugaboo of mine … dancers who have a low arch, trying to ‘lift’ their arches higher creating a whole host of alignment challenges)  

We know pronation is an aspect of many chronic injuries, knee and ankle pain, poor use of the rotator muscles at the hip, and, yes, plantar fasciitis.  If pronation was a root cause one would think all dancers who pronate would get plantar fasciitis and that certainly is not true.  Supination which is the opposite of pronating also influences the plantar fascia – as well as having a high arch.  Hmm… perhaps plantar fasciitis can have many factors to it… and isn’t quite as straight forward as we thought. 

Bone spurs

What about bone spurs? When my sister was diagnosed with plantar fasciitis (she wasn’t a dancer, but a slightly overweight business woman who was on her feet a lot) the podiatrist took an X-ray and showed her the bone spur and said ‘This is why you have plantar fasciitis!’.  

I found out that about 10-20% of the population has extra bone (spur) in front of the heel bone. (2,3) And many people have painless spurs and don’t even know it until they have an X-ray for something else.  The spur isn’t creating the pain, the pain is coming from the fascia and other soft tissue structures. (4)  Certainly, we should opt to first work with conditioning the fascia over having surgery to correct a bone spur.  Many a bone spur will return if the mechanical stresses that created it in the first place aren’t taken care of.  

Tight muscles

What about calf tightness?  I told my sister that because she wore heels all the time, it was her tight calf muscles that were influencing her plantar fascia and if she just focused on stretching her calf muscles her fasciitis would improve.  Stretching helped her stand flat footed without pain as her gastrocnemius and soleus muscles were so tight that she had to wear a heel insert in the beginning and slowly work herself into tennis shoes and being able to walk barefoot without pain.  Stretching was an important part of her rehabilitation – but was tightness the cause of her plantar fasciitis?  Or was it the heel spur the doctor found?  Or the fact that she had a high arch?  (which I was jealous of since she was the non-dancer and I had average height to my instep) 

We haven’t even talked about alignment influences.. being bowlegged, knock-kneed, uneven leg lengths, etc.  All of which influences how the weight goes through your legs and feet and into the floor.  

My new perspective on plantar fasciitis is less about decreasing inflammation and more about taking a multi-pronged approach to how I work with someone with this condition.  It’s clear to me that there isn’t an easy answer as to why one person is beset by this problem and another one not.  

Next newsletter we’ll talk about strategies to approach this challenging situation.  

To your success, 

Deborah 

Footnotes:  

1. Lemont H, Ammirati KM, Usen N. Plantar fasciitis: a degenerative process (fasciosis) without inflammation. J Am Podiatr Med Assoc. 2003;93(3):234–7. 

2.  Barrett SL, Day SV, Pignetti TT, Egly BR. Endoscopic heel anatomy: analysis of 200 fresh frozen specimens. J Foot Ankle Surg. 1995 Jan-Feb;34(1):51–6

3.  Moroney PJ, O’Neill BJ, Khan-Bhambro K, O’Flanagan SJ, Keogh P, Kenny PJ. The Conundrum of Calcaneal Spurs: Do They Matter? Foot Ankle Spec. 2014 Apr;7(2):95–101

4.  Tountas AA, Fornasier VL. Operative treatment of subcalcaneal pain. Clin Orthop Relat Res. 1996 Nov:170–8

Stretching, Assessment, Pinkie Balls & Hamstrings

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I received some great questions from Lynn and have imbedded my responses below.

Hi Deborah,

I have a few questions and was wondering the best way to go.  I have the Essential anatomy course for dancers and just started to dig into it a little bit because I bought it in the summer and just had my first baby in December so its been crazy.  Congratulations!!! I really want to learn more and more about anatomy and dancers. I never took anatomy at all and it has just been all my dance education along the way from anything I do know.  So thank you for doing this.  Its just hard because there is so so much information and I want to be able to answer a question if a kid asks me.  So I do things in small stages.  But was wondering I came from the erra of bouncing in stretching and then we moved in the static stretching.  Now I do understand dynamic because I do warm most of my classes with a jumping and getting things moving but then we usually go into stretches and based on what you were saying I was wondering if you have something like a sample of a class run down to get the kids warmed up properly for the 20min or so and then we go into technique, center work and across floor or center combos depends on the class.

Try warming them up in a cardiovascular fashion, jumping jacks, running, galloping, etc.  for about 5 minutes (which you are already doing) …. no stretching…. then go into class whether that is barre or modern warmup.  

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Pointing Hurts! Tale of an Os Trigonum

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Today’s post came from an email from a concerned mother who’s daughter was diagnosed with an os trigonum in both ankles.  She writes…

My daughter is 14 and very serious about her dancing.  She has heel pain and has worked with a PT for the past year and rested a  good part of last year.  After x-rays and consulting with a few doctors her conditioned was diagnosed.  As you may know, there is a small bone at the back of the heel that sticks out a bit and hyperflexion of the foot can irritate the tendons and ligaments, as I understand it, around the bone.  In my daugheter’s case the small bone has not fused, but is attached.  She often has pain when she points her feet.
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She is on pointe twice a week, but the medical people do not think the pointe work aggravates the condition.  It occurs in 10-15% of dancers and soccer players.
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Everyone seems in agreement on the diagnosis and the surgeons want to operate to remove the small bone, but my husband and I are concerned about Grace’s age, the risk of surgery and the extent of the recovery.   One surgeon quoted a journal article describing that 84% of surgery patients had positive outcomes. On the other hand, Grace often feels that she has tried everything and wants to condition resolved and to dance pain free.
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Do you have any suggestions or information that might help us in this situation?
Thanks, Susan
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Dear Susan, I’m so sorry to hear about your daughter’s ankle problem.  I am quite familiar with os trigonum’s as dancers are a common group that have challenges with them.  There are many people, I’m sure, who have them and don’t know it because they don’t work in the extreme ranges of motion that dancers do.
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I would disagree with your doctors that pointe work is not influencing her ankle pain.  The reason why she has pain when pointing is she’s closing the back of the ankle joint Picture-1when she does that – put her on pointe with the extra weight into the joint and it often makes it worse.   The diagram on the right shows how an os trigonum is like a nut in a nutcracker when the ankle closes.  That is why they feel pain while pointing or being on pointe, and why non dancers may not have pain from this extra bone.
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My suggestion wuold be to take her off pointe work at this time, and increase her anti-inflammatory efforts such as placing her feet in a bucket of ice water after dancing. (I know… doesn’t sound very pleasant)  The challenge with letting an os trigonum continue to irritate the tissue is the tissue in the posterior ankle area can become thickened and fibrotic – which isn’t good for anybody’s ankle.
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I’m assuming they tried putting her on an anti-inflammatory treatment program which probably only worked to decrease discomfort, but not alleviate it.  That, along with continuing to work in non painful ways is usually the first phase of treatment.  Certainly the work with a physical therapist who will make sure your daughter is working the ankle muscles correctly, to have correct alignment when pointing the foot as well as on pointe is all helpful.  I applaud you for trying all things non surgical before consenting to surgery.
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What I can tell you is that the dancers that I know of with os trigonums and chose to have the surgery are very happy dancers.  They fully returned to dancing and were so happy to pointe their feet and/or do pointe work without pain.  The downtime from this surgery is much less than many other invasive surgeries.  There are cases of professional ballet dancers being back to dancing within 3 months.  I have known others that were even faster.  I know she isn’t my daughter,  (I am mom to 3) but this is one surgery where I am more confident about better chances for a positive outcome.  Of course, there are risks to any surgery – but it sounds like your daughter is committed to dancing, and I do know that if it hasn’t gotten better with the more conservative measures you are taking now, that it probably won’t get better on its own. As a parent I would get her to the orthopedic surgeon that works with the athletes – and of course – has done their fair share of this specific surgery.
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I hope my email has helped in some small way.  It is so hard to make choices like this as a parent!
I’d like to request from my blog readers that if you have any experience with os trigonums please tell us about your experience by writing in the comments below.  We can learn from each other!
Warm regards,
Deborah
“Education is the key to injury prevention”

What’s up with snapping/popping hips?

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I had the pleasure of working with dancers from the Allegro Performing Arts Academy recently and they were the dancers shown in the picture on the post on strengthening the iliopsoas for higher extensions.  This week’s post is answering a common question about snapping or popping hips.  What does it mean?  There are different types of popping hip but first watch the clip below to see in action the type of popping hip I’m going to talk about.

The hip popping that is being shown in this clip is being caused by a tight IT Band snapping over the greater trochanter of the femur.  Huh?… what muscles/where are those spots you might ask?

 

greatertrochanter-300x248

 

 

The greater trochanter is the bump that is on the outside upper part of the thigh bone right before it angles in towards the center of the hip joint.

 

 

 

TFLGM-234x300

 

 

The IT Band, otherwise known as the iliotibial band, crosses over that area.  The iliotibial band is the fascial band that runs down the side of your leg that the gluteus maximus and the tensor fascia lata (TFL) muscles connect into high on the leg, and the band connects then to the bones below your knee.

 

ab-300x254

 

 
The gluteus medius and minimus don’t connect directly into the iliotibial band, but their tightness creates an imbalance around the hip that may lead to this snapping or popping hip problem.

 

 

 

When there is excessive pull or tightness from one or more of these muscles the IT band will ‘snap’ or ‘pop’ over the greater trochanter when you lean into or stick your hip out to the side.  that is what you are seeing as the clunk in the clip.  It’s pretty impressive, huh?  I’ve been asked by dancers if they are dislocating something because it is disconcerting to have such a significant pop, snap, clunk… however you want to describe it.

The good news is…. you can work to decrease the tightness around the area and the clunking, popping, and snapping will diminish.  The other benefit to addressing this?  As you decrease the tightness your range of motion should improve and consequently make movements of the hip joint, like développé, battements, ronde jambe, etc. easier and more efficient.

Stay tuned… next week we will look at the 3 different muscle areas and I’ll give you ways to release each area!  Have a productive and joyful week!

Deborah

“Education is the key to injury prevention”

 

Working with Overweight Dancers

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This week’s newsletter tackles the very sensitive and tricky topic of overweight dancers.  A reader writes…

You may have already discussed this issue in the body series but I just wondered if you had anything specific on over-weight dancers.  It is so tricky discussing weight issues with students and parents that I thought if there was a general article that I could send to all students regarding the problems with joints, etc. that it would be better coming from you or another source so that they would know it is not just me having this issue.

I worry so much about these girls who love to dance and want to perform full out but just don’t realize how large they are.  I wish the parents could indiscretely put them on “diets” by planning meals, portions and grocery shopping lists without even mentioning the word “diet”.  I would appreciate anything that would help get my point across in a good way.

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Weight is such a tricky topic.  I’m going to start on safer ground and first talk briefly about the ramifications of extra weight on the body.  The weight of our bodies is carried through the boney skeleton and of course pass through the joints.  It makes sense that carrying 10 or 15 extra pounds is going to put more of a working challenge on the body, but Dr. Jonathon Cluett estimates it increases the forces by 3 on the joints. Meaning if you are 15 pounds overweight you will be putting 45 extra pounds of force through the knee joint with every step you take.

If the overweight dancer has good posture and alignment they will absorb the extra force better than if they have poor alignment.  What I often see in the younger dancer is weak abdominals, a anteriorly tipped pelvis giving them a slight swayback.  In this scenario the knees are more vulnerable to injury and adding the extra weight increases potential for muscular strain and ligamentous injury.

There is research showing that being overweight leads to arthritis at an earlier age.  You want your BMI (Body Mass Index) to be in a normal range.  Exercise is essential to the health of the body – and dance class is a good place to develop extra strength and flexibility, but not necessarily increase your cardiovascular fitness.  I’m not sure that kids today are biking and running and playing on the playground in the same way we did 20 or 30 years ago.  We are becoming a more sedentary society and it is showing up in the increasing numbers of injuries in our children who only move in significant ways during the hour or two of PE class (if they haven’t already cut gym from the curriculum)

The self-esteem of the child who is overweight is a huge problem.  They begin to define themselves as someone who is overweight and if their parents are also overweight may decide at an early age that they are doomed to always packing on extra pounds.  It’s really hard to work with that situation – when the way the family eats.. and exercises… or not… can be at the foundation of our young dancer’s weight problems.

So what to do?  If the dancer is old enough (10 or 11) they may be able to start making their own choices about food.  When the studio owner is vocal about healthy dancing practices they could choose to have a nutritionist come talk to the students all together about good eating practices.  I love having outside people come in to talk  to my own students because it gives me an opportunity to talk with my students at the next class about what they heard.  It allows for a good group conversation or even some one on one conversations without making it seem like you are targeting them specifically.  Also, the majority of  parents will appreciate having a studio wanting to create healthy dancers!

Even a younger child needs to decide that they want to lose weight because they believe it will give them something positive in return.  So many of us who carry a few more pounds that what is ideal use food to give us something…  a feeling of security, a ‘sweet’ moment, a break, a reward. I believe instead of focusing on not eating sweets or bread or whatever might be your over-indulgence it makes much more sense to focus on what you can give yourself in other ways.

For example, when I get to feeling overwhelmed I tend to overeat.  When I stop to breathe or to take a short 10 minute walk around the block, or take the time to make a cup of tea… any of those activities will act to calm me down.  I have a choice about what strategies I use to alter my emotional well-being (or lack of) The challenge is it takes me planning out alternate strategies before I go on automatic pilot and reach for the muffin or cookie or whatever is around to placate my overwhelm.  Not always easy.

The older I get and the more in control I feel about my weight the more I focus on my internal dialogue – the thoughts that I say to myself all the time.  I’m going to share a quicktime clip that is part of the Inner Dance of Success Weight Loss Program.  The program focuses less on specific dietary advice and instead gives lots of options and choices for different strategies for weight loss – starting with changing your thinking.

Deborah

“Education is the key to injury prevention”

Working with a Leg Length Difference & Popping Ankle

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Quick reminder before answering the question that the 2011 New Year’s special will run through January 5th.  Purchase Essential Anatomy: A Multimedia Course for dancers and dance teachers for $149 and get $45 off one of the best tools for dance teachers to learn important anatomical principles.  Simply put TBS2011 in the coupon box when purchasing and hit apply in order to see your $45 discount..

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I L O V E  your blog – and I have a question.  (I am a computer dunce and could not figure out how to put this question on your blog for an answer)

 

I recently worked with (I am a Pilates and movement instructor) a dancer with a significant leg length discrepancy — her left leg is 1.8 centimeters longer than her right (femur is .6 c longer and lower leg is 1.2 c longer) .

The left side of her tailbone often hurts as does her left inner thigh.  She dances quite intensively and is experiencing more and more subtle aches – especially across her sacrum.

Suggestions for working with her to address her leg length issue??????
Thanks so much,
Tara

Great question, Tara.  When working on the reformer I would do my best to even out her leg length by having her stand or work with one of the foam nonslip cushions.  Look at her standing alignment both without anything under her left leg and then with standing on a pad. Does her alignment improve?

If placing a pad under her foot allows the weight to pass more evenly down the spine, through the pelvis and into the legs – that’s a good thing!  It’s quite common to have the lateral curves of the spine straighten out with a pad under the foot and that’s when you know it is something that should be corrected all the time by placing a heel lift in their regular shoes as well as their soft slippers, jazz or tap shoes.  There isn’t much to do with a pointe shoe – but if she corrects the inequity the majority of the time, being on pointe shouldn’t be a problem.

Best of all – this dancer will intuitively know whether or not the lift makes her standing, walking and dancing feel better – and the ache across the lower back and sacral area should disappear.

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My name is Tina and I am a 23 year old dancer residing in New York… Anyways, I have a question my tendon in my left foot pops when I go into releve or point and flex sometimes… its not all the time but enough to be annoying… feels like the tendon is moving over the bone or something… Maybe the Post Tib tendon? Anyways, I do pronate and have orthotics but I don’t know how this happened one day I just woke up and it was popping.  It doesn’t hurt but I don’t believe popping is good because it will eventually wear on the tendon… I want to dance still… I’ve been doing some peroneal strengthening exercises and checking out my alignment in releves… I just dont know what else would help… if you have anything suggestions or feedback that would be great and thanks!

Tina – you are on the right track with checking your alignment and keeping yourself out of pronation.  That’s great that you have orthotics for your regular shoes.  You might try taping your feet for pronation while dancing to see if that decreases the popping (there just aren’t goodorthotics for dancing, unfortunately)  and I would also go to a good podiatrist that will take the time to massage and manipulate your feet if some of the smaller bones you see that make up the arch of the foot.

I have a dear friend who was a professional ballet dancer and went every few months to her podiatrist in Chicago to keep her feet in good shape.  She was one of those loosey-goosey dancers – that I lovingly admired for her turnout and extensions – but it did mean that she had more joint laxity and was prone to ankle problems.

You’re right to want to get on top of this – because it is a change from normal for you – and over time will create strain on the posterior tibialis tendon.

Good luck!

“Here’s to the bright New Year, and a fond farewell to the old; here’s to the things that are yet to come, and to the memories that we hold.” anonymous

Happy New Year!

Deborah

How to keep young dancers from overturning out?

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I am teaching at a local ballet school.  I work with the children from the ages of 3 1/2 to 10, primarily.  I also conduct conditioning/pre-pointe classes for slightly older girls.  I am the only teacher for the youngest dancers but do share teaching assignments with other teachers for the girls in both the Ballet 2 and the Ballet 3 classes, and the pre-pointe classes.

Here is my dilemma – I would venture to state that roughly 100% of the students over the age of 8 are forcing their turnout – most with rolling in the ankles, some with exaggerated anterior pelvic tilts, most way over crossing their fifth positions.  I don’t allow any of those things in my classes, and am using several of your books to educate these young dancers so they can have a successful and safe dancing experience.

How do I help these students survive in other teachers’ classes?

If you do post this question (and I hope you will as it is vitally important) could you please make me “Anonymous”?  I don’t want to cause problems at this school as I think the students need me there.

Thanks!

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This is an excellent question and a common problem.  It is challenging to fix, though, if the teachers are encouraging the students to stand overly turned out – and it is also challenging because sometimes the students are the ones that are pushing their turnout because they want to ‘look good’.  I am going to focus my answer on what you can do with the students rather than trying to change the other teachers.  It’s really hard to create change in another teacher’s teaching methods especially if you don’t have the support of the studio owner.  You and I know that teaching ballet to young students using anatomical principles while encouraging the joy of dancing is very challenging!

The one exercise to illustrate how much functional turnout a dancer is working with is the clamshell exercise.  I’m going to add a variation on here for the younger dancers.

Have them on the floor, lying on their side with their buttocks touching the wall and their spines lengthened along the wall and their knees bent with their feet in line with their hips.  Being up against the wall will give them feedback whether they are rolling on their hip.  Then have them do the clamshell exercise and keeping the feet together open and turnout the top leg.  How far could they go?  So many dancers are hardly getting above 45 degrees!  It’s strange but true that I will find dancers who have more turnout at their hips than what they are able to functionally use in movement.

So that is the first focus I would offer to your students.  Develop the strength at the hip joint to accurately use their turnout.  After doing the clamshell exercise, make sure to tell them to stretch the turnout muscles!

Next I would encourage the students to practice barre without the barre.  It is much harder to over rotate when you aren’t gripping the barre.  Have them do that barre in stocking feet rather than soft slippers.  They may be able to feel the weight on their feet more easily and hopefully self-correct to bring the weight evenly on the pads of the big toe, little toe and heel.

Last suggestion I would have is to impress upon them to focus on their movement, rather than their positions.  This is a hard concept to get across because so many budding ballerinas are looking at pictures of a gorgeous dancer in a magnificent poses.  To help them focus on their movement I would have them begin to play with qualities.  Ask them to exaggerate what moving with tension and using all of their muscles feels like.  (this is commonly what they are doing☺ )  Then ask them to move gently, slowly, without any sharpness to their movement.  Try giving them different imagery to help.  A rubber band when stretched slowly won’t snap – but if it is stretched too quickly it may break or snap back.   Explore how a feather floating on the wind moves… and bring that into their demi plies or tendues.  Experiment with many images, including contrasting ones as well.

The goal is to have them thinking and feeling in new ways about their dancing, which in turn will give them better feedback encouraging them to more easily create changes in their patterns.  Perhaps a back door approach – but you never know what is going to create an aha moment.

I’d like to open up this conversation to other teachers…. What do you do to help young dancers use their turnout effectively and efficiently, and most importantly – safely?

Post your comments in the boxes below!

Have a great week!

Deborah

“Education is the key to injury prevention”

Scoliosis tips

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I am a ballet teacher and I have a student that is 15 and just found out she has scoliosis. She has been dancing all her life and is a good dancer. When I found out that she has scoliosis it put some things into perspective about her body and how she uses it. She has always had very tight hips and has an arch in her lower back. I was getting ready to give her the exercises from the Analyzing Turnout DVD but I wanted to ask you if there is anything that I shouldn’t have her do or better yet anything different that she can do to work around the scoliosis? Her limitations in this area make so much more sense to me know that I know what she is dealing with. She is affected in the thorax region and I would like to help her any way I can. She has aspirations of having a career in dance so any guidance you could give me would be greatly appreciated.

On another note, you are amazing! I have LOVED everything you have done and use it on a daily basis while teaching. When I was growing up and being taught ballet no one cared about how your body was built and how that played into learning how to use it. I think I am finally getting through to my students that it is okay if you don’t have perfect turnout and if you work correctly you can increase your turnout and still be able to move around when you are older.

Thanks so much for all you have done and are continuing to do for the dance community! I have had several other teachers sign up to get your newsletter and they all have enjoyed it as well!

Have a great day!

Becky

Great question!  Let’s talk about scoliosis.  There are 2 primary categories of scoliosis, the type that is idiopathic and comes on during the early adolescent growth, and a type I’ll call functional scoliosis, which is when the spine responds to a leg length different or other structural/muscular asymmetry.   Sometimes there is a combination of both.

I had a wonderful dancer/client I’ll call Sunshine (not her real name – but she had such a positive attitude:) who had her scoliosis picked up around the normal time of 12 -13 years of age.  She went to a doctor who specialized in scoliosis who said she needed to have surgery because the curve was greater than 40 degrees.   The mom was not about to say yes to surgery before they tried everything else first because she accurately understood that scoliosis surgery is one of the most difficult surgeries for children.  That is when they came to me.

I looked at Sunshine’s standing alignment and saw that she had leg length discrepancy and when I put something under the heel of her shorter leg, it improved (decreased) the spinal curves.  That was encouraging.  It meant that there was an aspect of her scoliosis that was functional.

One of her major curves in the thoracic area had a major rotary component to it.  It is what people see when a student with scoliosis rounds over…. The ribs rounding back on one side.

We started working on increasing her ability to rotate more evenly through all the areas of the spine.   You see every time the spine has lateral flexion (or side bends) it will always rotate.  It does this to take the stress off that area of the spine.

Try this.  Sidebend your head so your right ear goes towards your right shoulder.  Leave it side bent to the right (which is right lateral flexion of the neck) and now turn your chin first to the right, down towards your shoulder, and then rotate it to the left, up towards the ceiling.  It felt freer when you rotated right – yes?  This is an example of how the spine wants to rotate to take the strain away from the side bending.

I had her do twisted push-ups against the wall – doing more on the side with less flexibility.  She imagined a huge X going from the shoulders to the opposite hips – and instead of slumping into her normal standing alignment, which was sinking into one hip, she constantly corrected herself to imagine the 2 lines of her imaginary X were the same length.

click here to open short Quick Time clip showing twistedpushup (keep hips facing front, twist upper body to wall)

She had exercises (primarily rotation) received massage and craniosacral work to support the new muscle patterning, put a heel lift under the short leg – which she wore everywhere including her soft slipper – just not in modern class.  The lion’s share of the rehab I will give credit solely to her commitment to making postural changes.  This is not easy as an adolescent!

Sunshine went back to the doctor 3 months later, then 6 months later – and since she was showing improvement in her x-rays he allowed her to continue whatever she was doing☺!   She never did have surgery and continued to dance, graduating with a dance degree from college and is now dancing professionally with a company based in France!

The point of this longish story is not to say that surgery is NEVER needed – rather it is to encourage any parent who has a child recently diagnosed with scoliosis to make sure there are no functional aspects to the scoliosis that could be addressed.

As far as your question about giving her the exercises from the Turnout DVD – yes, you can give her any of them.  I would especially encourage you to see if her iliopsoas and hip flexors are tight – and then to have her focus on stretching them. Check or have someone check to see if there is a structural leg length difference that might be exacerbating the curve – and focus on giving her many images for long spine and one that easily rotates!

Hope this helps……

Warmest regards,
Deborah

Développés – how to strengthen

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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”