Sacroiliac pain

I am a dance teacher and have been experiencing pain in my sacro-iliac joint on my left side.  I figure it may be due to my demonstrating most exercises with my right leg and being supported on the left.

I have been to a chiropractor who helped me isolate the problem, but none of the treatments really helped ease the pain.  The next step they recommend is to have an MRI done.  Is there anything else I could try or anyone I should see before going through that expense?  I’m finding that the pain is getting worse, and all I can figure to do is to ice it during the day.

Just as an added bit of info:  I started carrying my bag on a cart this week instead of on my shoulder, and for the first time in a while, when I got out of bed this morning, I didn’t notice the usual pain in my back.  Maybe some connection?

You’re the best!  Lisa

fullbody-1-142x300Lisa, carrying a bag on your shoulder most likely didn’t cause the pain – but it may have been exacerbating it!  I’ve seen really interesting connections between movement patterns and shoes, purses, backpacks, bags, you name it:) The challenge with carrying a bag (I’m envisioning a dance bag that hasyour day packed inside of it) is the shift it creates between the torso and the pelvis.  Let’s say that you have it slung over your right shoulder or even crossed from your left shoulder to the right hip – automatically the pelvis shifts to accommodate the extra bulk.  (See image on the right and imagine a bag hanging on the right side of his hip.)  Do you see how the left side of the lower back and pelvis is crunched up?

It’s interesting that you mentioned that you typically demonstrate by standing on the left and having the right leg be your gesture leg.  Same pattern of slight pelvic shift left torso shift right.  I know it is traditional to always start with the right leg – but it might be good for you and for your students to mix it up every now and then and start off on the opposite leg!  Also check when sitting in a chair if you like to cross your right leg over your left more often…. same pattern:)

Now I have no idea if this is your pattern in standing but you can stand facing the mirror and look to see if you have any shifting – and in the meantime, if pulling your bag behind you rather than carrying it helps – keep doing it!  The other aspect of SI joint problems besides a pelvic torso shift is looking at whether or not the pelvis is torqued.  This can easily happen with a tight iliacus muscle (the ilio part of the iliopsoas muscle)

In the short clip below from Essential Anatomy: A Multimedia Course – I demonstrate how to check for a torqued pelvis.  Since I’ve taken this clip out of sequence let me explain that if you feel the bones at the front of the pelvis those points are your ASIS.  Ideally those 2 points of the pelvis should be even with each other.  When you have a torque, one ASIS will be lower towards your knees (generally on the side where you feel the discomfort in the back).  It’s as if one side of the pelvis is being draw forward and down. The torque happens at the sacroiliac joint and can cause pain.  The side that has the ASIS that is lower (in the clip the right side of the pelvis) will have more limited hip flexion.

http://www.youtube.com/watch?v=C_auFs7fYfg

Sometimes stretching the hip flexors will help to reduce the torque on the pelvis, and often I do a triggerpoint release to the iliacus muscle, which can help a lot.  I do teach dancers to release their iliacus triggerpoint themselves, but that is beyond the scope of a blog post.  I would encourage you to ask a physical therapist or the chiropractor if they can see if the triggerpoint is sore and how to release it.

Generally, when the release of the iliacus is succesful, the ASIS are even and you can bring your knee more easily towards your chest.  When there has been chronic inflammation or strain in an area it can take some time to calm down – but you will know you are on the right path – because it feels better!

Best wishes for a speedy recovery!

Deborah

“Education is the key to injury prevention”

Scoliosis tips

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

Arch in back

Thank you so much for all the information you provide on your web site and in Tune Up Your Turnout! Since I have a sway back, it was a nice surprise to buy a book about turnout and also get so much help with alignment.

After stretching the hip flexors (it’s like a miracle!) I can now lay on the floor with both legs straight and much less arch in my back, but only if my shoulders are forward (my whole spine is on the ground but the sides of my shoulders are up off the ground a little bit). If I press the shoulders down to the ground, the huge arch comes back. Is that a problem, and is there anything I can do to improve?

I know it’s going to take a while to get my alignment figured out, since the sway back has been there for years and I’ve only been doing ballet for a few months. I just want to make sure I’m doing the best I can and not putting any strain on the wrong muscles.

Thanks!!!
Katie

Sounds like you might have a problem with your lat muscles or the muscles on the front of the chest, the pecs.  Either of those will draw your shoulders forward in the way you described.

pec-300x197lats-300x300

 

 

 

 

 

 

 

Try this…. lie down on the floor as you described and get a sense of how much your back arches when you press the shoulders down. Then go a doorway and stand in the doorway with your right arm bent at a right angle and placed against the door frame. (Your hand to your elbow will be on the wall or door frame) Gently press your arm against the wall while you turn towards the left slowly. You’ll feel a stretch in the front of the chest on the right side. Do the same with the other arm.

recheck your alignment on the floor

Then go back to the doorway and this time you are going create a C curve to stretch the lats. Place your both hands on the edge of the doorframe, and then bow your body away from the door in a C shape. You’ll feel the stretch along the upper outside of the arm, going down the side of your body. Do both sides. (you’ll need to be on the other side of the door for the other side)

recheck your alignment on the floor

What did you learn? Did it increase your ability to lie on your back and have your shoulders less rounded forward while keeping your back in good alignment?

For many it will.

Happy stretching!!

Deborah

PS:  If you are interested in the Science of Dance Training Summer conference please let me know by March 24th.  Thank you!

“Education is the key to injury prevention”

Bone Bruise

Last week during an over enthusiastic assemblé I managed to slip, flip into the air, and fall on my back. My doctor said I bruised a bone; my sacroiliac joint. It has been nearly 2 weeks, and I have been resting it. However, it still hurts to développé do the left side, left passe, and land on the left side (it’s my left sacroiliac joint). I am supposed to start intense ballet classes next week. What should I do? Will dancing with the bone bruise make it worse, even though nothing is touching it? Is it ok to dance through this pain? Is the pain that I experience during passe due to damaged ligaments or something? I am really nervous about this.

Thanks, Miriam

Ouch! Bone bruises can take a long time to heal. You were right to make sure there was no fracture in the area – and then I’m imagining the doctor told you to ice the area to help decrease inflammation. With bone bruises you won’t see a lot of visible swelling, but rest assured, it’s there – so icing can help.

My concern is that you fell on the sacroiliac area so you may have created a small torque at that joint which isn’t helping your rehabilitation. Remember there is a small amount of movement that is possible at the sacroiliac joint, and it’s possible that landing so heavily on one side could have created a small shift.

Do you notice a difference in your discomfort between standing in parallel and doing a passé and doing it in turnout? If standing in parallel is better than in turnout you may have strained the deep external rotators – which are the turnout muscles)

Gentle stretching is the key.

Try sitting on a chair and cross your left ankle over your right thigh. Lace your hands underneath your left knee and gently press your left knee into your hands. This turns on the deep gluteal muscles. Now keep a gentle pressure down into your hands as you slightly tilt forward with a straight back. Think of the sits bones reaching back into space. You’ll feel a stretch somewhere in the left buttock area. If it is too strong – don’t tilt forward so much. You are in control of how much effort and how much pull – and it should be comfortable, not painful.

After doing this 1 – 3 times on each side – stand back up and try first position passé. Is there a difference? Any easier?

After a fall like you took you need to be aware and watchful for muscular imbalances and possible strains as after all – it wasn’t just the pelvis that took the hit. You have lots of muscles in that area that also were impacted and that is where I would have you focus your attention. The hip flexors might also be involved, and doing extra stretches may be useful.

As always…. listening to your body’s messages is key. If doing a specific movement increases your discomfort pull back. Think about what is different about that movement from movements that don’t hurt. Then you can begin to investigate more specifically what muscle area you need to attend to. It is often hard to figure out what is muscle and what might be ligament in an area such as the sacroiliac joint, but with gentle exploration you can begin to tease out more specifics as to what makes it worse and what makes it better. If you don’t feel that you are making a fast enough recovery I would encourage you to see a good physical therapist to check out the range of motion of both hips and the muscular balance around the pelvis.

Sending you positive intentions for a speedy recovery!

Warmly,

Deborah

“Education is the key to injury prevention”

Flat spine and back pain

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Secondly – I have a few spaces left in my Analyze This! Train Your Eye for Dance. It’s going to be a fantastic opportunity to hone your analysis skills. I’ve never offered this information before – and – I’m not sure I will again. Click Here for more details

I have a student who has experienced back pain. Here is her mother’s description of what the doctor said about her x-rays: “She has a reverse curve shape of the bone structure in her neck. There is definitely a narrowing of the spaces between the vertebrae at the base of the neck. There might be bone fusion that has already occurred. She has been having lower back pain and may have some narrowed spaces in the lower lumbar also.”

What does this mean for her dancing? What may I be doing as her teacher to help warm up her body before ballet? What do I need to be careful of? She is doing Cecchetti level 6 work.

Thanks! Carroll

I’m always so appreciative of teachers who ask questions – and wonder why? It’s those questions that started me on my own path – having students come up and say, my right knee bothers me when I’m doing plié in 5th – why? My left arabesque is higher than my right – why?

We know the spine is composed of 3 curves. At the neck and lower back areas the curve goes forward towards the front of the body, and in the chest area it curves towards the back of the body. These curves are essential for shock absorption.

I have seen young ballerinas work hard to make their neck absolutely flat. The center of their ear is just behind the middle of their shoulder. Flattening the neck creates a flattening response in the rest of the spine – similarly – flattening the lower back will often create flattening of the curves above it.

All bodies, including the prepubescent ballet body, should have curves to it. The buttocks should round slightly behind the lower back. As the x-ray report states, decreasing the curves of the spine will decrease the spaces between the vertebrae. This isn’t good.

Okay – we’ve established the fact that you need to have curves in your spine. Now how do you help her as her teacher? I would begin by putting her on the floor or mat and having her feel how there is space between her neck and her lower back and the floor. Her first impulse will be to flatten those areas. Then I would bring her up to standing and place her against the wall with her buttocks lightly touching and nothing else – so she again can have some feedback of what it feels like to have a natural curve in those areas. (decreased curve)

Warming up before class would focus on releasing tension. Watch her carefully for straining and pushing to put her body ‘in alignment’. Easy spinal swings, relaxing over a physioball (on her back as well as on her stomach) will feel good. I’m assuming that her physician has put her in physical therapy and she has exercises to do to help redevelop the natural curves to the spine.

Most of all – be aware of her standing stiffly, pulling her head back and up. The other pattern will be tucking under the pelvis. I’m not sure which end of the spine is more the culprit for her – but I imagine you have some ideas from being her teacher!

Having her discomfort decrease will be postive indicators that you are on the right track!

Warm regards,

Deborah

“Education is the key to injury prevention”

Another Podcast from the Science of Dance Training!

Lisa Howell and I have recorded another podcast and put it on our own iTune channel!

If you have iTunes on your computer open it up, and then go to the iTunes store. Then you want to click on podcasts. Put Deborah Vogel in the Search iTunes store space on the top right of the window and click return. The Science of Dance Training should pop up – and you can then subscribe to our channel! You will be able to automatically download any future podcasts right into iTunes! (Forgive me if the instructions seem like duh…. of course…. since I don’t have an iPod I didn’t know how to subscribe to a podcast channel before yesterday!)

It’s a large file – which is why I can’t post it on my website directly – but please do go and check it out! All the questions we answer are on backs and spines!

Deborah

Back and Neck Pain

Quick announcement before we get into this week’s question on neck and back pain. I’m so pleased to be able to now offer pinkie balls for sale, 4 for $10! You will find them under products, then click on equipment.

Also… it brings me great pleasure to offer Rebecca Dietzel’s A Dancer’s Guide To Healthy Eating! She is an anatomist who specializes in biochemistry. She teaches anatomy and kinesiology for the Ailey/Fordham BFA program as well as counseling dancers in nutrition. In the near future I’ll post a podcast that Rebecca has so generously offered to record – just for the Dancing Smart Website! More details to come.

Onto the question of the week…

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I have a student who has experienced back pain. Here is her mother’s description of what the doctor said about her x-rays:

“She has a reverse curve shape of the bone structure in her neck. There is definitely a narrowing of the spaces between the vertebrae at the base of the neck. There might be bone fusion that has already occurred. She has been having lower back pain and may have some narrowed spaces in the lower
lumbar also.”

What does this mean for her dancing? What may I be doing as her teacher to help warm up her body before ballet? What do I need to be careful of? She is doing Cecchetti level 6 work.

Thanks! Carroll

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When we look at the normal curves of the spine you can see that there is an arching to the lumbar and cervical curves. (this spine is facing right, the body of the vertebrae are on the inside of the body, and the bumps that you feel along the spinal column are the spinous processes on your back)

These three curves should be in balance, meaning that when one part curves more or rotates the other areas of the spine respond because they are connected.

Now imagine a young dancer who is pulling their chin back and up. I have seen many dancers work to make their spines ‘look’ flat and have that elegant neck that is so desired. You do want the ears over the shoulder and the head balanced easily on top of the neck. You create that by lengthening the whole spine upwards – not – by pulling the chin back.

Watch to make sure your young student doesn’t have an erroneous image of what it means to stand up straight and look like a dancer!

I always encourage my dancers (and non dancers) to warm up by rotating their spine easily and effortlessly. Spine health is often equated with the ability to rotate, and as I have mentioned in prior posts every time there is a lateral curve of the spine there is rotation. (I have never seen a perfectly straight spine – so we all have some degree of lateral curves). We want to be able to rotate the neck, upper back, and lower back evenly to the right and the left.

Your dancer probably is experiencing more discomfort in her lower back area over her neck. The neck is supporting the weight of the head while the pelvis and lower spine carries the weight of everything above it. How well aligned the spine is will determine how it travels through to the legs and how much or little muscular effort is required in standing.

The fact that she has narrowed disc spaces in this area as well is confirmation that something is off in her alignment. I’m assuming that her physician has put her into physical therapy where the PT can evaluate any muscular imbalances.

You don’t mention whether she is slightly tight muscularly, or more of a loosey-goosey flexible dancer. This will help to determine the type of exercises and stretches that would be most appropriate to bring her alignment back to neutral. This is what physical therapy will focus on.

As her teacher, your guidance in having her move in efficient alignment, with just enough muscle effort to create the movement without overworking is invaluable. My intuition tells me she is working too hard – pulling up too hard – and encouraging her to be a little more gentle with herself and her dancing and to enjoy how beautifully her body is moving would be helpful.

Until next time…. be well!

Deborah

“Education is the key to injury prevention”

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”