FHL Challenges and Rélevé

The flexor hallucis longus muscle attaches from the calf to the big toe. Problems there are often called ‘dancer’s tendonitis’ , as the repeated rélevés and pushing off of the foot. Of course, dancers aren’t the only ones that can have problems here, gymnasts, sprinters and swimmers (who push off from the blocks) can have challenges with this muscle.

It is an important controller of pronation and supination at the midfoot and helps to transfer force from the rear foot to the toes. It is underneath the soleus muscle and I suspect that weakness and/or tightness in one muscle influences the other.

Here is an excellent article on the FHL and athletes with great illustrations.

This area has been compromised on my right foot due to a sesamoid injury about 20 years ago. (those are the 2 tiny bones underneath the base of the big toe) My rélevé on that foot has been compromised. I simply can’t get up as high as I could before. The mobilization that I’m going to show you below has been very helpful.

While I do not expect to get my full rélevé back, I do want to maintain normal gait and the ability to roll through the foot correctly. If you have a ‘stiff’ big toe area give it a try! Of course, it goes without saying that you shouldn’t feel any pain while doing it. There can be other reasons for your big toe not flexing as well anymore that have nothing to do with the FHL. This is just an exercise to explore and see if it is helpful!

To your success!

Deborah

Compensations are tricky

I received the following question from a teacher…

One of my dancers tore her calf a year ago, but finally diagnosed in the fall last year. The calf has healed but she over compensated on the other side, so now she has tendonitis. The ortho said she has a thin achilles and it was short. Finally they now say the FHL is involved. Because the PT is not a dance specialist, I’m wondering how to get her back on her feet dancing again.

I asked the teacher for some additional information and she told me that her PT gave her rélevés on both legs and single legs as well as demi plié rises. Her problem is on the right side, and her teacher said that she does have a tendency to roll in on the feet and grip her toes.

You can see from the picture that her right foot does roll in more than her left. The 2 calf muscles are shaped differently as well, with the right one looking smaller. I’d want to measure to be sure. It’s not unusual to have an injury that heals but later have other challenges due to compensatory behaviors. Compensations can be so tricky to deal with – but always – the goal is to get the 2 sides moving in an integrated and anatomically efficient manner. This is always the challenge in the rehabilitative process, and frankly, sometimes it doesn’t get addressed. Once the pain of an area or joint diminishes many dancers go back to normal activities without realizing their movement quality is still affected. I have been guilty of this as well.

To that end I would start with focusing on strengthening the intrinsics, checking to see if the flexor hallucis longus (FHL) is tight and then working to integrate how she is balancing on each leg.

It’s always good to wake up the feet before you start doing exercises. Here is a quick, clear and concise clip I found on YouTube that shows how. The only thing I would add is to also separate the toes into a V to wake up the area between them. Instead of a quick massage to the arch you can always roll on a pinkie ball instead.

Next let’s check whether there is any tightness in the FHL. This important muscles travels from the back of the calf thought the medial side of the ankle and attaches on the big toe. Dancer’s tendonitis is often attributed to the FHL because of the strain it endures because of the multiple pliés/relevés one does over the course of a dance class.

If her demi pointe is as high as it was before, and both sides are equal, she probably didn’t lose any length/flexibility to the FHL muscle. (note to teachers: those of us who have lost our demi pointe on one side for whatever reason could probably use some FHL stretching, but I’ll save that for another post)

Strengthening the FHL and the other intrinsic muscles absolutely is a good idea. Below is a past clip on a couple of intrinsic strengtheners that don’t need a towel! The traditional way is putting your foot on a towel and then slowly pulling it towards your heel. It’s easy to clench your toes while doing this so these are the ones I give out instead.

(Warning: this clip is louder than the others, so you may want to turn down sound down slightly.)

Intrinsics can strengthen pretty quickly – as long as they keep good foot alignment and stay out of pronation in class. That would require decreasing their rotation at the feet and working to increase the use of rotation at the hips. I feel comfortable that her teacher will be watching and helping her work her turnout more efficiently.

Now to the important integration of her movement. Let’s start by asking her to do the simplest of movements of just walking in neutral and checking her balance on the 2 sides. Then in the next video I’m upping the challenge by slowly walking up the stairs. You’ll see how I need some work on my right side. I’m working on changing aa decades-old pattern for myself and I hadn’t realized how much it influenced my patterning.

Simple, simple movements, right? And yet – I would bet that this student may have some differences between her right and left legs and how she is supporting her weight on them. Yes – there are possibly more interesting and more intricate movements that she can do. What I’m interested in is whether or not her fundamental movement patterns are sound. She’s had an injury on both lower legs within the past year. She needs get back to neutral, to a balanced usage of her two legs in order to stop the cycle of injury/compensation/injury.

If I get feedback on how she does with these suggestions, I’ll certainly pass it onto the group. If you have questions or comments please post below.

To your success,

Deborah

Foam Roller variations

Had a fun zoom call with my son last night who is active in bouldering and climbing. He wanted to add in using the foam roller for recovery… good move, my son!

Using the foam roller as an adjunctive training method is smart. As a self-massage technique it does help recovery of the muscles and fascia, improves blood flow, reduces tension, and most importantly, increases your awareness and listening skills to your body’s needs.

The following 2 clips are short and are only done on one side. I would encourage you to foam roll on one side first, then stand up and notice any differences your effort made. You want the brain to acknowledge the differences so don’t skip this step.

Butterfly Position

Please help my poor hips! Despite all the stretching, my knees stay at least a foot off the ground when I sit or lie down in butterfly. When gently pushing the knees down, I feel a sharp pain deep in joint. What can I do?

I’m so sorry to hear of your stretching challenges! Let’s try to deconstruct some of the issues that may be influencing your inability to sit in the butterfly position. First let’s talk about the the wide variations in hip joints.

Look at the different facings of the acetabulum (hip socket) of these 2 pelvises. The left is facing more forward and the right is more on the side.

This picture shows how the angle of the ball of the femur can vary quite widely!

This last picture shows a femur with a longer neck (area next to the head or ball of femur) and the one on the right has a much shorter neck.

Photos reproduced with permission from Paul Grilley

All of these structural variations will influence your ability to sit in the butterfly position. So first… DON’T push your knees down in this position which creates pain. That’s a good indicator that the butterfly position is not optimal for you to get at inner thigh tightness. We don’t want to stretch in positions that don’t allow us to start from neutral. Can you sit up easily with your feet together even with your knees way up? Or do you roll onto the back of the pelvis?

If you can’t sit up easily in the position try stretching out the hip flexors and hamstrings and see if that makes a difference in your sitting alignment. Next I would try to find other ways to stretch out your adductor muscles. You could try these suggestions from my Ask Deb column in Dance Teacher Magazine.

I also thought I would show a very simple way to stretch the front area of the inner thigh muscles in standing – so I did a quick video to explain. (Didn’t notice that my dog Misha was listening carefully until I watched it… love my dog:)

My suggestion… try other ways to stretch the inner thigh that might be more productive and doesn’t base your stretching success on the butterfly position, which may be challenged by your particular hip structure.

To your success,

Deborah

Muscle Memory… What is it?

The path of movement is well established. A message is sent from the brain through the nervous system to the muscles to create movement. The more you practice a movement, the easier (and hopefully more skilled) you become at doing the movement because you have carved a neurological pattern in the brain.

The muscles also respond to the repeated practice of a movement. You build muscle by asking it to do a little bit more than what it currently can – by doing more repetitions or increasing the difficulty or load.

It used to be thought that it was just the repetition and the hardwiring in the brain that was the source for muscle memory… the ability to bring back a skill not practice for a while. But that didn’t explain why most people condition and strengthen much more quickly after taking time off, whether because life got in the way or you had an injury. After all, when you stop training you start de-conditioning.

When you build muscle the number of myonuclei increase which are known as the muscle stem cells. It was in 2010 that research first showed that even if you stop training for a significant period of time the number of myonuclei present in the cell remains even as the muscle atrophies.

When you start training again you don’t need to go through the process of building up the number of myonuclei and so conditioning and strengthening happens much more quickly.

In 2018, there was a study on humans (the 2010 research was done on mice) that had participants training at the gym for 7 weeks, then off for 7 weeks, and then back on for 7 weeks. This research showed that the changes to the DNA that occurred during the training session stayed even when not training. Cool! This means that our skeletal muscles have epigenetic memory!

Stay with me… I’ve got one more study to tell you about and then we’ll talk about why this is important. There was a study by Ogasawara that compared the results of strengthening a muscle continuously versus periodic strength training. In a nutshell it showed that over a 24-week period the two groups ended up with the same strength gains whether they were training continuously or having 6 weeks on, 3 weeks off.

Takeaways

I’ve always been a proponent of cross training. When you take a break from class and do something else… like swimming or pilates or even playing on a playground… it broadens your movement patterns. This is a very good idea for the fascia by keeping it conditioned and moving easily in all directions by varying your movement. It is also beneficial for injury prevention as overuse injuries are so common in dancers.

Now we have the research saying gains won’t be totally lost if you take a break of a few days or even a few weeks – and there might be some physical, mental and emotional benefits! You’ve got muscle memory on your side, and coming back refreshed and feeling physically ready to start a new school year is a good thing!

So let’s not let our students feel guilty for taking time off. Of course, they have to start training by rebuilding some of those patterns that are unique to dance, but the more advanced the dancer, the more quickly it will happen. Let’s just make sure they remember that sleep, nutrition & hydration and staying mentally resilient are all a part of their training.

To your success,

Deborah

Accessing the abdominals

I have a question about abdominal strength or should I say… lack of! I tell my students to pull up the front of their abdominals, but when I place my hand on their stomach I don’t feel anything. I’m not sure if they even know how to engage them. Can you recommend any specific ideas for ballet class?
Thanks!

Excellent question! I want to say that even when dancers do abdominal exercises on a daily basis it doesn’t necessarily mean they will use them efficiently in standing during the dance class. We need to get our students to use their abdominals effectively ALL the time, not just in class!

I’d like to first remind everyone that the only thing a muscle can do is contract. It can do a shortening contraction (concentric), lengthening contraction (eccentric) or isometric contraction, which stays the same length. When you are doing a crunch or sit-up, the abdominals are doing a shortening contraction – in other words – the two ends of the muscles are coming closer together.

If you are lying on your back knees bent and lifted towards your chest, and then slowly drop your toes to touch the ground, doing a leg lowering, you are doing an eccentric contraction. This is the type of contraction dancers need to use to keep their pelvis in neutral as they move their legs. It is also the most challenging of the contractions.

Too many students engage their abdominals so fiercely it is as if they have put an invisible belt around their waists and have cinched it closed. The first time they need to take a deep breath in they lose their abdominal support.

You might try this in class. Take 5 minutes to explore the sensation of the deep core when it’s turned on and working. Start on hands and knees with a flat back and slowly peel off one hand without shifting AT ALL! As they slowly peel off one hand, and placing it back down without shifting they will sense their abdominals supporting and staying flat. It’s not a big sensation. (of course do the other hand too)

I teach my students that if they learn how to engage the abdominals properly in standing and in movement, they won’t need to do umpteen sit-ups as a part of their training. Have your dancers stand easily in first or parallel position. Have them imagine they are lacing up their abdominals as they do their shoes. Have them place one hand below the belly button so they can feel the abdominal wall drawing up and inwards – while their other hand is just below the sternum, which is the area where the ribs come together in front. The area just below the sternum should be relatively soft as they need to continue to breath easily and effortless while they are using their abdominals. This will not feel like a strong contraction! Then walk around the room for at least 2 minutes maintaining the upright, neutral pelvis and long spine. That is how we should walk all the time!

The more they practice having a neutral pelvis through the deep engagement of the abdominals they will transfer that to their dancing, because that has become their normal alignment, whether standing in class or talking with a friend, or sitting in a chair!

To your success,

Deborah

“Education is the key to injury prevention”

How Fascia moves (or not) with lower back pain

https://en.wikipedia.org/wiki/Thoracolumbar_fascia

We’re going to continue looking at fascia’s role in the lower back and spine moving easily and freely.

We know lower back pain is no longer just an ‘older’ person’s challenge. I have met many college age students with chronic lower back pain. There is often a correlation between their activity level and the amount of time spent sitting and studying.

Healthy fascia is elastic – it should be able to stretch or lengthen and then come back to its original shape without stress.

Inelastic fascia doesn’t move well – it’s like having muscles that are stiff and unyielding. The two ultrasound clips below show the movement of the thoracolumbar fascia (shown in image above in gray). You can see how the fascia in the person with no low back pain moves easily while in the second clip the fascia has limited movement in the person with lower back pain.

Clips originally from Langevin H, Fox J, Koptiuch C, Badger G, Greenan- Naumann A, Bouffard N, Konofagou E, Lee W, Triano J, Henry S (2011). “Reduced Thoracolumbar Fascia Shear Strain in Human Chronic Low Back Pain”. BMC Musculoskeletal Disorders. (These clips are licensed under the Creative Commons Attribution 2.0 Generic license.)

Fascia needs to be well-hydrated, elastic and plastic (previous post) and kept in optimal order by good posture. Remember your postural habits influence and organizes your fascia. If you have a regular habit of slumping… then the fascia will shorten to reflect that. For dancers, it isn’t so much the posture we have in class, but our daily postural habits that can get us in trouble! And now… I’m going to go for a walk after sitting at the computer to type this!

To your success,

Deborah

Exploring Fascial Plasticity

Dancers are always concerned with maintaining or increasing the flexibility in their muscles. To really understand how muscles become more flexible we need to understand how to change the fascia that connect to the muscles.

Most dancers know that fascia, which is the dense connective tissue that surrounds the 200+ bones and the 600+ muscles of the body. It keeps structures (like muscles) separated from each other yet interconnected in a 3D like web.

Using an orange analogy, the outer rind is like the superficial fascia, and the sections of orange are similar to the fascia that surrounds our muscles, bones, nerves, etc. Fascia ties and connects everything together!

This is why if you have tightness in your neck, it may be influencing the flexibility of the hamstrings. There is a fascial line that connects the muscles along the back of the body called the superficial back line. I mention this because it bears repeating that if you are not getting the results that you want from your stretching efforts – look at other areas of the body that may be holding tension and creating a pull or tightness along the fascial line.

This young man is a perfect example of this. He was taking yoga classes and a student in the opera department. We found the tension at his neck significantly influenced his hamstrings. He was doing lots of hamstring focused stretching in yoga class but until he focused on releasing his neck tension he was unable to get release and relief along that back line. Doesn’t he look WAY more comfortable in his body in the picture on the right? That change took 3 months. As a side benefit – his vocal technique improved too!

Now back to talking about fascia and plasticity. Plasticity means the ease with which something is molded or shaped. Fascia will reshape itself when there is a slow, steady and sustained pull on it. Too fast of a stretch and fascia/muscle tears. Plasticity is different from elasticity. Elasticity is the ability of tissue to stretch and then go back to its original shape. Plasticity means the tissue over time (think potentially weeks/months) slowly reshaping itself into a new length. That is what dancers want from their stretching.

Bottom line… slow, steady, sustained stretching is the way to go. Doing some of that passive stretching that dancers love to do at the end of class can be very useful (at the end of class – not the start!) If you add on some muscular engagement from the opposite of the joint – you will get even more benefit! For example doing the typical standing quad stretch is good – but when you also lightly engage the glutes while using the abdominals to keep the pelvis in neutral – it becomes even more effective of a stretch! Hold that stretch for 30 seconds, take a quick break and then go back for another 30 seconds and see how your quads feel!

To your success!

Deborah

How to get the shoulder blades flat on the back?

“What suggestions do you have to help dancers get their shoulder blades to lie flat on their back?”   Felicia

Okey dokey!  Let’s first talk about the anatomy of the shoulder girdle so it will make sense. It really is important to get those shoulder blades lying flat on the back so they can support the arms in port de bras as well as stabilize the shoulder girdle in multiple movements and decrease the potential for injuries.

Anatomy of the shoulder girdle

The shoulder blades, aka your scapulas, are a fairly flat, triangular bones that hang on the backside of the ribs.  They connect the upper arm bone to the collarbone.  There are 6 movements of the scapula.  You can elevate and depress (essentially a shoulder shrugging motion).

You can protract and retract which is pulling them together and separating them.  Picture on left is retraction.  That is what I often see dancers do wrong when they are doing their port de bras.

And you can rotate the scapula upwards and downwards, which is describing how the bottom of the scapula moves towards or away from the spine.

We’ve all heard of ‘winging’ shoulder blades, and that is when the inside border of the scapula moves away from the ribs.  Some teachers call them chicken wings:) This happens when there is an imbalance in the muscles of the shoulder girdle and may require both doing some stretching and strengthening in the area.

What are common reasons for winging of the scapula?

If they have a rounded of slumped standing posture when they aren’t at the barre, it’s quite possible they have tightness in the pec minor and the latissimus muscles.  Those muscles will need to be stretched as you work to strengthen the stabilizer of the shoulder blades, the serratus anterior muscle. This is the primary muscle that will need to be strengthened.

Here are pictures of the 3 muscles I’m talking about.

 

 

 

 

 

 

Stretching the lat and pec minor

There are many different ways to stretch and strengthen these muscles but I’ll give you a couple of my favorites.

I like to stretch the lats by doing a doorway or what I call a C Curve stretch.  You may feel the stretch more at the armpit area or more towards the waist and lower back.  I’ll move gently looking towards and rounding my lower back to find the sweet spot of the stretch. Another stretch is called the prayer stretch and you can google that one.

A really nice way to stretch out the pec minor is lying on a foam roller and placing your arms on a high diagonal (sometimes I start by first doing slow angel wings to move through a range of motion) Breath and allow your arms to hang towards the floor.  Move your arms slightly to find your best places to stretch.

Strengthening the serratus anterior

Now onto the serratus anterior.  It is important to properly identify when this muscle is working.  Start standing, in good alignment, and draw your hands down towards the floor.  Feel the muscle engagement under your armpit?  That’s your serratus anterior.  I want you to keep that muscle engaged through the next exercise.  Start lying on your back with your elbows at a 90 degree angle and the back of your palms lying on the ground by your head.  (like the picture above on the foam roller but without the foam roller) Keeping your back lengthened, ribs dropped, slowly slide your forearms and back of the hands upwards. You are using the serratus anterior to keep your scapula drawing towards your pelvis the whole time.  This is not easy!  Keep them engaged!

If you want a challenge you can do the same thing as a wall slide – starting with your back against the wall, feet slightly away with knees bent.  Same instructions – keep the shoulder blades drawing downwards as the forearms keep contact with the wall and are sliding upwards.

Now have them stand and place their hands in a prayer position, pressing the palms together while drawing the scapula downwards. Maintain the placement of the scapula and open thearms easily to second position and notice how wide and open their chests are! Over time they will create better muscle balance and improve their port de bras line.

To your success!

Deborah

Stretching Concerns: How Much is Too Much?

I have a student who is stretching every time I see her. Always!  She has a teacher who wants her to have a penché of 180 degrees, which is difficult because she has tight hamstrings, even though we’ve been working on stretching them.  She says she is in a lot of pain and I’ve asked her to back off on the stretching but another teacher told her she needs to stretch her hips. Now the student is conflicted… does she stretch? or rest? And what stretches are best for her to do?

Wow!  Great question… let’s work through some of the issues.

How is she stretching?

What I don’t know is her age and where she is feeling her pain.  If she is still growing and feeling her discomfort in the muscles I would make sure she isn’t stretching passively – and instead encourage her to do more dynamic stretching.  An example of a dynamic hamstring stretch is placing your left heel on the seat of a chair and contracting the quadriceps of left thigh.  Then think of shifting the sits bone backwards in space without bending forward. Keep the foot flexed and the quads contracted the whole time.  It will feel different from the normal hamstring stretch.  Stretching dynamically, she is less likely to go to far and strain muscles.  Here’s an older article I wrote on Too Young For Splits Training? you might want to check out.

Where is her pain?

I’m really curious where she is feeling pain.  If she is feeling it in the hip joints I would encourage you to send her to a sports med doctor or PT that is well-versed in the demands of the dancer.  Any labral tears or joint challenges need to be ruled out to make sure she isn’t forcing her body into positions that are injuring the joint.  There have been many examples of young dancers forcing their stretching and damaging the joint capsule, for example.

Functionally strong?

Consider this student’s overall muscle balance.  Where does she fall on the spectrum between a loosey-goosey dancer and one that is tight and strong?  Is her flexibility and strength fairly even? Could she weak and tight and thus has a hard time supporting her movement from proper alignment? It may sound counter intuitive but some dancers would be better off gaining some functional strength in their movement.  For example, can this student sit on a chair and rock forward onto one leg and stand up easily without having the knee turn in or the foot pronating?  Can she easily stand in one position and do the smallest of tips forward and back to center as if she was starting into her penché?

Penché is quite a complicated movement that requires balance, flexibility, strength and a well placed pelvis and torso!  I have no doubt that there are other ways for her to work towards penché without focusing just on flexibility.  You were right in telling her to back off what is creating pain.  Hopefully, with some further analysis it will become clearer what the underlying issues are.

To your success,

Deborah