Pulled Up Knees & Anterior Impingement Syndrome

Greetings! Hope everyone is enjoying the spring weather. Let’s jump right into the questions!

My name is Samantha, I’m 12 and I just started ballet around 1 and half years ago. I’m in grade 5 and I have really bad technique, but what I am most concerned about are my knees. Whenever I pull my knees up in my exercises, the teacher says they’re not pulled up enough and I have to pull them up more, but they’re already as pulled up as they can be. One day she told me to sit on the floor in pike and flex my feet, she said to me that the skin under my knee that pokes out is meant to be touching the floor because it wasn’t. She gave me some exercises to do to help me fix it but I don’t think they’re working because whenever I do the exercise it just feels like she wants me to have hyperextended knees.

I was wondering if you had any other exercises or something for me to do to get the skin under my knee to touch the floor. Thank you!

You are correct, Samantha that pressing the skin behind your knees onto the floor is putting you into hyperextension – and you don’t want that! Knees (and legs) come in all shapes and sizes. Depending on the shape of your muscles and the structure of your joints – you may have more or less space between your knees and the floor.

Proper leg alignment means the center of the hip, knee and ankle joints will be in a line. Pushing your knee into hyperextension puts pressure and rotation on the delicate tissues of the knee joint.

Pulling up the knee is a phrase that is often misused. When you pull the kneecap up you are engaging the quadriceps. This is appropriate when you are straightening the knee or flexing the hip joint. It is not appropriate to have your knees pulled up all the time! Constantly contracting a muscle even when it isn’t necessary will only build tension and bulk!

If you have tightness in your calf or hamstring muscles, by all means stretch them consistently – that would be a much better exercise over practicing hyperextension!

I applaud your desire to understand your body better!

Next question

I am a 20-year-old dance student from Estonia.
I have been reading your newsletter for a while now; actually, as dance medicine is in the very early development stages in my country, it was the first information I received about dance injuries and injury prevention. So thank you for that.

My question is:

I have been experiencing pain in front of my ankle (on both ankles, more on the right one) when I go into a deep demi plié. My ankles also crack a lot when I do ankle circles.

I talked about this with some my dance teachers, but they didn’t really know what causes the pain. Also as I said- dance medicine isn’t very developed in Estonia, so most doctors would probably not know what to do with me, probably tell me to take some anti-inflammatory pills.

I have done some research myself and what I came up with was Anterior Impingement Syndrome. Is it a good guess?

The pain isn’t very strong and I haven’t had any swelling, but naturally I don’t want it to get any worse. Can you help me? What can I do to get rid of the pain or at least keep it from getting worse? Are there any helpful exercises?

Best wishes, Triin

Good research, Triin! I agree that anterior impingement syndrome might be what you have. Since you may not be able to have that diagnosis confirmed by a physician with x-rays, let’s talk about what you can do to release as much muscular tension around the ankle joint.

First, be very aware of the weight on your feet as you lower into the plié. Make sure you aren’t shifting forward over the front of the foot, but continue to keep even weight between the pads of the toes and the heel.

Next, I would look to decrease tension in the soleus muscle, which is the calf muscle underneath the gastrocnemius. When the soleus is tight it can decrease the depth of the plié. Here is a picture of my favorite way to stretch the soleus. Hold an easy stretch for a minute. The stretch shouldn’t be too strong, keep it in a comfortable range.

Notice that my left knee is bent – this brings the stretch into the soleus. If I wanted to stretch the gastrocnemius, I would keep the left knee straight. Do both ways!

Third, become more aware of when you are moving into pain. See if you can teach yourself not to ‘push’ into the demi plié. Don’t feel like it must look a certain way. I remember working with a ballet dancer who had an incredibly shallow demi plié – but boy could she jump! The shallow demi plié was more noticeable when she was at the barre, but put her in center, and you didn’t notice it. You must work within your own structure and see if the pain and discomfort is alleviated.

I’m hoping your ankles are only bothering you at the bottom of the demi plié – if they are bothering you while walking you might need to pull back from class until the inflammation has calmed down. You will never go wrong by listening carefully to your body’s messages!

Warm regards,

Deborah Vogel

“Education is the key to injury prevention”

Tucking Under, Painful Groin & Head Games

Announcements
I have not fallen off the face of the earth – but life has gotten in the way of regular posts. My plan is to remedy that, beginning with this posting – so….onto the questions!

Dear Deb, I was having a vivid conversation with a few friends and colleagues or mine on the subject of tucking under and when to emphasize it and when not to in the execution of the pelvic tilt on the reformer. Our answers varied and at times were totally opposite. We would like to get your opinion on the matter as to which cases one would emphasize the tucking under and when not. Thanks!

Good question! My answer would be to say the focus of the pelvic tilt is to bring the pelvis into correct alignment. I often think so many people emphasize it because they are starting from a swayback position – and need to engage the deep abdominals and the hamstrings to bring the pelvis to neutral. This is my focus always for the pelvic tilt.

Too often a pelvic tilt becomes a press your lower back into the floor – and of course – that isn’t what you want. When you properly engage the deep abdominals and high hamstrings the erector spinae muscles that are the large muscles along the spine should release and relax. I will often place my hand underneath the students lower back as they are on the reformer so I can monitor how they are initiating and following through on the pelvic tilt. That will tell me more than anything else about their muscle usage.

That would be my one size fits all answer. Whenever the pelvis is in a swayed position I would utilize the action of the pelvic tilt. If you have someone who always tucks under – too much so – you will have to focus them into the action of the deep abdominals and release of the hamstrings to bring the small lumbar curve back that everyone has!

Another one…..

Hi! I’m 13 years old and I’m a dancer I’ve been dancing forever sense I was three, and last week I was doing switch and center leaps. I’m not sure if you are familiar with them, but as I was doing them my left hip popped and then I landed on it wrong! Now I have pain in my groin when I stretch, I’m not sure what I did. I explained to my dad what I did and he said I might of hype extended my hip! Is that even possible? Or is my dad crazy and doesn’t know what he is talking about?! Should I see a doctor? What exercises should I do? How long do I have to sit out from dance?

If your hip is continuing to hurt you should see a doctor to rule out anything serious or severe. It is quite possible that you strained your iliopsoas muscle and it is going to take some time to heal as it is a very deep muscle. Take it easy for a few days and spend some extra time gently stretching the hip flexors through doing the runners lunge stretch.

While you probably didn’t injure the hip joint your dad is correct in that a switch leap requires the leg to go into a very fast extension – and when you aren’t properly warmed up or stretched out enough – sometimes you can get a deep pop as you are extending the leg. Switch leaps are hard! You need massive strength and flexibility for this movement!

Last one…

Hi Deborah, I have recently returned to the ballet classroom after many years with much hesitancy. At 40 years old, I now know my body and my mind much better than I did in my teens. I also know now what my ballet teachers should and should not have told me. I don’t know if you want to address this issue in your forum, but I feel strongly that it should be addressed somewhere, somehow.

I am noticing psychological ‘games’ if you will, that some ballet teachers tend to play with their students. (I haven’t noticed it as much in other disciplines.) I didn’t recognize them at all when I was younger, but as an adult I realize now they set me up for many psychological issues in and outside of the dance studio.

My first example is how they address individual students in front of the class. They announce something that is clearly addressed to one student as if it were a correction intended for everyone. This serves to isolate the student who knows they are being directly addressed. I was the only person removing my hand from the barre during barre exercises, and as if I were not old enough to make my own decisions, my teacher announced to the class that this is incorrect and we should not do this – as it will not help us at all. The same teacher announced there is no such position as ‘third position’ and that it is only for children and old ladies. I continued to remove my hand from the barre and work from third position because I knew it was best for me, however, I know from experience that younger students might not be willing or able to ‘disobey’ the instructor the way I do. I am still looking for a ballet teacher that will let me work slowly and gently on the anatomical principles I am learning from you.
Second, I have benefited from working with yoga and Pilates instructors that encourage me to work with my body ‘as it exists in the moment’, and not get upset if my body doesn’t do what I want it to or expect it to all the time, and allowed me to ‘feel what it feels like today’. This contradicted what I learned from my ballet training, which was I should perform better every day and at least as well as the day before. There was very little leniency for changes in mood, environment, etc. I learned to ignore what my body was telling me.

I am still reading through all of your newsletters and books, so perhaps you have addressed this already. I think it is vital to teach not only technique, but a psychological ‘tenderness’ towards your instrument, your body. And to be faithful to what you know is right for you and your body, even if it goes against what your instructor tells you. (Until you can find a better teacher)
Thanks for listening!

What rich observations! You brought up some very important points and quite eloquently, too! It is so true that in any profession there are going to be teachers and trainers who excel at what they do, and many who are not as qualified. It’s unfortunate that you have found one of the latter. To say that there is not such thing as third position is not only laughable it is a dangerous premise. Through the years of testing anatomical turnout I will say with confidence that third position is more appropriate than fifth for probably 50% of dancers. A bold statement – for sure – but one that is backed up by the injuries to the hips, knee and ankle joints that I so often see.

I am grateful for another point that you make – which is our bodies are changing and are different from day to day. So true – when you learn to listen lovingly to the messages you are receiving from your body it makes a huge difference. You are able to improve because as you listen to the day when you’re slightly sick, or have muscles strain or fatigue that you become aware of – then you adapt your workout and technique appropriately, It is what smart dancers do – and we must encourage our young dancers to learn to listen and to translate what our bodies are saying. This is quite hard if you have a dancer who tells you that ‘good dancers’ should expect to feel pain – it means you’re working hard!

I teach a 13 week course on somatics where the focus is on becoming aware of your thoughts, feelings and actions in response to your life. It is so gratifying to watch young adults become more confident with their choices and decisions because they have taken the time to listen and think about what is happening – what their results are. If we could only do the same thing for our dance students it would empower them to realize they and they alone are ultimately responsible for what is happening in dance class. It’s not that teachers are not also important – they are – of course! But no one knows how something feels in another persons body and if we teach them to disregard potentially important physical symptoms we are remiss in our responsibility as a teacher. Simply – everyone knows when something feels good – or not – or even the different between something that is uncomfortable because it might be a new skill – and something that is painful.

Thank you for your email, and good luck on finding a new ballet teacher!

Until next time,

Warm regards,

Deborah

“Education is the key to injury prevention.

Labral Tear

Dancing Smart Newsletter
March 16, 2008

Announcements:

First, I wanted to announce that I am in the process of creating an affiliate program for The Body Series products. This could be completed as quickly as the end of the week, and when it is ready to roll out, I will send an email out explaining how it works.

My reasons for deciding to try an affiliate program are two-fold. One, I need a way to generate more sales to support and maintain the website and newsletter. Hopefully, I will not offend anyone by saying that. I haven’t gone after sponsors and advertising to support the website because I wanted the information to be the primary focus.

Secondly, my purpose behind doing the newsletter and creating the products is to empower and educate dancers and dance teachers in a multitude of ways. The affiliate program could help studio owners, dance teachers, and dancers create an income stream while helping me spread the word that dance can be available to everyone, no matter what your body type of amount of turnout.

I ask you to consider partnering up with me. The program will be straightforward. You will receive a 10% commission on any sales that come through you or your link. If a person that you referred also becomes an affiliate, you will receive 5% commission on any sales they bring in. I want this to be a win/win situation for all of us. Watch for more info!

The second announcement is it has become clear to me that some of the email addresses from The Body Series have been captured by less than scrupulous individuals or organizations and are being used to send spam. I have received emails from store@thebodyseries.com that were NOT from me! I am looking at how to handle this situation – I don’t like getting spammed as much as the next person – and – I have never and will never share your email addresses with any other organization.

Onto the question of the week! You might want to reread the last blog post – as there was some great feedback from other readers. Thanks, Nancy (a retired orthopedic surgeon) for your contribution to the conversation about plantar fasciitis!

My daughter is 12 and had a labral tear of the hip three years ago from a gymnastic related trauma. She had arthroscopic surgery 1 and 1/2 years ago and she is still experiencing pain. Her orthopedic says her joint is perfect, though her capsule may be still tight, so we are doing joint mobilization exercises. Her PT says the pain is probably most related to her growth spurt. Do you have any recommendations of how to live through this painful experience? I am considering deep tissue work, topical glucosamine, and/or non-traditional medical options. She is so passionate about dance, and I fear she will be so devastated if she cannot experience peace and a pain-free state soon.

My heart certainly goes out to your daughter. She has come through a challenging situation. Her PT may be right on with the growth spurt connection – and – even if that is why she is in more pain now I believe she can begin to train and reeducate the muscles around the hip joint to move without pain.

I’m not clear whether she has been in some continual pain for a year and a half, or if this just recently came on with a growth spurt, but for both situations I would give the same advice for her pain.

Let me share a very recent experience with a client. I had a woman come to see me who was in significant pain around her left hip. Whenever she stepped down on it she would have shooting pain down her leg. She was walking with a cane and as she stepped onto the left leg she would tilt way over to the left with her torso as she quickly limped onto the ‘good’ right leg. She was miserable! She did all the right things, went to an orthopedic surgeon, a neurologist, and physical therapy through the pain management clinic at Cleveland Clinic. She wasn’t getting better and was feeling really depressed and desperate.

We worked first on my table and then in standing – my instructions to her were to move slowly and smoothly only as far as she did not have pain. When she was standing she had her left foot about 6 -8 inches in front of her right. She very slowly began to transfer her weight onto the left foot and it took almost 10 minutes before she could transfer her weight to the left foot without pain. (she didn’t take full weight on the leg because that would give her pain. It took another 10 minutes to discover she could begin to lift her right heel off and start to take the weight onto her left foot. We stopped and felt successful with that much. We spent another chunk of time working with getting herself from her side to a sitting position without pain as she has to do getting out of bed.

She discovered that there were ways for her to move with good anatomical alignment and not invoke the pain. Her pain pattern had become so ingrained with fear as well as compensatory patterns that muscles were in spasm and turned off without her knowing it!

Two weeks later she walks into my office still with cane in hand but totally upright and without pain! I was so inspired! She was so happy – and couldn’t believe her pain level had decreased so much in such a short period of time. She still had pain – especially when she tried to move too quickly, but I feel confident, in time, that too will go away.

I share this story with you to describe the potential for somatic education to repattern movement. I was working with her similar to what a Feldenkrais or other somatic practitioner would. I use as a textbook in one of my college classes, Thomas Hanna’s Somatics: Reawakening the Mind’s Control of Movement, Flexibility and Health. It is a wonderful read – I recommend it strongly. You could explore the following websites to find a somatic practitioner in your area.

http://somatics.org/about or http://www.hannasomatics.com/training/index.php or http://www.feldenkrais.com

It might be that everything with the structure of the joint has been fixed – and now your daughter needs to re-pattern her movement from any less than optimal compensations that occurred from the surgery and pain of the labral tear.

As a side note – I have used successfully used plain MSM cream that I get from richdistributing.com for decreasing inflammation and adhesions – and always keep some on hand.

Best wishes for a speedy recovery for your daughter!

I’ll close with a quote from Thomas Hanna.

“Somatic Exercises can change how we live our lives, how we believe that our minds and bodies interrelate, how powerful we think we are in controlling our lives, and how responsible we should be in taking care of our total being.” —Thomas Hanna

Be well!

Deborah

“Education is the key to injury prevention”

Plantar Fasciitis

Dear Deb,

I am a dance teacher and teach 23 hours a week. I have plantar fasciitis and can’t seem to get rid of it. I’ve been stretching, icing, rolling my feet on tennis balls, wearing tennis shoes in all dance classes, wear insoles recommended to me by my chiropractor, gotten my feet adjusted and put electric stim through them, and taped my feet daily. I’m still in pain. This began in Nov. I was just wondering if you had any other ideas. I appreciate any advice you can give! Thank you! Kelly

You are certainly doing everything right, Kelly. Following a textbook rehab process for plantar fasciitis.


For those who don’t know what plantar fasciitis is – it is an inflammation of the plantar fascia that is on the bottom of your foot. Fascia is a sheet or band of connective tissue that surrounds muscles and binds cells together. In some areas it is thin, like the fascia under your skin, and other areas quite thick, like on the ball of your foot.

Tom Myers wrote a wonderful book called Anatomy Trains, which looks at the myofascial meridians of the body. He proposes there are a series of myofascial lines of that travel through the body. For example, the superficial back line begins with the plantar fascia at the foot, goes up the back of the leg, continues up the muscles of the spine and ends over the top of your head at the eye sockets. Tension in any area along this line will influence the whole.

I know you are already rolling on a ball to help release the plantar fascia. I would tell you to do that as well! Let’s see if you can find other areas that may be influencing the plantar fascia. You didn’t mention if you had plantar fasciitis on one or both feet. When you have it only on one foot I always take a very careful look at the pelvic/torso shifts, and for any potential leg length differences. If it is on both feet, then pick the side that seems to be a little worse.

Before you roll the ball under your foot, try sitting on the floor and placing it underneath the thigh. Press the hamstring gently into the ball to encourage release. When you are in a tight area, slowly, slowly flex your foot. Very slowly – take 4 very slow counts to flex it. Do that a few more times under your hamstring, before doing the same thing for the back of the calf. Place the ball under the calf to massage it, but then also taking the time to do very, very slow flexing of the foot while the ball is still under the calf.

Now stand up and see how the foot feels. Is there any less pull on the bottom of the foot? Hopefully so!

Now you want to stand with your back to the wall and place the pinkie ball along the same side of the spine of the leg you were just working on. One spot might be right along the spine somewhere between the shoulder blades. You are leaning on the ball with your feet securely placed about a foot away from the wall, or whatever distance feels comfortable. Now with the ball staying in one spot along your spine, gently and slowly, very slowly drop your head towards your chest stretching the muscles along the side of the spine.

You can repeat that a few times at other spots along that same side of the spine.

Now recheck how your feet feel. Do you feel any less strain at the feet? This is a good exploration for dancers even without plantar fasciitis. It always astonishes me the detailed relationships between body areas. You just explored releasing tension along the superficial back line of fascia – without ever touching the plantar fascia itself – and yet – the plantar fascia most likely has been helped.

If this made a difference to how you feel in standing and walking, Kelly – it might be useful to find a massage therapist who specializes in myofascial massage. In addition, I would encourage you to continue exploring and releasing any tension you might find above the level of the foot. This may mean that you need to make some changes in your movement dynamics like the speed of your walking.

If you find you can walk more easily and without as much strain by walking more slowly than you normally do – then you need to become aware of your speed and try to walk slowly and easily, allowing the foot to roll without pain, and the weight to transfer firmly yet smoothly from one foot to another.

Please let me know how you do with these suggestions – and I’m also always eager to read your comments if you care to leave them.

Warmest regards, and hope everyone has a wonderful week!

Deborah

“Education is the key to injury prevention”

Peroneal Tear

Hope everyone has a Happy Valentine’s Day!

Hi! I’m a musical theatre major at Texas State Univ. I’m 19 years old and have been dancing for about 2 years, ever since I decided to major in Musical Theatre. I’ve taken mostly ballet, with a few jazz courses here and there. I’m still somewhat of a beginner, yet I have good facility, and the potential to be a great dancer.

Aside from all of this, I’m also very athletic. I weight train 4-5 times a week, working with a trainer.

Earlier today, I went to the gym to weight train. I was going to do squats, so I made sure to stretch my legs sufficiently. I usually do a stretch routine of about 15-20 minutes before getting into any workout. I was all stretched out, and ready to start the squat machine. However, I felt that I needed to “warm up” a little more, and told my trainer that he could go to the bathroom while I ran a lap around the track.

I began to run, and 3 steps into it, I had an improper landing on my left ankle, causing the foot to roll in. I heard a SNAP! And I was unable to walk anymore…

My trainer came and asked me what happened. I told him that I landed wrong and snapped something. He then went and got ice to prevent the swelling in my ankle.

To make a long story short, I went to a physician here at school that checked all around the ankle. She diagnosed me as having injured my peroneal tendon. She said that it didn’t seem too dangerous, and that I would have to stay off of it for a while. She also wants me to go see a therapist for recovery.

My question is this: Will I be able to dance professionally (not necessarily in a corps de ballet, but on Broadway.)? How will this injury affect my ballet? I know that the peroneal tendon is vital in the execution of certain steps/exercises, but do you think that this will have long-term effects?

Thanks in advance, Joseph

There are 2 peroneal muscles, the peroneus longus and peroneus brevis. They run along the outside of the calf with the brevis attaching to the 5th metatarsal, and the longus continuing under the foot to the first metatarsal.

The peroneal muscle is strained when you sprain your ankle. Often a peroneal tendon strain happens exactly as you described where you land on the outside edge of your foot and roll over on it. It is common to hear a pop or a snap with some immediate swelling occurring.

I’m glad to hear the physician feels it was minor, and I’m imagining you are walking with either an elastic bandage to help keep swelling down, or perhaps if it was a more severe strain you may be using an air cast or lace-up ankle brace. Ibuprofen or an anti-inflammatory may have been prescribed as well.

It is a very good idea to see a physical therapist for rehabilitation. You will need to strengthen the peroneal muscle and to work on improving proprioception at the joint. (Balancing exercises).

Balance, even for non-dancers, needs to be addressed regularly. The only way to improve balance is to practicing balancing. The only way to maintain good balance is to continue practicing. If you don’t use it – you lose it! (This is a major problem in our elderly population)

Everyone recovers from an injury at a different rate. How long it takes you to return from this injury depends on the severity of the strain. It could be a couple of weeks to a couple of months.

Your first goals are to walk straight ahead without limping or pain, then to have equal strength to the uninjured ankle, as well as equal range of motion as compared to the uninjured ankle. As your balance and strength improves you will challenge it more – but don’t be in a hurry!

This injury not only has to keep you from a professional career – it is very possible that because of this injury you will ultimately be stronger and more balanced in your movement. When you are working with the physical therapist or trainer they will evaluate your gait and look for other asymmetries that may have been contributing factors to this injury. Don’t worry, focus on each gain, and keep a strong mental intention about your full recovery. Peroneal strains can be a temporary set-back, but typically not a permanent problem.

On with the dance!
Deborah

“Education is the key to injury prevention”

Abdominal Strength

Dancing Smart Newsletter
February 1, 2008

Greetings! I hope 2008 has gotten off to a fabulous start!

Question of the week…

I have a question about abdominal strength. The studio I teach at recently had several students from another studio move to our studio. It’s very apparent that the training they have been receiving at this other studio is sorely lacking. One of the major problems I’ve run into with them is abdominal strength or lack of it. In ballet, I will tell them to pull up the front of their abdominals, but when I place my hand on their stomachs, I feel nothing. I don’t think they even know where or how to engage the abdominal muscles. Besides them doing abdominal strengthening exercises, can you recommend any specific ideas for ballet class?

Thank you, Sarah

Excellent question, Sarah! I want to first say that even when dancers do sit ups or crunches on a daily basis it doesn’t necessarily mean they will use them efficiently during the dance 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.

If you are standing still or sitting in a car and engage your abdominals, you are doing an isometric contraction because the distance between the two ends of the muscle aren’t changing.

I teach my students that if they learn how to engage their 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.

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.

I’m not opposed to doing extra strengthening for that area – it might help them become aware of the state of their abdominals. Half sit-ups or sit backs, leg lowering, and any of the Pilates exercises are excellent for getting them in touch with their abdominals. Slouching alignment and poor sitting habits outside of class promote weak abdominals.

The challenge is that good abdominal usage in dance means good coordination between their breath and their core strength. Once they understand that using your abdominals doesn’t mean the whole area is rock-hard will help them engage them more appropriately.

On with the dance!

Deborah

“Education is the key to injury prevention”

Knee Pop and Long Leg!

Greetings!

After reading your letter about the popping hip, I was wondering if you could shed some light on a problem that I have been having. I have been having a popping sensation at the back of the knee. After x-rays and an MRI, I visited an orthopedic that told me that “he doesn’t know what to tell me”, he thinks it is my hamstring. The popping started back in October and since then has for the most part gone away, but there are times that I can still feel it “pop” or get a sensation as though it needs to pop. Do you have any ideas or suggestions that I can try? I guess I need to tell you that there is no particular exercise that bothers me, most of the time it happens I am just walking!

Thanks! Nancy

Good question – and – I’m happy to hear that the ‘pop’ is slowly going away. It’s not unusual at all to find that the lateral hamstring is tighter than the others. For women, it has to do with the width of our hips and potentially tighter iliotibial bands. (The IT band connects from the muscles on the outside of the hip and runs down the outside of the leg to below the knee)

Are your IT bands tight? If so, I would work with a foam roller along the outside of the leg as well as the front and back.

Some dancers have some natural rotation that occurs at their feet while walking. You want to keep the hip/knee/ankle in alignment when walking, and that usually means facing straight ahead. You might note if the times you are noticing the pop if you are wearing shoes that perhaps shift your gait. I see dancers walk more turned out while in heels, for example.

It is amazing how often a favorite pair of shoes can be traced to some small tweaks and pulls. I’m not saying that is what created your ‘pop’ but simply when there is something going on that isn’t a straight forward cause/effect – it is useful to broaden our observations to look for less common influences.

Next question…

I have a big problem standing in fifth position. I cannot seem to straighten my legs and still maintain a closed fifth position, mostly because one leg is insanely longer than the other one! My teachers are always telling me to straighten my legs and I just can’t seem to do it. As a result, I grip my quads a lot to try and keep a straight fifth position. Then my teachers tell me to lift up and turn out to keep me from gripping my quads, but then I can’t keep from tucking under. Will I ever be able to have a straight fifth with my uneven legs? What should I do?
Thanks! –Kelly

There is a simple solution to this problem, Kelly. That is to get a lift to put in your soft slippers of the short leg. I have seen this problem before when the dancer comes to see me and is having some knee, hip, or ankle problems on the long leg side.

If there is enough difference that you cannot easily cheat your 5th (I’m not encouraging anyone to cheat anything) that tells me you are standing unevenly between the two legs even in open positions.

Stand in first position facing the mirror. Slowly lower into demi plié. Do you shift to the longer leg side at the bottom of the plié? Now put something small – less than a half inch in thickness under your short leg. Repeat your demi plié. Does it look more even? How does it feel?

If it feels significantly better it would be worth going to the drug store and purchasing a pair of heel cushions and place one of them in your soft shoe. It is an inexpensive fix. Take the other lift and put it in your walking shoes and notice if you feel more evenly balanced as you go through the day.

Warmest regards,
Deborah

Are My Knees Straight?

Greetings!

Using a blog for the newsletter has gotten thumbs up! Thanks to all who emailed or posted a comment. Let’s go right to the question of the week!


My ballet teacher told me I sometimes don’t straighten my legs in élevé as much as I should. She said I needed to tighten my quad muscle. I thought I was doing that. What muscle is she talking about exactly? She said it is above the knee. Is that all I need to do to have stick straight legs? Is there any other way to keep my knees straight at all times?
Thanks, Val

I’ve got a couple of thoughts, Val. One is that you might have some weakness in either the quadriceps muscle or the calf muscles, or both. The quadriceps muscles are hip flexors and knee extensors. That means they bend the thigh towards the pelvis and they straighten the knee. Here are pictures of the quadriceps muscles and the calf muscles. In the picture of the calf muscles, the gastrocnemius muscle has been cut away so you can see the soleus muscle underneath.


Start by standing in parallel, sideways to the mirror. Are your legs straight with the knees in line with the hips and ankles? You don’t want the knees to be behind the middle of the hip and ankle because they would mean they are hyperextended, and you don’t want the knees in front of the middle of the hip and ankle, because that means they are slightly bent.

I’m assuming that when you are just standing still – your legs are
straight. Now slowly start to rise onto the balls of your feet. As you rise, do your knees bend at all? If so, there is some weakness.

To address the weakness you can do two very simple strength exercises. The first is to stand at the barre on one foot and do slow single leg relevés and élevés. Make sure you aren’t gripping the floor with your toes when you do so. You can do them in parallel and in turnout.

The second exercise is doing very small single leg demi pliés, both in parallel and in turnout. You again don’t need to lower very far, or do very many repetitions before you notice the quadriceps tiring. If your thighs are sore the next day then that is a sign that you overdid the repetitions and pull back some.

The other comment I want to make is that knees come in all shapes and sizes and sometimes the shape of your knee makes it look like they aren’t straight. If you have knobby knees like the picture of a very famous actress that is shown below – they may not look straight when they are.

One way to see if you have a structural problem with straightening your knees (and I have only seen a few people who couldn’t straighten their knees) is by lying face down with the only the lower part of the leg off the table. Notice in this picture that the right heel is higher than the left? This is a sign of a more significant contracture in the muscles – or a structural concern.

Again, if you can stand with straight legs – or lie down with your legs straight, then you need to focus on strengthening the muscles around the knee and ankle for your élevé and relevés. Good luck!

Until next time,

Warm regards,

Deborah

“ Education is the key to injury prevention”