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”