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