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Flattened lower back: Structure or Habits?

I have a student who has experienced some lower back pain. She had x-rays taken and was told that 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. 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 do I need to be concerned with during class? Thanks!

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? Then I would look at their alignment and movement with a more critical eye, noting their asymmetries and patterns. (Remember – everyone is asymmetrical!)

All bodies, including the prepubescent ballet body, should have 3 curves in the spine. 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. It is not accurate to judge spinal curves by the shape of their muscles and buttocks. Look at their alignment by analyzing where the centers of the ear, shoulder joint, hip, knee and ankle joints are.

I have seen young ballerinas work hard to make their neck absolutely flat. They pull their chin back and down. It’s a look they are trying to achieve. They don’t understand that lengthening the thoracic spine typically brings the head into alignment. Having the cervical curve flattened influences the other spinal areas. It must – they are connected!

I have also seen dancers try and tuck their glutes under, trying to make the lower back look less arched. As the x-ray report states, inappropriately trying to decrease the curves of the spine will narrow 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. Work with her to breath easily, allowing the ribcage and abdominals to gently expand and softly fall – without any extra muscular effort.

In efficient breathing the spine creates a ripple effect, and there will be a small movement at the head and pelvis when lying at rest on the back. This is appropriate. I suspect this student is an over-worker and probably ‘holds on’ when trying to create good alignment. It would be useful to see if this is because of inefficient muscle patterns or an erroneous idea of how to make her alignment look right.

Then I would bring her up to standing and place her in anatomical alignment 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. Do some easy demi pliés with her buttocks lightly sliding along the wall, keeping the weight on her feet between the 3 points and let her give you feedback. I often get the comment, ” I’m sticking my butt out” but if they could watch themselves from the side they would see the beautiful and aligned descent into and out of that demi.

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 – help her become aware when she is 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!

to your success, Deborah

“Education is the key to injury prevention”

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”

‘Center’ strength for young dancers

I’m a captain of my school dance team and our younger girls seem to be lacking in mainly knowing their center, their strength there and how to hold it (as well as their strength in general). I was wondering if you know of any exercises that could help?

Thanks, Rebecca

Great question, Rebecca! And a very hard one to answer. There are many abdominal strengtheners that are out there for you to do as a part of your training of your younger members. Exercises such as leg lowering, or physioball situps, even the regular ‘crunches’ will help to develop strength to the abdominal muscles. What they don’t do though, is help to train the young dancer on standing and moving from a powerful core. That requires that they learn how to move in good alignment and at their full height.

Here’s a few tips to help them explore what that feels like.

The simplest and quickest cuing I’ve found to get someone to lengthen their spine is to place their own hand on top of their head (right in the middle, not by their forehead or at the very back) – and then ask them to lengthen upwards into their hand. Watch them lengthen their spine and then ask them to keep that length as they move.

You’ll need a theraband for the next of tips – it doesn’t matter whether it is a stronger or lighter strength. Take the theraband and place one end under a foot (only 1 -not both) and the other end in the same hand. Grasp along the theraband so as you bend your arm and get tall at the same time – there is a light pull on the theraband. Feel how the abdominals are engaged – not in an aggressive fashion – but in a long and firm fashion. Do a demi plié on one leg keeping a light pull on the theraband.

Now transfer the theraband to your other hand so you have a diagonal pull and again notice how that wakes up your middle area as you align your body and do a few demi pliés on one leg. Then put the theraband under the other foot and do the same thing again, first using the same arm as leg before switching hands.

Another easy exploration is to take the theraband in each hand and gently pull your hands away from each other as if you were going to open to second position with your arms (to the side) now keeping a small pull walk, gallop, skip, or move in anyway you’d like. In order to keep that gentle pull between your arms you will have to engage your core as you move.

These tips will help to teach a dancer what it feels like when they are using their core. It takes strength to stabilize a properly aligned body – and my college students have often had ‘aha’ moments after trying these exercises. I’ve even put loops in one end of a theraband and put their foot in that – and then putting the other end of the theraband in either hand – had them explore how many ways they could move keeping tension on the band. That is a fun exploration!

Once they have the idea that alignment and core strength go hand in hand – I think whatever they do to physically strengthen their core will have a much better chance of being used as they are moving.

I know they are lucky to have you as their dance captain!

Warm regards,

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”

Longer Leg & Plantar Fasciitis

Greetings!
I’m sending this from the beautiful TCU campus where I have been teaching an intensive course this week to the dance dept. There is nothing like teaching to a group of students who are eager and avid to learn all they can to improve their technique. And an extra perk is the Texas sun and warmth – It’s going to be hard to go back to Ohio weather!

Quick reminder that registration for Lisa Howell’s Perfect Pointe Workshops ends today. Register at http://theballetblog.com/index.php?option=com_content&task=blogcategory&id=67&Itemid=152

Onto the questions of the week!

Thanks for creating such a valuable resource. I attended your session at the Dance Teacher’s Conference in New York back in August and found your information so helpful. One of my legs is a little longer than the other. This does affect my ballet dancing, particularly my turnout and jumps, etc.. I’ve also noticed that the longer leg is a little more weak than the other. Are there any exercises I can do to help? I am new to your newsletter so please forgive me if you have already addressed this issue. Thanks, Jennifer

Jennifer, if your legs are structurally at different lengths it can influence your alignment. It’s tricky to decide whether or not you should insert a small heel lift in your soft slippers. Your spine needs to be looked at to evaluate it’s curves and response to the shorter leg. Sometimes the spinal curves become less when the pelvis is balanced by putting a heel lift in – other times it might make your spinal curves worse, in which case you would not correct the leg length difference. I would suggest you see a PT or sports physician who could do an assessment of your spine and leg length.

aThere are some common patterns with uneven leg length – some of which you have referred to. When you look at the picture on the left you see the dancer has a pelvic shift right, torso shift left. The common pattern is to stand on the long leg, because to stand with more weight on the short leg would require you bend the long leg. You can see her left leg is the shorter leg.

Typically you come down heavier on the short leg side on each and every step. Sometimes dancers prefer to stand on their short leg and use their longer leg as the gesture leg – although I have seen the opposite preference also. It certainly can influence the turnout too. More often I see the long leg side having more challenges with turnout. It is easy to understand that you’d prefer to stand on your long leg and put your shorter leg in front in fifth position.

The dancer in this photo improved her alignment by putting a lift under her left heel. It evened out her shoulder line as well as equalizing the amount of weight through both legs. She put a lift in her every day shoes – as well as in her soft slipper. For modern dancers sometimes it is enough to have a lift in your shoes – keeping the musculature working evening for the majority of the time, then dancing barefoot without a lift.

There aren’t any special exercises I would offer to you to even out the two sides, rather I would encourage you to have an evaluation to see if a lift would be useful, and then do your stretches and strengtheners in such a way that you are working to balance out the 2 sides. If you find the muscles around the right hip tighter, but weaker, then do more stretching and strengthening on that side. Don’t feel you need to do your workout exactly the same on both sides. It is very common to have one iliopsoas muscle tighter than the other and I tell people if you only have time to do one side – do your right side, as many times as you can throughout the day. Then as the two sides feel more even, you can reflect by stretching more evenly as well.

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I have a student who is complaining of her arches and ball of the foot hurting when she rolls up to pointe. She has fairly flat feet and either tight calves or short Achilles tendons – she does not have a very deep demi-plie. She also tends to roll onto the outside of her pointes. Any ideas as to what can be causing her pain (plantar fasciitis?)? Courtney

heelpa2You’ve hit upon some of the reasons in your question. Having overly tight calf muscles will pull on the plantar fascia, and encourage such standing patterns such as standing slightly forward onto the ball of the foot. That decreases the pull slightly, but over time, certainly doesn’t help to get a deeper plié.

You didn’t indicate where she felt her pain when she rolls up to point. Plantar fasciitis is most often felt on the underside of the foot. The diagram to the left illustrates this.

illustration_sesamoiditisIf she is feeling pain down towards the toes, perhaps she is rolling to the outside of her feet as a way to get away from the pain. It would be useful to send to her a good sport podiatrist who may be able to evaluate her feet and make sure she doesn’t have any problems such as a sesamoiditis.

Have sesamoiditis once myself I know how easy it is to simply rise a little bit more towards the little toe side to get away from the irritation and inflammation of the area underneath the big toe.

There are other reasons she might feel some discomfort only in relévé, but we won’t go into those now. My advise would be to have her get checked out and make sure there isn’t anything structural going on.

As far as deepening her demi plié, I would encourage her to do a lot of soleus stretching. Spend 1-3 minutes in the following stretch.

soleus stretchUntil next time!

Warm regards,

Deborah

“Education is the key to injury prevention”