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Working with Tibial Torsion

I just returned from teaching an intensive course at TCU after a 2-year hiatus, due to the pandemic. It was WONDERFUL to be back teaching in person… even with a mask. This course starts with individual assessments before delving into essential anatomy. Love love love teaching it!

Anyways, there were quite a few students with tibial torsion who didn’t know they had tibial torsion… but were aware of always being told to get their knees over their feet! They were aware that parallel was challenging because during demi pliés, their knees felt like they were going to knock into each other. In first position, they had to pull their knees out over their feet, and were often also lifting up their arches as they were doing so.

The students began to understand that they needed to focus in 2 places, their feet and their hips, to work with their tibial torsion.

They began to monitor the weight on the feet, noticing whether or not it was even between the 3 points of the feet. (The heel, pad of the big toe, pad of the little toe) When the knees are being pulled out over the feet you will notice the weight shifting to the outside of the foot.

They need to temporarily reduce their external rotation at the hip while they work to turn on the turnout muscles appropriately. It is a common pattern to underutilize the rotators on the side with more tibial torsion.

Some of them found that they caught themselves pronating the foot on the side with less tibial torsion. (Monitoring the weight on the feet is always a good idea!)

As they got better with monitoring their hips and feet, their pelvis was better aligned. Why? Because an anteriorly tipped pelvis often goes hand in hand with underutilizing the rotators (and hip extensors) If the pelvis is slightly tipped forward it is easier to turn out the feet without straining the knees.

IT’S ALL CONNECTED!

Tibial torsion doesn’t have to get in the way of being an exquisite technician as long as students are smart about how they work with it. In fact – having the extra external rotation makes their first position look extra sweet, and won’t get in the way, as long as they work the rotators appropriately.

Tibial torsion often is created during growth spurts when the student is turning their feet out more than what they can accurately and efficiently create at the hips. The tibia responds to the force by rotating. It is SO common to see one leg with more tibial torsion and it almost always connects with less access to proper turnout at that same hip. While the student can’t un-rotate that bone, they can correct the way they are using their turnout.

It’s so rewarding to teach students about how their body works. I watched the lightbulbs go off – as they connected their patterns with their technique and their teachers’ corrections. When they shared their insights I clapped my hands in delight and had a huge grin on my face. It’s the best feeling – as I’m sure my fellow teachers would agree!

Below is a clip talking about tibial torsion from some years ago (I miss my dark dark hair:)

Enjoy!

External Tibial Torsion

Virtual classes

Hello all! I received a jam-packed full of good idea email from Ruth Ziegler answering my question of what do you do to keep yourself sane and hopefully less exhausted from teaching virtual dance classes. Her response is below… Thank you Ruth!

Great topic and so relevant!!!  I teach mainly adults – some very advanced, needing to get back to performances (hopefully) later on this summer and some not as advanced but definitely wanting NOT to lose strength, flexibility and technique.


I have been reading the information that is available through my teacher and dancer wellness groups about the dangers of trying to do a class “full out” while in limited spaces, on less than ideal floor surfaces.  I am very grateful for the generosity of many very skilled teachers, in giving sample classes, advice, suggestions, etc. 

Here are some great resources I have found: 

At Home Barre Class


Barre and Center Work from Pacific Northwest Ballet: 


I have a theme for each class I present – using the best music I can find, that goes with each theme. One week we did a mainly Russian inspired class and I sent out the reminder email about the class with some of the email written IN RUSSIAN Emoji No, I don’t speak Russian but I was able to find a translation of the phrases I wanted and I just did that.  We used some amazing Russian music and I took inspiration from this teacher: 

One week, we did a Broadway inspired class, using music from Cats, Cabaret, Sound of Music, Chicago, and incorporating  more contemporary types of ballet choreography. 

The technique classes are 90 minutes long and I spend a longer than normal amount of time at the barre or whatever support dancers may have. I include at least one or two exercises for turning and at least one exercise for petit allegro.  I even have a very safe “face the barre” build up for saute arabesque and cabriole derriere. 

I may start the class with a safe center floor “get moving” flowing sequence that I learned from Dmitri Kulev, Artistic Director of DKCBA.  Or … with advance notice, I will have dancers get out their large stability balls and we will do a few dancer- specific stability ball exercises before going to the barre.  We will repeat an exercise at the barre at a faster pace, to get the heart rate up, while staying very safe and not jarring knees, ankles, etc.  We will do the opposite for things like adagio – once at a normal tempo and then again at a slower tempo, to work on strength and stamina.

In the center, I have dancers do exercises that feel like the “real deal” but are safe.  We do tendus and degages with either a sustained balance or a pirouette, pas de basque, lots of waltzy things, very soft “pillow” jumps (ie. I ask dancers to work on the bounce and suppleness of the landing from a jump and not the height or strength of the jump), I have exercises for spotting, and of course we can always work on musicality, artistic expression, etc.  I always include an exercise that feels like a big jump but isn’t, and always include a formal reverence. 

Anyway ….. I STILL find it really hard and I am just exhausted after explaining, demonstrating, and dancing all the combinations in the classes.  I have a larger viewing screen but I still can’t really see all my students clearly.  That is quite frustrating.

Thanks so much for your generosity as well.  I am really enjoying the FUNctional Anatomy videos, as are my students!
Happy and safe dancing, Ruth

Thank you Ruth!

To your success,

Deborah

A Somatic Perspective on Ballet

I’ve returned from TCU where I annually teach an intensive course for their freshman dance majors.  What a pleasure it is – (and what an amazing new facility they have after massive renovations last year!)  My good friend, Elizabeth Gillaspy is a professor of ballet at TCU consented to sit down and allow me to tape a conversation with her.  The first are her thoughts for new ballet teachers and the importance of exploring teaching methods and ideas beyond ‘look like this’ – which is understandably the most common way we all began in our early ballet education.  (The clip is approximately 10 minutes, so it will take a minute or 2 to load)

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This second clip is discussing how important it is to explore the ballet form from a somatic base.  This conversation took place because of my appreciation of how Elizabeth can take young adult dancers and so lovingly help them make changes in their technique.  It is hard to rework patterns of turning out from the knees down, or muscling your way through an exercise – and Elizabeth does it beautifully.  Here are some of her philosophical thoughts on how looking at ballet as a somatic practice.  Be patient, as it is about 10 minutes it will take a few moments to load!

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Too old for pointe?

What is your feeling about adults (20’s and beyond) dancing on pointe?  Some people (dancers and teachers) feel that adults cannot be successful on pointe, and that, indeed, it is risky because of their “advanced age”.

I have a group of 30-45 year olds who do quite well, thank you very much.  They are strong, take many classes a week, and cross train with Pilates, etc. outside of ballet class.  These ladies are doing double pirouettes, some of them are doing fouetté turns, hops on pointe, etc.  They love dancing on pointe.

Are there any studies you know of that link additional risks associated with pointe work due solely to age?

I’d love to see the topic of myths and misconceptions about older dancers dealt with on your site, as well as tips for dancing safely as the years go by.

Thanks so much!

Ruth

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Great questions! Margot Fonteyn danced the role of Juliet at age 43.  Did she do it in her bare feet?  I think not☺ She did it in pointe shoes.

As is the case with most physical activities – how you do it  – is more important than what age you do it at.  I remember hearing when I was growing up that running will hurt your knees.  (tell that to the 69 year old woman who took up running and did her first marathon shortly after)

I also grew up with the idea that all dancers will get ugly feet and arthritis the longer they danced.

Why?  Because the majority of my teachers talked about their aching feet, I saw their huge bunions, and listened to their complaints of how their hips hurt!

Not a very pretty picture of aging dancers, is it?

Alignment and muscle balance are keys to optimal functioning in any chosen physical activity.  Your group of 30 – 45 year old dancers sound like smart dancers by cross training outside of dance class and maintaining a good relationship between strength and flexibility.

In fact, I would venture a guess that the older dancer is even more particular about their training over the late teen, early 20’s ballet dancer who feels more invincible and much less concerned about the physical effects of poor training – especially if they have accepted myths such as bunions are inevitable.  (Which they aren’t – sorry for my bluntness)

If your older dancers are paying attention to their alignment and proper training and conditioning for pointe work they can work as long as they choose to – or until other challenges such as osteoporosis might crop up.  On the other hand, continuing to dance is a great way to decrease the chances of osteoporosis along with good nutrition.

If they begin to have problems associated with doing pointe work they’ll handle it the same way as a younger dancer.  By checking out their alignment and technique first and then correcting any muscle weaknesses (Lisa Howell’s, The Perfect Pointe book is a fantastic resource for teachers and dancers.  You can purchase it through my website .

There are other interesting aspects to challenging yourself as you age.  The Berlin Aging Study looked at men and women over the age of 70.  This research was looking at how people feel about aging and comparing that to their vitality and resiliency.   Your older dancers (although not truly very old) are engaging in an activity that makes them feel younger and better about themselves!

In unpublished research based on the Berlin Aging Study, they found that people who feel younger are less likely to die than
those who don’t, given the same level of chronological age and equivalent physical health.

“Feeling positive about getting older may well be associated with remaining active and experiencing better health in old age.” “Thus, studies on self-perceptions of aging can contribute to our understanding of potential indicators of resilience in older adults and the aging self.”   (http://www.sciencedaily.com/releases/2008/12/081202153521.htm)

Bottom line – continuing to dance is good for our bodies, mind and spirit!  Your dancers will know when to hang up their pointe shoes – and it doesn’t sound like it is quite yet!

Deborah

“Education is the key to injury prevention”

PS:  Remember any order this month will receive a FREE copy of Tune Up Your Turnout:  A Dancer’s Guide or if you order an ebook or downloadable product, I will see a FREE copy of the 440 page Dancing Smart:  Tips to Improve your Technique

50% off on select DVD’s until midnight, January 4th!

Happy New Year!

I was sitting at my desk this morning reflecting upon the past year and setting new intentions for 2009. I am so grateful to have my dance community. As teachers, nothing makes us feel better than to share our knowledge with others, it is a win/win situation.

I thought about how wonderful the past week was with having my 3 children at home (plus a few of their special friends☺ I scaled back like many of you have, and yet this holiday season was one of the nicest ones in years because I wasn’t so stressed about doing it right. Fewer gifts and more laughing…

The kids and I had some good home-cooked meals (the African curry turned out super!) and played Cranium and Mad Gab, and my all time favorite card game ‘May I’. (It’s a Vogel tradition – I’ve played it since childhood – a type of rummy)

As a thank you to you, my appreciative dance community, my DVD’s are now half price – 50% off – until midnight PST, January 4th. My intent is to help you start the new years off right – with affordable and to the point (no pun intended) information to help you become even more amazing dancers and teachers than you already are.

When you go to the http://www.thebodyseries.com to order your DVD’s, the sale price will be reflected accurately in your shopping cart. There are 5 DVD’s being offered at half price

* Analyzing Turnout
* Analyzing Arabesque
* The Standing Leg
* Ballwork: Releasing Muscular Tension
* Strengthening the Lower Extremity

Perhaps you can round out your collection or give a gift to a special dancer.

When you are at the website, check out December’s Dancing Smart blog postings in case you didn’t catch one of the 7 posts! Make sure to listen to The Science of Dance Training podcast that Lisa Howell and I did together just before Christmas.

Most of all, please accept my warmest wishes for a peaceful, abundant, healthy and dance-filled 2009!

Deborah

“Education is the key to injury prevention”

Utilizing Turnout without tucking under

Greetings, everyone, and Happy New Year! May 2009 be the best year ever!

I’m wondering if you can help me with turnout. I understand the concept of turning out using the small rotator muscles underneath the buttocks, however every time I engage them, I can’t help but to engage my gluteus maximus also – which doesn’t benefit turnout. If I let go of my core I can relax these bigger muscles while maintaining turnout, so I’m wondering if this is an issue with how I hold my center more than turnout?
Thanks!
Emily

Congratulations for knowing that the turnout muscles are smaller and deeper – underneath the bigger gluteal muscles!

Whether or not the gluteal muscles contract depends on what the movement you are doing. The gluteus maximus is a powerful hip extensor – it takes the leg backwards and stabilizes the pelvis on the legs. They actually assist your turnout when you take the leg behind in a back tendu. If you are standing in first position and do a cambre forward and backwards, the gluteals will contract strongly when you cambre back.

When you are doing a demi plie, though, the gluteal muscle should not be contracting strongly because you are flexing the hip. If you contract the gluteal muscles when you are doing a demi plie, you will tend to tuck the pelvis under – not a desirable action.

So turning on the gluteals is almost automatic when you take the leg behind you – but how do you turn them off when you are moving your leg to the front or during the descent of a demi or grande plié?

One of my favorite exercises for teaching dancers where their turnout muscles are is to have them lie on their side with their legs bent with their knees forward and feet in alignment with their hips. Placing one hand on the top buttock area, slowly open your top knee like a clamshell keeping your feet together. If you do a set of 20 lifts (remembering to slowly close the knees together) you’ll definitely feel the deeper rotator muscles working, while being able to monitor whether or not the gluteal muscles are contracting.

Another good way to practice this patterning between the gluteals and the rotator muscles is to start by standing in parallel with one foot in coupe. You’ll then stay standing in parallel and slowly turn out and open the gesture leg to the side.

It is very easy to monitor whether or not you are keeping your pelvis square through the weight on your standing foot. Keep the 3 points of the feet firmly planted on the ground and don’t let your foot ‘roll in’ or pronate!

In time, you will have changed the pattern of always gripping the gluteals – and – your range of motion and ease of movement will be better!

Until next time,

Deborah

“Education is the key to injury prevention”

Hyperextension and Pregnancy tips

Announcements!

I now have a facebook account – and I invite you all to become my friend! If you have an account just search for me…. Deborah Vogel. (there are actually 10 women on facebook with my name – but I’m the only one holding a spine:)

Also…. I’m uploading videos to YouTube! You can subscribe to my Dance Smart Channel at
http://www.youtube.com/user/dancesmart Or… just search Deborah Vogel and you’ll find me too!

Onto the questions….

I returned to ballet about 5 years ago. I have been getting some pain in my knees which was diagnosed by my physiotherapist as anterior knee pain caused by weak thigh muscles.

A new teacher at my ballet school said that my hyperextended knees would also be causing the problem. I am working with her to try and stand straight without locking the knees but I am having problems trying stand properly on one leg while working the other.

Any help that you give would be much appreciated as all my teachers have differing opinions on hyperextended knees.

I am now 28 and also suffer from pronation.

Thank you

Kirsty

The three issues you mentioned, weak thigh muscles, hyperextended knees and pronated feet all go together. The good thing is as you start to address all 3 of them at the same time your knees should start to quickly feel better!

I’m assuming your physiotherapist is giving you quad strengthening exercises – so I won’t talk about them except to say that a single leg demi plie is a wonderful strengthener! (As long as your knees and feet are in alignment)

My opinion on hyperextension is that it creates a beautiful line in the air – and – needs to be controlled on the ground. When the knees go back into hyperextension the thighbone rotates inward, and the feet tend to pronate. This definitely opposes your goal of maintaining good turnout!

It’s not easy to change a chronic habit of hyperextending the knees – but it is well worth it! You can monitor your knees from your feet, making sure the weight is equal on the 3 points of the feet. You can also catch yourself dropping into your legs (as most dancers with hyperextended knees are rather loosey-goosey) and put your hand on top of your head and press into your hand, lengthening your spine. Practice balancing on one leg (not in hyperextension) to help your nervous system learn where the center of the joints are. It will take some time to change the habit – but I have seen many dancers do it!

Good luck!

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I am just into my pregnancy and work as a contemporary dancer and physical theatre performer. I hope not to stop my work and performances until my 7th or 8th month. However I know that I will have to modify my work and I’m game for that. I can’t seem to find a good resource — a book, a detailed article, anything! — that explains what activity should be modified and how to modify the activity as time goes on. Most of what I’ve found is very
general or specific to elite athletes like runners. Do you have any recommendations?

Sincerely
Lucy

I don’t know of any specific resources to send you to, Lucy, so I will give you my personal opinion after having 3 of my own – and counseling a few friends through their pregnancy and births.

chair-psoasThe first is – your iliopsoas is going to take a beating with being pregnant. As the baby gets bigger, the pull on your lower back is significant. The one stretch you cannot stop doing is some form of iliopsoas stretching. (I actually have a youtube video on 3 different ways to stretch your psoas) The one stretch that I don’t have on this video is a sitting stretch – but here it is on the right.

Ballwork all around the pelvis will be very useful for keeping the muscles looser. As your belly pulls the pelvis into a forward tilt, the abdominals contract to counter that and the gluteals also tend to contract more than normal to keep your pelvis upright.

Continuing dancing will help keep the abdominals in good shape – and stretching and ballwork will definitely help the gluts!

Those are my primary tips for a healthy pregnancy. It goes without saying that listening to your body is key – and – it is an amazing process that you are engaged with. Typically, the pregnant dancers I’ve known have, for the most part, had easier pregnancies than non-dancers. They danced as long as they were comfortable – and easily modified their movement. (for example, rolling down the spine becomes almost impossible – so do hamstring stretches standing with your leg on a chair instead) I truly enjoyed all 3 of my pregnancies. Best wishes and…

Congratulations!

Deborah

“Education is the key to injury prevention”

Buttock Pain

Greetings!

I hope everyone’s Thanksgiving holidays were wonderful…. I am grateful to have all of you in my dance community!

The new website is nearly done…. hoping by the next newsletter it will be up and running!

Here’s the question of the week…

My daughter is 14 and has been dancing for 10 years. She started a very intense dance schedule in June. She was dancing nearly 30 hrs, a week for the summer along with a 4 day intensive. She cut back to 21 hrs a week when school started and has been doing very well growing in her dance ability until now. She takes 3 ballet classes, 3 adv. pointe classes (all 1 1/2 hrs each), 4 jazz classes, 3 lyrical classes, salsa and conditioning. She recently started having pain in her right hip where the sciatic nerve runs. A teacher of her is a certified physical therapist. She felt around and noticed the nerves on both sides were moving and the muscles underneath were knotted up. The pain stayed right there and didn’t travel so we ruled out sciatica. We have iced and heated the area for a week and rubbed out as many knots as possible. It seemed to help and then she went to a jazz class and over did it and now we can’t get the pain to stop for very long. I can feel the knots and deep rubbing seems to help but only for a while. Once she wakes in the morning it starts all over again. What if anything else can we do for it? I know rest is needed but do you have any other advice for knotted muscles? Thank you for your time, Evie

I’m glad you have a physical therapist on board to help you out. I’m wondering whether your daughter could have something called piriformis syndrome. It’s a condition where the piriformis muscles which is the largest of the 6 deep muscles that are the ‘turnout’ muscles irritates the sciatic nerve. Some people only feel pain in the buttock area (this could be your daughter) and sometimes it goes PyrAnatA108down into the leg,
which is referred pain from the sciatic nerve. The sciatic nerve typically passes underneath the piriformis muscle, but in about 15% of the population the nerve goes through the piriformis muscle increasing it’s potential for trouble.

When dancers overwork the piriformis and the other deep rotators as they are trying to achieve more turnout then can create excessive tension in this muscle which presses or compresses on the nerve creating pain depending on where the nerve lies in relationship to the piriformis muscle.

For right now, let’s treat your daughter as if she has really irritated both the sciatic nerve and that the turnout muscles are knotted up and very unhappy!

The massage you are doing is good for releasing tension in the gluteal area, as well as using a pinkie ball or a tennis ball to put between the buttock and the wall to do self-massage. With piriformis syndrome I personally would not use any heat – only ice on the area, and would have her ice as much as possible. This might be a time where a few days of an anti inflammatory such as ibuprofen could be helpful. The next thing I would do is to stretch, stretch, stretch, the turnout muscles to help them release from their painful spasm.

seatedhipstretchShe can do this in a variety of ways. To the left is a sitting chair stretch that is very useful as she can easily do a stretch or two while in school!

Another way would be the traditional sitting on the floor with the legs folded and rounding down over the legs, gently moving from side to side to feel the stretch at the back of the buttocks where her pain is. Make sure to switch which leg is in front as that will change the focus of the stretch to the other side.

Rest is the final part of the treatment program. It doesn’t mean that she would have to take off from all of her dance classes – but it does mean she needs to significantly reduce the amount of classes that she is taking. Her first goal is to be pain free when she wakes up in the morning. If her pain is reduced by pulling back – or totally off classes, then she can slowly bring more classes back in. Working through the pain at this point will most likely increase the length of time for healing – and make for some poor muscle habits as she is trying to engage and work the turnout muscles while they are tender and tight.

Best wishes for a speedy recovery!

Deborah

 

Développés

Greetings!
I’m excited to announce that TheBodySeries.com is going through a complete overhaul! I will let you know as soon as it is complete and also let you know of the holiday specials I’ll be running to celebrate the new site. Stay tuned!

Onto the question of the week

Hi there!
I was hoping you might be able to help me. I am a professional dancer and for several years I have been struggling with développés, especially when executing this step to the side. I have good range of movement in my hip and I can flex my knee and raise it to a point where my knee is almost touching my shoulder. However, I cannot maintain the height of my thigh as I try to extend the leg. My thigh and consequently the working leg, drops significantly. When shouldering my leg I can let go and hold the working leg at a good height, however I cannot maintain the height of my thigh as I reach the crucial last moment of extension in the développé. I am really hoping you can help me identify why my extensions are not as high as they might be. Perhaps I have a weakness in the iliopsoas muscles or perhaps it is my quadriceps or hamstrings which need strengthening? Any advice would be greatly appreciated!

With Thanks, Beth

Great question, Beth – one a lot of dancers will be interested in!

When doing a développé to the front or side the hip flexors are the prime movers meaning they are the ones most responsible for getting the leg up, and the hamstrings are the antagonist muscles, meaning they need to lengthen to allow the leg to go up higher. You are a smart dancer to ponder both sides of the joint! So often dancers and teachers will only look at one side of the joint, such as the hamstring flexibility when trying to get the legs up higher.

It sounds like your hamstrings are flexible enough as you can bring your leg easily up to the desired position with your hand, then release your hand and then hold it there. I’m less inclined to think there is a challenge with the hamstring flexibility.

This brings us to the front of the joint to the hip flexors. In higher extensions such as développés the iliopsoas is of primary importance at the beginning of the movement and then at the end. The strength of the iliopsoas will help hold your thigh up while the quadriceps straighten the knee.

Normally, dancers are pretty strong with their quads – so let’s have you try strengthening the iliopsoas muscle in the upper ranges of extension. I learned this exercise from Karen Clippinger, a marvelous teacher and anatomist.

Start by sitting with your left leg bent in front of you with the foot on the ground and your right leg extended straight on the floor in front of you. You are resting slightly on your hands, which are behind you. You may be slightly on the backside of your pelvis, but you are focusing on stabilizing your pelvis and not allowing yourself to roll onto the sacrum while doing this exercise. Okay – now lift your right leg up, keeping it straight, as far as is easy. You might get to the level of the other knee or you may not.

Once you have lifted it, slightly bend the right knee, bringing your thigh closer to your chest (remember – without rolling back on your pelvis!) Then once you have brought it slightly closer straighten the knee slowly (again – without rolling back on your pelvis!) and then lower the right leg to the starting position on the ground. Repeat several times – and then do the other side. It may take some days or weeks to feel as if you can significantly bring the knee closer to the chest – but you will see a difference in your extensions if you practice this.

You can also do this exercise in turnout. Even though you are keeping the legs in front this new found strength will carry over to your side développés. To make it a bit harder you could put a theraband around both knees giving yourself some resistance as you bring the thigh towards your chest and/or you could put a low level weight around your thigh – just above or below your knee – do not put the ankle weight at the ankle!

Let me know how your extensions improve!

Warmest regards,

Deborah

“Education is the key to injury prevention”