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Hyperextension and Pregnancy tips

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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”

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”

Creating Strong Foot Muscles

Hello!
Anyone besides me feeling the fast descent into fall? I remind myself to enjoy every moment of the sun and warmth during this busy time. I have a request. When I was recently in New York at the Dance Teacher Summer Conference (great workshops:) there were a few teachers who said they found good online sources for pinkie balls. If you have a source, or a website where you have found the pinkie balls – will you email me? I will post them in an upcoming newsletter. Sometimes they are hard to find – and since I’m one of the lucky ones whose local store carries them – I need your help to find out where you are purchasing them!

Onto the question of the week……

My name is Yekta, 22, and I’m a sociology student at the university of Toronto in Canada. I’m really interested in dance and I did Persian dance and ballet when I was in Elementary school. I restarted my ballet at the university from May. I have very good dance instructor because she really understood my hyper mobility particularly my hyper extended knees and she really does not push me to do lots of work. She gave me some kinds of exercises to strengthen my muscles, because, I have lots of problems in maintaining my balance in passe, arabesque and this kind of things although I’m very good at pointing my feet. I want to get your hints for making my feet muscles strong in order to maintain my balance well and less painfully. What shall I do right now? Regards, Yekta

You bring up a good point that sometimes dancers with extreme flexibility have to work harder in order to stabilize their movement. My suggestion to you would be to begin doing a lot of balance exercises. You will see definite improvement in both your balance and alignment.

bThe first exercise is a simple one – whenever standing in one place for a minute or so, lift up one foot and balance. Standing at the bathroom sink brushing your teeth, and waiting in line at the bank are examples of when you can get a quick practice session in. Make sure that when you are standing on one leg you are NOT hyperextending. I realize that it will feel as if you are standing with a slightly bent leg, but you want to make sure your hip, knee and ankle are in alignment. Standing and balancing will also strengthen some of the weaker muscles around the knee and ankle.

Then take your shoes off and try standing on your bed or a sofa cushion placed on the floor and toss a small ball between your hands for up to 3 minutes. If you don’t have a ball available do port de bras, including head movement. Standing on one leg and turning your head right and left will be hugely challenging for many people.

If you want to focus on improving strength as well as balance, practice doing small demi plies on one leg! These are baby demi plies – smaller than your normal demi plié. You should not feel any strain at your knees while doing them. If you do feel strain it means you are not in alignment. Always monitor your feet to make sure the weight is even between the pads of the big toe, little toe and heel.

Good luck!

Deborah

“Education is the key to injury prevention”

Bowed legs

Quick announcement: I’ll be in NYC for the Dance Teachers Summer Conference sponsored by Dance Teacher Magazine and MacFadden Performing Arts Media. I hope to see many of my loyal readers! The subject of my two classes will be, Conditioning the Body for Jumps and 10 Tips Towards Keeping Teachers in Top Shape.

Hope to see you August 9-11!

I have read lot about bow legged issues in ballet, seeing as how I have them myself. Only it seems I was not only born with bowlegs, but my feet naturally turn out at the ankle. (My mother has told me stories of being told to massage my feet and ankles so that they will eventually correct themselves) It leads to awkward moments when I am fussed at for not placing my weight into the correct spot. (I tend to lean out towards my pinky toe both in basic walking and in ballet)

I have tried the ankle circles with the theraband, the relevés on both one foot, and both feet. I am missing something?

Thank you,
Krystal

Bowlegs are a structural challenge versus a muscular one. It is not at all uncommon to have a dancer with bowlegs who also turns out at the ankle. That is a logical compensation the body creates to put the feet flat on the ground. As you noted, otherwise bowlegged dancers have a tendency to supinate, or lean out towards your pinky toe in walking.

(note that the right leg in the photo looks as if it is either slightly longer or more hyperextended than the left. Also note that the knees are not facing the same direction as the feet. The feet are in parallel, and the knees are turned in)

Having bowed legs does not mean you can’t be a dancer – but there are a few things I want to draw your attention to. The first is making sure you are not hyperextending your knees while standing. You didn’t say whether what your joint flexibility is –but as we have discussed in previous newsletters, when you allow the knees to move into hyperextension, the thigh bone rotates inward, and the knees move apart – effectively creating bowlegs. In fact I have worked with dancers who thought they had bowlegs – but when their legs were in neutral position and straight had the hip, knee and ankle in alignment. It was only when they pushed into their hyperextension they looked like they were bowlegged. I don’t think this is the case with you as your mother and docs were aware of your leg alignment from an early age.

The second is to focus your turnout as efficiently as you can at the hip rather than relying on the turnout created by the feet. This will help prevent foot, ankle and knee strain. You have more turnout at your feet, probably because of tibial torsion. This again is a structural issue where the shin bone rotates over time, while growing, in response to the foot’s desire to be flat on the ground.
Dancers who have external tibial torsion as you do, can ‘t line up their knees and feet well. If you try and pull your knees out to line up with your feet it shifts you to the outside of your foot – and creates strain at the outside of the thigh.

As always, I would encourage you to stay focused on where your weight is on your feet. Keep it as even as possible between the three points of the foot. Pad of the big toe, pad of the little toe and heel. Your feet are your connection to the ground and you need it to be stable. How do dancers sprain their ankle? By rolling on the outside of the foot.

It’s not so much that you are missing something with working with bowlegs – it is more that efficient alignment is even more important. You need to keep the weight of the body from dropping into your legs. This is done by making sure your pelvis efficiently lined up, with deep abdominal support and imagining your legs and spine lengthening away from the floor.

No matter what your age is, even if you are at the end of your growth, you can become a beautiful dancer by developing good muscle balance and range of motion along with efficient alignment. Just remember that the way you stand and move outside of class has an enormous amount to do with what happens inside of class and keep up the good posture even when those around you are all slouched and slumped over.

Until next time,

Deborah

“Education is the key to injury prevention”