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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”

Toeing – In

Happy Labor Day weekend! Many of you have already started back into the fall semester and others will start on Tuesday. I hope your fall is getting off to a splendid start!

Onto the question of the week….

I had the great fortune of attending your classes at the DTSC again this year. I was returning after having taken your class 5 years ago – after which I ran right out and purchased some pinky balls. Since that time, my father has taken up working out and has had many successes with that. He has had the occasional ache and pain however, to which I have recommended some of your ball-work. Although he listened, it wasn’t until the PT suggested something similar that he gave my suggestions some validity! I’m trying to get him to borrow my ballwork video that I purchased. 🙂

My question today is in regards to my daughter’s feet. At an early age, watching her on the sidelines and even in her own early dance classes – I took notice of something funky going on with her feet. Now, age 6, I have concern still. As she has taken some ballet technique and gymnastics classes – it has become more apparent that her feet appear to turn in while in action. She can stand in first, draw her leg up to passé and keep the knee back, heel forward as long as I remind her. When her movement is stationary or sustained she understands and tries to make corrections… yet when she is dancing her feet turn in..quite a bit. A simple leap – toes turn in, a small arabesque – turned in, on the uneven bars her teacher called me over before coming to the conference because when she circles the barre – her foot turns in. I’m beginning to notice it might be in her right foot more then the left. The pediatrician looked at her feet at the 5 yr. and 6 yr. visit and has determined she is turned in slightly – but it is mild. Although she may never be a professional dancer – it is difficult for me as a dance teacher to see her little feet so turned in when she dances. Should I be concerned or not? Is there anything I can have her do at home to help? What type of orthopedist should I be looking for to look at her feet? If her feet are mildly turned in – is there any concern I should have other then dance related?

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Lovely question! Turning in of the feet or pigeon-toed can come from three different areas – at the feet, the shin bone, or the hips. Let’s take a look at each one individually.

9052When the feet turn in at the feet it is called metatarsus adductus . This is where the bones of the feet turn in. Typically, this is caught before the child even begins walking and the doctor would have suggested massaging and stretching the feet as she grew. Since it was not caught when she was really young, I would rule out this cause for your daughter’s turning in of her feet.

We have talked about tibial torsion in other newsletters, more often we talk about external tibial torsion – but there is internal tibial torsion. In dancers I see more external tibial torsion which describes an outward rotation of the shin bone. I often find this in dancers who aren’t using their turnout from the hips, but rather are turning out from the knee down. Over time, that stress from standing in too much turnout creates a rotation at the bone that one might think is a good thing – but actually, it means that your knees and the feet won’t be lined up and leaves the dancer vulnerable to knee and ankle injuries.

202b.Par.0001.ImageInternal tibial torsion, which your daughter might have is where the shinbone rotates in making for a pigeon-toed walk. This isn’t unusual in toddlers and preschoolers, and often corrects itself as they become more active in running and walking – the 5-6 year old stage. Sometimes toeing in lasts into the school years, but usually isn’t a problem. In fact there are some sports that favor internal rotation, such as martial arts, soccer, and sometimes basketball.

If the toeing in was happening just from the shin you could sit your daughter on the edge of a table with her knees facing forward and you would see a clear inward rotation of the shin bone – as in the picture to the right.

When the turning in is coming from the hip it is called anteversion. The normal range of turnout and turn in at the hip is 45 degrees for both. When you have more turnout it is called retroversion, when you have more turn in it is called anteversion. This is a structural situation where it describes the angle of the neck of the femur to the shaft or long body of the femur or thigh bone. If you test your daughter’s range of motion at the hip by lying her on her stomach that might give you an idea if she has some natural anteversion.

W Sitting1A child with anteversion easily W sits – as shown in this picture. It will be interesting to find out what the relationship is between the two hips – are they even as far as their range, or is one more turned out or more turned in. This is very common, and while it isn’t a significant issue, you would want a young dancer to create her first position based on the lesser turned out leg, rather than the more turned out leg.

Watching the recent Olympics and especially the gymnastics competition, I was struck by how many of the gymnasts had a slight tendency to turn in their feet on the balance beam as well as on the floor routines. No one would ever say that their line wasn’t beautiful and elongated – even if it wasn’t as turned out as what the dance world would like.

All in all, I think I would take a look at these 3 areas on your daughter, see if you can get a better idea where her toeing in is coming from – and then encourage her to be as well-rounded and active in all ways as possible. At 5-6 years of age, I’m prone to suggest going light on the amount of turnout emphasis and focus on the alignment of the hip, knee and foot – which is what you are already doing. Since she can do that when she thinks about it – my intuition says she will improve her ability to automatically line her legs up as she gets older and better able to maintain that specific focus during class. Now you have a way to periodically assess her range of motion and know better where to focus her attention.

Below are pictures of what normal turnout would look like, a retroverted hip (excessive turnout) and an anteverted hip (more turn in than turnout)

Normal ext RotNormal amt. of turnout – 45 degrees

 

 

 

Retroversion t-oRetroversion – more than normal turnout (leg is resting on other thigh)
Anteversion: more than normal amt. of turn inOLYMPUS DIGITAL CAMERA

Until next time,

Be well,

Deborah

“Education is the key to injury prevention”