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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”

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”