May 30, 2008

Dancing Smart Newsletter: 5/30/08

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Recitals are around the corner, please remember to take care of yourself!

Onto the questions of the week:

Hi. The top of my left ankle is continually painful, in an aching sort of way. It must be some sort of tendon thing. I also have arthritis in the big toe on that foot. Any helpful suggestions?

My first suggestion is to do some daily work to release any muscle tightness from the front of the calf by kneeling on a pinkie ball and massaging the anterior Tibialis muscle which is on the outside of the shin bone.

Next, I would check out your alignment of that foot. Do you have a tendency to pronate? The reason why I ask is that when you pronate the big toe takes a hit, and often a bunion begins creating an ideal arthritic situation. If this is true, try taping your foot for pronation which will lift and support the bones in the arch of your foot. If it feels better to be in a running shoe with good support I would suggest not going barefoot and teaching in a shoe with an arch or taping your feet.

If the dull ache continues you'll want to go to the physicians and get an x-ray to rule out a stress fracture or other boney problems, such as a spur. I just took my daughter in for this exact reason – and fortunately – it got ruled out temporarily – which gives me permission to work in these other ways. Although, that being said, if the ache doesn't improve within a couple of more weeks I will have more x-rays done, because stress fractures are tricky and sometimes don't show up right away.

Hoping it is an easy fix!


First of all, thank you so much for the Amazing Turnout and Arabesque DVDs. They have been extremely useful!

My question for you is: I sometimes get cramps in the foot or both feet during class. The cramps concern the 2nd to 5th toes, making them completely frozen. Can you tell me if this is because of tight extensor digitorum longus or could it be more due to tight intrinsic foot muscles? I do proper warm-up and even use a golf ball to massage the tight spots on my soles before each class. I wonder what I am missing. Can you recommend a good stretch for that?
Thanks! Louisa

You are doing the right actions to release the plantar fascia and the intrinsic muscles of the foot. The act of cramping usually happens when there isn't enough strength in the intrinsic muscles, they fatigue, and then cramp. (I'm making an assumption here that you eat well and do not have a chemical/nutritional imbalance in your body)

Sit in a chair or on the ground with your leg and foot straight and in front of you. You are going to watch your toes as you slowly lengthen through the ankle keeping the toes flexed and separated, before slowly continue to lengthen the toes while keeping them separated. At first this can be hard! Only pointe your foot as far as you can keep the toes lengthened. Once you have reached that point, gently wave your toes in the air. If you cramp during this exercise you know that you have to strengthen the foot muscles and that should cut down on the in class cramping. Of course, keep using the pinkie ball or golf ball to release any tension in the foot and calf. You can use the golf ball for the foot, but when working on the calf I would only use the pinkie ball.


I'm 34 and I've been dancing (ballet) since I was young. I currently take 5-6 intensive ballet classes a week. Last July I pulled my right hamstring when a guest teacher pushed my leg into a higher penché. My hamstring in my supporting leg gave out. It was very painful for several weeks, but I danced through it, taking anti-inflammatories and going easy on my extensions. My physio gave me stretches and strengthening exercises and I had some massage work done.

Nearly 10 months later and I'm still having issues with it. I'm only now getting some flexibility back, but I don't have nearly the same flexibility in that leg. Stretching after class or at home only seems to make things worse — I'm usually quite sore the next day.

The routine seems to go like this: My hamstring starts to feel better (ie. it doesn't hurt); I take my extensions and splits a little further; I get sore; I back off until it feels better, etc. etc. It seems to be a chronic problem now.

I guess my question is: is stretching making things worse, or am I just stretching too much?? I've been told that inactivity will result in scar tissue (I sit all day at a computer at work) so I try to stretch for at least 15 minutes every day.

Thanks so much for your help!

My heart goes out to you. I have seen 2 other dancers whose hamstrings were torn by well-meaning but anatomy-ignorant teachers. Sometimes the damage is done before the dancer thinks to say 'stop'! It is never appropriate to increase a dancer's extension in this way. One of the other dancers was taken out for a full year from her professional career in Europe! She was lying on the ground stretching, and had a teacher lift the leg up into a hamstring stretch and press it towards her body. This dancer was very flexible, but her body did not have the time to adapt to someone else's force and tore her hamstring. Enough said – never – stretch out someone's hamstrings unless you are a physical therapist who has been trained to listen, feel and watch for the subtle cues from the muscles.

There are 2 suggestions I have for you. The first would be to have someone who is trained either by Tom Meyers ( or a massage therapist that does myofascial release work. Rolfing is another name for another type of myofascial release work. They will work slowly, deeply, and along the entire posterior muscular line, as well as any other fascial lines they see are off. The whole body adjusts to trauma, and your hamstring tear was certainly a traumatic event. By releasing corresponding areas that tie into the fascia of the hamstrings you are treating the whole body rather than just the hamstrings. (An aside, Tom Meyers book, Anatomy Trains is wonderful!)

The second suggestion may seem a little more off the beaten track. It seems like common sense to acknowledge that our emotions have an influence on our physical body just as our thoughts do. Our thoughts and our emotions are integrally connected as thoughts create the chemicals of emotions.

I'm not going to go into a deep conversation about the field psychoneurophysiology, but I am going to suggest that you try working on the issue of this injury with EFT. EFT is a tapping technique that has been described as emotional acupuncture. If you go to you can first watch a very short video introduction to EFT, read the online manual, and search in the thousands of case reports where athletes and others have used EFT for performance enhancement as well as relief from physical ailments. Just typing in injuries in the search box will bring up 171 cases of where EFT was used for injuries.

I use EFT and while I don't totally understand how and why it works I am all for any and all techniques that empower us to create change in our own lives.

Please send me an update on how you are doing.

To your good health!


"Education is the key to injury prevention"

May 20, 2008


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Onto the questions of the week – and hope everyone has a wonderful holiday weekend!

I have a 13 yr old female student whose right side hip "pops" out and in while dancing. She says especially when she tries to turn out more. What advice or suggestions can I give her? Sincerely, Tasha

As long as there is no pain during the hip 'pop' – I would suspect a muscular imbalance to how she is creating her turnout. The first logical place to check is the tightness of her hip flexors, specifically the iliopsoas. Try having her spend some time stretching the iliopsoas then see if she feels more hip freedom and less hip popping when she begins dancing. If so – then encourage her to do the standing lunge or the runners lunge in between exercises or when she is waiting to move across the floor.

Here is a picture of a sitting and hanging stretch for the hip flexors. You can also do a standing stretch as well as a runners lunge.

My question is a simple one. Is a woman of 32 years too old to commence dancing? I'm physically quite fit and strong. However, I know that being fit and able to do an hour workout class isn't the same as being physically fit for dance. The type of dancing that I'm referring to is modern/contemporary dance. I started taking classes a few months ago when I realized that it was dance that I wanted to pursue-I know, it took me a while. I also find that whenever I do any sort of dancing, I find myself drawn to ballet type movements: I'm always on my toes, I'm always doing leaps--even before I ever saw these movements being performed. Are these movements typically found in modern/contemporary dance techniques? Also, does it matter that I look quite young? Although I don't think that me looking young matters, I do look as if I'm in my early twenties. How much does age matter in this world? And last but not least, what is a good stretching exercise in order to achieve a good side leg lift? Thank you, and I look forward to hearing from you. Nicole

The simple answer to your question about age and dancing is NO – it is never too old to commence dancing! There is much research that is being done on how exercise can reverse the aging process, even if you begin in the latter decades of your life. Dance is a good choice for many as it focuses on building strength and flexibility.

How much does age matter is an interesting question. To quote Jack Benny, "Age is strictly a case of mind over matter. If you don't mind, it doesn't matter.” I will admit to generally feeling that more mature dancers are more interesting to watch. For me athleticism without that special spark or connection is not as engaging. Mature dancers has more to do with life experience than age in years. What I know is our bodies as well as our brains are plastic, meaning there is constant change going on. If dancing brings you happiness and joy – then it is doing good things for you!

As far as your question about good stretching exercises to achieve a side leg lift I would focus on stretching the hamstring muscles at the back of the leg from the standing position.

Have a wonderful weekend!


"Education is the key to injury prevention"

May 7, 2008

Dancing Smart Newsletter: 5/9/08

Dancing Smart Newsletter

Greetings! Recital time is around the corner – make sure you are taking care of yourself, as hard as that may be right now. When we are running on fatigue our work efficiency goes way down. Remember when you are even slightly dehydrated a decrease in mental functioning is probable – so make sure to drink enough good, clean water!

Questions for this week

I have been reading your newsletters and they have been giving me such valuable information that I have been looking for to assist me in completing my Higher School Certificate (Australia N.S.W.) in Dance. Thank you, so so much! I also have a question; I have been having this horrible pain in the bottom of my foot when I dance, especially on demi pointe. It is next to my big toe below the actual toe. It feels like a bone or something is sticking out and it cracks against the floor and is very painful. It seems to be only during ballet but has gotten so bad that it hurts to walk on it. Any suggestions as to what it is and how I should go about fixing/helping it? Thanks for your time, Amy

Underneath the big toe are two sesamoid bones. They act like a pulley to provide a smooth surface for the tendons to glide over. The tendons can become irritated and inflamed, and is not an uncommon problem for dancers. I had a bout of sesamoiditis a few years ago.

Here's a side diagram of a foot that my son drew (he did a good job, yes?) You can see one of the sesamoid bones. You have 2 under the base of each big toe.

You may or may not have swelling or bruising – but a key symptom is pain on demi point because of the weight that is being placed on the sesamoid bones during relevé. Some dancers may also experience some discomfort or pain simply flexing and pointing the big toe.

My suggestion is to ice, de-inflame, and pull back from all relevé and demi pointe work. Go to a physician who may chose to x-ray your foot and make sure there isn't a fracture to one of the sesamoid bones.

Time is your best friend with dealing with sesamoiditis – by giving that area the time that it needs to heal.


I'm writing a paper about how we use our core in ballet or just dance in general. I've tried talking with some of my own teachers, but they haven't been explaining things very well, or they will refer me to something I don't understand. The questions I have to answer are; how is the core utilized in dance/ballet movements? What are the benefits of a strong core for dancing? If your whole body was strong, except for your core, how would that affect your dancing? Thanks so much! Dianna

Dianna, try thinking of your 'core' being like the hub of a bicycle wheel. It is in the center of the body with your arms and legs being like the spokes of the wheel. When the hub of the wheel strong, then the spokes that radiate from it will be strong and straight and the wheel will roll (move) well. If the hub of the wheel was weak or wiggly and kept moving - it would create wobbly and uncertain movement. Can you imagine how hard it would be to ride a bike if the wheels shifted and wiggled? Core strength gives support to your arms and legs (the spokes) so your movement is clean, efficient, and as effortless as possible. I hope that helped!



"Education is the key to injury prevention"

May 1, 2008

Dancing Smart Newsletter: 5/2/08

Dancing Smart Newsletter: Pronation –vs.- Supination
May 2, 2008

Only one question for this week from Shirley. Thanks for giving permission for me to use your photos in the newsletter!

It always cheers me up when I get the email notification of a new post. Because I will get to learn something new or have a better understanding of the body (so important to us).

Have written to you earlier on, regarding my painful navicular accessory bone at my instep area. I went on further and keep reading and searching information related to this condition. But what puzzled me was that with my flexible flatfeet condition I pronate, and I notice that from the back, my heel bone DO look like this (but my right is worse than my left feet) which worsen my arch pain and pain of my accessory bone.

But when I check my shoes, they are worn out on the outside edges, which means that I supinate? And sometimes I realize that I will shift my weight to the outer edges of my feet and have to intentionally bring my weight in, so that I can feel more weight beneath the ball of my feet near the big toe area.

How is it possible that I pronate but show signs of supination?

I did a foot ink print recently. My feet have all right arch areas. I am now protecting my feet through regular massage, ball rolling and arch supports, and proper footwear. Yet, I still suffer from pain, which gets worse when rehearsal gets long and strenuous.

FYI, I am dancing professionally in a contemporary dance company. mainly dancing barefooted.

Thanks so much, Shirley

Delicious question! Let's begin with looking at the photos you sent. You're having pain in the arch of the foot around the navicular area. Without an x-ray it is impossible to know if you have an accessory navicular bone, which would be an extra navicular bone in your foot. Everyone has a navicular bone, it's the keystone of the medial arch of the foot. When that navicular bone drops in pronation you lose the integrity of the arch and begin to strain the plantar fascia because the weight is no longer evenly divided on the three points of the feet.

When you look at the the picture notice the bunion beginning and the big toe shifting over. The bone that is sticking out on the inside of the foot is the navicular bone and/or an accessory navicular bone. It's a common pronation pattern to see a bunion and shift of the big toe like this.

When we look at the photo of her feet and ankles from behind you can see there is a difference in the angle of the calf between the two legs. Do you see that the right calf is angled to the outside as if it is more bowed? That is one of the structural reasons that is making the right foot pronate more than the left foot. You want to make sure that you aren't allowing the knees to press back into hyperextension, Shirley as that sometimes creates a 'bowing' effect to the lower leg as the leg rotates inward.

Even with dancers who pronate it isn't unusual to find them hitting the outside edge of their shoes first and then rolling towards the big toe - creating a diagonal path of weight rather than having the weight transfer from the middle of the heel through the second and third toes. If there is some bow to the lower legs it will be challenging to feel that you are square and flat on your feet - sometimes you'll naturally following the subtle bowing and feel as if you are sickling your feet when pointing. Always, though, you want to attempt to have even weight between the 3 points of the feet.

When we look at the photo of your first position you can see the pronation, more on the right than the left. I would have to check the amount of turnout in your hips and see if you have either a tight right iliopsoas muscle influencing your turnout, or if the right hip simply has less range. It is a common mistake to set up the first position for the greater turnout side - which is opposite of what it should be. Just something to check:)

You are doing all the right things with foot massage, etc. What I would suggest that you try is taping your arch for a few classes or rehearsals. The tape can't hold you totally out of pronation but it does a good job of reminding the foot not to roll in.
You may need to go to a physical therapist or athletic trainer to show you how to tape for pronation.

See if having some pressure taken off the navicular decreases your pain. I'm hoping so! I'm glad you are able to continue dancing and the pain has not limited your motion. Do pay very close attention while wearing the tape to how your feet feel in jumping, doing first position, etc. The movement that bothers you the most may give you some clues to what else you might be able to shift and change.

If you are having some swelling or pain after moving, make sure you are also de-inflamming the area with ice and/or some form of anti-inflammatory. One the feet get inflamed it is hard to calm them down. Healthy feet whether they belong to dancers or nondancers are essential to well-being!

Let us know how the taping goes, Shirley!

Best wishes for a speedy recovery,


"Education is the key to injury prevention"