Dancing Smart Newsletter: 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.



When 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.

Internal 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.

A 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 amt. of turnout - 45 degrees



Retroversion - more than normal turnout (leg is resting on other thigh)


Anteversion: more than normal amt. of turn in




Until next time,

Be well,

Deborah

"Education is the key to injury prevention"

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.

The 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"

Pronated versus flat feet

Greetings!
It was so wonderful to meet some of you last weekend in New York at the Javitts Center! Yea to Dance Teacher magazine for putting on a wonderful conference! This sunday I'll be in Brockport, NY for the Dance Rochester workshop.

Onto the question of the week...

My daughter has danced for 10 years and had hoped to start pointe this year. Her teacher says she cannot start point due to the fact that she tends to roll her ankles inward, it seems as though she is flat footed. I took her to an orthopedic specialist who said it was a common problem and not severe enough to do anything about it. He said everyone is built differently and people should not be so critical! Is this a problem that should cause her to delay pointe classes or should we look for a new dance instructor?

Believe it or not – I'm going to side with the dance teacher. She caught your daughter pronating her feet, which is rolling in on the arches. That is a different situation from having flat feet. When you have flat feet it means there is no visual instep. Someone with flat feet can be a very strong dancer, they simply won't look like they have as high of an arch as most people. This is a structural issue, not a functional. Asians and African Americans, for example, have more of a genetic tendency towards structural flat feet.


This image is of pronated feet - these are not flat - rather they are rolling in. If you look at flat feet from the back the heel and heel bone would be straight, not curved towards the floor.







From the side you can see that a flat foot has little or no space between the arch and the floor.







Pronated feet, on the other hand, means the weight is not being evenly divided on the foot and there is more weight on the inner border of the feet. If left unattended, that is a problem and concern for a dancer. You want to see the weight evenly divided between the pads of the big toe, little toe and heel.

Your doctor isn't the first one who thinks that pronation is something the average youngster will grow out of. What they don't understand is the challenge of turnout and standing in first position to pronation. The child who is primarily in sneakers (with an arch support) and running around or involved in sports is using their legs primarily in a parallel stance. I can't tell you how many young dancers I have seen who begin pronating because they are over turning out their feet. Ballet is a wonderful activity - and I love dance – and – pronation is a problem that needs to be addressed as early as possible.

What I would suggest for your daughter, if she really wants to go on pointe this year – she is going to have to prove to the teacher she can stand in first position (or any other position for that matter) without rolling in her arches. It will take first and foremost awareness on her part of when she is rolling in.

If she is in the habit of wearing flip flops – she needs to temporarily stop. They are not good for growing feet with the exception of walking from the car to the beach. Speaking of beaches – walking on the sand barefoot is a wonderful strengthening for the feet and the calves!

She can practice balancing on one foot while tossing a ball back and forth between her hands – again – not allowing herself to roll in, and maintaining good alignment as she is doing so.

She can focus on strengthening the foot and calf muscles. You can find useful exercises in my Tune Up Your Turnout book – as well as in many other useful dance books. Lisa Howell has written a fantastic ebook called the Perfect Pointe Manual. You can check it out at www.theperfectpointebook.com/PerfectPointeBook/?hop=home2php&gclid=CJDJtNvyjZUCFRKLxwody1etfw

Your doctor isn't stupid for not knowing how to guide you in this situation – I think he/she just doesn't have the insight into the specific challenges for dancers. I remember taking my son to the doctors after he twisted his ankle pretty badly when he was 8. My doctor said I didn't need to give him an anti-inflammatory or ice or do rehab – that he was active and would work his way out of it. I needed the doctor to rule out anything more significant – which is what you needed to do with your daughter. But after I got that information I went to work with icing and then doing some rehab with my son. Some fun things like each of us standing on one foot and tossing a ball back and forth to each other and slowly increasing the distance. It helped his joints relearn where center is because as soon as you have an injury or a dysfunctional pattern, the body compensates.

With continued guidance and some extra work on your daughter's part – I'm sure she'll be ready for pointe work in no time!

Warm regards,

Deborah

"Education is the key to injury prevention"

August 8, 2008

This week's newsletter has a different focus. Instead of answering a question, I'd like to share an excerpt from Train Your Brain: A Teen's Guide to Well Being, my newest book. This book isn't just for dancers – I took some of the brain concepts I have learned and use in my own life and made them teen friendly.

The following is from the back cover of the book.

Being a teen is not for the weak – and you can be stronger.
You can be smarter.
And you can be happier.
All you need to do is pump a little iron…with your brain!

Train Your Brain: a Teen’s Guide to Well Being is like a set of barbells for your mind. In these pages, you’ll learn life-changing workout routines that will help you:

• Perform like a pro – on the court, in the classroom, anywhere and everywhere
• Be a better friend and meet new friends
• Take charge of your feelings
• Dream up goals and make them happen

Follow eight kids with problems just like yours as they discover how to pump up their lives…by changing their minds. Using techniques like:

• Mental Rehearsing
• Creating a Feeling
• Refocusing
• and the very powerful Acting as If

combined with lots of fun activities and little-known secrets about your mind, you can begin to create new paths in your brain – and in your life!

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This 48-page book is packed with wonderful ideas and strategies for teens as well as younger children to feel more confident and empowered in their life. I'd like to share Chelsea's section. She is 10 years old and loves ballet. She is the only ballet dancer out of the 8 characters – there are boys who play basketball and topics such as school, family and friends that are touched upon. Enjoy!

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Name: Chelsea
Age: 13
Likes: ballet, baking, talking on the phone, and eating cookies
Dislikes: big dogs and the dark

If you saw Chelsea playing with her brothers or talking in class, you’d think she was always happy and carefree. But, if you saw Chelsea walk into her ballet class, you’d see a whole new girl. For some reason, Chelsea got nervous when dance class rolled around. She didn’t know why and didn’t want to quit because she loved dancing…and had been doing it since she was three. But for the last few months she’d become so nervous-everyone was improving it seemed, except for her. Chelsea’s body started feeling stiff and her feet felt like lead. She was clumsy and her dancing wasn’t smooth at all. Even stretching was hard for her…she felt as if her muscles were too short for her body. Chelsea wasn’t sure what to do but she knew that she didn’t want to keep going to class if it was going to be like this. Was it time to quit doing something she loved?

Ahhhh, another perfect example of a situation that needs help from the brain. Chelsea needs something that can help her to calm down and focus her attention back on the fun of dancing. This brings us to Brain Fact #2: Create a Feeling.

This may sound confusing but it’s really easy. Before I tell you how to do, let me share a little brain secret. Your brain if full of little paths, like roads, that are formed whenever you do something or think something. So, let’s say you eat 10 hot dogs and then you throw up. Well, you created a path. So then, the next time you eat a hot dog, your brain will return to the path that goes with hot dogs. Along that path is also throwing up. So, now, when you think hot dogs you also think throwing up. And when you think throwing up, you think hot dogs. And each time you think those thoughts, the path becomes stronger…kind of like putting new cement on the road so it’s stronger.

The cool thing about these paths is that we can purposely create paths that help us. That is what Create a Feeling is all about. We’re going to connect a simple action (like making a fist or curling your toes) with positive, confident thoughts. That way, you’ve created a path. And you know that positive, confident thoughts create positive, confident feelings. So, when you need those positive, confident feelings, you’ll be able to do a simple action that is connected to those good thoughts and BAM, positive, confident feelings come along.

Let’s Rewind and Replay Chelsea’s dance problem and see if Create a Feeling can help her out…

If you saw Chelsea playing with her brothers or talking in class, you’d think she was always happy and carefree. But, if you saw Chelsea walk into her ballet class, you’d see a whole new girl. For some reason, Chelsea got nervous when dance class rolled around. She didn’t know why and didn’t want to quit because she loved dancing…and had been doing it since she was three. But for the last few months she’d become so nervous in class that she could barely move. Chelsea wasn’t sure what to do but she knew that she didn’t want to keep going to class if it was going to be like this. She needed to find a way to start enjoying dance class again. She decided to get her brain to help her find a way to get her confidence and joy back. She decided to create a path. First, she came up with a small action. She decided she would take a deep breath in and slowly let it out. At the same time she thought of her past dance recitals. She remembered how comfortable her body felt dancing, how loud the clapping was when she bowed, how her legs moved to the music. She practiced taking a deep breath in and slowly exhaling while thinking these positive thoughts a few times everyday. By the time dance class rolled around, Chelsea was ready. When she felt her body start to freeze up at the dance studio doors, Chelsea took a deep breath. Automatically, her body relaxed and the confident, positive feelings of past recitals flooded her body. Chelsea smiled; she’d created a path that would help her look forward to dancing again!

I hope you enjoyed this excerpt from Train Your Brain: A Teen's Guide to Well Being!

I'm off to the Dance Teachers Summer Conference tomorrow. I'm going to bring some extra copies of Train Your Brain: A Teen's Guide to Well Being. I don't have a booth this year, so if you would like to look through this book please come to one of my workshops! Hope to see you there!

Until next week,

Deborah

"Education is the key to injury prevention"

Dancing Smart Newsletter: 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"