Dancing Smart Newsletter: 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.

The 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"

Dancing Smart Newsletter: Buttock Pain

Greetings!

I hope everyone's Thanksgiving holidays were wonderful.... I am grateful to have all of you in my dance community!

The new website is nearly done.... hoping by the next newsletter it will be up and running!

Here's the question of the week...

My daughter is 14 and has been dancing for 10 years. She started a very intense dance schedule in June. She was dancing nearly 30 hrs, a week for the summer along with a 4 day intensive. She cut back to 21 hrs a week when school started and has been doing very well growing in her dance ability until now. She takes 3 ballet classes, 3 adv. pointe classes (all 1 1/2 hrs each), 4 jazz classes, 3 lyrical classes, salsa and conditioning. She recently started having pain in her right hip where the sciatic nerve runs. A teacher of her is a certified physical therapist. She felt around and noticed the nerves on both sides were moving and the muscles underneath were knotted up. The pain stayed right there and didn't travel so we ruled out sciatica. We have iced and heated the area for a week and rubbed out as many knots as possible. It seemed to help and then she went to a jazz class and over did it and now we can't get the pain to stop for very long. I can feel the knots and deep rubbing seems to help but only for a while. Once she wakes in the morning it starts all over again. What if anything else can we do for it? I know rest is needed but do you have any other advice for knotted muscles? Thank you for your time, Evie

I'm glad you have a physical therapist on board to help you out. I'm wondering whether your daughter could have something called piriformis syndrome. It's a condition where the piriformis muscles which is the largest of the 6 deep muscles that are the 'turnout' muscles irritates the sciatic nerve. Some people only feel pain in the buttock area (this could be your daughter) and sometimes it goes down into the leg,
which is referred pain from the sciatic nerve. The sciatic nerve typically passes underneath the piriformis muscle, but in about 15% of the population the nerve goes through the piriformis muscle increasing it's potential for trouble.

When dancers overwork the piriformis and the other deep rotators as they are trying to achieve more turnout then can create excessive tension in this muscle which presses or compresses on the nerve creating pain depending on where the nerve lies in relationship to the piriformis muscle.


For right now, let's treat your daughter as if she has really irritated both the sciatic nerve and that the turnout muscles are knotted up and very unhappy!


The massage you are doing is good for releasing tension in the gluteal area, as well as using a pinkie ball or a tennis ball to put between the buttock and the wall to do self-massage. With piriformis syndrome I personally would not use any heat - only ice on the area, and would have her ice as much as possible. This might be a time where a few days of an anti inflammatory such as ibuprofen could be helpful. The next thing I would do is to stretch, stretch, stretch, the turnout muscles to help them release from their painful spasm.


She can do this in a variety of ways. To the left is a sitting chair stretch that is very useful as she can easily do a stretch or two while in school!


Another way would be the traditional sitting on the floor with the legs folded and rounding down over the legs, gently moving from side to side to feel the stretch at the back of the buttocks where her pain is. Make sure to switch which leg is in front as that will change the focus of the stretch to the other side.


Rest is the final part of the treatment program. It doesn't mean that she would have to take off from all of her dance classes - but it does mean she needs to significantly reduce the amount of classes that she is taking. Her first goal is to be pain free when she wakes up in the morning. If her pain is reduced by pulling back - or totally off classes, then she can slowly bring more classes back in. Working through the pain at this point will most likely increase the length of time for healing - and make for some poor muscle habits as she is trying to engage and work the turnout muscles while they are tender and tight.


Best wishes for a speedy recovery!


Deborah