April 24, 2008

Dancing Smart Newsletter: 4/24/08

Greetings! Hope everyone is enjoying the spring weather. Let's jump right into the questions!

My name is Samantha, I'm 12 and I just started ballet around 1 and half years ago. I'm in grade 5 and I have really bad technique, but what I am most concerned about are my knees. Whenever I pull my knees up in my exercises, the teacher says they're not pulled up enough and I have to pull them up more, but they're already as pulled up as they can be. One day she told me to sit on the floor in pike and flex my feet, she said to me that the skin under my knee that pokes out is meant to be touching the floor because it wasn't. She gave me some exercises to do to help me fix it but I don't think they're working because whenever I do the exercise it just feels like she wants me to have hyperextended knees.

I was wondering if you had any other exercises or something for me to do to get the skin under my knee to touch the floor. Thank you!

You are correct, Samantha that pressing the skin behind your knees onto the floor is putting you into hyperextension – and you don't want that! Knees (and legs) come in all shapes and sizes. Depending on the shape of your muscles and the structure of your joints – you may have more or less space between your knees and the floor.

Proper leg alignment means the center of the hip, knee and ankle joints will be in a line. Pushing your knee into hyperextension puts pressure and rotation on the delicate tissues of the knee joint.

Pulling up the knee is a phrase that is often misused. When you pull the kneecap up you are engaging the quadriceps. This is appropriate when you are straightening the knee or flexing the hip joint. It is not appropriate to have your knees pulled up all the time! Constantly contracting a muscle even when it isn't necessary will only build tension and bulk!

If you have tightness in your calf or hamstring muscles, by all means stretch them consistently – that would be a much better exercise over practicing hyperextension!

I applaud your desire to understand your body better!

Next question

I am a 20-year-old dance student from Estonia.
I have been reading your newsletter for a while now; actually, as dance medicine is in the very early development stages in my country, it was the first information I received about dance injuries and injury prevention. So thank you for that.

My question is:

I have been experiencing pain in front of my ankle (on both ankles, more on the right one) when I go into a deep demi plié. My ankles also crack a lot when I do ankle circles.

I talked about this with some my dance teachers, but they didn't really know what causes the pain. Also as I said- dance medicine isn't very developed in Estonia, so most doctors would probably not know what to do with me, probably tell me to take some anti-inflammatory pills.

I have done some research myself and what I came up with was Anterior Impingement Syndrome. Is it a good guess?

The pain isn't very strong and I haven't had any swelling, but naturally I don't want it to get any worse. Can you help me? What can I do to get rid of the pain or at least keep it from getting worse? Are there any helpful exercises?

Best wishes, Triin

Good research, Triin! I agree that anterior impingement syndrome might be what you have. Since you may not be able to have that diagnosis confirmed by a physician with x-rays, let's talk about what you can do to release as much muscular tension around the ankle joint.

First, be very aware of the weight on your feet as you lower into the plié. Make sure you aren't shifting forward over the front of the foot, but continue to keep even weight between the pads of the toes and the heel.

Next, I would look to decrease tension in the soleus muscle, which is the calf muscle underneath the gastrocnemius. When the soleus is tight it can decrease the depth of the plié. Here is a picture of my favorite way to stretch the soleus. Hold an easy stretch for a minute. The stretch shouldn't be too strong, keep it in a comfortable range.

Notice that my left knee is bent – this brings the stretch into the soleus. If I wanted to stretch the gastrocnemius, I would keep the left knee straight. Do both ways!

Third, become more aware of when you are moving into pain. See if you can teach yourself not to 'push' into the demi plié. Don't feel like it must look a certain way. I remember working with a ballet dancer who had an incredibly shallow demi plié – but boy could she jump! The shallow demi plié was more noticeable when she was at the barre, but put her in center, and you didn't notice it. You must work within your own structure and see if the pain and discomfort is alleviated.

I'm hoping your ankles are only bothering you at the bottom of the demi plié – if they are bothering you while walking you might need to pull back from class until the inflammation has calmed down. You will never go wrong by listening carefully to your body's messages!

Warm regards,

Deborah Vogel

"Education is the key to injury prevention"