Teaching Smart

Dancing Smart Newsletter: Hyperextension and Pregnancy tips

2008-12-07T13:20:00.008-05:00

Announcements!

I now have a facebook account - and I invite you all to become my friend! If you have an account just search for me.... Deborah Vogel. (there are actually 10 women on facebook with my name - but I'm the only one holding a spine:)

Also.... I'm uploading videos to YouTube! You can subscribe to my Dance Smart Channel at
http://www.youtube.com/user/dancesmart Or... just search Deborah Vogel and you'll find me too!

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

2008-12-01T11:48:00.008-05:00

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

Développés

2008-11-15T07:15:00.003-05:00

Greetings!
I'm excited to announce that TheBodySeries.com is going through a complete overhaul! I will let you know as soon as it is complete and also let you know of the holiday specials I'll be running to celebrate the new site. Stay tuned!

Onto the question of the week

Hi there!
I was hoping you might be able to help me. I am a professional dancer and for several years I have been struggling with développés, especially when executing this step to the side. I have good range of movement in my hip and I can flex my knee and raise it to a point where my knee is almost touching my shoulder. However, I cannot maintain the height of my thigh as I try to extend the leg. My thigh and consequently the working leg, drops significantly. When shouldering my leg I can let go and hold the working leg at a good height, however I cannot maintain the height of my thigh as I reach the crucial last moment of extension in the développé. I am really hoping you can help me identify why my extensions are not as high as they might be. Perhaps I have a weakness in the iliopsoas muscles or perhaps it is my quadriceps or hamstrings which need strengthening? Any advice would be greatly appreciated!

With Thanks, Beth

Great question, Beth - one a lot of dancers will be interested in!

When doing a développé to the front or side the hip flexors are the prime movers meaning they are the ones most responsible for getting the leg up, and the hamstrings are the antagonist muscles, meaning they need to lengthen to allow the leg to go up higher. You are a smart dancer to ponder both sides of the joint! So often dancers and teachers will only look at one side of the joint, such as the hamstring flexibility when trying to get the legs up higher.

It sounds like your hamstrings are flexible enough as you can bring your leg easily up to the desired position with your hand, then release your hand and then hold it there. I'm less inclined to think there is a challenge with the hamstring flexibility.

This brings us to the front of the joint to the hip flexors. In higher extensions such as développés the iliopsoas is of primary importance at the beginning of the movement and then at the end. The strength of the iliopsoas will help hold your thigh up while the quadriceps straighten the knee.

Normally, dancers are pretty strong with their quads - so let's have you try strengthening the iliopsoas muscle in the upper ranges of extension. I learned this exercise from Karen Clippinger, a marvelous teacher and anatomist.

Start by sitting with your left leg bent in front of you with the foot on the ground and your right leg extended straight on the floor in front of you. You are resting slightly on your hands, which are behind you. You may be slightly on the backside of your pelvis, but you are focusing on stabilizing your pelvis and not allowing yourself to roll onto the sacrum while doing this exercise. Okay - now lift your right leg up, keeping it straight, as far as is easy. You might get to the level of the other knee or you may not.

Once you have lifted it, slightly bend the right knee, bringing your thigh closer to your chest (remember - without rolling back on your pelvis!) Then once you have brought it slightly closer straighten the knee slowly (again - without rolling back on your pelvis!) and then lower the right leg to the starting position on the ground. Repeat several times - and then do the other side. It may take some days or weeks to feel as if you can significantly bring the knee closer to the chest - but you will see a difference in your extensions if you practice this.

You can also do this exercise in turnout. Even though you are keeping the legs in front this new found strength will carry over to your side développés. To make it a bit harder you could put a theraband around both knees giving yourself some resistance as you bring the thigh towards your chest and/or you could put a low level weight around your thigh - just above or below your knee - do not put the ankle weight at the ankle!

Let me know how your extensions improve!

Warmest regards,

Deborah

"Education is the key to injury prevention"

Dancing Smart Newsletter

2008-11-06T21:09:00.003-05:00

Greetings!
I haven't gotten to answer any questions over the past few weeks as I've had some special events such as spending time with Lisa Howell, the wonderful Australian dance physiotherapist who authored the Perfect Pointe Book and the Perfect Pointe System! Lisa and I then went off to the IADMS Conference (International Association for Dance Medicine and Science) where I got to meet - some of you!

I so appreciate learning and being inspired by all the good work that is happening in dance medicine from around the world. Thanks to all who stopped to introduce themselves to me!

Onto the questions of the week....

My question concerns soreness around the sits bones during lunges and straddle split stretches (both the kind where you face a wall and push yourself closer and where you lie on your back perpendicular to the wall with your legs dropped open). I'm used to feeling sore there when working on hamstring flexibility, but never before with other stretches. It's especially odd with the lunges, because the soreness is in the buttock of the BACK leg. Rotating the leg inward seems to help a little. Do you have any ideas what may be going on here?

Your turnout muscles also attach in the area of the sits bone. You gave a good clue that rotating the leg inward helps relieve the soreness some. Why don't you try putting a pinkie ball or a tennis ball underneath your pelvis and rolling lightly around. Pay special attention to the sitting bone area. After gently massaging that area do your stretching and see if there is any difference in your response. Let me know if that helps!

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Another dancer writes....

If the hamstrings are tight where might a dancer feel discomfort?

We talked about this in class this morning. It seems logical that if the hamstrings are tight you would feel that tightness at one of the ends of the muscle. Either around the sits bone like the above question - or at the knee. But interestingly, often hamstring tightness and problems show up as lower back aches, and lower back problems will be felt in the hamstrings.

Think about a dancer who has tight hamstrings and is sitting on the floor with one or both of the legs in front of them. As you can see from this picture, the hamstrings aren't being targeted very effectively - rather the back is taking the brunt of the stretch.

Try using the pinkie ball on your back and pelvis. I really should buy stock in a pinkie ball company! - just teasing!

Sometimes releasing muscular tension above or below the hamstrings will help. I have students spend about a minute rolling a pinkie ball underneath one foot. They are massaging the plantar fascia of the foot. Then they go to touch their hands towards the floor and generally at least 50% of them will feel the hamstring loosened up on the side they used the pinkie ball. They didn't stretch the hamstring directly - and it still benefited!

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I promise I'll get back on track with the newsletter. I'm working on updating the website and along with that bringing some new information to you! Stay tune for more info in future newsletters!

Warm regards,
Deborah

Dancing Smart Newsletter

2008-10-17T16:44:00.000-04:00

My ballet teacher has been helping me a lot with my feet because they are my weak spot. She said that I am too strong in the outer part of my feet, instead of being strong in the inside part. She said that I am more prone to injury because of this, and that this is incorrect.
I know this is true, especially because my feet are pretty close to flat. I "roll in" my ankle in class and outside of class when just walking around. I try not to roll in as best as I can. I was wondering if there are any exercises to help strengthen my inner part of my foot.

Thanks, Rachel
PS: I have a theraband.

Rachel, I'm not sure what you mean exactly with the stronger outer part versus inner part of your foot. When your foot rolls in it is called pronation and yes, there are definitely exercises you can do to help strengthen the muscles of the feet.

Your first focus is to bring your turnout in to where you feel equal weight between the pads of the big toe, little toe and heel. Check how you are standing when you are waiting in line at lunch – or standing and brushing your teeth. The habit of pronation probably occurs in your regular life as well as in ballet class.

Start with rolling for a moment or two on a tennis ball or pinkie ball to release and relax the foot muscles. Start by simply by 'playing the piano' with your toes. Keeping the pads of the toes on the floor, lift the toes up in the air and starting with your little toe, put it down on the ground, then the 4th toe, etc., with the big toe being the last. Now reverse and lift the big toe up, the 2nd toe next, and so on. You can use your hands to help do this exercise. If your feet start to cramp, stop and roll on the ball for a moment.

The next exercise is to practice pointing your feet by separating your toes as they begin to lengthen. You will start to cramp on this - and again - stop and roll on the ball before trying it again. You can do this exercise easily with putting the theraband around your toes and pressing gently against the theraband as you extend your toes.

Next tip – get rid of your flip-flops! Wear good supportive shoes with an arch support to help you keep from rolling in. Becoming aware of your rolling in or pronating is the first step in changing your feet – and I can't emphasize enough the importance of standing with equal weight on the 3 points of the foot.

I am really late-starter, having taken my first ballet class at 36.
My 6 teachers in the past 4 years adjusted the classes' level to the level of the knowledge of the majority participants. Inevitably, I ended up in a class way over my head or way below my level, which eventually left me with an enhanced ability of copying, and huge gaps in my technique.

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I am a faithful reader of your newsletter and I found your book, Tune up your turn out a great help too. Now at 40, I am taking 3 classes a week, I feel that the largest improvement in my dancing would come from understanding of the muscular recruitment of proper posture.
I can’t seem to get hold of the right balance between my deep abdominals, hip flexors and extensors. I don't know if I am tucking under or holding my center. The visual that I got from my teachers is that I should think belly button to the spine, or lengthen from the bottom of my spine, but I don’t find this very helpful. Should I really be aiming for a straight lower back devoid of its natural curve?

I naturally stand swayback, in a slight turnout with hyper extended knees. Standing in parallel feels really weird, as if my knees are about to knock, and correcting for the exaggerated lordotic curve I end up on bent legs with tight hip flexors and ribs fanning out. I am experimenting with different recruitments, but I am afraid of acquiring bad postural habits, and I certainly don’t need any more of those.

I know that you can’t possibly diagnose my posture by email, but I was hoping that you might have a few tips, or visual images I can try. I know a bit about musculoskeletal anatomy, so to me it would be more useful if someone could address the issue in those terms, as in get out of the quads, use more hip flexors, for example, but this is wishful thinking with the teachers I encountered here.

I would be grateful for your advice.

Zsuzsanna from Budapest, Hungary

Sounds like you have learned a lot over the past 6 years! First – check out whether or not your slight hyperextension is connected to your swayback. Very often it is – and when you bring your knees out of hyperextension, the pelvis comes out of its forward or anterior tilt.

Your lower back will not board straight – and I wouldn't want you to work towards that – clearly as you describe it creates other problems. What if you shift your focus to the pelvic bowl? If you were lying down on your back with your knees bent and your lower back just resting on the floor I would want you to feel that the pubic bone and the two points on your pelvis that feel like they are sticking up are on a level plane. (Those are your ASIS, or anterior/superior iliac crests)

Note that if you flatten your lower back against the floor your ASIS are probably closer to the floor that your pubic bone, and when you arch your back your pubic bone is closer to the floor that your ASIS.

Now come back up to standing. In standing it is more challenging for me to have a sense of the ASIS and pubis relationship so I shift to thinking that my pubis is lifting gently towards my sternum above it. This helps me to maintain the correct torso/pelvis alignment without putting my thinking (and corrections) into my lower back.

I also imagine that the pelvis is a bowl and I keep a small amount of lift between the pubis and my belly button in order to keep the front of the bowl from spilling their abdominal contents out as they do when you go into a swayback.

Let me know how it goes with bringing your knees to neutral when standing (you can hyperextend when its in the air) and bringing the front of your pelvic bowl up.

Best wishes!

Deborah

"Education is the key to injury prevention"

Dancing Smart Newsletter

2008-10-02T11:07:00.012-04:00

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.

There 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

You'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.

If 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.

Until next time!

Warm regards,

Deborah

"Education is the key to injury prevention"

Dancing Smart Newsletter

2008-09-19T06:19:00.003-04:00

Hello all!

I am including information about Lisa Howell's workshops that will be happening this October! She is a wonderful resource to dancers, dance teachers and dance medicine specialist. She is a physiotherapist who resides in Australia and is coming to the US for a visit. She will be at Oberlin College on October 18th and 19th. That's listed as the Cleveland workshop. I have included her email in this post after our question.

Question of the week...
I am 13 yrs. old and i have been having problems with my knee. I have pain under my knee cap and sometimes it get to the point where it hurts to walk. (It also hurts to walk up and down stairs and especially if I go into a deep plié or a grand plié) I am a very very active dancer and I would like to know what is wrong with my knee. I just went to the doctor two days ago and they said I should stay take about 5 days off of dance and take the anti-inflammatory medicine they prescribed for me, but as the days go on it doesn't seem to be getting any better. I really hope you can tell me a way to help heal my knee so I can start dancing again. Thank you so much for all your help.
-MARIAH

Dear Mariah,
I would first say to follow your doctor's advice, and take the time off from dance - and take the medication to reduce any swelling. If you are having pain while walking or climbing stairs, you certainly shouldn't be in dance class until you can do daily movements without pain.

That being said, once your pain is better you've got to figure out why it started hurting. Have you gone through a recent growth spurt? Bones grow faster than muscles, and knees are often a place that feel those 'growing pains'.

Was their a change in activity prior to your knee hurting? Did you start a new technique class, or start with a new teacher, or just come off summer vacation? It can be a real shock to the body when you are off from dance for a while, and then jump in and start taking daily classes.

What's your turnout like? Is the knee that hurts on the side that has less turnout? Often our turnout is unequal and we compensate by rotating the foot out farther on the side that has less turnout at the hip, and then we put a twist at the knee.

It's also possible that a piece of cartilage got irritated for some reason that will remain unknown - and - by taking care of it, you will be back to dancing in no time at all. Best wishes for a speedy recovery. Continue to ice, rest it, and follow your doctor's suggestions. It's possible that he will put you in physical therapy next so you will be guided in correcting any imbalances of muscle strength and flexibility.

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Email from Lisa Howell.......

I am delighted to announce that I will be commencing a short series of workshops designed for young dancers and dance teachers in Cincinnati, Cleveland and New York City this Fall. I am in America to present at the International Association for Dance Medicine and Science (IADMS) Conference in Cleveland, after winning an award for "The Greatest Contribution to Dance Medicine" at the 2007 Conference.

This is an experience not to be missed, as it provides a different approach to many of the ways dance students are trained in class. Workshops are limited to just 20 participants to allow maximum contact with each student, so get in early to secure your place. Courses run from 13th -16th October in Cincinnati, 18th and 19th October in Cleveland, and 29th and 30th of October in New York City.

I am passionate about the education of dancers; not only to prevent injury, but to extend the boundaries of what each dancer believes is possible. I have done this in some way with our site www.theballetblog.com however, the information that I share online is merely the tip of the iceberg.

I have developed several other programs that are changing the way that dance is taught in many centers. My unique way of combining medical knowledge into a usable form in the studio has allowed teachers all over the world to increase the safely of their classes, while young dancers improve their technique and performance quality. I have run these workshops many times throughout Australia and feel that they are a wonderful way to spread my knowledge further.

The workshops give a fresh approach for young dancers to really learn about their own bodies. They incorporate basic anatomy, safe dance techniques, self treatment strategies and special exercises not normally taught in class. Students leave inspired and empowered, eager to get back into class to use all of their new skills! Teachers often comment that the students are much more focused after attending these sessions, and are much easier to work with in class.

In this series of workshops I also introduce my unique "Front Splits Fast Flexibility Program". This system is like no other program currently in dance schools, as it employs concepts and techniques based on mobilizing the nerves and fascia in the body, rather than stretching muscles. Every student and teacher alike who has participated in this workshop has been astounded at the ease of releasing tension in their body with simple to use techniques, and excited at the possibilities this opens up for them in their training. This program is not available for purchase online at present, and is only available at the courses, with each attendee receiving a dvd as well as a full instruction manual.

The Original 'Perfect Pointe Book' has been developed into a two hour workshop, and again each participant receives a manual and dvd of the program. It takes the girls systematically though a series of tests and exercises, organized into four easy stages, and is rapidly changing the way that the worldwide dance community approaches pointe work. The sequel, "Advanced Foot Control For Dancers" is a progression from the initial resource, and begins to teach older students more detailed anatomy of their feet, along with specific strengthening and massage techniques to accelerate their dancing, and allow optimum recovery from injury.

The workshop series also presents, for the first time, "The Perfect Pointe System," a four hour workshop just for dance teachers, allowing them to learn the finer details of assessing exactly when young students are ready for the progression to toe shoes. It is one thing to know how to teach girls to dance. It is completely something else to know exactly how to test for specific weaknesses that may limit a child en pointe and what to do about those weaknesses. I was devastated when I learnt that dance teachers were not taught this in their formal training, as it is imperative to the health and longevity of their feet, and therefore, their career. I simply had to create these resources to get this kind of specialist information out where it is needed most.

For further information on any of the courses please visit the site at www.theballetblog.com or click here to go directly to the page:

http://theballetblog.com/index.php?option=com_content&task=blogcategory&id=67&Itemid=152

Courses run from 13th -16th October in Cincinnati, 18th and 19th October in Cleveland, and 29th and 30th of October in New York City. All enrollments must be processed by 1st October 2008 to allow printing of all course manuals and dvd's.

This is an experience not to be missed! It is a great chance for your daughter or son to get inspired and educated in a really fun way!

Please do not hesitate to contact me if you have any further questions, and I look forward to seeing you and yours at the workshops!

Kindest Regards,

Lisa Howell

Dancing Smart Newsletter: arabesque

2008-09-12T13:49:00.002-04:00

Exciting announcement! Lisa Howell, the wonderful physiotherapist from Australia, who wrote the Perfect Point System – is coming to the US for the IADMS conference!

This conference is being held in Cleveland, OH, and Lisa is going to present a weekend workshop at Oberlin College in Oberlin, OH. I am so excited to meet her in person and learn from her!

Listen to these workshop topics….Advanced Foot Control, Front Splits Fast (I'm really looking forward to that one☺) Core Control, The Perfect Pointe System – to name a few.

I don't know when Lisa will be back on our shores so if you are within flying/driving distance you'll want to really think about coming to Oberlin the weekend of October 18th -19th.

You want to go to

http://clicks.aweber.com/y/ct/?l=NFO_l&m=1a.rs5vy1k9S89&b=0w_sbbHGgjIBMiY7IlCo6w

Lisa is going to cap each workshop at 20 participants in order to give personal attention. Please join me the weekend of Oct. 18-19 when Lisa shares her very valuable information.

An extra bonus – if any of the readers of my Dancing Smart Newsletter come – you can pump me full of questions on Saturday night – maybe we can all go out to dinner together at my favorite Oberlin restaurant.

Don't delay in signing up, though, in order to be one of the 20 participants for Lisa Howell's US weekend workshop! (Definitely cheaper than going 'down under')

No onto the question of the week….

I've got a question about arabesque. Many of my students open their hips more than is necessary as they approach 90 degrees, which makes squaring their shoulders a problem, as well as turning out their base leg and aligning their ribs over their hips, leading to a lack of balance. This year, one of my goals with them is to instill a better sense of squareness. However, as soon as they start to really try to square their hips, their working leg turns in, drops, and the back of the knee softens. Grrr! I understand the meaning of turning out within the hip joint as much as possible, and we do work that, of course, but how exactly do you square your hips and still get any height on a back extension? I'm starting to think I need to concentrate more on the base leg turnout, because they'll be less able to open that working hip if the standing leg is rotated more, right? Sigh........Thanks for any reply........
Jennifer

Delicious question, Jennifer! You have discovered one of the 'myths' of ballet – that you can keep your hips square as you do an arabesque. It's why I created the DVD Analyzing Arabesque!

When you are taking a leg into a back tendu, you can keep your hips square for a short period of time. How long you can keep your hips square has to do with the range of motion of the hip flexors and your own personal boney hip structure. A few dancers can stay totally square for the whole back tendu – more often than not – most dancers have already opened the working hip by the time they reach the end of the tendu.

For an arabesque – I have never seen a dancer stay totally square in an arabesque. It is anatomically impossible. That being said the concept of squareness is one that we should strive for. But how?

You have hit the most important nail on the head and it has to do with the standing leg. The better a dancer gets at maintaining the turnout of the standing leg while doing a back tendu or arabesque, the squarer the hips will appear.

As you know the spine will rotate and spiral away from the leg in arabesque (right leg in arabesque, the spine spirals to the left) in order to keep the upper body focused forward. This also helps to keep the dancer on her standing leg.

The most important areas to work on if your students aren't staying square are
1. flexibility of the hip flexors, especially the iliopsoas (this will help to give them a higher arabesque and an easier time staying up on their standing leg)
2. flexibility and strength of the rotators (this will help them rotate both legs more evenly – instead of focusing on one of the legs more than the other)
3. ability of the standing leg to maintain turnout (to keep the hips square)
4. range of motion of the spine to allow that easy spiral and to keep the upper spine upright (which makes the leg look higher)

Bottom line – the hips will open some – and the pelvis will rotate – effectively 'turning in' the standing leg. And – by focusing on countering that tendency by keeping the weight balanced on the standing foot (not dropping back into the heels as is so common) and thinking stabilizing and rotating the standing leg – you've got your best chance for that elegant line of the arabesque.

Your thinking is on the right track!

Warm regards,
Deborah

"Education is the key to injury prevention"

Dancing Smart Newsletter: Toeing - In

2008-08-29T16:14:00.009-04:00

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?

~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*~*

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"

2008-08-19T09:30:00.009-04:00

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

2008-08-14T14:17:00.007-04:00

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"

2008-08-07T17:36:00.006-04:00

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!

*************

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!

*************

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

2008-08-01T08:13:00.003-04:00

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"

Dancing Smart Newsletter: 7/23/08

2008-07-23T06:56:00.004-04:00

It was brought to my attention that some of you were receiving blank emails when I was sending out the notice of another newsletter being posted. I have hopefully resolved this issue! I appreciate those who took the time to let me know all was not right!

Here's the Q&A for today.

Deborah, I have been thrilled to find your web site, thank you, thank you! My question- I have an advanced male student who was a former gymnast. His hyper-flexible back and anterior pelvic tilt leave him loose and improperly aligned in his movement. His entire mid section, ribs, abdominals and spine are too flexible and unstable for classical ballet. Since he has been performing more and training less, I have noticed it getting worse and want to give him a workout to do outside of the classroom. I would love your input on specific exercises to teach his core muscles control and stability. I know that crunches and sit-ups are not the answer.

Great question! It is so true that simply doing crunches and sit-ups in the normal way won't give you the functional control that dancers need. I've got a few suggestions for your loosey-goosey gymnast.

There are a few tweaks we can give to the traditional exercises, which will pack a lot more punch for the time spent. I'm going to suggest that your dancer purchase a big physioball to work with, although I will also give you ways to do these without a physioball.

Physioball sit-ups
Begin by sitting on the physioball and slowly walk your feet away from the ball until your lower and middle back is resting on the ball. (you are arching back over the ball as in a bridge position) Clasp your hands behind your head, keeping your elbows out to the side as you slowly do a sit-up, keeping your lower back on the ball and your feet secure on the floor or even with your feet on the floor and toes touching a wall so they don't slide. Exhale while doing the half sit-up.

You are going from an arched position to a contracted one. This is more challenging than going from a neutral position of lying flat on the floor to the half sit-up position. A variation without the physioball would be to rest on the bed with your knees bent and just the shoulder blades, shoulders and head hanging off the bed. Then slowly exhale as you do your half sit-up. You could do that with your legs straight, but only if you don't have tight hip flexors.

Leg Lowering
You'll begin lying on your back with your knees bent and feet resting on the floor with your spine lengthened and at rest. Deepening in the front of the hip joint, softly flex at the hips and lift each foot off the ground without tucking your pelvis under or pushing your low back against the floor. This will be your starting position.

You are doing a variation of leg lowering that will teach you to use the abdominals to stabilize your movement. Keeping the knee bent, slowly take one leg away from your chest, keeping the lower leg parallel to the floor. You are going to monitor your low back and stop when your low back starts to arch away from the floor. Bring that leg back in towards your chest as you switch legs and begin to extend the other leg away from your body. When you first begin to do this exercise your legs won't travel very far away from your body. As you develop the core strength of the deeper abdominal muscles you will be able to extend your legs all the way to straight.

I want to emphasize that you must set up the abdominals before you ever move a muscle Think of the bellybutton being drawn to the back of the spine, or the abdominal area having one of those girdle supports that employees wear to lift heavy objects. The focus is on maintaining your support and control - not simply engaging at the point when you start to feel your pelvis tipping.

Alternate your legs as slowly as you need to be able to maintain that support. If you want to work harder, don't bring your knee back as far towards your chest. This will load your abdominal muscles keeping them at a higher engagement level. Remember, when you use those deep abdominals it means that you will have a sense of engagement even when you are inhaling, but you will need to keep breathing! Too many dancers forget to breath when they are using their abdominals - definitely a bad habit!

Pelvis tipping forward
Even though dancers can have a lot of flexibility in their legs and back, they can also have tight hip flexors that pull the pelvis down in front giving the back that arched look. So let’s talk about how a tight iliopsoas muscle can influence your abdominal usage. We know that the iliopsoas muscle is a major postural muscle. It attaches from the middle area of the spine (T-12) and at the lesser trochanter of the femur (at the inside top of the femur, close to the groin.) The deeper muscles are in the body, the more they influence the alignment of the bones. The iliopsoas muscle, when it is overly tight, will pull the low back into a swayback. You could do 50 sit ups a day to strengthen your abdominal muscles, and stand up and still look like you had weak abdominals. So, the first step is to make sure that your iliopsoas muscle is stretched and has enough flexibility that when you are standing there is not a pull on the low back. Then the abdominal muscles have a chance to do their job of keeping the pelvic bowl upright which allows the weight of the upper body to transfer correctly down the spine onto the back of the pelvis and through to the legs in standing or the ischial tuberosities or sitting bones when sitting. One of the simplest way to stretch the iliopsoas muscle is by doing the runners lunge stretch.

I'll end with a quote from Ted Shawn. "Dance is the only art in which we ourselves are the stuff of which it is made."

Until next time,
Warm regards,

Deborah

"Education is the key to injury prevention"

Dancing Smart Newsletter: 7/9/08

2008-07-09T16:36:00.002-04:00

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!

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Recently I've been doing a lot of tendus and the like daily to increase the strength and stop my toes "crunching" while pointing. Over the past few days the tendon/muscle going from the top of my toe over the arch has become incredibly sore and "crunches' when I flex and pointe. After some very brief research on the net, I found that this could be tendonitis. More research also points to a small bone fracture or something to do with the tissue. I was just wondering what you think this is and how to treat it?
Regards,
Jane

My recommendation would be to use the pinkie ball to see if releasing tension from the anterior tibialis muscle will release the discomfort on the top of your arch. That muscle contracts when you flex your foot and needs to stretch and lengthen when you are pointing.

You'll want to gently kneel on the pinkie ball to massage the front, outside portion of your calf where the anterior Tibialis muscle is. After doing the front of the calf, take some time to massage the bottom of your foot by standing and rolling your foot over the ball. If you are practicing your tendus and lengthening the toes you are strengthening the intrinsic muscles of the foot – always a good idea! That, along with lengthening the front of the ankle is what creates a beautiful tendu.

If releasing the pull from the muscles around the ankle helps – super! If the top of your foot continues to feel sore, and you are hearing crunching or cracking noises – I would encourage you to go to the doctors and get some x-rays in order to rule out a stress fracture or other boney problem.

The doctor should also look carefully at your standing alignment to make sure your foot is not pronating, which so strongly affects the muscle balance around the foot.

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I am suffering from Plantar fasciitis...I am doing everything (ice, taking time off, walk with heels, massage, exercises for the feet and legs, hamstring and calf lengthening and ease) and there is no change. What do you recommend?

I was diagnosed by a foot doctor.
Lori

Lori, you are following the traditional protocols for plantar fasciitis, and since it is not getting better I would look at other potential factors. Is one foot or both bothering you? Did it start all of a sudden, or come on more gradually? Were there any precipitating events?

It appears that you are going to need to put on your detective's cap to figure this one out. I would check for any imbalances between the two legs. Could there be a leg length driving this problem? Does one foot have a tendency to pronate more than the other? Do you have a difference in your turnout between the two legs? Are you able to walk more comfortably when your arch is taped up for pronation? Often, that will help ease the pull and strain to the plantar fascia, which will help it heal.

As far as immediately trying to release the strain – I would encourage you to find a practitioner who has been certified by Tom Meyers, who wrote Anatomy Trains, the best book on understanding the myofascial relationships in the body, in my humble opinion. Here is the link to his practitioner list. http://www.anatomytrains.com/kmi/practitioners

There are massage therapists who have studied other myofascial techniques that could also be useful. My focus would be on releasing the entire line of fascia that runs from the bottom of your foot all the way up the back of your leg, spine, neck, and finally ending on your head. It could be that other areas are feeding this posterior line of fascia and once they are released the weight and pull on the plantar fascia will be released.

Plantar fasciitis can be a very tenacious problem – I wish you the very best for a speedy recovery!

Warm regards,
Deborah

"Education is the key to injury prevention"

Dancing Smart Newsletter: 6/20/08

2008-06-20T18:58:00.001-04:00

Greetings!
Hope everyone is enjoying their summer activities! Right to the questions for the week…

I have had an uncomfortable tightness and pain in my left hip area for about a year. My hips easily pop now. When doing anything that involves the left leg, it won't go as high and feels like it wants to give out. I feel a little pain when stretching in side splits and leaning to the left and trying to stretch the leg in arabesque. I have seen two orthopedic surgeons with two opinions. One said it was a definite labral tear (no MRI) and the other said it was tight hip flexors. Is there a way to distinguish between the kinds of pain or area each would cause so I know how to fix this problem?
Thank you, Jaime

Jaime, I'm not sure how the definite labral tear was diagnosed without an MRI. Since the fix for a labral tear is surgery – I would certainly want that confirmed before going further.

Tight hip flexors are easy enough to address physically through stretching and massage work. If you stretch and release the hip flexors – do you feel a difference in the hip? It should be a pretty straight-forward even if it doesn't hold for long. It takes time to truly change any tight muscle.

What I would suggest is doing the rehab for a tight hip flexor and if that isn't helping think about getting an MRI done to more accurately assess the joint.

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I have just had a student diagnosed with Scheuermann's Kyphosis, which I don't know much about and am currently researching. Do you know anything about the condition and how it will affect the student's ability to dance.

Her mother is concerned that the doctors will suggest that she give up dancing. I think that in the case of Kyphosis, dancing will help to keep the spine loose and help to control the progression?

Any help would be greatly appreciated, both by myself and my dancer!
Jane

Scheuermann's kyphosis is an abnormal rounding of the upper back. Think of a very elderly person who is walking stooped over with just their head picking up. That would be a potential end point for someone with Scheuermann's. With your student being young – hopefully without back pain and a mild curve – there is much they might do. I imagine they will give her a brace to keep her spinal alignment upright and put her in some type of physical therapy. Pilates on the equipment with a knowledgeable physical therapist is one such possibility. It's quite possible that dance has been a very positive activity for her already! We know that spine health means maintaining your ability to flex, extend and rotate. I can't think of a better activity that dance which involves all of those motions of the spine!

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My 12-year old daughter loves modern dance, but she often has pain in her right ankle and foot. Her right arch provides very little support so that she pronates when she walks. From the back her right foot and leg look very similar to the photo that accompanied your May 2 post. I would very much like to know what we should do now to: 1. Minimize her pain 2. Not injure her ankle/foot 3. Make sure that she does not have problems as she gets older. My family doctor grudgingly gave me a prescription for orthotics, but without better understanding of the problem (she has a terrible time turning out at all and could have issues higher up in her legs and hips), it seems foolish to just go for the orthotics. What would you suggest? I am based in central Pennsylvania. It strikes me as ironic that we have orthodontists who fixate on kid's teeth, but I'm having a hard time finding someone who can help with my daughter's feet and legs. Thanks for the wonderful newsletter!
Rebecca

It sure can be frustrating to find practitioners who understand what you are going through. Often I counsel my students to find the closest, largest dance studio and see where their dancers go. For you that might the Central Pennsylvania Youth Ballet.

Another way would be to poll the local soccer athletes and runners who they go to. Sports medicine physicians and therapists might not be dance savvy – but they are movement savvy.

As far as your questions you're on the right track with first and foremost getting her some orthotics. This will accomplish a multitude of issues with correcting the pronation and giving the muscles around the ankle a chance to redevelop balance. In fact, I would have her practice balancing on one foot, while in her orthotics, tossing a ball back and forth between her hands to challenge herself. See if she can stay on one foot for between 1-3 minutes.

She's 12 – so that means she is growing and moving into the sometimes awkward teenage years. Once you find a practitioner that is versed in sports or arts medicine have them keep checking her leg length. When there is one ankle or foot that hurts – I'm always suspicious that there is something going on above that is creating a weight imbalance - like a long leg or a pelvic/torso shift.

If the foot that hurts is on the side that she has less turnout – then she needs to decrease her first position until she is able to line up the ankle/knee/hip more accurately. She might want to read my Tune Up Your Turnout book for more exercises – and – to understand more appropriately how to create turnout at the hip.

Best wishes for a safe and speedy recovery!

Happy Solstice everyone!

Deborah

"Education is the key to injury prevention"

Dancing Smart Newsletter: 5/30/08

2008-05-30T09:55:00.006-04:00

If you are interested in creating extra income for yourself, please check out last week's newsletter to get the scoop on the affiliate program!

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!

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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.

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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 (http://www.anatomytrains.com/kmi/practitioners) 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
http://www.emofree.com 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!

Deborah

"Education is the key to injury prevention"

2008-05-20T10:03:00.006-04:00

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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!

Deborah

"Education is the key to injury prevention"

Dancing Smart Newsletter: 5/9/08

2008-05-07T09:56:00.006-04:00

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.

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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!

Warmly,

Deborah

"Education is the key to injury prevention"

Dancing Smart Newsletter: 5/2/08

2008-05-01T10:31:00.016-04:00

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,

Deborah

"Education is the key to injury prevention"

Dancing Smart Newsletter: 4/24/08

2008-04-24T08:59:00.004-04:00

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"

Dancing Smart Newsletter: 4/18/08

2008-04-18T10:34:00.002-04:00

Announcements
I have not fallen off the face of the earth – but life has gotten in the way of regular posts. My plan is to remedy that, beginning with this posting – so….onto the questions!

Dear Deb, I was having a vivid conversation with a few friends and colleagues or mine on the subject of tucking under and when to emphasize it and when not to in the execution of the pelvic tilt on the reformer. Our answers varied and at times were totally opposite. We would like to get your opinion on the matter as to which cases one would emphasize the tucking under and when not. Thanks!

Good question! My answer would be to say the focus of the pelvic tilt is to bring the pelvis into correct alignment. I often think so many people emphasize it because they are starting from a swayback position – and need to engage the deep abdominals and the hamstrings to bring the pelvis to neutral. This is my focus always for the pelvic tilt.

Too often a pelvic tilt becomes a press your lower back into the floor – and of course – that isn't what you want. When you properly engage the deep abdominals and high hamstrings the erector spinae muscles that are the large muscles along the spine should release and relax. I will often place my hand underneath the students lower back as they are on the reformer so I can monitor how they are initiating and following through on the pelvic tilt. That will tell me more than anything else about their muscle usage.

That would be my one size fits all answer. Whenever the pelvis is in a swayed position I would utilize the action of the pelvic tilt. If you have someone who always tucks under – too much so – you will have to focus them into the action of the deep abdominals and release of the hamstrings to bring the small lumbar curve back that everyone has!

Another one…..

Hi! I’m 13 years old and I’m a dancer I’ve been dancing forever sense I was three, and last week I was doing switch and center leaps. I’m not sure if you are familiar with them, but as I was doing them my left hip popped and then I landed on it wrong! Now I have pain in my groin when I stretch, I’m not sure what I did. I explained to my dad what I did and he said I might of hype extended my hip! Is that even possible? Or is my dad crazy and doesn’t know what he is talking about?! Should I see a doctor? What exercises should I do? How long do I have to sit out from dance?

If your hip is continuing to hurt you should see a doctor to rule out anything serious or severe. It is quite possible that you strained your iliopsoas muscle and it is going to take some time to heal as it is a very deep muscle. Take it easy for a few days and spend some extra time gently stretching the hip flexors through doing the runners lunge stretch.

While you probably didn't injure the hip joint your dad is correct in that a switch leap requires the leg to go into a very fast extension – and when you aren't properly warmed up or stretched out enough – sometimes you can get a deep pop as you are extending the leg. Switch leaps are hard! You need massive strength and flexibility for this movement!

Last one…

Hi Deborah, I have recently returned to the ballet classroom after many years with much hesitancy. At 40 years old, I now know my body and my mind much better than I did in my teens. I also know now what my ballet teachers should and should not have told me. I don't know if you want to address this issue in your forum, but I feel strongly that it should be addressed somewhere, somehow.

I am noticing psychological 'games' if you will, that some ballet teachers tend to play with their students. (I haven't noticed it as much in other disciplines.) I didn't recognize them at all when I was younger, but as an adult I realize now they set me up for many psychological issues in and outside of the dance studio.

My first example is how they address individual students in front of the class. They announce something that is clearly addressed to one student as if it were a correction intended for everyone. This serves to isolate the student who knows they are being directly addressed. I was the only person removing my hand from the barre during barre exercises, and as if I were not old enough to make my own decisions, my teacher announced to the class that this is incorrect and we should not do this - as it will not help us at all. The same teacher announced there is no such position as 'third position' and that it is only for children and old ladies. I continued to remove my hand from the barre and work from third position because I knew it was best for me, however, I know from experience that younger students might not be willing or able to 'disobey' the instructor the way I do. I am still looking for a ballet teacher that will let me work slowly and gently on the anatomical principles I am learning from you.

Second, I have benefited from working with yoga and Pilates instructors that encourage me to work with my body 'as it exists in the moment', and not get upset if my body doesn't do what I want it to or expect it to all the time, and allowed me to 'feel what it feels like today'. This contradicted what I learned from my ballet training, which was I should perform better every day and at least as well as the day before. There was very little leniency for changes in mood, environment, etc. I learned to ignore what my body was telling me.

I am still reading through all of your newsletters and books, so perhaps you have addressed this already. I think it is vital to teach not only technique, but a psychological 'tenderness' towards your instrument, your body. And to be faithful to what you know is right for you and your body, even if it goes against what your instructor tells you. (Until you can find a better teacher)

Thanks for listening!

What rich observations! You brought up some very important points and quite eloquently, too! It is so true that in any profession there are going to be teachers and trainers who excel at what they do, and many who are not as qualified. It's unfortunate that you have found one of the latter. To say that there is not such thing as third position is not only laughable it is a dangerous premise. Through the years of testing anatomical turnout I will say with confidence that third position is more appropriate than fifth for probably 50% of dancers. A bold statement – for sure – but one that is backed up by the injuries to the hips, knee and ankle joints that I so often see.

I am grateful for another point that you make – which is our bodies are changing and are different from day to day. So true – when you learn to listen lovingly to the messages you are receiving from your body it makes a huge difference. You are able to improve because as you listen to the day when you're slightly sick, or have muscles strain or fatigue that you become aware of – then you adapt your workout and technique appropriately, It is what smart dancers do – and we must encourage our young dancers to learn to listen and to translate what our bodies are saying. This is quite hard if you have a dancer who tells you that 'good dancers' should expect to feel pain – it means you're working hard!

I teach a 13 week course on somatics where the focus is on becoming aware of your thoughts, feelings and actions in response to your life. It is so gratifying to watch young adults become more confident with their choices and decisions because they have taken the time to listen and think about what is happening – what their results are. If we could only do the same thing for our dance students it would empower them to realize they and they alone are ultimately responsible for what is happening in dance class. It's not that teachers are not also important – they are – of course! But no one knows how something feels in another persons body and if we teach them to disregard potentially important physical symptoms we are remiss in our responsibility as a teacher. Simply – everyone knows when something feels good – or not – or even the different between something that is uncomfortable because it might be a new skill – and something that is painful.

Thank you for your email, and good luck on finding a new ballet teacher!

Until next time,

Warm regards,

Deborah

"Education is the key to injury prevention.

Dancing Smart Newsletter: 3/16/08

2008-03-16T14:16:00.002-04:00

Dancing Smart Newsletter
March 16, 2008

Announcements:

First, I wanted to announce that I am in the process of creating an affiliate program for The Body Series products. This could be completed as quickly as the end of the week, and when it is ready to roll out, I will send an email out explaining how it works.

My reasons for deciding to try an affiliate program are two-fold. One, I need a way to generate more sales to support and maintain the website and newsletter. Hopefully, I will not offend anyone by saying that. I haven't gone after sponsors and advertising to support the website because I wanted the information to be the primary focus.

Secondly, my purpose behind doing the newsletter and creating the products is to empower and educate dancers and dance teachers in a multitude of ways. The affiliate program could help studio owners, dance teachers, and dancers create an income stream while helping me spread the word that dance can be available to everyone, no matter what your body type of amount of turnout.

I ask you to consider partnering up with me. The program will be straightforward. You will receive a 10% commission on any sales that come through you or your link. If a person that you referred also becomes an affiliate, you will receive 5% commission on any sales they bring in. I want this to be a win/win situation for all of us. Watch for more info!

The second announcement is it has become clear to me that some of the email addresses from The Body Series have been captured by less than scrupulous individuals or organizations and are being used to send spam. I have received emails from store@thebodyseries.com that were NOT from me! I am looking at how to handle this situation – I don't like getting spammed as much as the next person – and – I have never and will never share your email addresses with any other organization.

Onto the question of the week! You might want to reread the last blog post – as there was some great feedback from other readers. Thanks, Nancy (a retired orthopedic surgeon) for your contribution to the conversation about plantar fasciitis!

My daughter is 12 and had a labral tear of the hip three years ago from a gymnastic related trauma. She had arthroscopic surgery 1 and 1/2 years ago and she is still experiencing pain. Her orthopedic says her joint is perfect, though her capsule may be still tight, so we are doing joint mobilization exercises. Her PT says the pain is probably most related to her growth spurt. Do you have any recommendations of how to live through this painful experience? I am considering deep tissue work, topical glucosamine, and/or non-traditional medical options. She is so passionate about dance, and I fear she will be so devastated if she cannot experience peace and a pain-free state soon.

My heart certainly goes out to your daughter. She has come through a challenging situation. Her PT may be right on with the growth spurt connection – and – even if that is why she is in more pain now I believe she can begin to train and reeducate the muscles around the hip joint to move without pain.

I'm not clear whether she has been in some continual pain for a year and a half, or if this just recently came on with a growth spurt, but for both situations I would give the same advice for her pain.

Let me share a very recent experience with a client. I had a woman come to see me who was in significant pain around her left hip. Whenever she stepped down on it she would have shooting pain down her leg. She was walking with a cane and as she stepped onto the left leg she would tilt way over to the left with her torso as she quickly limped onto the 'good' right leg. She was miserable! She did all the right things, went to an orthopedic surgeon, a neurologist, and physical therapy through the pain management clinic at Cleveland Clinic. She wasn't getting better and was feeling really depressed and desperate.

We worked first on my table and then in standing – my instructions to her were to move slowly and smoothly only as far as she did not have pain. When she was standing she had her left foot about 6 -8 inches in front of her right. She very slowly began to transfer her weight onto the left foot and it took almost 10 minutes before she could transfer her weight to the left foot without pain. (she didn't take full weight on the leg because that would give her pain. It took another 10 minutes to discover she could begin to lift her right heel off and start to take the weight onto her left foot. We stopped and felt successful with that much. We spent another chunk of time working with getting herself from her side to a sitting position without pain as she has to do getting out of bed.

She discovered that there were ways for her to move with good anatomical alignment and not invoke the pain. Her pain pattern had become so ingrained with fear as well as compensatory patterns that muscles were in spasm and turned off without her knowing it!

Two weeks later she walks into my office still with cane in hand but totally upright and without pain! I was so inspired! She was so happy – and couldn't believe her pain level had decreased so much in such a short period of time. She still had pain – especially when she tried to move too quickly, but I feel confident, in time, that too will go away.

I share this story with you to describe the potential for somatic education to repattern movement. I was working with her similar to what a Feldenkrais or other somatic practitioner would. I use as a textbook in one of my college classes, Thomas Hanna's Somatics: Reawakening the Mind's Control of Movement, Flexibility and Health. It is a wonderful read – I recommend it strongly. You could explore the following websites to find a somatic practitioner in your area.

http://somatics.org/about or http://www.hannasomatics.com/training/index.php or http://www.feldenkrais.com

It might be that everything with the structure of the joint has been fixed – and now your daughter needs to re-pattern her movement from any less than optimal compensations that occurred from the surgery and pain of the labral tear.

As a side note – I have used successfully used plain MSM cream that I get from richdistributing.com for decreasing inflammation and adhesions – and always keep some on hand.

Best wishes for a speedy recovery for your daughter!

I'll close with a quote from Thomas Hanna.

“Somatic Exercises can change how we live our lives, how we believe that our minds and bodies interrelate, how powerful we think we are in controlling our lives, and how responsible we should be in taking care of our total being.” —Thomas Hanna

Be well!

Deborah

"Education is the key to injury prevention"

Dancing Smart Newsletter: 3/2/08

2008-03-02T17:49:00.004-05:00

Dear Deb,

I am a dance teacher and teach 23 hours a week. I have plantar fasciitis and can't seem to get rid of it. I've been stretching, icing, rolling my feet on tennis balls, wearing tennis shoes in all dance classes, wear insoles recommended to me by my chiropractor, gotten my feet adjusted and put electric stim through them, and taped my feet daily. I'm still in pain. This began in Nov. I was just wondering if you had any other ideas. I appreciate any advice you can give! Thank you! Kelly

You are certainly doing everything right, Kelly. Following a textbook rehab process for plantar fasciitis.

For those who don't know what plantar fasciitis is – it is an inflammation of the plantar fascia that is on the bottom of your foot. Fascia is a sheet or band of connective tissue that surrounds muscles and binds cells together. In some areas it is thin, like the fascia under your skin, and other areas quite thick, like on the ball of your foot.

Tom Myers wrote a wonderful book called Anatomy Trains, which looks at the myofascial meridians of the body. He proposes there are a series of myofascial lines of that travel through the body. For example, the superficial back line begins with the plantar fascia at the foot, goes up the back of the leg, continues up the muscles of the spine and ends over the top of your head at the eye sockets. Tension in any area along this line will influence the whole.

I know you are already rolling on a ball to help release the plantar fascia. I would tell you to do that as well! Let's see if you can find other areas that may be influencing the plantar fascia. You didn't mention if you had plantar fasciitis on one or both feet. When you have it only on one foot I always take a very careful look at the pelvic/torso shifts, and for any potential leg length differences. If it is on both feet, then pick the side that seems to be a little worse.

Before you roll the ball under your foot, try sitting on the floor and placing it underneath the thigh. Press the hamstring gently into the ball to encourage release. When you are in a tight area, slowly, slowly flex your foot. Very slowly - take 4 very slow counts to flex it. Do that a few more times under your hamstring, before doing the same thing for the back of the calf. Place the ball under the calf to massage it, but then also taking the time to do very, very slow flexing of the foot while the ball is still under the calf.

Now stand up and see how the foot feels. Is there any less pull on the bottom of the foot? Hopefully so!

Now you want to stand with your back to the wall and place the pinkie ball along the same side of the spine of the leg you were just working on. One spot might be right along the spine somewhere between the shoulder blades. You are leaning on the ball with your feet securely placed about a foot away from the wall, or whatever distance feels comfortable. Now with the ball staying in one spot along your spine, gently and slowly, very slowly drop your head towards your chest stretching the muscles along the side of the spine.

You can repeat that a few times at other spots along that same side of the spine.

Now recheck how your feet feel. Do you feel any less strain at the feet? This is a good exploration for dancers even without plantar fasciitis. It always astonishes me the detailed relationships between body areas. You just explored releasing tension along the superficial back line of fascia – without ever touching the plantar fascia itself – and yet – the plantar fascia most likely has been helped.

If this made a difference to how you feel in standing and walking, Kelly – it might be useful to find a massage therapist who specializes in myofascial massage. In addition, I would encourage you to continue exploring and releasing any tension you might find above the level of the foot. This may mean that you need to make some changes in your movement dynamics like the speed of your walking.

If you find you can walk more easily and without as much strain by walking more slowly than you normally do – then you need to become aware of your speed and try to walk slowly and easily, allowing the foot to roll without pain, and the weight to transfer firmly yet smoothly from one foot to another.

Please let me know how you do with these suggestions – and I'm also always eager to read your comments if you care to leave them.

Warmest regards, and hope everyone has a wonderful week!

Deborah

"Education is the key to injury prevention"

Dancing Smart Newsletter: 2/13/08

2008-02-12T20:32:00.001-05:00

Hope everyone has a Happy Valentine's Day!

Hi! I'm a musical theatre major at Texas State Univ. I'm 19 years old and have been dancing for about 2 years, ever since I decided to major in Musical Theatre. I've taken mostly ballet, with a few jazz courses here and there. I'm still somewhat of a beginner, yet I have good facility, and the potential to be a great dancer.

Aside from all of this, I'm also very athletic. I weight train 4-5 times a week, working with a trainer.

Earlier today, I went to the gym to weight train. I was going to do squats, so I made sure to stretch my legs sufficiently. I usually do a stretch routine of about 15-20 minutes before getting into any workout. I was all stretched out, and ready to start the squat machine. However, I felt that I needed to "warm up" a little more, and told my trainer that he could go to the bathroom while I ran a lap around the track.

I began to run, and 3 steps into it, I had an improper landing on my left ankle, causing the foot to roll in. I heard a SNAP! And I was unable to walk anymore...

My trainer came and asked me what happened. I told him that I landed wrong and snapped something. He then went and got ice to prevent the swelling in my ankle.

To make a long story short, I went to a physician here at school that checked all around the ankle. She diagnosed me as having injured my peroneal tendon. She said that it didn't seem too dangerous, and that I would have to stay off of it for a while. She also wants me to go see a therapist for recovery.

My question is this: Will I be able to dance professionally (not necessarily in a corps de ballet, but on Broadway.)? How will this injury affect my ballet? I know that the peroneal tendon is vital in the execution of certain steps/exercises, but do you think that this will have long-term effects?

Thanks in advance, Joseph

There are 2 peroneal muscles, the peroneus longus and peroneus brevis. They run along the outside of the calf with the brevis attaching to the 5th metatarsal, and the longus continuing under the foot to the first metatarsal.

The peroneal muscle is strained when you sprain your ankle. Often a peroneal tendon strain happens exactly as you described where you land on the outside edge of your foot and roll over on it. It is common to hear a pop or a snap with some immediate swelling occurring.

I'm glad to hear the physician feels it was minor, and I'm imagining you are walking with either an elastic bandage to help keep swelling down, or perhaps if it was a more severe strain you may be using an air cast or lace-up ankle brace. Ibuprofen or an anti-inflammatory may have been prescribed as well.

It is a very good idea to see a physical therapist for rehabilitation. You will need to strengthen the peroneal muscle and to work on improving proprioception at the joint. (Balancing exercises).

Balance, even for non-dancers, needs to be addressed regularly. The only way to improve balance is to practicing balancing. The only way to maintain good balance is to continue practicing. If you don't use it – you lose it! (This is a major problem in our elderly population)

Everyone recovers from an injury at a different rate. How long it takes you to return from this injury depends on the severity of the strain. It could be a couple of weeks to a couple of months.

Your first goals are to walk straight ahead without limping or pain, then to have equal strength to the uninjured ankle, as well as equal range of motion as compared to the uninjured ankle. As your balance and strength improves you will challenge it more – but don't be in a hurry!

This injury not only has to keep you from a professional career – it is very possible that because of this injury you will ultimately be stronger and more balanced in your movement. When you are working with the physical therapist or trainer they will evaluate your gait and look for other asymmetries that may have been contributing factors to this injury. Don't worry, focus on each gain, and keep a strong mental intention about your full recovery. Peroneal strains can be a temporary set-back, but typically not a permanent problem.

On with the dance!
Deborah

"Education is the key to injury prevention"

Dancing Smart Newsletter: 2/2/08

2008-02-02T06:28:00.001-05:00

Dancing Smart Newsletter
February 1, 2008

Greetings! I hope 2008 has gotten off to a fabulous start!

Question of the week…

I have a question about abdominal strength. The studio I teach at recently had several students from another studio move to our studio. It's very apparent that the training they have been receiving at this other studio is sorely lacking. One of the major problems I've run into with them is abdominal strength or lack of it. In ballet, I will tell them to pull up the front of their abdominals, but when I place my hand on their stomachs, I feel nothing. I don't think they even know where or how to engage the abdominal muscles. Besides them doing abdominal strengthening exercises, can you recommend any specific ideas for ballet class?

Thank you, Sarah

Excellent question, Sarah! I want to first say that even when dancers do sit ups or crunches on a daily basis it doesn't necessarily mean they will use them efficiently during the dance class.

I'd like to first remind everyone that the only thing a muscle can do is contract. It can do a shortening contraction (concentric), lengthening contraction (eccentric) or isometric contraction, which stays the same length. When you are doing a crunch or sit-up, the abdominals are doing a shortening contraction – in other words – the two ends of the muscles are coming closer together.

If you are lying on your back knees bent and lifted towards your chest, and then slowly drop your toes to touch the ground, doing a leg lowering, you are doing an eccentric contraction.

If you are standing still or sitting in a car and engage your abdominals, you are doing an isometric contraction because the distance between the two ends of the muscle aren't changing.

I teach my students that if they learn how to engage their abdominals properly in standing and in movement, they won't need to do umpteen sit-ups as a part of their training. Have your dancers stand easily in first or parallel position. Have them imagine they are lacing up their abdominals as they do their shoes. Have them place one hand below the belly button so they can feel the abdominal wall drawing up and inwards – while their other hand is just below the sternum, which is the area where the ribs come together in front. The area just below the sternum should be relatively soft as they need to continue to breath easily and effortless while they are using their abdominals.

Too many students engage their abdominals so fiercely it is as if they have put an invisible belt around their waists and have cinched it closed. The first time they need to take a deep breath in they lose their abdominal support.

I'm not opposed to doing extra strengthening for that area – it might help them become aware of the state of their abdominals. Half sit-ups or sit backs, leg lowering, and any of the Pilates exercises are excellent for getting them in touch with their abdominals. Slouching alignment and poor sitting habits outside of class promote weak abdominals.

The challenge is that good abdominal usage in dance means good coordination between their breath and their core strength. Once they understand that using your abdominals doesn't mean the whole area is rock-hard will help them engage them more appropriately.

On with the dance!

Deborah

"Education is the key to injury prevention"

Knee Pop and Long Leg!

2008-01-24T08:47:00.000-05:00

Greetings!

After reading your letter about the popping hip, I was wondering if you could shed some light on a problem that I have been having. I have been having a popping sensation at the back of the knee. After x-rays and an MRI, I visited an orthopedic that told me that "he doesn't know what to tell me", he thinks it is my hamstring. The popping started back in October and since then has for the most part gone away, but there are times that I can still feel it "pop" or get a sensation as though it needs to pop. Do you have any ideas or suggestions that I can try? I guess I need to tell you that there is no particular exercise that bothers me, most of the time it happens I am just walking!

Thanks! Nancy

Good question – and – I'm happy to hear that the 'pop' is slowly going away. It's not unusual at all to find that the lateral hamstring is tighter than the others. For women, it has to do with the width of our hips and potentially tighter iliotibial bands. (The IT band connects from the muscles on the outside of the hip and runs down the outside of the leg to below the knee)

Are your IT bands tight? If so, I would work with a foam roller along the outside of the leg as well as the front and back.

Some dancers have some natural rotation that occurs at their feet while walking. You want to keep the hip/knee/ankle in alignment when walking, and that usually means facing straight ahead. You might note if the times you are noticing the pop if you are wearing shoes that perhaps shift your gait. I see dancers walk more turned out while in heels, for example.

It is amazing how often a favorite pair of shoes can be traced to some small tweaks and pulls. I'm not saying that is what created your 'pop' but simply when there is something going on that isn't a straight forward cause/effect – it is useful to broaden our observations to look for less common influences.

Next question…

I have a big problem standing in fifth position. I cannot seem to straighten my legs and still maintain a closed fifth position, mostly because one leg is insanely longer than the other one! My teachers are always telling me to straighten my legs and I just can't seem to do it. As a result, I grip my quads a lot to try and keep a straight fifth position. Then my teachers tell me to lift up and turn out to keep me from gripping my quads, but then I can't keep from tucking under. Will I ever be able to have a straight fifth with my uneven legs? What should I do?
Thanks! –Kelly

There is a simple solution to this problem, Kelly. That is to get a lift to put in your soft slippers of the short leg. I have seen this problem before when the dancer comes to see me and is having some knee, hip, or ankle problems on the long leg side.

If there is enough difference that you cannot easily cheat your 5th (I'm not encouraging anyone to cheat anything) that tells me you are standing unevenly between the two legs even in open positions.

Stand in first position facing the mirror. Slowly lower into demi plié. Do you shift to the longer leg side at the bottom of the plié? Now put something small – less than a half inch in thickness under your short leg. Repeat your demi plié. Does it look more even? How does it feel?

If it feels significantly better it would be worth going to the drug store and purchasing a pair of heel cushions and place one of them in your soft shoe. It is an inexpensive fix. Take the other lift and put it in your walking shoes and notice if you feel more evenly balanced as you go through the day.

Warmest regards,
Deborah

Dancing Smart Newsletter: 1/08/08

2008-01-08T16:39:00.000-05:00

Greetings!

Using a blog for the newsletter has gotten thumbs up! Thanks to all who emailed or posted a comment. Let's go right to the question of the week!

My ballet teacher told me I sometimes don't straighten my legs in élevé as much as I should. She said I needed to tighten my quad muscle. I thought I was doing that. What muscle is she talking about exactly? She said it is above the knee. Is that all I need to do to have stick straight legs? Is there any other way to keep my knees straight at all times?
Thanks, Val

I've got a couple of thoughts, Val. One is that you might have some weakness in either the quadriceps muscle or the calf muscles, or both. The quadriceps muscles are hip flexors and knee extensors. That means they bend the thigh towards the pelvis and they straighten the knee. Here are pictures of the quadriceps muscles and the calf muscles. In the picture of the calf muscles, the gastrocnemius muscle has been cut away so you can see the soleus muscle underneath.

Start by standing in parallel, sideways to the mirror. Are your legs straight with the knees in line with the hips and ankles? You don’t want the knees to be behind the middle of the hip and ankle because they would mean they are hyperextended, and you don’t want the knees in front of the middle of the hip and ankle, because that means they are slightly bent.

I’m assuming that when you are just standing still – your legs are straight. Now slowly start to rise onto the balls of your feet. As you rise, do your knees bend at all? If so, there is some weakness.

To address the weakness you can do two very simple strength exercises. The first is to stand at the barre on one foot and do slow single leg relevés and élevés. Make sure you aren’t gripping the floor with your toes when you do so. You can do them in parallel and in turnout.

The second exercise is doing very small single leg demi pliés, both in parallel and in turnout. You again don’t need to lower very far, or do very many repetitions before you notice the quadriceps tiring. If your thighs are sore the next day then that is a sign that you overdid the repetitions and pull back some.

The other comment I want to make is that knees come in all shapes and sizes and sometimes the shape of your knee makes it look like they aren’t straight. If you have knobby knees like the picture of a very famous actress that is shown below – they may not look straight when they are.

One way to see if you have a structural problem with straightening your knees (and I have only seen a few people who couldn’t straighten their knees) is by lying face down with the only the lower part of the leg off the table. Notice in this picture that the right heel is higher than the left? This is a sign of a more significant contracture in the muscles – or a structural concern.

Again, if you can stand with straight legs – or lie down with your legs straight, then you need to focus on strengthening the muscles around the knee and ankle for your élevé and relevés. Good luck!

Until next time,

Warm regards,

Deborah

“ Education is the key to injury prevention”

Dancing Smart Newsletter: 12/28/07

2007-12-27T12:38:00.000-05:00

Welcome to Teaching Smart! This blog will house the Dancing Smart Newsletter and gives you the opportunity to add your helpful suggestions at the end of the post. Hopefully, posting the newsletter in this format will decrease the newsletters that get caught by spam filters and create more active dialogue between us. I'm always open to feedback and learning - and will be the first to admit I don't have all the answers! Please be respectful in your responses and it goes without saying that the focus and content should stick to the posting topic.

Warmest wishes for a successful 2008!

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About two years ago when I started training very seriously for just ballet, I started having a popping sensation in my hip. I soon learned that I had snapping tendon syndrome. During the winter of that year I hurt it badly enough where I couldn't walk comfortably and couldn't dance for about two weeks. It got better, but I always had the same popping.

Now two years later, I have learned that I have had snapping tendon tendonitis. It hurts whenever I do anything to a la seconde (especially doing développés, ronde de jambs, and retire/posse). It also hurts when developing devant and fouettes of course.

Last year I got physical therapy at the local exercise place and it didn't help at all. I've read your "Tune Up Your Turnout" book (and love it :) and I've been stretching in a lunge position during class often. Any other stretches or exercises I can do? Will my tendonitis ever go away even though I've stopped growing, and are foam rollers helpful?
Thanks, Rachel

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It's unclear from your description whether the popping is coming from the front of the side of the hip. Snapping hip syndrome usually refers to the pop at the side of the hip that comes when the thick band of tissue (the iliotibial band) snaps over the greater trochanter which is the bump on the outside and top of the thighbone.

The foam rollers are extremely helpful as you roll slowly on the outside of the hip, and down the outside of the thigh. It can be pretty tight and uncomfortable, so only put as much pressure on the foam roller as you can easily tolerate.

If the popping is coming from the front of the hip it is the hip flexor tendon that is causing the snap. I'm happy to hear you are doing the stretches from Tune Up Your Turnout, which focus on stretching out the iliopsoas muscle with the lunge stretches, and standing quadriceps stretching. Keep doing those and add on a new way of stretching with the foam roller.

Start resting with the foam roller at the top of both thighs. You are going to rest on your elbows. Gently allow your weight to drop into the foam rollers. Slowly bend both knees until you feel a subtle stretch. Keeping your knees bent let both feet drop to one side, then the other. It will feel as if you are rolling across the width of the quadriceps. (The foam roller stays in the same place on your thighs)

After doing a couple of passes, shift forward slightly so the foam roller is now a bit closer to your knees. Repeat bending your knees and slowly letting your feet drop from one side to the other – easily and slowly.

Try this once again bringing the foam roller closer to your knees – staying at least 4 inches above the knees. In this final position your chest is probably now resting on the floor as you drop the feet from side to side. The last position will be the most tender (or at least is for me) so please do this carefully and slowly.

Then stand up and see how your legs feel – hopefully a lot looser!

It does help that you have stopped growing as growth spurts are notoriously challenging for dancers and athletes. Can you get rid of your tendinitis? Absolutely, Rachel! Tendinitis is an overuse syndrome and can be very tricky to work with. It often seems like it is 3 steps forward, then 1 step backwards. Decreasing the overall tension of the contributing muscles and creating a better balance between strength and flexibility will give you better muscle tone, increased range of motion, and decreased pain.

Good luck, be patient, and let me know how you do!

Happy New Year!

Deborah

"Education is the key to injury prevention"