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This column is intended to provide you with some helpful suggestions and information. Due to the heavy volume, not all questions are able to be answered. Please note that only dance-specific questions will be addressed. Answers
provided by "Ask An Expert" to questions submitted to Gaynor Minden are
intended for informational purposes only, and do not in any way constitute
therapy or professional services. Please refer issues related to diagnosis
and treatment of a specific problem to a qualified health care professional
in your local area. Questions submitted to this column become the property
of Gaynor Minden, Inc.
Go to This Month's Questions I'm 12 years old and have been working very hard on my turnout. Lately I noticed a clicking sound on one side of my hip. My hip is also very sore. Should I be concerned? - Susan from Ohio "Clicking"
in the hip without pain is not a cause for concern. However, if the soreness
you describe accompanies the "clicking" sound - you should make an appointment
with your doctor. When you are examined, be prepared to tell the doctor
which motions cause the clicking, what aggravates the soreness and what,
if anything, makes it better. My teacher told me that because I tend to "wing" I am more likely to get bunions. Is this true? - Ashley from Massachusetts Bunions
are typically caused by three factors: genetics, improper footwear and
faulty biomechanics. What your teacher describes is the latter. "Winging" the feet can contribute to bunions by stressing the big toe joint. This
is especially true in exercises like tendus to the back where dancers
tend to push the joint into the floor. Plan to spend some time with your
teacher working on proper foot alignment both in and out of the classroom
to avoid the development of bunions. I am dancing 5 days a week and have developed Achilles tendinitis. Are there specific exercises that will help me to heal more quickly? - Jennifer from California The
best prescription for acute tendinitis is rest. If you experience pain
while walking, try trading in your sneakers for a low heeled shoe to reduce
the tension. Resist the temptation to over-stretch your tendon. Once you
have pain free motion in all directions, begin gentle exercise.
Begin with "ankle alphabets" (draw the alphabet in big capital letters
with your big toe) whenever you are seated or relaxing. You may advance
this exercise by performing them in a tub of water for some resistence.
Once you can draw the alphabet from A - Z twice without fatigueing, add
some standing relevés. Alternate sets of 10 repetitions with straight
knees and a set with slightly bent knees. This will strengthen all the
muscle groups in your calf and prepare you for return to dance class. My knees are very hyperextended. I feel my legs are not "straight" unless I push back into my knees. Are there exercises that I can do at home to help me keep from hyperextending my knees? - Marcy from Texas Hyperextended knees require constant awareness and retraining to avoid
injuries later on in you career. Try standing in front of a mirror facing
sideways. Practice shifting between hyperextended, neutral (or straight)
and slightly bent knees. Establish what is a true "straight" line so you
have a visual image of what is correct. Be aware whenever you are standing
to keep the knees in this "straight" position. It is important to stand
with your weight shifted towards the front of your feet rather than sit
back in the heels which can encourage hyperextension. As an exercise at
home, try using a theraband tied to something secure at floor-level. Stand
with the ankle of your working leg in the theraband and pull the band
from tendu a la seconde into first position. Begin with 10 repetitions.
Once you feel that you can maintain your knee in a neutral position, you
may then add fifth or third position. These exercises must be performed
keeping the knee in neutral or what will feel to you to be slightly bent. I'm 13 and have a very weak arch. My feet are strong but flat. I've heard of a foot stretch device but I want to know how to improve my arch in a healthy way. - (Anonymous) Unfortunately, it is your bony structure which ultimately determines how your feet appear. If you do not have naturally what dancers call "good feet", there will be a limit as to how much you can "improve your arch". Be aware that more and more stretch can also mean more and more flexibility and thus weakness. If you have strong feet to begin with, don't sacrifice your strength simply for appearance sake. Every time you stretch your feet you should also do a strengthening exercise in order to maintain your strength. A simple stretch for the top of your arch is to kneel on the floor on both knees. Do this on a carpet or some sort of padding. Sit on your heels and make sure your feet are will aligned underneath you and not turned inward. Reach your hands down underneath one foot and grasp the top of your arch. Gently stretch the top of the foot up towards you. Be careful not to bend the toe joints. Hold the stretch for 15 - 30 seconds.
As an alternative, consider wrapping your arches for performance. A little
COBAN wrap with moleskin pad underneath looks great from the stage and
beneath your tights no one can tell the difference. I've been taking ballet for 7 years and I've noticed that my thigh muscles may be over developed. What can I do to elongate the tops of my thighs? - Faye from Arizona We receive dozens of questions with regards to elongating or lengthening various muscles. As dancers we often fall into bad patterns and overdevelop our quadriceps or thigh muscles. This is easy to do because the quadriceps is a group of 4 muscles and when our smaller muscle groups are weak, the thigh muscles end up doing all of the work. Make sure you incorporate thigh stretches into your routine. In between barre and center work be sure to stretch your thigh out by bending your knee and grasping your foot behind you. Make sure the knees are as close together as possible. Drop your chin down and tighten your buttocks muscles to increase the stretch. Hold it for 30 seconds.
When practicing your splits be sure the back leg is parallel and not turned
out. Most importantly, be sure your classroom work emphasizes strengthening
of the inner thigh muscles and the backs of the thighs or hamstrings.
A well balanced group of muscles is the best way to insure you won't overdevelop
one particular group. I am a 13 year old girl with a persistent case of Osgood-Schlatter's Disease for the past 3 years. Is there anything that I can do to relieve the pain and/or get rid of the symptoms. - Leigh Osgood-Schlatter's disease usually occurs in the active growing child between the ages of 10 - 15. It is important to see your doctor or physical therapist to determine what if any exercises my be required due to muscle imbalances and also to determine if there is any swelling. In most cases it is not necessary to limit activities other than those that specifically cause irritation of the pain. It is usually recommended that the student eliminate both kneeling and jumping.
Osgood-Schlatter's is most often self limiting (meaning it goes away by
itself after a certain time) so make sure you have frequent check-ups. I'm 16 years old and I hope to be a professional ballet dancer someday. The one thing that stands in the way is my balance. My teacher says I need to pull up and hold my center more. - Sonja If you and your teacher have agreed that weak ankles are not the source of the problem, then follow your teacher's advice. In order to be able to "pull up more" and "hold your center" add some abdominal strengthening to your warm-up. Try some abdominal curls before your barre work. Lie on the floor with your knees bent and your feel flat. With your hands behind your head, curl up off the floor as high as your bra strap. Hold for 5 seconds and roll back down. Repeat 10 - 15 times. It is very important to work on your balance at the barre. Where you position your hand at the barre is key. It should always be slightly in front of you in order to discourage hanging on too tightly. Whenever possible, imagine the barre isn't even there. The ability to do barre work with all of its demanding weight shifts will be extremely helpful to your ability to balance in the center. Once you are feeling stronger in your stomach muscles and more stable
in your barre work add some imagery. Don't think of your balances as static
postures but as continually growing positions. During a passé balance,
imagine yourself being lifted up by your waist. Translate this to your
pirouettes by imaging the movement as the same as a corkscrew movement.
As your foot spirals down into the floor the rest of your body spirals
upward. I'm 12, and I've noticed that my turn out is extremely tight. I have been working very hard to improve it every day for the past 7-8 months and I have seen little to no change. It is very frustrating. I have even asked several of my teachers if I am doing the exercises correctly. They said yes. What am I doing wrong? - (Anonymous) It is a universal desire among ballet dancers to want to increase their turn-out. It sounds like you are on the right track with performing your exercises every day. If you and your teachers agree that there has been no change, it may be due to a strength problem and not a flexibility problem. Many dancers focus too strongly on increasing the range of their turn-out with stretches, but never develop the strength to hold the turn out while they are dancing. Remember that you must do two things equally. You must stretch your internal rotators (or the muscles that turn your legs in) and strengthen the external rotators (your turn-out muscles). Add this exercise to your routine. Lie on your back with your legs up in the air at a 90" angle in parallel. Open your feet into a wide first position squeezing the buttocks and keeping the knees straight. Come back into parallel and repeat slowly 10 times. On your last repetition, stay turned out and do 10 little pulses increasing the turnout each time without coming back into parallel. Perform 3 sets of this exercise. Good Luck. I'm a 15 year old dancer. Recently, the back of my heel, leading to my calf has been giving me great problems. I get a sharp stabbing pain that lasts for quite a while, and comes back when I rise on the balls of my feet. Any suggestions as to what I can do to prevent this, or stop it? - Emily It's difficult to determine what your injury may be from a written description. It is in your best interest to make an appointment with your doctor to get a definitive diagnoses. If the doctor decides that what you have is a case of tendinitis there are several things you can do. First you will need to rest for a period until the pain has subsided. Couple this with ice massage to the painful area. Fill a Styrofoam cup with water and place it in your freezer. Once it is frozen, tear off the top of the cup so that some of the ice is exposed. Wet it slightly and rub over the painful area in circular motions. Be sure to give yourself periodic breaks to allow your skin to adjust to the cold. An ice massage should only last 5 minutes and can be done twice a day in the morning and in the evening. Be aware that many factors contribute to tendinitis. Perhaps the surface you are dancing on is aggravating your condition. If you are dancing in heels or character shoes as you stated, upon your return to dancing make sure your shoes are well padded on the insides to help absorb some of the forces you are absorbing from the ground. I have been a Highland dancer for 12 years. I have been recently developing bumps on the joint where my big toe is connected to my foot and my big toe points outward. Sometimes this bump hurts a lot, but the pain is relieved when I dance without a shoe on. We wear our shoes small and they stretch. I was wondering if this has anything to do with this bump. I've been to a chiropractor and he called it a "pump bump". If this is it, what is a pump bump and how can prevent/heal it? - Kirsten "Pump Bumps", also known as Haglund's Deformity are a painful protrusion or bump on the back of the heel. This does not sound like what you describe. More likely, you have developed a bunion. As you mentioned, your shoes are probably too tight. Choose a slightly larger size shoe next time and insert a "toe spacer" between the big and 2nd toe to reduce the stress on that joint. (See Toe Separators for more information.) Dr. Scholl's sells these spacers and most drug stores carry them. The bad news about bunions is that once you have them they do not go away. However, you can prevent them from getting worse. Try the following exercise. Sit on a chair with your foot out in front of you. Dig your heel into the floor and flex your foot up so only the heel is touching the floor. Fan your toes out, concentrating on the big toe pulling as far away from the others as possible. Let the big toe come back in very slowly taking 5 counts to return to the starting position. This exercise is very difficult for most people and may take some time to master, but keep at it. Work up to 15 repetitions and perform them every day. I am 13 years old. Three months ago I went to my doctor, she said that I had Achilles tendinitis in the left foot. I was given several exercises to do. I have been doing these exercises for three months now, but my left foot still hurts when I go on point and when I tendu. What should I do? - Deidre If
a follow-up visit to your doctor reveals no additional diagnoses beyond
tendinitis, it is possible you have left out one critical element of healing...Rest.
If you have been doing exercises for tendinitis for 3 months and have
not gotten any relief, chances are you have never given your injury time
to heal. Three years ago when I was pregnant with my first child, I stopped going on pointe as it hurt my stomach. Now I am pregnant with our second child and cannot ease off pointe as I am teaching much more regularly. I am in no discomfort this time whilst on pointe at ten weeks pregnant. I would appreciate any suggestions or comments you might have to help me continue as long as possible. - Glynis from Tokyo, Japan Pregnancy affects many different aspects of our bodies. Each person experiences each pregnancy in a completely unique way. Be aware that your body is releasing a hormone called relaxin. This hormone's primary function is to allow your pelvis to widen for the birth process. However, relaxin is systemic, affecting your entire body and can therefore make you more prone to ligamentous injuries. Dancers are flexible to begin with and this is a good reason to adjust your normal routine. I would caution you to ease off pointe work in the center because your center of gravity is changing daily and you are at greater risks for falls. If you feel secure at the barre during the early stages of your pregnancy, you may choose to continue. Eventually however, it will be in you and your baby's best interest to taper off. Consider choreographing some set barre or center work for your classes so they can follow along once you are unable to continue. You might also enlist some of your students to be "demonstrators" each class and set some time aside to work with them on the daily exercises. I am a new physical therapy graduate and am very interested in the field of dance medicine. I spent 17 years of my life training to be a dancer and was involved in a professional dance company for 2 years. I've always wanted to apply my knoweldge of dance to the physical therapy field but don't know quite how to do it. I know that I can't start off in a dance physical therapy clinic (I live in Austin, TX), but I wanted to know the types of steps I should take to eventually work in that field. I also wanted to know if it is a good idea to become licensed in Pilates. I have been taking classes for several months and have wondered if it will make me more marketable in the dance arena. I would appreciate any assistance you can provide, - Trisha Hemby You'll
be glad to know that the number of dance companies and clinics with PTs
specializing in dance medicine is increasing all the time. I'm sure in
the future you'll be able to work in such a setting. In the meantime I
suggest you investigate a mentoring situation. Some clinics now have formal
mentoring programs which means you spend anywhere from one day to several
weeks observing/following/assisting a PT who treats dancers. In Texas
you can try contacting Michael King PT with Houston Ballet, Barbara Olson
PT at Northwest PT in Austin and Donna Ritter PT in Dallas. If I'm not
mistaken, the Performing Arts Special Interest group of the APTA can give
you more information on mentoring programs. Pilates training I think would
serve you well. Not only would you be more marketable but it will give
you an exercise repertoire to build on. Pilates and yoga based exercises
are often integrated into exercise rehabilitation programs for dance injuries.
There are many excellent training centers; in particular I recommend Elizabeth
Larkam Body Balance in San Francisco, Marie Jose Lawrence Long Beach Dance
Conditioning in Long Beach, California and Physical Mind Institute in
Santa Fe New Mexico. Katy Keller I had surgery on my foot in December of 1999 to remove a lump near the bottom of my big toe that was causing pain and discomfort while I was dancing. The doctors assumed it was a cyst, but after removing it found out that it was scar tissue. The doctor explained it to me as a pinched nerve that had built scar tissue around it. In taking out the scar tissue, they also had to remove about three inches of nerve. This is my left foot, so it makes turns so hard to do and it's constantly swelling or hurting. I wanted to ask someone whether this was just normal or if I should go get help for it. The doctor told me there would be sharp pains if the nerve was growing back, but being a dancer with this injury makes it much worse than if it were someone else and I don't necessarily have the time to wait around and baby it. Any feedback would be appreciated. - April - Deidre If a follow-up visit to your doctor reveals no additional diagnoses beyond tendinitis, it is possible you have left out one critical element of healing...Rest. If you have been doing exercises for tendinitis for 3 months and have not gotten any relief, chances are you have never given your injury time to heal. Katy
Keller, P.T. - Megan Freeland As a double major in dance and exercise you have an excellent background to enter a Physical Therapy program. Contact the American Physical Therapy Association for a list of PT schools at 1-800-999-2782. You might also consider certification as an athletic trainer or pilates instructor. In the meantime, you could contact your local dance companies and offer your services as an exercise specialist. Katy Keller, P.T. My name is Wendy Smith, I am a P.T. in south Florida, and I am preparing a lecture for a local dance group on injuries/prevention. I have read several journal articles and have one book ("Dance Injuries their care and prevention" by Daniel Arnheim.) Are there any other resources that you recommend, i.e.books or articles? I found your column very helpful by the way! Any advice would be appreciated! - Wendy An excellent book on dance injuries is Dance Medicine: A Comprehensive Guide.Ryan A, Stephens R Eds. Chicago, IL: Pluribus Press, 1987. You should also consider subscribing to the Journal of Dance Medicine and Science published by the International Association for Dance Medicine and Science at www.iadms.org. Many dance magazines have monthly columns on dance injury/prevention; try Dance Magazine, Pointe Magazine and Dance Spirit www.dancespirit.com
Katy
Keller, P.T. Hi PT Keller. I am a dance major at the University of Washington and am doing a project on preventative physical therapy for dancers. I would like to know what difference is there between treating a dancer as compared with an athlete and why? Also why has Physical therapy gotten more specific to the dancers needs? Thankyou for your time. Ps. could you send me some suggestions as to what pieces of literature I can read to help me with my project. - Miriam You ask "what is the difference between treating a dancer and an athlete?" There are indeed many similarities. The difference lies in the mechanisms of injury and locations of injuries. Runners for example tend to develop achilles tendinitis whereas dancers are more prone to flexor hallucis longus tendinits from all the work up on "releve". Or for another example, an ankle sprain that occurs in the pointe position while wearing pointe shoes presents differently than an ankle sprain that occurs on the field while wearing cleats. The turned out positions in dance also impose stresses on the hip and leg that are very different from those of other sports. For both dancers and athletes, rehabilitation needs to prepare them to return to the specific physical demands required; the demands are different for each sport and dance form. Look up Dr. Hamilton's article on this topic: Hamilton L, Hamilton W: Classical Ballet; balancing the costs of artistry and athleticism. Med Probl Perform Art. 1991;6:39-44.
Katy
Keller, P.T. Q: I'm a 14 year old dancer with achilles tendonitis that has been lasting for 4 months. I went and saw a doctor and he put me on medication for a week, and I sat out of class for a week and a half. I iced it every night for about 10 minutes. Now several months later, it still continues to hurt even as I stretch it and ice it. I really want to continue ballet...and I'm going to an intensive summer camp where going on pointe is very frequent. What should I do? Please write back. Nicole A:
Dear Nicole, Sincerely, |
