Sincerely,
Josh

Unfortunately, Josh, you can’t undue the tibial torsion once you have it – but it doesn’t have to stop you from dancing. You do, however, need to focus first and foremost on keeping the weight even between the 3 points of the foot, the pads of the big toe, little toe, and heel. The knees will not be over the middle of the foot as we so often hear in dance class. For the dancer with tibial torsion if they pull the knees out to get them over the middle of the foot they are doing it by supinating the foot or overly using the sartorious muscle to pull the knees out to the side. Then you’ll have more problems than just pulling the knees out to the side!

The treatment? To simply balance out any muscular imbalances and keep the weight on the feet properly placed while working the turnout as well as you can from the hip – not the knees and feet.

Thank you,  Angelise

Having an experience like that is scary, Angelise.  You had a wake-up call – and while it doesn’t mean you have to stop dancing, it does tell you there are some things that need to be taken care of.

First – it is possible to turn out from the knee down and not at your hip.  When you flex the knee you can rotate the shin bones out – which makes the knee very vulnerable, putting strain on the inside of the knee.   A lunge, as you described, is a perfect place for this to happen.  You had full weight on the front leg and depending on your where you placed the back tendu leg, you may have already been twisted at the hips and the knee.

Let’s see if I can explain that further.  If you are standing in first position and do a tendu derriere with the left leg notice if your pelvis rotates slightly to the left at the end of the tendu.  For many dancers it does, especially if they are trying to keep the foot going back in a straight line, instead of a slight diagonal.

Then you go to lunge on the front leg and as you plié you’ll automatically bring the pelvis back around to the front, but now the knee and foot are no longer in alignment – and walla – the potential for strain or a brief dislocation like what happened to you.

What are my suggestions for you?  One – I want you to see a physical therapist who works with dancers so he/she can evaluate the strength and alignment of the muscles around the knee as well as your overall leg alignment.  They will be able to guide you into what to stretch and what to strengthen.  I don’t know if you are hyperextended, or slightly knock-kneed, or have overly muscular thigh muscles – each situation would have a slightly different solution.  It might be that you have a kneecap that is shaped a little funny.

After an evaluation you’ll be able to start addressing the imbalances in order to prevent another occurrence.  In the meantime, I would decrease your turnout – never get into first or fifth position through a demi plié (which often puts a twist at the knee before you’ve even begun to move) and work to strengthen your turnout muscles through the clamshell exercise.

Working your turnout correctly is SO important!  Angelise, you’ve inspired me to have an April special – I’ll add on Tune Up Your Turnout – a book that has received multiple fantastic reviews – free – with any product order.

To your good health!

Deborah
“Education is the key to injury prevention”

I lately struggle lots with my knees, especially when I do a plie type exercises in second position, this is in gym and dance classes. I have to admit I am 40, but have been dancing all my life.

Was wondering if you have any suggestions to strengthen my knees.

Regards,

Lisel

Great question, Lisel! Plié in second position requires a slow controlled action from the quadricep muscle. This means the lower part of the muscle is doing an eccentric contraction – it is lengthening at the same time it is controlling your descent. That is the hardest kind of contraction for a muscle.

The other interesting consideration is that dancers tend to turnout more in second position than they would in first or fifth position. It’s just easier to be in a wide position and turnout.

One of the easiest ways to easiest ways to train your quads for that movement is by placing a physioball (one of the large balls that you can sit on) behind you on the wall. Your feet are away from the wall and in parallel first position and you are leaning with slight weight against the ball.  Then you simply do some slow and smooth demi pliés.

Slow and smooth is key.  Once you can easily do 10 – 15 reps on 2 feet try doing 5 single leg demi’s.  It will really work your balance so start with really baby demi’s and not lowering very far.

You could also sit and put a 5 pound ankle weight on one leg.  Slowly extend to straight, and then slightly (and slowly) bend the knee (only 4-5 inches) and straighten it again.  Be careful not to lock back into the knees when you are straightening.

By doing reps at a smaller range, slowly and smoothly, you are focusing the work more intensely.  This should translate to better muscular control in your second position plies.

As always – make sure your feet are accurately placed in a turnout range that your hips dictate.  In other words don’t turn out farther in second position than how you would easily stand in first position.

Hope that helps!

Deborah

PS:  remember the early bird special on the Science of Dance Training Summer conference is only until March 30th! Check it out by clicking here!

There are three areas where snapping or popping may be felt and heard.  The most common area is at the outside of the hip at the greater trochanter of the femur. Snapping hip syndrome is named for the clunking sound that occurs at the greater trochanter when the dancer stands and shifts their weight onto the leg, which creates the snapping sensation and clunking sound.  Extremely tight lateral hip muscles create this clunk as they snap over the greater trochanter.  This is not a desirable action as it’s an easy way to develop bursitis or tendonitis in the greater trochanter area over time due to the constant irritation.  The solution is to stretch the lateral hip muscles.  You can do this by standing on one leg and letting the hip move sideways as the upper body.

The second area of popping is around the front of the hip. This pop is often heard during a kick or battement.  For some dancers their hip pops every time they lift their leg, and for others once they ‘pop’ their hip by standing on one leg tipping the pelvis forward as they lean to the side, it won’t pop for a while.  This type of popping is generally related to the iliopsoas tendon.  Sometimes the iliopsoas tendon snaps over the bony ridge of the pelvis or femur.  There is always a bursa that acts like a pillow between the joint and a tendon and when the iliopsoas bursa gets irritated and inflamed you will also feel pain in the front of the hip besides hearing and feeling the pop.  If you feel a popping sensation in the front of the hip try stretching out the iliopsoas by frequently doing a runner’s lunge stretch.  This stretch can be done standing with your foot up on a surface, sitting (as shown) or on the floor in the more traditional stretch.  If stretching the iliopsoas muscle helps decrease the popping, then briefly stretch before or after battements, and periodically during class between combinations and at the end of class. As with all tight muscles when you first begin to stretch, the muscle acts like a yo-yo.  You stretch it out and then it wants to go back to its original shape.  It takes time and commitment to truly change the flexibility of a muscle.

The third area where pops may be felt is within the joint.  Labral tears are often the cause. What is a labral tear?  Let’s start by remembering that the hip joint is a ball and socket joint.  The head of the thigh bone is the ball, and the acetabulum is the socket.  In latin ‘labrum’ means lip.  So the acetabular labrum is the ring of cartilage that is attached to the edge of the acetabulum and acts to deepen the bowl shape where the head (or ball) of the femur rests.

Injuries to the labrum can occur from chronic trauma, such as a dancer working to turnout their leg through sheer muscular determination and force, and also acute trauma, such as a fall or violent motion at the joint.

Signs and symptoms that accompany a labral tear may be pain with certain movements, (usually in the groin area), loss of strength, decreased range of motion, and a ‘catching sensation’ in the hip.

I checked in with sports physician, Vernon Patterson, DO, and asked him about labral tears at the hips.  He reported that the majority of patients with labral tears have a history of acute injury while weight bearing that resulted in a sudden onset of groin pain and a period of pain and disability.  The initial injury may have been earlier in their career, but memorable. If the dancer did not have any significant injury history to the area then he would be concerned about structural problems that could make them highly susceptible to other joint problems, including labral tears.

While the majority of hip popping is benign and won’t cause painful problems, they are a signal that the muscle balance around the hip needs to be evaluated. But if there is pain with the popping sensation see a physician.  Your hips will thank you for listening!

#1: I have my splits, but they aren’t straight (my hips aren’t straight). I’m wondering; is it necessary for your hips to be straight in the splits to be able to do good kicks and stuff? Or is it okay to not have straight hips in ballet?
Thanks!!! Talya

#2: I am a professional ballroom dancer and teacher who primarily competes in West Coast Swing. I have been working for over a year now to be able to do a split. The type of split I’m referring to is either left leg in front with right leg going back or vice versa. I find that I can get down quite far but there is still about two inches between the floor and me. Can you suggest exercises or stretches that will enable me to do a full split? I maintain a daily Pilates and yoga practice so I’m quite flexible.
I’ve been reading your newsletter for quite some time now and really enjoy it. Thank you, Ellany

#3: What are some good stretches for a good or high extension and leaps? My splits are fine but my extensions and leaps (jete) need some work.
Please help! La Precious

Deb’s Answer:
These three questions are speaking to the same issue of flexibility versus strength, and so I put them together. For Ellany, she is missing the last few inches of her splits, and for La Precious she has her splits, but needs work on her leaps and extensions. Talya’s question fits right in because of the misconception that you can keep your hips square doing the splits – which you can’t.

Let’s start first talk about square hips. Keeping your pelvis facing forward while going into the splits is a focus. The picture of a flexible gymnast in the splits has the back leg more parallel than what a dancer has in arabesque or a split leap. The dancer is working towards a turned out (and high) back leg which requires good front of the hip flexibility to allow the leg to go behind. The more you can keep the pelvis square – or facing forward – the easier it is to determine the path for the two legs when they open into the splits – certainly important if you are working on a balance beam, but slightly less so in the dance class. So Talya, the short answer to your question is it okay not to have square hips in ballet is yes – and – when you are doing battements or splits leaps focus your efforts on keep the pelvis facing forward – don’t get discouraged if you can’t maintain a perfectly square pelvis – and continue your stretching.

Now let’s talk some about flexibility. Since Ellany does yoga and Pilates on a regular basis I know that she is stretching regularly. The most basic analysis of the splits are that the front let have a strong stretch happening in the hamstrings and buttock muscles, while the back leg is stretching the front of the hip. The front leg should have the knee facing the ceiling and the back leg will either have the knee facing down to the ground, which stretches the hip flexors more or the knee facing to the side, which stretches the inner thigh muscles more.

I would have you first see what the natural inclination of your back leg is as you go down into the splits. Do you want to turn your leg out? Then focus on increasing and deepening your hip flexor stretches. Does your leg stay nicely behind and facing the floor? In which case, focus for a while on increasing the flexibility of your adductor, or inner thigh muscles.

The more pitched forward your pelvis is when you are going down in the splits, the more likely the hip flexors are keeping you off the ground. That may also give you a clue whether it is the hip flexors (usually the iliopsoas) or inner thigh muscles.

The last question I would ask of you is where do you feel the resistance to deepening the splits? If you don’t feel much muscular resistance to the lowering in the splits, then you might look at having some myofascial massage work done to release tightness in other areas along the front or back line that may be getting in your way.

With LaPrecious feeling that she has her flexibility and splits down, but unable to make her leaps more spectacular, that may be a deficiency in strength. More often I see weakness in the hip extensors (hamstrings) over the hip flexors (quads). Try lifting your back leg up more quickly sometimes makes a difference. Dancers are often overly focused on the front leg and lifting it u p high. The back leg is doing a very fast battement as soon as it pushes off (as in a grand jeté).

If your back leg doesn’t get as high as you’d like in your leaps, then focus on strengthening the extensors of the hip, the hamstrings and gluteal muscles.
You can do that by placing a small weight on one leg and doing back tendus or dégagés. You could also use a theraband and do the same thing by looping it around your foot and a support such as a heavy chair or sturdy pole or column.

Increasing your strength or your flexibility doesn’t happen overnight and consistency is key.

Hi! I have always have struggled with my turnout due to my bone structure. I have a few questions regarding my turnout and would LOVE to hear your advice. First, I have pretty good turnout when my legs are in the air especially in passe where I can have an 180 degree passe and still maintain good turnout on my standing leg. I do not have this turnout when my legs are in contact with the floor, such as in fifth position. Why? Second, I have always had to really work on my fifth position. I feel that my bum is sticking out and that I have too big of a curve in my lower spine. I do not tuck my pelvis only lengthen it downwards and I also pull my front up in addition to strengthening my lower abs. Why is my alignment not straighter? Lastly, when I stand in fifth position my hips always seem to twist into the barre even though I am holding my turnout in both legs. I know I will never have perfect turnout but would like to use what I have the best that I can. Thank you so much for your time. I bought “Tune Up Your Turnout” and thoroughly enjoyed reading it. Thank you so much!!! Katherine

click below for my response. Be patient – it’s a 7 minute response and might take a moment or two to load.

Click here

Enjoy!

I’m wondering if you can help me with turnout. I understand the concept of turning out using the small rotator muscles underneath the buttocks, however every time I engage them, I can’t help but to engage my gluteus maximus also – which doesn’t benefit turnout. If I let go of my core I can relax these bigger muscles while maintaining turnout, so I’m wondering if this is an issue with how I hold my center more than turnout?
Thanks!
Emily

Congratulations for knowing that the turnout muscles are smaller and deeper – underneath the bigger gluteal muscles!

Whether or not the gluteal muscles contract depends on what the movement you are doing. The gluteus maximus is a powerful hip extensor – it takes the leg backwards and stabilizes the pelvis on the legs. They actually assist your turnout when you take the leg behind in a back tendu. If you are standing in first position and do a cambre forward and backwards, the gluteals will contract strongly when you cambre back.

When you are doing a demi plie, though, the gluteal muscle should not be contracting strongly because you are flexing the hip. If you contract the gluteal muscles when you are doing a demi plie, you will tend to tuck the pelvis under – not a desirable action.

So turning on the gluteals is almost automatic when you take the leg behind you – but how do you turn them off when you are moving your leg to the front or during the descent of a demi or grande plié?

One of my favorite exercises for teaching dancers where their turnout muscles are is to have them lie on their side with their legs bent with their knees forward and feet in alignment with their hips. Placing one hand on the top buttock area, slowly open your top knee like a clamshell keeping your feet together. If you do a set of 20 lifts (remembering to slowly close the knees together) you’ll definitely feel the deeper rotator muscles working, while being able to monitor whether or not the gluteal muscles are contracting.

Another good way to practice this patterning between the gluteals and the rotator muscles is to start by standing in parallel with one foot in coupe. You’ll then stay standing in parallel and slowly turn out and open the gesture leg to the side.

It is very easy to monitor whether or not you are keeping your pelvis square through the weight on your standing foot. Keep the 3 points of the feet firmly planted on the ground and don’t let your foot ‘roll in’ or pronate!

In time, you will have changed the pattern of always gripping the gluteals – and – your range of motion and ease of movement will be better!

Until next time,

Deborah

“Education is the key to injury prevention”

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
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Onto the questions….

I returned to ballet about 5 years ago. I have been getting some pain in my knees which was diagnosed by my physiotherapist as anterior knee pain caused by weak thigh muscles.

A new teacher at my ballet school said that my hyperextended knees would also be causing the problem. I am working with her to try and stand straight without locking the knees but I am having problems trying stand properly on one leg while working the other.

Any help that you give would be much appreciated as all my teachers have differing opinions on hyperextended knees.

I am now 28 and also suffer from pronation.

Thank you

Kirsty

The three issues you mentioned, weak thigh muscles, hyperextended knees and pronated feet all go together. The good thing is as you start to address all 3 of them at the same time your knees should start to quickly feel better!

I’m assuming your physiotherapist is giving you quad strengthening exercises – so I won’t talk about them except to say that a single leg demi plie is a wonderful strengthener! (As long as your knees and feet are in alignment)

My opinion on hyperextension is that it creates a beautiful line in the air – and – needs to be controlled on the ground. When the knees go back into hyperextension the thighbone rotates inward, and the feet tend to pronate. This definitely opposes your goal of maintaining good turnout!

It’s not easy to change a chronic habit of hyperextending the knees – but it is well worth it! You can monitor your knees from your feet, making sure the weight is equal on the 3 points of the feet. You can also catch yourself dropping into your legs (as most dancers with hyperextended knees are rather loosey-goosey) and put your hand on top of your head and press into your hand, lengthening your spine. Practice balancing on one leg (not in hyperextension) to help your nervous system learn where the center of the joints are. It will take some time to change the habit – but I have seen many dancers do it!

Good luck!

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I am just into my pregnancy and work as a contemporary dancer and physical theatre performer. I hope not to stop my work and performances until my 7th or 8th month. However I know that I will have to modify my work and I’m game for that. I can’t seem to find a good resource — a book, a detailed article, anything! — that explains what activity should be modified and how to modify the activity as time goes on. Most of what I’ve found is very
general or specific to elite athletes like runners. Do you have any recommendations?

Sincerely
Lucy

I don’t know of any specific resources to send you to, Lucy, so I will give you my personal opinion after having 3 of my own – and counseling a few friends through their pregnancy and births.

The first is – your iliopsoas is going to take a beating with being pregnant. As the baby gets bigger, the pull on your lower back is significant. The one stretch you cannot stop doing is some form of iliopsoas stretching. (I actually have a youtube video on 3 different ways to stretch your psoas) The one stretch that I don’t have on this video is a sitting stretch – but here it is on the right.

Ballwork all around the pelvis will be very useful for keeping the muscles looser. As your belly pulls the pelvis into a forward tilt, the abdominals contract to counter that and the gluteals also tend to contract more than normal to keep your pelvis upright.

Continuing dancing will help keep the abdominals in good shape – and stretching and ballwork will definitely help the gluts!

Those are my primary tips for a healthy pregnancy. It goes without saying that listening to your body is key – and – it is an amazing process that you are engaged with. Typically, the pregnant dancers I’ve known have, for the most part, had easier pregnancies than non-dancers. They danced as long as they were comfortable – and easily modified their movement. (for example, rolling down the spine becomes almost impossible – so do hamstring stretches standing with your leg on a chair instead) I truly enjoyed all 3 of my pregnancies. Best wishes and…

Congratulations!

Deborah

“Education is the key to injury prevention”

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