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 Thank you Thank you!!! Angelica

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Angelica… your question is a bit hard to answer because I’m not clear with how knock kneed you are. You are accurate that it does make it impossible to get your hip/knee/ankle in a straight line, and that is also true with a dancer who is bowlegged. How far apart are your feet when your knees are touching? It may be very helpful to go to a physical therapist that works with dancers to have the different elements of your technique looked at. For example, being knock kneed doesn’t have to influence your turnout, so you’ll want to see what the hip structure is like. Is it possible that you have a hip joint that structurally turns in some? (called an anteverted hip) I would address the hip joint separately at first from the knees.

Here’s a very short clip showing how anteversion (being structurally turned in) or retroversion (being structurally turned out) would test at the hip joint. (The 2 clips are taken from my new Essential Anatomy: A Multimedia Course for Dancers and Dance Teachers)

Moving down to the feet – the goal is to be as even as possible between the three points of the feet. With knock knees there is a strong tendency to pronate, or roll in. Training your balance on one leg would be key. Try standing on one foot and tossing a pinkie ball in the air for up to 3 minutes. Notice what area first gets tired. That is an area of tightness or weakness. Often dancers will find the outside of their hip on the standing leg getting sore first, and I encourage them to do more pinkie ball release around the pelvis and outside of the hip if that does happen.

What I want you to focus on is the fact that you have danced all your life and you continued right into college! And you don’t mention that you’ve had any significant injuries – a definite good sign. With knock knees the goal is to keep the muscles as balanced as possible from the hip down. There isn’t any exercise that will ‘cure’ the knock knees since it is a structural issue except surgery – and I’m not sure I would recommend it, especially if you are fully functioning (meaning moving without discomfort or pain).

There are certain types of dance that may be easier on your body than others, and you’d know what those are by just doing them. I’m not encouraging you to change forms – but to just explore. I had a student at Oberlin who had pretty significant knock knees, and she ended up competing nationally on the swing circuit!

My point is you obviously love dancing, and you want to improve – I got it. I want you to focus on improving the balance of all the muscles around the hip joint first. Test your turnout – look at the balance between the quads and the hamstrings – as well as the outer hip muscles and inner thigh muscles. Get them as flexible and strong as possible. Focus on your feet and improve your balance by balancing in as many different ways as possible, on your bed, on a soft pillow, standing on one leg with your eyes, closed, etc. You’ll be focusing on what you can do to improve, rather than being so aware of your knees, which you can’t structurally change.

At the college is there anyone that teaches a dance kinesiology class that you could meet with to muscle test you? That might help guide you where to focus your efforts on bringing balance to the muscle groups – the same focus that every dancer should have.

I’ve seen lots of nontraditional bodies moving in beautiful ways.. I don’t want you to give your dream up of continuing to have dance in your life after college.

warmest wishes for a great junior year at school!

Deborah

“Education is the key to injury prevention”

Thanks a lot for taking the time to read my letter!
Liz

Great questions, Liz! Let’s start with the easier one first. If your ankle is popping more, that doesn’t necessarily mean that you are on your way to developing Achilles tendonitis – but it does make me wonder what’s happening in your standing alignment. Evaluate honestly if the weight is staying balanced between the front and back of the foot – are you over turning out at the feet in first position – and can you do a demi plié and keep the anterior tibialis tendon (the one at the front of the ankle) during the descent of the plié. Check those 3 areas and correct them as they may be creating some muscle imbalance.

Stretching is key for the Achilles tendon – and while most do the traditional lunge calf stretch, I prefer putting my foot over a thick book, and then stepping forward with the other leg to do a modified lunge. You don’t have to step very far forward to get a super stretch of the calf muscles. Also do this also with the back knee just barely bending to place the stretch down towards the tendon. Both variations are important.

Onto développés.

Many dancers aren’t aware of the importance of a strong iliopsoas to their extensions and développés. When you are lifting the leg to the front there is a point above 90 degrees where the quads are less effective and the iliopsoas becomes more important for a gorgeous high extension.

I’m posting a quicktime movie of an iliopsoas strengthening exercise. You will place a theraband around the thighs and then bring the knee towards the chest.. You can also do straight leg legs or développés. The more upright you are by moving from your elbows to your hands, the harder. Do these exercises with the leg slightly turned out leg. It is a challenging exercise but you will be quite happy with the results, I promise! Then stretch the iliopsoas afterwards. I’ll be curious if your ‘popping’ will get better after balancing out the strength to flexibility of the all important iliopsoas muscle.

This clip is taken from my new Essential Anatomy: A Multimedia Course for Dancers and Teachers

I’m putting it all together as we speak – and they will be ready to order (along with some very special bonuses) next week – for sure! I have put together over 3 hours of quicktime movie clips (along with an outline and study guide) that bring anatomy to life – talking and illustrating important muscles, concepts and what to do… in order to dance smart and teach smart. After clicking the link the movie will open up and take just a moment to load.

psoas strengther with theraband

Until next week!

Deborah

“Education is the key to injury prevention”

Another thing do you have any advice on “six o clock” penchés and tilts?
Thanks, Angelise

Great questions, Angelise! Summers are a great time to cross train and work in ways that you can’t during the regular school year. If you have the access to a pool, you could increase your cardiovascular fitness through swimming or water walking (a form of jogging in the pool). Biking as hard as you can for a minute and then pulling back is a form of interval training. Biking instead of running is easier on the dancer’s body.

Doing a barre in your room is a good idea. You can work slowly and carefully, paying attention to the weight on your feet, keeping the weight evenly divided between the 3 points of the foot. It would be great to do a barre without holding onto ‘a barre’ or ‘dresser’. I wouldn’t worry so much about pulling a muscle because you’ll be paying close attention to what you are doing, how it feels.

You ask a good question about being warm. Usually in the summer it takes less time to warm the muscles up. A few jumping jacks or jogging in place, should get the body going unless you are working in an air-conditioned room, then it may take a bit longer. Some dancers will feel they are almost at a light sweat. That never happened for me… but there was a sense of inner warmness that I would feel. It’s hard to put into words, so I would simply pay attention to how your body feels and you will learn what is ‘warm’ for you.

Penchés and tilts require the hardest type of contraction of a muscle, which is an eccentric contraction. The hamstrings on your supporting leg are stretching while you are slowly lowering.

My main tip is to practice keeping the weight placed between the front and back of the foot as you are lowering in your penché. Many dancers fall back too much onto their heel as they are lowering. Keeping even weight will help you keep the arabesque shape and the abdominals engaged as you lower.

The depth of the penché will be influenced by your hamstring flexibility. Once you have reached the range of the hamstrings you’ll start to bend the upper body forward – be aware of that and only go as far down as you can maintain your arabesque line. With repeated focused practice you will improve!

Deborah

“Education is the key to injury prevention”

Jessicas _Daily Affirmation

or

click here to watch it on YouTube

It’s important to note here that we all have a favorite perceptual mode that we work from. Mine is kinesthetic. I pepper my language with sentences that include the word I FEEL _____. When I listen to clients, others will say, I SEE what you mean, or, I HEAR you.

Let me use an example of describing little jumps to a group of beginning ballet students. I could describe an image of a merry go round horse, or jumping on a pogo stick to help them keep their alignment upright when they land. I could direct them to listen to how their feet land on the floor. Or I could ask them to monitor kinesthetic cues and have them describe what is happening in their knees and ankles.

Going back to the common phrase of tuck under I would encourage teachers to describe anatomically what the goal is, which is the middle of the hip, knee, and ankle joint stay in a vertical line if you look at the dancers from the side. Try putting the dancers against the wall with their heels a few inches away. In this position the buttocks/pelvis would lightly be touching the
wall, and the upper back would not touch at all. (Let’s face it; even with the skinniest of dancers, our pelvis should be farther back in space than our shoulders). Have the dancer soften in front of the hip joints and deepen into a demi plié. They will see right away if they stay in alignment over their feet.

Some of them will tuck under and their head/shoulder area will hit the wall as their pelvis moves away. Some of them may totally move away from the wall and shift forward over the front of their feet. The wall becomes a way for them to monitor their alignment in the demi plié.

Ideally, we should give different images to our students so they can chose the one that clicks with them. When I teach dance classes I use anatomy to describe what is happening in joints of the body as a way of introducing movement. I try not to demonstrate very much as I have found they end up watching me and not putting it in their bodies quickly enough, or
they have an unspoken goal of wanting to LOOK like the teacher.

Historically, the goal of teaching has been conformity, rather than efficiency. We build our movement vocabulary on our past movements whether or not they are efficient. The plié, relevé, and tendu are the base for a multitude of other more challenging movements, no matter what the style of dance. If your student overly tucks under their pelvis when they do a demi
plié, putting strain on the knees, then that is the base movement that they build their jumps on.

The body is so resilient that often the effects of the inefficient alignment are not felt until adolescence, or into our twenties, when the body finally says enough! That’s when you pick up the coffee cup and your back goes into spasm, or you wake up in the morning and your feet hurt when you start walking on them. You can’t figure out why your body is suddenly talking so painfully to you. Turning your head to back out of the driveway and going into spasm may be the straw that broke the camel’s back and not the sole reason why you are now in spasm.

Bottom line – when a student isn’t getting what we are saying, sometimes we need to figure out a different way to communicate the goal, not just say it louder or more often. (All the teachers who are also parents will agree with that ) Good teaching sometimes means adapting the message so the student can get it. Most of them are trying hard, they are passionate
about dancing, as passionate as we are for helping them achieve their dreams.

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!

Deborah

“Education is the key to injury prevention”

I am a teacher who teaches 6hrs straight a day, some tap, mostly jazz.  I stretch with one of my classes throughout the day. I am finding when I have my next class my hamstrings are even tighter. Any suggestions on why I feel I am losing my flexibility which was great 2 yrs ago. I am a male and 36 yrs of age. Thanks in advance for your help!  Rocco

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Great question – and – I will admit that your question hit a small nerve for me, as I don’t like some of the changes I see in my own flexibility. I had been chalking up the changes to not spending the same amount of time stretching now that I am teaching over performing, so I decided to look at the research.

This is what I found.

“Even elderly men and women over seventy years old can increase their flexibility (Brown et al. 2000; Lazowski et al. 1999). With strength training the elderly, even in their 90s, can increase their strength and muscle mass-not as fast and as much as young people, but they can (Fiatarone et al. 1990; Lexell et al. 1995)” Thomas Kurz, author of “Stretching Scientifically”.

YES! I found other research that supported the statement that aging and decreasing flexibility or strength do not necessarily go hand in hand. But let’s get real, okay? That is not the experience that most people have as they age. Why not?

The study of physiology and aging also states that as we age, our muscles and joints tend to get tighter, and that is because as we age connective muscle tissue shortens. This shortening of connective tissue can influence the range of motion we have at a joint, especially if muscle balance isn’t maintained.

Rocco’s question about his hamstrings could be a perfect example of this.  Rocco, I would have you look at your lower back muscles, the iliopsoas, and the erector spinae muscles and work to loosen them up by doing the psoas lunge (runner’s lunge) and the more normal rounding forward stretches we do for our spine. Often when the lower back muscles are tight, we will feel the strain in our hamstrings, and when the hamstrings are tight, that stress will be felt in our lower back. When one muscle group gets tight, the other muscle groups will try and compensate. The same pattern happens with strength. If one muscle is weaker, another muscle will try and take over some of the work – often setting up a possibility for strain or tendonitis, etc. in the compensatory muscle.

We are very aware of muscle balance and alignment as dancers, and when we are still taking class for ourselves we continue to work on maintaining good muscular balance. Teaching, however, as our main form of exercise, does not do the same good things for our bodies, simply because we are so focused on our students as we are moving. It’s been my experience that even if I am stretching with a class I am still observing students, talking and counting as I am stretching, yes – I’m aware of what is happening in my own body – but not truly in dialogue with it.

There are lifestyle changes that happen after the age of 30 that influence our flexibility and strength. We begin to have more responsibilities, less time to focus on our own health and well-being. Certainly, this has been a juggling act that many people – not just dancers – are faced with.

So – the good news is our bodies are adaptable and can improve its flexibility and strength even after a long period away from dancing (or having children, or whatever our reasons are).  The bad news is that it will take making it a priority and stretching and strengthening, not twice a week, or three times a week – but small amounts daily, or as close to that as possible.

It’s not useful to beat up on ourselves for not having the body we used to have when we were in our 20′s. And, we can take comfort in the knowledge that when we begin taking time out to stretch daily, we WILL see the results of our efforts.  Jane Fonda was right on when she said if you don’t use it you’ll lose it!

I’ll close with a quote from Dr. Michael Kaplan, director of the Rehabilitation Team, a sports medicine and physical therapy clinic in Maryland who says, “There’s no reason why people in their thirties and forties and even older can’t have just as much flexibility as when they were younger–or even more flexibility. A 60-year-old can have more flexibility than a 20-year-old, if she works at it and stretches.”

As dance teachers you all have many stretches that you have learned over the years to better your flexibility.  If you haven’t already, you might be interested in checking out my Effective Stretching dvd.  These stretches were designed to stretch muscles and fascia, sitting in your chair, easily and effortlessly.  They are simple to do – and – as the title suggests – very effective at creating change.  The dvd came out after I worked with my musicians and dancers over a couple semesters creating stretches they could do while they were studying or as a preparation for practicing.  Many students had more significant responses in their flexibility and function with these stretches over doing the typical passive, hang out and stretch ones they had been doing for a while.  Plus – if you order any product before the end of the month you’ll get a free Tune Up Your Turnout book!

Happy dancing!

Deborah

“Education is the key to injury prevention”

I have a group of 30-45 year olds who do quite well, thank you very much.  They are strong, take many classes a week, and cross train with Pilates, etc. outside of ballet class.  These ladies are doing double pirouettes, some of them are doing fouetté turns, hops on pointe, etc.  They love dancing on pointe.

Are there any studies you know of that link additional risks associated with pointe work due solely to age?

I’d love to see the topic of myths and misconceptions about older dancers dealt with on your site, as well as tips for dancing safely as the years go by.

Thanks so much!

Ruth

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Great questions! Margot Fonteyn danced the role of Juliet at age 43.  Did she do it in her bare feet?  I think not☺ She did it in pointe shoes.

As is the case with most physical activities – how you do it  – is more important than what age you do it at.  I remember hearing when I was growing up that running will hurt your knees.  (tell that to the 69 year old woman who took up running and did her first marathon shortly after)

I also grew up with the idea that all dancers will get ugly feet and arthritis the longer they danced.

Why?  Because the majority of my teachers talked about their aching feet, I saw their huge bunions, and listened to their complaints of how their hips hurt!

Not a very pretty picture of aging dancers, is it?

Alignment and muscle balance are keys to optimal functioning in any chosen physical activity.  Your group of 30 – 45 year old dancers sound like smart dancers by cross training outside of dance class and maintaining a good relationship between strength and flexibility.

In fact, I would venture a guess that the older dancer is even more particular about their training over the late teen, early 20’s ballet dancer who feels more invincible and much less concerned about the physical effects of poor training – especially if they have accepted myths such as bunions are inevitable.  (Which they aren’t – sorry for my bluntness)

If your older dancers are paying attention to their alignment and proper training and conditioning for pointe work they can work as long as they choose to – or until other challenges such as osteoporosis might crop up.  On the other hand, continuing to dance is a great way to decrease the chances of osteoporosis along with good nutrition.

If they begin to have problems associated with doing pointe work they’ll handle it the same way as a younger dancer.  By checking out their alignment and technique first and then correcting any muscle weaknesses (Lisa Howell’s, The Perfect Pointe book is a fantastic resource for teachers and dancers.  You can purchase it through my website .

There are other interesting aspects to challenging yourself as you age.  The Berlin Aging Study looked at men and women over the age of 70.  This research was looking at how people feel about aging and comparing that to their vitality and resiliency.   Your older dancers (although not truly very old) are engaging in an activity that makes them feel younger and better about themselves!

In unpublished research based on the Berlin Aging Study, they found that people who feel younger are less likely to die than
those who don’t, given the same level of chronological age and equivalent physical health.

“Feeling positive about getting older may well be associated with remaining active and experiencing better health in old age.” “Thus, studies on self-perceptions of aging can contribute to our understanding of potential indicators of resilience in older adults and the aging self.”   (http://www.sciencedaily.com/releases/2008/12/081202153521.htm)

Bottom line – continuing to dance is good for our bodies, mind and spirit!  Your dancers will know when to hang up their pointe shoes – and it doesn’t sound like it is quite yet!

Deborah

“Education is the key to injury prevention”

PS:  Remember any order this month will receive a FREE copy of Tune Up Your Turnout:  A Dancer’s Guide or if you order an ebook or downloadable product, I will see a FREE copy of the 440 page Dancing Smart:  Tips to Improve your Technique

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”