Thanks to all who took the quick survey. I’m going to keep it open for a few more days and then I’ll send more information out by the end of this weekend.

Again….. click here to listen to the podcast on balancing!

Deborah

The dance is a poem of which each movement is a word. ~Mata Hari

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!

You bring up a very important point that dance teachers need to be aware of. Our language should be as anatomically accurate as possible. As teachers, we should be aware of the tendency to teach our students using the phrases that worked for us. The problem is these phrases like the two you mentioned can create a wide variety of responses in the body and not all desirable ones. For example, I can imagine a teacher using the phrase tuck under when the student has a swayback and they are trying to get the student to bring the front of the pelvis more upright and in alignment with the torso. Another teacher might use the phrase “pull in your bellybutton” with that same end goal in mind. If you use the phrase tuck under, the student may look like they are standing in better alignment, but muscularly they are contracting their gluteals and shifting forward over their feet to produce that command.

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.

Best wishes for an amazing 2010!

Deborah

I’m enjoying your dance smart messages so very much, and share them with the other dance teacher in my school. Recently a student of mine injured her ankle, and had it diagnosed as a bad sprain. She has now returned to dance class, but is, of course, finding it weak. Having not had any physical therapy, she has asked me for recommended exercises to help strengthen it.
Any suggestions? Thanks very much.
Shelley

Good question Shelley. It distresses me some that your student didn’t receive any physical therapy. I have seen many injuries that have been traced back to sprains that weren’t fully rehabbed. I’m assuming that your student can walk, stand, and slowly relevé without pain in her ankle. One of the first focuses would be to retrain the nervous system where center is at the ankle joint. This is done through balancing exercises. This one part is essential in the rehab process because the body immediately compensates after an injury such as a sprained ankle. If we don’t take the time to retrain the musculature around the joint through balancing, they will continue to act in the compensatory pattern.

Start by standing on one foot making sure you are not sinking into the hip. First begin in parallel, and then you can move into doing these turnout exercises in a slightly turned out position. Toss a ball from one hand to the other, balancing on the one leg, for one minute initially and working up to balancing and tossing the ball for three minutes. (When I was training gymnasts I would make them do this on the balance beam, so our dancers have it easy!)

When you get pretty good at balancing for three minutes in this way, challenge your nervous system by standing on a moveable surface such as a sofa cushion, your bed, or the middle of a small mini tramp.

Whatever feels tired first means one of two things, that muscle group is weak or tight, or both weak and tight. Just by virtue of doing the balancing exercises you will be strengthening and asking all the muscles to work to keep you in balance. If you get tired around the outside of the hips you should stretch that area after doing the balance exercises.

To work at strengthening the muscles around the joint your student may want to work with a wide strip of theraband and do pointing and flexing with her foot inside the theraband. She would also want to resist the theraband moving her foot into abduction which is a flagged foot, opposite of sickling her foot. To do that she would hold the theraband off to the left if she was working with her right foot and move her right foot away from the midline of the body.

You can do straight abduction, and also work the foot in a half circle shape going from flexion out to the side and into a Pointe, and then reversing the motion. [Whew, it is challenging to describe movement in words sometimes.] It is the peroneal muscles that are strained when you sprain your ankle for those of you who want to look it up in an anatomy book. She should move cautiously back into jumps and leaps and pointe work until she feels confident that her ankle is strong enough. Post sprain is a vulnerable time when it would be very easy for her to re-sprain the joint.

Happy December!

Deborah

“Education is the key to injury prevention”

#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.

Thanks, Miriam

Ouch! Bone bruises can take a long time to heal. You were right to make sure there was no fracture in the area – and then I’m imagining the doctor told you to ice the area to help decrease inflammation. With bone bruises you won’t see a lot of visible swelling, but rest assured, it’s there – so icing can help.

My concern is that you fell on the sacroiliac area so you may have created a small torque at that joint which isn’t helping your rehabilitation. Remember there is a small amount of movement that is possible at the sacroiliac joint, and it’s possible that landing so heavily on one side could have created a small shift.

Do you notice a difference in your discomfort between standing in parallel and doing a passé and doing it in turnout? If standing in parallel is better than in turnout you may have strained the deep external rotators – which are the turnout muscles)

Gentle stretching is the key.

Try sitting on a chair and cross your left ankle over your right thigh. Lace your hands underneath your left knee and gently press your left knee into your hands. This turns on the deep gluteal muscles. Now keep a gentle pressure down into your hands as you slightly tilt forward with a straight back. Think of the sits bones reaching back into space. You’ll feel a stretch somewhere in the left buttock area. If it is too strong – don’t tilt forward so much. You are in control of how much effort and how much pull – and it should be comfortable, not painful.

After doing this 1 – 3 times on each side – stand back up and try first position passé. Is there a difference? Any easier?

After a fall like you took you need to be aware and watchful for muscular imbalances and possible strains as after all – it wasn’t just the pelvis that took the hit. You have lots of muscles in that area that also were impacted and that is where I would have you focus your attention. The hip flexors might also be involved, and doing extra stretches may be useful.

As always…. listening to your body’s messages is key. If doing a specific movement increases your discomfort pull back. Think about what is different about that movement from movements that don’t hurt. Then you can begin to investigate more specifically what muscle area you need to attend to. It is often hard to figure out what is muscle and what might be ligament in an area such as the sacroiliac joint, but with gentle exploration you can begin to tease out more specifics as to what makes it worse and what makes it better. If you don’t feel that you are making a fast enough recovery I would encourage you to see a good physical therapist to check out the range of motion of both hips and the muscular balance around the pelvis.

Sending you positive intentions for a speedy recovery!

Warmly,

Deborah

“Education is the key to injury prevention”

My daughter, stepped on a pencil a year ago. She is 14 and loves ballet. The pencil graphite lodged deep in the bottom of her foot. She was operated on by a good podiatrist. He had to cut through 3 layers of muscle and the plantar fascia was repaired. She seemed fine. She went back to ballet and was still doing fine. After a few months, she went slowly on pointe. She was fine until she started doing pointe for longer periods. At that point, her progress went way backwards to the point where it hurt to walk. We went to a great physical therapist and she got much better. She massaged it, iced it, put on ultra sound, had Ashley do exercises..etc.She is just getting back to ballet this month, but her foot is hurting again. It isn’t hurting as much as before, but it began to hurt after she was doing ballet classes again. She danced the first few classes for only 15 minutes. She was fine at that point. When she went up to 30 minutes, she began to have trouble. She is not on pointe. Ashley is still doing massage on the foot, putting ice on it, and doing stretches based on the physical therapist’s orders.

Her physical therapist and podiatrist are very good, but really don’t know about ballet. Any ideas on how to get her better and back to ballet? Your input would be greatly appreciated.

A concerned mom,
Joan

Joan – you’ve been very fortunate to have a good podiatrist and physical therapist. It is encouraging that she does respond very well with the physical therapy. I suspect that there was a compensation that occurred after surgery that hasn’t been fully addressed. When we injure something on one of our legs, whether that is a foot injury like your daughter had or a knee or hip issue – our body automatically compensates. It is quite amazing in that respect – we start to stand with more weight on the other leg, potentially start having a muscular imbalance between the two sides, and so on. It is so automatic that we don’t realize going back to class that there still may be some compensatory movement happening.

I would also question if there has been some fascial restriction above the level of the plantar fascia. I wrote a post about flexibility and fascia that you’ll want to read. I wonder if there is some fascial pull in the torso or pelvis that has not been dealt with yet. If there is a pelvic/torso shift or a rotation that is occurring it could be changing her muscle usage and ballet technique. While it is hard to assess these shifts yourself, have your daughter face a mirror and stand in a neutral position with her arms just hanging by her sides.

When you look at the figure below you can see she has a pelvic shift right, torso shift left (you always describe the direction from their point of view) Notice how she makes her shoulders look square, but when you look at the arms and how they hang there is more space between her left arm and pelvis, while her right arm touches her pelvis. She is not standing with equal weight on the two legs. If she turns out into first position she most likely will continue this imbalanced pattern.

There may be something like this that is going on with your daughter. Perhaps her dance teacher could meet with the two of you before or after class to look at her alignment markers. Is the middle of the ear over the middle of the shoulder, hip, knee and ankle from the side? From the front if you drop a plumb line from her nose does it fall evenly between the 2 feet? Are her hips, knees and ankles in alignment?

While everyone is asymmetrical, and I would expect to find some shifts, rotations, etc., it could be that her shifts are causing enough of an imbalance in class where she is not working evenly on her two feet. It might also be very useful to find a massage therapist that will look at your daughter’s standing alignment and based on what she sees, work to release the myofascial tensions. This will be different from a regular massage. He/she will slowly stretch and lengthen the fascia – not always a comfortable technique, but the results are well worth it.

Hope this gives her a few more suggestions for a speedy recovery. I’m rooting for her!

Warmly,

Deborah

“Education is the key to injury prevention”