Listening to Pain for a Longer Dance Career

I’m working with a dancer this summer who reminds me a lot of me. When we first started to work together she didn’t know what pain was. Silly, right?

This lovely young lady is dealing with some pretty chronic hip, knee, shoulder and neck pain upon many passive and active movements. How has she been dancing? How does one successfully perform the infinite ranges of motion and challenges of stability that dancing requires when it hurts to do a basic, passive movement?

A lot of things are possible when you ignore pain. But for how long can you maintain that?

A huge part of what I do with some clients is pain education, something many dancers won’t ever get.

No dance teacher ever taught me how to listen to my pain, but told me to push through it. We’re told that pain is an inherent part of our existence. But I’m telling you it doesn’t have to be.

I don’t care how annoying it gets, I will ask you how you feel after every exercise.

If I know you have knee pain, I will always ask you how your knees feel, because as lovely and sweet and awesome as my aforementioned client is, she never mentions pain until I ask her. And then it finally comes out after some probing. “That hurt my knee”. WHY DIDN’T YOU TELL ME DURING THE EXERCISE WHEN YOU FIRST NOTICED IT???

Dancers…

The presence of pain changes motor control and facilitates the development of compensation. That’s why you don’t ever want to repeatedly perform movements that hurt.

Yes, to dance you will have to do some things with your body that feel uncomfortable, but that isn’t the same as pain. Do you know the difference between pain and discomfort?

I have never had a formal education in the science of pain, just like I never received a formal education in anatomy, biomechanics, neurophysiology, or many other things that I would have liked that relate to my interests in the field of training and rehabilitation. Fortunately (or unfortunately), I learned straight from the source.

While my dance teachers may never have warned me that “if X joint starts to hurt upon Y movement, go seek help because that’s bad”, I learned eventually, anyway. Was it worth it? I often wonder…

So in case a dance teacher fails to deliver this important message (that might save your dance career, by the way):

If your arm goes numb when you put it over your head, go see someone about it.

If it hurts your neck when you turn your head to one side, go see someone about it.

If your knee sometimes gives out painfully while you’re walking down the street, go see someone about it.

If any part of your body is experiencing pain at any time while you dance or otherwise, take a freaking break and go see someone about it!

It doesn’t make you weak to acknowledge pain, and taking time off from dancing when movement is painful won’t cause irreparable regression. You often need to regress to progress. That’s what pain is telling you. That’s your education from pain. Let it teach you it’s lesson, and move on to better things.

Pain is your body’s way of telling you something isn’t right. Will you listen? It’s an opportunity to make huge improvements. Will you take it?


 

Muscles You’re Using Wrong: Neck Edition

Welcome to another exciting edition of “muscles you’re using wrong”. I got some really great feedback on my first entry in this series, Calf Edition, so I’m back for round two: THE NECK.

The photo of the deep front line below, from Anatomy Trains, serves as a nice visual intro as to how the neck can become a common lieu of muscle compensation. You can see how the neck muscles are fascially connected in a chain to the diaphragm, torso, legs and feet.

A brief primer on muscle compensation as it relates to dancers: Before many of us learned to move fundamentally- squat, lunge, pull and push- we learned complex dance movement. This is especially true if you started dance when you were but a wee toddler. As a result, dancers can easily develop dysfunctional stabilization strategies, and learn to create movement from random places that have no business getting involved.

As babies, one of the first fundamental movements we learn is to lift our heads, making neck function kind of a big deal.

In calf edition, I outlined how foot-pointing all day every day can cause the plantar flexors (muscles of foot-pointery) to become majorly involved in movements they needn’t be. I personally have seen (and experienced n=1) how various muscles of the lower leg can compensate for the glutes, hamstrings, quads, psoas and more. This not only can disrupt movement pattern quality, but can eventually lead to painful movement.

Today it’s all about the neck. For me, this is huge- If I’m not careful, my body instinctively tends to stabilize with my neck muscles instead of my abdominals. This is common in many dancers and non-dancers alike.

My brief neck injury history: While half-asleep, on the morning of opening night of a show, the mere act of turning my head to the side caused an intense sternocliedomastoid spasm that incapacitated my neck for 3 days. My neck was so overworked, most likely from it’s unnecessary usage as a whole-body stabilizer, that I injured it not while dancing, but while luxuriating in the dreamy bliss that is the first 10 seconds of waking. Not a great start to a day, AND I couldn’t perform in the show.

Why did this happen?

As I mentioned above, your neck CAN get more jacked than your deep abdominals. This can become a complicated topic, so for the simple purposes of today’s post, we will look at how the neck flexors and extensors can inhibit the transverse abdominis from properly stabilizing your body.

It starts with that deep front line Thomas Myers presents in Anatomy trains. Check out the awesome video below in which you can see the deep front line dissected from the body. Very cool stuff, fascia is.

And T. Myers is a fox.

In the deep front line, the deepest of the body’s stabilizers are intimately connected fascially, sharing a neural and mechanical network, making it easy enough for one part of the line to compensate for another in the presence of acute trauma or from just moving like crap over long periods of time.

Another imbalance can occur within the neck itself between the flexors (in the front) and extensors (back): If the neck extensors become too overworked and tight, the neck flexors can become weak. This happens easily in our society of texting, computering, and other things that make us slouch and adopt a head forward posture. An oversimplification of neck imbalances, but still significant to understand.

While repositioning the head is very important, in today’s post we’ll be talking mainly about how this poor neck posture can cause the neck flexors and extensors to become recruited for core stability instead of the transverse abdominis (TVA). A poor strategy.

As a funny, but non dance-related aside: The other day at the gym I was witness to a trainer and his client as they took their monthly body part progress measurements.  They remarked at how all his various muscles had not changed in girth (the goal was to get more jacked), EXCEPT FOR HIS NECK, which had increased in size. They brushed it off as “haha that so weird”, but I noted his forward head posture and his poor core stabilization patterns and guessed that his neck had grown because it was probably doing more work than any other muscle.

Food for thought… But back to business.

I see two  common situations in which the abdominals can become downregulated to the dominant neck musculature (though anything is possible, not just these two scenarios):

1. Sternocleidomastoid (SCM) compensating for transverse abdominis (TVA)

This one is MY pattern- Neck flexors stronger than TVA. In a perfectly functioning body, if that even exists, before we even move the TVA fires to stabilize us. However, some of us activate our SCMs first for that job.

These people have forward head posture, and will often also have jaw tension and SCMs that you can see pop out (because they’re so jacked). Like in the dancer below.

2. Neck extensors and suboccpitals compensating for TVA

The neck extensors stronger than TVA pattern represents the chin-pokers and shruggers. I personally see this less commonly in my dance clients than the above neck to core compensation. The SCM’s seem to be bigger culprits in compensation and I am not 100% sure why.

Here’s simple way you can assess which scenario is you, using the deadbug exercise as a reference.

Here’s the basic arm and leg deadbug:

Try it 3 ways.

1. With your chin poked up to the ceiling, neck extended (to engage neck extensors).

2. With your head lifted off the floor, chin tucked, looking at your knees (to engage the neck flexors).

3. With your neck in neutral, looking right up at the ceiling, neither poking nor tucking the chin.

The neck position in which the deadbug feels more solid and less shaky is your compensation pattern.  For me, I crush deadbugs all day if I lift my head up and look down at my knees. But with my neck in neutral I’m shaky and unable to keep my spine neutral.

If you are already strongest with your neck in neutral, then you have nothing to worry about. You rock. And I hate you.

How to reverse your pattern:

DISCLAIMER: I can only provide a general strategy for this issue, nothing more. I don’t know you, and can’t assess you magically through this blog post, but I can easily assume that if you dance you have some kind of neck to TVA compensation, and this will almost certainly help you to reduce some neck tension and improve core stabilization, so that you can dance better and not hurt your neck in random silly ways like I did.

That said…

Step 1: Neck stretch. To downregulate the muscles of the neck which may be overworking. Breathing deeply and feeling the neck relax is the key to actually getting some benefit from this stretch.

Step 2: Head lift. To reposition the head back in line with the rest of the spine. You can also put your hands at the base of your skull to feel if you are tensing your suboccipitals  and poking your chin up. You should be aiming the back of your neck up to the ceiling, NOT poking up your chin.

 Step 3: Deadbug. Again, this time as an exercise, not an assessment. To activate and strengthen the TVA while the neck has been freshly downregulated. Do your best to feel your neck is relaxed, and only do only as many reps as you can before you feel like your neck is starting to tense up and do the work.

Start with that. Repeat. Do it daily if necessary.

If you want to take it a step farther, get assessed by someone who understands dancers, get manual therapy on your neck if you need it (always fun), and then get a movement specialist to coach you through your core training and provide you with a full-body strength training program which will integrate correct neck and core patterns.

For more on neck compensation, check out this great article from Dr. Perry Nickelston on his blog, Stop Chasing Pain, in which he describes how the neck can compensate not only for the TVA, but for the obliques in their role of creating rotation.

I’d love to hear if you’ve found this info helpful. Give me your feedback in the comments below to keep the discussion going.