The desired aesthetic for dancers to point their feet, pull up their arches, and push their knees out as far as possible can create the avoidance of some important joint movements (listed a bit further below) which are necessary for shock absorption upon landing a jump.
I have landed from jumps feeling shooting pain through my ankle, but put on a smile and “danced it off” to keep going. Landing a jump well is pretty important.
Often in working with dancers, our initial instinct is to initiate plyometric training in an attempt to teach the dancer how to land more softly, with better mechanics.
Is this wise as a first measure?
What if reducing foot and ankle injuries was less related to training strength and power, and more to practicing the allowance of joint movements necessary to absorb shock upon landing.
Unfortunately, these movements that are commonly avoided for the sake of aesthetics. (I will refer to these movements cumulatively as “loading the spring”).
When you land a jump, you load your spring.
Consider that paradoxically, to clean up a jump, the landing might need to look a little more “ugly” (by ballet standards, anyway).
Guess what, pronation and valgus are not the evil step-children we’ve been avoiding.
Let’s let go of judging what the movement looks like for a moment, and honestly appraise what movements need to happen in the human body for optimal shock absorption to take place.
“Ugly” joint mechanics for optimal shock absorption (AKA loading the spring):
Looks kind of like this
Rear-foot (calcaneus/talus): Eversion, plantar flexion, internal rotation. Yes, pronation! Which drives… Ankle: dorsiflexion Tibia, femur: internal rotation (not turn-out!?) Knee: flexion, external rotation, valgus Hip: flexion, external rotation, adduction Pelvis: lateral hike, anterior tilt Lumbar/thoracic spine: extension, rotation towards landing leg, side flexion towards landing leg
Wait… Allow pronation, internal rotation, and valgus? Aren’t these “bad”?
In the human body, the above joint actions must occur to eccentrically load the muscles necessary for successfully absorbing shock (plantar fascia, medial quad, glutes, etc). These are not static joint positions, but brief moments (less than a second) that the human body must pass through.
What would happen if we helped dancers to experience these important moments in their bodies, rather than brace and control in conditioned avoidance of “ugly” positions?
The “suspension” movement to train more optimal shock absorption. Notice the joint actions of the front leg? Think this is ugly?
5 ways classical dance training can alter landing position and limit optimal shock absorption:
1. Feet get stiff.
In a closed chain (foot on floor), the rear-foot and fore-foot need to be mobile and move in opposition in each plane, allowing joints to open and close to take the shock of the landing.
In dance, the foot can become very strong and rigid losing mobility and ability to oppose through pronation and supination. Feet can get stuck stiff and inverted or stiff and everted. Neither is ideal.
Add to this that many exercises dancers use to strengthen their feet and ankles are done with a band, open-chain, which does not allow foot opposition and is not specific to how the foot was designed to function on the floor, in gait.
2. Attempting to maintain perfect turnout in foot and leg while landing.
Upon landing, the rear-foot (talus and calcaneus) needs to evert and internally rotate (pronate!) to load the spring of the plantar fascia and windlass mechanism. The rear foot drives the tibia and femur to internally rotate and the knee and hip to open. This is what we want!
Dance often demands that we turn everything out: Foot, ankle, thigh, knee-cap; and by limiting this necessary internal rotation we also limit the ability of the knee and hip to open and absorb shock.
Landing with everything turned-out can limit natural movement and jam up joints rather than “load the spring” to manage impact.
Landing with the foot and leg turned out… Not the type of pronation we want!
Landing with lots of turnout in the foot, tibia, and thigh, limiting shock absorption.
3. Landing in hip ABduction rather than allowing ADduction (again, that turnout!)
To absorb shock optimally, the hip must adduct in the frontal plane, following what the foot is doing below. In dance, however, we are trained to avoid inward knee movement and deny ourselves this important moment of valgus.
Dancers, wanting to always be turned out to the maximum, tend to land with the knee pushed out and hip abducted, preventing that lovely shock absorption from taking place.
4. Trying to keep the pelvis upright, not allowing an anterior tilt to occur to with landing.
Upon landing, the hemi-pelvis on the landing leg side should anterior tilt to “load the spring” (which in this case is the glutes, which load with anterior tilt). Being cued to tuck under, or keep the pelvis perfectly level all the time and avoiding anterior tilt, again, denies the dancer of this important moment.
5. Chronic extension posture preventing dancer from extending further upon landing
Lumbar and thoracic spine extension is another way to “load the spring”, allowing the dancer to eccentrically load and then use the abdominals to enter and rebound out of the landing.
If a dancer is already stuck in an extended position with static lordosis and rib flare at rest (which is quite common…), this spring-like mechanism will not take place, and vertebrae may compress rather than abs taking load.
Do you stand like this at rest? Can’t get out of extension?
Now, you may be thinking…
“But I see so many dancers who land with their knees going in and over-pronating, and that is not a good look.”
“Surely asking a dancer to land with an anterior tilt and extended spine is not safe??”
These movements: Pronation, knee valgus, anterior tilt, and spine extension, are not bad. If you could not perform these movements, I would question how you are able to walk.
These joint movements only become a challenge when a) You get stuck in them, or b) You can’t get into them at all.
Landing WITHOUT permitting a brief moment of pronation will not allow shock absorption.
Landing already IN an anterior tilt and extended spine will not allow shock absorption.
I do not mean that we should coach dancers to land excessively pronated, turned-in, with knee valgus. These are subtle, fleeting moments in a spectrum of movement. Subtle, but important.
If we give dancers activities that allow them to experience naturally moving in and out of these foreign positions safely, they might just choose to store this as a useful pattern and use it in their dancing at the appropriate time without over-coaching and conscious effort.
A good place to start would be the “suspension” movement, which was created by Gary Ward and taught through Anatomy in Motion. Suspension simulates the shock absorption phase of gait following heel-strike. It could be used as a warm-up before class, or as a supplementary exercise as part of a cross-training program.
Notice I’m doing my best to pronate (not easy for me!), internally rotate my leg, and allow my knee to come inside my big toe, while slightly anteriorally tilting my right pelvis and extending my back?
Work in progress…
What you might feel while suspending:
Front leg quad getting burny (this is eccentric loading- the muscle contracting as it lenghtens)
Front leg glute getting burny (eccentric loading)
Front leg plantar fascia stretching and opening
Front leg achilles tendon area/calf stretching and opening
Back leg hip stretching and opening
Back of the neck stretching
Abdominals stretching (rectus/obliques)
Give it a try and see what happens.
Please note, however, that I don’t feel it is wise to TRY to land like this. Don’t attempt to change anything about your landing. Simply give your body this experience outside of class, and trust that you have now shown your body some new landing strategies that it may chose to employ the next time you jump, with little conscious effort. Landing with a few extra degrees of real pronation and ankle dorsiflexion might make a huge difference.
And just for fun…
Exercises from Anatomy in Motion haven’t only been helping me land jumps feeling more safe, but I feel (subjectively, yes) that my developpe height and hip mobility are improved, both on the standing leg, and the gesture leg.
Here’s something I’ve been working on (believe it or not, this is actually easier with a weight over head- Lot’s of great feedback for not falling over):
Transition from side to back in a grand rond de jambe was something I could never do without crazy hip cramping. The other day, after working on some AiM I tried it out, and it felt pretty good! No cramping. Leg comfortably around 90 degrees. Had to take a video (don’t try this at home unless you feel solid about plain old Turkish get-ups).
Don’t think you’ll be seeing me in a ballet class anytime soon, though ;). These days, I’m loving parallel standing leg, and no one can convince me that turnout is prettier. It’s just a different aesthetic. My choice. My knees…
injury rate for ballet dancers over an eight-month period was 61 percent. This is comparable to rates found in other studies for athletes in collision sports such as football and wrestling. The average time lost because of a ballet injury was 10.5 days, with the actual time loss ranging from one to 87 days.
In THIS study, the injury incidence in professional Irish dancers was shown to be 76%.
And in THIS study of young ballet dance students, of the 476 students in being observed, 438 injuries were recorded. The injury incidence rate was 0.8 per 1,000 dance hours.
If you dance, you will get hurt.
Am I scaring you? I’m only doing it to make a point. How does hearing these statistics make you feel? Are you inspired now to go out and take care of your joints? Or are you paralyzed, discouraged, and unsure what to do about it?
That’s my point. Scary stats aren’t enough to inspire action. Telling dancers they need strategies to prevent injuries doesn’t count as guidance. One-off injury prevention workshops don’t give long-term support that dancers need.
THIS study done in the UK looked at dancers’ perspectives towards injuries and pain, and one conclusion was:
Danceinjury rates do not appear to be decreasing significantly, despite greater awareness and the promotion of the “healthier dancer” in dance training schools, universities and among professionals in the UK.
The way we’re presenting injury prevention to dancers is not effective enough.
There’s enough research supporting cross-training to make it mainstream, yet even the dancers who cross-train get injured.
And fear mongering, kind of like I’m doing now (it’s only to make a point!), isn’t an effective means of getting dancers interested in preventing injuries, it only makes them focus on their fears.
Is it really helpful to focus on pain? To be told that you will get hurt if you don’t do x-y-z? Has being scared into trying to prevent injuries ever really inspired you?
Michael Mullin’s Facebook page is always full of gems like this one below, which I’ve been making a conscious effort more recently to be aware of in my own practice:
Pain science shows us that focusing on pain only draws our attention to it more, making it more pronounced and threatening in our minds. The more we fear pain, the more we try to stiffen ourselves to prevent feeling it, and the more we alter our movement patterns in compensatory ways that can cause even higher risk of injury.
Please watch this TED talk by Lorimer Mosely, author of Explain Pain, which summarizes nicely why things hurt (and read his book, too):
What if we stopped focusing on pain and injuries?
And what if we stopped putting the onus on the dancer to change they way they do things, and instead, change how WE work with dancers.
It’s a mistake to keep telling our students the same things over and over expecting them to change, while we ourselves refuse to adapt to their situation. We don’t study dance science for our own personal gain after-all, it’s to help the dancers. Isn’t it?
Our language needs to change.
What if, instead of naming programs as “injury prevention screens” we called them “performance optimization screens?” They are the exact same program only with a different name.
What if instead of saying “don’t do this or you will become injured!”, we said, “If you try to do things this way instead, you will be creating better patterns of moving that will help you perform better and stronger”.
Subconsciously we react differently to hearing words like pain, injuries, don’t, not, and bad. Over time, constantly hearing these words can start to change the way we feel about ourselves, and limits our potential.
Take the emphasis off the threat. Let dancers focus on their love of dance.
Does inducing fear help reduce pain in the same way that encouraging dancers to experience gratitude does?
Consider that you’re trying to motivate a dance student, or yourself for that matter, to start a cross-training or therapeutic exercise program. How would you word it to them?
Would you a) Attempt to instill a fear of spraining an ankle if you don’t do it, or b) Express how the exercises will make you stronger and better at dancing.
I think it’s obvious.
Changing your language, both to yourself and to others, is a challenge. It requires that you are completely aware of every word coming out of your mouth. This seems unrealistic but it is possible, and this subtle switch can make a massive difference, and is 100% worth the effort, with zero cost.
I have made this switch myself, and it drove me crazy when I realized how my words could be sending the wrong subconscious message to my clients, and to myself, despite my best intentions.
They say you become what you focus on. I know this to be true.
When I was recovering from an eating disorder, the hardest part was trying to teach myself how to eat again in “normal” portion sizes, without becoming completely obsessive about it. I’m sure if you’ve been through one yourself you can relate to the challenges of acclimating back to being a regular person who eats regularly.
Food was on my mind constantly. When would I eat next? How much would I eat? What would I eat? How many calories? How many carbs? How much protein? Did I deserve to eat that many carbs? Should I go exercise before or after eating? Is that too many calories or not enough? And then how many hours should I wait until I eat my next meal? What should I have for my next meal? Should I just skip eating today altogether??
When I reflect back on the hours wasted and the mental energy spent every day just thinking about food, it’s no wonder I was always exhausted and injured.
It wasn’t until I finally decided to stop thinking about food that I was able to eat like a “regular” person again. Canada is not a third world country. There is ample food here. I had no need to worry for hours each day about where my next meal would come from.
When it comes to injuries, constantly obsessing about them and their prevention is counterproductive in a similar way that my food planning obsession was. It’s a waste of mental energy that can be used more productively.
Don’t get me wrong, we need people to think about injury prevention, but it’s not the dancers who should be worried. It’s us- The scientists, the physiotherapists, the trainers, teachers, parents, and doctors to think about these things, maybe even worry about them a little, but only so that the dancers don’t have to.
Let the dancers worry about dancing, and we, the dance educators can carry the burden of their injuries. Because we’re geeks and we’re into it, and our bodies aren’t the ones on the line.
We, the educators, trainers, and therapists, need to learn all we can about prevention, but not only prevention- We also need to learn how to communicate this information to dancersin a way that doesn’t make them afraid, but empowers them to become stronger. Because the fear and obsession tactics don’t work.
In my first year at Ryerson University I remember that we were asked what our biggest fears were, as dancers. Our response? A unanimous fear of becoming hurt and no longer being able to dance.
What causes this fear of injuries?
You’re afraid of injuries because you don’t know enough about how your body works to be able to heal yourself without an entire team of specialists (which you can’t afford).
Injuries are scary because of the time off you don’t want to take, for which you will have nothing else to fill it with, because dance is all you know.
You’re afraid to become hurt less because of physical pain, and more because you tempt losing a piece of your identity.
You don’t want to think about the fact that you can’t afford rehabilitation fees.
And you’re afraid of injuries because you perceive that teachers will judge you as inferior for becoming hurt (“if your technique was better this wouldn’t have happened to you!”).
So you push these fears to a dark corner in your mind so that you can dance without limits. When you’re not injured you feel invincible, and it feels good to dance like you’re invincible. The best dancers to watch must be the ones who feel invincible because they don’t hold anything back.
You don’t need the constant reminders that you will get hurt, you need goals for performance, a well designed strength training program that is actually fun to do and that helps you feel immediate reward so that you’ll want to keep doing it. You need to be educated on how your body works so you can enjoy using it and, by understanding your limits, you can respect them.
What I feel is lacking for most dancers, unless part of a professional ballet company, is a safety net that has your back when you do get injured. Because injuries will happen. We as educators know that we can help dancers to get injured less often, but it still happens.
By safety net I mean a system that ensures that a dancer doesn’t need to be afraid of becoming injured, because they will have access to the support they need financially, emotionally, physically, and mentally in that situation.
It’s not the dancer that needs to change, it’s you and I. How we educate, train, and make ourselves a part of a dancers’ rehab process. We need to change the system rather than expect the dancers to fit into the one that currently exists, and often fails them.
Anyone who has become injured knows that it doesn’t just hurt the physical body, but it can trigger deep depression and cataclysmic feelings of low self-worth. You feel like you’re losing your identity when you lose your ability, if not only temporarily, to dance.
I am fortunate to live in Canada and that my father works for the government.
Had to insert a Justin Trudeau pic in here somewhere
Despite this accessibility, my rehabilitation experience was not good and, eventually I maxed out my parents’ coverage to the point that I stopped going because I could not afford it anymore. I even paid for treatments out of my own pocket that were ineffective.
I felt bad about myself for not getting better. I felt judged by my teachers and felt the pity of my peers. I felt guilty that I had used all of my parents’ insurance coverage and still could not dance.
It could have been much different if a system was in place to help. If I didn’t have to make decisions alone that I knew nothing about. I was alone and ignorant. Alone, even though I’m sure every dancer in my class had gone through a similar struggle.
At the IADMS conference this past October, I distinctly remember one presentation showing us evidence that insufficient coping skills was one of the top reasons dancers get injured. I can relate.
Most of us don’t have a support system unless we go out and create one for ourselves. We all have the right to a safety net. An incredibly supportive, effective, affordable network.
What if each dance program/school had a network that consisted of a rehabilitation team, a strength and conditioning team, and a therapist.
Welcome to my perfect world where:
1. Each dance school/program has a built in a budget for student rehabilitation. This budgeted amount is established knowing that dancers will get hurt- Not if, but when. This allows dancers to receive a certain minimum amount of treatment for their injuries, and a subsidized rate beyond that amount, so that they can focus on their dancing without fear.
2. Strength and conditioning is a mandatory part of the curriculum. Not a bootcamp, Barre fitness style class, but a sensible, periodized, dance-specific program taught by a competent coach who would have as much a role in education as supervising exercise, empowering dancers to become their best while feeling good about themselves and their abilities.
3. The dance program has it’s own team of rehabilitation specialists. They observe dance classes, communicate with the other teachers and faculty, and, most importantly, aren’t only into making money with fancy treatments and passive therapies. Did you know that some physios can make hundreds of dollars by prescribing an injection that takes them 5 minutes to administer? Makes it pretty tempting to do this than work long-term with a patient to teach them how they came to be injured.
4. Dance teachers are educated on how to speak and interact with their students. They are taught to avoid negative language and help them adopt a growth mindset, set goals, and raise their self-worth rather than make them feel bad about their abilities.
Imagine how reassuring it would be to dance at a school that had this kind of support system. The dancers in this program would thrive knowing that if their worst fears came true, they wouldn’t have to deal with it alone. It would allow them to dance with more confidence, not subjected to inappropriate language and fear mongering with no talk of solutions.
I write this because a dancer I know has been going through some hard times in his last year university and a system like this could have prevented his current situation, as well as that of many dancers.
I “met” Michael via email (probably chatting initially about deadlifts and hamstring injuries, two things we have in common).
Despite his best intentions, desire to learn how to take care of his body, and love of strength training, he became badly injured and has now accumulated thousands of dollars in medical bills he can’t afford to pay, and is still trying to get back on his feet.
Michael’s not an idiot. He’s way smarter than I was at his age.
Michael didn’t do anything wrong. He only wanted to work hard and succeed at something he loves, but he didn’t have the support and education he needed to overcome his injuries.
When his physiotherapy program was not helping him improve adequately, he didn’t know whether he should call it quits and find someone new, because that isn’t taught in school.
When he was cleared to go back to dance, still in pain, he was not educated on how to know when to rest, something we all need an education in.
He loves strength training and knows it’s good for him to do, but like most students, he wan not able to afford supervision and a customized program that would have ensured his cross-training was helping him, not just grinding him into the dirt (unlike other collegiate athletics programs which almost always include strength and conditioning training).
Michael didn’t get adequate recovery because he felt guilty about resting, and felt judged for sitting out. He didn’t have a better plan so he pushed through his injuries to perform in a show which, by the end, found him unable to walk without pain.
While he will probably look back a few years from now and see his situation so clearly, it’s not so easy to make the right choices when your life is ruled by judgement, competition, and pressure to succeed, with little support.
Michael needed a system.
He needed better quality physio that insisted upon adequate recovery, guidance for his cross-training, financial aid, compassion from his teachers, and to be re-assured that he would have a smooth transition back into dance if he followed their advice.
He needed a trustworthy system with this kind of incredible communication between rehab, cross-training, and teaching, with the budget to support him so he didn’t have the financial burden at the forefront of his mind.
Of course there are some challenges this model poses.
The big one: Money. Where does this budget to subsidize rehab, training, and education come from?
Another biggie: Time. Convincing the head of a dance program that it is necessary to make time for screening and strength and conditioning in the already packed curriculum isn’t an easy sell.
This system is my dream. Just give me 10 years and I’ll make it happen ;).
How is Michael now coping with his situation? He’s started a Go Fund Me campaign to help pay for his medical expenses and get back to dancing. It takes courage to put oneself out there and ask for money. I certainly would rather have given up completely than ask for help.
But Michael shouldn’t have to be asking for money. Dance students should not have to reach out to their friends and strangers on the internet because they can’t afford physical therapy. That said, this is Michael’s reality, and if you’d like to help him out, please contribute to his campaign. Better yet, reach out to UC Irvine where he studies and ask them to consider creating a better support system for their dance students.
Michael has been inspired by his situation to start a charity that would support dancers through times of need like his. For now, his Go Fund Me campaign is his charity, and if he meets his fundraising goal, he also hopes to donate to a charity that does something similar to support dancers. Please help him out, and share this post.
And if you are aware or organizations that support dancers, please let me (and Michael) know about them. Many of us are not aware what resources are available to us, so post them in the comments below.
What do you think? Am I too idealistic? (I for sure am, but I’m not changing). Can you relate to Michael’s experience? I’d love to hear your thoughts.
And yes, realize that I used a lot of negative verbiage in this post, but it was mostly to make a point!
Everyone in Pittsburgh is super friendly. I love America. I really do.
The hotel gave us free unlimited fruit (which I definitely didn’t take advantage of everyday). At the conference itself we got unlimited free coffee (which I didn’t also take advantage of…). And I got to hang out with dance-science nerds all day for 4 days. Dance science majors, PhDs, and other professionals who work with dancers in a big way. It wasn’t intimidating at all. But as Julien Smith says, “Strive to be the stupidest person in the room”, meaning, try to hang out with people smarter than you. Mission accomplished, IADMS. And how.
There was a lot of sarcasm in that paragraph. Apologies.
Another bonus was that I got to meet the actual faces of people I’ve only ever interacted with via email and social media, including some DTP readers, and it wasn’t creepy at all to meet my internet friends. The internet is so awesome for connecting with people (but that doesn’t mean you’ll see me on a dating site any time soon).
Lauren Warnecke and I at the IADMS opening reception. Dance-fitness super heroes.
Back story to this photo: Lauren Warnecke, Catherine Tully, and I were out for dinner, and while Catherine was in the washroom, a server asked Lauren and I if we were super heroes (apparently there was some kind of Marvel related show going on next-door at a convention center and he assumed we were part of it). Must be all those deadlifts because neither of us were wearing our capes. Hence the obligatory super hero photo. I love Pittsburgh!
IADMS was a great, but here’s what I left the conference feeling: It’s all very well and good that we, the people passionate about the dance sciences, are able to network and share our experiences and wisdom with each other, but the high costs and travel required to attend conferences like this are excluding a very important group of people: Dancers.
We all want to make accessibility of information, affordable training, and therapies more available to dancers, and we ‘re all passionate about it, but the actual doing is lacking.
How do we make information on best-practices for dancers more readily available to dancers? How do we provide dancers with affordable, high-quality supplementary training? And how do we give them access to the rehabilitation and therapy they need (especially in countries like the US where insurance doesn’t always cover therapists).
You could say I’m pretty passionate about accessibility. This accessibility issue is what my career path is based upon after all.
So, with a head full of science, and inspired to share it all with the dancers who need it, I created the Dance Stronger Quiz. Because it’s the very least I can do to help make this information available, in a (hopefully) fun format.
The DS quiz is designed to test your knowledge on what evidence shows are the best practices to improve dance performance and prevent injuries, but it also will teach you a bunch or new stuff(or be a nice review for some of you).
When you’re done, you can get the answer key sent to you via email, and it would be great if you let me know how you did in the comments below the quiz. Nothing like a little friendly competition 😉
Oh, and in other news…
WANT TO LISTEN TO AN INTERVIEW I JUST DID?
Yeah you do! I can’t bear to listen to myself talking and I haven’t listened to this interview since it was recorded, but people have been telling me that it was pretty good, dare I even say AMAZING. You’ll be the judge.
I had the delightful opportunity to speak with Annett Bone of DancePreneuring Studio about some things that I give a damn about. In particular, enjoying longevity in dance without messing yourself up.
Annett was one of the original trial members of the Dance Stronger program. She is an absolute gem, and her podcast covers topics relating to dance, entrepreneuring, and living a creative life.
We had an excellent chat about how to adopt a mindset that will help you succeed at dance long-term, and you’ll hear me talk all about the many ways I screwed up, got injured, and why I started the Dance Training Project in the first place.
And while I’m giving updates on the various places on the web I’ve been doing stuff, maybe you didn’t get the memo that I’ve closed up my training studio on Adelaide St. to join the personal training team at Sports Medicine Specialists.
SMS has a program called Dynamic Functional Training (DFT) which allows a part of your training to be covered through your insurance. YAY! So while I am happy/sad about leaving my training studio to join SMS- sad because I no longer am able to offer a lower studentcharity rate for my university dancers- I’m mostly happy because now you can train with me through your (or your parents’) insurance.
DFT sessions are 30 minutes in length. To join the DFT program you first need to see a physio/MD at SMS. They will then refer you to me [or another fine trainer at SMS, but please choose me :)]. These 30 minute sessions act as “out-sourced physio”, meaning that rather than the physio work on exercises with you, you do them with me. It’s a pretty awesome program, and it can save you money if you have health benefits.
There is a rather large list topics that I wish dancers were formally taught in the studio as supplementary workshops.
And FYI, if you’re a dance student at York University in Toronto, I will be coming at you with a free workshop series (starting in November), including exciting topics such as Making Breathing Sexy, Core Training Badassery, Developing Hip Mobility and Turnout Like a Boss, and, How to Warm-Up Like Jean Claude Van Damme. You don’t want to miss this workshop series.
Remember your training JC!!
In my dance career, workshops at our studio were limited mostly to applying stage make-up, pointe-shoe-tying, and how to audition. All very important things, but what good is knowing how to tie your pointe shoes if you you don’t have ankles to tie them to?
Which leads me to todays’ topic: Something I wish was taught on the FIRST DAY of every new dance training season…
How to choose a rehabilitative therapist that will actually help you.
I’m writing this from the IADMS conference in Pittsburgh, and I feel fortunate to be able to discuss topics like this with other incredible professionals in the fields of dance medicine and science.
As dance educators and professionals supporting dance wellness it’s important to recognize that we’re not going to be able to absolutely prevent injuries 100% of the time through out work and research, but we’re doing our dang best to minimize damage while optimizing performance.
Considering the (reported) injury rate in dance is between 80 and 100%, be aware that if you are a dancer (or even just dance for fun) you probably will get hurt at some point and you should absolutely know how to choose someone trustworthy to help you through those inevitable periods of injury and pain.
Knowing this, I recommend you make friends with a rehabilitative therapist (which I will refer to as therapists from here on in) such as a chiropractor, physiotherapist, massage therapist, movement coach etc.
I have personally had terrible experiences with therapists “back in the day” and I’ve worked with too many clients who have also worked with ineffective therapists. Sometimes this is how people find me- They’ve lost faith in the rehabilitation industry as a whole and are looking for exercise-based methods to reclaim their bodies.
My question is about finding someone to work with to do that, after I resolve my [pelvic floor] issues. I’ve read about studies where they compared various people who do posture correction work and none of them came up with the same diagnosis or treatment plan for a given person. I’ve also had personal experience with being told things by one practitioner that subsequent practitioners questioned, and also with practitioners who were stuck on one treatment approach even when things clearly weren’t improving. But they always seem so sure of themselves, it can be difficult and even seem arrogant to think that I know better than they do.
So what is the savvy healthcare consumer to do? Even people who come highly recommended can be the wrong choice. How do you know when “give it more time” and “spend more time on this at home” have worn out their welcome? Let alone sussing out whether the recommended approach has any merit at all; anatomical cause and effect isn’t always as obvious and logical as we think.
Getting second, third and fourth opinions can help, but in this country health insurance is always an issue and mine doesn’t cover anything “alternative” whatsoever. So getting enough care without can be difficult due to cost, and the more I can do it with traditional doctors and physical therapists who are included in my insurance coverage, the better.
If there are any strategies for finding really competent and compatible practitioners, I’m all ears (or eyes in this case).
Can I get a hell yes! I can relate. I know a lot of you can, too.
There are so many amazing practitioners out there waiting for you, but yet we still flip flop from therapist to therapist who rarely will agree on the cause on injury and treatment strategy, which can be very frustrating, consuming time and money you don’t have.
First, my own story (because this blog is all about Monika! Me me me!):
For years I kept going back to the same physio/chiro/massage therapist (yes he was all three) for my multiple lower-back and hamstring injuries. I chose him because his was the clinic I always walked by on the way to school. I didn’t do my research, I chose him because he was convenient.
Guess what- My injuries didn’t ever feel better. But I kept coming back to him anyway because I didn’t know better.
I didn’t know anything about what made a clinician good or bad, I didn’t know how quickly I should be recovering to gauge whether my progress was reasonable, and I didn’t know what a sensible treatment strategy was. But because he was such a nice guy, I trusted him to fix me.
I perceived all his specialties to be a good thing, and it wasn’t until later that I wondered “why he didn’t just focus on one thing, and do that one thing really well?” I should have known to look for a new therapist when, after asking what exercises I should be doing, he said, “You don’t need to do anything, just keep coming back”. Hindsight…
Dr. PT RMT would massage me, ultrasound me, put me in the traction machine, use the electrostim machine that made me giggle uncontrollably, all the modalities. But when I asked for exercises to help me strengthen my back, I got nothing.
He never tried to help me move better. He never tried to help me prevent future injuries. He didn’t give me any reassurance or guidelines for my return to safe dancing. But because he was a nice guy, I trusted him to fix me, and he let me down. It saddens me to see this still happens to dancers all the time. And we don’t know better!
I should have asked more questions. I should have gone to get a second opinion. And I definitely should not have assumed that just because I was in rehab that things were getting better, or that one round of physio will fix the issue forever.
Consider this conversation I had with a dance student in a class I was teaching:
Dancer: “My knees are both screwed up so I can’t do this exercise”
Me: “I would probably recommend you go see someone about that, I can give you a good referral.”
Dancer: “Oh it’s OK, I went to physio ages ago and I have exercises”.
Me: “… do you do them?”
Dancer: “No, but I don’t think my knees will ever get better so I just deal with it”
It’s like for some reason we think that just going once, to one therapist will cure us, and if it doesn’t that we have to accept that we must live with our pain forever.
If your therapist isn’t helping you get better, go find someone else. And there is no guaranteed time frame for recovery from any injury, so please do not assume that if things aren’t getting better after a month that you are doomed for life. It is very important to take ownership of your role in the rehabilitation process. You are not doomed to always be in pain unless you allow yourself to be.
And just how do you recognize the qualities that make a good therapist? It’s not just about the certifications, degrees, and fancy anatomy talk. Just what are these mysterious qualities?
The top 5 characteristics I would look for in a rehab specialist are:
1) Movement based approach
2) Absence of ego
4) Detective spirit
5) Interest in education
Knowledge is very important, and, of course, my favourite therapists to refer my clients to are incredibly smart; but, they also have my three other criteria, without which I would glance over their long list of credentials.
I also feel it is important to have a therapist who works with movement, not just passive modalities that require you to lie still for the entire session. Therapists should be able to admit to not being all-knowing. They should be curious enough to ask if you’re open to some safe and sane experimentation.
A practitioner should be willing to refer you to someone else who can help you better than they can when necessary, and they should communicate with that person to make sure you get the best treatment. A good therapist lastly should ask you lots of questions to make sure they understand your full history.
An effective therapist will be asinterested in educating you as they are in treating you. You will want to look for a therapist that is also a good role model who practices what they preach. A compassionate therapist doesn’t make you feel bad about yourself, but gives you hope and empowers you.
Does your therapist give you homework and outcome measures to help keep you progressing? Do they make sure you fully understand your homework exercise and watch you do it before you leave? Do they have an efficient assessment protocol that looks not just at joint structure and passive range of motion, but active movement that is normally done in your life’s routine? Do they watch you walk, squat, lunge, twist and bend?
An honest therapist gives you realistic advice. They don’t promise that thirty minutes in the traction machine, three times a week, will cure you, or that you just need to keep coming back for an adjustment every week for the rest of your life.
A good therapist will guide you in your healing journey but also help you understand that YOU are responsible for healing yourself. They will remind you that rehabilitation is hard work and it is impossible to predict how swiftly you will recover. However, it is entirely possible that recovery will be quicker than you think.
You may have found yourself in the frustrating situation of hopping from therapist to therapist, each with their own opinion and “fix”, but still you get nowhere. For this reason, I think it is crucial that you find not just one therapist, but a network of them that see each other regularly, refer patients to each other, and you know are always working to continue their education.
When you choose to enter a network of therapists that all operate on the same principles and share a “detective” mindset, who communicate and refer to each other openly, you know that you’re going to come out with more solutions than questions.
These are the networks I would look into when choosing a practitioner (based on the results I have personally had, and those of my clients, colleagues, teachers, and friends):
But remember that despite the reputation of a network, not everyone will be brilliant, so do your research and interview your potential therapist. Make sure that their expertise matches your needs.
If you’re hypermobile and deal with chronic injuries due to spinal instability, for example, you probably don’t want to work with a massage therapist with no skills in strength or movement training. If your joints are already loose, you don’t need more muscle release- You need to learn how to use your muscles!
What have your experiences been with rehabilitation? Who was your favourite practitioner? What was the worst experience you had? Share in the comments below and tell other readers who you’d recommend in your area to spread the love.
The way teachers sometimes talk about our quads, it’s easy to feel like we’re expected to dance without them.
“Don’t grip your quads!”
“The movement should come from underneath the leg, use your hamstrings, not your quads!”
“Don’t do squats, you don’t want to over-develop your quads.”
“Your quads are too big.” (FYI if a teacher ever tells you that, find a new teacher! Just my opinion…)
I’ve got news for you: Your quads aren’t bad.
And I’m going to explain why in today’s post.
NO MUSCLES OR MOVEMENTS ARE “BAD”
Just like pronation isn’t bad. You may be warned against using your quads or pronating your feet, but you actually need these important muscles and movements to function optimally and avoid injury in dance.
You need to use your quads to dance, and ideally they should be strong. Trying to dance without your quads is just silly so you can stop feeling bad about it right now.
I’m talking about the “Lift your leg using your hamstring” cue during developpe or grand battement front and side, and other such movements. Sorry, it just isn’t possible. Your hamstrings don’t do that.
I’m sure you’ve had teachers tell you that to lift the leg, you shouldn’t be using your quads, but rather your inner thighs (adductors), hamstrings, and butt. And if you feel your quads “gripping” that’s bad bad bad and you will get big, bad, bulky quads as a result.
I have muscular legs. It’s my genetic programming since puberty and even before. I’m athletic. I’m not a perfect ballet body-type.
As such, I was always told that this was because I was working the wrong way. My technique was all backwards. I was using my quads too much and that I need to stop because my quads would get too big and I wouldn’t be hired as a dancer. It made me feel awful about myself, my body, and my abilities as a dancer.
I’m sure many of you can relate to this fear of quad over-use.
But for the record, that’s all BS. You quads are supposed to lift your leg. Let them do their dang job.
THE QUAD-FEAR IS EVERYWHERE
Here are a few examples of this quad fear mindset from around the net:
Q: “For two years I took a ballet class for one day a week. And my teacher told me I had extreme potential to be a professional ballet dancer. So she told me to sign up for the alabama ballet school which I did. In january she let me en pointe but the pointe classes weren’t that good so I had to practice and learn by myself at home. Everything went well except for developpes and grand battements. I used my quads instead of my inner thigh muscles. now i’m trying to figure out how do I not use my quads and just my inner thigh muscles for the developpes.”
A: “…Always remember, your developpes and grand battements both initiate from the backs on the legs (glutes). So during all your ballet classes, try to feel each movement initiating from the glutes as this will help to stop using your quads…”
Ok so yes it’s true that many dancers have trouble activating their adductors, but your goal shouldn’t be to stop using your quads. And FYI, your glutes don’t flex the hip (anatomy speak for ‘lift the leg’), so it’s impossible to use your butt for this movement. Your butt actually stretches as you lift your leg up in front of you (more on that a bit further down this post).
And just check out some more comments under the main Q&A (in particular about the quads “bunching up”. How exactly does one make their muscles bunch up? Is that like an advanced spindle cell compression technique I don’t know about??)
“In ballet when lifting your leg for something like a grande battement, you are not supposed to grip with your quads, you are supposed to push from underneath the leg, more so with the hamstring. This can be quite difficult because our first instinct is to grab with the quad.”
Our first instinct is to “grab with the quad” because one of your quads, the big rectus femoris, was designed to help lift your leg. Again, let it do it’s dang job! The hamstring stretches when you lift your leg up, it does not do the work.
Nichelle from Dance Advantage does a really great job explaining the whole mis-interpreted “lift from underneath” cue HERE. She explains that this cue could just be a poor choice of language as the root of our quad confusion:
‘Note that the language in the phrase I’ve repeated above, “coming from underneath,” could easily be interpreted by students as implying that the muscles underneath the leg (the hamstrings) are responsible or must be used to lift the leg. It seems to me that this may be how the myth of lifting with the hamstrings gets passed along.’
Semantics are a bitch.
This post is to de-demonize the quads.
In fact, in the majority of dancers I work with, their quads are pretty dang weak. Sorry. It’s true.
All your quad aversion might be making you weaker.
For example, I love split squats as a supplemental strengthening exercise for dancers (more info on split squats later in this post). Many dancers I initially work with can only do 5 repetitions with their body weight before having to stop from intense quad burning. Does that sound like a dancer who needs to learn how to use their quads better?
And just a note, even though we’re focusing on the quads for this particular post, remember that it’s not productive to isolate one muscle group under a laser, but rather I encourage you to look at how it’s functioning in context of whole body movement.
That said, welcome to quad city.
WHAT DO THE QUADS DO?
Lets talk about quad function.
There are 4 quads—–>
All of them straighten your knee.
Only one of them straightens your knee all the way (vastus medialis).
Only one of them also flexes the hip (rectus femoris).
Main quadriceps group functions: Knee extension + hip flexion. Aka anything that lifts your leg up above 90 degrees with your knee straight. That’s, like, a lot of stuff you do in dance…
The rectus femoris in particular is the quad muscle that lifts your leg up in hip flexion. Because it crosses two joints- the hip AND the knee- it is more common for this muscle to be inhibited, or weak, because it is bigger and has more responsibilities.
Here are some other important muscles that help to flex the hip in a developpe:
Adductors pectineus and magnus
Tensor fasciae latae (TFL)
Rectus femoris is the only hip flexor also responsible for keeping the knee straight. Because of it’s dual function, if it gets weak, any of the other hip flexors on that list could get over-used and tight.
Got tight hips? Maybe your quads are weak…
Or maybe one of the four quads is weaker than the other 3, and this imbalance itself makes your quads feel sore and “grippy”.
So to stretch or to strengthen- It’s not always a simple answer.
DISCLAIMER: I’m not an expert at teaching dance technique and I’m not a ballet teacher. What I do quite well, however is provide dancers with supplementary exercises to help them experience their bodies in new ways that will automatically help them perform their dance techniques better.
So I’ll share some of my more quad-related nuggets with you today.
It’s not so simple as “foam roll and stretch your quads”, or “strengthen your quads with lunges”. Re-training your quads for optimal function is movement pattern dependent, meaning your quads might quite strong doing one thing, but soft as sh!t at another movement pattern.
I hope today to show you a few examples of different ways that I’ve worked with dancers on their quad needs.
SHOULD YOU STRETCH YOUR TIGHT, OVERWORKING QUADS?
Most of the time, no.
Try first asking “why are they tight?” because “they need to be stretched” is rarely the answer.
Like I mentioned earlier, it’s important to not just to stretch or strengthen the quads looking at them under a laser beam, in isolation. You have to look at whole body movement, and how and when the quads are working (or not) within that pattern.
Maybe your quads feel tight because they’re under-working and you need to stop stretching them… A viable possibility. A very similar thing happens with excessive hamstring stretching.
IMPROVE ALIGNMENT FOR OPTIMAL QUAD FUNCTION
Here’s what I see most often: A dancer who doesn’t have awareness of the position of their pelvis or spine or knees or feet during a given movement affecting how the quads (and other muscles, of course) are recruited.
Like the example of the split squat earlier, when a dancer learns where their pelvis should be in space during this exercise, it changes how it feels big time, and they go from being able to do 20 down to 5.
Another common example: Stiff feet and ankles can affect how the quads activate. Will just stretching the quads change how the foot functions? Probably not on its own, because the way your feet interact with the floor influence how things above them work.
And often hamstrings that hold too much protective tension (from overstretching, perhaps?) can prevent the quads from functioning properly. Trust me, all the hamstring stretching I did didn’t help me one bit to straighten my legs fully.
Stretching a muscle without working to improve the position of your bones- feet, pelvis, whatever- they are reacting to won’t change anything. It’ll just make that muscle feel kind of tight.
There are so many possibilities, and we all have our own unique story. I’ll share my own experience, and maybe you can relate.
MY QUAD CONUNDRUM
An n=1 example.
I’m a clear case of quads not functioning optimally because I never seem to be able to straighten my knees all the way while lifting my leg up. I got the “straighten your knees” correction a lot. Made me think, “dang, my quads are all grippy I should stretch them more”.
POP QUIZ: Which muscles straighten the knee and lift your leg? (you should know this by now…)
However, if I lie on my stomach and try to pull my heels to my butt to stretch my quads, I can’t get them all the way there. And I don’t feel a quad stretch despite the clear stiffness.
So which is it? Are my quads weak because I can’t straighten my knee? Or are they tight and need stretching because I can’t get my heels to my butt?
Should I stretch or should I strengthen?
The answer is kind of both, but mostly WORK ON ALIGNMENT. Which of course you couldn’t know without looking at me in person (this is why I can’t give you specific advice over the internet, guys!).
Remember your quads don’t work in isolation. They do what they do because of what’s happening above and below- The ankles, knees, pelvis, and spine.
In my case, mobilizing my hips and feet, and repositioning my pelvis helped me to feel better quad recruitment, and as a result of muscles doing their jobs properly and not needing to hold as much tension, I can get my heels closer to my butt, too.
I’ve seen this with several of my clients as well. Sometimes activating the quads will help them to release tension elsewhere that is preventing them from lengthening. Yes, activating the quads can release tension from the hips.
So yeah… It’s not as simple as stretch this, strengthen that.
Like many of my blog posts, you’ll probably have more questions than answers at this point. But that’s ok! I really do want you to think and ask questions. Don’t believe everything you think you know.
HOW TO OPTIMIZE QUAD FUNCTION FOR BETTER STRENGTH & EXTENSIBILITY
Strength meaning, you can activate them at the right time, generate enough force to lift your leg as high as you want, and protect your knees from exploding?
Extensibility meaning that because they activate at the right time, harmoniously with other muscles with similar and opposite functions, they can lengthen further because they don’t hold the excess tension that a poorly coordinated movement pattern tends to accumulate.
If movements like plies, squats, lunges, hip bridges and even back-bends cause discomfort in your hips, lower back, or knees, could be sign your quads need some lovin’.
I’m going to suggest that the supplemental work you do to help re-train your quads should include movements and positions you don’t into very often in dance.
In this exercise you must stand with both legs parallel (internal rotation), and as narrow as you can manage (adducted). The back leg (extended hip) is the “working” leg, that you’ll be focusing on straightening while it is in extension behind you.
All you have to do is breathe. Put one hand on your back, one on your stomach, or even put your hands on the sides of your ribs. As you inhale, expand into your hands. As you exhale, get all the air out. Aim for a 3 times as long exhale to inhale. Exhale so much that you give yourself no choice but to inhale. Try to keep your butt relaxed.
As you do this, you may notice that the position of your pelvis changes subtly. As you keep your awareness on your back leg straightening, you may notice your hip, calf, or ankle stretching, and your quad starting to burn. Good. Keep going. Keep breathing. Go until that quad burn becomes too intense. I don’t know how long this will take you.
Go for a little walk around. How does it feel to have awoken your quad and reposition your pelvis with your breath and focused awareness? Probably kind of lopsided, but loose in the hip and awesome. Do the other side now.
From here, some exercises to strengthen your quads and improve alignment include:
Try these out, and see how your new positionally stronger quads feel in dance.
One client asked me once, how do these exercises transfer into dance?
Think of it this way- You were a human first, and a dancer second. Make the human stronger, and the dancer will be too.
Also, take a look at the performance pyramid below.
Many dancers specialize so early and start dancing as young as 2, and so never got the functional movement, or general physical preparation part. Our performance pyramids are all upside-down!
By re-balancing our bodies to be good a general movement first, and then layering back on the performance, and THEN specific skill (arabesques and stuff), you’ll definitely notice a difference.
You’ll also be a lot more durable and won’t have to worry about your knees while you dance.
But you don’t have to agree with me or believe me. Just give the advice and exercises a try for yourself. Try strengthening your quads rather than stretching them. I think you’ll notice a huge difference in your alignment, your movement, mobility and strength, and how your body feels on a daily basis.
Let me know what you think in the comments below. How did these exercises work for you? And if you’re a life-long quad-stretcher, let me know how it feels, perhaps, to stop stretching them, and work on strength instead.
And if you want more exercises and ideas like the ones in this post, then you’re going to LOVE Dance Stronger. Dance Stronger is a book and 4 week training program designed to get you stronger for dance (duh).
The exercises in this post are actually directly from the program (these are the reject videos, because of the bad sound quality, sorry!), but to get a full understanding of how to integrate them into your dance cross-training, you’ll have to join the full program, which is available 100% by donation!
I think you’ll really love it.
And if you loved this post (or if you hated it) please let me know in the comments below, and share with a friend. Let’s stop the quad fear, together.
Very quick post today, and it’s about ankles and feet.
First, check out these two videos. In particular, check out her front (left) foot/ankle as she performs a split squat. What do you see in the before vs. after?
I hope you saw what I saw: A big change in the control of her pronation. Rather, an improvement in her ability to limit excessive pronation on the descent, and then successfully re-supinate as she came up.
Just FYI, pronation isn’t bad. You need it for shock absorption. You need it when you dance as a part of turn-out.
In fact, to extend your hips and activate your glutes you need to be able to pronate so that you can then re-supinate, driving hip extension from the ground up.
Much like you need sadness to perceive happiness, darkness to perceive light, you need pronation to perceive re-supination and to extend your hips. Yin and yang baby.
You don’t need orthotics to prevent your foot from pronating (well, sometimes, maybe. But it’s not a long-term solution).
You’re better off working on motor control and training yourself to become an orthotic.
Pronation can become problematic when it happens at the wrong time, in excess, and gets stuck there at rest.
By the same token, anterior tilt isn’t bad. Lumbar hyper-extension isn’t bad. They are necessary movements for dance and for life.
But they can be troublesome if you’re stuck in one of those positions, or they happen at the inappropriate time. Does your lower back hyperextend doing a sit up? That’s not supposed to happen… But it might if you’re like me, and some other dancers who are stuck in ineffective extension patterns.
Thank you, back-bends and chest breathing.
The time between the first and second videos was about 5-10 minutes. What did we do in that time?
An Anatomy in Motion inspired exercise that looked something (but not exactly) like this:
And we used an AiM wedge under the lateral part of her left foot to coax it to re-supinate at the appropriate time.
How can this help her dancing?
Proper control of pronation and re-supination means glute activation and hip extension will happen at the right times.
For this particular dancer, it means that she’ll be able to save her back by extending at the hip instead of her spine in excess.
It means she’ll have better arch strength and probably be able to point her feet better.
Being able to activate her glutes at the right time means her sore, tight hamstring will be able to relax and feel better.
And one of her main goals for working with me, improving ankle stability for better balance, is likely to become more solid too.
We have a lot of work to do yet, but not bad for a 10 minute experiment, eh?
I’m not an AiM practitoner, but I’ve been playing around with Gary Ward’s concepts, and having some pretty cool results. What happens at the foot is kind of a big deal. If you can find an AiM person near you, I highly recommend it.
The main take-away?
Be aware that pronation isn’t bad. If someone recommends you get orthotics to limit pronation, get a second opinion. Find someone who does AiM and they will teach you how to become your own orthotic.