Katy Keller, P. T., the Senior Physical Therapist at Westside Dance Physical Therapy, the New York City Ballet and the Juilliard School, provides an in-depth look at some issues that are of interest to all dancers.

Improving Your Turnout
Working to improve your turnout is an important part of dance training but you should never force or strain the hips in the process. By approximately age 12 the hip joints are formed and you can't change the amount of your skeletal turnout. You can do specific stretches and strengthening exercises to improve ease of turnout and technique. The muscles crossing the front, side and back of the hips should be gently and routinely stretched. The deep stomach muscles, hip rotators and abductors should be strengthened to keep the pelvis correctly placed.

Dancers often experience little pops and clicks of their joints and tendons which are usually not cause for concern. If however, the clicks are persistent and associated with pain or soreness then you must have the problem evaluated by an orthopaedic doctor. The doctor may recommend stretching exercises, a modified dance schedule and physical therapy. Sometimes anti-inflammatory medication is prescribed. Tightness of the muscles that cross the front or side of the hip can cause the tendon to snap over the hip joint and make a clicking sound. In addition to checking for tightness and weakness of hip muscles, the doctor also checks that the legs are equal length, the pelvis is level and the hip joints are healthy. It is very important that you see your doctor for correct diagnosis and guidance. Your dance teacher can help you correct technique faults that contribute to "snapping hip". Some of the technique faults to avoid include "sitting into the hip" of the standing leg, "hiking the hip" of the working leg, twisting the pelvis and forcing positions.

You may also want to find out about Functional Footprints©, our new exercise device to help train correct hip rotation and alignment for turnout. The device should be used with supervision by a physical therapist or teacher. Complete instructions, diagrams and cautions come with the device. For more information look at Dance Magazine's "What's New" feature by Marian Horosko in the March 1999 issue or call the distributor at 1-800-343-5540 or 201-652-1989.

Dealing With Achilles Tendinitis
Many dancers develop achilles tendinitis. Left untreated this can become a chronic problem, but with prompt, proper care it can be resolved.

There are specific exercises that can help if you have achilles tendinitis but first you must allow the tendinitis to calm down and begin healing. Stop taking class for at least a week and then gradually build up by taking partial class no more than 3 times a week, sitting out the jump and turn combinations. It is very important that you see your doctor for the correct diagnosis and guidance. A diagnosis of tendinitis means there is microtrauma and inflammation of the tendon. You should ice at least once or twice a day to help promote healing and decrease inflammation. A good way to ice is to rub the tendon up and down with an ice cube for about 3 minutes until it is slightly red and cold. If after 2 weeks you are not feeling a lot better then return to your doctor for further advice. If your tendinitis is chronic you will need to follow different guidelines.

Exercise
Exercises to stretch out tight calves, strengthen weak feet and legs, and loosen stiff insteps can help reverse tendinitis. To stretch out your calf, lie on your back with one leg out on the floor and the other leg raised straight up to the ceiling. Hold the ends of a belt in your hands with the middle of the belt wrapped under the ball of the raised foot. Flex your foot back to stretch the calf as you gently pull on the ends of the belt. The stretch should be felt along the back of the leg. Hold the stretch for 15 seconds and then repeat with the other leg. Relevés (heel rises) are a good way to strengthen weak feet and legs. Initially do relevés sitting down in a chair so there is very little weight on the feet. Make sure you are raising and lowering your heels slowly, smoothly and without sickling or winging. Progress to relevés in parallel on both feet and then to single leg relevés holding onto a stable support for balance. If relevés cause any discomfort then it is too soon to do them. Try just rocking back and forth from the heels to the balls of the feet. As you rock to your heels lift the toes and then as you rock to the balls of your feet lift the heels about 2 inches off the floor. Ten repetitions of these exercises at any one time is enough.

For more exercise ideas you can try some of the resistance band exercises described in the Dancers Dozen. Of course, do not do any exercises that cause discomfort, and be sure to work with the supervision of a teacher or physical therapist.

Technique
Technique faults also contribute to causing tendinitis. Technique faults to watch out for include rolling in and landing from jumps without articulating through the feet or putting the heels down. The Achilles tendon connects the calf muscle to the heel and normally the tendon runs straight up and down. When the feet roll in however, the Achilles is forced into a bowed position and is more likely to strain. Rolling in happens when the dancer incorrectly distributes too much weight on the inner boarders of the feet, forces plié too deeply or forces turnout incorrectly from the floor up. Work with your dance teacher to correct these technique faults.

Shoes
Pointe shoes can also cause strain on the Achilles and other tendons of the feet if they fit poorly or if they are too soft or the ribbons are tied too tight. Some dancers sew elastics into the pointe shoe ribbons at the area where the ribbons cross the Achilles tendon. This works very well to keep the ribbons snug and secure without excessive pressure on the tendons.

Be careful on hard floors and stages. If your tendons are bothering you and you are taking dance class on a hard floor, leave out the jumps especially the big jumps across the floor. Take class up until jumps then sit down and watch the rest of class. Or if your teacher permits, go to the back of the class and practice small jumps in first and second position holding the barre. Focus on articulating your feet for a quiet landing and getting your heels down. Then slowly and gently stretch out your calves and legs. Do not do any jumping or stretching exercises if you feel pain.

Dancers who are prone to tendinitis or who have to work on hard floors can try putting shock-absorbing insoles in their dance shoes. Drug stores and shoe repair stores usually carry Dr. Scholl's or Spenco brand insoles. If needed trim the edges of the insoles with a scissors so that they fit in your shoes without bunching up. Gaynor Minden pointe shoes are manufactured with shock-absorbing materials and can be very helpful in preventing tendinitis.

With any injury it is always important for you to see your doctor for proper diagnosis and guidance. Sometimes an extra bone in the back of the ankle can cause Achilles-like symptoms. An x-ray may be necessary to make the diagnosis. Tendinitis of the big toe tendon (flexor hallucis longus) is also common in dancers. In this case, the discomfort is usually felt just behind the inside ankle bone. Don't ignore your symptoms. The sooner you get help, the sooner you'll heal.

Avoiding Bunions
If one of your parents or a grandparent has bunions you are more likely to develop them since there is a hereditary factor, however you can still do a lot to prevent bunion development. In addition to avoiding "winging" also work to avoid rolling in at the feet - both can contribute to the development of bunions. Make sure your dance shoes and street shoes are fitted properly. Dancers often wear shoes that are too short, too narrow in the toe box or not supportive enough. Remember, your feet keep growing into your twenties. Even once you've stopped growing your feet may continue to widen over time especially if you are dancing many hours a week. Some dancers need to wear orthotics (custom made arch supports) in their street shoes to prevent biomechanical problems that contribute to bunion development. A podiatrist or physical therapist can help you determine if you need orthotics.

"Winging" refers to a technique fault in which the feet are forced outward from the ankles toward the pinkie toes like wings of a bird. A small degree of "winging" can add to the beauty of the line of the leg. The dance student however, should focus more on healthy alignment of the leg than on the look. The center of the foot should be in line with the middle of ankle and leg. This alignment is particularly important for tendus, relevés and jumps. When the feet wing there is more pressure on the big toe joint. The joint can become inflamed and the big toe itself can gradually become angled creating a bunion.

Try the following exercise to improve the alignment and strength of your feet. Stand with your legs and feet parallel with a tennis ball placed between your ankles. Slowly rise up onto the balls of your feet and then lower back down while keeping the ball between your ankles. The ball helps you keep your ankles aligned without winging or sickling. Perform a maximum of ten repetitions at any one time.

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About Katy Keller

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