Tips for Turns

Turning is one of the quintessential dance elements. With the integration of core stability and control, balance, turn-out (in ballet, at least), weight shift, proper use of arms, and spotting, turning is a culmination of all of our training. For some, it comes easily and appears effortless. For others, turns be the bane of their existence. In today’s blog post, we’ll cover some tips and must haves for spectacular turns.

 

Core

It should go without saying that you need great core strength, stability, and control to execute turns that are based on technique versus sheer luck. You must be able to keep your core muscles engaged with your ribs in so that your shoulders and hips stay level while turning. Some exercises that may assist you in this (outside of crunches and planks) involve core work on a stability or exercise ball. One exercise would be to perform a bridge with your feet on the stability ball. You can start with your arms on the floor and progress to lift them into 1st or 2nd position. There are certainly more exercises that can be done with the stability ball to increase your core strength. Stay tuned for links to other exercises and videos here, or contact me for coaching.

Weight Shift

Ensuring that you can properly and efficiently shift your weight from two legs onto one leg is essential. Even in chaînés turns, the majority of the turn is performed on one leg, not two. You must start (even in turns from 5th position) with more of your weight on what will become your standing leg. This will require the least amount of energy input to get your weight where it needs to be (hence, efficiency) while minimizing room for error. In other words (and to be blunt), the more ground you need to cover to get into your turn, the more possibilities there are for you to screw it up. Also, many dancers tend to not shift their weight fully over their standing leg. Most err on the side of not pushing enough versus launching themselves off their back foot and falling forward (not to say that doesn’t happen). In a way, it’s much like kicking up into a handstand. Most will not kick enough for fear of going past vertical and falling into a bridge (or onto their backs). With that being said, you must shift your weight forward enough so that your hips and over the ball of your standing foot, and your head and shoulders are stacked beautifully on top. If you find you’re falling out of relevé, it’s often due to your hips falling backwards (behind vertical) and/or losing your turn-out in said position. Practicing your relevé balance from your preparation (in 4th, 5th or 2nd) and making sure you can hold this position is a great way to see just how much oomph you need (or don’t need) to get into your turns and stay balanced.

Balance/Relevé

Speaking of balance and your relevé, it goes without saying that you cannot turn if you cannot first balance. And you must balance with your core engaged, your weight shifted properly, and your heel forward. Whether the leg you’re lifting is in passé, attitude, arabesque, a la seconde, or any other position, the principles remain the same. You must hold your turn-out (for ballet) on both legs. Letting go of the turn-out or not shifting the weight properly will often result in your heel dropping down and you completing your turn flat or falling out of your turn. In addition to the strength required to get into position and the balance to control and maintain it, you also need a little something called “eccentric control” to land your pirouette well. This refers to the control you need to have in your standing leg (especially the lower leg) as you lower the heel (so that it doesn’t just drop or you don’t hop and land). For this, I recommend doing controlled eccentric relevés. You can do these at the barre or off a stair even to begin, before moving center floor. With eccentric relevés, you rise up onto your toes as per usual, but you then take 5-10 seconds to slowly lower the heel with control without sickling and without rolling in as you lower. This can be done in parallel in the beginning, and can then progress to a turned out position. If you find that your ankles are weak, you can also begin by doing this on both legs before shifting onto one foot.

Arms

Arms have multiple purposes when turning. Their distance from us can affect the speed of our turning. They add to the aesthetics of the turn. But their often-neglected role is to provide additional balance for us. Most dancers know to keep the elbows lifted when turning with the arms in first or second position. The two things I find that dancers forget as they progress from first learning their pirouettes to doing them based on muscle memory (which can be good or bad, depending on habits) is their role in the initial spiraling of the turn and their role in keeping us en pointe, so to speak. The opening of the arm from our preparation into an en dedans or en dehors turn is often thrown away. The 2nd arm also often pulls in too quickly, making the dancer tilt to one side and fall off her/his leg. Inherent in this is the notion of the balance they (should) provide. When preparing for an endehors pirouette to the right, the right arm reaches forward in the preparation while the left arm reaches side. But more than this, the left arm should reach a little bit back (stemming from the shoulder blade) to begin to initiate the spiral that will spark the turn. While we don’t want to wind up too much, we need a little bit of tension here for a successful pirouette. Finis Jhung speaks of this often. Once the dancer begins the pirouette, the right arm opens to the side, and the left arm should pull out to the left somewhat to maintain a right-to-left balance during this phase of the turn. If we pull entirely to the right with nothing grounding us to the left, we will inevitable fall to the right. This holds true in fouettés, as well. As you come into the plié and begin your rond de jambe, the opposite arm should pull out the side and slightly back to help ground you and maintain the right to left balance during the turn. Without this balance between the arms and this opposition, we don’t stand a chance of consistently being balanced en relevé or en pointe.

Spotting

Oh, the dreaded spotting. There’s a myth that’s been taught and perpetuated in our field that I’d first like to dispel. Spotting does NOT keep you from getting dizzy. I repeat: spotting does not keep you from getting dizzy. Spotting allows you to land where you need to land, complete multiple turns when doing so, and travel in a straight line or a ménage during traveling turns. For traveling turns, you must find your spot before you place your foot, as the placement of the foot dictates where you end up going. To spot effectively, you first must have good posture. The back of the neck must be long with the ears lifted and chin neutral. The head must remain in this position atop the spine while turning. Many lead with their head during turns, both endehors and (especially) endedans. When turning to the right, you must keep the left ear back in line with the left shoulder. When turning left, the opposite is true. This keeps the head over the spine and prevents you from throwing your head into the turn, which will ultimately result in a loss of balance. To make sure you can spot while still holding your balance, you can practice spotting without turning. To do this, you can try to relevé in first position with the arms in first, and practice maintaining the relevé (with turn-out, heels forward, and core engagement) while turning the head to one side, then the other, and then back to center. This should be done with an element of sharpness if you’re working towards traveling turns with speed or multiple turns.

Holding Turn-out

Another element that goes without saying is that if you’re turning in a turned-out position you need to maintain that turn-out throughout the turn (and yes, there are a lots of turns in that statement). There are several exercises that can help you to tap into your turn-out and strengthen those muscles in the hip. You can do clams with a theraband while lying on your side or lifted into a side plank position. You can work your turn-out on rotation discs by going between parallel and first position or by doing pliés and relevés on them in external rotation. You can also work your turn-out in a bridge on the stability ball. Please keep in mind that these are just a few examples, and not nearly an exhaustive list. If you need more help going through some of these or need more ideas to improve your turn-out, I’m always available for more coaching.

Lastly, I’d like t leave you with a concept that Finis Jhung uses to teach turns, which is based on the physics of a spinning top. He teaches that you need the lift of the spine, especially in the plié preparation (and I’ll add the lift of the lower abdominals as an integral part of your core engagement), that a spiraling action through the use of the arms and torso (as described above) is necessary, and that a pressing down with back heel during the preparation of a pirouette as well as with the standing leg into floor is an integral part of turning. Your energy must be grounded to turn smoothly. You should not be hopping up onto your relevé or hopping out of it.

 

I hope you enjoyed this look into turns. If you have additional questions, are in need of more individualized exercises, or would like to schedule a coaching session, feel free to contact me here or here.

 

Sources

https://finisjhung.com/

https://pbt.dance/

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AFFILIATE DISCLOSURE

This website contains affiliate links, which means Tricia may receive a percentage of any product or service you purchase using the links in the articles or advertisements. You will pay the same price for all products and services, and your purchase helps support Tricia’s ongoing research and work. Thank you for your support!

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Kinesiotape

I decided to do an experiment on the longevity of a few different brands of kinesiotape. My n=1 experiment consisted of testing 4 different tapes (KT Tape, Theraband, Kinesiotex Gold, and Rock Tape) to see which one truly lasted the longest. I performed the same exact application every time (for patellar tracking) on both knees with clean legs without any lotion to try to control the conditions as much as possible. The kinesiotape potentially stayed on through showers, dancing, teaching, rehearsals, painting the office at my house, and doing PT work, so I wasn’t sedentary in the least. Please note that, if it lasted long enough, I removed all tape after day 7 to allow my skin to breathe. The video here shows my findings with updates on each of the tapes as I went (please excuse the one video I did in which my phone decided to change the orientation from landscape to portrait). I also took a few photos (below) of my knees after I removed the longest lasting tapes so that I could document any redness or irritation to my skin.

And now, for the results!

And the winner is…….

1. Theraband Kinesiotape

The Theraband Kinesiotape lasted for 7+ days with minor fraying at the edges. I had no redness or irritation after I removed the tape. No peeling was noted during the week. Here’s a picture of my knees after taking it off:

2. Rock Tape & Kinesiotex Gold

There was actually what I would deem a tie for 2nd place. Both Rock Tape and Kinesiotex Gold also lasted 7+ days. For Rock Tape, there was no peeling up of the tape from the edges, but some fraying was present. The potential downside here was some minor skin irritation around the knee once the tape was removed. I commented on this in the video, and I’ll attach a few pictures here. Again, for me, this was mild. But if you know you have sensitive skin, or are putting it on an area that doesn’t already have some tough skin (as knees and elbows tend to be a it tougher), you may want to go with a different brand.

The Kinesiotex Gold also lasted 7+ days. There was some minor peeling on one knee for me as well as a little fraying (which occurred with ¾ brands), but the area that started peeling after day 2 hadn’t grown much (only a little bit) by day 7, so it was still pretty long-lived. This tape also did not leave any redness or irritation on my skin once I removed it.

4. KT Tape

The KT tape did not hold up well for me. While there was no fraying, it just didn’t seem to adhere very well to my skin, and only lasted 1 day. I’m not sure if I got a bad batch of tape from them, but it certainly didn’t last as long as the others I tested. You may have a different experience with this brand of tape, but all I can do is report my findings. Based on my experiment, if you’re looking for longevity, there are better bands out there.

 

Well, there you have it. There are other brands out there that I haven’t tried, but of four of the major brands of kinesiotape, there are certainly some that stand out as exceptional when it comes to durability and longevity. Please keep in mind that I also only tested this on my knees, and other areas of the body may be different. Humidity, bodyhair, and activities can also affect durability and longevity. And again, if you know you have sensitive skin, or if you’re working with a certain patient population or clientele that does, please be aware that tape may affect them differently and choose wisely. Any of these brands may react differently on an inner thigh than a knee, and my results aren’t guaranteed to be yours. With that being said, I hope this helps you in your search for a tape that serves you or your patients/clients best.

 

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AFFILIATE DISCLOSURE

This website contains affiliate links, which means Tricia may receive a percentage of any product or service you purchase using the links in the articles or advertisements. You will pay the same price for all products and services, and your purchase helps support Tricia’s ongoing research and work. Thank you for your support!

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Plica Syndrome

Photo Credit: http://www.farnorthendurance.com

Plica is soft tissue that is present in about a fair amount of the population (estimates range from 50-95%). It’s essentially a fold in the synovial membrane on the anteromedial (front and middle) aspect of the knee. We all have it when we’re in utero, but for some, it’s reabsorbed during development. For those that still have it, it can be asymptomatic, or for some, it can become thickened and inflamed when the knee is overused. Risk factors include altered patella mobility, tightness of the quadriceps or hip muscles, muscular imbalances, improper technique with repetitive movements, a change in activity level or exercise routine, abnormal hip or knee structure, abnormal hip or knee biomechanics, trauma, or twisting. Plica syndrome may manifest as pain and/or tenderness in the anteromedial knee, catching or snapping when bending or straightening the knee, tightness in the knee, painful movement (especially the arc between 30° and 60°), pain with transfers, pain with stair climbing, or weak quadriceps.

Rehab

Your therapist will target your rehab based on his/her findings as to what may be contributing to your plica pain. This could include strengthening weak muscles, stretching tight muscles, gait training, stair training, transfer training, neuromuscular re-education, and addressing proper biomechanics and patellar tracking.

Strengthening exercises may include double or single leg squats (or mini squats), the leg press, steps-ups, lunges, or closed chain walking (forwards, backwards, and sideways). Your therapist may also focus on VMO activation via short arc quads (in parallel or turned-out) and things of the like. In addition to strengthening, stretching the quadriceps, hip flexors, and hamstrings may be beneficial. Pay attention to your biomechanics as you do things like go up stairs or get up out of chairs. Your knees may fall in towards the center of your body a bit instead of staying in line over your foot and ankle, which may be caused by weak gluteal muscles in the hip. This can, in turn, put extra pressure on the anteromedial portion of your knee. If this is the case, your therapist will add gluteal strengthening to your regimen, as well. Your therapist may also look at the biomechanics of your feet as you walk, jump, and land, as they may affect how your whole leg absorbs impact. Outside of exercises, bracing and taping (via kinesiotape or leukotape) may also be utilized for proper tracking and support.

In some instances, surgery is required, where the portion of the plica that’s interfering with movement will be resected, or cut out. If surgery is required, your doctor will most likely recommend RICE for a few days before starting rehab to reduce pain and swelling, increase AROM, improve strength, gait, and balance, and eventually, add in agility training, like running and jumping.

 

I hope you enjoyed our exploration of the knee. Please keep in mind that the list of injuries here is not exhaustive. If there is another injury you’d like me to go over, please let me know in the comments section.

Next up: a break from the joints, and a look into which kinestiotape lasts the longest. Stay tuned!

 

Sources:

http://physioworks.com.au/injuries-conditions-1/plica-syndrome

https://en.wikipedia.org/wiki/Plica_syndrome 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684145/

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AFFILIATE DISCLOSURE

This website contains affiliate links, which means Tricia may receive a percentage of any product or service you purchase using the links in the articles or advertisements. You will pay the same price for all products and services, and your purchase helps support Tricia’s ongoing research and work. Thank you for your support!

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Patellar tendinopathy

Photo Credit: http://alitriestri.blogspot.com/2012/01/jumpers-knee.html

In the last blog post, we discussed chondromalacia patella.  Today, we take a look at patellar tendinopathy, also known as jumper’s knee. Patellar tendonitis or tendinopathy can result from an overuse injury from running or jumping, and produces microtears and degeneration in the patellar tendon(or ligament) in the case of tendinopathy or inflammation in the case of tendinitis. Most people feel pain at the bottom of their kneecap. In addition to pain, you may also get swelling here. As with many of the common injuries and ailments we’ve discussed, poor biomechanics and weak muscles may predispose you to this condition.

Rehab

As with chondromalacia patella, addressing your faulty biomechanics and strengthening the muscles surrounding your knee are an integral part of rehabing jumper’s knee. Your therapist will look at your jumping and landing techniques, and target strengthening and re-education of any muscles they find lacking here. Often, weak gluteal muscles can contribute to your knee falling in towards the middle of your body when landing (more so in women than men), which contributes to this problem. Again, strengthening and neuromuscular re-education will be huge here, as will how you plié, your knee alignment while climbing stairs, and your techniques for jumping and landing. Taping or bracing may also help.

Your strengthening exercises may include targeting your VMO, including quad sets with your foot turned our slightly, short arc quads (SAQ’s) in parallel or turned-out, SAQ’s or long arc quads (LAQ’s) with a ball or pillow between your knees, mini squats against a wall or ball squats, single leg mini squats or heel drops off a step, stationary lunges, and step-ups or step-downs.  Exercises should be done in pain-free range and only done as long as you can control the movement and maintain proper alignment.  If your hamstrings are weak, you may also include hamstring curls on a machine or using ankle weights or a Theraband (latex-free version here). To target gluteals (so that your knee doesn’t fall in towards mid-line when landing), you may incorporate hip abduction with some extension (think somewhere between a la seconde and arabesque….. that dreaded position dancers are always cautioned against).  This can be done in standing, in side-lying (S/L), on your hands and knees (quadruped), or prone.  If your adductors (inner thigh muscles) are weak, then you may have to do standing or S/L adduction, squeezing your legs together against resistance as you might do while using a Magic Circle in Pilates, or using the hip adduction machine at the gym (while a viable option, this is not my favorite).

Stretching may also be necessary to attain muscular balance.  For instance, the outer thigh is typically not weak, but tight.  Make sure to stretch the outer thigh possibly using a strap or roll it out using a foam roller. If your hamstrings or quads are tight relative to one another, make sure to stretch these, as well, which can be done with or without a strap.  Inner thighs can be stretched in a straddle position.  Hip flexors can be stretched in a lunge.  Gluteals can be stretched using the figure 4 stretch.

 

After muscular balance has been achieved, you’ll have to re-educate your body on how to land properly, maintaining proper alignment so as to not put pressure on the front of the knee again.  Your physical therapist will guide you in this process.  Using a mirror or videotaping are also great ways to provide you with feedback on exactly what’s going on as you land from a jump.  Utilizing technology and your therapist’s expertise can be immensely helpful during your rehab, and get you back to class faster and safely.

 

That wraps up our look into jumper’s knee.  Stay tuned next week as we conclude our investigation into common knee injuries by discussing plica syndrome.

Sources

http://www.sportsinjuryclinic.net/rehabilitation-exercises/knee-hamstring-thigh-exercises/vmo-rehab

http://physioworks.com.au/injuries-conditions-1/patella-tendonitis-tendinopathy

http://www.sportsinjuryclinic.net/sport-injuries/knee-pain/jumpers-knee

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AFFILIATE DISCLOSURE

This website contains affiliate links, which means Tricia may receive a percentage of any product or service you purchase using the links in the articles or advertisements. You will pay the same price for all products and services, and your purchase helps support Tricia’s ongoing research and work. Thank you for your support!

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Chondromalacia Patella

Photo Credit: http://www.houstonmethodist.org/

Chondromalacia patella refers to cartilage damage to the underneath side of the patella (the part that contacts the femur). It is often due to wear and tear over time, but can occasionally be caused by trauma, as well. Symptoms include pain with stair climbing (especially underneath the kneecap), getting stiff after sitting for long periods of time, and grinding in the knee known as crepitus. Muscle imbalances can also put you at a greater risk for this condition, the most notable being a difference between the strength of the VMO versus the strength of the more lateral muscles.

The VMO, or vastus medialis oblique, is a part of the quadriceps group of muscles.  This particular muscle sits just above and medial to the kneecap, and runs on an oblique, or diagonal orientation from the adductor magnus tendon to the tibial tuberosity.  This muscle plays a vital role in proper patella tracking.  If it is weaker than the muscle more lateral to it, like to vastus lateralis, the patella may not track properly (may be pulled more tot he outside of the leg). The patellar groove (also known as the intercondylar fossa of the femur) allows the patella to move along the femur without much friction or interference.  Should the patella be pulled out of this groove, the underneath side may encounter more friction as it tracks.  This can results in more wear and tear to the underneath side of the kneecap, resulting in chondromalacia patella.

Another thing that can lead to poor patellar tracking here is something called a poor Q patella between the quadriceps muscle (from its attachment at the AIIS) and the patellar tendon/ligament (and its attachment on the tibial tuberosity).  A normal Q angle is approximately 10-12 degrees for men and around 15-18 degrees for women.  A higher number can indicate poor patellar tracking, which may result in degeneration to the underneath side of the patella.  Those who hyperpronate at the ankle (or roll in) are at a higher risk for an increased Q angle.  Muscle imbalances, such as those mentioned above, may also affect your Q angle.

Photo credit: http://www.lbgmedical.com

Rehab

While no one (therapist or doctor) can fully reverse damage that has already been done to the cartilage underneath your patella, you can take actions to reduce pain, restore muscle balance, and keep it from progressing.  Your therapist will check the biomechanics of your knee, hip, and ankle as you move and walk, climb stairs, etc., to ensure proper patella tracking. Bracing and taping can be helpful in these cases.  Making sure the muscles surrounding your knee are strong and balanced is key.  This will often target strengthening the VMO while ensuring muscles like vastus lateralis, your IT Band, hamstrings, and calves are not too short (ie, need stretching to improve flexibility).

Some ways to target your VMO include quad sets with your foot turned our slightly, short arc quads (SAQ’s) in parallel or turned-out, SAQ’s or long arc quads (LAQ’s) with a ball or pillow between your knees, mini squats against a wall or ball squats, single leg mini squats or heel drops off a step, stationary lunges, step-ups or step-downs.  Exercises should be done in pain-free range and only done as long as you can control the movement and maintain proper alignment.

Photo credit: http://patellofemoral.completesportscare.com.au

Your therapist may also include neuromuscular re-education in your plan of care.  This involves re-teaching your muscles in which ones should fire and which ones shouldn’t (or perhaps, shouldn’t fire as much) when performing certain functional tasks.  This can often be very simple in concept, but difficult to master and frustrating at times, as you’ll be focusing on breaking bad habits and replacing them with good ones. When working to re-educate your muscles on the “right way” to do things, awareness and attention to detail are paramount.

Another part of your rehab regime may be agility training, which will include things like running, jumping, and landing training.  The Bosu Ball can again be helpful here, as I’ve often employed doing lunges with the front leg on the Bosu Ball once a certain amount of strength and control has been met, but more challenge is needed before the patient or dancer is released from physical therapy to resume his/her normal level of activity.

This concludes our look into chondromalacia patella.  Stay tuned next week as we look into patellar tendinopathy and jumper’s knee.

Sources

http://www.sportsinjuryclinic.net/rehabilitation-exercises/knee-hamstring-thigh-exercises/vmo-rehab

https://en.wikipedia.org/wiki/Intercondylar_fossa_of_femur

http://www.sportsinjuryclinic.net/sport-injuries/knee-pain/q-angle

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AFFILIATE DISCLOSURE

This website contains affiliate links, which means Tricia may receive a percentage of any product or service you purchase using the links in the articles or advertisements. You will pay the same price for all products and services, and your purchase helps support Tricia’s ongoing research and work. Thank you for your support!

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Patella Dislocation or Subluxation

Photo credit: www.adam.com

The patella (commonly referred to as the kneecap) sits in front of the knee and is held in place by a ligament (the patellar ligament) that extends above it and below it to attach it to the thigh and the lower leg.  As stated in our blog post on the knee’s structure and function, the patella serves to protect the articular surface of the joint.  It also increases the leverage that the patellar ligament can exert on the femur based on its angle.  The patella sits in a groove (the patellofemoral groove), where it can slide up and down according to the actions occurring at the knee.  When this goes smoothly, we don’t have any problems.  But if the patella shifts out of alignment with this groove, it can cause all sorts of problems.

Patella dislocations occur most commonly when the patella shifts laterally to the outside of the knee.  This can be the result of a blow to the knee or a twisting injury. Those at increased risk for such an occurrence include those with a weak vastus medialis oblique (VMO), which is one of your quadriceps muscles towards the middle and front of your thigh (just above the patella), those who hyperpronate at the ankle (or roll in excessively), and those with something called an increased Q angle (or those that appeared knock-kneed).  If the patella shifts out of line, it can sublux, which is a bit more subtle, or it can totally dislocate to the outside of the femur. Once it is out of proper alignment, it can sometimes spontaneously reduce (go back on its own). If not, it must essentially be popped back into place (hopefully, by a healthcare professional).   This type of injury may require surgery, but not always.

Rehab

If you’ve dislocated your patella, chances are that you’ll be out of dance (or other activities) for a while, especially if you’ve had surgery. This sort of injury will often require a brace, and post-operatively, you’ll be using crutches with limited weight bearing that will increase gradually over time. Whether you’ve had surgery or not, the acute phase begins with RICE.  If you’ve read the previous blog posts on recovering from injury, you may start to notice a theme here.  Once your doctor allows more activity, you’ll proceed as with ligament strains or meniscus tears with AROM activities (including some stretching), followed by gait training, strengthening exercises (in non-weight bearing positions before weight bearing exercises take their place), balance activities, and finally, agility training. Your doctor and physical therapist will guide you with when weight bearing is appropriate (and how much), how much you’re allowed to bend you knee (which can be mediated by the brace), when you’re allowed to do exercises without the brace (and which exercises, specifically), etc.

Your AROM activites may include such as quad sets and heel slides as well as quadricep, calf, and hamstring stretches.  Your strengthening exercises may include Therbands for resistance, ankle weights, and exercise equipment, such as a leg press or a Pilates reformer.  Here, you may do things such as squats, step exercises, hamstring curls, terminal knee extension, and something physical therapists call short arc quads (SAQ).  Your agility and balance exercises may include the Bosu ball (ball side up or down), balance activities on two legs, one leg, and then on your toes, and jumping techniques/landing training.  If surgery was performed, then you’ll be following your doctor’s specific protocol. Rehab will definitely target the VMO and ensure that all muscles around the knee are as strong as possible. Your therapist will focus on how your knee and patella track with activity and make any corrections possible to ensure proper alignment. You may also be dancing with a brace or taping for a while, as well, and it may be a while before your back to dancing full-out again (especially if you’ve had surgery).

That’s it for patellar dislocations and subluxations.  Stay tuned next week as we find out what exactly chondromalacia patella is.

Sources

https://en.wikipedia.org/wiki/Patella

http://orthoinfo.aaos.org/topic.cfm?topic=A00350

http://www.orthoinfo.org/topic.cfm?topic=A00325

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AFFILIATE DISCLOSURE

This website contains affiliate links, which means Tricia may receive a percentage of any product or service you purchase using the links in the articles or advertisements. You will pay the same price for all products and services, and your purchase helps support Tricia’s ongoing research and work. Thank you for your support!

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Ligament Sprains and Tears of the Knee

Photo credit: http://orthoinfo.aaos.org/topic.cfm?topic=a00297

This week, we continue our discussion on common knee injuries by going over sprains and tears of the ligaments of the knee.  Two weeks ago, we went over the structure and function of the knee, so you can always refer to that for more information.

Spraining or tearing ligaments is another common injury in the knee for dancers and many athletes. The four most commonly affected ligaments are the anterior cruciate ligament (ACL), the posterior cruciate ligament (PCL), the medial collateral ligament, (MCL), and the lateral collateral ligament (LCL). Since we’ve already referenced their strcture and function, we’ll move on to mechanisms of injury. These ligaments can be injured traumatically via a sudden stop or change in direction, contact (such as tackling in football), landing a jump incorrectly, hyperextding the knee or taking a blow to a straight leg, a simple mis-step, or a blow to the side of the knee. Sprains can also result from twisting injuries (primarily MCL and LCL in this case). Symptoms include pain, swelling, instability, and loss of ROM. Remember from the blog post on ankle injuries that sprains are graded based on the severity of the tear. Beyond special your history, symptoms, and special test, and MRI is often utilized ton confirm what is torn and the severity of the tear. More severe sprains may require immobilization, bracing, and/or surgery for repair. Taping may help in more mild cases, and during rehab.

Rehab

As with meniscus tears, your doctor will most likely recommend RICE in the acute phase. Once the acute phase has passed and once surgery (if applicable) has taken place, you’ll begin your rehab in much the same was as with meniscus tears by focusing on getting your ROM back. Some surgeries may limit your weight-bearing initially, or how much you’re allowed to straighten and bend your leg. A hinge brace may be utilized to allow for only some movement, and you may be on crutches for a while. Your doctor and physical therapist will help guide you in this process, and some doctor’s will issue a specific rehab protocol for your therapist to follow post-operatively. You’ll also incorporate stretching the quadriceps, hamstrings, gastrocnemius, and other tight muscles that may be limiting your progress. Once you’re cleared to strengthen, you’ll begin to perform exercises lying down and in weight bearing, first without, and then with resistance (via Theraband or ankle weights), to strengthen your affected leg. Keep in mind, you’ll be working to strengthen the entire leg (hip, knee, and ankle), as chances are, the whole leg was essentially affected by the injury (and possibly surgery). You’ll also incorporate gait training and balance activities. With sprained ligaments, stability becomes an important factor during rehab, and incorporating lateral movements and things of the like (especially with MCL and LCL sprains) will be integral.You may even work on balance and stability exercises on a Bosu ball, first with two feet, and then with one foot. Once appropriate, you’ll introduce agility training so that you can get back to your full dancing abilities as soon as you’re able.

 

Sources

http://orthoinfo.aaos.org/topic.cfm?topic=a00549

http://orthoinfo.aaos.org/topic.cfm?topic=a00420

http://orthoinfo.aaos.org/topic.cfm?topic=a00550

 

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AFFILIATE DISCLOSURE

This website contains affiliate links, which means Tricia may receive a percentage of any product or service you purchase using the links in the articles or advertisements. You will pay the same price for all products and services, and your purchase helps support Tricia’s ongoing research and work. Thank you for your support!

__________________________________________

 

Meniscus Tears

Common Knee Injuries- Meniscus Tears

Last week, we looked at the structure and function of the knee.  This week, we begin our examination of common knee injuries.  First up: meniscus tears.

As stated in last week’s blog post, the meniscus serves as a shock absorber between the femur and the tibia. The medial is more commonly injured, especially with MCL injuries. The lateral is less commonly injured, but is more often injured with ACL tears versus the medial meniscus. Mechanisms of injury include twisting or turning, trauma, and sometimes even squatting. Degenerative tears can also occur with aging. Tears are typically confirmed via MRI, but can be inferred from history (what happened when the symptoms started), symptoms, and special tests your physical therapist can perform. Symptoms of a meniscus tear involve pain, stiffness, swelling, catching or locking, giving way or buckling, limited range of motion (ROM), and subsequent weakness.

Copyright © Nucleus Medical Media, Inc.

The four most common tears are bucket handle, radial, flap, and horizontal. Bucket handle tears describe a rip down the middle of the meniscus (form front to back). The meniscus remains attached as a whole, but torn part floats towards the center of the knee like the handle of a bucket (still attached at the sides). While there is good blood flow in this area, it often needs to be repaired surgically. The good news is that is can often be reattached versus shaved off, and you can retain all of your shock absorber. Because tears here cause a portion of the meniscus to float towards the center of the knee, it gets in the way of the knee fully extending, causing what is known as locked knee (unable to fully extend). This type of tear is often a result of a twisting injury. Radial tears run perpendicularly from the inner rim of the meniscus out towards the edges. Radial tears tend to be in areas of poor blood flow, and often require surgery to shave and trim the affected area. Flap tears are a type of horizontal tear that result in the a piece of the meniscus being able to peel away from the rest, which can result in it getting caught places where it ought not to. This, too, usually requires surgical intervention. Other horizontal tears can result in the meniscus almost being torn in half (horizontally), resulting in one meniscus almost looking like two lying on top of each other. This is a common type of tear that often also requires arthroscopic surgery. If tears occur on the outer 15% of either meniscus, they have a better chance of healing on their own, as this area of the menisci is more vascularized. Tears in the remaining menisci may require surgery if symptomatic. Degenerative tears, which appear more like fraying at the inner edges of the menisci, are often not symptomatic, and may not require surgery.

Rehab

Initially, your doctor will most likely advise you to follow the RICE protocol:

  • Rest
  • Ice
  • Compression (with brace, kinesiotape, or an ace bandage)
  • Elevation (keeping the foot above the height of the heart when reclined)

After the acute phase (whether form injury or after surgery), you’ll begin to gently reintroduce movement and function again by focusing on increasing active range of motion (AROM) and strength. Your physical therapist will guide you in what’s appropriate to do and when. Some examples include quad sets to work on straightening the knee and heel slides (with a strap and without) to work on bending the knee. It’s best to keep these motions in what physical therapists often refer to as relatively “pain-free” range. If you’ve had surgery, you will most likely have pain, so this won’t be entirely pain-free. If you already have pain at rest, then it’s best to do these movements in a range that will not make your pain levels spike. Once your able to do these without increased pain, you’re physical therapist will usually tell you you’re ready to move onto strengthening exercises. Here, you may introduce things like mini squats, step-ups, and leg raises (standing or lying down), terminal knee extension, leg press, and hamstring curls. You’ll be able to progress these exercises by increasing weight, Theraband resistance (latex free version here) and/or repetitions. You may also begin to incorporate some balance exercises here: shifting from two feet to one foot, then standing on a softer surface, then on elevé. You may even do balance exercises on a Bosu Ball, which is a great way to increase proprioception.  You’ll eventually progress to things like jumping and hopping again, or running, but these are final steps in your rehab. Again, your therapist will be able to guide you through your recovery.

That’s it for meniscus tears.  Stay tuned next week as we dive into ligament sprains and tears.

Sources

https://en.wikipedia.org/wiki/Patella

https://en.wikipedia.org/wiki/Popliteus_muscle

http://orthoinfo.aaos.org/topic.cfm?topic=a00358

http://www.miamisportsmedicine.com/MeniscalInjury.html

http://www.howardluksmd.com/types-meniscus-tears/

http://radsource.us/meniscal-tear-patterns/

http://emedicine.medscape.com/article/1252011-overview

__________________________________________

AFFILIATE DISCLOSURE

This website contains affiliate links, which means Tricia may receive a percentage of any product or service you purchase using the links in the articles or advertisements. You will pay the same price for all products and services, and your purchase helps support Tricia’s ongoing research and work. Thank you for your support!

__________________________________________

The Knee- An Introduction

 

Photo Credit: The Daily Mail UK

Welcome to the introduction to the knee. The knee is a hinge joint where the femur (thigh bone) meets your tibia (lower leg). Hinge joints primarily move in one plane (like a door hinge), however they do have a little bit of play in the coronal and even transverse planes to allow for the types of movements that humans do (and to allow for correction and injury prevention). The knee also contains a sesamoid bone, the patella (or kneecap). A sesamoid bone is a bone that develops inside a tendon or ligament. This bone serves to protect the articular surface of the joint and also increases the leverage that the patellar ligament can exert on the femur based on its angle. There are four main ligaments in the knee to keep it from buckling front to back or side to side. Six muscles or muscle groups also cross the knee joint, as does one thick, long, fibrous band.

Structure and Function

As stated above, the knee is a hinge joint. Most of its movement will result in flexion or extension. The little bit of rotation that occurs in the knee occurs when bending the knee from a locked or fully extended position. The tibia (lower leg) must rotate inwardly to allow knee flexion to occur (or the femur must rotate slightly outwardly on the tibia to allow for knee flexion). The muscle that performs this unlocking action is called the popliteus. It runs from the lateral epicondyle of the femur to the posterior portion of the proximal tibia, and is one of the deepest muscles in this part of the body.

The play that the knee has side to side allows us to walk on uneven terrain without injury and can even allow for some amount of give with impact before injury occurs. The ligaments that prevent too much movement in this are called the medial collateral ligament (MCL) and the lateral collateral ligament (LCL). These are common areas of sprains, which we’ll get to a little bit later. In addition to these two ligaments on the side of the knee, the anterior cruciate ligament (ACL) and posterior cruciate ligament (PCL) run criss-cross, one in the front of the knee (ACL) and one in the back of the knee (PCL). These prevent the tibia (lower leg) from falling forward or backward. These four ligaments help to attach the thigh to the lower leg and help to maintain proper alignment.

Photo Credit: Myers Sports Medicine and Orthopaedic Center

There are two other main soft tissue structures in the knee, which help to absorb shock. They are called menisci. Each knee has one medially and one laterally. This is another common area of injury, as tears can occur from impact or from twisting (something we do quite often in dance). The medial meniscus is more commonly injured, whether acutely or due to degenerative changes. This is partly due to the fact that the lateral meniscus moves more freely in the joint than the medial meniscus. The medial meniscus may also be injured in concert with the MCL, as the MCL attaches to the medial meniscus. This is not the case on the lateral side. But lateral meniscus tears are more common with ACL injuries than are medial meniscus tears.

As for the muscles that cross the knee joint, the two largest groups are the quadriceps on the front of the thigh and the hamstrings in the back of the thigh. The quadriceps contain four different muscles that originate on the pelvis or the femur itself, and attach to the tibia at the tibial tuberosity via the patellar ligament (or commonly referred to as the patella tendon, which contains your kneecap). The work together to straightern and extend your knee. The hamstrings originate on the ischial tuberosity (commonly referred to in dance class as the sits bones) and run along the back of the leg until they separate (two on the inside and one on the outside). The two on the inside (semimebranosus and semitendinosus) attach to the tibia and your outermost hamstring (biceps femoris) attaches to the fibula. The hamstrings work in concert to bend or flex the knee.

In addition to these larger muscle groups, you also have popliteus (previously mentioned), gastrocnemius, gracilis, and the IT Band crossing the knee joint. The gastrocnemius is your most superficial calf muscle. This helps you do your relevés. It also helps to bend the knee a little. Gracilis is the only muscle of your adductor group that crosses the knee on the inside of your leg. It originates off of your pubic bone, and inserts on your tibia with semitendinosus in a wonderful spot known as pes anserine (goose’s foot). One other muscle joins them to insert here, called sartorius (the tailor’s muscle and the longest muscle in the body), which comes from part of your pelvis and crosses the hip and knee joint before attaching here. Finally, the IT band, which is a thick, fibrous extension of a hip muscle known as TFL, comes down the outer part of the thigh and inserts on the lateral epicondyle of the tibia. For those out there that aren’t as big on your anatomy, it essentially goes into your knee joint, and can be a common area of irritation in the outer knee for all types of athletes.

That wraps up our overview of the structure and function of the knee.  Stay tuned next week as we begin our journey into common knee injuries.  First up: meniscus tears.

Sources

https://en.wikipedia.org/wiki/Patella

https://en.wikipedia.org/wiki/Popliteus_muscle

http://orthoinfo.aaos.org/topic.cfm?topic=a00358

http://www.miamisportsmedicine.com/MeniscalInjury.html

http://www.howardluksmd.com/types-meniscus-tears/

http://radsource.us/meniscal-tear-patterns/

http://emedicine.medscape.com/article/1252011-overview

 

Foot and ankle

Welcome to the introduction to the foot and ankle. There are 26 bones in this area (28 if you count the 2 sesamoid bones) of the body, 33 joints (which is a fair amount for such a small area), and over 100 soft tissues structures (muscle, tendons, and ligaments). The joints in the foot work in concert to allow for triplanar movement, meaning that movement within the foot and ankle can occur in the frontal or coronal plane, the sagittal plane, and the transverse plane. Some joints, such as the subtalar joint, allow movement in all of these planes at once. As with anything, you need a balance of mobility and stability for optimal function.

foot-and-ankle(Photo source: http://www.leadingmd.com/ankle_kalman/overview.asp)

Structure and Function

The foot is divided into 3 parts: the forefoot (metatarsals and phalanges), the midfoot (navicular, cuboid, and 3 cuneiform bones) and the hindfoot (the talus and calcaneus). The way these areas interact and your bones lay result in your arches. You have 4 arches in your foot: medial, lateral, fundamental longitudinal, and transverse. They allow for shock absorption with each step we take, and help to spring us forward into movement.

The “ankle” joint itself is where the talus articulates with the bottom of the tibia and fibula. Plantarflexion and dorsiflexion occur here, or the pointing and flexing of the foot. Your subtalar joint is between the talus and the calcaneus, or heel bone. This is where inversion and eversion occur. Inversion is the combination of plantarflexion, adduction, and internal rotation. Eversion is the combination of dorsiflexion, abduction, and external rotation. The tarsometatarsal joints are where the cuneiforms and cuboid articulate with the metatarsals. These bones mainly slide against each other, and don’t produce large movements. The toes (or phalanges) articulate with the metatarsals at the MTP joints (metatarsophalangeal), which is what you would consider the “knuckles” of your feet. The toes can flex and extend at these joints.

In terms of soft tissue, you have several ligaments, muscles, and tendons in this area of the body. Some of the muscles originate in the calf, and some muscles are intrinsic (originating within the foot itself). The muscles on the back of the calf (gastrocnemius, soleus, and plantaris) assist in plantar flexion. The muscles on the outside of the calf (the peroneals) assist in eversion. The muscles in the front of the shin (anterior tibialis) assist in dorsiflexion. The muscles in the medial part of the lower leg (posterior tibialis) assist in inversion. You also have intrinsic and extrinsic muscles that help to flex and extend the toes. While this is not an exhaustive list, it’s an easy way to look at certain compartments of the lower leg and see how they affect motion at the foot and ankle.

lateral-ankle-ligaments

(Photo credit: https://en.wikipedia.org/wiki/Lateral_collateral_ligament_of_ankle_joint)

Some of the main ligaments and connective tissue structures in the foot are the deltoid ligament, the spring ligament, the calcaneofibular ligament (CFL), the anterior talofibular ligament (ATFL), and the plantar fascia. The deltoid and spring ligaments are on the medial side of the ankle. They help to stabilize the medial arch and keep you from hyperpronating, or rolling in too much. For those with flat feet, these ligaments are often stretched out and weak. The CFL and ATFL are on the lateral side of the ankle. They work to prevent inversion, or rolling your ankle out. Those with weak ligaments here are prone to ankle sprains. The plantar fascia is a band of soft tissue that connects your heel to your toes. It runs the length of your foot, and helps to support your arch. Athletes and those who are on their feet a lot (such as dancers) are more prone to small tears and irritation here, which results in plantar fasciitis. Again this list is not nearly exhaustive, but these are a few of the main connective tissue structures in your feet, which play an important role in injury and injury prevention.

Common Injuries

Ankle Sprains

ankle-sprain

(Photo credit: http://blog.nasm.org/fitness/understanding-preventing-ankle-sprains-corrective-exercise/)

Ankle sprains typically occur when you invert your foot (rolling your foot so that the outer part of your ankle over-stretches). It can occur the other way, but that typically results in a fracture due to the alignment of the bones in that are of the lower leg (how your tibia and talus line up). We that being said, we’ll focus on lateral ankle sprains. For dancers, this is very easy to do in pointe shoes, especially if you’re not keeping your heel forward, and fall into sickling. Often times though, we may get through dance class just fine, only to roll our ankles while walking to our cars. In either case, the CFL is the most commonly sprained ligament in lateral ankle sprains. The next most commonly affected ligament in sprains in this area is the ATFL. Sprains can vary in severity, from a grade I (microscopic tearing) to a grade III (complete tear) sprain. Swelling and bruising are quite common. Doctors may take x-rays to ensure no bones are broken. MRI’s may also be ordered, if complete tearing is suspected. Depending on the severity of your sprain, crutches and bracing or some sort of immobilization may be indicated.

Rehab

Initially, your doctor will most likely advise you to follow the RICE protocol:

  • Rest
  • Ice
  • Compression (with brace, kinesiotape, or an ace bandage)
  • Elevation (keeping the foot above the height of the heart when reclined)

After the acute phase, you’ll begin to gently reintroduce movement and function again by focusing on increasing active range of motion (AROM) and strength. Your physical therapist will guide you in what’s appropriate to do and when. Some examples include writing the alphabet in the air with your foot, pumping your ankle (pointing and flexing it), and practicing inversion and eversion. It’s best to keep these motions in what physical therapists often refer to as “pain-free” range. If you already have pain at rest, then it’s best to do these movements in a range that will not make your pain levels spike. Once your able to do these without increased pain, you’re physical therapist will usually tell you you’re ready to move onto strengthening exercises. Here, you may use a theraband to do the above movements. You may begin doing elevés (lifting up on your toes, for the non-dancers out there) and toes raises (rocking back on your heels). You may also begin to incorporate some balance exercises here: first flat on the ground on two feet, then one foot, then on a softer surface, then on elevé. You’ll eventually progress to things like jumping and hopping again, or running, but these are final steps in your rehab. Again, your therapist will be able to guide you through your recovery.

Plantar fasciitis

plantar-fascia

(Photo credit: http://www.instructions.tips/plantar-fasciitis-or-joggers-heel-how-to-get-rid-of-the-pain-in-the-heel/)

The plantar fascia is a thick band of connective tissue that runs from your heel to your toes. As mentioned previously, it helps to support your arch. Those who are on their feet a lot, those with flat feet who tend to overpronate, those with high arches, runners, dancers, those who are overweight, and those with tight calf muscles and achilles tendons are more prone to injury here, commonly referred to as plantar fasciitis. Plantar fasciitis is considered an overuse injury, and refers to small tears and irritation that occur in the plantar fascia. People who suffer from this complain of intense pain in the feel of the foot that is worse in the morning (especially the first few steps out of bed), Pain that increases after sitting for a long time, pain in the bottom of the foot that increases with stair or ladder climbing, and pain that worsens after being on your feet for a long time. Diagnosis is usually done based on your symptoms, your foot structure, and your personal history, but a doctor may take an x-ray to confirm that there aren’t any stress fractures or heel spurs.

Rehab

Recovering from plantar fasciitis is not an easy task. Initially, it will often involve ice to the bottom of the foot, stretching the calf and achilles, and possible taping techniques to help reduce the symptoms. You will alos most likely be advised to back off of some of the acitivites that have contributed to your condition. Supportive shoes and orthotics or heel cups may also be recommended (no flip flops if it’s summer). Night splints that keep the foot in a flexed position are sometimes helpful, as well. Your physical therapist may also include iontophoresis, a modality in which an electrical impulse is used to deliver anti-inflammatory medication through the skin into the heel. Once the pain starts to subside, your PT will guide you in strengthening and balance exercises depending on where you were weak. Dorsiflexion and eversion movements are often utilized before adding plantarfexion and inversion exercises, as these usually do not increase pain. Just be patient in your recovery here, as getting back to normal takes time.

Fractures

The most common fractures in the foot for dancers are a fracture of the 5th metatarsal or stress fractures. One type of fracture of the 5th metatarsal is actually often referred to as a dancer’s fracture. This typically occurs when rolling the ankle outward, which leads to a strong ligament in the outer foot actually pulling a piece of the bone from the base of the 5th metatarsal away from the rest of the bone. This can usually be treated conservatively (or non-operatively) by having the person wear a CAM boot for about 6 weeks (guided by x-rays to confirm that the bone has properly healed before discontinuing use). A Jones fracture, which also occurs in the 5th metatarsal, occurs a little more distal to the avulsion fracture, and often results from repetitive motion, overuse, or trauma to the area. This injury also more commonly affects those with high arches and those prone to supination. This is more challenging to treat because the blood flow in this area of the foot is more limited, and more often requires surgery. Stress fractures occur from overuse or repetitive injuries and often occur with an increase in activity or a change in how things are being performed. They can also occur with different footwear (for dancers) or when exercising on a new surface. Most common areas for stress fractures in the foot and lower leg are the 2nd and 3rd metatarsals, the calcaneus, the fibula, the talus, and the navicular.

5th-met-fractures

(Photo credit: https://www.foothealthfacts.org/conditions/fractures-of-the-fifth-metatarsal)

Rehab

Again, your doctor may begin my ordering RICE. Certain fractures will also require immobilization by things such a CAM boot. You may not be able to participate in dancing or other activities for 6 weeks, while the bone is healing (This will vary depending on the type and severity of the fracture). Once you’re ready to begin more active rehabilitation, your physical therapist will guide you through AROM exercise first (Do you see a trend here?). Once your ROM activities are pain-free, you’ll begin to incorporate strengthening and balance exercises before including agility training (running, jumping, etc), and returning to dancing or other activities as normal.

Hallux Limitus or Rigidus and Hallux Vaglus

hallux-rigidus

(Photo credit: http://www.drwolgin.com/Pages/HalluxRigidus.aspx)

Hallux limitus is a condition in which the ROM at your first MTP joint (where your big toe attaches to your foot) is limited. It’s the beginning stages of arthritis in this joint, and bone spurs begin to form, which limit mobility. Hallux rigidus is a more advanced form of this condition, resulting in very limited motion at this joint (hence, the toes is fairly rigid). Here, your cartilage erodes and the joint itself starts to fuse. As movement at the big toe is vital for walking and all weight bearing activities, these conditions can be very limiting. They can also be very painful. Most note pain and swelling around the 1st MTP joint, and state that pushing off while working is difficult and uncomfortable. For a dancer, going up onto elevé or relevé without sickling or compromising heel height would be restricted and painful, if not impossible.

Dorsal forefoot showing bunion with loose joint capsule. SOURCE: 60215A referenced from: http://www.beverlyhillsfootsurgery.com/aesthetic-bunion-correction/ http://libweb.allencc.edu/CPT0070.html http://eraofknowledge.blogspot.com/2008/11/hallux-valgus-deformity-bunion.html

(Photo credit: http://medical.miragesearch.com/treatment/orthopedic-joint-treatment/hallux-valgus-bunions)

Hallux valgus occurs when the big toe begins to angle towards the 2nd toe, resulting in a bunion. Technically speaking, it’s when the 1st ray (or 1st metatarsal) begins to deviate medially while the 1st toe begins to deviate laterally. Those with flat feet, tight calves, lax ligaments, and forefoot varus are more prone to this condition, as are those with a longer 1st ray. This imbalance often occurs when the lateral muscles that pull the big toe out towards the 2nd toe are overly developed or stronger than the ones that would pull the big toe medially. In addition, having a lax medial capsule at the 1st MTP also contributes to the dysfunction and imbalance here. While there is no conclusive evidence that female dancers get bunions more than non-dancers, hallux valgus is certainly a condition that rears its ugly head in the dance world (Davenport et al). Conservative treatment may include things such as taping, use of spacers, and use of supportive and proper footwear (with a broad toe box to decease pain and pressure), but this is often not enough to reverse hallux valgus. This may allow the dancer to finish her career before having surgery, but does not usually allow her to avoid surgery completely.

Rehab

RICE, shoe modifications, and anti-inflammatories are often the first line of defense when hallux limitus or rigidus appear. Rehab with a physical therapist will often focus on restoring ROM to the 1st MTP joint (or retaining what’s still there) through ROM activities, gentle stretching, and manual therapy such as soft tissue mobilization and joint mobilizations/distraction to address tight muscles and soft tissue structures as well as improve the roll and glide that occurs in a healthy, functioning joint. Modalities will be utilized to decrease pain. Orthotics may be prescribed to limit great toe extension. Stretching the muscles of the calf will also be incorporated. If certain muscles are weak, they will then be addressed through a strengthening program, as will balance by exercises on two feet or one foot on varying surfaces to improve proprioception. If this fails, surgical procedures such as a cheilectomy or fusion may be indicated. For hallux valgus, most treatment occurs after surgical intervention, and will also include the aforementioned, (managing pain though use of modalities, restoring ROM, increasing strength, improving gait, and improving balance).

 

I hope you enjoyed this week’s look into the foot and ankle. Next up: the knee. Stay tuned!

 

Sources

https://en.wikipedia.org/wiki/Arches_of_the_foot

https://en.wikipedia.org/wiki/Subtalar_joint

https://en.wikipedia.org/wiki/Lisfranc_injury

http://www.orthobullets.com/foot-and-ankle/7005/ankle-ligaments

http://orthoinfo.aaos.org/topic.cfm?topic=a00150

http://www.mayoclinic.org/diseases-conditions/plantar-fasciitis/home/ovc-20268392

https://www.foothealthfacts.org/conditions/fractures-of-the-fifth-metatarsal

http://www.footeducation.com/foot-and-ankle-conditions/jones-fracture-5th-metatarsal-stress-fracture/

http://orthoinfo.aaos.org/topic.cfm?topic=a00379

http://www.aofas.org/PRC/conditions/Pages/Conditions/Hallux-Valgus.aspx

https://www.researchgate.net/publication/262583749_Hallux_Valgus_in_Dancers_A_Closer_Look_at_Dance_Technique_and_Its_Impact_on_Dancers’_Feet

http://www.physiotherapy-treatment.com/Hallux-Limitus.html

http://www.philipphysicaltherapy.com/Injuries-Conditions/Foot/Foot-Issues/Hallux-Rigidus/a~6714/article.html

http://www.footvitals.com/joints/hallux-limitus.html

http://www.aofas.org/footcaremd/conditions/ailments-of-the-big-toe/pages/hallux-rigidus.aspx

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AFFILIATE DISCLOSURE

This website contains affiliate links, which means Tricia may receive a percentage of any product or service you purchase using the links in the articles or advertisements. You will pay the same price for all products and services, and your purchase helps support Tricia’s ongoing research and work. Thank you for your support!

__________________________________________