Patellar Femoral Syndrome Part 2

          My last post discussed the chronic condition known as patellar femoral syndrome, the related symptoms, and possible treatments.  Since it is always better to bypass injuries than figure out how to recover from them, this post will address some causes of this condition and how to avoid them.

      This condition occurs when the patella, or knee cap, is misaligned. When it is misaligned, it cannot slide along the groove in the femur when it moves. The patella can move out of this position as a result of an acute injury from a fall or a sudden movement, but one of the main causes is a misalignment that develops over a period of time.  This misalignment occurs when the muscles that are meant to stabilize this joint and hold the knee cap in position begin pulling on the knee joint unevenly.  

          Muscle groups work in pairs. The pairs work opposite each other - one group extending while the other flexes, or bends the joint. In order to create stability, both groups need to pull on the joint evenly, creating equal tension in all directions. When one muscle group is tighter than its partner group, the tension is unequal and the patella is pulled out of position.   
                   

        This condition can be the result of tight quadriceps, which are the four muscles along the front of the thigh, or tight hamstrings, which are the muscles that run along the back of the thigh. These muscular imbalances can be avoided by making sure that all of the muscles are worked and stretched evenly. 
        
        Dancers tend to use certain muscle groups more than others and need to be aware of what muscles may not be worked as often. Cross training in other activities like yoga, Pilates, biking, swimming or walking can help ensure that all muscles are worked evenly.  Dancers also need to be aware of the iliotibial band, also called the IT band for short - this tendon connects the gluteus maximus muscle and the tensor fascial lata muscle to the skeleton.  Dancers use the gluteus maximus a lot since it is responsible for returning the leg to its original position after it has been lifted to the front, lifting the leg in arabesque, and is one of the main muscles involved in turning the leg out.  

            The tensor fascia lata is constantly relied upon by dancers as it is responsible for lifting the leg to the front and the side and rotating it inward. 

        The constant use of these two muscles causes the IT band to grow tight. Dancers need to stretch out the IT band often so it does not pull the knee joint out of position.

        By simply being aware of which muscles might need some extra work and being sure to stretch every muscle equally, most chronic conditions relating to poor skeletal alignment can be avoided.  It is extremely important for dancers to learn about muscular imbalances, to know their own bodies and to cross train to be healthy, strong dancers.

Using Breath to Enhance Stretching

         "Conscious breathing is my anchor.” ― Thích Nhất Hạnh

          Breathing is a function of the autonomic nervous system and occurs naturally and efficiently without any conscious help from us. However, being aware of our breathing patterns and allowing them to work in tandem with our actions, can enhance our dancing as was discussed in the post, Reminding Dancers to Breathe. Breathing can also be used to help dancers stretch effectively.

          Dancers spend a good deal of time trying to increase muscle flexibility and joint range of motion. There are different ways to stretch, and some are more effective than other as has been discussed in the posts: Stretching - When Not to Do It, Stretching - Working With Your Body Type, and Stretching - Ballistic, Dynamic & Static - Which is Most Effective.

          While dynamic stretching should be used during the warm-up, static stretching can be used at the end of classes, rehearsals, and performances as part of a cool-down and can increase flexibility while releasing any muscular tension that may have developed. Being aware of our breathing and how it affects our muscles, can help us create effective stretching strategies.

          As we inhale, our diaphragm contracts to make room for the intake of air. As the air floods in, our lungs expand, and blood pools there for a short time. Since the blood is pooling and not circulating as quickly, the heart receives a message to pump faster to increase circulation. When we exhale, the blood quickly moves back into the heart. A large amount of blood in the heart means that each heart beat can circulate a substantial amount of blood and the heart can slow down. As the heart rate slows, the entire body relaxes and releases tension. It is for these reasons that when we stretch we should use the inhale to prepare for the stretch and move into the stretch on the exhale.

          As we inhale, we should focus on lengthening and aligning our skeletons, and we should begin to release into the stretch as we exhale. As we inhale again, we should come out of the stretch slightly and re-lengthen before we move into the stretch a bit deeper on the next exhale. This process can be repeated several times to increase the depth of the stretch. By using our breath, we also keep the stretch reflex from occurring.

          The stretch reflex is a built-in safety mechanism that the body uses to help avoid muscles damage. When a muscle is elongated too far, the brain senses it might tear and sends a message to the muscle fibers to contract to prevent the tear from happening. A muscle contraction tightens the muscle and prevents it from stretching any further. By relaxing into the stretch and then coming out of it slightly before stretching deeper, we are able to prevent this reflex from occurring.

          It is also important to be sure we are never holding our breath as we stretch. Holding our breath causes all of our muscles to tighten and contract. If you find yourself holding your breath while stretching, it may mean that you are pushing too far into the stretch for your body.

          Although dancers tend to focus on increasing flexibility and joint range of motion when stretching, they need

to remember that stretching can also relieve tension and relax the body after a class, rehearsal, or performance.

          Being aware of our breathing and using it in tandem with stretching, can help us increase flexibility while relieving muscle tension rather than fighting against ourselves and locking more tension into the body.

Cooling Down After Class - Does It Serve Any Purpose?

"If you don't take care of your body, where will you live?" - Author Unknown

        The broad music begins, the grand allegro has been shown, and dancers begin soaring through the air performing saute de chats, grand pas de chats, and tour jetés.  After traveling across the floor, they return to line to perform the combination once more.  The breathing is audible, and the dancers’ faces are flushed.  Their hearts are beating quicker, they are breathing harder and faster, the increased frequency of heart contractions have pumped blood faster through their arteries, and their blood pressures have risen.

            All too often, class time runs out and movement draws to a complete stop.  The teacher dismisses the class, the students bow, clap, and quickly exit the studio to make room for the next class. 

            In order to stay healthy and minimize the stress on the body, it is important for all dancers to learn about the benefits of a cool-down.  Just as the warm-up prepares the body for what is to come, the cool-down slowly returns the body to the pre-exercise, resting state.

            A cool-down is a gradual decrease in activity that allows the heart rate and the breathing, or respiratory, rate to gradually slow down and return to normal.  As this slowing occurs, blood circulation also gradually slows.  Without this gradual decrease in activity, a quick drop in heart rate will decrease the pressure in the arteries rapidly.  This sudden drop in blood pressure can cause dizziness and fainting.

            A simple exercise performed at the end of class, similar to a reverence, that incorporates a gradual slowing down of the body is all that is needed.  The exercise might include grand pliés in second position, slow head circles, slow reaches or circles with arms and stretching.  A cool-down is an ideal time for dancers to work on flexibility and range of motion.  The muscles are now completely warm and will not be required to perform any more explosive activities, providing the perfect time for static stretches to be held for 20-30 seconds.  While stretching, the internal temperature of the muscles gradually decreases and, therefore, reduces the chances that muscles will cramp or go into spasm upon leaving the studio.  Muscle cramping becomes a bigger concern during cold, winter months when warm bodies move out into the cold air.  Muscles, like everything else, contract when cooled and will do so quicker when moving from one extreme temperature to another.

            The cool-down takes no longer than 5 minutes at the end of class and provides the benefits of decreasing some of the stress exercise puts on the body, avoids dizziness or fainting, assists in developing range of motion, and helps decrease muscle spasms and cramping after class. 

            If time does not allow for a cool-down in class, each dancer should take responsibility for the health of his or her body and perform an individual cool-down, including stretching.  It will take only a few minutes out of the day, but will keep you dancing healthier, and your body will thank you for it!

            

How to Increase Turnout Safely

            "Turn-out is something a dancer does, not necessarily something he has." - Anne Woolliams

            Since turnout is an integral part of ballet technique, it is important for dancers to learn how to turn out and maintain it in ways that are healthy for their bodies. 

            The hip is the only ball and socket joint in the leg.  This type of joint allows for movement in all directions and provides the ability to rotate the leg outwardly, or turn out.  The amount of turnout a dancer has is largely pre-determined by the angle and length of the femoral neck, the facing of the hip sockets and the flexibility of the muscles of the hip.

            The hip joint is formed where the head of the femur, or thighbone, fits into the socket, or acetabulum of the pelvis.  The neck of the femur forms an angle, between the femoral head and the long shaft of the femur that allows the femur and pelvis to connect.  This average angle measurement is about 15°.  When the angle is less than 15°, the legs will naturally rotate outward, but if it measures more than 15°, the legs will naturally rotate inward. (2)

            Outward rotation also occurs naturally if the hip sockets, or acetabula, face sideways rather than diagonally forward.

            Those with a longer femoral neck enjoy a greater range of motion at the hip joint.  However, a shorter femoral neck limits the range of motion because the femur comes in contact with the outer rim of the pelvis.

            The muscles surrounding the hip include those that flex the thigh, extend the thigh, inwardly rotate, outwardly rotate, adduct (pull the leg toward the midline of the body) and abduct (pull the leg away from the midline of the body).

            Unlike the previously mentioned bony structures, muscles can be changed through exercise.  Ballet dancers often ask which muscles they should strengthen and/or stretch to improve their turnout.  The answer is a simple one – all of them.  All of the muscles surrounding the hip perform more than one function.  There is no muscle that acts only as an outward rotator.  Moreover, it is important to remember that ballet dancers perform exercises that always require an additional action to turning out.  A grand battement to the front requires flexion, a grand battement to the back requires extension, beats require adduction and dégagés require abduction.  When these exercises are being performed, the muscles of the opposite hip must also work as stabilizers to keep the dancer’s standing leg steady, turned-out and lifted.

            By strengthening and stretching all of the hip muscles in a conditioning program, the dancer will increase the range of motion at the hip joint.  This greater range of motion will allow for increased turnout, and the strength training will provide the dancer with the ability to maintain that rotation during exercises.

quadriceps stretch

seated frog press           

In Dance Kinesiology, Sally Sevey Fitt provides a hip conditioning program which includes single leg lifts to 45 degrees  while lying on the back and the stomach, stretching the hamstrings while lying on the back and holding the legs in second, stretching the quadriceps, the seated frog press, the yoga sit stretch and the lying knee press. The lying knee press involves lying on the back with the feet hip distance apart. The knees are allowed to fall in and are then actively pressed together for 20 seconds. This action is followed by allowing the lower body to twist to the right while the left leg is rotated inward to stretch the outward rotators and is then repeated for the right leg. (1)

yoga sit stretch

            A word of caution….A stretch that dancers often use to increase turnout is known as the frog and is done while lying on the stomach.  This stretch needs to be AVOIDED!  The position of the legs places unnecessary stress on the ligaments of the knee and can do more harm than good.

AVOID THE FROG!!!

            By using a supplemental conditioning program to strengthen and stretch the muscles surrounding the hip, dancers will establish a greater range of motion and develop the strength necessary to hold positions.  Exercises done in class specifically target the outward rotators while supplemental exercises will keep the hip healthy and prevent dangerous muscular imbalances from occurring and causing injuries.

(1) Fitt, Sally Sevey. Dance Kinesiology. New York, NY:Schirmer Books; 1988.

(2)Wilmerding, Virginia & Krasnow, Donna. Turnout for Dancers:  Hip Anatomy and Factors Affecting Turnout. International Association of Dance Medicine and Science; 2011.  Retrieved from http://www.iadms.org/displaycommon.cfm?an=1&subarticlenbr=325.

                                                                                                     

Stretching Part 3 - Ballistic, Dynamic & Static Stretching: Which is Most Effective?

“Blessed are the flexible, for they shall not be bent out of shape.”

–     Author Unknown

Truth Number 1 – Dancers must be flexible.

Truth Number 2 – In order to increase and maintain flexibility, dancers must stretch.

So….what is the most effective stretching method for a dancer to use?  Is it ballistic stretching, static stretching, dynamic stretching or some combination of different methods?

Ballistic stretching is characterized by bouncing movements.  The problem with ballistic stretching is that the movement never allows the muscle to pause in a lengthened position.  The constant bouncing moves the muscle between a contracted position and a lengthened position quickly and abruptly.  As the muscle lengthens quickly, the body activates the stretch-reflex.  This reflex is a safety mechanism that protects the body from injury.  The muscle sends a message that it is being forcefully lengthened.  As a result, the reflex mechanism begins to contract the muscle in an effort to prevent tearing.  This lack of lengthening, therefore, does not effectively stretch the muscle or increase flexibility.

Dynamic stretching is a type of stretching that keeps the body constantly moving.  A lot of dynamic stretching exercises are already built into a ballet barre.  These exercises gradually increase in range of motion until the muscle has reached its maximum length.  A gradual fondu exercise that begins with an extension to tendu and progresses to a full extension en l’air would be an example of a dynamic stretch.  Research studies conducted within the last decade show that dynamic stretches increase flexibility and in some cases even improve muscular strength and agility.

Static stretches are very familiar to dancers.  Static stretches are held for certain amounts of time like splits or barre stretches.  Research has shown that for static stretches to be effective at increasing flexibility, they must be held for 30-60 seconds.  These stretches are just as effective at increasing flexibility as dynamic stretches, but they also have an immediate negative effect on muscular strength, power and endurance.  This negative effect has been shown to be present for up to an hour after the stretch is performed.  Executing this type of stretch during class could have a negative effect on exercises like grand battement and jumps.

            Flexibility is a necessity for dancers and all of the research states that both dynamic and static stretching are effective at increasing and maintaining that flexibility.  However, research also indicates that in order for a dancer to have the necessary strength and power to execute center work, dynamic stretches should be done at the beginning of class and static stretches should be saved for after class and rehearsal and used as a cool-down.


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Stretching Part 2 - Working With Your Body Type

“You’ve got your body for life, you might as well learn to get along with it."                      – Sandy Kunskov

Taking care of our bodies requires that we understand that our bodies are different and, therefore, parts of our training regimens must also differ.

            Way back in 1954, William Sheldon wrote The Atlas of Men which documented differences in body types, or somatotypes.  He divided somatotypes into the categories of ectomorph, mesomorph and endomorph.

                                                

            The ectomorph has a long and lithe body with wide hips, the mesomorph has a solid square body with broad shoulders and the endomorph is recognized by its rounded body shape.

            The ectomorph’s muscles, tendons and ligaments tend to be loose.  The ectomorphs are the dancers who can drop down into a split every day without fail.  They may stretch at home but truly do not have to do much to maintain their naturally high levels of flexibility.

            Mesomorphs have an extremely dense muscular system.  Flexibility does not come naturally to them.  These are the dancers who must stretch daily and work extremely hard at achieving and maintaining the necessary flexibility for dancing.

            The endomorph’s muscular structure falls in between that of the loose ectomorph and the dense mesomorph.  These dancers have a natural potential to be flexible and can maintain that flexibility as long as they remember to stretch a few times per week.

            The potential to be flexible is available to everyone.  A body type can never be used as an excuse, but it is important for a dancer to have an understanding of his/her somatotype.  This small bit of knowledge can help a dancer improve his/her flexibility by simply acknowledging natural tendencies and working with them.