What to Do About "Shin Splints"

“Pain insists upon being attended to.” - C.S. Lewis

            “Shin splints” are a common complaint among all different kinds of dancers that can lead to other complications like fractures, if not properly treated.

            The real name for “shin splints” is tibial stress syndrome and occurs when the muscles of the lower leg become swollen and irritated and stress and irritate the periosteum of the tibia.  The periosteum is a sheath that encases bone and has many nerve endings.  As the muscles pull on the periosteum, microscopic tearing occurs, and the nerve endings signal the brain that something is wrong, and we feel pain.

            Those experiencing tibial stress syndrome, will complain of a dull aching pain in the lower leg along the side of the tibia, or shin bone.  This condition most commonly occurs in the tibialis anterior muscle but can also occur in the tibialis posterior, the flexor digitorum longus or the peroneal muscles. (Fitt, 1988).  It is a chronic condition, meaning that it develops slowly over a period of time and then lingers.  Unlike an acute injury, like a fracture of sprain that occurs in an instant and then heals, this condition dissipates slowly and can recur over and over again.

            Tibial stress syndrome is classified as an overuse injury that can be caused by a sudden increase in training or bouts of excessive jumping, but can also be caused by other factors like dancing on a hard surface such as concrete, improper foot alignment which can lead to feet rolling inward when landing from jumps, improper weight distribution in the feet, or muscular imbalances in the lower leg.

            The treatment for tibial stress syndrome involves rest and a break from all jumping.  Ice will help decrease the inflammation of the muscles and the periosteum and will alleviate the pain as will taking an anti-inflammatory.  Gentle stretching can also help.  The muscles along the front of the shin can be stretched by pushing forward on the arches while either standing or kneeling, and the calf muscles can be stretched in exercises described in last week’s post about tight calf muscles.

            Although rest, ice, anti-inflammatories and stretching will alleviate the symptoms, it is important that the dancer determine the cause of tibial stress syndrome to prevent it from constantly recurring.  A physical therapist who is well versed in dance medicine will be able to do a screening to determine if the condition is being caused by muscular imbalances and/or misalignments that can be corrected through strengthening and stretching exercises.

            It is important that dancers do not ignore the pain and continue to dance, in spite of having “shin splints”, because of the additional damage that can be done.  Paying attention to the body’s signals and seeking treatment immediately will shorten the recovery period and keep the dancer healthy.

                                                                                                             

Fitt, S. (1988) Dance Kinesiology.  New York, NY: Schirmer Books.

Do I Really Need to Put My Heels Down When I Jump?

            The dance, just as the performance of the actor, is kinesthetic art, art of the muscle sense." - Rudolf Arnheim


          A pointed foot, a high relevé, a fully stretched foot in a jump – these are all sought after in dance.  Whether dancers study ballet and are constantly on their toes, study tap and dance on the balls of their feet, study Irish dance and are always in a relevé, or study modern and jazz and are stretching their feet in jumps, they demand a lot from their calf muscles.

            There are two calf muscles that are responsible for plantar flexion – what dancers call pointing their feet – the gastrocnemius and the soleus.  Each time a dancer relevés, points his or her feet, or stretches the foot in a jump, these muscles contract to make the action happen.

            The gastrocnemius is the bulging muscle that we see at the back of every dancer’s calf.  This muscle attaches to the femur, or the thighbone, crosses behind the knee, and connects to the calcaneus, or heel bone, via the Achilles tendon.  Its jobs are to flex, or bend, the knee and plantar flex the ankle.  The gastrocnemius is responsible for the movement required in walking, jumping, pointing the foot, and performing a relevé, and is strongly relied upon in fast moving exercises.

            The soleus is located underneath the gastrocnemius, closer to the bones of the lower leg, the tibia and fibula.  It is attached to these two bones near the knee joint, runs the length of the calf, and also connects to the calcaneus by way of the Achilles tendon.  The soleus is a stabilizing muscle that is responsible for maintaining proper alignment at the ankle joint.  This muscle is the one that holds the foot in relevé or in a pointed position.  The soleus is used extensively in adagio exercises or any movements that require held balances.

            Since these muscles are constantly worked, they grow stronger, and if they are not stretched, tighter.  Tight calf muscles create a muscular imbalance in the body that can lead to other issues.  The tighter the calf muscles are, the stronger the pull on the Achilles tendon.  An irritated Achilles tendon becomes inflamed and develops tendonitis. 

           

  A strained Achilles tendon exerts a strong pull on the calcaneus, which causes the bone in front of it, the talus, to tilt.  As the talus tilts, the joint between the talus and the navicular bone becomes misaligned and causes the foot to pronate, or roll inward.

            

             When tight calf muscles pull upward on the heel, the body weight is shifted forward over the ball of the foot.  To compensate for this weight shift, the curve in the lumbar spine increased to help maintain an upright posture.  This increase curve, however, results in lower back strain and causes pain.

            Although this muscular imbalance is a common one in dance, it is not unavoidable.  Dancers can work on maintaining flexibility in the calf muscles without sacrificing strength.  Being sure to keep the heels on the floor during demi-pliés stretches the calf as does making sure the heels connect with the floor after all relevés and jumps.

                                           Additionally, regularly stretching the calf muscles is a good idea for dancers.  The yoga position downward  dog is an excellent exercise for lengthening the calf as is lying on the back, extending a leg upward, and using a theraband around the foot to pull it into a flexed position.  A standing lunge will also stretch the calf.

All of these exercises should be done with a straight leg to stretch the gastrocnemius and repeated with a bent knee to stretch the soleus.  

These stretches should all be done in parallel positions to be sure that all the muscle fibers are stretched equally. 

            By simply being sure to keep the heels on the floor whenever possible, landing on the entire foot after jumps, and adding a few stretches to their routines, dancers can avoid the problems that tight calf muscles can create.

The Need for Calcium

“The harder the demand placed upon the structure, the stronger the foundation must be.”

          Making healthy food choices involves knowing which foods to eat when and knowing the best way to get the vitamins and minerals our bodies need to function optimally. Our bones are an extremely important part of our body since they protect our organs, manufacture red blood cells, provide a place for muscles to connect, and provide the framework for our bodies.

           

            As was discussed in a previous post, Dancers and Bone Health, bone tissue is constantly being renewed until the age of about 35 when bone building, or modeling, begins to slow down.  At that time, our bodies have to depend upon the bone tissue that was amassed during the adolescent years to keep the bones healthy and strong.

            Studies have found that dancers’ bone mass measurements, or bone mineral density values, are below what is expected and can cause stress fractures.  This connection is discussed in detail in the post Why Dancers May Be At Risk for Stress Fractures and Osteoporosis.  In addition to engaging in weight bearing activity to increase bone mineral density, dancers need to be concerned about the amount of calcium they ingest.

            Calcium does many jobs in the body.  It aids in muscle contractions, sending messages throughout the nervous system, and regulating hormone and enzyme levels, but its main job is to develop strong bones.  Most dancers do not get enough calcium simply because they restrict caloric intake, and the foods that contain the most concentrated amounts of calcium tend to be high in calories.

            During the teen years, calcium intake should be about 1300 mg/day, while adults should ingest between 1000 and 1300 mg/day.  An important thing to remember is that calcium absorption is aided by vitamin D.  Sunlight is the best source of vitamin D, but, unfortunately, our necessary use of sunblock prevents us from absorbing it.

            The best way to meet our calcium and vitamin D needs is through dairy products like low-fat milk, yogurt, or cheese.  A 1996 study found that calcium fortified orange and apple juices are also good sources of readily absorbable calcium. (1)

            Almond milk is a good source of calcium for those who need to avoid dairy, providing more calcium per serving than dairy milk, but it does not contain vitamin D.  Other dietary sources of calcium are salmon with bones, tofu, almonds, broccoli, kale, and spinach.

 

            While calcium intake can also be boosted with supplements, it is important to know that a study conducted in 2007 found that those who ate calcium rich foods had higher bone density values than those who relied upon calcium supplements. (2) 

            Calcium supplements are available as calcium citrate and calcium carbonate.  Calcium citrate is 21% calcium and easily absorbed by the body.  Calcium carbonate is 40% calcium but relies upon stomach acids to help absorption and needs to be taken with food.  It is also important to know that calcium in absorbed best in doses equal to or less than 500 mg at a time and that the body’s ability to absorb calcium decreases with age. (3)

            Low bone mineral density is a problem because it leads to weakened bones, stress fractures, and osteoporosis.  It is important for dancers to amass as much bone tissue as possible when they are young, and carefully monitoring their calcium intake is an important part of that process.

(1) Andon, M.B., Peacock, M., Kanerva, R.L, & DeCastro, J.A. (1996). Calcium absorption from apple and orange juice fortified with calcium citrate malate. Journal of American College of Nutrition, 15(3), 313-6.

(2)Napoli, N., Thompson, J., Civitelli, R., Armamento-Villareal, R.C. (2007). Effects of dietary calcium compared with calcium supplements on estrogen metabolism and bone mineral density. American Journal of Clinical Nutrition, 85(5), 1428-33.

(3) Office of Dietary Supplements National Institutes of Health. (2012). Calcium [Fact Sheet]. Retrieved from http://ods.od.nih.gov/factsheets/Calcium-HealthProfessional/