Learning About The Ankle

           “We will be in tune with our bodies only if we truly love and honor them. We can’t be in good communication with the enemy.”  -Harriet Lerner


          Dancers are athletes and, as such, their bodies endure many hours of physical activity.  The ankle joint is one that all types of dancers depend upon in order to perform.  The ankle needs to be strong enough to support the dancer and remain stable while being flexible enough to execute dance steps.

            The ankle is the site where most dance injuries occur, and it is helpful to both dancers and dance educators to understand the anatomy of this joint.

The ankle is home to two separate joints.  The actual ankle joint is formed where the tibia, the fibula, and the talus meet.   The tibia is the large bone of the lower leg that is located on the inside of the shin while the fibula is the narrow bone that is found on the outside of the shin.  The talus is the bone located on the top of the arch of the foot where the lower leg and foot meet.  This joint is a hinge joint that is responsible for the ability to plantar flex (point) and dorsiflex (flex) the foot.

From Southern California Orthopedic Institute

            The other joint that is responsible for ankle movement is the subtalar joint.  This joint is formed where the talus and the bone located beneath it, the calcaneus meet.  When these two bones glide over each other, the foot can be moved from side to side.

            The ankle is held together by a series of ligaments.  Ligaments are responsible for connecting bone to bone and for preventing certain movements that could dislocate and/or compromise the joint.

            The inside, or medial, side of the ankle is home to the deltoid ligaments and the calcaneonavicular ligament.  These ligaments connect the tibia to the talus and the calcaneus.  They are responsible for stabilizing the inside arch of the foot, holding the talus in place, and keeping the ankle from collapsing inward.

            The lateral collateral ligaments are found on the outside, or lateral side of the ankle.  The syndesmosis ligaments connect the tibia to the fibula and provide stability at the top of the ankle.  The strongest lateral ligament is the posterior talofibular ligament.  It connects the fibula to the talus and prevents the talus from slipping backwards and externally rotating.  The calcaneofibular ligament connects the fibula to the calcaneus and prevents the foot from twisting too far away from the body, or everting.  The anterior talofibular ligament connects the fibula to the talus, stabilizes the talus, and prevents the foot from twisting too far toward the body, or inverting.  This ligament tends to be the weakest lateral ligament of the ankle.

From Foot Doc

              Next week’s post will discuss ankle sprains, the frequency at which they occur in dancers, their causes, and treatment.

Dancers and Cocaine Use

            "Dancing appears glamorous, easy, delightful. But the path to paradise of the achievement is not easier than any other." - Martha Graham

          Dancers – they accomplish supernatural feats with their bodies, they have an extremely strong work ethic, and audiences applaud their efforts.  However, those supernatural feats take their toll on the body, the strong work ethic leads to hours and hours of class and rehearsals, and when the applause dies down, the performance high fades along with it.

            Dance is a difficult pursuit, and the stress of it can lead to eating disorders, which I have written about at length here, or substance abuse.   Cocaine abuse has been a problem within the dance community since the 1980’s.  Ballerina Gelsey Kirkland wrote candidly about it in her autobiography, Dancing On My Grave, and American Ballet Theater dancer, Patrick Bissell died of a cocaine overdose in 1987.

            Originally used as a painkiller, cocaine is made from coca leaves and usually mixed with cornstarch, talcum powder, sugar, or other drugs.  It is normally either snorted in through the nose or smoked.

            Cocaine creates a hyper vigilant state that increases alertness, creates high energy levels, decreases appetite, and creates a euphoric state.  All of these effects would seem to be advantageous for dancers.  Being alert means learning combinations quickly, lots of energy means the ability to dance at peak levels for a longer time, appetite suppression means that the dancers can control their weight without thinking so much about it, and the euphoric state replicates the high created during a performance and prevents feelings of post-performance letdown.

            Unfortunately, like most substances, cocaine also has a downside.  All of these “benefits” occur because cocaine blocks neurotransmitters from being absorbed.  Neurotransmitters are substances that line the pathways between different nerves so that impulses, or messages, can travel from the body to the brain and back again.  When absorption is blocked, a chemical build-up occurs in the body, and the neurotransmitters norepinephrine, serotonin and dopamine accumulate. 

            Norepinephrine and serotonin increase heart rate and constrict blood vessels.  The increased heart rate causes breathing to increase and puts a strain on both the heart muscle and the lungs.  The constricted blood vessels increase blood pressure and limit the amount of blood that can flow to the heart, brain and digestive system.  The lack of blood flow to the heart can lead to heart attacks or irregular heartbeats, the lack of blood flow to the brain can cause a stroke, and low blood flow to the digestive system can cause ulcers.

            Additionally, cocaine use causes a breakdown in muscle tissue that is released into the bloodstream and breaks down into a substance that causes kidney damage.  If cocaine is snorted, there will be sinus tissue damage, and it if is smoked, it can result in lung tissue irritation and/or damage.

            Cocaine is a highly addictive drug and is a definite problem in the dance community.  Dance educators, directors, and dancers need to acknowledge this issue and help dancers find help if they are using it and raise awareness to prevent other dancers from following this path.

            A new short film, Ballon, seeks to do just that.  It follows a ballerina through a cocaine addiction and her journey to become healthy once again.  More information on this film can be found here.

            Any effort to keep dancers healthy needs to start with awareness and education.  By arming dancers with the knowledge of what cocaine does physiologically, we can hopefully help decrease the problem and keep them dancing longer, stronger and healthier.