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.

Stretching Is Good for Dancers, Isn't It?

“Blessed are the flexible for they will not allow themselves to become bent out of shape.” – Robert Ludlum

        Dancers need to be able to raise their legs as high as possible, split their legs 180° apart in a leap, and turn them out as far as possible when necessary. When all of that is considered, there is no mystery in the fact that dancers spend an inordinate amount of time stretching, working on flexibility, and trying to increase range of motion in most of their joints.

                        How then, could stretching be bad?

        There is a right way and a wrong way to stretch. Knowing the difference between the two and listening to the body will mean the difference between improving dance performance and setting a body up for injury.

        The dancer’s goal is to stretch muscles. Flexible muscles improve posture, increase a dancer’s ability to move freely, help prevent injuries, and provide increased blood circulation throughout the body. Tight muscles tend to pull on the skeleton and force the body into unnatural positions. Tight muscles prevent movement, and are more apt to tear during quick movements. They also tend to constrict blood vessels and decrease blood flow.

         One important quality of muscles is that they are elastic. When a muscle is stretched, although it becomes more flexible, the muscle fibers do not lose their elasticity and become lax. Ligaments are the fibrous strands that connect bones to each other. In addition to holding the skeleton together in correct alignment, they also prevent the body from moving in ways that it is not designed to move. Unlike muscles, they are not elastic. When they become stretched out, they cannot do their jobs; the body is allowed to move in ways that can cause injuries like bone dislocations, and the body’s alignment becomes distorted. For these reasons, dancers need to be sure to concentrate on stretching muscles and not ligaments.

        Ligaments are found at the joints. Any stretches that pull on the joints or focus on those areas stretch ligaments and could be causing more harm than good. 

The "frog stretch", pictured above, pulls on the ligaments surrounding the hip and the knee and could be setting the dancer up for injury. 

This lunge position which is often suggested for stretching the quadriceps muscle group also pulls on the ligaments of the hip. 

        Dancers need to focus on stretching exercises that stretch the center of the muscles. When stretching correctly, the dancer should feel a gentle pull in the belly of the muscle. If any pulling is felt at the joint, the dancer could be performing the stretch incorrectly, or the stretch may not be a good one because it is stretching parts of the body that should not be stretched and will not increase flexibility.

        The lunge pictured above can be replaced with a lunge with a bent back knee that will focus on the actual quadricep muscles instead of straining the ligaments of the hip.

        Dancers need to be aware of these differences and take time to listen to their bodies. By doing so, they will be able to choose stretches that are safe and effective at increasing flexibility.

Dancing Through the Adolescent Growth Spurt

          The body is the dancer’s instrument. Anytime that a musician purchases or plays a new or different instrument, there is time spent adjusting to the new instrument and adapting to its differences. As dancers, however, we take our bodies for granted and do not always acknowledge the physiological changes that occur. By not acknowledging these changes, we can become self-defeating and grow frustrated quickly when our bodies do not respond the way we are expecting.

          A major change that every dancer experiences is the growth spurt that occurs during the adolescent years. This period of rapid growth typically occurs between the ages of 11 and 14 and lasts between 1 and 2 years. Dancers who are in the midst of this growth spurt may experience difficulty balancing, a loss of flexibility and strength, and a lack of coordination.

          Any type of growth affects how the body moves through space and responds to the demands place upon it. Unfortunately, during the adolescent growth spurt, there seems to be no set pattern of growth. Quite often the arms and legs grow faster than the torso, which shifts the dancer’s center of gravity causing balance issues. In some cases, one arm or leg may even grow quicker than the other, completely undermining any sense of balance that the dancer may try to establish.

          In the body, bones grow quicker than the soft tissues of the body- the muscles, tendons, and ligaments. Since the tendons, muscles and ligaments are attached to the bones, they are pulled taut as growth occurs. Because they are pulled so tightly, the dancers become less flexible and their muscles lose strength as well.

          As this rapid growth continues, the nervous system struggles to keep up with the skeletal and muscular systems. New nerve cells, or neurons, and nerve pathways are formed. Since these pathways are brand new,it takes time for movements that used to seem so easy to become natural once again. As a result, the dancer may seem and feel uncoordinated.

          With all of these changes occurring, the dancer may feel as if he or she is no longer in control of his or her body and may grow very frustrated. Progress in class may suddenly stop, or dancers may feel like they are regressing and may not understand why.

          It is important that dancers be patient with themselves during this period of time. They need to respect what is happening in their bodies and find other ways to work that will help their technique without causing frustration or predisposing them to injury. Dancers should adjust their expectations of themselves and the way they approach class. They should focus more on alignment and placement during this period of time than on range of motion.  The legs should not be held or lifted as high in exercises, but instead the dancers should think about the position of the legs. The growth spurt is also an ideal time for dancers to work on strengthening the core through Pilates and yoga exercises.

          Focusing on placement, alignment and core strengthening will challenge the dancer during the growth spurt without straining the body, frustrating the dancer, or setting the dancer up for an injury.

          The adolescent growth spurt is a challenging time for dancers, but it is only temporary. It need not be a setback if the dancers understand what is happening in their bodies and are educated about how to deal with all of the changes and work with their bodies to continue to be healthy dancers.

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More information about dancing through the adolescent growth spurt can be found on the International Association of Dance Medicine and Science website.

More Reasons Why Dance is Good for Our Bodies

           "Stifling an urge to dance is bad for your health - it rusts your spirit and your hips." - Terri Guillemets

         We begin dancing, our heart rate increases, the number of blood vessels increases, increased blood flow delivers more oxygen and nutrients to our muscles, and our circulatory system becomes more efficient as was discussed in last week's post.

           Additionally, our nervous, skeletal, and muscular systems are called upon to work at their peak levels, and our bodies reap the benefits.

            As we dance, our nervous system responds in a variety of ways.  The nervous system is continually growing and adapting to accommodate the body’s needs. Each time we engage in a new movement, a new neural pathway is formed. This pathway is the route that a message travels on to go from the brain to the muscle and back to the brain again and is made up of specialized cells called neurons. Messages are passed along the neurons with the help of substances called neurotransmitters. As we begin to move, the brain, which is the control center of the nervous system, signals the body to release extra proteins and neurotransmitters. The proteins promote new neuron growth, and the neurotransmitters help to improve the speed at which messages travel the pathways. These new, efficient neural pathways increase muscle responses and coordination.

            Additionally, when we dance, the brain releases endorphins, which are hormones that promote feelings of happiness and euphoria. These feelings help improve moods, and studies have shown that physically active people recover more quickly from mild depression and have a healthier mental state.

            Dance can also create a healthier skeletal system.  Since dance is a weight bearing activity, it can positively affect bone density.  The cells in our skeletal system respond to increased weight loads, or stressors, by increasing bone tissue to protect the body.  The constant impact with the floor that occurs when dancers execute dance steps, jump, and practice choreographed falls increases the load, or amount of weight, the body must support. The bones respond by adding more layers of protein cells called collagen to support the load.  These layers increase bone density and help protect against broken bones and stress fractures. Dancing can also decrease the risk of developing osteoporosis, which is a bone disease that manifests itself in brittle bones that break because they are not dense enough to support the body and the loads placed upon it.

            Lastly, the muscular system’s response to dance is also a healthy one. As we dance and call upon our muscles to move our bodies in various ways, several things happen. As physical activity increases, the number of mitochondria found in muscle cells increases. The mitochondria are the organelles found in individual cells, which produce the ATP, or energy, that the body needs to move. The more mitochondria in our muscles cells, the greater the energy production capabilities. As muscles are exercised continually, individual muscle fiber size increases by 40-50%. As fiber size increases, muscles grow stronger, the nervous system must create more neural pathways, and muscles generate more power.  Additionally, connective tissue like tendons and ligaments also grow stronger, and the body develops greater protection against injuries.

            Clearly, dance provides the body with a multitude of benefits and can create happy, healthy people when they take the time to learn to dance in ways that are anatomically correct for their individual bodies.

When Dance Training Gets in the Way of Being Healthy

            Dancing should look easy; like an optical illusion.  It should seem effortless.  – Bruce Marks

         A dancer’s job is to create a grand illusion for the audience.  The most difficult steps must look easy, and no one must ever guess that pointe shoes contain feet that are home to bunions, blisters and bleeding toes.  Like athletes, dancers need to perform with sore, and sometimes injured or overworked muscles, but unlike athletes, dancers must never show any sign of weakness.  Dancers must always be ready to push themselves to the next level to secure a role or a job, and there is no option for taking the easy way out.

 

            While all of these qualities are necessary in a field where performance is the ultimate goal, it is these same qualities that can be harmful to dancers when they begin cross-training or conditioning classes.

            Pilates and yoga instructors and personal trainers usually offer several variations of an exercise, ranging from beginner to advanced levels.  Most dancers, in spite of being new to this type of training, will choose the most advanced version simply because that is what they have been trained to do.  Although dance teachers might make statements like, “You may do a double turn if you want,” or “You may add beats to this exercise if you’d like,” dancers know that if they want to be noticed, an option does not truly exist.  They are expected to challenge themselves.  Unfortunately, since dancers’ muscles are specifically trained for dance exercises, the advanced version may be too difficult at first and strain the dancer’s body.

            As the conditioning class or session progresses and the trainer looks to the client to determine if he or she can handle a heavier weight, more repetitions or a more difficult exercise, the dancer will not portray an accurate picture.  If a dancer finds an exercise taxing or difficult, no one will ever know it.  Dancers are always performing, and they are trained to make the most difficult look the easiest.

            Lastly, since dancers are used to working with sore or tired muscles and have extremely high levels of pain tolerance, they may not always listen and respond to their bodies the way others do.  A pulling or burning sensation in the muscle may be ignored and classified as a slight twinge that must be worked through, and dancers may continue the exercise, assuming that they are feeling “good pain” when in fact they are feeling an injury occurring.  Dancers may not even realize they are injured until swelling or extreme pain occurs.

            When in a cross-training or conditioning program, dancers need to remember that starting to train at the beginner level is not a bad thing, it is okay to acknowledge tired muscles and to listen to their bodies in a different way, and trainers need to remember that dancers will push themselves to the absolute limit.  Cross training in dance is necessary and effective, but both dancers and trainers need to be aware of the psychological ramifications of dance training in order to keep the dancer healthy.