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.

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.

Caring for Muscles During the Performance Season

            "Take care of your body.  It's the only place you have to live." - Jim Rohn

          With the Nutcracker performance season upon us, dancers will be spending extra hours in rehearsals, numerous hours in theaters, and will be expending tons of energy entertaining countless audience members.  While performing is the ultimate goal of dance training, it still takes a toll on the body.  My last post addressed the risk of injuries that result from overused and fatigued muscles.  Over the long term, cross-training and periodic training can help prepare dancers for the stress of performance, but it is also important for dancers to know how to care for their muscles during the performance season.

            It is extremely important for dancers to warm-up before all rehearsals and performances.  Warming-up increases blood flow to the muscles, which ensures the delivery of oxygen and fuel, and raises the internal temperature of the muscles, which leads to the increased flexibility necessary to perform beautiful grand jetés and développés.  Most companies will hold a formal warm-up class before rehearsals and performances, but if there is not one available, it is each dancer’s responsibility to take the time to sufficiently warm-up his or her body to reduce the risk of injury.

            After the warm-up is complete and while the dancers are waiting for their turns on stage, is the perfect time to don all those fashionable sweaters and leg warmers that dancers always carry around in their bags.  Many dancers mistakenly wear these clothes at the beginning of class and peel them off as the body grows warm.  Their intended purpose is to keep already warmed-up muscles from growing cold while waiting.

 

            Drinking water is also a necessity to keep muscles working well.  Hydration is extremely important when trying to avoid muscle cramps.  Muscles are 70% water, which is why the fibers can move freely against each other.  When muscles are dehydrated, the lubrication decreases and movement becomes painful.

            Muscles should definitely be stretched once a performance and/or rehearsal are completed.  Static stretching in the wings before an entrance will not help a performance.  Instead it may hinder it!  My post on different types of stretching will help you understand why static stretching before a performing may actually decrease a muscle’s ability to contract efficiently.  When static stretching follows a performance, however, it is a valuable part of the cool-down that keeps dancers flexible and allows time for the internal temperature of the muscles to gradually decrease.  Stretching and cooling down reduce the chance that muscles will cramp or go into spasm when leaving the studio or theater.  Being sure to wear warm clothes over dance clothes  will also help keep muscles from cramping when dancers leave a warm studio or theater and move out into colder air.   

 

            Finally, a snack that is high in protein will help repair any minor muscle damage that might have occurred while dancing and help ensure that the muscles will be ready for another several hours of rehearsing and/or performing the following day.

            

The Many Faces of the Healthy Dancer

     Dance is a multi-faceted field - it includes educators, students, performers, dance scientists, dance medicine professionals, and dance therapists.  As a result this blog also has many faces and its mission has many branches.

     Since the new year has attracted many new subscribers and followers who might not have had a chance to read all of my past posts, I thought I would add snippets from a variety of them here so they will have a taste of what my blog is about.

     
When I first began the blog 15 months ago, I wrote a series of posts about flexibility in dancers and stretching.  Stretching is an important part of dance but it's important for educators and dancers to know when to stretch and how to use stretching to improve dance technique and not hinder it.

Stretching Part 1 - When Not To Do It!!
When we consider everything that happens in every system of the body on a daily basis, we begin to realize that the human body is truly a miraculous creation. My students hear me repeat daily that we are only given one body, and it is our job to take care of it. If I had a dime for each time I have heard a dance teacher tell his/her students to go into the studio and start stretching to warm up, I would be rich. Yet, every time I hear it, I cringe. Read more...



 

As a dance educator, I firmly believe in the value of dance in everyone's life.  Dance is a powerful tool for enriching learning and one that should be made available to every child.



The Case for Dance in Public Education
Each day students enter schools, sit at desks and get ready to learn. They read, they write, they use computers, and they take standardized tests that are used to determine the effectiveness of the educational system. They are told things like, “You can’t think while you’re moving,” or “You’ve got to be still to learn things.” In walks the dance educator, the radical thinker, who actually believes that movement aids learning and encourages higher order thinking. Read more...

February is National Eating Disorder Awareness month. Having seen and worked with several dancers with eating disorders, I believe that education is indeed the key to prevention and wrote several posts on healthy eating, eating disorders, and body image in dancers. Last year nutritionist Nancy Clark donated a copy of Nancy Clark's Sport Nutrition Guidebook that we gave away in a contest. This year the month of February will include another giveaway related to healthy eating. 

          Dancers and Body Image

Dancers are given the opportunity to observe themselves daily in full-length mirrors while wearing only tights and a leotard and must learn to live in harmony with their bodies. They, unlike other athletes, are constantly faced with the challenge of developing the muscles required to perform well while making certain that the lines they produce are clean and aesthetically pleasing to the audience. Additionally, dancers are in constant competition with their classmates for the teacher’s attention or for a coveted role in a performance.  Therefore, it is not surprising that dancers judge themselves harshly and are extremely critical of their bodies:  their legs are never long enough, their feet are never arched enough and their stomachs are never flat enough. In a 2010 interview about body image, Pilobolus’ Jeffrey Huang said, “Criticizing our bodies is second nature to dancers.” One need only mention the possibility of wearing white unitards to a group of dancers to hear groans and observe the, perhaps subconscious, movement of arms being placed across abdomens to hide stomachs. Read more...

     Dance science is a fairly new field of study, and although it has presented many ideas that make sense and are backed by scientific evidence and research, these ideas often challenge dance traditions.  Because of this, it is imperative that these ideas continue to be presented and dancers are encouraged to think about how to improve their technique in ways that keep them dancing longer, stronger and healthier.

Forcing Turnout: Is It Really That Bad For You


Turnout is an integral part of ballet technique. It involves externally rotating each leg 90° so that the inside of the leg is visible from the front.
Since few dancers are born with an ideal body structure for turnout, ballet dancers often feel the need to force their legs to rotate more than is anatomically feasible. Dancers bend their knees, outwardly rotate their feet and then force the body to hold that position while they straighten their legs. It is quite easy to spot the dancer who is forcing turnout. Teachers need to check to see if the dancers’ kneecaps, or patellas, are facing the same direction as their toes. If they are not, the rotation is being forced and the dancer is probably struggling to hold the position. Read more...

The Barre: Why It Might Be Time To Step Away...

There are few absolutes in the world, but every dancer who enters a ballet class knows that he or she should claim a space at the barre because barre work is the first part of class. It is at the barre that muscles warm-up, stretching begins, new movements are introduced, dancers acclimate to the space and neurological pathways, that will be called upon in the center, are established or reinforced. Therefore, barre work is an excellent way to prepare the dancer’s body for work that will be done in the center, isn’t it? Read more...

If you enjoy reading posts on this blog, please help The Healthy Dancer become one of the Top 10 Dance Blogs of 2013.  Simply click on this link, (it will bring you to a post about the contest), scroll down and leave a comment on the bottom of that post letting me know why you enjoy this blog and that will count as your vote!

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!