Are You Ready For Pointe?

When I was a young dancer, I remember wrapping ribbons around my ballet shoes and going on my highest tippy toes pretending I was in pointe shoes. I couldn’t wait to turn 13 so I can start dancing en pointe like all the big girl ballerinas.

Then came the day! I got my first pair of pointe shoes and had my first pointe class. Within a few minutes I remembered thinking, “ow this hurts”, followed by “this is much harder than it looks”. I spent the next 5 years struggling through pointe classes and performances, accompanied by lots of ankle sprains, painful blisters, bunions, and blackened toenails (that would occasionally fall off).

Looking back now, I wish someone would have told me that I was not ready to start pointe at 13.

There is a misconception that all ballet dancer’s are ready to start pointe by the age of 11-13 years of age because of sufficient bone maturation. This is false! Yes, bone maturation is important but is not the sole marker.

When it comes to pointe readiness, a strong ballet foundation, and adequate mobility, strength, and body control is imperative for a dancer to be successful en pointe.

“There’s no reason to get a young dancer on pointe if she cannot do anything once she is there.”

- George Balachine

The Pre-Pointe Assessment: What's The Pointe?

A pre-pointe assessment goes beyond just the dancer’s feet. We take a thorough look at the dancer as a whole. During the assessment, the physiotherapist will examine overall mobility, strength, balance, body alignment, trunk and core stability, and neuromuscular control. These components are all critical in pointe work. The purpose of a pre-pointe assessment is to identify deficits in each category and to provide corrective steps to address the problems to reduce risk of injuries once en pointe.

What should I expect at a pre-pointe assessment?

At the beginning of the session, the physiotherapist will ask a series of questions to better understand the dancer's background and medical history. After that, the dancer will be asked to perform a series of dance and non-dance specific tests and movements.

It is recommended that dancers dress in clothes they can dance in (ie bodysuit, tights, shorts, leggings, athletic wear) and dance shoes (for turning). After the assessment, the physiotherapist will debrief and provide recommendations and exercises based on the findings from the assessment.

What are the risks of starting pointe before a dancer is ready?

There are several risks with rushing to pointe work, including:

• Overuse injuries: inadequate strength of foot and ankle muscles will cause compensations up the chain including knee, hips and low back, as well as stress fracture in the foot

• Strains & sprains: dancers with inadequate ankle strength put themselves at risk for ankle sprains and chronic ankle instability

• Foot malalignment: poor pointe technique can put unnecessary stresses through foot joints which overtime can lead to irreversible deformities such as bunions and hammer toes

Successful pointe work requires a lot of patience, commitment, and a willingness to listen to and apply corrections. Having the right attitude and expectations going in lay the foundation for a successful transition to pointe.

If you’re considering starting pointe work, book an assessment with Anh at Ladner Village Physiotherapy online, by email or phone at (778) 630-8800.

Low Back Pain in Dancers and Gymnasts

For dancers and gymnasts, low back pain can come in many forms and can involve the spine itself. Two of the most common spinal injuries are:

1. Spondylolysis - a stress fracture of the pars interarticularis, a thin area of the vertebra that is more vulnerable to injury.

2. Spondylolisthesis - occurs if stress fractures are on both sides of the vertabra and allow a slippage of one vertebrae over the other to occur.

Dancers and gymnasts are at a higher risk of developing these spinal injuries due to repetitive hyperextension-type movements such as back-bending. These movements put significant load on the pars interarticularis, a thin part of the vertabra that connects the main part of the vertebra at the front with the bony bits at the back.

When you combine hyperextension with forceful dismounts and landings (gymnasts, we’re talking to you), it increases the risk of both spondylolysis and spondylolisthesis significantly. As more and more dancers are combining gymnastic skills into their routines, I expect to see more dancers with these conditions as well.

A slippage of less than 50% (a Grade 1 or 2 spondylolisthesis) is often treated with physiotherapy including hands on treatment techniques and exercise. A slippage of greater than 50% (a Grade 3 or 4 spondylolisthesis) is considered more serious and usually involves the care of a specialist.

Both spondylolysis and spondylolisthesis can happen at any spinal level. It most commonly occurs in the L5 vertebra, with L5 slipping forward over S1 (see the photo above). The second most common site is L4. 

What do spondylolysis and spondylolisthesis feel like?

Athletes will often complain of the following:

• Dull pain that can be sharp with movement

• pain with extension type movements including arabesque, bridges, back walkovers, back hand springs etc.

• Focal pain in the low back but may radiate into the buttock or down the legs

• Symptoms that are worse with activity and better with rest

How is it diagnosed?

Diagnosis starts with a thorough subjective history. If a spondylolysis or a spondylolisthesis is suspected, imaging via X-ray, CT or MRI will be ordered to confirm a diagnosis.

It is important that athletes with suspected spondylitic conditions be medically cleared before beginning an exercise program. This is crucial for the health and well being of the athlete as the wrong exercises can aggravate and worsen the injury.

How do we treat it?

Spondylitic conditions can cause instability of the low back. Spinal stabilization through core stability training is a key component in prevention and rehabilitation in these young athletes. Often, athletes focus on the large muscles and neglect the little guys that are responsible for stabilization. Core stability training targets the little muscles that directly support the spine including the transversus abdominis, multifidi, paraspinal, and internal and external obliques.

Appropriate flexibility is also important after a spinal injury. Tightness of certain hip muscles can increase the extension of the low back which can exacerbate symptoms.

If you’re suffering from back pain, give us a call at (778) 630-800, email us or book online. 

Are Your Nerves Limiting Your Mobility?

Our dance physiotherapist Anh is back! Here, she discusses neural mobility and tension - what it is, why it occurs and why dancers especially should know about its wide-ranging effects.

Hey dancers! Are you or do you know someone who stretches for hours a day, every day of the week and still can’t get into their splits? As dancers we often think about stretching our muscles to improve mobility. But what if it isn’t your muscles that are preventing you from touching your toes or achieving the splits? What if the problem is your nerves?

Your nerves are meant to move freely throughout your body. They connect our brains to our big toes and everything in between.

Neural tension occurs when a nerve’s ability to move has been impeded.

You can think of your nervous system as a tangle of ropes, extending from your brain to all areas of your body. Imagine one of these thick ropes starting at the top of your head, running down your spine, behind your glutes, down the back of your leg and all the way into the bottom of your foot and toes (this would be your sciatic nerve). If there is a restriction anywhere along the line of this rope, you won’t be able to move your leg the way you should.

Like rope, nerves do not like to be stretched or squeezed - both affect the ability of the nerve to do its job. In order to achieve full range of motion, nerves need to glide back and forth in the body. If a restriction is present and not removed, further stretching can cause irritation of the nerve over time.

So how do I know if it's neural tension that's preventing my mobility and not muscle?

1. If you are experiencing burning, tingling, numbness, or shooting pain that radiates past the muscle that is being stretched

2. If the sensation of stretching changes with different head and neck positioning

3. If the sensation of stretching changes with a change in position of a joint unrelated to the muscle being stretched (ie. stretching your hamstring feels better when your feet are pointed vs when your feet are flexed)

How do I get rid of neural tension?

First things first - if there’s neural tension, there’s a reason for it. As physiotherapists, we assess and identify the source of the tension. Is there something squeezing the nerve in the back? What about in the glutes or behind the knee? Finding the source of the problem is always the first step.

We then use a combination of techniques including manual therapy, soft tissue massage and specific exercises designed to help settle the tissue down and not reaggravate it.

Without a doubt, nerve flossing comes into play. Nerve flossing is a dynamic stretching technique that mobilizes the nerve. Think of a piece of dental floss: when you are flossing your teeth, you pull on one side of the floss and allow the other side to slacken, then reverse directions. Nerve flossing is the exact same idea - it is performed by tensioning one end of the nerve while slacking the other end.

Nerves control your muscles. If a nerve feels unsafe (like when going from sedentary to being over stretched) it will send signals to the muscle to contract and stiffen. This puts the dancer at risk of muscle strain. It is important to incorporate nerve flossing techniques and movements into your warm and stretch routine. 

For more information on neural tension and its effect on mobility, book online or give us a call at (778) 630-8800.