The Dancer’s Essential Warm-up – Part 1 The Foot and Ankle

Photography by C. Rennison-Rae

The Anatomy

The foot consists of 26 bones and is divided into three separate parts- the hind foot, the midfoot and the forefoot.

·         The hind foot consists of the talus, calcaneus (heel bone), navicular, cuboid and 3 cuneiform bones.

·         The midfoot is comprised of 5 metatarsals.

·         The forefoot consists of the toes, each with three parts (the phalanges). Only the big toe (also known as hallux) has two phalange, just like the thumb.

The talus is a very important bone as it transfers the body’s weight to the foot, and is stabilised by multiple ligaments which are often exposed to injury due to insufficient strength at the joint.

The ankle Talocrural joint is classified as a hinge joint. Due to it being this kind of joint, movement is only possible in one plane i.e. plantarflexion (pointing the toes) and dorsiflexion (flexing the foot). The gastrocnemius, soleus and toe flexors work together to produce this movement. Dorsiflexion is carried out by the tibialis anterior, extensor hallucis longus, the peroneus tertius and the long toe extensors.

Inversion (sickle foot) and eversion (winged foot) of the ankle occurs at the Subtalar glide joint. Inversion is produced by the tibialis anterior and tibialis posterior. Eversion is carried out by the peroneal muscles.

Source: Bing Images

The importance of warming-up the foot and ankle

Strong coordinated feet are essential to a dancer’s technique.

The foot is required to be stable, yet at the same time, flexible and elastic. The joints of the foot are shock absorbers, built for dynamics and balance of the foot. Mobility of the foot is genetically determined, but good training from a young age can improve its form and mobility. Strength and stability are also important areas within the foot, which can be trained (an area I shall talk about in a future post).

Due to this, it is vitally important that the dancer thoroughly prepares their feet for class and performances. Fully preparing from the bottom of the kinetic chain up will contribute to preparing the rest of the body.

Follow these steps to correctly warm up your feet

Foot circles

This exercise not only acts as a gentle mobilisation exercise, but is also good for focusing the mind.

1.       Start by lying on your back. Bring the left knee to your chest and hold the shin parallel to the floor. Dorsiflex the ankle.

2.       Circle the foot to the outside, through a pointed foot, to the inside and back to the start in a dorsiflexed position.

3.       Repeat this 6 times and then repeat this movement in the opposite direction.

Note: Focus on working the whole range of movement while imagining yourself stirring a pot of thick porridge.

Good toes, naughty toes

1.       Sitting upright with your legs stretched out in front of you

2.       Wrap a theraband around the balls of the foot and hold either end of the band in both hands.

3.       Starting with the ankle in a neutral position, slowly roll through the foot to pointed ‘good’ toes. This movement should be against the resistance of the band.

4.       Slowly return the ankle to the neutral ‘naughty’ positon, resisting the recoil of the band.

5.       Repeat this exercise 15 times on each foot.

Good Toes

Naughty Toes

The Franklin Method

There are eight steps to follow to feel the full effects.

Preparation – stand comfortably on both feet and feel fully aware of your body

1.       Massage

Using one ball e.g. a tennis ball, gently roll your foot back and forth on the ball, massaging the whole sole of your foot.

How much pressure you apply is dependent on you as an individual.

2.       Forefoot rotation

Put your forefoot on the ball, keeping the heel on the floor. Inwardly rotate and outwardly rotate your foot, touching the little and then big toe to the ground.

Your knee and hip will move with the rotation of the foot. Go to your own comfort.

Repeat 5-6times each side.

3.       Inward/outward foot rolling with toes towards the sky

Continue rolling the foot inwards and outwards but reach the toes towards the sky.

4.       Point flex

Keeping a straight knee, roll the ball under the arch of the foot, point and flex 5-6 times (plantar flexion and dorsiflexion).

5.       Toe scrunch

With your forefoot foot still on the ball, hug the ball with your toes. Repeat this 5-6 times.

6.       Heel rotation

Bring the ball under your heel, toes brace on the floor. Rotate the heel inward and outward. Repeat 5-6 times.

7.       Step up

Place the ball in the centre of the foot and step up on it briefly, taking the other foot off the floor. Repeat 5-6 times. Keep alignment and posture.

8.       Take the ball away and stand on both feet. Notice how one foot feels different from the other.

Massage

Forefoot rotation

Heel rotation

Point flex

Forefoot rotation

Massage

Step Up

Toe Scrunch

Toes towards the sky

Single leg balance

1.       Using a folded towel, folded yoga matt or cushion place this under the standing leg.

2.       Raise the working leg off the floor and keep the standing leg slightly bent.

3.       Close your eyes and stabilise the joint.

4.       Progress this exercise by turning out or standing on demi pointe.

Hope you find these useful!

-E

The secret tool to rehabilitation

 Support

 The often forgotten essential tool of rehabilitation.

Having recently read an online article by ballet dancer Rebecca King, it made me reflect on my own experience of providing support within the rehabilitation of clients.

Too many times within grassroots have I experienced players being put down by their coaches and fellow team mates through missing games due to serious injuries. This mocking is often because they’re not ‘putting their body on the line’ for the team anymore, which is primarily due to the fact that they’ve done this one too many times and their body has finally given up. What angers me the most is that no credit and understanding is given to these players who are working their boots off to get back onto the field and it is then left to me as their rehabilitator to not allow this player to become despondent. Not only is this destructive to the team environment but it is harmful to athletes mental and physical wellbeing. If it was me, I know I certainly wouldn’t want to return to a team with an attitude like this.

As a therapist, our role is not to simply drill out numerous exercises for our athlete, but to also ensure a good mental state and preparedness listening and advising our clients when they have concerns. Thus I try to ensure all my sessions are run with light-heartedness, good-humour and in a safe environment, where they can feel relaxed and open to talk. From doing this, my athletes work hard to please both themselves and me.            

Support from the team and staff are not the only places this care should be coming from, support from both friends and family are key. This allows for good psychological health within and away from sport and can aid to a better recovery.

Let me know your thoughts on this area! Have you experienced a lack of support from your team and how did you overcome it?

- E

The importance of Vitamin D for the dancer

It’s pretty standard that a sunny day brings out a good mood in all. I just love opening the curtains wide and letting the sun’s rays flood the house and jump at the chance of visiting the beach in some shorts to catch some colour. Well it turns out that the sunshine isn’t just good for our moods, but also building a healthy body…

With limited hours being spent in natural sunlight due to many hours being spent inside from classes or rehearsal, dancers are at a greater risk of Vitamin D deficiency. A 2013 study by Wyon et al. found dancers to have insufficient levels of vitamin D, especially within the winter months.

Vitamin D is a vital nutrient for maintaining strong bones and helping the body to absorb calcium. Calcium is vital for growth, immune function, blood pressure, muscle mass and strength. So it is no coincidence that research has found vitamin D supplementation to be beneficial in increasing vertical jump height and isometric muscle strength, whilst also reducing injury rates within elite ballet dancers.

It is believed that due to the high levels of stress which is placed on dancer’s bones and muscles, a vitamin d deficiency can cause greater harm on their bodies, than others who train at a less intensive level. A stress fracture is a common injury within the dancing population, and although it may be caused by poor programming, technical or biomechanical factors, it could also be linked to a vitamin D deficiency.

Dr Wolman (National Institute of Dance Medicine and Science) recommends that dancers need about 1000 IU of vitamin D3 a day, however for the deficient dancer higher levels may be needed. If you are worried about your Vitamin D levels, contact your Dr who can perform a simple blood test to calculate your levels.

Vitamin D can be found in natural sources of food such as salmon, tuna, eggs, cheese and milk. You might, therefore wish to contact a registered dietician who can advise you further.

Concussion

A ‘complex pathophysiological process affecting the brain, induced by biomechanical forces’ – Kuhn and Solomon, 2015

What?

Concussion, also known as minor traumatic brain injury (TBI), is 'the sudden but short-lived loss of mental function that occurs after a blow or other injury to the head' (NHS, 2014). Clinical signs and symptoms encompass emotional, cognitive and physical areas.

Injury to the brain is caused by a sudden acceleration or deceleration caused though a knock to the head.

This indirect force produces a violent jarring of the brain within the skull. Unlike what we often think, the brain is not fixed within the skull, it is suspended, the two do not move as one. Imagine an apple within a Tupperware box. A violent knock to this box will cause the apple to bash against the walls of the plastic box and become bruised. Such damage occurs to the brain within the skull.

The brain balances a series of electrochemical events in billions of brain cells. However when the brain is shaken or jarred soft tissue damage occurs causing brain function to be temporarily disrupted. This is when we might spot clinical changes within the individual.

Signs and symptoms 

·    periods of memory loss/the inability to recall

·    Disturbances in vision/seeing double/seeing stars/blurred vision

·    A period of confusion

·    Headaches

·    Gait disturbance

·    Unsustainable sleeping patterns

·    Vomiting

·    Blank expression

·    Delay in answering

·    Drowsiness

·    Tonal changes

·    May or may not loose consciousness (in fact only 10% of concussed individuals loose consciousness

These symptoms may occur immediately following impact to the head, or can develop hours, days or weeks later. If any of the symptoms becomes problematic or persistent, further assessment should be made by a GP.

Between 1.6 and 3.6 million individuals are affected by sports related concussions each year in the United States. Within the 2011-2012 National Hockey League season 4,878 concussions were reported per 100 games. This sport has seen a steady rise greater than tenfold in the concussion rate between the 1986-1987 season and 2011-2012 season.

Why is the incident rate increasing so dramatically?

·    Increase in player size? Athletes are now heavier, taller and stronger than previous years, meaning there is more force travelling through each hit. Within the NHL player height has increased by 1 inch and an average weight by 10 pounds.

·    Greater recognition and reporting?

·    Player position - concussion is also seen more commonly within some playing positions than others. For example, within the National Football League, research has seen concussions to occur more frequently in wide receivers, tight ends and defensive backs.

Mechanism of injury

Within sport, possible causes of concussion include

·         head to head contact

·         Knee to head contact

·         Ball to head contact

·         Head to ground contact

·         Fighting - within the NHL, 9% of concussions are due to fights between players.

·         Additionally, the NHL has recognised concussion rates to be higher when the individual is unaware, unexpecting and unprepared for a hit.

 

Management

Even a minor blow to the head may leave an individual concussed. Someone who has a concussion may not necessarily be aware of it, or they may not admit it due to a fear of being taken out of the game. Symptoms of concussion can often be delayed, therefore it is important to continuously assess the player. I suggest an on-pitch assessment, side-line assessment and medical room assessment for constant watch of any deterioration of health.

Immediate Pitch assessment should be actioned, followed by a side-line and medical room assessment to watch for any deterioration in symptoms.

IF IN DOUBT, SIT THEM OUT. Continuing to play may increase the players risk of more severe, and/or longer lasting concussion symptoms and an increase in a risk of other injuries. The SCAT3 form can used to evaluate the level of injury.

Should the player show signs of a more serious head injury, an immediate action of emergency care should be taken, i.e. CPR, phoning 999 for an ambulance.

These symtoms include:

·         Remaining unconscious after the initial injury

·         Lack of coordination or balance

·         Seizure or fit

·         Repeated vomiting or nausea

·         Slurred speech

·         Prolonged vision problems

·         Weakness in extremities

·         Fluid/blood leaking from the ears or nose

·         A persistent headache

·         Sudden deafness

·         Difficulty staying awake

Return to play protocol

The RFU have put together a Graduated Return to Play protocol which can be viewed here … http://www.englandrugby.com/mm/Document/MyRugby/Headcase/01/30/49/33/returntoplayafterconcussion_Neutral.pdf

My own experience of dealing with concussion over the past 4 years has changed. 4 years ago, it was difficult to get a player to take a concussion injury seriously and they were often encouraged to stay on the pitch despite my advice. However most recently, in light of new research and guidelines, this is changing and if I tell a player they can’t go back on, they don’t and my advice is fully supported by the coaches. I believe there still needs to be better education across all sports with regards to concussion but I have seen attitudes beginning to change. This can only be for the better.

-E

Recommended Sites

·         http://www.englandrugby.com/my-rugby/players/player-health/concussion-headcase/

·         https://www.headway.org.uk/about-brain-injury/individuals/types-of-brain-injury/traumatic-brain-injury/

·         http://playerwelfare.worldrugby.org/concussion

6 things I love about working as a Sports Therapist

1.       Educating and aiming to protect players from further damage

I love treating people, but it gives greater satisfaction when I can educate my clients to enable them to take steps to improve their health on their own.

2.       The people you meet

I have met some wonderful people throughout my time working and look forward to meeting many more interesting people. I absolutely love listening to old stories told by client’s and learning different things from each of them.

3.       Helping others

I like to help people. I always have and I always will. Seeing a client improve or having one tell you they are now pain free makes my day!

4.       The places you travel

Despite waking up at 4.30am for some away games and the eventful University American Football journeys I have been on, I love visiting new places. It's just another mini adventure for me! I even love those freezing cold snowy days on the side-lines when I can't feel my toes or fingers. Being outside and able to watch sport is an ideal weekend activity for me, so combined with doing the job I love, it is a winning combination!

5.       Family and friends

At all the clubs/teams I have been involved in, I have been welcomed and made to feel as part of one big family. With my first team (Teesside University Cougars), it felt like I had 30 big brothers who would look after me. I have made some lifelong friends (young and old) while being part of these teams and am forever grateful for their support promoting me and my work. 

6.       Continuous learning

In this job, you never truly leave education. To hold onto my professional insurance and membership, it is a requirement to continue my professional development. However, as you might be aware within this job, you will constantly be returning to books and journal publications to seek new ways of treatments or to investigate further into an injury. I absolutely love this, as since leaving university I miss the deadlines, which I guess it is part of the reason I write this blog. Yey to learning!

-          E

OPENING OF MY NEW SPORTS INJURY CLINIC

Exciting things are happening at Performance Sports Therapy! I am very happy to announce the opening of my sports injury clinic at North Shields RFC, Tyne and Wear from the 1^st April.

At my clinic I shall be offering –

-          Injury assessments

-          Sports and swedish massage

-          Peripheral and spinal mobilisations

-          Kinesio Taping

-          Sports Strapping

-          Ultrasound

-          Injury Rehabilitation programmes and coaching

-          Strength and Conditioning programmes and coaching

-          Pitch-side first aid for your sports team(s)

Facilities

-          Clinic

-          Sports field

-          Gym

Prices-

-          Injury assessment & treatment – 1 hour (includes 15minute assessment) - £35

-          Strapping & Taping is also available at a small additional cost.

-        Massage or Injury Treatments

        30mins - £25

        1 hour - £35

-       Training

Injury rehab/S&C (45mins) - £30

Injury rehab/S&C (90mins) - £45

-        Block booking

Block booking of 4 sessions (45mins) = £170 (saving £10)

Block booking of 6 sessions (45mins) = £250 (saving £20)

Block booking of 8 sessions (45mins) = £330 (saving £30)

-        Bring along a friend for a fun workout (45mins) - £50 (£25 per session)

-      Program only

Rehab/S&C 12 week program only - £45

-      Please get in contact with me if you require my services as pitch-side assistance

Prior to your first session or program purchase we will discuss your goals and I will design a workout based on these. If you go on to book a block of sessions then we will discuss your goals in more depth and I will design a program to achieve these.

Contact me via the below:

performancesportstherapy@hotmail.com