A Tale of Two Ankles

 This is a Public Service Announcement and a shout out of gratitude for all the Dance Medicine specialists out there. If you are in need of injury assessment and care, Doctors for Dancer https://doctorsfordancers.com/ is the place to start as many providers offer telemedicine sessions. 

Meanwhile, back to the ankles…

This is a story of two dancers seeking treatment for their lateral ankle strains. Both had rolled their ankle and strained the lateral ligaments about a year or so ago, and the return to classes was causing pain with jumping and in external rotation/turnout. 

Both dancers had an X-ray and MRI. The MRI revealed ligament strains at the lateral ankle (ATFL and PTFL) and both dancers were referred to orthopedic surgeons. A little foreshadowing here–cue that music where you KNOW something bad is about to happen! 

Dancer A went to a Sports Medicine specialist who shared that he did not have a lot of experience working with dancers but he had treated many athletes. His evaluation of Dancer A’s ankle was that she was “too weak” in the foot, ankle, and calf region and needed to do strengthening exercises for the calf. Both the dancer and their parents asked multiple questions about turnout, pointe work, and any specific advice to do calf raises differently? (since the dancer was already doing calf raises/releves 20x-80x in each technique class. 

Sports Medicine doc recommended Physical Therapy. Dancer A started PT with a highly recommended PT who gave her lots and lots of calf raises and exercises to strengthen her calves and quadriceps as he proclaimed that yes, she was “too weak” and that is why the injury had not healed. (More on the nocebo effect of telling a dancer they are “too weak”  in the next blog post!) 

Dancer A’s ankle did not improve, in fact, the exercises made it feel worse. Dancer A had to limit her classes considerably and worried that she would have to quit dance entirely due to this injury that continued to get worse. Due to the worsening pain levels, the PT and Sports Medicine doctor suggested less dancing and perhaps surgery would be required.

Dancer B saw the same Sports Medicine doctor and the same PT. She was given the same diagnosis and rehab exercises. Her ankle did not improve, in fact the exercises made it feel worse. Dancer B was disappointed in the level of care available in her mid-sized city. She researched options for dance specific care in a larger city. She found an orthopedic surgeon and PT office that specializes in dancer care for the professional dance companies.

At the appointment, Dancer B was quite pleased to see that this doctor’s office had a barre and marley floor area. This doctor, a former dancer, even got down on the floor and palpated the tissues of her foot, ankle, and calf during relevé and in external rotation/turnout. He gave very specific instructions for returning to barre work with supportive taping strategies and how to know when she had pushed it too far in technique class. 

Dancer B saw the referred physical therapist, a former professional dancer. This PT examined her ankle and lower leg muscles and showed her how the “tightness” or neurologically locked state of her lower leg was preventing the bones of her foot and ankle from aligning properly. Dancer B asked, “Wait. Are you saying that my calf is NOT too weak?” The PT said, “No, calf raises are not what you need right now.” 

Yep–you guessed it–cue that power ballad soaring crescendo music where you know something AMAZING is about to happen…

Dancer B progressed with the dance specific exercises and massage prescribed by the new PT. Her ankle started to feel better, even returning to dance classes 5 days per week. 

She was thrilled to be back to dancing without pain but she felt a lot of frustration that the Sports Medicine doc and PT had given her the OPPOSITE information that was needed to heal her ankle injury. These practitioners did not understand the specificity of her injury due to the fact that they had no true kinesthetic experience with the demands of ballet technique on the foot, ankle, and leg. She had wasted a lot of time and money and had received information that regressed her injury. 

To be clear, both practitioners are EXCELLENT at what they do for their patients. However, these ankle injuries required a dance specialist to understand the underlying cause of the stalled healing and what solutions were needed. 

Cue the happy-ever-after music!

Both dancers are now getting the dance specific care to rehab their injuries and are back to dancing in their Apolla Shocks for additional foot and ankle support.

The morale of this story? Seek out dance specific practitioners for injury assessment and care, and dance specific trainers for conditioning needs. 

@danceconditioningtechnique

www.danceconditioningtechnique.com

 

Susan Haines is a dance science specialist in Pilates and NKT based in Bellingham, WA bridging the latest research in fascia, biomechanics, and neuroscience into dance training.

Susan is a Level III NeuroKinetic Therapy practitioner; a sophisticated
treatment modality that addresses the causes of dysfunctional movement in
the motor control center. This work led her to create Dance Conditioning
Technique, a unique training system that focuses on foundational strength.
She has worked with dancers from American Ballet Theatre, American
Repertory Ballet, Ballet Austin, and Oregon Balle Theatre to create
conditioning programs for greater ease in turnout, pointe work, and partnering.
She has an MFA from UNCG-Greesnboro where she studied with leaders in
the field of Somatics and Kinesiology: Dr. Jill Green and B.J. Sullivan. She is a
NCPT  Pilates instructor who studied under Carolyn Watson, MS, LaC, and
Karen Clippinger. She is trained in functional movement patterning and taping
with Dr. Perry Nickelston and is a certified FMT Mobility Specialist. She is on
faculty at Western Washington University teaching contemporary, ballet, jazz,
and kinesiology in her Apolla Shocks. She has presented her dance
conditioning research at conferences nationwide.