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NB All information in here should be treated as a friend's suggestion - ie while we believe the information to be mainly correct, you should apply common sense about following it. If it hurts, if it looks wrong for you, don't do it*.
You may also find the following pages useful:Well, I'm not an expert, and e-mail is a poor medium to relay exercises (wish I could recommend a book!), but I'll try to describe some of the exercises / massage techniques I've learned from my osteopath, yoga instructor ( & massage therapist) and some things Laura Scott did in warmups. I've seen many variations of these exercises on my travels, so I hope I'm not just telling you what you already know.
With the hands, pull on & separate the toes. Massage through the arch & ball of the foot so you can move each pair of metatarsals back a forth relative to each other. Also each metatarsal has articulations you should be able to manipulate along the length of the foot. Get the top & sides of the ankle (also inner arch on the side of the foot - a muscle that gets used lots for pointing the foot), then into the back of the ankle, achilles and calf. Keep breathing deeply as you massage, and I'm not sure exactly how it works, but the best massages I've received almost always involve changing the foot position as you massage (point/flex of foot or toes, and inner/outer rotation). Rule of thumb: if it feels good, keep doing it. If it hurts like crazy, it may be that it REALLY needs a massage, or you may want to get some expert advice. If you can't tell, I'd recommend the latter: at least if they tell you it just needs a good massage, you know you're heading down a good path. Tight muscles can start pulling things out of alignment, which causes the muscles to work improperly so they get tighter, and it goes in a vicious circle.
A good orthotic helps to introduce spaces where you need them & have lost them, gives support & a bit of massage as you walk. But you can't just keep using the same orthotic for years: as the problems start to correct themselves, you need to adjust the orthotic to new needs.
In yoga class, we generally worked the feet while sitting on the floor or lying on our backs. When lying on our backs, we used progressive pelvic tilts (right up to the board position) to lenghten the spine and massage the sacral region first, then worked on extension of the leg from the hip through the heel (with flexed foot, heel pointing to the ceiling with straight leg, other leg bent & if possible supported on a bench or bar) to open the hip & knee joints, then worked on pointing and flexing the foot rolling through the foot (i.e. keeping toes flexed into the point, then pulling them down last). The heel was stretched throughout, and the feeling was one of introducing space through the ankle joint & using all the foot articulations. We also did foot rotations with the leg stretched (this can also be done with knees bent & both feet up, taking care to keep the weight over a flat, stretched back). The thing to watch for is that you aren't moving your legs at all - no rotation from the knees or hips! Think of very loose ankles & lots of space in the joints. If one foot snaps and the other doesn't, try to transfer the feeling of what's working in the good foot to the other one.
Other exercises included trying to articulate the toes independently of each other. I can do my baby toes and big toes, but not the ones in between. It makes a really nice sequence of stretches, though, to point your big toe while flexing the others, then vice versa.
In morning warmups, Laura started us out on a chair with our feet flat on the floor. We started by flexing the toes, then laying them out flat and long. Then we rolled the feet side to side, trying to get each toe to down in turn. Then we started to move the feet back to stretch the achilles & alternated this with rolling through the foot up to the ball & point. All before taking any weight on the feet! She also used lots of point & flex exercises in warmups & cool-downs to differentiate between a pointed foot & pointed toes.
For strengthening, I once had a ballet teacher who did really SLOW releves. We didn't just shoot up onto the balls & stay there for 8 counts: we'd use 8 counts to go from flat to the ball, and 8 counts to come back down. We usually did them turned in to make sure we were mainting proper alignment of the foot to the leg. A series of those and then some plies to stretch out will really work the foot!
Hope this helps.
Norah
Once your dancer's symptoms subside and they do start back to dancing, be sure they start at a level of intensity that is lower than before their injury. Use slow progressive steps to get them back to pre-injury levels gradually. For example, if they practiced 1½ hours a day pre-injury, start back at 15 to 20 minutes a day for a week. If there are no increases in discomfort then increase by 5 minutes a day each week until you reach the level you want. Also, heat pre-exercise, ice post exercise, stretch (both anterior and posterior lower leg muscles) and strengthen the muscle groups mentioned above, but pay close attention to the anterior muscles of the lower leg.
As is basic to any overuse type injury, the muscles are unable to handle the stresses placed on them. Although it is a muscular injury we are discussing here, faulty biomechanical factors probably play larger role in this problem than, say, dancing one day on a concrete floor. You may have started feeling the symptoms after dancing on the concrete, but the problem may ultimately lie in a biomechanical fault. Before allowing the dancer to return to competition, the biomechanical and training errors must be corrected. This point cannot be overemphasized. Without proper corrections, the chance of re-injury is very high.
I'm so glad you stressed this Bill as an overuse syndrome. So many times people refer to shin splints as the muscle tearing away from the bone which only happens in VERY severe cases. Also these severe cases might actually be a tibia/fibula fracture.. so wise to seek medical advice if serious.
"The next steps in a shin splint prevention program include: Flexibility exercises to include the low back, hamstrings and Achilles tendon."
and don't forget the calf muscles. Of course if you're working to stretch the achilles, you'll be stretching these as well. Highland dancers work so hard to strengthen the calf, they forget to work the anterior muscles as well. Interesting Bill should mention the lower back after my posting regarding alignment.
Something else that can be useful in addition to Bill's comments...
Ice massage and taking 2 aspirins before work out can be helpful. Do this 15-20 min. before class.
Watch how your student is landing. Are they landing toe-ball or just on the ball? The stress of pounding on the ball can lead to stress on the anterior muscles and ball.
And I agree, nothing is better than proper warm up and conditioning.
I recently found the following sites that gives plenty of info about foot pain and foot care, and are designed for the layman. Seem to be serious.
led me to :
Hope you may find them useful.
I've been compiling some info on plantar fasciitis and have come up with the following summary.
Things that help:
I also think that the above information implies that if you allow the heel to hurt you are aggravating the condition. One can alleviate the pain and its associate inflammation by rest, massaging the calf and foot, wearing boots laced tightly to prevent foot movement, ibuprofen and ice. The general absence of dancing in the summer seems to be an ideal time to attack plantar fasciitis with a view to eradication.
My case of plantar fasciitis lasted 18 months. It was unusual in that instead of the typical tearing of the plantar fascia from the heel, the length of my plantar fascia had hundreds of small tears in it (called distal plantar fasciitis). For distal plantar faciitis, recovery is typically 12-18 months. Unfortunately, I took 18 months. That was a long time to watch others dance and not be able to join in.
I attribute my injury to improper warm-up. In my classes, I now strongly emphasize the need for proper warm-up and begin with undemanding dance exercises.
I began treatment by using a 90º foot splint nightly for several weeks. It took 2-3 nights for me to learn how to sleep all through the night with my foot flexed. I started using heel cushions and arch supports all the time. I still use these in my dancing ghillies, today. I took naproxen daily (better than ibuprofen for inflammation). I applied an ice pack nightly. At the end of my disability I got a weekly lower leg and foot massage. After several weeks of massage I had recovered. It made me wish that I had started the massage sooner.
Extracted from postings to highland-dance, the highland and scottish step dance mailing list. See http://www.scottishdance.net/highland/.
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Last updated 8-10-02 .