Health & Body

How to Treat and Prevent Common Overuse Injuries

Tension in the legs is related to core weakness. Photo courtesy of AZ Dance Medicine Specialists

In the lead-up to competition season, "Again! From the top!!" can be overheard in studios across the nation. As students rehearse their routines ad nauseam in the final push to get ready, longer hours can sometimes mean that warm-ups get lost and increased repetition can create overuse injuries. Plus the extreme tricks and greater demands for flexibility can put stress on the joints and tendons of growing and adolescent bodies.

"In the dance industry, we are very used to releasing and stretching," says Dr. Alexis Sams, physical therapist and owner of AZ Dance Medicine Specialists. "But the key to injury prevention is matching mobility with stability. You are not going to get the results you want without doing the stabilizing work." While Dr. Sams does not recommend that students self-diagnose an injury and believes in the necessity of a professional assessment when a student reports pain, she has found that many overuse injuries can be prevented by strengthening the core and glute muscles, and sticking to a proper warm-up. Here are three common places where students report pain, what may be causing it, and the best exercises to address and prevent the injury.

Foot Pain

"The most common injury I see is FHL tendinitis," says Sams. "It is often misdiagnosed as Achilles tendinitis or plantar fasciitis and the resulting pain from overuse is most often related to a glute muscle not firing properly." The flexor hallucis longus (FHL) is part of a trio of muscles that begin deep in the back of your lower leg and end at the big toe. The muscle plays a part in pointing your foot and big toe. A tenderness or painful sensation can occur along any point in the muscle: in the back of the ankle, under the middle of the foot or at the base of the big toe.

"I first look at stability in a dancer's standing leg in a functional position like coupé or passé. Then I palpate along the FHL to see where there are tender points and different levels of tone and tension. Lastly, I scan the core and back extensors to find the reason for the glute dysfunction." While the body is complicated, the exercises Sams gives students for more functional glute strength are simple.

Single-Leg Bridges

1. Lie on your back with your knees bent, feet planted hip distance. Cross the right ankle to the left knee in a "figure 4" to reduce stress on the hip flexors.

2. Lift your pelvis off the ground and hold for 5–10 counts before lowering.

3. Repeat multiple times on the same side before switching legs.

"Dancers underestimate how difficult this is, especially when you do it correctly, which means with a level pelvis. Try to keep your foot as relaxed as possible, and visualize squeezing the glute instead of foot that is irritated," says Sams.

Knee Pain

The scorecard says "you need to work on stretching your knees more." But stretching and overstretching to fix "bent knees" can actually result in knee pain. "Many studio kids show up with knee pain that is usually resulting from a muscle imbalance. The tension in their legs is related to core weakness," explains Sams. "That is why stretching is not the answer. Their leg muscles are gripping their knees for a stability the core is not providing." After testing for abdominal strength, hamstring strength and quadricep strength, Sams usually spends time releasing the popliteus, a small muscle that runs deep in the back of the knee.

"When the popliteus contracts, it helps lock the knee in extension, but when it is super-tight and over-contracted, it can restrict the same desire for extension." While getting such deep tissue work is best done in the realm of physical therapy, students can take this core exercise with them anywhere to build more stability that will best support long, extended lines. (And if you do need to increase your hamstring flexibility, work on progressive stretching after class, when your body is already warm.)

Prone Plank

1. Kneel in a four-point position with hands under shoulders. Alternatively, come down to your forearms, with your elbows under your shoulders.

2. Maintaining the tone and support of your abdomen and a level pelvis, reach your legs behind you, toes tucked under to connect with the floor.

3. Hold position for as long as you can maintain the integrity of your core, your body in one long line from heel to head. Repeat at least two more times.

Hip Pain

Photo courtesy of AZ Dance Medicine Specialists

Side plank is a great way to work the core and stabilize the hips.

Snapping-hip syndrome can bring a painful popping sensation to every lift of your leg, especially above 90 degrees as most often, a tendon is catching on a bony prominence. "The underlying causes are most often related to an iliopsoas issue or the inguinal ligament. But again, addressing a core weakness as well as prioritizing and stabilizing the rotators of the hip can help manage it," Sams says. For this, she recommends the ever versatile side plank. "Studies show side planks give you the biggest bang for your buck, working all core stabilizers as well as the hip muscles."

Side Plank

1. Sit on one hip with your legs extended, feet stacked on the knife edge of your bottom foot. Position your elbow or hand underneath your elbow.

2. Lift your hips into the air, maintaining the support of your abdomen and the alignment of your body: ear over ear, shoulder over shoulder, hip over hip, foot over foot.

3. Your body should remain in one long line from heel to head.

4. Repeat eight times on each side, holding four counts each, and resting for

Mary Malleney, courtesy Osato

In most classes, dancers are encouraged to count the music, and dance with it—emphasizing accents and letting the rhythm of a song guide them.

But Marissa Osato likes to give her students an unexpected challenge: to resist hitting the beats.

In her contemporary class at EDGE Performing Arts Center in Los Angeles (which is now closed, until they find a new space), she would often play heavy trap music. She'd encourage her students to find the contrast by moving in slow, fluid, circular patterns, daring them to explore the unobvious interpretation of the steady rhythms.

"I like to give dancers a phrase of music and choreography and have them reinterpret it," she says, "to be thinkers and creators and not just replicators."

Osato learned this approach—avoiding the natural temptation of the music always being the leader—while earning her MFA in choreography at California Institute of the Arts. "When I was collaborating with a composer for my thesis, he mentioned, 'You always count in eights. Why?'"

This forced Osato out of her creative comfort zone. "The choices I made, my use of music, and its correlation to the movement were put under a microscope," she says. "I learned to not always make the music the driving motive of my work," a habit she attributes to her competition studio training as a young dancer.

While an undergraduate at the University of California, Irvine, Osato first encountered modern dance. That discovery, along with her experience dancing in Boogiezone Inc.'s off-campus hip-hop company, BREED, co-founded by Elm Pizarro, inspired her own, blended style, combining modern and hip hop with jazz. While still in college, she began working with fellow UCI student Will Johnston, and co-founded the Boogiezone Contemporary Class with Pizarro, an affordable series of classes that brought top choreographers from Los Angeles to Orange County.

"We were trying to bring the hip-hop and contemporary communities together and keep creating work for our friends," says Osato, who has taught for West Coast Dance Explosion and choreographed for studios across the country.

In 2009, Osato, Johnston and Pizarro launched Entity Contemporary Dance, which she and Johnston direct. The company, now based in Los Angeles, won the 2017 Capezio A.C.E. Awards, and, in 2019, Osato was chosen for two choreographic residencies (Joffrey Ballet's Winning Works and the USC Kaufman New Movement Residency), and became a full-time associate professor of dance at Santa Monica College.

At SMC, Osato challenges her students—and herself—by incorporating a live percussionist, a luxury that's been on pause during the pandemic. She finds that live music brings a heightened sense of awareness to the room. "I didn't realize what I didn't have until I had it," Osato says. "Live music helps dancers embody weight and heaviness, being grounded into the floor." Instead of the music dictating the movement, they're a part of it.

Osato uses the musician as a collaborator who helps stir her creativity, in real time. "I'll say 'Give me something that's airy and ambient,' and the sounds inspire me," says Osato. She loves playing with tension and release dynamics, fall and recovery, and how those can enhance and digress from the sound.

"I can't wait to get back to the studio and have that again," she says.

Osato made Dance Teacher a Spotify playlist with some of her favorite songs for class—and told us about why she loves some of them.

"Get It Together," by India.Arie

"Her voice and lyrics hit my soul and ground me every time. Dream artist. My go-to recorded music in class is soul R&B. There's simplicity about it that I really connect with."

"Turn Your Lights Down Low," by Bob Marley + The Wailers, Lauryn Hill

"A classic. This song embodies that all-encompassing love and gets the whole room groovin'."

"Diamonds," by Johnnyswim

"This song's uplifting energy and drive is infectious! So much vulnerability, honesty and joy in their voices and instrumentation."

"There Will Be Time," by Mumford & Sons, Baaba Maal

"Mumford & Sons' music has always struck a deep chord within me. Their songs are simultaneously stripped-down and complex and feel transcendent."

"With The Love In My Heart," by Jacob Collier, Metropole Orkest, Jules Buckley

"Other than it being insanely energizing and cinematic, I love how challenging the irregular meter is!"

For Parents

Darrell Grand Moultrie teaches at a past Jacob's Pillow summer intensive. Photo Christopher Duggan, courtesy Jacob's Pillow

In the past 10 months, we've grown accustomed to helping our dancers navigate virtual school, classes and performances. And while brighter, more in-person days may be around the corner—or at least on the horizon—parents may be facing yet another hurdle to help our dancers through: virtual summer-intensive auditions.

In 2020, we learned that there are some unique advantages of virtual summer programs: the lack of travel (and therefore the reduced cost) and the increased access to classes led by top artists and teachers among them. And while summer 2021 may end up looking more familiar with in-person intensives, audition season will likely remain remote and over Zoom.

Of course, summer 2021 may not be back to in-person, and that uncertainty can be a hard pill to swallow. Here, Kate Linsley, a mom and academy principal of Nashville Ballet, as well as "J.R." Glover, The Dan & Carole Burack Director of The School at Jacob's Pillow, share their advice for this complicated process.

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Teachers Trending

From left: Anthony Crickmay, Courtesy Dance Theatre of Harlem Archives; Courtesy Ballethnic

It is the urgency of going in a week or two before opening night that Lydia Abarca Mitchell loves most about coaching. But in her role as Ballethnic Dance Company's rehearsal director, she's not just getting the troupe ready for the stage. Abarca Mitchell—no relation to Arthur Mitchell—was Mitchell's first prima ballerina when he founded Dance Theatre of Harlem with Karel Shook; through her coaching, Abarca Mitchell works to pass her mentor's legacy to the next generation.

"She has the same sensibility" as Arthur Mitchell, says Ballethnic co-artistic director Nena Gilreath. "She's very direct, all about the mission and the excellence, but very caring."

Ballethnic is based in East Point, a suburban city bordering Atlanta. In a metropolitan area with a history of racism and where funding is hard-won, it is crucial for the Black-led ballet company to present polished, professional productions. "Ms. Lydia" provides the "hard last eye" before the curtain opens in front of an audience.

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