Wednesday, 2 January 2008

Introduction to dancers Anatomy for teachers and dancers

Forward: Due to the complex nature of this subject I thought it would be beneficial to cover the salient points of how anatomy can assist a teacher during a class by recognizing the more common problems of the young dancer.

Intro to Anatomy for the Teacher and Dancer
The Knee
Knock knees
Osgood-Schlatter disease or Growing Pains
Achilles Tendon 2
The Knee and Bending
Bow Legs
Sway Back Knees.

Intro to Anatomy for the Teacher and Dancer
When a teacher looks at a dancer, they see a blank canvas onto which they can apply the experience of their years as a teacher. Perhaps this young dancer will become World Champion or a Principle Dancer in a company. Maybe they will go on to teach other young hopefuls in turn but one thing is for sure though and it is this. If the dancer does not do exactly what the teacher says they will not learn enough to succeed on the narrow path to becoming a professional dancer or teacher.

What we have to assume is that the teacher is aware of three things and is able to apply all three in equal measure and at the right time.

The first is an all-encompassing knowledge of Dance techniques.
An ability to motivate and make the dancer succeed at class work.
A complete understanding of dance anatomy and physiology.

The Teacher can not do the first without knowledge of the third in case they damage the dancers anatomical structure. A young dancer is growing and can be damaged by faulty technique in teaching.

The second is dangerous unless the teacher is aware of stresses on the young dancer, both mental and physical. Individual dancers can have problems executing certain movements and in pushing themselves or by getting pushed may actually cause anatomical trauma or damage.

The third relies on the teachers willingness to explore this area of study in order to improve their own teaching ability. All young trainee teachers should study anatomy and specifically dance anatomy at an early stage in their schooling to protect their charges. Respectable already look at this aspect of teaching on a regular basis through regular articles like this one continue to ensure the high standard of qualified teachers.
What I will look at is some of the basic names of anatomical parts but without mentioning everything in detail. This will cover the teachers interest in body anatomy and problems.

Starting at the lower part of the femur, the knee joint is one of the most difficult of joints to heal if damaged. Most of you will know that a sprained ankle can heal relatively quickly but a sprained knee can take up to three times as long and indeed may never recover fully. I will go into the reasons for this later but suffice to say the knee is very delicate and is one of the most complicated joints in the body.

Comprising of two CONDYLES at the front, they become a smooth surface that fits into the PATELLA that allows articulation.
At the rear of the PATELLA, the CONDYLES create a depression that is the back of the knee. This is called the INTERCONDYLOID FOSSA.

On either side is a projection called the EPICONDYLE or this is easily felt.
The top area of the TIBIA fits into the femur that allows the knee to articulate and these forms the KNEE JOINT itself. Although it essentially makes a straight up and down action possible, slight rotation is also possible when the knee is bent.The head of the FIBULA can be felt on the outer side of the TIBIA, just below.

The PATELLA is not part of the knee joint although it is called the KNEECAP. This is because the PATELLA is attached to the TIBIA below by ligament tissue and is attached at the top by the QUADRATES FEMORIS MUSCLE on the front of the thigh. The QUAD straightens the Knee Joint.

In between the PATELLA and the FEMUR is a sac of fluid called a BURSA that protects the two bones against friction.A smaller BURSA protects the front of the Knee and yet another lies below the PATELLA.

On the upper part of the TIBIA lies the half moon shaped SEMI LUNAR CARTILAGE.
The complicated arrangement of the LIGAMENTS in the Knee holds the bones together in a horizontal and vertical fashion. Problems of the knee are as follows: Too much kneeling can cause inflammation of the main bursa. If a dancer comes down hard on the knee, either badly or constantly, e.g. rehearsal, the swollen bursa may start to leak causing extreme pain and stiffness. Damage to the smaller bursa will be a lot more serious.
Normal bending and stretching the Knee will cause little or no problems for the average dancer, as the ligaments are tight, protecting the knee joint. However, in a partial bending or flexed position the ligaments are looser across the knee joint which in turn destabilizes the joint allowing more movement than the joint can safely take. What happens in a simple movement, such as a transfer of weight from one leg to the other? It puts a strain on the medial ligament and while the muscles that surround the knee can take this strain, any sudden twist can cause too strong a pull. The ligament then stretches or drags the cartilage, which in turn can dislocate or move. Movements that can cause this include any slight rotation of the performed with a relaxed knee and can start the problem that will move the cartilage eventually.

Any movement that increases rotation of the knee must finish each rotation by straightening the knee joint using strong extension as a counter active movement.

Treatment is difficult but not impossible but can leave the knee permanently weak and therefore liable to reoccurrence of trauma or injury.


The knee locks when fully straight but just before it locks; a small muscle on the inside of the thigh locks the joint with a small rotation inward and unlocks with a small rotation outward. Your instruction to your student to pull up their thighs actually means that they should lock their knee joint. This in turn gives the knee a smooth appearance instead of a knobbly look.The problem arises when the child is a little too enthusiastic and the patella is pulled up. This can cause, either the ligament attaching the patella to the tibia or the tendon of the muscles at the front and at the back of the knee, to stretch. This will result in pain above or below the knee. Rest and treatment is advised for two or three days and you must watch that the child does not jerk or pull the knee while at exercise.

Although I have explained that pulling up is in fact a locking action, this is different from a knee that actually locks or indeed a knee that gives excessively easily. The causes are possibly a patella slipping or cartilage being pinched but the knee may recover temporarily. The dancer must get to the doctor or specialist to ensure that there is no inflammation under the patella or other condition that may re-occur if not attended to. If inflammation is discovered it could lead to a complete stop to dancing. Overuse of a weak joint or a joint inclined to this condition could bring this about.

At this point, I will look at the dislocation of the patella. This happens mainly to female dancers. The usual thing is that they feel is a partial dislocation as it goes out then clicks back in. If the kneecap actually goes right out of place, one should first look at whether the quadriceps muscle is out of condition or not strong, enough or perhaps the dancer has poor leg alignment.

Whatever the answer is it usually happens to girls because of the wider hip placement gives an increased angle of quadriceps pull on the tendon. It may be caused by another dancer accidentally kicking the dancer in question when the dancer is relaxed and this will make the patella slide over and lodge in the lateral aspect of the knee. Not turning the knee out and over the foot the foot on the first step of a jumping action from one leg can force the patella to be pulled latterly. The dancer is unable to move his or her leg in a semi flexed position. If it happens, then Ice therapy, cast or rigid bandage should be used with a two or three week layoff.
Knees that are well aligned tend to give little if any trouble. It is when the student has knock-knees and those with sway back legs. Also look out for dancers with short hamstring muscles; identified by being unable to straighten their knee joint without some effort.

Knock knees are loose at the joint and this will make the dancer unstable and may affect the muscles, ligaments and structure on both sides of the knee. I mentioned in my last article that some dancers unfortunately turn out from the knee instead of the hip and it is this condition that allows them to do this quite simply. The tibia is slightly turned out and it is this that allows them the necessary movement to turn out from the knee. The results are strain on the foot and the knee with secondary strain on the upper outside thigh and eventually the hip and lower back. Talking about Knock-Knees leads me to discuss this condition in relation to Irish and Highland. Knock-Knees are the result of an exaggerated slope inward from the width of the pelvis or from a very small angle at the upper part of the femur. Girls are more prone to the pelvic situation where they have wider hips than boys and therefore have a greater slope inward.

To test for knock-knees ask the pupil to stand facing away from you with their knees together and feet slightly turned out. If there is a gap at the heels greater than one and a half inches then the pupil will have great difficulty studying for advanced work for the reasons I will give later. The resultant stance will invariably also show that the dancer rolls in, as this is normal in Knock-Knee condition. This test is made with the smallest amount of turnout, as the inner condyles of the femur will prevent the heels from coming together. The condyles are quite large at a young age, and get progressively smaller as the child grows and with a large turnout may give a false impression as to the amount of Knock-Knee condition.

Although not a curable condition, there are specific anatomical examples that you should know about. This may help in slight improvement.

Very young children may grow out of this condition due to the flexibility of the skeleton and the unequal development of the two femoral condyles. The child can appear knock-knee at three or four then completely recover by five or six. As the child gets older and the bones get progressively harder, the condition becomes irreversible. Rolling in or out are conditions that can be helped if caught at a young enough age. Trying to change the line of the foot at a later age will put stress on other areas of the feet, legs, knees or hips.

The neat strong type of child can work through this condition with a degree of Knock-Knee up to two inches. In a thin or tall child, there may well be some looseness at the knee joint that will identify later trouble.

Speed will be affected, as it will be difficult to acquire it, as will be good elevation and good elevation work. The push up from the floor is not taken in a straight line from foot to hip as determined but through an angle at the knee joint that will of course put strain on the feet and the knees. On the other hand, dancers with a stiff knee as opposed to a loose knee will experience strains of the ligaments, cartilage problems and possible inflammations.

The child will give you indication if you encourage them to mention if they are experiencing any slight pain or discomfort while performing new or repeated exercise. Far from encouraging them to complain, it brings them closer to the teacher that can solve these problems by perhaps correcting a movement they are doing incorrectly.

Osgood-Schlatters disease or Growing Pains

Let us look at the child who complains about pain on the inner or the outer part of the knee. From age 12 to 14, the child can suffer Osgood's-Schlatters, commonly called growing pains. The inner side can also be ligament strain or cartilage displacement. If you first have a look at the exercises, and specifically any kind of knee bending action, you may find that this movement is being done incorrectly. Osgood-Schlatter disease is a very common variety of overuse injuries that occurs in knees of young people between the ages of 11 and 14. It is related to growth of the bones and occurs in dancers or sports persons who have not yet finished growing.

The symptoms are pain, swelling and inflammation about the tibial tubercle. This is the bump on the front of the shinbone (or tibia) where the kneecap tendon (or patellar tendon) is attached. If the muscles at the front of the thigh are forced the pain will be transmitted through the thigh or into the inside of the knee. It will then be painful to straighten the knee. The tibial tubercle is also the site of a growth plate. This is an area of cartilage where bone growth occurs. The growth plate cartilage is weaker than the underlying bone and the tendon attached to it. Invariably we are looking at incidences where the bones are growing faster than the tendons and causing stress in these areas.

When the forces across the knee are greater than the muscles can accommodate, the growth plate is pulled away from the underlying bone. This results in the pain, swelling and inflammation that is indicative of the disease. Activity such as dance exacerbates the pain. Often pain occurs in both knees. As with other overuse type injuries, symptoms are more common after the summer or winter break, or after a sudden increase in competition preparation.
While Osgood Schlatters is more common in boys we see it more in girls as we see more girls in dance than boys. The age is important, as this is a time of fast bone growth, which is the common cause. In addition, the foot, ankle, and leg pains are associated with growth plate centres. The period of problems arise between 11 and 14 years.

The thin, flat, crescent - shaped growth centres separate bone and cartilage in younger children. As a child nears puberty, these growth centres close and ossify the process by which cartilage becomes bone as it develops from the centre of the bone itself. It is softer at the ends when the child is young and continues to harden as the child matures. Indeed the bones sometimes continue to grow until the age of 20 but usually fully ossify or harden around age 16 to 18. As I said the bones grow so much faster than the muscles and tendons and these are unable to match that growth. This means less flexibility and strength, which in turn increases stress on the tibial tubercle. Adolescents do experience accelerated growth spurts.Between the ages of 8 and 12, dancers become more competitive, these children may complain of pain or parents may notice limping.

I suggest that before a new class season starts conditioning can help to prevent development of Osgood-Schlatters disease. Incorporating stretching to increase flexibility into the workout routine is also important and it is very important to stretch to cool down after a class. It is not only dance that makes the condition worse it can also be P. E, Gym class etc, football, other sports etc that contribute to the condition. An overall approach must be considered from the parental side in this case as well as the dance teacher.

Shin-splints could be considered:
Shin-splints usually involve pain in the front or inside part of the lower leg. This pain frequently results from tendonitis or the inflammation of the muscles where they attach to the bone.
When a dancer has Osgood-Schlatters disease, x-rays are necessary to make sure that they do have more serious problems such as tumours or possible infections. X-rays may show small extra pieces of bone forming in the patellar tendon where the growth plate cartilage has been pulled away from the underlying bone.

Treatment begins with a short period of rest and methods to reduce the inflammation, such as ice and inflammatory medications. Exercise programs are begun, emphasizing flexibility and strength, particularly in the quadriceps muscles. A brace may be advised which decreases the force on the tibial tubercle and is often used to keep the dancer competing. The general reason for this treatment is to control the symptoms until the growth is finished. Once the growth plate has fused to the underlying bone, the problem resolves.
Lacing the Hullachan properly will help redcue this tendonites.
Achilles Tendon
2-Growth Pains

A common pain is the severe pain behind the heel, which stems from overusing the foot and ankle in hard competitive preparation. The fibres of the Achilles tendon pull on the growth plate of the heel and create inflammation within the heel bone.

However, growth centre pain which can include Achilles Tendonitis is even more common among children who have flat feet, toe-in or have other foot problems. For these youngsters, an orthotic, a splint or soft cast is usually enough to properly position, strengthens feet and ankles, and prevents future pain and injury in their walking shoes. We can apply suitable soft orthotics in their Hullachan Pros as well.

With prompt treatment, growth centre pain persists only a few days or weeks and usually without the need for any surgery. However untreated, growth centre injury can require long term treatment.

The notable features of growing pains includes:
1. Intensity - Usually mild, sometimes a few children complain of a lot of pain that makes them cry. The pain can be short or it can last for over an hour.
2. Frequency - Intermittent, Some children get the pains every day or at night, others once a week or so, and some get them every so often. The pains tend to occur after a child has had sports at school or attends a dance class.When Normally, late afternoon or evening before going to bed. Occasionally the pain will make a child wake up at night.
5. Where - In the muscles but not in the ankles or knee joints. Many children report that the pain is in front of their thighs, in the calves, or behind the knee. Joints can be affected by other more serious diseases and appear swollen, red, tender, and warm. The Osgood Schlatters joint looks normal.

Other symptoms - restlessness, but usually no tenderness, redness, swelling. or fever.
Paediatricians find one symptom useful in making a diagnosis of Osgood Schlatters and that is how the child responds to being handled while in pain. Children who have pain from a serious medical disease do not like to be touched because any movement tends to increase the pain. Children with "growing pains" respond quite differently; in liking to have their legs massaged. That makes them feel better and they like to be held and cuddled.
The child's physician should be notified if any of the following occur with your child's pain: Regular pain, swelling, or redness in the joint or lower limb area, fever, limping, unusual rashes, loss of appetite, weakness, lethargy, or uncharacteristic behaviour. These signs generally do not accompany Osgood Schlatters and may be an indication of a more serious disorder.
Growing pains may seem harmless enough from an adults perspective or even a teachers perspective, but to a child, they are very distressing. Since the child seems better and is free of pain in the morning, parents sometimes suspect that the child is faking the symptom. This is generally not the case ---the pain is quite real and it is at these times that they need their parents reassurance and support more than ever! If you do not believe me, just ask your own parents! I did and it was explained to me that I too suffered this condition. Both my children have been through it as well.
These recommendations must not be relied upon as medical advice and it is not intended to replace the advice of your child's doctor.

The Knee and Bending the knee in class.
Knee bends and lunges are hard on the knee especially when returning upwards. Leaning or falling forward puts great strain on the inside of the knee joints and this strain can increase substantially if their is any relaxation or sitting when at the lowest point of the movement. Bad positioning can put strain on the feet and knees and eventually give serious ligament problems.

The problem arises when the teacher advocates the practice of a deep plies or knee bend. This can stretch the ligaments, the Internal Cruciate Ligaments that can develop a weak knee.
Less experienced dancers may bounce when going down into Grand Plies or a deep knee bend when warming up because they do not have sufficient muscle control. This may open the knee joint suddenly and tear the ligaments supporting the structure. Although all plies must be done with perfectly aligned thighs, ankles and feet, this is occasionally not checked in detail. Some dancers rise from Grand Plies or a deep knee bend straight into turn or spinning movement. While acceptable in experienced dancers it is folly to suppose that all dancers can do this as they must have complete physical control of the knee joint. If executed with the weight on the inner side of the thigh resulting in strain on the inner ligament, the medial ligament.

The deep knee bend should start, as far as the younger pupil is concerned, with the feet turned out and slightly apart. This is easier to correct and less complicated as far as the dancers muscle and joints are concerned.

In this position, also called the second position in Ballet, the stretch on the inner thigh, muscle is more immediate than in first position which is where the legs are together with the feet turned out and the back of the heels touching each other.. It stretches the large blood vessels that run down the inner leg and thereby increasing circulation faster than if the knee bend or plies had been executed in first.

The knee bend also known as the Plies (plee-ay) assists the dancer in warming up. It is important to determine the depth of the deep knee bend (grand plies) and even whether it is entirely necessary at the beginning of a class. I would prefer the dancer to be well warmed up before doing a deep knee bend. This is done through looking at the strength of the spine, the flexibility of the hip joint, the elasticity of the muscles on the inner side of the thigh and the length of the Achilles tendon. When you execute plies or knee bends in second position this gradually loosens the hip joints so that the knees are pressed out fully. The movement taken until the thighs is parallel to the floor with the back straight and the knees over the centre of the feet. Yes, of course this takes a few months of practice to get it perfect but it should be practiced only as far as the dancer is able.

In relation to Highland and Irish dancers who may have short tendons; the grand plies or deep knee bend may be a limited action by default. The tendon, attached to the calf muscle may prevent the Highland or Irish dancer from a degree of flexibility in the ankle joint and if pushed, could result in tearing.

In fact, faulty plies may well be the cause of slipping cartilage later.. Always make sure that the bending action is correctly performed with the knees over the centre of the foot and not twisted in or out. The back straight and the shoulders straight. A teacher will know the proper technique.

Never allow a pupil to sit in the plies or knee bend as this will result in stress on the joint, ligaments and muscles. Although ligaments can be stretched due to the support of the surrounding muscles, sitting in the plies then make the same ligaments take the weight of the body without muscle protection and this will then weaken the knees.
No professional school would immediately start a class of with full knee bend. They would work from partial knee bend to develop the warm up as this gradually allows the Knee Joint to function without sudden stress.
Follow plies or knee bends with quick single leg exercises to allow good blood flow through to the toes.

Bow Legs
The other problems with knees can be Bow Legs.
Although two kinds exist, one happens mainly with boys where the femur is normal but the tibia curves outward. The main type happens in both sexes where the bow is from the thigh. This is caused when the femoral curve happens on the side of the leg rather than on the front. The resultant space between the knees is caused when the condyles face slightly inwards instead of to the front.

Bow Legs interfere with the correct placement of the hip and the condition, although it can be slightly improved upon, will always be there. Boys can however achieve a slightly better elevation but girls are more variable as it depends on the position of the feet as they are affected by the position of the legs.
To conclude: although I have said correction of these problems is extremely difficult if not impossible, you should be aware of specialist doctors advice. In the early stages Orthotics may help to extend tight musculature or weak musculature to be strengthened but it is important that wrong exercises are not done that may accentuate to alignment of the leg.

Sway Back Knees.
These may be the result of very young dancers having Bow Legs and pressing their knees back stretching the ligaments at the rear of the knee and leaving the front very flat. The dancer being asked to pull up their thighs and instead have pressed the knees back without being corrected may also cause it.
I think that this will probably cover the salient points although I should mention that it really only skims the surface. At least these points affect your job as a teacher and I strongly suggest that the study of this information can only lead to even better teaching.

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