Pilates For Dancers: With an Emphasis on the Dislocated Knee Melissa May June 1, 2014 Greenwood Village 2014 1
Abstract: Like most athletes, dancers are hard on their bodies. Injuries will always be prevalent, with varying severity. Some dancers encounter more injuries than others, some being genetic, while others are functional. The difference between the injuries male dancers encounter, those female dancers encounter, can also be varied. Body types, the intensity of one s dance schedule, genetics, injury history, what type of dance, other daily activities are all factors that can affect how or how often one is injured. Because of weakness and instability, once a certain area is injured, the injury is very likely to reoccur in the same area. Dislocation of the knee is a common injury for dancers because of the range of motion that can be demanded during their daily classes and rehearsals. Many times at a young age, dancers, especially ballerinas, are taught to force their bodies past their natural ability. Ballet in itself is a very unnatural thing for the human body. The amount of force put on the joints and muscles, the torque and range of motion, are all opposite of what the human body is supposed to do. But many times dancers are willing to do whatever it takes to be the best, even if it means doing what is contradictory for their tired, overworked bodies. 2
Table of Contents Abstract... 2 The Knee... 4-6 Case Study... 7-8 Conditioning Program... 9-11 Conclusion... 12 Bibliography... 13 3
Anatomical Description: The knee is a hinge joint, or a ginglymous joint, that connects the upper part of the leg to the bottom half of the leg. It is made up of the tibiofemoral and patellofemoral joints. Because of its location, it is the common cause of pain for many people. It is capable of flexion, extension, and minimal amounts of rotation. The kneecap, or patella, joins the quadricep to the tibia. The kneecap is attached by tendons and ligaments, so it is able to move when the leg is flexing or extending. The kneecap also helps in protecting the knee against injury and direct stress. In addition to the tendons that act on the knee joint, there are also muscles that help to stabilize and mobilize the joint. The vastus lateralis, vastus intermedius, vastus medialis, and popliteus are just a few of these muscles. Depending on one s genetics and lifestyle, the kneecap may or may not track correctly. Because of their anatomy and structure, women are more prone to this. Many athletes also experience problems with their knees. Picutre: theapprofessor.blogspot.com 4
Picture from: http://noyeskneeinstitute.com 5
Muscular Anterior View: 6
A Case Study Client s Information: My client is a 16 year old ballet student from Colorado. She started dancing at the young age of 3. As a young dancer, she also pursued interests in gymnastics. My client has an intense ballet schedule at a local ballet academy, as well being enrolled in high school. At the ballet academy, she participates in weekly classes, rehearsals, and performances. She is active dancing, a minimum of 5 days a week, for at least 15 hours per week. My client first dislocated her knee on May 4, 2013. The recommended treatment for this was a soft brace, and was in physical therapy for 3 months. She began to regain her strength back and started dancing again in July. Client s Injury: On February 27, 2014, my client dislocated her knee for the second time. She had been back to her full range of motion, and had been dancing her regular schedule, before this second injury to the same knee. When she dislocated her knee the second time, it was more severe. She had a tear in her Medial Patellofemoral Ligament (MPFL). This was determined from scans. Her patella was not tracking correctly. After seeing an orthopedic surgeon that specializes in youth sports medicine, my client and her parents decided that surgery was the best solution. The surgeon determined that my client s cause was caused by a genetic factor. The surgery would be as a preventative measure, seeing as the dislocation was becoming a reoccurring injury. The surgery was to tighten her knee s surrounding ligaments and tendons, as well as repair the MPFL tear. Doctor s Recommendations: My client s surgery was scheduled a few weeks after the injury occurred. She was on crutches for most of the time leading up to the surgery, but this led to decreased range of motion and strength in her leg. The surgery had to be rescheduled for three weeks after the original date. My client s surgeon would not perform the surgery as scheduled because of the lack of mobility in her knee. My client started to go to physical therapy twice a week, to regain the range of motion in her knee. My client s surgery took place on April 14, 2014. The diagnosis was patellofemoral instability. During my client s surgery, her procedures included, a tibial tuberosity medialization osteotomy, medial patellofemoral ligament reconstruction, and a lateral release with lengthening and quadriceps plasty. 7
Post Surgery: There were no complications with the surgery, so my client went home that same day, with some swelling, but in very little pain. The following day, my client was instructed to ice for the next 24 hours, and elevate her leg with a pillow under her calf, not her knee for the next two weeks. The surgery went as well as expected. My client was instructed to wear a straight leg brace, and walk with crutches until further directed by the doctor. Progress: My client used a Continuous Passive Motion machine (CPM) for 6-8 hours a day for a week. The machine helped her move her knee to a 70 degree angle. A week after the surgery, my client returned to school and started using the CPM for 4-6 hours a day. Nearly four weeks later, she has reached a 90 degree angle with the CPM, and no longer needs to use it. My client still needs to wear the straight leg brace when she is at school, as well as one crutch to help her get around. She continues to ice daily, to help with any swelling. Since the surgery, she has been going to physical therapy twice a week. Physical therapy along with Pilates has been doing great things for my client s recovery process. She is happier and with a lot more hard work and patience, be dancing again. 8
Conditioning Program: Block Session 1 Warm-up Foot Work Abdominal Work Hip Work Spinal Articulation Stretches Full Body Integration (F/I) Arm Work Leg Work Lateral Flexion/Rotation Back Extension Roll Down Fundamental: Pelvic curl, Spine Twist Supine, Chest Lift, Chest Lift with Rotation Reformer: Parallel Heels, Parallel Toes, V-Position Toes, Open V Heels, Open V Toes, Calf Raises, Prances, Prehensile Mat: Hundred Prep, Roll-Up Reformer: Frog, Circles Down, Circles Up, Openings (after 10 sessions) Step Barrel: Shoulder Stretch Lying Side Reformer: Elephant Reformer: Arms Supine Series Mat: Gluteals Side Lying Series Mat: Side Lifts Step Barrel: Side Lift Mat: Back Extension Roll Down 9
Block Session 10 Warm-Up Foot Work Abdominal Work Hip Work Spinal Articulation Stretches Full Body Integration (F/I) Arm Work Leg Work Lateral Flexion/Rotation Back Extension Roll Down Fundamental: Pelvic curl, Spine Twist Supine, Chest Lift, Chest Lift with Rotation Leg Circles Reformer: Parallel Heels, Parallel Toes, V-Position Toes, Open V Heels, Open V Toes, Calf Raises, Prances, Prehensile Reformer: Hundred Prep, Hundreds, Coordination Chair: Standing Pike Cadillac: Supine Leg Series Mat: Spine Stretch, Roll Over Reformer: Standing Lunge Cadillac: Sitting Forward Chair: Shrugs, Triceps Press Sit, Triceps Prone Gluteals Side Lying Series Mat: Side Lifts Chair: Side Stretch Chair: Swan Basic Roll Down 10
Block Session 20 Warm-Up Foot Work Abdominal Work Hip Work Spinal Articulation Stretches Full Body Integration (F/I) Arm Work Leg Work Lateral Flexion/Rotation Roll Down Fundamental: Pelvic curl, Spine Twist Supine, Chest Lift, Chest Lift with Rotation Leg Lifts/Changes, Leg Circles Cadillac: Parallel Heels, Parallel Toes, V-Position Toes, Open V Heels, Open V Toes, Calf Raises, Prances, Prehensile Avalon: Warm Up Series Cadillac: Supine Single Leg Series Mat: Spine Stretch Chair: Pelvic Curl Reformer: Standing Lunge Cadillac: Side Reach, Sitting Forward Ped-a-Pull: Arms Standing Series Chair: Leg Press Standing Magic Circle: Sitting Series Chair: Side Stretch Step Barrel: Side Lift Back Extension Reformer: Breaststroke Prep, Pulling Straps 1 Roll Down I chose these exercises because all dancers, especially younger dancers need help learning and understanding their body. Even at a young age, it is essential that dancers learn how to use their core muscles. Their core is the base of all dancing. It aids in balance, stability, precision, posture, etc. In this particular case study, it is important to strengthen the core, as well as all the muscles surrounding the knee, to help stabilize and support the injury. In my client s case, it is extremely important to note the tracking and alignment of her knee. My client did not have the ROM or stability to fulfill the integrity of the exercises at first, so modifications were used, such as balls, therabands, foam rollers, magic circles etc. In the beginning of my client s sessions, I also had to adjust the spring tensions to accommodate my client s injury and her progress. 11
Conclusion: All dancers should practice Pilates. Dancers, especially ballet dancers, work certain muscles groups in the same way. Ballet uses a lot of repetition, in order to obtain muscles memory, as well as to aid in remembering choreography. In doing this, dancers are causing muscle imbalances. Muscle imbalances can result in pain, misuse of muscles, and injury. More times than not, dancers have more flexibility than strength, and Pilates can help to balance that out. This will ultimately make them a stronger, healthier dancer. Injuries will always be apart of a dancer s life, but what is important is how you can minimize and treat those injuries. Common injuries, such as a dislocated knee, can be prevented by being proactive and strengthening all of the muscles around that certain area. Since that Pilates is an overall workout for the body, it will not only enhance a dancer s training, but also prolong their dance career. 12
Citations Beim, Gloria M.D. The Female Athlete s Body Book: How to Prevent and Treat Sports Injuries in Women and Girls. The McGraw-Hill Companies: 2003. Print. Isacowitz, Rael and Clippinger, Karen. Pilates Anatomy. Human Kinetics: 2011. Print. Kent, Michael. Food and Fitness: A Dictionary of Diet and Exercise. New York: Oxford University Press, 1997. Print. Polousky, Dr. John D. Operative Report. The Medical Center of Aurora. Aurora, CO. 4 Apr 2014. 13