Achilles problem

[Lilac]

Dd is 15 and has been relatively injury free to date. She has started experiencing a pain in her Achilles and the dance teacher has contacted me to say she is quite concerned about this, and advised taking her to a physio. We are not very knowledgeable about such things, and don't want major problems to develop. She is supposed to be taking exams in Tap and Ballet this term, and is also busy with festivals and possibly auditions. We would be very interested if anyone has any advice, experience etc. Thanks.

[Jan McNulty]

I would suggest you follow the teacher's advice as soon as possible.

 

It is worth searching the doing dance forum as I'm sure there have been some mentions of dance physios, which I guess would be the ideal.  Can your DD's teacher recommend anyone in your area?

[lovetoballetdance]

Hello

I was always find the exercise of doing rises on to Demi pointe on a step and allowing my heels to go as far down as they can. This stretches the Achilles and strengthens

[lovetoballetdance]

* that is just an exercise to do in the meantime, I would defiantly go see a doctor to get it sorted out

[Thecatsmother]

You do not want to mess around with Achilles pain. I would get it checked out by a dance physio or a physio if you do not have access to a dance one nearby.

 

In the meantime, icing will help reduce inflammation plus I would avoid jumping and anything that makes it feel like it is pulling too much which may include depth of plié. Most symptoms like this are usually easily treated if caught early but best to be proactive and get it assessed by a professional before it becomes a chronic problem. It will also be important to look at what caused this in case it's a technical fault or result of a growth spurt that needs to be kept an eye on in class. It's great that your teacher is alerting you to her concerns. I would also check whether wearing certain shoes during the day make it worse or better. Sometimes shoes with a v small heel can take the pressure off it temporarily.

[Ellie]

Agree with everything Balleteacher said. If it is achilles tendonitis, or anything related, you don't want to ignore it. 

[Anjuli_Bai]

I, too concur.

 

Anything to do with the Achilles should be taken seriously.  

 

While you are investigating what movement or technical correction may be necessary to rectify the problem, also consider her street shoes.  Sandals can be a problem - they are not supportive and stress the foot.  Same for dressy heeled shoes.  Non resilient, non-supportive shoes can also be problem areas.  

 

Hard floors, overwork, not fully getting the heels down in contact with the floor in landing a jump - or taking off for a jump without full contact with the floor - are other problem areas.  This is particularly important in petit allegro.  Insufficient warm-up is another area to investigate.  

 

Overuse - too much stress on the foot during a busy schedule of classes, rehearsals and performing.

 

This is one area you do not want to become chronic - so a thorough assessment and rest if indicated, should be taken seriously.  Even after the pain subsides and all seems to be well, healing is still occurring - so restorative healing should not be hastened:  "it doesn't hurt, so all must be well."  Err on the side of fully allowing it time to heal.

 

A good phsio is an asset - but a observant teacher is also necessary.

[Harwel]

All the above advice is very good. But a Physio assessment is essential. Massage one way along the tendon (up or down but not both) is also good as it encourages blood flow to the area to aid healing. This may feel very tender and she may feel an area which is inflamed at its most tender point, go very gently but try to massage this out. Also never stretch it before class. Always strengthen with rises and foot mobilisation exercises to warm up. Dynamic stretching prior to class warms up but does not weaken the body. Long slow stretches should only be done after class. Good luck and hope she gets it assessed soon.

[drdance]

All sound advice here. Try to get to a good dance or sports physio as soon as possible. In the meantime AVOID Demi pointe or rises - rises are good strengthening exercises to do once it's been assessed by the physio but I'd err on the side of caution before starting to strengthen/stretch the ankle. Plenty of ice to take down any existing inflammation as well as resting for a few days. Then your DD will need to avoid demi pointe (including full plies), and any jumping. Demi plies should be ok as long as she doesn't over stretch the Achilles' tendon. Get a tennis ball to massage the calves as tightness here can cause stress on the tendon. Gentle massage of the tendon can help stimulate healing but take care with this and follow it up with ice.

 

Basically what has happened is if you imagine the tendon as a rope, it has become overstretched and overworn and some of the fibres have started to break so instead of a nice new rope you have one that looks a bit tatty and worn, and frayed in places. The body is usually great at repairing these more frayed bits but if the 'rope' gets pulled too hard or too fast before the repair has had time to set, it will get damaged again. So you want to give the 'rope' time to heal itself, without too much pulling on it. Anything that loads the tendon will pull on it (rises or relevés) as will stretching it.

 

To allow it best chance to heal itself, use ice, gentle massage of the tendon, supportive shoes (flip flops can cause problems due to toe gripping and lack of support) and a small heel can also help take the strain off the tendon by putting it into a shortened position.

 

Has your DD been wearing flip flops a lot this summer? Also is her pain on the inside of her ankle or the outside? If it's on the inside of the ankle it may be a tendinitis related to the big toe - flexor hallucis longus (FHL) is a long thin muscle in the calf and has a long tendon which runs from the big toe, under the foot, behind the a ankle bone and next to the Achilles' tendon. It's common for dancers to get pain related to this tendon specifically, and the thought of flip flops made me think it could be this. Treatment is very similar but worth being aware of.

[Huddsballetmum]

Hi Lilac

 

My dd (now 14) suffered about 18 months ago  with her Achilles and needed to see a physio.  She was advised to ice it each day, rest for 3 weeks and was given some strengthening exercises.  We did exactly what she was told to do and she has never had a problem since.  She keeps repeating the exercises to ensure that the tendon is strengthened, but apparently it is quite common in girls of this age as they are growing.

[LinMM]

I echo all the advice here as a much older person still recovering from overuse strain injury of the Achilles.

 

Your daughter is much younger so will probably recover quickly but please REST it completely until you have seen a physio .....struggling on with it can delay healing in the end.

The physio will then advise how long to completely rest and WHEN to start strengthening exercises again.

 

Mine has taken ages over 4 months now and am still only on demi plié!! And no jumping!!

Dr Dance the description you have given of that muscle and tendon connected to the big toe is exactly the injury I have and have been doing a lot of work to loosen up the calf muscle in that leg. I am lucky in that the pain around the ankle and general stiffness has gone now but still feel something going on now above the ankle and into the calf muscle if I do overdo things.

 

The other day I decided I would try some jumping in the swimming pool......supported in water etc etc both on two feet and on the bad leg. This was a mistake though!! As it hurt quite a bit afterwards but recovered in a couple of days and didn't stiffen up or anything.

 

Unfortunately this type of injury cannot be hurried but if I had sort advice from a physio sooner I think I may not have done so much damage.

 

I do stress though that a teenager should .....with the correct advice .....recover much more quickly than four months!! I hope your daughter is back dancing soon.

[Guest dancer2027]

Hi last year I suffered with tendonitis, It happened purely from trying to stretch out the Achilles' tendon but pushing it too far and not being warm, about 10 minutes later I could not walk and it took 3 months to recover fully.

 

Unfortunately once you have it once you are likely to get it again, luck of the draw whether you are born with long Achilles or not!

 

What I learnt from the experience was that ensuring I always fully warmed up particularly my calves (and when I start to feel it slightly in class just going to the barre and stretching out; I'm sure your teacher will show your dd exercises). A lot of the problems come from the calves so I always massage mine after class, particularly when coming back from a holiday and I'm stiffen up quickly. Also keeping legwarmers on for the first few barre exercises etc

 

Other than that find a good physio or osteo. Wear comfortable shoes with a small heel as to not put unnecessary strain on the calves and Achilles. Pm me if you want some help on how to deal with tendonitis... Been there done that!!

[Guest dancer2027]

Also thought I would add that my osteopaths technique which worked, having already tried the rest and ice it method which worked for a while but soon the pain came back when I was in class again, was to fully break down the tissue around the tendon through controlled exercises. Then through massages, rest, light stretching etc, I recovered fully from what actually became tendonosis (like the worse version!). Good luck hope your dd feels better and it doesn't come to all that I mentioned haha! Xx

[Spacy]

Not trying to alarm anyone but my DD has been injured since April. She saw a local physiotherapist who thought it was tendonitis-it may have been to start with. she was advised to rest elevate and ice and do the exercises you have described.

I am not  convinced she rested for as long as she should and possibly went on  to sustain another injury.

We continued to see local physiotherapists who then suggested we saw a physiotherapist who has dance injury experience. Following an MRI scan( we paid for locally)  it seems she has an inflamed bone. The local surgeon wanted to start steroid injections which I had some reservations about.

We are now waiting for an NHS appointment  for a dance injury specialist.

My daughter has been unable to dance properly since April, she has attended two SS's but has been unable to fully participate. She is hoping to audition for full time vocational school for September 2015 and we are very concerned she will need some sort of surgery.

I think what I am trying to say is I really wish we had been to see a physiotherapist who had more experience of this type of injury far earlier as my daughter may be in a better position than she is now.

I have to say my DD is coping really well with things but I think she will be devastated is she can't audition. it really is so hard for her and I can't really do much to help the situation.

[sarahw]

Hi Spacy

Poor you and dd. It sounds like a nightmare. Hopefully you are on the correct path now and things will improve. Good luck.

[Lilac]

DD seeing physio recommended by dance teacher this Wednesday so hopefully she will begin to start sorting things out. Thanks for all the advice.