Strained tendon - common in dancers?

[Lemongirl]

Dd has been complaining of pain under her big toe which hurts particularly she she flexes her foot.

 

I took her to the osteo today and he said its a strained tendon. It looks a bit swollen too. He said she should put an ice pack on it several times a day and see how it is after a few days.

 

She's doing EYB soon and rehearsals start next Wed. Is it likely to be ok by then? She's a bit worried.

 

She's never had any sort of injury before, is this common in dancers?

[Anjuli_Bai]

First there is no predicting when an injury will heal. But heal it must or it may become chronic.

 

Ice - yes.

 

Elevation - above the heart (difficult I know) but as much as possible. Any elevation is better than none.

 

Rest - crucial

 

It is not healed if there is any swelling and it is still healing after swelling and pain are gone.

 

A strained tendon is a soft tissue injury (as opposed to bone) and this means it is vulnerable to further injury.

 

Check her street shoes and make sure they are sturdy, supportive and with resiliant soles for cushioning. No sandals, no flip flops, etc.

 

Perhaps she can attend rehearsals and observe and/or walk through them for the first few days and then if all seems well, dance them in trainers or other supportive shoes. That means, no turning on the foot, no jumping, no rising onto demi-pointe. And then, see how it is.

 

You don't want this to become chronic - that's the most important thing.

[drdance]

Inflamed tendons (tendonitis type problems) are very common in dancers - they get many of these types of injury and they're common if the dancer increases their normal workload or changes it eg moves to a different studio (floor), or uses new or different shoes.

 

What happens is that every time a tendon or muscle is used some microscopic damage is caused - called microtrauma. Usually, with sufficient rest in between bouts of using the muscles/tendons, this microtrauma recovers all by itself and we don't even know it's happened. It is in fact the recovery from this microtrauma in muscles that helps them get stronger, as they rebuild as a result.

 

In cases where this repeated microtrauma doesn't have the time to fully recover each time it can gradually build up to a point where it becomes painful. At this point it is really important to reduce the workload on this tendon and to try to help the inflammation to settle down so that it can recover. Plenty of ice and a couple of day's worth of anti inflammatory tablets can help BUT only if the workload is reduced. In these cases dancers so often ignore the little 'niggle', take anti inflammatorys and carry on dancing, which adds to the damage and doesn't give the area chance to recover.

 

Once the inflammation has settled down, it is important to perhaps try to work out what may have contributed to it.

 

As an example of how to deal with such a condition: I had a student (now at WL) with very short achilles tendons and when her workload increases she's prone to bouts of tendonitis in one leg, which is her weaker side. The first time it flared up we managed it by stopping all jumping, demi pointe and grande plies, adding a heel lift into her shoes to take the tendon off stretch, and lots of ice. Once she was pain free I showed her how to stretch out her calf muscles and worked on her technique in demi plie to make sure she wasn't rolling to increase her plie.

[Lemongirl]

Thank you.

 

I shall make sure she rests and elevates it as much as possible. I'm giving her nurofen too.

 

Re shoes: the only supportive shoes she has at the moment are trainers, should she wear these every day until it heals? What abou at home, she normally wears only socks or bare feet indoors...?

[taxi4ballet]

We were told by a pharmacist that it's ok to use ibuprofen gel as well as medicine as long as it used on a small area of skin.

 

From experience of dd's injury a few months ago, absolute complete rest for a couple of days, and then wear shoes with a heel of about an inch, as it takes pressure off the tendon. How about her school shoes?

 

Has she any idea how she did it, or has the injury crept up on her?

 

I'm just thinking it might be worth getting an x-ray to rule out a stress fracture, which is what we were advised to do. They were really kind at the hospital when I explained she was a ballet dancer doing vocational training, and they had several people including the consultant look at her x-ray, which was ok, thankfully.

[drdance]

Any shoes that are supportive and comfortable will be fine. Has she been wearing a lot of flip flops lately? As they require some 'gripping' of the toes, particularly the big toe - avoid these at the moment. Trainers would be fine. Even indoors, just to help protect it, especially if walking without shoes on is sore.

 

Some gentle calf stretches should help, as it might be the FHL tendon (the tendon that makes the big toe 'point') which is bothering her. This tendon attaches up in the calf and stretching the calves might take the strain off. But any pain with these, and she should stop doing them.

[Anjuli_Bai]

Thank you.

 

I shall make sure she rests and elevates it as much as possible. I'm giving her nurofen too.

 

Re shoes: the only supportive shoes she has at the moment are trainers, should she wear these every day until it heals? What abou at home, she normally wears only socks or bare feet indoors...?

 

I would have her wear supportive shoes even indoors as this will help to keep any further injury from happening - like stubbing her toe accidentally, etc.

[drdance]

Hi Lemongirl, how's your DD's foot doing? Has the swelling and pain reduced any?

[Lemongirl]

Hi, thanks for asking.

 

It's MUCH better, the swelling has gone down and she says it's less painful.

 

EYB starts on Wed so 3 days to go. I'm hoping it will be ok by then. Should she carry on as usual with ice, rest, elevation until then and see how it is?

[Anjuli_Bai]

Hi, thanks for asking.

 

It's MUCH better, the swelling has gone down and she says it's less painful.

 

EYB starts on Wed so 3 days to go. I'm hoping it will be ok by then. Should she carry on as usual with ice, rest, elevation until then and see how it is?

 

I would say - yes, healing is still taking place even after swelling and pain have subsided.

[Lemongirl]

So how will I know if shes safe to dance?

[Anna C]

Well you won't really, until she does some dancing and you see how it is. Could you get a physio to assess it before Wednesday?

[drdance]

Keep up with the ice, etc. An assessment by a physio or osteopath before rehearsals start would be a good idea.

 

I'd also encourage your DD to avoid anything that causes the foot to hurt during classes and rehearsals, so perhaps not doing full plies in 1st/5th, not doing any releves/anything on demipointe or pointe and no jumping, just for this first week - and to let the EYB teachers know that she's recovering from an injury. They should be supportive but it will take a lot of inner strength for your DD to stick to that plan as she'll want to be trying to impress the teachers and the other dancers. She can still do that by using her arms, head and upper body beautifully. And she should ice her foot down after the rehearsals too.

 

With inflammation type injuries you need to really make sure that they've recovered before doing something that might flare it up again - if it stops hurting on day 1 and then on day 2 you dance full out, chances are by day 3 it'll be sore again. It's a case of gradually increasing the work that you're asking the foot to do, testing it out and when it gets to a point that it starts hurting again, you know thats the limit for the time being.

[Anjuli_Bai]

It would help if she can walk through the rehearsals in trainers for at least the first 2-3 days and see how that goes. And even then, no rising on demi-pointe (which includes all the grand pliés except second), no jumping, no turning. As drdance says, it's an opportunity to work on the head, arms, back, etc.

 

If she encounters any pain - that's a stop sign. Even an ache - or a feeling of tiredness. Always err on the side of caution.

 

It's a hugely difficult lesson to learn, but all of us have to learn it at some time in our lives.

 

Good luck to her!

[Anna C]

The good news is that there are 3 and a half weeks until the performances, so there's no rush. Watching, learning and marking through will all help her learn the dances while she recovers. :-)

[Lemongirl]

Thank you all, that's really helpful advice. Thanks for taking the time to reply.