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Returning to pointe after an ankle injury


Balletmumfor2
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My daughter landed awkwardly a fortnight ago after having completed a double pirouette on flat. Her ankle was painful, so she iced it, sat out for the remainder of the lesson, then walked out to the car at the end telling me it was sore. The next morning it was extremely swollen and she couldn't weight bear so we took her to A and E. They x-rayed it, told her it was soft tissue damage, gave her a support bandage and told her to elevate it when she could. She was allowed to walk on it and keep it moving as much as she could. The ankle was swollen and painful for a full week. Following the weekend it felt better however, an she returned to class to start exercising it lightly. She had been advised she could dance as soon as she felt comfortable. She has now been back a full week avoiding jumps and pirouettes but is keen to get back to normal ASAP as she has 6th form auditions this year. I appreciate that in an ideal world we would seek scans or physio at this point but money and time constraints make this very difficult. I was therefore wondering if anyone could give us any advice about how to return and how long to wait before pointe. Her teacher has just said take it slowly and carefully! We have followed medical advice but it now seems to be down to our choice and any suggestions or advice would be most welcome.

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Thankyou Taxiforballet. She doesn't have separate pointe classes now but wears soft blocks or pointe shoes for all lessons as her teacher feels girls at her level should treat pointe shoes like normal ballet shoes not as something they use for a separate class. She has remained in flat shoes for now though. We still have the dilemma of what is slowly. Does she try pointe after 2 weeks, three? Not dancing myself and being given little information as to her specific injury I feel it is difficult to advise her. I was hoping that some of our 'experts' on this forum could give some general advice as I appreciate every injury is specific to the individual. Maybe she should try jumps this week and see how that goes? I know she intends to ask her SA teacher about it today so she may get more specific advice from that source. It is obviously a balance between allowing maximum healing for the injury and getting herself to peak condition for her auditions. Advice on strapping or supporting her ankle may also be relevant if anyone has any experience of this.

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I'm not trained either medically or dance.  All I can say is that when my son had a soft tissue ankle injury it was definitely a case of slowly and carefully.  He doesn't dance - for him it was more to do with sport and hiking - so not the intensity of dance.  He had to do shorter sport sessions and hike shorter distances or his ankle would swell slightly but building up gradually was fine and he was able to complete his duke of Edinburgh silver hike 3 months later with no problems whatsoever.

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I agree your SA teacher will know more and she may be able assess your daughters injury and giver her exercises. Take her advise and don't rush a foot that is healing, otherwise the injury may get worse right on audition time. Some private point lessons just before audition might be benificial, good luck.

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Thank you everybody. We agree with all you have said. If we don't get anything more specific from her SA teacher it may be a case of trying some jumps and seeing how it feels. She has had no problems at all doing classes this week even though she sometimes does 2/3 hours each night. One of her teachers even adapted his non syllabus class so she could do it all without sitting out. Regarding her auditions, I am just conscious she has GCSE mocks in the new year so it may be harder to fit them in. She usually has a weekly private festival lesson so will get plenty practice on pointe once we feel it is safe for her to start again as both her ballet and character are on pointe. We have a festival at the end of this month and English championships next month if her ankle is okay! Guess it's just bite the bullet, have a little go and see how the ankle responds, stopping at any slight discomfort. I still think support could be beneficial for her. Will let you know what her Royal teachers says.

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Don't they still have a physio you can see through RBS associates? Definitely worth making use of that if you can't afford for her to see a dance physio privately. It's really important you get a proper assessment done from someone who understands the demands of a dancer, especially as she wants a career in dance.

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Hi JulieW. I think we can access the RBS physio but it will be based in London I suspect and we are at Birmingham for SA's and live a couple of hours away from there so I suspect travel costs and time off work and school would not make it a viable option. We do have private health insurance but I suspect they would not pay out for physio now since her ankle seems absolutely fine for day to day activities. Thankyou!

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I would advise careful monitoring and strapping to help protect the ankle while it heals. Ideally see a dance physio but continue to use ice after class, gradually mobilise and definitely use taping if it is a hyper mobile foot. Lisa Howell has a good clip on taping for pointe work. The other thing I would say is monitor pain and swelling and if this worsens seek more advice. It is all too common to want to get back ASAP but this may delay the process in the long term. Theraband exercise could be done in the meantime to strengthen foot and ankle plus practising just standing on one foot which can be done with eyes shut if it gets too easy. All this should bring her back stronger in time but my advice is given without full knowledge of the extent of injury so be guided by your teacher and pain levels.

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Do check with your insurance company - it's quite likely she'd be covered for physio if the gp is happy to write a referral. There are some fab dance physios in Birmingham. My son had constant physio for various ailments for years while he was at Elmhurst using our insurance.

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A soft tissue injury is much more difficult to deal with than a broken bone because once bone has healed it is stable and simply needs to regain mobility.  But a soft tissue injury is much more difficult to assess and has the potential to become chronic if not allowed to heal - really heal.

 

The cessation of pain is NOT an indicator that the healing is complete.  Rest and care must go beyond the point when pain has ceased.  A good rule of thumb is always err on the side of caution.

 

Frankly, I do not advise strapping - for three reasons.....it's an artificial support doing the work of the muscle/joint and thus the possibility of undermining the needed natural strength of the ankle.   It hides the real strength or lack thereof of the healing ankle.  It gives a false sense of mental support and comfort and the dancer becomes dependent on it for "signals" as to what is really happening.

 

The question of "what does slowly mean?" - is too exact a question.  There are too many variables and no exact answers.  Even the advice of "let pain or lack thereof be your guide" - doesn't quite do it.  Pain can be delayed and one might not know one has overdone until the next day.

 

I know that my response is not very helpful when it comes to answering your questions - but there are no exact answers - except caution.  Avoiding the possibility of this injury becoming chronic  is what is important and if this interferes with an upcoming schedule of dance activities - one makes that choice.

 

A good teacher is your best guide.

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I agree with above but would say having broken both ankle bones that when you fall over and break a bone there is nearly always some degree of soft tissue injury as well. Depending on how awkwardly you fall will determine this.

 

When I broke my right ankle I slipped on some cut wet grass and ended up sort of sitting on it. I managed to walk round Brighton for over two hours before I realised was probably more serious than I thought but it was a simple fracture and I was just walking along!

 

When I broke the left one I was running round a sharp bend into a room and slipped on a wet floor and I really did twist it as well.

Everyone was saying oh you've just sprained it because I could move my toes......but I "knew" within 5 mins it was broken. This was much worse and I could not put on any weight at all. Again a fairly simple bone fracture but this time more damage in general.

The first one took six months to heal the second (two years later) took nine months because there was more soft tissue damage and this is the one that still gives me odd moments today!

In both instances the bones healed well but I'd still wrenched the ankle and its the ligaments and tendons which seem to take ages to heal sometimes.

Definitely err on the side of caution because my left ankle seemed okay for a couple of years before it suddenly played up again.....after a really long twelve mile walk one day!!

I wasn't dancing again when I broke them.....and probably a good job too as I might have been tempted to go back too soon!! And may have created more probs!!

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Thank you all for your responses. I knew when I posted that I wasn't going to get a specific answer but having things spelt out by others clears the mind and is a great support! She did her SA class today on flat with no jumps and her teacher has told her she is right to get back slowly, bit by bit. Have suggested she ices it now she's back home. She didn't strap it but did wear the light support bandage the hospital gave her to wear whilst walking. Will also get her to try a few theraband exercises tomorrow. Thankyou again to everyone who has responded. It is much appreciated. :)

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I hope your DD's return to full fitness continues as well as it seems to have started, Balletmumfor2. I was just wondering whether it is worth asking the RBS whether as an SA your DD could be seen by the dance physios in Birmingham who treat Birmingham Royal Ballet dancers? I would be surprised if the only dance physios who can be accessed via the RBS associate scheme are in London.

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  • 3 weeks later...

Hi All,

After all your helpful suggestions and advice, I thought I should update you on DD's ankle injury. It is now roughly six weeks since she first injured her ankle and this week she returned to pointe work with no problems as yet. She has a festival next week so after taking it easy on flat for 4 weeks thought she should see how it felt. She has done very little with it except fully rest for the first couple of weeks until the swelling went down then basic class (minus jumps and pirouettes) to slowly gain strength and maintain mobility. She was talking about doing triple pirouettes from fifth in SA class today so hopefully she has been lucky and it is now healed. It just shows however, how easy it is to go from fully fit to unable to dance! Thanks again for all the support and advice we were given. X

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Update sounds good. Just be aware that pointe requires a lot of extra strength and stability that might not be there instantly. She'll almost need to go back to basics for a few weeks - is there a lower grade pointe class that she can join in? I know they are reluctant to do this but it would be great preparation instead of just going fully onto pointe from nothing.

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Thanks drdance. Think she did Barre only on pointe ion Tuesday evening, small bit of pointe Wednesday then pointe at end of SA class yesterday. She has been pretty good, staying off pointe totally for as long as possible but now wants to strengthen it up. She doesn't have separate pointe classes but wears her pointe shoes for all non syllabus so I suspect she'll slowly build it up doing a bit more each week. Definitely wouldn't want her to reinjure it again! Thanks again for your advice. much appreciated. :)

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Just as long as she is careful about building it up gradually, and more importantly, easing off again if her ankle gets a bit sore or inflamed - it's perfectly normal in the recovery process, it's how strength is built up again, but it's also a warning sign to go easy for a couple of days to allow that healing and strengthening to take place.

 

Good luck!

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