Last night I had a SKYPE call that on one level was lovely, and on another made my blood boil...
One of my old clients, who has been dancing in London for the last 3 years contacted me for an online consult, as she has been struggling with her left foot for the last 12 months. She has seen several Physios in the UK, but they have not been able to actually resolve the issue. If she rests it does get slightly better, but as soon as she returns to class it flares up again.
She is booked in to have a Cortisone injection today, in an attempt to relieve the pain, and wanted to make sure that she had the best possible rehab plan as she is due to start her first professional contract in just 8 weeks time. She obviously wants to be fit and fabulous for starting at that company, and was not confident in the advice that she had been given, and so wanted to check everything with me first.
The bit that was lovely, was being able to work so easily with her online, due to the fact that she had been working with me for a long time before moving to the UK, so was familiar with all of the anatomical terms, and its always so lovely to have one of my students start into their first "real" job.
However, the bit that made my blood boil was how little had been done to actually isolate and fix the real issues contributing to her foot issue over the last 12 months, and the advice given for rehab following the injection. She reports being told that she only needed one day off following the injection, that her foot would be fine and she could return to full class the following day...
This is NOT a good idea!
With any chronic injury, there is always some reason why the pain has persisted, and even if the Cortisone is effective in reducing any current inflammation, there is no way that it will actually remove the cause of the inflammation. If she returns to class then the same habits that led to the injury developing in the first place will still be there. We need to focus on identifying and correcting these issues, and then develop a new "motor program" for all of the basic movements in classical dance. You need to make sure that you have the right rehab for your injury.
I reminded her that while it takes just 700 repetitions to "install" a motor program (or muscle memory), it takes at least 3500 to change one. This means, that if she has been doing a tendu wrong for the last year, then it will take a lot of very specific and conscious retraining to correct that pattern so that it happens automatically in class. She reported that it had become hard to really articulate her foot in class, especially when doing fast choreography, whereas her right one was effortless.
We spent some time working through all of the anatomy of her left foot and established several issues that were stopping her from working the foot correctly. I have now set her up with a program, using a combination of the Advanced Foot Control for Dancers program, and the Will I Ever Dance Again program to help her not only correct the issues that led to the current injury, but also to improve on several other problem areas that she has been struggling with. The beauty of the Will I Ever Dance Again program is that it works on the principle of Relative Rest, which allows the dancer to still continue with her training, while giving the foot time to heal.
In this dancers case, I have advised her to completely offload the foot for 2 days, to give the Cortisone a chance to work on the current inflammation. During this time she is to not do any of her normal foot strengthening, but to focus on all of the hands on releases and mobilising techniques to restore mobility to the areas we identified in her assessment that were contributing to the issue.
She has a comprehensive list of stretches, activation exercises and strengthening that does not involve her left foot, and can work on a floor barre with the foot in a relaxed position, rather than fully pointed or flexed, by following the Floor Barre section of Will I Ever Dance Again?
In the first week she is doing a lot of specific strengthening for the right foot, all from the Advanced Foot Control Program, to help train up specific movement patterns. This helps train the movement patterns that the left foot will have to replicate in the following week. She is also doing several exercises while using a mirror to reflect the image of her right foot in a way that leads the brain to think that the left foot is doing the work (a crazy bit of very effective neuro reprogramming as developed by David Butler).
I have also shown her a taping technique to offload one of the muscles that was being overloaded, until she can learn how to use it correctly. She is maintaining her cardio with a swimming program, while keeping the injured foot taped so that it is not pushed fully into a pointed position.
Over the next 6 weeks we will work to rebuild her foot to optimal strength for jumping and pointe work using both programs, and get her ready to start ths exciting new stage of her life pain free!
This is a far more comprehensive program and approach, and one that I am sure will have a much better outcome. I hope that by sharing this story you will have a better idea of how to effectively manage the rehab of any chronic injuries. I would love to hear your feedback, so please post any feedback in the comments section!
Are you getting the right rehab for your injury?