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Ballet Talk for Dancers

Hypermobility “Talk” with DD’s Instructor


tldx

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Last night, DD (9) narrowly avoided a severe injury during her floor work. Her instructor attributed it to DD’s hypermobile feet and ankles. She was moving across the floor and had gotten her foot so far behind her ankle that she wasn’t able to get it back up in time to catch her when she put that foot down and went down hard. Luckily she landed with her ankle straight and just bruised her foot, but had she been off just a few degrees, we would have wound up at the doctor.

 

After class the instructor came out to give me the details about what happened and we started talking about the challenges that those floppy joint pose. It was decided that we should come in early one day within the next couple of weeks to discuss this in greater detail. This instructor seems to have a fair amount of experience with students like DD, and has helped her with some ankle exercises in the past.

 

DD is hypermobile in pretty much every major joint, with extension ranging from quite mild to extreme. This is all very new to me and I admit that I know pretty much nothing about it. (Everything I know about ballet I have learned from DD or this board.) I was hoping that I could get some guidance from the voices of experience here. Any suggestions of what sorts of questions I should be asking? What sort of guidance we might need? What we may expect?

 

DD has seen multiple orthopedists over the years for her ankles, which have always been problematic, but have improved a great deal. At her most recent appointment, the orthopedist did say that DD’s ankles were strong enough for pointe when the time came. PT has never been recommended. The doctors never mentioned anything about any of her other joints and honestly I didn’t know to ask.

 

I’m not looking for any medical advice here; we’ve been there and gotten nowhere, and are still playing wait and see. I’m curious only as this pertains to ballet, as we’ll be having that meeting with her instructor pretty soon. I have absolutely no idea what to ask other than “how likely is it that’s she’s going to really hurt herself” and I know that there is more to it than that.

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Moderators, please feel free to "disappear" my reply if you need to respond first, or if it's too medical in nature... .

 

We discovered my DD had hypermobility/ligamentous laxity when she was right around the same age as yours, due to a sprained foot when she landed floppily after a failed pirouette. Her dance instructor was not at all helpful--she wanted her to wear Ace bandages on her ankles, and high-top sneakers, so you're very lucky that yours is knowledgeable!

 

The dance teacher sent us to a podiatrist, which was a complete waste of time and energy, and he wanted to tape her feet like he would a soccer player's. Hmmm.

 

Next, our family doctor recommended evaluation for the condition by a pediatric orthopedist, and he ran DD through a screening of easy but telling physical movements that showed just how much hypermobility she was dealing with in each joint (fingers, elbows, everything). He was not a dance specialist but had some rudimentary knowledge in that area.

 

He didn't recommend PT but he did tell her to avoid impact exercise such as running/jumping on pavement, etc. Dancing was deemed the perfect type of exercise for her. After DD was being forced to do impact activities in gym class, and coming home with knee and ankle pain, our family doctor recommended she be excused from gym. Low-impact exercise, and dancing on the sprung floor, are what she does now.

 

A visit to a pediatric orthopedist might help you come up with the best questions for your DD's teacher. I certainly felt better asking questions once I understood the medical reasoning behind what I was talking about. We also had a good discussion that led to us waiting for DD to go en pointe until she was 12...and she's never had a pointe injury.

I also found some helpful information at the website for the Harkness Center for Dance Injuries in NYC http://hjd.med.nyu.edu/harkness/ (search ligamentous laxity).

 

Good luck with your bendy child!

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To dustbunny--Thanks so much for posting the above link to the Harkness Center. I also have a "bendy" child. She has not had an injury because of this but I am watching. I want to do my best to prevent a career-ending injury and hopefully minimize any injury she gets. I feel that I have to really educate myself about this issue because I haven't found anyone else (teacher) that is really thinking long term.

 

Does anyone else know of any other resources or medical centers?

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Pilates with someone who really knew what she was doing, PT with someone who really knew what she was doing, a summer intensive where they broke down all the body parts and explained, lots of strength building and body awareness/education helped a lot. Nine is very young so she is going to need someone who can really explain it and help her internalize. She is too young for pointe, but do not let her go on pointe until it is resolved. It took a lot of research to find the right support after an injury.

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I also have a bendy child that is now 15. Unfortunately, most ballet programs seem to focus on stretching rather than building strength. We did make a school change so that she would be in a program that focused on slow progression and LOTS of repetition. Her previous eastern European teacher’s style always kept me on edge that my DD would be over stretched and just pushed too fast and injuries were inevitable. Her current program includes a mix of styles and has a Pilates program that also focuses on building strength. Although she has gone through puberty and her muscles are more able to develop, she still needs to spend more time strength training than most of her peers. We have used her physical therapist as a regular resource to give her exercises for specific things when they creep up. This has been the most valuable resource for us. The PT is more knowledgeable about the tendons and muscles and even the smallest exercises and stretches have made a difference. And these PT appointments are mostly covered by insurance.

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Hi, I also have a DD (15 yrs) who is hypermobile and is now in pre-professional training. She was very fortunate to have a teacher early on who recognised the difficulties she would have in gaining strength to control her hypermobility and who also felt that quality was far more important than quality. Having said that it was up to me as a mother to source information and find supportive health professionals. This was particularly important in the couple of years prior to starting pointe work. DD attended the perfect pointe course (Lisa Howell) with a dance physiotherapist a year before she started pointe (at 12 years). She was then aware of the exercises she needed to do regularly to strengthen her feet and ankles. When she finally attended her pre-pointe assessment a year later with the physiotherapist it was apparent that the hard work had paid off. Having said that DD has found that she still has to do her exercises regularly and even then she (to her great frustration) lacks the control of both her ankles and feet that many of her peer group have. They however rave about her "beautiful feet"!

DD's physiotherapist has cited research that has shown that professional dancers with higher level of hypermobility have longer recovery times from injury and don't progress as far through the ranks of professional ballet companies : ( The positive side is that DD has developed a much greater understanding of her bodys strengths and limitations and has learnt the patience of a saint as it has taken her longer to develop strength. I feel that doing everything to reduce the possiblity of an injury is money well spent!

The IADMS ( International Association for Dance Medicine & Science) has some useful information in the resource section and specifically mentions recommendations for hypermobile dancers.

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How do you know if your child is hypermobile? A podiatrist diagnosed dd with hypermobile feet. Does that mean the rest of her is? She is bendy is some ways but not naturally flexible ....

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I wanted to thank everyone for their responses, and the information shared is very interesting, but I think that maybe I wasn’t clear enough in my questions.

 

I will be meeting with DD’s instructor to discuss DD’s joints. I am wondering what questions I should ask her instructor when we meet, what I might expect the instructor to tell me, even what impact this may have on her training. Since I will be speaking with her ballet instructor, I expect the discussion to focus on how this affects DD in terms of ballet.

 

DD has been to multiple orthopedists and thus far we have learned nothing helpful from them. In fact, none of them looked at any joints other than her ankles and none mentioned hypermobility, until I specifically asked the one we saw last summer. Our best luck was with a podiatrist who prescribed hard orthotics for DD to help keep her ankles properly aligned. The constant support of the orthotics, combined with exercises recommended by one of DD’s instructors have finally helped to really improve DD’s ankle strength, greatly reducing her pronation. The instructor knows that DD has been to orthopedists.

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I am a mom of dancers - none of them to my knowledge have any issues with hypermobility. But I do. I was diagnosed at a recent doctors appt where they were evaluating me for other stuff - based on my complaints of pain/aches in my elbows, knees and hips. Prescription was for occupational therapy to do a joint protection program (which I haven't done yet). The long and short of it is exercises to improve the strength of all the muscles around the joints affected AND awareness to not move the joint into the hypermobile zone.

 

tldx, if I were you, I would continue to ask about exercises that she should do. Whether he/she has noticed it with other joints (knees?) How the instructor can help her be more aware of her foot placement to avoid injuring her ankle?

 

If you do go back to the orthopedist or get a referral to physical or occupational therapy - they should be able to do the hypermobility tests to identify which joints are hypermobile, and then help with the exercises to strengthen and protect those joints.

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