““Dance is the hidden language of the soul” ~ Martha Graham
85% of people will suffer lower back pain at some point in their life
5% become chronic and unremitting
70% of reoccurring symptoms and compensations
20% of LBP (low back pain) patients also have SI joint (synovial portion) as a pain generator
Truth be told, these stats are just for the basic population; many of whom play recreational sports on the weekends and many of whom rock the role of “Desk Jockey” as a professional study or in the corporate world. However, this post takes into account the above stats as well as sports specifics and in today’s post we focus on the sport of dance.
With sport, comes a new gambit of neuromuscular training and adaptive skill sets that, if not implemented correctly or at the right times during the athletes training cycles can lead to breakdowns in the body, some of which; could result in long term discomfort.
Over the course of the last few years I have been compiling case studies on the consistent patterns I have been noticing in today’s population. Clients who participate in the same sport, or have similar professions all exhibit similar movement breakdowns and somatic pain; yet they experience them very different (based on unique mechanics and their reflection of the world).
One specific group of clients I have noticed over the years who exhibit early onset of lumbo-pelvic dysfunctions and low back pain are dancers. Much of my work in this area has been observing the fundamentals of dance and the specialized movement patterns to deduce consistent patterns that can lead to breakdowns in dance.
For this post I have limited the information to Western Contemporary and Classical Ballet movements, however, it should be noted that many forms of dance can be applicable, such as; the Classical North Chinese dance of Niuyangge, as well as the Classical styles of Indian Dance; Bharatanatya, Odissi, Kathak and many others. These fundamentally arranged groups include; alignment, plié, relevé, passé, degagé, développé, rond de jambe, grand battement, forward stepping patterns, elevation and break falls and other motor dance specific patterns.
For this post I would like to restrict my thoughts to Alignment as this gives a broader scope of how alignment directly relates to the common place “lumbo-pelvic dysfunction” and ‘back pain” featured in this article. It is where a coach should start observing the student and then start to breakdown each movement into specific mechanical sequences.
Although this word will have varying definitions to some researchers, clinicians etc, and the generalization of the word is pretty common place. Alignment is based on the arrangement of the body segments and skeletal structure in a vertical column with respect to the line of gravity.
A biomechanical research paper on dance by Donna Krasnow, MS, a professor and head of the Department of Dance atYorkUniversityproduced a study outlining early research in this field.
“One of the early research studies investigating alignment was a master’s thesis by Bannister (1977),3 which examined the interrelationships of pelvic angle, lumbar angle, hip mobility, and the correlation of alignment to low back pain. Participants were 8 male and 55 female university dance students. They were photographed from front and side views, next to a plumb line suspended from the ceiling. Measures of flexibility were taken for hip flexion and abduction in a seated position, and pain was assessed by questionnaire. Analysis consisted of t-tests and Pearson product moment coefficient of correlation.
Bannister concluded that the four variables (lumbar angle, pelvic angle, and flexibility in hip flexion and abduction) do not predict low back pain and that posture, flexibility, and pain are independent. (Biomechanical Research in Dance: A Literature Review, Conditioning with Imagery for Dancers, by Donna Krasnow, M.S, M. Virginia Wilmerding, Ph.D., Shane Stecyk, Ph.D., ATC, CSCS,MatthewWyon, Ph.D., Yiannis Koutedakis, Ph.D. – March 2011).
Instability of the pelvis can be noted in observing some of the more repetitive movements in classical ballet, such as; relevé (pre and post turn out with full execution), passé (unilateral balance and weight shift), degage (forward stepping, pre and post turn out), ronde de jambe (adduction at the hip joint and unilateral weight shift), as well as the bottom positioning in the plie. All of these movement patterns allow for observational analysis that directly relate to the fundamental movement strategies in dance and the lower limb mechanics and relationship connection from the hip to knee to ankle, as well as the reverse relationship of the pelvis to spine to shoulders and head positioning.
The spine and it’s segmental make up are key indicators to how the body loads and distributes weight efficiently in the body. For dancers the spine must be flexible and have Tensegrity to properly move and react. Spinal deviations in verticality, primarily in the upper spine, lower spine, and total spine are common, and these breakdowns in movement strategy and pelvic stability can be easily observed. When there is a lack of mobility, or in the case of dancers; a lack of stability in the spine this energy will be re distributed to the pelvis of shoulders.
When we combine the alignment of the spine and the alignment of the pelvis we can then begin to observe some of the preliminary breakdowns that could be resulting in the somatic pain in the lower back that the dancer is “feeling” and exhibiting.
When there are mechanical breakdowns in hip stability, dances will normally feel referral into the spine. There is an area of increased stress where the rigid thoracic spine joins the flexible lumbar spine, and a second area where the lumbar spine joins the rigid pelvis below. Both of these areas can have problems. Stability and Strength conditioning are key to ensuring this relationship is well balanced. These dancers may need to work on their upper-body strength to help prevent this injury.
The majority of back problems come from the lowermost segment of the back—theLumbosacral spine. This area is put under extreme stress when performing grand battements, port de bras, arabesques, and attitudes and is prone to muscle strains, disc disease and stress fractures later on as the dancer/ client ages. To build on this; our fascial systems, plasy a significant role in the tension, compression and release within movement and in rest. In relation to the spine and LPHC the thoraco-lumbar fascia is the barer of energy load, re load and distribution. It is the epicenter from which all other lines intersect, cross over and move. In dance ensuring the fascial lines are balanced is also key. Our fascia and connections become stiffer, as this is a normal response to age and the protective barrier of our superficial and deep fascial lines.
Lumbo-Pelvic Hip Complex (LPHC) and Dysfunction:
In the publication “Corrective Strategies for Lumbo-Pelvic-Hip Impairments” by Canadian Sports NSCM introduces LPHC THE lumbo-pelvic-hip complex (LPHC) is a region of the body that has a massive inﬂuence on the structures above and below it. The LPHC has between 29 and 35 muscles that attach to the lumbar spine or pelvis. The LPHC is directly associated with both the lower extremities and upper extremities of the body. Because of this, dysfunction of both the lower extremities and upper extremities can lead to dysfunction of the LPHC and vice versa. In the LPHC region speciﬁ cally, the femur and the pelvis make up the iliofemoral joint and the pelvis and sacrum make up the sacroiliac joint. The lumbar spine and sacrum form the lumbosacral junction.
Collectively, these structures anchor many of the major myofascial tissues that have a functional impact on the arthrokinematics of the structures above and below them.
Above the LPHC are the thoracic and cervical spine, rib cage, scapula, humerus, and clavicle. These structures make up the thoracolumbar and cervicothoracic junctions of the spine, the scapulothoracic, glenohumeral, acromioclavicular (AC), and sternoclavicular (SC) joints
How LPHC dysfunction can relate to dancers?
Dancers with lumbopelvic/hip dysfunctions are incredibly challenging for sports injury professionals to diagnose and treat because there are so many working parts to observe.
Firstly, as movement coaches we no there is no such thing as “isolation,” Therefore; the lumbar spine, pelvis and hip should never be considered separately: a complex interplay exists between them, as we are integrated system. Subtle changes or inadequacies in one area will have a definite impact on the surrounding areas.
Secondly, after determining the “somatic pain” referral points, we then steer the client away from this focus. The key word here is “refer.’ The pain is merely where the energy is being blocked, but it is referred, not the point of origin. Focus less on identifying painful structures and more on the mechanical dysfunction, which requires a thorough understanding of the function and structure of the lumbopelvic hip complex. This applies to both the ‘normal’ function, as in, the client’s day to day movement AND the mechanically specific functions for dancers, which is considerably different in terms of range of movement and muscle control. We need to account for both of these ranges.
Under-active muscles vs. over-active muscles and how they interact with each other, plays a significant role in movement pattern execution and motor control efficiency. There are a number of muscles in the upper and lower extremities whose function may be related and have an effect on the LPHC, all of which help to restore and maintain normal range of motion, stability and strength, as well as eliminate any muscle inhibition. Each dancer will exhibit his or her own specific mechanics in relation to what muscles/systems are over and under active.
How to prevent and or treat LPHC Dysfunction and somatic pain in dancers:
The key is a balance of mobility (functional mobility for your sport) and stability and strength, so that the joints and connective tissue can properly respond and react when loading and unloading the skeletal structure. Overall conclusions can be observed as such:
(1) Somatic and neuromuscular training can be effective in improving alignment and retaining improvements. This includes strength and stability exercises patterned to the movement control.
(2) There is day-today alignment variability that needs to be taken into consideration
(3) Pelvic positioning and spinal alignment are key determinants and observing their relationship in execution of dance specific motor control and day to day motor control will allow the coach and client better understand the movement strategies needing to be applied ,
(4) Dancers use different strategies for differing conditions. Understanding the clients motivators and learning style are key to success
- NSCM “Corrective Strategies for Lumbo-Pelvic-Hip Impairments – http://www.nasm.org/uploadedFiles/1/CES_II/NASM_CES_LPHC.pdf
- “Biomechanical Research in Dance: A Literature Review”, by Donna Krasnow et al – http://www.citraining.com/Biomechanical-Research-in-Dance.html
- The National Ballet of Canada- http://national.ballet.ca/thecompany/about/