Physical therapy

A few weeks ago a friend from class and I went to see ABT perform Giselle. At dinner before the performance I was whining about how the pain in my heel didn't seem to be getting better. My friend commented that she'd started seeing a physical therapist. Her PT was a former dancer, had really helped her dancing in ways she hadn't expected. I asked for contact info for her PT, which she happily provided.

As I was researching her PT, it occurred to me that in 2020 I'd started working with a PT who was associated with The Washington School of Ballet, and thus very familiar with ballet dancers and their injuries. I'm friends with some other dancers who'd worked extensively with him, and my first couple of sessions with him were good, but then the world shut down due to the pandemic. Patrick's office is much more convenient for me, so I booked an appointment with him.

My first session with Patrick was yesterday afternoon. I attended class a few hours earlier, and I tried to take note of what caused my heel pain to flare. Barre was mostly okay, though there were some tiny twinges when I raised to demi-pointe with my weight on that foot. The adagio in centre caused some more twinges, and when we got to the jump preparations I called it quits.

At the start of the appointment I recited my relevant history, including a pain in my left instep that developed in March for which I had X-ray and MRI imaging, but resolved itself with no specific treatment. We then did a couple range of motion tests, which showed that my back and hips have gotten a little more flexible over the last three years — how many 60-some year olds can say that?

Then he got down to examining my leg and foot: manipulating the joints in my foot and feeling the muscles in my lower leg for tightness. Some of this was briefly unpleasant but never actually painful. The verdict? He doesn't believe that I have an actual injury, which has been one of my serious concerns. Rather, he thinks that the tightness in my lower leg and lack of flexibility in my forefoot is causing my foot to supinate (roll outward). To compensate for this the peroneal muscles tighten, which explains the pain where the peroneal tendon turns around the heel.

So how do I fix this? Firstly, I need to work on the flexibility in my foot and tension in my leg muscles. For example, during the initial exam the extension of my left big toe was very limited. Even at the end of the session, after he'd worked my foot and leg, he could only achieve about 70° extension. This well short of the 85° extension he said is needed for a good demi-pointe position. Lack of flexibility is a problem not just in my big toe but throughout both feet, though it's worse in my left than my right for some reason. In fact, the reason I sought out physical therapy in 2020 was my limited foot flexibility.

Secondly, he feels certain muscles in my lower leg are not strong enough to handle the stresses imposed on them. He specifically mentioned tibialis anterior and tibialis posterior, relatively small muscles next to the big bone in the lower leg.

To begin addressing these issues he suggested lightly working the muscles in my legs with a massage gun. I'd started using one recently, but he gave me specific areas he wants me to work. He also gave me an exercise which involves placing a ball between my ankles and rising to demi-pointe on both feet while squeezing the ball. 

While demonstrating this last exercise he noted that I'm moving my hips forward to balance rather than my upper body. This results in a slight arch in my back. I'm speculating that this may help explain why I find myself falling backward out of turns. Maybe I'll improve my turns at the same time I fix the pain in my feet? That'd be a real bonus.

One of my questions going in was whether I should continue taking classes. I'd taken two weeks off after the initial event last month, and when I went back the pain seemed worse. Patrick indicated that I could continue but should let my body be my guide, not pushing when the pain said I should stop. I've already dropped back from four classes a week to three, which avoids having classes on consecutive days. I think I'll continue this pattern and see how things progress.

I have my next appointment in two weeks.