As The Spine Rotates
Over the last few weeks I have begun working with dancers virtually, allowing for more time to assess and address the aches and pains that are usually spot treated until the off season when we have more time. It has become apparent how important spinal mobility is and how often dancers are able to find alternative pathways to create mobility, especially rotational mobility.
ON this week's episode of the dance docs Dr. Davenport and I will take a deep dive into the anatomy and mechanics of spinal rotation, common movement faults that we tend to see in dancers, and how to work to create a beautiful spiral through the spine.
Did you know that 80-90% of population has spine related problems?
Anatomy review
Spine is made up of disc spine and joints
Spinal curves alternate between more motion and less motion
Lordotic (forwards)- Cervical and Lumbar
More unstable, more motion
Kyphotic (backwards)- Thoracic and Sacrum
More stable, less motion
Bones and Disc
If you touch your back you feel the spinous process of the vertebra which is the very tip of the bone
Most of the vertebra live more anterior (in front) in the body of the vertebra. Closer to the center of gravity
Spine alternates between a bone and a disc
Bones are names by location in the spine:
Cervical C1-7
Thoracic T1-12
Lumbar- L1-5
Sacrum- 5 fused joints
Disc are named relative to the bones that it sits between
L4/5 disc
C5/6 disc
Joints are the main stabilizers or motion segments of the spine
Official name is zygoapophyseal joints (Z Joints)
Most clinicians call them the facet joints
Helps us to determine where too much or too little motion is occurring
Biomechanics of the facet joints
Cervical facets are on ~45° angle and lie in the frontal plane
Rotation Right in cervical Spine
Downglide on the R upglide on the L
Side bending and rotation are the same in the cervical spine
Thoracic facets are on ~60° angle and lie in the frontal plane
Side bending Right in the thoracic spine
Upglide on the left downglide on the right
Side bending produces relative rotation to the opposite side due the the crowding of the ribs
Rotation right in the thoracic spine
Gapping on the R and compression on the left
Slight side bending to the left produces gapping on the right
Your body produces these coupled motions in the thoracic spine to help maintain your shoulder and head level
If there was no slight side bending or rotation opposite the ribs would over crowd and your shoulder would dip down
Upper thoracic segments will follow movement closer to mid cervical spine
Lower thoracic segments will follow movements closer to the lumbar spine
Lumbar facets are at 90° and lie in the sagittal plane
Due to this orientation you have very little rotation that occurs in the lumbar spine
Lumbar side bending Right
Downglide on the right upglide on the left
Lumbar rotation (very little)
Gapping on the right compression on the left
Fascia
Like a sweater that covers your entire body
It’s one continuous structure that connects you from head to toe
It helps to attach, stabilize, enclose and separates muscles and internal organs
Fascia restrictions around the hip flexors can cause decreased ROM within the thoracic spine.
R hip flexor tightness increased tension in the fascia of this area can lead to decreased rotation to the L
Hold onto your T-shirt down by your right pocket and notice how you have increased pulling across the front as you try and rotate to your left.
This is similar to how a fascia restriction may limit your ROM
Muscles
Right over the facet joints lie your primary stabilizing musculature
Multifidi, rotatores
Tension of these muscles can also cause decreased ROM
Many times it is hard to tell whether the joint caused the initial pain and then muscle tension or was it a weakness or strain in the muscles that caused the joint to become overworked and irritated
Many time treatment will focus on all components and not just the bone or muscle
Body as a Road Map
When you are young you are constantly moving allowing the body to maintain balanced flexibility and stability. This allows your movement patterns to run on the main highways of your body
Pathways that are designed to take stress, meant for high traffic, are a little more durrable
As you get older and motion may become limited somewhere, so your body’s GPS routes you onto a backroad, thinking the the main highway is congested
Backroads are not as efficient in getting you from point A to point B as the main highway and are not designed for a lot of travel
Your body will continue to run on the side roads causing increased wear and tear until that road becomes warn out (this is where you see pain)
If you ask your body to do a movement (fouetté, ballroom standard frame) your body will do everything it can to complete it
As a dancer you have a very detailed map and your body can find those back roads even quicker to complete complex motions
Think of your Therapist or Doctor as a master navigator who really understands how to read the map and help you get from point A to point B in the most efficient way. It is their goal to make sure that the main highways are clear and remind the GPS system to no longer send you on the backroads.
How does poor mobility affect certain dance populations
Ballroom
Standard ballroom frame for women requires increased thoracic extension as the cervical and lumbar curves are maintained more neutral
If thoracic spine is stiff it can cause increase pain in lumbar and cervical spines
Modern or contemporary dancers
Tend to have fewer rotational issues due to the training
Class usually involves upper, middle lower curves of the spine
Increased work through spine as you move up and down off the floor
Constantly working through all three planes of motion
Helps to maintain dynamic stability and mobility of the spine
Ballet
Technique is very upright and held
can lead to an overall decrease in thoracic mobility
Most ballet technique does not have you moving segmentally through the spine.
Most segmental movement in ballet happens in the frontal plane,
Some segmental mobility in sagittal and transverse planes.
Due to lack of rotational mobility Dr. Kat finds that ballet dancers will extend through the thoracic spine as a compensation pattern until they find a segment that rotates well (usually around the T/L junction or upper lumbar region).
Assessing a dancer with back pain
Direction of preference-
Buttock pain (highway of pain)- could be spine, SIJ, or hip
True low back pain patients will have a direction of preference
Sitting vs standing
Forward bending vs backward bending
The direction of preference will help us to
identify the structure that is the main pain generator and how to decrease pain
Help identify muscles that need to be strengthened to allow for of loading the irritated structure and how to best support and dynamic stabilize
How to identify affected spinal level by pain location
Location of pain can be frustrating because it is referred pain
Pain in the buttocks can be coming from the spine
Knee pain can come from irritated nerve in the back
Sometimes pain directly in the low back can be caused by problems higher up in the spine
A therapist may work on improving mobility above and below the painful area to decrease the stress on the painful segment
Bilateral lower extremity pain is a flag to look at the back and core stability along with the painful structures
What Does an Assessment with Dr. Davenport MD Look Like?
Patient History
Want to find what direction preference
Specific time of day or activities
Test and Measure
Spine motion in different planes of motion and in different positions
Forward bending/ backward bending
Sidebending
Rotation
Want to reproduce the pain
Helps the doctor to understand where the body wants to be and what structures are involved
Do their best no to torture their patients but want to find a in depth understaning
Once MD has made diagnosis usually sends to PT for further workup
What does and Assessment with Dr. Kat PT Look Like
Over the years I have begin to look more at functional movements and limitations rather than just the cardinal planes of motion
One of the first things that I do is ask the dancer to show me the motion is most limited, or technique area that is bothering them the most (video this component)
Many times the rotation component is not the most painful- it's usually a side bending, forward or backward bending
Functional assessment of motion may include
Standing rotation
Hips facing forward
Allowing hips to rotate to see down the chain into hip knee and foot
Seated rotation
Take the lower body out of the equation
Someone who might have the R hip flexor causing decreased rotation L can now rotate further to the L because you have taken the restriction out of play
Squats
Stiffness and asymmetry
Flexibility or stiffness of the whole human body
Thoracic stiffness- patient will have difficuty keeping chest up or raising arms overhaed
May show deviation to one side or the other based on hip mobility
May also see and area of rotation in the spine
Half kneeling/squat with trunk rotation
Does that patient have equal rotation to both sides
Is one hip flexor tighter than the other
Can they balance in this position or are they falling over
Core activation
Supine marching
single leg lower
I always watch for:
rib cage placement/movement as the leg extends away from center (loss of core control)
Innominate rotation as the leg extends away from the center (too much tension in the LE/hip flexors)
*Side note- Not included in podcast
After looking at functional movement I also:
Palpate for spinal position/ alignment
Complete passive intervertebral motion (PIVM)
Asses soft tissue tone
Assess for fascial restrictions
Side to Side Comparison and Symmetry
Equal mobility to both side helps create equal distribition of forces through the spine
Able to more more freely because muscles on one side are not too tight or too lax
Creates efficiency of movement
Helps to avoid wearing out one specific segment or over fatiguing a certain muscle
How do Your Assessments Turn Into Treatments
Lets your testing measures become your exercises for the dancer
Half kneel
Break it down
Improve hip extension of back leg
Improve rotation of L/S (can they keep their hips square)
If the pelvis is more symmetrical does this improve their balance
Do all the above corrections improve the dynamic stability and allow for improved rotation
Core exercises ← Always
I find that I am doing more initial exercises to improve the alignment of the thoracic spine
Theraband attached behind dancer add press down of arms to increase core activation and thoracic alignment and allow for improved diaphragm excursion
Supine marching, femur arcs, single leg extension
Get creative how can you engage the core and produce the desired movement pattern you are looking for
Focus initial exercises to be in neutral spine position
Progress from
single side (marching, femur arcs)
Cross Body (dead bugs, bird dogs)
Stabilizing the spine
Focus initially on strengthening exercises in the frontal and sagittal planes of motion
Remember your mechanics- rotation is often a coupled motion (side bending and gapping/compressing)
Find control in more stable planes of motion and then add in rotation
Dynamic Stability and Static mobility
Due to dancers being more flexible it is important to create dynamic stability from the muscles first before improving the passive mobility
Need the joints to be supported before you make them mobile or else they just move back into the faulty position
Will find backroads due to instability instead of retraining back onto the main highways
Global vs Local stabilizers
Muscles that control rotation are smaller- multifidi, rotatores they are smaller muscles and need time to build up endurance to support rotation
These muscles along with transverse abdominis turn off when there is onset of low back pain
Larger muscles often create compression of the facet joints rather than dynamic mobility
Larger muscles for rotation like obliques, paraspinals, lats, have multiple functions so I train those to release and stabilize more dynamically first and then move into deeper stabilizers and adding rotation components
Forward lunge with rotation (strength and ROM)
Runners lunge with rotation (core and stretch)
Single arm rows with rotation (strength)
Mermaid with rotation (stretch and breath)
Muscles are relative lazy (especially small stabilizers)
Dancers are so strong that many times they will live in faulty movement patterns for years before they cause problems
Takes a lot of conscious effort to get off the back roads and retrain the GPS to get back on the main highway
Things to look for when retraining movement
If you can put your hands on the segments that are not activating correctly
Try not to give your patient an exercise and walk away- they need to re-map
Right now work on your verbal cues to re-train and correct movement
Right now may be a great time to work on re-training movement patterns
Which muscles should you be activating for a certain movement
Less visual feedback more internal feedback
How the brain learns
20% listening <— External
30% observing <—External
50% watching and listening ← external
80% by doing ← internal
95% by teaching (can your patients explain the correct movement pattern to you?) ← internal
Find the muscles that should be working rather than creating a picture
Breath is very important-
Normal breathing helps to keep you in a parasympathetic state and allows for improving remapping of poor movement patterns, and maintain midline control
Don't forget that diaphragm is part of the core
Diaphragm can be strengthened
Focus on alignment of rib cage
Try to avoid thoracic extension when doing breathing exercising
Can bend knees to help maintain neutral spine position
Honor your Breath!!
Keep moving, keep rotating and we look forward to hearing from you!
In Health,
The Dance Docs