Ask The Dance Docs Episode 1: Tips for injury prevention, heels to pointe shoes, and best supplements for inflammation

Thank you for tuning in to the initial episode of Ask the Dance Docs, we are excited that you are joining us today.  On today’s episode Dr. Kathleen Davenport MD and myself sit down to discuss our top tips for injury prevention, how to transition from heels to pointe shoes, and what are some supplements to help subdue inflammation.

What is your number one tip for injury prevention?

• Strength and conditioning 

  • Proper full body warm-up optimizing all major muscle groups prior to starting class (at least 15 minutes)

    • Core, lateral hips, feet, hip extensors, multifidi, calves, shoulders

    • Want to increase overall heart rate and break small sweat 

    • Can do this through having planned workout and keeping the body moving or you can add small bursts of cardio into program

  • Warm-up, cool down, and cross training should be based on the kind of rep that you are performing to avoid imbalances and weakness optimize all muscle groups

• Research has shown that a prior injury is the leading cause of a second injury.

  • Making sure that you have rehabbed appropriately from a prior injury will help correct imbalances that can lead to more serious injuries

• Stretching Static vs Dynamic

  • Save Static stretching for the end of the day

  • Stretching for creating change in muscle length

    • Recommended for 30 seconds to 1 minute.  You want to create a habituation of the muscle spindle and activation of the GTO to allow for greater lengthening of the muscle fibers.

    • Recommended at the end of the day

  • Add Dynamic stretching into your morning/before class routine

    • Dynamic stretching includes, walking lunges, eccentric calf raises, hip swings, flat backs, sun salutations

• Get enough sleep- body needs time to recover 

  • 7-9 hours is recommended for the regular population

  • 9-10 hours for athletes and those recovering from injury

  • Good sleep and decreasing stress are important aspects for injury prevention and recovery

    • Stopping doing is equally important, stopping, resting, sleeping and recovering is just as important in terms of injury prevention

Heels to pointe shoes, how do I prepare my feet?

• Transition gradually

  • Do not assume that hours of dancing en pointe are going to prepare you for dancing in heels

  • If you have not danced in heels in recent months (or years!) then start wearing your heels around the house to get your feet used to them.

• Lateral Ankle ligaments, especially the ATFL, have increased stress when in heels; this can lead to minor sprains so ankle strengthening is important.

  • Exercises for strengthening can include:

    • Thera-band around the feet, side stepping in ½ demi pointe (Dr. Kat’s favorite)

    • Foot intrinsic exercises like, toe drumming, towel scrunches, short foot, big toe exercises with rubber band.

• If you are switching from heels to pointe shoes in the same show you are going to want to actively stretch your calves after being in heels and wake up your toe flexors.

  • Downward Dogs (posterior chain stretch) releves, treading

  • Foot intrinsic exercises (listed above)

  • Quick rolling on a foot roller, small spikey ball, or vibrating massage ball (quick rolling helps to increase proprioception in the foot)

• You may need to modify your shoes.

  • Add padding, toe spaces, heel grips, and toe box fillers to make sure your shoes fit. 

• Don’t forget the street shoes

  • IF you’re doing repertory that requires change into different shoes (flat, pointe, character) you may make it through that program with fewer issues if you wear supportive comfortable shoes when out of the studio

  • Make sure you give your feel and ankles a rest period if you’re working them in new and/or challenging ways.

• Listen to your feet and ankle

  • If your feet begin to cramp more than normal, or earlier in the day, or with specific skills like jumps this may be an early sign of an injury or pre-injury.

  • Anytime there are changes to a dancer routine, footwear, or style of dance there is a risk that the body may respond with an injury.

  • If you are having early warning signs and they are not subsiding, see someone right away as a small cramp can resolve quickly, but could also turn into a stress fracture or other injury if ignored.

What are the best supplements to subdue inflammation?

Curcumin

• Curcumin is the main active ingredient in turmeric. 

• It has powerful anti-inflammatory effects and is a strong antioxidant.

• Counteracts the two leading causes on muscle damage: both oxidative stress as well as inflammation. 

• I recommend this to dancer when they are in busy rehearsal weeks and long theater weekends, periods of time when their recovery may not be optimized, their food choices may be different than normal, their sleep routine or location may have changed or the dancers is coming back from an injury and no longer wants to take some of the stronger prescription strength anti-inflammatories

• When we look at timing of taking curcumin there is no clear consensus on when is the most beneficial timing for taking this supplement.  You need to find the timing that works best for you.

Omega-3’s

• These are a family of essential fatty acids that pay an important role not just in decreasing inflammation but also have a number of other health benefits such as:

  • Help to dilate blood vessels and airways leading to improved blood flow and oxygen exchange helping you during those hard efforts.

  • Decrease inflammation and pain- assists with recovery 

  • Supporting the immune system

• Omega-3s are not produced in the body and so you need to get this from eating foods that contain omega-3’s or from supplementing.

• There are three main components to look for when incorporating omega-3’s into your diet

  • ALA (plant sources)

    • Chia seeds, hemp, flax, and walnuts

  • EPA + DHA

    • widely recognized as the most beneficial

    • wild caught cold water fish and algae

• The human body does not convert ALA to EPA and DHA very well, so focus on direct dietary sources or a EPA/DHA supplement

 Tart Cherry Juice

• Much like Curcumin Tart Cherry Juice helps to decrease inflammation and oxidative stress.

• Tart Cherry Juice has been shown to lessen pain and accelerate strength recovery after exercise and decreases blood markers of inflammation/oxidative stress.

• Benefits have been shown in both strength and endurance based exercise.

• I tend to recommend Tart Cherry juice to my athlete when they are in show weekends, or really hard rehearsal weeks when there is a smaller window on intense performance.  I have not seen strong results when using tart cherry juice to combat built up inflammation and fatigue.

• Tart Cherry juice has been show to help naturally boost melatonin, so I have recommended it as a sleep aide ~30 minutes before bed along with good sleep hygiene habits.

Magnesium (muscle fatigue)

• Magnesium essential electrolyte for and is needed for more than 300 biochemical reactions in the body.

• When looking at the role magnesium has on muscles it acts as a natural calcium blocker, helping your muscles to relax after contacting.  When magnesium levels are low, your muscles may contract too much and cause muscle cramps. 

• Natural sources of magnesium

  • legumes, nuts, seeds, bananas and green leafy vegetables. Smaller amounts are found in meat and fish.

• Can also get magnesium through Epsom salt baths, and magnesium lotions

• Magnesium may be low if you have:

  • Prolonged muscle soreness or your muscles are feeling really heavy

  • Increased muscle cramping at night

  • Tension without improvement or recovery

• Magnesium also helps to improve sleep through in ability to relax muscles

  • Another critical supplement to help speed up recovery

Vitamin D (muscle and bone health)

• Vitamin D is not just good for bone strength (but that, too!) as it can help many other areas of the body

• While not specifically anti-inflammatory, if your body is stronger then there is a possibility it will not respond to increased load in an inflammatory cascade and may recover faster

• It is difficult to overdose on Vitamin D, but it is possible. So make sure you’re not overdoing the supplements and check a level before going on high doses and recheck in 3-6 months

  • Optimal vitamin D level for an athlete is 50-100 ng/mL to optimize recovery

• Natural sources

  • Fish, egg yolks, mushrooms, fish, many products are now fortified with vitamin D

• When supplementing is D2 or D3 better

  • Recommend D3 due to the body’s ability to readily use this form

• The best vitamin D is from the sun (~15-20 minutes daily), but supplements can be taken as well

If you have questions regarding this episode or would like to submit questions visit our contact page at www.Thedancedocs.com or e-mail us directly at Thedancedocs@gmail.com

*Resources for this episode are available upon request