Dancers require unique strength and flexibility, which other performers and athletes do not.¬† Because of this, they are prone to injury if not physically prepared for training and performances. One way to reduce incidence of dance injury is to ensure that the dancer is physically and psychologically prepared for pointe work. The exciting part is that there are ways to test whether your dancer is ready to put on those pointe shoes!
In order to be prepared for pointe, she should be over the age of 12 and have several years of dance experience.¬† Now is when your physical therapist comes in!¬† You need adequate strength in your feet, as well as flexibility into plantar flexion (pointing your feet).¬† Additionally, there are dancer specific tests that your PT can assess including the Topple, Saute, and Airplane tests.¬† For the Topple test, the dancer will perform a single pirouette with good control during the turn as well as the landing.¬† The Saute test is comprised of a single leg jump performed 16 times consecutively.¬† The dancer must have good control and form with 8/16 of these jumps.¬† Lastly, the Airplane test is completing 5 single leg squats while your trunk and back leg are parallel to the floor.¬† Your therapist will assess the alignment of your lower extremity as you perform this movement.
So before you put on your pointe shoes, see your physical therapist to assess whether you are ready for this advanced form of dance. The last thing you want to do is begin training en pointe without the adequate strength, neuromuscular control, and flexibility that pointe requires ‚Äď this can land you off your feet and with an injury!
Every New Year starts with well-intentioned resolutions to change behaviors and achieve personal goals.¬† However, it is estimated that only 8% of people actually follow-through with their New Year‚Äôs resolutions.¬† Setting and achieving goals, whether part of a New Year‚Äôs resolution or not, is a skill which can be learned with practice and a little resilience.¬† In order to have any realistic chance of achieving any personal goal, you have to clearly identify what it is that you want, make a plan to achieve it and then work on that plan every single day.
Begin with a Written List
First, imagine that you have all the time, money, skills, education, and experi¬≠ence that you need to accomplish any goal you can set for yourself.¬† Dream big!¬† Write down whatever goals come to mind in 30 seconds.¬† Your goals must be in writing. They must be clear, specific, detailed, measurable, and written in the past tense as if they have already been achieved.¬† Only 3% of adults have written goals and we call these people ‚Äúsuccessful‚ÄĚ.¬† Those who do not put their list in writing do not have goals, they have wishes.¬† The simple act of writing down your goals cements them in your subconscious mind.¬† Without conscious awareness, you then begin taking small incremental steps towards achieving your goals.¬† Next, review your list and identify the one goal which if achieved would have the biggest impact on all your other goals.¬† This one goal is where you start.
The strategy of putting your goals to paper is a must do within any context including those related to health and fitness goals.¬† For example, I have a goal related to improving my back squat performance.¬†¬† My goal is as follows, ‚ÄúI have improved my 1-repetition maximum back squat to twice my bodyweight by the end of 2018.‚ÄĚ¬† This goal is written on paper and visible on my mobile phone every time I access it. ¬†¬†The goal is clearly visible in my mind and not a day goes by where I will not be reminded of it.¬† Life‚Äôs challenges can never derail me from working on this goal.¬† What is your most important health or fitness goal for the New Year?¬† Write it down.
Develop Your Plan
Planning starts with writing down a list of every single step that you can think of that you will have to follow to ultimately achieve your goal.¬† When you write out a list of all the things you will need to do to achieve your goal, you begin to see that your goal is far more attainable than you originally thought.¬† Next, organize your list by arranging the steps that you have identified by priority.¬† Identify the most important steps and begin working on them first.¬† The 80/20 Rule says that 80% of your results will come from 20% of your activities.¬† What are your 20% of activities which will make the biggest impact on achieving your goal?
Returning to my goal of improving the back squat, there are endless steps I could pursue to achieve this goal.¬† However, through several hours of deliberation and re-writing of my goals and priorities, I have arrived at the 3 biggest activities which will lead to goal achievement.¬† I will prioritize squat technique practice, gluteus maximus strength, and thoracic spine mobility.¬† Now, I have a clear goal, list of steps needed to achieve my goal, and clear priorities to focus on.¬† What is your plan to achieve your biggest goal for the New Year?
Work on Your Plan Every Day
Your plan to achieving your goal and working on your priorities needs to be broken down into actionable steps.¬† ¬†Start by planning each day, week, and month in advance. ¬†Plan each month at the beginning of the month. ¬†Plan each week the weekend before.¬† And most importantly, plan each day the evening before.¬† Write down these actionable steps and then tackle the most important ones at the start of each day.¬† Don‚Äôt put off the most important steps to the end of the day, week, or month.¬† Procrastination only leads to frustration anda sense of¬† loss of control over your goal.
Every morning I ask myself, ‚ÄúIf I could only do one thing all day long, which one activity would contribute the most value to my goals?‚ÄĚ¬† Returning to the squat, this might include performing a series of thoracic mobility exercise first thing in the morning before the rest of the world is coming at me full speed. ¬†Your ability to select your most important task and then to work on it with purpose, without distraction, at the start of your day will build momentum towards achieving your ultimate goal.¬† What is the most important action you can take at the start of your day to get you closer towards your goal?
Final Thoughts on Goals
Decide exactly what you want, write it down, make a plan, and work on it every single day.¬† If you commit to these strategies and develop positive habits, you will accomplish more in the next few weeks than many people accomplish in a year.¬† Join the 8% of people who actually turn dreams into goals and goals into reality.¬† Get started today and don’t look back.
Old habits die hard.¬†¬† New habits are even more difficult to start.¬† When it comes to rehabilitating from an injury, long-term success often depends on developing new positive habits which promote a healthy and active lifestyle.¬†¬† After completing a course of physical therapy or following the achievement of any fitness goal, it is easy to relax and resort back to old habits.¬† These old habits could be spending too much time relaxing in front of the television or losing track of several hours while parked in front of a computer.¬† In order to maintain or maximize positive change from an exercise program, new habits must take the place of the old habits.¬† Out with the old and in with the new.
Intentional behavior change can be broken down into five stages.¬† Research has found that people move through these stages when modifying or changing behavior. The time a person stays in each stage is variable, but the steps required to move through the process is not.¬† These five stages are very applicable to optimizing outcomes in physical therapy.
Stage 1: Precontemplation
The first stage is typically characterized by a resistance to change.¬† During precontemplation individuals do not consider change as an option or they do not see the benefit in changing.¬† Many who begin their rehabilitation are unsure about how exercise and behavior change can help their condition.¬† Perhaps, they are confused about why the doctor has not ordered an MRI?¬† At this point, it is imperative that the physical therapist does not attempt to coerce or force the patient into change.¬† Only through open communication, trust, and a positive working relationship can an individual progress beyond this stage.
Stage 2: Contemplation
During the second stage, the individual begins to see that a change may be beneficial but is unsure how to proceed.¬† Here a patient may begin weighing the pros and cons of following through with their initial home exercise program.¬† It is common for individuals to remain stuck in this stage throughout their rehabilitation.¬† Chronic contemplation or procrastination often leads to unsuccessful courses of treatment or frequent relapses of symptoms.¬† It is imperative that any patient moves beyond this stage before completing their course of care with their physical therapist.
Stage 3: Preparation
¬†Now the individual is ready to take the initial steps towards change.¬† This stage is characterized by the intention to change and taking steps towards change.¬† Developing a plan for change with your physical therapist is very important at this point.¬† Without purpose, goals, and a plan change will never be long-lasting.
Stage 4: Action
This stage is characterized by concrete steps that will lead to the desired change.¬† This may involve beginning a daily walking program or strength training in the gym three days per week.¬† This is where the foundation for lifelong positive healthy habits is built.¬† We like to see individuals progress into this stage before their final few visits in physical therapy.
Stage 5: Maintenance
Maintenance may be the most important stage because it involves effort to maintain the changes made during the action stage.¬† Success will require individuals to make modifications in their lifestyles and work to prevent relapses.¬† While in the maintenance stage, people are less tempted to relapse and grow increasingly more confident that they can continue their changes.¬† This is where positive habits are solidified.¬† Unfortunately, many do not remain in this stage long enough and ultimately resort to old habits leading to relapse.¬† We see this when dieters achieve a weight loss goal only to regain it back, plus more, within 2 years.¬† In rehabilitation, we often see individuals return for the same problem year after year because they were unable to follow-through with this final stage of intentional change.
Some argue that it is human nature to resist change.¬† I disagree.¬† Some of us choose to remain comfortable with routines based on non-productive habits.¬† We will ultimately become what we think about most of the time.¬† If we can‚Äôt wait to leave work and relax on the couch, then this is what we will become.¬† If we are serious about our long-term health and life goals, we will take that 30-minute walk instead.¬† Any human being with purpose, goals, and a plan to change can accomplish great things.
One or two months of physical therapy are only the start towards behavior change.¬† Take what you have learned from your physical therapist and consider this one small step towards building healthy habits which will benefit you for a lifetime. ¬†¬†Long-lasting intentional change is hard but we all know waiting around for things to change never gets us closer to our goals.
Resilience is the ability to recover from or adjust to misfortune or change.¬†¬† Successful recovery from injury requires resilience to overcome physical and psychological challenges.¬† There will always be times during rehabilitation when things seem to never go as planned.¬† This could be a set back where pain or swelling increases temporarily for unexplained reasons.¬† During these situations, it can be easy to look for excuses or a quick fix solution.¬† However, the true solution often lies within us in the form of resiliency.
Physical therapists, trainers, or coaches can assist by instilling a sense of resiliency within their patients or clients.¬† This begins by developing trust and truly understanding what the end goal is.¬† Understanding the desired outcome and feeling prepared for when adversity strikes is a crucial step towards building resilience.¬† Attempting to motivate or push individuals is rarely successful under conditions of adversity.¬† Parents who continuously push their child in sports often undermine resilience and contribute to burnout.¬† The same often occurs during rehabilitation when healthcare providers fail to collaborate and problem solve with their patients.
Resilience and Mindset
Patients and athletes recovering from an injury often expect the worst.¬† This mindset is extremely detrimental to recovery.¬† In order to handle adversity and the challenges of rehabilitation, it is important to put in good old-fashioned hard work. ¬†This work must be purposeful, intense, and practiced repeatedly in order to build resilience.¬† Those who commit to putting in the work build resilience and begin to expect success. ¬†Those who fail to put in the work often expect the next set back and feel helpless about it.¬† Ultimately, we become what we continuously think about.¬† Expecting a set back with a sense of helplessness will nearly always lead to failure.
Putting in the Work & Mental Toughness
Following through with a rehabilitation program at 100% is an example of putting in the work.¬† This contributes to developing resilience through physical means such as building a foundation of strength and optimizing movement patterns.¬† Putting in the work also develops resilience through mental toughness.¬† When injury or adversity ensues, some look for passive solutions while others dig deep into their mental toughness and work to make things right.¬†¬† These are life skills and personal traits which go beyond rehabilitation or sport.
Successful recovery from injury requires resilience.¬† Resilience requires purpose, goals, hard work, repetition, and mental toughness.¬† Developing a trusting and collaborative relationship with your physical therapist will better prepare you for when adversity strikes.¬†¬† When adversity does appear, the solution is often found within. ¬†¬†The resilient individual will adapt and overcome. ¬†When things are not going well during rehabilitation, take back control and get yourself back on track.
The traditional medically oriented examination occurs with a patient on a treatment table focusing on the isolated area of pain.¬†Even worse, a static image such as an MRI may be taken to determine the ‚Äúcause of the problem‚ÄĚ.¬†These types of examination procedures provide only limited information for any professional seeking to develop a treatment plan.¬†The human body does not function on an examination table or in an MRI tube.¬†Movement occurs from a complex interaction of the nervous system with our muscles and joints.
In order to determine an accurate diagnosis and arrive at the best treatment plan, whole patterns of movement should be the focus.¬†A baseball player experiencing pain during the late cocking phase of throwing should be examined throwing a ball in this position.¬†A football player experiencing pain or giving way in the ankle should be examined in the same functional position which recreates his symptoms.¬†This sure seems like common sense, but it is not always common practice.
The Area of Pain is Often Not the Cause
Many times, problems in the hip can lead to pain in the back.¬†Problems in the upper back can lead to pain in the shoulder. And, problems in the ankle can contribute to pain in the knee.¬†I could go on and on with examples of what is typical in an outpatient physical therapy clinic.¬†In order to uncover the cause of pain or poor movement, whole movement patterns must be assessed and treated.¬† For individuals with pain in the front of their knee, isolated treatments to the knee rarely provide substantial relief.¬†Assessing movement patterns such as an overhead squat, step down, or running is often the key to determining the corrective course of action.
Movements, Not Parts
Assessing and treating movement patterns, not isolated body parts, is the key to a speedy and long-lasting recovery.¬†It is very common for limited mobility in the upper back and hips to lead to abnormal motion in the low back.¬†Movement compensations in the low back then manifest as ‚Äúdisc problems‚ÄĚ under an MRI.¬†Treating the ‚Äúdisc‚ÄĚ is rarely successful in alleviating these types of problems.
Pain Changes Movement
Sustaining a previous injury increases the risk for future injury. Spraining an ankle in middle school can contribute to knee pain in high school.¬†This is because pain or injury changes the way we move.¬†Individuals with previous history of ankle sprains have been shown to demonstrate delayed activation of their glute muscles and difficulty balancing on one leg several years later. If these compensations are not identified and corrected, movement patterns are changed and injury risk increases.
The human body will follow the path of least resistance in order to perform a task.¬† The nervous system will choose to perform the most efficient pattern of movement from an energy standpoint. The body will attempt to conserve energy during movement in case it needs it later during a crisis.¬†However, the most efficient pattern of movement is often not the optimal pattern of movement.
Using the same example of an individual with a previous ankle sprain, we often see asymmetrical weight shifting during exercises such as a squat or deadlift.¬†The asymmetrical weight shift will allow the body to lift the weight at that moment in time.¬† However, with continued compensation of movement, asymmetrical training stresses will be applied leading to suboptimal performance and the potential for further injury.
Muscles Do Not Have Memory
Pain alters the way our nervous system organizes patterns of movement. Muscles do not have memory.¬†The brain stores patterns of movement and then signals muscles to execute what is believed to be the most efficient pattern.¬†With repeated performance of compensatory movement patterns, the abnormal becomes the new normal.¬†The asymmetrical squat is now programmed in the central nervous system and remains long after any injury has healed.¬†The nervous system is very complex and we do not completely understand how this works.¬†However, we do know these patterns can be reprogrammed and corrected with appropriate movement training by skilled professionals.
Optimal Movement is Individual
There is no single best way for all individuals to move.¬† We are all structurally built differently.¬†One person‚Äôs hip socket may be oriented facing slightly downward.¬†Another person‚Äôs hip socket me be more outward facing.¬†These structural differences will change positioning of the body during movements such as a squat or lunge.¬†Attempting to teach all individuals to move in exactly the same fashion is unreasonable and has the potential to increase risk for injury.¬†All movements, exercises, and exercise programs should be individualized based on the findings from a detailed assessment by a skilled professional.
We should be looking past the isolated area of pain and uncover the true cause of the problem by assessing whole functional movement patterns.¬†This type of assessment identifies subtle problems with movement which we may be unaware of.¬†Once you are made aware of these compensations, you can start to address them.¬†Correcting the problem will take conscious effort and require coaching from a skilled professional.¬† Once you are able to perform the movement correctly and automatically, it is time to increase the load and strengthen the movement pattern.