Preventing Dance Injury - Alisa Pravdo

Samantha StoutJanuary 14, 2023Ballroom Chat: Episode #65
alisa pravdo ballroom chat

In Episode 65 of Ballroom Chat, Alisa Pravdo discusses dance injury prevention and recovery. Samantha and Alisa delve into the common causes of feet and ankle related injuries for dancers and answer some listener questions related to their own injury experiences. Alisa also stresses the importantance of proper strength and conditioning training, cross training, and nutrition for dancers and non-dancers alike.

Alisa Pravdo is an assistant professor at the University of Maryland School of Medicine in Physical Therapy and Rehabilitation Science. She also is a Board Certified Orthopedics Specialist and a Fellow of Orthopedics in Manual Physical Therapy. Alisa also holds a Bachelor of Arts degree in Dance from Goucher College.

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Episode Transcript

[00:00:00] Samantha: Welcome back to another episode of Ballroom Chat, the podcast dedicated to sharing the dance journey. I'm your host Samantha with Love Live Dance. We are kicking things off with a little bit of injury prevention and recovery talk, uh, which is super, super important for all of my lovely dancers at whatever level you are currently dancing at. I had the amazing opportunity to talk with Alisa Pravdo. She is an assistant professor at the University of Maryland School of Medicine in Physical Therapy and Rehabilitation Science. She also is a board certified orthopedics specialist, and she is a Fellow of Orthopedics in Manual Physical Therapy.

She also, very importantly, has a Bachelor's of Arts degree in Dance from Goucher College. And she was a dancer for many, many years before becoming a physical therapist. So we talked today about what actually brought her into physical therapy from her history of dance, how she works with clients that are either dancers or in other athletic pursuits.

And we answer a bunch of your questions and talk about some of your experiences and get her opinion on what we can be doing better to prevent injuries from starting, protecting ourselves once injuries have happened, and how we can recover faster, um, once those injuries do occur. So a lot of great information from Alisa today.

I hope you enjoy our conversation. Well, thank you so much, Alisa for being a guest on today's podcast.

[00:01:41] Alisa: Thank you for having me.

[00:01:43] Samantha: So I mentioned in the introduction that we are super excited to chat with you today because of all of the injury prevention and sports medicine that you have in your background.

Um, but you are also a former dancer, which is super exciting. So

[00:01:58] Alisa: I was,

[00:01:58] Samantha: um, let's kind of kick things off by telling the audience a little bit about your dance background and how it led you into physical therapy and orthopedics.

[00:02:07] Alisa: Awesome. So I've danced my entire life. I think I was two and a half at my first dance recital. Um, and that was my major in college as well, along with psychology. So I went to Goucher College, um, and graduated with a Bachelor of Arts and Dance in 2008. Um, and that's really when. I was thinking about getting into physical therapy and working with dancers, and I reached out to do a clinical rotation or just some shadow hours with the physical therapist that was treating the dance department.

So that's when I got my feet wet with that. Um, my background, I came from one of those studios in the suburbs of Philadelphia that it's like a competition studio. So grew up doing ballet, modern, jazz, tap. Um, lyrical was always my favorite. I think I knew personally at a young age I probably wouldn't be a ballerina, um, just based on my anatomy and my natural turnout.

Um, however, I am ballet trained and I love it. I would say lyrical and modern was like my, my love and passion or my area to shine. Um, so then after college, after graduating Goucher in 2008, I went to PT school at University of Pittsburgh and got my D P T there. Um, and I graduated there in 2012. and I did get to do a little bit of an internship too with the Pittsburgh Ballet Theater.

So I got to work backstage with a Nutcracker and, and get my feet wet with working with dancers too, which is, I'm sure we'll get into that today. Definitely different than treating just the everyday orthopedic population, which I also love to do. So I guess for me, you know, it's funny, I think when people were talking about going to PT school, people think, do I wanna be a physician or do I wanna be a pt?

I never said that . I was like, do I wanna go to New York and try to make it as a dancer, maybe work as a waitress, maybe get a job , um, or do I wanna go to PT school? And I ultimately went with PT school, just, I think being someone who likes to have a plan and know my next steps, but it makes sense. I feel like my, my love and passion for the way that the body moves and for the way it works and for anatomy, um, brought me into the world of physical therapy.

Even going back when I was, um, at Goucher I did an internship at Shepherd Pratt. thinking I wanted to do dance psychology, so working more with dancer, um, with, it was really on a floor of women that had eating disorders and it was almost where you didn't want them to move a lot because you didn't want them to burn too many calories.

And even though I found that interesting, I learned that that wasn't what I wanted to do every day. I wanted to do more with movement. I wanted to be more active. So that's kind of what led me into PT

[00:04:51] Samantha: yeah.

[00:04:51] Alisa: As a long answer.

[00:04:52] Samantha: No, that's, that's awesome. That's, that's awesome.

Um, yeah, I, I think it's super interesting that you mentioned that you spent a little bit of your time in college kind of working behind the scenes with the Nutcracker and like getting that hands-on experience.

How much of your own personal dance experience has influenced the way that you approach your practice of physical therapy? Like, do you see the body in a different way than maybe your coworkers or the students that you're working with now with University of Maryland?

[00:05:25] Alisa: Yeah, I think, you know, that's just always where my basis will be, cuz that was my whole life. And I think as you, you guys know as dancers, like it's a way of living. It was my like what I did every night and weekend. It's the way you move. And looking at somebody walk and looking at somebody's turnout. It's something we try to teach our students all the time is watch your patient do the thing they're having trouble with.

We can have you lay down on a mat table and do clamshells all day, but I don't watch that person run. I don't watch that person leap. I don't watch them golf and look at their golf swing. Then I'm gonna miss where the breakdown is. And I think that's where people that come to PT for years and years and years and maybe we're not hitting that, that's what we're missing.

So we're trying to create PTs that will be better than that. Um, and that will really capture what's going on with somebody functionally and make changes in real time. So I think. I can tell when somebody walks in the room as a dancer, like I remember my mom saying that to my dance mom friends, like friends of, you know, the parents when we were growing up to, you can just watch them like, you know, that they're dancers by the way they hold themselves, the way they walk in.

And I think there's just a way that we move as dancers that stands out to me. So, yeah, I think there's something I'm looking for. And if I'm treating somebody who's not a dancer, which I do very regularly, most of the time, I might have to watch a video on their sport and watch what they do to kind of get myself up to what they need to do functionally in the way they move.

So I think there is, there's, people think, oh, you know, you can straighten somebody's leg a certain degree, that their hamstrings are flexible. But as a dancer, we need more than an average of 70 degrees of a straight leg race. Dancers wanna kick their legs up here, so that's not the normal for that person.

And I think as, as a dancer, having somebody treat you that knows that background is really helpful because they know what's important to that person and not just like what a normal is.

[00:07:23] Samantha: For sure, for sure. Well, and I, and I like the fact that you just said, you know, if you're working with someone that maybe is in a different sport that you're not as familiar with, you go and watch the footage and try and learn what it is that their sport requires or, or what their job requires so that you can attack, you know, what their needs are because it might be different than, you know, a 60 year old or a 70 year old or an 80 year old that is at a fall risk, which is where, you know, my mind tends to go first with physical therapy and then Oh, right. And also the sports medicine thing, that's like a huge component of the industry. .

[00:07:57] Alisa: Yeah. It's amazing how much falls into the PT umbrella, which is really the fun part of my job. Um, you know, I, I thought maybe all I wanted to do was work with dancers and go like right into, I would love to be a PT that works with a Broadway show.

Um, but I really do like seeing the mix of everybody and, and my clinic, I treat as probably as young as six year olds and up to people that are a hundred if, if they're here that long. And yeah, needs of everybody are so different. And I mean, one of the first things that we should be doing as PTs is asking you as a person, what are your goals of being here?

What do you wanna achieve? What's important to you? Because yeah, sometimes it's just being able to walk in the grocery store versus, Hey, I wanna do a two hour ballet or a ballroom competition. . Yeah. Um, so as you can see, my, you know, I, I know less about ballroom dancing specifically than ballet, modern, tap, jazz.

But I think there's a lot of things that, you know, I would ask the same questions. What are your shoe wear? What's your rehearsal schedule? What's required of you? So all that still falls into it.

[00:09:03] Samantha: For sure, for sure. Well, I'm kind of going along with your list of questions. Um, how much does the equipment that we use, right, the shoes, the clothing, the attire, um, affects the movement itself and both injury prevention and the likelihood of injury in the first place.

[00:09:26] Alisa: So there's definitely something to that. There is specificity of training. So, you know, a baseball player needs a ton. If you can see, my shoulder needs a ton of external rotation to have that power behind them and less internal rotation where their power is. So it's not a bad thing if that's what that athlete needs for their sport.

So same thing with dancers, you know, especially ballerinas, you wanna be in that turned out position so much that our hips get really, really externally rotated. Um, and maybe we lose some of that ability to internally rotate. Shoes. I mean shoes, whether I'm working with runners or dancers, I like that person, or they're cleats if they're a soccer player, I like them to bring in the shoe that's required of them because that's what you're using. I'm, I'm assuming you're probably in high heels most of the time when you're dancing.

[00:10:12] Samantha: I've got examples that will, that I'll pull out here momentarily to talk through because I've got a bunch of questions for you when it comes to what we're wearing and should we be wearing them. But yes,

[00:10:21] Alisa: so I think shoes are certainly gonna play a big role, especially when people are on point. But even modern dance and bare feet, um, and we'll talk about high heels and there's character shoes that I had to wear too, so I was in heels temporarily too. Um, so I think that will play a big role in a lot of things.

Um, injury for sure. Outfits less, but probably depends on if you're wearing a heavy thing or, um, a corset that would constrict your breathing . Um, so I think it depends on the costume. If I'm thinking of a really light costume that is spandexy and easy to move in, not so much, but heavier skirts or like heavier gowns that could play a role, especially if you're not used to dancing in that.

Like how often do you practice in that? Is it just like a week of dress rehearsals or is this something you were practicing in from completing up to your performance? So we can, I'm sure we'll get more detailed into that.

[00:11:18] Samantha: Yeah. Yeah. So, um, maybe let's, let's start with the feet and work up the body because

[00:11:23] Alisa: Okay.

[00:11:24] Samantha: That's, that's, I tend to think of, um, as a dancer. It's like feet up, center out, which I know

[00:11:30] Alisa: Yeah.

[00:11:31] Samantha: Is in conflict with itself, but that's kind of okay with it.

[00:11:34] Alisa: We. Feet up in, in D p T curriculum as well, uh, doctor Physical Therapy School, so I'm okay with that. .

[00:11:41] Samantha: Awesome. So, um, obviously in ballroom dance we have different footwear, um, depending on if you are a lead or a follow, if you are dancing, specific dance styles, if you're dancing more socially versus competitively.

And the theory is that the footwear is both functionally appropriate and aesthetically pleasing. Those might or may not come into conflict with each other occasionally, but, um, the most comfortable pair of shoes that I have in my current repertoire, and I will say for the podcast listeners, I am not, um, endorsing any of the brands that I currently have.

These are just what I currently have in my closet. Some I'm still competing in, some I'm not, I'm not gonna get into the whys or hows or what's, but typical example of a teaching practice shoe or, or a lady's practice shoe, um, has a, what we refer to as a Cuban heel. So it's a wide base. Um, it is a split soul, so we don't have a, a shank running through the middle of the arch.

This is a Cuban heel, so it's a one and a half inch heel. Um, it's similar to what the gentleman will wear competitively for Latin. So the guys will actually wear a Cuban heel as well. And then this is a closed shoe, uh, closed toed shoe. You can find them in the West coast community that have an open toe shoe similar to a sandal.

So this is like my foot saver. This is the most comfortable shoe that I have, and it's got a one and a half inch heel to it. So right off the bat, what, what are your kind of take as far as like living in something 20 to 30 hours, that is that heel height and that construction?

[00:13:22] Alisa: So the first thing I think when someone is on a heel like that all day would be, I'm wondering about like what happens to your Achilles and your Grastoc length.

So your calf musculature, so I'm assuming they're probably pretty strong because you're on point, just like a ballerina would be on a point shoe. Um, but at the same time as there's shortening that occurs in that muscle as well because it's in a position of being shortened. It's already in that almost contracted position.

So one thing I would wanna know is, So many of us can get through running, dancing, jumping, without actually having very strong calves. So one of the things I always look with my dancers is how many single limb heel raises you can do on both sides. So just generally speaking, you should be able to do 25 single heel raises where you just go up onto your toe, um, bilaterally without any discomfort to say you have a five out of five strength. A lot of people get around that without actually having that strength. The other thing I l you know, I think when I look at a shoe and I'm looking at a runner is how flexible is their foot? Probably as dancers, we tend to run on a little bit of a hypermobile side on the more flexible side. So depending on that person's foot, I would wanna look at them, stand with and without a shoe on, I wanna watch them walk.

If that foot is very, very flexible. Looking at that shoe is also very, very flexible in the, in the fore foot. So it would make me think. There's not a lot of support there for that person. However, somebody with a really, really strong foot who's maybe been pointing their foot since they were two, um, or 11 or however they were when they started train uh, dancing, might be strong enough to be in that position.

I know I have a lot of friends that like to lift weights with being in bare feet and dance all the time in bare feet, and if your foot is strong enough to support that, I think that shoe would be fine for that reason. So I really, you know, everyone's foot is different, so I don't think that there's a one right shoe for everybody.

Looking at that, it would make me ask you, how do you feel in that shoe? You said you're most comfortable in that shoe. Are you comfortable or is it comfortable compared to the other ones, it's, are there even Val Ballroom shoes that have hard

[00:15:42] Samantha: Yes

[00:15:42] Alisa: souls like a shank. Like a point shoe .

[00:15:46] Samantha: Yeah. It's, I I would say it is the most comfortable shoe if I'm wearing a non sneaker shoe. Right. Um, do my feet hurt at the end of like a 12 hour teaching day? Absolutely. Absolutely. Without a doubt. Um, do they hurt less than if I was wearing some of the other shoes I'm about to show you? Yeah. Yeah. It's, it's noticeable. But if, if I was going purely for comfort and I'm gonna teach for 12, you know, 10, 12 hours, I've got a 30 hour week ahead of me, or 40 hour week ahead of me, um, I just need to survive this week. And I'm not worried about being able to properly demonstrate at the highest ability to my students what I'm asking them of. I just need to be able to stand and watch them. I'm gonna wear a pair of sneakers every single day. I'm not gonna wear those.

[00:16:42] Alisa: Okay. And are you pointing in your shoes?

[00:16:48] Samantha: I am absolutely pointing in my shoes. I'm not going on point.

[00:16:53] Alisa: Okay.

[00:16:53] Samantha: Right.

[00:16:55] Alisa: Gotcha. Yep. Yeah, I would really wanna look at that dancer's foot. So I have a lot of feelings when I look at that. I also think you guys are amazing for being, it's been a lot of years since I've been in a point shoe for that many hours in a day. Um, but I, I re remember being hard and we're also not on point the whole time you're on a point shoe, but up and down and up and down and up and down quite a bit.

[00:17:19] Samantha: Yeah. Yeah, for sure. And if you think about, well, we'll circle back to it cuz that's, that's, that's one of the big things that I wanted to get into today. Um, okay. But yeah, so, so the Cuban heel or the teacher practice shoe. That is what our gentlemen are competing in, in Latin, and that's the appropriate teaching shoe should you wish to not be in your full heels.

Um, when we get into ballroom, which is standard and American smooth, um, we then have something more akin to a lady's pump. So I've just got two examples. One is more of the standard shoe variety. So this does have, um, a metal shank going through, so I can't bend the shoe in half. Uh, this one I think is a two inch heel and it goes straight to a point.

Um, so it's more of the straight heel size. It has a little bit of flexibility where I can go up on the ball of my foot, but I don't have the ability to fully point that toe should I want to. And then this is more of the smooth style variety. It does, it has a little bit of the support, but it ends, so I can actually go ahead and point that toe and flex it fully.

Um, but the arch is a little bit more supported. This is a two and a half inch heel and it goes to a flare on the base, so it's a little bit wider at the bottom. Um, but this is both, both of those are closed toed once again. Um, so the ball of the foot is covered by material.

[00:18:53] Alisa: I see that. Okay. Well that definitely shows too that with your Cuban heel, with that wider base of support, that's definitely gonna be more comfortable for 12 hour days versus a much more narrow heel, which I know you guys have to wear as well. But I wouldn't be surprised if there's foot, calf, hip and back discomfort with wearing that all day.

[00:19:16] Samantha: For sure. For sure. And just a little bit, kind of giving you the context for how we use those shoes. Um, we do have a full contact with the ground as we're taking forward and backing backwards walking steps.

[00:19:31] Alisa: Okay.

[00:19:32] Samantha: So, um, we're pushing off of our standing leg in order to create movement, but if we are doing a forward action and we are lowered, so we're in a softened knee, we are hitting the heel and then rolling either to a flat foot or all the way up to the ball of the foot in that shoe, same thing going backwards.

We would be pointing the toe softening onto the ball of the foot and then going all the way back to the heel.

[00:19:59] Alisa: Okay. And you're not doing well. Do you do large leaps off the ground?

[00:20:06] Samantha: Um, the only time that we have a leap. would be in, um, Quickstep, which you would have like a figure four or you would have a rocket where you do that kind of spread, but you're in closed connection with your partner.

[00:20:23] Alisa: Okay

[00:20:23] Samantha: so you would have either hip to rib connection with your partner or just rib connection with your partner. Um, so we aren't gonna have like the full leap that you would see a ballerina.

[00:20:37] Alisa: That makes sense. And that can also help descend and control that person's landing. So it's not like all coming down on the shoe if you're connected in some way.

Yes. Does that makes sense?

[00:20:48] Samantha: Yeah. So that's, that's kind of our ballroom shoe. Um, that, like I said, is, is more of a traditional walking method, exaggerated, um, but you are using, you are putting pressure through the heel, all the way through the ball and still rising up to the ball of your foot and then lowering down to a flat.

[00:21:06] Alisa: Mm-hmm. ,

[00:21:07] Samantha: the last shoe that I have is more of a rhythm or a Latin. So this is, um, once again, this for me is a two and a half inch heel because I'm five 10 and I don't need to be on a three and a half inch heel. But they do sell and dancers do dance on up to a three and a half inch heel. Um, I have a flare once again, so it's a little bit wider, but I have seen competitors dance on a straight or even a stiletto style heel. Um, this does once again have a little bit of arch support, but the ball of the foot has the ability to bend and flex and then you are on more of a sandal. So it's, um, connected pinky to, to big toe kind of in that, that large knuckle. Um, we do have dancers that will trim the toe block off so they can actually have the pads of their toes on the ground while they're dancing.

[00:22:01] Alisa: Okay.

[00:22:01] Samantha: And typically in Latin and rhythm dancing, the weight is supposed to be held more on the front of the foot. So we talk about getting the ribcage and the spine over the, the ball of your foot over the front of your foot. We use the heel more as like a grounding at the finish of the movement to like settle the hip or roll through the hip.

But you're mostly dancing on the front of your foot when you're, when you're doing Latin or rhythm dancing.

[00:22:29] Alisa: Okay, that makes sense With those shoes. Do people have the opportunity to put other things on the bottom of their shoe if they needed some extra arch support or something under a toe, um, could they get that in there without it being seen ,

[00:22:45] Samantha: um, without it being seen? No. Um, do dancers do it? Absolutely. Um, you see folks that have like arch support that they add into their shoe, or if, um, some of our older dancers, even some of our younger dancers have bunions or other things they can put pads or cushions in to kind of customize their shoe to be a little bit more comfortable.

Um, but it is, it's visible. People notice if that's the case.

[00:23:14] Alisa: Sure.

[00:23:18] Samantha: Yeah. So just your, if let, let's talk about like the least common denominator. Healthy person in their twenties to thirties, relatively athletic. Um, Fairly mobile, no other history that would put them at a higher than likelihood risk of injury.

[00:23:41] Alisa: Mm-hmm. ,

[00:23:41] Samantha: simply by taking a look at the footwear that we are wearing, is there something that you would recommend if we can't change the footwear that we can do on our own to make sure that we are not putting ourselves at a higher likelihood just based on what we've got on our feet?

[00:24:00] Alisa: Yes. So before I even answer that, I want, is there like very common issues that as a ballroom dance community that you see more than others? So are you seeing a lot of Jones fractures or issues with the fifth metatarsal? Are you seeing, um, like a hallux valgus and bunions, like anything that sticks out to you and then I can target that answer a little bit.

[00:24:25] Samantha: Yeah. So, um, when I asked, um, my Instagram followers what they would like to talk about or what their history with injury has been, um, I specifically limited it to, um, feet and knees for the purpose of this conversation.

[00:24:42] Alisa: Okay.

[00:24:42] Samantha: Um, because I know backs, shoulders, hips, like the answer is yes. If, if the question is what, what is a problem for dancers as far as injury goes? Yes. Is the answer

[00:24:55] Alisa: yes.

[00:24:56] Samantha: Um, but the ones that came out were, um, fifth metatarsal break mainly from, um, improperly rising and having a little bit of ankle weakness and rolling onto that pinky toe when they shouldn't have.

[00:25:11] Alisa: Mm-hmm.

[00:25:12] Samantha: bone spurs scarring of the joint. Uh, Scar tissue in joints in their feet. Um, a lot of dancing on fractures without realizing they were dancing on fractures. Um, yeah, I think those are the main ones when we're talking specifically about foot injuries

[00:25:33] Alisa: and that makes sense and very, you know, comparable to, um, a ballet population. I just remember when I started working with dancers, seeing the scar on the bottom of everybody's great toe, and I was like, what is that? So many dancers had an F H L or a flexor hallucis longus release, which is like the muscle that helps you point or flex your great toe. Um, so in a point shoe, I think I'm gonna see that more than in your shoe.

However, I am not surprised. That was my first guess with the fifth metatarsal, just with the shape of that shoe and not having a lot of support, I could certainly see people rolling to the outside of the foot, whether it's. Traumatic not supposed to happen thing or repetitive microtrauma over many, many, many hours of practicing.

That then leads to a stress fracture that people don't realize they have for a long time. Um, if you ever have that point tenderness in one spot, that's a sign to kind of ask yourself, could this be a stress fracture where if it kind of radiates along the whole side of the foot or it, it wraps around here, um, that's not always as likely to lead me down that pathway, but like it hurts right in the spot. It hurts when I touch this spot. Ask yourself if it's something you need to get looked at. Of course, your dance shoes are not ideal . Um, but we, that's not our option, right? So if we are dancing in a heel, we are dancing in our heel. Um, if you're somebody that has issues with balance, then you're gonna be someone better with that Cuban heal or the wider, however, your, your scenario of our healthy 20 to 30 year olds, um, no reason that they shouldn't be able to dance in a heel. The biggest thing is keeping your foot and calves strong. So we say in clinic kill, like, kill the calves. So we want to kill , like work your calf musculature to the point of failure.

Like to the point that like, that's all I can do right now. So all the heel raises you can do, releves. So just with your knees straight, with your knees bent, holding it. So coming up onto your tippy toes, holding it with your knee straight for 60 seconds. Doing it again with your knee slightly bent. Hold that for 60 seconds.

So hitting all different areas of your gastroc and your soleus. Um, . Another thing I'm a big fan of, of working with dancers, but anybody who, um, has weakness in their foot, really, I wanna say look at the strength of your posterior tibialis, which is a muscle that lets you point and invert. So it's kind of like a J motion.

Um, we will work on doming cuz that muscle comes down and connects to the navicular in the foot. And it's one of the muscles that almost helps to hold up the arch of the foot. So look at your foot positioning if it's flat. If you don't have an eye high arch, I strongly encourage that you start working on something we call doming.

You can certainly look that up on the internet. It is there, but it's not a scrunch of your toes. I don't want you working all the flexors of your toes, you're trying to keep your toes straight and lift the arch of your foot. So my hand is mimicking my foot. It's really quite difficult, . Um, but that. Will be working the muscles that help to support holding your arch up.

There's been studies done on this patients and people really do better after strengthening that muscle. It doesn't mean if you have a flat foot, all of a sudden you're gonna have an arch. It doesn't change the, it's your anatomy and that's okay. Um, but what you can do is strengthen the muscles to support your foot.

So same idea. If someone starts doing really well with that, maybe I take the arch of their foot up or maybe I put something in their shoe to give them some arch support. Yes, I don't do that all the time. And yes, that can help. Yes, you might wanna do that in your high heel, but it's not something you have to do if you really start working the active muscles in doing that.

Um, so that might help you with rolling in and rolling out and causing some of the stress fractures. I don't know if your dancers have, so with the ballerina, when they start, you know, getting into competition and start getting into a point shoe, good dance, teachers should, should, and mine did take us to the store to help us get fitted for the right point shoe for us.

So there's block points, which, um, point shoes, which are really, really a wide base of support. And then there's all different brands and, and really what I learned is you want a shoe that mimics your foot. So I thought, I have a narrow base, I have a narrow foot. So I wanted a block, I wanted this wide base to make up for it, but I quickly learned, I actually wanted a shoe that mimics the shape of my foot to help me distribute my weight on point.

So even though there's different styles, can you pick variations of that style when you go to buy your dance shoes.

[00:30:25] Samantha: Um, yes and no . Okay, so, so what I would say is there are many different iterations of the same style of shoe. So, um, if I. Pull the Latin shoe back out. So things that you can customize, you can, I've found a round shoe.

Some, uh, sellers have more of a square base, so you can choose what kind of toe base you want. This is more of a braided. You'll have some that are more like strapped. Some might have, um, like a mesh in between the straps. Some will have more straps than others. This is kind of a crisscrossing at the ankle.

Sometimes you'll see more of like a T shape or it'll just be a singular ankle strap. So there's a little bit of customization there. What I would say though, this is just my experience, um, having the shoe manufacturer or shoe retailer in the space with you fitting it to your foot is something that you really only come across at competitions where you've already bought your shoes and you're buying more shoes.

Or if you are at a studio that specifically brings in someone to do a trunk show, which you have to have a certain amount of clientele base before someone's gonna come into your shop or into your studio. So a lot of times, either you're buying blindly online, which can have mixed results. You're waiting for that competition to go and actually sit down with someone and have them fit your foot, which they may or may not have the right shoe in stock at that competition.

Um, or you are in a situation where you're at a studio and that studio owner has partnered with one of the brands and has an amount of stock in that you can put on your foot. Um, I would say most people are probably buying online or buying from their studio, and if they're buying from the studio, it's, does this shoe fit?

Okay, great. Buy it. Not necessarily having that conversation of what is that, what is the benefit of having a tight heel cup or a wider toe base or a tight toe base or more arch supporter, less arch support for you, the student? Because quite honestly, we're not trained in that as teachers.

[00:33:04] Alisa: Sure, yes, yes. I understand that. Um, I remember going back to take one of the first continuing ed courses that I took as after I graduated as a pt and, and it was on fitting dance shoes and I. I literally danced for over 20 years of my life and I'm just learning what the right dance shoe is like. That's, that's crazy. Um, so okay, an ideal world then.

Yes. It's finding someone to fit your foot and talk through the materials and the width of your heel and all of those things with you. My advice for those of you that that's not a option at the moment, um, is to try to find a shoe that mimics your foot. So if you have that broader, you know, metatarsals where it's kind of the knuckles of your toes are, if that's a wider foot for you, then I would recommend one that is wider. Um, and if you have a narrow foot, don't think that wider is better. So you actually want it to fit your foot, cuz that's gonna help you better distribute the load of the force going through the foot. The reason I even started thinking about that is because of, of bunions. So the reason a lot of bunions occur is Wolf's law, if you go back to science from being younger, is if there is force applied to it, it's gonna build that force to fight it and grow bone so that it doesn't get irritated and uncomfortable. So if you're someone who really likes to wear pointy shoes and all of a sudden you realize that like the side of your great toe is starting to stick out, make sure that you're, you're also wearing shoes that don't just rub that spot because your body is doing its natural response of trying to fight that and protect yourself.

Um, sometimes that's our anatomy and maybe that's passed down from our, our grandparents and parents. And there's nothing in your control. If you have a bunion, we call that hallux valgus. So it's when that, that great toe, the side of it, it looks like a big ball and then the toe kind of points that way. It's a tough surgery to go through and heal from even though it's something that is done a lot.

So, um, my suggestion to you, if you're someone who has that, is really look at the material that goes over your toe so you have that braided one. Is that comfortable? Is that soft? Is that better for you? Um, versus like a harder piece of plastic there, I would not pick for somebody who's having issues with that great toe, or starting to get a bunion there.

Um, you might also get them on the, I get them on the pinky toes on my feet. So it kind of, depending on where, where you distribute your load in, in that foot posture, um, can really influence where you rub. So look at your foot, pair up even something you guys can do in dance class, but pair up and look at each other and say like, okay, you have a flat arch, or you, you need something that has a little bit of a harder shank versus like, your foot is really strong.

You can have something that you can bend and it's flexible and okay, your toe goes in that way. Make sure you get a material that's gonna be a little softer going over the base of your toes versus something that can be a little bit different. I mean, even like, if you can get. A cut, like something that has cutouts like that might be really good for your foot if there's rubbing in that spot to have something that's open there, um, versus somebody who, who wants that closed and protected.

But if it's, if it's truly a bunion or it's totally this growth of bone because something is rubbing there, really look at your shoes and see if something is rubbing there and what can you do to, to take away that extra pressure.

[00:36:32] Samantha: Yeah. And and I imagine that goes for both in the activity that you're doing and also outside of that, so

[00:36:41] Alisa: Absolutely.

[00:36:41] Samantha: I know for me, like I very rarely wear heels now outside of when I'm dancing because I know I'm putting my foot through the stress on the dance floor. I don't wanna like

[00:36:52] Alisa: yeah.

[00:36:52] Samantha: Double it than when I'm going out for date night. I'll wear something more comfortable just to give my feet kind of a breather to let them relax and chill out for a couple of hours.

[00:37:02] Alisa: Yes. And that's really good that you know that. So, you know, realize, okay, if I'm gonna be in dance practice or in dance class for 10 hours, like what do I need to do when I'm not here? Like, do I need to completely go opposite into a different shoe? Do I need to be barefoot? Um, do I need a supportive sneaker for a day to give the muscles in my foot a little bit of a break? for sure. That's good that you, you do that.

[00:37:26] Samantha: Um, kind of going along with that, we had a question from one of our followers about suggested exercise to minimize, to minimize heel pain after practice. Um, now I know for me personally, a lot of my pain is more on the ball of my foot, big toe joint area, but for someone who is experiencing it more heel, achilles area of, of their foot, what would you suggest someone do to to minimize pain and also help with recovery after practice?

[00:37:59] Alisa: that's a great question. So when I first think heel pain, my first question for that person would say, do you have any history or current back issues? Because I wanna make sure that it's not referred pain to the heel from an L five disc or a nerve. Um, doesn't mean it's something surgical or something that it could just be pressure on an nerve contributing and causing heel discomfort.

Um, so if, if it's not, if it's truly local to the heel, it's related to practice. Um, that could be from an Achilles tendonitis, that could be something, um, of a plantar fasciopathy type of issue. So different things that connect into your heel. So that could be your calf musculature, and that could be the plantar fascia on the bottom of the foot.

So I do not recommend Googling what to do for plantar fasciitis and rub your foot on a ball and an ice bottle that is not . Uh, very rarely what I give to people. But that's what you'll see online. Um, If I'm going to give that to somebody if, if you are really, really high arch, so again, look at your foot position.

If you have a nationally crazy high arch and it's stress and tight on that plantar fascia, one thing I would say try to do, hold your ch a great toe and then just pull it back into extension and see if it's tight along the bottom of your foot. So that's just stretching the plantar fascia that goes along the arch of your foot.

If that feels uncomfortable to you and you have that high arch, then I think rubbing it out, using a ball, using your own hand, that's fine. If you have a flat arch, chances are the plantar fascia is actually overstretched. So I don't want you to roll it out more. I don't want you to massage it cuz you're just feeding in and trying to overstretch something that's already overstretched.

That's this, that's the hard part of like, you know, all our bodies are different and come see me because then I can give you, you know, a detailed exam that's specific to your body. So take all these kind of general points and, and really look at yourself if you're listening to our podcast. Um, and then really try to figure out the right thing for you.

So a lot of times somebody's foot is more flat, um, and flexible. And then that's the person I want to strengthen. So for that person, I would say go back to that doming exercise we talked about. There's also something called toe yoga that kind of works you through like just lift your great toe, lift the other four toes and not your great toe, and then lift those four toes and just put your pinky toe down.

Um, I'm terrible at it. It's really, really hard. But different things you can, you can try to do. If you google toe yoga, you'll see it. Um, but different foot intrinsic strengthening exercises. The other big thing I'm gonna probably go back to several times today will be calf strengthening. So whether it's a tendonitis, which -itis is inflammation, so if it's, that's usually an acute thing, something that happened more recently. Um, and it's inflamed, so that's different than what a lot of us have where it's more of a tendonosis, we're in the tendon. It's almost degeneration and breakdown. So this is your, your runner, your dancer with Achilles pain for months. Um, that's probably the majority of us have more of an -osis than an -itis.

Um, so for that person, I recommend heat over ice because I wanna bring blood flow to the tendon. I wanna bring the oxygen and nutrients that helps you heal. Um, with a true -itis, you just sprained your ankle, it just happened that day, and you like to ice it. Sure. That first 24 to 48 hours, that's when something like ice will be more effective.

Um, I'll also say there's no. If you love ice or you love heat, this will always be a conversation with healthcare providers. Neither is gonna hurt you, so I want you to do what helps your body. My bias, my training has really focused on the reasons that heat is a little more beneficial than ice. So I would personally recommend if you only have time for one or right after exercise, I would say to put some heat.

Um, but like I said, if your body loves ice, it's okay. Do what, do what feels good to you. So with that osis tendonosis, maybe that's causing the heel pain cuz it attaches into your calcaneus or your heel. For that person, I would heat it. I would do a lot of calf strengthening and doming exercises. Again, knee bent and knee straight.

A lot of people do releves with their knees straight. Make sure you're also doing it with your knees bent and those isometric holds. Um, I am not a no pain, no gain person. I'm not somebody to usually tell somebody like, push through it, it should hurt. But the research with Tendonosis does show that you do push into that painful area, that it's all about load.

So if you're someone that has heel pain or Achilles pain that's been there for several months to years, um, it's not an acute finding, it's something more chronic that's been going on. Maybe it comes and goes. I would say load is important. So you wanna do a lot of repetitions in weightbearing, single limb, double limb.

Um, and it's okay to feed in, like to go into that discomfort with a true tendonosis. Um, it's the one thing I would really, one of the things that I would push somebody to go a little bit into the discomfort when they're doing.

[00:43:19] Samantha: Awesome.

[00:43:19] Alisa: So that's my advice with that.

[00:43:21] Samantha: Excellent. Um, kind of along with that, um, the other, um, I'm gonna kind of l link to, uh, a, a question and an, and a story that was shared with me.

Um, and the question is kind of moving up the chain. So talking about n knee injury prevention, um, and, and talking about the calf. One of the, the wonderful, um, followers of the podcast shared with me that they actually had a pretty nasty calf tear that essentially ended their ability to dance competitively, um, because they found themselves in a situation where the body moved, the foot didn't, and unfortunately something had to give. And we do see that a lot happening more so in the knee. In my experience, I've, I've heard of more stories happening with knee injuries resulting because the foot didn't move when the body did, but in this person's case, it was a calf tear that happened. So, Aside from the obvious of make sure that if you're rotating your foot moves as well, um, what can we do to either strengthen, um, different areas or what can we do to just prevent that from happening if we're doing everything else correctly?

[00:44:29] Alisa: Yeah, that's a good question. And that's, you know, that risk is always there for any athlete. Um, the best we can do is proprioception. Plyometrics. So yes, like work your natural turnout. That's something we talk about in dance all the time, so it don't force it from your knees. Um, so in training at. In class before you actually go out to do routines on the floor, warming your body up, making sure that you are, you know, doing something dynamic across the floor.

So whether you're walking and kind of kicking, um, or walking and doing some butt kicks or walking and doing some releves, but something where you are warming your body up and getting everything to communicate with each other. So your core, your hips, your knees, your feet, like everything should kind of be there.

So that hopefully in that second that something would happen. Where like by example, you know, when I'm talking to patients is that second you almost roll your ankle, you step down that curb and you almost roll your ankle, but you catch yourself. That's what plyometrics is and, and proprioceptive exercises are to do.

So when I say proprioceptive, that's your body's ability to pull in muscles and nerves and everything that kind of comes together to stabilize you. And it, it all happens that quick. , but doing these exercises where you're working on, on a warmup, where you're working on turning out from your hips and not forcing the turnout from your knees where you're pushing, and I, I know you probably don't have to be in a, in a turned out position quite as much as a ballerina, but you're pirouette, you're doing

[00:46:03] Samantha: Yeah. And there's still

[00:46:03] Alisa: spins and turns

[00:46:05] Samantha: and there's still a lot of external and, and internal rotation in, in both standard and ballroom. And then when you get into Latin, and we, we actually are supposed to have an amount of turnout, um, and coming from the hips and not from the ankle or the knees, that's a big challenge for a lot of folks.

[00:46:22] Alisa: It's big. It's big. And most of us do not have as much out as we would like and we force it. So please, if you don't have as much turnout, it's okay. Use what you have so that you're not injured. Because if you hurt yourself and then you can't dance at all. That's just not worth it. And I know that's easier said than done, and it's one of the reasons I'm a PT and not a dancer, is my turnout is my turnout. And it's not a ballerina's turnout . Um, so what our, what our natural anatomy, you know, that's something that we don't have control over, but what we do is strengthening and working on neuromuscular reeducation and these types of exercises within our physiological limits and our natural ability to be the best we can be with what we have to hopefully prevent injury.

Um, so that can also just be like, for an example, people I feel like always know things like skater jumps or lunge jumps. So kind of getting where you have to soften your hips, your knees and work into this rolling through your foot position as you land from a jump. I'm a big fan of just small jumps in place before going on stage.

Again, just like working through your foot, softening your knees, softening your hips, engaging your core. Um, just the, the best you can get everything talking to each other and we don't think about it, right? We just get up and do it. So taking that time to be like, am I warmed up and can I work on these things?

But going through just these drills in class and going through these moves and practicing your spins and practicing your pirouettes, it's never as fun as like doing your routine on the floor. But it's so important because that's what allows us to be successful on the floor. So, you know, you, that moment might happen, but the more training you do behind that strengthening and the dynamic warmups will hopefully give you that, that foot up to prevent an injury from occurring in that moment.

[00:48:16] Samantha: Well, and I imagine, and, and I know we've kind of talked about this in previous episodes, that it's not just the warmup, it's also the cool down, and it's making sure that

[00:48:24] Alisa: yeah,

[00:48:24] Samantha: we're getting our body ready to do all of the things that we're gonna ask for it, and then also telling it, okay, it's, it's time to soften and get ready to go back into the car for 45 minutes for the commute home.

[00:48:36] Alisa: So true. Yes. Um, and I think it's pretty well known today that like your warmup should be dynamic versus static. So we don't want you just like sitting in a straddle for a warmup. Um, but like I mentioned, like a butt kick or even doing like grand battements or just kicking your leg. Um, but doing something dynamic across the floor at the barre.

Um, I know like a lot of dancers do like the, the, the leg in and out, kind of just to warm things up and work on rotation, but doing things through movement and start small and build up high before going into your workout. And then after, you can start going into a little bit more static positions and really breathing through it, but absolutely you don't want, you know, your blood to pool in an area. Um, that can cause what my friend loves to say, DOMS. So delayed onset muscle soreness. So you feel really good in that moment. You stop, you go home and then the next two days you're like, what did I do? So just that cool down is gonna help prevent that because it moves the metabolites in your system. It prevents a buildup in your calf or in your hip where you're gonna feel sore and aching the next day.

[00:49:42] Samantha: For sure, for sure. There is so much more that I wanna get into, um, but I know that we're, we're pushing on time. Um, I want to, um, I wanna talk first about when and how to seek out a physical therapist and a, a good physical therapist to work with dancers. Because I feel like so often, and I know I am guilty of this, I know I have colleagues that are guilty of this.

The acceptance of pain as a reality of our industry prevents us from seeking out help early enough to prevent something. And it's almost always a, well now you've been dancing on a fractured foot for seven years. The only option is surgery. And we know that you don't wanna do surgery cuz that's gonna end your career.

So when should we start seeking out help from medical professionals? How soon should we start? Should we wait for our bodies to, to give us pain signals before we reach out? Or should we already be working with someone to prevent injury from day one?

[00:50:54] Alisa: If it was up to me, in a perfect world, I feel like it would be so great to have pt, almost like you would see a primary care provider.

So doing these check-ins to just doesn't mean you have to come see me three days a week, but to. To come in and tell me what you're feeling, what's demanded on your body, what are you having difficult with, for me to watch you do what you do to give you the strengthening exercises to help prevent injury?

I would, I would love if I could see all athletes, including dancing athletes, um, pre-injury . That is not always this option in our insurance world right now. Um, but that's what I would love. And just to have these like check-ins where we could go through and do that. Um, I have this young dancer right now who is doing great and heal from an ankle fracture, and her mom is telling all of her friends, and I love it, that like they're watching her dance and she's going across the floor and they're wa like she's learning all these things cuz I see her knees come into a valgus position every time she plies and I see her foot roll in, I can just see future injuries that are possible even though she healed from a fracture and has no pain right now, she's 12 years old. Like she's a long history that I could teach her things and I'm teaching her things that will hopefully prevent her needing to come back for an injury.

Um, so it's great cuz now I'm starting to see some of her, her friends come in too. Um, so that would be ideal. I mean, the second you start having pain or something unusual, and I'm like this too, I don't go to a doctor unless I really, really, really need to. So I understand. Um, and I, you know, if you told me not to dance, I probably wouldn't listen.

So one thing I, you know, I always tell my students and to tell our patients like, you have to give them a win. So, okay, if this hurts maybe I need to take them out of jumps right now, but can they still do barre or can they still go in and do, they can do these and they can mark the moves, but just taking somebody out of something they love is usually not what you wanna hear.

You probably won't come back to see me and I'm not helping you anyway. Um, so I feel like you have to know what that person wants and needs. If you have, I personally wouldn't, I would tell you not to wait much more than a week if you're having something that's not getting better yourself. So relative rest is different than rest.

I don't mean do nothing. I definitely don't want you laying in bed all day. Um, but maybe you're not leaping or maybe you wear sneakers instead of high heels for that class. Um, and you mark a move or you don't turn out as far. So I don't think you should do something that's painful if it hurts every time you do this and you just do it over and over and over. Don't do that. Which kills me cuz like my whole life, my dad was like, it hurts when you do that. Don't do that. But , there's actually, you know, some, some meaning to that. Um, so do everything else you can do, but don't do that one thing. Give it relative rest. Does it get better?

Then okay, then jump in from where you are. And I don't think you need to see a medical provider. Um, but if it's been almost a week, if things aren't getting better with relative rest, I would see a, a good pt. And like you said, that's hard. Um, there's a lot of PTs out there and there's a lot of great PTs out there.

Um, but there's a lot of PTs also that don't know how to treat a dancer or, um, don't understand what it is that we're looking for. So obviously if you can find a PT that has a dance background, That's awesome because they're gonna understand a little bit more what's demanded on you. Now. At the same time, I treat athletes all the time that play sports that maybe I didn't, um, you know, I'm a runner and I, I like soccer, but I didn't do lacrosse, which I'm in Maryland and everyone plays lacrosse,

Um, so I really, I played, you know, played around myself just to understand a little bit of what's demanded on them and I asked them and I watched them. So it doesn't mean you can't have a great physical therapist without a dance background. You certainly could. There's also, um, like I am a manual physical therapist.

That's what my residency and fellowship was in and orthopedics. But there's actually performing arts residencies out there as well. I know we have one at John's Hopkins. Um, so there's definitely people out there too that have gone even further in their education to understand dance injuries. So after that week, I would say I would find somebody that's either recommended by a friend that they really liked or someone that has some kind of dance background or interest if possible.

Um, and that doesn't mean that you have to see them all the time, but we should work with you to like, okay, I wanna see you twice a week right now, but just for a couple weeks to see what's going on. And then hopefully we'll get you back to what you need to be doing. I'm a fan of relative rest over, just stop.

If you're, and also like how intense is that pain? Is it localized pain with a certain move versus like, I'm having numbness and tingling down my leg, I'm having bowel bladder changes. If there's something that's a little bit more outta the ordinary, I would even come to see us sooner than that.

[00:56:03] Samantha: Well, and, and I wanna kind of key into that as well, because. I'll, I'll speak from my own personal experience. I would say I have a background of like a two on the pain scale in my feet. That's constant. If I'm dancing, if I'm on my feet, if I'm teaching, it's there. It's not acute. I can't pinpoint it. It's not needles or or stabbing pain. It's similar to day two. If you did leg day or arm day, it's that you got a good workout in.

[00:56:35] Alisa: Yeah.

[00:56:35] Samantha: Dullness that never goes away. But I have had days recently where I've called my mom saying I'm at a seven right now. Do I need to go to the icu? And she's like, all right, it's a seven. Talk me through it. Elevate your feet. Stay off 'em for 24 hours. Call me in the morning and I call her and I'm like, okay, it's like a five now.

And she's like, okay, elevate your feet, put some heat on it. Stay off your feet. Don't put on the heels. And you know, 48 hours later it's a three and then it's down to a two. And it's like, okay, you really overworked your feet in that moment. Maybe let's do some, strengthen your exercises to avoid it. So for you, when you hear something like that, or you're working with a client that's like, I kind of have this background static, but I'll have peaks and valleys, how important is it to act quickly on the peak?

Or do you wait for it to go back to the static and see if that static is elevated?

[00:57:43] Alisa: And I hear your story, like I would say, come see me now and let's look at your foot. Let's see what's going on. Because if you get this from time to time, even if it's not a seven, even if it's a two, I would still wanna look at you and give you things that you could work on at home and see if that makes a difference in that.

And maybe you won't get those seven days. Um, for someone who is, and that's hard, I get it. Like I have a three-year-old, I don't wanna go to a doctor's appointment after I work all day and I'm away from her all day. I wanna come home, I wanna be with my kid. I don't wanna go to pt. So I get it and I wanna get my workout in too.

So it's how do we, I get it. But if you're able to , I would say it wouldn't be a bad thing to go get that looked at. If you're in that valley stage, that's a great time to go too. Many of us don't go at that time. Many of us wait for it to be bad. Um, and then we seek help because that's when it hurts and that's when we're thinking about it all the time and having, getting difficulty getting through our day.

Um, so I say a lot of people just do that naturally, but if you're someone who has a story like you, um, and they have like an underlying baseline weekly discomfort, that's the person I would say, go see an ortho PT and see what you could do preventatively to prevent anything from spiking.

[00:59:01] Samantha: Awesome.

[00:59:01] Alisa: We certainly can , I mean, I get I back aches like I always have. It started when I was dancing in, in high school. Um, and honestly if I'm active and I, and I'm running is what I've gotten into in my later years here. But, um, I, I feel like. If I'm active, I feel pretty good and I know what I need to do exercise wise to prevent that from happening. And probably once or twice a year, like I have a big uptick in, in my symptoms and then I need a coworker to help with some hands-on care to get me back to my baseline.

Um, other than that, I, I pretty much maintain it myself doing the exercise exercises I need to do. So I think it's a great idea to, any of your dancers that have that ability to seek out somebody when they're in a little bit of a lull can also help just to teach them some things to do on their own to hopefully prevent it from spiking.

[00:59:53] Samantha: Yeah. So the last question that I wanna kind of end today on, um, and it, it might require a follow up conversation if you're willing.

[01:00:02] Alisa: Sure.

[01:00:02] Samantha: Um, is the, the issue of experimentation in athletics. So obviously, Dance, specifically ballroom dance, we refer to it as dance sport. It is equal parts athletic endeavor and artistic expression.

[01:00:24] Alisa: Absolutely.

[01:00:24] Samantha: And as with anything that kind of falls into the athletic realm, there is a push to grow and further the sport, either by being faster or more graceful or leap higher, or you know, spin more times or be more powerful, faster, longer, bigger. Just push it to the nth degree. And with that comes coaches that have found success or have pushed their personal experience of athletics that then bring in students either young in age or middle in age or older in age, and push them to further the next generation. Possibly with or without medical oversight, possibly with or without long-term studies on potential side effects or issues down the road for doing things. So what can we do as students of the sport and teachers of the sport and leaders in the industry to make sure that we are cautious when experimenting with the next generation?

[01:01:42] Alisa: That's a great question. So I think with all sports, like you're saying, there is this need to like keep pushing and be better. I mean, to see what some of the dancers do today when I was that age, certainly different . Um, they're amazing and I don't think I looked like that when I was six. Um, but you know, that flexibility in how they're like forced into some of these positions, um, I would like to see some long-term studies on that as well.

I think there's definitely been some, some research out there that shows the importance of, of not just doing one sport, but that kids should be, I think it was like three like, but no more than a certain amount too. And I, um, can check myself on like what was actually said by, I think like one of the sport associations.

Um, but it's the same idea with adults, like that ability to cross train. So if you're a swimmer, you also have like a weightlift day or do you go on walks, um, and do some other kind of workout as well. Or if you're a runner, hopefully, you know, if you run marathons and just run marathons all the time, that's the person that gets a lot of stress fractures and breakdowns in issues in other areas.

So we know it is good to mix in different types of exercises and activities. So I think that's important that they're not just doing one thing and just constantly stretching or constantly working their muscle in the same way over and over, but that there's a difference in the way that the body has to work.

I think it's okay to wanna to grow and I think it's amazing what young people can do. And I mean, I guess people would say that about us too 20, 30 years ago. And how every generation just seems to do more. There is an importance in making sure, I think that, that children understand that they need rest.

Nutrition is huge. Um, and luckily our PT program, and I believe other PT programs around the country are really starting to incorporate more nutrition into our curriculum. And we are not licensed nutritionist, but having certain conversations about protein and, and eating enough to fool your body, especially in a dance world.

But eating disorders and disordered eating, I mean, we can have our own conversation and podcast conversation on that, um, is certainly a real issue with anybody at any age group in any sport. Um, not just ballerinas, but wrestlers and people that the way in and, and just being, you know, today's society, we all have some of those social norms placed on us.

Talking about nutrition with our, with our young dancers. Um, and then also making sure that they get breaks. Like is there a winter break? Is there a spring break? It shouldn't be seven days a week, but a lot of us do it five to six days a week. Um, and making sure they're not having pain, that they're doing things right, that we're not forcing them into a turnout that they don't have, that we're not standing here pushing their leg further than it really should go into a hamstring stretch.

Great. Give a little stretch, but don't push it past what that muscle can actually stretch, where then you, you tear something or you hurt their joint. Um, so I think it's really listening to them as individuals and, and pushing them to their ability, but not necessarily to whatever a max is for the most flexible person in the room.

And that's hard. I think that's gonna take us all a lot of time and attention. But that would be the best thing we could do for them is really look at each one individually, push them to their physiological maxes, but not past that because that's when they break down or they don't wanna do it anymore, or they start to have pain.

[01:05:32] Samantha: Yeah. And obviously we have to pay special attention to kids because, you know, bones and muscles are still growing and developing and, um, as individuals, they're still developing. So there's, you know, there's always a little bit of a power differential in the room, but even as adults that are either continuing to do this or coming to dance, coming to ballroom dance later in life, what are those red flags for you? Where, where you would be the person in the room to say, stop this. This has gone too far, this is not working for this person, or, Encourage someone to be their own advocate to say, time out. I'm not understanding what you're asking of me, or I don't think I can physically do this.

[01:06:16] Alisa: Yeah. And I think there's lots of signs. So I look, I look a lot at body language and like facial grimacing and expressions, especially in, in children, but like you said, across the lifespan, because sometimes we don't say it. Um, but you can see in somebody's face that they're uncomfortable. So like maybe they are literally clenching their teeth or they're making a face, or they're avoiding emotion.

If I see that someone's kind of not putting as much weight down on that leg, or they're shortening a step that they don't usually do, or maybe they're not kicking as high, like that's my chance to say just, just checking in or like, you feeling okay? Is anything uncomfortable? Um, so those are my big re like red flags.

Something physical, but really like an avoidance. Or you can just see like a mood change in kids for sure. And then, you know, with kids you kind of have that conversation because it could be a bad day at school, it could be something with friends. I guess even with us adults that we all have our days too.

So you can kind of, there's just like this avoidance of doing something physically that shows me that something doesn't feel right. The, I, I feel like over the years I can kind of identify early on if there's a problem with nutrition and sometimes you can tell if somebody is frail or I've had somebody tell me that they don't wanna do a clamshell because they don't want their butt to look bigger.

Um, and I appreciated their honesty, but that tells me quite a lot, um, about how much they're putting onto the way their body looks and what they're willing to do, um, or not to do, to make them feel better. So, you know, my, I wanna build that rapport with a person. I don't ever wanna accuse somebody of an issue that's not there.

Um, and it doesn't even, I mean, there's kids today that like portion out egg whites and um, Turkey bacon , and then they wanna go lift at, at high school. And it's just like, even though they don't have an eating disorder, like that might be disordered eating for a, for a high school student to, to think out how much protein that they are putting in their bodies so that they can build a certain amount of muscle.

Um, so there's always these things I'm looking for, and I don't always jump on it right away, but once I build this relationship with a patient, can I identify a need that I need to refer this patient to a nutritionist? And I might just start with somebody like that. Like, how are you doing with nutrition?

Because your body does need food to heal from an injury and to be strong. And there's a physical demand that we're doing on each other. And even if we want, you know, this thin, strong appearance, We need to fuel to be able to do that successfully. Um, so I at least I try to always screen for that and identify when it's something that I can have a conversation with a person or do I ask them like, would you like to talk to a nutritionist about them?

And being at the University of, of Maryland, Baltimore, it's really great cuz I have all these connections so I can identify if somebody needs social work or I can identify if somebody is in a domestic abusive situation or somebody needs to talk to a nutritionist. And I have all these resources at my hands and I'm very proud to work here for those reasons.

Um, but I think for you being in the studio, just looking for signs that somebody is physically avoiding something, that something hurts, um, and then if there's these other red flags that you're catching that somebody might need to talk to somebody else in some other way as far as are they avoiding doing certain things, are they not eating the way that they should be. And that's something you might not always be able to see in your role.

[01:09:54] Samantha: Yeah. And I, and I imagine that goes along with pushing through something, like pushing to do something, even though you're seeing all of those markers as well. So,

[01:10:06] Alisa: yeah.

[01:10:06] Samantha: You know, I'll have students, they're like, no, I can do it. I can do it, I can do it. And yet they're gritting their teeth or I can hear the joints squeak as they're trying to lift their arm in a certain way. And I'm like, stop, please stop. Because I know that what you are doing right now is only going to make it worse.

[01:10:23] Alisa: Yes.

[01:10:23] Samantha: So I would rather us not, I know you wanna get your perfect frame. I know you wanna get your perfect form. I know we're working on a contra body movement position, and you're feeling that stretch in your, in your um, side, but, Let's take a break and let's walk away from this and say, okay, it's not a bad thing that you can only do this right now because this is enough. I, I'm happy with this. Let's not continue to push it.

[01:10:52] Alisa: And that's awesome that you do that and identify that. And I hope that most dance teachers and coaches, um, do that as well. And it's, it's hard. I mean, even for us, but certainly when you're a young person, like you don't think of the future. Like you think of right then and there and you wanna be great and you wanna do this, and you wanna do what your classmates are doing and you wanna please your teacher. But it's so hard to say, like, if you hurt yourself right now, you won't be able to do this in a week or in a year. So mark the move or just don't kick as high, or like you said, take five minutes, just like walk for five minutes and stretch for a second, and then let's see if we can jump in, is a much better solution.

So, I mean, the biggest things are the non-verbal signs, like you said, but the, the facial grimacing and the avoidance. And that's a big sign of a fracture too. Like if somebody won't put weight down, that's a big step to us. Um, if there's, like, there's a clinical prediction rule that if somebody needs to get an x-ray, um, for the foot or ankle and it's, it's discomfort in certain places, but one of the criteria is that they can't put four, they can't walk for four steps like immediately after an injury. Um, that's a big sign that like, all right, maybe, maybe you need to get that looked at. Um, stress fractures also don't always show up right away. So sometimes someone who gets a, an X-ray right away after an injury happens and they say it's negative, if you are still having pain two or three weeks later, consider getting a repeat x-ray because it can take two or three weeks for a stress fracture to show.

Um, hopefully it won't. I am not a pusher of getting imaging done . Um, very much the opposite. Um, but that something like a fracture is something that we don't wanna miss.

[01:12:39] Samantha: Yeah, and that's really good to know too, that it could take several weeks for that to show up on an x-ray because again, coworkers, students have said, this hurts gone in for an x-ray, it's come back clean and have pushed themselves and then a month later have been wondering, okay, well. It wasn't a fracture, why is it still hurting? So that's very good to know that that is a possibility.

[01:13:07] Alisa: Yeah. If it's still point tender and hurts a lot, two or three weeks after, I would consider getting it looked at again. Cuz I see that, like you said, a lot.

[01:13:17] Samantha: Yeah.

[01:13:17] Alisa: People like, oh, I went to urgent care, it's negative. But then a couple weeks later it just, it's just the process of the calcification and with a stress fracture, it just sometimes doesn't show up for two to three weeks.

[01:13:29] Samantha: Yeah. The other thing, um, that I would say is incredibly important for dance instructors and I imagine incredibly important for PTs as well when you're doing an initial consult, is tell us the medical history that you are willing to share with us.

[01:13:43] Alisa: Yes.

[01:13:43] Samantha: Even if you don't think it's pertinent.

[01:13:46] Alisa: Yes, yes.

[01:13:46] Samantha: Even if you have full range of motion on your hip. If it was replaced three years ago, please tell me that you have a hip replacement. .

[01:13:55] Alisa: Yes. I can't, I cannot reinforce that enough. And sometimes I think people just don't even realize it because it's their normal, like they've been living with it.

But I'll say like any medical history, I should be aware of, you know, any problems with blood pressure, anything like that. And they say no. And then I see in their chart they're on blood pressure medication, . Um, but to them it's cause it's, they're on medication so it's controlled. So they don't think that, but I need to know that because that blood pressure medication can blunt what I will see when I take your vitals and I need to know that, to know how to understand how you're responding to certain exercises.

So yeah, people just don't realize sometimes it's not even on purpose, , that they didn't share with us surgeries or histories or they had a hip dysplasia as a baby. Like maybe you don't think about that cuz it was so long ago. But if you had hip dysplasia as a baby and you're having some issues or you're very hyper mobile as a dancer, there's probably a correlation there. And that's really good for us to know, especially if you're having dislocations or issues like that, um, that tells me that your joint is, is pretty loose and that's really important in how I'm gonna do your exercises and, and manual techniques.

[01:15:09] Samantha: Yeah, absolutely. Yeah. Awesome. Well, like I said, I feel like I barely scratched the surface on some of these, um, these, these case stories that I would love to get your opinion on.

I know a lot of people are eager to to hear more from you. Um, yeah. And just more understand their bodies better and understand injury prevention better. So, um, maybe if, if you are willing we can schedule a follow up and have you on for another episode.

[01:15:37] Alisa: Yeah, I would love to do that. This was fun.

[01:15:39] Samantha: Awesome. Well thank you so much Alisa for chatting with me today as part of the podcast.

[01:15:44] Alisa: My pleasure. Thanks for having me.

[01:15:46] Samantha: Thank you once again to Alisa for being such an amazing guest. Um, like I said, we will hopefully have her on for a future episode of the podcast to talk about more of your injury stories, more common occurrences, um, that she has with dancers, how we can better prevent some of our upper body and back injuries and a whole bunch of other conversations. Um, so if you would like to find out more about her, you can do so using the link in the description box below.

As always, I'm Samantha. I'm your host with Love Live Dance. You can support the podcast by following Ballroom Chat on Instagram and Facebook. We also have a Patreon page.

Differently, uh, than maybe past outros. What I would love if you have made it this far in the podcast, either on YouTube or everywhere podcasts are available, is to comment below, either something that you are going to start doing in order to prevent injuries, or if you have something specific that you would like us to chat about the next time I have Alisa on the podcast, you can either send me a message or send a Ballroom Chat a message through our Facebook and Instagram, and we will make sure to cover that topic next time um, we chat.

So thank you once again for listening. I hope you have a wonderful rest of your day. Stay safe, stay positive, and I hope to see you dancing very soon.