This series was first published in 2014 for Arizona Dance e-Star, a publication of the Arizona Dance Coalition. In this series of articles you’ll learn how to treat low back pain… hip and groin pain… knee and leg pain… and ankle and foot pain. In Part 3 I’ll discuss how our muscles work, the function of pain, and share my thoughts on ballistic vs static stretching.
Legs, Wonderful Legs
If you have ever opened an anatomy book you have observed how the muscles of the leg are inextricably connected to the hip, knee and ankle and wonderfully encased in a neat stocking of skin.
Most people know very little about the miracle known as the leg. However, most of us have experienced the hamstring or calf muscle cramp that sends us screaming from the bed to stretch it out, if in fact, we are able to move at all.
Muscles, all muscles, are designed and programmed to do two things: contract and relax. Unless your muscles get together and agree on the move you need to make, you can’t get out of the tub, drink your coffee or tour your jeté!
If, for instance, you decide to lift your leg out of the bath tub the muscles in the front of your thigh (the agonists) must initiate the action. However, before the agonists can get your knee up the antagonist, the hamstrings, must be notified. Should this programming be flawed, you may be stuck in the tub indefinitely or you would fall forward out of the tub.
Those beautiful columns are also an auxiliary pump for the heart. It is the action of the muscles of the leg that help pump the blood back up to the heart. Keeping the legs free of spasm helps the muscles, veins, arteries, nerves and lymph systems to do their work more efficiently and effectively.
We Are All Hung Together
Pain is one of the greatest reminders that we are all of a piece, and that trying to treat only a part of the body, organ, mind or spirit while leaving the rest on the shelf, just doesn’t work.
Joints are anchors for the muscles that move them. If the knee hurts the trouble most often lies in the quadriceps and the gastrocnemius. If the hip bothers the abductors, adductors and gluteals are usually to blame.
Reviewing the Rules of a Bonnie Prudden Myotherapy® Treatment
• Never go harder than a 5, 6, 7 on a scale of 1 to 10
• Always treat BOTH sides even if only one hurts
• Always treat ADJACENT and OPPOSING muscle groups
• Always stretch the muscle groups with Corrective Exercise following treatment to the area
Hips and Knees / Knees and Hips
You can’t treat one without treating the other. Hip and knee pain often go hand in hand. When you look at the anatomy of the leg you can clearly see that many of the muscles run over both the hip and the knee joint.
Don’t forget we are all of a piece and don’t forget the rules. Also, don’t forget that the trigger point numbers in this series are the same as are pictured on the body maps in Bonnie Prudden’s books.
To treat hip pain you must start by addressing the same trigger points as for low back pain which are shown in last month’s issue: gluteals, beltline and groin.
Once you have completed these areas and done the Corrective Exercise, have your hurting partner lie on one side with the bothersome hip up. A pillow between the legs will provide comfort and help keep them steady. Use your elbow to find the three points shown in the accompanying diagram labeled ABDUCTORS numbers 3, 4, 5 in the hip area. To keep from slipping put your hand palm down and use your thumb and forefinger to cup the elbow.
Next, move to the tensor fascia for two points, 31 and 32. To locate that area on yourself take the weight off your leg and place your hand as if you were going to slip it into your side pocket. Now stand on that leg and you will feel it contract under your hand. This powerful and often disruptive muscle creates tension (through the iliotibial band or IT band)) so that your knee doesn’t collapse. Follow the IT band down and catch a couple more trigger points on that line.
Think of yourself as a marionette controlled by strings. If the string attached to the inside of your knee is pulled the leg will come across your body. At the same time that action will also pull on your hip. So following the rules, address the opposing muscle group, the adductors.
Have your Myotherapy partner lie on her bothersome side with the top leg in front out of the way. Using your elbow again, look for trigger points on the inside of the leg in a line from just below the knee to the groin following the points on the adductor illustration. Go easy, these are apt to be very tender.
After completing these steps, get up from the table and perform the following Corrective Exercises: Hip Wags and Hip Twists, and Cross Overs, both front and back.
Repeat each of the Corrective Exercises 4 times. Is the pain gone, eased, moved, or changed in any way?
Continue the exercises throughout the day and continue doing them the next day. Remember to do them often throughout the day but only four repetitions at a time. If at the end of the second day you still have discomfort than repeat the treatment and add the following steps….for the quadriceps and hamstrings… adjacent muscle groups.
A Word About Corrective Exercises
• We call them Corrective Exercises because, if done correctly and faithfully, they teach the muscles new habits by putting them through an active range of motion and in a variety of ways.
• Muscles need variety and reminders, especially if they have been hurt. Treat yours gently while they heal.
The quadriceps consist of four muscles which are especially powerful when it comes to the dancer. Across the quadriceps runs the longest muscle in the body. The Sartorius, which affects both the hip and the knee, attaches to hip bone and to medial shaft of the tibia.
Have your partner lie on her back. Keeping all this in mind it is best to treat the quadriceps by doing three lines of trigger points: one down the center of the leg, a lateral line and a medial line. Cup your elbow between your thumb and forefinger to keep from slipping. Go in easy and hold each point for 7 seconds. You can do the center line and the medial line from one side.
The dancer’s hamstrings (there are three) must be very powerful AND very flexible. Inflexibility of the hamstrings is tied to stress and not enough physical activity to offset the stress and tension of the day. Inflexible hamstrings also account for 50% of all low back pain. Make sure all those you love can stand with their feet together, knees straight and bend over and touch the floor. If they can’t then treat the hamstrings with Bonnie Prudden Myotherapy® and Corrective Exercise and then retest. You will probably find that they can reach a little further and over time, with regular treatments and consistent hamstring flexibility exercises, they will get there.
To treat the hamstring have your partner lie face down. As with the quadriceps, address three lines for the hamstrings as shown in the diagram. Start just above the popliteal fossa (the back of the knee) in your hunt for trigger points. Go every 2 inches or so all the way up the back to the leg to the seat. If you have trouble locating the medial and lateral lines bend the knee. The tendons will be in plain view and can be used as your guideline of where to begin. Return the leg to the straight position before treating the trigger points. Follow the medial line to the seat. Walk to the other side to treat the lateral line. Once the three lines have been completed it is time for the Corrective Exercise, in this case the Flexibility Bounce. Gentle bounces are the order of the day. Tie them to something you do often throughout the day (like going to the bathroom) until your Flexibility Bounce, BOTH TO THE FRONT AND TO THE SIDE, becomes a habit.
Ballistic or Static Stretch… That is the Question?
When I was a young ballet student (way back in 1948) our stretching was always done at the end of the class when our muscles were warm from being worked for an hour. Ballistic stretch was used, bounces were gentle, done to the rhythm of the piano music selected and no one ever got hurt. In 1970 when I was teaching physical education at the University of New Hampshire a professor introduced me to what he said was the new static stretch. I tried it but found that not only did it not increase my flexibility, it hurt too. I went back to ballistic.
In 1971 I met Bonnie Prudden. The stretches she showed us were ballistic, and performed at the end of the class to music suggesting a gentle bounce rhythm. At about that time static and ballistic became controversial. Ballistic was getting a bad rap mostly because those using it were not only very tight, they were bent on becoming more flexibly no matter what. Everyone was confused. One person said one thing, someone else said another. What to do???? Bonnie explained it this way. When you perform static stretch the muscles set up a tension to keep you from going any further and hurting yourself. When you use ballistic stretch it confuses the muscle and encourages it to let go. Over many years we who use the Prudden method of both exercise and Myotherapy find that ballistic stretch works best for our purposes.
More About Stretching
James Garrick, beloved and respected sports doctor and author of Peak Condition, says that nobody thought much about stretching until the early 1960s when the football people decided that weight training should be a part of the program. Free weights were used and a maximum amount of weight was lifted through a minimum range of motion. The result was muscle bound muscles and muscle injuries. And subsequently ill-conceived programs of stretching.
You often hear athletes say “the knees go first.” This is mostly because they are over used, under treated and disrespected. Along with controversy about ballistic vs static stretch was the controversy about knee bends. “Don’t do knee bends.” “Don’t bend over.” “Bend your knees to lift the box.” Joints were made to go through full range of motion and what you don’t use you lose. Two of the most damaging activities for hips and knees is running on the road and aerobic dance. There is nothing wrong with running but cross country is much kinder to your body. And there is nothing wrong with dance but jumping up and down in the same way over and over (and usually on cement albeit covered with tile or carpet) is not dance. Bonnie used to say, “We’ve ruined our chassis to save our motors.”
Erasing Knee Pain
The knees are controlled by the quadriceps in the front of the upper leg and the gastrocnemius is the back of the lower leg. You’ve already treated the quadriceps so now have your partner lie face down with her ankles over the end of the table or a small pillow under the ankles.
Look again at illustration HAMSTRINGS and GASTOCNEMIUS. Before you begin the trigger point search gently squeeze each calf muscle. Calf muscles, like all muscle, should be soft and pliable when at rest. After you have finished treating the calf muscle test it again by gently squeezing it. You will most likely find that it is now “softer” than before.
When the gastrocnemius is treated the person often reacts by bending the other knee. This means the therapist might get kicked in the head. We usually treat the center and lateral lines from the opposite side so that our bodies keep the reaction from being lethal. When treating the medial line use your wrist to prevent being hit and remind your partner not to kick you.
Pretend the lower leg is covered with nylons of the olden days with a seam down the middle. Starting just below the popliteal space follow the seam line down the center of the muscle to the Achilles tendon. Follow this with the medial and lateral lines starting with 47 and 47A on the diagram. Now check to see if the muscle is softer and congratulate yourself. Have your partner follow this with a few gentle Half Knee Bends.
Now how do you feel? Hip pain gone, knee pain gone, looser, lighter? Continue with your Corrective Exercises for the hip and knee: Cross Overs (both front and back), Hip Wags, Hip Twists, Thigh Shift, Hamstring Flexibility Bounce (both front and side), and Half Knee Bends.
A Word About Music
As dancers you all love music. It is a part of you. When you hear it you can’t wait to move. It lifts your spirit and makes everything better. As you do your Corrective Exercises put on some music. Something like New York, New York by Roger Williams works well, and in the 3:30 minutes it takes to play you will have completed all your exercises and hardly noticed.
In the next issue we’ll address painful ankles, feet, and the Classic Greek Foot.
For more information about Bonnie Prudden®, Bonnie Prudden Myotherapy®, workshops, books, self-help tools, DVDs, educational videos, and blogs, visit www.bonnieprudden.com. Or call 520-529-3979 if you have questions or need help. Enid Whittaker, Managing Director, Bonnie Prudden Myotherapy®. Drawings by Bonnie Prudden.