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Chronic Hip and Back Pain

One of the most common occurrences that we see in the clinic is Full Time Dancers with chronic hip and back pain. The curious thing is that many of these students also have recurrent or chronic issues with their digestive system. This interaction is extremely complicated, but I wanted to write an article on the first level of this relationship, and how we can help dancers through it. I hope it makes sense!

These students are also usually hyper mobile, which is often desirable in a dancer, however at present if they also lack the deep control of her local stabilisers (especially the small deep back muscle, pelvic floor and deep abdominals, as well as her true turnout muscles) to control this increased movement effectively, they will often have problems. If the deep muscles are not effectively engaging to control the spine at a segmental level, then the bigger back muscles will grip on, trying to substitute for the deeper ones.

Unfortunately, these two muscle groups are physiologically very different. The deep back muscles are designed for endurance; that is, to work at a low intensity for long periods of time. The bigger back muscles are more phasic muscles, and are designed for movement. The faster twitch muscle fibres are best used for short bursts of activity.  If the big back muscles (Erector Spinae) are on constantly this results in stiffness and pain in the low back, as the muscles are being used for a job that they are not physiologically designed to do. This then usually leads to chronic hip and back pain.

Anyone who has this scenario will feel that they constantly want to have a massage, and will frequently stretch and crack their back trying to relieve the pressure. Unfortunately this often gives only very temporary relief. Real relief comes from specifically retraining the deepest muscles, but this is often easier said than done…

While most dancers spend a lot of time trying to strengthen their abdominals, but there are a few critical factors that may have made this difficult to achieve.

The body has a rather unfortunate default mechanism in that when there is low back pain present, the deep stabilizers of the low back (specifically the Multifidus and Rotatores muscles) are actually inhibited, meaning that they are very hard to activate, even if you is doing all of the right exercises. Attempting these exercises while pain is still present will usually just result in more recruitment of the bigger back muscles. Relieving the discomfort in the low back is essential before trying to strengthen these muscles.

Chronic Hip and Back Pain in Hypermobile Dancers

Alexandra Istrate

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