- Look above the shin
Landing from a jump with poor hip or buttock strength can lead to an inward collapse of the knee. This can place abnormal rotational forces on the shin. Similar lack of upper leg control can lead to collapse of the foot arch, again causing increased stress on the shin. My favorite upper leg strength evaluation is to put a dancer into second position plie. Ideal alignment has the kneecap directly under the hip and over the second toe.
Plie in second position: note kneecap directly under hip and over second toe
2. Look immediately below the shin
Decreased ankle dorsiflexion (ability to move shin towards the foot or foot toward the shin) can also increase stresses on the shin. Common causes of this decreased motion include tight calf muscles or restricted movements between the tibia (shin bone) and the talus (first bone of the foot). Side-to-side comparisons can help identify abnormal motion.
3. Try to stand on toes or walk on the outside of the foot
In demi-pointe, the calcaneus (heel bone) should move inward when standing on the toes. Dancers should also be able to walk comfortably on the outside border of the foot. Limited heel motion or inability to walk on the outside of the foot suggests abnormal motion of the sub-talar joint. Poor motion of the sub-talar joint (which is underneath the ankle joint) is another cause of increased stress to the shin.
4. Never under appreciate the importance of the big toe
It is amazing how restricted movement of the big toe can lead to big problems in the shin. Limited ability to raise the big toe off the ground leads to higher forces on the front of the shin. Stretching of the flexor halicus longus muscle that controls big toe motion can be life and career-saving.
5. Stressful causes of cramping calves
While most calf tightness or cramping is due to muscle fatigue, be very suspicious of cramps that can be pointed out by a finger-tip. If this finger-tip pain happens to be right next to bone, be even more suspicious. I have found multiple cases of tibial stress injuries that started with a concern of calf cramps.
Red arrows point to shin stress injuries
6. How are the iron stores?
Some cases of difficult shin pain may be complicated by low iron stores in the body. Higher risk dancers include females with heavier menstrual periods or performers with restricted dietary iron of red meat, red fish, dark poultry, leafy green vegetables, nuts and raisins. Blood tests under the supervision of a dance medicine specialist can help make the diagnosis.
7. What are you wearing on your feet?
I often see patients wearing ill-fitting or poorly supportive shoes or sandals for non-athletic activities. I’ve learned that if you can twist a shoe or sandal like a rolled newspaper, then there isn’t much mid-foot support. Using relatively inexpensive over-the-counter arch supports in daily use shoes can allow one to be both fashionable and functional. Leave sandals for the pool or beach!
8. Where are you dancing?
Harder dance floors make it harder on the shins. Wood floors with appropriate cushioning underneath are most comfortable for the legs. Harder floors (such as parking lots or concrete) are often seen with conventions or dancing on a production set. Try to limit the number of leaps and jumps on harder surfaces.
These eight tips are designed to reduce shin issues from starting, and to limit shin pain if and when it shows up. This information is not a substitute for working with dance medicine specialists. Never let shin pain limit your dancing, and never hesitate to visit with dance medicine professionals. The earlier you get a proper plan to treat shin problems, the earlier you should be able to return to jumping and leaping without pain.
Dr. Chris Koutures is a dual board-certified pediatric and sports medicine specialist who practices at ActiveKidMD in Anaheim Hills, CA. He is a team physician for USA Volleyball (including participating in the 2008 Beijing Olympics), the U.S. Figure Skating Sports Medicine Network, Cal State Fullerton Intercollegiate Athletics, Chapman University Dance Department, and Orange Lutheran High School. He offers a comprehensive blend of general pediatric and sport medicine care with an individualized approach to each patient and family. Please visit activekidmd.com or follow him on twitter (@dockoutures).
