By Dr. Chris Koutures, Backstage SoCal contributing expert
There are a few certainties in the dance world. Legs are going to hurt. Arms, back and hips are going to hurt. Oh, and let’s not forget one more certainty. “Dancers better be doing their core work.” Is there any certainty that “core work” can make dancers stronger and reduce pain? If so, then what exactly is the “core” and how does it affect dancers?
There are probably many definitions of dancer core work. From a dance medicine viewpoint, I’ll offer two “core” perspectives that I routinely see contributing to dancer injuries.
1) The Northern Core – upper body including shoulder blade stabilizers, muscles in the
back of the neck, and front of the chest
2) The Southern Core – lower back stabilizers, hip external rotators and hip flexors
While the “Northern Core” provides the primary foundation for arm and head movement, the ‘Southern Core” is the backbone for hip, leg, and foot control. Don’t forget that these two regions also support each other. A strong and stable upper body supports the lower area and better lower control makes the upper region move more effectively.
Poor Northern Core control is often a main contributor to dancer headache, neck, shoulder, and arm pain. Without addressing those “core strength’ issues, it will be almost impossible to make the dancer feel and perform better. It’s the same kind of story with dancer foot, ankle, knee, hip, and lower back pain issues. Sure, one can focus on the foot in cases of big toe or midfoot pain (and that is part of the treatment).
However, if any Southern Core issues aren’t fully investigated and treated, then the foot pain will likely continue. So, let’s jump right into a “stronger” look at both Northern and Southern Core Issues.
NORTHERN CORE
The shoulder girdle complex serves as the foundation of head, neck and arm movement in athletes and performers. In dancers, this area is under more stress with overhead shoulder movements, partnering, or floor work.
This complex is actually three main joints:
- Connection of the shoulder blade (scapula) to the rib cage
- Connection of the collarbone (clavicle) to the scapula
- Connection of the humeral head (ball) to the scapula (socket) – this is the most well-known “shoulder joint”
Abnormal muscle forces can affect positioning of certain bones and joints leading to pain, relative weakness, and aesthetically unpleasing posture and technique. If I see a dancer with head, neck, shoulder or arm pain, even before I do an exam, I am pretty confident that at least one of the three following issues is causing problems:
1.) Pain in the front of the chest at the coracoid process where part of the biceps and pectoralis muscles attach to the shoulder girdle. Muscle tightness can pull on the entire scapula and affect the function of other muscles. Nerves next to the coracoid can also be irritated leading to pain running down the entire arm. This type of irritation doesn’t just come from dance, it is also worsened by common regular life activities. We often operate in a “forward head/neck” position every time we use our smartphones, computers and other devices. Even taking notes in class can put pressure on the front of the chest.
Photo from Schlechter JS in Pediatric Sports Medicine: Essentials for Office Evaluation (Koutures and Wong eds). SLACK Incorporated, 2014
2.) Incomplete muscle control around the shoulder blade can lead to a “SICK scapula.” This
is where the scapula rides lower, more to the outside, and at abnormal angles. These
positions can cause pain and limit the ability of other muscles to properly function.
In dance, this is commonly seen with reaching overhead or to the side, and also with lifts
and using props.
3) Tightness in the back of that ball and socket joint (called the glenohumeral joint) can
limit movement and create pain. This is more seen with floor work and also with lifts.
How can a dancer address these issues?
A complete examination with a dance medicine specialist can confirm the source of problems and help develop a treatment plan. This should include technique recommendations for dance classes, strengthening and stretching exercises, and possible modifications of amount and type of dance during the recovery period.
SOUTHERN CORE
Want to turn, leap, and jump higher with more grace and limited pain? That’s when dancers must depend on the Southern Core – muscles behind the hips/lower back and abdominal/hip flexors in the front of the pelvic region.
Limited stability of the lower back and pelvis can lead to troubles with the knees, lower legs, and feet. Show me a dancer with knee or foot issues and I’ll probably find dysfunction with the Southern Core.
In fact, do you want to know my quickest ways to evaluate your Southern Core?
Go into plie in 2nd position.
Is the center of your kneecap right above your 2 nd toe and below your hip? If yes, then your Southern Core is probably doing a good job. If your knees, shin bones or feet collapse inward, then you don’t have a fully functioning Southern Core. Pain-free and full arabesque motion is due to solid Southern Core strength.
What is this Southern Core?
1.) The gluteal muscles (maximus and minimus) and hip external rotator muscles are
responsible for control of the legs. Weakness of these muscles does not look great
(inward collapse of the knees and middle of the feet with plie in 2 nd for example) and it
doesn’t feel great.
2.) Tight hip flexors can cause abnormal forward tilt of the pelvis, placing increased force on the bones of the lower lumbar spine and limit hip flexion. These abnormal stressors on
the lower back can lead to bone stress injuries especially with lower back extension
(arabesque) and rotation. While any lingering back pain deserves medical evaluation,
dancer back pain with leaning backwards or rotating needs more urgent
examination.
Forward tilt of the tailbone leading to increased curve and stress forces on the bones of the lower back
3.) The tailbone (sacrum) connects to both of the iliac (pelvic bones). Limitations or
abnormal positioning of this joint (aka sacroiliac joint) may lead to pain and limitations in
dance movements.
How should a dancer try to prevent issues with the Southern Core?
Well, the best way to strengthen the Southern Core is literally to focus on your Butt (muscles). Exercises such as bridges, squats, and lunges can build the Southern Core- especially if they are done with proper technique. That means those hips are lined up over the kneecap which is right above the 2nd toe. Attention to this alignment isn’t just for “core work,” it is absolutely crucial during dance moves (such as turnout, jumping and leaping) as well.
Summary on Core Work for Dancers
Focused central strength – shoulders/necks/upper chest and lower back/buttocks/hips – is essential for dancers, and many injuries I see are due to deficits in the key core areas. A strong and stable upper body that supports the lower area and gives the dancer better lower control makes the upper region move more effectively and contributes to painless moves across the dance floor.
If there are any concerns, contact my office to learn more about Dancer Core Strength and how to either reduce or treat dance injuries.
