Musculo-skeletal   [back to the Category]

Muscular tightness in calf and Achilles tendonitis   [read the french version]

Author :   Errol Toran, D.C.

This month's Case en Pointe concerns one of the most common dance injuries - Achilles Tendonitis. Ann, a classically trained dancer presented to the office with deep pain and muscular tightness in her left calf. The sharpest pain was located on the outside behind the knee with a chronic dull pain in the general area of the achilles tendon. The beginning of class was the worst because her calf took longer and longer to warm up. At the barre, even the most shallow plies were torture. Every time that she tried to point her foot she felt the achilles grip. Her calf would just start to loosen up and feel better when the class would begin small jumps. By the time she got to the second side, she would have to stop. She found that she could stretch out the calf before grand battements and she could make it through the adagio. It was in the second or third pass of big jumps where she would land on the injured leg and have it buckle due to the sharp pain.

The calf is made up of two muscles, the Gastructnemeus and the Soleus. They both terminate in the achilles tendon but the deeper soleus attaches to the shin bones while the gastrucnemius stretches to the top of the knee. This means that when the knee is bent and the toes are pointed, movement is governed by the soleus. The gastrucnemius is the prime mover when the knee is straight. This means that pain in fondue is probably due to soleus injury and landing with an outstretched leg from a grande jete aggravate a gastructnemeus injury. There are several other muscles in the lower leg that could also cause pain and need to be ruled out by a health care professional.

Upon examination it was found that Ann suffered a shift in her pelvic bones that caused one leg to be functionally longer than the other. The artificial lengthening caused the muscles on the back of the leg to be stretched. When she lands on that leg, the already stretched muscle is under even greater tension. The same is true for port de bras forward or when she rolls up to releve or on pointe. Increased tension, gradual (repeated releve) or sudden (landing from jumps) will tear the muscular and tendonous tissues when they are repeatedly traumatized.

Healing can occur while still taking class or performing, the trick is to reduce the tension. Some movements in class may have to be temporarily eliminated and the tissues have to be actively treated. Rest or stretching alone will not correct the condition. The pelvic bones have to be re-oriented and the calf muscles must be massaged, and the inflamed tissues treated with electric muscle stimulation. Once the inflammation and injury has been reduced, a gradual rehabilitation protocol needs to be implemented. Going back to class on a weak muscle or tendon can be a big mistake because re-injury will cause the acute condition to become chronic. Protect your career, be patient as your body heals, take your time and do it right.