Your Training

Beating Achilles Tendonitis: How to Avoid This Common Ailment of Pointe Dancers Everywhere

Thinkstock.

Bianca Bulle was always prone to ankle sprains. When she was 18, her recoveries became more complicated: She started experiencing Achilles tendonitis due to muscle weakness and fluid buildup in the ankle. "The last thing to get back to normal would be my Achilles, which was so incredibly tight and painful," says Bulle, now a principal at Los Angeles Ballet.

The Achilles is the body's largest tendon, attaching the bottom of the calf muscles to the back of the heel. It contracts and releases as you relevé and plié, as well as when you jump and even walk. Tendonitis, or inflammation, of the Achilles is one of the most frequently reported overuse injuries among active people, according to the American Physical Therapy Association. You'll know it by the pain or tightness at the back of the heel. If the condition gets bad enough, the tendon can rupture, which requires surgery to fix.

Achilles tendonitis is especially common among dancers on pointe, but it's not inevitable. With rest and proper conditioning, you can work to avoid it with careful technique and a commitment to cross-training.


Boston Ballet School pre-professional students. Photo by Igor Burlak Photography, Courtesy Boston Ballet.

What Causes It?


Margaret Tracey, director of the Boston Ballet School, sees Achilles tendonitis most among summer intensive students who aren't used to a heavy schedule of pointework, or young pre-professional dancers who move up a level and increase their weekly pointe schedule. But while overuse is one source of the ailment, it's rarely the only factor.

For instance, the Achilles take on more than their fair share of the load during relevés and other movements if the muscles that support the feet and ankles are underdeveloped. The same is true for larger muscle groups that support bigger movements. "Glutes and quads are big muscles for a reason," says Dr. Sarah Edery-Altas, a former professional dancer and a physical therapist at the Harkness Center for Dance Injuries at NYU Langone Health. "They're meant to propel your body up into the air."

Poor technique habits, such as not putting the heels down during jumps, can also stress the Achilles. "If I know a student is not using the depth of her plié, or not fully going through the foot and just gripping the back of the ankles, I talk to them," Tracey says.

Additionally, rolling in or forcing your turnout so that knees don't track over toes can mess with your heel alignment, aggravating the tendon. But be careful: Edery-Altas says some dancers try so hard not to roll in that they pull up on their arches too much; walking around that way can cause other alignment issues.

Sometimes, anatomical issues are the culprit. An os trigonum, or an extra bone that develops behind the ankle in some dancers, can irritate the FHL (flexor hallucis longus), which can be misdiagnosed as Achilles tendonitis and missed by many orthopedists.


Thinkstock.

How Do I Treat It?

Because of the many possible factors, it's important to get a professional medical opinion. If your Achilles is tight, stiff or tender for more than two days, especially first thing in the morning or before you warm up, you should visit a doctor (ideally one familiar with dancers' needs) to find out what's causing it. Edery-Altas recommends icing at the end of the day and resting the Achilles when possible to manage pain. That can mean doing fewer jumps and relevés, or sitting out of class altogether, depending on what your doctor says. While relative rest will allow tissues to heal, reducing activity won't cure it forever. "If you take away jumps and relevés and feel better, and then you go back, the same thing is going to happen again," she says, "because you haven't changed your mechanics, strength or technique."

Strengthening intrinsic muscles of the feet and ankles—doming, towel scrunching, resistance band point/flex exercises and learning to tap each toe individually—can help take the load of pointework off the Achilles. (See above for a helpful strengthening exercise.) Edery-Altas also recommends bodyweight-based strengthening exercises, especially squats, which target the large glute, quad and hamstring muscles.

As for ballet class, it pays to plié. The Achilles is elastic, so elongating it in a full plié before a jump will give you more power as the tendon springs back to size, says Edery-Altas. Bulle recommends using elastic ribbons, which are gentler on the backs of the ankles. Stretching your calves periodically throughout class is also important. You can do a basic calf stretch and runner's lunge, or hang the heels off a step. Dynamic stretching helps, too. Bulle practices yoga's downward dog pose, "not holding it but moving through the stretches."

If you've taken time off to heal, use caution when returning to class. Edery-Atlas says it's not okay to push through the pain, even if it only reaches 2 or 3 on a scale of 10. At that point, you should stop or modify movements that bother the tendon, and talk to your physical therapist or doctor again. You may not be ready to return to class yet.

Have your teacher monitor your technique closely. You may need a PT's help to retrain your body—alignment issues, especially, may be too subtle to correct on your own. Talk to your teacher about the PT's recommendations in terms of what to watch for, as well as any restrictions on your dancing. Tracey encourages her students to talk to her right away if they're feeling pain. "We have one instrument," she says. "From time to time it's out of tune, but it's our job to make sure we keep it strong and healthy."

Relevé Exercise for Achilles Tendons

Dr. Sarah Edery-Altas of the Harkness Center for Dance Injuries recommends this exercise, which targets the calf muscles that
connect to the Achilles tendon, for conditioning as well as for recovering from tendonitis. Those recovering may experience pain that ranks 2 or 3 on a scale of 10. That's okay for this exercise.

1. Stand in parallel, with feet a comfortable hips' width distance apart.

2. Keep your knees straight for the whole exercise, and lean the torso forward slightly, maintaining a neutral spine.

3. Lift your heels in a full relevé.

4. Lift one foot off the floor, and lower the standing heel slowly.

5. Repeat on the other side.

  • Try 15 reps twice daily for 12 weeks.
  • If you have time and can tolerate it, the exercise can also be done with bent knees and with the heels hanging off a step, for a larger range of motion.
Show Comments ()
Ballet Stars
Elisabeth Beyer. Photo Courtesy VAM Productions.

Congratulations to the 2018 YAGP winners! After months of semi-finals, 1,800 dancers from around the world were chosen to attend a week of finals in New York, competing for ballet scholarships and contracts. We've been following the action all week (you can catch up on our backstage coverage, here). The 2018 competition wrapped up on April 19 with the Stars of Today Meet The Stars of Tomorrow gala which featured performances from pros like American Ballet Theatre's Isabella Boylston and New York City Ballet's Tiler Peck. Following today's awards ceremony, YAGP has just announced this year's winners (aka the dancers you're going to want make note of). Check out the full list and highlights from the competition below.

Senior Women

1st Place: Elisabeth Beyer (15), Ellison Ballet - Professional Training Program, NY, USA

2nd Place: Guo Wen Jin (16), Shanghai Dance School, China

3rd Place: Seon Mee Park (18), Korea National University of Arts, Korea

3rd Place: Basia Rhoden (15), Master Ballet Academy, AZ, USA


Guo Wen Jin; Courtesy VAM Productions

Keep reading... Show less
Ballet Stars
Photo by Rob Becker, courtesy DePrince.

In January, a commercial for Chase's QuickPay Mobile App starring Michaela DePrince aired on national television. In March, it was announced that Madonna would be directing the movie version of DePrince's autobiography. And in April, she graced the cover of Harper's Bazarre Netherlands. With all the buzz, it's easy to forget that the Dutch National Ballet soloist has been sidelined since August 2017 with a ruptured Achilles tendon. Pointe checked in with DePrince to see how her recovery is going.

Last fall, you ruptured your Achilles tendon. How did that happen?

It was the first of August. I was in Sicily doing an event with Google. We had dinner at a temple and it was just absolutely incredible. I'm kind of clumsy outside of ballet, so I thought it would be safer if I took my shoes off. Then Lenny Kravitz starts to sing a song and he dedicates it to me. I got up and went to go sit next to him on the stage. When I got up from sitting, I stepped in the wrong place at the wrong time. I knew right away that I ruptured my Achilles. They brought me to an ambulance and took me to the hospital. I flew back to the Netherlands the next day and had an appointment with the doctors here in Amsterdam. They said, "Yeah, you ruptured three quarters of your Achilles." And then on August 14, I had surgery.

Keep reading... Show less
Ballet Stars
From left: Jennifer Stahl, Lonnie Weeks and Sasha De Sola in rehearsal for Trey McIntyre's new work. Photo by Christian Peacock for Pointe.

Photography by Christian Peacock

Summer is always a lively time at San Francisco Ballet, as the dancers return from vacation and launch into rehearsals for the upcoming season. But last July through September felt absolutely electric with creativity as the company created 12 world premieres for Unbound: A Festival of New Works, a cutting-edge program that will run April 20–May 6 at the War Memorial Opera House.

Artistic director Helgi Tomasson invited a wish list of international choreographers to participate: David Dawson, Alonzo King, Edwaard Liang, Annabelle Lopez Ochoa, Cathy Marston, Trey McIntyre, Justin Peck, Arthur Pita, Dwight Rhoden, Myles Thatcher, Stanton Welch and Christopher Wheeldon. Each got about 12 dancers, three weeks' studio time and, aside from a few general guidelines, total artistic freedom.

Keep reading... Show less
Ballet Careers
Make sure you're comfortable slipping into pointe shoes for center. Photo by Jim Lafferty.

I was offered a company contract (my first!) starting this fall. What should I do in the meantime to make sure I'm as prepared as possible? —Melissa

Keep reading... Show less
News
Olga Smirnova. Photo by Quinn Wharton.

Several weeks ago, Youth America Grand Prix announced that the lineup for tonight's Stars of Today Meet the Stars of Tomorrow gala at Lincoln Center's Koch Theater would include Bolshoi Ballet principal Olga Smirnova and first soloist Jacopo Tissi. But an article in Page Six published last night states that Smirnova and Tissi were denied visas to enter the US.

YAGP organizers "believe the Department of Homeland Security's decision may be motivated by the myriad tensions between the superpowers," says the piece, noting that "Smirnova is so revered in Moscow that her treatment could create a Russian backlash." The Mariinsky Ballet's Kimin Kim did receive a visa and was allowed to perform as scheduled.

Keep reading... Show less
Ballet Stars
Houston Ballet principal Connor Walsh getting early practice as a leading man. Photo courtesy Connor Walsh

It's that time of year again—recital season! And not so long ago, some of your favorite ballet dancers were having their own recital experiences: dancing, discovering, bowing, laughing, receiving after-show flowers, making memories, and, of course, having their pictures taken! For this week's #TBT, we gathered recital photos—and the stories behind them—from five of our favorite dancers.

Gillian Murphy, American Ballet Theatre

Murphy gets ready for her role as "Mary Had a Little Lamb." Photo courtesy Gillian Murphy.

"This photo was taken by my mom when I was 11, waiting in the dressing room (the band room of West Florence High School in South Carolina) before I went onstage as 'Mary' for a recital piece featuring 3-year-olds as little lambs.I had so much fun being the teacher's assistant in the baby ballet class each week, particularly because my little sister Tessa [pictured below] was one of the 3-year-olds. I remember feeling quite grown up at the time because I was dancing in the older kids' recital piece later in the program, but in this moment I was just looking forward to leading my little lambs onstage in their number."

Keep reading... Show less

Sponsored

Videos

Sponsored

mailbox

Get Pointe Magazine in your inbox

Sponsored

Win It!