The Sprained Ankle That Won't Heal
Do you have a sprained ankle that won't heal? It's not that rare. Studies have shown that 10 to 30 percent of sprains will have symptoms later. So what is a sprained ankle anyway? It's the most common injury in all of sports and dancing.
Dancing pushes your body to its limit. If you roll over on your ankle when landing from a jump, you can sprain or injure the ligaments on the outer (lateral) side that hold the joint together. This is different from a "strain," which affects your tendons and muscles. An easy way to remember this distinction is this: You sprain your ankle, but you strain your Achilles tendon. The degree of injury varies, depending on the damage to the ligaments. We determine this by a physical exam and X-rays that help us classify the ankle sprain as Grade I (mild), II (moderate), or III (severe). The most serious sprain involves a complete tear of the ligaments with marked instability that often requires surgery. Fortunately, most sprains are Grade I or II and heal in three to six weeks. The exceptions are those that continue to cause trouble. This is the "sprained ankle that won't heal."
In medical circles, residual problems from sprained ankles cause considerable angst, because they can be hard to diagnose and difficult to treat-especially when telltale signs are ignored by stoic dancers. Problems with old sprains tend to fall into three categories: swelling, pain, and instability ("giving way").
It's normal for a sprained ankle to swell, sometimes for four to six weeks, or longer. But swelling that persists for more than three months may be a sign of trouble. The lining of the capsule surrounding a joint is called the synovium, and anything inside the joint that irritates the synovium will cause it to secrete fluid. Swelling inside of a joint is often a sign that something is causing irritation. (The swelling that is seen from the outside is a combination of soft tissue swelling around the joint and fluid within the joint itself.) In the ankle there are several reasons for this condition. While these may seem alarming, treatment is possible. But first, let's take a look at the culprits.
Chronic synovitis Sometimes there is damage to the surface of the joint that does not show up on any tests, such as an X-ray or MRI, even though it continues to cause irritation and excess fluid.
A bone chip At the time of injury, a bone chip may have been knocked loose, leaving a "loose body" floating around inside to cause trouble.
An OCD lesion "OCD" in sports medicine stands for osteochondritis dissecans (not obsessive compulsive disorder). The easiest way to think of this is like a cavity in a tooth. It is something that leaves a small hole in the surface on the ankle bone (the talus) with a dead piece of bone in it. An MRI study will usually pick this up.
A bone bruise This is not black and blue. Instead, it feels like an achy pain that is difficult to explain and lasts for months. There is edema, or fluid, within the bones themselves that we can only see on an MRI study. Fortunately, it is rarely serious and gradually fades away.
What can you do? Treatment for chronic swelling, no matter what the cause, usually requires sleeping with the leg elevated on a pillow at night and putting on an elastic ankle support in the morning when you get out of bed. If the swelling is minimal and is slowly going away with no other symptoms, it is OK to dance, but go easy on the jumps and grand plies till all the swelling is gone. However, if it doesn't feel so good then don't do it! An ankle support (no need for metal hinges, etc.) usually feels good at this stage.
It also helps to avoid the saltshaker, which leads to water retention. With diligence, the swelling should go away. However, if the leg is swollen up the shin, something else may be happening, and it needs to be checked out by your doctor. Swelling that does not go away is a sign that something more is wrong. Normal joints do not swell.
There are several common causes of ankle pain that does not go away:
The sinus tarsi syndrome Lingering inflammation, scar tissue, or a partly torn ligament can occur in the hollow place in the side of the anklebone called the sinus tarsi (sinus in Latin means hollow or sunken and the tarsus is the ankle). This is the most common cause of the sprained ankle that won't heal. While it can be difficult to discern this problem on an X-ray or MRI, a physical exam by a dance medicine specialist can pinpoint the diagnosis by locating the exact area that hurts.
A tarsal coalition Residual pain in the sinus tarsi after the original sprain heals can also be due to an unrecognized tarsal coalition. The ankle has two components: the regular ankle joint that moves up and down, and the subtalar (ST) joint beneath it that moves in and out. Together, they make up the ankle joint complex. Some people are born with limited motion in their ST joint because the bones in this area are joined together where they ought to be separate—a coalition. It can usually be seen on an X-ray or MRI. This condition is present in about five percent of ankles. It usually occurs in one ankle only, rather than both. As with a sprain, it can be mild, moderate, or severe. In dancers, it is usually mild or it would have caused trouble before the sprain. Dancers with mild symptoms can often work around it.
The high ankle sprain This is marked by tenderness in the front of the ankle on the outside. Unlike routine ankle sprains where the main damaged ligaments lie right in the sinus tarsi, this one affects a ligament that is higher up, at the level of the ankle joint itself. This is the so-called "high" ankle sprain, which can be a real bugaboo because it takes two to three times longer to heal than a routine sprain. It may not show up on medical tests, so the diagnosis is usually made on the basis of the physical exam.
Secondary problems Lastly, there are several conditions, such as FHL tendonitis ("dancer's tendonitis") and the os trigonum syndrome that seem to pop up out of nowhere. Dancers often think that the residual pain is part of the healing process when it is actually a separate problem. Later the sprain may heal, but these conditions can continue to be painful and may even require surgery if left unaddressed.
"My ankle gives way" is probably the second most common leftover problem with ankle sprains after the sinus tarsi syndrome. We doctors see it all the time. Many things can cause this problem. Fortunately most respond to appropriate treatment.
Peroneal weakness There are two peroneal tendons that run parallel down the outside of the ankle; one is short and the other is long. Their major function is to keep the ankle from rolling over and prevent sprains. After an injury they can remain weak, so the ankle is poorly protected from further roll-overs. It's easy at this point to fall into the vicious cycle of "Because it's weak it rolls over and because it rolls over it's weak," which can go on for months. If this is the problem, it is easy to fix. Simply restore the normal peroneal strength with physical therapy. A few months of daily use of a theraband, under the guidance of a physical therapist, will usually strengthen the peroneals. (They gain strength faster if the exercises are done in the full "tendu" position.)
Laxity of the ankle ligaments Grade I sprains do not usually damage the ankle ligaments to any extent, but repeated Grade II or Grade Ill injuries can lead to permanent looseness of the ligaments that hold the anklebones together. This is a difficult situation, because they can be tightened only by surgery. The surgery is quite effective, but the recovery is usually three months or more. So it is nice to avoid it if you can.
Many loose ankles often give way because of a combination of looseness and weakness. These can often be brought up to full strength with physical therapy and then they don't give way anymore. The number one indication for ankle ligament surgery is the failure of rehab to correct the problem.
Pain, swelling and instability
The problems associated with a recurring sprained ankle can co-exist and produce all three symptoms. In this ease the diagnosis is particularly difficult. There is one last problem that might be going on:
Peroneal tendon damage With repeated sprains, the peroneal tendons can develop small longitudinal rents or tears. When this happens, the tendons swell up in the sheathes that surround them and cause achy pains, chronic swelling and weakness that cannot be corrected by exercise. This problem is easy to miss and hard to correct because it usually gets worse in spite of all treatment. Fortunately, this condition also responds well to surgery.
The best way to diagnose these various problems is to see a sports or dance medicine specialist for a history, physical exam, and appropriate studies. Your doctor may request X-rays followed by an MRI, CT and/or bone scan. Physical therapy is usually the first step in the recovery. Do not try to treat yourself! There is an old expression in medicine that says, "Someone who treats themselves has a fool for a physician." Merde!
William G. Hamilton, M.D. is the orthopedic consultant for New York City Ballet, American Ballet Theatre, The School of American Ballet and the Jacqueline Kennedy Onassis Ballet School.
Alicia Alonso's famed ballet company in Cuba has a new leader: the beloved hometown prima ballerina Viengsay Valdés.
Ballet Nacional of Cuba just named Valdés deputy artistic director, which means she will immediately assume the daily responsibilities of running the company. Alonso, 98, will retain the title of general director, but in practice, Valdés will be the one making all the artistic decisions.
I'm terrified of performing choreography that changes directions. I messed up last year when the stage lights caused me to become disoriented. What can I do to prevent this from happening again? I can perform the combination just fine in the studio with the mirror.
—Scared, San Francisco, CA
From the angles of your feet to the size of your head, it can sometimes seem like there is no part of a dancer's body that is not under scrutiny. It's easy to get obsessed when you are constantly in front of a mirror, trying to fit a mold.
Yet the traditional ideals seem to be exploding every day. "The days of carbon-copy dancers are over," says BalletX dancer Caili Quan. "Only when you're confident in your own body can you start truly working with what you have."
While the striving may never end, there can be unexpected benefits to what you may think of as your "imperfections."
It's the second week of Miami City Ballet School's Choreographic Intensive, and the students stand in a light-drenched studio watching as choreographer Durante Verzola sets a pas de trois. "Don't be afraid to look at the ceiling—look that high," Verzola shows one student as she holds an arabesque. "That gives so much more dimension to your dancing." Other students try the same movement from the sidelines.
When Arantxa Ochoa took over as MCB School's director of faculty and curriculum two years ago, she decided to add a second part to the summer intensive: five weeks focused on technique would be followed by a new two-week choreography session. The technique intensive is not a requirement, but students audition for both at the same time and many attend the two back-to-back.
On a summer afternoon at The Ailey School's studios, a group of students go through a sequence of Horton exercises, radiating concentration and strength as they tilt to one side, arms outstretched and leg parallel to the ground. Later, in a studio down the hall, a theater dance class rehearses a lively medley of Broadway show tunes. With giant smiles and bouncy energy, students run through steps to "The Nicest Kids in Town" from Hairspray.
"You gotta really scream!" teacher Judine Somerville calls out as they mime their excitement. "This is live theater!" They segue into the audition number from A Chorus Line, "I Hope I Get It," their expressions becoming purposeful and slightly nervous. "Center stage is wherever I am," Somerville tells them when the music stops, making them repeat the words back to her. "Take that wherever you go."
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Dance artists, as a rule, are a resilient bunch. But working in a studio in New York City without heat or electricity in the middle of winter? That's not just crazy; it's unhealthy, and too much to ask of anyone.
Unfortunately, Brooklyn Studios for Dance hasn't had heat since mid-November, making it impossible for classes or performances to take place in the community-oriented center.
So what's a studio to do? Throw a massive dance party, of course.
As winter sets in, your muscles may feel tighter than they did in warmer weather. You're not imagining it: Cold weather can cause muscles to lose heat and contract, resulting in a more limited range of motion and muscle soreness or stiffness.
But dancers need their muscles to be supple and fresh, no matter the weather outside. Here's how to maintain your mobility during the colder months so your dancing isn't affected:
A newly launched initiative hopes to change the face of ballet, both onstage and behind the scenes. Called "The Equity Project: Increasing the Presence of Blacks in Ballet," the three-year initiative, funded by the Andrew W. Mellon Foundation, is a partnership between Dance Theatre of Harlem, the International Association of Blacks in Dance and Dance/USA.
"We've seen huge amounts of change in the years since 1969, when Dance Theatre of Harlem was founded," says Virginia Johnson, artistic director of DTH. "But change is happening much too slowly, and it will continue to be too slow until we come to a little bit more of an awareness of what the underlying issues are and what needs to be done to address them."
From the outside, it seemed like the worst of New York City Ballet's problems were behind them last winter, when ballet master in chief Peter Martins retired amid accusations of abuse and sexual harassment, and an internal investigation did not substantiate those claims.
But further troubles were revealed in August when a scandal broke that led to dancer Chase Finlay's abrupt resignation and the firing of fellow principals Amar Ramasar and Zachary Catazaro. All three were accused of "inappropriate communications" and violating "norms of conduct."
The artistic director sets the tone for a dance company and leads by example. But regardless of whether Martins, and George Balanchine before him, established a healthy organization, the issues at NYCB bespeak an industry-wide problem, says Jawole Willa Jo Zollar, founding artistic director of Urban Bush Women. "From New York City Ballet to emerging artists, we've just done what's been handed down," she observes. "That has not necessarily led to great practices."
If you've ever wondered what goes on behind the scenes at Dance Magazine, now's your chance to find out. Dance Magazine is seeking an editorial intern who's equally passionate about dance and journalism.
Through March 1, we are accepting applications for a summer intern to assist our staff onsite in New York City from June to August. The internship includes an hourly stipend and requires a minimum two-day-a-week commitment. (We do not provide assistance securing housing.)
For the past few months, the dance world has been holding its collective breath, waiting for New York City Ballet to announce who will take over the helm as artistic director.
Though former ballet master in chief Peter Martins retired over a year ago after accusations of sexual harassment and abuse (an internal investigation did not corroborate the accusations), the search for a new leader didn't begin until last May.
Nine months later, the new director's name could be released any day now. And we have some theories about who it might be:
Some people take this profession as just a chapter of their life. They feel like dance is a job—a fun job, but a job. Other people live their life through dance. I never considered being a ballerina a profession. It's a lifestyle.
If I don't have a performance, I feel like a tiger trapped in a cage. I have so many emotions, I feel I need to give them to somebody, to exhaust myself—I need to cry or laugh, or else it's suffocating. Other people might scream or throw bottles into the wall. We dancers scream onstage through our movement. For me, it's like sweeping off the dust in my soul.
Back in 2011, Yale University's dean of science was thinking about refreshing the program's offerings for non-majors when he happened upon a Pilobolus performance. A light bulb went off: Dance is full of physics.
That realization led to what has become an eight-year collaboration between particle physicist Sarah Demers and former New York City Ballet dancer Emily Coates, both professors at Yale who were brought together to co-teach a course called The Physics of Dance. Their partnership has involved everything from directing a short film to presenting a TedX Talk and performing a piece that Coates created, commissioned by Danspace Project. This month, they're publishing a book about what they've discovered by dialoging across two seemingly disparate disciplines.
What's next for the dance world? Our annual list of the dancers, choreographers and companies that are on the verge of skyrocketing has a pretty excellent track record of answering that question.
Here they are: the 25 up-and-coming artists we believe represent the future of our field.
Though Polunin has long had a reputation for behaving inappropriately, in the last month his posts have been somewhat unhinged. In one, Polunin, who is Ukrainian, shows off his new tattoo of Vladimir Putin:
Watching Bohemian Rhapsody through the eyes of dancer, there's a certain element of the movie that's impossible to ignore: Rami Malek's physical performance of Freddie Mercury. The way he so completely embodies the nuances of the rock star is simply mind-blowing. We had to learn how he did it, so we called up Polly Bennett, the movement director who coached him through the entire process.
In a bit of serendipitous timing, while we were on the phone, she got a text from Malek that he had just been nominated for a Golden Globe. And during our chat, it became quite clear that she had obviously been a major part of that—more than we could have ever imagined.
Sebastian Abarbanell remembers being asked as an undergrad at Trinity Laban in London to perform wearing only a dance belt. "I said no," he says, "because I felt uncomfortable." Now a performer with Sidra Bell Dance New York, he's performed partially nude several times, without reservation. The difference? "It comes with more experience and maturing as a dancer," he says. "When you see a dancer living in their skin, you don't need to put anything else on them. When I said no in college, I wasn't in my skin yet."
Getting in your skin—and getting comfortable wearing only your skin onstage—requires a particular alchemy of vulnerability, agency, preparation and practice.
Birmingham Royal Ballet announced today that international star Carlos Acosta will be taking over as director in January of 2020. Current BRB director David Bintley will be stepping down this summer, at the end of the company's 2019 season, after a 24-year tenure. "It is a tremendous honor and privilege to have been appointed to lead Birmingham Royal Ballet," Acosta said in a statement.
Since retiring from The Royal Ballet in 2015, Acosta has focused much of his attention on his native Cuba, where he's proven his directorial abilities at the helm of Acosta Danza, the contemporary company that he founded in 2016. In 2017 Acosta also opened his first Dance Academy through his foundation, which provides free training to students. We don't yet know how Acosta will balance his time between his projects in Cuba and his new role at BRB.
My personal life has taken a nosedive since I broke up with my boyfriend. He's in the same show and is now dating one of my colleagues. It's heartbreaking to see them together, and I'm determined never to date a fellow dancer again. But it's challenging to find someone outside, as I practically live in the theater. Do you have any advice?
—Loveless, New York, NY
The inimitable Carol Channing, best known for her role as the titular Hello, Dolly!, passed away today at 97.
Though she became a three-time Tony winner, Channing was born in Seattle, far from the Great White Way, in 1921. After growing up in San Francisco, she attended the famed Bennington College, studying dance and drama. She later told the university, "What Bennington allows you to do is develop the thing you're going to do anyway, over everybody's dead body." For Channing, that meant decades of fiery, comical performances, bursting with energy.
Something's coming, I don't know when
But it's soon...maybe tonight?
Those iconic lyrics have basically been our #mood ever since we first heard a remake of the West Side Story film, directed by Steven Spielberg and choreographed by Justin Peck, was in the works. THE CASTING. THE CASTING WAS COMING.
Well, last night—after an extensive search process that focused on finding the best actors within the Puerto Rican/Latinx community—the WSS team finally revealed who'll be playing Maria, Anita, Bernardo, and Chino (joining Ansel Elgort, who was cast as Tony last fall). And you guys: It is a truly epic group.