The most vulnerable tendons in a dancer are the tendons of the foot & ankle. Though, the patellar & hip flexor tendons are also commonly over-stressed, as well. One thing is certain. Dancers, perhaps more than any other athlete, must take extra care of their tendons. This requires routine preventative and maintenance care, with the goal of building resilience. Let’s talk about what a tendon is.
A tendon is a “tough, high-tensile-strength band of dense fibrous connective tissue that connects muscle to bone.” Tendon – Wikipedia. It is a beautiful blend of elasticity & strength, made up mostly of collagen. This allows a tendon to efficiently transmit the forces of muscle contraction to the skeletal system while taking on significant amounts of tension. A tendon stretches during muscle contraction, allowing the muscle to activate with little or no change in its length.
Most tendons have a poor blood supply… meaning, it takes longer to heal after strenuous activity or injury. One of the many reasons tendons need extra love.
What makes a “healthy tendon”?
In a healthy tendon, “the collagen fibers are parallel to each other and organized” Tendon – Wikipedia.
Women may be more susceptible
Estrogen has been found to affect the acute exercise-related increase in collagen synthesis. This study and others have discovered that women’s tendons are slower at regenerating collagen after activity. So, it is in the female dancer’s best interest to do all she can to stimulate that process.
Role of Genetics
In addition to gender, your specific genetic makeup may make you more susceptible. For instance, the COL5A1 gene affects the structure & function of collagen in the ligaments & tendons and the COL1A1 gene builds the collagen chain that affects the strength of tendons.
Vitamin C is also essential to producing collagen in the body. Your genetics can play a role in how well your body uses Vit C, particularly the CLS23A1 gene. These are a few of the insights you will gain in the DanceRX genetic test!
Does tendon pain indicate tearing of the tendon?
For the most part, tendon injuries do not involve tearing of the tendon. Pain, weakness and swelling often occur as a result of inflammation of the outer covering of a tendon (tenosynovitis or paratenonitis), not the main portion of the tendon. Another common area that causes pain is the area where the muscle & tendon join (musculotendinous junction). Chronic, long-lasting tendon pain issues are most often a result of a change in the organization and matrix of the collagen fibers (tendinopathy) and not inflammatory at all. It’s more about this disorganization than a separation of fibers (tearing) or inflammation (see visual). With time, this does make the tendon weaker and inefficient, leading to tears if not addressed appropriately.
This review describes Achilles tendinopathy as “a failed healing response, with haphazard proliferation of tenocytes, some evidence of degeneration in tendon cells and disruption of collagen fibers, and subsequent increase in non-collagenous matrix.” Basically, tendinopathy is a tendon that loses its original properties, making it unable to withstand stress as it should.
What Can You Do?
Several studies reveal that gradual, controlled linear loading of a tendon can realign the collagen fibers and thicken a tendon. Tendon length does not change, what you are born with is what you get. But, with short-term and long-term controlled loading of the tendon, collagen regeneration increases.
However, the type and frequency of loading matters. This study concluded that “strain rather than stress/torque determines the collagen-synthesis stimulating response seen with exercise.” And, further, that “only with very prolonged loading, (there can be) a robust change in the size and mechanical properties of human tendons.” This means that controlled, graduated and routine strengthening along the length of a tendon (not haphazard, twisting or jumping -type exercises) will have this effect. Hence, dancing alone won’t cut it.
How Do You Do It?
Here is my favorite program for progressive, linear strengthening of the Achilles and Flexor Hallucis Longus (2 most common tendinopathies in dancers): Progressive Tendon Loading for Ankle/Foot
** Note: these should be nearly pain-free. If you are having pain at any stage, drop back to the prior stage for an additional 2 weeks.
Week 1 – Use Both Feet (5 sets of 5)
Week 2 – Both Feet (3 sets of 10-12)
Week 3 – Both Feet (2 sets of 20)
Week 4 – Single Leg (5 sets of 5 each leg)
Week 5 – Single Leg (3 sets of 10 each)
Week 6 – Single Leg (2 sets of 15 each)
Week 7 – Single Leg Raises (2 sets of 15) plus Step-Ups on 8” step (5 sets of 5 each leg)
Week 8 – Single Leg Raises (2 sets of 15+) plus Step-Ups on 8” step (5 sets of 10 each)
Week 9 – Single Leg Raises (2 sets of 15+) plus Step-Ups on 8” step (2 sets of 15 each)
Continue the week 9 routine 3x/week up to daily
- Additional progression options (after the 9-week build-up):
- Add dumbbells (start with 2lbs in each hand, progress through week 1-9 again. Increase weight every 9wks, maxing at 10lbs in each hand for Double leg, 15 lbs per hand for step-ups and 5lbs per hand for single leg)
- Increase reps, gradually, up to 3 sets of 30.
- Increase speed of reps (be sure to still get full range of motion)
- Add in Forward Lunges
- Add in Jump Rope (double & single leg) for 2-5 min
The Fasciitis Fighter can be purchased here.
Patellar Tendon Loading
For Patellar Tendon loading, use these exercises: Patellar Tendon Progressive Loading Exercises
Follow the same progression as above, using the following guidelines:
- Leg Press or Squats (double weeks 1-3, then single leg weeks 4+)
- Lunges (add in at week 7)
- Additional progression options (after the 9 week build-up):
- Add dumbbells to Double Leg Squats and Lunges (start with 15% body weight in each hand (10% for lunges). Progress through week 1-9 again. Increase weight every 9 weeks, maxing at 70% body weight in each hand (60% for lunges).
- Increase reps, gradually, up to 3 sets of 30.
- Increase speed of reps (be sure to still get full range of motion)
- Add in Monkey Step-Downs (5 sets of 5, progressing to 2 sets of 15+)
- Add in Jump Rope (double & single leg) for 2-5 min
What if You Already Have Tendon Pain?
These plans are intended for maintenance & preventative purposes. If you are already experiencing pain in the Achilles, ankle tendons, and/or Patellar tendons, you should start with daily isometrics for at least 2 weeks (5 sets of 30-45 sec holds). Then try the programs listed, as long as there is no pain.
Isometric Loading for Patellar Tendon
Isometric Loading for Ankle Tendons
Make it a Habit
I see so many overworked tendons in the dancers I work with, most of whom have not done much direct work on tendon loading to supplement dancing activity. It is so much harder to “fix” a painful tendon than to put the care into keeping them healthy to begin with. Train to dance, don’t dance to train… your tendons will be much more resilient.
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