Download Eversion - Basi Pilates

Eversion
Noé Serrano
22 April 2007
The Center Studio
San Francisco, CA
Summary
When one is trying to apply the mechanics of the ankle and foot to dance, there are several
technique areas that deserve more discussion. One of these is the issue of achieving the desired
aesthetics and placement in demi-point or pointe positions. Another issue is achieving desired foot
placement when the knees bends, such as in plies. In ballet, still another important concern is the
introduction of point work. The peroneus brevis shares a similar proximal line of pull to the
peroneus longus, and so it also assists with ankle-foot plantar flexion and is a prime mover for foot
eversion. The peroneals’ line of pull also enables them to produce abduction of the forefoot, a
motion used by dancers to create a beveled foot, a commonly used position in many ballet and some
modern schools of dance. The use of the stirrup muscle for a proper function for inversion and
eversion is crucial for ankle-foot action in dancing. This case study presents a corrective approach
to strength of the stirrup muscle to aid the many actions of the feet in a balanced manner. The
surgical procedure was the right foot osteotomy 1st metatarsal, arthodesis 2nd digit right foot,
arthosplasty right 3rd & 4th digits, tenotomy and capulatomy right 2nd, 3rd & 4th metatarsals phalengeal
joints.
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Contents
Summary
02
Table of contents
03
Anatomical description
04
Introduction
05
Case study
08
Conclusion
10
Bibliography
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Anatomical description
Lateral crural muscles
Lateral crural muscles are located on the lateral portion of the lower leg in the lateral
compartment of the leg. The lateral crural muscles are composed of the peroneus longus and
peroneus brevis. These muscles are closely associated in terms of origin and function and are
sometimes jointly referred to as the peroneals muscles. These lateral crural muscles cross the lateral
portion of the ankle behind malleolus and both produce eversion of the foot and ankle-foot plantar
flexion.
Attachments and Primary Actions of Peroneal Muscles
Muscle
Proximal attachment(s)
Distal attachment(s)
Peroneus longus
ƒ Lateral tibia condyle
ƒ Lateral aspect of
ƒ Lateral aspect of upper
first cuneiform
2/3 of fibula
ƒ Proximal first
metatarsal
Peroneus brevis
ƒ Lateral aspect of lower
ƒ Tuberosity at
2/3 of fibula
proximal en of 5th
metatarsal
Primary action(s)
Foot eversion
A-F plantar flexion
Depresses head of
first metatarsal
ƒ Foot eversion
ƒ A-F plantar flexion
ƒ
ƒ
ƒ
Peroneus Longus (perone, fibula + longus, long) originates from the lateral and upper
portions of the tibia and fibula. It courses superficially along the lateral lower leg and then continues
under the foot to insert on the undersurface of the first cuneiform and first metatarsal (at the base of
the great toe).
Peroneus Brevis (perone, fibula + brevis, short) originates lower on the fibula than the longus
and runs deep to the longus for much of its upper course. It’s attaching distally onto the lateral foot
(proximal 5th metatarsal).
When weight bearing, both the peroneus longus and brevis are considered important
dynamic stabilizers of the foot and the lower leg relative to the foot. These muscles provide and
important counterbalance for the invertors of the foot such as the tibialis anterior and posterior, and
flexor hallicus longus and are essential for preventing ankle inversion sprains.
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Introduction
Eversion of the foot involves lifting the outer border of the foot. When the foot is
unweighted, eversion usually combined with the forefoot abduction.
This combination of
movements is considered a desired aesthetics in some dance forms such as ballet, and is often
referred to as “winging” or “beveling the foot” and often encouraged when the foot is pointed or in
demi-pointe. The peroneus longus appears to be particularly important in creating this combined
movement of forefoot abduction, slight eversion, and plantar flexion. This movement of eversion is
also very important when the foot is weight bearing. Here, the everters (the primary muscles:
peroneus longus and peroneus brevis and the secondary muscles: extensor digitorum longus, and
peroneus tertius) can be used to shift the weight very slightly or extremely medially to create the
beveled line desired by many ballet schools when on demi-pointe or pointed. To achieve this latter
aesthetic, the everters can be used to shift the body weight and position the forefoot and midfoot
relative to the rearfoot while co-contraction of the plantar flexor and inverters is used to help
maintain balance, especially in slow inwards turns or to finish an inward turn in balance. The
everters perform the important function of limiting supination of the foot. This latter function is
very important for maintaining balance, preventing “falling out” of turns, and preventing ankle
sprains.
The repetitive use of demi-pointe and pointe in dances places great demands on the foot and
requires specialized strength, flexibility, and technique development. In terms of flexibility, extreme
ankle-foot plantar flexion is required to achieve the desire aesthetic of these positions and allow the
body weight to be appropriately placed over the ball of the foot (demi-pointe) or toes (pointe). In
terms of plantar flexion strength and range, the ankle-foot plantar flexors have to contract forcefully
to achieve and maintain this position of the foot, and ballet dancers have been reported to have very
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high levels of plantar flexor strength. Although the triceps surae muscles produce a large percentage
of the plantar flexor torque, other plantar flexors can help slightly reduce the demands on the triceps
surae and help achieve the desired aesthetic. Two such plantar flexors are the flexor hallucis longus
and flexor digitorum longus. The flexor hallucis longus and flexor digitorum longus have been
shown to have a shortening effect on the foot in a front-to-back direction, and so can help achieve
the desire “high arch” look on pointe. Three other plantar flexors – the tibialis posterior, tibialis
anterior, and peroneus longus – function together to lift the arch and help maintain balance on
demi-pointe and pointe. These three muscles can be termed the stirrup muscles because they run
behind the medial and lateral malleoli to converge to attach onto the undersurface of the medial
longitudinal arch on a stir-up like arrangement. All tree muscles have attachments onto the plantar
surface of the cuneiforms, with the tibialis anterior and peroneals also both attaching onto the base
of the first metatarsal, while the tibialis posterior has additional attachments on the navicular and
other metatarsal bases. Their attachments put them in a perfect position to lift the midfoot higher
up in a perfect position to lift the midfoot higher up in plantar flexion, in respective of the position
of the toes. In terms of stability, the stirrup muscles can be used to keep the body weight
appropriately positioned in a medial-lateral direction over the axis of the foot. Their co-contraction
(in combination with other muscles) can be used to allow the weight to rise to the toes and lower
from the toes without undesired inversion or eversion, and to make subtle adjustments of the body
weight to enhance balance and dance aesthetics. For example, contraction or pulling up, with lateral
stirrup muscles will shift the body weight medially on the foot (eversion) and prevent excessive
rolling out (inversion) on the foot, such as is commonly seen in “falling out” of multiple pirouettes.
In terms of these medial stirrup muscles, theoretically, the tibialis anterior when on demi-point or
pointe due to its additional desired action of ankle-foot plantar flexion.
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Hallux valgus (L. great toe + turned out outward) is a lateral deviation of the distal end of
the great toe (hallux) at metatarsophalangeal (MTP) joint, also involving a deviation of the first
metatarsal toward the midline of the body (metatarsus primus varus). This bony deviation changes
the line of pull of the muscles that cross the MTP joint, such that many of these muscles will tend to
have a bowstring effect that further increases the valgus deformity, and in more advance cases
causes the sesamoids to displace to the lateral side of the head of the first metatarsal. This valgus
deviation if the hallux also tends to make the medial aspect of the hallux also to become more
prominent, and the resultant friction and trauma from overlying footwear can readily lead to a bony
outgrowth (exostosis), an inflamed bursa between the exostosis and skin, and a callus on the
overlying skin. This bony and soft tissue enlargement on the inside of the head of the first
metatarsal is termed a bunion.
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Case Study
Cross training, as a training tool is key to use while recuperating from an injury or recovering
from surgery in downtime and to stay upbeat. A well-rounded dancer can benefit from Pilates
training. Although Pilates excels as a torso toner, its exercises require contribution from various
muscle groups, so comprehensive, all-over strength and agility are the results. Pilates works deep,
finding those hard-to-target muscles so essential to ballet technique. Pilates discovers and corrects
imbalances and misalignments that can hinder a dancer’s progress. The exercises are designed to
ensure that both sides work equally; they will not let the strong side compensate the weaker one.
They build dancer’s “powerhouse” – abdomen and lower back – creating a super strong core that
supports all other movement. For example, a long – legged dancer, or a teenager who just had
growth spurt, may have trouble holding his/her lower back still during grand battement front. By
targeting those abdominal muscles and back extensors, Pilates can develop the strength and control
needed to perform the ballet exercise correctly. Mat work and selective apparatus exercises have
been selected accordingly to the needs of the person, tailored to surgery recovery process. The feet
are the foundation of the body when upright: standing, walking, running, and jumping. Any
misalignment of the feet, in a static position or in motion, results in postural deviations and
compensations all the way up the kinetic chain. It is imperative to strength and re-educate the
stirrup muscles to avoid bad habits and create new ones as early as possible. One advantage of this
method is that the work can be performed out of the feet without bearing weight in them getting the
benefit of specific targeted muscle group aided by the Block System®. Special attention needs to be
put to the subtalar joint, due to its importance to achieve correct foot alignment, during the Foot
Work in the apparatus to achieve correct motion (supination and pronation), which will lead to a
neutral alignment.
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The following is a Comprehensive Program for this case study. This program is constructed
upon the Block System® and BASI™ approach with the “whole” concept as a guidance to ensure
that the program will achieve its goal. The program includes apparatus and mat work.
BLOCK
WARM UP
FOOT WORK (CADILLAC/REFORMER/WUNDA)
ABDOMINAL WORK (REFORMER)
HIP WORK (REFORMER)
SPINAL ARTICULATION (WUNDA CHAIR)
STRETCHES (STEP BARREL)
FULL BODY INTEGRATION I
ARM WORK (ARM CHAIR)
LEG WORK (WUNDA CHAIR)
LATERAL FLEXION/ROTATION (MAT WORK)
BACK EXTENSION (REFORMER)
MAT WORK BLOCK
SUPINE WARM UP
ABDOMINAL SECTION
HIP EXTENSION – BRIDGING I
SUPINE SPINAL ARTICULATION
SITTING SPINAL ARTICULATION
SITTING STRETCHES
SUPINE ROTATION
HIP EXTENSION – BRIDGING II
LATERAL FLEXION/ROTATION
BACK EXTENSION
FULL BODY INTEGRATION
SPINAL MASSAGE
RELAXATION & FOCUS
EXERCISES
Pelvic Curl, Supine Spine Twist, Chest Lift,
w/Rotation, Leg Changes, Roll-up
Parallel Heels, Open V Heels, Single Leg
Heel, Hip Opener (CADILLAC)
Calf Raises (WUNDA CHAIR)
Hundred Prep
Hundred
Frog, Down & Up Circles, Openings
Pelvic Curl
Hamstrings, Adductors, Hip Flexors
Elephant
Chest Expansion, Hug-a-Tree, Up & Down
Circles, Salute, Biceps, Rhomboids
Hamstring Curl, Hip Opener
Side Lifts, Side Kick
Breaststroke Prep
EXERCISES
Pelvic Curl, Supine Spine Twist, Chest Lift,
Chest Lift w/Rotation, Single Leg Lifts/Leg
Changes
Hundred Prep, Roll Up, Leg Circles, Rolling
(Roll-like-a-ball), Hundred
Shoulder Bridge Prep
Roll Over
Spine Stretch
Saw, Spine Twist
Corkscrew
Scissors
Side Lifts, Side Kick
Back Extension, Swimming
Teaser Prep, Back Support
Seal Puppy
Rest Position
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Conclusion
While pronation and supination are normal foot movement, excessive amounts of either can
easily lead to foot problems. Learning to use optimal placement of the foot when standing, desired
knee-foot alignment, and coordinated use of the stirrup muscles can aid with development of
desired dance skill. Similarly, strengthening of the stirrup and other key muscles and stretching to
achieve both adequate dorsiflexion and plantar flexion can help enhance ankle and foot function and
prevent injuries. If any injury does occur, effective treatment and aggressive rehabilitation are vital
to prevent recurrence or instability and to allow a successful return to dance.
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Bibliography
Body Arts and Science International™ ©2000 – 2004. Study Guide (6): 62
Clippinger, Karen. (2007). Dance anatomy and kinesiology. Champaign, IL: Human Kinetics. (6): 316319, 328-329, 333, 352-353
Isacowitz, Rael. (2006). Pilates. Champaign, IL: Human Kinetics. (1): 17-19, 25, 29-30, (12): 326327
Kirstein, Lincoln. (1987). The Classic Ballet. New York, NY: Knopf. 24-29, (1): 74-77, (4): 233-240
Minden, Eliza. (2005). The ballet companion. New York, NY: Fireside. (2): 80-81, (3): 108, 115 (4):
233-234, 249, 253-255
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