Achilles heel.

Last week I talked about my own Achilles injury and the important part strength training had in my recovery - so this week, we have some practical things that you can do to take care of yours.

Depending on which studies you read, lower leg injuries account for somewhere between 50 to 90% of injuries in professional ballet dancers. Studies of recreational runners show similar results, particularly when you take into account that that weakness and poor foot mechanics can contribute to knee injuries too. Unsurprisingly, in an attempt to tackle this significant issue, the ballet world has put a lot of work into researching what can be done - so here’s a round up of some ideas to keep your feet and lower legs strong and healthy, whether you run, dance, or just use them to get about!

Yep, I mean it! The Australian Ballet’s healthcare team are great at putting science before tradition, and they’ve gathered some pretty compelling evidence to show that passive stretching - which usually forms a big part of a dancer’s warm up - is not helpful. Once they convinced sceptical dancers to stop stretching their calves, the company’s injury rate plummeted - historically, at least three dancers needed lower leg surgery each year; since they stopped stretching in 2005, their surgery rate has been pretty much zero. You can give tight muscles a gentle roll out instead - or just work on getting them stronger, so that they don't feel tight any more :)

The Australian Ballet didn’t only stop stretching - they implemented a really simple calf endurance exercise into their daily class, and it made a huge difference. It's since been adopted by ballet companies around the world - here’s how to do it at home:

• Lightly hold the back of a chair or kitchen counter (or similar) for balance, and stand on one leg, in parallel
• Keep a slightly soft, neutral knee
• Rise onto the ball of your foot, then lower your heel back down
• Keep it slow - About 50 bpm (so a little slower than one up or down per second)
• Maintain a straight line from your second toe up through the ankle (dancers - no sickling or winging your foot!)
• Start with 8 on each leg, and gradually add one at a time as your endurance increases - you’re aiming for 25 to 30 on each leg for ballet dancer leg strength
• Don’t stretch at the end - remember point no. 1!
• Repeat daily

Once your calves are strong, you can start adding weight to your calf endurance exercises (though I wouldn't recommend you move onto this unless you're used to working with weights, or have a qualified instructor on hand).

If you have access to gym equipment, you can do this on a calf press, leg press or seated at a Smith machine. Try three sets of 10 reps, starting with low resistance, and gradually increase - during my rehab, I was aiming to move at least double my own body weight on each single leg rise. If you can’t get to a gym, you could try resting a heavy sandbag across your shoulders or wearing a weighted backpack as you do the standard calf rise - I managed to improvise a passable solution during lockdown doing it this way. Make sure you’re really careful about your posture, stability and alignment, and don’t go too heavy without the proper gear and training.

This mysterious phrase is something you hear a lot when you spend time with a dance healthcare team, as it’s become clear that strong, articulate, mobile feet are are a key starting point for healthy bodies. It's too much to go into here, and I haven't been able to find a resource which explains it as well as I'd like - so I'll be making a video and blog soon to guide you through the exercises I've picked up over the years!

Two things tendons hate are being overworked, or being exposed to a sudden change in load - so you need to bear in mind your "acute to chronic workload ratio". This simply means how much work your body is doing right now (acute) to how much it was doing over the previous four weeks (chronic). If you add up the previous four weeks and divide it by the most recent week, you'll get a ratio - and you want this ratio to be between 0.8 to 1.2, and no higher than 1.5.

Confused?! Thinking about running is an easier way to explain:

Last week you ran 9.5km

Week before you ran 6km

Week before that, you ran 7.5 km

Week before that, you ran 7km

Average of the last four weeks = 7.5km

So, your ratio is: last week (9.5) divided by the 4 week average (7.5) = 1.26

Uh oh - that 9.5km of running in the most recent week was a bit too much of an increase, and has tipped your ratio over the edge into the red light zone - 8km would have been a more consistent increase, and would have kept your acute to chronic workload ratio at a healthy 1.12.

If you really get into it, this is a complicated topic, and it’s certainly more tricky to apply to dance than a more easily measurable sport like running. But, it gives you a good idea of the length of time it takes for your body to adapt to a higher workload - and can be particularly useful when you're recovering from an injury (have you ever counted how many jumps you do in a day? More on that in a later blog!).

So, I hope you've gathered some useful tips - if you want more explanation, check out the links below or send me a message, as I'd be really happy to help!

Australian Ballet's calf rise programme: https://australianballet.com.au/behind-ballet/how-to-get-strong-calves

Incorporating science into dance healthcare: https://www.danceaustralia.com.au/expertise/ballet-meets-science

A simple explanation of the ACWR: https://www.runnersworld.com/training/a20841513/acute-to-chronic-training-ratio-calculator/

If you'd like to know more about the ACWR, look into Dr Tim Gabbett, who pioneered the whole idea - you'll find interviews with him on YouTube and loads of articles (I've met him!)