Conditioning With Imagery: A Chat With Donna Krasnow

Conditioning With Imagery: A Chat With Donna Krasnow

One of the most important things you can do to better yourself is to talk to a lot of people that are way smarter than you. Be the stupidest one in the room every once in a while (but not all the time…).

That’s exactly what I set out to do when I contacted Donna Krasnow. We sat down in her hotel room discussed things to do with training dancers. It was great.

Donna Krasnow is a former professional dancer, full professor at
York University’s Dance Department, choreographer, and creator of C-I Training
(Conditioning With Imagery for Dancers). She is the co-author of the new book
Conditioning with Imagery for Dancers, with professional dancer Jordana Deveau. Visit her website here for more info.

Krasnow specializes in dance science research, concentrating on injury prevention, conditioning for dancers, and motor learning and motor control. Her most recent research focus has been the adolescent dancer, psychological issues surrounding injury and dance training, and motor control in elite dancers. She received her M.S. degree in Dance Science in 1994 from the University of Oregon and is a Level I Certified GYROTONIC® Trainer . Her articles have been published in Medical Problems of Performing Artists; Journal of Dance Medicine & Science; Impulse: the International Journal of Dance Science, Medicine, and EducationJournal of Dance Education; Bulletin of Osaka University of Health and Sport Sciences; Medecine des Arts; and Dance Research Journal.

If you haven’t gathered, Donna is way smarter than me, and chances are way smarter than  the majority of you reading this too.

She was in Toronto this week teaching the Conditioning With Imagery teacher training course. This course teaches other dance science enthusiasts and teachers her training method, which she has used to help countless dancers improve their technique and understanding of the moving body, as well as to prevent unnecessary injuries. Though I only had an hour to speak with her, it was enlightening, to say the least.

Here now is a summary of our chat:

What caused her to first become interested in the physiology and science of dancing?

Donna told me that her reason was actually kind of selfish- She, like many dancers, was tired of getting injured! She has a list of injuries that could go on and on, but her back was a big issue for her in the past.

Sound familiar?

This led her to start reading and learning about new methods of training the body to make it more resilient. She studied in yoga, pilates, floor-barre classes, Qi Gong and somatic practices, among other things, and eventually began to put it all together which created the foundations of what is now her Conditioning with Imagery philosophy.

So what is “Conditioning with Imagery”?

Donna explained that conditioning with imagery is a blending of science with somatics. It borrows from the best of several techniques.

She retold to me the story of being in Philadelphia for a convention and having the opportunity to experience presentations of many different training methods, one of which was by Sally Fitt (author of Dance Kinesiology) and was all about the science side of training, and another was an Alexander technique presentation, which is all about using imagery to reprogram the body.

This got her to thinking, why must the two- science and imagery- be separate? Hence the creation of conditioning with imagery

For those of you who don’t care much for the science side of dance, the rest of this article may not be for you, so skim at your leisure, as I press forward into more specific aspects of training dancers.

I asked Donna what she thought of  training hip drive and posterior chain power. Did she think it was useful, as it often is for other athletes? Olympic style lifting or plyometric training in particular.

“Yes. If the dancer has a need for it.”

She explained to me that many dancers are naturally good jumpers and it would not be a productive use of their time to work on something they are already good at. Hip drive power does help with vertical jump height, which is of importance to dancers, but if they don’t need much extra help in that regard, it is not necessary.

She states that the training must be specific to dancing. For this very reason, she is not in favour of ballet dancers doing much plyometric training. Her experience is that it will not transfer over to a dance setting as one would like it to, for the feet are in a parallel position which is not very helpful for dancers who work in turn-out.

I asked about doing plyometric work in a turned out position, and we both agreed that it would probably not be safe for the knees.

Olympic lifting could however be quite beneficial for dancers needing help with their jumps.

There is still much research to do in this area. Perhaps I’ll do some more reading of my own and see what I can find. Stay tuned for that.

Can you guess what Donna thinks about dancers developing upper body strength?

She’s all for it! Donna points out that dancers often need arm strength for lifts and to fall safely to the floor, among other choreographic elements.

However, she explained how the traditional methods of upper body training are not appropriate for dancers. That is to say, the traditional method is aimed towards male trainees who want to build muscle (hypertrophy) without any kind of functional end-goal.

Dancers do not need to hypertrophy their upper body muscles, but rather need endurance and strength. She pointed out the common misconception that women dancers shy from strength training in the fear of becoming bulky, but this is only because they look at male bodybuilders who follow a set and rep scheme with the aim of getting bigger muscles.

Donna suggests that for dancers it is optimal to use a rep range geared toward muscle endurance (12-15 reps), with a lower weight, and to do 2 sets.

The arms need strength, endurance and control. To avoid upper body training is a common mistake.

Other imbalances that are prominent in dancers, and which Donna stresses should be addressed include:

  • The spine and core
  • Lateral quads dominant over medial quads
  • Excessive foot pronation
  • Weak adductors and gluteus medius

I then selfishly asked:

What is your favourite core strengthening/motor control exercise?

Her reply: “I don’t have a single favourite!” (rats…)

She explained that she is in her third day of teaching the CI Training course (and intensive course which runs for 6 days), and she’s aleady gone through about 7 core exercises. She states there has to be versatility, because that is the nature of dance. You must have a range of movements.

Not only that, but “core training” has to be always happening. Even if it is not a “core” exercise, the core must be cued to work. A good core exercise is one that transfers over to the dance setting.

So what about Crunches? Crunches are fine if done correctly, but by themselves are not sufficient for dancers’ needs. They need a variety of exercises that deal with core support, trunk stabilization, and balance control. Perhaps not the most efficient use of your time.

We got to talking more about core conditioning, and Stuart McGill’s name came up (to whom she refers fondly as Stu. They’ve met, and I’m a little jealous). McGill is a big name in the athletic performance training, and lower back pain prevention and rehabilitation game.

I have dabbled  in implementing his method of “abdominal bracing” to prevent lower back injuries while training training my own dancers.

I asked her what she thought of the idea of abdominal bracing, and if it was effective for dancers.

In her mind, bracing the abdominals is actually counterproductive for dancers early in their training, and they should rather be instructed to lengthen. This simple use of imagining the spine elongating, and the narrowing of the waist, she states, has been much more effective in her experience.

She explains that you must look at the function of the spine for the dance population: The spine does a lot of moving through all planes, and this motion often needs to be fluid. It makes sense that bracing the abdominals without understanding how to control it segmentally would hinder a dancer’s ability to control his/her body effectively.

Donna talked about how many of the athletes McGill is training do not require the fluidity of the spine that dancers do, and so for a shot-putter, for example, bracing the spine would be highly effective.

There is a place for bracing the abdominals in dance training, however it should be learned after the dancer first understands how to control the spine’s individual segments. She refers to the work of Australian, Paul Hodges, which focuses on deep segmental stability and “hollowing” of the abdominals, rather than bracing them.

Her method is to start by training the deep muscles that control and stabilize the spine as it curves and arches, and then do more McGill type things, like planks and birddogs.

Thanks for that tip, Donna!

At the gym I work at, they have one of those full body vibration plates that supposedly give faster results by exercising on a vibrating surface. I asked Donna if she knew anything of the science behind these contraptions.

To which she replied: “I have no comment until I see the research.”

Donna is the kind of person who needs to see concrete evidence before she jumps on a bandwagon. This is a good quality to have in order to avoid a lot of the bull-shit that marketed to us these days. Remember when we thought this was a good idea?

I mentioned to Donna that I had read the abstract of a study which used the vibration plate in a training protocol for dancers and found that they were able to increase their ankle stability to a higher degree than a group of dancers who did conventional exercises, not vibrating. She replied to this that she could see how it may have some benefits in terms of proprioceptive issues, as the vibrations create a more unstable surface.

Here’s another study that found dancers could improve their vertical jump height by using the vibrating plate in their training…

Perhaps I will read more on this topic, seeing as I have access to one of these (expensive) machines. Are they worth it? Who knows. I’m still sceptical, and my opinion is that this machine was created by people who are lazy and don’t like hard work. But who knows!

Like Donna said, “I don’t know until I see the research”.

I asked Donna if she could describe a particular “a-ha!” moment on her journey to understanding movement.

She exhaled deeply and replied that there were too many to even mention. One in particular that she shared with me was the realization of the “neuromuscular”, and just how important motor control was.

It is not simply enough to strengthen the weak muscle, or stretch the tight ones. That’s only part of the picture. Donna expressed that it is equally important to make changes to habitual movement patterns. Retrain the way you move in everyday life, as well as in a dance setting.

As she put it, in class, you work hard to do good for your body for 3 hours a day. But if for the rest of the day you’re slumped over, in awkward positions, walking strangely and adopting a generally poor posture, you’re not helping yourself, and you’re undoing any of the positive work you did in class.

In recent months, I’ve discovered how much the mind needs to make changes as well as the body. Many dancers are in a less than optimal emotional and psychological state which does not allow them to perform physically at their highest potential. I asked Donna what role she thought psychology and emotional health played in dance training, and if she felt it deserved more attention.

She agreed, but said that the emotional health of a dancer must be approached indirectly. It’s in how you relate to your dancers or clients that will affect them psychologically.

Donna expressed how she felt that many dance teachers do a bad job of this. The learning environment is created through the language used by the teacher, and often this language is one that is critical, and negative. For example, she told me story of how a young girl she was coaching had quite a pronounced pelvic tilt that caused her stomach to protrude slightly. What did her previous teachers tell her? Push your stomach in! Push your bum in!

According to Donna, the language you use should not ask the dancer to hide any part of them. Don’t ask the dancer to hold in their stomach, this is counterproductive not only physically, but it will foster a negative emotional environment. Instead, she suggested the image of lengthening the body.

She also explained that many dancers have “issues of beauty”. What this means is that they are so stuck to notions that for a position, such as a perfectly turned out 5th, to be beautiful, they need to crank their bodies in unnatural ways, and this is more important than being safe and protecting their bodies. This notion needs to be retaught. As I mentioned earlier in this post,  you mustn’t be stuck to the idea that you need 180 degree turnout, most of us can never obtain this safely and it’s just not worth it.

Donna stated that many postural dysfunctions are in fact rooted in emotional trauma, and that she found many were able to change emotionally by changing the way their bodies move. This rang 100% true to me. If you want to test this theory, try walking around all week with absolutely perfect posture. Really focus on it. I challenge you to tell me you don’t feel like a  whole new person by the end of the week.

Donna also stressed the importance of the spiritual aspect of dance. Many of us have lost this. Dance began as a spiritual practice, and it should always have that same importance. Again, we have issues with beauty. Actually expressing the spirit through dance will always be more moving that a perfectly executed triple pirouette.

What Donna felt was most lacking in dancers, and what could be considered their biggest issue, is that they lack education on the things that really matter. They have tons of skill acquisition, but very little knowledge. I asked her to share what she felt were the 3 best pieces of advice she could give dancers wishing for longevity in their careers, and here  they are, just for you:

  1. Be vigilant about warm-up and conditioning.
  2. Work only with people who honour the body.
  3. Never put aesthetics and fashion above health.

Amazing.

This post is once again becoming lengthy, and so I want to wind things down by sharing with you what Donna said to be the most rewarding part of her career so far (and she’s done a lot, from choreography, to performance, to teaching, to conditioning, to research, creating her own training method, writing a book, and more…)

For her, it was not the material accomplishments that were most rewarding, but the giving and the receiving, in both directions, that has taken place throughout her career. The science aspect of things combined with the beauty of performing and choreographing was what she felt was the most fulfilling.

I will close with what I think is a recurring theme of this blog, and which Donna stresses as extremely important: The art of dance is just as important as the science.

If you want to learn more about Donna,  her teacher training course, or read her book, head to her website for more information.

I want to thank Donna graciously for taking time out of her busy schedule to speak with me. It was fantastic.

I urge you all strongly now to check out Julien Smith’s blog . Take cold showers daily, talk to strangers, do things that scare the crap out of you, and hang out with people that are way smarter than you.

Oh, and like me on facebook .

 

 

 

 

 

 

 

 

Smart Mobility for Dancers- Better Ways to Stretch

Smart Mobility for Dancers- Better Ways to Stretch

“So, you’re a dancer! You must be really flexible- Do you stretch a lot?”

The amount of times I’ve heard that… Yes- I’ll admit, I am pretty darn flexible (used to be, anyway, before I injured my hamstring).

Do I stretch a lot? Well, not really.

Was I always flexible? No. Before I danced, I couldn’t do the splits. I could barely touch my toes (though now I know better than to do the standing toe-touch stretch, which you shouldn’t do either if you have a history of lower back pain).

The concept of stretching is controversial, and has many supposed, and some legitimate benefits. The kind of stretching dancers do could be considered highly dangerous for the average person. By this I mean, holding intense static stretches immediately prior to a class or performance. The following is part of the Twitter status of a prominent dance company, who will remain nameless, announcing their auditions “…Come early to stretch!” I cringed. No, people, don’t come early to stretch, lest you want to injure yourself.

By contrast, the kind of active stretching that is done intrinsically during the bulk of a dance class is highly beneficial for increasing one’s mobility and range of motion (henceforth denoted as ROM) at a particular joint. Dancers don’t stretch as much as you think they might to maintain their level of flexibility. Getting there takes years of hard work, maintaining is easy. How did we get there? Consistent, hard work in class, and always pushing to work with the maximum ROM for any given movement. A little bit of specific stretching, to the particularly tight parts, helps, especially for men.

There is a lot of information out there saying not to stretch statically before doing physical work, but to do dynamic stretching instead; and there are all kinds of programs with different philosophies for increasing one’s flexibility. My favourite is Pavel Tsatsouline’s “Forced Relaxation”- This guy is really flexible, but you can tell he’s really strong too, and his approach to increasing flexibility actually has some merit. Mostly, I just love his video series because it is one third terrifying, one third hilarious, and one third motivates me to go get super flexible.

Check out one of his videos here: Pavel Tsatsouline- Forced Relaxation

For the purposes of this article, I’m going to talk less about “stretching”, and more about increasing “mobility”. What’s the difference? Stretching primarily refers to increasing the length of a muscle, while mobility can be considered an all encompassing term, referring to the joint as a whole- Its ligaments and musculotendinous unit.

What is mobility?

Mobility refers to the total range of motion through which a particular joint is able to move, which can be expressed as a measurement in degrees. Mobility affects your ability to perform certain isolation (single joint) movements and compound movements (multi-joint).  Not to be confused with hyper-mobility, which refers to an excessive range of motion of a joint, measurable at an angle which is larger than is optimal (unless you use this ability to monetary advantage somehow, like a circus contortionist).  Hyper-mobility requires supplementary strengthening in order to control and prevent injuries as it is generally caused by extremely lax ligaments.

Stretching- How to do it right, without compromising your safety

Flexibility is a misunderstood term. According to McGill, there is no relationship between static joint flexibility and dynamic performance. We often think of increasing ROM in simplistic terms: Make muscle longer by stretching it out. There is however much more to take into consideration. Some variables you should consider:

  • The muscles surrounding the joint in question– Do they need to be stretched? If your joint is lacking mobility, it is likely that one or both muscle groups are dysfunctional. One side may be overactive, and the other, underactive. Do you really need to stretch, and thus weaken, an already underactive and weak muscle? Probably not.
  •  Passive tissue restrictions– Fascial adhesions cannot simply be stretched out, but must be manually released by someone qualified, or by yourself, with a tool such as a lacrosse ball, or other SMR tool (anything can be an SMR tool, if you’re creative). There are also training styles which can”train” the fascia to become more flexible through specific exercises.
    Ligaments often should not be stretched, as once they become lax, they will never regain their former elasticity, which could become problematic in terms of stability.
  • Pain threshold– Many of those who necessarily do need to stretch certain muscles may not have the pain threshold high enough to withstand what is necessary, and their mobility will hinder because of lack of intensity while stretching or releasing muscles. Others, with high pain thresholds, may stretch too intensely, which could result in weakness or lack of stability.
  • Neuromuscular modulation of length and tensionWe must never leave the brain out of the equation. There are reflexive structures in our muscles (spindle, golgi tendon organ) that send nerve impulses to the brain, telling it when to contract or relax a muscle in order to prevent the muscle from tearing. This is also a factor that is altered when stretching, as these receptor sites can be become more or less responsive with training. In fact, according to McGill, modifying neuromuscular processes has the largest affect on functional range of motion.

Is there a “best way to stretch”?

Stretching should be performed simultaneously with tension challenge. What does this mean? Not holding a static position, but rather actively moving through the ROM. Think “grande-battements”, using your maximum effort and leg height.

Evidence suggests that passive tissue stretches rarely contribute to increasing ROM, and rather, one should train their tolerance to stretch, allowing them to take the joint to further positions. Passive tissue stiffness and loads do not change at a specific joint angle. In other words: Muscles cannot be stretched to increase ROM, they must be “trained” to grow stronger in a larger ROM. Stretching the passive tissues also reduces stability- A joint lacking passive stiffness requires more muscular contraction to maintain stability.

A recent study suggests that  static stretching caused a deficit in strength, power output, and muscle activation at both slow and fast velocities, and thus practitioners are urged to consider a risk-to-benefit ratio when advising any stretching protocols.

Another study, done by the Journal of Strength and Conditioning Research, found that dynamic stretching could actually increase muscular power:

“Dynamic stretching produced percentage increases in peak knee extension power at both testing velocities that were greater than changes in power after static stretching. The findings suggest that dynamic stretching may increase acute muscular power to a greater degree than static stretching. These findings may have important implications for athletes who participate in events that rely on a high level of muscular power.”

Active flexibility is more important for performance, dance performance in particular, where muscular force is produced through an often extreme range of motion.  Training the joints under tension throughout the full ROM, that mimic the specific ROM of the activity in question, are most beneficial for improving joint mobility. This is part of the reason why anyone who is smart will squat as deep as they safely can- Not only will it activate a larger muscle area leading to an increase in strength, but it can assist with increasing joint mobility, leading to better, deeper squats.

Why is mobility important?

Mobility is extremely  important for dancers, but also for athletes and people in general. I could write you a list  of the many benefits, but I think a visual is more fun and effective, so check out this diagram I made- I call It the mobility cycle, and it outlines the cyclical nature of the positive repercussions which are made possible by having optimal joint mobility:

1)      Optimal mobility allows for optimal stability, strength and neural control of a muscle-tendon unit.  When a joint has  the most mobility it can safely achieve, it’s motor unit will be able to access the maximum amount of muscle fibres. This optimal neural control allows for optimal strength, and stability. This is called…

2)      Symmetry! When mobility, stability, motor control and strength are all at peak function. This naturally creates…

3)      Muscle balance! Muscle balance is achieved when all the many muscles of a joint are equally strong and flexible. One group is not tight and overactive, and the other side is not weak and over-stretched. Muscle balance is synonymous with optimal force production at that joint, as well as…

4)      Decreased risk of injury! Obviously when muscles are balanced, bones, ligaments, and bursae, among other things that can potentially get squished together or pulled on inside the joint, will be able to move freely and safely, in a pain-free way. When one can exercise and move in a way that won’t lead to pain, one can safely achieve…

5)      Optimal range of motion! This happens not necessarily by stretching statically, but by being able to move through the maximum range of motion in a safe, active, way. How does this help the athlete?

6)      Optimal  athletic performance! All the aforementioned combined factors create the optimal athlete and performer. This can then restart the cycle, because when an athlete is always performing optimally, his/her joint mobility will be able to increase even more, or at the very least, the attained optimal mobility can be maintained. The good times just keep on rolling, so to speak.

Mobility is the gift that just keeps on giving.

 

Where people tend to lack mobility

In general, people tend to have the same requirements in terms of where they need mobility and stability the most, but just in varying degrees.  Rather, I should say people require symmetry, but to get there, some places need a little more mobility, as they tend to get a bit “stuck”. The joint by joint approach, popularized my Mike Boyle, shows where most people would benefit working on either mobility or stability :

T-Spine- Mobility
Scapulae– Stability
Shoulders– Mobility
Lumbar spine– Stability
Hips– Mobility
Knees Stability
Ankles– Mobility

Symmetry refers to optimal balance between stability, mobility, strength and motor control. By adding mobility to the places that need it, symmetry can be attained, as long as the other 3 criteria are also taken into consideration as needed.

Dancers require a tremendous amount of symmetry, as the nature of the activity requires consistent balance, awareness, and strength of the whole body.

Where does balance come from? Harmonious mobility and stability.
How is strength created?  From optimal force production- The result of balanced muscles by means of optimal mobility and stability.

So you see, mobility is necessary if you want to get strong. This means that yes, you will at times need to pay close attention to stretching, in a specific, intelligent manner, of course.

How to Gain Instant Mobility at any joint

These guidelines can apply to any given joint, and require a competent assessment of the current condition of the joint through motion analysis:

1)      Strengthen the weak/elongated muscles of the joint.

2)      Release (SMR, ART, FST, ect.) the tight muscles of the joint.

3)      Dynamically stretch the tight muscles.

4)      Full body integrated movement involving the joint in question.

5)      Statically stretch the tight muscles.

 

 Sample Ankle Mobility Routine

Caroline has an extreme limitation in her ankle mobility. To help her with this I’ve put together a simple routine that will take about 20 minutes to do, give or take. It should be noted that Caroline has a potential limitation in her ankle mobility, due to a bone spur in one ankle, which may not be able to be improved through exercise. But it won’t hurt trying! Here’s a new saying I’m trying out- When life gives you vermin, you make vermincelli… I know, it’s not ideal. Pretty lame actually. But I’m tired of hating on lemons! Anywho…

Here is a current picture of Caroline’s ankle mobility:

 This is as far into a “demi-plie” Caroline can go before her heels come off the ground, and she loses her neutral pelvic alignment. Ideally her knees should surpass her toes, and the triangle created should have smaller angles.

 

 

 

 

 

A photo to compare to Renee-Claude, who has pretty decent ankle mobility:

 

 

 

 

 

 

 

 

I have other clients (including Renee-Claude) perform the same routine outlined below, but Caroline would benefit from it the most if done regularly. Because she is so restricted, I’ve recommended that she do the release exercises every day, 3 times a day at first. For optimal results she should start by doing this routine about 3 times per week. As her mobility improves she can go down to 1 or 2 times per week. Once she has achieved her maximum potential mobility, she can do this routine as needed, when she feels a little tight.

 

 

1)      Self-release plantar fascia and release jaw fascia.

Caroline also suffers from plantar fasciitis which affects the tension in her calves. I’m not sure if this is a “chicken or the egg” situation, and which issue contributes to which more. In any case, tight plantar fascia doesn’t help with the ankle mobility. While your hands are free, this is a good time to do some self release on the jaw fascia. All the fascia in your body is connected. The fascia in your jaw is connected to the fascia in your legs and feet. Caroline (and most people) holds tension in her jaw- She actually has trigger points in her jaw. Doing this will help relieve the tension in her feet, calves and hamstrings.

 

 

2)      Self-release posterior compartment (calf muscles)

Using a hard acupressure, lacrosse ball, or foam roller. Or, if you have money, go see a skilled professional. Go slow. Stop on any particularly painful spots (trigger points) for about 10 seconds or so. Caroline says that when she does this, some trigger points send referral pain all the way up to her head. This does not surprise me as her calves are extremely tight. She has previously told me she sometimes gets tension headaches, and she holds much of her tension in her upper trapezius. I told her to spend about 5 minutes on each calf, but I’m sure she could spend about 20 minutes going through all the trigger points. She’s just that tight.

 

3)     Theraband resisted dorsiflexion

This will help to strengthen the tibialis anterior (muscle of the shin). Strengthening it will also cause it to become shorter, and will allow her to actively reach a smaller dorsiflexion angle (increased ankle ROM).

 

 

4)      Dynamic soleus/achilles tendon stretch 

Dynamically stretching through her full range of motion will help to actively lengthen the now released muscles. Muscles respond better to stretch after they have been released, as they are more relaxed, and less reflexive. Move into the deepest possible lunge before your heel comes off the ground, hold for 5 seconds, release, and repeat several times on each leg.

 

 

 

5)      Static stretch for posterior compartment

If Caroline is not planning on doing anything active, now is a good time to stretch statically. If however, she’s about to squat, or do a dance class, I would say save the static stretching until she’s done. We want to avoid weakening the muscle right before she needs to use it.

 

 

 

After these 5 steps, your ankles will feel nice and loose and you’ll have a larger ROM. You will find, for example, that perhaps your “demi-plie” feels deeper.  The affects of muscles release are only temporary, however, and for optimal results, this must be repeated at a high frequency, several times per week, for mobility to be increased and maintained.

Ankle Mobility and Stability in Dancers

Dancers can sometimes lack dorsiflexion ability due to the high frequency of time spent on their toes, in plantar-flexed position. This is similar to the concept of dancers lacking internal hip rotation ability, as I explain in this post. It is therefore beneficial for them to work on increasing the mobility in their ankles in the opposite direction they work with in class, to maintain balance at the joint.

As found in a recent study on dancer ankle mobility and stability:

“Professional dancers showed a significantly increased plantarflexion of both feet in comparison to all other groups “

By the way, plantarflexion is when you point your feet. There was however no mention of dorsiflexion ROM…

The specific work-related demands of ankle joints did not improve all components of functional ankle stability in professional dancers. Therefore, the inclusion of proprioceptive exercises in the daily training program is highly recommended, aiming to improve functional ankle stability and thus to minimize the risk of ankle injuries.”

As I have already explained, the work dancers do in class is one-directional: Working only in one direction of a range of motion can hinder overall mobility and stability of a joint, thus affecting it’s balance and strength, and overall, whole-body performance. Inclusion of exercises that work the function of the entire joint, not just the extremes of ROM required in a dance setting, is optimal for a dancer’s technical performance and injury prevention.

That’s about all I’m going to say about mobility for now. I am trying a new thing where I keep these articles less than 3000 words (this one’s getting close…). There’s something to say about brevity- In writing AND in the gym. Efficient, abbreviated training styles rouse results; efficient, abbreviated writing rouses readers.

 

References:

Crowe, A, and P Matthews. “The effects of stimulation of static and dynamic fusimotor fibres on the response to stretching of the primary endings of muscle spindles.”Journal of Physiology. (1964): 109-131

Manoel, M,  et al. “Acute Effects of Static, Dynamic, and Proprioceptive Neuromuscular Facilitation Stretching on Muscle Power in Women.” Journal of Strength & Conditioning Research. (2008)

Marek, S, et al. “Acute Effects of Static and Proprioceptive Neuromuscular Facilitation Stretching on Muscle Strength and Power Output.” Journal of Athletic Training. (2005): 94–103.

McGill, Stuart. Ultimate Back Fitness and Performance. 4th. Orthopedic Physical Therapy Products, 2006.

Rein, S, et al. “Postural control and functional ankle stability in professional and amateur dancers..” Clinical Neurophisiology. (2011): 1602-10.

Roberston, M. “Addressing & Identifying Muscular Imbalances in the Hip & Pelvis.” Muscle Imbalances Revealed. (2010)

Somerset, D. “Training the Myofascial Lines for Back Injuries”. Muscles Imbalances Revealed. (2010).

 

Your Burning Turnout Questions Answered

Your Burning Turnout Questions Answered

Your Burning Turnout Questions Answered

Still worried your “sub-par” turnout will affect your ability to perform professionally as a dancer? Be careful who you compare yourself to, and perhaps reconsider your technical priorities- It’s time to dance smarter, not harder.

If you ask a dancer what one aspect of their technique they wish was better, no doubt in their top 5 will be “turnout”. Turnout refers to the angle at which one can externally rotate their femur, tibia and ankle. The “ideal” degree of turnout would be 180 degrees, meaning that if you started with your feet together, and rotated your legs outward, your feet would create a straight line, with your toes pointing directly away from each other.  Not to be confused with “external hip rotation”, which refers only to the ability of the hip to rotate. Turnout refers to the total amount of external rotation, as a combined effort from the hip, knee and ankle joints. Research suggests that on average, 60% of turnout is created by outward rotation of the hip.  20-30% percent of turnout may then emanate from the ankle, with the remaining percentage created by the tibia and knee joint.

In dancer-land, we are obsessed with turn-out. Unfortunately for us, this obsession is the cause of so many of our woes. Many dance-injuries can be traced back to an instance, or a series of accumulated instances, where one sacrificed safety and common-sense, in order to achieve maximum degrees of turn-out. Hell, I did it.

In fact a correlation has been shown between the degree of gait turnout (while walking) and the incident of injury in dancers. A recent study that looked at the angle of foot external rotation and pronation compared with the number of injured dancers, and found some interesting, yet predictable, things:

“The results show a tendency toward a pronated foot posture (mean, 9°) in the angle of turnout position. A significant relationship was noted between the Foot Posture Index and angle of turnout and between the number of reported injuries. Twenty-eight injuries were reported; male dancers experienced a mean of 2.8 injuries and females a mean of 1.6 injuries. An inverse relationship was noted between age at training initiation and total reported injuries. All of the dancers reported a history of injury to the spine or lower limb, and 9 of the 12 reported an injury within the previous 12 months.”

Yep, 100% reported past injury in the spine and lower limbs. 75% injury rate in the past year. Sounds about right. But it shouldn’t!

Another Study looked at what they called “compensation turnout”, which is the difference between a dancer’s passive external rotation ability from the hips, and the degree of turnout they work with in class. The dancers with the highest degree of compensation turnout also reported the most injuries:

“Based on a self-reported history of low back and lower extremity injuries, ballet dancers have a greater risk of injury if they reach a turnout position that is greater than their available bilateral passive hip external rotation range of motion.”

I do not find any of this surprising. By the way, passive external rotation ability is tested by anchoring the knees and hip and moving the dancer into external rotation. It is sometimes difficult to measure, as it is tricky to pin point the moment when the knee becomes involved.

But enough of the obvious perils of forcing ones turnout. Let me explain what is really happening inside our bodies when we turnout, and how it is that we got so obsessed with it in the first place. Is it actually important for a dancer to be turned out?  My philosophy is, it’s a good idea to know why you’re being asked to do something, rather than blindly doing what someone tells you. Knowledge really is power, guys. Today’s life lesson brought to you in part by turnout…

What’s really going on inside our hips?

It really is “all in the hips”. Well, most of it anyway. In a perfect world, we would have almost all our turn-out come from our hips. But life is hard, and many of us aren’t blessed with Zhakarova-esque, hip rotation abilities. That’s not to say you’re allowed to give up and blame “bad genetics” for not having so-called good turnout. It’s like saying you have  bad posture because your dad has bad posture. Rather, it is because you slouch all day and never try to fix it! You’re weak and you have bad habits. Don’t blame your dad. Brevity and succinctness were never really my forte, and so allow me now to explain the 7 main  factors influencing your turnout abilities (I’ll try to go easy on the anatomy-speak):

1.       Angle of femoral anteversion

Anteversion refers to the position of neck of the femur relative to its shaft. A smaller angle (anteversion) causes the foot to naturally point inward (pigeon toed-ness). A larger angle causes the foot to naturally point outward (retroversion) and puts the individual at a genetic advantage as to the degree they will be able to maximally turnout their legs. This angle cannot be altered with training. Sorry guys. You can’t change your bone structure… Yet.  Take a look at the figure below from the IADMS website , if you’re more of a right-brainer, like me, and fancy words like anteversion, or femur mean little to you.

Hip angles affecting turnout

2.       Orientation of the acetabulum

I know, I know, I said I’d keep the level of anatomical jargon to a limit, but acetablulum is a really great word to throw out as often as you can. Not only is it fun to say, but it makes you sound smart! And really, as a dancer you should know what an acetabulum is- You’ve got two of them! It’s your hip socket.

If your acetabulum opens more to the side, you have an adavantage over those whose hip sockets open more to the front. The more laterally oriented the acetabulum, the more turn-out you can achieve. Again, until plastic surgery permits, this factor is not able to be changed.

3.       Shape of the femoral neck

Size and shape of the neck of the femur can either help or hinder your external rotation abilities. Let’s think of an analogy using Slurpees, just because I’m from Manitoba, and we sure love our Slurpees in Manitoba. So let’s say you have a Slurpee, and two different straws: One is thin, the other is one of those amazing, extra-large “spoon-straws”. If you try to stick each of them into the Slurpee and wiggle it around, which do you think has the most mobility? Probably the thinner one, right? Same goes for your femoral neck as it fits into the acetabulum- A thinner, more concave neck will have more movement ability, and thus more freedom to externally rotate.

4.       Ligament Elasticity and Laxity

The iliofemoral ligament, to be precise. This is the ligament that becomes tight as you extend or laterally rotate the hip. Through intense stretching (or injury), ligaments can be made more lax. It is controversial whether attempts should be made to alter the flexibility of this ligament purposefully, as it may alter its capacity to stabilize the hip. Dancers generally have a huge imbalance between stability and mobility, tending to favour the latter. It is dangerous when ligaments lose their laxity because they can never fully regain their elasticity once stretched too far, like low-quality hair elastics, used too many times. I would not recommend trying to stretch this ligament excessively. It might actually back fire on you by causing your hip flexors to become chronically tight from picking up the slack, as they are the muscle group assisting the iliofemoral ligament. As a dancer, your hip flexors are probably already tight, don’t make them tighter.

5.       Flexibility and strength of the muscle-tendon unit

This is the part you’ve been waiting for: You can strengthen your hip external rotators, and increase the flexibility of your adductors and internal rotators. Your muscle-tendon unit has its own maximal potential, however, and beyond that theres really not a whole lot you can do but work the best with what you have been given. Perhaps at the end of this article I will allude to some strategic strengthening/flexibility exercises, but as per usual, this post is already lengthy, and I still have so much to say.

6.       Other individual variations of the feet, knees, ankles and lumbar spine

These other factors play a small but important role in your turn-out abilities. Everyone possesses different degrees of rotation and neural control abilities at these locations, which mustn’t be discounted.

7.       Neural control and mental focus

Some folks simply lack the neural connection to the muscles responsible for externally rotating the hip. This can be trained to improve, in a class setting, or though one-on-one coaching, and requires constant cueing.  However, if the dancer does not have the desire to learn, he/she will not ever develop the required motor control of the appropriate muscles. Motivation to improve turnout is therefore a pre-requisite for any sort of attempts to improve it. This seems blatantly obvious, but people seldom attempt to improve any aspects of their being lest they have appropriate amounts motivation to do so. “Appropriate amount of motivation” is a relative term. As you may have noticed, some people enjoy working harder than others. These people are generally more successful. If the dancer doesn’t have the work ethic and mental focus, gaining the appropriate motor control over these muscles will not happen, despite any natural passive turnout abilities that may be present.

Why is turn-out  so important?

So why did the obsession with turn-out begin? It has been instilled in us that the more turn-out, the better the dancer. The more you can externally rotate your legs, the better it “looks”. Have you ever questioned why? It goes beyond just looking aesthetically pleasing.

In reality, turnout serves only a few functional purposes for the dancer (when used intelligently, of course). The first is to facilitate sideways movement, which you hardly need an excessive, 180 degree turnout to do.

The second, is that it facilitates lifting your leg, especially to the side. The femur has more abduction ability when in external rotation. The reason ballerinas like Svetlana Zhakarova can lift their legs up to their ears with ease: They have access to a lot of external rotation from their hips. The greater your ability to access your maximum turn-out, the higher you can lift your leg before bones stop you from going any further.

 

One could also argue that the more turnout ability you have, the higher strength potential you will have at the hip joint through the access to a higher number of muscle fibres. If these muscles are trained properly, it could produce higher jumps, higher extensions, and better stability, among other things. There is very little research on the topic, however, and this is purely educated speculation, on my part.

Beyond that, our obsession with turnout is purely aesthetic. Extreme turnout is now the standard for professional ballet companies. Think of the difference between Olympic athletes and “good” athletes. The ones who make it to the Olympics often have genetics on their side, and they set the gold standard, though this doesn’t make the “merely” good athlete any less, well, good. Thank God ballet isn’t in the Olympics.

Can it be improved?

I have already partially answered the question of can we improve our degree of turnout, and the answer is, yes-  If you work on it from both mental and physical side, it can be improved to a certain degree. However, of the 7 factors mentioned above, only two can be trained to improve. This means that even if you are doing external rotator strengthening exercises every day, three times a day, your muscles only have so much potential strength- A limit so to speak. After they’ve hit that limit, there’s nothing left you can really change.

So maybe you’re wondering, “Why do professional ballet dancers have so much turnout?” Are they doing top secret turnout-improving exercises, not made available to the public? Much like weight-loss, there is no secret to improving turnout- Just a combination of hard work and genetic variance.

I hate to break it to you, but elite, professional ballet dancers were selected at a young age to join professional schools. These professional schools select young girls (and boys) when they are under 10 years of age, ideally, based on their genetic potential.  At this age, natural “talent” and coordination is not really something they care about- Those can be trained. What is most important is that they have a perfectly aligned blank canvas to do with as they please.  Trust me, I tried out for all these schools when I was between 14 and 15, and though I was told by my teacher that I was a “better dancer” than many of the girls that were accepted, it was the natural structure of my body that was just not optimal for professional ballet. That, and 15 is too old to be accepted to such a school. It’s a harsh world.

Furthermore, professional ballet schools stick to their low acceptance age in the belief that up until about 11 or 12, the bony structure of the pelvis can actually be altered with training. Much like stretching the iliofemoral ligament, this is highly controversial, and there is little evidence to support this.

“It has been theorized that early training may be able to actually affect bony constraints, allowing for a moulding of femoral torsion up to about age 11 or 12, but after that age, improvements in passive turnout would be due to stretching of soft tissue constraints (capsule, ligaments and muscles)” 

According to some orthopedic  surgeons, a minimum of 60 degrees of hip external rotation should be present if a dancer wishes to pursue a career in classical ballet. This is an extremely high degree. It was found that the average among professional ballet dancers was about 59.9 degrees. Women tended to have more passive turnout ability than men. However the methods for measuring turnout are variable, and subject to error. In modern dancers, their comfortable degree of turnout was about 29 degrees– Half as much as their genetically endowed counter-parts.

The questions you should ask yourself are:

1) How much natural turnout do you have?
2) Is it really that important for you to be a professional ballet dancer?

If you answered “not much” to the first question, and “not very” to the second, then it seems obvious to me that if you are still trying to forcefully improve your turnout- Stop now, and adopt a more functional approach, lest you retire at 30, or younger.

Should you attempt to improve turnout?

So we’ve established that yes, to a certain degree one can improve their turnout. But the lesser addressed question is should the dancer try to improve his/her turn-out? My answer: Yes and no.

Yes, if you can do it intelligently and functionally.

No, if you do it dangerously.

What is intelligently improving your turn out? It may be better to first point out what I deem as dangerous attempts to improve turn-out. The obvious ones are:

  • Creating unnecessary torque at the knees by pushing too far into your knee turnout.
  • Collapsing the arches of the foot.
  • Tilting the pelvis forward and arching the back.
  • Excessive stretching of the ligaments of the pelvis (iliofemoral ligament in particular).

In my approach to helping dancers improve their turn-out, my philosophy is not to train the external rotators by doing tons of hip isolating exercises. Rather, what I find is more helpful is to use integrated exercises, that strategically stabilize, mobilize, strengthen, and increase the neural control of the whole body’s alignment. Many dancers have an imbalance between their quads and hamstrings, between their hip-flexors and their glutes, their abductors and adductors, and their external and internal hip rotators. The former of each pairing generally being over-active. By strategically strengthening the right muscles, and releasing the over-active ones, proper alignment can be found. Then, the external rotators can be fully accessed, and strengthened. You will feel like a whole new dancer.

But I can’t give away everything in this article. You’ll have to contact me to talk privately about what I can do for you. Forgive me for setting a mysterious tone.

Functional turnout: Sounds pretty… Functional

Functional is the key word here, in case that wasn’t obvious. Functional turnout is defined as the amount of turn-out you can access without involving your knee and ankles. Often, dancers first bend their knees, allowing them to access more rotation from their hips. Then when they straighten them, they can’t maintain that same degree of hip rotation, so they rotate from their knees instead. The same happens at the ankles. The lumbar spine compensates as well. Coryleen (et al) recommends three qualitative criteria for functional turnout:

 1) Keep the center of the knee over the midline of the foot

2)  Keep equal weight over both feet

3)  Keep weight evenly distributed among the calcaneus, the first metatarsal head, and the fifth metatarsal head

“These qualitative criteria are intended to limit the magnitude of turnout to available hip external rotation and to prevent unwanted compensatory movements at other joints.”

By ensuring you use only the turnout you were naturally endowed with, you will be better aligned through your pelvis, you will be injured less frequently, and you will reduce tension in your upper body.

Have you ever received corrections to relax your face, neck and shoulders? To engage your abdominals and not arch your back?  These corrections can often stem from the fact that you are forcing your turn-out too hard, from the wrong places.

It’s time to re-think your technical priorities.

Unnecessary tension in the body is caused by mal-alignment from the desired result of extreme turnout. We’ve established that unless your goal is to become a professional ballet dancer, extreme turn-out is not necessary. Chances are, if you are reading this, and are not yet a professional ballet dancer, you either missed your chance, or it was never genetically possible. If instead, you make your alignment a priority without sacrificing it for maximum, unnatural turn-out, you will naturally be able to release your body’s tension, and your technique will actually start to improve.

Funny how when you work with your body, rather than against it, it cooperates with you.

Dance requires optimal function. Function with your optimal turnout. Not Svetlana’s.

Having  a greater ease of access to your maximum hip external rotation, and not cranking from your knees and ankles, will help with maintaining your neutral alignment while you dance, thus decreasing your risk of injury, reducing your upper body tension, and generally helping you not look “weird”.  Because we’ve all received that correction before- Especially the current and former Ryerson dancers reading this.

Some Interesting Findings Comparing Dancers to Regular-folk

Here is something that really blew me away: The hip external rotators of dancers are NO STRONGER than the external rotators of non dancers.

I can imagine you saying, in a tone of disbelief, but how can that be??!

In a study comparing external rotator strength in dancers and non dancers, aptly named: An evaluation of differences in hip external rotation strength and range of motion between female dancers and non-dancers”, it was found that rather than dancers having more actual hip rotation strength (as one would predict), they had managed to shift the strength curve, so that they had more access to their external rotators, than their internal rotators. The total degree of rotation was the same,  but dancers tended to be able to access more external rotation and less internal rotation, whereas non-dancers could access a much higher degree of internal rotation than external rotation.

The findings of my assessments reflect the findings of this study: My non-dancer participant had much more internal rotation, but limited external rotation, and my dancers all had very little ability to internally rotate, but extreme amounts of external rotation.

In fact, rather than being stronger, dancers have just managed to shift their motor control towards the external side of their rotation ability. This heightened motor control ability allows them to produce more force, which is why they appear to have stronger hip external rotators.

Now here’s where things can potentially get interesting in terms of what I do at the DTP.

Specific training effects for velocity, muscle action, and angle are well established in athletic populations, but the angle specific strength of the hip external rotators has not been determined in dancers.”

My theory is that by training the external rotators for strength at the individual functional turn-out level with full body integrated movements, such as the squat and deadlift, and explosive lifts, the posterior chain will develop a high degree of functional strength and power in the turned out position specific to each dancer. This will contribute to the dancer having an ease in accessing their turn-out, as well as higher jumps, greater ability to lift the leg, and better single leg stability, among other things. I shall write more about the benefits of hip drive, and posterior chain strength and neural control for dancers in another article, as this one is long enough already.

In our investigation, the ability of the ballet dancer to achieve extreme hip ER is demonstrated as a shift in the strength curve. There is no greater overall strength of the hip external rotators in the dancers compared with the non-dancers, but they are able to achieve greater strength at angles in the inner range of hip ER…This shift is significant as it may show a training effect related to angle specific strength.”

This is not to say the internal rotators shouldn’t be trained for function as well. To be extremely imbalanced is not helpful in terms of stability. Often times, training the internal rotators and adductors to work better will help the dancer to improve all of the aforementioned technical aspects through harmoniously working muscles groups. This necessity of muscle harmony is why rather than giving my dancers isolation exercises, I move them as quickly as I can into more integrated movements that require the control of opposing muscle groups together.

Although as a muscle group, the hip external rotators were not found to be stronger between groups, the dancers were able to generate significantly greater force in the inner range of hip ER, highlighting the requirements of hip ER during turnout in ballet. This study shows the ability of the dancers to achieve significantly greater hip ER ROM (inner hip ER range) at the expense of hip IR ROM (outer hip ER range). The total hip ROM was similar between the groups.”

The new clinical findings of this study:

  •  “Dancers show greater hip external rotation strength into extremes of hip external rotation”

This means that dancers could produce the most force in their last degrees of external rotation. Emphasizes the point that you should always try to work at your maximum functional turnout for the most force production, which equals better jumps and stability.

  • “Greater hip ER ROM is not the sole prerequisite of a dancer, rather strength and ROM at angles specific to the demands of ballet are required”

If you have the natural range of motion, but not the strength, it won’t help your technique. Learn to hone your skill advantage.

  • “Dancers exhibit a greater right to left side strength difference than non-dancers and this greater asymmetry must be kept in mind when assessing a dancer’s strength as it shows their preference of a single limb. This asymmetry may contribute to alterations in the kinetic chain and may be a risk factor for injury”

Imbalances from one side of the body can lead to injury. Dancers always start with their right foot for any given exercise, so it does not surprise me to hear that we have more mobility and strength on our right sides.

  • Musculoskeletal assessment or screening of dancers must include strength measurements at angles specific to the demands of the task, rather than assume overall strength differences to exist between trained and untrained populations for specific muscle groups”

This was already  the assumption I had. Now that it is clear that dancers are not in fact any stronger than the average person, just more adapted to turning out, it seems like it will be advantageous to those dancers who decide to train their external rotators for strength at their specific angle of functional turnout.

The mechanics and intricacies of how the dancers’ body works are becoming a more mainstream science, and everyday more research is being done on how to optimize dancer performance at the physical level. As Krasnow puts it,

“As a group, dancers are just beginning to appreciate the potential for using science and its spin-off technologies to improve dance training and performance. …Some of the specific performance improvements the movement sciences may be able to help dancers achieve include higher extensions and arabesque, longer leaps, cleaner turns, and more effective use of turnout.”

Take advantage of this information and technology. Dance smarter, not harder.

Key Points to take away from this article:

  • Very few factors affecting your degree of external rotation are able to be altered.
  • A correlation has been found between angle of gait turnout and injury rate in dancers.
  • It is safer and more effective to work at a functional level of turnout.
  • High degrees of turnout are not crucial for the dancer unless wishing to perform at an elite level of professional ballet.
  • Attempting to improve one’s turnout can prove dangerous, and must be done with intelligence and caution.
  • Dancers and non-dancers have similar hip external rotation strength- Dancers have just adapted to access more of the muscle fibres in the external rotation range, giving them the illusion of increased strength.
  • Dancers who attempt to strengthen their specific angle of functional turnout through integrated movements will reap the technical advantages compared to the dancer who does not take any strengthening  or cross-training measures.

 

References

Calais-Germaine, B. Anatomy of Movement. Eastland Press, Incorporated, Seattle, WA, 1993.

Cimelli, S, and S Curran. “Influence of turnout on foot posture and its relationship to overuse musculoskeletal injury in professional contemporary dancers: a preliminary investigation..” Journal of the American Podiatric Association. (2012): 25-33. Print.

Clippinger, Karen. Dance Anatomy and Kinesiology. Human Kinetics, 2007. 196-200.

Coplan, J. “Ballet dancer’s turnout and its relationship to self-reported injury..” Journal of Orthopaedic and Sports Physiotherapy. (2002): 579-84

Coryleen, B, et al. “Relationship Between Hip External Rotation and Turnout Angle for the Five Classical Ballet Positions.” Journal of Orthopaedic and Sports Physical Therapy. 27.5 (1998)

Greene Haas, J. Dance Anatomy.Human Kinetics, Champaign, IL, 2010.

Gupta, A, B Fernihough, G Bailey, et al. “An evaluation of differences in hip external rotation strength and range of motion between female dancers and non-dancers.” British Journal of Sports Medicine. 38.6 (2004)

Grossman, G, D Krasnow, et al. “Effective Use of Turnout: Biomechanical, Neuromuscular, and Behavioral Considerations.” Journal of Dance Education . 5.1 (2005)

Strzepek , Nichelle. “Everything You Ever Wanted to Know About Turnout – Part I.” Dance Advantage. 2008

Wilmerding, V, and D Krasnow. “Turnout for Dancers: Hip Anatomy and Factors Affecting Turnout.”International Association for Dance Medicine and Science. 2011.