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.


 

 

The Problem With Dancers Today

We have problems

No, not “dancer-problems”, like those mentioned in this moderately humerous video. But rather, the problem WITH dancers.

There are a number of them. And the one thing they all have in common is that they are
self-imposed, avoidable, and have a direct correlation to the staggeringly high rate of injuries associated with the profession. The problems I speak of aren’t just physiological, but also psychological in nature- Both feeding off of each other in a vicious, cyclical fashion. A perpetual-motion machine of sorts, accelerating down a seemingly endless highway, not an obstacle in sight. Endless that is, until the inevitable brick wall. What happens if you ignore the brick wall?

But I recall fondly what my favourite philosophy professor once said, “The best analogy for the thing in question, is the thing itself.” And so I digress.

I am nearly done the initial interview process of my program, and it is really fascinating. I want to thank all my dancers for letting me delve into their psyche. Among one of the most interesting questions for me to ask was why they dance. What kept them motivated, and what in particular they like about it? It is important to note how some of them couldn’t pin point specifically what they liked about it. By the way, every dancer I interviewed reported some kind of repetitive injury, in varying degrees to either their back, knees, ankles, hips or rotator cuff. Or all of the above. It was fascinating to hear why they kept at it, despite constantly sustaining these injuries.

To the general masses of people, and many athletes even, injuries and pain tend to stop them from continuing to do the activities which hurt them, time and time again. At the very least, they alter what they are doing so that it hurts less. This lead to problem #1 with dancers:

They don’t listen to their bodies.

Call it suffering for your art, or whatever you want, but if you don’t listen to the messages your body is sending you, there will come a time, when you won’t have a functional body to create your art with. These messages are actually really easy to interpret: Pain means stop, no pain means go (or rather, proceed with caution). Pain is generally your body telling you to slow down, and stop, because what you’re doing to it feels really bad. If you do not stop, your body will stop you, eventually, and it won’t be pleasant. You will be out of commission for longer than if you had initially listened to your body, and be stuck on the sidelines, watching your peers (which can actually be an excellent learning experience if you let it). Being stuck on the sidelines is damaging for the ego. As Stephanie Hanrahan points out,

“When injured, dancers are expected to watch classes. Although a few found they could learn something while in the role of spectator, no one enjoys the role. Many would rather dance on an injury instead of observe. Additionally there is the underlying stress of others improving and looking good when the individual cannot participate because of illness or injury.”

It is clearly more intelligent to avoid injury in the first place, by not doing stupid things, but many of us must learn the hard way. Such is life, I suppose.

There is obviously a difference between good pain, and bad pain. If you have to stop and consider whether it is a good pain or not, it probably isn’t. I read something interesting on Rusty Moore’s fitness blog, Fitness Black Book. His article was titled: “Are you in shape or do you just have a high pain tolerance?” Having a high pain tolerance certainly can help one to push through a tough performance, class or training session, but if you don’t have a great level of fitness (which we’ve previously established that most dancers don’t) and still push through the pain, the benefits are likely to be limited, or even non-existent verging on harmful.

Their use of imagery is inefficient

Rather than have to consciously apply a visualization to a movement every time you do it, wouldn’t it be nice to just have that feeling automatically, every time? My philosophy for training dancers is not to give suggestions for what kind of imagery you could use during classes, but rather to instill that feeling in the dancer at a very basic lecvel, which they will then bring into class during more complex work.

The first phase of my training program is inspired by Dr. Stuart McGill’s method of training athletes while sparing their backs and other joints. His first phase is named,“grooving motion and motor patterns”, and this is where physiological adaptations are made which not only provide you with the appropriate imagery, but gets it stuck in your system. This trains your muscles to fire automatically, as needed: You won’t have to visualize youself as “ a tree, growing out of the earth” to get on your leg, or “water flowing off of your arms”, to find the proper arm position. This just wasn’t my style, and for many dancers, it doesn’t work.

Instead, a better method is the anatomical education of what specific muscles need to work, and what muscles don’t. Then, train the appropriate muscles to become hyper-responsive. Many people, even dancers, don’t know what it feel like to use the right muscles, and the best way to teach this is through the use of imagery.

It has been found that it is most effective to apply different types of imagery for any given exercise. In a study published in the Journal of Dance Medicine and Science, it was  determined that using kinesthetic imagery (imagining a feeling) was more useful to improve turn-out during a plie exercise, but using visual imagery, (picturing your body from an external point of view), was more helpful for jumping.  They concluded that,

the success of motor imagery in improving performance may be task-specific. Dancers may benefit from matching imagery modality to technical tasks in order to improve alignment and thereby avoid chronic injury”.

In fact, many dancers I interviewed told me they did indeed use a mixture of internal and external imagery.

Once one has this proper “feeling”, the muscles can then be made stronger. If the muscles you need to be “on your leg” (aka, the hamstrings, glutes, and abdominals, working in harmony) are strong and hyper-reactive, then they will react, and strongly, when you need them. Makes sense, no? The less you have to think about what your body is doing, the more room there will be for you to blossom artistically by focusing on what really matters- Your emotional expression. Think less, feel more. Isn’t that what art is about?

Another study conducted by the Auckland University Sports and Medicine department found that using kinesthetic imagery was more effective for motor control that visual imagery, or rather: Focusing on what it felt like to use your body was more effective in activating the right muscles than was visualizing what it should look like. My interpretation of this is that because though many of us know what certain positions should look like, we often don’t have a clear and distinct image of what our own bodies will look like doing that very thing. I believe many dance teachers would agree that it is more effective to find your own unique “feel” for a movement. This way we not only activate the appropriate muscles with more strength, but we also don’t get that awkward “trying to dance like someone we’re not” look. An intangible, but very difficult to hide, quality of movement.

Appropriately applied kinesthetic imagery allows the dancer to simply dance as the best versions of themselves without comparison or judgement. Once the appropriate imagery in ingrained in the dancer, then I believe that visual imagery can be used as a supplement, such as in jumps.  To jump higher, is a visualization that is universal, which is likely why the study found visual imagery helped the dancers during jumping exercises.

But enough about imagery, I could say more, so perhaps a whole post should be devoted to the subject instead. On to dancer problem #3:

They have weak arms

When I told my physiotherapist that I could do chin ups, he said “And you call yourself a dancer? You should be ashamed”. Obviously he was joking, but it just points to the fact that people don’t associate dancers with having arm strength. But why shouldn’t they have strong arms?

The thing is, dance, by definition, allows for an unlimited range of movements. Often times, in modern choreography, dancers need to propel themselves with the use of their arms, or lift each other. Gender lines are crossing, and it is not uncommon for a female dancer to lift a male dancer. In actual fact, dancers need strong arms, because the possibilities in choreography are endless!

Maybe today, the current piece you’re working on does not require you to lift anyone, but next week, your choreographer might ask you to balance on one arm, to perform a dive-roll and land by absorbing the shock of impact with your arms,  Maybe you’ll have to lift another dancer over your head. What happens if you aren’t ready for these challenges? You get injured.

A recent study by the Sports Medicine Assessment Research and Testing Laboratory, and the Performing Arts Medicine Program, at George Mason University, showed that dancers could benefit from strengthening their arms to reduce risk of injury due to the potential high upper-body demands of modern dance choreography:

“…Our preliminary work suggests that modern dance alone may not produce upper-body muscle endurance gains. Hence, it is suggested that modern dancers should engage in strength and conditioning training programs to enhance upper-body endurance.”

No kidding.

They may be susceptible to having weaker bones

Because dancers are often inside, dancing in the studio, and not outside, frolicking in the sunshine (sigh), they may be at risk for vitamin D deficiency when compared to other athletes with similar work-loads. Lack of vitamin D could potentially increase one’s susceptibility to illness. Vitamin D has been shown to boost the immune system, and taking too much time off to rest because of illness, may cause your technical progression to stall. Not to mention, if you come to class sick, you’re at a higher likelihood of injuring yourself in your weakened state.

One also needs vitamin D to properly absorb the calcium necessary for strong bones. Now, because we’ve already established that dancers are relatively unfit in general, they may not have bones as strong as they should when compared with the high volume work-load they take on. Supplementing with vitamin D and adding strength-training to their routine ensures they won’t break any (or at least not too many) bones prematurely.

In a recent study done by the Department of Kinesiology at Pennsylvania State, it was shown that more than half of highly-trained young male ballet dancers presented with low levels of vitamin D in winter. However further investigations were stated as necessary to determine if this could negatively impact bone growth and place them at higher risk for musculoskeletal injuries.

Vitamin D also has been shown to promote a general “good feeling”- Which all dancers could use a little more of every now and again.

They don’t warm up.

Need I list the benefits, or rather, the necessity, of performing a proper warm-up? I get tired of repeating myself, but, not warming up properly, or neglecting it completely, is a huge contributor to the elevated dancer-injury rate.

Here is the warm-up I did on the day I sustained my acute hamstring strain:

1)      Rubbed some Tiger Balm on hamstring.

2)      Stretched hamstring for about 30 seconds.

3)      Sat in center splits for a couple minutes.

Ready for class!!

Can you see the problem there? I have since reformed my ways. Stretching does not a proper warm-up, make! Instead, do some jumping jacks, or do your own mini-barre. Then maybe some self myofascial release to any particularly painful areas with a hard rubber ball, or a foam roller (just get a lacrosse ball from Canadian Tire for four bucks).  Do some dynamic stretches that move you through a sub-maximal range of motion. Roll around on the floor a bit. Hold plank, for a minute or two. Do some push ups. SITTING IN YOUR SPLITS IS NOT A WARM-UP! Do not weaken the muscles you will be needing in class by lengthening them right before you need to use them. But you all knew that, right?

They have postural issues that they are generally unaware of

I was always under the impression that, because I was a dancer, naturally I must have excellent posture. That is, until it was pointed out to me just how bad it really was.

My shoulders used to round forward excessively, my head was about an inch forward of where it should be, putting excess pressure on my spine (they say that even having your head forward an inch of where it should be, is like adding the weight of an extra head). My pelvis was tilted forward, and I walked with my toes pointing out. All these things combined with a heavy volume of work puts a great deal of stress on places that aren’t designed to handle it. It is no wonder I had chronic back pain for years, which later cumulated to three consecutive back injuries, chronic knee pain, ankle pain, biceps femoris tendonitis, leading to a second degree hamstring strain, followed by ischial bursitis in my left hip. I could probably list more. I’m pretty sure I strained my groin a few times, but it’s hard to keep track. The point is, they all could have been avoided had I corrected my muscular imbalances, fixed my “normal person” posture, and thus improving my “dancer posture”.

It was shown, in a recent study comparing the postural stability of injured dancers and non-dancers, that although the injured dancers received ballet training, their postural stability may still be inferior to that of the non-dancers.

They take pride in walking with turn out and being hyper-mobile

Not only does walking with your toes pointing out put excess stress on your knees, hips and ankles, but it looks really weird. I spend a lot of time people-watching (if you don’t, you should try it, especially in Toronto. It’s really interesting), and one thing I’ve observed is this: The only people who walk with excessive turn-out are dancers, and people who aren’t all together in the head. Seriously.

Could I be alluding something to the mental state of dancers? Perhaps… But mostly, I just want for you to not have knee, hip, lower back and ankle pain.

In a study done by the Wales Centre for Podiatric Studies, a link was found between the number of injuries, and the degree of turn-out with which the dancer tended to walk:

“A significant relationship was noted between the Foot Posture Index and angle of turnout, and between the number of reported injuries and change in foot posture in the angle of turnout”.

Dancers are also oddly proud of having hyper-mobile joints. Strange how we’re so proud of the things that cause us so much harm. I’m starting to believe dancers really do have something inherently wrong with their ontology…

Hyper-mobility does not make you dance better. It only makes you better at getting into high risk positions, from which you don’t have the strength to return. 

When your joints are more mobile than they are strong, and I’m talking about the HUGE discrepancy most dancers have, it puts the ligaments and tendons at high risk of injury. Dancers often sit on the sidelines stretching, but too few actually take the time to strengthen. My theory is because it takes more actual “work” to strengthen a muscle than it does for the already-flexible dancer to flop into a split. People just don’t like to do the things that are good for them, that is, until they realize how good it can feel when they do. Which is why I didn’t eat vegetables until I was 19. That’s a bit of an exaggeration. But again, I digress.

But Why?

I joke about dancers being stupid, but really, we aren’t. Dancers have to be extremely intelligent to do what they do. So is the madness really about making sacrifices for the sake of art? 

I think the problem is, that dance, from the beginning, was all about control. In the courts, where dance became highly popular among royalty, they had to maintain a certain control and poise. I can imagine King Louis probably had a lot of problems himself, and he pretty well invented ballet as we know it today. Interesting foreshadowing…

As dance progressed and pointe shoes were invented, dancers had to display their control and poise, despite wearing ridiculously designed shoes (for some reason deemed aesthetically pleasing) and while withstanding enormous pain. It has since been ingrained in our souls, that we as dancers mustn’t show pain, but rather hide it. Dance is painful, therefore pain is beautiful, so pain and dance must go together. We mustn’t ask for help. If something is too hard, we don’t say no, we do it and if we get hurt, so be it, we’ll keep dancing because we are in control. Are we though?

It goes back to the question of “why do you dance?” Why haven’t you quit despite the criticism, the injuries, the feelings of inadequacy, the hard, hard work, for hours a day.

This is what my dancers told me: They said they dance because they want to express themselves. They love to move. Nothing can stop them from doing it because the feeling of expression through movement is unrivaled.

So why then, if you love to move, do you do things that will ensure you won’t have a functional body to move with about 20 years from now? And if you love to express yourself physically, why do you damage the very vehicle for your expression?

And do you know what the answer was to that question? Recognition. Praise. Feeling accomplished. Having your hard work acknowledged. Dancers are highly critical, and though they are good at putting on a show of confidence, all they really want, or rather need, is someone to tell them they’re good enough. I’m starting to be really convinced that if dancers are willing to put their bodies through hell and back, just to be acknowledged, there must be something very wrong with us all in the head.

I firmly believe that the arts are the only thing that can simultaneously keep you young, yet mature you beyond your years. The arts take immense intelligence, but require foolish risk.

What you should take from this article, is not that I am criticizing dancers for wanting to be good at what they do, but I am criticizing the lengths they take, and their questionable methods to get the praise they want so badly. I’ve been there, but I’ve since discovered that it is better to be kind to your body.

Stay strong, dancers.

 

P.S. To read Rusty’s blog post on fitness vs. pain tolerance:

http://fitnessblackbook.com/interval-training/are-you-in-good-shape-or-do-you-just-have-a-high-pain-tolerance/
References:

Ambegaonkar, J., Caswell, S., Winchester, J., Caswell, A., & Andre, M. (2012). Upper-body muscular endurance in female university-level modern dancers: a pilot study. Journal of Dance Medicine and Science, 3-7.

Cimelli, S., & Curran , S. (2012). 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 Medical Association, 25-33.

Ducher, G., Kukuljan, S., Hill, B., Garnham, A., Nowson, C., Kimlin , M., & Cook, J. (2011). Vitamin d status and musculoskeletal health in adolescent male ballet dancers a pilot study. Journal of Dance Medicine and Science, 99-107.

Giron, E., McIsaac, T., & Nilsen, D. (2012). Effects of kinesthetic versus visual imagery practice on two technical dance movements: a pilot study. Journal of Dance Medecine and Science, 36-38.

Hanrahan, Stephanie J. (1996) Dancers’ perceptions of psychological skills 9-10, 19-27

Lin, C., Lee, I., Liao, J., Wu, H., & Su, F. (2011). Comparison of postural stability between injured and uninjured ballet dancers. American Journal of Sports Medecine, 1324-31.

Stinear, C., Byblow, W., & Steyvers, M. (2006). Kinesthetic, but not visual, motor imagery modulates corticomotor excitability. Experimental Brain Research, 157-164.