How to Reverse Engineer a Jump Landing for Happier Joints

How to Reverse Engineer a Jump Landing for Happier Joints

The ankle and foot are among the most common site of injuries in dancers, and is it any surprise?

The desired aesthetic for dancers to point their feet, pull up their arches, and push their knees out as far as possible can create the avoidance of some important joint movements (listed a bit further below) which are necessary for shock absorption upon landing a jump.

I have landed from jumps feeling shooting pain through my ankle, but put on a smile and “danced it off” to keep going. Landing a jump well is pretty important.

Often in working with dancers, our initial instinct is to initiate plyometric training in an attempt to teach the dancer how to land more softly, with better mechanics.

Is this wise as a first measure?

What if reducing foot and ankle injuries was less related to training strength and power, and more to practicing the allowance of joint movements necessary to absorb shock upon landing.

Unfortunately, these movements that are commonly avoided for the sake of aesthetics. (I will refer to these movements cumulatively as “loading the spring”).

When you land a jump, you load your spring.

Consider that paradoxically, to clean up a jump, the landing might need to look a little more “ugly” (by ballet standards, anyway).

Guess what, pronation and valgus are not the evil step-children we’ve been avoiding.

Let’s let go of judging what the movement looks like for a moment, and honestly appraise what movements need to happen in the human body for optimal shock absorption to take place.

“Ugly” joint mechanics for optimal shock absorption (AKA loading the spring):

suspension

Looks kind of like this

Rear-foot (calcaneus/talus): Eversion, plantar flexion, internal rotation. Yes, pronation! Which drives…
Ankle: dorsiflexion
Tibia, femur: internal rotation (not turn-out!?)
Knee: flexion, external rotation, valgus
Hip: flexion, external rotation, adduction
Pelvis: lateral hike, anterior tilt
Lumbar/thoracic spine: extension, rotation towards landing leg, side flexion towards landing leg

Wait… Allow pronation, internal rotation, and valgus? Aren’t these “bad”?

In the human body, the above joint actions must occur to eccentrically load the muscles necessary for successfully absorbing shock (plantar fascia, medial quad, glutes, etc). These are not static joint positions, but brief moments (less than a second) that the human body must pass through.

What would happen if we helped dancers to experience these important moments in their bodies, rather than brace and control in conditioned avoidance of “ugly” positions?

Inline image 3

The “suspension” movement to train more optimal shock absorption. Notice the joint actions of the front leg? Think this is ugly?

5 ways classical dance training can alter landing position and limit optimal shock absorption:

 

1. Feet get stiff.

In a closed chain (foot on floor), the rear-foot and fore-foot need to be mobile and move in opposition in each plane, allowing joints to open and close to take the shock of the landing.

In dance, the foot can become very strong and rigid losing mobility and ability to oppose through pronation and supination. Feet can get stuck stiff and inverted or stiff and everted. Neither is ideal.

Add to this that many exercises dancers use to strengthen their feet and ankles are done with a band, open-chain, which does not allow foot opposition and is not specific to how the foot was designed to function on the floor, in gait.

2. Attempting to maintain perfect turnout in foot and leg while landing.

Upon landing, the rear-foot (talus and calcaneus) needs to evert and internally rotate (pronate!) to load the spring of the plantar fascia and windlass mechanism. The rear foot drives the tibia and femur to internally rotate and the knee and hip to open. This is what we want!

Dance often demands that we turn everything out: Foot, ankle, thigh, knee-cap; and by limiting this necessary internal rotation we also limit the ability of the knee and hip to open and absorb shock.

Landing with everything turned-out can limit natural movement and jam up joints rather than “load the spring” to manage impact.

Landing with the foot and leg turned out… Not the type of pronation we want!

Landing with lots of turnout in the foot, tibia, and thigh, limiting shock absorption.

Landing with lots of turnout in the foot, tibia, and thigh, limiting shock absorption.

3. Landing in hip ABduction rather than allowing ADduction (again, that turnout!)

To absorb shock optimally, the hip must adduct in the frontal plane, following what the foot is doing below. In dance, however, we are trained to avoid inward knee movement and deny ourselves this important moment of valgus.

Dancers, wanting to always be turned out to the maximum, tend to land with the knee pushed out and hip abducted, preventing that lovely shock absorption from taking place.

4. Trying to keep the pelvis upright, not allowing an anterior tilt to occur to with landing.

Upon landing, the hemi-pelvis on the landing leg side should anterior tilt to “load the spring” (which in this case is the glutes, which load with anterior tilt). Being cued to tuck under, or keep the pelvis perfectly level all the time and avoiding anterior tilt, again, denies the dancer of this important moment.

5. Chronic extension posture preventing dancer from extending further upon landing

Lumbar and thoracic spine extension is another way to “load the spring”, allowing the dancer to eccentrically load and then use the abdominals to enter and rebound out of the landing.

If a dancer is already stuck in an extended position with static lordosis and rib flare at rest (which is quite common…), this spring-like mechanism will not take place, and vertebrae may compress rather than abs taking load.

patho turnout

 

Do you stand like this at rest? Can’t get out of extension?

Now, you may be thinking…

“But I see so many dancers who land with their knees going in and over-pronating, and that is not a good look.”

“Surely asking a dancer to land with an anterior tilt and extended spine is not safe??”

These movements: Pronation, knee valgus, anterior tilt, and spine extension, are not bad. If you could not perform these movements, I would question how you are able to walk.

These joint movements only become a challenge when a) You get stuck in them, or b) You can’t get into them at all.

Landing WITHOUT permitting a brief moment of pronation will not allow shock absorption.

Landing already IN an anterior tilt and extended spine will not allow shock absorption.

I do not mean that we should coach dancers to land excessively pronated, turned-in, with knee valgus. These are subtle, fleeting moments in a spectrum of movement. Subtle, but important.

If we give dancers activities that allow them to experience naturally moving in and out of these foreign positions safely, they might just choose to store this as a useful pattern and use it in their dancing at the appropriate time without over-coaching and conscious effort.

A good place to start would be the “suspension” movement, which was created by Gary Ward and taught through Anatomy in Motion. Suspension simulates the shock absorption phase of gait following heel-strike. It could be used as a warm-up before class, or as a supplementary exercise as part of a cross-training program.

Notice I’m doing my best to pronate (not easy for me!), internally rotate my leg, and allow my knee to come inside my big toe, while slightly anteriorally tilting my right pelvis and extending my back?

Work in progress…

What you might feel while suspending:

  • Front leg quad getting burny (this is eccentric loading- the muscle contracting as it lenghtens)
  • Front leg glute getting burny (eccentric loading)
  • Front leg plantar fascia stretching and opening
  • Front leg achilles tendon area/calf stretching and opening
  • Back leg hip stretching and opening
  • Back of the neck stretching
  • Abdominals stretching (rectus/obliques)

Give it a try and see what happens.

Please note, however, that I don’t feel it is wise to TRY to land like this. Don’t attempt to change anything about your landing. Simply give your body this experience outside of class, and trust that you have now shown your body some new landing strategies that it may chose to employ the next time you jump, with little conscious effort.  Landing with a few extra degrees of real pronation and ankle dorsiflexion might make a huge difference.

And just for fun…

Exercises from Anatomy in Motion haven’t only been helping me land jumps feeling more safe, but I feel (subjectively, yes) that my developpe height and hip mobility are improved, both on the standing leg, and the gesture leg.

Here’s something I’ve been working on (believe it or not, this is actually easier with a weight over head- Lot’s of great feedback for not falling over):

Transition from side to back in a grand rond de jambe was something I could never do without crazy hip cramping. The other day, after working on some AiM I tried it out, and it felt pretty good! No cramping.  Leg comfortably around 90 degrees. Had to take a video (don’t try this at home unless you feel solid about plain old Turkish get-ups).

Don’t think you’ll be seeing me in a ballet class anytime soon, though ;). These days, I’m loving parallel standing leg, and no one can convince me that turnout is prettier. It’s just a different aesthetic. My choice. My knees…

Does Training in Parallel Reduce Turn-out in Classically Trained Dancers?

Does Training in Parallel Reduce Turn-out in Classically Trained Dancers?

So you do ballet… Perhaps you’ve asked some of these questions:

“What’s the best exercise to increase my turnout range of motion?”

or

“Will training in turned IN positions and in parallel make my turnout worse?”

or

Why can’t I be Svetlana Zakharova????!”

The above are really great questions. Many of us wish we had more turnout, have tried without success to improve it, and have possibly even become injured somewhere along the way.

Turnout is a tricky thing. Despite advancements in the dance sciences there is still no consensus between dance teachers and dance healthcare professionals on how safe and effective it is to attempt improve turnout beyond a certain extent. There will also come a time in your training where you’ll just have to accept the range of motion you were given and move on with life. Sorry, but grinding bone (femur) against bone (acetabulum) doesn’t actually help anything.

And that leaves the other question, “Will training in parallel reduce turnout?”

Short answer: No. 

I wish I could end this post here. But I guess you probably would like an explanation.

First I want to say that I empathize. My turnout is naturally terrible (though within normal ranges for life in general, my hip external rotation is not optimal for classical ballet).

Next, I totally understand the concern that training in parallel could reduce your turnout ROM. This is actually a linear rationalization if you don’t have a good understanding of functional dance anatomy.

Unfortunately, this line of “more is better” thinking doesn’t take into account things like muscle overuse, soft tissue tension-holding patterns, strength imbalances, changes in neuromuscular control, alterations in boney alignment, and injuries. Things are little bit complicated for ballet dancers who dedicate their lives to turnout to the extent that it can kind of screw some joints up.

Working to optimize turnout is like managing a nutrient deficiency. You don’t want to jump to the conclusion that you need more of  a nutrient, megadose without a professional opinion or doing much research, and then somehow expect things to miraculously get better, not worse.

You don’t need to be worried about cross-training in parallel reducing your turnout and, if you dance, you probably need to work on getting more hip internal rotation (turn in) before starting on the quest for maximum hip external rotation. Why? Because if you can’t internally rotate your hips enough, you probably have some other range of motions that are limited too. I would bet money that if you can’t turn-in enough, you probably have trouble getting to neutral spine and pelvis. And by the way, neutral spine is MANDATORY if you are attempting to improve your turnout, as stated HERE on the IADMS website:

The use of core support and an awareness of pelvic alignment are also crucial if turnout is to be fully functional in dynamic dancing. Generally, muscles are at a biomechanical disadvantage in poor alignment; if the pelvis is in anterior tilt (swayback) or posterior tilt (tucked), it may not be possible to use the muscles that contribute to turnout optimally.

Also, in terms of injury prevention (particularly to the hips, back and knees), having enough turn-in is kind of a big deal, as loss of hip internal rotation on one or both legs can increase the likelihood of hip and back injury.

So all that said, I highly recommend doing parallel hip activities like yoga, strength training with weights, and walking around with a more parallel hip alignment (which will feel pigeon-toed, I know).

To boot, going beyond mere parallel by using specific exercises to improve your hip internal rotation is probably the best idea you’ve ever had as a dancer. If you don’t already follow Miguel Aragoncillo’s blog, he is on a roll with his posts on hip internal rotation. I suggest you read THIS, and THIS. They make me so happy.

And if you are one of those people who think that the way to better turnout is by doing MORE things that require turnout, like just doing more ballet classes, and forcing your turnout harder (and possibly from the wrong places), and that dancers shouldn’t cross-train, then I’m sorry, but we’re going to have to fight.

I came across one of such people, who believes in the dance-only-approach, HERE. The author, Mary Fernandez (a ballet teacher), states:

I don’t have anything against pilates or yoga,  just not for classical dancers! The reason for this is that ballet requires turn-out, and those other disciplines actually work against turn-out.

I think it only stands to reason that the classical ballet lesson in and of itself ought to be completely sufficient, completely capable of producing a masterful classical artist. Anything less reveals that the training is inefficient.

Ahhhhhhhh. I’ve had teachers like this. And I disagree completely. It would be great if dance classes alone were sufficient, but unfortunately the research states otherwise.

Many studies such as this one, suggest that methods of supplemental strength training, can reduce injury rates and improve technical performance. It’s just science, guys…

Oh and one more thing: Lifting weights once or twice per week WON’T make you bulk up, if that’s something you’re worried about (many dancers and teachers are). In the picture below you’ll see my client Sam, who is a dancer at Ryerson University, just killing it.

won't bulk you up

She has been training with me for the past 2 years. She squats. She deadlifts (like a champ). She can do excellent push-ups. Does she look particularly bulky? Nope. But her ballet teacher is still scared she’ll instantly hulkify. Don’t hold your breath for that, is all I can say.

Main points to remember:

  • Training in parallel positions won’t worsen your turnout.
  • Training in parallel can help correct muscle imbalances and overuse caused by excessive forcing of turnout.
  • Training to get a better range of motion in hip internal rotation is important and should be assessed before trying to increase hip external rotation.
  • Loss of internal rotation at the hip is correlated to hip and lower back pain.
  • Cross training with yoga and weights will not destroy your dance technique and turnout.
  • Loss of hip internal rotation interferes with your ability to get into neutral pelvis and spine.

Stay tuned for a post in the future that talks about this in more detail, because I swear I could go on and on for days.

Your Hips Don’t Lie- A Realistic Look at Improving Turnout

Your Hips Don’t Lie- A Realistic Look at Improving Turnout

I get at least a few emails a month asking how to improve turnout. It’s kind of a big deal. Especially if you do ballet.

I know that not all readers of this blog are ballet/contemporary dancers, but every dance form relies on turnout to a certain extent.

I’ve already written a rather lengthy article about turnout HERE, so I recommend you read that too when you’re done with this one. But unlike my first turnout article, what I have to say today has a different tone.

Disclaimer- This will not be a “how to” guide for increasing turnout. I’m not going to give you exercises and stretches that will help your turnout, nor will I claim that it’s even possible to increase your turnout beyond a certain extent.

So, umm, what does that leave to talk about? Attitude.

Not that kind of attitude… Bad joke. I know.

Rather, after having read this, I want you to have a full understanding of why turnout is so hard to change, and why you should focus instead on having a more realistic attitude about your turnout capabilities. And maybe I’ll throw in a few fun anatomy words. Like gastrocnemius. By far the best muscle name of all time.

Ok let’s get started.

What is turnout?

First, I want you to remember that turnout is not the same things as hip external rotation. Turnout is the sum of rotation that occurs at the hip, knee and ankle. Obviously it’s safer to get the majority of your turnout range of motion from the hip, because it’s the most mobile of the three joints, and was designed to rotate in it’s socket.

The tibia can rotate internally and externally, with the range of motion varying from 16  to 60 degrees between individuals.

The foot, too, has a certain degree of external rotation, and it also glides, or tilts side to side into pronation and supination (though it’s a lot more complex that that, in real life), To get more turnout we often see dancers who roll in the foot (pronate). This is most commonly seen in 5th position with the feet. Is not good. Encourage dancers to use a more neutral foot alignment.

Relax. You are not Svetlana.

Many dancers, dance teachers and parents, don’t understand that not everyone is able to get to 90 degrees of “perfect” turnout. Or even 80, or 50 degrees.

Everyone’s body is different. We all have unique variations. I definitely don’t have perfect turnout, and it was actually a relief when I learned that there wasn’t much I could do about it.

In anatomy class, my first year at Ryerson, is when I learned for the first time from our prof that were anatomical factors affecting turnout that we have no control over. It really took the pressure off, after having teachers tell me my whole life that I needed better turnout. This new understanding of my body was a relief, and so I encourage dance teachers to let their students know too, so they don’t stress themselves out.

We can’t all have turnout like Svetlana, nor should we. What a boring world that would be.

The main problems with this whole “I need more turnout” thing:

  • If bone is hitting bone, you can’t turnout farther than that. Get over it. Trying to grind bone against bone also feels really awful. Don’t make your labrum hate you (how’s that for a fun anatomy word?)

  • For you young, aspiring professional ballerinas (and men too)- if you are anteverted   (click the link to read more about that), then it probably wasn’t meant to be. 90 degree turnout won’t be possible for you. Get over it. You can still dance,  just maybe not professional ballet (which isn’t as glamorous as you might think).
  • Forcing your turnout past it’s natural point in dance class won’t help to improve it. You’ll probably just screw up your knees and have to stop dancing. It also doesn’t look very nice. But that’s subjective…
  • You know that “clam” exercise that you do to strengthen your “turnout muscles”? They’re probably not doing anything. Your hip external rotators are likely to be chronically tight and even causing pelvic dysfunction that should be addressed before you try to develop more strength in them.

 

  • Don’t forget about the internal rotators- The loss of hip internal rotation is indicative of potential pelvic dysfunction which could lead to injury and stability issues, and should be addressed in a training program (more on that later on in this post though…)

I’ve also noticed some interesting things in dancer hips that are good to know about before you start trying to get more turnout (bear in mind I work mostly with university level dancers who train primarily in ballet, modern and jazz).

1) Overall loss of internal rotation range of motion in both hips. In regular populations, loss of internal rotation is associated with low back pain, and SI joint dysfunction… Hmm. Internal rotation is actually important. Read more about that HERE on Mike Reinhold’s site. Seriously. It’s a good read with some interesting case studies correlating loss of hip rotation (on one and/or both sides) with low back pain and SI joint dysfunction.

2) More hip external rotation on the RIGHT, and subsequently, more hip internal rotation on the LEFT. I’ve even seen the opposite, which seems to be related to what age the dancer started their studies. Any imbalance side to side can be a risk factor for injury, so maybe you should try to sort that out before trying to add more external rotation.

3) Inability to actively achieve their passive range of motion in hip rotation. Meaning that if I took your leg and manually moved you to your end range of motion in external rotation, and then asked you to try to get to the same place using your own strength, it probably wouldn’t add up to the same amount. In theory, you should be able to get the same active and passive ROM, so maybe you should work on that before trying to get more turnout.

4) Inhibition of the abdominals and glutes. This means they don’t work as hard as they need to, causing other muscles (like the hip external rotators) to compensate to stabilize and align your body. This makes getting more turnout hard, and even risky.

The good news is that those 4 things are mostly trainable, meaning you can improve them with training. Yay!

But your hips don’t lie. And more importantly, your bones don’t lie.

You can’t change your bones

I won’t go  into excruciating detail, because I’ve already done that in another article, but things like angle of femoral anteversion, orientation of the hip socket, width and length of femoral shaft, and anterior pelvic ligament laxity will affect how much turnout you can get. And there’s no way to train these things.

For example, I just assessed a dancer who looks a little anteverted. I can’t claim that for sure without an expert second opinion, but you can sort of see it through palpation. Anteversion means the head of her femur faces a little more to the front, and that kind of sucks if you want 90 degree turnout. In her case, forcing it to go farther will only cause her hip pain (which she is already experiencing).

fenoral anteversion in dancers

To quote Bill Hartman from an article of his on femoral anteversion

Because this [anteversion]  is a structural adaptation, the rotation is not something that will change with typical hip rotation mobility exercises and attempting to do so will only result in injury.  If you should have an athlete with excessive hip internal rotation, developing a stronger core and glutes is essential.

So please understand that there are a lot of things about turnout that you don’t have power over, and in some cases it can be dangerous to try to get more turnout without a full understanding of what’s happening in your body.

I guess the underlying theme of this post is it might be time let it go. Change your mindset. Stop stressing out about turnout.

Dancers- Explain your anatomical limitations to your teachers if and when you feel too much pressure from them.

Dance teachers- Understand these limitations, educate your dancers, and encourage them to do the best with what they’ve got.

Here’s my personal opinion on training turnout- There are other things more important and more productive to train. Additional training time is better spent on things like strength development, that are proven to be effective and safe.

Rather than focusing on turnout, focus first on alignment.

We know that we can improve alignment through soft tissue release, exercise, and postural awareness. We know we can train the the core to become stronger and develop better control. But we don’t know if it’s possible to change your turnout beyond your genetic bony structure. It’s probably not. Not safely anyway.

Training turnout can be potentially risky, and I think many experts agree that a safer thing to do would be to work only with functional turnout (from hips, without twisting the knees and ankles).

Focus on what you can control (functional turnout, core strength, alignment), and don’t stress about what you can’t. It’s not the turnout that makes one dancer better than another. Although it is a nice bonus.

An important note on core strength

Remember that if you do decide to focus on training your turnout, you should first develop core strength, and in particular, a good understanding of what neutral spine is for you. Again, alignment is one of the most important thing that you can actually improve.

Many dancers (and most people, in general) have weakness and inhibition of their abdominals, glutes and other stabillizers of the spine and pelvis, with tons of compensation strategies to make up for this weakness. They might also have no idea where neutral is. Couple those trends with our obsession with forcing turnout, and you’ve got a recipe for pain.

Who and when should you train for more turnout?

In my opinion, the only time you should focus directly on improving turnout is if your active range of motion is less than you can get passively. Note you should also work on developing more hip internal rotation for injury prevention, as I mentioned earlier. But that’s a post for another time.

As a strength and conditioning specialist, I do not claim to be an expert on improving turnout. However, my dancers, after becoming stronger, and better aligned, reap the benefits of improved body awareness, and are able to work better with their functional turnout, which I think is more important than focusing on something they might never be able to attain (90 degree turnout).

For more info on turnout, check out these two great resources on the IADMS website:

Hip Anatomy and Factors Influencing Turnout

Turnout for Dancers: Supplemental Training

I’d love to hear about your turnout training philosophies. Have you had success improving yours? What do you do to improve your turnout? Leave a comment and let me know.

 

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.