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.