Associations between Turnout and Lower Extremity Injuries in Classical Ballet Dancers

Abstract

Study Design: Descriptive correlational study. Objectives: To determine relationships between aspects of turnout and injury history in preprofessional classical ballet dancers, and to determine the clinical utility of various methods used to assess turnout. Background: In Australia 50% of professional dancers currently have persistent or recurrent injuries, with 36% of these injuries commencing before 18 years of age (preprofessional level). Overuse or nontraumatic dance injuries are often attributed to faults in technique, with poor turnout and inappropriate compensatory strategies consistently cited as the main cause. Methods and Measures: Twenty-nine dancers (24 female), aged 15 to 22 years, were recruited from a preprofessional classical ballet program. Measurements were taken of passive and active hip external rotation (ER) range of motion (ROM) in supine, and functional turnout angles in standing. Three turnout variables were derived: active ER lag, compensated turnout, and static-dynamic turnout difference. Injury history over the previous 2 years was ascertained by interview. Pearson product moment and Spearman rank correlation coefficients were used to determine associations between turnout variables and injury history. Results: All dancers reported a history of injury, with 93.1% reporting a history of nontraumatic injuries and 41.4% reporting a history of traumatic injuries. Number and severity of nontraumatic injuries were associated with reduced functional turnout (r or rho Ͼ 0.38; P Ͻ .04), but not with hip ER ROM. Number and severity of traumatic injuries were not associated with turnout. No correlation was found between hip ER ROM and functional turnout. Conclusions: Functional measures of turnout are more relevant than hip ER ROM to prevalence of nontraumatic dance injuries. Control of turnout in classical ballet dancers should be assessed dynamically and in functional positions. J Orthop Sports Phys Ther 2005;35:307-318.

Musculoskeletal Injuries in Dance: A Systematic Review

“…For the purpose of inclusion, "specialist dance medicine provision" programmes included implementation of in-house dance medicine teams, screening and exercise programmes [15][16][17][18][19][20][21][22][23][24][25][26][27].…”

Management of a Delayed Union Sesamoid Fracture in a Dancer

“…39 With unrealistic expectation of perfect turnout of 180°, dancers with insufficient hip external rotation may force their turnout, result- ing in excessive foot pronation (known as "rolling in"), which increases loading of the medial foot structures, including the sesamoids (FIGURE 1A and 1B). 28,39,48 Studies have demonstrated a positive correlation between self-reported lower extremity injury (defined as "of a sufficient severity to affect dance training or performance") and "functional" turnout, which exceeds available physiologic range of motion (ROM). 17,48 In students training at a preprofessional ballet program, 5.9% of their injuries occurred at the medial forefoot.…”

“…28,39,48 Studies have demonstrated a positive correlation between self-reported lower extremity injury (defined as "of a sufficient severity to affect dance training or performance") and "functional" turnout, which exceeds available physiologic range of motion (ROM). 17,48 In students training at a preprofessional ballet program, 5.9% of their injuries occurred at the medial forefoot. 48 Dance footwear ranges from dancing barefoot, in thin leather-soled ballet slippers lacking shock absorption, to high-heeled character shoes that prolong and increase loading on the female forefoot.…”

“…10,48,50,63 The onset of sesamoid symptoms is associated with repetitive stress and recent increase in weight-bearing activity. 5 In our experience, when dance students enter a preprofessional training program, they experience a sudden increase in hours of dancing, which makes them particularly vulnerable to injury.…”

“…17,48 In students training at a preprofessional ballet program, 5.9% of their injuries occurred at the medial forefoot. 48 Dance footwear ranges from dancing barefoot, in thin leather-soled ballet slippers lacking shock absorption, to high-heeled character shoes that prolong and increase loading on the female forefoot. 23,42 Hard floor surfaces increase shock attenuation demands on the feet, 21,61 while raked (inclined) stages are reported to be associated with 28% to 37% of all injuries.…”