Fysita

Dance, is it a sport or a hobby? Or is it art? Dance is visible in every culture and apparently we are good at it when we perform. We then bring our body to different angles and ask a lot of all our muscles and joints. Not everybody can dance well, but everyone tries it.

‘Danse’ (in French), by many it is seen as art. During this choreography, the dancers use all the energy they have in their bodies to show their dance to the audience. Their bodies sometimes come in positions that are not natural for a normal human being. Think of a twist in the hip during a ‘plié’ or a beautiful jump with the legs in one straight line during a ‘grand jeté’. They often ask extreme things of their bodies and that can cause nasty injuries.

It is said that if dancers want to improve their turnout, they overcompensate in other regions of the body, such as the spine, hip, knees, ankles and feet. This also causes muscle problems and injuries that often links to overloaded.

The most common injuries in (modern) dancers are injuries to the lower extremities and the lower back¹. The reasons are mainly overload and poor technique during the turnout^2.  The compensation that may occur during the turnout in other regions of the body is responsible for the injuries in dancing.

Forcing a turnout or ‘over turning’ is a compensation term that describes how a dancer’s feet rotate outside, beyond the available range of motion that is possible in the hip.

Here is a description of how dancers themselves increase their turnout by compensating the joints:

• 1. They provide an enlarged anterior pelvic tilt (buttom backwards and a concave spine). (fig. 1)
  • The concave spine provides an enlarged lordosis in the lower part of the spine and an enlarged kyphosis in the upper part of the spine (between the shoulder blades). (fig. 2)
• 2. Performing a turn out under friction of the floor in a closed chain outwards, or ‘screwing the                             knee’ (demi-olié).
  • The enlarged torsi in the knee causes laxity of the ligaments around the knee. The patella can be permanently misaligned by multiple turns and it will increase the pressure on the cartilage.

• 3. Extreem over pronation of both feet.
  • This happens to develop more balance while turning out. The dancers create a more stable surface and therefore more balance. However, it gives more pressure on the ligaments of the ankle, the muscles and tendons of the foot and lower leg.

Ultimately, these compensations lead to stress in the lower back, hip, knee and ankle. Several studies indicate that low back pain is caused by extreme or prolonged anterior pelvic tilt (fig.1) and a bad turnout technique can exacerbate this³.

In addition, various studies have investigated compensating during a turn out and injuries among dancers. During the studies, the functional outward and passive rang of motion of the hip was measured. Eventually, a relationship has been found between the dancers’ injury and compensation during the turnout. In 90% of the dancers who compensated 25º, they found an injury in their history of dance⁴.

Unfortunately, further research is needed to speak for a large group of dancers with the same style, that over compensated causes their injuries in these specific regions⁵. It is important for the physiotherapists that they can correctly measure a turnout and decide whether there is over compensation in these dancers.

♦1. Ojofeitimi S, Bronner S. Injuries in a modern dance company. Effect of comprehensice management on injury incidence, 2011.
♦2. Negus V, Hopper D, Briffa NK. Association between turnout and lower extremity injuries in classical ballet dansers, 2005.
♦3. Trepman E, Walaszek A, Micheli LJ. Spinal problems in dancers, 2005.                                                                                                  ♦4 Coplan JA. Ballet dancers’s turnout and its relationship to self-reported injury, 2002.                                                                          ♦5. van Merkensteijn GG, Quin E. Assesment of compensated turnout characteristics and their relationship to injuries in       university level modern dancers, 2015.