IADMS Madrid 2001   [back to the Category]

Compensatory mechanisms for insufficient turn-out of the hips and their adverse effects in dance   [read the french version]

Author :   Boni Rietveld, MD

Thursday 1 November 2001
5:45 – 6:05 pm Room 1

Compensatory mechanisms for insufficient turn-out of the hips and their adverse effects in dance: Anatomy of muscles (that should be) used in turn-out and turned-out movement

Boni Rietveld, MD, Medical Centre for Dancers & Musicians, Westeinde, The Netherlands

To compensate for lack of turn-out in the hips the dancers unconsciously use the phenomenon that the Y (or ilio-femoral) ligament of the hip joint is relaxed in flexion and abduction (of the hip). This is clearly demonstrated by the fact that turn-out is easier in second position and/or while bending forward.
Relaxation of the Y-ligament - and herewith larger turn-out - can be achieved by hyper- lordosing the lower back (= flexing the hips) and starting in a little demi-plie-position (= abducting the hips). Furthermore flexion of the knees allows some extra turn-out in the knee joints which is impossible with the knees extended. By grasping the floor with the feet the larger turn-out is maintained.
Then the dancer “stretches-up” and turns out from the feet up instead out from the hips down: the knees are extended undergoing a large torsion force, the spine is straightened and the hips and knees are forced beyond their anatomical external rotation limits. Due to the torque on the floor the feet hyperpronate (in dance this valgus/eversion/abduction movement is called “rolling-in”) causing eversion of the subtalar joint with added stress on the medial structures, abduction of the forefoot and lateral (valgus) stress on the hallux with malalignment of the MTP1 joint.
This compensatory mechanism is a causative factor in the large number of injuries in the knees, spine, hips and feet of the dancers. It will be demonstrated either with a dancer on stage, or with slides (double projection) and overhead projector “animation.”
The muscular anatomy of muscles (that should be) used in turn-out and turned-out movement will be addressed by an in dance medicine experienced physiotherapist of a National Ballet School. Of course this means primarily the deep external rotators of the hip; and at the same time the adductors and abdominal muscles. The risks of anterior tilt of the pelvis, contracture of the internal rotators and of too much involvement of the muscles used in parallel movement (hip flexors, quadriceps and gluteus maximus) will be explained.
In an interactive session with an orthopaedic surgeon, dance teacher, dancer and physiotherapist practical ways to achieve proper turn-out will be approached and discussed.
Clinical dance medical relevance: (learning) proper turn-out technique at a young age and avoiding compensation are prerequisites for the prevention of dance injuries.