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First in a planned series about ballet

by Katherine Hartsell, PTA

dance physical therapistBallet is a form of dance that aims to appear graceful and natural, but masked beneath the beauty of this art form is physically demanding work that requires precision, strength, integrated flexibility and control. Central to it all is a concept called turnout. This term describes the position of the legs rotating away from the midline of the body and historically, “perfect turnout” demands 180 degrees of such rotation. Most dancers have an acute understanding of the esthetics of turnout, but may not have learned how bones, ligaments, and muscles all work together to create their own unique degree of turnout. Even basic understanding of anatomy and kinesiology can help one appreciate how complicated this position is to obtain and how injurious forced turnout can be.

Bones and ligaments

The exact orientation of the hip socket, the precise shape of the thigh bone and the particular way that the thigh is angled all help determine a dancer’s structural turnout. The amount of elasticity in one’s hip ligaments plays a significant role in how much resistance a dancer meets when attempting to turn out. Further down the leg are additional variations affecting turnout. One such example is in the shin bone which twists slightly and impacts the appearance of turnout, sometimes dramatically. A dancer’s bony architecture, and the ligaments that hold it together, play a quiet but important role in the pursuit of turnout.

Muscle Strength

The back of the hip is layered with muscles that turn the thighs outward. The most superficial layer is the gluteus maximus, but the more important muscles for the refined technique of ballet are six deep rotator muscles. Depending on the ballet position being performed, other muscles contribute to external rotation (such as the sartorious in passé). Strengthening the rotators intelligently, with neuromuscular control, is essential to obtaining proper turnout. Maintaining turnout during the dynamic movement of ballet requires deep core support and the placement of a neutral pelvis. Additionally, lower leg and foot strength is needed to support the expression of hip rotation. Areas of weakness show up uniquely in any of these areas for dancers, sparking compensation and pain in a variety of areas, including the lower back, sacroiliac joint, hips, knees, and ankles.

Integrated Flexibility

Dancers are notorious for stretching, but there is often an imbalanced approach. Some dancers have inherent tightness in their internal rotators, which, if unaddressed, can limit turnout. In order to achieve a neutral pelvis-the ideal positioning for turnout creation- the front of the hip often needs stretching and the lower back as well. Additionally, the external rotators, can tighten and weaken from overuse, but dancers routinely forget to stretch them.

Turnout: A complex dance

As introduced above, there are complicated factors involved in creating the technical lines sought after in ballet. Some of these factors should be acknowledged as limitations and some factors are training blind spots that can transformed. At Boston Sports Medicine, we work with dancers to enhance understanding of the many factors that influence turnout and target gaps in technique to optimize dancing potential and physical health.

Katherine Hartsell is a Physical Therapy Assistant at Boston Sports Medicine