Tag Archives: hip injuries

Hip, Lock and Key or Sylph Perception


I always liked  to do this:

Hip wave

There are many ways of doing it, not just the pose in the picture which may be wrong or right. What always seemed important to me about doing it, and many other modern dance positions-I’ll call this one the “hip wave”, is that they “align you.”  You will find this (probably better explained in many modern dance technique books.” I recommend two (2)-On The Count of One and The Dancer Prepares (I am always recommending these-there are many more), just two classics. I am classic-that is another way of saying older.

The exercise: It is sort of like wearing a blindfold and smelling, tasting, hearing and feeling stimuli, without the use of sight-let’s us not forget that sixth sense of (sylph) perception. Lying on the floor can help you with many problems-immediately note the amount of curvature in the spine, translated into not feeling the lower back (or any other part of the back!) resting on the floor. Breathing will help with this-another post. Feel the part of the back that receives more pressure (and is doing more work) which will be tighter and uncompromising-this is what you need to focus on relaxing into the floor. Part of any dance technique, ballet included is communicating with your own body-before you can communicate to others, you have to have control of the self. If your body is not doing what you tell it to, order or demand it to, then it is time to start some serious investigation into your sylph, and find a way to reach your body, just the way you might try to reach someone else. Why try less hard when the stubborn party is you! More reason to be able to teach it….be successful.

In this position (above pictured), as in other positions of modern dance, at first you will possibly feel completely disoriented. I am not talking about gymnasts, handstands or other “set” movements that may be a part of your everyday routine or circumspect. I am talking about isolating what makes you feel uncomfortable and why, then reworking it, or controlling it, to get it to work for you-find out what is so great about it/not so great, by experimentation. I could steal other writers and bloggers and websites information and give this information to you in boring technical terms, sports terms, but it would not really reach most dancers. Dancers are visual and sensitive creatures frequently who learn best by delving into self exploration, diagnosis and psychology-and they are right. I am asking you to assume this position and let it control you, in a way. The dancer above is in control of this position, but in being so controlled, she is losing out on the many possibilities of the position and assuming just the one rather tense/practiced one we see. It looks alright, maybe too perfect, to some teachers, absolutely incorrect modern. The purpose of this position for say Isadora Duncan or Doris Humphrey might have been freedom, letting go, discovering one’s range of movement. In isolating this aspect, we simply increase the tension in order to control the pose-not what will be helpful, in short-more harm, useless.

What about letting the leg go where it wants initially, playing with it, and then possibly, letting the leg fall naturally in a 360 degree circle, bringing it back up each time after it falls to its maximum ability to do so? What is wrong with falling, letting go? The muscles of the rest of the body will act to protect you, let them. See how they do this. Trust them. Don’t think so much about thinking so much! Raising and lowering the leg in a relaxed fashion, is much more difficult in this position than it seems because you are fighting the natural use and range of your muscles. It’s funny how gravity pulls the leg “up” and our instinct is to pull it back down (up). It feels very unnatural and there couldn’t be anything more natural about it. Imagine being in space-anti-gravity.

Watch a child do it-there will always be one who spends a lot of time in this position-dancer. For whatever reason, this child knows this is funny and will often laugh to himself because you (adults) do not get it. They immediately understand why this is not “normal” as if they have discovered something no one else has, giving them power over their elders. They will try various things in this position, trying to emulate an “upside-down person”, a “backwards” person. They will try to walk and run backwards after this, and do other things the opposite way, realizing that not only are unexplored ranges of movement challenging, they are the antithesis of moving forward, possible, interesting. Life moves you forward, the coach yells “go” and you do not move backward-this would be seen as retarded to middle-school students, dumb. It is the joke in many Disney and related children’s movies, slowly reaffirming silently to children acceptable and unacceptable behaviors and it is the slow progression of “speeding up,” industrialization, which prevents many people taking the time to sit through a ballet or dance program. What child or any human, left alone, does not find the movement of motion pictures fascinating in reverse? This era knows the dvd, but what of the vcr, microfiche-or the pages of a book read backwards?  Of course, once we explore this range we forget its initial curiosity, take it for granted, and continue to move forward the rest of our lives, but the truth is you can get to the same destination by turning around and walking backwards-but we lose the sense of where we are going, because we are not trained, so dependent are we on our eyes, to proceed without them leading us. If our other senses are engaged more frequently, they become better honed and more useful. Doing it “with your eyes closed” is losing meaning in today’s society. But life is busy and hurried and we do not take the time to “look back,” so even more oftentimes, it is hard to see beyond….

When in this position for the first time, do not use a mirror to check your progress or how you look. Try to adjust yourself to your surroundings-yourself and the planes of space. The ceiling is now the floor-or is it? Actual dancers spend much of their time in the air, being suspended by a partner, and diving or jumping-all leaps of faith and it is very important to get used to having  to realign yourself without two feet planted on the floor. Close your eyes if necessary to block out external stimuli and find your center of balance. Then raise your leg as high as you can comfortably. Comfortably is the key word here. Do not lock your hip. Use your toes and back and arms. Forget what you have learned in ballet or dance class-it does not help you here. Move your leg around in a complete circle-not all at once, and slowly. Floor-range, at every conceivable angle and degree. Then try the other leg. It may be necessary to “come up for air” as this is fatiguing and when fatigued, we grip, we try to hold on, keep it up. Not yet. let it fall! Don’t grip your hips. Once you start to feel the movement within your hip, you will also begin to notice the muscles that naturally are in use. These are the muscles that will be strengthened with this exercise. and your mind. You are letting your body teach you where your range is, and this is it, really, naturally. You begin to see the strength of gravity and how much a leg actually weighs! Quit a lot. You see how you have trained those muscles to teach that leg to do everything from an upright position. How you are not uniformly strong-how naturally weak those muscles are in reverse. Interesting.

You can strengthen back muscles from this position, too. It is a natural trait for the muscles to try to lift the leg and you will find this is what is most fatiguing this exercise or position is, as apparently we all have really weak backs in different positions. It is rare to find a person unilaterally trained. As you adjust to your new range, you can increase strength and turnout from this position, too. You can gradually rehabilitate your hips and isolate problems with your usual alignment from this and other unusual positions. This tricks your body into “starting over” putting your body and your sylph back into control one step at a time, one exercise at a time, one day at a time. You can learn to “tilt” into and out of this position and to increase your range of movement front to back, side to side, and all places in between. You will find muscles in your sides that are not strong, not being spoken to, not trained. Forgotten. its possibilities seem almost endless if you are willing to discover them. You can attempt it on releve. It is just one point of discovery, but it is a good place to start learning where your actual turnout is, how you can gently improve it, and whether you are forcing turnout all around. Since there is no place for you to lean, or rest against, although you can try that too, one is relying on one’s own body for support and one’s mind and tendencies for instinctual directions or fixes. Try to do this bending one leg, or both, turn, scoop, and a whole new plateau of movement will appear, a level, literally, not experienced by most classically trained dancers or grown-ups. I think this might have been how modern dance technique was discovered. What are we not doing???There are six strings on a guitar, 12 on a classical. A dancer should have use of all 12 strings of his/her instrument, not half or a third, or one. Right? I have known guitarists who can get nearly all of the same notes out of a six-string guitar, but it quite a bit harder on the instrument and the guitarist. It is more work.

Although the common issue of hip pain when forcing turnout can lead to other injuries, particularly fractures of the femoral neck, bursitis, tendonitis, etc….even actual displacement of the hip (yup), finding your correct turnout is like a key and a lock. Every mechanism is different. You cannot put your key into the grooves of your lock like everyone else-you have to find the groove that will allow your leg to rise comfortably, turnout comfortably. It is not the dancer with the perfect flat turnout it is the dancer with the comfortable turnout, beautiful turnout, that catches our eye. If your key will not turn in the lock, chances are, you are trying to move your leg against the cup-shaped acetabulum, hitting it against the mechanism, just like a key in a lock. If you train the muscles and ligaments around that area to “force” the leg through unnatural poses, it trains the muscles to repeat this exercise even when you tell it to do the right thing-muscle memory. It is akin to walking into a wall-you will either directly hit it like a bird on a sliding glass door, or you will scrape and careen off it, damaging the bursa and the cartilage in the joint. It should be a smooth transition with no bumps or scraping. If you notice these feelings when doing this exercise, the best thing to do is to see a doctor. If you are still in the preliminary or early stages of experiencing this problem no permanent damage might have occurred, at least not irreversible damage (possibly), and id instructed by your doctor, you could then see a physical therapist for exercises to do for increasing the correct usage of the surrounding muscles and ligaments as well as for strengthening the leg in the socket and increasing mobility in the hips.

Repeated forceful attempts at trying to put the key into the lock the wrong way will damage the hip, lock and key. Remember a key always should move easily in the lock. If it doesn’t, that is a possible congenital disorder of too little lubrication, or a sign that bursa are already damaged, engorged or inflamed. I do not recommend the use of cortisone injections to decrease size of swollen bursa-the best medicine are anti-inflammatories, such as ibuprofen (taken once or twice), and then complete rest. Other medical symptoms and explanations of bursitis are available here:

http://www.onhealth.com/bursitis/page2.htm#what_are_bursitis_symptoms_and_signs

 

Another symptom of gripping the hips is that your derriere will get bigger, or appear to, because the muscles are tight. There is a stretch called “the triangle” to help remedy this condition.

Probably stemming from yoga exercises, this will help loosen your gluteous maximus muscles after a workout. As long as you are warm, this exercise can be done often, but try not to sit in it too long (15-30 second holds, building up from 2-5 times per leg).

Strong, supple gluteal muscles keep the legs, pelvis and torso properly aligned. When your glutes are too tight — from excessive working or over-training, your alignment can be affected, leaving you with pain in the sciatic nerve, knee or lower back. A curved back is one indication of the need for this exercise. Forced turnout is also a possible culprit. Use a triangle stretch to retain or regain gluteous flexibility and counter soreness, stiffness and pain in your lower half and the aforementioned caboose enhancement. Do this stretch daily, and after each class, if your butt muscles are particularly tight.Advice before doing:

Warm up for 5 to ten minutes at least to increase circulation in the areas you are going to stretch do that the exercise has a maximum benefit to those targeted spots-you will feel it if it is working and it will not feel as keyed in if you do not-you will learn the difference. A brisk walk will suffice if you are not dancing. It works best after a class, especially one in which you lift your legs a lot and this works well after pointework.

First pose:

Sit on the floor facing a “front” with your spine perfectly straight, shoulders down (correctly) and slightly back. Extend your legs extended in front of you. Keeping your legs together (ankle bones touching preferably), start to bring your knees up to point toward the ceiling, sliding the flat feet toward you buttocks a few inches off the ground-not up by your chest-you are going to put the left leg over the right-stacking it so to speak. When knees are pointing directly at the ceiling, feet flat on the floor and back straight (shoulders down)….Second Pose:

Begin to slide your right foot more toward your buttocks (and up toward your chest), keeping your position aligned as before (spine, flat feet, ankles together, shoulders down). If you need to, use your hand to put your leg into a position closer to your body-after practice, you will not need to “assist”. Your right leg will be forming a “comfortable” triangle with the floor. Picture the next pose, which is to bring the left leg up and over the right, when preparing to position yourself.

You will be aligned with the right knee directly in front of or “square,” with your pelvis.

Pose Third:

Now, pull in or “retract” you left leg, until it is also in a triangle and put it over your right leg. Slide your left foot along the floor, resting it alongside your right hip and forming a triangle with your left leg. Make whatever adjustments are necessary to “stack” your left knee directly over your right. Press your inner thighs together gently. You should feel a little tension in your outer left hip. Also, there is a tendency for the left hip to raise, the right hip to press into the floor and the alignment to go awry. take a moment and find a comfortable but correct position with the hips “square,” both as much on the floor as possible, back straight and shoulders down.-this is a continual battle and part of the “fun.” This natural and correct alignment will do wonders for your stretch and your pose-almost no one doesn’t have stretching going on somewhere in this and those especially “out of shape” or incorrectly trained, will have much to grapple before becoming fluent in this pose and able to control it for the best stretch.One problem with people who believe they have control of this stretch is the tendency to grip with their hips, the floor and use the stomach muscles to “scoop” the leg into position. It is the back, straight, which gives the support necessary to relax the leg and for “crossing over” the other leg.

4th Pose:
Keep your back long and extend forward from your hips, placing your fingertips on the floor in front of you for support. When you feel moderate tension along your left buttock, hold the position for up to 30 seconds, breathing normally. Return the torso to an upright position and then repeat the forward hinge up to four times, then reverse.
Keep on dancing!
This link has some of the information here and a “training program” available online, although all of this information is generally available elsewhere.

http://www.theballetblog.com/article/improving-technique/training-turnout-part-2-isolating-your-true-turnout/

If you live in NYC-OUT THIS NUMBER IN YOUR CELL PHONE NOW!

212-598-6022-Harkness Dancer Clinic

They have a One-on-One Injury Prevention Assessment Program ~FREE~

The Harkness Center offers one-hour, free-of-charge injury prevention assessments for dancers. During the injury prevention assessment session each dancer is seen individually for an hour by a therapist who reviews the dancer’s complaints, medical and nutrition histories and performance during a battery of tests. The screening is designed to evaluate the risk the dancer is exposed to and to discuss the dancer’s concerns before an injury occurs. At the conclusion of the assessment the dancer is given an individually tailored injury prevention exercise regime with recommendations for modification of their technique, training strategies, footwear and/or dance environment. The aim of the screening is to maximize each dancer’s potential for wellness. Thousands of dancers have participated in this program and have rated it 3.9 out of a perfect 4.0 for its relevance and helpfulness. Harkness has educational programs for dancers!

For additional information and to download an individual assessment form:

http://hjd.med.nyu.edu/harkness/patient-services/injury-prevention-assessments-and-workshops

If you have specific question email: harkness@nyumc.org

 

Keep On Dancing!!!

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Turn-out, Injuries, Hips, Knees and Feet: The importance of not overtraining, crosstraining, and specifically strengthening the opposing sides….


Margaret Barr's "Strange Children" [...
Margaret Barr’s “Strange Children” [ballet], 1955 / photographer unknown (Photo credit: State Library of New South Wales collection)

Dancers are strange children. For what other persons would set out to achieve the impossible, inch by inch, seeking a kind of perfection and freedom which allows them to communicate to others more artfully, those existing ballets created for bodies conditioned for performing these unbelievable and frequently imperceptibly impossibly difficult steps and combinations of steps? To the untrained eye, this intentionally looks easier than it is. But as they attempt to achieve more and more of the masterpiece that remains in the dancer‘s brain, only the very successful are considered to be so, and no one but a consummate artist can detect many of the imperfections and flaws contained therein. Certainly, no one but ballet dancers understand this, or stand united on the subject. Modern dancers detest it. The public doesn’t get it. And the trick is after all of that, dancers are forbidden to let you see their hard work. It is truly an art only really appreciated, deeply, by the best. And only they can criticize it, develop it, or lay at our feet the secrets of it. For most dancers themselves, you will find, find it difficult, if not impossible to explain, not all of it, anyway. They try. Misogynists or mystics?

jose limon

That photo is of Jose Limon. Sometimes, my thinking (and writing) delves into deeper, or more technical, areas where I am not an expert, but have concerns on the subject. Problems and experiences we have had may help to serve other people similarly facing such issues. That is by no means stating that I am, or have become, and expert on the subjects noted. It is very possible that I am wrong in stating some things, but I am thinking it out as I go-is there any other way? It is merely a line of thinking that I have found, or measures, which may prove to be, helpful to others. So I think, in this instance, I will share this. My daughter, has for some time been dancing and she is a hard worker. Because she started later, and had to learn so much to be caught up and prepared for her age level of dancing, she has traversed, in instances, very quickly, the long-practiced maneuvers, steps and poses of other ballet students, who frequently do not understand WHY they do things, or WHAT they are doing, but they do it everyday. So this is good for them, too. In addition to speeding up her practicum to achieve her dancer-sylph, she had had to work on her various short-comings.

All dancers have them. Each one, each area of the body needs to be fit, balanced and prepared for the hard work to come. getting to that point is obviously frustrating for even the best dancers (and the keeping it of it is also a repeated task). All dancers find they have some shortcomings. As the years, or levels, pile up, the dancing becomes more difficult, requiring the basic ability to execute various steps, and combinations correctly, and then more ability, and ultimately-perfection. But even at the preliminary stages when working, quickly, or more rapidly than they are accustomed to, and throughout your dancing career-however long that may be-foundation is forgotten in the moment of dancing, and you just dance as fast or as well as you can. It would admittedly be, a very tedious process,  if one had to stop every minute or so, and correct oneself, be corrected, or think about it, but that is what needs to be done, and what should be done, but it is NOT what is done beyond the basic level for many dancers. This is how most injuries occur.

Over-training is another common way to injure oneself. In order to become better, faster, it is very easy to get hurt and when you add on to that any other frailties, anatomical differences, technical abilities or shortcomings, it is a recipe for injury of some kind, all kinds, and we are finding-most kinds. One injury, when working at so high a level of training, can spiral outward, on the mend, with less than active (not as active) muscles, and result in consequential injuries, either to the first, or new. You almost can’t stop, but then you HAVE to. Most injuries will get worse if you continue to dance on them making the recovery time inevitably  longer and the possible injury itself-worse. My daughter’s injuries nearly all fall into this category, for nothing is essentially wrong with her-thank God. She is not deformed, has straight legs and only some hyperextension issues, which believe it or not is becoming more noticable with stretching and straining to become a ballerina. When anything is overstretched, it is a problem. Always.

She will have to watch out for these and many other injuries in the future, but for starters, these have been enough. In a nutshell, too soft pointe shoes (little support) resulted in an achilles injury (and a failure to really work her feet to make them stronger). While taking it easy on that (for months) and stretching to become able to do higher poses, achieve more turn-out and better grand jetes, she torqued her knee (and after 21 performances of Nutcracker, or something very close to that). Mind said, “turn-out” in plie, and knee refused. Overtraining and fatigue, I thought immediately. Then, while recuperating from that (80%) is about all I could rein her in-she experienced a deep groin pain preventing her from turning out at all, for no apparent reason. Many days had I suspiciously eyed her laying on the floor in the butterfly position, and thought,”too passive”, but….I was right, and wrong.

The hip injury is getting better, but for many weeks she has not been able to do much (involving turn-out) that does not cause pain. Oddly developpes do not hurt, while a simple ronde a terre-does, and a tendu! Movement of the whole leg in the hip joint. The hip. I came up with this after much research and found that most hip injuries in other dancers are down to five and we did want to rule-out the femoral fracture (Harkness/NYU). Whew! But all of them which did mention a pain, were on the outside or front of the hip and not deep inside it. The bad ones were deep, but, we knew it was

HTC modded keyboard running on my Samsung
HTC modded keyboard running on my Samsung (Photo credit: DanieVDM)

getting better and was not related to hip popping, so that ruled out all the rest except the femoral fracture-common to dancers, and she did not feel it was broken (she would deny it if it was!). They are very easy to break actually and require surgery…. Movements to the side hurt more and above the hip line in front???  Only certain positions means certain ligaments or muscles. Sometimes you can feel warmth (none), notice swelling (Ibuprofen), but she didn’t and neither ice nor heat were particularly effective. A warm bath might help, but it did not.

All of these things should be noted, and a journal should be kept following injuries so you can remember the activity associated with it that causes (caused) pain. My dancer cannot always recall what she was doing when it happened, especially if it becomes worse after class-could have been anything! A doctor will ask. The more you know, the better diagnosis they can give. Dancers do not like to think about their injuries, let alone, keep a journal of them. Morbid, but effective. Tell them to try recording it on their phones. Most Android phones have this capability and the recordings will show up in S Memo (or in Apps) and Media-they can find that; it is very handy for the lazy speakers. I did not say “lazy dancers.” These notes record by voice, too. Tell them to tell their phone to “record a memo.”

Her second injury, to the knee, I felt sure was related to her turn-out issues. I did not expect it was a turn-in issue. But is is. She has a great turn-out, but a poor turn-in. The doctor confirmed this, and we also ruled out hip or foot problems-basically they are perfect for life. We are still learning about dancing. Too much turn-out (stretching) has resulted in two injuries from weak turn-in-specifically the adductors and the hip muscles. If one is over turned out, and the body has to suddenly transition to a turn-in, and does not react quickly and forcefully enough-the counter-muscle strains-the one that helps you control turn-in and turn-out. Over turned-out-funny. In stretching, most dancers fail to realize strengthening has to be done in equal amounts as stretching, of the same muscles, for support and control. Teachers do not explain this. At all. And apparently, not effectively, especially for young students who have short attention spans.

For anyone involved in the serious study of dance, no doubt, the discussion of turn-out has arisen in class. You probably know by now if you have good or perfect turn-out because you will have heard it from teachers. It’s the next thing down from “feet.” Remarkably, many successful dancers have notably deficient turn-out. It is the actual foundation of all classical ballet. It is stated by doctors that the ease at which it is obtained (sometimes) appears to be correlated with the age at which dancing is begun. In short, turn-out is relative to ballet, therefore, it will be stated by some that it should be learned early. It is and it is not. Let me re-state that many professional dancers turn in all the time-they fail to remember to turn-out. It is perhaps the conditioning of it, not physiologically, but mentally, that makes it more well-remembered by the earlier you start, but in fact, that has to do with memory and not actual ability to turn-out. There is also functional turn-out and structural turn-out. Even those very rare students with “perfect (structural) turn-out,” turn-in (do not have good functional turn-out). It is not only one part of the hip that is actually responsible for how much turn-out one has, and actual deformity-again, popular in ballet (only), does occur, and is therefore deemed “perfect.” FURTHERMORE, it is just as important for dancers with this turn-out to remember, all the time, to turnout at the correct times-and they don’t! Children who do not want to work on turn-out are quick to notice this in professional dancers as “okay,” but it is not, necessarily. Everyone is different!

Perhaps they can exhibit better turn-out, which is nagged about in the studio, but face it, when they get on stage-they forget. Any dancer is only trying to remember 6,000 things on stage, and as you watch most of them, particularly soloists, you will notice they turn in, frequently, or you will notice that they do not exhibit their perfect turn-out, except when at the barre in first position or in plies, in second. Ligaments change, and dancers have to not only stretch to initially achieve turn-out, and exercises to strengthen it-do not stop at the barre (I’ll tell you why), but most dancers have to maintain their own degree of turn-out by stretching daily and remembering to reinforce turn-out in the studio and while dancing, all the time, for the rest of their lives.

As people get older, much older, all of their ligaments and muscles begin to deteriorate, so not exhibit the same elasticity as when they were younger, but dancers continue to dance, turned-out, or turned-in, and they continue to get nagged about it, until it is second nature, for the most part, for them to remember to turn-out or they get beyond the point professionally when any teachers complain about it anymore. That is one indication of a professional-not having to be taught anymore. It is up to the dancer to work on it, keep it and nurture it. Holding turn-out is how you refer to it in class and that is exactly what it means. Therefore, it is not the degree of turn-out which is extremely important in all dancers, but their ability to control it; that requires strength! And the lack of control causes injuries. Wait and see or get on it now, to prevent  injuries.

Dancers with perfect turn-out also turn-in, because of strength issues-not just memory loss or forgetfulness. It is the body’s natural inclination to do so, and the mind of a dancer must think about so many other things, occasionally (LOL), that sometimes it can just go-that is why you train to control it, so it goes where you want it to, and how far you want it to.

There are many exercises in ballet, poses in variations, and most importantly, but never mentioned,transitions in classical ballet, which cannot be accomplished without injury to a dancer who does not possess adequate turn-out to do them. Perhaps more importantly, not turning-out first and then failing to hold the required degree of turn-out can be dangerous if not life threatening, then dance threatening (and this is the worse of the two-for dancers!). This is anatomy and physiology, and fact. It is fairly safe to say, then, and I do, that all dancers turn-out excessively, whether good schools tell them to or not, they learn to, it is conditioned in other ways, even if teachers tell you they do not force turn-out. They teach turn out, refer to turn-out and yell, “TURN OUT,” and they have to if they teach Ballet.

English: First Position of the feet in Ballet
English: First Position of the feet in Ballet (Photo credit: Wikipedia)

Notice the “over turn-out” in first position? Slightly? What is too much for many persons is simply put, too much without control. I always releve (turned-out) in every position, just to check that my alignment is correct and that the right muscles are engaged, and that I can releve from that position. It is evident when doing this, if you feel awkward, or forced, that you are! Fix it-turn a little tiny bit in and gain control from that position before you open further. Practice making transitions and moving from these positions, think of variables, so that when the time comes, it is no sweat-you have done that before, and the body remembers it. Sometimes, I also attempt a plie from whatever position this happens to be, all of them, to make sure there is nothing wrong, to see what I can do, and to strengthen infrequently used muscles that may contribute to a better position in the end, by cautious means. What a lot of teachers mean by teaching turn-out young is that they can put dancers in over turned-out position and due to the laxity of the muscles at that age they do not readily see injury-that does not mean that it is not occurring, only that you can’t see it. Ask Mikhail Baryshnikov about his knees and forced turn-out and I am sure you will get an earful. I have found, over the years, that my habit, hard to instill or demand in others, fixes almost any turn-out problem, assures that I can execute the position(s) correctly (with the correct amount of turn-out), in transitions, or quickly, without hurting myself, and that after years of doing it, I have no issues or injuries! It’s like falling, with practice, you can learn to fall without injury, or with substantial reduction of injury. Falls happen-practice. After years of doing this, and I am much, much older than any of you reading this, it helps strengthen those muscles directly associated with each position, the best. How do you learn to surf? You surf. Is there exercise for learning to surf or be a better surfer? Yeah, surfing. How do you build up the muscles used in surfing? Surfing. Practice, practice, practice-not repeat, repeat, repeat! Also, holding these positions is easier after many repetitions, and many years. I have good balance from it in most ballet positions, and I haven’t really danced as hard as you are for 30 years! But I still do the exercises….

If, as a dancer, you attend a new class, and the teacher has you do something for which you are not physically prepared to do, you will fall out of it. That is the best sign, this muscle is not trained. Train it by doing the exercise over and over. Do not think to use the fail-safe quadriceps for anything except stability and pumping-force. The Amish say, there is always another way, and there is almost always another muscle that needs work when your quadriceps engage to protect you-they do not jump into action unless it is to protect you from a major tumble-from everything. The finer muscles responsible for controller finer movements-are ignoring you, not engaging, not working, because you haven’t trained them to listen. Most dancers think they have no faults, are not lazy, but mentally, there are things we just do not bother to do. We ALL do this. We also rely on routines and it is virtually impossible to do all of the exercises you need to do in one routine, so make list and rotate them-less chance for injury! It is hard, harder than 64 small jumps in center, all of them a foot or more off the ground, and then again, because it seems so easy we just take it for granted, but I bet you can do those jumps. Working and strengthening the finer muscles is hard, because these muscles are hard to find, hard to visualize, and they all work together at times, making the isolation of them very difficult to sort out, or the use of them fathomable. They are truly not as complicated as they seem, but you have to take the time and think about them, research them, practice using and finding them-or try to-and prevent injury.

Adequate turn-out for dancers is that degree of turn-out required for that dancer, based on his/her body structure, bone shape (especially the femur, acetabulum and pubis) which determine the range of movement of the hip, and also the ilio-femoral ligament, obturator externus (front-see picture below), and piriformus, gemellus inferior, obturator internus and externus (front), which in addition are responsible for the strength of the hip movements. Overstretching in the butterfly, for example, which virtually no teacher will tell you is harmful (“do it 3x a day!”), but it is. It is when you do not strengthen the hip, or stretch the hip sufficiently in the opposite direction. But enough is said about this to beginning or ambitious dancers who

OBTURATOR EXTERNUS MUSCLE

must stretch to attain a better degree of turn-out and they need to be particularly watchful, especially if they are teenagers. No exercises are specifically given for it in ballet class. Repeated 2x per day, these stretching exercises can overstretch the adductors, resulting in serious groin pain in the student, usually deep in the tissue, where ice and heat may have little impact. Ibuprofen can help, but must not be relied upon for daily use. The pain can be so severe the dancer cannot turn-out-that is actually the key to the cause of this pain, for most other injuries to the hip result in different kinds of pain inside or outside the hip, but not affecting the turn-out per se.

Piriformis - Muscles of the Lower Extremity An...
Piriformis – Muscles of the Lower Extremity Anatomy Visual Atlas, page 8 (Photo credit: Rob Swatski)

From all of the material I have read about possible hip injuries, it is my own conclusion, and that of a venerable dance doctor, that without sufficient strength in the adductors, and overstretching present, a sudden twisting or turning can result in a straining of the muscles of the groin and on the inside of the upper thigh if they lack the tone to prevent overstretching. The pain in the upper thigh is frequently called “rider’s strain,” and is caused by too much stretch of the adductors when doing movement a la seconde (Dancer’s Book of Health, L. M. Vincent). It is said that some dancers, with ligament laxity, may even feel the thighbone “go out of joint.” This continual dislocating may lead to joint degeneration, so the importance of good muscle conditioning and avoidance of over stretching cannot be ignored! He says to “always seek control more than height”, and when warming up, do not risk strain by caving in to the temptation of placing the leg on the barre for the first stretch. Check with your dance teacher/physical therapist before performing these exercises to make sure they do not interfere with your goals.

Interestingly, students who feel that they do not possess enough turn-out can fall prey to this type of injury if their leg is inclined to drop “backward,” so they will often find that their turn-out is not lacking, but rather their ability to control it is. These types of exercises will help, but for specific muscle attention (there are six sets- count them- of muscles and ligaments responsible for turn-out, and a few other muscles besides) it would do to look up and verify which muscles to strengthen, what each set does, and the individual ones, and to go over where they are, when they are used and what to do to strengthen each one and each group, just to prevent injury and to be aware of this rather complicated area of the body, prone to injury in female dancers with a high level of ballet classes, training or just plain dancing. There are classes, sometimes, led by physical therapists (and dancers) to integrate whole body strengthening and conditioning to prevent injury in the different parts of the body that ballet dancers are susceptible to. These injuries are particularly a problem for adolescent students for growth and hormone reasons. Look no further than the Nureyev Foundation in Switzerland, to locate a dance doctor (a real one-not a quack) in your area, or a dance-trained physical therapist, who can help you discover more about your dancing body and its limits, as well as its possibilities!

http://www.noureev-medical.org/content/contact-information

Deep muscles of the medial femoral region.
Deep muscles of the medial femoral region. (Photo credit: Wikipedia)
Your hip adductors (left) are all responsible for moving your leg in toward the midline of your body–a movement called adduction. Located on the inside of your thigh, your adductors stretch from the inside of your knee to the bottom of your pelvis. Strong adductors are important in knee and hip stability, and if they become weakened, you may find your knees are prone to dropping outward. Additionally, performing exercises for your adductors will tone the area of your inner thigh. There are a variety of exercises you can perform for this important muscle group.
Medicine Ball Squats

Stand with your feet hip-width apart. Place a light medicine ball or soccer ball between your knees. Keeping the ball in place by squeezing your knees together, squat until your knees are bent to 90 degrees and your thighs are parallel to the floor. Push your hips forward and straighten your knees to stand up. Make sure that you concentrate on pushing your knees in against the ball throughout this exercise.

Lying Side Inner Thigh Lift
Lie on the floor on your left side with your body straight and your head resting on your outstretched left arm. Cross your right leg over your left and place your right foot on the floor, creating a figure-4 shape and allowing space to lift your lower leg. Raise your left leg inward by using your adductor muscles. Lift your foot 8 to 12 inches off the ground. Slowly lower your foot back to the floor and repeat before rolling over and changing sides. Make this exercise harder by wearing ankle weights-no more than 1 lb, and work up to that!

Hip Adductor Machine

Sit on the machine with the leg pads against your knees and your legs as far apart as comfortable. Press against the pads and push your legs together until the machine arms touch. Pause for one to two seconds before slowly returning to the starting position and repeating. This machine can strain your muscles if you are weak here, as most dancers are, it is advised to put it on its lowest setting and do no more than 12 reps the first several times, working up to three sets of 10 or twelve. Dancers also have to be careful not to bulk up-so many of these exercises have to be done in moderation, compared to general athletes, or those trying to get into shape. Dancers have a preferred shape, and need to remember to work the opposing side EQUALLY. In this case, that means, to put the pads on the outside of the leg and reverse the exercise. Most dancers will find it is easier to press the pads out (a no-brainer), than in. That is where you need work!

Lying Pillow Squeeze

This one is easy, so you will really feel “the pee” muscles working. My daughter hates it when I say this. Lie on your back with your legs bent and your feet flat on the floor (also on the bed or while you are waiting for lights to change to green in the car-anywhere and from any position). Place a large pillow between your knees. Keeping your head on the floor and your arms by your side, press your knees together and squeeze the cushion as hard as you can for five seconds. Relax slightly, but keep the cushion in place. Push your knees together again and continue repeating for the desired number of repetitions. Only a few will be possible at first, so do not overdo it. It is more important to hold it for 5-10 seconds than to repeat it often. It is also more challenging. Work up!

Many dancers experience imbalance between the hip adductors or inner thighs and abductors, the hip and gluteus muscles. To counter this muscular imbalance, here is a stretch which needs to be held at least 30 seconds. Personally, I do not recommend “adjustments” like pulling the leg (performed by some over-zealous chiropractic offices, and  frequently, without any warning!).

Preparation:

1) On floor or mat, lie face up with arms extended at sides

2) Lift one leg straight up then bend knee and hip to 90 degrees flexion

Execution:

1) Lower bent knee leg to opposite side toward hand.

2) Hold stretch for 30 seconds, maintaining 90° flexion in hip with both shoulders flat on the floor.

3) Repeat with opposite side.

For definition and reaffirmation:
Think that some dancers use the outer thigh more than they ought to, when it is the inner thigh which is typically responsible for turn-out.  Working the turn-out muscles require isolating them and using them-nothing else will work. The adductors are the frequently forgotten five muscles of the inner thigh that connect to the pelvis—the Pectineus, the Adductor Magnus, the Gracilis, the Adductor Brevis, and the Adductor Longus. Look those up and write down their meanings, then locate them in yourself and work on them. When a dancer has had an injury to the knee, for example, these muscles will have atrophied while the dancer was resting from the knee injury. The tendency for the dancer to resume the level of previous training that his/her body was accustomed to is presumed, since most dancers who have not had a previous injury will not be aware of or expect these initial limitations so they just jump right back into class “to get back to where I was”! Right? NO.WRONG!!!!!!!!!!!!
Even a few days off, literally, can lead to some scary loss of muscle tone and requires s-l-o-w and steady passive and active stretching to get back to ground zero. I also recommend the warm-up exercises of Ballet for Dummies (Evelyn Cisneros is one of the authors-and certainly NO Dummie!) In it, they well discuss passive and active stretching and the importance of EACH for dancers. Too much passive stretching before dance class can also lead to injury in dance class. Best to do moderate exercises (warm up) before class, and stretching OUT after class, for up to 45 minutes.
Yoga and Pilates demand strong inner thigh muscles — fortunately, routine practice of both strengthens the inner thighs.The Pilates Reformer is also said to produce amazing results, but work with a trained professional. Don’t do any stretch to the point of discomfort and don’t force any stretch. Work up!
A good stretching program is key to maintaining muscular balance. Hip and adductor muscles are focused on in CORE workouts, but prior to this, which can result in overworking some muscles and under working others that dancers use, dancers had to rely on themselves to diagnose and usually fix what was wrong, and in good ballet classes, teachers address this, usually through modern dance techniques and other exercises. There are many modern dance exercises which I believe prevent any issues in these areas through dancing. On The Count of One and The Dancer Prepares give some really good advice, and there is no end of information available on the subject. You will not hear this through an orthopedic doctor, who relies on personal links with general physical therapists to practice exercises, get patients “back”, which might be good for octogenarians or football players, but are not fulfilling for a dancer beyond an early stage of injury recovery. Dancers demand more-faster.

Although some of the same muscles come into play with athletes and the general population, dancers refine their use, and rely on a good deal many more muscles than does a football player, and also work at a higher level of training each one for specific uses not understandable to most orthopedic doctors unless they are also dance professionals. A dancer also uses them a lot more and a lot more turn-out stretches, means a lot more and tougher turning-in exercises. My argument here is that most of these types of injuries are turn-in injuries, rather than turn-out injuries, actually. A good modern (basic, then intermediate) technique class-Graham or Horton is best and can also work absolute wonders to this balancing act; it can act as the antithesis to ballet, thus working all of the needed muscles in a dancer’s range, while being easy on the body, when exactly properly performed, and done at least four days per week for any significant results. Since this is not available or possible for all professional dancers (who do not have the time to become modern dancers), many of them rely on yoga. Yoga is everywhere and gets you in places nothing else does, but is not as active as modern, and not dancing.

The important points here are to listen to your own body, and do not readily accept the physical therapy or medical advice of a medical professional untrained in the dance profession. Dancers are different and require the patience themselves to identify areas of concern, underwork, overwork and injury. All bound together, usually. Any pain in executing any position might indicate the dancer is doing something wrong, and the sooner this is diagnosed and corrected, usually through re-teaching and strengthening the affected part, ASAP, the better. You might say that dancers are continually pushing the limits and need to train smartly. They hold their fate in their own hands and how they approach such injuries can be the end of one or most connected injuries as well, or the beginning of several more related ones. Therefore, it is important to sort it out, when you can’t dance it out.
Keep on Dancing!