Associations between turnout and lower extremity injuries in classical ballet dancers

Negus, Vicki BSc (Physiotherapy), Master of Sports Physiotherapy, West Australian Ballet, Perth, Western Australia, Australia; Hopper, Diana PhD, Curtin University of Technology, Perth, Western Australia, Australia; Briffa, N. Kathy PhD, Curtin University of Technology, Perth, Western Australia, Australia

Purpose

To determine relationships between aspects of turnout and injury history in pre-professional classical ballet dancers, and to determine the clinical utility of various methods used to assess turnout.

Participants, Setting, Equipment

Twenty-nine dancers (24 female), aged 15 to 22 years, were recruited from a pre-professional classical ballet program at a university in Western Australia.  They were excluded if they were currently injured.  Dancers were tested at the university.  A standard goniometer was used for all range-of-motion testing, and for all measurements of turnout angles.

Study Variables

Injury history over the previous 2 years was ascertained by interview.  Injury was operationally defined as any pain, discomfort, or other musculoskeletal problem, which required modification of, or time away from, dance training, examinations, or performance.  Injuries were graded based on duration and severity.

Three new turnout variables were derived (Active ER Lag, Compensated Turnout, and Static-Dynamic Turnout Difference) from measurements of passive and active hip external rotation (ER) range of motion (ROM), and functional turnout angles in standing.  

Procedure

Passive and active hip external rotation (ER) range of motion (ROM) was measured in supine, and functional turnout angles measured in standing.  Functional turnout angles were assessed in first and fifth ballet positions, before and after jumping (sautés).  

Intra-tester reliability (measured using ICCs) was high (>0.98 for hip ER ROM measurement; > 0.82 for functional turnout angle measurement).

Correlation coefficients (Pearson product moment (for normative data) and Spearman rank (for non-normative data)) were used to determine associations between each of the turnout variables and injury history.

Results

All dancers reported a history of injury, with 93.1% reporting a history of non-traumatic injuries and 41.4% reporting a history of traumatic injuries. 

No correlation was found between hip ER ROM and functional turnout (P>.143).

Number and severity of non-traumatic injuries were associated with reduced functional turnout (r or rho>0.38; P<.04), but not with hip ER ROM (P>.05).

Number and severity of traumatic injuries were not associated with turnout (P>.172).

Conclusions

Functional measures of turnout are more relevant than hip ER ROM to prevalence of non-traumatic dance injuries. Control of turnout in classical ballet dancers should be assessed dynamically and in functional positions.

Accurate assessment and training of turnout in classical ballet dancers will aid in prevention of non-traumatic injuries.  Future research could benefit dancers by investigating optimal strategies for training of turnout.