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Sports Medicine

, Volume 6, Issue 5, pp 295–307 | Cite as

Prevention of Hip and Knee Injuries in Ballet Dancers

  • D. C. Reid
Injury Clinic

Summary

Hip problems form about 10% (7.0 to 14.2%) of most published series of ballet injuries. The abnormally large range of external rotation needed for a perfect turnout is primarily due to soft tissue adaptation, more readily achieved in the young dancer. Insufficient range of motion at the hip throws considerable stress on the other lower limb segments. The snapping hip syndrome is common (43.8% of hip problems), with about one-third associated with pain. A tight iliotibial band may contribute to this, and balanced flexibility requires special attention to abductor stretching. The external clicking hip must be distinguished from the internal clicking hip, which is associated with the joint and psoas tendon. Stress fractures of the hip are easily overlooked and, if undetected, they may progress to a complete fracture.

Knee problems account for 14.0 to 20% of complaints, and over 50% of these are perior retropatellar problems. This includes synovial plica, medial chondromalacia, lateral patella facet syndrome, subluxing patella and the fat pad syndrome. Specific diagnosis leads to specific treatment and the best chance of cure. Mild hyperextension of the knee may be aesthetically desirable, but excessive range leads to symptoms in the posterior capsule and poor control. Young dancers with a tendency to very lax joint structures should be identified early and protected from overstretching. In the author’s series, meniscal lesions did not appear to be as big a problem as reported elsewhere in the literature.

Ballerinas appear to have less leg strength than other groups of athletes, having only 77% of the weight-predicted norms. The introduction of strength training for male and female dancers may reduce injuries and improve balance, but it requires an intensive educational programme to dispense with the many myths.

There are several references to the development of early arthritis but, while relatively common in the foot, symptomatic arthrosis in ballet dancers’ hips and knees is not more prevalent than in the general population.

The young age at which serious dance training begins, the long and rigorous hours of practice, the thin ballet slipper, dancing en pointe and unusual dietary regimens may all contribute to injury patterns in varying degrees.

Keywords

Knee Injury Iliotibial Band Ballet Dancer Knee Problem Synovial Plica 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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References

  1. Binnie JF. Snapping hip. Annals of Surgery 58: 59–66, 1913PubMedCrossRefGoogle Scholar
  2. Brodelius A. Osteoarthrosis of the talar joints of footballers and ballet dancers. Acta Orthopaedica Scandinavica 30: 390–314, 1961Google Scholar
  3. Chandler SB. The iliopsoas bursa in man. Anatomical Record 58: 235–240, 1934CrossRefGoogle Scholar
  4. Cohen JL, Segal KR, Witriol I, Meaple WD. Cardiorespiratory response to ballet exercises and the VO2max of elite ballet dancers. Medicine and Science in Sports and Exercise 14: 212–217, 1982PubMedGoogle Scholar
  5. Davies GL, Kirkendall DT, Leigh DH, Lim MD, Reinbold TR, et al. Isometric characteristics of professional football players. Medicine and Science in Sports and Exercise 13: 76, 1981CrossRefGoogle Scholar
  6. Dickenson AM. Bilateral snapping hip. American Journal of Surgery 6: 97–101, 1929CrossRefGoogle Scholar
  7. Dunn B. Physiotherapy and the ballet. Physiotherapy 51: 125–128, 1965PubMedGoogle Scholar
  8. Ende LS, Weckstrom J. Ballet injuries. Physician and Sportsmedicine 10: 101–118, 1982Google Scholar
  9. Fairbank T. An atlas of general affections of the skeleton, E.S. Livingstone Ltd, Edinburgh, 1951Google Scholar
  10. Fitt S. Conditioning for dancers. Dance Research Journal 14(1): 33–38, 1981CrossRefGoogle Scholar
  11. Galabert R. Preventing dancers’ injuries. Physician and Sportsmedicine 8(4): 69–76, 1980Google Scholar
  12. Gordon S. Off balance: the real world of ballet, Pantheon Books, New York, 1983Google Scholar
  13. Gordon S. In Peterson et al. (Eds) The demands of dance training in the medical aspects of dance, Sports Dynamic Publishers, London, Ontario, 1986Google Scholar
  14. Grahame R. Joint hypermobility — asset or liability? A study of joint mobility in ballet dancers. Annals of the Rheumatic Diseases 31: 109–112, 1972PubMedCrossRefGoogle Scholar
  15. Grahame R, Saunders AS, Maisey M. The use of scintigraphy in the diagnosis and management of traumatic foot lesions in ballet dancers. Rheumatology and Rehabilitation 14: 235–238, 1979CrossRefGoogle Scholar
  16. Hamilton WG. Medical problems in ballet. Physician and Sportsmedicine 10: 98–114, 1982Google Scholar
  17. Hobby K, Hoffmaster L. In Peterson et al. (Eds) Supplementing traditional training for dancers in the medical aspects of dance, Sports Dynamics Publishers, London, Ontario, 1986Google Scholar
  18. Howse AJG. Orthopaedists aid ballet. Clinical Orthopaedics and Related Research 89: 52–63, 1972PubMedCrossRefGoogle Scholar
  19. Hutchensen DC, Denman FR. Non-infectious iliopectineal bursitis. American Journal of Surgery 72: 576–579, 1946CrossRefGoogle Scholar
  20. Jacobs M, Young R. Snapping hip phenomenon among dancers. American Corrective Therapy Journal 32(3): 92–98, 1978PubMedGoogle Scholar
  21. Jones FW. The anatomy of snapping hip. Journal of Orthopaedic Surgery 2: 1–3, 1920Google Scholar
  22. Kirkendall DT. Comparison of isokinetic power-velocity curves in various classes of American athletes. Doctorial dissertation, Ohio State University, Columbus, 1979Google Scholar
  23. Kirkendall DT, Bergfeld JA, Calabrese L, Lombardo JA, Street G, et al. Isokinetic characteristics of ballet dancers and response to a season of ballet training. Journal of Orthopedics and Sports Physical Therapy 5: 4, 207–210, 1984Google Scholar
  24. Knott M, Voss D. Proprioceptive neuromuscular facilitation, Harper and Row, New York, 1968Google Scholar
  25. Leighton JRA. Flexibility characteristics in males 10–18 years. Archives of Physical Medicine and Rehabilitation 37: 494, 1956PubMedGoogle Scholar
  26. Linrenberg G, Pinshaw R, Noakes TD. Iliotibial band friction syndrome in runners. Physician and Sportsmedicine 12(5): 118–130, 1984Google Scholar
  27. Mayer L. Snapping hip. Surgery, Gynecology and Obstetrics 29: 425–428, 1919Google Scholar
  28. Matheson G. Stress fractures and stress reactions. American Journal of Sports Medicine 15(1): 46–52, 1987PubMedCrossRefGoogle Scholar
  29. McConnell J. The management of chondromalacia patellae: a longterm solution. American Journal of Physiotherapy 32(4): 215–223, 1986Google Scholar
  30. McLeish RD, Charnley J. Abduction forces in one-legged stance. Journal of Biomechanics 3: 191–209, 1970PubMedCrossRefGoogle Scholar
  31. Meinel KK, Atwater AE. Analysis of components of the ‘turnout’ in beginning and advanced female ballet dancers. Medicine and Science in Sports and Exercise 20 (Suppl.): 2, 1988Google Scholar
  32. Micheli LJ. Overuse injuries in children’s sports. Orthopedic Clinics of North America 14: 337–360, 1983PubMedGoogle Scholar
  33. Micheli LJ, Gillespie WJ, Walaszek A. Physiologic profiles of female professional ballerinas. Clinics in Sports Medicine 3(1): 199–208, 1984PubMedGoogle Scholar
  34. Miller EH, Schneider HJ, Bronson JL, McLain D. The classical ballet dancer: a new orthopaedic consideration in athletic injuries. Clinical Orthopaedics and Related Research 111: 181–191, 1975PubMedCrossRefGoogle Scholar
  35. Moreira FEG. Snapping hip. Journal of Bone and Joint Surgery 22(2): 506, 1940Google Scholar
  36. Mostardi RA, Porterfield JA, Greenberg B, Goldberg D, Michelene L. Musculoskeletal and cardiopulmonary characteristics of the professional ballet dancer. Physician and Sportsmedicine 1: 53–61, 1983Google Scholar
  37. Nikolaev IA, Najdenov S. Occupational osteoarthropathies and the classical dancer. Archives des Maladies Professionelles, de Médecine du Travail et de Sécurité Sociale 31: 39–42, 1970Google Scholar
  38. Nunziata A, Blumenfeld I. Cadeva a resorte: a proposito de una variedad. Prensa Medica Argentina 38: 1997–2001, 1951PubMedGoogle Scholar
  39. Parsons EB. The snapping hip. Texas State Journal of Medicine 26: 361–362, 1930Google Scholar
  40. Quirk R. Ballet injuries: the Australian experience. Clinics in Sports Medicine 2(3): 507–514, 1983PubMedGoogle Scholar
  41. Quirk R. Injuries to the lower limb in ballet dancers. In Proceedings of the VI National Meeting of the Australian Association for Sports Medicine, Ballarat, NSW, November 1985Google Scholar
  42. Reid DC. Preventing injuries to the young ballet dancer. Physiotherapy Canada 39: 4, 231–236, 1987Google Scholar
  43. Reid DC, Burnham RS, Saboe LA, Kushner SF. Lower extremity flexibility patterns in classical ballet dancers and its correlation to lateral hip and knee injuries. American Journal of Sports Medicine 15(4): 347–352, 1987PubMedCrossRefGoogle Scholar
  44. Rovere GD, Webb LX, Cristina AG, Vogel JM. Musculoskeletal injuries in theatrical dance students. American Journal of Sports Medicine 11(4): 195–207, 1983PubMedCrossRefGoogle Scholar
  45. Samarco GJ. The dancer’s hip. Clinics in Sports Medicine 2(3): 495, 1983Google Scholar
  46. Schaberg JE, Harper MC, Allen WC. The snapping hip syndrome. American Journal of Sports Medicine 12(5): 361–365, 1984PubMedCrossRefGoogle Scholar
  47. Schneider HJ, King AT, Bronson JL, et al. Stress injuries and developmental change of lower extremities in ballet dancers. Radiology 113: 627–632, 1974PubMedGoogle Scholar
  48. Silver DM, Campbell P. Arthroscopic assessment and treatment of dancers’ knee injuries. Physician and Sportsmedicine 13(11): 75–81, 1985Google Scholar
  49. Singleton MC, Le Veau BF. The hip joint; structural stability and stress: a review. Physical Therapy 55: 145–152, 1959Google Scholar
  50. Solomon RL, Micheli LJ. Technique as a consideration in modern dancer injuries. Physician and Sportsmedicine 14(8): 83–92, 1986Google Scholar
  51. Sparger C. Physiotherapy at the Sadlers Wells school of ballet. Physiotherapy 38: 8–13, 1952PubMedGoogle Scholar
  52. Staple TW. Arthrography demonstration of iliopsoas bursa extension of the hip joint. Radiology 102: 515–516, 1972PubMedGoogle Scholar
  53. Washington EL. Musculoskeletal injuries in theatrical dancers: site, frequency and severity. American Journal of Sports Medicine 6(2): 75–98, 1978PubMedCrossRefGoogle Scholar

Copyright information

© ADIS Press Limited 1988

Authors and Affiliations

  • D. C. Reid
    • 1
  1. 1.Glen Sather Sports Medicine ClinicUniversity of AlbertaEdmontonCanada

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