Prevention of Hip and Knee Injuries in Ballet Dancers
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.
KeywordsKnee Injury Iliotibial Band Ballet Dancer Knee Problem Synovial Plica
Unable to display preview. Download preview PDF.
- Brodelius A. Osteoarthrosis of the talar joints of footballers and ballet dancers. Acta Orthopaedica Scandinavica 30: 390–314, 1961Google Scholar
- Ende LS, Weckstrom J. Ballet injuries. Physician and Sportsmedicine 10: 101–118, 1982Google Scholar
- Fairbank T. An atlas of general affections of the skeleton, E.S. Livingstone Ltd, Edinburgh, 1951Google Scholar
- Galabert R. Preventing dancers’ injuries. Physician and Sportsmedicine 8(4): 69–76, 1980Google Scholar
- Gordon S. Off balance: the real world of ballet, Pantheon Books, New York, 1983Google Scholar
- 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
- Hamilton WG. Medical problems in ballet. Physician and Sportsmedicine 10: 98–114, 1982Google Scholar
- 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
- Jones FW. The anatomy of snapping hip. Journal of Orthopaedic Surgery 2: 1–3, 1920Google Scholar
- Kirkendall DT. Comparison of isokinetic power-velocity curves in various classes of American athletes. Doctorial dissertation, Ohio State University, Columbus, 1979Google Scholar
- 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
- Knott M, Voss D. Proprioceptive neuromuscular facilitation, Harper and Row, New York, 1968Google Scholar
- Linrenberg G, Pinshaw R, Noakes TD. Iliotibial band friction syndrome in runners. Physician and Sportsmedicine 12(5): 118–130, 1984Google Scholar
- Mayer L. Snapping hip. Surgery, Gynecology and Obstetrics 29: 425–428, 1919Google Scholar
- McConnell J. The management of chondromalacia patellae: a longterm solution. American Journal of Physiotherapy 32(4): 215–223, 1986Google Scholar
- 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
- Moreira FEG. Snapping hip. Journal of Bone and Joint Surgery 22(2): 506, 1940Google Scholar
- 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
- 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
- Parsons EB. The snapping hip. Texas State Journal of Medicine 26: 361–362, 1930Google Scholar
- 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
- Reid DC. Preventing injuries to the young ballet dancer. Physiotherapy Canada 39: 4, 231–236, 1987Google Scholar
- Samarco GJ. The dancer’s hip. Clinics in Sports Medicine 2(3): 495, 1983Google Scholar
- Silver DM, Campbell P. Arthroscopic assessment and treatment of dancers’ knee injuries. Physician and Sportsmedicine 13(11): 75–81, 1985Google Scholar
- Singleton MC, Le Veau BF. The hip joint; structural stability and stress: a review. Physical Therapy 55: 145–152, 1959Google Scholar
- Solomon RL, Micheli LJ. Technique as a consideration in modern dancer injuries. Physician and Sportsmedicine 14(8): 83–92, 1986Google Scholar