Dance

For Patients

The Principle

A joint is strongest in the middle of its range and weakest at the ends.

Most sport works in the middle. Dance deliberately works at the ends and asks for control there.

Holding a position the joint barely reaches, over and over, is a specific kind of demand.

At the Knee

Turnout is rotation that should come mostly from the hip. When the hip cannot supply it, the knee and foot make up the difference.

A knee that is twisted to create turnout is held in rotation while it bends and straightens, which it does not tolerate well.

Jumping and landing happen constantly, usually on one leg and often with a straight knee on landing. 3.14.8 covers landing.

Deep knee bends in plié load the kneecap joint through a large range. 3.12.3 covers those pressures.

Clinical Relevance

Where turnout comes from is the key question in a dancer's knee pain, and it can be assessed.

Many dancers start young, so loading begins while the skeleton is still growing. 2.4.2 covers growth.

Pain that appears in a particular position rather than during general activity is a useful clue.

No injury rates are given on this page, because no source was available to check them against.

For Medical Students

The Principle

Range of motion and control through range are separate capacities, and dance demands both at the limits.

Where an aesthetic requirement exceeds an anatomical capacity, the difference is taken from a neighbouring joint.

That substitution is the central mechanism in dance injury and it is visible on examination.

At the Knee

Anatomical turnout is hip external rotation. Functional turnout adds tibial rotation and foot pronation when the hip is insufficient.

A knee held in external tibial rotation while flexing and extending through plié experiences abnormal patellofemoral tracking. 3.12.1 covers tracking.

Repetitive single leg landings, often with limited knee flexion for aesthetic reasons, raise peak forces. 3.14.8 covers landing.

Grand plié takes the knee into deep flexion under load, which maximises patellofemoral contact pressure. 3.12.3 covers it.

Dancers commonly have generalised hypermobility, which changes both capability and vulnerability. 3.2.10 covers stability during motion.

What Changes It

Available hip external rotation, which determines whether turnout is substituted.

Age at starting and training volume during growth. 2.4.2 covers ossification.

Floor type, since sprung floors reduce landing loads substantially.

Footwear, from bare feet to pointe shoes, which changes the ankle's contribution.

Hypermobility, which is overrepresented in dance populations.

Clinical Relevance

Measure hip external rotation and compare it with standing turnout, since the gap is the mechanism.

Ask which position reproduces the pain, because dance pain is often position specific.

Consider hypermobility, which changes the assessment and the rehabilitation.

Avoid quoting injury rates, which this page does not, because no source was available.

MRCS Level

The Principle

Dance is the chapter's clearest example of a demand set by an external aesthetic rather than by a physical objective.

In every other sport here the movement exists to achieve something measurable. In dance the position is the point.

That removes the usual argument that a safer technique is also a better one, which is the lever used everywhere else.

At the Knee

Compensated turnout places the tibia in external rotation relative to the femur through the whole squat cycle, altering patellofemoral tracking and medial soft tissue tension. 3.12.1 covers tracking.

Patellofemoral pain is the commonest presentation, consistent with that mechanism. 3.12.9 covers it.

Deep flexion under load in grand plié places contact on the proximal patella and the odd facet, which are rarely loaded elsewhere. 3.12.2 covers contact areas.

Hypermobility raises end range capability and reduces passive restraint, so the same position is achieved with less bony and ligamentous help. 3.2.10 covers stability.

Training through growth, with high volume at a skeletally immature stage, is the population feature that distinguishes dance from adult sport.

What Changes It

Hip external rotation range, which is the primary determinant of compensation.

Hypermobility status.

Floor compliance, which is a facility level modifiable factor.

Training volume during growth, which is where an intervention does most good.

Aesthetic requirement of the genre, since classical ballet demands turnout that contemporary dance does not.

How It Is Measured

Clinical measurement of hip rotation against functional turnout, which is the specific assessment and is cheap.

Motion capture in dance science laboratories, which is available in a small number of conservatoires. 3.16.7 covers capture.

Force plate measurement of landing, which quantifies the floor's contribution.

Beighton scoring for hypermobility, which is clinical and reproducible.

The dance medicine literature is smaller than the sports medicine literature and is concentrated in a few centres, so findings generalise cautiously.

Clinical Relevance

Measure the gap between hip rotation and functional turnout, which is the mechanism and the modifiable target.

Assess hypermobility, since it alters both the presentation and the rehabilitation.

Raise floor compliance as a facility level intervention, which helps everyone who uses the room.

Recognise that a safer technique may not be an acceptable one in this discipline, which is unusual among the sports here.

Weigh the dancer's age, physiology, comorbidities, knee demand, psychological state and their own ideas, concerns and expectations, because vocational training through childhood makes the stakes of a restriction unusually high.