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	<title>Dance Advantage &#187; injury</title>
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		<title>Life Lessons on Injury: Arriving at Plan C</title>
		<link>http://danceadvantage.net/2010/10/18/injury-plan/</link>
		<comments>http://danceadvantage.net/2010/10/18/injury-plan/#comments</comments>
		<pubDate>Mon, 18 Oct 2010 13:20:06 +0000</pubDate>
		<dc:creator>Lauren Warnecke</dc:creator>
				<category><![CDATA[Blog]]></category>
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		<category><![CDATA[barefoot]]></category>
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		<category><![CDATA[dance career]]></category>
		<category><![CDATA[dance injury]]></category>
		<category><![CDATA[dancing with an injury]]></category>
		<category><![CDATA[end of career]]></category>
		<category><![CDATA[foot injury]]></category>
		<category><![CDATA[ignoring an injury]]></category>
		<category><![CDATA[injury]]></category>
		<category><![CDATA[Lauren Warnecke]]></category>
		<category><![CDATA[moving on]]></category>
		<category><![CDATA[new beginnings]]></category>
		<category><![CDATA[performing]]></category>
		<category><![CDATA[personal story]]></category>
		<category><![CDATA[perspective]]></category>
		<category><![CDATA[physician]]></category>
		<category><![CDATA[sports medicine]]></category>
		<category><![CDATA[surgery]]></category>
		<category><![CDATA[toe]]></category>
		<category><![CDATA[torn ligament]]></category>
		<category><![CDATA[walk it off]]></category>

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		<description><![CDATA["Rarely do we stop to consider the idea of not dancing, or having a plan B if it doesn't work out.  I always considered myself a careful dancer, if not a rational one.  I am meticulous about technique and proper form to prevent the chance of injury, but when the occasional sprained ankle or ingrown toenail came up my instinct was always to dance through it, or “walk it off”, as the saying goes."]]></description>
			<content:encoded><![CDATA[<div id="attachment_5640" class="wp-caption alignright" style="width: 80px"><a href="http://danceadvantage.net/author/artintercepts/"><img class="size-thumbnail wp-image-5640" title="ArtIntercepts-icon" src="http://danceadvantage.net/wp-content/uploads/2010/04/ArtIntercepts-icon-70x70.png" alt="Art Intercepts icon" width="70" height="70" /></a><p class="wp-caption-text">More Art Intercepts...</p></div>
<p>In the throngs of vigorous dance training, rarely do we stop to consider the idea of not dancing, or having a plan B if it doesn&#8217;t work out.  I always considered myself a careful dancer, if not a rational one.  I am meticulous about technique and proper form to prevent the chance of injury, but when the occasional sprained ankle or ingrown toenail came up my instinct was always to dance through it, or “walk it off”, as the saying goes.</p>
<p>What I didn’t and couldn’t prepare for was that one injury that got the best of me.  <em><strong>The one I couldn’t walk off.</strong></em> Five days before graduating from college, I was bright-eyed, full of dreams, and dancing as an apprentice for a reputable modern dance company in Chicago.  At a dress rehearsal that evening I turned wrong on my left foot.  I felt something slip out of place in the ball of my foot and for nearly every step for the rest of the run my foot collapsed underneath me.  After finishing the piece I sat down with my foot elevated and thought for sure it was broken.  It began to swell, but I could still wiggle my toes and walk with a limp.</p>
<p>I spoke with the artistic director I was working for, and he referred me to a sports medicine physician who often did pro-bono work for the company.  The next day, she took an x-ray and indicated that my foot wasn’t broken.  I pleaded with her to find a way to get me through the performances, since they would be the final shows of my college career &#8211; have I mentioned that I do not have a history of rational thinking with regard to injury?</p>
<div id="attachment_8355" class="wp-caption alignright" style="width: 378px"><img class="size-full wp-image-8355  " src="http://danceadvantage.net/wp-content/uploads/2010/10/ouch.jpg" alt="Photo of Lauren smiling through the pain and sporting a very bruised foot at the time of her injury," width="368" height="250" /><p class="wp-caption-text">&quot;Walking it off...&quot;</p></div>
<p>The physician gave me anti-inflammatory drugs, a shot of cortisone, and acupuncture on the foot, which by this time had developed a nasty bruise around the injury site.  <em><strong>I went away without a diagnosis (other than it not being broken), and a band-aid</strong></em>, promising myself that after the shows I would take a good 4-6 weeks to heal.  With the performances opening the next day, I went off to my job at a coffee shop to stand for 6 hours and was told that I could not wear athletic shoes on the job in case a mystery shopper came in and reported it.  A girl&#8217;s got to make a living, right?</p>
<p>I made it through the shows, and did take a fair amount of time off until the swelling and bruising subsided.  I had medical insurance through my job at the coffee shop, but couldn’t afford the co-pay and deductible to seek out further medical advice and establish a treatment and rehab plan.  Returning to dance was sheer guess work, and over the first year out of college I was essentially in a revolving door, continually going back, re-injuring the foot, taking a week off, and going back again.  The sporadic training schedule made it difficult to maintain my weight; I was depressed, broke, and asked to leave the company.</p>
<h2>Plan B</h2>
<p>Ultimately, that foot got the better of me, and my career.  Plan B ended up being working full-time at the coffee shop and spitefully separating myself from the dance community that I had worked so hard to be a part of.  I later found out that I had torn a ligament between my first and second toes, triggering the second toe to dislocate (the &#8220;collapse&#8221; I experienced).  Barefoot dancing is especially difficult in this case because of the amount of torque placed on the joint in rotational movement.  To this day, twisting at a certain angle causes the second toe to pop out of place from time to time.  No amount of rest will fix this; torn ligaments are notoriously slow and tricky to heal without some sort of surgical intervention.  Aside from the expense and inconvenience, there is also the possibility that a surgery could limit the range of motion in my arch and metatarsals, making it difficult or impossible to rise to demi-point.  The alternative is leaving it the way it is, and rationalizing the fact that I’m a barefoot dancer who can’t dance barefoot.  At first I figured it was a sign that I wasn’t meant to dance.</p>
<h2>Plan C</h2>
<div id="attachment_8374" class="wp-caption alignleft" style="width: 303px"><img class="size-full wp-image-8374   " title="Synapse Arts: Lauren Warnecke" src="http://danceadvantage.net/wp-content/uploads/2010/10/shoes.jpg" alt="Recent photo of Lauren dancing" width="293" height="438" /><p class="wp-caption-text">Lauren Today (photo by Eddie Eng for Synapse Arts)</p></div>
<p>However, after six years and a series of random career changes, I would eventually return to the stage.  Ultimately, dance is what I’m supposed to do, and I was recently given the opportunity to present some of my choreography with a small modern dance company.  I discovered that it’s much easier for me to continue dancing if I wear shoes or tape to provide some sort of support to my metatarsals (the exact formula is still a work in progress…).  By performing in my own work, I have the option to wear ballet shoes instead of dancing barefoot, which greatly reduces the chance of dislocating my toe.</p>
<p>At the end of the day, what I went through (and on many levels am still going through) is fuel to my fire.  My experience was the catalyst for my interest in kinesiology, and is the passion behind <a href="http://www.artintercepts.org">Art Intercepts</a>.  Instead of wallowing in what might have been, I spend the better portion of my time and energy seeking out safe teaching practices to prevent injury and advocating for injured dancers who need treatment and rehabilitation from medical professionals who understand their craft and their careers.</p>
<p>As a young dancer, I felt pigeonholed into thinking that I only had two options (dance or don&#8217;t dance), when plan C was as simple as being a barefoot dancer who wears shoes &#8211; <strong><em>and it took me six years to figure that out</em>.</strong></p>
<p>Aside from medical treatment, there is a wealth of services out there in career counseling, vocational rehabilitation, and physical therapy.  Utilizing these resources gives the dancer more options and a fresh perspective on what a dance career actually looks like (which is different for every dancer).  The dance community desperately needs access to these resources, and at a price dancers can afford to pay.  Furthermore, many company directors, teachers, and choreographers often share the distorted conviction that injuries that aren’t fixable through a week of rest are an inconvenience that renders the dancer expendable and replaceable.  Regardless of artistry or aesthetic, dancers are people, and their health and well-being must come first.</p>
<h4>Are you struggling with a potentially career ending injury?</h4>
<p>Here are a couple of links to some fabulous organizations and resources:</p>
<p><a href="http://www.ric.org">Rehabilitation Institute of Chicago</a></p>
<p><a href="http://www.uic.edu/sph/glakes/harts/#location">Occupational Health Service Institute at the University of Illinois at Chicago</a></p>
<p><a href="http://www.iadms.org/">International Association for Dance Medicine &amp; Science</a></p>
<p><a href="http://www.artsmed.org/">Performing Arts Medicine Association</a></p>
<p><a href="http://www.chicagoartistsresource.org/dance/node/9159">Information on Worker’s Compensation</a></p>
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<p><small>© Lauren Warnecke for <a href="http://danceadvantage.net">Dance Advantage</a>, 2010. |
<a href="http://danceadvantage.net/2010/10/18/injury-plan/">Permalink</a> | Category: <a href="http://danceadvantage.net/category/blog/" title="View all posts in Blog" rel="category tag">Blog</a>, <a href="http://danceadvantage.net/category/dance-life/" title="View all posts in Dancethropology" rel="category tag">Dancethropology</a>, <a href="http://danceadvantage.net/category/for-students/" title="View all posts in Dancing" rel="category tag">Dancing</a>, <a href="http://danceadvantage.net/category/featured/" title="View all posts in Featured" rel="category tag">Featured</a>, <a href="http://danceadvantage.net/category/for-students/wellness/" title="View all posts in Health and Wellness" rel="category tag">Health and Wellness</a>  |  <a href="http://www.google.com/blogsearch?hl=en&q=http://danceadvantage.net/2010/10/18/injury-plan/" title="Linking blogs to this article, on Google"><em>Who's talking about this article?</em><strong></a> </small></p>
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		<title>When Should My Child See A Doctor for Dance Injuries?</title>
		<link>http://danceadvantage.net/2009/06/03/when-to-see-a-doctor/</link>
		<comments>http://danceadvantage.net/2009/06/03/when-to-see-a-doctor/#comments</comments>
		<pubDate>Wed, 03 Jun 2009 13:00:56 +0000</pubDate>
		<dc:creator>Nichelle (admin)</dc:creator>
				<category><![CDATA[Blog]]></category>
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		<category><![CDATA[health]]></category>
		<category><![CDATA[injury]]></category>
		<category><![CDATA[Parents]]></category>
		<category><![CDATA[physician]]></category>
		<category><![CDATA[prevention]]></category>
		<category><![CDATA[teens]]></category>

		<guid isPermaLink="false">http://danceadvantage.net/?p=2666</guid>
		<description><![CDATA[It is normal to have temporary muscle soreness after a challenging class or when working in a new way. Often small injuries become more severe because proper care is not administered early or because dancers continue self-care despite warning signs that more specialized care may be necessary.]]></description>
			<content:encoded><![CDATA[<p style="text-align: justify;">Most injuries in dance don&#8217;t happen suddenly. Instead, students often suffer from chronic overuse injuries. Some minor impairments can be treated without visiting a physician. Too often, though, smaller injuries become more severe because proper care is not administered early or because dancers continue self-care despite warning signs that more specialized care may be necessary.</p>
<p style="text-align: justify;">Parents and teachers of children and teens want to know, &#8220;What are the warning signs that a dance student should see a doctor?&#8221;</p>
<p style="font-size: 16px;"><span style="color: #11c5b6;"><strong>1.  Here is what you need to know&#8230;</strong></span></p>
<p style="text-align: justify;"><strong>Pain = Cause for Concern</strong></p>
<p style="text-align: justify;"><strong>P</strong><strong>ain is our body&#8217;s way of telling us something is wrong</strong>. Even the youngest children (3 or 4 years of age) can tell us where and when something hurts. Unfortunately, sometimes dancers learn very early to overlook or ignore pain. Teachers and parents can create an environment in which students develop a mindset to <strong>recognize and respect their body&#8217;s warning signals. There is no gain in ignoring pain.</strong></p>
<p style="font-size: 16px;"><span style="color: #11c5b6;"><strong>2.  Here is the answer to the question&#8230; </strong></span></p>
<p style="text-align: justify;"><strong>If the pain, discomfort, or problem persists beyond 2-4 days, consult your teacher. If the teacher does not see the source of, or cannot correct the problem your child should see a doctor.</strong></p>
<p style="text-align: justify;"><strong> </strong></p>
<div class="wp-caption aligncenter" style="width: 339px"><strong><strong><a href="http://www.flickr.com/photos/amandatait/3045188176/"><img src="http://farm4.static.flickr.com/3253/3045188176_7fb247460c.jpg" alt="Photo by Amanda Tait" width="329" height="219" /></a></strong></strong><p class="wp-caption-text">Photo by Amanda Tait</p></div>
<h3><strong>Acute Injuries</strong></h3>
<p style="text-align: justify;">These are usually obvious because they come about as a result of an incident. Landing wrong from a jump. Falling from a lift. Slipping while crossing the stage. Severe injuries like broken bones obviously need immediate attention and a visit to the doctor. For most common ailments&#8230;</p>
<ol>
<li>First aid suggests the <a href="http://sportsmedicine.about.com/cs/rehab/a/rice.htm">R.I.C.E method</a> (rest, ice, compression, and elevation) for strains, sprains, swelling, etc.</li>
<li>In addition, staying hydrated and eating well promotes healing.</li>
<li>See #2 above</li>
</ol>
<p><a href="http://www2.answerbag.com/articles/How-to-Rehabilitate-Common-Dance-Injuries/ee15309b-c8a6-74e8-de8b-94f0c0f48d54"><span style="text-decoration: underline;">More about treating common dance injuries</span></a></p>
<h3 style="text-align: justify;"><strong>Overuse/Chronic injuries</strong></h3>
<p style="text-align: justify;">Overuse or chronic injuries are sometimes triggered by an event that is allowed to persist without proper rest or rehabilitation. However, often they are caused or aggravated by other circumstances (this is a great list, adapted from <a href="http://kidshealth.org/parent/firstaid_safe/outdoor/sports_safety.html">this one about kids in sports</a>):</p>
<ul style="text-align: justify;">
<li>growth spurts</li>
<li>imbalance between strength and flexibility</li>
<li>inadequate warm-up</li>
<li>excessive activity (for example, increased intensity, duration, or frequency of training)</li>
<li>improper technique</li>
<li>unsuitable floors</li>
</ul>
<h3 style="text-align: justify;"><strong>Signals of Chronic Pain<br />
</strong></h3>
<p style="text-align: justify;">&nbsp;</p>
<div class="wp-caption alignright" style="width: 221px"><a href="http://www.flickr.com/photos/uninen/2684271013/"><img src="http://farm4.static.flickr.com/3105/2684271013_15df1a51b6.jpg" alt="Photo by Ville Säävuori" width="211" height="279" /></a><p class="wp-caption-text">Photo by Ville Säävuori</p></div>
<p>Deborah Vogel (<a title="The Body Series" href="http://www.1shoppingcart.com/app/?Clk=2379846" target="_blank">thebodyseries.com</a>) offers these four signals of chronic pain, as well as an excellent explanation of  how dance injuries start in small ways, in an <a href="http://www.thebodyseries.com/newsletters/2006/11/11_10_06%20Hamstring%20Strain.html">article about a hamstring/sciatic injury</a>. I highly recommend you read her words for yourself.</p>
<ol style="text-align: justify;">
<li>Pain that gets progressively worse during working out.</li>
<li>Pain that comes after you work out and the next day comes			      back after <em>less</em> working.</li>
<li>Pain that is accompanied by a certain movement (e.g. arabesque).</li>
<li>No real sense of &#8220;pain&#8221; but a definite restriction of movement.</li>
</ol>
<p style="text-align: justify;">It is normal to have temporary muscle soreness after a challenging class or when working in a new way. Anything that persists, particularly in the ways mentioned above, should be discussed with a physician or dance/athlete specialist. This should be done sooner, rather than later (see #2 above).</p>
<p style="text-align: justify;"><strong>A Note on Anti-Inflammatory Drugs</strong></p>
<p style="text-align: justify;">These are often overused in the dance community. Sometimes a doctor will recommend them and they can help bring down swelling. However, they are misused when taken to &#8220;get through a class&#8221; or otherwise mask pain (see #1 at the top of this post).</p>
<h3 style="text-align: justify;"><strong>Reinjury</strong></h3>
<p style="text-align: justify;">Dancers often re-injure themselves when they return too quickly to activity. <em>Temporary</em> muscle soreness can sometimes improve with a return to class. However, if moving makes it feel worse, the body may need more rehabilitation time and/or medical attention.</p>
<p style="text-align: justify;">After and injury, always ease back into activity. <strong>It is better to be safe than sorry.</strong> Dancers don&#8217;t like to hear this when they are eager to get back or feel pressure to return to class but, remind them that temporary setbacks are just that &#8211; <em>temporary</em>, and not worth <em>permanently</em> injuring oneself.</p>
<blockquote>
<p style="margin: 0pt; font-size: 14px; text-align: center;"><span style="color: #f88d39;"><strong>“An ounce of prevention is worth a pound of cure.”</strong></span></p>
</blockquote>
<p style="font-size: 16px;"><span style="color: #11c5b6;"><strong>Prevention</strong></span></p>
<p style="text-align: justify;">Of course, preventing injury in the first place is ideal. Although sometimes this is not entirely possible there is a lot a parents can do to keep their dance students injury-free.</p>
<p style="text-align: justify;"><strong>Find a studio that is committed to safety </strong></p>
<ul>
<li>What is your studio&#8217;s philosophy?</li>
<li>Is there proper flooring (i.e. &#8211; something sprung or with some &#8220;give&#8221;)?</li>
</ul>
<p style="text-align: justify;"><strong>Find a studio that is committed to quality instruction</strong></p>
<ul>
<li>Do the students spend a reasonable portion of their class warming-up (<em>not</em> stretching but individual body-part and full-body exercises that encourage blood flow)?</li>
<li>Are students encouraged to master foundational basics before moving on?</li>
<li>Do students receive individual attention and feedback from their teachers?</li>
<li>Etc&#8230; (<a href="http://danceadvantage.net/my-pages/finding-quality-dance-instruction/">see this series for more on quality instruction</a>)</li>
</ul>
<p style="text-align: justify;"><strong>Encourage dancers to stay hydrated</strong></p>
<ul>
<li>How much water is really necessary is debated, however, there are many active dancers that probably do not drink enough water. <a href="http://www.wikihow.com/Drink-More-Water-Every-Day">Here are some suggestions to improve water intake.</a></li>
</ul>
<p style="text-align: justify;"><strong>Encourage healthy, balanced nutrition</strong></p>
<ul>
<li>I know this can be a tough one for families and kids on the go but it is so important! Here are some good pointers on <a href="http://kidshealth.org/parent/nutrition_fit/nutrition/habits.html">healthy eating from kidshealth.org</a>. Another great resource: <a href="http://nourishinteractive.com">nourishinteractive.com</a></li>
</ul>
<p style="text-align: justify;"><strong>Some other things you can do</strong></p>
<ul>
<li>Encourage rest and proper sleep habits</li>
<li>Encourage a positive outlook</li>
<li>Remove the stress and pressure to &#8220;work through&#8221; or &#8220;push on&#8221; through injury</li>
<li>Try cross-training with other activities (not to load extra onto already tired kids but to promote balance in the body; you might even speak to your child&#8217;s teacher or studio owner about alternatives within the studio)</li>
</ul>
<p style="font-size: 16px;"><span style="color: #11c5b6;"><strong> </strong></span></p>
<h4><span style="color: #2aabab;"><strong>Check Out These Related Articles!!</strong></span></h4>
<p style="text-align: justify;"><a href="http://www.dancespirit.com/articles/1426"><strong><span style="text-decoration: underline;">Learning How to Gauge Injuries Can Prevent You From Being Sidelined</span></strong></a></p>
<p style="text-align: justify;"><strong>This is an excellent article from Dance Spirit magazine. It offers easy guidelines about when to sit out and when to see a doctor.<br />
</strong></p>
<p style="text-align: justify;"><a href="http://www.dancespirit.com/articles/1981"><strong><span style="text-decoration: underline;">Talking to Your Doctor About Injuries</span></strong></a></p>
<p style="text-align: justify;"><strong>Another one from Dance Spirit, this article lays out exactly what doctor&#8217;s need to know from dancers. A dancer&#8217;s &#8220;normal&#8221; may be different than a non-dancer due to the type of training dancers receive. Physicians need to know what you were capable of <em>before</em> your injury. This article has a lot of great information and stresses that dancers should not minimize their pain, as is their tendency.</strong></p>
<p style="text-align: justify;"><a href="http://balletshoesandpointeshoes.blogspot.com/2009/03/breaking-tiny-foot-bones-and-getting.html"><strong><span style="text-decoration: underline;">Breaking Tiny Foot Bones</span></strong></a></p>
<p style="text-align: justify;"><strong>Stress fracture signs and treatment on Ballet Shoes and Pointe Shoes Blog.<br />
</strong></p>
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<p><small>© Nichelle Strzepek for <a href="http://danceadvantage.net">Dance Advantage</a>, 2009. |
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		<title>Everything You Ever Wanted to Know About Turnout &#8211; Part I</title>
		<link>http://danceadvantage.net/2008/10/10/turnout-part-i/</link>
		<comments>http://danceadvantage.net/2008/10/10/turnout-part-i/#comments</comments>
		<pubDate>Sat, 11 Oct 2008 03:28:13 +0000</pubDate>
		<dc:creator>Nichelle (admin)</dc:creator>
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		<category><![CDATA[can I improve my turnout]]></category>
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		<category><![CDATA[outward rotation of the hip]]></category>
		<category><![CDATA[recognizing improper turnout]]></category>
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		<description><![CDATA[Although we sometime use the word turnout as a noun or a position (i.e. "Your turnout could be better."), it is more appropriately thought of as an action, a verb. Because outward rotation is not the body's natural state, the work does not stop once the position or desired degree of rotation has been attained. Instead, outward rotation of the hips requires continual action within the body, even when the rotation is held in a position (like ballet 5th).]]></description>
			<content:encoded><![CDATA[<p style="text-align: right;"><span style="color: #800000;"><strong>What You&#8217;ll Find In Part I<br />
</strong></span></p>
<ol style="text-align: right;">
<li><strong>How Important Is Turnout, Really?<br />
</strong></li>
<li><strong>Explaining The Mechanics Of Turnout</strong></li>
<li><strong>Recognizing Proper/Improper Turnout</strong></li>
<li><strong>Nature vs. Nurture</strong><strong> </strong></li>
</ol>
<p style="text-align: left;"><span style="color: #800000;"><span style="color: #003366;"><strong>If you want to learn some techniques for <em>improving</em> your turnout, you can jump straight to </strong></span><strong><span style="color: #003366;"><a href="http://danceadvantage.net/2008/10/10/turnout-part-ii/"><span style="text-decoration: underline;">Part II</span>.</a> But I highly recommend you read this first because it provides crucial information that will help you make better use of the information in Part II.</span><a href="http://danceadvantage.net/2008/10/10/turnout-part-ii/"><br />
</a></strong></span></p>
<p style="text-align: left;"><a href="http://www.flickr.com/photos/cujoquan/502242634"><img class="alignright size-medium wp-image-6873" title="converse-fifth-turnout" src="http://danceadvantage.net/wp-content/uploads/2008/10/converse-fifth-turnout-261x200.jpg" alt="" width="261" height="200" /></a>If you study classical ballet, you are well aware that the outward rotation of the hips (or turnout) is essential to the training and traditions of this form. Even if you are not trained in ballet, as a dancer you probably use turnout at least some of the time. Concert or theatrical dance forms (like modern or jazz dance) in particular utilize turnout within their movement vocabulary. Ask most dancers, and you&#8217;ll discover that turnout is high on their list of things to improve and increase.</p>
<h5 style="text-align: left;"><strong>But is having extreme turnout really ideal?</strong></h5>
<p style="text-align: left;">The human body is designed primarily for forward motion. We walk, run, sit, and stand in the sagittal plane. In dance, the use of turned out legs is primarily utilized for ease of motion on the proscenium stage, a venue in which the performers present movement to an audience which sits entirely on one side of the stage (as opposed to all around or on three sides).</p>
<p style="text-align: left;"><strong>A little history:</strong> When dance (ballet) moved to this forum from the royal courts, dancers spent more time moving side to side, necessitating a degree of turnout.  Since then, this rotation of the legs has been exaggerated, accepted as the ideal, and adopted as the aesthetic in ballet.</p>
<p style="text-align: left;">With developments in dance medicine, there is evidence that 180-degree turnout is not possible, necessary, or even healthy for all ballet dancers &#8211; even the pros (although how much this has changed about ballet training traditions is debatable).</p>
<p style="text-align: left;">Sideways locomotion certainly does not require rotation to such a degree. Turnout does allow the greater trochanter to avoid the ilium as the leg is lifted above the waist,  however 180 degrees of turnout is not required for this clearance. In fact, Gayanne Grossman, associate professor of anatomy and kinesiology at  Temple University suggests that &#8220;most dancers have a <em>maximum rotation of 55 degrees</em> in their hips.&#8221; [<a href="http://findarticles.com/p/articles/mi_m1083/is_/ai_n28048812" target="_blank">see this 2008 article from Dance Magazine</a>] This means that many who appear to have 180º turnout  are making up the difference in the lower leg. <strong> </strong></p>
<blockquote style="text-align: left;">
<p style="text-align: justify;">I suspect that dancers who have danced for years without injury probably discovered early that <span style="font-size: larger;">it is not how much turnout you have that is important, it is how you use what you have.</span> Therefore, it is imperative to know how to use it!</p>
</blockquote>
<p style="text-align: left;"><strong>What you need to know to make the most of your turnout:</strong></p>
<ul style="text-align: left;">
<li>How the hip functions</li>
<li>What is improvable and what is not</li>
<li>How to increase turnout safely and without injury</li>
<li>What you can do to maintain optimum turnout for your body</li>
</ul>
<h4 style="text-align: left;"><span style="color: #ff9900;">Understanding How Turnout Is Achieved</span><strong><br />
</strong></h4>
<p style="text-align: left;"><strong>In anatomical terms, turnout is the outward (sometimes called lateral, or external) rotation of the hip <em>joint</em>.</strong></p>
<p style="text-align: left;">The hip joint is the joining of the head/top of the <em>femur</em> (thigh bone) to the <em>acetabulum, </em>or hip socket (seen in the diagram below).</p>
<p style="text-align: left;">&nbsp;</p>
<div class="zemanta-img zemanta-action-dragged" style="margin: 1em; display: block; text-align: left;">
<div class="wp-caption aligncenter" style="width: 260px"><a href="http://commons.wikipedia.org/wiki/File:Gray342.png"><img title="Front view of hip joint with capsular ligament..." src="http://upload.wikimedia.org/wikipedia/commons/thumb/c/c4/Gray342.png/300px-Gray342.png" alt="Front view of hip joint with capsular ligament..." width="250" height="267" /></a><p class="wp-caption-text">Image via Wikipedia</p></div>
</div>
<div class="mceTemp" style="text-align: left;">
<dl class="wp-caption alignright">
<dt class="wp-caption-dt"><img src="http://upload.wikimedia.org/wikipedia/commons/5/55/Posterior_Hip_Muscles_1.PNG" alt="Muscles of lateral (outward) rotation" width="197" height="240" /></dt>
<dd class="wp-caption-dd">Muscles of lateral (outward) rotation</dd>
</dl>
</div>
<p style="text-align: left;">This joint is a ball and socket joint, which allows for a wide range of motion on all three planes (sagittal, lateral, and transverse).  The hip joint can produce <em>flexion</em> (forward of the body), <em>extension</em> (as in standing, not the unfortunately labeled lifting of the leg which is actually flexion in anatomical terms), <em>abduction</em> (away from the midline of the body), <em>adduction</em> (toward the midine of the body), <em>inward rotation</em> (turning-in), and <em>outward rotation</em> (turning-out).  Most dance movements are a combination of these actions.</p>
<h5 style="text-align: left;">Muscle Action</h5>
<p style="text-align: left;">The hip joint is very complex and most of the muscles surrounding the socket are responsible for more than one action of the hip joint.  These muscles both initiate and restrict movements of the hip. The outward rotators are pictured in the diagram on the right.  <strong> </strong></p>
<p style="text-align: left;">The muscles that pass posterior (behind) the hip joint contract to initiate turnout while the anterior muscles lengthen, and those anterior (in front of) the joint contract to initiate inward rotation while the posterior muscles lengthen.</p>
<p style="text-align: left;">If this is confusing, picture the spine of a book -<br />
<a href="http://www.flickr.com/photos/melanieburger/"><img class="aligncenter" src="http://farm2.static.flickr.com/1252/1451941259_f59d40d2f0.jpg?v=0" alt="" width="172" height="129" /></a></p>
<p style="text-align: left;">When the book is opened the outside edge of the binding contracts while the other edge lengthens and visa versa.  This inverse relationship is true for all muscle actions and is the key to analyzing movement.</p>
<h5 style="text-align: left;">False  Turnout</h5>
<p style="text-align: left;">Turnout  does not occur from anywhere other than the hip. A <em>false turnout</em> can be achieved by pronating the tarsus (rolling in) to create the  illusion of a wider turnout than is being achieved by the hips alone.   This causes a twisting in the knee, a joint which is only designed to  extend and flex in the sagittal plane, and this usually leads to  misalignment of the pelvis, which actually <em>reduces</em> outward  rotation.  False turnout also creates the potential for a myriad of  injuries, as we&#8217;ll discuss in <a href="http://danceadvantage.net/2008/10/10/turnout-part-ii/" target="_self">Part II</a>.</p>
<h4 style="text-align: left;"><span style="color: #ff9900;">Turnout Is A Verb</span></h4>
<p style="text-align: left;">Although we sometime use the word turnout as a noun or a position (i.e. &#8220;Your turnout could be better.&#8221;), it is more appropriately thought of as an action, a verb.</p>
<p style="text-align: left;">Because outward rotation is not the body&#8217;s natural state, the work does not stop once the position or desired degree of rotation has been attained. Instead, outward rotation of the hips requires continual action within the body, even when the rotation is held in a position (like ballet 5th).</p>
<h5 style="text-align: left;"><strong>How To Recognize Proper/Improper Turnout<br />
</strong></h5>
<p style="text-align: left;"><strong>There are some simple visual cues that indicate turnout is being forcefully executed. </strong></p>
<p style="text-align: left;">As  mentioned above, dance instructors looking for indication of false  turnout will expect to see the feet roll in, the pelvis tilt, and the  knees and toes pointing a different direction than the center of the hip  joint indicates.</p>
<p style="text-align: left;">When a dancer is forcing turnout beyond  their physical capabilities, tension will appear in the buttocks and  probably other areas of the body such as the shoulders or neck.</p>
<p style="text-align: left;"><img class="alignleft size-full wp-image-439" title="turnout" src="http://danceadvantage.net/wp-content/uploads/2008/10/turnout.jpg" alt="" width="72" height="108" />When you hear teachers say &#8220;knees over toes,&#8221; they are asking you to properly align the turnout of your legs and avoid pronation both in standing and in plié.</p>
<p style="text-align: left;"><strong>Students, try this:</strong> Bend your knees slightly, turn  out as much as you can, and then gently lengthen the legs. You are forcing your turnout. What does it feel like? Do you feel a tension or twisting in the knees? Are your feet  rolling toward the big toe (pronating) to maintain this position? Do you feel balanced or secure in this position?</p>
<p style="text-align: left;"><img class="alignright size-full wp-image-441" title="pelv-sway" src="http://danceadvantage.net/wp-content/uploads/2008/10/pelv-sway.jpg" alt="" width="72" height="72" />When the legs are opened without force and turnout is supported with the deep rotators, iliopsoas, and abdominals, one should be able to trace a line directly from the hip, through the center of the knee, and to a point between the second and third toe of the foot.  A neutral or properly aligned pelvis (with the sitz bones pointing downward) is a good indicator as well because when the turnout is forced, generally the pelvis will tilt, creating a swayed back.</p>
<p style="text-align: left;">A dancer who consistently performs with false or forced rotation in the hips will eventually complain of sciatic, knee, foot, and/or back pain. Therefore, if a dancer is having any of these problems it is always a good idea to pay special attention to their turnout and alignment while dancing.</p>
<h5 style="text-align: left;"><strong>Nature vs. Nurture</strong></h5>
<p style="text-align: left;">Almost everyone &#8220;afflicted&#8221; with what he/she considers a limited degree of turnout has at one time found solace in the idea that, for some, the degree of turnout is limited by the unchangeable structure of the body and not for lack of trying.</p>
<p style="text-align: left;">It is true that some have a narrow sacrum which allows for more efficient locomotion overall. Men have a narrower sacrum than women, giving them the potential for more impressive jumping skills. Of course the width of this area varies among women as well. But, before you begin to think that having a narrow pelvis is ideal, some have observed that this narrow pelvis often is paired with a forward facing acetabulum. This facing results in, you guessed it, a lesser degree in outward rotation than those with a side-facing hip socket. The depth of the acetabulum can also affect turnout.  A shallow hip socket allows for higher degrees of both outward and inward rotation in the hip than does a deeper hip socket.</p>
<p style="text-align: left;">Aside from these natural limitations, turnout is only hindered by problems in how we have nurtured (or not nurtured) the muscles and tissues surrounding the hip, and perhaps our mental state or expectations. There are three ways in which a dancer can nurture their ability to turnout and to actively maintain that turnout during movement:  <strong>Awareness, Release, and Strengthen Without Tension</strong>.  And we will learn more about these in <a href="http://danceadvantage.net/2008/10/10/turnout-part-ii/" target="_self">Part II</a>!</p>
<blockquote style="text-align: left;">
<h5 style="text-align: justify;">Dance Advantage recommends further investigation:</h5>
<p style="text-align: justify;">Deborah Vogel&#8217;s <strong>Tune Up Your Turnout</strong> is a handy resource. Easy to read with the essentials of what you need to know as a teacher or student. Deb answers your most pressing questions about turnout, provides stretches for the appropriate muscle groups, and offers quality advice on how to test and improve your range of motion safely.</p>
<p style="text-align: justify;">Also check out the <strong>FUNctional Anatomy</strong> curriculum for your classroom (by Deb Vogel and Anneleise Burns Wilson) and Deb&#8217;s new multimedia course, <strong>Essential Anatomy</strong> that comes with video, outlines, and study guides.</p>
<p style="text-align: justify;">You can get all of the above at <a title="The Body Series - Products" href="http://www.1shoppingcart.com/app/?af=759130" target="_blank"><strong>The Body Series</strong></a>. I have been following Deb&#8217;s work online for years and have such faith in her as an information source for dancers, that I don&#8217;t mind at all telling you that that link is an affiliate link. <a href="http://danceadvantage.net/about/blog-policies/disclosure/"><img class="size-full wp-image-6471 alignnone" title="help" src="http://danceadvantage.net/wp-content/uploads/2010/06/help.png" alt="What's this?" width="10" height="10" align="absmiddle" /></a></p>
</blockquote>
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