What are the factors that affect turnout from the hip?
I’m sure most ballet dancers in training would agree that working on turnout presents an ongoing challenge of the utmost importance. “Perfect” turnout is defined as 180-degree angle between the longitudinal axes of the feet, and this is something we all admire and perhaps aspire to achieve through our training. But experts in the field strongly advise that ‘dancers at all levels should remember that the notion of the perfect 180 degrees of turnout traditionally recommended (in ballet) is anatomically and biomechanically uncommon’ (Quin et al, p. 44).
Whist we can all look in the same anatomy books at the same pictures, the crucial thing to remember is that we are all individuals. All our anatomical structures, our bones and joints, our ligaments and muscles, are all highly unique. We are not only very different from the text books, but we are very different from one another, and may even have differences between one side of our body and the other! Unfortunately, we can’t just open up our bodies, x-ray style, and take a good look. So, in order for us to work safely, correctly and effectively with our bodies we need to understand and appreciate the mechanisms at work as we strive towards achieving turnout, and this will include considering possible limitations.
Researchers and educators in the field agree that in order to work safely, and to guard against poor alignment decisions which carry significant potential for injury, turnout should come from the hip, with particular attention given to maintaining correct pelvic alignment.
Leading researchers in the field, Wilmerding and Krasnow, writing on behalf of IADMS (2011), have identified five main factors that affect turnout at the hip, and it is these five factors that form the foundation on which I have built and organised this article, with a focus on building clarity of understanding for the reader as I proceed:
1. Angle of femoral anteversion
This refers to the angle between the neck of your femur and its main shaft. The hip is a ball and socket joint with the round head of the femur inserting into the hip socket. The head of the femur has a neck before it extends into the main shaft/length of the bone.
Understanding the terminology used by Wilmerding and Krasnow can be a bit challenging here as their explanations refer in the first instance to anterior angulation, known as femoral anteversion. A normal hip is identified as having the neck of the femur angled forwards of the shaft of the femur by 15 degrees. An increase in anterior angulation, (anterior meaning front/forwards; neck and shaft angled towards each other), essentially means a reduction of this angle (as the neck and shaft will be angled closer together) – hence the confusion – increase indicating reduction in this sense. Femoral anteversion can therefore cause the toes to turn in when walking (pigeon toed) and the knees to face inward – in the ballet class, even as the legs are rotated from the hip to turnout the knees may still face the front, making turnout difficult.
A decrease in anterior angulation essentially means an increase in this angle, (the neck and shaft, will be angled further apart) and this is known as femoral retroversion. Here the knees and feet tend to face outwards meaning the potential for turnout is likely to be greater and easier.
2. Orientation of the acetabulum.
The acetabulum is the hip socket, and where the hip socket is located, and how it is orientated in your pelvis will have an impact on your ability to turnout. Generally speaking, hip sockets face the side with a slight forward orientation. The more the hip sockets face to the side in an individual the greater the capacity for turnout, and the less forwards orientation there is (more sideways) the greater the potential for turnout will be.
3. Shape of the femoral neck.
The less contact there is between the femoral neck and the acetabulum the better in terms of turnout potential. A long and concave neck is less likely to have contact with the outer edge of the acetabulum than one that is short and less concave.
4. Elasticity of iliofemoral or Y ligament.
The Y-ligament is the strongest ligament in the body, and it has only minimal elastic properties. The main role of this ligament in terms of our everyday functioning and wellbeing, is to stabilize the hip, and in doing this it opposes extension of the hip (taking the leg to the back) and limits how much the femur can rotate externally (turnout). Grossman and colleagues suggest that “usually the Y ligament will limit hip extension before the foot comes off the floor in tendu back” (2005, p. 16). This knowledge helps us to appreciate the difficulty frequently experienced in relation to maintaining turnout whilst performing movements such as an arabesque or a penche. Grossman and colleagues suggest “the less hip extension a dancer has, the more contribution from the lumbar spine is required for all posterior movements of the femur” (2011, p. 17). The importance of pelvic alignment in relation to turnout has already been emphasised, and Wilmerding and Krasnow highlight the common tendency of dancers to tilt the pelvis forwards, thereby creating some laxity in the ligaments of the hip in an effort to increase hip rotation. But this they suggest is not only ‘aesthetically undesirable’ but ‘potentially damaging’ (2011, p. 5). Effective pelvic alignment requires the muscles of the hip flexors and the abdominal muscles to work together cooperatively. The abdominal muscles attach at both the ribs and the pelvic brim and therefore control the raising (contraction) and controlled lowering of the pelvis. Even if your abdominals are strong they may not be able to maintain the correct level of the pelvic brim if your hip flexors are extremely tight; and by the same token, if your hip flexors happen not to be tight and are able to stretch, they will be unable to prevent your pelvis from tipping forwards into an anterior tilt if your abdominal muscles are weak. Grossman and colleagues highlight the importance of the length-tension relationship of muscle which “means that muscles are strongest at their resting or mid-range and weaker when elongated or shortened” (2005, p. 17). One can see from the above description that an anterior pelvic tilt is actually counterproductive because the hip flexor muscles are shortened and the hip extensors and abdominals lengthened: “these muscle groups are at a mechanical advantage for maximal strength when neutral pelvic alignment is maintained” (2005, p. 17). An anterior pelvic tilt also means the ability to engage the six deep rotator muscles, referred to in Part 1 of our Turnout Wednesday Wisdom series as crucial for effective turnout from the hip, will be compromised and therefore far less effective.
5. Flexibility and strength of the muscle-tendon unit.
Finally, Wilmerding and Krasnow (2011) advise that the muscles and tendons that surround the hip may be unnaturally tight in some people, which has the potential to restrict turnout; though stretching techniques may offer the potential for improvement here.
One can appreciate that only some of the factors highlighted here that affect turnout at the hip can be addressed through training, and those that cannot must serve to promote our understanding of our individuality and uniqueness, and enhance our appreciation of both the body with it’s capabilities and limitations, and the aesthetic of ballet that requires us, in the presence of the findings from eminent researchers in the field, not only to work hard but to be knowledgeable in relation to grounding our expectations of turnout in factual knowledge of the body, and prioritise the application of correct technique.
Whist I have endeavoured to make the findings of leading researchers and educators in this field accessible, and I hope easier to understand, I acknowledge that this drive for simplicity and clarity has the potential to lack the essential richness of detail that the original articles contain in abundance. I would therefore encourage all dancers inspired to find out more, to visit the original articles listed below in the references in order to maximise and increase their understanding.
Grossman, G., Krasnow, D., & Welsh, T. M. (2005). Effective use of turnout: Biomechanical, neuromuscular, and behavioural considerations. Journal of Dance Education, 5(1), 15-27. https://doi.org/10.1080/15290824.2005.10387279
Quin, E., Rafferty, S., & Tomlinson, C. (2015). Safe dance practice. Human Kinetics.
Wilmerding, V., Krasnow, D., & the International Association of Dance Medicine and Science (IADMS). (2011). Turnout for dancers: Hip anatomy and factors affecting turnout. https://iadms.org/media/3597/iadms-resource-paper-turnout-anatomy.pdf