268 Dance Anatomy and Kinesiology
range while form is maintained; (3) center floor with
range gradually increasing while form is maintained;
and (4) gradual addition of choreographic-specific
challenges such as adding torso or arm movements
or classic pre- and post-linking movements. When
adequate strength and skill are developed, the risks
are dramatically lowered, and hinges offer both an
important artistic element and an effective means of
developing strength and skill for many demanding
movements that require lowering the body weight
to(ward) the floor or raising the body away from
the floor.Twisting of the Knee in Dance
Although the relative rotary motion between the tibia
and femur expands functional movement capacities,
excessive rotation can produce potentially injurious
ligamental or patellofemoral stress. Thus, particular
care must be taken to avoid excessive rotation with
turnout or other dance movements.Forcing Turnout
Some dancers use excessive rotation from the knee
downward to achieve turnout, and this practice is
termed “screwing the knee” or forcing turnout. To
avoid forcing turnout during dynamic movement,
it is important to recall that knee flexion allows
more rotation of the tibia due to slackening of
ligamental constraints, as well as external rotation
of the femur associated with unlocking the knee.
Thus, when the knee bends, such as at the base of
a plié or during a weight shift, it is easy to shift the
heel forward to obtain greater turnout of the feet.
However, this practice should be avoided because
when the knee straightens, the femur internally
rotates and the ligaments become taut, and unde-
sired torsional stress will occur at the knee if the
foot is positioned excessively outward (figure 5.25).
Conversely, when extending the knees it is easy to
exaggerate the associated internal rotation of the
femur if external rotation is not maintained at the
hip joint. Again, the distal tibia is being held more
externally rotated by the foot against the floor as
the femur internally rotates, resulting in torsional
stress at the knee. Both of these undesired practices
also create a more laterally positioned tibial tuberos-
ity relative to the midpoint of the patella, increas-
ing the Q angle and increasing patellofemoral
stress.
Unfortunately, how much rotation from the knee
downward is “normal” versus potentially injurious is
controversial. In reality, dancers training in dance
forms where “perfect” turnout is emphasized derivesignificant portions of their turnout from the knee,
the ankle-foot, or both; and in a study of elite ballet
dancers only approximately 58% of active turnout
came from the hip (Hamilton et al., 1992). While
some individuals are critical of the use of full turnout
of the feet, the issue is complex in that use of such
positioning of the feet at an early age may facilitate
the development of hip external rotation, and the
incidence of knee injuries has not been shown to
be higher in schools that emphasize greater turnout
than schools that allow less lateral positioning of
the feet. Furthermore, some rotation of the tibia is
normal. For example, 7 to 14° of external rotation
was found to occur during stair climbing (Hamill
and Knutzen, 1995). In one study of dance, about
27° of knee external rotation was found to accom-
pany a plié, and about 22° of knee external rota-
tion occurred on the support leg during a penché
(Worthen, Patten, and Hamill, 1998). So, further
research is needed to clarify the relationship between
tibial rotation and injury risk.
However, whatever the aesthetic demands of the
school of dance, it is logical that the greater the pro-
portion of turnout that can be achieved from theFIGURE 5.25 Dancer demonstrating extreme forced
turnout while standing in first position.