Turn Out Reeducation in Dancers with Knee Pain

For the adolescent dancer starting or coming back to a fall program is a very exciting time and usually filled with much anticipation and eagerness to continue learning and growing as a dancer.  During this time many dancers are continuing to grow biologically and this offers new challenges for the dancer to navigate. One of the most common issues we see arise in this population is the development of knee pain (Smith 2015).

While there are many contributing factors to knee pain, lumbopelvic control and hip strength are a few biomechanical influences that may need to be addressed (Negus 2005). Focusing on inner ranger hip external rotation strength is needed to effectively work in a turned out position and maximize the ability of the joints and tissues of the knee to withstand the forces of this fundamental technique in ballet.

Often, pre-professional dancers use the tensor fascia lata (TFL) and superficial fibers of the gluteus maximus muscles to perform turn out. These muscles are not pure hip external rotators. The 6 deep hip external rotator muscles that are needed to turn out are:

Obturator internus, obturator externus, superior gemellus, inferior gemellus, quadratus femoris, and piriformis

One exercise we use to train hip external rotation without compensatory patterns is on the turn out discs. Have your dancer perform hip external rotation by palpating the hip external rotators and greater trochanter. Make sure compensatory muscles, such as the TFL and superficial fibers of the gluteus maximus, are not active. Can you challenge your dancer to use this technique in first position?

emily-parallel-to-discs emily-to-discs-2

Remember to address any other potential biomechanical influences as well as manage the overall loading of tissues (Rathleff 2016) as the dancer continues participating in dance activity.

Good luck in the year ahead!






Smith PJ, Gerrie BJ, Varner KE, et. al.  Incidence and Prevalence of Musculoskeletal Injury in Ballet: A Systematic Review. The Orthopedic Journal of Sports Medicine. 2015: 3(7):2325967115592621.

Negus V, Hopper D, Briffa KN.  Associations Between Turnout and Lower Extremity Injuries in Classical Ballet Dancers. Journal of Orthopedic Sports Physical Therapy. 2005; 35:307-318.

Rathleff MS. Patellofemoral pain during adolescence: much more prevalent than appreciated.  Br J Sports Med 2016; 50:831–832.