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Dance Technique incorporating safe dance practice

Performing sequences relative to anatomical structure

Causes and prevention of injury

Common dance injuries

Hip and groin

Introduction
Chronic injury
Prevention
Treatment

Introduction

The hip containing the ischium, ileum and pubis bones used together (acclabulum), is a typical synovial joint called a ball and socket joint with a larger articular surface. It is said to be the strongest joint in the body. The heavy network of ligaments and fibrous tissue forms a capsule enclosing the joint. It is a deep socket with strong supporting muscles.

The range of movement at the hip is in all directions. This movement is determined by the surrounding ligaments; mainly the powerful y-shaped ilia femoral (anterior), which holds the head of the femur into the cup-shaped cavity of the pelvis, the ischia femoral (posterior), and the medial pubo femoral. The normal range of movement at the joint is 65 degrees forward 45 degrees to the side and 15 degrees backwards. The ilio femoral ligament prevents hyperextension to the back more than any other direction.

The muscles immediately working on the hip joint, and also responsible for turn-out, are six deep pairs of external rotators; obturator externus and internus, gemellus superior and inferior, and quadrates femoris and piriformis. There are various accessory muscles, such as adductor magus and brevis, gluteus maximum and medius, biceps femoris, iliopsoas and sartorius.

In Australia, hip injuries are more common in dancers than in any other sports men or women. It seems they are also more likely to occur in women than in men, due to the different anatomical features present in the femur and pelvis. Approximately ten thousand women suffer from osteoporosis/ oestrogen-related hip fractures per year. Within these women many develop degenerative states in their later lives and often require hip replacement.

Tendencies concerning hip troubles in dancers compared to the rest of the population include:

• Hip conditions, which are rarely seen in non-dancing adolescents, are seen commonly in adolescent dancers.
• Hip conditions are not commonly seen in non-dancers aged between 20 and 40 years, yet they are prevalent in dancers of this age group also.
• Degenerative conditions in 50 to 60 year olds (the decade most hip replacements are done) are not commonly in the hip for non-dancers, whereas the hip is the most common area for dancers of this age.
• Iliotibial Band Syndrome often causes hip pain. A muscle called the tensor fascia lata, which is broad, short and flat, lies over the outside of the hip. A slender tendinous band arises from it, which inserts into the outside of the tibia bone just below the hip. This whole structure stabilises the femur. With unaccustomed activity, it becomes tired and tightens. When this happens it can snap over the greater trochanter of the hip, causing a lot of pain and creating a popping sensation.

Chronic injury

Hip pain is also related to overuse. Hip, and groin overuse injuries are often a sign of muscle strain, tendon strain or hip bursitis (where numerous burae around the hip become inflamed). Common sites for this are the front of the hip (pain comes with lifting the leg and turning inwards) and the outside of the thigh (pain is associated with movement in second position).

Other hip problems arise from:

• excessive rotation of abnormal foot strike against the floor which can be transferred up into the thigh and hip
• pronation of the foot can also cause thigh and hip to roll inwards
• constant stress and twisting which can cause thigh and hip bones to crack (stress fractures)
• hip pointers, where a blow to the rim of the pelvis causes bleeding where the muscles are attached
• limb-length discrepancies
• subluxations and dislocations (acute) are quite rage, but can result from violent injury, often associated with fractures of the acetabulum.

Main reasons for hip conditions in dances are as follows:

• Predominance of turn out imbalancing body structures.
• Landing from jumps - compression forces in the hip are considerable. Turn out and unsuitable landing surfaces exaggerate these. Landing uncentred can also cause problems.
• Movements on one leg -the moving leg can threaten its own hip with activities like high kicks, ronde de jambe and arabesques, by causing strain on the involved muscles about the supporting and moving legs.
• Pointe work- increases both compression and pulling forces about the hip because of a loss of the shock absorption systems in the foot.
• Lack of strengthening - emphasis is placed on flexibility, whereas the intensive leg work in dance demands strengthening exercises more than any other physical activity.
• Slouching - carrying upper body weight, behind the centre of balance at the hips causes weight to fall through the wrong parts of the bones and joints.

Prevention

Prevention of most hip problems comes with sufficient warm up before doing exercises, reducing the risk of strains. To prevent hip injury, a great degree of external rotation of hips is needed and extensive hip flexibility (men usually lack a great amount of hip flexibility as they generally begin dance training later than women do). However, a flexible hip joint without ample muscular strength and control is not advantageous. A sudden twist or turn can result in the straining of the muscles in the groin and inside of the upper thigh.

These prevention techniques should be applied to dancers at an early age, as children may suffer pain from pulling on growth plates, stress fractures or tendonitis (hip pointers).

Treatment

There are many ways to treat hip and groin pain. The first thing you should do is stretch the injured area. Good examples of these stretches are:

• Hip rotations - lying flat on your back, legs out straight. Turn toes out as far as possible, then turn toes in as far as possible. Repeat 6 times. - lying flat on back, bring one knee up to the chest and rotate clockwise 6 times then anti-clockwise 6 times. Repeat 6 times on each leg.
• Hip flexor stretch - lying flat on back, bring one knee up to the chest and pull. Holds for 10 seconds, repeat on other side.
• Knee over leg stretch (Iliotibial Band Stretch) - lie on back with legs out straight. Fascia lata and Iliotibial band and strengthen with lateral leg lifts (stretch tensor).
• Treatment for hip pointers - rest for 1 to 2 weeks until pain subsides. (prevention - wear hip pads).
• For osteoarthritis (caused by wear and tear - chronic all you can do is take anti-inflammatory agents and decrease amount of activity, A hip replacement may later be required.
• Broken hips need to be repaired surgically.
• If hip pain continues and all else fails, (stretching, physical therapy with ice, avoiding activity, etc). An orthopaedist may inject cortisone into the bursae (sacs situated between the skin and bony points). This works well in reducing pain.

When applying correct technique to an exercise there are a few important things to remember:

• Whenever executing lateral movement of the leg in second, the hip must remain perpendicular to the spine. Higher elevation may be obtained by tilting the torso to keep the hips square.
• When sitting stretched in second position, feet and legs must be kept in a straight line with the pelvis. The spine should be extended to maintain the pelvis in good alignment with both the trunk and head.

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