13 October 2014

For 25 Years Dance Educators have Ignored the structural limitations of students and refused to incorporate accentuated stretch programs.  The mentality, you either have it or you don't is the thought train at the top, and that there is no way to improve a child's mechanical ability.    One master teacher from Russia went as far as to say, that if we went by the rule book, the ballet classes would be taught from 3rd position, not fifth, because 90 percent of the students don't have the mechanical ability to work correctly from a fifth position.

When I teach accentuated classical ballet stretch and flexibility classes, I demonstrate what I teach, and provide hope to all with the story about how I developed all of my flexibility, after a started dance training as a part of my sports development program for cross country skiing, when I was in my early 20's.  Following three years of intensive training in modern, jazz and ballet, I was awarded a scholarship to study the Soviet system of ballet training at the Nutmeg Ballet and Conservatory for the Arts, in Torrington Connecticut.  When I arrived at the school, I had more hip flexibility or turnout, than 95 percent of the children in the program, many of which trained there from pre-ballet. -- Regimen Changes Body by Linda Boultinghouse by Permission of The Register Citizen, Torrington, Connecticut.  The type of training Apatow is providing will be "a major thing of the future," Dante says. "We're going to somehow tie it into our whole training program.

For many years, the importance of classical ballet specific flexibility and alignment training has been emphasized for dance education programs.   In classical ballet (the foundational training for all styles of dance), training is executed in a turned out alignment,and requires specific stretches that must be integrated into the pre-class warm-up.  Unfortunately this guidance is many times ignored, at a cost of progressive joint stabilization and deformities in childhood development, that make correct postural alignment a virtual impossibility, and follow the student for a lifetime.  -- Centers for Disease Control called to require proper stretch and flexibility training before every classical ballet technique class: Sports Medicine & Science Institute, 13 October 2014.

6 April 2009 - Updated

United Nations Arts Initiative
Arts Integration Into Education
Url: www.unarts.org
Twitter: unarts

Sports Medicine & Science Institute
Url: www.esportsmedicine.org
Email: info@esportsmedicine.org

Preventing Permanent Joint Damage and Deformity in Classical Ballet Development
Guidelines for Child Safety - Lower Extremity

As a parent, you need to understand the scope of training your child participates in, with emphasis on safety and injury prevention.

Case 1.

Your child experiences an Achilles tendon or ankle injury in dance class or rehearsal.  As a precautionary measure, you seek guidance from your physician for a diagnostic work-up.  

First, does the physician check the alignment mechanics in the foot/ankle/knee complex?  If the answer is no, then the direct mechanism of injury has been overlooked and there is no foundation for true alignment stabilization, healing and future injury prevention.  

the classical ballet mechanical ideal: heel behind centerline of foot, knee cap tracking over the center line of ankle and foot. In the plie  position (ABT Dictionary), the hip complex and kneecap must track through this line.  This alignment is maintained through demi-pointe and pointe.

How to test lower extremity alignment:  Have the child or student stands in parallel (heel behind centerline of the foot), and then execute demi-plie.  Drop a straight line from the kneecap to the floor.  Where does the kneecap track?  If the kneecap tracks through the centerline of the ankle foot, the alignment is correct.  If the kneecap tracks to the inside of the foot, then the foot, ankle and knee complex is in a stressed internally rotated alignment.

This internal rotation pattern represents the most common mechanism of stress on the knee/ankle/foot complex with compensatory shifts that translate to the pelvis and spine.  This stressed alignment must be corrected first in the parallel position, since if it cannot be executed in parallel, it is impossible for execution in turnout.

Restoration of correct alignment, in parallel and turned out positions, must be the  objective of the physician, with guidance for the therapist, teacher and parent regarding integration into all classroom instruction..  If ignored, the symptomatic condition may be alleviated via rest, but the vulnerability will remain.  In the context of surgery, if the alignment variable is not addressed, then the mechanism of stress is not addressed, resulting in an expensive procedure that could mark the end of a career.

Turnout: External Rotation of the foot

1. What is functional limitation of the student regarding turnout and what are the consequences of forced turnout?

In the United States, the mechanical ideal in classical ballet alignment and the mechanical ability to execute the demands of the training is a serious challenge.  Instead of adapting a program and concentrating on an intensive stretch and flexibility emphasis in every class, it is common to see students subject to the same demands as the 1 out of a1000 who would be selected in say an Eastern Bloc development program.  A common practice to function in denial, regarding the  functional limitations of the child, allowing the child's body to gradually adjust to the stresses (which will happen when you start training at a young age).

When we take young children, progressive loading of the joints facilitates an adaptive strengthening and capacity to execute movements with incorrect or stressed alignment.  Despite the stressed alignment,  joint complex adaptation, bone development and articular stabilization facilitates function in a non symptomatic state.  This holds true until an activity encompasses a load that is beyond the ability of the malaligned joint complex to accommodate, and an injury is sustained.

  Joint deformation challenges from forced turnout, include compensatory stabilization in articular development of the foot/ankle complex, knee complex, hip complex and spine.

In teaching older developmental levels of dancers during international summer programs, classical ballet based biomechanics classes have revealed upwards of 90% of students being unable to execute a parallel plie correctly.  Many of these students experienced joint discomfort when instructed how to execute the correct alignment in parallel.  In classical ballet training, if we can't execute correct parallel plie, we can't work correctly in a turned out position.

When dancers and coaches from Eastern Bloc countries are asked about these challenges, many will tell you that the vast majority of students in classical ballet dance development programs do not posses the mechanical attributes required for the training.  In a strict sense, they should never be allowed to turnout beyond what their mechanical ability allows.  But this is an unpopular view that detracts from the potential number of participants in a program, so instead of emphasizing the unpopular alignment instruction, they adapt accordingly.  

In gymnastics, the same holds true but from a slightly different vantage point.  In Eastern Bloc development programs, young children (from a selection process) are placed in classical ballet based choreography training, to develop fundamental movement mechanics, 6 days per week, 45 minutes per day (in conjunction with the introduction of sports specific movement).  But here in the United States, there is no time for the fundamental movement mechanics training.  When the former gold medal Eastern Bloc coaches try to emphasize the importance of such training during U.S. coaches education programs, they experience great resistance.  From a business standpoint, in order to enroll thousands of children in a program, the sessions per week must be limited in number and duration.  In order to keep their prestigious national team coaches positions, the Eastern Bloc coaches adapt accordingly.  

My focus when teaching USA Gymnastics Coaches development programs is integration of classical ballet based alignment and biomechanics into the sports specific movements. [1]  

Analysis, Correction and Retraining for Professional  Dancers and International Ballet Competition

Biomechanical Analysis, Correction and Retraining consultation with Student Emily Patterson, Joffrey Ballet, IMDB, The Company (2003),  Save the Last Dance (2001).  Parents: Dance Development Questions: Contact Susan Patterson: President, Board of Directors, Nutmeg Conservatory for the Arts.

The development of classical ballet based biomechanical analysis, correction and retraining took place during the 80's and established international acclaim in conjunction with Nutmeg Conservatory dancers training for the Prix de Lausanne international ballet competition.

The focus of this work was to conduct a comparative alignment analysis of the dancer, to the classical ballet based biomechanical ideal, as a first step in correcting spine and extremity alignment developmental problems (stabilization in ankle complex, knee, hip complex, spine, etc.) that resulted from 8-10 years of typical classical ballet training.  The next step was to assess the potential for range of motion of the dancers spine and extremity mechanics, concentrated flexibility work, retraining in the fundamentals at the barre and choreography specific movement. This allowed the dancer to progress to the next technical level of development, previously impossible through the classical ballet development program alone. [2]

Additional information on this work is available on the International Dancescience Development Program (eDancescience.org) [3] web site:

Sports specific specialized applications of this work include equestrian, football, baseball, soccer, hockey, wrestling, martial arts, cross country and alpine skiing.

Classical Ballet Biomechanics and Orthopedic Analysis Certification

The lack of educational resources has prompted the development of the online:
Additional programs include:
  • Educational/Development clinics:  An intensive program that includes detailed powerpoint presentation of the CBBBOA1 materials, hands on participation in analysis of alignment challenges, exam and certificate.  This program can be adapted for dance or sports specific applications.  On site programs also allow for integration of one on one classical ballet based biomechanical analysis, correction and retraining sessions.
  • Virtual consultancy for dance and sports development programs. Email and telecommunications combined with digital photos facilitates global access to classical ballet based biomechanical analysis and guidance to assist performance optimization and identification of articular alignment problems that are associated with the mechanism of joint injury.   For additional information visit the International Dancescience Development web site. [3]

As an athlete, Stephen Michael Apatow [4] was fortunate enough to acquire scholarships that allowed me to pursue my aspirations.  The pursuit of excellence and the Olympic Ideal [5] represents the motivation for the development of our programs, and we will go out of our way to provide support for all dancers, athletes and development programs, during this difficult economic period.


1. 1998 Gymnastics Coaches Workshop: Choreography-Ballet Based Analysis, Correction & Retraining for Gymnastics Development Programs: Sports Medicine & Science Institute. Url: http://www.esportsmedicine.org/sportscience/gtcworkshop.html
2. Biomechanical Analysis, Correction and Retraining: Reaching the Next Level of Performance in Classical Ballet and Olympic Development Programs: Sports Medicine & Science Institute. Url: http://www.esportsmedicine.org/news/82005/805001.html
3. International Dancescience Development Program: Url: www.edancescience.org
4. Stephen Michael Apatow: Founder, Humanitarian Resource Institute, United Nations Arts Initiative, Sports Medicine & Science Institute and International Dancescience Development Program: Url: www.apatow.org
5. Reaffirming the Olympic Ideal for the Purpose of Continuing the Progress of Humanity: Humanitarian Resource Institute. Url: www.humanitarian.net/olympic_ideal.html


Copyright © 2014 Sports Medicine & Science Institute  All rights reserved