The Hidden Battle: Hip Impingement in Dancers and the Importance of Proper Muscle Activation
- Veronica K
- Mar 17
- 6 min read
Understanding Hip Impingement in Dancers
Hip impingement, or femoroacetabular impingement (FAI), is a condition where extra bone growth on the femoral head or acetabulum creates abnormal contact between the hip joint structures, leading to pain, stiffness, and reduced mobility (Ganz et al., 2003).
In dancers, this condition is particularly problematic because hip mobility is crucial for turnout, alignment, extensions, and overall performance.
Two Sides of Hip Impingement: Structural vs. Functional
Hip impingement can arise due to:
Structural Causes: Some dancers are born with anatomical variations, such as cam or pincer impingements, which predispose them to FAI (Philippon et al., 2007). These structural abnormalities can lead to labral tears and early joint degeneration if exacerbated by repetitive stress and improper movement mechanics in ballet.
Functional Causes: Poor muscle activation patterns, improper technique, and excessive force in movements like développé or grand battement can contribute to functional impingement. When dancers misuse their glutes, hip flexors, or turnout muscles, they create excessive anterior hip compression, leading to irritation and eventual labral damage (Nepple et al., 2013). Over time, repeated compression and friction in the hip joint can contribute to bony adaptations, similar to structural impingement. The body may develop excess bone as a protective response, forming cam or pincer lesions over time. This means that even dancers without a genetic predisposition can develop hip impingement due to chronic faulty movement patterns.
Expanding on Movement Dysfunction and Ballet Injury Prevention
Faulty movement patterns play a significant role in developing hip impingement. Some common dysfunctions include:
Overactive Glutes: When dancers grip their glutes excessively, they restrict the natural movement of the hip joint, causing compensations in other muscle groups.
Anterior Pelvic Tilt: Poor core engagement and excessive lumbar arching can push the femoral head forward, leading to impingement symptoms.
Turnout from the Knees and Ankles Instead of the Hips: This misalignment places stress on the hip joint rather than utilizing the deep rotators properly.
How Ballet Teachers Can Help Prevent Hip Impingement
Dance educators play a crucial role in preventing impingement by:
Teaching Proper Turnout Mechanics: Encouraging engagement from the deep rotators rather than relying on gripping the glutes.
Emphasizing Core and Pelvic Stability: Ensuring dancers have the necessary core strength to support their pelvis and prevent excessive anterior tilt.
Encouraging Functional Strengthening Exercises: Implementing controlled eccentric movements, such as slow développés, to build strength without overloading the hip joint.
Monitoring Alignment in Extensions: Avoiding cues that push dancers to force their legs higher at the expense of joint integrity.
If you're an instructor looking to deepen your understanding and ability to protect dancers' bodies while enhancing their performance, I invite you to explore my Instructor Certification Training, endorsed by the Ohio Physical Therapy Association for 16.5 continuing education units. This program equips dance educators with the tools to create Safer, Stronger Dancers™ while promoting long-lasting careers in the art of dance.
My Journey with Hip Impingement
At 18, I suffered a labral tear that was initially dismissed by doctors as growing pains or simple muscle soreness. I was told that my hip pain was normal for a dancer and that I needed to "push through."
As the pain worsened, I sought further medical advice, only to encounter skepticism from professionals who doubted hip impingement as a valid condition. One doctor even told me I would never lift my leg above 90 degrees again and scared me with the idea of a career-ending surgery!
When I went back to school for physical therapy, everything changed. I began to truly understand proper activation patterns, alignment, and range of motion. I realized that my hip's functional capacity had been compromised for years due to forcing my body into positions it wasn’t designed for, combined with the wrong muscle activation.
My ballet technique needed adjustment, and the misalignment I had been working with only worsened the situation. It wasn't just the structural impingement—it was how I had been using my body that had exacerbated it.
Through targeted strength training, corrective exercises, and years of redirecting my ballet technique, I learned to functionally use my hip in ways I hadn’t before. This approach even allowed me to avoid surgery for my labral tear.
The tear was minor and was only aggravated by improper stretching, poor warm-ups, and poor alignment, especially during intense ballet movements and gymnastic-like actions I used to perform in competitive dance.
By focusing on alignment and the right muscle engagement, I was able to not only manage the tear, avoid exacerbating the impingement, but also strengthen the surrounding muscles to support the hip joint and prevent further damage.
Through a combination of rehabilitation, re-education in muscle activation patterns, and strength training, I have not only recovered but now at 33 and after having two kids, my extensions are above 90 pain-free!
In the end, the combination of a properly aligned body, targeted exercises, and educated training allowed me to continue dancing at a high level without the need for surgery, proving that with the right approach, injury recovery and prevention are possible.
Conservative and Surgical Treatment Options
Conservative Approaches:
Neuromuscular Re-education: Dancers must learn how to activate the correct muscle groups for movement, ensuring deep core engagement, proper turnout initiation from the rotators, and a balanced relationship between the hip flexors and extensors. This approach is utilized in the Veronica K Method™ of ballet corrective exercise training sessions (Emara et al., 2011).
Manual Therapy & Myofascial Release: Soft tissue restrictions around the hip can contribute to pain and compensation patterns. Addressing these restrictions can alleviate impingement symptoms (Hunt et al., 2021).
Strength & Mobility Training: Hip stability must be prioritized before increasing range of motion. A focus on eccentric control in movements like développé can reduce stress on the hip joint (Reiman et al., 2014).
Surgical Options:
For cases where structural impingement is severe, arthroscopic hip surgery to reshape the femoral head or acetabulum and repair the labrum may be necessary. Post-surgical rehabilitation is critical to avoid returning to the same faulty movement patterns that caused the issue in the first place (Philippon et al., 2007). Once you recover from surgery, starting a program like my ballet corrective exercise plans can help prevent re-injuring the same area. Often, therapy or exercises fail for ballet dancers because the underlying issue—the dancer’s muscle activation patterns during technique—were never properly addressed or changed in the dance classroom.
Why Dance Educators Must Take This Seriously
Hip impingement is a real and often misunderstood condition that can lead to career-ending injuries if not addressed early. Too often, dance educators emphasize extreme lines and extensions over longevity and technique. Encouraging dancers to “push through” pain or force higher legs without proper mechanics can contribute to long-term hip damage.
Instead, educators should prioritize:
Proper turnout engagement from the deep rotators rather than the glutes.
Core stability to prevent excessive anterior pelvic tilt.
Strengthening of the hip stabilizers to promote joint integrity.
My experience has shown me that recovery is possible with the right approach. If I had received proper education and intervention earlier, I could have avoided years of struggle. My hope is that by raising awareness, we can create safer training environments for dancers, reducing preventable hip injuries and ensuring longevity in dance careers!
References
Emara, K., Samir, W., Motasem, E. H., & Ghafar, K. A. (2011). Conservative treatment for mild femoroacetabular impingement. Journal of Orthopaedic Surgery, 19(1), 41-45.
Ganz, R., Parvizi, J., Beck, M., Leunig, M., Nötzli, H., & Siebenrock, K. A. (2003). Femoroacetabular impingement: a cause for osteoarthritis of the hip. Clinical Orthopaedics and Related Research, (417), 112-120.
Hunt, D., Prather, H., Harris-Hayes, M., & Clohisy, J. C. (2021). Movement pattern training to improve function in people with hip-related pain: a systematic review. Sports Health, 13(5), 432-442.
Nepple, J. J., Vigdorchik, J. M., & Clohisy, J. C. (2013). What is the association between sports participation and the development of proximal femoral cam deformity? Clinical Orthopaedics and Related Research, 471(8), 2456-2463.
Philippon, M. J., Yen, Y. M., Briggs, K. K., & Kuppersmith, D. A. (2007). Early outcomes after hip arthroscopy for femoroacetabular impingement in the athletic population: A prospective study. The American Journal of Sports Medicine, 35(10), 1721-1726.
Reiman, M. P., Thorborg, K., & Cook, C. (2014). Functional testing for the young, active hip patient. Journal of Hip Preservation Surgery, 1(2), 66-76.