Kinematic Analysis of the Gait in Professional Ballet Dancers

The Effect of Rehabilitation Intervention on Movement of Lower Limbs and Pelvis

during the Gait in Professional Ballet Dancers

Lucie Teplá, Markéta Procházková, Zdeněk Svoboda, Miroslav Janura and Jana Vaculíková

Faculty of Physical Culture, Palacky University, Tr. Miru, Olomouc, Czech Republic

1 OBJECTIVES

Professional ballet dancers could be compared to

high-performance athletes (Leanderson et al., 1996).

Ballet position on the top of the foot (en´pointe)

requires extreme plantar flexion and foot pronation

(Lung, Chern, Hsieh & Yang, 2008). This is a

special situation that distinguishes dance from other

sports (Miller, 2006). This increases the risk for

overused injuries (Gilbert, Gross, & Klug, 1998).

These undesirable effects of ballet can be translated

to performance of common daily activities like

walking.

The aim of this study was to assess the effect of

rehabilitation intervention on kinematic parameters

during the gait in ballet dancers.

2 METHODS

Thirteen professional ballet dancers (5 males, 8

females; mean age 25.8±5.6 years; height 172.8±8.1

cm; weight 59.8±12.2 kg) participated in this study.

This experimental group participated in

rehabilitation intervention for six week.

Rehabilitation program consisted of neuromuscular

exercise techniques and manual therapy. We

evaluated performance of the gait in dancers before

and after this rehabilitation.

The experimental group was compared with the

group of twelve controls (3 males, 9 females; mean

age 24.3±2.75 years; height 173.3±6.01cm; weight

72.2±12.73 kg). The exclusion criteria for all

subjects were any serious musculoskeletal injuries or

surgery of the lower limbs.

Additionally, control

group had no ballet experience. Kinematic data were

obtained using the optoelectronic system Vicon MX

(Vicon Motion Systems, Oxford, London).

Reflective markers of kinematic model PlugInGait

were placed at the pelvis and the lower limbs. Each

participant performed five successful trials of gait at

self-selected walking speed.

Angle variables of lower limbs and pelvis were

evaluated in all three planes. The data was evaluated

in Statistica (Version 9.0, Stat-Soft, Inc., Tulsa, OK,

USA) using Wilcoxon test (p<0.05) for comparison

of differences between dancers before and after

rehabilitation and Mann-Whitney test (p<0.05) for

comparison of dancers and control group.

3 RESULTS

Selected kinematic variables in the observed groups

are shown in Figures 1–2 and Table 1. To compare

the experimental group before and after

rehabilitation, dancers demonstrated decreased hip

adduction (p < 0.05) after intervention. Dancers also

demonstrated significantly greater maximal ankle

dorsal flexion during the stance phase (p < 0.05) as

well as greater maximal hip abduction (p < 0.01)

before and after rehabilitation compared to the

control group. Dancers reached significant greater

internal knee rotation (p < 0.05) and smaller external

rotation (p < 0.05) after rehabilitation in comparison

with the control group. The other kinematic

variables were not statistically significant.

C D1 D2

0 102030405060708090100

–25

–20

–15

–10

–5

Gait cycle ( %)

(

)

dorsal flexionplantar flexion

: p < 0 05D1 vs. C .

D2 vs. C: p < 0.05

Figure 1: Ankle movement in the sagittal plane during gait

(C – controls; D1 – dancers before rehabilitation; D2 –

dancers after rehabilitation).

Teplá L., Procházková M., Svoboda Z., Janura M. and Vaculíková J..

Kinematic Analysis of the Gait in Professional Ballet Dancers - The Effect of Rehabilitation Intervention on Movement of Lower Limbs and Pelvis during

the Gait in Professional Ballet Dancers.

 2014 SCITEPRESS (Science and Technology Publications, Lda.)

C D1 D2

Gait cycle (%)

(

rees)

adductionabduction

D: p < 0052 vs. C .

D1 vs 2: p < 0 05. D .

0 102030405060708090100

–10

–8

–6

–4

–2

Figure 2: Hip movement in the frontal plane during gait

(C – controls; D1 – dancers before rehabilitation; D2 –

dancers after rehabilitation).

Table 1: Maximal values (mean±SD) of selected

kinematic variables.

Variable C D1 D2

Ankle dorsal flexion*/& 7.8±7.5 14.2±3.3 13.5±3.1

Knee internal rotation * 23.0±8.7 14.9±8.3 23.9±21.3

Knee external rotation * 0.9±6.4 -7.1±6.8 -1.1±11.2

Hip abduction * / & -6.1±2.3 -9.3±2.0 -8.6±1.8

Hip adduction # 5.6±3.0 6.8±1.5 5.8±1.8

Legend:

C – controls; D1 – dancers before rehabilitation;

D2 – dancers after rehabilitation;

Statistically significant differences (p < 0.05):

* between controls and dancers before rehabilitation;

& between controls and dancers after rehabilitation;

# between dancers before and after rehabilitation.

4 DISCUSSION

The observed increased dorsal ankle flexion in

dancers can be explained by special ballet position

(e.g. grand plié, demi-plié), which require excessive

range of dorsal ankle flexion. If the foot is

frequently forced into extreme range of movements,

it loses ability to support the medial arch and act as a

shock absorption. Dancers subsequently overload

the medial part of the foot. This causes increased

pronation (Rusell, 2010). Insufficient range of

movement in hips together with hyperpronation is

compensated by increased external tibia rotation,

which was demostrated in dancers before

rehabilitation. This causes greater medial load of the

knee, which can predispose to injury (Cimelli and

Curran, 2012; Clippinger, 2007). In addition,

chronic ankle instability is often associated with hip

abductor weakness (Rusell, 2010). The increased

range of hip can be caused by inadequate

coordination between adductors and abductors.

The results show that six-week long

rehabilitation did not affect performance of walking

in professional dancers. However, the observed

parameters in dancers after rehabilitation can predict

improved alignment of these joints during gait,

which may reduce stress load being applied on the

lower limb´s structures. The results confirm that the

long-term rehabilitation should be a necessary part

of comprehensive care about dancers to improve

their ballet techniques and prevent injuries.

ACKNOWLEDGEMENTS

This work was supported by the Ministry of

Education, Youth and Sport of the Czech republic

(grant number MSM 6198959221) and Faculty of

Physical Culture (grant number FTK_2012:031).

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Clippinger, K.,

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Lung, C.-W., Chern, J.-S., Hsieh, L.-F., Yang, S.-W.,

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