Updated: 3 September 2011

Contact: Stephen M. Apatow
Founder, Director of Research & Development
Sports Medicine & Science Institute
Humanitarian University Consortium
Graduate Studies Center for Medicine,
Veterinary Medicine & Law
Phone: 203-668-0282
Email: s.m.apatow@esportsmedicine.org
Url: www.esportsmedicine.org

International Dancescience Development Program
Internet: www.edancescience.org

Child Safety, Injury Prevention and Performance Optimization

Classical ballet training is the most advanced technical movement mechanics training in the world, providing the foundation for all styles of dance, sports and Olympic development programs.

Nothing is more disturbing than teaching an international ballet development program, with a cross section of U.S. and international students, with 95 percent unable to stand in a parallel position and execute a simple plie with correct alignment.

One of the first objectives in classical ballet training is learning how to stand with correct posture. The parallel position of the feet encompasses distribution of weight, heel aligned with the center line of the foot (1st/2nd metatarsal head).  As the knees bend in a simple plie position, [1] alignment is maintained with the knee cap tracking directly through this center line of the ankle/foot complex (preparing for eventual work on pointe).

As training progresses, the student eventually learns how to work in turnout (1st, 2nd, 3rd, 4th, 5th positions), or alignment positions where the foot externally rotates, while maintaining correct knee, ankle, foot alignment.

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, the hip complex and kneecap must track through this line.  This alignment is maintained through demi-pointe and in the most advanced training, on pointe.

In Eastern Bloc development programs, a selection process is used to identify students best suited for participation in dance or sports (Olympic) development programs. In Romania, pre-gymnastics training encompasses 6 days a week, 45 minutes per day of classical ballet based choreography training, to develop fundamental movement mechanics prior to the introduction of sports specific movement.   In the late 90's, Geza Pozar, Romanian National Team coach/choreographer for Nadia Comăneci [2] shared with me the importance of this work for all participants in for the USA Gymnastics National Team Coaches Education Programs.  

Stephen M. Apatow, [3] Founder, Director of Research and Development for the Sports Medicine & Science Institute teaching a gymnastics a coaches development program at the Gymnastics Training Center in Rochester, NY. in 1998.  Gymnastics coaches in this photo include Maria Filotova, a member of the 1976 and '80 Soviet Union Olympic teams, and Sasha Kourbatov,  former member of the Russian international team. [4]

Here in the United States,  all children are allowed to participate, irregardless of their physical limitations.  We progress directly into sports specific training, while we skip the fundamental movement mechanics (classical ballet based choreography training), and don't integrate accentuated flexibility training to better enable the functional capacity of the students.   The dilemma, there is no time, too many children in the programs, and it doesn't fit into the business model.  

In the classical ballet world, Eastern Bloc teachers, trained at the worlds top training schools understand the meaning of technically correct and if such a standard was upheld, that there would be very few students working in 5th position.  In reality, if correct alignment was the rule,  they would be working in a modified 5th or a 3rd position.  But Eastern Bloc ballet and Olympic coaches, many times remain silent, because these are unpopular topics.  

Excellence vs Mediocrity

The challenge with mainstream classical ballet training, pre-ballet to professional level, is insufficient classical ballet specific stretch and flexibility training, that prepares the students for the demands of the development program.  The consequences of this oversight, is repetitive movement mechanics that load the spine or extremities with incorrect alignment.  The result being adaptive joint deformation and many times permanent stabilization.

Can you take a young child and adapt them to a deformed or malaligned position without pain ?  In many cases, yes, at least until the non-symptomatic stressed alignment progresses into a full blown injury.  

  Joint deformation challenges from forced turnout, include compensatory stabilization in articular development of the foot/ankle complex, knee complex, hip complex and spine.  The entire body is interconnected, head to toe.  Any incorrect alignment variable causes a compensatory adjustment to accommodate function.

Typical alignment challenges at the barre.  Line A represents the ideal line that a correct foot would track through.  The mechanical ideal would encompasses the knee cap tracking through the center of the ankle/foot complex or Line A.  Line B represents the true degree of hip turnout possessed by the student, that would require internal rotation of the foot so that correct parallel knee, ankle, foot alignment would be maintained in a turned out position.

Orthopedics: The Classical Ballet Mechanical Ideal

In the field of medicine, including the specialized field of orthopedics, the topic of correct postural alignment is a missing focus of study.  In the absence of a mechanical postural alignment ideal, there exists no reference point to address the mechanism of joint stress and injury.  In the late 80's, Stephen M. Apatow [3] took his studies in sports medicine and exercise physiology into the study of classical ballet, as an athlete training for international competition in the sports of cross country skiing and rowing. As a result of this work, he was asked to develop a specialized program for optimization of the elite ballet dancer preparing for the Lausanne International Ballet Competition. [4].  Analysis was based on the mechanical ideal in classical ballet training, correction of spine and extremity articular variables associated with stabilization/deformation and then retraining in the fundamentals.

The success of this work yielded immediate results and served as a starting point for the integration of this work into all levels of the pedagogical program at Nutmeg Conservatory for the Arts. In the early 90's the Sports Medicine and Science Institute was formed and  biomechanical analysis, correction and retraining programs were developed for athletes in Olympic and sports development programs that include professional football, national level gymnastics, wrestling, martial arts hockey, skiing, figure skating, equestrian rider development [5] and Armed Forces Development Programs. [6]  At the request of the medical community, this work has been integrated into orthopedic applications for cases that include entrapment neuropathies, scoliosis, rheumatoid arthritis, asthma, fibromyalgia, friedreich ataxia, multiple sclerosis [7] and veterinary cases [8] (canine, equine):


Loma Fowler
: Dressage scholarship recipient for rider biomechanical analysis, correction and retraining. -- BalletEquestria: Rider & Equine Development Programs. [9]

Today, the Sports Medicine & Science Institute and International Dancescience Development Program emphasizes the importance of postural analysis, based on the classical ballet mechanical ideal.  Any deviation from the correct classical ballet based alignment ideal, corresponds with a limitation of potential performance, joint stress and injury.  If postural alignment is neglected, then analysis, diagnosis and treatment, that targets the mechanism of injury is compromised and contributes to the widespread overuse of pharmaceuticals and unnecessary surgical procedures in the treatment of more than 10 million sports injuries each year in the United States. [10]  Typical challenges in ballet include:

Accessory Bone Pain: Aka Accessory Bone Pain, Painful Accessory Bones, Os Trigonum Syndrome, Os Trigonum, Accessory Tarsal Navicular. -- Family Practice Notebook. [11]

Education initiatives associated with classical ballet based biomechanics and accentuated stretch and flexibility need to be integrated into all dance and sports development programs.  The International Dancescience Development Program advocates the incorporation of this work into every technique class and rehearsal, to optimize the progress of every student in the classical ballet development program. These same principles apply to sports and Olympic development programs.

The following introductory distance education and certification course was developed for students, parents, dance instructors, physicians and therapists associated with dance, sports and Olympic development programs:

For additional information, visit the International Dancescience Development Program web site at: www.edancescience.org


1.   Plie: ABT Dictionary. Url: www.abt.org/education/dictionary/terms/plie.html
2.   Nadia Comăneci: Wickpedia. Url: www.en.wikipedia.org/wiki/Nadia_Com%C4%83neci
3.   Stephen M. Apatow: Sports Medicine & Science Institute and International Dancescience Development Program. Url: www.apatow.org
4.   1998 Gymnastics Coaches Workshop: GTC Gymnastics Training Center in Rochester, NY. Url: www.esportsmedicine.org/sportscience/gtcworkshop.html
4.   Regimen Changes Body: Linda Boultinghouse, Register Citizen, Torrington, Connecticut. Url: www.esportsmedicine.org/rcb.html
5.   JudoSport International: Url: www.judosport.org
6.   Armed Forces Development Programs: See: Special Protective Forces for Humanitarian Operations. Url:  www.unarts.org/H-II/ref/spf_deopressoliber.html
7. Sports Medicine & Science Institute: Url: www.esportsmedicine.org
8.   Pathobiologics International: Url: www.pathobiologics.org
9.   BalletEquestria: Rider & Equine Development Programs. Url: www.balletequestria.org
10.   The Merck Manual - Home Edition, Sec. 5, Ch. 57, Sports Injuries: Url: www.merckmanuals.com/mmanual_home/sec5/57.htm
11. Accessory Bone Pain: Family Practice Notebook.Url: www.fpnotebook.com/Ortho/Foot/AcsryBnPn.htm

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