Balance and strength in nonprofessional dancers with snapping hip:: A cross-sectional study
Snapping hip syndrome (SHS) is prevalent among dancers, affecting their well-being and increasing injury risk. Little is known about SH and its relationships with factors commonly associated with injury. The study aimed to describe and compare (affected vs. unaffected sides) dynamic balance, hip muscle strength, functional turnout (FTO), compensated turnout (CTO) and passive hip external rotation (HER) range of motion (ROM) in nonprofessional dancers with SH and explore interrelationships. The cross-sectional study included a convenience sample of adult and adolescent nonprofessional dancers diagnosed with SH, from multigenre dance schools in Cape Town, South Africa. Demographic information was collected. Outcome measures were the numeric pain rating scale (pain), Y balance test (dynamic balance), goniometry (active and passive HER) and handheld dynamometry (hip muscle strength). Affected and unaffected sides were randomly tested. Statistical analyses included paired t-tests for side-to-side comparisons, one-way analysis of variance (ANOVA) for age comparisons across pain categories, and Pearson’s correlation coefficients to explore relationships between variables. Twenty-three women voluntarily participated (mean age: 22 (6.4) years). Study outcomes did not differ between affected and unaffected sides (p=0.28–0.70). HER muscle strength on the affected side and CTO demonstrated a moderate positive correlation (r=0.51, p=0.01), suggesting that improving HER muscle strength will improve FTO.
- ARMSTRONG, R. & RELPH, N. (2018). Screening tools as a predictor of injury in dance: Systematic literature review and meta-analysis. Sports Medicine-Open, 4(33). doi: 10.1186/s40798-018-0146-z
- BARNES, R.; WILSON, M. & RAUBENHEIMER, J. (2020). Effect of a core stability, m. gluteus medius and proprioceptive exercise programme on dynamic postural control in netball players. South African Journal for Research in Sport, Physical Education and Recreation, 42(1): 1-11.
- BOLIA, I.; UTSUNOMIYA, H.; LOCKS, R.; BRIGGS, K. & PHILIPPON, M.J. (2018). Twenty-year systematic review of the hip pathology, risk factors, treatment, and clinical outcomes in artistic athletes-dancers, figure skaters, and gymnasts. Clinical Journal of Sport Medicine, 28(1): 82-90. doi: 10.1097/JSM.0000000000000440
- BOONSTRA, A. M.; STEWART, R. E.; KÖKE, A. J.; OOSTERWIJK, R. F.; SWAAN, J. L.; SCHREURS, K. M. & SCHIPHORST PREUPER, H. R. (2016). Cut-off points for mild, moderate, and severe pain on the numeric rating scale for pain in patients with chronic musculoskeletal pain: Variability and influence of sex and catastrophising. Frontiers in Psychology, 7(Sep): 1-9. doi: 10.3389/fpsyg.2016.01466
- BYRNE, D.P.; MULHALL, K.J. & BAKER, J.F., (2010). Anatomy & biomechanics of the hip. Open Sports Medicine Journal, 4(1): 51-57. doi: 10.2174/1874387001004010051
- CASTARLENAS, E.; JENSEN, M.P.; VON BAEYER, C.L. & MIRÓ, J. (2017). Psychometric properties of the numerical rating scale to assess self-reported pain intensity in children and adolescents. Clinical Journal of Pain, 33(4): 376-383. doi: 10.1097/AJP.0000000000000406
- CHAMPION, L.M. & CHATFIELD, S.J. (2008). Measurement of turnout in dance research: A critical review. Journal of Dance Medicine & Science : Official Publication of the International Association for Dance Medicine & Science, 12(4): 121135.
- CHEATHAM, S.W.; CAIN, M. & ERNST, M.P. (2015). Snapping hip syndrome: A review for the strength and conditioning professional. Strength and Conditioning Journal, 37(5): 97-104. doi: 10.1519/SSC.0000000000000161
- COPLAN, J. A. (2002). Ballet dancer’s turnout and its relationship to self-reported injury. Journal of Orthopaedic and Sports Physical Therapy, 32(11): 579-584. doi: 10.2519/jospt.2002.32.11.579
- DEHGHAN, F.; HAERIAN, B.; MUNIANDY, S.; YUSOF, A.; DRAGOO, J. & SALLEH, N. (2013). The effect of relaxin on the musculoskeletal system. Scandinavian Journal of Medicine & Science in Sports, 24(4): 220-229. doi: 10.1111/sms.12149
- DEPARTMENT OF HEALTH. (2020). South African Good Clinical Practice: Clinical trial guidelines: Pretoria: Department of Health.
- FERREIRA-VALENTE, M.A.; PAIS-RIBEIRO, J.L. & JENSEN, M.P. (2011). Validity of four pain intensity rating scales. Pain, 152(10): 2399-2404. doi: 10.1016/j.pain.2011.07.005
- FLATO, R.; PASSANANTE, G.J.; SKALSKI, M.R.; PATEL, D.B.; WHITE, E.A. & MATCUK, G.R. (2017). The iliotibial tract: imaging, anatomy, injuries, and other pathology. Skeletal Radiology, 46(5): 605-622. doi: 10.1007/s00256-017-2604-y
- GROSS, C.; RHO, M.; AGUILAR, D. & REESE, M. (2018). Self-reported hip problems in professional ballet dancers : The impact on quality of life. Journal of Dance Medicine & Science, 22(3): 132-136. doi: 10.12678/1089-313X.22.3.132
- GROSSMAN, G. (2003). Measuring dancers active and passive turnout. Journal of Dance Medicine & Science, 7(2): 49-55. doi: 10.1177/1089313X0300700203
- GUPTA, A.; FERNIHOUGH, B.; BAILEY, G.; BOMBECK, P.; CLARKE, A. & HOPPER, D. (2004). An evaluation of differences in hip external rotation strength and range of motion between female dancers and non-dancers. British Journal of Sports Medicine, 38(6): 778-783. doi: 10.1136/bjsm.2003.010827
- HAEFELI, M. & ELFERING, A. (2006). Pain assessment. European Spine Journal, 15(SUPPL. 1): 17-24. doi: 10.1007/s00586-005-1044-x
- JACOBS, C.L.; CASSIDY, J.D.; CÔTÉ, P.; BOYLE, E.; RAMEL, E.; AMMENDOLIA, C.; HARTVIGSEN, J. & SCHWARTZ, I. (2017). Musculoskeletal injury in professional dancers: Prevalence and associated factors: An international cross-sectional study. Clinical Journal of Sport Medicine, 27(2): 153-160. doi: 10.1097/JSM.0000000000000314
- JACOBSEN, J.S.; THORBORG, K.; SØBALLE, K. & ULRICH-VINTHER, M. (2012). Eccentric hip abductor weakness in patients with symptomatic external snapping hip. Scandinavian Journal of Medicine & Science in Sports, 22: 140-146. doi: 10.1111/j.1600-0838.2012.01525.x
- KENNY, S.J.; CRITCHLEY, M.L.; WHITTAKER, J.L.; KODALORE VIJAYAN, V.W. & EMERY, C.A. (2021). Association between pre-participation characteristics and risk of injury amongst pre-professional dancers. Physical Therapy in Sport, 52: 239-247. doi: 10.1016/J.PTSP.2021.10.003
- KENNY, S.J.; PALACIOS-DERFLINGHER, L.; SHI, Q.; WHITTAKER, J.L. & EMERY, C.A. (2019). Association between previous injury and risk factors for future injury in pre-professional ballet and contemporary dancers. Clinical Journal of Sport Medicine, 29(3): 209-217.
- KIZILTOPRAK, S. & DINCER, S. (2022). Comparison of hip abductor strength in pre-professional ballet dancers with and without snapping hip. Turkish Journal of Sports Medicine, 57(2): 86-91.
- doi: 10.47447/tjsm.0603
- LAIBLE, C.; SWANSON, D.; GAROFOLO, G. & ROSE, D.J. (2013). Iliopsoas syndrome in dancers. Orthopaedic Journal of Sports Medicine, 1(3): 1-6. doi: 10.1177/2325967113500638
- LEAVEY, V.J.; SANDREY, M.A. & DAHMER, G. (2010). Comparative effects of 6-week balance, gluteus medius strength, and combined programs on dynamic postural control. Journal of Sport Rehabilitation, 19(3): 268-287. doi: 10.1123/jsr.19.3.268
- LEWIS, C.L. (2010). Extra-articular snapping hip: A literature review. Sports Health: A Multidisciplinary Approach, 2 (3): 186-190. doi: 10.1177/1941738109357298
- LINEK, P.; SIKORA, D.; WOLNY, T. & SAULICZ, E. (2017). Reliability and number of trials of Y balance test in adolescent athletes. Musculoskeletal Science and Practice, 31: 72-75. doi: 10.1016/j.msksp.2017.03.011
- MARTINEZ, B.R.; CURTOLO, M.; LUCATO, A.C.S. & YI, L.C. (2014). Balance control, hamstring flexibility and range of motion of the hip rotators in ballet dancers. European Journal of Physiotherapy, 16(4): 212-218. doi: 10.3109/21679169.2014.933485
- MIGDOU, A.; TRIANTAFYLLOU, A.; GKRILIAS, P.; KYRIAKIDOU, M. & PAPAGIANNIS, G. (2024). Hip injuries in dancer athletes due to biomechanical loading: A systematic review. Engineering Proceedings, 81(1): 5. doi: 10.3390/engproc2024081005
- MUKAKA, M. (2012). Statistics corner: A guide to appropriate use of correlation coefficient in medical research. Malawi Medical Journal, 24(3): 69-71.
- NEGUS, V.; HOPPER, D. & BRIFFA, N.K. (2005). Associations between turnout and lower extremity injuries in classical ballet dancers. Journal of Orthopaedic & Sports Physical Therapy, 35(5): 307-318. doi: 10.2519/jospt.2005.35.5.307
- NORRIS, B. & TRUDELLE-JACKSON, E. (2011). Hip- and thigh-muscle activation during the star excursion balance test. Journal of Sport Rehabilitation, 20(4): 428-441. doi: 10.1123/jsr.20.4.428
- PETERSON, S.J. & FOLEY, S. (2021). Clinician’s guide to understanding effect size, alpha level, power, and sample size. Nutrition in Clinical Practice, 36(3): 598-605. doi: 10.1002/ncp.10674.
- PLISKY, P.J.; RAUH, M.J.; KAMINSKI, T.W. & UNDERWOOD, F.B. (2006). Star excursion balance test as a predictor of lower extremity injury in high school basketball players. Journal of Orthopaedic & Sports Physical Therapy, 36(12): 911-919. doi: 10.2519/jospt.2006.2244
- POTALIVO, G. & BUGIANTELLA, W. (2017). Snapping hip syndrome: systematic review of surgical treatment. Hip International, 27(2): 111-121. doi: 10.5301/hipint.5000464
- SCHWIERTZ, G.; BEURSKENS, R. & MUEHLBAUER, T. (2020). Discriminitive validity of the lower and upper quarter Y balance test performance: a comparison between healthy trained and untrained youth. BMC Sports Science, Medicine and Rehabilitation, 12(1):73. doi: 10.1186/s13102-020-00220-w
- SHERMAN, A.A.J.; MAYALL, E. & TASKER, S.L. (2014). Can a prescribed turnout conditioning program reduce the differential between passive and active turnout in pre- professional dancers ? Journal of Dance Medicine & Science, 18(4): 159-168. doi: 10.12678/1089-313X.18.4.159
- SMITH, P.J.; GERRIE, B.J.; VARNER, K.E.; MCCULLOCH, P.C.; LINTNER, D.M. & HARRIS, J.D. (2015). Incidence and prevalence of musculoskeletal injury in ballet: A systematic review. Orthopaedic Journal of Sports Medicine, 3(7): 31-34. doi: 10.1177/2325967115592621
- THORBORG, K.; PETERSEN, J.; MAGNUSSON, S.P. & HOLMICH, P. (2010). Clinical assessment of hip strength using a handheld dynamometer is reliable. Scandinavian Journal of Medicine & Science in Sports, 20: 493-501. doi: 10.1111/j.1600-0838.2009.00958.x
- VAN MERKENSTEIJN, G.G. & QUIN, E. (2015). Assessment of compensated turnout characteristics and their relationship to injuries in university level modern dancers. Journal of Dance Medicine & Science, 19(2): 25-30. doi: 10.12678/1089-313X.19.2.57
- VAN WILGEN, C.; AKKERMAN, L.; WIERINGA, J. & DIJKSTRA, P. (2003). Muscle strength in patients with chronic pain. Clinical Rehabilitation, 17(8): 885-889. doi: 10.1191/0269215503cr693oa
- VIA, A.G.; FIORUZZI, A. & RANDELLI, F. (2017). Diagnosis and management of snapping hip syndrome: A comprehensive review of literature. Rheumatology: Current Research, 7(04). doi: 10.4172/2161-1149.1000228
- WAHL, C.J.; WARREN, R.F.; ADLER, R.S.; HANNAFIN, J.A. & HANSEN, B. (2004). Internal coxa saltans (snapping hip) as a result of overtraining: A report of 3 cases in professional athletes with a review of causes and the role of ultrasound in early diagnosis and management. American Journal of Sports Medicine, 32(5): 1302-1309. doi: 10.1177/03363546503258777
- WINSTON, P.; AWAN, R.; CASSIDY, D. & BLEAKNEY, R.K. (2007). Clinical examination and ultrasound of self-reported snapping hip syndrome in elite ballet dancers. The American Journal of Sports Medicine, 35(1): 118-126. doi: 10.1177/0363546506293703
- WITKE-WOZNIAK, A.; WYCHOWANSKI, M.; DAMBSKI, T.; SZYMFEL, K. & KOCHANSKI, T. (2016). Hip muscle strength and static balance in patients with snapping hip syndrome – a pilot study. Postepy Rehabilitacji, 3(2012): 55-68. doi: 10.1515/rehab-2015-0049
- WORLD MEDICAL ASSOCIATION DECLARATION OF HELSINKI ETHICAL PRINCIPLES FOR MEDICAL RESEARCH INVOLVING HUMAN SUBJECTS. (2013). JAMA: Journal of the American Medical Association, 310(20): 2191-2194. doi: 10.1001/jama.2013.28105
- YEN, Y.M.; LEWIS, C.L. & KIM, Y.J. (2015). Understanding and treating the snapping hip. Sports Medicine and Arthroscopy Review, 23(4): 194-199. doi: 10.1097/JSA.0000000000000095
License
Copyright (c) 2025 Roxanne Lategan, Karina Berner, Yolandi Brink (Author)

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.