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Hi Lisa,

I looked through your articles and don't see any discussion on Sartorius strains or injuries. I have a student that complains of pain at the knee and front of hip - she's been to two physician specialists to rule out any anatomical anomalies, and there are none. She's also run through a series of physical therapy by a "dance injury" doctor of physical therapy.

At first I thought she might have a chronically inflamed psoas, but with a "tucked" under pelvic alignment, I'm ruling that out as she complains of pain with attitude devant, developpe devant and ronds de jambe en l'air.

Her spine is a "reverse" curve in that that lumbar spine curves outward and thoracic spine is fairly flat. We've run her through the Front Splits Fast program and yoga program with little relief. We've tested her turnout from the prone position and she shows about a 50 degree range of motion both inward and outward. Her parents and I are puzzled at what to do next.

Could you please post some comments on Sartorius strain and causes and solutions?

Thank you very much,
Valerie

Hi Valerie

Thanks so much for your question, and I hope that I can help you out a little.

First of all, I need to ask why you would rule out a chronically inflamed Psoas, as in fact, all of the things that you describe indicate that this might be the case, especially in regard to the tucked under pelvis, and reversed spinal curves. I have actually written another post that explains this in detail about Chronic Hip and Back Pain

One of the biggest issues I note with any student with hip issues is the tendency to this type of tucked posture. It often develops as they are trying to engage their deep abdominals and hold turnout, however this posture actually contributes to destabilising the deep little low back muscles (Multifidus) making the true core more unstable. If a dancer maintains a flexed lumbar spine, the Psoas muscle (that attaches to the front of the spine) is often recruited to stabilize the low back. This then makes it less available for what a dancer really needs it for which is supporting the lifted leg in extensions.

sartorius musclerectusIf the Psoas is unavailable, then the load of the weight of the leg is transferred to the Rectus Femoris and Sartorius muscles, so this may well be the issue that she is having. Both have an attachment point at the front of the hip and the knee, so it depends on the location of the pain as to which one is being overloaded.

I would highly suggest that you get a copy of the Training Turnout program that goes over this issue, and the correct retraining of the hip in detail as well as the New Approach To Core Stability book which explains the specifics of retraining the deep muscles of the low back.

The first thing to do would be to focus on correct alignment of the low back and to strengthen the deep stabilisers of the low back. This will allow the Psoas to release it's stabilizing role, and be used more for lifting the leg.

During the process of retraining all of her Motor Paterning and Muscle Memory I would advise that she keep BOTH legs at glisse height at the barre and during adage, until she has the strength and awareness to control her spine, standing leg turnout, working leg turnout and core stability. Retraining common steps does take quite a lot of repetitions, so it is better to keep the leg low during this process, as well as to let the inflammation clear completely.

I do hope that this helps you understand the situation better and helps her settle the pain as quickly as possible.

Kindest Regards,
Lisa Howell

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