Background: Stigma looms within the dance world surrounding being “an injured dancer”, deterring reporting of injury and contributing to the mentality of “needing to push through pain” to remain employed. With the nature of injury within dance resulting in time away from performing, it is imperative that we examine the contributors to injury, to mitigate rates and prevent complex injuries. Turnout (TO) is described as the degree of external rotation achieved from the lower leg, with the aim of increasing overall range of motion (ROM) especially in abduction, facilitating elongation of the lower limb and supporting stability in static and dynamic balance. Research exists surrounding misaligned/ compensated turnout (CTO) in dancers and its correlation with lower limb injury prevalence.

Objective: This systematic review aims to gather existing research and analyse the methods and tools used in determining degree of CTO, investigating whether a true relationship exists between CTO and lower limb injuries in dancers.

Methods: A systematic literature review was conducted according to the PRISMA Guidelines using the databases APA Psycinfo, ScienceDirect, SocINDEX, CINAHL, and SPORTDiscus. Peer-reviewed only studies investigating the relationship between compensated or forced TO and lower limb injuries in all genders, ages, and levels of dancers were included. Non-primary sources were excluded alongside those pertaining details of dance styles outside of ballet, contemporary/modern-dance, and musical theatre. 6 articles were included in analysis, and screening, data extraction and methodological bias scores were executed by the author independently. Methodological quality was impacted by the general lack of standardised measuring, and combination in retrospective and prospective cross-sectional design, with the AXIS bias screening of included articles ranging from ‘fair’ - ‘good’. The studies focused on the degree of turnout achieved at the hip only, with no accountability from non-hip contributors of turnout (NHCTO), or natural anatomical variations.

Results: Of 866 potentially relevant studies, 6 were included for analysis within this systematic review. The overall results attained from included articles, confirms a positive statistical significance exists between CTO and lower limb injury prevalence in ballet and contemporary/modern dance dancers. The results of this systematic review reflect previous academic sources, indicating that compensatory patterns of turnout may increase risk of dancers experiencing lower limb injuries.

Conclusion: No definitive causation between CTO and lower limb injuries could be made at this time, however, this review has brought to light the complexity in analysing TO and through literature analysis, offers alternative methods for future studies, in support of propelling modern research. Data presented could help shape the teaching delivery of dance, educating dancers on their individual risk of injury, in an attempt to mitigate injury rates. Despite a trending consensus, this review highlights the need for future research to further examine wearable goniometers against the gold-standard 3D kinematic imaging, in assessing dynamic ROM during sporting activities such as dance, while considering NHCTO within TO calculations.