Understanding Muscle Hypertrophy and Hypertonicity: A Comprehensive Guide for Ballet Dancers and Instructors
When it comes to understanding the body in dance and rehabilitation, two terms often arise: muscle hypertrophy and hypertonicity. Although they sound similar, they refer to completely different physiological states. For dancers preparing for pointe work or instructors guiding them, it’s essential to differentiate these concepts to create a safe and effective training program and avoid ballet injuries.
Drawing on my experience working as a physical therapist assistant with stroke patients in acute rehab I’ll shed light on the appearance of hypertonic and hypotonic muscles and their implications in movement. Lastly, we’ll explore why overtraining certain muscle groups, like the calves, is a misconception in pre-pointe training and provide strategies to prepare dancers safely for pointe work.
What is Resting Muscle Tone?
Resting muscle tone is the baseline tension in a muscle when it is not actively contracting. This state, regulated by neural inputs and muscle properties, ensures the body can respond efficiently to movement or balance requirements. Alterations in muscle tone significantly affect function, impacting strength and range of motion (1).
Hypertonicity and Hypotonicity: What Are They?
In my clinical experience working with stroke patients, I often would see two extremes of muscle tone:
Hypertonicity (Hypertonic Muscle): This refers to abnormally high muscle tension at rest. Stroke patients with hypertonic muscles often appear rigid, tight, and resistant to passive movement. Hypertonicity may result in spasticity, characterized by involuntary contractions (2). For example, after a stroke, hypertonic biceps may pull the forearm into a fixed bent position, challenging to release.
Hypotonicity (Hypotonic Muscle): On the opposite spectrum, hypotonic muscles exhibit decreased tone, appearing floppy or weak. These muscles often require retraining to regain function and responsiveness (3).
It's important to note that while the terms "hypertonicity" and "hypotonicity" are often used casually in the dance world, they typically refer to neurological conditions rather than simple muscle tightness or weakness. True hypertonicity and hypotonicity are characterized by altered muscle tone due to neurological impairments, such as stroke, cerebral palsy, or spinal cord injury.¹ For most dancers, variations in muscle tone are related to factors like fatigue, hydration, lack of education on how to train, or emotional state, rather than underlying neurological issues.
What is Muscle Hypertrophy?
Muscle hypertrophy is the increase in muscle size due to exercise, particularly resistance training. This is not the same as hypertonicity talked about in the last section. It results from the repair and growth of muscle fibers following micro-tears caused by physical stress. This adaptation is natural for dancers, whose rigorous training often leads to hypertrophy in their thighs, calves, and glutes (4).
Hypertrophy itself is not problematic—it reflects strength and conditioning. However, disproportionate hypertrophy can create imbalances, reducing functionality and increasing the risk of injury. This is where we go into talking about pre-pointe classes that are using muscle hypertrophy incorrectly.
The Misconception of Overtraining Calves for Pointe Preparation
Some believe that strengthening the calves through repeated relevés is the key to pointe readiness. This type of hypertrophic calf training is not functional for dancers. While strong calves are essential, focusing solely on hypertrophy in this area is misguided for several reasons:
Overuse Injuries: Overtraining the calves can lead to Achilles tendinopathy, plantar fasciitis, and stress fractures, all common in ballet dancers (5,6).
Muscle Imbalances: Overemphasizing the calves neglects the anterior and lateral muscles of the lower leg, impairing alignment and pointe technique (7).
Limited Ankle Mobility: Tight, hypertrophied calves can restrict dorsiflexion (upward ankle movement), critical for proper pointe alignment, petite allegro, and ballet injury prevention (8).
Creating Balanced Pre-Pointe Training Programs
To prepare dancers for pointe, adopt a full body approach instead of isolating the calves:
Balanced Muscle Training: Focus equally on the anterior (tibialis anterior), posterior (calves), and lateral lower leg muscles with exercises like resisted ankle dorsiflexion, lateral ankle work, and eccentric calf raises (9).
Ankle Mobility and Fascia Release: Use tools for instrument assisted massage & foam rollers to release tight fascia that restrict ankle articulation. Work on exercises to mobilize the ankle joint for a full range of motion (10).
Foot Arch Activation: Strengthen the medial, lateral, and transverse arches of the foot with exercises like doming, marble pickups, and toe articulation drills (11).
Core and Postural Stability: Core strength goes beyond the abdominals to include the pelvic floor, diaphragm, and spinal stabilizers. This supports balance and alignment during pointe work (12). I cannot tell you how many pre-pointe dancers are inhibited by improper breathing techniques!
Vestibular Training: Improve spatial awareness with single-leg balances, turn preparation drills, eye tracking and proprioceptive exercises on a variety of surfaces (13).
Proper Technique Development: Ensure dancers avoid compensatory patterns and activate muscles correctly, minimizing injury risks and maximizing progress (14).
Why Balanced Training Matters
As dancers, muscle development is part of the journey. Hypertrophy is not the enemy, but disproportionate development or overtraining specific muscles like the calves can lead to injuries. It is okay and completely HEALTHY to look muscular as a ballet dancer. But, the muscle has to be functional.
Dancers need well-rounded strength and mobility for safe and effective pointe work. This is why I build my pre-pointe readiness/foot and ankle program. To help dancers understand that yes, you must train your lower leg and foot muscles. But, balance is key. Click here to learn more about working in my ballet injury prevention programs.
For Dance Teachers & Therapy Practitioners:
If you’re an instructor unsure where to start training dancers for pointe readiness, or a dancer seeking a balanced pre-pointe program, explore my Ballet Injury Prevention Certification. Together, we’ll build strength, mobility, and technique for safe pointe preparation. www.veronicakballet.com/certification/
References
Kandel ER, Schwartz JH, Jessell TM, et al. Principles of Neural Science. 5th ed. McGraw-Hill Education; 2013.
Lance JW. Spasticity: Disordered Motor Control. Neurology. 1980;30:1-19.
Bobath K. Adult Hemiplegia: Evaluation and Treatment. 3rd ed. Butterworth-Heinemann; 1990.
Schoenfeld BJ. The Mechanisms of Muscle Hypertrophy and Their Application to Resistance Training. J Strength Cond Res. 2010;24(10):2857-2872.
Kadel N. Achilles Tendinopathy in Dancers. Clin Sports Med. 2008;27(3):637-652.
van Middelkoop M, Kolkman J, van Ochten JM, et al. Prevalence and Incidence of Lower Extremity Injuries in Ballet. Am J Sports Med. 2008;36(4):735-740.
Angioi M, Metsios GS, Koutedakis Y, et al. Fitness and Injury in Ballet. J Dance Med Sci. 2009;13(4):115-123.
Hoch MC, McKeon PO. Dorsiflexion and Lower Extremity Injury. Curr Sports Med Rep. 2011;10(6):299-304.
Wilkerson GB. Dynamic Ankle Stability. J Orthop Sports Phys Ther. 2012;42(6):518-526.
Schleip R, Muller DG. Training Principles for Fascial Health. Curr Sports Med Rep. 2013;12(4):200-209.
McKeon PO, Hertel J, Bramble D, et al. Foot Arch Function. J Sport Rehabil. 2009;18(4):482-490.
Hodges PW, Richardson CA. Transversus Abdominis and Lumbar Stabilization. Phys Ther. 1996;76(4):464-476.
Horak FB. Postural Stability in Dance. Neurophysiology of Dance Movements. 2010;12:135-150.
Kiefer AW, Riley MA, Shockley K, et al. Techniques and Injury Prevention in Dance. J Dance Med Sci. 2011;15(3):115-120.
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