Updated: 5 days ago
November 14th, 2020
We write this blog with a mixture of satisfaction, irritation and fascination all at the same time, an interesting combination I assure you.
The source of my fascination lies in how far pole dance and pole fitness has journeyed over the past 10 years; it has progressed in leaps and bounds in so many areas.
However the source of our irritation also lies in that the progress is still not enough. There is a lack of researched evidence focused on pole specific injuries in the medical world, so instead we ‘borrow’ evidence researched on other sports like rock-climbing and gymnastics which don’t require the same musculoskeletal demands as pole dancing. Therefore this research doesn’t quite hit the nail on the head in the schemes of understanding pole mechanics and injury prevention.
And the source of my satisfaction? Filling in this knowledge gap by providing you, the everyday pole dancer, with the knowledge required to prevent injuries for yourself and hopefully the dancers at your studio. And with that, hopefully the aim of progressing the future of pole dance for the better. So with that in mind, we present to you all the information (research and clinical) currently known on the twisted grip over a 2-part series.
It’s a bit to take on board, so make sure you take it at a slow pace to absorb all of the twisted grip goodness. We can promise you it’s worth it! Let’s start at the beginning…
What is twisted grip?
The twisted grip is one of many different pole grips that can be utilised to shoulder mount, static V (Ayesha) and/or handspring to name a few. It is also grip used for many beautiful spins such as skater/ballerina/music box dancer.
To understand twisted grip, you will need to understand basic shoulder anatomy. Twisted grip involves shoulder flexion (varying degrees dependent on the trick) and full internal rotation of the arm. It's the rotation that makes it feel twisted.
FIGURE 3: SHOULDER EXTERNAL ROTATION AT 0, 90 & 180 DEGREES
FIGURE 4: SHOULDER INTERNAL ROTATION AT 0, 90 & 180 DEGREES
Why does twisted grip have such a bad rap in the pole community?
Well that’s a good question! To be honest, certain instructors have chosen not to teach twisted grip because of their individual experiences with it and some have been quite outspoken about this grip in the past. Some of these polers have experienced injury as a result of twisted grip and/or their body simply just doesn't like feel good in this grip.
Firstly it's important to know that some polers bodies' will naturally love twisted grip and other's just simply won't. Whatever your body prefers, that's ok. Our bodies are not designed to love every trick or grip out there. And it is important to note that shoulder injuries can occur in any pole grip.
So why is it that twisted grip continually gets demonised?
The short answer is that twisted grip can be a less forgiving position for the shoulder than most. We will cover this in a lot of detail later in our Anatomy 101 section.
What’s important to note is that twisted grip shouldn't be unnecessarily feared if we approach it and its use in the right way. If we're strong enough to handle the demands of twisted grip and don't overload it, then we are far less likely to have any issues !
Epidemiology of shoulder injuries in pole dance
Considering pole dance is a primarily upper body dominant activity, it is only natural that we would expect to see a greater number of shoulder injuries. In fact, the shoulder is the most commonly injured area amongst all types of aerialists and gymnasts, followed by hamstring injuries from split style movements (Nicholas, 2019).
Ground breaking epidemiological pole research led by Dr Joanna Nicholas was undertaken at The University of Western Australia in 2019, looking specifically at the anatomical location of pole related injuries and their causes. 103 injuries were included in this study and assessed and diagnosed/characterised by local physiotherapists.
Out of the 103 pole-specific and related injuries included in this study over a 12-month period, 21 involved the shoulder (20.4% of the total injuries). And out of these 21 injuries, only 6 of them were directly related to twisted grip. That equates to a 6% of total pole related injuries directly due to twisted grip.
The remaining 15 shoulder injuries were caused by mechanisms including inversions, increase in volume/overuse, handstands, direct impact and loaded external rotation. So why is it that we get so hung up and fixated on the twisted grip injuries when more injuries were caused in a non-twisted position?
Well speaking purely from a clinical perspective, these tend to be the injuries that sometimes take the longest to resolve and can keep dancers from performing their favourite and most powerful moves, like static Vs, handsprings and Iron Xs.
But before we panic and start cursing the twisted grip, let’s breathe for a moment and try to understand how to unravel this twisted mess.
Don’t get it twisted
There are many nay-sayers in the pole community out there on twisted grip. It actually blows my mind a little. And the fear mongering that I’ve seen from studios and instructors alike over the past year is actually quite concerning. So here it is, straight from the Physio’s mouth:
Twisted grip is not bad for you! **
What’s interesting is that the unease about twisted grips is similar to the unease of the non-pole muggles when I talk to them about doing squats or deadlifts. These are simple movements for us active folk, but for them these movements freak them out because they worry about hurting their knees or backs etc. But in reality, when done well these movements make our bodies more robust and stronger.
You must be thinking by now, ‘but Simone, if twisted grip isn’t bad for you then why is it linked to a high number of pole related injuries in Dr Nicholas’ study?’
Well, the answer is quite simple and this is where the ** lies.
Just like every other pole trick out there, twisted grip is not bad for you when it is done well. Just like I wouldn’t want you to perform an invert with less than ideal technique for risk of an injury, I also wouldn’t want you to perform twisted grip incorrectly.
However, when done correctly twisted grip is a wonderfully powerful grip that teaches your body how to correctly engage muscles of the rotator cuff. In fact, I would argue that if you cannot perform twisted grips your shoulder strength is not robust enough and you are placing yourself at risk of injury with other advanced level tricks.
Let’s now geek out on the anatomy behind why twisted grip places our shoulder at a higher risk of injury.
Anatomy 101 of the Twisted Grip
In twisted grip two major things occur around the shoulder joint:
Full internal rotation movement of the shoulder reduces the active space available in the shoulder joint. This position is a closed pack position which can increase load on the joint and the structures within this space when in an overhead position.
Additionally, full internal rotation places the external rotators of the shoulder in a lengthened state and under considerable load. This is a challenging position for our rotator cuff muscles to contract in and produce force. Particularly when we are already attempting to support our body weight through the shoulder.
Now, please note there is nothing wrong with reducing shoulder space and placing your muscles and tendons in a compressive and lengthened position. We do that all the time as pole dancers. I mean – we do it to our hamstrings every time we do the splits!
But if the muscles around the shoulder aren’t strong enough to handle these demands, then you’re likely 'hanging' off the passive structures of the shoulder such as ligaments and joints. Increased passive load through the shoulder joint, does increase risk of rotator cuff related shoulder pain (previously referred to as impingement). This particularly rings true for ‘unconditioned novices who lack the strength and stability required to hold such extreme postures’ (Nicholas, 2019, p.180).
Rotator Cuff related Shoulder Pain (explained in a hot minute)
Now I’ve seen other blogs try to simplify twisted grip shoulder injuries and unfortunately it’s just not that simple. Our shoulder is full of different structures and everyone’s body can move differently. The shoulder complex is, well, just that… complex. And today’s blog is not the time to delve into the many different drivers of shoulder pain. That will be a huge blog in itself coming in the next few months. But just know this:
If your shoulder is not providing adequate strength to stabilise your humeral head (shoulder) in the joint, then the surrounding structures of the joint (bursa, ligaments, labrum, tendons etc) may become overloaded, which in turn can lead to pain.
There may even be increased movement that occurs in the joint, known as micro-instability. But the evidence is still not conclusive on this.
OK, so I know right now it doesn’t sound like I’m selling twisted grip very well. But this blog is not to turn you off twisted grip. It’s here to give you the knowledge of why pain in twisted grip (or any grip for that matter) can occur. Along with the understanding that twisted grip is actually not bad for you at all if you are strong enough to stabilise the shoulder joint in this position.
In fact, when your muscles have the ability to actively stabilise this position, twisted grip is actually for many people a much more powerful and stronger grip when learning how to handspring compared to a true/straight grip. And that’s one of the many reasons why we should learn how to twisted grip with a good and strong foundation!
That’s a lot of information to digest for today, so let’s leave it there. Next blog we will focus on how to correctly engage in a twisted grip, screening that should be done prior to starting on your twisted grip journey, along with how to best manage a twisted grip injury.
Shoulder injured or wanting tailored guidance and rehabilitation for your twisted grip related injury?
Then get in contact with myself via my ‘Contact Simone’ page to book an online appointment. Assessment and tailored rehabilitation to your injury will be provided in accordance with best practice and evidence-based treatment.
Until next time, train safe.
The Pole Physio
Disclaimer: This information is not tailored to you as an individual and do not constitute as medical advice. If you have medical or injury concerns, then please individually consult with a medical professional.
Nicholas, J.C. (2019). The psychological, physiological, and injury-related characteristics of recreational pole dancing. (Unpublished). URL: https://research-repository.uwa.edu.au/en/publications/the-psychological-physiological-and-injury-related-characteristic