Shooting from the hip.

DON'T THINK a hip replacement is in your future? Take this simple dance test: Do a battlement with one leg, then the other. Which did you kick first? Every dancer can say which leg gets more elevation and better turnout. Keep that internal conversation going. Leg dominance, number of dance years, degree of flexibility, type of roles, smoking, and alcohol consumption all can contribute to susceptibility to hip degeneration.

Continued rise over time is like a persistent drop of water that eventually erodes the whole dam. Jim Sohm, now administrative manager of the San Francisco Ballet School, never realized how severe his problem had become. His hips had caused him pain for years, a typical symptom of an incipient problem, but he ignored it. Then his back began to hurt. "I was moonlighting at the time with the San Francisco Opera Ballet as well," he recalls. "When Nutcracker season came, I wasn't able to run across the stage in my pas de deux." He went to see his doctor, and discovered his hips had degenerated to the point that it had begun to have an impact on his lower back. At 35, his performing career was over.

There's conflicting evidence about what causes hip degeneration; some studies indicate dancers are no more vulnerable than the rest of the population. While the jury remains out, as dancers, teachers, and choreographers, we all need to be aware of how we are working. There are approaches that will put less strain on your hips, according to Dr. Bill Ross, a family medicine physician in the Dance Medicine division of the Center for Sports Medicine in San Francisco. He recommends building strength in your legs and hips, countering excessive external rotation front turnout by working on internal rotation, and focusing on your alignment. Here are some ways:

STRENGTHEN YOUR TRUNK AND LEG MUSCLES. Resistance training for hip, knee, ankle, and foot muscles that uses your body weight, therabands, and Pilates will build up muscle strength. The more muscular support you have, and the stronger your core, the less strain on your joints. Consult your company's physical therapist or a trainer recommended by your dance studio. Dancers love to stretch, but they also need strength inside their stretch. (While yoga may increase your flexibility, it won't build up muscle strength.) It's a big reason why Pilates, with its varying kinds of resistance training, can help improve technique.

WORK ON CORRECT ALIGNMENT. Be sure you understand proper pelvic and leg alignment. Take to heart your teacher's instructions to keep your knees over your feet, lift your arches, pull in your bum and not let your belly hang out. Flexibility sags unless it's strengthened and aligned. Learn how to protect your joints with correct alignment.

KEEP YOUR HIP ROTATOR MUSCLES STRONG. The rotators of the hip are like the rotator cuff of the shoulder. They grab the ball of the thighbone and pull it into the socket. Counter the force of turnout's external rotation by sitting on a bed or table (so your feet are off the floor) with a resistance band around your thighs, and your ankles together. Then press outward against the band. A pillow between your knees helps to keep the distance correct between your legs.

It's important when young dancers are trying to push their limits that they stick to healthy practices. New York City Ballet's physical therapist Marika Molnar urges young dancers not push each other down into the "frog" position in order to increase turnout. She recommends that dancers go to a qualified therapist who can evaluate their particular body's available hip range. A physical therapist can also help develop the deep core strength necessary for dancing in turnout in a way that's sound and sensible.

Finally, listen to your body; pain relievers are not the answer. Develop your stretch evenly on both sides of your hips. If your stretch changes significantly, and you have recurring pain, see a doctor. And if you do have a hip replacement, remember that teachers can still teach, and dancers can still dance. (It may take two years to return to full capability.) Get informed. Work smart. And beat the odds.

Suzanne Martin is principal physical therapist for Smuin Ballet in San Francisco. She also has her own practice in physical therapy and Pilates.