Twisted Grip - Don't get it Twisted!

Hands up if you avoid any form of twisted grip like the plague?? Does your body not like it? Does your pole instructor refuse to teach it? Or have you just not heard good things about it?

Well whether it's from a negative personal experience or hearing stories from others, there certainly are a lot of pole dancers out there who stay well and truly clear of the twisted grip.

But why? In today's blog, we answer the question: Is twisted grip actually more dangerous than other pole grips?

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 our 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 satisfaction? Filling in this knowledge gap by providing you, the everyday pole dancer (and/or instructor), with the knowledge required to prevent injuries for yourself and hopefully other dancers at your studio. So with that in mind, we present to you all the information (research and clinical) currently known on the twisted grip in a very in-depth blog.

It’s a bit of information 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…

Fig 1: Shoulder Flexion

What is twisted grip?

Twisted grip; it is one of many different pole grips that can be utilised to Handspring and Ayesha. It can also be used in shoulder mounts (also known as a princess grip) and for for many beautiful spins such as ballerina.

To understand twisted grip, we need to understand basic should anatomy & biomechanics. Twisted grip can be broken down into three main components:

• Shoulder flexion (varying degrees dependent on the trick)

• Full internal rotation of the arm

• Good active overhead shoulder stability

Spoiler alert: It’s the internal rotation or the arm that makes it feel twisted!

Fig 2: 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, with some instructors being 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. And others actually just have no idea why they don't teach it in their curriculum, it's just the way things are done at their studio.

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 also 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.

But twisted grip shouldn't be unnecessarily feared, especially 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.

Of the 103 pole related injuries included in this study, 21 were injuries of the shoulder (20.4% of the total injuries). And out of these 21 injuries, 6 of them were directly related to twisted grip. That equates to a 6% of total pole related injuries and 29% of all shoulder injuries being directly related 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?

Because for a number of pole dancers out there, they continually hurt themselves in this grip. And for many others they would say they have never fully recovered from their injury.

Why? The answer here lies in a lack of understanding in the pole world about shoulder anatomy and biomechanics, particularly about the demands of this trick. And there is a lack of understanding by healthcare professionals to when it comes to rehabbing the shoulder to get back to twisted grip. So yes, twisted grip can be really challenging for some shoulders, but instead of fearing it, let's try to understand it (and rehab our shoulders fully!)

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 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.

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:

1. You are ready to handle it's demands

2. You don't overload it and perform it 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. Compared to a true grip, a twisted grip biomechanically speaking is much harder on our shoulders and has less room for error.

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 further shoulder injury with other advanced level tricks... But that conversation is for another day.

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

Our shoulder is an inherently unstable joint. It relies on the muscles and ligaments around it to prevent joint dislocation. In twisted grip two major things occur around the shoulder joint:

1. Full internal rotation movement of the shoulder reduces the active space available in the shoulder joint. Twisted grip places the shoulder in a closed pack position which can increase load on the joint and the structures within this space when in an overhead position if our muscles are unable to stabilise the joint.

2. 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 practitioners 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. 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.

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!

Am I more likely to injure myself in twisted grip compared to other grips?

Well, the research evidence is still out on this. But what we can say from clinical evidence is that yes twisted grip can be a more challenging position for some people because of the anatomical position required, BUT you are less likely to injure yourself in twisted grip if:

• You have the required range of shoulder movement

• You’re strong in your rotator cuff muscles and able to engage them in a twisted position.

I repeat: twisted grip is not bad!

However: If the LOAD (aka demands) of the trick/grip is greater than our bodies' CAPACITY (strength/mobility etc) then we place ourselves at risk of injury. And this goes for all tricks on the pole. This is similar to you trying to iguana or dragon’s tail before you have the strength and pole smarts to: not the best idea and may end in injury.

Your body MUST be able to tolerate the DEMANDS of the exercise and have the CAPACITY to tolerate its LOAD.

If your body is not ready to handle the demands of a twisted grip, then you will be placing yourself at increased risk of shoulder injury.

If you don’t feel comfortable doing a twisted grip then don’t push that position just yet. It likely feels uncomfortable because your body hasn’t been conditioned for that particular movement yet and like anything you need to strengthen!

What's the best way to learn twisted grip?

Well, we feel very strongly here that the best way to learn twisted grip is to feel strong and comfortable in your true grip/straight first. All the time we see polers being taught their Ayesha/static V in a twisted grip first. This trick is often the first time a poler is inverted with their entire body weight through their shoulders, so it just makes sense to use a grip that is more natural and comfortable for the shoulder to perform in. Once you're feeling good in this grip then you can progress to a twisted grip with your instructor's guidance.

Another issue we see is a progression of tricks too quickly. A huge issue in our eyes is studios teaching polers how to handspring before the even know how to Ayesha. Arrgghhh! Just don't! You're trying to get a poler to kick upside down but they don't know how to engage their shoulders correctly or hold the position when they are there! That is a disaster waiting to happen. And not just for the shoulder.

The number of upper limb injuries we have treated from learning a handspring far too early are astronomical. Strong shoulders are key to reducing your risk of injury. So learn your true grip ayesha first. Followed by your twisted grip. And only once you are owning that trick should you think about working on a straight and twisted grip handspring.

Is there a way we can know whether someone is ready to train their twisted grip shoulder mount or Ayesha? Yes there is. And we refer to it in the physio world as screening.

Screening

Screening is the best way to know if your body is able to tolerate the demands of the trick position. Again, there is no injury prevention research on this in the pole world but common sense dictates that if you break down the demands of the movement into anatomical joint positions and muscle actions then you are able to determine the pre-requisites for a twisted grip trick (or any trick for that matter).

So what movements and actions do we require for our twisted grip?

1. Full shoulder flexion (180 degrees)

The amount of shoulder flexion required is actually determined by the trick you’re attempting, however if you do not have full shoulder flexion then you’re not far from ready to attempt these tricks and need to go and work on your active and passive mobility first before proceeding.

(Please note this movement accounts for 60 degrees of upward rotation and elevation of the scapula)

2. Full shoulder internal rotation (90 degrees)

This is also a non-negotiable. To be in a twisted position you ideally require 90 degrees of active shoulder internal rotation in an overhead position. Too frequently this is a movement that people lack prior to commencing twisted grip tricks and ultimately contributes to their shoulder injury.

3. Strong shoulder external rotators (at mid to end of range shoulder flexion)

Our external rotators produce a great deal of force and stability for the shoulder joint in all of our pole tricks. And without these muscles we wouldn’t be able to actively hang off the pole because we would forever be dislocating our shoulder! Eeep!

When our shoulder is placed in an internally rotated position, such as a twisted grip, our external rotators are consequently placed on stretch. Similar to when you bend your knee, you shorten your hamstrings and lengthen your quads. As once muscle contracts, the other stretches.

And when a muscle is placed on stretch it is significantly harder for that muscle to produce force. This places it under considerable levels of strain which can lead to a soft tissue injury. So a twisted grip position makes it slightly easier for the internal rotators of the shoulder to engage and significantly harder for our external rotators to stabilise the joint. This holds true particularly for baby polers who have not undergone the muscular adaptations required (strength and stability) to hold such a challenging position.

As a result, we need to make sure both our external and internal rotators of the shoulder are super strong before trying this position. Particularly our external rotators. If we aren’t able to stop ourselves from ‘hanging’ out of the joint (i.e collapsing into shoulder internal rotation +/- elevation/depression), our passive structures become overloaded in an attempt to maintain shoulder stability. It's this overload that in turn may cause an inflammatory pain response or a structural injury to the surrounding structures.

So how can you test your overhead rotator cuff strength to determine whether you are ready to proceed with training for your twisted grip with your pole instructor?

If you’re not seeing a physio then a simple test is this ‘overhead rotation’ or ‘break the bar’ test. Can you rotate against the band’s resistance to a position of shoulder external rotation without any shoulder discomfort? If yes, then can you comfortably repeat this test x 10 times?

Please note – this test is not fool proof. It is not an accurate representation of testing your whole body mass in an eccentric position for your shoulder external rotators. However it is meant to be an intermediate test as very few positions are able to effectively re-create that load.

If the answer is no you need to see a physio to strengthen very specific muscles first before attempting the twisted grip.

If you experience shoulder discomfort during screening then you are definitely not ready to try this grip and need to seek guidance of a (pole/aerial) physio first. There is a key factor missing for you and a pole physio’s input is key.

Here’s our little flow chart summary of whether you’re ready to train twisty grips with your pole instructor:

Please Note: This is a quick medical screening of whether you’re able to physically perform a twisted grip position. This does not give you clearance to start working on a specific trick such as a shoulder mount, Ayesha or handspring. You may still not be ready for these tricks. Please consult with your instructor so they can provide you with tailored advice.

Are you already a ‘Victim of the Twisty?’

If you are a victim of the twisted grip (i.e past or current injury) and haven’t returned back to this grip out of fear or pain, then take a moment to ask yourself why you haven’t rehabbed your shoulder fully? Or why rehab hasn’t worked for you in the past?

Did you simply rest expecting the pain to resolve but didn't notice an improvement once you returned back to that trick? Or is it that your rehab didn't actually mirror the demands of pole dancing?

Rehab for a pole dancer must involve heavy strengthening of the shoulder through all ranges of motion, so it really does benefit to see a physiotherapist that understands the demands and position of your body in your sport.

And these shoulder injuries are serious injuries that should not be neglected by avoiding that movement. You need to strengthen your shoulder back to normal otherwise it will place you at an even bigger risk of injury down the track in other non-twisted grips. Yes, in non-twisted grips! With the correct TLC and guidance, shoulder injuries can fully rehabilitate.

Which means you can return to all pole movements you love, including twisted grip!

Engage – don’t hang!

One of the main reasons people injure their shoulder in twisted grip is because they lack external rotation strength and hang out of their shoulder as described earlier.

And at risk of sounding silly, you won’t need to rehab an injury if you don’t injure it in the first place. This is why we enjoy injury risk reduction (prevention) strategies so much – it’s easier to treat an injury when you’re not actually injured, and in the process these techniques just make you a stronger and more capable pole dancer.

So this is a reminder to anyone doing pole, you need to engage your shoulders/blades in all grips, but particularly in twisty grip due to the eccentric load of the external rotators.

To engage your shoulder:

1. Elevate your shoulder blade by letting it lift up as you reach. Do not, I repeat do not, pull your shoulder blade back and down.

2. Allow your shoulder blades to rotate away from your body like wings. Your shoulder blades need to upwardly rotate. Locking your shoulder blades down as you load your arm overhead will increase your risk of shoulder injuries.

Instead of pulling down with your shoulder blade to lift your body up the pole, think to pull through your bicep/elbow or think about bringing the pole to you. This changes the narrative for the shoulder blades and stops you from unnecessarily depressing them when they are meant to be elevated overhead.

Want to learn more from our knowledgeable team of physios?

Keep an eye out for the online shoulder workshop that we run, as they will give you the edge and information you need to strengthen for twisted grip along with tips and tricks to reduce your risk of shoulder injury in all grips. Information of these workshops can be found here.

Shoulder injured or wanting tailored guidance and rehabilitation for your twisted grip related injury?

Online telehealth appointments can be booked with the Pole Physio via our ‘Book Online’ page that can be found here. Assessment and tailored rehabilitation are provided in accordance with best practice and evidence-based treatment to help you unleash your 'poletential'.

Until next time, train safe.

The Pole Physio

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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.

References:

• 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