Dance Injuries Research Articles

Clinical Management of Dance Injuries in a University Setting

Clinical Management of Dance Injuries in a University Setting

11+ Dance: A Neuromuscular Injury Prevention Exercise Program for Dancers

ABSTRACT Epidemiological studies over the past decade indicate high injury prevalence in preprofessional ballet (76%) and professional contemporary and ballet dancers (60–69%). Injuries can have detrimental effects both for the dancers and the dance company. Most injuries are in the lower limb and reported as the gradual onset of overuse. Professional dance companies have reduced injury incidence and severity through the implementation of comprehensive injury audit programs and proactive exercise prescription. Injury prevention research in dance is scarce, and there has been no intervention targeting dance injuries. This article describes the development of 11+ Dance, an injury prevention training program designed for dancers, based on current evidence and best practice on injury prevention in sports. It is a 25–30-minute neuromuscular-based training program focused on strength, balance, and jumping/landing technique, with special attention to ankle, knee, and hip alignment. The high prevalence of injuries reported in the different styles of dance suggests that implementation of an injury prevention program is both the plausible and ethical action to take for all levels of performance.

The Association Between Stress and Injury: A Prospective Cohort Study Among 186 First-Year Contemporary Dance Students

The demanding environment that contemporary dance students are exposed to could result in high stress levels, which can influence injury susceptibility. Therefore, this study aims to investigate the association between stress and injuries. In the period between September 2016 and March 2020, four cohorts of first-year dance students (N = 186; mean age 19.21 ± 1.35 years) were followed for one academic year. Each month, general stress was assessed on a 0–100 visual analogous scale. The Oslo Sports Trauma Research Center Questionnaire on Health Problems was used on a monthly basis to monitor injuries. Injuries were defined as “all injuries” (i.e., any physical complaint irrespective of the need for medical attention or time-loss from dance) and “substantial injuries” (i.e., leading to moderate/severe/complete reductions in training volume or performance). Mann–Whitney tests were performed to measure differences in general stress levels between injured and injury-free students, while repeated-measures ANOVA were performed to investigate whether general stress scores increased before and during injury occurrence. The overall average monthly general stress score over all cohorts for all students was 39.81. The monthly general stress scores ranged from 31.75 to 49.16. Overall, injured and substantially injured students reported higher stress scores than injury-free students, with significant differences in 3 out of the 9 months for all injuries (September, October, March, p < 0.05), and in 5 months for substantial injuries (September, October, November, December, April, p < 0.05). Within the 3-month period before and during injury occurrence, a (marginally) significant linear effect of general stress across the time periods was found for all injuries [F(1.87,216.49) = 3.10, p = 0.051] and substantial injuries [F(2,138) = 4.16, p = 0.018]. The results indicate an association between general stress and injuries. Future research should focus on effects of varying stress levels on injury risk using higher sampling frequency, for instance by measuring weekly since stress levels are likely to fluctuate daily. Practically, strategies aiming at stress reduction might have the potential to reduce the burden of dance injuries and may have positive outcomes for dancers, teachers, schools, and companies.

Prevalence and Risk Factors of Dance Injury During COVID-19: A Cross-Sectional Study From University Students in China.

Objectives: Although coronavirus disease 2019 (COVID-19) has transformed the training environment of dancers worldwide, little is known on how this has affected injury prevalence, causes, and risk factors.Methods: An online investigation involving Chinese full-time dance students was conducted (September–November 2020), which covered two 6-month periods just before and during the first COVID-19 lockdown.Results: 2086 students (19 ± 2.4 years) responded to the investigation. Injury prevalence dropped from 39.6% (before the lockdown) to 16.5% (during the lockdown) (p < 0.01). It was noted that a significant increase in injury severity during the lockdown was caused due to a 4.1% increase in moderate-to-severe injuries (p < 0.05). During the lockdown, the injuries on the lower back, feet, and shoulders decreased significantly (p < 0.01), but the knee, ankle, and groin/hip joint injuries remained the same. Fatigue and the recurrence of an old injury remained as the top two perceived causes of an injury between the two periods with the increase in an unsuitable floor (p < 0.01), a cold environment (p < 0.05), and set/props (p < 0.05). The fatigue degree of students decreased (p < 0.01) and their hours of sleep increased (p < 0.01) during the lockdown. Binary Logistic Regression analysis indicated that dance injury is associated with fatigue, the hours of sleep, and the actions taken if they suspect an injury during the lockdown (p < 0.05), but is only related to the time set aside for a cooldown and age before the lockdown period (p < 0.05).Conclusion: Although injury prevalence dropped significantly during the first COVID-19 lockdown in Chinese dance students, the main dance injury characteristics remained the same. Decreased fatigue and longer hours of sleep could explain the aforementioned drop in injury prevalence during the lockdown.

Association between pre-participation characteristics and risk of injury amongst pre-professional dancers

Study designProspective Cohort Study. BackgroundFew investigations utilize evidence-informed pre-participation evaluation, inclusive injury definitions, and prospective surveillance to identify risk factors for dance-related injuries. ObjectiveTo evaluate pre-participation characteristics that may be associated with greater odds of dance-related musculoskeletal complaints in pre-professional dancers. MethodsFull-time pre-professional ballet [n = 85, 77 females, median (range) age 15-years (11–19)] and contemporary [n = 60, 58 females, 19-years (17–30)] dancers underwent pre-participation evaluation: baseline questionnaire, coping skills, body mass index, bone mineral density, ankle range-of-motion, active standing turnout, lumbopelvic control, and balance tests. Self-reported complaints (any physical problem making dance participation difficult, irrespective of medical attention or time-loss) were captured weekly via online questionnaires for one academic year. Self-reported musculoskeletal complaints were recorded weekly (yes/no). Potential risk factors were identified a-priori through systematic review. Associations between potential risk factors and musculoskeletal complaints were examined with generalized linear mixed method regression models. ResultsResponse rate was 99%, with 81% of dancers reporting at least one musculoskeletal complaint. Of 1521 complaints (19% first-time, 81% ongoing), the ankle (22%), knee (21%), and foot (12%) accounted for the majority. Injury history [odds ratio (OR) 7.37 (95% CI 3.41, 15.91)] and previous week's dance hours [OR 1.02 (1.01, 1.03)] were associated with dance-related musculoskeletal complaints. ConclusionsPrevalence of musculoskeletal complaints amongst pre-professional dancers is high and associated with injury history and training volume. Further understanding of the relationship between training load and injury is needed, with particular consideration of the dynamic and recursive nature of dance injury etiology. Level of EvidenceTherapy / Prevention, Aetiology / Harm, level 2b.

Perceptions of Motivational Climate and Association with Musculoskeletal Injuries in Ballet Dancers.

Sports science has identified the trainer-athlete relationship in the etiology of injuries. We aimed to investigate: 1) the association between empowering (EMC) and disempowering (DMC) motivational-climate and musculoskeletal injuries in ballet, and 2) if EMC moderates the association between DMC and injuries. A cross-sectional cohort survey-study was conducted online among ballet dancers (>18 yrs old) reporting acute and overuse injuries of the previous 2 years. Motivational climate was assessed with the Empowering-and-Disempowering Motivational Climate Questionnaire (5-point Likert scale). The Oslo Sports Trauma Research Centre Overuse Injury Questionnaire assessed severity of overuse injuries. Linear regression was performed adjusted for the confounders age, sex, expertise, experience, and initiation-age with an interaction term between EMC and DMC to assess effect modification. An international sample of 189 dancers (26.7±7.9 yrs; 130 professionals) reported 197 acute and 465 overuse injuries (in the previous 2 years). Mean EMC was 3.1±1.07, DMC 3.3±1.08. EMC was associated with less acute (b=-0.22; 95%CI -0.40 to -0.04) and overuse injuries (b=-0.74; 95%CI -0.99 to -0.50), while DMC was associated with more injuries (acute: b=0.30; 95%CI 0.13 to 0.47; overuse: b=0.74; 95%CI 0.50 to 0.98). When tested together and adjusted for confounders, EMC lost its protective effect (acute: b=-0.15; 95%CI -0.19 to 0.49; overuse: b=-0.34; 95%CI -0.81 to 0.13). DMC was positively associated with injuries throughout all settings (acute: b=0.43; 95%CI 0.10 to 0.76; overuse: b=0.46; 95%CI 0.00 to 0.91). EMC showed no moderating effects on DMC in the adjusted models. To avoid injuries, it is not enough to create an EMC, because any disempowering nuances may negatively affect empowering climates. Teachers should avoid DMC altogether to prevent injuries in dancers.

Diagnosis and Management of Foot and Ankle Injuries in Dancers

Diagnosis and Management of Foot and Ankle Injuries in Dancers

Viewing Injury in Dancers from a Psychological Perspective - A Literature Review.

It has been reported that injury among dancers has a lifetime incidence of 90%, and recent research suggests that up to 60% of those dancers injured will meet the requirements for clinical referral to a psychologist. This study aims to review the existing literature in the field of dance psychology that focuses on psychological antecedents and responses to injury. Several relevant theories in dance psychology are reviewed. From this literature, it is suggested that psychological techniques can be taught in educational settings to equip dance students with the necessary tools to look after their bodies and minds, reduce the risk of injury, and aid in healing existing injuries. Greater emphasis should also be placed on combining physical and psychological support to improve holistic care and treatment of dancers' injuries.

Dance Exposure, Individual Characteristics, and Injury Risk over Five Seasons in a Professional Ballet Company.

This study aimed to describe the relationships between dance exposure, dancer characteristics, and injury risk across five seasons in a professional ballet company. Dance exposure time and clinician-reported time-loss and medical attention injury data were prospectively collected from 118 professional dancers of The Royal Ballet between 2015/2016 and 2019/2020. Cox proportional hazards and shared frailty models were fitted to overuse and traumatic injuries; individualized robust Z-scores for 7- and 28-d accumulated exposure, and week-to-week change in exposure, age, sex, company rank, and injury history were included as time-varying covariates. Across 381,710 h of exposure, 1332 medical attention and 427 time-loss injuries were observed. Positive relationships were observed between week-to-week change in exposure and overuse time-loss (+1 Z-score hazard ratio (HR), 1.27; 95% confidence interval (CI), 1.06-1.53) and medical attention injury risk (+1 Z-score HR, 1.17; 95% CI, 1.06-1.28). A negative relationship was observed between 7-d accumulated exposure and overuse medical attention injury risk (+1 Z-score HR, 0.74; 95% CI, 0.66-0.84). Overuse time-loss injury risk was greater in soloists compared with the corps de ballet (HR, 1.47; 95% CI, 1.01-2.15) and in dancers with a higher previous injury rate (+1 injury per 1000 h HR, 1.06; 95% CI, 1.02-1.10). Only age was associated with traumatic time-loss (+1-yr HR, 1.05; 95% CI, 1.01-1.09) or medical attention injury risk (+1-yr HR, 1.04; 95% CI, 1.01-1.07). Professional ballet companies should implement training principles such as periodization and progression, particularly in the case of senior-ranking dancers, older dancers, and dancers with high rates of previous injury. These findings provide a basis for future prospective investigations into specific causal injury pathways.

Injury Incidence and Severity in Musical Theatre Dance Students: 5-year Prospective Study.

Dance injury research has mainly focused on ballet and modern dance with little data on musical theatre dancers. The purpose was to assess the incidence and severity of injuries in a musical theatre dance college over a 5-year period; 198 pre-professional musical theatre dancers (3 cohorts on a 3-year training course) volunteered for the study; 21 students left the course over the study period. Injury aetiology data were collected by an in-house physiotherapy team. Differences between academic year and sex were analysed using a Poisson distribution model; significant difference was set at p≤0.05. In total, 913 injuries were recorded, and more injuries occurred in academic year 1 than year 2 and 3. Overall injury incidence was 1.46 injuries per 1000 hours (95% CI 1.34, 1.56); incidence significantly decreased between year 1, 2 and 3 (p<0.05). There was no significant sex difference for incidence or severity. Most injuries were classified as overuse (71% female, 67% male). Pre-professional musical theatre dancers report a high proportion of lower limb and overuse injuries comparable to other dance genres. Unlike other studies on pre-professional dancers, injury incidence and severity decreased with academic year, even though workload increased across the course.

Generalized Joint Hypermobility and Injuries: A Prospective Cohort Study of 185 Pre-Professional Contemporary Dancers.

Generalized joint hypermobility (GJH) has been mentioned as one of the factors associated with dance injuries, but the findings are inconclusive. This study aims to investigate whether GJH, based on different Beighton score cut-off points, is a potential risk factor for injuries in pre-professional dancers. Four cohorts of first-year pre-professional dancers (N = 185), mean age 19.1 ± 1.3 years, were screened on musculoskeletal functioning at the start of their academic year. The Beighton score was used to measure GJH. During the academic year, the dancers completed monthly questionnaires about their physical and mental health. Based on the Oslo Sports Trauma Research Centre Questionnaire on Health Problems (OSTRC), three injury definitions were used (i.e., all complaints, substantial injury, and time-loss injury). To examine potential risk factors for injuries, univariate and multivariate regression models were applied. The response rate of monthly completed questionnaires was 90%. The overall mean (SD) Beighton score was 2.8. The 1-year injury incidence proportion was 67.6% (n = 125), 43.2% (n = 80), and 54.6% (n = 101) for all complaint injuries, substantial injuries, and time-loss injuries, respectively. The multivariate analyses showed a significant association between a previous long lasting injury in the past year and the three injury definitions (p < 0.05). Pre-professional contemporary dancers are at high risk for injuries and hypermobility. However, these two variables are not associated with each other. Health professionals should take injury history into account when assessing dance students, because this variable is associated with increased injury risk.

Does the Movement Competency Screen Correlate with Deep Abdominals Activation and Hip Strength for Professional and Pre-professional Dancers?

BackgroundDancers are a unique category of athletes who are frequently injured and experience pain. The primary cause of dance injuries is overuse, which could potentially be prevented. However, literature is scarce regarding validated methods of evaluating the risk of injury in dancers. The Movement Competency Screen (MCS) could potentially fill this gap.Hypothesis/PurposeTo investigate the validity of the Movement Competency Screen (MCS) for dancers by 1) examining the correlation between scores on this functional test and the activation of deep abdominals and hip strength; 2) investigating the correlation between MCS scores and those of the Functional Movement Screen (FMS™).Study DesignCross-sectional study.MethodsA total of 77 pre-professional and professional dancers from ballet and contemporary backgrounds were evaluated. The activation of deep abdominals was evaluated using ultrasound imaging and the hip strength was evaluated using a handheld dynamometer. The FMS™, another tool evaluating fundamental movement competency, was also administered.ResultsThe dancers’ MCS score was correlated with the activation of the transversus abdominis (r=0.239, p=0.036) and the strength of hip abductors (r=0.293, p=0.010), adductors (r=0.267, p=0.019) and external rotators (r=0.249, p=0.029). The MCS score was also correlated with the FMS™ score (r=0.489, p<0.001).ConclusionThis study shows that the MCS score is correlated with deep abdominal activation and hip strength in dancers, as well as with the FMS™ score. These findings provide evidence toward the validation of the MCS in dancers.Levels of EvidenceLevel 2B.

Growth, maturation, and overuse injuries in dance and aesthetic sports: a systematic review

ABSTRACT Overuse injuries are the most prevalent injuries in aesthetic sports, due to the repetitive nature of the training. Evidence of their relationship with growth, maturation, and training load is equivocal. The objective of this study was to investigate the effects of these factors on overuse injuries in dance and aesthetic sports. A database search was conducted using standard methods for article identification, selection, and risk of bias appraisal. The eligibility criteria for inclusion in the study consisted of peer-reviewed articles using any type of study design. Twenty-three studies met the criteria. These studies were cross-sectional in design, focusing on dance, gymnastics and diving. Nineteen studies indicated a positive association between growth, maturation, and overuse injuries and a further 6 reported a positive association with training load. There were inconsistencies in how the included studies accounted for important confounding associations of growth and maturation, in addition to showing high or unclear risk of bias. In conclusion, both the quantity and quality of research available on growth, maturation, and training load in association with overuse injuries in dance and aesthetic sports is lacking. The methodological approaches used, combined with the heterogeneity of the investigated populations, lead to equivocal and thus inconclusive results.

In your shoes: A qualitative study on the perspectives of professional dancers and staff regarding dance injury and its prevention

In your shoes: A qualitative study on the perspectives of professional dancers and staff regarding dance injury and its prevention

Os Joelhos! Os Joelhos! Protective Embodiment and Occasional Injury in Capoeira.

Capoeira, the African-Brazilian dance and martial art has enthusiastic devotees in Britain. Most practitioners are acutely aware of their capoeira embodiment, and have strategies to protect themselves from injury, and ways to seek treatment for any injuries they get. Drawing on data from a long-term ethnography and a set of 32 open-ended interviews with advanced students, the paper explores student strategies to prevent capoeira injuries, and their discoveries of effective remedies to recover from them, before it presents an analysis of their injury narratives using Frank's three-fold typology of illness narratives. The capoeira study therefore adds to the research on sports and dance injuries, and to the intellectual debates on the nature of narrative in research on illness and injury as well as exploring one aspect of the culture of capoeira students in the UK.

Special Anatomy Series

Objective: The objective of this article is to describe ultrasound imaging changes in the lower limb as it moves from the neutral anatomic position to external rotation (ER) position. This includes sonographic differences related to both positional changes and tissue torsion. Methods: Sonographic images were obtained in a 28-year-old healthy elite female highland dancer. Both short- and long-axis sonographic images were obtained with the transducer placed over the structure of interest with the hip in both neutral and externally rotated positions. Cine video was also recorded at each site to assess dynamic imaging changes in real time. Results: Ultrasound evaluation of the lower limb during ER allowed assessment of the appearance of positional change and torsion on the tissues from this movement. At mid-thigh, the vastus lateralis was replaced by the rectus femoris. At distal thigh, the rectus tendon was replaced by the vastus medialis. In mid-leg, the tibialis anterior was replaced by the soleus. At the ankle, the extensor hallucis and tibialis anterior tendons are replaced by the tibia and tibialis posterior tendon. Conclusion: The patterns of change with ER of the hip can be identified with ultrasound in multiple muscles throughout the lower limb. This provides the potential to be used as a tool for assessing appropriate movement patterns for performance and preventing injury in dancers and other athletes who repeatedly perform this maneuver.

Zdravstveni problemi profesionalnih baletskih igrača

Ballet is a professional activity that places risky physical and psycho-emotional demands on the human body. The goal of this study was to evaluate health-related problems among ballet dancers. Within the qualitative study, in-depth interviews were conducted with ballet dancers at the State Ballet of Georgia. Participants' mean age was 23.4 ± 3.5 years, the average BMI - 21.2 ± 2.2. Dancers had spent 9.2 ± 7.4 years studying dancing professionally. On average, they spent 8.5 ± 5.8 hours in class and 16.2 ± 11.6 hours in rehearsal. Most injuries were related to ankle/feet (16%), knee (60%), and neck (13%). Common risk factors for incurring pain and injury included overuse (19%), previous injury (11%), and fatigue (11%). Of the injured dancers, 80% chose to seek medical attention. Mostly, they visited traumatologists (40%) and physiotherapists (30%). The biopsychosocial condition of ballet artists is affected by physical workload, high risk of injuries, as well as constant stress. The result suggests high prevalence and recurrence of dance injuries. Ankle/feet, knee and neck are especially risky topological areas for injuries as particularly big pressure is placed on the feet and ankle joints. The majority of respondents sought advice from medical specialists rather than family physicians. It is necessary to prevent injuries and stress through raising awareness. A team of professionals (family physician, orthopedist, psychologist, nutritionist, endocrinologist, physical therapist, nurse) is needed to prevent injuries. Family doctors should pay more attention to the promotion of a healthy lifestyle during the consultation with ballet dancers.

Injuries in Estonian professional ballet dancers in the 2019/2020 season

The aim of the study was to find the occurrence of musculoskeletal injuries in Estonia professional ballet dancers in the 2019/2020 season. A total of 62 dancers participated in the study, 25 were male and 37 female dancers. This study was a questionnaire-based, which was compiled on similar studies to collect the data among ballet dancers working in Estonia. The study showed that 58% of dancers were injured in the last 12 months. The most common type of dance injury during this period was muscle or tendon strain (33%), followed chronic inflammation (21%) and ankle sprain (20%). The most common injured body site was foot (20%), ankle (18%) and knee joint (10%). The highest number of injuries occurred during rehearsals (44%), classical class (27%), and during performances (16%). More than half of Estonian ballet dancers sustained at least one injury during the last twelve months. The most common types of injury were muscle or tendon strain, chronic inflammation and ankle sprain. The highest number of injuries occurred in the foot, whereas the highest number of injuries occurred during rehearsals.

The science of biomechanics can promote dancers’ injury prevention strategies

Background The most common sports activities leading to menisci injuries are tennis, jogging, gymnastics, and dancing. Menisci injuries in dancers most frequently occur due to rotational forces applied to the knee. Objectives: Since dancers’ movement is of great biomechanical and rehabilitation interest, the purpose of this review is to explore the biomechanical approach of this issue as well as to identify any gap to this process and propose corresponding assessments. A literature review search database of Pubmed, Medline, EMBASE, AMED, Scopus, Google Scholar, and CINAHL was conducted using relevant keywords and phrases. Major Findings: The most common dance movement that can cause meniscus injury, is the grand plié, because of the excessive range of motion combined to compressive forces and axial rotations that occur during the execution of the movement. Conclusions Α complete three-dimensional kinematic assessment of the lower limb joints from dynamic grand pliés or in intermidiate positions of the legs has not been made. Thus, further research has to be done with the use of optoelectronic cameras and force plates, to accurately identify weather excessive knee rotation range of motion or moments could lead in medial or/and lateral meniscus tear during the grand plié.

Health Literacy for Collegiate Dancers: Provision and Perceptions of Health-Related Education in University Dance Programs.

Dancers have unique health issues, including high injury rates and functional, nutritional, and psychological concerns. Thererfore, developing dancers with high health literacy is crucial. This study examines 1. the types of health-related information offered in university dance programs, and 2. the perceptions of dance stakeholders (administrators, faculty, and students) toward health-related education provided to dancers in these programs. Participating stakeholders (N = 104) from 11 countries completed a web-based survey examining health-related offerings for dance students at their instituitions. Eighty-four participants (81%) indicated that health-related information was delivered at their instituition. The most commonly offered topics included functional dance anatomy (N = 82, 98%), recognizing dance injuries and illnesses (N = 66, 79%), and strength and conditioning for dancers (N = 61, 73%). Participants rated recognizing dance injuries and illnesses (N = 72, 69%), basic personal health (N = 70, 67%), and nutrition (N = 68, 65%) as the top three "extremely important" topics, even if these were not offered at their institution. Faculty and administrators reported similar attitudes toward topic importance as those reported by students. Fifty-five respondents (65%) reported textbooks were used to deliver health-related information, and content was also provided via journal articles (N = 58, 69%), organizational web sites (N = 39, 46%), and social media (N = 16, 19%). Reported barriers to providing adequate education included lack of dance faculty expertise to deliver course content (N = 7) and receiving care from practitioners lacking in knowledge of dance medicine (N = 5). Participants generally agreed that making health-related information available was important, and 81% of respondants indicated that it was formally offered at their institution. Variability was noted regarding topics rated "highly important," as compared to which topics were already provided. These findings offer insight into the current status of health-related education provided to dance students and can be used to improve curricula in university dance programs.