Pre-professional Dancers Research Articles

Cross-Cultural Adaptation of the Dance Functional Outcome Survey (DFOS) for Spanish Dancers.

A growing number of research papers regarding Spanish-speaking dancers justifies the need for an adapted Spanish version of the Dance Functional Outcome Survey (DFOS). The objective of this study was to cross-culturally adapt and validate the DFOS for Spanish-speaking dancers. A sample of 127 healthy and injured professional and pre-professional dancers were recruited. Test-retest reliability of DFOS-Sp was examined using intraclass correlation coefficients. Construct validity compared DFOS-Sp to the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) using Pearson correlations. Principal component analysis identified factors and internal-item consistency. Sensitivity was evaluated by generating receiver operating characteristic and area under the curve analyses. A subgroup of 51 injured dancers were followed across three time-points to examine responsiveness using repeated measures analysis of variance. Injured scores were analyzed for floor and ceiling effects. The DFOS-Sp showed high test-retest reliability (ICC2,1 ≥ 0.92). DFOS-Sp scores had moderate construct validity compared with SF-36 physical component summary scores (r ≥ 0.56). Principal component analysis (PCA) supported uni-dimensionality explaining 58% of the variance with high internal consistency (α = 0.91).Area under the curve (AUC) sensitivity values were excellent (AUC ≥ 0.82). There were significant differences across time (p < 0.001), demonstrating responsiveness to change, with no floor or ceiling effects. The DFOS-Sp demonstrated acceptable test-retest reliability and validity in Spanish-speaking dancers, with comparable psychometric performance to the English-language version.

Ultrasound imaging features of the Achilles tendon in dancers. Is there a correlation between the imaging and clinical findings? A cross-sectional study

ObjectivesTo analyze the prevalence of tendon pathology and performance associated in pre-professional classic dancers with no history of Achilles tendon (AT) pain. Design: A cross-sectional study was conducted. ParticipantsTwenty-nine classic ballet dancers without AT pain (58 tendons) were recruited. The tendons were classified (normal, abnormal) using ultrasound imaging (USI). Cross-sectional area (CSA) and thickness of flexor hallucis longus (FHL) muscle were measured using USI. Range of movement (ROM) of the first metatarsophalangeal join, balance test, endurance test and vertical jump were measured (bilaterally) as performance variables. ResultsMore than a half (62%) of the participants had at least one abnormal tendon, with 45% of the dancers in the abnormal group having bilateral abnormalities. Dancers with AT pathology had significantly more years of dancing and number of weekly pointe hours than those with no pathology on US imaging. No significant differences between the groups were identified for the rest of the variables. Dancing years were moderately correlated with AT thickness. ConclusionsAsymptomatic classic dancers had a high incidence of tendon pathology. Increased dancing years was associated with pathology in the AT. Nevertheless, these abnormalities may not affect dance performance.

Fit to Dance Survey: Elements of Lifestyle and Injury Incidence in Chinese Dancers.

The Fit to Dance survey has been conducted using primarily Western participants and has provided foundation data for other studies. The purpose of the current study was to replicate the Fit to Dance 2 survey focusing on features of health and injuries in pre-professional and professional Chinese dancers of different genres. The survey was translated into Chinese with several new and modified questions. The survey was posted online for a 3-month period. A total of 1,040 individuals (82.8% female) completed the questionnaire, including 871 dance students (83.7%) and 169 professional dancers (16.3%), with focus in Chinese folk dance (44.4%), Chinese classical dance (25.6%), ballet (10.2%), and contemporary dance (9.8%). Compared to the Fit to Dance 2 survey, alcohol consumption (29% vs 82%; p<0.01) and smoking (13% vs 21%; p<0.05) were significantly less in Chinese dancers, but a higher percentage reported using weight-reducing eating plans (57% vs 23%; p<0.01) or having psychological issues with food (27% vs 24%; p<0.05). Reported injuries in a 12-month period prior to data collection were significantly lower in Chinese dancers (49% vs 80%; p<0.01). The type of injury (muscle and joint/ligament) and perceived cause of injury (fatigue, overwork, and reoccurrence of an old injury) were the same in both the current and previous survey. Mean injury rate ranged from 4.9 injuries/dancer (contemporary) to 3.4 injuries/dancer (Chinese folk dance), which is comparable to previously reported data on Western dance populations. This report provides the first comprehensive data on the health and injury incidence of Chinese dancers.

Physiological Characteristics of Musical Theatre Performers and the Effect on Cardiorespiratory Demand Whilst Singing and Dancing.

Musical theatre (MT) combines acting, singing, and dancing within a performance. The purpose of the current study was two-fold: 1) to report on the cardiorespiratory fitness of pre-professional MT dancers, and 2) to examine the cardiorespiratory demand of singing whilst dancing. Twenty-one participants (16 females, 5 males; age 20±1.23 yrs; height 169.1±9.24 cm; weight 62.7±10.56) in their final year of pre-professional training volunteered for the study. All participants performed a maximal aerobic capacity test on a treadmill using a portable breath-by-breath gas analyser. Nine participants completed a 4-minute section from Chorus Line twice, singing and dancing and just dancing, in a randomised order whilst wearing the same portable gas analyser. Blood lactate was measured at the end of each trial. Male participants had significantly greater peak oxygen consumption (M vs F, 67.6±2.30 vs 55.6±4.42 mL/kg/min, p<0.001) and anaerobic threshold (% of peak VO2) (54.6±4.04% vs 43.1±3.68%, p<0.001), whilst maximum heart rate and heart rate at anaerobic threshold were similar. The physiological demands of dancing vs singing + dancing were similar, with the exception of the singing + dancing trial having significantly reduced mean breathing frequency and increased lactate (p<0.01). MT dancers' aerobic capacity is greater than that observed in other theatre-based dance genres. The observed breathing frequency and lactate differences in the Chorus Line trails could be due to singing reducing breathing frequency, thereby influencing cardiorespiratory recovery mechanics and subsequently blood lactate levels.

Intra- and Inter-Rater Reliability of a Ballet-based Dance Technique Screening Instrument.

To investigate intra- and inter-rater reliability of a ballet-based Dance Technique Screening Instrument used by physical therapists (PTs) and student PTs (SPTs) with prior dance medicine or dance experience. Ten pre-professional dancers were video-recorded in the sagittal and frontal planes while performing four dance sequences: 1) second position grand plié; 2) développé à la seconde; 3) single-limb passé relevé balance; and 4) jumps in first position. Dance videos and electronic versions of the demographics and scoring forms were provided through a secure online survey to 28 PTs and SPTs who served as raters. Raters reviewed a training video prior to scoring the 10 dancers. Raters were asked to repeat their assessments 1-2 wks later. Intraclass correlations (ICC) were assessed for all-raters, PTs, and SPTs for total and sequence scores. Twenty-eight raters assessed the videos one time. Inter-rater reliability was ICC=0.98 (CI95=0.96-0.99) (all-raters), with PTs and SPTs displaying similar values (ICC=0.96 and 0.96, respectively). Eighteen raters (11 PTs, 7 SPTs) repeated the video analysis. Intra-rater reliability was ICC=0.78 (CI95=0.72-0.83) with PTs ICC=0.81 and SPTs ICC=0.70. Correlations were high for all-raters. SPTs were as reliable as PTs in inter-rater comparisons. PTs exhibited higher intra-rater reliability compared to SPTs. These results substantiate the reliability of a standardized testing instrument to conduct dance technique assessment. Validity of this instrument was demonstrated in a previous study which found dancers with better technique were less likely to sustain injury. The ability to identify technique deficits can guide preventative programs that may reduce injury risk. Level III.

Which of the five classical ballet positions is the most demanding for the dancer’s body? An electromyography-based study to determine muscular activity

The study aimed to determine which of the five classical ballet positions is the most demanding regarding muscular activity, values of external rotation in the hip joints, angular values of foot progression as well as the inclination (tilt) of the pelvis in the sagittal plane. In this cross-sectional study, 14 female pre-professional ballet dancers (aged 11-16) participated. Participants were tasked with the sequential adoption of five classical ballet positions (CP1-CP5). The electromyographic activity of the muscles of the trunk and the lower limb was recorded with surface electrodes. Kinematic data including hip and knee external rotation, foot progression angle and pelvic tilt were collected using a motion capture system. Symmetric positions CP1 and CP2 were not as demanding as asymmetric CP3-CP5. Higher values of hip and foot external rotation without greater muscular effort in CP2 than CP1 was noticed. Considering asymmetric positions, CP3 did not trigger a greater activity of hip or foot muscular groups than CP4 and CP5. CP4 was characterised by the greatest pelvic anterior tilt and the lowest activity of GM in the forward lower limb. In CP5, forward lower limb entailed a higher activity of muscles supporting the foot than in the remaining positions. In terms of biomechanics, the most demanding classical ballet position in pre-professional dancers is CP4, followed by CP5, CP3, CP1 and CP2. This finding can be applied in educational methodology of dancers, figure skaters, synchronized swimmers, acrobatic gymnasts, rhythmic gymnasts or cheerleaders.

Risk Factors for Lower-Extremity Injuries Among Contemporary Dance Students.

To determine whether student characteristics, lower-extremity kinematics, and strength are risk factors for sustaining lower-extremity injuries in preprofessional contemporary dancers. Prospective cohort study. Codarts University of the Arts. Forty-five first-year students of Bachelor Dance and Bachelor Dance Teacher. At the beginning of the academic year, the injury history (only lower-extremity) and student characteristics (age, sex, educational program) were assessed using a questionnaire. Besides, lower-extremity kinematics [single-leg squat (SLS)], strength (countermovement jump) and height and weight (body mass index) were measured during a physical performance test. Substantial lower-extremity injuries during the academic year were defined as any problems leading to moderate or severe reductions in training volume or in performance, or complete inability to participate in dance at least once during follow-up as measured with the Oslo Sports Trauma Research Center (OSTRC) Questionnaire on Health Problems. Injuries were recorded on a monthly basis using a questionnaire. Analyses on leg-level were performed using generalized estimating equations to test the associations between substantial lower-extremity injuries and potential risk factors. The 1-year incidence of lower-extremity injuries was 82.2%. Of these, 51.4% was a substantial lower-extremity injury. Multivariate analyses identified that ankle dorsiflexion during the SLS (OR 1.25; 95% confidence interval, 1.03-1.52) was a risk factor for a substantial lower-extremity injury. The findings indicate that contemporary dance students are at high risk for lower-extremity injuries. Therefore, the identified risk factor (ankle dorsiflexion) should be considered for prevention purposes.

Vertical ground reaction force while performing an Indian classical dance, ldquo;Bharatanatyamrdquo;- A biomechanical study comparing three different surfaces

Introduction: Surface hardness of the dance floor has been implicated as a cause of repetitive strain injuries.The study aims to determine the peak ground reaction forces(GRF) on three different surfaces Wood (WD), Granite (GR) and Rubberised Polyvinyl (PV) Flooring) while performing Bharatanatyam. Methods: Five pre professional dancers performed dance step [Tatta Adavu] and a jump over three different surfaces fixed over two identical force plates. The Peak GRF forces during the dance step from the right lower limb was acquired. Analysis was done with one-way ANOVA for three independent groups p-value (0.05). Conclusion: A non-resilient surface and an elastic surface both produce higher impact forces while performing dance steps. Hence, selecting an ideal surface for dance is imperative to avoid injuries.

QUALITATIVE ASSESSMENT OF A SEQUENCE OF “ALLEGRO” IN CLASSICAL BALLET DANCERS WITH DIFFERENT TECHNICAL LEVEL

Since training of professional classical ballet dancers is primarily focused on the aesthetic component of performance there is a necessity to assess its qualitative aspects. This study aimed to investigate whether the Performance Competence Evaluation Measure (PCEM) adapted version for classical ballet can be a valid and useful tool: 1) to assess the performance of an “Allegro” sequence; 2) to discriminate between different levels of dancers’ experience. Twenty-four female classical ballet dancers divided in two subgroups [Ballet students (n = 12) and Pre-professional dancers (n = 12)] were recruited to perform a 70 seconds sequence of “Allegro” specifically choreographed. Each performance was assessed by three very experienced judges, which scores were based on a Likert scale (ranging from 1 to 5) to evaluate the following four parameters: 1) Full Body Involvement (FBI); 2) Body Integration and Connectedness (BIC); 3) Articulation of Body Segments (ABS); 4) Movement Skills (MS). The inter-rater reliability values were ranging from good (between 0.6 and 0.8) and very good (over 0.8) for all parameters, while the test-retest reliability showed a very good agreement for all parameters. The Allegro is a dance sequence with greater dynamism that better highlights differences of execution between dancers with different technical levels and the Mann-Whitney test showed significant differences for all parameters (P=0.001) with lower values for the ballet students. In conclusion, the PCEM adapted version for classical ballet showed to be a valid tool: 1) to assess the performance of Allegro; 2) to discriminate between different dancers’ level of experience.

An Exploration of Pre-Professional Dancers' Beliefs of the Low Back and Dance-Specific Low Back Movements.

Low back pain (LBP) is common in dancers. A biopsychosocial model should be considered in the aetiology of LBP, including a dancer's general beliefs of the low back and movements of the spine. This study aimed to determine pre-professional dancers' beliefs about their lower back in general and dance-specific movements of the spine and to explore whether these beliefs were influenced by a history of disabling LBP. 52 pre-professional female dancers (mean age 18.3 [1.4] yrs) were recruited and reported whether they had a history of disabling LBP and completed the Back Pain Attitudes Questionnaire (Back-PAQ) and a dance movement beliefs questionnaire. A linear mixed model was applied to determine the effect of a history of disabling LBP on dancers' beliefs (p<0.05). 20 dancers reported a history of disabling LBP. Regardless of this LBP history, dancers held generally negative beliefs as measured by the Back-PAQ (p=0.130). A history of disabling LBP did not influence dancers' perceived movement safety of all tasks (p=0.867), and dancers held negative beliefs towards extension activities. These beliefs were linked to the conceptions of perceived risk of damage and the need to protect the lower back. Dancers hold negative general beliefs around the low back and low back movements, regardless of a history of disabling LBP. Dancers perceive extension activities as more dangerous than flexion activities. These beliefs may reflect a combination of pain experience and beliefs specific to dance.

Increased Female Athlete Triad Knowledge Following a Brief Video Educational Intervention

To assess female high school athletes’ changes in Female Athlete Triad (Triad) knowledge following a brief educational intervention.Triad knowledge questionnaires were completed by female high school athletes before and after either an educational video intervention or control group activities.Four high schools in the Pacific Northwest.Ninety-three female high school athletes (15.9±1.2 years) participating in basketball, cheerleading, track & field, softball, soccer, golf, tennis, and volleyball.The 10-minute Social Cognitive Theory-based educational video highlighted Triad etiology, progression, impact on sports performance, and fueling strategies to decrease Triad risk.Triad knowledge score out of 7; proportion of participants who correctly answered each question.Mann-Whitney U tests assessed differences in pre and post intervention Triad knowledge scores between the control and intervention group. The McNemar test compared the proportion of participants (intervention group) who correctly answered individual Triad knowledge questions pre vs. post-intervention.Participants in the intervention group achieved greater increases in Triad knowledge following the intervention, than did control participants (P<0.001). For each Triad question, improvements in the proportion of participants (intervention group) who answered correctly was observed (P<0.05).The Triad educational video was an effective and timeefficient method for increasing Triad knowledge among female high school athletes.

Bone mineral density in adolescent elite ballet dancers.

Data documenting BMD in pre-professional adolescent ballet dancers is limited. This cross-sectional study assesses bone mineral density (BMD) in young adolescent elite ballet dancers and compares BMD values between males and females (with and without normal menarche) and body composition between dancers with and without low Z-score. Cross-sectional study of third year ballet students (female=23; male=15; mean age 14.7 years; SD: 0.5) of The Royal Ballet School of Antwerp (Belgium) training 22 hours a week. They completed questionnaires and underwent dual energy X-ray absorptiometry (DXA) to measure BMD and body composition. Each female participant completed questionnaires assessing menstrual status. DXA revealed that 12 out of 38 (32%) of the dancers had Z-score <-1. On average, male dancers had a lower BMD compared to an age-matched reference population (mean Z-score -0.9; SD 0.5), with 7 out of 15 having Z-score <-1. Overall, absolute BMD values were highest in the legs, followed by spine and arms. Dancers with Z-score <-1 had a significantly lower total mass. 43% of female ballet dancers had not yet had their first period and 39% had oligomenorrhea, but no significant differences between groups was detected. A third of adolescent elite ballet dancers had low to very low Z-score. Nearly 2 out of 3 dancers with a Z-score <-1 were males, showing that low BMD is not limited to female dancers. Among female dancers menstrual dysfunction was frequent, without apparent impact on BMD or body composition in the studied age group.

Multi-segment spine range of motion in dancers with and without recent low back pain

BackgroundAltered spine kinematics are a common in people with LBP. This may be especially true for populations such as dancers, who are required to perform repetitive movements of the spine, although this remains unclear. Research questionDo dancers with recent LBP display altered spine kinematics compared to their asymptomatic counterparts? MethodsA cross-sectional study of multi-segment spine kinematics was performed. Forty-seven pre-professional and professional female dancers either with LBP in the past two months (n = 26) or no LBP in the past 12 months (n = 21) participated. Range of motion (ROM) during standing side bending, seated rotation, and walking gait were compared. ResultsFemale dancers with LBP displayed reduced upper lumbar transverse plane ROM in seated rotation (Effect Size (ES)= −0.61, 95% Confidence Interval (CI): −1.20, 0.02, p = 0.04), as well as reduced lower lumbar transverse plane ROM (ES=−0.65, 95% CI: −1.24, −0.06, p = 0.03) in gait. However, there was increased lower thoracic transverse plane ROM (ES = 0.62, 95% CI: 0.04, 1.21, p = 0.04) during gait. No differences in the frontal plane were observed. SignificanceAltered transverse plane spine kinematics were evident in dancers with recent LBP for select segments and tasks. This may reflect a protective movement strategy. However, as the effect sizes of observed differences were moderate, and the total number of differences between groups was small, collectively, it seems only subtle differences in spine kinematics differentiate dancers with LBP to dancers without.

The role of prediagnostic data in injury epidemiology in preprofessional dancers.

preprofessional dance training starts at very early ages, on a highly demanding environment placing students at significant risk for injury. Injury management and prevention are a matter of concern. Given the constant interchangeability of risk factors, identifying injury patterns may prove to be equally as important. Data looking back from the time of injury through context-specific approaches are missing. To identify activity-related injury patterns based on prediagnostic data. Prospective, non-randomized, observational study, over a 3years period on a full-time preprofessional dance school featuring both gender students aged 9-21years old. Non-parametric statistics were used. A total of 625 dance injury records from 209 students, n=68 males and n=141 females, were analyzed. Season injury risk probability was identified, proving different for each skill level (SkL). Multiple individual injuries revealed a trend toward prevalence rates in advanced level, while index injuries incidence becomes more noticeable in entry level students. Overall incidence rates had no significant differences within SkL. Anatomical location was in line with previous research, although differences were found between gender and SkL. Most injuries occurred in classes, with jumps standing out as the main motor action associated with injury symptoms of gradual onset mechanism. Dance injuries happen because of dance practice. Knowing the context of injury history from the injured dancer perspective is determinant for management and prevention. prediagnostic data are an umbrella term encompassing several aspects of injury background and represents fertile ground for research. Context-specific methodological approaches are recommended.

SU139GENOME-WIDE ASSOCIATION ANALYSIS OF LIFETIME CANNABIS USE (N=184,765) IDENTIFIES NEW RISK LOCI, GENETIC OVERLAP WITH MENTAL HEALTH, AND A CAUSAL INFLUENCE OF SCHIZOPHRENIA ON CANNABIS USE

The motor system’s natural tendency is to move the limbs over equal amplitudes, for example in walking. However, in many situations in which people must perform complex movements, a certain degree of amplitude differentiation of the limbs is required. Visual and haptic feedback have recently been shown to facilitate such independence of limb movements. However, it is unknown whether motor expertise moderates the extent to which individuals are able to differentiate the amplitudes of their limb-movements while being supported with visual and haptic feedback. To answer this question 14 pre-professional dancers were compared to 14 non-dancers on simultaneously generating a small displacement with one foot, and a larger one with the other foot, in four different feedback conditions. In two conditions, haptic guidance was offered, either in a passive or active mode. In the other two conditions, veridical and enhanced visual feedback were provided. Surprisingly, no group differences were found regarding the degree to which the visual or haptic feedback assisted the generation of the different target amplitudes of the feet (mean amplitude difference between the feet). The correlation between the displacements of the feet and the standard deviation of the continuous relative phase between the feet, reflecting the degree of independence of the feet movements, also failed to show between-group differences. Sample entropy measures, indicating the predictability of the foot movements, did show a group difference. In the haptically-assisted conditions, the dancers demonstrated more predictable coordination patterns than the non-dancers as reflected by lower sample entropy values whereas the reverse was true in the visual-feedback conditions. The results demonstrate that motor expertise does not moderate the extent to which haptic tracking facilitates the differentiation of the amplitudes of the lower limb movements in an asymmetrical bipedal coordination task.

Dance Functional Outcome Survey: Development and Preliminary Analyses.

The Dance Functional Outcome Survey (DFOS) was developed as a self-report questionnaire for healthy and injured ballet and modern dancers, focusing on the low back and lower extremities. Our aim was to determine factor analysis and internal consistency of the 16 items and to investigate test-retest and equivalence reliability and validity of the DFOS compared to three orthopedic outcomes instruments. Data were collected from 80 healthy and injured adult ballet and modern pre-professional and professional dancers. DFOS Likert-type and visual analog scales were completed twice within 4–9 days to study test-retest reliability. The Cincinnati Knee Rating System, Olerud and Molander Foot-Ankle Questionnaire, and Oswestry Disability Index were used to assess concurrent validity using intraclass correlation coefficients in SPSS, p<0.05. To determine instrument dimensions and internal consistency of the items, we conducted exploratory factor analysis and calculated Cronbach’s α in JASP. DFOS demonstrated single factor loading and high Cronbach’s α; high test-retest repeatability and equivalence reliability ( r =0.74–0.99) and acceptable criterion validity compared to the orthopedic outcomes instruments (r≥0.67). These results support further study of a revised 14 item Likert-version DFOS for repeatability, validity and responsiveness.

Pre-professional dancers’ beliefs about the lower back and perceptions of safety during dance movements

Pre-professional dancers’ beliefs about the lower back and perceptions of safety during dance movements

How does ballet training alter ankle tendinous morphology and hemodynamics in asymptomatic pre-professional dancers? An ultrasonographic study

ObjectivesAmong symptomatic dancers, sonographic abnormalities are common. Whether asymptomatic dancers have any abnormalities remains unknown. Some dancers became cyanosis over distal feet after ballet training. The hemodynamic changes at the feet in ballet are not clearly understood. DesignCross-sectional study. MethodsIn 25 dancers and 14 non-dancers, B-mode ultrasonography was used to measure cross-sectional areas (CSA) of tendons of deep posterior compartment muscles. Doppler ultrasonography was used to measure peak velocity (Vpeak) of posterior tibial artery in three ankle postures: the neutral position, passively and forced actively plantar flexion (en pointe). The big toe oxygen saturation was recorded in neutral position and during 1-min en pointe. Single-leg standing heel rise test was performed to represent the muscle function. ResultsThe CSA of FHL was larger in dancers (0.26cm2 [0.20, 0.30] vs 0.21cm2 [0.17, 0.24], p<0.01), while other tendons were not different (all p>0.05). Higher Vpeak was recorded in passively plantar flexion than in neutral position (p<0.01, in both groups). The blood flow was undetectable during en pointe, more frequently in dancers (54.9% vs 14.3%, p<0.01). Oxygen saturation decreased during en pointe more prominently in dancers (85% [80, 90] vs 94% [84, 97], p<0.01). There was no significant difference in muscle function. ConclusionsUS showed the FHL tendon thickening and en pointe-related vascular compromise in pre-professional dancers, even when they are asymptomatic.

How does ballet alter ankle tendinous morphology and hemodynamics in asymptomatic dancers? An ultrasonographic study

Among symptomatic dancers, sonographic abnormalities are common. Whether asymptomatic dancers have any abnormalities remains unknown. Some dancers became cyanosis over distal feet after ballet training. The hemodynamic changes at the feet in ballet are not clearly understood. We aimed to investigate tendon morphology and hemodynamic changes in ankles of asymptomatic pre-professional ballet dancers with ultrasonography (US). In 25 dancers and 14 non-dancers, B-mode US was used to measure cross-sectional areas (CSA) of flexor tendons in the ankle. Doppler US was used to measure peak velocity of posterior tibial artery in three ankle postures: the neutral position, passively and forced actively plantar flexion (en pointe). The big toe oxygen saturation was recorded in neutral position and during 1-minute en pointe. Nonparametric Mann–Whitney test was used for between-group comparison and Wilcoxon signed-rank test for within-group comparison. Ankle plantar flexion range of motion was significantly larger in dancers ( P < 0.01). The flexor hallucis longus (FHL) tendon CSA was larger in dancers (0.26 cm 2 [0.2, 0.3] vs. 0.21 cm 2 [0.17, 0.24], P < 0.01), while other flexor tendons were not different between two groups (all P > 0.05). The peak velocity was significantly higher in passively plantar flexion than in neutral position ( P < 0.01, in both groups). The blood flow was undetectable during en pointe, more frequently in dancers (54.9% vs. 14.3%, P < 0.01). Oxygen saturation decreased during en pointe more prominently in dancers (85% [80,90] vs. 94% [84,97], P < 0.01). Ankle hypermobility and the FHL muscle contraction may decrease the blood flow of posterior tibial artery, more frequently in ballet dancers. US showed the FHL tendon thickening and en pointe-related vascular compromise in pre-professional dancers, even when they were asymptomatic.

Shame and Anxiety: The Mediating Role of Childhood Adversity in Dancers.

The combination of shame, anxiety, and a history of childhood maltreatment can have devastating effects on self-esteem and on the morbidity and mortality of an individual. Shame is a natural emotion evoked in social evaluative settings. Without some degree of shame, goal attainment is less likely. However, high levels of shame may increase pathology and decrease performance. In this crosssectional study, pre-professional and professional dancers were divided into two shame groupings: low (N = 193) and high (N = 25). Chi square and multivariate analyses of covariance (age and gender as covariates) were conducted to determine group differences for cumulative adverse childhood experiences (ACEs), anxiety, self-esteem, and shame factors. The high shame group had a greater distribution of childhood adversity (especially emotional, physical and sexual abuse, and emotional neglect). They also had clinical levels of anxiety and low self-esteem. In the path analyses, the causal model demonstrated that childhood adversity had a direct effect on anxiety and shame and an indirect effect on self-esteem. Shame and anxiety had a direct effect on self-esteem. Helping dancers become resistant to shame may decrease anxiety and buffer the effects of a history of childhood adversity. As internalized shame decreases, dancers may enhance their self-esteem, wellbeing, and ability to pursue and achieve their career goals.