Injury Occurrence and Return to Dance in Professional Ballet: Prospective Analysis of Specific Correlates.
ABSTRACT: Professional ballet is a highly challenging art, but studies have rarely examined factors associated with injury status in ballet professionals. This study aimed to prospectively examine gender-specific correlates of injury occurrence and time-off from injury in professional ballet dancers over a one-year period. The participants were 99 professional ballet dancers (41 males and 58 females). Variables included: (i) predictors: sociodemographic data (age, educational status), ballet-related factors (i.e., experience in ballet, ballet status), cigarette smoking, alcohol drinking, and consumption of illicit drugs; and (ii) outcomes: injury occurrence and time-off from injury. Participants were questioned on predictors at the beginning of the season, while data on outcomes were collected continuously once per month over the study period. Dancers reported total of 196 injuries (1.9 injuries (95% CI: 1.6⁻2.3) per dancer in average), corresponding to 1.4 injuries per 1000 dance-hours (95% CI: 1.1⁻1.7). In females, cigarette smoking was a predictor of injury occurrence in females (OR: 4.33, 95% CI: 1.05⁻17.85). Alcohol drinking was a risk factor for absence from dance in females (OR: 1.29, 95% CI: 1.01⁻4.21) and males (OR: 1.21, 95% CI: 1.05⁻3.41). Less experienced dancers were more absent from dance as a result of injury than their more experienced peers (Mann-Whitney Z: 2.02, p < 0.04). Ballet dancers and their managers should be aware of the findings of this study to make informed decisions on their behavior (dancers) or to initiate specific programs aimed at the prevention of substance use and misuse in this profession (managers).
Project description:In spite of the high rate of overuse injuries in ballet dancers, no studies have investigated the prevalence of overuse injuries in professional dancers by providing specific diagnoses and details on the differences in the injuries sustained as a function of age and/or years of professional practice.Overuse injuries are the most prevalent injuries in ballet dancers. Professional ballet dancers suffer different types of injuries depending on their age and years of professional practice.Descriptive epidemiology study.This descriptive epidemiological study was carried out between January 1, 2005, and October 10, 2010, regarding injuries sustained by professional dancers belonging to the major Spanish ballet companies practicing classical, neoclassical, contemporary, and Spanish dance. The sample was distributed into 3 different groups according to age and years of professional practice. Data were obtained from the specialized medical care the dancers received from the Trauma and Orthopaedic Surgery Service at Fremap in Madrid. The dependent variable was the study of the injury.A total of 486 injuries were identified over the study period, with overuse injuries being the most common etiology (P < .0001); these injuries were especially prevalent in junior professional dancers practicing classical ballet and veteran dancers practicing contemporary ballet (P = .01). Specifically, among other findings, stress fractures of the base of the second metatarsal (P = .03), patellofemoral syndrome, and os trigonum syndrome were more prevalent among junior professionals (P = .04); chondral injury of the knee in senior professionals (P = .04); and cervical disc disease in dancers of intermediate age and level of experience.Overall, overuse injuries were more prevalent in younger professionals, especially in women. This finding was especially true for the more technical ballet disciplines. On the other hand, in the athletic ballet disciplines, overuse lesions occurred mainly in the more senior professionals.This study provides specific clinical diagnoses obtained through physical examination as well as details on the different injury types sustained as a function of age and/or years of professional practice, an important aspect for ballet and sports practice in general.
Project description:Background:Professional dance is a physically demanding career path with a high injury prevalence, yet an ingrained culture of hiding or pushing through injuries. Developing better knowledge surrounding the cultural beliefs and behaviors related to injury reporting is critical to understand their incidence and burden. Therefore, the aim of this study was to investigate injury fear and injury reporting behaviors in professional dancers in Australia. Methods:This study utilized data collected in a cross-sectional survey of professional dancers in Australia. Descriptive analysis of injury fear and reporting stigma are presented with comparisons between subgroups (full-time versus part-time dancers; men versus women) conducted using two-sided Fisher's exact tests. Results:A total of 146 professional dancers were included. Over half (63%) of the respondents reported that they fear sustaining a dance-related injury, that they believe there is still a stigma surrounding injuries in dance (62%), and that this stigma has led to a delay in reporting or seeking care for an injury (51%). A lower proportion of part-time than full-time dancers reported that they would usually tell someone within their dance employment about an injury (35.1% vs. 59.6%, p = 0.006). Conclusion:Professional dancers are at risk of losing contracts or roles if they are injured, and therefore, it is common to dance through their occurrence. Many dancers, particularly those dancing part-time, are unwilling to tell their employers about their injuries. Action is required to improve this culture regarding injury reporting and help seeking for more effective injury understanding, prevention, and management in dance.
Project description:Objectives:The user experience, content and conditions for use of an online dance-health surveillance system (Performing artist and Athlete Health Monitor, PAHM) was examined through a focus group interview with professional ballet dancers. Methods:Nine professional dancers (56% female (n=5), average age=27.56± 5.17) completed biweekly questionnaires using the PAHM, including questions on health problems, injuries, mental complaints and illnesses. After 6?weeks, nine dancers participated in a focus group interview to investigate the user experience, content and conditions for use of the PAHM. Data were analysed using thematic analysis. Results:25 of the 27 questionnaires were completed (response rate of 93%). Dancers were positive about using the PAHM. They recommend to clarifying the questions about pain and injury, expanding items on mental health, including items on workload, sleep, rest and nutrition, and receiving feedback regarding their own results. Dancers were reluctant regarding sharing their personal data with others. Data on an aggregated level can be shared because this might gain insight into the association between scheduling, workload and injury risk. Conclusion:The user experience of the monitor contributes to the willingness of dancers to keep using the PAHM. Dancers recommended adjusting the content in the PAHM to match their dance activities and health problems. The conditions for using the PAHM effectively within a company are a safe and trusting culture. Even though the PAHM alone cannot change the culture in a ballet company, it can play a role in the communication between staff and dancers.
Project description:Introduction:Dance-related injuries have become a field of great interest to researchers, with the most commonly reported injuries being those sustained by ballet dancers. However, there is a lack of research into injuries sustained by those who perform modern and hip-hop dance. Methods:A systematic literature review using the MEDLINE research database was performed and a search carried out for full-text studies that investigate injuries in modern and hip-hop dance. Results:While a total of 74 hits were obtained from various searches, only nine studies were included in the systematic literature review. Six of them examined modern dancers, two examined break dancers and one examined hip-hop dancers. The results show that hip-hop dancers (and especially break dancers) sustain more injuries in comparison to modern dancers. The most common injuries are in the lower extremities, with studies revealing that overuse injuries occur in up to 71% of cases. Conclusions:The injury incidence rate in hip-hop dance seems to be higher compared to modern dance, chiefly because of the more demanding biomechanics involved and the dance techniques employed. Prevention management can have a positive effect on the number of injuries.
Project description:Background:Hamstrings have been analyzed extensively due to their tendency to shorten and their effect in the lumbo-pelvic dynamics and the sagittal position of the spine in trunk flexion with extended knees positions. It has been demonstrated that practicing a certain sport results in long-term changes in hamstring extensibility. Despite this, adequate extensibility of the hamstring musculature is essential for the dancer's performance. Several studies have found differences in the extensibility of the hamstrings depending on the dance style, but none have compared ballet, Spanish dance and modern dance. The purpose of the present research was to analyze the differences in hamstring extensibility among professional dance students based on dance style practiced and non-dancers. Methods:The sample was comprised of 210 students from the Professional Dance Conservatory (70 for ballet, 70 for Spanish dance and 70 for modern dance) and 70 non-dancers. For the assessment of hamstring extensibility, the angle in the passive and active straight leg raise (PSLR and ASLR, respectively) test, and the scores of the pelvic tilt in sit-and-reach (SR) test and the toe-touch (TT) test were randomly conducted. Results:The results showed significant differences for all the tests according to group (p < 0.001). In the PSLR and ASLR test, for both legs, and in the pelvic tilt in the SR test, the ballet dancers showed greater ranges of hamstring extensibility than the modern dancers and Spanish dancers (p ? 0.001). In the distance in the SR test and in the pelvic tilt in the TT test, the ballet dancers obtained higher values than the Spanish dancers (p = 0.004 and p = 0.003, respectively). The modern dancers showed higher ranges of hip flexion than the Spanish dancers in the ASLR test for both legs and in the pelvic tilt in the SR test (p from 0.007 to <0.001). Dancers showed significantly higher hamstring extensibility than non-dancers in all the tests (p < 0.001). Conclusions:The systematic practice of dance, regardless of the style, seems to lead to high ranges of hamstring extensibility. Ballet dancers have the greatest hamstring extensibility.
Project description:Background: The frequent and intensive training and performance of pre-professional ballet dancers and sportspersons is offered at a time when young ballet dancers and young athletes may be vulnerable to injury due to the progress through adolescence and growth spurts. Hypothesis: There are changes in range of motion during the progress through adolescence and growth periods in dancers and sportspersons. These changes in ROM can be linked to the increase of injury. Objectives: The primary aim of this systematic review is to determine whether there are changes in ROM during the progress through adolescence and growth spurts in dancers and sportspersons. The secondary aim is to determine whether these changes can predict the risk of injuries for adolescent dancers and sportspersons. Search strategy: Pubmed, Cochrane Register of Controlled Trails (CENTRAL), Cochrane Database of Systematic Reviews (CDSR), EBSCO Host databases: CINAHL Plus, MEDLINE, SPORTDiscus, Embase were searched using MeSH terms. Manual search in the Journal of Dance Medicine and Science and screening of the reference lists of identified studies and reviews was conducted. Selection criteria: Studies included adolescent dancers and sportspersons, aged 8-18, both sexes, growth spurt related to changes in ROM and injury incidence. Data collection and analysis: Search strategy was performed in the flow diagram of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). Two reviewers independently appraised each included study using Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) for methodological quality of the included studies. For data extraction, the following information was systematically extracted: first author and year of publication, study design, participants (sample size of mean age), age, maturation (if assessed), intervention, outcome(s), and some notes of each study. For evaluation of the risk of bias and precision the Research Triangle Institute Item Bank (RTI-IB) is included. Main results: Seven observational studies met the inclusion criteria of this current review. The results of this review suggest that there are changes in ROM during the progress through adolescence and growth spurts in dancers and sportspersons. These changes may lead to an increase in injury incidence. Conclusion: There is evidence linking to changes in ROM during the progress through adolescence and growth spurts in dancers and sportspersons. These changes in ROM may be related to injury incidence.
Project description:<h4>Background</h4>The unique repetitive nature of ballet dancing, which often involves transgressing endurance limits of anatomical structures, makes dancers prone to injury. The following systematic review aims to assess the effectiveness of physiotherapy interventions in the treatment of injuries in ballet dancers.<h4>Methods</h4>The review was performed in line with the PRISMA statement on preferred reporting items for systematic reviews and meta-analyses. Six electronic databases (PubMed, Ovid Embase, Cochrane, Medline, PEDro, Google Scholar) were queried. The study populations comprised active ballet dancers and/or ballet school attendees with acute and chronic injuries and those with persistent pain. There were no restrictions regarding age, sex, ethnicity or nationality. The Modified McMaster Critical Review Form for quantitative studies was used to assess the methodological quality of the studies reviewed in accordance with the relevant guidelines.<h4>Results</h4>Out of the total of 687 articles subjected to the review, 10 met the inclusion criteria. Diverse physiotherapeutic interventions were described and effectiveness was assessed using different parameters and measurements. Overall, the results indicate that physiotherapy interventions in ballet dancers exert a positive effect on a number of indices, including pain, ROM and functional status.<h4>Conclusions</h4>Due to the small amount of evidence confirming the effectiveness of physiotherapeutic interventions in ballet dancers after injuries and methodological uncertainties, it is recommended to improve the quality of prospective studies.
Project description:By chunking continuous streams of action into ordered, discrete, and meaningful units, event segmentation facilitates motor learning. While expertise in the observed repertoire reduces the frequency of event borders, generalization of this effect to unfamiliar genres of dance and among other sensorimotor experts (musicians, athletes) remains unknown, and was the first aim of this study. Due to significant overlap in visuomotor, language, and memory processing brain networks, the second aim of this study was to investigate whether visually priming expert motor schemas improves memory for words related to one's expertise. A total of 112 participants in six groups (ballet, Bharatanatyam, and "other" dancers, athletes, musicians, and non-experts) segmented a ballet dance, a Bharatanatyam dance, and a non-dance control sequence. To test verbal memory, participants performed a retrieval-induced forgetting task between segmentation blocks. Dance, instrument, and sport word categories were included to probe the second study aim. Results of the event segmentation paradigm clarify that previously-established expert segmentation effects are specific to familiar genres of dance, and do not transfer between different types of experts or to non-dance sequences. Greater recall of dance category words among ballet and Bharatanatyam dancers provides novel evidence for improved verbal memory primed by activating familiar sensorimotor representations.
Project description:<h4>Background</h4>Altered biomechanics from repetitive microtrauma, such as long practice hours in en pointe (tip of the toes) or demi pointe (balls of the feet) predispose ballet dancers to a multitude of musculoskeletal pathologies particularly in the lower extremities. Both ultrasound and magnetic resonance imaging (MRI) are radiation-sparing modalities which can be used to confidently evaluate these injuries, with ultrasound (US) offering the added utility of therapeutic intervention at the same time in experienced hands.<h4>Questions/purposes</h4>The purposes of this paper were: (1) to illustrate the US and MRI features of lower extremity injury patterns in ballet dancers, focusing on pathologies commonly encountered at a single orthopedic hospital; (2) to present complementary roles of both ultrasound and MRI in the evaluation of these injuries whenever possible; (3) to review and present our institutional approach towards therapeutic ultrasound-guided interventions by presenting explicit cases.<h4>Methods</h4>Online searches were performed using the search criteria of "ballet biomechanics" and "ballet injuries." The results were then further narrowed down by limiting articles published in the past 15 years, modality (US and MRI), anatomical region (foot and ankle, hip and knee) and to major radiology, orthopedics, and sports medicine journals.<h4>Results</h4>Performing ballet poses major stress to lower extremities and predisposes dancer to several musculoskeletal injuries. These can be adequately evaluated by both US and MRI. US is useful for evaluating superficial structures such as soft tissues, tendons, and ligaments, particularly in the foot and ankle. MRI provides superior resolution of deeper structures such as joints, bone marrow, and cartilage. In addition, US can be used as a therapeutic tool for providing quick symptomatic improvement in these athletes for who "time is money".<h4>Conclusion</h4>Performing ballet may cause major stress to the lower extremities, predominantly affecting the foot and ankle, followed by the knee and hip. US and MRI play complementary roles in evaluating various orthopedic conditions in ballet dancers, with US allowing for dynamic evaluation and guidance for interventions.
Project description:The aim of this study was to investigate the convergent validity of session rating of perceived exertion (s-RPE) with objective measures of internal training load (TL) in professional classical ballet dancers. Heart rate and s-RPE data were collected in 22 professional classical ballet dancers across a total of 218 ballet class or rehearsal sessions. Eleven participants completed at least 9 sessions, and were therefore included in analyses of individual relationships between s-RPE and objective measures. To calculate s-RPE, the session duration was multiplied by the RPE, measured using the modified Borg CR-10 scale. The Edwards summated heart rate zones (Edwards TRIMP) and Banister training impulse (Banister TRIMP) methods were used as criterion measures of internal TL. Pearson product-moment correlation coefficients were used to determine intra-individual relationships between s-RPE and objective measures. Repeated measures correlations were used to identify intra-individual relationships common across the cohort. Positive linear relationships were seen between s-RPE and objective measures across all session types [Edwards TRIMP: r rm (195) = 0.81, p < 0.001; Banister TRIMP: r rm (195) = 0.79, p < 0.001], in ballet class [Edwards TRIMP: r rm (58) = 0.64, p < 0.001; Banister TRIMP: r rm (58) = 0.59, p < 0.001], and in rehearsals [Edwards TRIMP: r rm (119) = 0.82, p < 0.001; Banister TRIMP: r rm (119) = 0.80, p < 0.001], as well as across both males [Edwards TRIMP: r rm (136) = 0.82, p < 0.001; Banister TRIMP: r rm (136) = 0.80, p < 0.001], and females [Edwards TRIMP: r rm (57) = 0.80, p < 0.001; Banister TRIMP: r rm (57) = 0.78, p < 0.001]. Intra-individual correlation coefficients ranged from 0.46-0.96 [Edwards TRIMP: mean r = 0.81 ± 0.11, p = 0.051 - < 0.001; Banister TRIMP: mean r = 0.78 ± 0.14, p = 0.13- < 0.001]. These results demonstrate that s-RPE is a valid and practical method for measuring internal TL in professional classical ballet dancers.