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

Development and Feasibility of an Adolescent Dancer Screen

Background

Adolescent dancers are at high risk for injuries due to the physical demands of dance training and the physiological changes that occur during adolescence. Though studies report high injury rates, there are few standardized screening tools available for adolescent dancers.

Hypothesis/Purpose

To develop and describe a standardized, feasible, evidence-based, and clinically relevant screen for adolescent dancers.

Study Design

Descriptive Epidemiology Study.

Methods

Dancers at two suburban pre-professional dance studios, in two cohorts, participated in the Columbia Adolescent Dancer Screen (CADS) that includes dance injury history, health questionnaires (EAT-26, SF-36, DFOS), aerobic capacity, range of motion, strength, balance/orthopedic special tests, and dance technique. Participants were asked to complete a weekly injury surveillance questionnaire derived from the Dance-Specific Oslo Sports Trauma Research Centre Questionnaire on Health Problems for 14 weeks following the screening. Feasibility was assessed using process and content analysis in four areas: practicality, demand, implementation, and adaptation.

Results

Descriptive data were collected from 32 female dancers aged 11-17 with cohort one averaging 18.57 dance hours per week and cohort two averaging 10.6 dance hours per week. The screen was practical, able to screen seven to eight dancers per hour utilizing nine assessors and requiring a one-hour commitment from dancers. Cost and space requirements were considered and kept to a minimum while utilizing portable equipment. All screening slots were filled with all dancers agreeing to follow-up injury surveillance, indicating high demand. The screen was implemented with two cohorts with revisions to improve efficiency applied for the second cohort.

Conclusion

The CADS is a feasible screening tool for adolescent dancers that overcomes barriers by being pragmatic, evidence-based, and efficient. Screening can be implemented to obtain baseline values, inform wellness recommendations, and establish relationships with medical professionals.

Level of Evidence

Level 3b.

Injury incidence and severity in Chinese pre-professional dancers: A prospective weekly monitoring survey

OBJECTIVES

To determine dance injury incidence and severity in full-time Chinese pre-professional dancers.

STUDY DESIGN

Prospective weekly online monitoring survey.

METHODS

Respondents were asked to record all dance-injury incidences between September 2020 and July 2021 using a remote weekly self-report injury monitoring tool. An inclusive definition of injury was used in this study to record all injuries, even if they didn't cause a cessation of training. Data were excluded if respondents completed <90 % of the survey period and had over 3 consecutive weeks of missing data.

RESULTS

450 individuals from 11 different schools were included in the analyses. A total of 1157 injuries were reported over a 30-week academic year. Injury prevalence was 64.9 % and injury incidence was 5.51 injuries per 1000 h. Forty-eight percent of the injuries were minor severity and 41 % were of moderate severity, and the main injury sites were knees (0.89/1000 h), lower back (0.80/1000 h), feet (0.58/1000 h) and groin (0.56/1000 h). Female dancers reported significantly higher injury prevalence and injury incidence, and higher rates of moderate to severe injuries than males. The university group reported higher injury incidence than the adolescent group (p < 0.05), whereas the latter reported higher rates of moderate to severe injuries than the former (p < 0.001).

CONCLUSIONS

The injury incidence found in this study (5.1 injuries/1000 h) is higher than most previous sets of data. Female dancers are at a higher risk of injury and reported higher levels of injury severity than male dancers, especially for the female adolescent group.

Weighting of visual and auditory inputs in dancers with and without previous ankle injury

Elite dance requires highly controlled balance performance in dynamic visual and auditory environments characterized by the use of stage lighting and music. Perturbing visual input is known to influence balance in dancers, but the effects of sounds have not been clearly established. Ankle inversion injuries are common in dancers and may also play a role in dancers' ability to respond to sensory perturbations. The aims of this study were to identify changes in static balance in response to visual or auditory perturbation in elite collegiate dancers with and without a history of ankle injury, and to describe coupling of measurements obtained from the waist and head during balance. Thirty-seven dancers: 22 controls and 15 with a history of ankle sprain, performed single-leg balance under static and dynamic visual and auditory conditions. Dancers demonstrated increased waist sway when viewing a dynamic visual scene and when presented with moving sounds and increased head sway with dynamic visuals. These results did not vary by history of ankle sprain. While dancers appear to dampen the impact of waist sway on head motion during single leg stance, even highly trained dancers may experience challenges controlling balance under perturbing visual and auditory conditions like those present during stage performance.

Relationships Between Common Preseason Screening Measures and Dance-Related Injuries in Preprofessional Ballet Dancers

OBJECTIVE: To examine modifiable and nonmodifiable factors for associations with dance-related injury among preprofessional ballet dancers over 5 academic years. DESIGN: Prospective cohort study. METHODS: Full-time preprofessional ballet dancers (n = 452; 399 female; median age [range], 15 years [11-21]) participated across 5 academic years at a vocational school. Participants completed baseline screening and online weekly injury questionnaires including dance exposure (hours/week). Zero-inflated Poisson regression models were used to examine associations between potential risk factors measured at baseline and self-reported dance-related injury. RESULTS: In count model coefficients, left one leg standing score (log coefficient estimate, -0.249 [95% CI: -0.478, -0.02]; P = .033) and right unipedal dynamic balance time (log coefficient estimate, -0.0294 [95% CI: -0.048, -0.01]; P>.001) carried a protective effect with increased years of training when adjusted for Athletic Coping Skills Inventory (ACSI) score. A significant association was found for left unipedal dynamic balance time and dance-related injury (log coefficient estimate, 0.013 [95% CI: 0.000, 0.026]; P = .045) when adjusted for years of training and ACSI score. There were no significant associations between dance-related injury and ankle and hip range of motion, active straight leg raise, or Y Balance Test measures. CONCLUSION: When adjusted for years of previous dance training and psychological coping skills, there was a significant association between limb-specific lumbopelvic control and dynamic balance tasks, as well as self-reported dance-related injury in preprofessional ballet. J Orthop Sports Phys Ther 2023;53(11):703-711. Epub 3 October 2023. doi:10.2519/jospt.2023.11835.

Descriptive Analysis of Mental and Physical Wellness in Collegiate Dancers

INTRODUCTION

Understanding the physical and mental health of collegiate dancers is important for developing appropriate screening protocols and treatment interventions. This study aims to provide descriptive data on the overall health, injury burden, and well-being of a group of collegiate dancers, including the interactions between injury, nutrition, and mental health, to provide insight for wellness screening and interventions in collegiate dance programs.

METHODS

Members of the School of Dance at the University of Utah were sent an electronic general health survey. The survey included questions regarding medical history, family history, injuries, diet, sleep quality, symptoms of depression and anxiety, and history of eating disorders.

RESULTS

Of the 231 dancers who received the survey, 198 responded (response rate = 85.7%). Fifty 2% of respondents had an active injury. Symptoms of depression and anxiety were common (35.4%), and 37.4% of the dancers were interested in receiving mental health support. Symptoms of depression and anxiety had a significant association with both a history of injury and active injuries (P = .033 and .039, respectively). History of eating disorder was also significantly associated with active injuries (P = .005). The most commonly injured body area was ankle or foot (n = 144, 72.7%), followed by lower leg or shin (n = 76, 38.4%), and knee (n = 61, 30.8%). Over a quarter of the dancers (n = 54, 27.3%) reported having trouble sleeping, and 9.1% reported having a history of eating disorder.

CONCLUSIONS

This study highlights the important interplay between mental health, sleep, nutrition, and injury. These results show that in a group of collegiate dancers, active injuries and mental health concerns are common, and that there are statistically significant associations between injury, nutrition, and mental health. These data provide insight into factors that affect dancer wellness and help inform future screening and intervention protocols for dance programs.