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Robson K, Pope R, Orr R. Incidence and Risk Factors for Acute Articular Cartilage Tears in Military and Other Occupational Settings: A Systematic Review. Healthcare (Basel) 2024; 12:595. [PMID: 38470706 PMCID: PMC10931416 DOI: 10.3390/healthcare12050595] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2024] [Revised: 02/27/2024] [Accepted: 03/04/2024] [Indexed: 03/14/2024] Open
Abstract
Damage to the articular cartilage resulting in an acute tear can lead to functional changes within the joint and increase the risk of osteoarthritis developing. There is limited understanding of the association between occupational risk factors and sustaining an acute articular cartilage tear in the military and other physically demanding occupations. Therefore, the aim of this systematic review was to identify and evaluate original research reporting on occupational risk factors associated with sustaining acute articular cartilage tears. METHODS A systematic review following the Preferred Reporting Items for Systematic review and Meta-Analysis-Protocols was conducted and registered with the Open Science Framework. Key academic databases were searched using terms from the following concepts: risk or cause, paid occupations, and acute articular cartilage tears. RESULTS Of an initial 941 studies, 2 studies met the eligibility criteria, both reporting data from military contexts; only one evaluated acute articular cartilage tears in both males and females. One paper focused on articular cartilage injury within the knee and the other within the ankle joint with incidence rates being 0.2 and 0.3 per 1000 person-years, respectively. People in more physically active occupations and individuals with an above-normal body mass index were reported as being at higher risk of sustaining an acute articular cartilage tear. CONCLUSION Physically demanding occupations, such as the military, may increase the risk for acute tears of the articular cartilage. However, the findings of this review indicate there is a paucity of research to underpin understanding of the injury mechanisms and occupational risk factors for acute articular cartilage tears.
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Affiliation(s)
- Kristy Robson
- Three Rivers Department of Rural Health, Charles Sturt University, Albury, NSW 2640, Australia
| | - Rodney Pope
- School of Allied Health, Exercise and Sports Sciences, Charles Sturt University, Albury, NSW 2640, Australia;
| | - Robin Orr
- Tactical Research Unit, Bond University, Robina, QLD 4226, Australia;
- Faculty of Health Science and Medicine, Bond University, Robina, QLD 4226, Australia
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Drysdale L, Gomes Z, Toohey L, Pumpa K, Newman P. Musculoskeletal Injury in an Australian Professional Ballet Company, 2018-2021: 953 Medical-Attention and 706 Time-Loss Injuries Over 4 Years. J Orthop Sports Phys Ther 2023; 53:712-722. [PMID: 37707788 DOI: 10.2519/jospt.2023.11858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/15/2023]
Abstract
OBJECTIVES: To describe the incidence rate, frequency, severity, recurrence, and burden of musculoskeletal injury in professional ballet. STUDY DESIGN: Descriptive epidemiological (retrospective). METHODS: Professional dancers (n = 73, 40 females, 33 males) provided consent for retrospective review of musculoskeletal injury data. Medical-attention injuries were reported to and recorded by onsite physiotherapists between January 2018 and December 2021. Time-loss injuries were any injury that prevented a dancer from taking a full part in all dance-related activities for >1 day. Injuries were classified using the OSICS-10.1 system. Injury incidence rates (IIRs; injuries/1000 h), severity, recurrence, and burden were calculated. RESULTS: Nine hundred and fifty-three medical-attention injuries were recorded in 72 (98%) dancers at an IIR of 2.79/1000 h (95% confidence interval [CI], 2.62-2.98). 706 were time-loss injuries, which were reported in 70 dancers at an IIR of 2.07/1000 h (95% CI: 1.92, 2.23). Overuse injuries represented 53% of medical-attention injuries. The most frequently injured body area and tissue/pathology were thoracic facet joint (n = 63/953, 7%) and ankle synovitis/impingement (n = 62/953, 6%). Bone stress injuries (BSIs) were the most severe with the highest median time loss (135 days, interquartile range [IQR] 181) followed by fractures (72.5 days, IQR 132). The injuries with the highest burden were tibial BSIs (13 days lost/1000 h; 95% CI: 13, 14). Jumping and lifting were the most frequently reported injury mechanisms. CONCLUSION: Almost all dancers required medical attention for at least one injury during the surveillance period. Approximately 74% of injuries resulted in time loss. BSIs and ankle synovitis/impingement were of high burden, and a high proportion of BSIs were recurrent. J Orthop Sports Phys Ther 2023;53(11):712-722. Epub 14 September 2023. doi:10.2519/jospt.2023.11858.
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Miranda Boson K, Couret AF, Bretas AC, Bolling C, Marques Andrade C. Don't stop me now: A qualitative study of how Brazilian dancers and staff perceive injury and its prevention. Phys Ther Sport 2023; 62:46-57. [PMID: 37327730 DOI: 10.1016/j.ptsp.2023.05.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Revised: 05/20/2023] [Accepted: 05/23/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVE To investigate how Brazilian dancers and dance staff perceive and deal with injury and its prevention in professional and non-professional contexts. DESIGN Qualitative study. SETTING Semi-structured interviews conducted using an online platform. PARTICIPANTS Thirteen participants (8 women, 5 men) from four different dance styles (classical ballet, jazz, contemporary and urban): 6 dancers, 6 staff and 1 classified as both. MAIN OUTCOME MEASURES Interviews were recorded, transcribed and analyzed based on Grounded Theory principles using comparative data analysis. RESULTS The main themes and findings were: 1) Injury definition: Injury was defined and classified based on pain, structural damage and consequent limitations and restrictions. 2) Dealing with injury: Dancers' fear of having to stop dancing justifies different behaviours facing injury. 3) Injury factors: Overload and many personal and environmental factors were perceived as related to injury. 4) Injury prevention: it is linked with physical preparation and additional measures and influenced by communication, trust, experience, time, access to preventive programs, dancers' personalities and environmental factors. Responsibility for injury prevention should be shared by all stakeholders. CONCLUSIONS To improve injury prevention, we need to acknowledge the dancers' drive to keep dancing, consider the multiple factors that influence their behaviours, and develop education and self-efficacy to help them make better decisions to reduce the risk of injury.
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Affiliation(s)
- Karina Miranda Boson
- Faculdade Ciências Médicas de Minas Gerais, Alameda Ezequiel Dias 275, Centro, Belo Horizonte, Minas Gerais, Brazil.
| | - Ana Flávia Couret
- Faculdade Ciências Médicas de Minas Gerais, Alameda Ezequiel Dias 275, Centro, Belo Horizonte, Minas Gerais, Brazil.
| | - Ana Clara Bretas
- Faculdade Ciências Médicas de Minas Gerais, Alameda Ezequiel Dias 275, Centro, Belo Horizonte, Minas Gerais, Brazil.
| | - Caroline Bolling
- Department of Public and Occupational Health, Amsterdam UMC, Van der Boechorststraat 7, 1081, BT, Amsterdam, the Netherlands.
| | - Carolina Marques Andrade
- Faculdade Ciências Médicas de Minas Gerais, Alameda Ezequiel Dias 275, Centro, Belo Horizonte, Minas Gerais, Brazil.
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Benoit-Piau J, Benoit-Piau C, Gaudreault N, Morin M. Effect of Conservative Interventions for Musculoskeletal Disorders in Preprofessional and Professional Dancers: A Systematic Review. Int J Sports Phys Ther 2023; 18:328-337. [PMID: 37020446 PMCID: PMC10069337 DOI: 10.26603/001c.73793] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Accepted: 02/14/2023] [Indexed: 04/04/2023] Open
Abstract
Background Preprofessional and professional dancers are among the athletes who sustain the most musculoskeletal disorders. In recent years, conservative treatment and preventive measures have been investigated in this population. However, no systematic review regarding their effectiveness has been conducted. Hypothesis/Purpose The aim of this systematic review was to locate, appraise and synthesize the available information on conservative interventions currently used for treating and preventing MSK disorders and their effect on pain and function in preprofessional and professional dancers. Study design Systematic review. Methods A systematic literature search was conducted using PubMed, CINHAL, ERIC, SportDiscus and Psychology and behavioral science collection. Prospective and retrospective cohort studies, as well as randomized and non-randomized controlled trials investigating conservative interventions for musculoskeletal disorders in preprofessional and professional dancers were included in this study. The main outcome measures included pain intensity, function, and performance. All included studies were evaluated for risk of bias using the Downs and Black checklist. Results Eight studies were included in the review. These studies included ballet and contemporary dancers, as well as professional and preprofessional dancers. In total, the studies included 312 dancers, 108 male and 204 female. Studies had a risk of bias that ranged from poor (8/28) to good (21/28) on the Downs and Black checklist. The conservative interventions used included customized toe caps, dry-needling, motor imagery, and strength and conditioning programs. The use of customized toe caps, motor imagery and strength and conditioning programs had promising results regarding pain and function in dancers. Conclusion In order to reach a solid conclusion, more quality studies are needed. The addition of control groups to studies, as well as multimodal interventions should be considered. Level of Evidence I.
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Affiliation(s)
| | | | | | - Mélanie Morin
- Faculty of medicine and health sciences Université de Sherbrooke
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Management of Stress Fractures in Ballet. J Am Acad Orthop Surg 2022; 30:543-553. [PMID: 35394992 DOI: 10.5435/jaaos-d-21-01021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Accepted: 02/23/2022] [Indexed: 02/01/2023] Open
Abstract
Stress fractures are highly prevalent in ballet dancers and lead to notable time loss from dancing. Nutritional status, body composition, bone mineral density, and rate of increase in activity are among the components that influence risk for stress fractures. Proper evaluation and management of stress fractures is essential including a review of the causative factors involved in each stress injury. The purpose of this article was to summarize current evidence for risk factors involved in dancers' stress fractures to optimize prevention and treatment. Identified associated factors include low energy availability, low bone mineral density, low fat body composition, abnormal lower extremity biomechanics, genetic factors, and high training loads.
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Singh Y, Pettit M, El-Hakeem O, Elwood R, Norrish A, Audenaert E, Khanduja V. Understanding hip pathology in ballet dancers. Knee Surg Sports Traumatol Arthrosc 2022; 30:3546-3562. [PMID: 35305112 PMCID: PMC9464154 DOI: 10.1007/s00167-022-06928-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 02/23/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE The literature on hip injuries in ballet dancers was systematically evaluated to answer (1) whether the prevalence of morphological abnormalities and pathology of hip injuries in dancers differs from the general population (2) if there are any specific risk factors which contribute to a higher rate of hip injury and (3) what are the outcomes of primary and secondary intervention strategies. METHODS A systematic literature search of Medline, EMBASE and the Cochrane Library was undertaken for all literature relating to hip injuries in ballet dancers using the PRISMA guidelines. Reference lists were also searched for relevant literature. Clinical outcome studies, prospective/retrospective case series published between 1989 and October 2021 were included. Review articles (non-original data), case reports, studies on animals as well as book chapters were excluded. RESULTS The search yielded 445 studies, of which 35 were included for final analyses after screening. This included 1655 participants, of which 1131 were females. The analyses revealed that damage at the chondrolabral junction and degenerative disease of the hip may develop at a higher rate in ballet dancers than in the general population (odds ratio > 1 in 15/18 cohorts). The intra-articular lesions were more frequently found in postero-superior region of the hip suggesting an alternative impingement mechanism. Furthermore, numerous risk factors specific for hip injury in ballet were highlighted amidst a wide body of literature which consistently reports risk factors for a more generic 'dancer vulnerability'. CONCLUSION Ballet dancers may suffer from both higher rates of chondrolabral damage and degenerative disease in their hips. In contrast to other sports, the intra-articular lesions are more frequently found in postero-superior region of the hip. Future research clarifying the prevalence of osseous abnormalities and prevention strategies in dancers may be pivotal in delaying the development of hip disease in this cohort. LEVEL OF EVIDENCE Level IV.
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Affiliation(s)
- Yash Singh
- Addenbrooke's Hospital, University of Cambridge School of Clinical Medicine, Hills Road, Cambridge, CB2 0SP, UK
| | - Matthew Pettit
- Addenbrooke's Hospital, University of Cambridge School of Clinical Medicine, Hills Road, Cambridge, CB2 0SP, UK
| | - Osama El-Hakeem
- Addenbrooke's Hospital, University of Cambridge School of Clinical Medicine, Hills Road, Cambridge, CB2 0SP, UK
| | - Rachel Elwood
- Addenbrooke's Hospital, University of Cambridge School of Clinical Medicine, Hills Road, Cambridge, CB2 0SP, UK
| | - Alan Norrish
- Academic Orthopaedics, Trauma and Sports Medicine, University of Nottingham, Queens Medical Centre, Nottingham, NG7 2UH, UK
| | - Emmanuel Audenaert
- Ghent University Hospital, C. Heymanslaan 10, Ingang 46-Verdieping 4, 9000, Ghent, Belgium
| | - Vikas Khanduja
- Department of Trauma and Orthopaedics, Young Adult Hip Service, Addenbrooke's-Cambridge University Hospital, Box 37, Hills Road, Cambridge, CB2 0QQ, UK.
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Abstract
Footwork is one of the basic features of flamenco dancing and is performed in traditional high-heeled shoes. The purpose of this study was to analyse the mechanical profile of flamenco dancing in terms of vertical ground reaction force, and knee joint kinematics of the supporting limb in footwork technique in order to understand causes which predispose injuries derived from the practice of flamenco dancing. The participant in our study was a professional female flamenco dancer (34 years, 58 kg, 1.65 m) who performed the ZAP 3 test, a sequence of single strikes of the feet performed continuously for 15 s. 3D lower extremity kinematic data were collected using a five-camera motion analysis system (Vicon; Oxford Metrics Ltd., Oxford, UK). Ground reaction forces were recorded using a Kistler force plate. Our analysis was based on 30 cycles of each lower limb consisting of 177 footwork steps. The vertical component of the ground reaction force did not reveal any significant differences between the left and the right limb. The most dynamic strike was provided by the heel (twice the participant's body weight). The mean angular displacement of the supporting limb’s knee was ~27°. Results reveal that these impacts could make the knee joint more prone to injuries.
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Panhale VP, Walankar PP, Sridhar A. Postural analysis in female Bharatanatyam dancers: a cross-sectional study. BULLETIN OF FACULTY OF PHYSICAL THERAPY 2021. [DOI: 10.1186/s43161-021-00042-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Gaining proficiency in Bharatanatyam dance form necessitates maintenance of different postures for prolonged duration. These repetitive movements place tremendous physical demands on the body at young age and may alter the postural profile of the dancer. The study aimed to evaluate the differences in terms of posture between female Bharatanatyam dancers and age-matched non-dancers. A cross-sectional study was conducted in 40 female Bharatanatyam dancers and 40 age-matched female non-dancers in the age group of 18 to 30 years. Analysis of erect standing posture of dancers and non-dancers was conducted in a reserved environment using a photogrammetric method. Static photographs of the subjects were taken in the sagittal plane. The measurement of the angles of the digitized photographs was performed using KINOVEA 0.8.15 software. Head protrusion angle, cervical lordosis angle, thoracic kyphosis angle, lumbar lordosis angle, and pelvic tilt angle were evaluated.
Results
There was no significant difference between the dancers and non-dancers with respect to head protrusion angle (p = 0.081), cervical lordosis (p = 0.15), and thoracic kyphosis (p = 0.33). Significant differences were identified between the dancers and non-dancers for lumbar lordosis (p = 0.00) and pelvic tilt (p = 0.00) using independent t test with dancers. Higher values of lumbar lordosis and pelvic tilt were observed in dancers.
Conclusion
Increased lumbar lordosis and anterior pelvic tilt were observed in Bharatanatyam dancers as compared to non-dancers. Hence, it is vital to establish preventive measures like postural re-education, muscular balance, and flexibility to prevent erroneous postural patterns capable of causing pain and injuries.
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Risk Factors, Diagnosis and Management of Bone Stress Injuries in Adolescent Athletes: A Narrative Review. Sports (Basel) 2021; 9:sports9040052. [PMID: 33923520 PMCID: PMC8073721 DOI: 10.3390/sports9040052] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2021] [Revised: 04/03/2021] [Accepted: 04/13/2021] [Indexed: 12/14/2022] Open
Abstract
Physical activity is known to be beneficial for bone; however, some athletes who train intensely are at risk of bone stress injury (BSI). Incidence in adolescent athlete populations is between 3.9 and 19% with recurrence rates as high as 21%. Participation in physical training can be highly skeletally demanding, particularly during periods of rapid growth in adolescence, and when competition and training demands are heaviest. Sports involving running and jumping are associated with a higher incidence of BSI and some athletes appear to be more susceptible than others. Maintaining a very lean physique in aesthetic sports (gymnastics, figure skating and ballet) or a prolonged negative energy balance in extreme endurance events (long distance running and triathlon) may compound the risk of BSI with repetitive mechanical loading of bone, due to the additional negative effects of hormonal disturbances. The following review presents a summary of the epidemiology of BSI in the adolescent athlete, risk factors for BSI (physical and behavioural characteristics, energy balance and hormone disruption, growth velocity, sport-specific risk, training load, etc.), prevention and management strategies.
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Walsh KP, Durante EC, Moser BR, Coetzee JC, Stone McGaver R. Surgical Outcomes of Os Trigonum Syndrome in Dancers: A Case Series. Orthop J Sports Med 2020; 8:2325967120938767. [PMID: 32743013 PMCID: PMC7376299 DOI: 10.1177/2325967120938767] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Accepted: 03/09/2020] [Indexed: 11/17/2022] Open
Abstract
Background Management of ankle pain in dancers can be challenging because of the repetitive stress and complex demands placed on this region. Despite the prevalence of ankle injuries in this population, literature on surgical outcomes and return to dance is limited. Purpose To retrospectively evaluate the efficacy and functional outcomes after surgical excision of a symptomatic os trigonum in dancers. Study Design Case series; Level of evidence, 4. Methods Between June 2006 and June 2016, a total of 44 dancers underwent surgical excision of a symptomatic os trigonum at a single institution and by a single surgeon. All patients presented with symptoms of posterior ankle impingement syndrome and subsequently failed nonsurgical treatment. Clinical analysis was conducted using various pre- and postoperative patient-reported outcome questionnaires, including the Veterans RAND 12-Item Health Survey (VR-12), Foot Function Index-Revised (FFI-R), and visual analog scale (VAS) for pain, as well as subjective patient satisfaction. Results A total of 44 patients (54 ankles; mean age, 18.2 years) were retrospectively evaluated at a mean follow-up of 33.4 months. The VR-12 Physical Health score improved from a mean score of 37.8 ± 11.9 to 51.2 ± 10.5 (P < .001). The cumulative FFI-R score improved from 46.45 ± 13.8 to 31.2 ± 9.7 (P = .044), with the subcategory of "activity limitation" representing the highest-scoring FFI-R subcategory at 65.28 ± 13.4 preoperatively and improving to 34.47 ± 12.4 at follow-up (P < .001). The mean VAS score for subjective pain improved significantly from 5.39 ± 2.84 to 1.73 ± 2.10 (P < .00044). Conclusion Overall, the findings of the present study demonstrate that dancers of varying style and level improved significantly according to various clinical measures. Patients included in this study reported that they returned to their previous level of dance upon completion of physical therapy and maintained thriving postoperative careers, which for several meant dancing at the professional level.
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Affiliation(s)
- Keifer P Walsh
- Alabama College of Osteopathic Medicine, Dothan, Alabama, USA
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Steinberg N, Tenenbaum S, Itzhak SN, Aviva Z. Can young dancers skip/recover from patellofemoral pain? A two-year follow-up. Res Sports Med 2020; 28:459-467. [PMID: 32449391 DOI: 10.1080/15438627.2020.1770249] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Aiming to follow the prevalence of patellofemoral pain (PFP) among young dancers over 2-years, and to assess the prevalence of re-injured/recovered dancers; 67 dancers (aged 12.8 ± 0.5) were screened for PFP at baseline, 65 dancers at 1st follow-up and 51 dancers at 2nd follow-up. All dancers (46) that took part in all the 3 screenings had at least one episode of PFP along the screenings. No dancers recovered in the 1st follow-up, yet 40.5% of the dancers with PFP at the 1st follow-up recovered in the 2nd follow-up. Along the 3 screenings, 23.9%, 34.8%, and 41.3% of the dancers had 1,2 or 3 PFP episodes, respectively. None of the dancers skipped PFP along the 3 screenings. A high prevalence of dancers had sustained PFP along the 2 follow-ups, with low recovery rate. Dancers and teachers should be alert to the need for devising modifications of training and injury prevention strategies from young age.
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Affiliation(s)
- Nili Steinberg
- Department of Human Movement and Sport Sciences, The Wingate College of Physical Education and Sports Sciences at the Wingate Institute , Netanya, Israel
| | - Shay Tenenbaum
- Department of Orthopedic Surgery, Chaim Sheba Medical Center Tel-Hashomer, Affiliated to the Sackler Faculty of Medicine, Tel Aviv University , Tel Aviv, Israel
| | - Siev-Ner Itzhak
- Orthopedic Rehabilitation Dept., Sheba Medical Center , Tel-Hashomer, Israel
| | - Zeev Aviva
- Department of Human Movement and Sport Sciences, The Wingate College of Physical Education and Sports Sciences at the Wingate Institute , Netanya, Israel
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Cross-Cultural Adaptation of the Dance Functional Outcome Survey (DFOS) for Spanish Dancers. Diagnostics (Basel) 2020; 10:diagnostics10030169. [PMID: 32245063 PMCID: PMC7151173 DOI: 10.3390/diagnostics10030169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2020] [Revised: 03/19/2020] [Accepted: 03/19/2020] [Indexed: 11/26/2022] Open
Abstract
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.
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Perry SK, Buddhadev HH, Brilla LR, Suprak DN. Mechanical Demands at the Ankle Joint During Saut de Chat and Temps levé Jumps in Classically Trained Ballet Dancers. Open Access J Sports Med 2019; 10:191-197. [PMID: 31827337 PMCID: PMC6902839 DOI: 10.2147/oajsm.s234289] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Accepted: 11/20/2019] [Indexed: 11/25/2022] Open
Abstract
Background During ballet, injuries to the Achilles tendon are associated with the take-off phase of various jumps. Research question The purpose of the study was to assess differences in mechanical demand on the body, specifically at the ankle, in two single-leg jumps commonly trained in ballet: a saut de chat (SDC) and a temps levé (TL). Methods Fifteen classically trained female dancers had 16 reflective markers placed on the lower body and each dancer performed each jump three times on a force plate. The marker position data and ground reaction forces (GRF) were captured synchronously at 250 Hz and 1000 Hz, respectively. Peak vertical GRF, mean rate of force development (RFD), peak ankle moment, and peak ankle power were determined and averaged across trials. Paired t-tests were used to determine differences between the SDC and the TL. Results When compared to the TL, the SDC displayed significantly higher peak vertical GRF (p = 0.003), RFD (p = 0.002), and peak ankle moment and power (p < 0.001). The effect sizes for these differences were large for all variables (Cohen’s d > 0.80). Conclusion The mechanical demand at the ankle joint is significantly greater for the SDC than the TL.
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Affiliation(s)
- Sarah K Perry
- Department of Health and Human Development, Western Washington University, Bellingham, WA, USA
| | - Harsh H Buddhadev
- Department of Health and Human Development, Western Washington University, Bellingham, WA, USA
| | - Lorraine R Brilla
- Department of Health and Human Development, Western Washington University, Bellingham, WA, USA
| | - David N Suprak
- Department of Health and Human Development, Western Washington University, Bellingham, WA, USA
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Abstract
BACKGROUND Dance is a physical pursuit that involves loading the spine through repetitive dynamic movements and lifting tasks. As such, low back pain (LBP) and low back injury (LBI) have been identified as common health problems in contemporary and classical ballet dancers. However, clarity regarding the experience of LBP and LBI in dance is lacking. OBJECTIVES To systematically review and synthesize the epidemiology of LBP and LBI in dance populations. METHODS A comprehensive search of 6 electronic databases, back catalogs of dance science-specific journals, and reference lists of relevant articles and a forward citation search were performed. RESULTS Fifty full-text articles were included in the final systematic review. There was considerable methodological heterogeneity among the included studies. The median (range) point, yearly, and lifetime prevalence of LBP was 27% (17%-39%), 73% (41%-82%), and 50% (17%-88%), respectively. The lower back contributed to 11% (4%-22%) of time loss and 11% (5%-23%) of medical-attention injuries. CONCLUSION Dancers are vulnerable to LBP and LBI. The use of definitions that are sensitive to the complexity of LBP and LBI would facilitate improved understanding of the problem within dance, inform health care strategies, and allow for monitoring LBP-specific intervention outcomes. J Orthop Sports Phys Ther 2019;49(4):239-252. Epub 18 Jan 2019. doi:10.2519/jospt.2019.8609.
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Injury Occurrence and Return to Dance in Professional Ballet: Prospective Analysis of Specific Correlates. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16050765. [PMID: 30832431 PMCID: PMC6427676 DOI: 10.3390/ijerph16050765] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/09/2019] [Revised: 02/26/2019] [Accepted: 02/27/2019] [Indexed: 12/27/2022]
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).
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Wezenbeek E, De Clercq D, Mahieu N, Willems T, Witvrouw E. Activity-Induced Increase in Achilles Tendon Blood Flow Is Age and Sex Dependent. Am J Sports Med 2018; 46:2678-2686. [PMID: 30067065 DOI: 10.1177/0363546518786259] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Previous research of a young adult population identified a lower increase in Achilles tendon blood flow immediately after a running activity as a significant predictor for the development of Achilles tendinopathy (AT). Furthermore, advancing age is often mentioned as a risk factor for the development of AT, and the highest incidence for AT is reported to occur in middle-aged recreational male athletes. PURPOSE To investigate the effect of age, sex, and type of physical activity on the increase in Achilles tendon blood flow. STUDY DESIGN Controlled laboratory study. METHODS Blood flow measurements of 33 subjects aged 18 to 25 years and 30 subjects aged 40 to 55 years were obtained before and after 4 physical activities performed in randomized order: running, cycling, dynamic stretching, and rope skipping. Blood flow measurements of the Achilles tendon were performed before, immediately after, 5 minutes after, and 10 minutes after the physical activities. The effect of age, sex, and physical activities on the increase in blood flow was investigated with linear mixed models. RESULTS The results of this study identified that running, rope skipping, and cycling resulted in a significant increase in tendon blood flow ( P ≤ .001), whereas stretching did not. Prominent was the finding that the increase in blood flow after activity was significantly lower in the older population as compared with the younger population ( P < .001). Furthermore, male participants in the older group showed a significantly lower increase in tendon blood flow than did their female counterparts ( P = .019). CONCLUSION This study identified that sex and age significantly influence the increase in blood flow after activity, possibly explaining the increased risk for AT among middle-aged recreational athletes. CLINICAL RELEVANCE This study possibly identified one of the mechanisms explaining why an older male population is at increased risk for developing AT. Given that the lower increase in blood flow is an identified risk factor according to previous research, preventative measures should focus on improving this blood flow during physical activity in the physically active older male population. Registration: NCT03218605 ( ClinicalTrials.gov identifier).
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Affiliation(s)
- Evi Wezenbeek
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Dirk De Clercq
- Department of Movement and Sport Sciences, Ghent University, Ghent, Belgium
| | - Nele Mahieu
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Tine Willems
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
| | - Erik Witvrouw
- Department of Rehabilitation Sciences and Physiotherapy, Ghent University, Ghent, Belgium
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Siev-Ner I, Stern MD, Tenenbaum S, Blankstein A, Zeev A, Steinberg N. Ultrasonography findings and physical examination outcomes in dancers with and without patellofemoral pain. PHYSICIAN SPORTSMED 2018; 46:48-55. [PMID: 28994332 DOI: 10.1080/00913847.2018.1391048] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVES To identify whether a physical examination for patello-femoral pain (PFP) is related to ultrasonography findings at the knee, and to identify possible factors related to PFP in young dancers. METHODS Sixty-seven young female dancers (7th grade, aged 12.8 ± 0.5) from three schools with identical special dance programs were included in the study. All the dancers were interviewed for demographic details, dance background, and training intensity; were evaluated for anthropometric measurements; underwent physical examination of both knees for PFP and for knee range of motion (ROM); and, had ultrasonography assessment for pathologies and of anatomical parts of their knees. RESULTS PFP was found in 54.5% of the 134 knees physically examined. In ultrasonography assessment, infra-articular effusion was found in 46.2% of the knees examined. H/week of dance practice was significantly higher among dancers with PFP (in both knees) compared with dancers with no PFP (p < .05). Knees with PFP had a significantly higher prevalence of intra articular effusion (p = .018) and higher prevalence of genu-recurvatum (p = .042). Knees with PFP had significantly greater growth plate width-anterior tibial tuberosity (p = .022) and a greater bony trochlear groove angle (p = .048). CONCLUSION This study describes the relationship between physical examination for PFP and the sonographic findings, and the factors related to knee injuries. The results showed a high prevalence of PFP and intra articular knee effusion among young dancers at the age of 12-13 years; and, that the number of hours of practice and anatomical structure are related to PFP. Our results should alert physicians, physiotherapists, athletic trainers and dance teachers to the need for devising modifications of training and injury prevention strategies from a young age (<12 years old).
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Affiliation(s)
- Itzhak Siev-Ner
- a Orthopedic Rehabilitation Department , Sheba Medical Center , Tel-Hashomer , Israel
| | - Myriam D Stern
- b Department of Radiology , Sheba Medical Center, Sackler School of Medicine , Tel Aviv University , Israel
| | - Shay Tenenbaum
- c Department of Orthopedic Surgery , Chaim Sheba Medical Center, Sackler Faculty of Medicine , Tel Aviv University , Israel
| | - Alexander Blankstein
- c Department of Orthopedic Surgery , Chaim Sheba Medical Center, Sackler Faculty of Medicine , Tel Aviv University , Israel
| | - Aviva Zeev
- d The Wingate College of Physical Education and Sports Sciences at the Wingate Institute , Netanya , Israel
| | - Nili Steinberg
- d The Wingate College of Physical Education and Sports Sciences at the Wingate Institute , Netanya , Israel
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18
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Smith BE, Selfe J, Thacker D, Hendrick P, Bateman M, Moffatt F, Rathleff MS, Smith TO, Logan P. Incidence and prevalence of patellofemoral pain: A systematic review and meta-analysis. PLoS One 2018; 13:e0190892. [PMID: 29324820 PMCID: PMC5764329 DOI: 10.1371/journal.pone.0190892] [Citation(s) in RCA: 249] [Impact Index Per Article: 41.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2017] [Accepted: 12/21/2017] [Indexed: 01/17/2023] Open
Abstract
BACKGROUND Patellofemoral pain is considered one of the most common forms of knee pain, affecting adults, adolescents, and physically active populations. Inconsistencies in reported incidence and prevalence exist and in relation to the allocation of healthcare and research funding, there is a clear need to accurately understand the epidemiology of patellofemoral pain. METHODS An electronic database search was conducted, as well as grey literature databases, from inception to June 2017. Two authors independently selected studies, extracted data and appraised methodological quality. If heterogeneous, data were analysed descriptively. Where studies were homogeneous, data were pooled through a meta-analysis. RESULTS 23 studies were included. Annual prevalence for patellofemoral pain in the general population was reported as 22.7%, and adolescents as 28.9%. Incidence rates in military recruits ranged from 9.7-571.4/1,000 person-years, amateur runners in the general population at 1080.5/1,000 person-years and adolescents amateur athletes 5.1%-14.9% over 1 season. One study reported point prevalence within military populations as 13.5%. The pooled estimate for point prevalence in adolescents was 7.2% (95% Confidence Interval: 6.3%-8.3%), and in female only adolescent athletes was 22.7% (95% Confidence Interval 17.4%-28.0%). CONCLUSION This review demonstrates high incidence and prevalence levels for patellofemoral pain. Within the context of this, and poor long term prognosis and high disability levels, PFP should be an urgent research priority. PROSPERO REGISTRATION CRD42016038870.
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Affiliation(s)
- Benjamin E Smith
- Derby Teaching Hospitals NHS Foundation Trust, London Road Community Hospital, Derby, United Kingdom
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - James Selfe
- Department of Health Professions, Manchester Metropolitan University, Manchester, United Kingdom
| | - Damian Thacker
- PhysioWorks (Sheffield), Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, United Kingdom
| | - Paul Hendrick
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham University Hospitals (City Campus), Nottingham, United Kingdom
| | - Marcus Bateman
- Derby Teaching Hospitals NHS Foundation Trust, London Road Community Hospital, Derby, United Kingdom
| | - Fiona Moffatt
- Division of Physiotherapy and Rehabilitation Sciences, School of Health Sciences, University of Nottingham, Nottingham University Hospitals (City Campus), Nottingham, United Kingdom
| | - Michael Skovdal Rathleff
- Research Unit for General Practice in Aalborg, Department of Clinical Medicine at Aalborg University, Aalborg, Denmark
- Department of Occupational Therapy and Physiotherapy, Department of Clinical Medicine, Aalborg University Hospital, Aalborg, Denmark
| | - Toby O Smith
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, United Kingdom
| | - Pip Logan
- Division of Rehabilitation and Ageing, School of Medicine, University of Nottingham, Nottingham, United Kingdom
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