Injury in ballet: a review of relevant topics for the physical therapist

Spotty Bone Marrow: A Frequent MRI Finding in the Feet of Ballet Dancers

INTRODUCTION

Bone marrow signal abnormalities on magnetic resonance imaging (MRI) are common in athletes. However, few studies evaluate the MRI appearance of bone marrow in the feet of ballet dancers. Our study aims to describe the "spotty bone marrow" (SBM) pattern in the tarsal bones of a cohort of ballet dancers, establishing its prevalence, distribution, potential associations, and evolution.<br/> Methods: Eighty-six MRIs of 68 ankles in 56 ballet dancers were retrospectively reviewed for mar- row signal alterations, which were classified as focal or SBM (defined as patchy fluid-sensitive signal hyperintensity spanning more than one location or tarsal bone). When SBM involved the talus, its anatomic distribution in the bone and morphologic pattern were recorded. Additional osseous and soft tissue findings were documented. For subjects with more than one MRI of the same ankle, the SBM's evolution was monitored.<br/> Results: Spotty bone marrow was identified in 44 ankles (65%). Spotty bone marrow was isolated to the talus (44%), present in all tarsal bones (25%), or distributed between the talus and one to three other tarsal bones (31%). In the talus, The SBM involved the entire bone (65%), the neck and body (31%), or the head and neck (4%). The SBM most commonly showed a random morphologic pattern (87%) but occasionally showed a peripheral predominance (13%). There was no statistically significant difference in the prevalence of other pathologies in ankles with and without SBM. In eight ankles with a follow-up MRI, the SBM worsened in one, remained stable in two, and improved in five ankles. None progressed to a stress fracture.<br/> Conclusion: Spotty bone marrow is an MRI finding frequently encountered in ballet dancers. It is usually self-limiting and should not be misinterpreted as a more aggressive pathology.

Relationship of Extrinsic Risk Factors to Lower Extremity Injury in Collegiate Ballet Dancers

Ballet dancers are thought to be at higher risk of lower extremity injury. This objective of this study was to describe the self-reported incidence, location, and factors associated with lower extremity injury in collegiate ballet dancers. Two hundred and forty-nine female ballet dancers responded to a questionnaire that addressed their injury event/location, dance behavior over the past 2 years, and overall dance history. Behaviors assessed included the following: types and number of shoes worn (pointé shoes/ballet slippers), wear time, training time (session frequency and duration), use of warm-up/cool-down, and use of a strengthening program and lower extremity accessory. Overall dance history included age of the onset of training, total years of experience, and number of dance styles. Backward multivariable logistic regression analysis was used to determine the extent to which variables measured were associated with injury. Ankle injury was the most prevalent injury. Years of wearing pointé shoes (adjusted odds ratio = 1.21, p = 0.01) and days/weeks in pointé shoes (adjusted odds ratio = 1.26, p = 0.04) were associated with an increased risk of injury; while additional strengthening (adjusted odds ratio = 0.39, p = 0.02) and use of lower extremity accessories during classes/rehearsals (adjusted odds ratio = 0.64, p = 0.01) were protective associations. These findings suggested that the use of pointé shoes, lower extremity accessories, and additional exercise should specifically be recorded during evaluation of injured ballet dancers; and must be considered potential factors to modify during rehabilitation.

Risk Factors for Lower-Extremity Injuries in Female Ballet Dancers: A Systematic Review

BACKGROUND

Ballet dancers have a high prevalence of injuries to the lower extremity. Many studies have investigated the relationship between dance injury and risk factors. However, risk factors for lower-extremity injury comparing recreational- and elite-level ballet dancers are scarce.

OBJECTIVE

To systematically review available original studies to assess risk factors for lower-extremity injury in female ballet dancers between recreational and elite ballet dancers.

DATA SOURCES

Five online databases [Web of Science, PubMed, OVID (Medline), EBSCO, and ProQuest] were searched systematically.

STUDY SELECTION

Included studies had an analytic study design published in the past 11 years and investigated an association between potential risk factors and lower-extremity injury in female ballet dancers.

STUDY APPRAISAL

Assessed independently by 2 reviewers using the Downs and Black (DB) criteria and Oxford Centre of Evidence-Based Medicine.

RESULTS

Seventeen studies were included. Alignment was a risk factor for lower-extremity injury in both recreational and elite ballet dancers. In elite ballet dancers, poor lumbopelvic movement control, inappropriate transversus abdominis contraction, decreased lower-extremity strength, and poor aerobic fitness were risk factors for lower-extremity injury. In recreational ballet dancers, hypermobility of the hip and ankle and longer training hours were risk factors for lower-extremity injury. Mean DB score was 15.94 (SD 1.57). The majority of studies were retrospective cohort studies or had poor follow-up, with 7 level 2b studies, 6 level 3b studies (cross-sectional), and 4 level 1b studies (prospective cohort with good follow-up).

CONCLUSIONS

Alignment was identified as a common risk factor for recreational and elite ballet dancers. Other risk factors differed between recreational ballet dancers and elite ballet dancers. Future studies are warranted to use a prospective study design, identify dance level-specific risk factors, and implement evidence-based prevention strategies.

The physical features suitable for classical ballet training

OBJECTIVE

The aim of this study was to determine the prerequisite physical features of classical ballet education.

METHODS

Students who enrolled and were rejected for the applications of State Conservatory Ballet Main Art Branch in the academic year 2013-2014 and 2014-2015 were compared with their exam results. This study involves defining the physical ability and determining physical fitness by using Eurofit tests including the Flamingo Balance test (FB), Plate Tapping (PT), Sit and Reach (SITR), Standing Broad Jump (SBJ), Handgrip test (HG), Sit Up in 30 Seconds (SU) and Shuttle Run 10 × 5 meter (SR), Heath-Carter somatotyping method and anthropometric measurements which determine ballet students' body type and physical abilities. Sixty-nine girls between 8-11 years old who applied for ballet education at the State Conservatory Ballet Main Art Branch were included in the study. While the average of age, height and weight measurements of enrolled students were 9.40 ± 0.74 year, 1.38 ± 0.08 m and 30.03 ± 4.73 kg respectively, the same dimensions were found in rejected students, i.e. 9.79 ± 0.94 year, 1.40 ± 0.10 m and 35.59 ± 7.31 kg respectively.

RESULTS

Measurements of diameter, circumference and subcutaneous fat were lower (p< 0.05) for enrolled students. The major body type of enrolled students was identified as mesomorphy, whereas the major body type of rejected students was identified as endomorphy. All dimensions of the Eurofit tests, except the strength test, were significantly different in enrolled students (p< 0.05).

CONCLUSIONS

The parameters used in this study can be convenient in objectively evaluating classical ballet education.

Effect of Kinesio® Taping on Ankle Complex Motion and Stiffness and Jump Landing Time to Stabilization in Female Ballet Dancers

Ankle sprain is the most commonly diagnosed injury experienced by ballet dancers with few studies investigating preventive support measures such as Kinesio taping. The need exists to examine the mechanical support characteristics of Kinesio taping and effect of application on ankle motion and performance. This may be important to understanding the mechanical mechanisms attributed to Kinesio ankle taping and justify its use in the prevention and treatment of jump landing injuries in ballet dancers. This study compared Kinesio taping with and without tension and no tape (control) on active and passive measures of ankle complex motion in healthy ballet dancers. A secondary objective was to examine the effect of Kinesio taping on balance using time to stabilization. Participants performed three ballet jumps with single-leg landings on a force plate across three ankle support conditions consisting of Kinesio taping, sham-Kinesio taping, and no tape. Sagittal and frontal plane motion and load-displacement of the ankle complex for each support condition were obtained using an ankle arthrometer. Kinesio taping with tension significantly restricted inversion-eversion rotation and increased inversion stiffness of the ankle complex (p < 0.05). No significant differences were found among the three ankle support conditions for jump landing time to stabilization (p > 0.05). Arthrometric results indicate Kinesio taping significantly restricted ankle complex motion in the frontal plane that is associated with lateral ankle sprain. Objective information on the nature of Kinesio taping support can assist sports medicine practitioners when recommending ankle support to athletes.

Dynamic Neuro-Cognitive Imagery (DNITM) Improves Developpé Performance, Kinematics, and Mental Imagery Ability in University-Level Dance Students

Dance requires optimal range-of-motion and cognitive abilities. Mental imagery is a recommended, yet under-researched, training method for enhancing both of these. This study investigated the effect of Dynamic Neuro-Cognitive Imagery (DNITM) training on developpé performance (measured by gesturing ankle height and self-reported observations) and kinematics (measured by hip and pelvic range-of-motion), as well as on dance imagery abilities. Thirty-four university-level dance students (M age = 19.70 ± 1.57) were measured performing three developpé tasks (i.e., 4 repetitions, 8 consecutive seconds hold, and single repetition) at three time-points (2 × pre-, 1 × post-intervention). Data were collected using three-dimensional motion capture, mental imagery questionnaires, and subjective reports. Following the DNITM intervention, significant increases (p < 0.01) were detected in gesturing ankle height, as well as in hip flexion and abduction range-of-motion, without significant changes in pelvic alignment. These gains were accompanied by self-reported decrease (p < 0.05) in level of difficulty experienced and significant improvements in kinesthetic (p < 0.05) and dance (p < 0.01) imagery abilities. This study provides evidence for the motor and non-motor benefits of DNITM training in university-level dance students.

Overuse Injuries in Professional Ballet: Influence of Age and Years of Professional Practice

Background:

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.

Hypothesis:

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.

Study Design:

Descriptive epidemiology study.

Methods:

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.

Results:

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.

Conclusion:

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.

Clinical Relevance:

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.

Professional ballet dancers' experience of injury and osteopathic treatment in the UK: A qualitative study

OBJECTIVES

Professional dancers suffer significant musculoskeletal injuries during the course of their careers. Treatment-seeking behaviour is important in all patient populations, yet is rarely investigated amongst professional dancers. This qualitative study aimed to form a better understanding of how dancers decide to seek treatment, and in particular to explore their experiences of receiving osteopathic care for their injuries.

METHODS

A qualitative study design using grounded theory was used as a methodological framework for data collection and analysis. Semi-structured interviews were used to explore professional dancers' experience of injury and decision-making to seek professional healthcare.

RESULTS

Five themes were constructed that explain and describe dancers' experience of injuries and their views and perspectives of treatment, these were; the growing dancer, the fear factor, learning to cope, effective treatment, and returning autonomy.

CONCLUSION

The personal development of each dancer consisted of an amalgam of internal and external pressures. These pressures combine with experiences of pain and injury to influence a dancer's decision-making behaviour when injured and deciding to seek treatment. The study also provide factors relevant in the effective treatment of dancers, and outlined participants' preference for a global physical approach to assessment and treatment of their musculoskeletal pain.

Biomechanical modeling as a practical tool for predicting injury risk related to repetitive muscle lengthening during learning and training of human complex motor skills

Previous studies have shown that muscle repetitive stress injuries (RSIs) are often related to sport trainings among young participants. As such, understanding the mechanism of RSIs is essential for injury prevention. One potential means would be to identify muscles in risk by applying biomechanical modeling. By capturing 3D movements of four typical youth sports and building the biomechanical models, the current study has identified several risk factors related to the development of RSIs. The causal factors for RSIs are the muscle over-lengthening, the impact-like (speedy increase) eccentric tension in muscles, imbalance between agonists and antagonists, muscle loading frequency and muscle strength. In general, a large range of motion of joints would lead to over-lengthening of certain small muscles; Limb’s acceleration during power generation could cause imbalance between agonists and antagonists; a quick deceleration of limbs during follow-throughs would induce an impact-like eccentric tension to muscles; and even at low speed, frequent muscle over-lengthening would cause a micro-trauma accumulation which could result in RSIs in long term. Based on the results, the following measures can be applied to reduce the risk of RSIs during learning/training in youth participants: (1) stretching training of muscles at risk in order to increase lengthening ability; (2) dynamic warming-up for minimizing possible imbalance between agonists and antagonists; (3) limiting practice times of the frequency and duration of movements requiring strength and/or large range of motion to reducing micro-trauma accumulation; and (4) allowing enough repair time for recovery from micro-traumas induced by training (individual training time). Collectively, the results show that biomechanical modeling is a practical tool for predicting injury risk and provides an effective way to establish an optimization strategy to counteract the factors leading to muscle repetitive stress injuries during motor skill learning and training.

Longitudinal study of sports injuries in practitioners of aerobic gymnastics competition

ABSTRACT Introduction: Aerobic gymnastics, since its membership in the International Gymnastics Federation, has undergone changes in its regulations. Objective: To analyze the injuries found in Spanish aerobic gymnastics athletes during different editions of the Code of Points. Methods: A descriptive, longitudinal and compara-tive study was carried out on the epidemiology of injuries in aerobic gymnastics published during different editions of the Code of Points. Results: It highlights that the number of injuries decreased from 156 to 38 last year. This decline has been related to the restriction on the number of difficulties in the exercise and the number of elements to be performed on the floor. However, they have increased the number and value of the difficulties. Conclusions: Therefore, it is concluded that the changes made in the regulations are intended to safeguard the health of athletes and ensure that competition develops at its best artistic and technical aspect.

The usefulness of performance matrix tests in locomotor system evaluation of girls attending a ballet school - preliminary observation

[Purpose] Learning ballet is connected with continuous use of the locomotor system while subjecting it to high loads. Therefore, we conducted some research defining the appearance of weak links in the motor system, in order to eliminate the risk of injury. [Methods] Fifty-two female students of a ballet school were examined. To identify weak links, low-threshold Performance Matrix tests were performed. An analysis of weak link occurrence in the locomotor system was carried out, using two way analysis of variance ANOVA Tukey's HSD test, clustering methods and Principal Component Analysis (PCA). [Results] The average age of the subjects was 11.64±0.53 years (mean ± standard deviation), their average body height was 151.1±7.5 cm, their average body weight was 35.92±5.41 kg, and their average time of learning at ballet school was 2.17±0.65 years. We found that there were significant differences in weak links occurrence in the motor system of every girl examined. [Conclusions] Weak links were found in every location of the motor system. Our results show that the influence of weak link location is essentially different from their occurrence, and that learning ballet has a significantly different impact on the number of weak links in different locations.

Análise da incidência lesional na ginástica aeróbica espanhola de elite

INTRODUÇÃO: A ginástica aeróbica (GA) é uma disciplina que possui exigências físicas específicas e treinamento adequado para prevenir ou minimizar a ocorrência de lesões esportivas. OBJETIVO: Analisar a incidência de lesões na GA e a sua vinculação com fatores de treinamento MÉTODO: Realizou-se um estudo em 40 desportistas valencianos com idades compreendidas entre nove e 17 anos. O procedimento de coleta de informações foi através de um questionário de morbidade. A variável dependente foram as lesões durante a temporada 2009-2010 e as variáveis independentes principais foram a carga de treinamento, o material de proteção, superfície de treinamento, gesto técnico e tipo de lesão e zona corporal lesionada. RESULTADOS: As lesões mais reincidentes foram as relacionadas a ligamentos, afetando por igual os membros superior e inferior. A metade das lesões ocorreu após a realização dos saltos, apesar do uso de algum material de proteção, além de terem ocorrido no início da temporada. Relações significativas entre o número de lesões e a experiência, os dias de treinamento e o número de competições (p < 0,05) foram encontradas. CONCLUSÕES: O número de lesões diminuiu enquanto o uso de medidas de proteção, com destaque para as munhequeiras, aumentou. Metade das lesões produziu-se durante o período de aprendizagem técnica de dificuldades.

Ballet injuries: injury incidence and severity over 1 year

STUDY DESIGN

Prospective, descriptive single-cohort study.

OBJECTIVE

To assess the incidence and severity of injuries to a professional ballet company over 1 year.

METHODS

Data for an elite-level ballet company of 52 professional dancers were collected by an in-house medical team using a time-loss injury definition.

RESULTS

A total of 355 injuries were recorded, with an overall injury incidence of 4.4 injuries per 1000 hours (female, 4.1; male, 4.8; P>.05) and a mean of 6.8 injuries per dancer (female, 6.3; male, 7.3; P>.05). Mean injury severity was 7 days (female, 4; male, 9; P<.05). Most injuries were classified as overuse (64%; female, 68%; male, 60%; P>.05); mean severity of injury was 3 days for females and 9 days for males (P<.05). The percentage of traumatic injuries was 32% for females and 40% for males (P<.05); the corresponding severity was 6 and 10 days, respectively (P<.05).

CONCLUSION

The relatively high number of injuries reported and the resulting loss of dance time support the need to introduce interventions to reduce the risk of injury in professional dancers.J Orthop Sports Phys Ther 2012;42(9):781-790. Epub 19 July 2012. doi:10.2519/jospt.2012.3893.

Mechanics of Jazz Shoes and Their Effect on Pointing in Child Dancers

There has been little scientific investigation of the impact of dance shoes on foot motion or dance injuries. The pointed (plantar-flexed) foot is a fundamental component of both the technical requirements and the traditional aesthetic of ballet and jazz dancing. The aims of this study were to quantify the externally observed angle of plantar flexion in various jazz shoes compared with barefoot and to compare the sagittal plane bending stiffness of the various jazz shoes. Sixteen female recreational child dancers were recruited for 3D motion analysis of active plantar flexion. The jazz shoes tested were a split-sole jazz shoe, full-sole jazz shoe, and jazz sneaker. A shoe dynamometer measured the stiffness of the jazz shoes. The shoes had a significant effect on ankle plantar flexion. All jazz shoes significantly restricted the midfoot plantar flexion angle compared with the barefoot condition. The split-sole jazz shoe demonstrated the least restriction, whereas the full-sole jazz shoe the most midfoot restriction. A small restriction in metartarsophalangeal plantar flexion and a greater restriction at the midfoot joint were demonstrated when wearing stiff jazz shoes. These restrictions will decrease the aesthetic of the pointed foot, may encourage incorrect muscle activation, and have an impact on dance performance.

Changes in biomechanics and muscle activation in injured ballet dancers during a jump-land task with turnout (Sissonne Fermée)

Large impact loading with abnormal muscle activity and motion patterns may contribute to lower extremity injuries in ballet dancers. Yet, few studies investigated the influence of injury on the ballet movement. The purpose of this study was to find the neuromuscular and biomechanical characteristics in dancers with and without ankle injury during a jump-landing Sissonne Fermée task. Twenty-two ballet dancers were recruited and divided into the injured group (n = 11) and the uninjured group (n = 11). They performed a ballet movement called "Sissonne Fermée" with reflective markers and electrodes attached to their lower extremities. Ground reaction force, joint kinematics, and muscle activity were measured. The injured dancers had greater peak ankle eversion but smaller hindfoot-to-tibial eversion angles. Also, the injured dancers had greater activity of the hamstring of the dominant leg and tibialis anterior of the non-dominant leg during the pre-landing phase. The injured dancers had greater tibialis anterior activity of the dominant leg but less muscle activity in the medial gastrocnemius of the non-dominant leg during the post-landing phase. The injured dancers had a greater co-contraction index in the non-dominant ankle and a lower loading rate. The higher co-contraction indices showed that the injured dancers required more muscle effort to control ankle stability. Furthermore, the injured dancers used a "load avoidance strategy" to protect themselves from re-injury. Neuromuscular control training of the ankle joint for ballet dancers to prevent injury is necessary.

Análise da relação entre dor lombar e desequilíbrio de força muscular em bailarinas

OBJETIVO: Investigar a relação entre dor lombar e desequilíbrio de força muscular na região lombopélvica em bailarinas clássicas. MÉTODOS: O estudo foi do tipo exploratório transversal e desenvolvido nas academias de dança das cidades de Divinópolis e Oliveira, MG. Foram selecionadas 42 bailarinas, divididas em dois grupos (Grupos Dor e Sem Dor) de acordo com a presença ou não de queixas de dor na região lombar. Inicialmente, as bailarinas foram submetidas, por um único examinador, a quatro testes para avaliação do desequilíbrio de força muscular na região lombopélvica: músculos glúteo máximo × isquiossurais e glúteo máximo × paravertebrais no movimento de extensão de quadril; glúteos máximo e médio × tensor da fáscia lata no movimento de abdução de quadril; abdominais e flexores de quadril no movimento de flexão de quadril. Em seguida, um segundo examinador aplicou os testes de força muscular para os músculos abdominais e paravertebrais. Para verificar a associação entre a queixa de dor lombar e a presença de desequilíbrios musculares foi utilizado o teste qui-quadrado. O nível de significância estabelecido foi de α = 0,05. RESULTADOS: A maioria das bailarinas, independente do grupo do qual participavam, apresentou desequilíbrios de força muscular na região lombopélvica, porém apenas o desequilíbrio entre abdominais × flexores de quadril teve associação significativa com a dor lombar (p = 0,043). CONCLUSÃO: Desequilíbrios musculares lombopélvicos são frequentes em bailarinas clássicas. Entretanto, não é possível afirmar se tais desequilíbrios são adaptações específicas do balé clássico ou disfunções associadas a quadros álgicos resultantes de falhas no treinamento.

The illusion of weightlessness

The ballet pointe shoe is an interesting example of a product that has developed from the experimentation of a dancer to extend the art form. Over time, as the use of such a shoe became part of the tradition the form stagnated and there was little formal interaction with the user as to its continued effectiveness in terms of injury, cost and fit. This work re-examines the shoe from the dancer's point of view and demonstrates a way forward that illustrates that even with severe constraints the designer with a user-centred approach can improve the performance of a product whilst maintaining a required external aesthetic.

Injury patterns in elite preprofessional ballet dancers and the utility of screening programs to identify risk characteristics

STUDY DESIGN

Retrospective descriptive cohort study.

OBJECTIVES

To describe the distribution and rate of injuries in elite adolescent ballet dancers, and to examine the utility of screening data to distinguish between injured and noninjured dancers.

BACKGROUND

Adolescent dancers account for most ballet injuries. Limited information exists, however, regarding the distribution of, rate of, and risk factors for, adolescent dance injuries.

METHODS AND MEASURES

Two hundred four dancers (age, 9-20 years) were screened over 5 years. Screening data were collected at the beginning and injury data were collected at the end of each training year. Descriptive statistics were used to characterize distribution and rate of injuries. Inference statistics were used to examine differences between injured and noninjured dancers.

RESULTS

Fifty-three percent of injuries occurred in the foot/ankle, 21.6% in the hip, 16.1% in the knee, and 9.4% in the back. Thirty-two to fifty-one percent of the dancers were injured each year, and, over the 5 years, there were 1.09 injuries per 1000 athletic exposures, and 0.77 injuries per 1000 hours of dance. Significant differences between injured and noninjured dancers were limited to current disability scores (P = .007), history of low back pain (P = .017), right foot pronation (P = .005), insufficient right-ankle plantar flexion (P = .037), and lower extremity strength (P = .045).

CONCLUSION

Distribution of injuries was similar to that of other studies. Injury rates were lower than most reported rates, except when expressed per 1000 hours of dance. Few differences were found between injured and noninjured dancers. These findings should be considered when designing and implementing screening programs.

Comparison of Repetitive Movements Between Ballet Dancers and Martial Artists: Risk Assessment of Muscle Overuse Injuries and Prevention Strategies

Studies show that 64%-80% of professional dancers need to stop performing for extended periods due to Overuse Syndrome (OS). Although ballet and Tae-Kwon-Do seem to have similarities in muscle lengthening, the Tae-Kwon-Do injury rate is significantly lower. Identifying differences between both skills should provide insights for OS prevention. Therefore, the aims of this study are to quantitatively determine the diversities in intensity between both skills, to identify muscles at risk, and to draw possible prevention strategies from the comparison. The methods used were 3D motion capture and biomechanical modeling. Six ballet dancers and five Tae-Kwon-Do artists participated in the study. The results show that intensity during Tae-Kwvon-Do is higher than that during ballet, particularly for small muscles. As inteinsity cannot be responsible for higher injuries, strength training for small muscles and shorter exercise duration in Tae-Kwon-Do may account for the reversed rate; consequently, this is a promising procedure for ballet training. Clearly, further studies are needed to validate this conclusion.

Common musculoskeletal problems in the performing artist

In this chapter we touched on a wide variety of unique musculoskeletal conditions in the musician and dancer. We outlined generalized methods of evaluation that stress the importance of the interdisciplinary approach in this highly specialized patient population and stressed the importance of specific involvement of the music or dance instructor in evaluation and management. We sought to emphasize the need to refer to specialized care early when in doubt of diagnosis or when usual first-line treatments fail. We gave examples of specific injury patterns common in these subgroups and suggestions for early management. Finally, we described some general principals for prevention of musculoskeletal injury in this group. A physician treating the performing artist must always keep in mind that in this unique patient population, their occupation is not only a means of earning a living, it is their passion. Artists make great sacrifice both physically and mentally to bring the world such immeasurable beauty. It is our responsibility to care for them in the most comprehensive and compassionate manner possible while informing them as honestly as possible about their treatment options.

Dance-Related Injury

Although dance medicine has derived extensive knowledge from sports medicine, some aspects covered in the practice of dance medicine are unique to this field. Acute and overuse injuries must be analyzed within the scope of associated mechanisms of injury, mainly related to the practice of specific dance techniques. Even though most available medical literature concerning dance medicine is specific to ballet-related conditions, many of the concepts covered here and in other articles can be helpful in the treatment and diagnosis of participants in other dance disciplines. Continued research is expanding the knowledge on injury patterns of different dance disciplines. It is the experience of dance practitioners that dancers are quite in touch with their bodies; thus, when their ailments are systematically analyzed, and underlying cause can usually be identified. In this sense, it is evident that the principles of dance medicine and rehabilitation allow the practitioner to arrive at a diagnosis and treat the underlying causes to prevent reinjury, ameliorate sequelae from injury, and minimize residual deficits after injury.

Musculoskeletal injuries in the Norwegian National Ballet: a prospective cohort study

The purpose of the present study was to determine the incidence of musculoskeletal injuries among professional ballet dancers in the Norwegian National Ballet. A 19 weeks prospective study with registration and clinical assessment of dancers with injuries was conducted. Medical staff working for the National Ballet registered incidence of injuries. In addition the dancers filled out a questionnaire about previous injuries, their work situation, and factors they believed increased the risk of injuries. Of the 41 dancers (80% response rate), 31 dancers experienced one injury or more. The majority of injuries involved foot and ankle. Twenty-two per cent of the injuries were acute injuries. Seventy-five per cent of the injuries were soft tissue injuries. Most injuries were of mild to moderate severity. Sixteen per cent of the injuries resulted in absence from work. Factors, the dancers believed were associated with risk of injuries were related to training, organizational factors and environmental factors. Seventy-eight per cent of the dancers experienced "negative" stress at work. Sixty-four per cent experienced that they had little influence on their work conditions. This study showed, however, no significant association between these psychological factors and musculoskeletal injuries. It is concluded that there is a high incidence of musculoskeletal injuries in the Norwegian National Ballet.

The experience of back pain in young Australians

The usual activity level and history of low back pain was determined by questionnaire in 614 young Australians (9-27 years); dancers (25%), gymnasts (5%) and a control group who did not participate in dance or gymnastics for > or =6 hours/week during the previous three months (70%). These groups demonstrated significantly different activity levels (dancers >gymnasts >controls). Of all respondents, 34% experienced pain of more than two days duration in the previous year, and 50% in all previous years. The incidence and magnitude of pain in the previous year was significantly greater in the dancers and gymnasts (P<0.05) compared to the controls. The incidence of pain was not linked to the average total hours of activity until this exceeded 30 hours per week. There was no significant difference in the incidence of pain in the previous year between control group respondents who did and did not undertake regular activity. The average hours of activity per incident was approximately 20 hours for the dancers and approximately 5 hours for the other groups. This study has demonstrated that back pain in active and inactive adolescents presents a significant challenge for health-care practitioners involved in the management and prevention of symptomatic spinal disorders.

A ballet dancer with chronic hip pain due to a lesser trochanter bony avulsion: the challenge of a differential diagnosis

Physical therapy assessment involves confirmation of a medical diagnosis. To help discuss this process, this case report is presented regarding a ballet dancer who experienced 6 years of chronic hip pain and dysfunction. Many diagnostic tests and surgical procedures were performed by various physicians in search of a diagnosis. Physical therapy assessments did not support the working diagnoses, and treatment given according to evaluation findings was not effective. Initial hip radiographs revealed a bony ossicle at the lesser trochanter, which was overlooked. Hip radiographs taken 5 years later revealed the same bony ossicle. Ultimately, surgical removal of the ossicle eliminated the hip pain, and the patient returned to full activity and dance again. With the attempt to confirm the patient's diagnosis, the physical therapy approach to problem solving is discussed. This case gives an example where it is important to question the physician's diagnosis when the physical therapy assessment and treatment response do not support it. it is also evident that an in-depth physical therapy assessment may be self-limiting if pathology has not been ruled out properly by the physician.