Welcome to the Podiatry Arena forums, for communication between foot health professionals about podiatry and related topics.
You are currently viewing our podiatry forum as a guest which gives you limited access to view all podiatry discussions and access our other features. By joining our free global community of Podiatrists and other interested foot health care professionals you will have access to post podiatry topics (answer and ask questions), communicate privately with other members (PM), upload content, view attachments, receive a weekly email update of new discussions, earn CPD points and access many other special features. Registered users do not get displayed the advertisments in posted messages. Registration is fast, simple and absolutely free so please, join our global Podiatry community today!
If you have any problems with the registration process or your account login, please contact contact us.
The aim of the present study was to assess the prevalence and types of injuries in 1336 young, non-professional female dancers (age 8-16 years) who participated in a descriptive mixed (cross-sectional/ longitudinal) cohort study. Previous and current injuries were diagnosed and later classified into seven major categories. Our results show that 569 (42.6%) of the dancers examined manifested an injury. Advanced age and increased exposure to dance yielded an equivalent increase in the prevalence of injured girls: from 1 of 10 girls in the 8-year-old age cohort (mean = 1.05 per 1000 h) to 1 of 3 girls in the 14-year-old age cohort (mean = 1.25 per 1000 h). Time elapsing between first and second injuries decreased with age. Among the youngest group of dancers (8-9 years) the most common injury was tendonitis (41%), while in adolescent dancers (14-16 years) knee injuries became the leading cause of complaints (33%). We conclude that young, non-professional dancers are at high risk of injury. Dancers who had been injured in the past were at higher risk for re-injury. Tendonitis in the foot or ankle joint was a common injury among the youngest dancers, while knee injuries were common among adolescent dancers. A routine screening of this dancer population by an expert in dance medicine will reduce the risk for an injury.
Background: The angle of turnout is thought to predispose professional dancers to overuse musculoskeletal injuries of the lower limb; yet, the influence of angle of turnout on foot posture is currently unknown.
Methods: Twelve professional contemporary dancers (five women and seven men; mean age, 26.8 years) were recruited. The angle of gait and angle of turnout were measured using a quasi-static clinical tracing method. Foot posture was assessed in the base of gait and angle of turnout using the Foot Posture Index. Each dancer completed a dance history and injury questionnaire.
Results: The results show a tendency toward a pronated foot posture (mean, 9°) in the angle of turnout position. A significant relationship was noted between the Foot Posture Index and angle of turnout (ρ = 0.933–0.968, P < .01) and between the number of reported injuries and change in foot posture in the angle of turnout (ρ = 0.789, P < .01) (right foot only). Twenty-eight injuries were reported; male dancers experienced a mean of 2.8 injuries and females a mean of 1.6 injuries. An inverse relationship was noted between age at training initiation and total reported injuries (r =−0.867, P < .01). All of the dancers reported a history of injury to the spine or lower limb, and 9 of the 12 reported an injury within the previous 12 months.
Conclusions: Turnout is one of the most fundamental aspects of dance technique. This study suggests a trend toward pronation in angle of turnout and a link to lower-limb musculoskeletal injury
Extrinsic and intrinsic risk factors associated with injuries in young dancers aged 8-16 years.
Steinberg N, Siev-Ner I, Peleg S, Dar G, Masharawi Y, Zeev A, Hershkovitz I. J Sports Sci. 2012 Jan 30
In the present study, we tried to determine the association between joint ranges of motion, anatomical anomalies, body structure, dance discipline, and injuries in young female recreational dancers. A group of 1336 non-professional female dancers (age 8-16 years), were screened. The risk factors considered for injuries were: range of motion, body structure, anatomical anomalies, dance technique, and dance discipline. Sixty-one different types of injuries and symptoms were identified and later classified into four major categories: knee injuries, foot or ankle tendinopathy, back injuries, and non-categorized injuries. We found that 569 (42.6%) out of the 1336 screened dancers, were injured.The following factors were found to be associated with injuries (P < 0.05): (a) range of motion (e.g. dancers with hyper hip abduction are more prone to foot or ankle tendinopathies than dancers with hypo range of motion; (b) anatomical anomalies (scoliotic dancers manifested a higher rate of injuries than non-scoliotic dancers); (c) dance technique (dancers with incorrect technique of rolling-in were found to have more injuries than dancers with correct technique); (d) dance discipline (an association between time of practice en pointe and injury was observed); and (e) early age of onset of menarche decreased risk for an injury. No association between body structure and injury was found. Injuries among recreational dancers should not be overlooked, and therefore precautionary steps should be taken to reduce the risk of injury, such as screening for joint range of motion and anatomical anomalies. Certain dance positions (e.g. en pointe) should be practised only when the dancer has already acquired certain physical skills, and these practices should be time controlled
Modern (or contemporary) dance has become increasingly popular, yet little has been reported with respect to modern dance injuries and their consequences. The purpose of this study is to define the incidence, risk factors, and management of musculoskeletal injuries in professional modern dancers. A total of 184 dancers in the United States completed an anonymous 17-page questionnaire on their injuries, including extensive details regarding the two most severe injuries that had occurred in the prior 12 months. According to their self-reports, a total of 82% of the dancers had suffered between one and seven injuries. The foot and ankle (40%) was the most common site of injury, followed by the lower back (17%) and the knee (16%). The rate of injuries was 0.59 per 1,000 hours of class and rehearsal. Injured male dancers returned to full dancing after a median of 21 days, while females returned after a median of 18 days. Most dancers missed no performances due to injury. Of the medical consultations sought by dancers for their injuries, 47% were made to physicians, 41% to physical therapists, and 34% to chiropractors. The majority of dancers adhered to the advice given them by consultants (87% of males and 78% of females for the most severe injury). While the majority of injuries were considered work-related (61% of the most severe injury and 69% of the second most severe), few were covered by Workers' Compensation insurance (12% and 5% respectively). These professional modern dancers suffer from a rate of injury similar to other groups of professional dancers. Most dancers return to a partial level of dancing several weeks before attempting full-capacity dancing.
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.
The objective of this study was to assemble and synthesize the best available literature from 2004 to 2008 on musculoskeletal injury and pain in dancers. MEDLINE and CINAHL were the primary sources of data. Indexed terms such as dance, dancer, dancing, athletic injuries, occupational injuries, sprains and strains, musculoskeletal diseases, bone density, menstruation disturbances, and eating disorders were used to search the databases. Citations were screened for relevance using a priori criteria, and relevant studies were critically reviewed for scientific merit by the best-evidence synthesis method. After screening, 19 articles were found to be scientifically admissible. Data from accepted studies were abstracted into evidence tables relating to: prevalence and associated factors; incidence and risk factors; intervention; and injury characteristics and prognosis of musculoskeletal injury and pain in dancers. Principal findings included: a high prevalence and incidence of lower extremity, hip and back injuries; preliminary evidence that psychosocial and psychological issues such as stress and coping strategies affect injury frequency and duration; history of a previous lateral ankle sprain is associated with an increased risk of ankle sprain in the contralateral ankle in dance students; fatigue may play a role in ACL injury in dancers; acute hamstring strains in dancers affect tendon more than muscle tissue, often resulting in prolonged absence from dance. It is concluded that, while there are positive developments in the literature on the epidemiology, diagnosis, prognosis, treatment, and prevention of MSK injuries and pain in dancers, much room for improvement remains. Suggestions for future research are offered.
Musculoskeletal disorders (MSDs) in dancers and former dancers participating in the largest dance festival in the world
L. Grego Muniz de Araújo, H. Luiz Monteiro, C. Marcelo Pastre Science & Sports; 8 November 2012
To verify the presence of musculoskeletal disorders (MSD) in dancers and former dancers participating in the 27th Joinville Dance Festival.
Material and methods
The research was conducted at the 27th Joinville Dance Festival in Santa Catarina, Brazil, with 173 participants in the competition, where 139 were dancers and 34 were former dancers with at least ten years of practice. In order to obtain information related to MSDs, dancers answered a specific questionnaire.
The study group consisted of adults (28 ± 9 years) with body mass index within the normal range (21.3 ± 2.3) with high weekly training time (955.7 ± 837.2) and featuring long-time experience in dancing (18 ± 7 years). The lumbar spine and knees were the most affected by MSDs. The pain of high intensity was the symptom that most often appeared in reports among survey participants.
It is important to have deeper knowledge of the prevalence of pain among professional dancers, the factors associated with pain conditions and its impact on everyday life in order to plan new forms of prevention and plan new forms of prevention and treatment within a multidisciplinary approach.
Press release: Study finds increase in dance-related injuries in children and adolescents
Dance is a beautiful form of expression, but it could be physically taxing and strenuous on the human body, particularly for children and adolescents. A new study by researchers at the Center for Injury Research and Policy of The Research Institute at Nationwide Children's Hospital examined dance-related injuries among children and adolescents 3 to 19 years of age from 1991 to 2007. During the 17-year study period, an estimated 113,000 children and adolescents were treated in U.S. emergency departments for dance-related injuries.
According to the study, which is being published in the February 2013 print issue of the Journal of Physical Activity and Health, the annual number of dance-related injuries increased 37 percent, climbing from 6,175 injuries in 1991 to 8,477 injuries in 2007. Sprains and/or strains (52 percent) were found to be the most common types of dance-related injuries, with falls (45 percent) being the most common causes of injuries.
The study also found that 4 out of 10 injured dancers were between 15 and 19 years of age.
"We believe this could be due to adolescent dancers getting more advanced in their skills, becoming more progressed in their careers and spending more time training and practicing," said Kristin Roberts MS, MPH, lead author of the study and senior research associate at the Center for Injury Research and Policy at Nationwide Children's Hospital. "We encourage children to keep dancing and exercising. But it is important that dancers and their instructors take precautions to avoid sustaining injuries."
"Safety precautions such as staying well-hydrated, properly warming up and cooling down, concentrating on the proper technique and getting plenty of rest can help prevent dance-related injuries," said the study's senior author Lara McKenzie, PhD, principal investigator at the Center for Injury Research and Policy at Nationwide Children's and also a faculty member at The Ohio State University College of Medicine.
The Sports Medicine experts at Nationwide Children's treat the types of injuries seen in performing arts and dance athletes. Due to the increase in the number of dance-related injuries seen during the last few years, they have designed a number of services to address the needs of the young dancer.
"Adolescents are still growing into their bodies and as such often develop imbalances that can lead to injury," said Eric Leighton, ATC, an athletic trainer in Sports Medicine at Nationwide Children's. "It's critical that intervention and injury prevention be made available to them to address balance, strength and functional body control deficits as they grow. From pointe readiness screens to injury prevention programming, our team has a comprehensive approach to address the needs of these athletes."
This is the first study to use a nationally representative sample to examine dance-related injuries that were treated in U.S. emergency departments. Data for this study were obtained from the National Electronic Injury Surveillance System (NEISS), which is operated by the U.S. Consumer Product Safety Commission. The NEISS provides information on consumer product-related and sports and recreation-related injuries treated in hospital emergency departments across the country.
Injuries among Talented Young Dancers: Findings from the UK Centres for Advanced Training.
Steinberg N, Aujla I, Zeev A, Redding E. Int J Sports Med. 2013 Jul 30.
The aim of the present study was to characterize the injuries of young dancers attending Centres for Advanced Training. 806 dancers, ages 10-18 years responded to surveys regarding their biological profile, dance experience and injury history, and were examined for their anthropometric profile. Of the 806 dancers, 347 reported an injury. Based on 4 age groups, the total hours of practice per week increased significantly with increasing age. Incidence of injuries per 1 000 h of dance practice for dancers ages 11-12 were found to be significantly higher compared to the incidence for dancers ages 13-18 (p<0.05). Foot and ankle and other lower extremities were the most common injury location, and muscle injuries were the most common type of injury. Total months in CAT training (OR=1.044, 95% CI=1.014-1.075) and hours per week in creative style practice (OR=1.282, 95% CI=1.068-1.539) were found to be significantly associated with injuries. In conclusion, both young and mature dancers are exposed to extensive risk of injury. The intensity of training (such as number of months and number of hours of training per week) is important factor that should be taken into account in order to decrease future injuries among young dancers.
The purpose of this study was to investigate the incidence and magnitude of clinically significant psychological symptoms among outpatient injured dancers presenting for musculoskeletal issues and to identify features of “at risk” dancer-patients who might require additional psychological support when injured. The Brief Symptom Inventory® (BSI), a highly reliable and valid screening tool for psychological distress, was administered to first- and last-visit injured dancers at an orthopedic clinic in the Netherlands from February to May 2008. In all, 153 BSI surveys were completed, including 82 among first-visit patients and 71 among end-treatment patients. Scores were examined for the influence of age, gender, dance level, style, pain, perceived level of artistic compromise, and anatomic location of injury. Dancers' scores were compared to normative values for adult non-psychiatric patient community members. Ninety-two dancers (60.1%) met requirements for clinical referral to a psychologist or psychiatrist, having scored two or more standard deviations (SD) above the norm in at least one of nine psychopathological symptoms. Across first- and last-visit groups, dancers met referral criteria for an average of four psychopathological symptoms. First-visit dancers demonstrated higher distress than the general population on 90% of BSI dimensional symptoms and last-visit dancers on 50%. On the Global Symptom Index, a summary score for overall distress and the best measure of psychological discomfort, 46.6% of dancers demonstrated “above average” distress (≥ 1 SD) compared to the general population, and 19.6% demonstrated “high” (≥ 2 SD) or “very high” (≥ 2.5 SD) distress. Compared to academy level pre-professional students, professionals showed reduction in BSI scores on somatic, cognitive, interpersonal sensitivity, anxious, hostile, phobic, and global scores following resolution of injury, particularly among those greater than 25 years of age. Students and professionals less than 25 years of age demonstrated little change in scores from the initial visit to the end of treatment. In addition, students worsened in somatization and depression domains over time, suggesting perseverative or brooding behavior and poor coping skills. Amateurs overall scored average or below average on the BSI compared to the general population at both time points. It is concluded that healthcare providers should be made aware that outpatient injured dancers presenting for musculoskeletal assessment may additionally have high levels of psychological distress, and this may warrant formal evaluation by a mental health professional.
Background Ballet dancers are both artists and athletes with extreme physical demands placed on them. Clinical experience and previous studies suggest that they are at high risk of sustaining injuries, but more high-quality prospective studies are needed.
Objective To assess the prevalence of injuries and illnesses among professional ballet dancers in the Norwegian National Ballet Company, using a newly developed injury surveillance method. Information gained may provide a foundation for future prevention interventions.
Design Prospective cohort study.
Participants A total of 57 dancers in the National ballet company agreed to participate. During the first 32 weeks of the registration there has been 5 drop-outs.
Interventions Every second week all dancers received a recently developed online questionnaire which records symptoms of illness and injury, as well as reduced participation and dancing performance due to health problems.
Main outcome measurements Prevalence of injuries and illnesses.
Results Preliminary results after 32 weeks. The average response rate was 81% (64–89%). The average injury prevalence was 64% (32–84%), and the average illness prevalence was 9% (4–20%). The prevalence of substantial injuries, defined as injuries leading to moderate or severe reductions in dance participation or performance, or total inability to dance, was 29% (18–45%). Thirty-four percent of injuries were located in the ankle, 18% in the lower leg, 12% in the knee and 11% in the foot.
Conclusions The prevalence of injury is extremely high among dancers at the Norwegian National Ballet Company, being considerably higher than among elite athletes from Olympic sports. Future efforts to prevent injuries in this group are warranted.
Press release: Young dancers at a higher risk of injury
Gruelling training loads are placing young ballet dancers at risk of serious and in some cases, career-ending injuries, with new research revealing young dancers are at a higher risk of injury relative to other adolescent athletic populations.
The study, published by Sports Medicine Australia in The Journal of Science and Medicine in Sport, found that extremely high and unvaried training loads, coupled with the impact of adolescent growth spurts, may pre-dispose young pre-professional dancers to high levels of overuse injury.
Lead author Christina Ekegren, Physiotherapist and PhD candidate, Department of Epidemiology and Preventative Medicine, Monash University said more than three-quarters of the dancers monitored sustained an injury over the period of the one year study.
“Of the injuries sustained, a number were quite severe, with 23 of the 378 injuries requiring surgery, and as many as 60 per cent requiring investigation through medical imaging,” said Ms Ekegren.
“Five of the dancers were forced to drop out of elite ballet school as a result of their injuries, while on average the time lost from dance through injury was about a month.”
Ms Ekegren said overuse was the most common cause of injury, with 72 per cent of injuries occurring as a result of overuse and likely exacerbated by high training loads without adequate recovery time.
“Previous research has confirmed that dance, and in particular, ballet, is one of the most demanding physical activities undertaken by young people,” Ms Ekegren said.
“During our surveillance, we found that the majority of the dancers monitored danced six days per week with each participant dancing an average of 30 hours per week – this was on top of their normal school work.
“There was very little variation in the type of training undertaken, with the majority of time spent in ballet classes.
“Given that injuries sustained by young dancers during their training often recur in their professional careers and are a leading cause of early retirement, if young dancers could avoid injury they could potentially extend their professional longevity.
“Injury prevention would also result in significant health-related cost savings, with dancers also avoiding the negative psychological impact and adverse effects on career development that occur through missing long periods of time from training.
“These findings highlight the need for dance teachers to carefully monitor their students’ training loads and modify them accordingly to avoid injury, while young dancers should also be educated on the importance of adequate recovery time to avoid injury re-occurrence.“
The study, Injuries in pre-professional ballet dancers: Incidence, characteristics and consequences, was one of the first to follow the recently developed International Association for Dance Medicine and Science (IADMS) injury reporting guidelines. The occurrence of injuries in 266 dancers aged 16-19 years from three elite ballet schools in London was monitored over the period of one school year.
Kinematic analysis of modern dance movement "stag jump" within the context of impact loads, injury to the locomotor system and its prevention.
Gorwa J, Dworak LB, Michnik R, Jurkojć J. Med Sci Monit. 2014 Jun 27;20:1082-1089.
Background This paper presents a case study of kinematic analysis of the modern dance movement known as the "stag jump". Detailed analysis of the kinematic structure of this movement as performed by the dancers, accompanied by measurements of impact forces during landing, will allow the authors to determine, in subsequent model-based research phases, the forces acting in knee joints of the lower landing limb.
Material and Methods Two professional modern dancers participated in the study: a male and a female. The study consisted in recording the values of ground reaction and body motion, and then determining and analyzing kinematic parameters of performed movements.
Results The results of measurement of joint angles in the landing lower limb, pelvis, and foot position in relation to the ground, as well as the level of vertical components of ground reaction, provided insight into the loading response phase of the "stag jump". The measurements and obtained results show differences between the man and woman in ground reactions and kinematic quantities.
Conclusions The results obtained during the research may be used in the development and teaching of dancing movements. Training sessions, carried out in the biomechanical laboratory, with active participation of dancing teachers, could form a basis for a prevention model of injuries and physical overloads occurring within this occupational group. Primary differences in the "stag jump" performance technique probably result from the different educational path the man and the woman went through.
Ballet is an art that puts extreme demands on the dancer's musculoskeletal system and therefore significantly affects motor behavior of the dancers. The aim of our research was to compare plantar pressure distribution during stance phase of gait between a group of professional ballet dancers and non-dancers. Thirteen professional dancers (5 men, 8 women; mean age of 24.1 ± 3.8 years) and 13 nondancers (5 men, 8 women; mean age of 26.1 ± 5.3 years) participated in this study. Foot pressure analysis during gait was collected using a 2 m pressure plate. The participants were instructed to walk across the platform at a self-selected pace barefoot. Three gait cycles were necessary for the data analysis. The results revealed higher (p < 0.05) pressure peaks in medial edge of forefoot during gait for dancers in comparison with nondancers. Furthermore, differences in total foot loading and foot loading duration of rearfoot was higher (p < 0.05) in dancers as well. We can attribute these differences to long-term and intensive dancing exercises that can change the dancer's gait stereotype.
Summer dance intensive programs are an integral part of many serious dancers' training. The risk and rate of injury in this setting have not been well studied. The goal of this data analysis is to detail the epidemiology of dance injuries reported during a summer dance intensive over a consecutive 3 year period. Data collection included information regarding the number of evaluation and treatment sessions conducted at the program's walk-in clinic, body regions injured, whether the injuries were recurrences of pre-existing conditions or newly sustained during the intensive, and at what point in the program they were recorded. Overall, more of the clinic's clientele presented with multiple injuries than with single discrete injuries. The anatomic distribution of injuries appears to be consistent with previously reported data, with the four most commonly injured body regions being ankle, pelvis and hip, knee, and lumbar spine. Injuries sustained during the intensive (IR) occurred at a 2:1 ratio to pre-intensive injuries (PR). Relative to those with PR injuries, dancers with IR injuries were far more likely to present during the first half of the program. This study is a first step toward filling a gap in the literature by describing injury incidence in a specific population within the dance community.
Metatarsal Pain and Plantar Hyperkeratosis in the Forefeet of Female Professional Flamenco Dancers.
Castillo-López JM, Vargas-Macías A, Domínguez-Maldonado G, Lafuente-Sotillos G, Ramos-Ortega J, Palomo-Toucedo IC, Reina-Bueno M, Munuera-Martínez PV. Med Probl Perform Art. 2014 Dec;29(4):193-197.
The objectives of this study were to determine the frequency of metatarsal pain and of hyperkeratosis on the plantar forefoot in female professional flamenco dancers, and to determine whether there is a relationship between the two disorders.
Forty-four female professional flamenco dancers, with a minimum activity of 25 hrs/wk, participated in this cross-sectional study. The presence or absence of metatarsal pain while dancing was recorded, and plantar pressures were measured on a pressure platform, both barefoot and shod with the usual dance shoe. The heel height of the dance shoe was also measured.
Of the dancers, 80.7% experienced metatarsal pain while dancing, and 84.1% presented with plantar hyperkeratosis. Plantar hyperkeratosis coincided with the presence of metatarsal pain in 67.04% of the feet studied. The maximum load point in the feet when the dancers were barefoot was located 59.5% in the rearfoot and 40.5% in the forefoot; when dancers wore their specific flamenco dancing shoes, it was located 52.4% in the rearfoot and 47.6% in the forefoot.
Metatarsal pain and plantar hyperkeratosis in the forefoot are common foot disorders in female flamenco dancing. The incidence of the maximum load point being located in the forefoot, and the difference between the results of the tests while shod or barefoot, are both too low to support the idea that the raised heels of flamenco shoes are a major contributing factor for these injuries. Therefore, these disorders may be caused by chronic repetitive trauma suffered during the practice of footwork dancing.
Background: Classical ballet is an art form that seems graceful on the surface. However,
beneath the disguise of beauty and ease lies an extremely physically demanding activity
that calls for dedication, strength and perseverance. Ballet requires a specific body type
and precise techniques, which predispose the dancer to musculoskeletal injury. Although
a few studies have been conducted to investigate biomechanical factors as risk factors for
injury in ballet dancers, few have included amateur ballet dancers and a range of
Objectives: This study aimed to determine characteristics of ballet-related injury in
amateur ballet dancers in the greater Durban area; to measure and record lower limb
biomechanical measurements of these dancers; and to identify associations between the
biomechanical measurements and characteristics of injury in the population.
Method: A quantitative, questionnaire-based survey with biomechanical measurements
was conducted on 21 amateur ballet dancers in the greater Durban area. Statistical
analysis included the description of categorical variables using frequency and
percentages in tables and bar charts. Continuous variables were summarised using
mean, standard deviation and range, or median and range as appropriate. Independent
Sample T-tests were used to compare biomechanical measurements between two
independent groups. A p value <0.05 was considered as statistically significant. Pearson’s
correlations and ANOVA testing were also used.
Results: The period prevalence of ballet-related injury over the last 2 years was found to
be 62% and the point prevalence 38%. There were 37 total previous injuries, most of
which occurred in the hamstring (24%). Most of the worst previous injuries were reported
to have occurred in the low back (31%). Most of the worst previous (70%) and current
(93%) injuries occurred over time. The worst previous injuries reported ranged from mild
to severe in severity, while the worst current injuries reported ranged from mild to
Significant associations were found between right weight-bearing ankle dorsiflexion and
previous injury; right weight-bearing ankle dorsiflexion and current injury; ‘functional
turnout’ and onset of injury; right non weight-bearing ankle dorsiflexion and onset of injury;
and ‘compensated turnout’ and onset of injury.
Conclusion: The results suggest a significant association between musculoskeletal
ballet-related injury and reduced weight-bearing ankle dorsiflexion; between injuries that
occur over time (overuse injuries) and decreased ‘functional turnout’; and between
overuse injuries and decreased non weight-bearing ankle dorsiflexion. These findings may
help identify risk factors for injury in ballet dancers and contribute towards preventing
The objective of this study was to review the evidence for selected risk factors of lower extremity overuse injuries in young elite female ballet dancers. An electronic search of key databases from 1969 to July 2013 was conducted using the keywords dancers, ballet dancers, athletes, adolescent, adolescence, young, injury, injuries, risk, overuse, lower limb, lower extremity, lower extremities, growth, maturation, menarche, alignment, and biomechanics. Thirteen published studies were retained for review. Results indicated that there is a high incidence of lower extremity overuse injuries in the target population. Primary risk factors identified included maturation, growth, and poor lower extremity alignment. Strong evidence from well-designed studies indicates that young elite female ballet dancers suffer from delayed onset of growth, maturation, menarche, and menstrual irregularities. However, there is little evidence that this deficit increases the risk of overuse injury, with the exception of stress fractures. Similarly, there is minimal evidence linking poor lower extremity alignment to increased risk of overuse injury. It is concluded that further prospective, longitudinal studies are required to clarify the relationship between growth, maturation, menarche, and lower extremity alignment, and the risk of lower extremity overuse injury in young elite female ballet dancers.
Background Despite overuse injuries being previously described as the most frequent in ballet, there are no studies on professional dancers providing the specific clinical diagnoses or type of injury based on the discipline.
Hypothesis Overuse injuries are the most frequent injuries in ballet, with differences in the type and frequency of injuries based on discipline.
Study Design Cross-sectional study; Level of evidence, 3.
Methods This was a descriptive cross-sectional study performed between January 1, 2005, and October 10, 2010, on injuries occurring in professional dancers from leading Spanish dance companies who practiced disciplines such as classical, neoclassical, contemporary, and Spanish ballet. Data, including type of injury, were obtained from specialized medical services at the Trauma Service, Fremap, Madrid, Spain.
Results A total of 486 injuries were evaluated, a significant number of which were overuse disorders (P < .0001), especially in the most technically demanding discipline of classical ballet (82.60%). Injuries were more frequent among female dancers (75.90%) and classical ballet (83.60%). A statistically significant prevalence of patellofemoral pain syndrome was found in the classical discipline (P = .007). Injuries of the adductor muscles of the thigh (P = .001) and of the low back facet (P = .02) in the Spanish ballet discipline and lateral snapping hip (P = .02) in classical and Spanish ballet disciplines were significant.
Conclusion Overuse injuries were the most frequent injuries among the professional dancers included in this study. The prevalence of injuries was greater for the most technically demanding discipline (classical ballet) as well as for women. Patellofemoral pain syndrome was the most prevalent overuse injury, followed by Achilles tendinopathy, patellar tendinopathy, and mechanical low back pain.
Clinical Relevance Specific clinical diagnoses and injury-based differences between the disciplines are a key factor in ballet.
Background Most published studies on injuries in the ballet dancer focus on the lower extremity. The rigors of this activity require special training and care. By understanding prevalence and injury pattern to the musculoskeletal system, targeted prevention and treatment for this population can be developed.
Purpose To determine the incidence and prevalence of musculoskeletal injuries in ballet.
Study Design Systematic review; Level of evidence, 4.
Methods A systematic review registered with PROSPERO was performed using PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. Level 1 through 4 evidence studies reporting incidence of musculoskeletal injuries in male and female ballet dancers were included, with the numbers and types of injuries extracted from each. Injury rates were recorded and calculated based on professional status, sex, and nature of injury. Incidence was defined as number of injuries sustained over a specific time. Prevalence was defined as proportion of subjects with an injury at a given point in time.
Results The studies analyzed reported injury incidence or prevalence in more than 1365 amateur and 900 professional dancers. The mean age was 16.2 years among amateur and 27.0 years among professional dancers. The incidence of injury among amateur dancers was 0.99 and 1.09 injuries per 1000 dance hours in males and females, respectively; 75% of injuries were overuse, with similar rates among males and females. In professional dancers, the incidence of injury was 1.06 and 1.46 injuries per 1000 dance hours in males and females, respectively, and 64% of female injuries were overuse, compared with 50% in males (P < .001). Only 3 studies provided prevalence data, including 62% prevalence of lumbosacral pain, 58% painful snapping hip, and 29% patellofemoral pain. Lower extremity injuries comprised 66% to 91% of all injuries, with the foot and ankle accounting for 14% to 57%.
Conclusion The overall incidence of injury among amateur and professional ballet dancers is 0.97 and 1.24 injuries per 1000 dance hours, respectively. The majority are overuse in both amateur and professional dancers, with amateur ballet dancers showing a higher proportion of overuse injuries than professionals (P < .001). Male professional dancers show a higher proportion of traumatic injuries, accounting for half of their injuries (P < .001).
Lower Extremity Injury Patterns in Elite Ballet Dancers: Ultrasound/MRI Imaging Features and an Institutional Overview of Therapeutic Ultrasound Guided Percutaneous Interventions
Razia Rehmani MD, Yoshimi Endo MD, Phillip Bauman MD, William Hamilton MD, Hollis Potter MD, Ronald Adler MD, PhD HSS Journal; July 2015
Altered biomechanics from repetitive microtrauma, such as long practice hours in en pointe (tip of the toes) or demi pointe (balls of the feet) predispose ballet dancers to a multitude of musculoskeletal pathologies particularly in the lower extremities. Both ultrasound and magnetic resonance imaging (MRI) are radiation-sparing modalities which can be used to confidently evaluate these injuries, with ultrasound (US) offering the added utility of therapeutic intervention at the same time in experienced hands.
The purposes of this paper were: (1) to illustrate the US and MRI features of lower extremity injury patterns in ballet dancers, focusing on pathologies commonly encountered at a single orthopedic hospital; (2) to present complementary roles of both ultrasound and MRI in the evaluation of these injuries whenever possible; (3) to review and present our institutional approach towards therapeutic ultrasound-guided interventions by presenting explicit cases.
Online searches were performed using the search criteria of “ballet biomechanics” and “ballet injuries.” The results were then further narrowed down by limiting articles published in the past 15 years, modality (US and MRI), anatomical region (foot and ankle, hip and knee) and to major radiology, orthopedics, and sports medicine journals.
Performing ballet poses major stress to lower extremities and predisposes dancer to several musculoskeletal injuries. These can be adequately evaluated by both US and MRI. US is useful for evaluating superficial structures such as soft tissues, tendons, and ligaments, particularly in the foot and ankle. MRI provides superior resolution of deeper structures such as joints, bone marrow, and cartilage. In addition, US can be used as a therapeutic tool for providing quick symptomatic improvement in these athletes for who “time is money”.
Performing ballet may cause major stress to the lower extremities, predominantly affecting the foot and ankle, followed by the knee and hip. US and MRI play complementary roles in evaluating various orthopedic conditions in ballet dancers, with US allowing for dynamic evaluation and guidance for interventions.
Etiology and body area of injuries in young female dancers presenting to sports medicine clinic: A comparison by age group.
Stracciolini A, Yin AX, Sugimoto D. Phys Sportsmed. 2015 Aug 8:1-6
Improving knowledge regarding injuries sustained by pediatric dancers is important in order to better understand injury risk. The aim of this study is to analyze dance injury etiology and body area by age in a cohort of young female dancers presenting to a pediatric sports/dance medicine clinic.
The cross-sectional epidemiological study of a 5% probability sample of dancers evaluated between 1/1/2000 and 12/31/2009 with a musculoskeletal injury requiring physician evaluation. A total of 2,133 charts were reviewed from which 171 female dancers 8-17 years old (mean age 14.7 years) were identified. Data were stratified by age, <12 years and ≥12 years, and analyzed based on injury body area, type, and etiology. Fisher's exact test was used to determine statistical significance.
Injuries sustained by dancers in the younger age category (<12 years) were largely to the foot-ankle/lower leg/knee (93.3%) versus thigh-hip/spine/upper extremity (6.7%). In comparison, dancers in the older age group (≥12 years) had a large proportion of injuries to the foot-ankle/lower leg/knee (67.3%) as well, but had a notably larger fraction of injuries to the thigh-hip/spine/upper extremity (32.7%; p = 0.04). Approximately two-thirds of the injuries sustained in the younger age group (<12 years) were classified as bony. In comparison, injuries in the older age group (≥12 years) were roughly half bony and half soft tissue (51.3% and 48.7%, respectively; p = 0.29). Most injuries were overused in etiology for both younger and older age groups (86.7% and 82.1%, respectively; p = 1.00). Through puberty, there was a decline in the injuries to the foot-ankle/lower leg/knee. Conversely, there was an increase in the thigh/hip-pelvis/spine/upper extremity injuries through growth.
Injuries to young female dancers in this study cohort were mostly categorized as overuse in etiology, and differed by the age group and the body area. Increased information regarding dance injuries can help guide future injury prevention efforts.
Pediatric Dance Injuries: A Cross-Sectional Epidemiological Study
Amy X. Yin, MD, Dai Sugimoto, PhD, Daniel J. Martin, BS, Andrea Stracciolini, MD PM & R; Article in Press
The purpose of this study was to analyze characteristics of dance injuries evaluated by sports medicine physicians.
A cross-sectional epidemiological study of a 5% random probability sample of patients presenting for sports medicine evaluation between January 1, 2000 and December 31, 2009.
The sports medicine clinic of a tertiary level pediatric medical center
181 pediatric dancers (171 female and 10 male; 14.8 ? 2.0 years old) with 222 injuries.
Main Outcome Measures
Injury diagnoses, location, type, and treatment.
Forty-six injury diagnoses were recorded in this random sample of pediatric dancers, with the most common being tendonitis/tendinopathy, patellofemoral pain syndrome, apophysitis, ankle impingement syndrome, and hip labral tear. Most of the injuries occurred in the lower extremities, with knee and ankle injuries being the most common. Injury classification by type revealed that joints were the body structure most likely to be injured, followed by soft tissues, skeletal elements, and growth plates. The most frequent joint injury was patellofemoral pain syndrome. The most frequent soft tissue injury was tendonitis/tendinopathy. The most common skeletal injury was a pars stress reaction/spondylolysis. The most common physeal injury was apophysitis. Dancers were mainly treated with physical therapy, surgery, or physical therapy in addition to orthotics.
Pediatric dancers experienced significant, and occasionally rare, injuries that may have long-term health consequences. While injuries mostly occurred in the lower extremities and mainly involved joints, the most common specific diagnosis was tendonitis/tendinopathy. There is still much to learn about management of dancers, and there is need for further research into injury prevention, diagnosis, and treatment.
Background Preprofessional dancers partake in rigorous training and have high injury prevalence. Attempts to identify risk factors for dance injuries have focused on a diversity of intrinsic and extrinsic factors.
Objective To identify and evaluate the evidence examining risk factors for musculoskeletal injury in preprofessional ballet and modern dancers.
Methods Fifteen electronic databases were systematically searched to October 2015. Studies selected met a priori inclusion criteria and investigated musculoskeletal injury risk factors in preprofessional (elite adolescent, student, young adult) ballet and modern dancers. Two reviewers independently assessed the quality and level of evidence using the Downs and Black (DB) criteria and a modified Oxford Centre of Evidence-Based Medicine 2009 model, respectively.
Results Of 1364 potentially relevant studies, 47 were included and scored. Inconsistent injury definition and methodology precluded meta-analysis. The most common modifiable risk factors investigated were anthropometrics (ie, body mass index, adiposity), joint range of motion (ie, lower extremity), dance exposure (ie, years training, exposure hours) and age. The median DB score across studies was 8/33 (range 2–16). The majority of studies were classified as level 3 evidence and few considered risk factor inter-relationships. There is some level 2 evidence that previous injury and poor psychological coping skills are associated with increased injury risk.
Conclusions Because of the lack of high-quality studies, consensus regarding risk factors for musculoskeletal injury in preprofessional dancers remains difficult. There is a need for injury definition consensus and high-quality prospective studies examining the multifactorial relationship between risk factors and injury in preprofessional dance.
The objective of this study was to provide an epidemiological review of the literature concerning ballet injuries affecting pre-professional ballet dancers. The literature search was limited to published peer-reviewed reports and involved an extensive examination of Scopus, SPORTDiscus, and CINAHL. The following search terms were used in various combinations: ballet, injury, epidemiology, risk factor, pre-professional, and intervention. Additional citations were located using the ancestry approach. Unlike some other athletic activities that have been the focus of recent intervention research, there is a paucity of intervention and translational research in pre-professional ballet, and sample sizes have often been small and have not accounted for the multivariate nature of ballet injury. Exposure-based injury rates in this population appear similar to those reported for professional ballet dancers and female gymnasts. A preponderance of injuries affect the lower extremity of these dancers, with sprains and strains being the most frequent type of injury reported. The majority of injuries appear to be overuse in nature. Injury risk factors have been tested in multiple studies and indicate a variety of potential injury predictors that may provide useful guidance for future research.
Arthroscopic Release of Flexor Hallucis Longus Tendon Sheath in Female Ballet Dancers: Dynamic Pathology, Surgical Technique, and Return to Dancing Performance
Hiroki Funasaki, M.D., , Hiroteru Hayashi, M.D., Kanako Sakamoto, M.D., Rei Tsuruga, M.D., Keishi Marumo, M.D. Arthroscopy Techniques; 30 November 2015
Stenosing tenosynovitis of the flexor hallucis longus (FHL) tendon is known as a major overuse lesion in female dancers. We describe arthroscopic surgical techniques in relation to the dynamic pathology of the disease. Crepitus and pain on moving the great toe with the ankle in plantar flexion on preoperative examination confirm the diagnosis of FHL stenosing tenosynovitis even if the os trigonum is not evident. The ankle is approached through standard posterolateral and posteromedial portals. A 4.0-mm-diameter 30? arthroscope is used. Soft tissues around the talus are cleared with a motorized shaver and a radiofrequency device. The posterior aspects of the talus, os trigonum, and FHL tendon surrounded by the tendon sheath are visualized. The dynamic pathology of the FHL tendon is well observed on passive motion of the great toe. The prominent bone fragment of the talus is removed and the tendon sheath is cut with a retrograde knife and a motorized shaver from the superior border down to the entrance of the fibro-osseous tunnel. Arthroscopic release of the FHL tendon sheath is a useful and easy method to directly approach the dynamic pathology of FHL tenosynovitis in female ballet dancers.