Dance-Related Injury

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Dance techniques and their relation to injury

Physique and dance technique receive significant attention among dancers, instructors, and clinical staff. Professional dancers embody the ultimate consequences brought about by rigorous training to master techniques that repetitively risk injury by exceeding the limits of their anatomic and physiologic capabilities. Knowledge about the technical requisites of dance is an important consideration in the care of the dancer. Understanding the biomechanics of dance is essential for dance medicine

Mechanisms of acute and overuse injuries in dance

Acute injuries are usually associated with a single episode during which normal or insufficient tissue is subjected to a sudden stress or strain that exceeds the tissue's capacity to maintain physiologic or functional integrity, resulting in macrotrauma. A potential cause for acute dance injuries is incorrect performance of movements, which may occur secondary to other factors, such as tiredness, muscle fatigue, or loss of balance [18]. In general, dancers experience acute injuries in the upper

Incidence of injuries in dancers

Medical literature profiling the incidence of injury within modern, theatrical, and classical ballet companies reports that the incidence of injuries ranges from 17% to 95% [39]. The patterns of injury seem to be fairly consistent, particularly in ballet, and the incidence of injuries in a variety of studies has been found to be greatest for the lower extremity (57%–75%), followed by the ankle and/or foot (34%–54%), and, less frequently, the lower back and/or pelvis (12%–23%) [17], [36], [37],

Conditions affecting the hip

The “snapping hip” refers to a click with a snapping sensation that occurs during movement of the thigh. Lateral (external) snapping on the hip corresponds to motion of the iliotibial band (ITB) over the greater trochanter; medial (internal) snapping that occurs medial or anterior to the hip is caused by the iliopsoas tendon moving across the femoral head or iliopectineal eminence (Fig. 1) [4], [42]. Lateral snapping more commonly affects the supporting leg while attempting rotation movements

Conditions affecting the ankle

The most common acute injury in dancers is ankle sprain. Anterior and posterior impingement syndromes may occur in association with acute and overuse injuries.

Ankle sprain is the most common traumatic injury among dancers [15], [17], [25], [40]. As in the general population, most ankle sprains in dancers involve injury to the lateral ligament complex, whereas injury to the medial ligaments is rare [56]. The mechanism for inversion ankle sprains involves foot plantarflexion and inversion, such

Female athlete triad

Similar to other athletes involved in sports activities that place a high emphasis on esthetics, the female dancer is at increased risk of the female athlete triad, (disordered eating, amenorrhea, and osteoporosis). Dancers aspiring to attain or maintain an ideal lean figure may place significant efforts on aggressive dieting and a vigorous training regimen. These efforts may lead to amenorrhea and an increased risk of osteoporosis. For dancers who maintain an intensive training regimen, these

Stress fractures: relation to dance training, nutritional factors, and hormonal factors

The structural integrity of bone is maintained by ongoing bone resorption and bone formation in a dynamic process known as bone remodeling. Stress forces, such as those that arise from weight bearing or muscle actions, are a positive stimulus for bone remodeling. According to Wolff's law, bone architecture is modified by mechanical loading on bone tissue, with sites of mechanical stress developing increases in cortical mass [86]. Piezoelectric principles also influence bone remodeling.

Considerations in management and prevention of dance injuries

Prevention is the keystone to avoid injuries, and for dance injuries, preventive strategies may be directed toward previously identified risk factors. When emphasizing prevention of new injuries, a supervised training regimen should be monitored for gradual progression of intensity (length and frequency) and type of activity (eg, initiating a new dance style) [23]. A dance screening clinic may be the most comprehensive setting to implement prevention strategies but is mainly available for

Summary

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

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References (98)

  • A.L. Deutsch et al.

    Imaging of stress injuries to bone. Radiography, scintigraphy, and MR imaging

    Clin Sports Med

    (1997)
  • E.A. Arendt et al.

    The use of MR imaging in the assessment and clinical management of stress reactions of bone in high-performance athletes

    Clin Sports Med

    (1997)
  • L.C. Schon et al.

    Dance screen programs and development of dance clinics

    Clin Sports Med

    (1994)
  • W.G. Hamilton et al.

    A profile of the musculoskeletal characteristics of elite professional ballet dancers

    Am J Sports Med

    (1992)
  • K. Khan et al.

    Hip and ankle range of motion in elite classical ballet dancers and controls

    Clin J Sport Med

    (1997)
  • S. Kushner et al.

    Relationship of turnout to hip abduction in professional ballet dancers

    Am J Sports Med

    (1990)
  • D.C. Reid

    Prevention of hip and knee injuries in ballet dancers

    Sports Med

    (1988)
  • A. Gupta et al.

    An evaluation of differences in hip external rotation strength and range of motion between female dancers and non-dancers

    Br J Sports Med

    (2004)
  • K.L. Bennell et al.

    Changes in hip and ankle range of motion and hip muscle strength in 8–11 year old novice female ballet dancers and controls: a 12 month follow up study

    Br J Sports Med

    (2001)
  • A.J. Margherita

    Issues in gymnasts and dancers

  • K.M. Khan et al.

    Can 16–18-year-old elite ballet dancers improve their hip and ankle range of motion over a 12-month period?

    Clin J Sport Med

    (2000)
  • F. Bejjani et al.

    Performing artists' occupational disorders and related therapies

  • P.A. Bauman et al.

    Femoral neck anteversion in ballerinas

    Clin Orthop

    (1994)
  • E.H. Miller et al.

    A new consideration in athletic injuries. The classical ballet dancer

    Clin Orthop

    (1975)
  • V. Negus et al.

    Associations between turnout and lower extremity injuries in classical ballet dancers

    J Orthop Sports Phys Ther

    (2005)
  • C.B. Gilbert et al.

    Relationship between hip external rotation and turnout angle for the five classical ballet positions

    J Orthop Sports Phys Ther

    (1998)
  • K. Khan et al.

    Overuse injuries in classical ballet

    Sports Med

    (1995)
  • W.T. Hardaker

    Foot and ankle injuries in classical ballet dancers

    Orthop Clin North Am

    (1989)
  • T.D. Brown et al.

    Foot and ankle injuries in dance

    Am J Orthop

    (2004)
  • C. Nilsson et al.

    The injury panorama in a Swedish professional ballet company

    Knee Surg Sports Traumatol Arthrosc

    (2001)
  • S.B. Brotzman et al.

    Clinical orthopaedic rehabilitation

    (2003)
  • T. Brown et al.

    Where artistry meets injury

    Biomechanics

    (1998)
  • K.R. Milan

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

    J Orthop Sports Phys Ther

    (1994)
  • J. Howse

    Dance technique and injury prevention

    (2000)
  • Micheli LJ, Solomon R, Solomon J. Boston Dance Medicine Conference update 1998. Presented at Boston Dance Medicine...
  • S. Bronner et al.

    Profile of dance injuries in a Broadway show: a discussion of issues in dance medicine epidemiology

    J Orthop Sports Phys Ther

    (1997)
  • Micheli LJ, Solomon R, Solomon J. Soviet-American dance medicine. Presented at 1990 Glasnost Dance Medicine Conference...
  • Y. Koutedakis et al.

    The dancer as a performing athlete: physiological considerations

    Sports Med

    (2004)
  • M. McCormack et al.

    Joint laxity and the benign joint hypermobility syndrome in student and professional ballet dancers

    J Rheumatol

    (2004)
  • P. Klemp et al.

    A hypermobility study in ballet dancers

    J Rheumatol

    (1984)
  • B.A. Kaufman et al.

    Bone density and amenorrhea in ballet dancers are related to a decreased resting metabolic rate and lower leptin levels

    J Clin Endocrinol Metab

    (2002)
  • M.P. Warren et al.

    Scoliosis and fractures in young ballet dancers. Relation to delayed menarche and secondary amenorrhea

    N Engl J Med

    (1986)
  • A. Bowling

    Injuries to dancers: prevalence, treatment, and perceptions of causes

    BMJ

    (1989)
  • S. Bronner et al.

    Occupational musculoskeletal disorders in dancers

    Phys Ther Rev

    (2003)
  • J.G. Garrick et al.

    Ballet injuries. An analysis of epidemiology and financial outcome

    Am J Sports Med

    (1993)
  • R. Solomon et al.

    The “cost” of injuries in a professional ballet company: a five-year study

    Med Probl Perform Art

    (1999)
  • R.W. Evans et al.

    A survey of injuries among Broadway performers

    Am J Public Health

    (1996)
  • S. Bronner et al.

    Injuries in a modern dance company: effect of comprehensive management on injury incidence and time loss

    Am J Sports Med

    (2003)
  • M.R. Safran et al.

    Lateral ankle sprains: a comprehensive review: part 1: etiology, pathoanatomy, histopathogenesis, and diagnosis

    Med Sci Sports Exerc

    (1999)
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