The Use of Physical Screening Tools to Identify Injury Risk Within Pre-Professional Ballet Dancers: An Integrative Review

El uso de herramientas de cribado física para identificar el riesgo de lesiones en los bailarines de ballet preprofesionales: Una revisión integradora

Published 2022-11-19 — Updated on 2022-11-19

Open | Download
HTML Icon XML Icon
Issue
Vol. 4 No. 2 (2022)
Section
Review Articles
How to Cite
1.
The Use of Physical Screening Tools to Identify Injury Risk Within Pre-Professional Ballet Dancers: An Integrative Review. Rev. Investig. Innov. Cienc. Salud [Internet]. 2022 Nov. 19 [cited 2024 Dec. 30];4(2):in press. Available from: https://riics.info/index.php/RCMC/article/view/154
DOI

https://doi.org/10.46634/riics.154
Dimensions
PlumX
license
Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.

Niall MacSweeney
Faculty of Sport, Allied Health and Performance Science; St May’s University; London; United Kingdom
    https://orcid.org/0000-0002-2303-855X
    Charles Pedlar
    Faculty of Sport, Allied Health and Performance Science; St May’s University; London; United Kingdom
      https://orcid.org/0000-0002-3075-9101
      Daniel Cohen
      Sports Science Centre; Colombian Ministry of Sport; Bogotá; Colombia
        https://orcid.org/0000-0002-0899-4623
        Ryan Mahaffey
        Faculty of Sport, Allied Health and Performance Science; St May’s University; London; United Kingdom
          https://orcid.org/0000-0002-5241-0429
          Phil Price
          Faculty of Sport, Allied Health and Performance Science; St May’s University; London; United Kingdom
            https://orcid.org/0000-0001-8849-2959
            Show authors biography

            Objective. To conduct an integrative review of all relevant research investigating the physical risk factors for injury within pre-professional ballet dancers, to provide insight that may benefit practitioners within these institutions and highlight areas for future research within this specialised population.

            Design. Studies were identified from the following electronic databases: MEDLINE via PubMed, SPORTDiscus via EBSCOhost, and Web of Science Core Collection via Web of Science. 8,415 titles were identified during the electronic search process. Five studies satisfied the inclusion criteria and were included in the review. The modified Agency for Healthcare Research and Quality (AHRQ) scale for observational studies was used to assess study quality.

            Results. The review identified that the following physical characteristics may influence prospective injury risk in pre-professional ballet dancers: age and maturation status, anthropometrics and body composition, strength and power, joint mobility and range of motion, specific dance function, and cardiorespiratory fitness.

            Limitations. The research identified lacked methodological quality. This, combined with the low number of studies identified, makes the design of screening protocols challenging for practitioners.

            Originality. Despite the number of pre-professional balletic institutions worldwide, previous reviews have not used a systematic search strategy or investigated both sexes in this cohort. Due to the unique demands of ballet, an understanding of the interaction between injury and physical characteristics is a critical step in order to reduce injury burden.

            Conclusions. This review succeeded in determining risk factors for injury within this population, but, due to insufficient evidence, could not provide robust screening recommendations.

            Article visits 1243 | PDF visits 337

            1. Mitchell S. Health and Wellbeing in Elite Female Ballet Dancers: Implications of Maturity Timing. [Internet] [Doctoral Dissertation]. Bath (Somerset): University of Bath; 2018. Available from: https://researchportal.bath.ac.uk/en/studentTheses/health-and-wellbeing-in-elite-female-ballet-dancers-implications-
            2. Caine D, Goodwin BJ, Caine CG, Bergeron G. Epidemiological Review of Injury in Pre-Professional Ballet Dancers. J Dance Med Sci. 2015 Nov;19(4):140–8. doi: https://doi.org/10.12678/1089-313X.19.4.140
            3. Ekegren C, Quested R, Brodrick A. Epidemiology of Injuries Among Elite Pre-Professional Ballet Students. Br J Sports Med. 2011 Apr;45(4):347–347. doi: https://doi.org/10.1136/bjsm.2011.084038.105
            4. Mitchell S, Haase A, Cumming S, Malina R. Understanding Growth and Maturation in the Context of Ballet: A Biocultural Approach. Res Dance Educ. 2017 Sep;18(3):291–300. doi: https://doi.org/10.1080/14647893.2017.1387525
            5. Poggini L, Losasso S, Iannone S. Injuries During the Dancer’s Growth Spurt: Etiology, Prevention, and Treatment. J Dance Med Sci. 1999 Jun;3(2):73–9. [online]. Available from: https://www.ingentaconnect.com/content/jmrp/jdms/1999/00000003/00000002/art00006?crawler=true [Accessed 2022 Sep 04].
            6. Koutedakis Y, Jamurtas T. The Dancer as a Performing Athlete: Physiological Considerations. Sports Med Auckl NZ. 2004 Feb 1;34:651–61. doi: https://doi.org/10.2165/00007256-200434100-00003
            7. Allen N, Nevill AM, Brooks JHM, Koutedakis Y, Wyon MA. The Effect of a Comprehensive Injury Audit Program on Injury Incidence in Ballet: A 3-Year Prospective Study. Clin J Sport Med. 2013 Sep;23(5):373–8. doi: https://doi.org/10.1097/JSM.0b013e3182887f32
            8. Mattiussi A, Shaw J, Williams S, Price P, Brown D, Cohen D, et al. Injury Epidemiology in Professional Ballet: A Five-season Prospective Study of 1596 Medical Attention Injuries and 543 Time-loss Injuries. Br J Sports Med [Internet]. 2021 Aug [cited 2021 May 13]; doi: http://dx.doi.org/10.1136/bjsports-2020-103817
            9. Caine D, Bergeron G, Goodwin BJ, Thomas J, Caine CG, Steinfeld S, et al. A Survey of Injuries Affecting Pre-Professional Ballet Dancers. J Dance Med Sci. 2016 Aug;20(3):115–26. doi: https://doi.org/10.12678/1089-313X.20.3.115
            10. Ekegren C, Quested R, Brodrick A. Injuries in Pre-Professional Ballet Dancers: Incidence, Characteristics and Consequences. J Sci Med Sport. 2014 May;17(3):271–5. doi: https://doi.org/10.1016/j.jsams.2013.07.013
            11. Bowerman E, Whatman C, Harris N, Bradshaw E. A Review of the Risk Factors for Lower Extremity Overuse Injuries in Young Elite Female Ballet Dancers. J Dance Med Sci. 2015 May;19(2):51–6. doi: https://doi.org/10.12678/1089-313X.19.2.51
            12. Gamboa J, Roberts L, Maring J, Fergus A. Injury Patterns in Elite Preprofessional Ballet Dancers and the Utility of Screening Programs to Identify Risk Characteristics. J Orthop Sports Phys Ther. 2008;38(3):126–36. doi: https://doi.org/10.2519/jospt.2008.2390
            13. Hamilton L, Hamilton W, Warren M, Keller K, Molnar M. Factors Contributing to the Attrition Rate in Elite Ballet Students. J Dance Med Sci. 1997;1(4):131–8. Available from: https://www.ingentaconnect.com/content/jmrp/jdms/1997/00000001/00000004/art00002#expand/collapse
            14. Kenny S, Whittaker J, Emery C. Risk Factors for Musculoskeletal Injury in Preprofessional Dancers: A Systematic Review. Br J Sports Med. 2016 Aug;50(16):997–1003. doi: https://doi.org/10.1136/bjsports-2015-095121
            15. Rice PE, Nimphius S. When Task Constraints Delimit Movement Strategy: Implications for Isolated Joint Training in Dancers. Front Sports Act Living [Internet]. 2020 May [cited 2021 Jan 28];2. doi: https://doi.org/10.3389/fspor.2020.00049
            16. Kolokythas N, Metsios GS, Galloway SM, Allen N, Wyon MA. 11+ Dance: A Neuromuscular Injury Prevention Exercise Program for Dancers. Strength Cond J [Internet]. 2022 Mar [cited 2022 May 2]; doi: https://doi.org/10.1519/SSC.0000000000000692
            17. Armstrong R, Relph N. Screening Tools as a Predictor of Injury in Dance: Systematic Literature Review and Meta-analysis. Sports Med - Open. 2018 Jul 18;4(1):33. doi: https://doi.org/10.1186/s40798-018-0146-z
            18. Kilburn C, Singh H, Makowski A, Musselman K. Perspectives of Physical Therapists Regarding the Use and Value of Screening Assessments and Preventative Programs for Elite-Level Dancers. J Dance Med Sci. 2020 Mar;24(1):3–11. doi: https://doi.org/10.12678/1089-313X.24.1.3
            19. Mainwaring L, Finney C. Psychological Risk Factors and Outcomes of Dance Injury. J Dance Med Sci. 2017 Aug;21(3):87–96. doi: https://doi.org/10.12678/1089-313X.21.3.87
            20. Moita J, Nunes A, Esteves J, Oliveira R, Xarez L. The Relationship Between Muscular Strength and Dance Injuries: A Systematic Review. Med Probl Perform Art. 2017 Mar;32(1):40–50. doi: https://doi.org/10.21091/mppa.2017.1002
            21. Kolokythas N, Metsios G, Dinas P, Galloway S, Allen N, Wyon M. Growth, Maturation, and Overuse Injuries in Dance and Aesthetic Sports: a Systematic Review. Res Dance Educ. 2021 Jan;1–23. doi: https://doi.org/10.1080/14647893.2021.1874902
            22. Bowerman E, Whatman C, Harris N, Bradshaw E, Karin J. Are Maturation, Growth and Lower Extremity Alignment Associated with Overuse Injury in Elite Adolescent Ballet Dancers? Phys Ther Sport. 2014 Nov;15(4):234–41. doi: https://doi.org/10.1016/j.ptsp.2013.12.014
            23. Whittemore R, Knafl K. The integrative review: updated methodology. J Adv Nurs. 2005 Dec;52(5):546–53. doi: https://doi.org/10.1111/j.1365-2648.2005.03621.x
            24. Manchikanti L. Evidence-Based Medicine, Systematic Reviews,and Guidelines in Interventional Pain Management: Part 4: Observational Studies. Pain Physician. 2009 Jan 14;1;12(1;1):73–108. doi: https://doi.org/10.36076/ppj.2009/12/73
            25. Buenaventura RM. Systematic Review of Therapeutic Lumbar Transforaminal Epidural Steroid Injections. Pain Physician. 2009 Jan 14;1;12(1;1):233–51. doi: https://doi.org/10.36076/ppj.2009/12/233
            26. Parr AT, Diwan S, Abdi S. Lumbar interlaminar epidural injections in managing chronic low back and lower extremity pain: a systematic review. Pain Physician. 2009 Jan-Feb;12(1):163-88. doi: https://doi.org/10.36076/ppj.2009/12/163
            27. Datta S, Lee M, Falco FJ, Bryce DA, Hayek SM. Systematic assessment of diagnostic accuracy and therapeutic utility of lumbar facet joint interventions. Pain Physician. 2009 Mar-Apr;12(2):437-60. doi: https://doi.org/10.36076/ppj.2009/12/437
            28. Page MJ, McKenzie JE, Bossuyt PM, Boutron I, Hoffmann TC, Mulrow CD, et al. The PRISMA 2020 statement: an updated guideline for reporting systematic reviews. BMJ. 2021 Mar;372:n71. doi: https://doi.org/10.1136/bmj.n71
            29. Rudavsky A, Cook J, Docking S. Proximal Patellar Tendon Pathology can Develop During Adolescence in Young Ballet Dancers—A 2‐year Longitudinal Study. Scand J Med Sci Sports. 2018 Sep;28(9):2035–41. doi: https://doi.org/10.1111/sms.13095
            30. Leanderson C, Leanderson J, Wykman A, Strender LE, Johansson SE, Sundquist K. Musculoskeletal injuries and generalized joint laxity in ballet dancers. (Pt. 4). [Doctoral Dissertation]. Huddinge (Stockholm): Karolinska Institutet; 2012. Available from: https://www.proquest.com/openview/b566579a33a77b3b58905f3f57e93be8/1?pq-origsite=gscholar&cbl=2026366&diss=y
            31. Twitchett E, Brodrick A, Nevill. A, Koutedakis. Y, Angioi. M, Wyon. M. Does Physical Fitness Affect Injury Occurrence and Time Loss Due to Injury in Elite Vocational Ballet Students? J Dance Med Sci. 2010 Feb;14(1):26–31. [online] Available from: https://pubmed.ncbi.nlm.nih.gov/20214852/ [Accessed 2022 Sep 04]
            32. Wyon M, Twitchett E, Angioi M, Clarke F, Metsios G, Koutedakis Y. Time Motion and Video Analysis of Classical Ballet and Contemporary Dance Performance. Int J Sports Med. 2011 Nov;32(11):851–5. doi: https://doi.org/10.1055/s-0031-1279718
            33. Liiv H, Wyon MA, Jürimäe T, Saar M, Mäestu J, Jürimäe J. Anthropometry, Somatotypes, and Aerobic Power in Ballet, Contemporary Dance, and Dancesport. Med Probl Perform Art. 2013 Dec;28(4):207–11. doi: https://doi.org/10.1055/a-1083-6539
            34. Kozai A, Twitchett E, Morgan S, Wyon M. Workload Intensity and Rest Periods in Professional Ballet: Connotations for Injury. Int J Sports Med. 2020 Jun;41(06):373–9. doi: https://doi.org/10.1055/a-1083-6539
            35. Krishan K, Sharma A. Estimation of Stature From Dimensions of Hands and Feet in a North Indian Population. J Forensic Leg Med. 2007 Aug;14(6):327–32. doi: https://doi.org/10.1016/j.jcfm.2006.10.008
            36. Stokic E, Srdic B, Barak O. Body Mass index, body fat mass and the Occurrence of Amenorrhea in Ballet Dancers. Gynecol Endocrinol. 2005 Apr;20(4):195–9. doi: https://doi.org/10.1080/09513590400027224
            37. Stracciolini A, Quinn B, Geminiani E, Kinney S, McCrystal T, Owen M, et al. Body Mass Index and Menstrual Patterns in Dancers. Clin Pediatr (Phila). 2017 Jan;56(1):49–54. doi: https://doi.org/10.1177/0009922816642202
            38. Wielandt T, van den Wyngaert T, Uijttewaal J, Huyghe I, Maes M, Stassijns G. Bone Mineral Density in Adolescent Elite Ballet Dancers. J Sports Med Phys Fitness. 2019 Sep;59(9):1564–70. doi: https://doi.org/10.23736/S0022-4707.19.09700-7
            39. Schmitz K, Hovell M, Nichols J, Irvin V, Keating K, Simon G, et al. A Validation Study of Early Adolescents’ Pubertal Self-Assessments. J Early Adolesc. 2004 Nov 1;24(4):357–84. doi: https://doi.org/10.1177/0272431604268531
            40. Mirwald R, Baxter-Jones A, Bailey D, Beunen G. An Assessment of Maturity from Anthropometric Measurements. Med Sci Sports Exerc. 2002 May 1;34:689–94. doi: https://doi.org/10.1097/00005768-200204000-00020
            41. Malina R, Choh A, Czerwinski S, Chumlea W. Validation of Maturity Offset in the Fels Longitudinal Study. Pediatr Exerc Sci. 2016 Jan;28(3):439–55. doi: https://doi.org/10.1123/pes.2015-0090
            42. Khamis H, Roche A. Predicting Adult Stature Without Using Skeletal Age: The Khamis-Roche Method. Pediatrics. 1994 Oct;94(4):504–7. [online] Available from: https://europepmc.org/article/med/7936860 [Accessed 2022 Sep 04]
            43. Moeskops S. The Effects of Growth, Maturation and Training on Strength and Power Development in Young Artistic Female Gymnasts [Internet] [Doctoral Dissertation]. Cardiff (Wales): Cardiff Metropolitan University; 2021. Available from: https://figshare.cardiffmet.ac.uk/articles/thesis/The_effects_of_growth_maturation_and_training_on_strength_and_power_development_in_young_artistic_female_gymnasts/14447238/1
            44. Longo U, Ciuffreda M, Locher J, Maffulli N, Denaro V. Apophyseal Injuries in Children’s and Youth Sports. Br Med Bull. 2016 Dec;120(1):139–59. doi: https://doi.org/10.1093/bmb/ldw041
            45. Micheli L. Preventing Youth Sports Injuries. J Phys Educ Recreat Dance. 1985;52–4. doi: https://doi.org/10.1080/07303084.1985.10603797
            46. Kolokythas N, Metsios GS, Galloway S, Allen N, Wyon M. The Relationship of Year Group and Sex on Injury Incidence and Countermovement Jump in Adolescent Ballet Dancers: A Cross-Sectional Analysis. 2022 Jun 30 [online]; doi: https://doi.org/10.12678/1089-313X.091522b
            47. Clarkson P, Freedson P, Skrinar M, Kelly B, Carney C. Anthropometric Measurements of Adolescent and Professional Classical Ballet Dancers. J Sports Med Phys Fitness [Internet]. 1989 Jun;29(2) [online]. Available from: https://pubmed.ncbi.nlm.nih.gov/2593653/ [Accessed 2021 Sep 28]
            48. Twitchett E, Angioi M, Metsios G, Koutedakis Y, Wyon M. Body Composition and Ballet Injuries A Preliminary Study. Med Probl Perform Art. 2008 Sep 1;23. doi: https://doi.org/10.21091/mppa.2008.3020
            49. Benson J, Geiger C, Eiserman P, Wardlaw G. Relationship Between Nutrient Intake, Body Mass Index, Menstrual Function, and Ballet Injury. J Am Diet Assoc. 1989 Jan;89(1):58–63. doi: https://doi.org/10.1016/S0002-8223(21)02061-7
            50. Zaletel P, Sekulić D, Zenić N, Esco MR, Šajber D, Kondrič M. The Association Between Body-Built and Injury Occurrence in Pre-Professional Ballet Dancers - Separated Analysis for the Injured Body-Locations. Int J Occup Med Environ Health. 2017 Feb 21;30(1):151–9. doi: https://doi.org/10.13075/ijomeh.1896.00818
            51. Frusztajer NT, Dhuper S, Warren MP, Brooks-Gunn J, Fox RP. Nutrition and the Incidence of Stress Fractures in Ballet Dancers. Am J Clin Nutr. 1990 May 1;51(5):779–83. doi: https://doi.org/10.1093/ajcn/51.5.779
            52. Mountjoy M, Sundgot-Borgen JK, Burke LM, Ackerman KE, Blauwet C, Constantini N, et al. IOC Consensus Statement on Relative Energy Deficiency in Sport (RED-S): 2018 update. Br J Sports Med. 2018 Jun 1;52(11):687–97. doi: https://doi.org/10.1136/bjsports-2018-099193
            53. Francisco R, Alarcão M, Narciso I. Aesthetic Sports as High-Risk Contexts for Eating Disorders—Young Elite Dancers and Gymnasts Perspectives. Span J Psychol. 2012 Mar;15(1):265–74. doi: https://doi.org/10.5209/rev_sjop.2012.v15.n1.37333
            54. Lauersen J, Andersen T, Andersen L. Strength Training as Superior, Dose-Dependent and Safe Prevention of Acute and Overuse Sports Injuries: A Systematic Review, Qualitative Analysis and Meta-Analysis. Br J Sports Med. Dec 2018;52(24):1557–63. doi: https://doi.org/10.1136/bjsports-2018-099078
            55. Bohannon RW. Manual Muscle Testing: Does it Meet the Standards of an Adequate Screening Test? Clin Rehabil. 2005 Sep 1;19(6):662–7. doi: https://doi.org/10.1191/0269215505cr873oa
            56. Aitkens S, Lord J, Bernauer E, Fowler WM, Lieberman JS, Berck P. Relationship of Manual Muscle Testing to Objective Strength Measurements. Muscle Nerve. 1989 Mar;12(3):173–7. doi: https://doi.org/10.1002/mus.880120302
            57. Escolar DM, Henricson EK, Mayhew J, Florence J, Leshner R, Patel KM, et al. Clinical Evaluator Reliability for Quantitative and Manual Muscle Testing Measures of Strength in Children. Muscle Nerve. 2001 Jun;24(6):787–93. doi: https://doi.org/10.1002/mus.1070
            58. Imura A, Iino Y. Comparison of Lower Limb Kinetics During Vertical Jumps in Turnout and Neutral Foot Positions by Classical Ballet Dancers. Sports Biomech. 2017 Mar;16(1):87–101. doi: https://doi.org/10.1080/14763141.2016.1205122
            59. Briggs J, McCormack M, Hakim AJ, Grahame R. Injury and Joint Hypermobility Syndrome in Ballet Dancers—a 5-Year Follow-Up. Rheumatology. 2009 Dec 1;48(12):1613–4. doi: https://doi.org/10.1093/rheumatology/kep175
            60. Day H, Koutedakis Y, Wyon MA. Hypermobility and Dance: A Review. Int J Sports Med. 2011 Jul;32(7):485–9. doi: https://doi.org/10.1055/s-0031-1273690
            61. Gensemer C, Burks R, Kautz S, Judge DP, Lavallee M, Norris RA. Hypermobile Ehlers-Danlos syndromes: Complex Phenotypes, Challenging Diagnoses, and Poorly Understood Causes. Dev Dyn. 2021 Mar;250(3):318–44. doi: https://doi.org/10.1002/dvdy.220
            62. Ahonen J. Biomechanics of the Foot in Dance: A Literature Review. J Dance Med Sci. 2008 Aug;12(3):99–108. Available from: https://www.ingentaconnect.com/content/jmrp/jdms/2008/00000012/00000003/art00005
            63. Milan K. Injury in Ballet: A Review of Relevant Topics for the Physical Therapist. J Orthop Sports Phys Ther. 1994 Feb;19(2):121–9. doi: https://doi.org/10.2519/jospt.1994.19.2.121
            64. Luk P, Thordarson D, Charlton T. Evaluation and Management of Posterior Ankle Pain in Dancers. J Dance Med Sci Off Publ Int Assoc Dance Med Sci. 2013 Jun;17(2):79–83. doi: https://doi.org/10.12678/1089-313x.17.2.79
            65. Kaufmann J, Nelissen R, Exner-Grave E, Gademan M. Does Forced or Compensated Turnout Lead to Musculoskeletal Injuries in Dancers? A Systematic Review on the Complexity of Causes. J Biomech. 2021 Jan;114:110084. doi: https://doi.org/10.1016/j.jbiomech.2020.110084
            66. Champion L, Chatfield S. Measurement of Turnout in Dance Research A Critical Review. J Dance Med Sci. 2008 Dec;12(4):121–35. [online] Available from: https://www.ingentaconnect.com/content/jmrp/jdms/2008/00000012/00000004/art00002?crawler=true [Accessed 2022 Sep 04].
            67. Russell TT. Weighing the Risks in Physical Activity. JOPERD J Phys Educ Recreat Dance. 2005 Mar;76(3):4–14. doi: https://doi.org/10.1080/07303084.2005.10608212
            68. Buchheit M. The 30-15 Intermittent Fitness Test: 10 year review. Myorobie J 2010;1 [online]. Available from: https://30-15ift.com/wp-content/uploads/2013/07/buchheit-30-15ift-10-yrs-review-2000-2010.pdf [Accessed 01 June 2022].
            69. Malone JJ, Barrett S, Barnes C, Twist C, Drust B. To Infinity and Beyond: The Use of GPS Devices Within the Football Codes. Sci Med Footb. 2020 Jan 2;4(1):82–4. doi: https://doi.org/10.1080/24733938.2019.1679871
            70. Massard T, Carey DL, Whalan M, Sampson JA, Hulin BT, Lovell R. Comparison of Player-Dependent and Independent High-Speed Running Thresholds to Model Injury Risk in Football. J Sports Sci. 2022 Mar 19;40(6):606–13. doi: https://doi.org/10.1080/02640414.2021.2006414
            Publish with RIICS

            Scimago

            Most read in the last 30 days

            Sistema OJS 3.4.0.7 - Metabiblioteca |