factors for musculoskeletal injury in elite-professional modern dancers: A
prospective cohort prognostic study

S & Bauer NG. Physical Therapy in
2018; Online Ahead of Print January xx, 2018.  Doi: 10/1016/j.ptsp.2018.01.008

Take Home Message: Dancers who had
low or high hypermobility score, muscular tightness, poorer technique, or a
recent injury history (as assessed through preparticipation screening) had
higher injury risk.


Clinicians are increasingly using screening
visits to determine injury risk in many settings/sports, and this includes
elite-modern dancers.  The extreme
demands of dance may predispose someone to injury; but, we know very little
about risk factors for dance-related injuries. 
Therefore, the authors of this study retrospectively investigated some
common risk factors (hypermobility, technique, muscular tightness, recent
injury history) among participants in a university modern dance program.  The researchers screened 180 students as
freshmen in a fine arts pre-professional modern dance program and followed them
through their four-year program. 
Baseline screening consisted of height, weight, blood pressure, postural
analysis, range of motion, muscle strength, flexibility, balance, joint laxity,
aerobic fitness, and dance technique analysis (various dance positions: binary
yes/no).  Over the four years – 84%
suffered at least one injury (defined as needing medical attention), most
commonly in the lower extremity, and overuse injuries were significantly more
frequent than acute injuries.  A dancer
with a low or high hypermobility (Beighton) score was at greater risk for injury and missed more time due
to injuries than those with medium scores. 
Dancers with poorer technique scores were more likely to sustain an
injury, as well as dancers with tight muscle groups (e.g., hamstrings, hip
flexors, quadriceps) – specifically for overuse injuries.  The authors reported an apparent positive
relationship between the numbers of tight muscle groups and the overuse injury
risk.  Lastly, dancers who reported 2 to
4 injuries in the prior year were 40% more likely to sustain a new injury
compared to those with no history of injury.

This study shows that there are some
clear risk factors that should be screened for within a modern dance
cohort.  The findings of this study
identify possible areas of intervention prior to or simultaneous to
participation in a pre-professional modern dance program.  It may be advantageous to develop injury
prevention programs for dancers that start upon entry into the program and
focuses on flexibility, neuromuscular control, and dance technique. I would be
curious to see if these baseline screening scores change at all over their four
years in the program and how that might play into injury risk.  It was also interesting to see the high
number of injuries within this cohort; especially in the lower extremity and
with overuse injuries.  It was also fascinating
to see the very specific technique assessment, and how those with good
technique were less likely to get injured. 
This may show an importance towards technique specific assessments by
sport/duty rather than standardized assessments performed across all
activities.  The uniqueness of dance
tasks may also explain why those with low hypermobility scores are at risk for
injury too.  The authors did not report
on this – but I wonder whether these individuals were more likely to suffer an
acute injury than the other groups.  This
study demonstrates clear links between baselines assessments and injury risk
including hypermobility, technique, tightness, and recent injury history. Baseline
assessments may be very valuable and an athletic trainer who works directly
with these participants may be able to individualize prevention interventions
for modern dancers.       

Questions for Discussion:  What
baseline assessments do you use within your patients?  What things might you typically see and how
do you use this information for possible intervention?

by: Nicole Cattano
by: Jeffrey Driban