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

Bronner S & Bauer NG. Physical Therapy in Sports. 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?
Written by: Nicole Cattano
Reviewed by: Jeffrey Driban
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