One thing the professional dancer has in common The traditional clothing worn in many ballets con- with the dance student is attendance at daily tech- sists of simple leotards and tights. This attire permits nique classes. Similar technique errors to those found minimal adaptive taping or bracing. In contrast, cos- in students may be found at the professional level, tumes may be extremely elaborate in Broadway, other with long-standing neuromuscular habits that are dif- theatrical, or theme park productions.
Women may be ficult to change. Frequently, specific repertory creates required to dance in 4-inch heels; dancers may wear imbalances that result in faulty alignment, or a heavy headpieces or masks. Dancing in heels puts the dancer may struggle with minor injuries that produce ankle in a less stable posture. Heavy masks and head- compensatory patterns of poor placement. Recent innovations in manmade materials afford the poten- Environmental conditions tial for light masks and props but are not always Dancers may be called upon to dance in venues rang- utilised in costume design.
They may perform outdoors in Roman amphitheatres where temperatures range from baking sun to Intrinsic risk factors extremely cool. Floor surfaces may NORA and sport epidemiologists have called for change in consistency across the same stage due to WMSD studies, which examine intrinsic and extrinsic painted surfaces, inset tracks for movable sets, or, variables separately and in combination. To multiple steps or chairs that provide unstable surfaces date, most models incorporate only one or two intrin- for jumping.
These include breakaway bases in The ballet aesthetic of the female sylph makes the softball,11 and helmets in cycling. Modern dancers are often barefoot. Flexibility refers to the length of both contrac- Female dancers demonstrate increased incidence of tile and non-contractile tissues that cross the joint. An scoliosis. Liederbach the Beighton criteria, most researchers have found et al.
The anatomi- cate hypermobility. Surveys of injuries in Broadway and West End the- They are categorised as having benign hypermobility atrical dancers found that female dancers were more or hypermobility syndrome. Women sustained more overuse foot injuries researchers also reported that dancers demonstrated and men more traumatic injuries, injuries to the increased hip external rotation at the expense of inter- shoulder, and required more surgeries. Several sports and dance reports dancers.
Flexibility may be part of the selection process suggest that younger dancers may require some sort of success as a dancer, however, increases in hip exter- of transitional program to assist them in managing nal rotation and abduction are seen with greater the new stresses of professional dance.
One study reported dancers who sustain one injury during a season are higher ankle dorsiflexion and plantarflexion strength more likely to sustain another injury during the same but unaltered ratios in both male and female ballet season. A recent study analysed injury factors from dancers. This produces VO2max values within the range of Injury surveillance non-endurance athletes. Dance injury surveillance system Demographics Year of data collection years of dance training Name years professional Company years in company Gender Company status principal, soloist, etc.
One injuries per dance hours. The US National Athletic parison of these two groups of dancers with athletes Injury Registration System defined reportable injury per exposure hours suggests that dancers experi- as limiting participation for at least 1 day following ence a lower incidence of injuries. However, it is diffi- the injury.
A defini- In any surveillance system, it is also important to tion of injury that includes time-loss and medical cri- include contextual information about the injury, teria is similar to that of the US Occupational Safety including venue in or outdoors, raked or non-raked and Health Administration OSHA. This information helps to explain the injury that results in restriction of work, lost time, or relationship of exposure and type of workload to requires medical treatment beyond first aid.
Implementation of standards of definition and Other criteria include description of the popula- reporting will permit comparison of one dance popu- tion, exposure, and injury severity, type, and lation to another, or dance to various sports or occu- anatomic region Table 1.
Without a universally pational injuries. Descriptive studies that report on injuries seen within Screening programmes one regional hospital or clinic may deflate the true prevalence, as they cannot define the complete popu- The primary instrument for identification and subse- lation at risk.
Who reports the injury dancer or med- quent correlation of intrinsic risk factors with muscu- ical personnel and when the injury is reported loskeletal injury is the pre-season or pre-employment retrospective or prospective report affect the calcu- screening. Through the development of large data- lation of injury incidence. It is by correlat- questionnaires were shown to deflate the true inci- ing screening results with injury patterns that dence compared to prospective weekly surveillance hypotheses on intrinsic risk factors for injury are systems in athletes.
Preventative measures can then be initiated to spectively in a comparison of data collection meth- decrease the risk factors. The definitions of severity and type of injury are Screenings of pre-professional dancers, at the also important in any discussion of injury patterns.
School of American Ballet and the Boston Ballet, Several time-based definitions of severity exist includ- found decreases in lower extremity range of motion ing: minor less than 1 week , moderate 1—4 weeks , ROM and flexibility, and strength of core trunk and and severe more than 4 weeks. To allow compar- each of these measures, supporting the usefulness of ison of injury rates between populations, exposure the screening process. In sports, this is defined as the number of uncover pathology, and help define population char- injuries per h of sports participation.
To date, this definition, annual injuries at a modern dance screens have been used primarily in professional and organisation ranged from 0. While there is no question about Three levels of prevention—intervention strategies are the value of such information, dance medicine must employed in the comprehensive management pro- aim to move beyond descriptive report of screening grammes established by dance organisations Fig.
Primary injury and, ultimately, injury prevention. Secondary prevention, coaches to assure timely triage, and implementation defined as the early detection of injury with interven- of preventative and rehabilitative programmes to tions to reverse, prevent, or slow progression, assure the optimal fitness of the athlete. In industry, includes immediate triage to ascertain timely inter- comprehensive safety and managed care occupational vention or referral, modification of or removal from initiatives have demonstrated both health and finan- specific work roles, and physical therapy to minimise cial cost-effectiveness.
A large self-insured medical musculoskeletal complaints. Tertiary prevention, centre utilised proactive safety and ergonomic pro- which seeks to minimise the effects of injury on the grammes to abate workplace hazards. Similar plans reported accommodation to minimise specific risks. For instance, when specialists was compared to a discounted managed- the dance screen identifies a dancer with increased care system in a 2-year concurrent effectiveness joint mobility such as genu recurvatum greater than study.
These dancers are advised to in the specialist programme. There are posterior capsule. When standing in first position, no preventative measures implemented to emphasise their heels and thighs should touch. Dancers may wellness. Several exceptions, however, do exist. For dancers with hip dys- addition of case management and intervention ser- plasia, dancers are taught to avoid the extremes of vices at one ballet company decreased annual injuries joint motion in non-weight-bearing as well.
On-site physical therapists can dance organisations. They reduce time loss and quickly assess overuse trends during this period and decrease WC claim costs. Regardless, occupational employ countermeasures to protect the body. These programmes successfully introduced pre- and ii a quantitative performance measure. The ventative cross training such as aerobic conditioning, DFOS has been examined for content validity, relia- reducing muscular imbalances, and addressing tech- bility, and sensitivity in adult modern and ballet nique problems.
Implementation of cross training dancers. General health measures The use of general health measures in tandem with Outcome measurement of health and functional status domain or disease-specific functional measures has been recommended to achieve greater specificity and Previous comprehensive managed care initiatives sensitivity for the context under study.
While prehensive assessment of health includes measures of these measures are important to organisations, it also physical, mental, and social functioning, as well as important to measure outcomes at the individual general health perceptions.
Adequate measurement of the recovery vide a yardstick of comparison across disease, age, of an individual following injury requires objective and treatment in the general population. To The Short Form SF has been demonstrated be objective, a functional outcome measure should to be reliable and valid across age, language, ethnicity, accurately reflect long-term changes in functional and disease.
Health specific outcome measures in response to changes in concepts within the physical domain include physical health care in the s and s was invaluable in functioning, role-physical ADL and work , bodily the evaluation of treatment efficacy.
Measures include pain, and general health. Health concepts within the self-report questionnaires and performance-based emotional domain include vitality, social functioning, tests. While orthopaedic functional outcome mea- role-emotional, and mental health. Questionnaire sures attempt to be independent of diagnosis and scores are transformed into standardised z-scores, activity level, the majority are oriented to ADL of the producing summary scores for each of the eight non-athlete, with obvious ceiling effects when applied health concept areas as well as physical and mental to the athlete.
Many validated rating scales exist for evaluating Recently, SF was examined prospectively in 50 joint injury and the outcome of treatment including professional dancers, some of whom went on to sus- those developed for the spine, hip, and ankle. The Tegner and Lysholm scale also rated sports intensity Maintaining musculoskeletal health in dancers aspir- but did not include dance among the activities.
Outcomes injury. Occupational physical activities and osteoarthritis of the knee. Occupational activity and risk of osteoarthritis.
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