Epidemiology of Dance-Related Injuries Presenting to Emergency Departments in the United States, 2000-2013

Health consultations at a performing arts health centre among classical music students based on electronic health record data: a cross-sectional study

Physical and mental health problems in music students are usually identified using self-reported data. The use of an Electronic Health Record database can avoid biases to give an overview of the extent of health problems in this population. Therefore, the aim of this study is to gain insight into both physical and mental health related issues in classical music students using this type of data collection. An Electronic Health Record database including five years of data from a Performing Arts Health Centre (PAHC) of a university or the arts, was used to analyze the number and characteristics of health consultations in music students. The total number of students, health consultations and the average number of visits per health consultation were calculated over five years. Furthermore, numbers and percentages of both physical and mental health consultations were registered. Also, the number and percentage of health consultations per instrument group were compared to the proportion of each instrument group within the specific sample. Over a period of five years, 230 students visited the PAHC and 417 health consultations were reported. 43.5% of the students who visited a health professional indicated at least one physical health consultation, 29.1% at least one mental health consultation and 27.4% at least one in both categories. An injury was the most frequently registered physical health consultation (40.2%), followed by performance improvement (9.8%) and stress (9.6%). Voice students registered relatively most health consultations. As far as we know, this is the first cross-sectional study using Electronic Health Record data from a PAHC to gain insight into both physical and mental health related issues in a population of classical music students. Looking at the variety of health consultations registered in the database, a multidisciplinary team and multidisciplinary approach are necessary to meet the needs of the students in terms of physical and mental health support and performance improvement.

Pediatric Dance-Related Injuries Treated in Emergency Departments in the United States, 2000-2020

OBJECTIVE

This study investigated the characteristics and trends of children aged 3 to 19 years treated in US emergency departments for dance-related injuries.

METHODS

Retrospective analysis of data from the National Electronic Injury Surveillance System from 2000 through 2020 was conducted.

RESULTS

An estimated 489,119 children received emergency treatment for a dance-related injury, averaging 23,291 children annually, and the rate of injury increased 68.1% during the 21-year study period. Girls accounted for 80.3% and children aged 15 to 19 years accounted for 46.5% of cases. Sprains/strains were the most frequent diagnosis (44.4%), and lower extremities were the most commonly injured body region (56.4%). Compared with other body regions, patients aged 3 to 10 years were more likely to sustain head/neck injuries (odds ratio, 3.94, 95% confidence interval, 3.42-4.52) than 11- to 19-year-olds. Falls and noncontact mechanisms of injury accounted for 35.6% and 32.1% of injuries, respectively. Unstructured dance activity was associated with 30.8% of dance-related injuries overall and 67.0% among children aged 3 to 5 years. Ballet/pointe dancers frequently sustained lower extremity sprains/strains (39.2%). Compared with other dance types, break dancing was more commonly associated with injuries to an upper extremity than other body regions (odds ratio, 4.76, 95% confidence interval, 3.66-6.19).

CONCLUSIONS

The rate of pediatric dance-related injuries treated in US emergency departments is increasing. Unstructured dance activity was an important source of dance-related injury, especially among children aged 3 to 5 years. The injury diagnosis and body region injured varied by child age and type of dance. Additional targeted prevention efforts should be implemented that address the injury characteristics of dancer subgroups.

Alignment of the metatarsal heads affects foot inversion/eversion during tiptoe standing on one leg in demi-pointe position: A cross-sectional study on recreational dancers

Classical ballet dancers stand on tiptoe in the demi–pointe position where the ankle is plantarflexed, and the toes extend around a mediolateral axis passing through the second metatarsal head. Foot sickling, the foot inversion/eversion when the forefoot is grounded, should be avoided to achieve esthetics and prevent injuries during tiptoe standing. The foot inversion/eversion angle may change depending on the metatarsal heads through which the toe extension axis passes. This study investigated the relationship between metatarsal alignment in both load positions and foot inversion/eversion angle during tiptoe standing. Nine recreational female ballet dancers performed tiptoe standing on a single leg in the demi–pointe position. The foot inversion/eversion angle, the centre of pressure (COP) positions, and angles between adjacent metatarsal heads in the horizontal plane were investigated using motion–capture data and magnetic resonance imaging of the forefoot. As the angle between the second and adjacent metatarsal heads became more acute during tiptoe standing on the non-dominant leg, the dancers everted the foot more and significantly loaded the first toe–side more, and vice versa (r = −0.85 and −0.82, respectively). Then, the load positions were distributed on the distal side of the second metatarsal head. These were not seen during standing on the dominant leg with COPs more proximal to the second metatarsal head. In conclusion, dancers load the distal part of the second metatarsal head during tiptoe standing on the non–dominant leg. When the angle at the second metatarsal head was acute, within the triangle formed by the first, second, and third metatarsal heads, even slight mediolateral shifts of load positions altered the toe extension axis around that metatarsal head; the dancers loaded medial to the second metatarsal head and everted the foot and vice versa. Therefore, the angle between the second and adjacent metatarsal heads influenced the foot inversion/eversion angle.

Incidence and prediction of ankle injury risk: a prospective cohort study on 91 contemporary preprofessional dancers

Objectives

This study examines the incidence of ankle injuries and identifies ankle injury risk among contemporary preprofessional dancers.

Methods

A total of 91 first-year contemporary preprofessional dancers were prospectively followed during one academic year. Self-reported ankle injuries, assessed with the Oslo Sports Trauma Research Centre questionnaire, were categorised as all complaint ankle injuries, substantial ankle injuries or time-loss ankle injuries. In addition, ankle injuries leading to medical attention were included. Regression analyses were used to determine the association between potential risk factors (dancer characteristics, history of ankle injury in the previous year, ankle range of motion and dorsiflexion) and ankle injuries.

Results

The 1-year ankle injury incidence proportion was 18.7% (n=17), 8.8% (n=8), 15.4% (n=14) and 7.7% (n=7), respectively, for all complaint ankle injuries, ankle injuries requiring medical attention, time-loss injuries and substantial injuries. Being male (OR=0.27; 95% CI 0.09 to 0.75) and being a student of the Bachelors in Dance and Education (OR=0.27; 95% CI 0.08 to 0.97) were univariately associated with a lower risk of an ankle injury.

Conclusion

Almost 20% of first-year preprofessional dancers reported an ankle injury, with more than 80% of the dancers reporting that their injury leads to dance time loss. Males and students of the bachelors in dance and education were at lower risk of ankle injuries. As ankle injuries are common among dancers, studies with larger sample sizes, a more heterogeneous population (eg, different dance styles) and longer follow-up periods are necessary to evaluate the impact of ankle injuries in further detail.

Ankle Stability and Movement Coordination Impairments: Lateral Ankle Ligament Sprains Revision 2021

This revised clinical practice guideline (CPG) addresses the distinct but related lower extremity impairments of those with a first-time lateral ankle sprain (LAS) and those with chronic ankle instability (CAI). Depending on many factors, impairments may continue following injury. While most individuals experience resolution of symptoms, complaints of instability may continue and are defined as CAI. The aims of the revision were to provide a concise summary of the contemporary evidence since publication of the original guideline and to develop new recommendations or revise previously published recommendations to support evidence-based practice. J Orthop Sports Phys Ther 2021;51(4):CPG1-CPG80. doi:10.2519/jospt.2021.0302.

Epidemiology of Patients with Dance-Related Injuries Presenting to Emergency Departments in the United States, 2014-2018

BACKGROUND

Updated rates and patterns associated with patients with dance-related injuries reporting to US emergency departments (EDs) is needed.

HYPOTHESIS

Between the years 2014 and 2018, there will be an observed rise of patients with dance-related injuries seen within US EDs.

STUDY DESIGN

Retrospective analysis.

LEVEL OF EVIDENCE

Level 4.

METHODS

Utilizing the National Electronic Injury Surveillance System (NEISS) database, data were abstracted for all structured dance-related injuries for all people who presented to a NEISS participating hospital from January 1, 2014, to December 31, 2018. Data were abstracted on age, sex, race, disposition, location on the body where the injury happened, and free text box regarding the mechanism and nature of the injury. Each patient case was associated with a weight to provide national incidence rate (per 100,000) estimates. Descriptive statistics were used to summarize counts, percentages, and rates across patient cases.

RESULTS

Between years 2014 and 2018, 4152 patients reported to the NEISS EDs with a dance-related injury. Most injuries occurred in female patients (83.3%; n = 3459) and among those who were 10 to 18 years old (76.2%; n = 3164). The most common injuries were ankle sprain/strain (12.7%; n = 527) and knee sprain/strain (10.4%; n = 431). Almost all patients were treated and released (97.1%; n = 4033). These data yielded population-weighted estimates of 125,618 injuries for the study period, with an increasing trend over time (19.2% increase over 5 years). Incidence rates were over 4 times higher for female (12.4) than for male patients (3.0) and highest in the 10- to 18-year-old age group (incidence rate = 46.4).

CONCLUSION

Patients with dance-related injuries reporting to EDs increased over a 5-year period from 2014 to 2018. The majority of dancers in the study were female patients, between the ages of 10 and 18 years, nearly half of the patients reported to the ED with a sprain/strain, and almost all patients were treated and released.

CLINICAL RELEVANCE

An increase in access to proper injury prevention medical services and education should be provided to female dancers between the ages of 10 and 18 years.

STRENGTH OF RECOMMENDATION TAXONOMY

B.

Predicting Injury Status in Adolescent Dancers Involved in Different Dance Styles: A Prospective Study

The positive effects of dance on health indices in youth are widely recognized, but participation in dance is accompanied with a certain risk of injury. This prospective study aimed to investigate injury occurrence and to evaluate the possible influences of specific predictors on the occurrence of musculoskeletal problems and injuries in adolescent dancers. Participants were 126 dancers (21 males; 11–18 years), who were competitors in the urban dance, rock and roll, and standard/Latin dance genres. Predictors included sociodemographic factors, anthropometric/body build indices, sport (dance) factors, and dynamic balance. The outcome variable was injury status, and this was evaluated by the Oslo Sports Trauma Research Centre Overuse Injury Questionnaire (OSTRC). Predictors were evaluated at baseline, and outcomes were continuously monitored during the study period of 3 months. During the study course, 53% of dancers reported the occurrence of a musculoskeletal problem/injury, and dancers suffered from an average of 0.72 injuries over the study period (95% CI: 0.28–1.41), giving a yearly injury rate of 280%. Gender and dance styles were not significantly related to the occurrence of injury. Higher risk for injury was evidenced in older and more experienced dancers. Dynamic balance, as measured by the Star Excursion Balance Test (SEBT), was a significant protective factor of injury occurrence, irrespective of age/experience in dance. Knowing the simplicity and applicability of the SEBT, continuous monitoring of dynamic balance in adolescent dancers is encouraged. In order to prevent the occurrence of musculoskeletal problems/injuries in youth dancers, we suggest the incorporation of specific interventions aimed at improving dynamic balance.

Female Athlete and Sports-Related Concussions

Female athletes are participating in collision sports in greater numbers than previously. The overall incidence of concussion is known to be higher in female athletes than in male athletes participating in similar sports. Evidence suggests anatomic, biomechanical, and biochemical etiologies behind this sex disparity. Future research on female athletes is needed for further guidance on prevention and management of concussion in girls and women.

Do Grade II Ankle Sprains Have Chronic Effects on the Functional Ability of Ballet Dancers Performing Single-Leg Flat-Foot Stance? An Observational Cross-Sectional Study

Ballet dancers have a higher risk than the general population of ankle sprains. Ankle proprioception is of the utmost importance for executing static and dynamic positions typical of ballet dancing. Ankle sprains can create changes in functional ability that may affect ballet performance. The aim of this cross-sectional observational study is to evaluate if non-professional ballet dancers that were previously injured with a grade II ankle sprain carry a long-term stability deficit in ballet specific positions (passé, arabesque) and in single-leg flat-foot stance, thereby affecting ballet performance. We enrolled 22 amateur female ballet dancers, 11 who previously had a grade II ankle injury and 11 who had no history of ankle injury. Stabilometric data (Center of Pressure Speed and Elipse Area) were assessed with the postural electronic multisensory baropodometer in normal, arabesque, and passè positions with both open and closed eyes. Using an unpaired t-test, we compared healthy and pathological feet of the ankle injury group for a standard monopodalic position and two ballet-specific positions. No difference between pathological and healthy feet of non-professional ballet dancers who suffered grade II ankle injury was detected. According to the parameters considered in this study, grade II ankle sprains seem to have a favorable prognosis in the sample that we evaluated.