Associations Between Turnout and Lower Extremity Injuries in Classical Ballet Dancers

[ research report ] C lassical ballet dancers are a unique combination of athlete and artist who perform complex movement patterns requiring both muscle strength and control. Ballet places particularly high demands on the trunk due to the requirement for extreme range of motion and tolerance of high compressive forces.1 A possible sequela of these spinal loads may be low back pain (LBP), which is consistently reported to be one of the most prevalent chronic injuries in professional ballet dancers. 2,9,14,25 In nondancers, LBP is associated with musculoskeletal changes, including alteration in muscle size, symmetry, 3,4,11,22 and fat content. 37 These changes include reduced cross-sectional area (CSA) of the multifidus in patients with acute, subacute, 22 and chronic LBP. 3,11 Two investigations found that people with unilateral LBP had a smaller multifidus on the side 3,22 and at the spinal level of pain.22 These changes were associated with longer symptom duration.3 Another study found that people with unilateral LBP had decreased CSA of the multifidus bilaterally and symmetrically.4 By contrast, when the CSA of the erector spinae has been differentiated from the multifidus, changes in CSA have not been demonstrated in active people with chronic LBP. 4,11 Changes in other muscles have been identified. The CSA of the psoas muscle has been shown to be reduced bilaterally in people with chronic LBP, 40 and this decrease in CSA has been associated with increased symptom duration on the painful side in individuals with unilateral LBP.3,10 In cricketers with LBP, when compared with pain-free cricketers, the T T STUDY DESIGN: Cross-sectional, observational study. T T OBJECTIVES:To investigate the cross-sectional area (CSA) of trunk muscles in professional ballet dancers with and without low back pain (LBP). T T BACKGROUND:LBP is the most prevalent chronic injury in classical ballet dancers. Research on nondancers has found changes in trunk muscle size and symmetry to be associated with LBP. There are no studies that examine these changes in ballet dancers. T T METHODS:Magnetic resonance imaging was performed in 14 male and 17 female dancers. The CSAs of 4 muscles (multifidus, lumbar erector spinae, psoas, and quadratus lumborum) were measured and compared among 3 groups of dancers: those without LBP or hip pain (n = 8), those with LBP only (n = 13), and those with both hip-region pain and LBP (n = 10). T T RESULTS:Dancers with no pain had larger multifidus muscles compared to those with LBP at L3-5 (P<.024) and those with both hip-region pain and LBP at L3 and L4 on the right side (P<.027). Multifidus CSA was larger on the left side at L4 and L5 in dancers with hip-region pain and LBP compared to those with LBP only (P<.033). Changes in CSA were not related to the side of pain (all, P>.05). The CSAs of the other muscles did not differ between groups. The psoas (P<.0001) and quadratus lumborum (P<.01) muscles were larger in male dancers compared to female dancers. There was a positive correlation between the size of th...

show abstract

Section: Participantsmentioning

confidence: 99%

Size and Symmetry of Trunk Muscles in Ballet Dancers With and Without Low Back Pain

Gildea¹,

Hides²,

Hodges³

2013

Journal of Orthopaedic & Sports Physical Therapy

View full text Add to dashboard Cite

show abstract

“…Iontophoresis with dexamethasone has been described in the literature as an effective anti-inflammatory in the treatment of PTT dysfunction. 37 She also continued to wear the cam walker for 3 more weeks, but only at school or when walking long distances. She was permitted to begin walking through rehearsals in her athletic shoes with orthoses but not to perform relevé or jumping.…”

Section: Casementioning

confidence: 99%

Management of Dancers With Symptomatic Accessory Navicular: 2 Case Reports

Smith

2012

J Orthop Sports Phys Ther

View full text Add to dashboard Cite

“…Increased stiffness is thought to reflect the augmented activity of superficial trunk muscles (3,28), which is commonly reported in association with LBP (7,39) and may be a strategy to protect the spine from pain and injury (16,39). Support for this proposal comes from modelling studies, which have identified that contraction of superficial trunk muscles increases spinal stability (7,39).…”

Section: Trunk Damping But Not Stiffness Is Modified In Dancers Withmentioning

confidence: 62%

“…On the basis of data from non-dancers (17,39) it is reasonable to speculate that trunk control, including the ability to regulate movement quality, might be modified in ballet dancers with a history of low back pain (LBP).…”

Section: Introductionmentioning

confidence: 99%

“…Demographic data, including age, gender, years of dance, limb dominance, and anthropometric measures, were recorded from each participant. Hypermobility scores, 34 site and degree of spinal curvature, 32 leg-length difference, 32 and functional lower-leg turnout 39 were measured by an experienced physiotherapist.LBP was investigated in a number of ways. Participants completed the International Physical Activity Questionnaire long form 8 and questionnaires related to general health and injury, the latter of which included a body chart on which the dancers were to indicate the area of pain.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Physiology and pathophysiology of low back pain in ballet dancers

Gildea¹

View full text Add to dashboard Cite

Classical ballet dancers combine artistry and physical skills to perform graceful and exciting movements. Lengthy, exacting dance training potentially promotes unique adaptation of motor control to; execute these movements; maintain optimal physiological function, and provide stability to avoid injury and pain. Yet low back pain (LBP) is common in dancers. Differences in motor control are frequently observed between non-dancers with and without LBP. This often involves reduced and delayed activity of deep trunk muscles and augmented activity of superficial muscles. These changes are proposed to affect the control of movement and stiffness of the trunk. LBP is also associated with deficits in postural control, an aspect of motor control, which depends on control of the trunk. Some features of adaptation in motor control are relatively common; but there are some features that are specific to individuals or different populations. It is essential to understand how motor control is adapted in elite classical ballet dancers with LBP as less optimal motor control has potential to impair performance and limit the capacity to dance. The overall objective of this thesis was to investigate aspects of motor control in dancers with and without LBP, with specific attention to trunk muscle morphology and to postural stability.Studies I and II investigated trunk muscle size, symmetry and function, in dancers with and without LBP, at rest and during simple manoeuvres, with magnetic resonance imaging (MRI). Reduced size of the multifidus muscle was observed in dancers with LBP and dancers with both back and hip/pelvic region pain. This finding is similar to that for nondancers. Study II provided preliminary evidence of a behavioural change in transversus abdominis (the deepest abdominal muscle); expressed as reduced length change of this muscle measured with MRI, in dancers with LBP. Thickness of transversus abdominis, obliquus internus abdominis and multifidus muscles were asymmetrical in dancers but this was not related to LBP. This may be related to repetitive performance of asymmetrical movements. Studies III and IV investigated postural control. In Study III, the trunk was perturbed in order to measure the dynamic properties of stiffness, damping and mass as an indication of control of the trunk. Dancers with LBP had less damping (control of velocity) than dancers without LBP, but this could be changed with motor imagery in the dancers with LBP. Study IV used linear and non-linear measures of centre of pressure trajectories to investigate standing balance in dancers with and without LBP and nondancers. Balance was measured with the feet in parallel and the dance-specific turned out 'first' position; which increases the dependence on trunk motion for balance in the anteroposterior direction. Dancers without LBP used more movement to control balance iii than non-dancers. These findings suggest that "less" movement does not define optimal balance in dancers. Dancers with a history of LBP used strategies that were more s...

show abstract

Associations Between Turnout and Lower Extremity Injuries in Classical Ballet Dancers

Cited by 29 publications

References 0 publications

Size and Symmetry of Trunk Muscles in Ballet Dancers With and Without Low Back Pain

Size and Symmetry of Trunk Muscles in Ballet Dancers With and Without Low Back Pain

Management of Dancers With Symptomatic Accessory Navicular: 2 Case Reports

Physiology and pathophysiology of low back pain in ballet dancers

Contact Info

Product

Resources

About