Abstract:Low range femoral torsion, termed "lateral shaft torsion," has been associated with greater range of hip external rotation and turnout in dancers. It is also hypothesized that achieving greater turnout at the hip minimizes torsion at the knee, shank, ankle, and foot, and consequently reduces incidence of lower limb injuries. The primary aims of this study were to investigate: 1. differences in range of femoral shaft torsion between dancers with and without lower limb injuries; and 2. the relationship between f… Show more
“…Femoral version was also investigated in three studies. One study measured version using MRI which did not differ to femoral version in the general population [ 6 ], whilst the other studies assessed version using ultrasound or an inclinometer and did not include controls [ 29 , 30 ]. Fig.…”
Purpose
The literature on hip injuries in ballet dancers was systematically evaluated to answer (1) whether the prevalence of morphological abnormalities and pathology of hip injuries in dancers differs from the general population (2) if there are any specific risk factors which contribute to a higher rate of hip injury and (3) what are the outcomes of primary and secondary intervention strategies.
Methods
A systematic literature search of Medline, EMBASE and the Cochrane Library was undertaken for all literature relating to hip injuries in ballet dancers using the PRISMA guidelines. Reference lists were also searched for relevant literature. Clinical outcome studies, prospective/retrospective case series published between 1989 and October 2021 were included. Review articles (non-original data), case reports, studies on animals as well as book chapters were excluded.
Results
The search yielded 445 studies, of which 35 were included for final analyses after screening. This included 1655 participants, of which 1131 were females. The analyses revealed that damage at the chondrolabral junction and degenerative disease of the hip may develop at a higher rate in ballet dancers than in the general population (odds ratio > 1 in 15/18 cohorts). The intra-articular lesions were more frequently found in postero-superior region of the hip suggesting an alternative impingement mechanism. Furthermore, numerous risk factors specific for hip injury in ballet were highlighted amidst a wide body of literature which consistently reports risk factors for a more generic ‘dancer vulnerability’.
Conclusion
Ballet dancers may suffer from both higher rates of chondrolabral damage and degenerative disease in their hips. In contrast to other sports, the intra-articular lesions are more frequently found in postero-superior region of the hip. Future research clarifying the prevalence of osseous abnormalities and prevention strategies in dancers may be pivotal in delaying the development of hip disease in this cohort.
Level of evidence
Level IV.
“…Femoral version was also investigated in three studies. One study measured version using MRI which did not differ to femoral version in the general population [ 6 ], whilst the other studies assessed version using ultrasound or an inclinometer and did not include controls [ 29 , 30 ]. Fig.…”
Purpose
The literature on hip injuries in ballet dancers was systematically evaluated to answer (1) whether the prevalence of morphological abnormalities and pathology of hip injuries in dancers differs from the general population (2) if there are any specific risk factors which contribute to a higher rate of hip injury and (3) what are the outcomes of primary and secondary intervention strategies.
Methods
A systematic literature search of Medline, EMBASE and the Cochrane Library was undertaken for all literature relating to hip injuries in ballet dancers using the PRISMA guidelines. Reference lists were also searched for relevant literature. Clinical outcome studies, prospective/retrospective case series published between 1989 and October 2021 were included. Review articles (non-original data), case reports, studies on animals as well as book chapters were excluded.
Results
The search yielded 445 studies, of which 35 were included for final analyses after screening. This included 1655 participants, of which 1131 were females. The analyses revealed that damage at the chondrolabral junction and degenerative disease of the hip may develop at a higher rate in ballet dancers than in the general population (odds ratio > 1 in 15/18 cohorts). The intra-articular lesions were more frequently found in postero-superior region of the hip suggesting an alternative impingement mechanism. Furthermore, numerous risk factors specific for hip injury in ballet were highlighted amidst a wide body of literature which consistently reports risk factors for a more generic ‘dancer vulnerability’.
Conclusion
Ballet dancers may suffer from both higher rates of chondrolabral damage and degenerative disease in their hips. In contrast to other sports, the intra-articular lesions are more frequently found in postero-superior region of the hip. Future research clarifying the prevalence of osseous abnormalities and prevention strategies in dancers may be pivotal in delaying the development of hip disease in this cohort.
Level of evidence
Level IV.
“…A total of 914 studies were excluded by examining their titles and/or abstracts. A further 8 studies were excluded after a full-text review because they did not report hip morphological parameters, 4,7,[23][24][25][26][27][28] and one study was excluded because it was on young female dancers who did not train at professional or competitive levels. 6 This left 12 studies [29][30][31][32][33][34][35][36][37][38][39][40] eligible for this systematic review, all of which were cohort or case-control studies (Table 1 and Figure 1).…”
“…Femoral version was a feature measured by three studies that defined where the axis of the lower limb naturally lies in relation to the hip. 8,10,34 If a dancer has a lesser degree of femoral version the lower limb will be positioned in an already externally rotated position, suggesting that less strength and coordination is required to reach a greater turnout angle. Tibial torsion is the natural (usually external) rotation of the tibia from the proximal to the distal end of the bone 9 (Fig.…”
Section: Discussionmentioning
confidence: 99%
“…Twenty-eight studies were identified that measured HER; 19 were crosssectional studies, [7][8][9]12,15,[22][23][24][25][26][27][28][29][30][31][32][33][34][35] six casecontrol, [36][37][38][39][40][41] two cohort, 42,43 and one randomized control trial. 44 Passive and active ranges of motion were assessed using a variety of tools: standard goniometer, modified goniometer, digital inclinometer, and kinematic analysis.…”
Section: Hip External Rotation (Table 4)mentioning
confidence: 99%
“…44 Passive and active ranges of motion were assessed using a variety of tools: standard goniometer, modified goniometer, digital inclinometer, and kinematic analysis. Participants were assessed in four different positions: prone (16 studies [7][8][9]15,23,[25][26][27][28]31,[34][35][36][37][38]44 ), supine (seven studies 12,29,33,[39][40][41]43 ), sitting (six studies 7,9,30,[39][40][41][42] ) and standing (two studies, 24,32 both kinematic analysis). Some studies used more than one position.…”
Section: Hip External Rotation (Table 4)mentioning
Turnout, or external rotation of the lower limbs, is an integral part of classical ballet technique. Contributions of lower limb structures to turnout can be separated into HER (hip external rotation) and NHCTO (non-hip contributions to turnout). This study aimed to review systematically
methods used to measure turnout in dance medicine and science research, thereby updating the literature since the Champion and Chatfield review of 2008. CINAHL, EMBASE, PubMed, and Web of Science were searched in January 2018 by two independent reviewers. Peer-reviewed studies measuring turnout
in dance were included, except those published prior to March 23, 2006, as that was the last date of publication included in the previous review. Abstracts, theses, and editorials were excluded. From each study, study design, population (sample size, sex, age, genre of dance, and level of
training), details of the protocol used, and result of turnout measurement were extracted, as well as reliability data. All included studies were assessed for risk of bias, using either Newcastle-Ottawa scale, AXIS tool, or PEDro scale as appropriate for each study design. A total of 41 studies
met the inclusion criteria. Twenty-eight studies measured HER, nine measured NCHTO, and 22 measured total turnout (TTO). An increased number of studies investigated TTO (N = 22; N = 4 passive TTO) and NHCTO (N = 9) since 2006. All studies scored above half the points attainable from their
respective tools. Results suggest HER remains the most common protocol for measuring turnout (N = 28), despite the fact it disregards input from structures below the hip. It is concluded that researchers should focus on quality of reporting of protocols to ensure repeatability and facilitate
comparison of results. Future studies should include absolute reliability and validity testing of all currently used protocols so that standardization can be fully achieved.
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