Management of Stress Fractures in Ballet

Abstract

Stress fractures are highly prevalent in ballet dancers and lead to notable time loss from dancing. Nutritional status, body composition, bone mineral density, and rate of increase in activity are among the components that influence risk for stress fractures. Proper evaluation and management of stress fractures is essential including a review of the causative factors involved in each stress injury. The purpose of this article was to summarize current evidence for risk factors involved in dancers' stress fractures to optimize prevention and treatment. Identified associated factors include low energy availability, low bone mineral density, low fat body composition, abnormal lower extremity biomechanics, genetic factors, and high training loads. Ballet dancers participate in rigorous training and conditioning to achieve seemingly effortless, powerful, aesthetic artistic movements. Caring for these performing artists requires attention to their unique injuries and the remarkable volume of activity undertaken in classes, rehearsals, and performances. Stress-related bone injuries are challenging for both dancers and professional companies because treatment often includes prolonged rest from participation. An understanding of the multifactorial, multisystem nature of these injuries is required to properly diagnose, treat, and prevent the spectrum of these injuries. This review summarizes the current best evidence in dance medicine epidemiology, risk factors, and evaluation and provides a stress fracture management and prevention protocol used in elite ballet. Epidemiology of Stress-related Bone Injury in BalletStress fractures may occur secondary to one of the three mechanisms: (1) abnormal stress on normal bone, (2) normal stress on abnormal bone, or (3) abnormal stress on abnormal bone. Ballet dancers may be especially susceptible to the latter. 1 Recent evidence has described a greater incidence of stress injuries in younger, female dancers. [2][3][4][5] In a systematic review by Smith et al, 2 amateur male and female dancers sustained 0.99 and 1.09 injuries for every 1,000 dance hours, respectively, whereas professional male and female dancers sustained a total of 1.06 and 1.46 injuries, respectively, during the same period. In professional female dancers, 64% of injuries were related to

Causes and Treatment of Birth Trauma-Related Femoral Fracture: A Longitudinal Study

“…(12) Torsion injury resulting in spiral fracture of the femur shaft has been proposed as the most common mechanism of injury. (13)The bulk of the fractures in our dataset were of the same type. If the breech is fixed at the pelvis, excessive traction on the leg during vaginal breech delivery could result in a femoral shaft fracture.…”

Hip Pain in Ballet Dancers: Evaluation and Management

“…Although outside the scope of this review, the differential diagnosis for hip pain in ballet dancers should include referred pain from other regions (eg, lumbar pathology and core muscle injury) and metabolic issues (eg, stress reaction/fracture). 14 A recent systematic review of hip/groin injuries in dancers noted that 85% of these injuries were due to overuse rather than a traumatic event. 1 This review will focus on three commonly observed hip pathologies in ballet dancers: impingement, instability, and extra-articular snapping hip syndrome (SHS).…”

“…The culture of ballet promotes hours of practice at a young age, with professional ballet dancers having logged thousands of hours of training. 14 Ballet classes often range from 1 to 4 hours in length and use repetitive movements, which may contribute to overuse injuries despite good dance mechanics. Unlike many sports that are seasonal, training is often year-round without prolonged periods of rest or seasons of cross-training with other activities.…”