Occupational Musculoskeletal Disorders in Dancers

Abstract

INTRODUCTIONDancers represent a medically under-served occupational group at high risk for work-related musculoskeletal disorders (WMSD). They are highly trained individuals who perform repetitive, reproducible, and consistent movements. 1 The annual incidence of injury in professional dancers is 67-95%. [2][3][4][5][6] Traditionally, dancers are considered to be both artists and athletes. Accordingly, medical practitioners have adopted a sports medicine model in the care of dancers within their respective organisations. Activities such as annual screenings and performance coverage pattern themselves after pre-season team screenings and game coverage. This approach has been effective enough to produce a recent offspring, dance medicine, which has sought to describe patterns of, and risk factors for, dance-related injury. As dance medicine continues to grow, many of its specialists are also drawing from another model, occupational medicine, to develop injury prevention and management programmes tailored to the special needs of this population.In this article, we borrow from both the sports and occupational medicine models to review some of the issues in addressing WMSD in dancers. Consideration will be given to injury risk factors and options for organisational management of injury. To further our discussion, Figure 1 illustrates a dance medicine conceptual model demonstrating the interaction of intrinsic risk factors of the dancer/worker with extrinsic risk factors of dance/work that may result in musculoskeletal injury and the points at which prevention measures can be introduced. MULTIFACTORIAL RISK FACTORSWMSD incur enormous health and financial costs. They account for over 85% of workers' compensation (WC) claims in the US, with estimated annual costs ranging from $13-54 billion. 7,8 In order to design optimal prevention and intervention strategies for workers, it is important to ascertain the nature of risk for WMSD. Risk factors are attributes or elements ABSTRACT Professional dancers are a medically under-served occupational group at high risk for workrelated musculoskeletal disorders. Historically, a sports medicine approach has been used in the treatment of dancers and dance companies. Recently, health care providers have also applied occupational medicine concepts to the dance organisation. Consideration of risk factors and the application of organisational programmes to prevent work-related musculoskeletal disorders in dancers are discussed. Deficiencies in our understanding of the contribution of risk factors towards injury are outlined for future consideration. The majority of dance organisations are non-profit and have no injury prevention strategies in place, viewing medical programmes as an unaffordable luxury. The application of a customised sportsoccupational medicine approach shows promise in reducing the human and financial costs of work-related musculoskeletal disorders.

Injury Patterns in Elite Preprofessional Ballet Dancers and the Utility of Screening Programs to Identify Risk Characteristics

“…Tremendous efforts continue to be undertaken in university, semiprofessional, and professional dance settings to conduct physical screening examinations with the goal of preventing injuries. 35,46,50,51,63,64 Many authors suggest that there are measurable intrinsic characteristics that contribute to dance injuries, 8,18,26,34,61,66 such as imbalances in strength and flexibility, insufficient or excessive joint range of motion, or poor postural alignment. 8,24,26,34,66 While these may be intuitive assumptions, very few studies have been conducted to investigate the relationships between measurement of intrinsic characteristics and dance injuries.…”

“…34,45,53,60,62 There are many reviews in the literature describing the distribuancers are highly trained athletes who are at significant risk for injury due to intense competition and the repetitive nature of their movement patterns. 8,18,66 Professional dance companies have reported that as many as 67% to 95% of their dancers are injured on an annual basis, 3,7,8,65 while 1 dance school reported that as many as 77% of their adolescent dancers were injured in 1 academic year. 40 In ballet, the greatest proportion of injuries is reported to occur in adolescent dancers 12 to 18 years of age.…”

Management of a Delayed Union Sesamoid Fracture in a Dancer

“…23,42 Hard floor surfaces increase shock attenuation demands on the feet, 21,61 while raked (inclined) stages are reported to be associated with 28% to 37% of all injuries. 18 Finally, females are at greater risk for stress fractures, 11 and the vascularity of their sesamoids is less extensive than that of males.…”

“…5,11,20,28,40,64 A cavus foot is relatively rigid, likely resulting in limited shock attenuation when landing from jumps. A plantarflexed first ray increases weight-bearing pressures medially over the first MTP joint.…”

“…They execute repetitive foot and ankle motions (alternating between extreme plantar flexion and dorsiflexion) with minimal to no supportive footwear, which predisposes them to overuse injuries of the foot and ankle. 10,11,39 Dancers apply a large amount of stress to the hallucal sesamoids when moving onto their toes to grand plié and demi-relevé (ankle plantar flexion and metatarsophalangeal [MTP] joint dorsiflexion), full relevé (ankle and MTP joint plantar flexion), and during eccentric deceleration occurring with jumps and hops. 14,53,58 STUDY DESIGN: Case report.…”