Untangling risk factors including discipline-specific exposure for injuries in preprofessional and professional circus artists in the USA

Abstract

ObjectiveThis prospective cohort study quantified injury patterns related to specific circus discipline exposure in preprofessional and professional circus artists.MethodsCircus artists (n=201; ages 13–69; 172 female, 29 male assigned sex at birth) were enrolled in 10 cities across the USA. Participants were followed for 1 year from enrolment, completing a weekly training log and undergoing a physical therapist evaluation for injuries. The circus-specific extension of the International Olympic Committee 2020 consensus on recording injury and illness in sports was used to analyse injury patterns.ResultsThe study completion rate was 77% (n=155). Data were analysed by participant subgroup (age, professional status, sex at birth). The highest injury rates in participant subgroups were for males (5.69/1000 exposures) and related to discipline subgroups, were in aerial with ground elements (5.93/1000 exposures) and aerial (4.26/1000 exposures). Adults had more injuries related to aerial, whereas adolescents had more related to ground disciplines (χ2(2)=10.62, p=0.005) and non-time loss injuries (χ2(1)=5.45, p=0.02). Females had a higher proportion of repetitive injuries (70% vs 55%) than males (χ2(1) = 4.43, p=0.035). Individuals with an eating disorder history had more (p<0.004) injuries (mean 2.27±2.29) than those without (mean=1.48±0.96).ConclusionsThis study showed that intrinsic factors (age, sex at birth and history of eating disorder) and extrinsic factors (circus discipline exposure) affect injury risk. We need to account for the intersectionality of these factors to address risk management at an individual and group level.

Preparation For Flight: The Physical Profile of Pre-Professional and Professional Circus Artists in the United States

“…This descriptive study was a secondary analysis of a prospective, observational cohort study. 11 Rolling enrollment occurred September -December 2018 (four facilities) and September 2019 -January 2020 (six facilities). This included completion of informed consent/assent forms and an intake questionnaire for demographics, training, and medical history, followed by an examination with the physical therapist (PT) assigned to the facility.…”

“…Additional demographic information was previously published. 11 Physical examination measures included height, mass, shoulder, hip, and lumbar ROM, shoulder and hip flexibility, accelerated three minute-step test, shoulder, abdominal, and hip manual muscle testing (MMT), and grip dynamometry. Functional tests including single limb and handstand balance, closed kinetic chain upper extremity stability (CKCUEST) test, and pull-ups.…”

“…For pre-professional and professional circus artists, injuries were most common to the shoulder (22%), lumbosacral (13%), elbow (10%), wrist (8%), and hip/groin (7%). 11 No differences in injury frequency per body region were found between groups by professional status, age, or assigned sex at birth (ASAB). 2 To provide optimal care, healthcare professionals should have knowledge about typical injuries in circus, the discipline specific physical demands and norms for physical exam and performance measures as they may differ from the general population, other athletes, or performing artists.…”

“…In the year following the examination, professionals trained more than pre-professionals (9.27 vs 6.87 sessions/week). 11 Training load for the period prior to testing was not collected and may have been very different since some training time was reduced due to the COVID-19 pandemic. However, average pull-ups in the pre-professional group (4.87+/-3.66) was similar to recreational aerialists who reported a similar training load (6 hr/week; 4.56+/-3.81 pullups), 10 suggesting that training time may be a factor.…”

“…Professionals demonstrated greater hamstring and straddle flexibility than pre-professionals despite both groups participating in a low number of flexibility-specific conditioning sessions (0.01 /week). 11 Differences may be due to the content of the conditioning sessions or professionals may better integrate relevant exercises into skills-based training. Differences by professional status may demonstrate physiologic adaptations necessary for the performance demands of a professional career and could potentially be used as screening measures to assess preparedness for performance in professional companies or progression to professional status, but it may be context specific based on the demands of the show or professional company.…”