Search

Ankle injuries are common among young ballet dancers. These injuries may be attributed to ankle instability, insufficient lower extremity strength, and poor balance control. The purpose of this study was to explore whether these dancers exhibit functional ankle instability and if their single-leg balance control and lower extremity muscle strength correlate with functional ankle instability and leg injuries. Twenty-one ballet dancers (aged 10 to 17 years) participated in the study. The Cumberland Ankle Instability Tool (CAIT) questionnaire was used to examine functional ankle stability. Isometric muscle strength of the major lower extremity muscles was measured with a digital hand-held dynamometer. Single-leg balance was evaluated with the Y-Balance Test (YBT) and three Athletic Single-leg Stability Test (ASLST) protocols. Lower extremity injuries (self-reported) within 6 months after testing were recorded for correlation analyses. Both dominant and non-dominant ankles of the subjects exhibited functional ankle instability (26.71 and 25.71, respectively). Raising the center of mass (passé and first arm position) during the ASLST did not significantly affect balance performance (p = 0.104). However, removing extrinsic visual feedback significantly decreased single-leg balance (p < 0.001). In general, there was low correlation (r ≤ 0.49) between muscle strength, CAIT, YBT, and ASLST scores with lower extremity injuries. It is concluded that for young ballet dancers lower extremity muscle strength and single-leg balance control may not be strong contributing factors to leg injuries. This study also suggests that functional ankle stability may not have a direct impact on single-leg balance, and ballet dancers rely heavily on extrinsic visual feedback for single-leg balance control. Teachers might consider minimizing extrinsic feedback to challenge ballet dancers when implementing training protocols for single-leg balance control.

Background There is convincing evidence that dancers suffer injuries to the triceps surae musculature. Research on the immediate effects of dry needling (DN) is limited, and it is important to understand the acute effects of this treatment prior to performance. Purpose The purpose of this pilot study was to assess the immediate effects of DN on myofascial trigger points in terms of skin surface temperature, pain, active and passive range of motion, and torque production in the triceps surae of ballet dancers. Study Design Randomized, double-blinded pilot study Methods Professional ballet dancers that fit inclusion and exclusion criteria (n=11) were randomly assigned to an experimental or control group. The dancers had three pre-determined standard point (SP) measurement spots that were used as a baseline for surface temperature comparisons. The dancers were also palpated for trigger point (TP) spots. Both SP and TP spots were marked for future measurements. The experimental group received DN, while the control group received sham DN (SHAM) to their bilateral calves at the TP spots. Immediately prior to and following treatment, both DN and SHAM groups were tested for skin surface temperature, pain, range of motion, and plantar flexion torque by blinded assessors. Paired t-tests and independent t-tests were performed to examine for differences between groups. Results The surface temperature for the TP was higher than the SP measurements prior to intervention (Right calf p= .014; Left calf p= .031). There were no significant changes in VAS scale reported pain and ROM. The plantar flexion torque measurements showed an increase in the DN group of the left calf at the angular velocity of 60 degrees/sec. Conclusion This was a unique pilot study examining the acute effects of DN on professional ballet dancers. The results were limited due to low sample size. However, the methodology for this study and surface temperature results invites future research. Level of evidence Level 1b

The ankles of ballet dancers are routinely under heavy loading that may lead to osteoarthritic changes. It would be clinically useful to identify such pathology as early as possible in a dancer's career. Therefore, the purpose of this study was to compare quantitative measurements in magnetic resonance (MR) images of the talocrural and talonavicular joints in ballet dancers and healthy non-dancers for use in formulating prediction of chronic injury and degenerative joint disease in these locations. Quantitative measurements in MR images of the talocrural and talonavicular joints were compared in 10 female ballet dancers, 10 healthy female non-dancers, and nine male ballet dancers. Fat-suppressed density-weighted proton, T1rho, and T2 mapping images were acquired with a 3.0 T MR scanner. Medial and lateral subchondral bone distance between the tibia and talus (MSBD and LSBD), axial navicular-talus axis angle (ANT angle), sagittal talar neck angle against the posterior talocalcaneal joint (TN angle), and curvature of navicular surface at the talonavicular joint were measured on sagittal images. The medial subchondral bone distance was found to be significantly larger in female dancers than female non-dancers (4.05 mm vs. 2.75 mm, p < 0.05), whereas there were no significant differences in LSBD (2.63 mm vs. 2.63 mm, p = 0.87). Axial navicular talus angles in female dancers were significantly larger than those in female non-dancers (38.9° vs. 24.3°, p < 0.05). There was a tendency for the TN angle to be smaller and navicular curvature (NC) to be larger in female dancers compared to female non-dancers, though the differences were not significant (TN angle: 16.6° vs. 22.3°, p = 0.09, and NC: 0.186 vs. 0.165, p = 0.28). There were no significant differences in T1rho or T2 values of talonavicular joint cartilage. These results show that the bony anatomy of dancers' ankles may adapt to the stresses placed on them by ballet.

Ankle injuries are highly prevalent in ballet, with strength highlighted as a primary risk factor. To profile ankle strength, fourteen female ballet dancers (age: 19.29 ± 1.59 years) completed an isokinetic testing protocol comprising concentric eversion (CON

The aim of the present study was to evaluate the effects of 5 month kettlebell-based training on jumping performance, balance, blood pressure and heart rate in female classical ballet dancers. It was a clinical trial study with 23 female dancers (age = 21.74 ± 3.1 years; body height = 168.22 ± 5.12 cm; body mass = 53.69 ± 5.91 kg) took part in the study. Participants were divided into two groups: a kettlebell group (n = 13), that followed a commercial kettlebell training protocol named the “Simple & Sinister protocol”, and a traditional dance training control group (n = 10). In the kettlebell group, kettlebell training completely replaced the jump and balance section of dance classes. Both groups performed balance and jumping tests before and after the training period. Blood pressure and the heart rate were also measured. The kettlebell group showed significant improvements in the balance tests (antero-posterior and medio-lateral oscillation) with both legs and eyes open as well as in all types of jump exercises (unrotated: +39.13%, p < 0.005; with a turnout: +53.15%, p < 0.005), while maximum and minimum blood pressure and the heart rate decreased significantly (max: -7.90%, p < 0.05; min: -9.86%, p < 0.05; Heart rate: -17.07%, p < 0.01). The results for the control group were non-significant for any variable. Comparison between groups showed significant differences for all variables analyzed, with greater improvements for the kettlebell group. Our results suggest that specific kettlebell training could be effective in improving jump performance and balance in classical dancers to a significantly greater degree compared to classical dance training.

Background: Prevalence and severity of symptoms related to muscle and joint pain seem to be high in most dancers. Hypothesis: There will be a worse quality of life related to foot health for ballet dancers compared with nondancers. Study Design: Case-control study. Level of Evidence: Level 4. Methods: A sample of 156 women was recruited from a clinic of podiatric medicine and surgery. Self-reported data were measured by the Foot Health Status Questionnaire (FHSQ), which has 33 questions that assess 8 health domains of the feet and general health, namely, foot pain, foot function, general foot health, footwear, general health, physical activity, social capacity, and vigor. Results: Statistically significant differences ( P < 0.05) were shown for foot pain, foot function, foot health, and general health, which together revealed a worse foot health–related quality of life (lower FHSQ scores) but a better general health (higher FHSQ scores) for ballet dancers compared with nondancers. The remaining domains did not show statistically significant differences ( P > 0.05). According to multivariate linear regression models ( P < 0.05), the practice of ballet dance (group) was the only independent variable that predicted the dependent variables, such as foot pain ( R2 = 0.052;β = +8.349), foot function ( R2 = 0.108; β = +11.699), foot health ( R2 = 0.039; β = +10.769), and general health ( R2 = 0.019; β = −6.795). Conclusion: Ballet dancers showed a negative impact on quality of life related to foot health but better overall quality of life (general health) compared with nondancers. Clinical Relevance: Paying attention to a dancer’s foot health could provide important benefits for the dancer’s foot health and physical practice of dance.

BACKGROUND The purpose of this study was to evaluate the results of endoscopic excision of symptomatic os trigonum in symptomatic ballet dancers of Odisha. The hypothesis was that posterior endoscopic excision of the os trigonum would be safe and effective in treating PAIS related to the os trigonum. METHODS Between May 2015 and May 2018, 30 ankles of 20 consecutive patients underwent arthroscopic removal of the symptomatic os trigonum for posterior ankle impingement syndrome (PAIS) in prone position. 12 patients were male, 8 female. All patients were ballet dancers by profession where they do the dance in acute flexion of ankle. All patients were discharged on the same day and allowed full weight bearing after 2 weeks post operatively. Mean duration of postoperative follow up was 24 months and no patient was lost to follow up. Clinical evaluations were performed preoperatively & post operatively using the American Orthopaedic Foot & Ankle Society (AOFAS) ankle - hind foot score and the Visual Analogue Scale (VAS) for pain. The surgical time, time to return to profession (dancing), patient satisfaction and any complications related to the surgery were assessed. RESULTS Average AOFAS ankle hindfoot score increased from 72.6 ± 5.1 (range 64 - 78) preoperative to 93.8 ± 3.2 (range 86-100) post-operative (p

Background Since ballet dancers begin their training before skeletal maturity, accurate and non-invasive identification of cartilage diseases is clinically important. Angle-dependent analysis of T1rho and T2 sequences can be useful for quantification of the composition of cartilage. Purpose To investigate the angle-dependent T1rho and T2 profiles of ankle cartilage in non-dancers and dancers. Material and Methods Ten female non-dancers, ten female dancers, and 9 male dancers were evaluated using T1rho and T2 mapping sequences. Manual segmentation of talar and tibial cartilage on these images was performed by two radiologists. Inter- and intra-rater reliabilities were calculated using intraclass correlation coefficients (ICCs) and Bland–Altman analysis. Mean thickness and volume of cartilage were estimated. Angle-dependent relaxation time profiles of talar and tibial cartilage were created. Results ICCs of the number of segmented pixels were poor to excellent. Bland–Altman plots indicated that differences were associated with segment sizes. Segmented cartilage on T1rho demonstrated larger thickness and volume than those on T2 in all populations. Male dancers showed larger cartilage thickness and volume than female dancers and non-dancers. Each cartilage demonstrated angular-dependent T1rho and T2 profiles. Minimal T1rho and T2 values were observed at approximately 180°–200°; higher values were seen at the angle closer to the magic angle. Minimal T2 value of talar cartilage of dancers was larger than that of non-dancers. Conclusion In this small cohort study, regional and sex variations of ankle cartilage T1rho and T2 values in dancers and non-dancers were demonstrated using an angle-dependent approach.

Using electrocardiography and echocardiography, we screened elite men and women ballet dancers for abnormal cardiovascular conditions using an observation design with blinded clinical analysis of cardiac function tests. Fifty-eight (females

Due to frequent movements involving extreme hip amplitudes, ballet dancers often present with hip pain and chondrolabral lesions as seen in femoroacetabular impingement. The lesions appear even with normal anatomy. Diagnosis is often delayed, and treatment is challenging, especially in skeletally immature patients. This study reports the case of an adolescent ballet dancer suffering from a large symptomatic labral tear. The literature has also been reviewed for context regarding the pathophysiology and current therapeutic management of these injuries.

Several classical dance complex movements, such as pointe, require body weight to be supported properly to avoid risk of foot injury. Regarding the choice of toe cap for pointe shoes, it is unclear which type can better alleviate pain symptoms and toe deviation angle in dancers. The aim of the current crossover study was to investigate the acute effect of using different types of toe caps among well-trained professional dancers on pain perception and toe deviation angle. Ten young female professional dancers volunteered to participate in the study. Each participant was tested during two separate sessions with an interval of 72 h in between. Participants were tested in the two sessions with a standard commercial or a customized prototype toe cap, always with pointe shoes, and in randomized order. An anteroposterior X-ray examination was performed separately for each participant and a visual analogue scale for pain perception was administered following each situation (with a standard commercial or a customized prototype toe cap). Significant amelioration was obtained when a customized toe cap prototype was used both for toe deviation angle and for visual analogue scale. Use of a customized toe cap prototype compared to a standard one may acutely reduce both toe deviation angle and pain in elite female professional dancers.

Injuries involving the first metatarsophalangeal joint and its associated structures are common, especially in athletes. However, injuries to the hallucal sesamoid complex constituted only 3% of all podiatric sports medicine injuries reported by Agosta. This case study reports a female ballet dancer with an isolated fibular sesamoid retraction injury that presented with a history of chronic microtrauma secondary to overuse. When consulting epidemiologic studies of forefoot injuries involving the hallucal sesamoid complex, we were unable to find a single instance of an isolated retraction of the fibular sesamoid resulting from chronic use, demonstrating the unusual nature of this case.

AIMS: To compare the differences in bone mineral density (BMD) at loaded and non-loaded skeletal sites in professional ballet dancers. We hypothesized that in both male and female elite ballet dancers, a significant difference in BMD will be observed between impact and non-impact sites. METHODS: 44 elite ballet dancers, 22 men (age 26.4±5.9 yrs) and 22 women (age 24.9±5.3 yrs), were examined. BMD measurements were performed using dual-energy x-ray absorptiometry at three skeletal sites—forearm (FA), lumbar spine (LS), and femoral neck (FN)—and analyzed using t-tests, ANOVA, and linear regression models. Information about career duration, training volume, health habits, and menstrual disorders (women) was collected. RESULTS: Z-scores for LS and FN were significantly higher in men than in women. However, Z-scores for FA were similar in men and women and fell below the expected range for age (

Overuse pathologies are prevalent in ballet injury. Ten amateur ballet dancers (age: 23.20 ± 3.08 years) completed a progressive 5-stage choreographed routine on two consecutive days. Tri-axial accelerometers positioned at C7 and the dominant and non-dominant lower-limb were used to calculate accumulated PlayerLoadTM (PLTOTAL) and uni-axial contributions of the anterior-posterior (PLAP), medial-lateral (PLML), and vertical (PLV) planes. PLTOTAL increased significantly (p = 0.001) as a function of exercise duration within-trial, however there was no significant change between trials (p = 0.18). PLTOTAL at C7 was significantly (p = 0.001) lower than both lower-limbs, with no bilateral asymmetry evident (p = 0.97). Planar contributions to PLTOTAL were significantly greater in PLV than PLAP and PLML (p = 0.001). PlayerLoadTM demonstrated within-trial sensitivity to the progressive routine, however no residual fatigue effect was observed between trials. The results of this study suggest that accelerometers have efficacy in athlete monitoring and injury screening protocols, however unit placement should be considered for practical interpretation.

Flexor hallucis longus (FHL) dysfunction is a condition experienced primarily by athletes, including ballet dancers and runners. Accurate diagnosis and definitive treatment at the initial evaluation can often be difficult given the number of foot and ankle pathologies that share similar signs and symptoms. The evaluation process tends to be a diagnosis of inclusion rather than a specific pathology with an accepted rehabilitation plan. For example, patients with medial arch pain may undergo an extended rehabilitation period with an evolving differential diagnosis requiring several treatment modifications. A more appropriate rehabilitation paradigm should adapt to the potential changes in patient symptoms and presentation, addressing functional impairments as they arise. This case study describes the successful management of a patient with chronic FHL dysfunction, leveraging a flexible, multimodal treatment approach to address the evolving functional impairments rather than focusing on a single, discrete diagnosis. At a two-year follow-up, the patient remains pain-free.

Posterior ankle impingement syndrome (PAIS) involves pain at the posterior as- pect of the ankle, due in dancers largely to repetitive hyperplantarflexion. In daily practice, corticosteroid injection is often used to relieve the pain of PAIS, but little has been recorded with regard to its effectiveness. The primary objective of this study was to determine the ef- fect on pain of corticosteroid injections in professional and elite student ballet dancers with PAIS. The secondary ob- jectives were to evaluate the prevalence of PAIS, the duration of the effect of injection, patient satisfaction with the effect of injection, time to return to class and performance, and ability to dance after injection. All members of the Dutch National Ballet and the National Ballet Academy Amsterdam received a self-administered questionnaire focused on the use and effect of corticosteroid injections in the treatment of PAIS. The response rate was 61% (77 of 126). Of the included dancers, 38% (29 of 77) had suffered from PAIS, and 38% (11 of 29) had received at least one injection. The numeric rating scale (NRS) was used to assess the severity of pain before and 2 and 6 weeks after injections. The median NRS pain before injection was 9.0 (IQR 8.0-9.5), 3.0 (IQR 0.5-6.5) 2 weeks after injection, and 3.0 (IQR 0.5-6.0) 6 weeks after injection. Overall median NRS satisfaction with the effect of injection was 7.0 (IQR 0-10), and satisfaction with the duration of the effect was 5.0 (IQR 2.0-10). It is concluded that there is a high prevalence of PAIS in ballet dancers and corticosteroid injections are regularly used for pain reduction with good results.

Due to the drastically rising coronavirus disease (COVID-19) incidence since March 2020, social life was shut down across the globe, and most opera houses were closed. As a result, there are limited data on SARS-CoV-2 infections among artists. The Bavarian State Opera has been reopened in September 2020. This study aimed to identify the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection among employees in the Bavarian State Opera. In addition, the various hygiene strategies for the work groups within the institution are described. During the study period from September 1, 2020 to July 31, 2021, 10,061 nasopharyngeal swabs were obtained from 1,460 artistic staff members in a rolling system. During the entire study period, 61 individuals tested positive for SARS-CoV-2. None of the patients had a severe disease course. Compared to the seven-day-incidence per 100,000 German inhabitants, the estimated corresponding incidence among employees was lower at 37 weeks and higher or equal at 9 weeks. Among the infected individuals, 58.3% were symptomatic, 23.3% were presymptomatic, and 18.3% were asymptomatic. Forty-five percent of employees reported that they had been infected in their private environment, 41.7% suspected that their colleagues were the main contact, and 13.3% were unsure about the origin of their infection. Twenty-four diseased employees were ballet dancers, eight from the orchestra, seven from the administration, seven from the choir singers, six from the costume department, 10 from technical support, and one guest solo singer. In the 2020/2021 theater season, increased SARS-CoV-2 infections and large disease outbreaks were avoided at the Bavarian State Opera. Hygiene strategies, that existed since the beginning, was specifically designed for various work areas in the opera. Regular, mandatory PCR testing and follow-up of positive cases with the issuance of quarantine were performed. Using this disease management approach, artistic work at and reopening of the Bavarian State Opera was feasible with a well-controlled risk.

Ballet is a professional activity that places risky physical and psycho-emotional demands on the human body. The goal of this study was to evaluate health-related problems among ballet dancers. Within the qualitative study, in-depth interviews were conducted with ballet dancers at the State Ballet of Georgia. Participants' mean age was 23.4 ± 3.5 years, the average BMI - 21.2 ± 2.2. Dancers had spent 9.2 ± 7.4 years studying dancing professionally. On average, they spent 8.5 ± 5.8 hours in class and 16.2 ± 11.6 hours in rehearsal. Most injuries were related to ankle/feet (16%), knee (60%), and neck (13%). Common risk factors for incurring pain and injury included overuse (19%), previous injury (11%), and fatigue (11%). Of the injured dancers, 80% chose to seek medical attention. Mostly, they visited traumatologists (40%) and physiotherapists (30%). The biopsychosocial condition of ballet artists is affected by physical workload, high risk of injuries, as well as constant stress. The result suggests high prevalence and recurrence of dance injuries. Ankle/feet, knee and neck are especially risky topological areas for injuries as particularly big pressure is placed on the feet and ankle joints. The majority of respondents sought advice from medical specialists rather than family physicians. It is necessary to prevent injuries and stress through raising awareness. A team of professionals (family physician, orthopedist, psychologist, nutritionist, endocrinologist, physical therapist, nurse) is needed to prevent injuries. Family doctors should pay more attention to the promotion of a healthy lifestyle during the consultation with ballet dancers.

usc Objectives: to compare the deep hip external rotator (DHER) muscle (piriformis, gemelli, quadratus femoris (QF)) cross-sectional area (CSA) in dancers and athletes and evaluate the relationship between DHER size and hip pain. Study design: cross-sectional study. Setting: elite ballet and sport. Participants: 33 professional ballet dancers and 33 age and sex-matched athletes. Main outcome measures: CSAs of piriformis, gemelli and QF on magnetic resonance imaging (MRI). Hip pain scored with the Copenhagen Hip and Groin Outcome Score (HAGOS): Hip pain was categorised as ‘yes’ if HAGOS pain score was 0.05), and CSAs were not associated with hip pain. Male and female dancers had similar sized DHER muscles. In athletes, CSA of piriformis was 55% (p = 0.02, Cohen's d(95%CI) = 0.98 (0.26,1.71)) and the gemelli were 34% (p = 0.03, Cohen's d(95%CI) = 0.98 (0.26,1.70)) larger in men than women; QF was 36% larger (p = 0.08, Cohen's d(95%CI) = 0.77 (0.06,1.48)). Conclusion: although ballet dancers perform in external rotation, their DHER are no larger than athletes and muscle size was not associated with hip pain. Refereed/Peer-reviewed

Background The unique repetitive nature of ballet dancing, which often involves transgressing endurance limits of anatomical structures, makes dancers prone to injury. The following systematic review aims to assess the effectiveness of physiotherapy interventions in the treatment of injuries in ballet dancers. Methods The review was performed in line with the PRISMA statement on preferred reporting items for systematic reviews and meta-analyses. Six electronic databases (PubMed, Ovid Embase, Cochrane, Medline, PEDro, Google Scholar) were queried. The study populations comprised active ballet dancers and/or ballet school attendees with acute and chronic injuries and those with persistent pain. There were no restrictions regarding age, sex, ethnicity or nationality. The Modified McMaster Critical Review Form for quantitative studies was used to assess the methodological quality of the studies reviewed in accordance with the relevant guidelines. Results Out of the total of 687 articles subjected to the review, 10 met the inclusion criteria. Diverse physiotherapeutic interventions were described and effectiveness was assessed using different parameters and measurements. Overall, the results indicate that physiotherapy interventions in ballet dancers exert a positive effect on a number of indices, including pain, ROM and functional status. Conclusions Due to the small amount of evidence confirming the effectiveness of physiotherapeutic interventions in ballet dancers after injuries and methodological uncertainties, it is recommended to improve the quality of prospective studies.

AIMS: Professional ballet dancers are at risk for degenerative knee cartilage changes. In the current study, we evaluated the knee cartilage with T2 mapping methods in professional ballet dancers and healthy controls and investigated possible differences of T2 values between these groups. METHODS: We included healthy dancers with 5−20 years of professional ballet dancing experience and sex-matched healthy controls without knee pathology. T2 values of the knee cartilage were measured from axial, coronal, and sagittal images. The values were measured by free hand region of interest (ROI). RESULTS: The study population consisted of 44 people (22 dancers, 22 controls), with mean age of 25.57 ± 5.53 yrs. We found no significant relationship between sex and T2 values. We detected a significant positive correlation between age and T2 values for patellofemoral joint cartilage. T2 values of patellofemoral and tibiofemoral joints of dancers were significantly higher. Mean T2 values of patellofemoral joint were around 32 in all planes in dancers and around 12 in controls (p

Objectives To compare the cross-sectional area (CSA) of hip external rotators, obturator externus (OE) and obturator internus (OI), in ballet dancers and nondancing athletes, and evaluate the relationship between obturator muscle size and hip pain. Design Case-control study. Setting Elite ballet and sport. Participants 33 male and female professional ballet dancers and 33 age and sex-matched athletes. Main outcome measures CSA's of OE and OI measured on magnetic resonance imaging (MRI) of one hip. Hip pain was scored with the Copenhagen Hip and Groin Outcome Score (HAGOS): HAGOS pain score of 100 was defined as no pain and a score less than 100 was defined as pain. Participants weight and height. Results Estimated marginal mean CSA of OE was 14% larger in dancers than athletes (p = 0.01, ηp2 = 0.1); the size of OI was similar (p > 0.05). Men and women in both groups had similar sized OI and OE. There was no interaction between the estimated marginal mean CSA of either obturator and hip pain. Conclusions It appears that ballet selectively increases muscle size of OE, but not OI. Obturator size was not related to mild hip pain, as OE and OI size was similar in dancers and athletes with and without pain.

Patellar tendon pathology appears to develop in young athletes. It is not known how this tendon develops through adolescence. This longitudinal study investigated proximal patellar tendon development during the adolescent growth spurt in young ballet dancers and identified whether puberty (estimated by maturity offset) had an effect on tendon development. Fifty two dancers (32 female and 20 male dancers, ages 11-18 at baseline) had ultrasound images of their tendons every 6 months for 2 years. Changes in tendon size (anterior-posterior diameter) on grayscale images and echogenicity, as quantified using ultrasound tissue characterization, were recorded each time. Maturity offset was calculated used to estimate peak height velocity (adolescent growth spurt). Maturity offset did not affect effect tendon composition before peak height velocity; however, after participants passed peak height velocity, maturity offset increased the composition of stable echopattern (P < .05): a 4% differential increase in type I echopattern, indicative of normal tendon structure, and a decrease in type III echopattern (more disorganized echopattern) by 0.7% per year. Anterior-posterior thickness increased by 0.2 mm/y (P < .05) measured 2 cm below the patella. Following peak height velocity, the proximal patellar tendon attachment increased in thickness and demonstrated a more stable echopattern representative of aligned fibrillar structure. Future research is required to further understand this normal maturation and the factors that support this process, with the aim of reducing the development of patellar tendon pathology in the adolescent jumping athlete.

Ischiofemoral impingement syndrome (IFIS) is an unusual cause of hip pain. Certain strenuous sports can cause this impingement, such as dancing. We report the case of an 11-year-old ballet dancer with bilateral IFIS secondary to overtraining and hypertrophy of the quadratus femoris. This syndrome is frequently evoked in the field of orthopedics following hip replacement. Bilateral IFIS is rare and should be sought in the context of an intense sport such as dance when any other cause has been eliminated.

To assess the association between clinical features and magnetic resonance imaging (MRI) findings in posterior ankle impingement syndrome (PAIS) and to compare the prevalence of imaging findings between participants with and without a clinical diagnosis of PAIS.Case-control study.Elite ballet and sport.Eighty-two male (54%) and female participants comprising ballet dancers (n = 43), cricket fast bowlers (n = 24), and football (soccer) players (n = 15).Clinical: posterior ankle pain on body chart, passive plantarflexion pain provocation test. Patient-reported outcome measures: Oslo Sports Trauma Research Center Overuse Injury Questionnaire, Foot and Ankle Ability Measure Sports subscale.Imaging findings including posterior ankle bone marrow edema, os trigonum (± bone marrow edema, and increased signal at synchondrosis), Stieda process (± bone marrow edema), talocrural and subtalar joint effusion-synovitis size, flexor hallucis longus tendinopathy, and tenosynovitis identified as present or absent on 3.0-Tesla MRI.Imaging findings were not associated with posterior ankle pain or a positive ankle plantarflexion pain provocation test. Imaging findings were not associated with patient-reported outcome measures. Imaging findings did not differ between PAIS-positive and PAIS-negative groups. Os trigonum and Stieda process were prevalent despite clinical status.The lack of association between imaging findings and clinical features questions the role of imaging in PAIS. Clinicians should rely primarily on clinical assessment in the diagnosis and management of patients with PAIS.

The purpose of the study is to integrate Laban Movement Analysis to coaching approach for Dancer. With LMA/BF, this study is to analyze the dancer’s movement which causes problems, and aim for re-thinking and re-patterning of the movements in accordance with BF to improve upon the problematic movements and prevent further injuries. As a result, through LMA/BF of coaching, some differences were observed in Dancer’s movement. Dancer showed more awareness in his Body and Mind. Also, it helped him think more deeply about every part of his body and try his movements with a whole new perspective. LMA/BF work can then provide the dancers repatterning and reconditioning, and enable them to dance in a more efficient and safer way.

Introdução: O método Pilates é considerado uma atividade física eficaz na promoção de saúde, por ser considerada de baixo impacto e de intensidade leve a vigorosa, sendo buscado por diversos grupos com objetivos e necessidades específicas, que comumente envolvem a manutenção da flexibilidade. Objetivo: Esta revisão tem por objetivo identificar e analisar artigos originais que relacionam o método Pilates e a flexibilidade, publicados entre 2002 e 2012 nas línguas portuguesa e inglesa. Material e Métodos: Realizou-se uma busca eletrônica nas bases Google Acadêmico, LILACS, Portal Periódicos da Capes, PubMED e SciELO, até a data limite de 22 de março de 2012. Utilizou-se os termos “Pilates” e “flexibilidade” na língua portuguesa e “Pilates” e “flexibility” na língua inglesa. Resultados: Foram identificados 136 estudos com resumo disponível, sendo selecionados 23 artigos que atenderam aos critérios de inclusão, dos quais 12 foram publicados em língua portuguesa e 11 em língua inglesa. Foi verificado que 22 estudos foram realizados com pessoas jovens ou adultas, saudáveis e com patologias músculo-articulares. Conclusão: O método Pilates mostrou-se eficaz não somente na melhora da flexibilidade, como também na resistência muscular, equilíbrio e propriocepção, obtendo resultados relevantes como o aumento da qualidade de vida e a redução do risco de lesões. Todos os estudos relacionados nesta revisão demonstraram que o método Pilates contribui positivamente para a manutenção da flexibilidade dos diferentes grupos investigados, com ganhos significativos em bailarinos. DESCRITORES: Técnicas de Exercício e de Movimento. Flexibilidade. Atividade Física.

Flexor hallucis longus (FHL) tendinopathies are typical of ballet dancers and other athletes that repetitively use their ankles and feet in hyperflexion and hyperextension in a forced manner [1–4].

Ballet creates a unique set of nutritional requirements for optimal performance. This chapter presents the nutritional status of ballet dancers including the prevalence of low body weight and low energy intake. The interaction of amenorrhea, low body weight, restricted energy intake and risk for bone injuries is explored. A nutrition prescription to support the physical demands of training and performance while preventing injuries is provided. Finally, a plan is presented for ballet schools and companies to promote balanced diets and normal weight as well as to help dancers avoid eating disorders and delayed puberty caused by extensive dancing and inadequate nutrition.

Excessive forces and/or loading rates during landing may place ballet dancers at risk for overuse injury. The ability to estimate and monitor the landing forces of ballet dancers could help to improve injury prevention and rehabilitation; however, force platforms are not conducive to testing outside of a laboratory. Fortunately, it may be possible to indirectly assess landing forces via a wearable accelerometer. The purposes of this study were to examine the relationship between impact accelerations, recorded via a pelvis-worn accelerometer, and the peak forces and loading rates during performance of a common ballet manoeuvre, and to examine if a wearable accelerometer is sensitive to fatigue-related changes in landing forces. Fifteen ballet dancers continuously performed a ballet manoeuvre until self-determined exhaustion while impact accelerations and landing forces were simultaneously recorded using an accelerometer and force platforms. We observed very strong, positive relationships between the impact accelerations and the peak forces and loading rates during the landings. In addition, the changes in impact accelerations with fatigue paralleled the changes in the peak forces and loading rates. As a result, it appears that a wearable accelerometer could be used to estimate and monitor landing forces in ballet dancers.

OBJECTIVE A causal link between ballet, hip pain, and pathology has not been established. Change in ballet dancers' hip pain and cartilage defect scores were investigated over 5 years. DESIGN Longitudinal. SETTING Professional ballet company. PARTICIPANTS Twenty-one professional ballet dancers (52% men). INDEPENDENT VARIABLES Baseline and follow-up Copenhagen Hip and Groin Outcome Score (HAGOS-pain subscale); incidence of hip-related pain and levels of dance participation collected daily over 5 years; bony morphology measured on baseline 3T magnetic resonance imaging (MRI). MAIN OUTCOME MEASURE Change in cartilage defect score on MRI between baseline and 5-year follow-up. RESULTS Cartilage scores did not increase in 19 (90%) dancers. There was one new cartilage defect and one progressed in severity. At follow-up, all 6 dancers with cartilage defects were men. Group HAGOS pain scores were high 97.5 (7.5) and not related to cartilage defects (P = 0.12). Five (83%) dancers with baseline cartilage defects reported HAGOS pain scores

AIMS: Research demonstrates that dancers benefit from reduced injury risk and improved health by engaging in strength training and conditioning (STC). Historic bias within the discipline of dance, however, establishes a long-standing stigma that gains in muscle mass and strength lessen a dancer's aesthetic appearance, and thus many dancers rebuff STC as a supplement to dance training. However, there is growing evidence that dancers and dance educators are beginning to understand the importance of additional resistance training and cardiovascular conditioning. This study explored dancers' perceptions and utilization of STC using a general qualitative approach. METHODS: Twenty-three female collegiate dancers (13 contemporary dancers, 10 ballet dancers, mean age 19.95 x 0.97 yrs) volunteered to participate in this study. The principal investigator conducted individual, semi-structured interviews. RESULTS: Inductive analysis revealed three major themes: 1) evolving body image, 2) motivation, and 3) education. Trustworthiness was established using member checks, peer debriefing, and journaling. This study concluded collegiate dancers utilized STC as a means to enhance the individual's body image. This was driven by a continuum of motivating factors. Although collegiate dancers are utilizing STC, education on STC techniques and practices was minimal. CONCLUSIONS: While further research is needed, results from this study suggest STC could be initiated and promoted in the discipline of dance to further enhance physical fitness and general well-being. Dancers and dance instructors should receive education about the importance of STC within dance training as well as how to safely implement STC exercise into training regimens.

BACKGROUND: Data documenting BMD in pre-professional adolescent ballet dancers is limited. This cross-sectional study assesses hone mineral density (BMD) in young adolescent elite ballet dancers and compares BMD values between males and females (with and without normal menarche) and body composition between dancers with and without low Z-score. METHODS: Cross-sectional study of third year ballet students (female=23; male=15; mean age 14.7 years; SD: 0.5) of The Royal Ballet School of Antwerp (Belgium) training 22 hours a week. They completed questionnaires and underwent dual energy X-ray absorptiometry (DXA) to measure BMD and body composition. Each female participant completed questionnaires assessing menstrual status. RESULTS: DXA revealed that 12 out of 38 (32%) of the dancers had Z-score

Physical training has frequently been indicated for ballet dancers to strengthen their trunk muscles, improve their performance, and avoid injuries. The current authors hypothesized that these dancers could benefit from Pilates exercises to stabilize their trunk muscles and improve joint stability and neuromuscular efficiency (NME). Our study aimed at evaluating the NME and isometric strength of the internal oblique (IO) and multifidus (MU) muscles in a healthy 24-year-old classical ballerina before and after an 8-week Pilates exercise intervention. The muscles were tested with electromyography (EMG) and a dynamometer, and the resulting torque and EMG values were used to calculate the NME. Based on the results, the Pilates exercises could improve the NME of the muscles tested, since the torque increased and the EMG activity decreased after the intervention.

AIM To investigate hip magnetic resonance imaging (MRI) findings in asymptomatic professional male rugby players and male ballet dancers compared to age-matched controls. MATERIALS AND METHODS After ethics committee approval and consent from participants, 11 professional rugby players, 10 professional ballet dancers, and 10 controls completed activity and symptom questionnaires and underwent 3 T MRI of their self-declared dominant hip. Each scan was independently scored by two musculoskeletal radiologists for multiple features, including: joint morphology, acetabular labrum appearance, cartilage loss, and capsular thickness. Clinical and MRI features were assessed for variance by group using one-way analysis of variance (ANOVA) tests and Tukey post-hoc pairwise comparison of means. RESULTS Labral tear prevalence was 87% with no significant difference between groups (p>0.05). Rates of paralabral cysts were significantly higher in ballet dancers (50%), compared to rugby players (0%) and controls (10%; p=0.01). Acetabular cartilage loss was present in 54% with no significant differences between groups. Superior capsular thickness was significantly greater in ballet dancers (5.3 mm) compared to rugby players (3.8 mm) and controls (3.8 mm; p=0.03). CONCLUSION Despite the difference in type of activity between groups, there were equally high rates of labral tears and acetabular cartilage loss, questioning the role that sport plays in the development of these findings and their relationship to symptoms. The focally increased superior capsular thickness in ballet dancers may be an adaptive response to extreme ranges of movement.

Background: The prevalence of anorexia nervosa among males is increasing but few data are available in the literature. This cross sectional study aims to evaluate resting energy expenditure (REE) and phase angle as a marker of qualitative changes of fat free mass (FFM) in three leanness groups as compared with control subjects. Methods: 17 anorectic (AN) males, 15 constitutionally lean (CL) individuals, 12 ballet dancers (DC), and 18 control (CTR) subjects were evaluated. REE was measured by indirect calorimetry (V max29- Sensormedics), and body composition was evaluated by bioimpedance analysis (BIA) at 50 kHz (DS Medica). Phase angle (a bioimpedance variable related to nutritional status) was used to evaluate differences in FFM characteristics between these three types of leanness. Results: REE, adjusted for FFM and fat mass (FM), were significantly higher in CL and lower in AN individuals (1783 &plusmn, 47 vs. 1291 &plusmn, 58 kcal, p &lt, 0.05) compared to the other groups. Body composition was similar in AN and CL whereas dancers had the highest FFM (58.9 &plusmn, 4.8 kg, p &lt, 0.05), anorectic males showed the lowest phase angle (5.8 &plusmn, 1.2 degrees vs. other groups, p &lt, 0.05) and dancers the highest phase angle (7.9 &plusmn, 0.7 degree vs. other group, p &lt, 0.05). Conclusions: Our findings confirm that phase angle could be a useful marker of qualitative changes, above all in the field of sport activities. On the other hand, there is the need to further evaluate the relationship between resting energy expenditure, body composition and endocrine status in different conditions of physical activity and dietary intake.

The purpose of this study is to compare the effects of stretching methods on flexibility, muscle activation, and pressure pain threshold in ballet dancers, and to suggest an effective stretching method.Thirty-three ballet dancers were randomized to the static stretching group (n = 11), muscle energy technique stretching group (n = 11), and vibration-assisted stretching group (n = 11). The angle of hip joint extension in arabesque, activation of the rectus femoris in devéloppé, and pressure pain threshold on the rectus femoris in the sitting position were measured to compare the effects of the different stretching methods. Paired t-test was used to compare the pre and post-intervention findings within each group and one-way analysis of variance to compare the difference in the amount of changes among the groups.The hip joint extension angles increased in all stretching methods (p 0.05); however, vibration-assisted stretching and muscle energy technique stretching were more effective than static stretching (p 0.05). The activation of the rectus femoris decreased in all groups (p 0.05); however the muscle energy technique stretching group and vibration-assisted stretching group showed a significant decrease in muscle activation compared with the static stretching group (p 0.05). The pressure pain threshold significantly improved only in the static stretching group (p 0.05); and vibration-assisted stretching group (p 0.05).Compared with static stretching and muscle energy technique stretching, vibration-assisted stretching is a beneficial method for improving flexibility, muscle activation, and pressure pain threshold in ballet dancers.

This study describes trends in mean standing functional turnout angles measured on a floor protractor (FP) and the Functional Footprint(®) rotational instrument (RI) during routine clinical screens. Twenty-three professional ballet dancers, 26 collegiate modern students, and 46 ballet academy dancers participated in the study. All dancers demonstrated greater total turnout on the FP compared to the RI (p < 0.001), and the collegiate dancers had significantly smaller total turnout angles compared to both of the other groups (p < 0.001). A significant interaction between measurement method and training group (p = 0.047) on lower extremity asymmetry indicated that only in professionals left turnout angle was greater than right turnout angle on the RI (4.30° ± 6.64°) but not on the FP (0.17° ± 4.57°). It is concluded that turnout can be measured using either the FP or the RI measurement method, with recognition that FP measurements will be an average of 10° greater than those on the RI. Lower extremity asymmetries in turnout angles may be better detected on the RI than the FP.

Fire was one of the most terrifying dangers for women and children in the nineteenth century. Many burned to death in highly inflammable clothing. A new, sylph-like Romantic feminine ideal in dress arose in tandem with the gas lighting that illuminated the light white cottons and almost “immaterial” materials that became fashionable during the Neoclassical period. These textiles included machine-woven gauze, tulle, and tarlatane, and they put working-class ballet dancers pirouetting near gas footlamps at particular risk. French prima ballerina Emma Livry died when her tutu caught on fire, and the charred remains of her costume are still preserved at the Musee-bibliotheque de l’Opera in Paris. In the late 1870s, another popular, mass-produced fabric, flannelette, was sold as a cheap, washable substitute for woolen flannel. Yet the soft, raised, furry “nap” of the fabric that kept children warm set them ablaze because most working-class homes lacked proper fire guards. In response to the dangers ush...

BACKGROUND: Ballet is a high-performance activity that requires an advanced level of technical skills. Ballet places great stress on tendons, muscles, bones, and joints and may act directly as a trigger of injury by overuse. OBJECTIVES: 1) to describe the main types of injuries and affected areas related to classical ballet and 2) to compare the frequency of musculoskeletal injuries among professional and non-professional ballet dancers, considering possible gender differences among the professional dancers. METHOD: A total of 110 questionnaires were answered by professional and non-professional dancers. The questionnaire contained items related to the presence of injury, the regions involved, and the mechanism of the injury. RESULTS: We observed a high frequency of musculoskeletal injuries, with ankle sprains accounting for 69.8% of injuries in professional dancers and 42.1% in non-professional dancers. Pirouettes were the most frequent mechanism of injury in professional dancers, accounting for 67.9% of injuries, whereas in the non-professional dancers, repetitive movement was the most common mechanism (28.1%). Ankle sprains occurred in 90% of the women's injuries, and muscle sprains occurred in 54.5% of the men's injuries. The most frequent injury location was the ankle joint in both sexes among the professional dancers, with 67.6% in women and 40.9% in men. CONCLUSIONS: The identification of the mechanism of injury and time of practice may contribute to better therapeutic action aimed at the proper function of the dancers' bodies and improved performance by these athletes.

Elite ballet dancers are at risk of health issues associated with Relative Energy Deficiency in Sport (RED-S). This study determined the nutritional status, estimated energy status, and assessed factors related to RED-S in vocational female ballet students. Using a cross-sectional study design, we measured dietary intake (food diaries and 24 h dietary-recall) and energy expenditure (accelerometry) in vocational female ballet students (n = 20; age: 18.1 ± 1.1 years; body mass index: 19.0 ± 1.6 kg·m2; body fat: 22.8 ± 3.4%) over 7 days, including 5 weekdays (with dance training) and 2 weekend days (without scheduled dance training). Furthermore, we assessed eating behaviors, menstrual function, risk of RED-S (questionnaires), and body composition (dual x-ray absorptiometry). Energy and macronutrient intakes of vocational ballet students were similar during weekdays and weekend days (P > 0.050), whereas total energy expenditure was greater on weekdays than weekend days (P < 0.010; 95% CI: 212, 379). Energy balance was lower on weekdays (−425 ± 465 kcal·day−1) than weekend days (−6 ± 506 kcal·day−1, P = 0.015; 95% CI: −748, −92). Exercise energy expenditure was greater on weekdays (393 ± 103 kcal·day−1) than weekend days (213 ± 129 kcal·day−1; P < 0.010; 95% CI: 114, 246), but energy availability was similar between time periods (weekdays 38 ± 13 kcal·kg FFM·day−1; weekend days 44 ± 13 kcal·kg FFM·day−1; P = 0.110). Overall, 35% of participants had an energy intake

In the world of dance in general and in classical dance in particular, space determines the borderline reality in which the dancer performs the most exact anthropotechnical practices and where the interpretive forces take place (also known as duende, artistic projection and / or artistry). The human being confronts the space that inhabits. But not only the spaces (as structures), also the things that coexist inside the spaces sustain the reality of human beings, that is why it is important to reflect on them. In the case of classical dance, these things serve as working tools, they are the bar, the mirror, the floor, the work clothes, the shoes and the resin, for pointing out the most important ones. In this work, I make a philosophical reflection on the influence and meaning that these work tools acquire throughout the formative years of ballet dancers.; En la realidad de la danza el espacio determina la realidad limítrofe y el marco de referencia en el que el ser que danza lleva a cabo las prácticas antropotécnicas más exactas y donde tiene lugar las fuerzas interpretativas (también conocidas como duende, proyección artística y/o artistry). De manera que el ser se enfrenta a sí mismo en los lugares que lo albergan. En el caso de la danza es posible distinguir al menos tres realidades espaciales: el espacio de formación (salón de clase), el espacio de escenificación (teatros, lugares de interacción con el público) y el espacio in extenso de la vida del bailarín (la casa, el mundo). En este trabajo sólo nos detenemos en el espacio formativo. Morada en la que el bailarín ha de pasar la mayor parte de su vida.