INJURIES IN PROFESSIONAL DANCERS: A SYSTEMATIC REVIEW

Cardoso, Allana Alexandre; Reis, Nycolle Martins; Marinho, Ana Paula Ramos; Vieira, Melissa de Carvalho Souza; Boing, Leonessa; Guimarães, Adriana Coutinho de Azevedo

doi:10.1590/1517-869220172306170788

ABSTRACT

Movement is a fundamental element of dance, and the dancer’s body is the raw material through which the art of dance is expressed; for this, it demands the utmost discipline in the pursuit of technical and artistic excellence. To meet the professional demands, dancers are subjected to strenuous training routines, which can lead to the development of injuries in this environment. The objective was to examine the etiology, main affected segments, prevalence, and instruments used to evaluate the lesions in studies with professional dancers and/or in comparison with similar populations. We selected articles published in the last decade in the databases BIREME, LILACS, MEDLINE EBSCO, WEB OF SCIENCE, SCOPUS (Elsevier), and PubMed, with cross-sectional, observational cohort and case control design published in Portuguese, English, or Spanish. Systematic reviews, case studies, dissertations, theses, book chapters, cross-referenced articles, and studies published outside of the last decade were not included. The search used combinations of the terms “dancing* and athletic injuries* and musculoskeletal* and pain*”. A principal investigator and two reviewers conducted the survey and analyzed all the potentially relevant articles, initially by the abstract and title. Twelve articles were included, with 1,149 participants (965 professional dancers of classical ballet, modern dance, contemporary dance, and breakdance, 104 amateur dancers, and 80 elite athletes). Nine studies found simultaneous lesions with emphasis on the foot and ankle (n=4), upper and lower limbs lesions (n=4) and lower and upper limb joints (n=1). Other studies have found lesions in the anterior cruciate ligament (n=3). There was no agreement regarding the instruments for detecting lesions in professional, pre-professional, and amateur dancers. There was a prevalence of studies aimed at classical ballet modality, evidencing a higher frequency of lower limb involvement in professional dancers.

Keywords:
dancing; athletes/injuries; movement

[1] Correspondence: Rua Luís Fagundes, 120, bloco 07, apto 721, Praia Comprida, São José, SC, Brazil. 88103-500. allana.alexandre@gmail.com

N	Reference	Study location	Population	Gender (M/F)	Modality	Lesion etiology
1	Hopper LS, et al.¹⁹	United Kingdom	52-58*	25-29/ 27-29	Classical ballet	Floor surface
2	Orishimo KF, et al.¹⁶	United States	80 (40 PD; 40 athletes)	40/40	Classical ballet and modern dance	Inappropriate jump landing technic
3	Liederbach M, et al.²⁵	United States	80 (40 PD; 40 athletes)	40/40	Classical ballet and modern dance	Muscular Fatigue
4	Allen N, et al.³	United Kingdom	52	25/27	Classical ballet	Excessive movement repetition and activities overload
5	Rein S, et al.²²	Germany	30	10/20	**	Lack of stability
6	Kauther MD, et al.¹⁷	Germany	144 (40 PD; 104 amateurs)	NI	Breakdance;	Excessive movement repetition and lack of safety gear
7	Bronner S, et al.⁴	United States	1	0/1	Modern dance	Non-retreat of activities after a home accident
8	Elias I, et al.²⁰	United States	11	5/6	Classical ballet	Biomechanical stress and excessive repetition
9	Liederbach M, et al.¹⁸	United States	298	115/183	Classical ballet and modern dance	Overload and Fatigue
10	Meuffels DE, et al.²³	Holland	253	NI	Classical ballet e contemporary	Biomechanical stress
11	Dore BF, et al.²⁴	Brazil	141	61/80	**	Excessive strain
12	Lo S, et al.²¹	United States	1	0/1	Classical ballet	Activities overload

	OBJECTIVE		MAIN RESULTS	D&B
1	Hopper LS, et al.¹⁹	Investigate possible lesions risk factors related with the mechanical proprieties of the regular used pavements by professional ballet companies.	96 lesions were register in 18 weeks and after the definition of the right floor, 69 lesions were included in the analysis; the occurrence of the MMII and lumbar were responsible for 72% of the total of lesions, where 38 in males and 31 in females; PD can execute classes, rehearsals and shows in inappropriate floor to a safe dance practice.	11
2	Orishimo KF, et al.¹⁶	Compare the biomechanical landing task of PD and team sports athletes related to typical neuromuscular deficit related to anterior cruciate ligament lesions (ACL) and difference between genders.	PD of both genders shown a better landing mechanic, obtaining lower levels of ACL lesions when compared to female athletes; PD shown better core stability then athletes; Female dancers landed with a inferior lateral body flexion comparing with athletes of both genders, however, male PD land with a straighter posture, because in their technic, they are not always allowed to use swing of their arms to produce a jumping dynamic; the intensive technical training of PD can be partially responsible to the protections biomechanical shown during the jumping lands, favoring the lower rate of ACL lesions.	14
3	Liederbach M, et al.²⁵	Compare PD and athletes based in their resistance and fatigue in the biomechanical factors of a jump-landing task, before and after reach the fatigue related to the associated risk variable.	PD take more time to reach the fatigue level when compared to athletes; Even to PD or athletes the landing parameters are changed by the fatigue, helping the knee flexion movements decrease during the jump landing, favoring the ACL lesions.	14
4	Allen N, et al.³	Report the incidence, severity and etiology of injuries suffered by a group of PD and analyses the impact of the dance activity and PD classification about the lesions and the differences between genders.	During a year, an average of 6,8 lesions per PD (women 6,3; men 7,3; p>0,05) were register. The average severity of the lesion was significantly higher (p<0,05) in men (9 days) then in women (4 days). The majority of the occurring lesions in women was classified as transitory (94%) followed by light (5%) and moderate (1%). The majority of lesions in male PD was classified as transitory (87%), followed by light (9%) moderate (2%) and severe (2%). Between both genders the number of lesions classified as transitory were significantly higher than (p<0,05) when compared to the light intensity, moderate or severe.	13
5	Rein S, et al.²²	Compare the postural control and ankle stability among PD, amateurs and a control group.	PD present a better ankle movement amplitude as a better postural control, followed by a specific weight distribution, being significant in the anterolateral region of the foot; however, the articular position sense and the electromyography answer do not present differences between professional and non-professionals.	13
6	Kauther MD, et al.¹⁷	Investigate the rate of lesions in PD and breakdancing amateurs, excessive use and other medical problems related to this modality.	On the whole 1665 acute lesions were related during the trainings; six of the amateurs breakdancers (4,2%) never had suffer a lesion; Was verified an average of 11,6 (variation, 0-42) lesions per individual; When compared, PD suffered significantly more lesions than amateurs.	14
7	Bronner S, et al.⁴	Report about the repair and rehabilitation of long hallux extensor and tendon lacerations of a PD.	First case of repair and rehabilitation of the short muscular extensor of hallux tendon laceration, long hallux extensor tendon and of the metatarsophalangeal joint; the PD back to normal activities in 17 weeks, after 32 physical therapy sessions	11
8	Elias I, et al.²⁰	Examine the pattern of images by magnetic resonance of bone marrow edema (BMO) in ankles of PD to evaluate the clinical relevance of the lesions.	Bone marrow edema in talus was observed in 9 of 12 evaluated ankles, reporting a moderate co-relation between pain and edema in PD, probably related with biomechanical stress reactions, due the unique maneuvers frequently realized; clinically, this condition can indicate a lesion sign by strain on the ankle bone.	11
9	Liederbach M, et al.¹⁸	Measure the ACL lesion incidence between classical ballet and modern dance PD, and compare the rate among genders and dance groups.	From 298 dancers, 12 had an ACL lesion in a period of 5 years, where the incidence was 0,009 per 1000 exposures. The jump landing in one leg was the mechanism in 92% of the cases. The incidence was not statistically different between gender and dance modality. However, female PD of modern dance obtained from 3 to 5 times more lesion risk when compared to both genders PD of classical ballet.	14
10	Meuffels DE and Verhaar JA²³	Report the ACL lesion incidence and the clinical care designated to this lesion in PD of classic and contemporary of 3 professional companies.	The classical ballet company shows a grater ACL lesions risk probability when compared to the two investigated contemporary companies; all lesions occur in the jump landing, with prevalence of the left side with hips extroversion, more precisely on “grandjeté” to the dancers; 6 of the PD had some lesion historic with surgical procedure and were followed up by a medical team; after the lesion, all the 6 PD reported unreliability feelings to execute jumps; after return to dance; 3 of the 6 quit dance in order of the lesions.	13
11	Dore BF and Guerra RO²⁴	Investigate the prevalence of associate factors to the pain symptomatology in PD.	High levels of tolerance to pain were observed in 70,2% of PD; the lumbar region pain was present in 85,8% of subjects; were verified positive co-relations between the intensity pain level with daily life activities, sleep, humor and personal relationship; Was determine high pain prevalence in PD observing great interference in the pain symptomatology in many personal life activities and professional of this group.	12
12	Lo SL, et al.²¹	Report a strain fracture in the distal phalanx of the first metatarsus with strain lesion in a PD.	Strain fracture of the first metatarsus of the PD’s right foot, defined as activities overload lesion.	11

Brasil

Brasil

INJURIES IN PROFESSIONAL DANCERS: A SYSTEMATIC REVIEW

LESÕES EM BAILARINOS PROFISSIONAIS: UMA REVISÃO SISTEMÁTICA

LESIONES EN LOS BAILARINES PROFESIONALES: UNA REVISIÓN SISTEMÁTICA

ABSTRACT