Journal of dance medicine & science: official publication of the International Association for Dance Medicine & Science (J Dance Med Sci)

Publications in this journal

• Article: Use and effectiveness of orthotics in hyperpronated dancers.

  Rélana M E Nowacki, Mary E Air, A B M Rietveld
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  ABSTRACT: Hyperpronation is a common foot problem in dancers. The aim of this study was to investigate the usage and effectiveness of orthotics in the management of symptomatic hyperpronation among dancers. A prospective cohort study of all dancer-patients in the investigators' practice who were prescribed orthotics for new symptoms related to hyperpronation between July 2008 and January 2009 was conducted. In this group, the longitudinal medial arch angle of the foot was measured by the Foot Build Registration System (FBRS), both barefoot and while wearing the orthotics. In addition, patients filled out questionnaires addressing perceived effectiveness of the orthotics for pain reduction and dance ability, among other items. A second retrospective study was conducted in order to obtain longitudinal data regarding dancers' compliance with, and subjective evaluation of, wearing orthotics over the preceding 6 years. Among participating dancers who met criteria for the prospective (N = 24) or retrospective (N = 81) aspects of the study (total N = 105), 67% wore orthotics at the time of follow-up. The average compliance in usage was 6.0 (± 1.5 ) days per week and 7.5 (± 3) hours per day. The average rate of satisfaction was 67.9 (± 26.5), average degree of relief in symptoms was 58.3 (± 28.3), and self-reported degree of improvement in dance ability was 45.7 (± 27.9) on a 100 mm Visual Analogue Scale (VAS). There was a significant decrease in pain from the day of orthotics prescription to follow-up (25.9%, or 18.9 mm decrease on the VAS, CI 6.6-30.9, p = 0.005) in the prospective group (N = 24). Orthotics were found to decrease the medial longitudinal arch angle significantly during static stance with the orthotic in place (CI 0.08-1.65, p = 0.03). It is concluded that the dancers in this study demonstrated a high rate of compliance in obtaining and wearing their orthotics and experienced a significant decrease in pain.
  Journal of dance medicine & science: official publication of the International Association for Dance Medicine & Science 01/2013; 17(1):3-10.
• Article: The effects of different shoes on plantar forces in irish dance.

  Paul Trégouët, François Merland
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  ABSTRACT: The purpose of this study was to compare the effects of different footwear on plantar loading in Irish dance. Participants were 12 open class dancers (the highest level) who were actively engaged in Irish dance competition. Subjects had a mean of 9.2 ± 2.1 years of experience in Irish dance. All dancers completed one bar of a set phrase in each of three shoes: Irish dance soft shoe, hard shoe, and a dance trainer. The order in which the shoes were tested was counterbalanced with a Latin square design. The variables compared were maximum force, maximum pressure, and impulse. Data were collected at 100 Hz using a Pedar insole pressure sensor system. Values were analyzed for the whole foot, forefoot, and rearfoot. Significant differences between shoe types were observed in impulse (p < 0.01) and maximum pressure (p < 0.01), with the trainer exhibiting lower values than the other shoes. Differences were also found between shoes in loading on regions of the foot (p < 0.01), with forefoot values highest in the soft shoe. The footwear choice had a significant effect on the measured kinetics of the dancers. The trainer displayed significantly lower values for kinetics than did the soft shoe. Thus, it may be a safer (less injurious) choice for daily training.
  Journal of dance medicine & science: official publication of the International Association for Dance Medicine & Science 01/2013; 17(1):41-6.
• Article: Acute Effects of Warm-up Stretch Protocols on Balance, Vertical Jump Height, and Range of Motion in Dancers.

  Niamh Morrin, Emma Redding
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  ABSTRACT: The aim of this study was to examine the acute effects of static stretching (SS), dynamic stretching (DS), and a combined (static and dynamic) stretch protocol on vertical jump (VJ) height, balance, and range of motion (ROM) in dancers. A no-stretch (NS) intervention acted as the control condition. It was hypothesized that the DS and combination stretch protocols would have more positive effects on performance indicators than SS and NS, and SS would have negative effects as compared to the NS condition. Ten trained female dancers (27 ± 5 years of age) were tested on four occasions. Each session began with initial measurements of hamstring ROM on the dominant leg. The participants subsequently carried out a cardiovascular (CV) warm-up, which was followed by one of the four randomly selected stretch conditions. Immediately after the stretch intervention the participants were tested on VJ performance, hamstring ROM, and balance. The data showed that DS (p < 0.05) and the combination stretch (p < .05) produced significantly greater VJ height scores as compared to SS, and the combination stretch demonstrated significantly enhanced balance performance as compared to SS (p < 0.05). With regard to ROM, a one-way ANOVA indicated that SS and the combination stretch displayed significantly greater changes in ROM than DS (p < 0.05). From comparison of the stretch protocols used in the current study, it can be concluded that SS does not appear to be detrimental to a dancer's performance, and DS has some benefits but not in all three key area's tested, namely lower body power (VJ height), balance, and range of motion. However, combination stretching showed significantly enhanced balance and vertical jump height scores and significantly improved pre-stretch and post-stretch ROM values. It is therefore suggested that a combined warm-up protocol consisting of SS and DS should be promoted as an effective warm-up for dancers.
  Journal of dance medicine & science: official publication of the International Association for Dance Medicine & Science 01/2013; 17(1):34-40.
• Article: Effects of instructional focus on learning a classical ballet movement, the pirouette.

  Renata Alvares Denardi, Umberto Cesar Corrêa
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  ABSTRACT: This study investigated how changes in the focus of instruction might affect the learning by individuals who are not trained dancers of a complex classical ballet movement, the pirouette. Seventy-two volunteer college students were divided into six groups according to the focus of instruction: 1. head, 2. arms, 3. trunk, 4. knees, 5. feet, and 6. controls. In the acquisition phase, all groups performed 160 trials, over 2 consecutive days. At the beginning of each day, they received verbal instruction regarding some of the general principles involved in performance of the pirouette and viewed a video that illustrated those principles. Each group (head, arms, etc., exclusive of controls) was then given specific directions for controlling focus on its body part while performing the movement. After a week, all participants were asked to complete a retention test, with no additional instruction. The trials were videotaped with two cameras (frontally and laterally), and the results were analyzed by 10 specially trained examiners, utilizing Movement Pattern and Error of Performance measures. They revealed that all groups improved in the acquisition phase, and the improvement was maintained in the retention test. No differences were revealed between groups. It was concluded that generalized instruction in basic principles of the movement was more effective than focus on specific body parts in the teaching and learning of the pirouette.
  Journal of dance medicine & science: official publication of the International Association for Dance Medicine & Science 01/2013; 17(1):18-23.
• Article: Core Strength Training Using a Combination of Home Exercises and a Dynamic Sling System for the Management of Low Back Pain in Pre-professional Ballet Dancers: A Case Series.

  Jessica Beckmann Kline, John R Krauss, Sara F Maher, Xianggui Qu
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  ABSTRACT: Estimates of low back pain prevalence in USA ballet dancers range from 8% to 23%. Lumbar stabilization and extensor muscle training has been shown to act as a hypoalgesic for low back pain. Timing and coordination of multifidi and transverse abdominis muscles are recognized as important factors for spinal stabilization. The purpose of this study was to explore the effects of training methods using home exercises and a dynamic sling system on core strength, disability, and low back pain in pre-professional ballet dancers. Five participants were randomly assigned to start a traditional unsupervised lumbar stabilization home exercise program (HEP) or supervised dynamic sling training to strengthen the core and lower extremities. Measurements were taken at baseline and at weeks 3 and 6 for disability using the Patient Specific Functional Scale (PSFS), pain using the Numerical Pain Rating System (NPRS), core strength and endurance using timed plank, side-plank, and bridge positions, and sciatic nerve irritability using the straight leg raise (SLR). Data were analyzed using descriptive statistics. From initial to final measurements, all participants demonstrated an improvement in strength and SLR range, and those with initial pain and disability reported relief of symptoms. These results suggest that dynamic sling training and a HEP may help to increase strength, decrease pain, and improve function in dancers without aggravating sciatic nerve irritation.
  Journal of dance medicine & science: official publication of the International Association for Dance Medicine & Science 01/2013; 17(1):24-33.
• Article: Physical therapy rehabilitation strategies for dancers: a qualitative study.

  Megin Sabo
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  ABSTRACT: This was a qualitative study utilizing a phenomenological approach. The purpose was to determine what rehabilitation strategies physical therapists use with dancers and to discuss techniques for implementing these strategies from both the dancer's and the physical therapist's perspectives. Self-administered questionnaires were sent via email to dancers and physical therapists. Purposeful sampling was done through use of a criterion sampling method that required participants to have experienced dancer rehabilitation. Data were correlated to find common strategies and to encourage modification of current approaches. Physical therapists returned 29 surveys, while dancers returned eight. Five themes were identified in the areas of: 1. evaluation, 2. dance modification, 3. interventions, 4. education, and 5. communication. The conclusion of this study was that successful rehabilitative strategies involve ongoing evaluation that incorporates knowledge of dance technique and performance, dance-centered movement modification that is clearly defined, and an understanding of dance lingo.
  Journal of dance medicine & science: official publication of the International Association for Dance Medicine & Science 01/2013; 17(1):11-7.
• Article: Footwear in classical ballet: a study of pressure distribution and related foot injury in the adolescent dancer.

  Stephen J Pearson, Alison F Whitaker
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  ABSTRACT: This study explores the relationship between dance shoe type and foot pressure characteristics. During adolescence, while the foot is still developing, limiting focal pressure on the feet may help reduce the risk of injury. In order to "condition" the feet for advanced dance, where pointe shoes are worn, it may be advisable to first utilize demi-pointe shoes. Eight female dancers were each tested in four footwear conditions (barefoot, soft, demi-pointe, and pointe shoes), and patterns of foot pressure were compared. A questionnaire was also distributed among sixty-five adolescent females currently training at vocational dance schools to examine shoe use and injury rate before and after the onset of pointe work. During ballet-specific dynamic movement, soft shoes and pointe shoes significantly vary in the plantar pressures they impose on the foot. Demi-pointe shoes provide an intermediate pressure condition, which may help the dancer adapt more gradually to the pressure demands of pointe shoes. Dancers who wore demi-pointe shoes prior to starting pointe were found to be less likely to sustain a ballet-related injury or a lower leg, ankle, or foot injury (22% compared to 30% in those who had not worn demi-pointe shoes). The dancers in this group were also older when they first reported an injury.
  Journal of dance medicine & science: official publication of the International Association for Dance Medicine & Science 01/2012; 16(2):51-6.
• Article: Effects of expertise and auditory guidance on traditional dance performance.

  George Sofianidis, Vassilia Hatzitaki, Patricia McKinley
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  ABSTRACT: This study investigated how the dancer's level of expertise and the type of auditory guidance provided influence the kinematic profile of the lower limbs during traditional dance performance. Ten experts in traditional Greek dance (age: 25±3.29 years, five males and five females) and eleven novice participants (age: 26.45±3.88 years, six males and five females), all Greek natives, performed a series of Greek and Irish dance steps with auditory guidance of the metrics (verbal counting) and the music of the respective dances. An electromagnetic tracking system sampled (at 100 Hz) the angular displacement of the two lower legs about the Mediolateral axis during dance performance. Segment rotations were analyzed in the time and frequency domain. Expert dancers displayed significantly lower variability of lower leg rotation and stronger interlimb coupling when compared to novice performers. In novice performers, the power of the lower limb angular displacement extended to higher frequencies when dance performance was guided by music compared to metrical guidance. The addition of music and the origin of the dance interfered with performance for novices but not experienced dancers. Kinematic analysis of the lower limbs may open a new window for the investigation of learning and auditory guidance effects on dance performance.
  Journal of dance medicine & science: official publication of the International Association for Dance Medicine & Science 01/2012; 16(2):57-64.
• Article: Dance and neurocognition.

  Ruth Solomon, John Solomon
  Journal of dance medicine & science: official publication of the International Association for Dance Medicine & Science 01/2012; 16(2):87.
• Article: Musculoskeletal injuries and pain in dancers: a systematic review update.

  Craig L Jacobs, Cesar A Hincapié, J David Cassidy
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  ABSTRACT: The objective of this study was to assemble and synthesize the best available literature from 2004 to 2008 on musculoskeletal injury and pain in dancers. MEDLINE and CINAHL were the primary sources of data. Indexed terms such as dance, dancer, dancing, athletic injuries, occupational injuries, sprains and strains, musculoskeletal diseases, bone density, menstruation disturbances, and eating disorders were used to search the databases. Citations were screened for relevance using a priori criteria, and relevant studies were critically reviewed for scientific merit by the best-evidence synthesis method. After screening, 19 articles were found to be scientifically admissible. Data from accepted studies were abstracted into evidence tables relating to: prevalence and associated factors; incidence and risk factors; intervention; and injury characteristics and prognosis of musculoskeletal injury and pain in dancers. Principal findings included: a high prevalence and incidence of lower extremity, hip and back injuries; preliminary evidence that psychosocial and psychological issues such as stress and coping strategies affect injury frequency and duration; history of a previous lateral ankle sprain is associated with an increased risk of ankle sprain in the contralateral ankle in dance students; fatigue may play a role in ACL injury in dancers; acute hamstring strains in dancers affect tendon more than muscle tissue, often resulting in prolonged absence from dance. It is concluded that, while there are positive developments in the literature on the epidemiology, diagnosis, prognosis, treatment, and prevention of MSK injuries and pain in dancers, much room for improvement remains. Suggestions for future research are offered.
  Journal of dance medicine & science: official publication of the International Association for Dance Medicine & Science 01/2012; 16(2):74-84.
• Article: Differences in segmental coordination and postural control in a multi-joint dance movement: développé arabesque.

  Shaw Bronner
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  ABSTRACT: Analysis of skill at multiple points on the learning continuum provides insight into how complex limb and postural organization is modified with extended practice. Dancers at three skill levels were compared performing a domain-specific movement (développé arabesque) to identify motor control parameters underlying skill acquisition of a sequential multi-joint trunk and extremity movement. It was hypothesized that general organization would be similar between groups, but that segmental coordination and postural control would differ with skill level. Twenty-seven expert, advanced, and intermediate dancers performed six repetitions of an arabesque sequence with the right limb. Data were acquired with a five-camera motion analysis system. Differences between groups in pelvis and gesture limb displacement, joint coordination patterns, and variability were determined using ANOVA with post hoc comparisons where applicable. Subjects displayed similar movement organization and timing. Differences were found in postural pelvic control and intra- and inter-limb coordination. These differences were most apparent during the arabesque phase. Control of the pelvis appears to be a key area that requires prolonged practice to master.
  Journal of dance medicine & science: official publication of the International Association for Dance Medicine & Science 01/2012; 16(1):26-35.
• Article: Effects of kinesthetic versus visual imagery practice on two technical dance movements: a pilot study.

  Elizabeth Coker Girón, Tara McIsaac, Dawn Nilsen
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  ABSTRACT: Motor imagery is a type of mental practice that involves imagining the body performing a movement in the absence of motor output. Dance training traditionally incorporates mental practice techniques, but quantitative effects of motor imagery on the performance of dance movements are largely unknown. This pilot study compared the effects of two different imagery modalities, external visual imagery and kinesthetic imagery, on pelvis and hip kinematics during two technical dance movements, plié and sauté. Each of three female dance students (mean age = 19.7 years, mean years of training = 10.7) was assigned to use a type of imagery practice: visual imagery, kinesthetic imagery, or no imagery. Effects of motor imagery on peak external hip rotation varied by both modality and task. Kinesthetic imagery increased peak external hip rotation for pliés, while visual imagery increased peak external hip rotation for sautés. Findings suggest that the success of motor imagery in improving performance may be task-specific. Dancers may benefit from matching imagery modality to technical tasks in order to improve alignment and thereby avoid chronic injury.
  Journal of dance medicine & science: official publication of the International Association for Dance Medicine & Science 01/2012; 16(1):36-8.
• Article: A mixed methods investigation of dropout among talented young dancers: findings from the UK Centres for Advanced Training.

  Imogen J Walker, Sanna M Nordin-Bates, Emma Redding
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  ABSTRACT: The aim of this study was to understand reasons for dropout from a dance-talent program in the UK, using a mixed methods design. In-depth interviews were conducted with ten dropout students to explore the influencing factors in their decision to leave the program. In order to triangulate these findings, reasons for dropout were then examined from descriptive records of 147 young dancers who had withdrawn from the talent program over a four-year period. Overall, the most frequently cited reasons for dropping out were conflicting demands, change in aspirations, course content, difficulty making friends, and lost passion. Injury, financial factors, low perceived competence, and teacher behavior emerged as minor reasons. Intervention strategies that focus on changes in course content may be the easiest to implement and most effective means to enhance student retention.
  Journal of dance medicine & science: official publication of the International Association for Dance Medicine & Science 01/2012; 16(2):65-73.
• Article: A kinematic approach to calculating ground reaction forces in dance.

  James Shippen, Barbara May
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  ABSTRACT: A technique that can be used with dancers for the calculation of ground reaction forces in the absence of force plates is described. The ground reaction forces are required for analyzing potentially injurious activity within the dancer's body. However, the use of a force plate for this purpose disrupts the performance surface and could, due to its stiffness, in itself lead to injury. This technical report provides an indication that a technique utilizing kinematic calculations of ground reaction forces in dancers offers a viable alternative. The kinematic calculations technique is suitable for use across large performance surfaces, including sprung floors. In this preliminary study, it is validated against force plate output using data from a single dancer and is extended to consider tuning of the generic mass distribution model to improve accuracy in the calculation of ground reaction forces.
  Journal of dance medicine & science: official publication of the International Association for Dance Medicine & Science 01/2012; 16(1):39-43.
• Article: Effects of voice enhancement technology and relaxing music on the frequency of imagery among break dancers.

  Costas I Karageorghis, Danielle L Smith, David-Lee Priest
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  ABSTRACT: A device was developed in 2008 by Hypnoke International Ltd. for use by performance consultants and hypnotherapists. It enhances a practitioner's voice and blocks out auditory distractions while delivering imagery inductions, thereby increasing their effectiveness. This study examined the impact of voice-enhancement technology and relaxing music on the frequency of imagery experienced by a sample of elite British break dancers (N = 20; mean age = 26.5 years, SD = 1.5 years). An imagery script was administered to participants under four conditions: voice enhancement with music, voice enhancement only, a music-only control, and a no-voice-enhancement-and-no-music control. Frequency of imagery was assessed using the Sport Imagery Questionnaire. There was a higher incidence of imagery in the voice enhancement with music, voice enhancement only, and music-only conditions when compared to the no-voice-enhancement-and-no-music control. The key finding was that imagery was most frequent when voice enhancement was combined with music in a complementary manner. Thus, it is concluded that the use of voice enhancement technology can improve the efficacy of relaxation and imagery training for break dancers, and potentially, dancers in general.
  Journal of dance medicine & science: official publication of the International Association for Dance Medicine & Science 01/2012; 16(1):8-16.
• Article: Injuries in professional modern dancers: incidence, risk factors, and management.

  Selina Shah, David S Weiss, Raoul J Burchette
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  ABSTRACT: Modern (or contemporary) dance has become increasingly popular, yet little has been reported with respect to modern dance injuries and their consequences. The purpose of this study is to define the incidence, risk factors, and management of musculoskeletal injuries in professional modern dancers. A total of 184 dancers in the United States completed an anonymous 17-page questionnaire on their injuries, including extensive details regarding the two most severe injuries that had occurred in the prior 12 months. According to their self-reports, a total of 82% of the dancers had suffered between one and seven injuries. The foot and ankle (40%) was the most common site of injury, followed by the lower back (17%) and the knee (16%). The rate of injuries was 0.59 per 1,000 hours of class and rehearsal. Injured male dancers returned to full dancing after a median of 21 days, while females returned after a median of 18 days. Most dancers missed no performances due to injury. Of the medical consultations sought by dancers for their injuries, 47% were made to physicians, 41% to physical therapists, and 34% to chiropractors. The majority of dancers adhered to the advice given them by consultants (87% of males and 78% of females for the most severe injury). While the majority of injuries were considered work-related (61% of the most severe injury and 69% of the second most severe), few were covered by Workers' Compensation insurance (12% and 5% respectively). These professional modern dancers suffer from a rate of injury similar to other groups of professional dancers. Most dancers return to a partial level of dancing several weeks before attempting full-capacity dancing.
  Journal of dance medicine & science: official publication of the International Association for Dance Medicine & Science 01/2012; 16(1):17-25.
• Article: Pelvis and hip three-dimensional kinematics in grand battement movements.

  Shaw Bronner, Sheyi Ojofeitimi
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  ABSTRACT: Dancers frequently sustain hip injuries, including labral tears, coxa saltans, stress fractures, tendinosis, and joint disease. High velocity kicks (grand battement), with extreme abduction and external rotation (ER), may stress the hip, sacroiliac joint, and surrounding soft tissue. However, three-dimensional kinematic dance descriptions are limited. The purpose of this study was to describe the kinematics of the pelvis and hip in grand battement movements in healthy dancers. Seventeen advanced-level college dancers performed three battement conditions: battement devant to the front, à la seconde to the side, and derrière to the back. Data were collected with a 5-camera motion capture system. Repeated measures ANOVA (p < 0.05) compared peak pelvis and hip angular displacement and hip and toe velocity for all conditions and planes. Three-dimensional hip to pelvic ratios were calculated. There were differences in pelvic angular displacement between conditions in all planes (p < 0.00). Battement devant posterior pelvic tilt exceeded that of battement seconde. Both were opposite in direction from the anterior pelvic tilt of battement derrière. All conditions demonstrated pelvic obliquity toward the stance limb, with battement derrière greater than devant and seconde. Battement derrière transverse plane pelvic displacement exceeded that found in devant and seconde. There were also differences in hip angular displacement between conditions in all planes (p < 0.00). Battement derrière hip extension differed from battement devant and seconde flexion. The hip abducted in all conditions, with battement seconde exceeding devant and derrière. In the transverse plane, the hip rotated internally in battement seconde and externally in battement derrière and devant. In battement devant and seconde, peak hip ER decreased relative to baseline, while increasing at the peak of battement derrière. Battement peak velocities were relatively low. The ratio of hip to pelvic angular sagittal plane motion was 4.1, 2.6, and 0.5 in battement devant, seconde, and derrière respectively; 0.9, 2.6, and 1.5 in the frontal plane; and 0.6, 8.5, and 0.2 in the transverse plane. This confirms that pelvic motion provides a large proportion of the battement movement.
  Journal of dance medicine & science: official publication of the International Association for Dance Medicine & Science 01/2011; 15(1):23-30.
• Article: Injury, imagery, and self-esteem in dance healthy minds in injured bodies?

  Sanna M Nordin-Bates, Imogen J Walker, Jo Baker, Jocelyn Garner, Cinzia Hardy, Sarah Irvine, Corinne Jola, Helen Laws, Peta Blevins
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  ABSTRACT: The purpose of this study was to investigate a selection of psychological variables (help-seeking behaviors, mental imagery, self-esteem) in relation to injury among UK dancers. We recruited 216 participants from eight dance styles and six levels of involvement. It was found that 83.5% of the participants had experienced at least one injury in the past year. The most common response to injury was to inform someone, and most continued to dance when injured, albeit carefully. Physical therapy was the most common treatment sought when an injury occurred (38.1%), and dancers seemed to follow recommendations offered. Injured and non-injured dancers did not differ in their imagery frequencies (facilitative, debilitative, or injury-related) and scored similarly (and relatively high) in self-esteem. Neither facilitative nor debilitative imagery was correlated with self-esteem, but dancers who engaged in more facilitative imagery in general also reported doing so when injured. Altogether, it appears that injury is not related to dancers' self-esteem or imagery, at least not when injuries are mild or moderate. Even so, such conclusions should be made with caution, given that most dancers do sustain at least one injury each year.
  Journal of dance medicine & science: official publication of the International Association for Dance Medicine & Science 01/2011; 15(2):76-85.
• Article: Effect of footwear on dancers: a systematic review.

  Alycia Fong Yan, Claire Hiller, Richard Smith, Benedicte Vanwanseele
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  ABSTRACT: Dancers need their feet to be healthy and pain-free; therefore, the footwear they use is of great importance. Footwear has the potential to enhance or restrict movement and impact the dancer's body in various ways. To evaluate the effects of footwear on dancers, in particular the effects on foot motion and injury during dance movements, we undertook a systematic review of the literature. The major databases were searched for articles on theatrical dance styles and dance footwear. Sixteen articles were selected for inclusion in this study, ten on ballet and the remainder covering a variety of other genres. The contribution of dance shoes to the quality of dance movement is a relatively unexplored subject; little experimental research has been done. Prospective scientific evidence is needed to support or disprove traditional beliefs regarding the effects of footwear on dance performance and dancers' health.
  Journal of dance medicine & science: official publication of the International Association for Dance Medicine & Science 01/2011; 15(2):86-92.