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347
Injury incidence in hip hop dance
S. Ojofeitimi
1
, S. Bronner
2
, H. Woo
3
1
Analysis of Dance and Movement (ADAM) Center, Long Island University, Brooklyn, New York, USA,
2
ADAM Center, Long
Island University, Brooklyn, New York, USA,
3
Nike Sport Research Laboratory, Nike Inc., Beaverton, Oregon, USA
Corresponding author: Sheyi Ojofeitimi, DPT, ADAM Center, Long Island University, One University Plaza, LLC 6th Fl,
Brooklyn, NY 11201, USA. Tel: 718 246 6379, Fax: 718 246 6383, E-mail: sojofeit@gmail.com
Accepted for publication 10 June 2010
Hip hop dance has rapidly become a popular international
art form. There is limited information on injury patterns in
this population. The purpose of this study was to determine
injury incidence and patterns among three groups of hip hop
dancers. Three hundred and twelve intermediate, advanced,
and expert hip hop dancers were recruited at battles, dance
conferences, clubs, and on dance related web sites within the
United States and internationally. A Web-based survey was
conducted over a 6-month period. Inclusion criteria included
intermediate and advanced level dancers over the age of 13.
Dancers were divided into three main categories: Breakers,
Popper/Lockers, and New Schoolers. Separate analysis of
variances were used to compare injury pattern differences
between groups. Two hundred and thirty-two dancers re-
ported a total of 738 injuries. Five hundred and six of these
(sustained by 205 dancers) were time-loss (TL) injuries.
Annual injury incidence was 237% (162% involving TL).
Lower extremity injuries were 52% and upper extremity
injuries 32% of total injuries. Breakers had a higher injury
incidence compared with Popper/Lockers, and New School-
ers. Hip hop dancers report injury rates that are higher than
other dance forms but similar to gymnastics. These dancers
should be educated concerning injury prevention, biomecha-
nics, and use of protective equipment.
Originated in Bronx, New York by African Amer-
ican and Latino youth, (Pabon, 1999; Wiggles, 2009)
hip hop dance has become an international art form.
Hip hop dance has several styles that comprise
two main categories: Old School and New School
(Fig. 1). Old School dance styles emerged in the
1970s and 1980s (e.g. breaking,popping, and locking)
(Appendix). New School styles (e.g. house,krumping,
street jazz) developed in the mid-1980s to 1990s as hip
hop evolved (Okumura, 1992). Breaking, erroneously
referred to as break dancing, is an unstructured and
highly improvisational style that incorporates gym-
nastic and acrobatic movements. Popping involves
quick contraction and relaxation of muscles to
produce jerking of various joints. Locking relies
on fast, distinct arm and hand movements com-
bined with relaxed hips and legs (Pabon, 1999;
Wiggles, 2009). The movements are generally large
and exaggerated, and rhythmic and tightly syn-
chronized with the music. House dance emphasizes
fast, complex footsteps with fluid movements of the
torso (Cox, 2004). Krumping is characterized by
unrestrained, rapid-fire, and highly energetic moves of
the limbs and torso (Paggett, 2004).
With increasing rates of participation in hip hop
dance it is important for medical practitioners to
understand the injury rates and patterns in this
population. While case reports about breaking in-
juries exist, (Winkler et al., 1987; Lee & Clough,
1990; Jacobsen, 1993; Balfour-Lynn, 2002; Schneider
et al., 2002) information is limited concerning the
prevalence of musculo-skeletal injury in these dan-
cers. One report found 193 injuries occurred among
42 Breakers (Cho et al., 2009). Another study re-
ported 1665 injuries in 144 Breakers (Kauther et al.,
2009). Both studies focused only on Breakers and did
not report annual injury incidence.
We determined injury incidence and patterns in a
subset of hip hop dancers (Breakers,Popper/Lockers,
and New Schoolers), using standardized injury re-
porting guidelines (ICD-9, 2005; Bronner & Ojofei-
timi, 2006; Fuller et al., 2006). Because of their
acrobatic sequences, we hypothesized that Breakers
would have a higher incidence of injury compared
with Popper/Lockers and New Schoolers.
Materials and methods
Data were collected for 5 months using a secure web-based
survey (Survey Monkey, Portland, Oregon, USA) with 45
multiple choice and open-ended questions. Subjects provided
informed consent with study approval by the University
Internal Review Board. The survey was piloted and modified
according to recommendations by hip hop dance experts.
Scand J Med Sci Sports 2010 &2010 John Wiley & Sons A/S
doi: 10.1111/j.1600-0838.2010.01173.x
2012: 22: 347–355
348
The Breakers,Popper/Lockers, and New Schoolers in this
study are a unique subset of hip hop dancers. Unlike main-
stream/commercial hip hop dancers seen in music videos, these
dancers train and display their dance skills at battles (competi-
tions where dancers participate in dance-offs comprised of
quick-paced, turn-based routines, whether improvised or
planned) and on the streets to gain notoriety or win a cash
award. Survey participants were recruited at battles, dance
conferences, clubs, and on dance related web sites within the
United States and internationally. Inclusion criteria included
intermediate and advanced dancers over the age of 13. When
possible, computer stations were set up at dance events to
allow dancers to fill out surveys on site. Survey data was
exported into Microsoft Excel 2007 (Microsoft Corp., Red-
mond, Washington, USA). Duplicate or incomplete responses
were eliminated.
The survey was divided into two sections: Demographics
(dancer’s age, gender, ethnicity, country of residence, experi-
ence level [intermediate 5, advanced 6–9, expert 10
years], status [student, professional, teacher], primary dance
style and health insurance); and Injuries (musculo-skeletal
injuries sustained while dancing during the previous 5 years).
All of the injury-related questions were mandatory. The
survey did not progress until each had been answered. Dancers
selected from a mutually exclusive list of diagnoses (i.e. ankle
sprain, ankle/foot fracture, calf muscle pull or strain) for each
injury. Free text boxes allowed the subjects to include diag-
noses not listed. A ‘‘don’t know/don’t remember’’ option was
also available.
Dancers commonly rehearse or perform despite injuries
(Bowling, 1989; Caine et al., 1989; Public Health Agency of
Canada, 2001). To avoid underestimation, we defined injury as
a physical complaint (PC) sustained as a direct result of
dancing. A time-loss (TL) injury prevented one or more days
of performance or rehearsal in accordance with consensus
statements by sport and dance scientists (Bronner & Ojofeitimi,
2006; Fuller et al., 2006). To reduce recall bias, only injuries
occurring within the previous 12 months were included in this
analysis. Recurrent injuries (same type and site as previous
injury occurring within 3 months of recovery) were not in-
cluded. Injuries were coded into 12 anatomical locations under
four main body regions (head/neck, upper extremity, trunk,
lower extremity) (Bronner & Ojofeitimi, 2006) (ICD-9, 2005;
Bronner & Ojofeitimi, 2006; Fuller et al., 2006). Injury diag-
noses were divided into seven categories (fracture/bone stress,
joint/ligament, muscle/tendon, contusion, laceration or skin
lesion, central nervous system/peripheral nervous system
[CNS/PNS], and other). Injury severity was time based, with
minor,moderate,and severe injuries resulting in 1–7, 8–28 days,
and 428 days, respectively. Injury incidence was calculated by
dividing the number of injuries by the total number of subjects.
Separate analysis of variances were used to compare injuries by
gender, age category (Teeno18, Adult 18 years), experience
level (intermediate, advanced, expert), and dance style (Break-
ers,Popper/Lockers,New Schoolers) in SPSS (Version 15.0,
Chicago, Illinois, USA). Bonferroni’s post hoc analyses were
conducted where appropriate. Relative risk (RR) among Break-
ers was calculated using New Schoolers and Popper/Lockers
(non-Breakers) as the control group. Chi-square was used to
test for significance of RR values (Po0.05 level for all tests).
Results
Five hundred dancers attempted the survey. One
hundred and eighty-eight (38%) of these were partial
respondents (individuals who provide answers to
questions displayed, but quit before completing the
survey). These surveys were excluded from the study.
Demographics
Age of subjects ranged from 13 to 44 years. Mean age
for males and females was 23.4 5.4 years and
24.7 5.5 years, respectively (Table 1). The average
number of years dancing was 11.6 7.6 years (range
1–35), with differences (Po0.01) between males
(8.8 6.5 years) and females (14.4 7.7 years).
Sixty eight percent of the dancers were Breakers,
21% Popper/Lockers, and 11% New Schoolers.Break-
ers mean age and years of training were 23.7 5.4
years and 10.6 7.8 years, respectively. Popper/Lock-
ers mean age and years of training were 24.5 5.5
years and 14.0 7.8 years, respectively. New School-
ers mean age and years of training were 25.8 5.7
years and 15.1 8.7 years, respectively. Additional
demographic results are summarized in Table 1.
Injury patterns
Two hundred and thirty-two dancers reported 738
injuries. Of these, 506 (sustained by 205 dancers)
were TL injuries (Table 2). Annual injury incidence
was 237% (162% TL injury incidence) with no
differences due to gender, age category, or experience
level. However, there were differences between dance
styles. Breakers had higher rates of injury (Po0.01)
compared with Popper/Lockers and New Schoolers
whether or not injury involved TL.
Breakers injury incidence was 278% (194% TL
injury), with an average of 3.5 (2.8 TL) injuries
per injured dancer. Lower extremity injuries were
49% (46% TL) of total injuries in Breakers. Upper
extremity injuries were 34% (37% TL). Injury
Fig. 1. Subsets of hip hop dance.
Ojofeitimi et al.
349
incidence in Popper/Lockers was 152% (95% TL)
with 2.3 (1.7 TL) injuries per injured dancer. Lower
extremity injuries comprised 62% (69% TL), while
upper extremity were 25% (15% TL) of total injuries.
Injury incidence in New Schoolers was 144% (92%
TL), with an average of 2.3 (1.6 TL) injuries per
injured dancer. Lower extremity injuries were 69%
(67% TL) and upper extremity injuries accounted for
12% (9% TL) of the total injuries reported by this
group. Percentages of muscle/tendon, joint/ligament,
and fractures/bone stress, are reported in Table 3.
Injury comparisons
Breakers had higher rates of upper extremity injuries
compared with Popper/Lockers and New Schoolers
(Po0.01) regardless of the injury definition used.
Post hoc analysis revealed these differences were a
result of higher hand (Po0.01) and forearm/wrist
(Po0.05) injuries in Breakers.Breakers had a lower
percentage, but higher incidence of lower extremity
injuries (Breakers 135% vs Popper/Lockers 100%
vs New Schoolers 94%). Differences were only
significant for shin injuries (Po0.05) in comparison
to Popper/Lockers. Thoracic spine PCs (Po0.01),
TL neck (Po0.01), and shoulder (Po0.01) injuries
were also higher in Breakers compared with Popper/
Lockers.
Breakers had a higher RR of head/neck, shoulder,
wrist/forearm, and hand PC and TL injuries com-
pared with non-Breakers (Po0.01) (Table 4). Break-
ers also had higher RR ankle/foot, shin, arm/elbow
PC injuries (Po0.05). RR of arm/elbow TL injuries
could not be calculated due to zero occurrences
among Popper/Lockers and New Schoolers.
Mechanisms and severity of injury
Fifty percent of dancers indicated overuse as their
most common mechanism of injury, followed by
landing (42%), twisting (36%), and slipping (31%).
Primary causes of injuries were attributed to lack of
warm up (62%) and fatigue (57%). Secondary causes
were issues with the floor (Fig. 2). Most TL injuries
(55%) were minor, involving o1 week of lost time.
Moderate (8–28 days) and severe (428 days) injuries
were 26% and 19% of total injuries, respectively.
Discussion
To our knowledge, this is the largest study of hip hop
injuries to date and the only one that reports injury
incidence in Popper/Lockers and New Schoolers (Cho
et al., 2009; Kauther et al., 2009). Among hip hop
dancers, Breakers are noted to practice the most
extreme movements. It was therefore not surprising
that total injury and upper extremity injury incidence
in this subgroup was higher than that found in
Popper/Lockers, and New Schoolers.
Demographics
Our subjects age and varying ethnicities demonstrate
that hip hop dancers are not primarily African
American and Hispanic teenagers. In this survey,
more than half of the dancers were over 21 years old
and Caucasians and Asians made up the majority of
the population (Table 1). More than a half of the
subjects in this study were female. Hip hop dance
(especially Breaking) was traditionally male domi-
nated (Kramer & Cooper, 2009). During our data
collection period, we observed a noticeable number
of females competing in mixed groups (called crews)
Table 1. Demographics
Variable
N
(SD) Percent of subjects
Subjects 312 100
Male 143 46
Female 169 54
Mean Age (years) 24.1 (5.4)
*
Years dancing 11.8 (7.8)
N
%
Hip-hop dance style
Breaker
212 68
Popper
/
Locker
64 21
New Schooler
36 11
Ethnicity
African American 38 12
Asian 78 25
Caucasian 87 28
Hispanic 48 15
Other 61 20
Area of origin
United States 211 68
Canada 36 12
United Kingdom 26 8
Other Europe 26 8
Asia 12 4
Mexico 1 0
Status
Student 186 60
Teacher 135 43
Professional 136 44
Dance training
African 83 27
Ballet 110 35
Hip Hop 312 100
Jazz 123 39
Modern 112 36
Tap 72 23
Other 72 54
Health insurance coverage
Family 89 29
Employer 64 21
Self 38 12
Workers compensation 2 1
None 89 29
Other 30 10
*
Includes all forms of dance.
Injury incidence in hip hop dance
350
or against males at battles. The skill necessary to
compete at this level requires years of dedication and
practice. This may explain the 6 years difference in
years of training between males and females
Although 60% of the dancers categorized them-
selves as students, only 33% were solely students
(amateurs). Of the remaining 27%, 15% categorized
themselves as both teachers and professionals. This is
not surprising. Despite being professionals, dancers
are lifelong students. They must continue to train to
hone and garner new skills in order to stay compe-
titive. Due to the inconsistent nature of the perfor-
mance work, many professional dancers (dancers
who are contracted and paid to perform) teach at
dance studios and local community centers to sup-
plement their income.
The U.S. Census Bureau reports that 16% of the
population were uninsured in 2006 (DeNavas-Walt
et al., 2007). US citizens represented 20% of the
uninsured among our study subjects. Although
higher than seen in the general population, it is less
than the authors expected, given the street nature of
hip hop dance (Weiss et al., 2008). While all hip hop
dancers sustained injuries at high rates, Breakers
experienced injuries at almost twice the rate of
Popper/Lockers and New Schoolers. Recent studies
on Breakers also reported high incidences of injury.
Cho et al. (2009) reported 193 injuries in 42 Breakers
Table 3. Injury by group and diagnostic category (% incidence)
Injury definition
Breaker Popper
/
Locker
New schooler
Joint (non-bone)/Ligament PC 143 (24%) 22 (23%) 13 (25%)
TL 107 (26%) 14 (23%) 8 (24%)
Muscle/Tendon PC 163 (28%) 31 (32%) 7 (13%)
TL 120 (29%) 20 (33%) 4 (12%)
Bone stress/Fx PC 71 (12%) 5 (5%) 5 (10%)
TL 56 (14%) 3 (2%) 4 (12%)
Contusion PC 1 (0%) 2 (2%) 0 (0%)
TL 0 (0%) 1 (2%) 0 (0%)
Laceration/Skin lesions PC 2 (0%) 0 (0%) 1 (2%)
TL 0 (0%) 0 (0%) 1 (3%)
CNS/PNS PC 20 (3%) 4 (4%) 3 (6%)
TL 15 (4%) 3 (5%) 3 (9%)
Other PC 189 (32%) 33 (34%) 23 (44%)
TL 114 (28%) 20 (33%) 13 (39%)
PC, physical complaint; TL, time loss; CNS/PNS, central/peripheral nervous system.
Table 2. Injuries by group and anatomic region (% of total injury)
Area Injury definition
Breakers Poppers
/
Lockers
New schoolers Total (%)
Lower extremity Foot/Ankle PC 112 (19%) 26 (27%) 14 (27%) 152 (21%)
TL 70 (17%) 19 (31%) 9 (27%) 98 (19%)
Shin/Leg PC 48 (8%) 4 (4%) 7 (13%) 59 (8%)
TL 32 (8%) 3 (5%) 6 (18%) 41 (8%)
Knee PC 65 (11%) 13 (13%) 9 (17%) 87 (12%)
TL 43 (10%) 10 (16%) 3 (9%) 56 (11%)
Hip PC 62 (11%) 17 (18%) 6 (12%) 85 (12%)
TL 44 (11%) 10 (16%) 4 (12%) 58 (11%)
Trunk Lumbar/Pelvis PC 37 (6%) 6 (6%) 7 (13%) 50 (7%)
TL 26 (6%) 6 (10%) 6 (18%) 38 (8%)
Thorax PC 13 (2%) 2 (2%) 0 (0%) 15 (2%)
TL 9 (2%) 2 (3%) 0 (0%) 11 (2%)
Head Head/Neck PC 49 (8%) 5 (5%) 3 (6%) 57 (8%)
TL 37 (9%) 2 (3%) 2 (6%) 41 (8%)
Upper extremity Shoulder PC 53 (9%) 8 (8%) 3 (6%) 64 (9%)
TL 43 (10%) 3 (5%) 2 (6%) 48 (9%)
Arm/Elbow PC 23 (4%) 3 (3%) 0 (0%) 26 (4%)
TL 13 (3%) 0 (0%) 0 (0%) 13 (3%)
Forearm/Wrist PC 62 (11%) 9 (9%) 0 (0%) 71 (10%)
TL 48 (12%) 5 (8%) 0 (0%) 53 (10%)
Hand PC 65 (11%) 4 (4%) 3 (6%) 72 (10%)
TL 47 (11%) 1 (2%) 1 (3%) 49 (10%)
Total PC 589 (80%) 97 (13%) 52 (7%) 738 (100%)
TL 412 (81%) 61 (12%) 33 (7%) 506 (100%)
PC, physical complaint; TL, time loss.
Ojofeitimi et al.
351
(Cho et al., 2009). Kauther et al. (2009) reported
1665 injuries in 144 Breakers. Unfortunately, both
studies reported cumulative injury incidence over
the dancer’s career (1–22 years) making compar-
isons impossible. We report injury incidence rates
over 12 months. Had we included all Breaker
injuries sustained during the previous 5 years,
injury incidence would have increased to 349%
with 4.5 injuries per injured dancer. We chose to
limit our survey to a 12 month period because
studies show that recall accuracy declines with time
(Twellaar et al., 1996; Jenkins et al., 2002; Gabbe
et al., 2003).
Compared with other dancers (modern, ballet, tap,
aerobic) and gymnasts (Table 5), hip hop performers
experience a high injury incidence. Although within
the range reported for gymnasts, annual injury
incidence for hip hop dancers was 3.4 times the rate
for modern dancers, twice the rate for tappers, and 8
times the rate of TL injuries among ballet dancers.
Classical (ballet and modern) and tap dance training
are codified with systematic progression. Hip hop is
not. Poppers spend hours performing repeated iso-
metric muscle contractions and applying hyperexten-
sion thrusts to their joints. Lockers perform frequent
deep squats, ballistic splits, and valgus movements
(e.g. inverted knees, James Brown split). New School
styles, such as Krumping, involve intense frenetic
movements of the whole body at extremes of joint
motion. Breakers repeatedly practice acrobatic
movements to master specific Power Moves (Appen-
dix). Many of these movements are performed on
hard surfaces, wearing little or no protective gear,
and without supervision. Cho et al. (2009) reported
81% of their subjects trained without supervision
and 60% wore no protective devices. According to
Sharma et al. (1986), every injury reported was
potentially preventable with supervision, coaching,
and appropriate surfaces. Kauther et al. (2009) stated
that Breakers wear protective equipment after an
injury has occurred, rarely before.
The minimal amount of warm-up, cool-down, and
stretching we observed at battles provides another
plausible explanation for the higher rate of injuries in
hip hop dancers. Cho et al. (2009) found 33% of their
dancers did not warm up before dancing. Sixty two
percent of the dancers in this study indicated lack of
warm up as a contributor to injury (Fig. 2). Addi-
tionally, the sequence of a battle is not conducive to
staying warm. Competitors sit in a circle observing
their opponents and then dance again when it is their
turn.
Anatomical distribution of injury
Upper extremity injuries represented 32% of both
PC and TL injuries, with Breakers exceeding the
other groups (34% PC and 37% TL). Upper extre-
mity injuries accounted for 30% of injuries reported
by Kauther et al. (2009) and 49% of those reported
by Cho et al. (2009). Breakers sustained upper
extremity injuries at over 2.5 times the rate of
Popper/Lockers, and 5 times the rate of New School-
ers, ballet, and modern dancers (Table 5). This is not
surprising since Breakers must land and weight bear
on their shoulders, elbows, wrists, and hands while
the feet and legs move the body around an axis to
perform spins and other movements. Freezes (Ap-
pendix) require holding upside down positions while
supporting the body on 2 or 3 points of the upper
extremity. Breakers were 2 to 11 times more likely to
Table 4. Relative risk (RR) of injury in
Breakers
compared with non-
Breakers
Injury definition RR 95% CI
P
value
Foot/Ankle PC 1.3 1.0–1.7 0.03
TL 1.2 0.8–1.7 0.37
Shin/Leg PC 2 1.1–3.7 0.01
TL 1.7 0.8–3.3 0.13
Knee PC 1.4 0.9–2.1 0.11
TL 1.6 0.9–2.8 0.12
Hip PC 1.3 0.8–1.9 0.25
TL 1.5 0.8–2.6 0.15
Lumbar/Pelvis PC 1.3 0.7–2.4 0.31
TL 1 0.5–1.9 0.94
Thorax PC 3.1 0.7–13.3 0.11
TL 2.1 0.5–9.6 0.32
Head/Neck PC 2.8 1.4–5.6 0.00
TL 4.2 1.6–11.6 0.00
Shoulder PC 2.3 1.2–4.2 0.00
TL 4 1.7–9.9 0.00
Arm/Elbow PC 3.6 1.1–11.8 0.02
TL
** *
Forearm/Wrist PC 3.2 1.6–6.3 0.00
TL 4.5 1.9–11.0 0.00
Hand PC 4.4 2.0–9.2 0.00
TL 11.1 2.7–44.7 0.00
*
Risk could not be calculated due to zero observations in non-
Breakers
.
PC, physical complaint; TL, time loss.
Fig. 2. Contributing factors to injury.
Injury incidence in hip hop dance
352
sustain an upper extremity injury than Popper/Lock-
ers and New Schoolers combined (Table 4).
Dancers have a high rate of lower extremity
injuries. The incidence among our subjects is within
the range of tap (Mayers et al., 2003), and gymnastics
(Sands et al., 1993; Wadley & Albright, 1993; Kolt &
Kirkby, 1999; Cupisti et al., 2007), but higher than
reported in modern (Bronner et al., 2003), and ballet
(Solomon et al., 1999) (Table 5). The esthetic preci-
sion sought in elite classical (ballet, modern) dance is
achieved through relatively controlled movements
choreographed in a studio with sprung floors. Gym-
nasts practice and perform in supervised indoor
venues with protective equipment such as mats.
Breakers practice and perform in gymnasiums,
school yards, on sidewalks, or in subway (metro)
stations often wearing nothing more than sneakers as
protection.
Foot/ankle, knee, and hip injuries were a common
occurrence across all three groups (Table 2). How-
ever,there was a higher incidence of PC shin and
thoraco-lumbar injuries in Breakers vs Popper/Lock-
ers. The nature of the dance style brings Breakers
shins and torso in frequent contact with the floor.
Kauther et al. (2009) concluded that ‘‘[Breaking]
should be categorized as a collision or contact sport
as athletes purposely hit or collide with the ground
with great force’’. With these impacts, it is under-
standable that Breakers can easily develop tibial
stress injuries and thoraco-lumbar sprains and
strains. Similarly, the higher incidence of TL neck
and shoulder injuries in Breakers may be due to the
performance of movements that require them to
weight bear on their head or shoulders. Our RR
calculations (Table 4) support this argument.
The five most common injury sites in Breakers
were foot/ankle, forearm/wrist, hand, hip, and knee.
This pattern differs from that reported by Kauther
et al. (2009) who found the most common injury sites
to be spine (17%), knee (16%), shoulder (15%), skin
(14%), and wrist/hand (10%). Kauther’s categoriza-
tion of ‘‘spine’’ encompassed the neck, thorax, and
lumbo-pelvic area. Using the same definition,
‘‘spine’’ injuries in our study were 23%, thereby
also making it the most common anatomical injury
location among Breakers. That foot/ankle and hip
were not included in Kauther’s top five injury sites
was astonishing. The authors described this finding
as atypical for dancing sports (Kauther et al., 2009).
Injury diagnostic categories and severity
Breakers,Popper/Lockers, and New Schoolers had
different incidences of joint/ligament, muscle/tendon,
and bone/stress fracture injuries (Table 3). Muscle/
tendon injuries were the most common injury among
Breakers and Popper/Lockers, whereas joint/ligament
injuries were most common in New Schoolers. These
incidence rates are within the range reported for
tappers (Mayers et al., 2003) and gymnasts (Cupisti
et al., 2007) (Table 4).
Since dance movements are repetitive, it is not
remarkable that 50% of dancers attributed overuse
as the most common injury mechanism. Most injuries
Table 5. Comparison of dance and gymnastic injury incidences
This study
Breaking
*
w
(Cho et al., 2009;
Kauther et al.,
2009)
Modern
(Bronner
et al.,
2003)
Tap
*
(Mayers
et al.,
2003)
Ballet
*
(Solomon
et al., 1999;
Nilsson et al., 2001;
Byhring & Bo, 2002)
Gymnastics
*
(Kolt & Kirkby,
1999; Cupisti et al.,
2007; Harringe
et al., 2007)
Definition of injury PC/TL PC TL TL PC/TL TL
Injuries/injured subject 2.3–3.5 PC
1.6–2.8 TL
4.6–12.1 1.0–1.4 0.64–0.97 2.0–4.0 PC
0.3 TL
1.26–3.6
Injury incidence 144–278% PC
92–194% TL
460–1156% 26–81% 92% 70–100% PC
24% TL
70–302%
Lower extremity injury 94–135% PC
61–89% TL
145–425% 43–57% 73% 57–71% PC
20% TL
49–178%
Foot/Ankle injury 39–53% PC
25–33% TL
67–120% 19–31% 39% 37–38% PC
10% TL
26–95%
Upper extremity injury 17–96% PC
8–71% TL
226–334% 2–12% o1% 6–9% PC
0% TL
7–64%
Joint (non-bone)/Ligament 34–67% PC
22–50% TL
– – 55% 7% TL 13–126%
Muscle/Tendon 19–77% PC
11–57% TL
– – 16% 117% TL 17–91%
Bone stress/Fracture 8–33% PC
5–26% TL
– – 6% – 4–25%
*
Injury incidence was calculated from raw data provided by the authors.
w
Results based on cumulative (not annual) injury incidence.
PC, physical complaint; TL, time loss.
Ojofeitimi et al.
353
were minor, supporting this claim and making acute
trauma less likely. It is, however, common for all
dancers to practice or perform despite pain or injury
(Bowling, 1989; Caine et al., 1989; Sands et al., 1993;
Kolt & Kirkby, 1999; Garrick & Lewis, 2001). Rather
than resting, dancers continue to participate with
protective equipment or modification. These in-
stances of early return may decrease the number of
moderate and artificially inflate the number of minor
injuries. The authors observed several Breakers dan-
cing at battles with splints and braces to protect
existing injuries. At one battle, two Breakers returned
immediately to dancing (against medical advice) after
sustaining thumb and ankle sprains that we evaluated
and braced. Another reported participating in a battle
within days of an appendectomy.
‘‘Other’’ (diagnosis not listed or subjects did not
remember) injuries comprised 30% of injuries. This
occurs with retrospective studies since recall accuracy
declines with time and as level of detail requested
increases (Twellaar et al., 1996; Jenkins et al., 2002;
Gabbe et al., 2003). Jenkins and colleagues (2002)
reported a 3% decline in number of injuries reported
within a 2- and 12-month recall period (Jenkins et al.,
2002). They concluded that recall periods greater that
2 months are likely to significantly underestimate
injury rates. Although Gabbe and colleagues (2003)
found perfect agreement between retrospective and
prospective records in a 12-month recall period, only
61% of players could accurately recall diagnosis,
number of injuries sustained, and body region. If
retrospective surveys tend to result in underreporting
of injuries, then the actual injury incidence in this
population (especially Breakers) may be higher than
we report.
Limitations
This was a retrospective, self reported injury survey.
Prospective studies are necessary to track the inci-
dence of hip hop injuries. Although the internet was
an inexpensive and effective tool to distribute the
survey to a worldwide population of dancers, the
anonymity it provided may have encouraged false
reporting. Additionally, non-English speaking dan-
cers could not fill out the survey without a translator.
Respondent dropout rates are a common problem in
web surveys (Bosnjak & Tuten, 2001; Manfreda &
Vehovar, 2002; Mertler, 2003), with partial dropout
rates as high as 73% (Manfreda & Vehovar, 2002).
Based on this, the partial respondent dropout rate of
38% in this study is acceptable. The rate could have
been lower had each potential respondent been given
his or her own unique identification number in order
to gain access to the survey, save intermediate
responses, and return to complete the survey at a
convenient time. This is a consideration for future
studies.
Perspectives
Hip hop dancers are a medically underserved com-
munity with high rates of injury. With the increase in
participation and documented high rates of preven-
table injuries (Cho et al., 2009; Kauther et al., 2009),
education about injury prevention and use of pro-
tective equipment is warranted. Sports and dance
medicine practitioners must begin to recognize and
accept these dancers as legitimate artists and athletes.
They should be as familiar with the injury patterns of
hip hop dance as they are with classical dance and
other sports such as gymnastics and baseball. Offer-
ing a series of injury prevention workshops at battle
venues would provide a valuable service to this
community.
Key words: break dance, Breakers, dance epidemiol-
ogy, Poppers, Lockers.
Acknowledgements
This study was supported in part by Nike Inc. Our thanks go
to Laura Becica, DPT and Yu-Chien Cheng who constructed
the electronic survey and went above and beyond to assist in
recruiting subjects at battles, conferences, and studios. We
also thank Imran Sajid, MD for his assistance in recruiting
subjects and Lester Mayers, MD for his editorial comments.
Our gratitude goes to Robin Dunn, Ana ‘‘Rokafella’’ Garcia,
Miri Park, Erenia Valencia (a.k.a Honey Rockwell) who
mentored us in learning everything we could about hip hop
dance and culture.
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Appendix
Table A1. Glossary
Term Definition
Battle Any level of competition in which dancers, in an open space (typically a circle) participate in quick-paced, turn-based routines,
whether improvised or planned.
Breaking
Street dance style normally danced to funk or hip hop music. It includes both toprock (standing dance steps) and downrock
(sequences on the ground), incorporating extreme gymnastic
power moves
and
freezes
.
Freeze Halt of all motion in a stylish pose. Usually requires
Breakers
to suspend themselves off the ground using upper body strength, in
poses such as a handstand or pike.
Locking
A style of street dance originally called ‘‘Campbellocking.’’ It relies on fast and distinct arm and hand movements combined with
relaxed hips and legs. Movements are generally large and exaggerated, and often very rhythmic and tightly synched with the music.
Popping
Dance style based on the technique of quickly contracting and relaxing muscles to cause a jerk in the dancer’s body, referred to as a
pop
or a
hit
. This is done continuously to the rhythm of a song in combination with various movements and poses.
Power
moves
Refers to moves that require momentum and physical power to execute. Heavily involves weight bearing and propulsion on upper
extremities and/or head.
Injury incidence in hip hop dance
