Injury Prevalence Among Elite Adolescent Ballet Dancers is not Affected by Frequency of Questionnaire Administration: A 6-Month Exploratory Prospective Study.

INTRODUCTION: The Oslo Sports Trauma Research Centre Questionnaire on Health Problems (OSTRC-H) is a valid and reliable registration method for self-reported injuries and is regularly used among dancer populations. Monthly questionnaire administration is acceptable in athlete populations but has not been evaluated in dancers. The aim of this exploratory study was to assess the influence of weekly versus monthly administration of the OSTRC-H on estimated injury outcomes among elite adolescent ballet dancers. METHODS: Participants (n = 103) were prospectively followed for 6 months and completed the OSTRC-H online, evaluating perceived consequences of self-reported health problems during the previous week and the previous 4 weeks, respectively. Four definitions of dance-related injury were utilized: (1) all complaints, (2) substantial, (3) medical attention, and (4) time-loss injuries. Descriptive statistics estimated: (1) the number of injuries reported (count), (2) average injury prevalence [proportion, 95% confidence intervals (CI)], (3) average severity score (0-100), and (4) days of time loss (count) for each injury definition. The 4 outcome measures were then compared between weekly and monthly registration with paired sample t-tests (P < .05) and overlapping 95% CI. RESULTS: A significant difference between the number of all complaints injuries (weekly: 133; monthly: 94; P < .001) and substantial injuries (weekly: 64; monthly: 45; P = .012) was found. Regardless of injury definition, there were no significant differences between injury prevalence, severity scores, and days of time loss when reported weekly versus monthly. CONCLUSION: Monthly administration of the OSTRC-H is an acceptable method to estimate injury prevalence, severity scores, and days of time loss amongst elite adolescent ballet dancers.

Perspectives of Ballet Dancers on Causes of Their Injuries and Implementation of Injury Preventive Measures by Ballet Teachers and Masters.

OBJECTIVES: Ballet dancers have a high injury risk. We aimed to gain insight into the causes for acute and overuse injuries in ballet dancers and the level of implementation of injury prevention by ballet teachers/masters, as perceived by dancers. METHODS: An international cross-sectional online-survey was based on the Fit-to-Dance Questionnaire and literature. Adult amateur, pre-professional, and professional ballet dancers reported the perceived causes of their injuries sustained in the previous 2 years. Multiple answers per injury were possible. Also, dancers rated the level of implementation of measures to prevent injury by their ballet teachers and ballet masters based on 21 items using a 5-point Likert scale. Causes were analyzed per-injury as well as per-dancer. RESULTS: 188 ballet ensembles and 51 dance organizations were contacted, from which 192 ballet dancers (mean age 27 ±7.8 yrs, 83% females) responded. 119 dancers (62%) reported 203 acute and 164 (85%) reported 469 overuse injuries. Fatigue was the most frequently perceived cause for acute injuries in the per-injury (n=89, 43.8%) and per-dancer analysis (n=63, 32.8%). For overuse injuries, pressure from the teacher/master was most frequently perceived as cause in the per-injury analysis (n=240, 51.2%), specifically in pre-/professional dancers (n=233, 61.3%). In the per-dancer analysis, fatigue/overtraining scored highest for overuse injuries (n=107; 55.7%). Other causes were previous/repetitive injuries (acute-per-injury 26.1%, acute-per-dancer 22.4%; overuse-per-injury 46.3%, overuse-per-dancer 53.1%) or erroneous dance technique (acute-per-injury 24.6%, acute-per-dancer 21.9%; overuse-per-injury 47.8%, overuse-per-dancer 45.3%). With regard to perceived level of implementation of injury preventive measures by ballet teachers/masters to prevent musculoskeletal injuries, 2 items received high ratings, 12 moderate ratings and 6 low ratings. CONCLUSIONS: Fatigue and pressure accounted for the majority of perceived causes for injuries. Perceived support by ballet teachers/masters regarding injury prevention was moderate to low. Future research should focus on the awareness, attitudes, and the important role of ballet teachers/masters for injury prevention in dancers.

Health consultations at a performing arts health centre among classical music students based on electronic health record data: a cross-sectional study.

Physical and mental health problems in music students are usually identified using self-reported data. The use of an Electronic Health Record database can avoid biases to give an overview of the extent of health problems in this population. Therefore, the aim of this study is to gain insight into both physical and mental health related issues in classical music students using this type of data collection. An Electronic Health Record database including five years of data from a Performing Arts Health Centre (PAHC) of a university or the arts, was used to analyze the number and characteristics of health consultations in music students. The total number of students, health consultations and the average number of visits per health consultation were calculated over five years. Furthermore, numbers and percentages of both physical and mental health consultations were registered. Also, the number and percentage of health consultations per instrument group were compared to the proportion of each instrument group within the specific sample. Over a period of five years, 230 students visited the PAHC and 417 health consultations were reported. 43.5% of the students who visited a health professional indicated at least one physical health consultation, 29.1% at least one mental health consultation and 27.4% at least one in both categories. An injury was the most frequently registered physical health consultation (40.2%), followed by performance improvement (9.8%) and stress (9.6%). Voice students registered relatively most health consultations. As far as we know, this is the first cross-sectional study using Electronic Health Record data from a PAHC to gain insight into both physical and mental health related issues in a population of classical music students. Looking at the variety of health consultations registered in the database, a multidisciplinary team and multidisciplinary approach are necessary to meet the needs of the students in terms of physical and mental health support and performance improvement.

Aerobic and Anaerobic Fitness Levels of Pre-Professional Contemporary Dancers: An Exploration of 2 Dance-Specific Field Tests.

INTRODUCTION: The primary aim of this study was to present descriptive heart rate (HR), heart rate recovery (HRR) and RPE data for the DAFT and HIDT within one sample of contemporary dance students. The second aim was to explore if objective (HR) and subjective (RPE) data were correlated between tests. METHOD: 40 (11 males, 29 females) university dance students with a mean age of 18.8 ± 1.8 years performed the DAFT and HIDT on 2 separate occasions within 1 week. Measurements were HR after 4 minutes in all stages of the DAFT, the percentage of age-predicted maximal HR (%HRmax) of all stages of the DAFT and at the end of the HIDT, and peak HR (HRpeak) at the end of both tests. Subjective ratings of perceived exertion (RPE) and HR recovery after 1 minute of rest (HRR) were determined after the tests. RESULTS: HRpeak of the DAFT and HIDT were 188.1 ± 11.0 and 185.3 ± 7.3 beats·min-1, respectively. There were high positive correlations between HRpeak of the HIDT and stages 3 to 5 of the DAFT (r = 0.716-0.740, all P-values < .01). HRR (r = .678, P < .01) and %HRmax (r = .746, P < .01) showed moderate to high correlations between the DAFT and HIDT. The anaerobic training zone was reached in stages 4 and 5 of the DAFT and at the end of the HIDT. The subjective RPE scores did not significantly correlate between DAFT and HIDT, neither with objective HR data. CONCLUSION: Although the DAFT and HIDT differ in intensity and work-to-rest ratio, there were high correlations between HR and HRR data of both tests and both tests reached intensities above the anaerobic threshold (%HRmax > 85%).

A Systematic Review of Cardiorespiratory Fitness Tests Used in Dance.

Dancers need adequate cardiorespiratory fitness (CRF) levels in order to cope with the demands of dance classes and choreographies. Screening and monitoring of CRF is advised. The aim of this systematic review was to provide an overview of tests used to assess CRF in dancers and to examine the measurement properties of these tests. A literature search was performed in three online databases (PubMed, EMBASE, and SPORTDiscus) up until August 16, 2021. Study inclusion criteria were: 1. a CRF test was used; 2. participants were ballet, contemporary or modern, or jazz dancers; and 3. English full-text peer-reviewed article. General study information, participant information, CRF test used, and study outcome were extracted. If available, measurement property data were extracted (i.e., test reliability, validity, responsiveness, and interpretability). Of the 48 articles included in the review, most used a maximal treadmill test (n = 22) or the multistage Dance Specific Aerobic Fitness test (DAFT; n = 11). Out of the 48 included studies, only six examined the measurement properties of CRF tests: Aerobic Power Index (API), Ballet-specific Aerobic Fitness Test (B-DAFT), DAFT, High-Intensity Dance Performance Fitness Test (HIDT), Seifert Assessment of Functional Capactiy for Dancers (SAFD), and the 3-minute step test. Good test-retest reliability was found for the B-DAFT, DAFT, HIDT, and SAFD. Criterion validity was determined for the VO2peak of the API, the 3-MST, HIDT, and SAFD. For HRpeak, criterion validity was studied for the 3-MST, HIDT, and SAFD. While different CRF tests are being used in descriptive and experimental research within dance populations, the body of research supporting the measurement properties of such tests is very small. As many studies have methodological flaws (e.g., small participant numbers or no statistical analysis for validity or reliability), additional good quality research is required to re-examine and complement current measurement property results of the API, B-DAFT, DAFT, HIDT, SAFD, and 3-MST.

An analysis of teachers' instructions and feedback at a contemporary dance university.

Background: Given the demands posed by excessive practice quantities in modern dance, physical and mental health can be compromised. Therefore, there is a need to consider how quality of practice may be improved and possibly even reduce training times. Sports literature has shown that instructions and feedback given by coaches can have an effect on the quality of training and influence self-regulation and the performance of athletes. However, currently little is known about the use of instructions and feedback by dance teachers. The aim of the current study was, therefore, to examine the type of instructions and feedback given by dance teachers during various dance classes. Methods: A total of six dance teachers participated in this study. Video and audio recordings were made of six dance classes and two rehearsals at a contemporary dance university. The dance teacher's coaching behavior was analyzed using the modified Coach Analysis and Intervention System (CAIS). Additionally, feedback and instructions were also examined in terms of their corresponding focus of attention. Absolute numbers, as well as times per minute (TPM) rates were calculated for each behavior before, during, and after an exercise. Absolute numbers were also used to calculate ratios of positive-negative feedback and open-closed questions. Results: Most feedback comments were given after an exercise (472 out of 986 total observed behaviors). Improvisation had the highest positive-negative feedback ratio (29) and open-closed questions ratio (1.56). Out of the focus of attention comments, internal focus of attention comments were used most frequently (572 out of 900). Discussion/conclusion: The results make clear that there is a large variability in instructions and feedback over teachers and classes. Overall, there is room for improvement toward a higher positive-negative feedback ratio, a higher open-closed question ratio and producing more comments eliciting an external focus of attention.

Predicting readiness for return to sport and performance after anterior cruciate ligament reconstruction rehabilitation.

BACKGROUND: Determining readiness to return to sport after anterior cruciate ligament (ACL) reconstruction is challenging. OBJECTIVES: To develop models to predict initial (directly after rehabilitation) and sustainable (one year after rehabilitation) return to sport and performance in individuals after ACL reconstruction. METHODS: We conducted a multicentre, prospective cohort study and included 208 participants. Potential predictors - demographics, pain, effusion, knee extension, muscle strength tests, jump tasks and three sport-specific questionnaires - were measured at the end of rehabilitation and 12 months post discharge from rehabilitation. Four prediction models were developed using backward logistic regression. All models were internally validated by bootstrapping. RESULTS: All 4 models shared 3 predictors: the participant's goal to return to their pre-injury level of sport, the participant's psychological readiness and ACL injury on the non-dominant leg. Another predictor for initial return to sport was no knee valgus, and, for sustainable return to sport, the single-leg side hop. Bootstrapping shrinkage factor was between 0.91 and 0.95, therefore the models' properties were similar before and after internal validation. The areas under the curve of the models ranged from 0.74 to 0.86. Nagelkerke's R2 varied from 0.23 to 0.43 and the Hosmer-Lemeshow test results varied from 2.7 (p = 0.95) to 8.2 (p = 0.41). CONCLUSION: Initial and sustainable return to sport and performance after anterior cruciate ligament reconstruction rehabilitation can be easily predicted by the sport goal formulated by the individual, the individual's psychological readiness, and whether the affected leg is the dominant or non-dominant leg.

Neuromuscular Warm-Up is Associated with Fewer Overuse Injuries in Ballet Dancers Compared to Traditional Ballet-Specific Warm-Up.

Neuromuscular warm-up exercises (NMWU) have been shown to prevent injuries. In dance, research on warming-up is scarce. We investigated warm-up habits among ballet dancers and the effects of NMWU and traditional ballet-specific warm-up (TBSWU) on injuries. Using a cross-sectional survey among ballet dancers over the age of 18 years, we recorded acute and overuse injuries sustained in the previous 2 years. Warm-up behavior was assessed through 28 items. Dancers were grouped into NMWU or TBSWU: NMWU was based on neuromuscular warm-up programs in sports science and included exercises improving strength, power, proprioception, sensorimotor control, or cardiovascular stimulus; and TBSWU consisted of stretching, dance-technical exercises, marking steps and running-through-choreographies, or stretching with tools. Separate linear regression analyses adjusted for confounding factors were performed for acute and overuse injuries. A total of 192 dancers (26.7 ± 7.82 years, 159 females, 132 professionals) reported 203 acute and 469 overuse injuries. In total, 47.4% of dancers always warmed up (mean duration 20.7 ± 13.2 minutes) based on stretching (63%), technical-exercises (58.9%), strength-training (54.7%), and the barre (53.6%); and 9.4% never warmed up. A total of 31 dancers (16.15%) were classified as TBSWU, 16 dancers (8.3%) for NMWU, and 145 dancers did combined exercises. Those in the NMWU group were associated with fewer overuse injuries compared to those in the TBSWU group (ß = -2.34; 95%CI -3.54 to -1.14). No association was found with acute injuries. As in other athletes, NMWU might be protective against overuse injuries in dancers. Large-scale prospective cohort studies are needed to gain more insight into NMWU as a possible component of injury prevention in ballet.

Multiple Factors Influencing Healthy Performance for Pre-professional and Professional Classical Violinists: An Exploratory Study Focusing on Physical Health.

Musculoskeletal complaints are common in pre-professional and professional classical violinists and these complaints can affect violinists' performance. Therefore, it is important to identify the factors that contribute to healthy performance in this population. Qualitative studies with a variety of stakeholders are able to provide insights from different perspectives into factors influencing healthy performance for the pre-professional and professional classical violinist. In the current small-scale, exploratory study, semi-structured interviews were conducted with various stakeholders; two classical violin students, one classical violin teacher, a physiotherapist, a professional classical violinist, who is also a performance coach, and a health specialist who also graduated as a professional classical violist. Thematic analysis was conducted using Atlas.ti 9. We identified six themes that were indicated as important by the participants in terms of ensuring healthy performance for the pre-professional and professional classical violinist. The themes were: (1) physical aspects (involved in playing the violin); (2) practice routine and techniques; (3) interaction between physical and mental aspects; (4) culture; (5) role of the main subject teacher; and (6) preventive measures. Furthermore, when asked specifically about the development of a physical screening tool, the participants indicated that such a tool should include multiple factors covering various regions of the body, the inclusion of a questionnaire on risk-factors, and follow-up measurements. Also, collaborations between health professionals and main subject teachers were recommended as part of the screening tool to increase commitment of participating students. The results of the current study are based on the opinions, attitudes, and ideas of a small, selected group of participants only and cannot be generalized to a wider group of violinists. More research is needed regarding factors influencing healthy performance, before conservatoires and professional orchestras can develop programs for a healthy playing environment for pre-professional and professional violinists.

Quantifying Internal Load in Pre-Professional Contemporary Dancers: The Association Between Objective Heart-Rate Derived Outcome Measures and Subjective Dancers' and Teachers' Perceptions.

BACKGROUND: Monitoring heart rate is one of the most common methods used to quantify internal training load (ITL) in athletes. The aim of this study was to determine whether subjective measurements can be used as a simple, non-invasive, and inexpensive method for assessing ITL in pre-professional contemporary dancers.
Method: A total of 16 first-year contemporary dance students participated in this study. Students wore heart rate monitors during 56 training sessions. After each session, students completed the rate of perceived exertion (RPE) scale and teachers completed the rate of observed exertion (ROE) scale. For each session, we calculated the session-RPEs (sRPE), session-ROEs (sROE), and heart-rate-derived ITLs [i. e., Banister TRaining IMPulse method (TRIMP) and Edwards TRIMP]. Pearson correlation coefficients were calculated to determine the association between sRPE, sROE, Banister TRIMP, and Edwards TRIMP.
Results: Between-individual correlation between Banister TRIMP and subjective dancers' (sRPE) and teachers' perceptions (sROE) were moderate (r = .49, p < 0.01) to large (r = .57, p < 0.01). Between-individual correlations between Edwards TRIMP and the subjective perceptions (sRPE and sROE) were very large (r = .74, p < 0.01; and r = .79, p < 0.01). There was a statistically significant large (r = 0.52, p < 0.01) to almost perfect (r = 0.93, p < 0.01) within-individual correlation between the sRPE and the two measured TRIMP methods. There was a statistically significant small (r = .29, p < 0.01) to almost perfect (r = .92, p < 0.01) within-individual correlation between the sROE and the two measured TRIMP methods.
Conclusion: The results of this study suggest that the sRPE is a simple, non-invasive, inexpensive, and valid method for quantifying ITL in pre-professional dancers.

The Association Between Stress and Injury: A Prospective Cohort Study Among 186 First-Year Contemporary Dance Students.

The demanding environment that contemporary dance students are exposed to could result in high stress levels, which can influence injury susceptibility. Therefore, this study aims to investigate the association between stress and injuries. In the period between September 2016 and March 2020, four cohorts of first-year dance students (N = 186; mean age 19.21 ± 1.35 years) were followed for one academic year. Each month, general stress was assessed on a 0-100 visual analogous scale. The Oslo Sports Trauma Research Center Questionnaire on Health Problems was used on a monthly basis to monitor injuries. Injuries were defined as "all injuries" (i.e., any physical complaint irrespective of the need for medical attention or time-loss from dance) and "substantial injuries" (i.e., leading to moderate/severe/complete reductions in training volume or performance). Mann-Whitney tests were performed to measure differences in general stress levels between injured and injury-free students, while repeated-measures ANOVA were performed to investigate whether general stress scores increased before and during injury occurrence. The overall average monthly general stress score over all cohorts for all students was 39.81. The monthly general stress scores ranged from 31.75 to 49.16. Overall, injured and substantially injured students reported higher stress scores than injury-free students, with significant differences in 3 out of the 9 months for all injuries (September, October, March, p < 0.05), and in 5 months for substantial injuries (September, October, November, December, April, p < 0.05). Within the 3-month period before and during injury occurrence, a (marginally) significant linear effect of general stress across the time periods was found for all injuries [F(1.87,216.49) = 3.10, p = 0.051] and substantial injuries [F(2,138) = 4.16, p = 0.018]. The results indicate an association between general stress and injuries. Future research should focus on effects of varying stress levels on injury risk using higher sampling frequency, for instance by measuring weekly since stress levels are likely to fluctuate daily. Practically, strategies aiming at stress reduction might have the potential to reduce the burden of dance injuries and may have positive outcomes for dancers, teachers, schools, and companies.

Physical Activity in Women With Hypothyroidism on Thyroid Hormone Therapy: Associated Factors and Perceived Barriers and Benefits.

BACKGROUND: The purpose of this study was to analyze factors associated with physical activity (PA) and to identify perceived barriers and benefits of PA among patients with hypothyroidism on thyroid hormone therapy. METHODS: This survey-based cross-sectional study was conducted among members of the Dutch thyroid patient organization. Self-reported data on respondents' PA levels and demographic, clinical, and physical health variables were collected. Moreover, perceived barriers and benefits to PA were identified. Respondents were categorized as physically active when meeting the recommended Dutch PA guidelines and physically inactive otherwise. To compare physically active and inactive respondents, potential confounders were entered into univariate analyses. Factors showing significant correlations (P < .20) were added to a multivariate model to determine the associated factors of PA. RESULTS: About 1724 female respondents (mean age 53.0 [11.6] y) were included; 16.1% reported meeting the PA recommendations. Multivariate analysis showed that factors associated with PA included levothyroxine/liothyronine therapy, comorbidities, self-perceived physical fitness, and diminished physical endurance. Overall, physically related barriers to PA were rated highest. CONCLUSIONS: The vast majority of treated hypothyroid respondents are physically inactive and experience long-term exercise intolerance. Considering the health implications of physical inactivity, promotion of regular PA is of key importance in this population.

Prevalence of Mental Health Complaints Among Performing Arts Students Is Associated With COVID-19 Preventive Measures.

The aim of this study was to investigate the effect of COVID-19 preventive measures on the mental health of performing arts students. In a prospective cohort study, performing arts students (N = 213) from Codarts Rotterdam, University of the Arts, were invited to monitor their health during one academic year (September 2019-May 2020). Every month, students completed items on mental health complaints, stress, and sleep quality. Chi-square tests and repeated-measures ANOVA with deviation contrasts were performed to investigate whether COVID-19 preventive measures were associated with changes in mental health complaints, stress scores, and sleep quality. During the COVID-19 lockdown, subjective mental health, Mental Health Inventory-5 (MHI-5), and items on loneliness were additionally completed by the respondents. A total of 98 students (46.0%) were included in the analyses. The 3-month prevalence of mental health complaints was significantly higher during the COVID-19 lockdown compared to the two pre-COVID-19 periods (p < 0.001). Mean stress scores were significantly lower for February (35.20) and March (36.41) when compared to the overall mean (40.38). Sleep quality scores (mean) were significantly higher for April (6.90), and May (6.89) when compared to overall mean (6.58). Furthermore, at least 75.5% of the participants dealt with moderate to very severe loneliness in all 3 months during the COVID-19 lockdown. During lockdown, performing arts students perceived less stress and their sleep quality increased. However, the prevalence of mental health complaints increased. Besides, 3 out 4 students dealt with moderate to very severe loneliness.

Incidence and prediction of ankle injury risk: a prospective cohort study on 91 contemporary preprofessional dancers.

OBJECTIVES: This study examines the incidence of ankle injuries and identifies ankle injury risk among contemporary preprofessional dancers. METHODS: A total of 91 first-year contemporary preprofessional dancers were prospectively followed during one academic year. Self-reported ankle injuries, assessed with the Oslo Sports Trauma Research Centre questionnaire, were categorised as all complaint ankle injuries, substantial ankle injuries or time-loss ankle injuries. In addition, ankle injuries leading to medical attention were included. Regression analyses were used to determine the association between potential risk factors (dancer characteristics, history of ankle injury in the previous year, ankle range of motion and dorsiflexion) and ankle injuries. RESULTS: The 1-year ankle injury incidence proportion was 18.7% (n=17), 8.8% (n=8), 15.4% (n=14) and 7.7% (n=7), respectively, for all complaint ankle injuries, ankle injuries requiring medical attention, time-loss injuries and substantial injuries. Being male (OR=0.27; 95% CI 0.09 to 0.75) and being a student of the Bachelors in Dance and Education (OR=0.27; 95% CI 0.08 to 0.97) were univariately associated with a lower risk of an ankle injury. CONCLUSION: Almost 20% of first-year preprofessional dancers reported an ankle injury, with more than 80% of the dancers reporting that their injury leads to dance time loss. Males and students of the bachelors in dance and education were at lower risk of ankle injuries. As ankle injuries are common among dancers, studies with larger sample sizes, a more heterogeneous population (eg, different dance styles) and longer follow-up periods are necessary to evaluate the impact of ankle injuries in further detail.

Physical activity, sports participation and exercise-related constraints in adult women with primary hypothyroidism treated with thyroid hormone replacement therapy.

Awareness of physical activity (PA) constraints in patients with primary hypothyroidism on thyroid hormone replacement therapy (THR) is important. Hence, this cross-sectional matched case-control study aimed to determine PA and sports participation (SP) in patients with hypothyroidism on THR in comparison to control subjects. Accordingly, survey questions were selected from the National Survey on Injuries and Physical Activity in the Netherlands (IPAN), supplemented with questions related to self-reported clinical characteristics and exercise-related constraints (ERC) of patients. In total, 1,724 female patients (mean age 53.0 years ±11.6) and 1,802 controls (mean age 52.6 ± 13.2) were included. Compared to controls, patients were less likely to comply with the moderate-intensity PA guideline (OR 0.70; 95% CI: 0.611-0.803), although patients were more actively participating in sports (OR 1.40; 95% CI: 1.156-1.706). Two-thirds of patients reported that hypothyroidism was limiting their PA performance. These limitations were more pronounced in patients with autoimmune thyroiditis (AIT) than in patients with hypothyroidism from other aetiology (OR 1.93; 95% CI: 1.518-2.457), representing disease-specific exercise intolerance. In order to establish effective intervention programmes to encourage regular PA in hypothyroid patients on THR with exercise intolerance, further research is warranted to better understand PA barriers.

Generalized Joint Hypermobility and Injuries: A Prospective Cohort Study of 185 Pre-Professional Contemporary Dancers.

Generalized joint hypermobility (GJH) has been mentioned as one of the factors associated with dance injuries, but the findings are inconclusive. This study aims to investigate whether GJH, based on different Beighton score cut-off points, is a potential risk factor for injuries in pre-professional dancers. Four cohorts of first-year pre-professional dancers (N = 185), mean age 19.1 ± 1.3 years, were screened on musculoskeletal functioning at the start of their academic year. The Beighton score was used to measure GJH. During the academic year, the dancers completed monthly questionnaires about their physical and mental health. Based on the Oslo Sports Trauma Research Centre Questionnaire on Health Problems (OSTRC), three injury definitions were used (i.e., all complaints, substantial injury, and time-loss injury). To examine potential risk factors for injuries, univariate and multivariate regression models were applied. The response rate of monthly completed questionnaires was 90%. The overall mean (SD) Beighton score was 2.8. The 1-year injury incidence proportion was 67.6% (n = 125), 43.2% (n = 80), and 54.6% (n = 101) for all complaint injuries, substantial injuries, and time-loss injuries, respectively. The multivariate analyses showed a significant association between a previous long lasting injury in the past year and the three injury definitions (p < 0.05). Pre-professional contemporary dancers are at high risk for injuries and hypermobility. However, these two variables are not associated with each other. Health professionals should take injury history into account when assessing dance students, because this variable is associated with increased injury risk.

The Association Between Training Load and Injury Risk in Elite Youth Soccer Players: a Systematic Review and Best Evidence Synthesis.

BACKGROUND: Injury risk in elite youth soccer players is high. Implementing an optimal training load is of utmost importance to reduce the risk of injuries. OBJECTIVE: To conduct a systematic review and best evidence synthesis to explore the effects of internal and external training load on injury risk in elite youth soccer players. METHODS: MEDLINE, Embase, Web of Science, CENTRAL, and CINAHL were searched up until 17 January 2020. Each article had to meet all of the following criteria: (1) the study population consisted of male elite youth soccer players aged between 12 and 21 years; (2) a longitudinal, prospective study design was used; (3) soccer-related injuries were registered (i.e., self-reported or by medical staff); (4) external and/or internal load parameters were described; and (5) the article was published in an English peer-reviewed scientific journal. The quality of the included articles was assessed using the Newcastle-Ottawa Quality Assessment Scale (NOS). A best evidence synthesis was performed to rank the level of evidence. RESULTS: Five studies (2 high quality, 3 low quality) were included. Best evidence synthesis highlighted that there was moderate evidence for (1) no association between 2-, 3-, and 4-week cumulative loads for total distance covered; (2) no association between 1-week workloads (sRPE × duration); and (3) no association between A:C workload ratios (4 weeks) and injury risk. For all other comparisons, only insufficient or conflicting evidence was found. CONCLUSION: There is a paucity of evidence for an association between internal and external training load parameters and injury risk in elite youth soccer players.

Health Problems in Conservatoire Students: A Retrospective Study Focusing on Playing-Related Musculoskeletal Disorders and Mental Health.

OBJECTIVE: To gain insight into the prevalence and characteristics of physical health problems and mental health problems in first-, second- and third-year conservatoire students of the classical music department. Also, differences in mental health and general health were investigated between students with playing-related musculoskeletal disorders (PRMDs) and students without PRMDs. METHODS: Eighty-nine classical music students of Codarts Rotterdam, University of the Arts, were asked to complete a questionnaire targeting PRMDs (components derived from Musculoskeletal Pain Intensity and Interference Questionnaire for Musicians, MPIIQM), mental health (Mental Health Inventory-5), and self-rated general health (SF-1 from Short Form health survey SF-12). RESULTS: The response rate was 52% (n=46). Of all participants, 17.8% (n=8) had experienced PRMDs in the past 12 months and 45.7% (n=21) of the students reported poor mental health (MHI-5≤60). Students experiencing PRMDs in the past 12 months reported poorer general health compared to students without PRMDs (43.8 vs 67.1 [range 0-100], p=0.012). No significant difference was found between the groups with regard to mental health (62.0 vs 66.5 [range 0-100], p=0.522). CONCLUSION: The burden of PRMD complaints in this population of conservatoire students seems relatively low. However, the number of students facing mental problems in this population is a cause for concern. Conservatoires should focus on the subject of mental health in their curricula to increase more awareness and prevent mental problems. To investigate possible causality between PRMDs and general health, prospective studies are needed.

The impact of injury definitions on measures of injury occurrence in classical music students: a prospective cohort study.

BACKGROUND: Multiple definitions are used to investigate injuries in musicians, resulting in a wide range of prevalence rates. The aim of this study is to establish the impact of different injury definitions on the prevalence of injuries and disability in classical music students. Moreover, the practical implications of using different injury definitions are considered. METHODS: A prospective cohort study among first-year classical music students was performed using bi-monthly questionnaires focusing on injuries. Three injury definitions were used: 1) all MSK complaints injury (any MSK complaint resulting in a VAS pain score > 0 in the past eight weeks), 2) medical attention injury (any MSK complaint that resulted in a student consulting a health provider in the past eight weeks), 3) time-loss injury (any MSK complaint that resulted in partly/completely missing music classes or activities in the past eight weeks). For all injury definitions prevalences were calculated and compared. Furthermore, the Disabilities of the Arm, Shoulder and Hand performing arts module (DASH-pa) was used to calculate disability scores for all three injury definitions. RESULTS: Twenty-nine classical music students participated in the current study. The total response rate over one academic year was 85.3%. One year prevalences of all MSK complaints, medical attention and time-loss were 96.6, 17.2 and 13.8% respectively. The bi-monthly prevalences ranged from 74.1 to 96.0% for all MSK complaints, from 5.6 to 11.5% for medical attention injuries and from 0 to 11.5% for time loss injuries. Scores on the DASH-pa ranged from 15.6 to 26.9 for MSK complaints, 33.3 to 50 for medical attention and 47.9 to 62.5 for time-loss injuries. CONCLUSION: The choice of injury definition is a critical factor affecting the outcome of music injury surveillance studies. To reach a consensus, it is therefore important to consider the different injury definitions depending on the goal of the injury surveillance and the practical implications.

Limited Coping Skills, Young Age, and High BMI Are Risk Factors for Injuries in Contemporary Dance: A 1-Year Prospective Study.

This study investigated potential risk factors (coping, perfectionism, and self-regulation) for substantial injuries in contemporary dance students using a prospective cohort design, as high-quality studies focusing on mental risk factors for dance injuries are lacking. Student characteristics (age, sex, BMI, educational program, and history of injury) and psychological constructs (coping, perfectionism, and self-regulation) were assessed using the Performing artist and Athlete Health Monitor (PAHM), a web-based system. Substantial injuries were measured with the Oslo Sports Trauma Research Center (OSTRC) Questionnaire on Health Problems and recorded on a monthly basis as part of the PAHM system. Univariate and multivariate logistic regression analyses were conducted to test the associations between potential risk factors (i.e., student characteristics and psychological constructs) and substantial injuries. Ninety-nine students were included in the analyses. During the academic year 2016/2017, 48 students (48.5%) reported at least one substantial injury. Of all factors included, coping skills (OR: 0.91; 95% CI: 0.84-0.98), age (OR: 0.67; 95% CI: 0.46-0.98), and BMI (OR: 1.38; 95% CI: 1.05-1.80) were identified as significant risk factors in the multivariate analysis. The model explained 24% of the variance in the substantial injury group. Further prospective research into mental risk factors for dance injuries with larger sample sizes is needed to develop preventive strategies. Yet, dance schools could consider including coping skills training as part of injury prevention programs and, perhaps, providing special attention to younger dancers and those with a higher BMI through transitional programs to assist them in managing the stress they experience throughout their (academic) career.