Injury epidemiology in professional ballet: a five-season prospective study of 1596 medical attention injuries and 543 time-loss injuries.

OBJECTIVES: To describe the incidence rate, severity, burden and aetiology of medical attention and time-loss injuries across five consecutive seasons at a professional ballet company. METHODS: Medical attention injuries, time-loss injuries and dance exposure hours of 123 professional ballet dancers (women: n=66, age: 28.0±8.3 years; men: n=57, age: 27.9±8.5 years) were prospectively recorded between the 2015/2016 and 2019/2020 seasons. RESULTS: The incidence rate (per 1000 hours) of medical attention injury was 3.9 (95% CI 3.3 to 4.4) for women and 3.1 (95% CI 2.6 to 3.5) for men. The incidence rate (per 1000 hours) of time-loss injury was 1.2 (95% CI 1.0 to 1.5) for women and 1.1 (95% CI 0.9 to 1.3) for men. First Soloists and Principals experienced between 2.0-2.2 additional medical attention injuries per 1000 hours and 0.9-1.1 additional time-loss injuries per 1000 hours compared with Apprentices (p≤0.025). Further, intraseason differences were observed in medical attention, but not time-loss, injury incidence rates with the highest incidence rates in early (August and September) and late (June) season months. Thirty-five per cent of time-loss injuries resulted in over 28 days of modified dance training. A greater percentage of time-loss injuries were classified as overuse (women: 50%; men: 51%) compared with traumatic (women: 40%; men: 41%). CONCLUSION: This is the first study to report the incidence rate of medical attention and time-loss injuries in professional ballet dancers. Incidence rates differed across company ranks and months, which may inform targeted injury prevention strategies.

Patterns and Correlates of New Drug Initiation among Female Exotic Dancers: The Contribution of Occupational and Structural Risks.

Introduction: Exotic dance clubs (EDCs) can play pivotal roles in the production of drug-related risks for female exotic dancers (FED). We aimed to characterize the structural and occupational factors associated with new drug initiation post-EDC entry among new FED (N = 117) in Baltimore, Maryland. Materials and Methods: Logistic regression models tested the associations of new drug uptake, measured as initiating any illicit drug (including non-prescribed and diverted prescription narcotics) not used prior to EDC employment, with structural (e.g. debt sources, housing instability) and occupational (e.g. sex work, dancing as sole income source) vulnerabilities. Results: Most FED were younger than 24 years-old (60%), identified as Black/African American (61%), and did not complete high school (56%). Twenty-nine (25%) reported using any new drug post-EDC entry, with cocaine (34%) cited most frequently among newly initiated substances. In multivariable analysis, drug initiation was significantly associated with cumulative debt sources (Adjusted Odds Ratio [AOR] = 1.82, 95% Confidence Interval [CI]: 1.19-2.77), dancing as only income source (AOR = 4.21, CI: 1.29-13.71), and sex work (AOR = 9.26, CI: 2.74-31.32). Conclusions: Our findings implicate co-occurring structural and occupational factors in FED's initiation of illicit drugs proceeding EDC employment. Results demonstrate the coping role of drug use for FED in stressful working environments and the multiple vulnerabilities associated with illicit drug uptake. The study reinforces a need for harm reduction interventions (i.e. debt relief, employment connections, increased hourly pay) that consider the contribution of overlapping financial insecurities to the production of occupational risks motivating drug uptake.

Psychic Symptoms and Self-Esteem in Dancers.

INTRODUCTION: The mental health of the human being and a higher level of the self-esteem have the positive effects on the peace surrounding, stability, success and the personal satisfaction of any individual. The fundamental opinion is that the dance has the affect on the body and the psychical health of the people. To explore if the dancers have their less-expressed psychical symptoms and higher self-esteem. SUBJECTS AND METHODS: The examination was performed on the sample of 310 examinees, mostly of the young life age and who identified themselves as the dancers or non-dancers. For the requirements of the investigation there were used the socio-demographic question-form, the psychical symptoms estimation scale (RCL-90-R) and the Rosenberg self-esteem scale (RSES). RESULTS: The dancers show the smaller appearance of the psychical symptoms and that almost in all sub-scales, but their difference is not statistically significant. The statistically significant difference among the men and the women was recorded in the subscales of the somatisations, then the interpersonal vulnerability, the depression, the anxiety and the phobias. The dancers possess their higher self-esteem then the non-dancers, but statistically their difference is not significant. Comparing the results against the sex, the persons of the female sex possess the higher self-respect than the persons of the male sex. CONCLUSION: The dancers possess less of the psychical symptoms and their higher self-esteem than the non-dancers, but the difference within the results is not significant statistically.

Personal and Social Environmental Correlates of Square Dancing Habits in Chinese Middle-Aged and Older Adults Living in Communities.

This study aimed to examine personal and social environmental correlates of the physical activity habit of middle-aged and older adults, using Chinese square dancing as a natural exploratory example. Participants were 385 adults aged ≥45 years (93% female), who habitually danced on squares or parks of three old districts of Guangzhou. Multinomial logistic regression was used to identify personal, social, psychological, and behavioral correlates of multiyear dance. Old age, high education, sufficient leisure time, and stable social environmental factors were associated with persistent dancing, whereby education (relative risk ratio [RRR] = 1.64, 95% confidence interval [1.05, 2.57]) and social engagement (RRR = 1.66, 95% confidence interval [1.05, 2.63]) showed the largest effects. Participants dancing ≤1 year were least satisfied with their social relationships than their counterparts dancing 1-5 years (RRR = 0.68) or over 5 years (RRR = 0.58). Physical activity promotion for older adults should adapt from culturally appropriate group activities and leverage community social resources to encourage voluntary participation, particularly for low-educated older women.

Temporal trends in dancing among adults between 1994 and 2012: The Health Survey for England.

The benefits of physical activity are established, however, increasing population physical activity levels remains a challenge. Participating in activities that are enjoyable and multidimensional, such as dancing, are associated with better adherence. However, the extent to which the general population participates in dancing and its temporal trends has not been well studied. The aim of this study was to investigate temporal trends and patterns and correlates of dance participation in England from 1994 to 2012 using a series of large nationally representative surveys. We used data from the Health Survey for England 1994, 1997, 1998, 1999, 2003, 2004, 2006, 2008 and 2012 to examine dance temporal trends. Temporal trends data were age-standardized and correlates of dance participation were examined for males and females over each study year. Changes in population prevalence of dance participation were determined using multiple logistical regression with 1997 as the reference year. Of all survey participants (n=98,178) 7.8% (95%CI: 7.63-7.96) reported dance participation. There was a marked steady decrease over time, with the steepest decline from 2003 onwards. The multivariable-adjusted odds ratios for dance participation were 0.51 for males (95%CI 0.408-0.630, p<0.001) and 0.69 for females (95%CI: 0.598-0.973, p<0.001) in 2012 compared to 1997. Dance participation in adults in England has decreased markedly over time. This study suggests that dance is not being adequately utilized as a health enhancing physical activity, and therefore further research and resources should be dedicated to supporting dance in the community.

Contraceptive utilization among new exotic dancers: a cross-sectional study.

BACKGROUND: Female exotic dancers are a population at high risk of unintended pregnancy. The objective of this study is to describe the reproductive health needs and contraceptive utilization of exotic dancers. METHODS: New exotic dancers (< 6 months dancing) from 26 clubs in Baltimore City/County completed a one-time survey. RESULTS: Of 117 participants, 96 (82%) had current contraceptive need. The mean age was 24 years, and 55% were black. Sex work (45%), alcohol use disorder (73%), illicit (44%; e.g., heroin, crack, cocaine), and injection drug use (8%) were common. The majority (66%) reported contraception use in the prior 6 months. Condoms were reported by 46% whereas 45% reported non-barrier methods, most commonly hormonal injection. Consistent condom use was rare (3%), and only 11% used a long-acting reversible method. CONCLUSIONS: Despite their unique reproductive health vulnerabilities, female exotic dancers have unmet contraceptive needs. Targeted harm reduction strategies are needed to fill this gap.

Emergency Department Patient Burden from an Electronic Dance Music Festival.

BACKGROUND: Electronic dance music (EDM) festivals are increasingly common and psychoactive substance use is prevalent. Although prehospital care can obviate the transfer of many attendees to health care facilities (HCFs), little is known regarding the emergency department (ED) burden of patients presenting from EDM festivals. OBJECTIVES: This study describes the patient volume, length of stay (LOS), and presenting complaints of patients from a 3-day EDM festival in close proximity to an area ED. METHODS: Medical charts of patients presenting to one HCF from an EDM festival were reviewed for substances used, ED LOS, and sedative medications administered. Additionally, preparedness techniques are described. RESULTS: Over the 3-day festival, 28 patients presented to the ED (median age 21 years; range 18-29 years). Twenty-five had complaints related to substance use including ethanol (n = 18), "molly" or "ecstasy" (n = 13), and marijuana (n = 8). Three patients required intensive care or step-down unit admission for endotracheal intubation, rhabdomyolysis, and protracted altered mental status. The median LOS for discharged patients was 265 min (interquartile range 210-347 min). Eleven patients required the use of sedative medications, with cumulative doses of 42 mg of lorazepam and 350 mg of ketamine. All patients presented within the hours of 5:00 pm and 2:15 am. CONCLUSION: The majority of ED visits from an EDM festival were related to substance use. ED arrival times clustered during the evening and were associated with prolonged LOS. Few patients required hospital admission, but admitted patients required high levels of care. HCFs should use these data as a guide in planning for future events.

Assessment of DNA damage in a group of professional dancers during a 10-month dancing season.

Despite the numerous health benefits of physical activity, some studies reported that increased intensity and duration may induce oxidative stress in several cellular components including DNA. The aim of this study was to assess the level of basal DNA damage as well as oxidative DNA damage in a group of professional dancers before and after a 10-month dancing season. A group of individuals from general population was also assessed as a control. The alkaline version of the comet assay was the method selected to measure both basal DNA damage and oxidative stress, since this method quantifies both endpoints. In order to measure oxidative stress, the comet assay was coupled with a lesion-specific endonuclease (formamidopyrimidine glycosylase) to detect oxidized purines. The levels of oxidative DNA damage in dancers were significantly increased after the dancing season. Pre-season levels of oxidative DNA damage were lower in dancers than those obtained from the general population, suggesting an adaptation of antioxidant system in dancers. Results of the present biomonitoring study indicate the need for more effective measures to protect ballet dancers from potentially occupational health risks related to regular intensive physical exercise.

The effect of dance therapy on the balance of women over 60 years of age: The influence of dance therapy for the elderly.

Dance therapy is a physical activity that can lead to balance improvement in older adults. The aim of the study was to evaluate the effects of dance therapy on balance and risk of falls in older women. Twenty-four older women (mean age 66.4 years old) attended dance sessions for three months. Pretest/posttests were completed using the Postural Stability Test, the Limits of Stability Test, and the Fall Risk Test M-CTSIB. Results showed the Limits of Stability Test was significantly higher (17.5%) after dance classes. Regular use of dance therapy shows promise in improving balance by increasing the limits of stability.

Eating Disorders in Non-Dance Performing Artists: A Systematic Literature Review.

PURPOSE: Previous literature on dancers and athletes has shown a large impact of eating disorders (EDs) on these individuals, but there is limited research on EDs affecting non-dance performing artists (i.e., musicians, actors, etc.). This systematic review aimed to identify and evaluate the literature on EDs in non-dance performing artists. METHODS: A systematic review of the literature was performed on 24 databases, using search terms related to EDs and non-dance performing artists. All results from the databases were systematically screened for inclusion and exclusion criteria. RESULTS: The initial search returned 86,383 total articles, which after screening and removal of duplicates and irrelevant papers yielded 129 results. After screening the 129 full-text results for eligibility, 10 studies met criteria for inclusion: 6 papers addressed EDs in musicians, and 4 papers addressed EDs in theatre performers. Most studies used questionnaires and body mass index (BMI) as diagnostic tools for EDs. Most were small-scale studies and participants were mostly students. Because of the studies' heterogeneity and varying quality, the results obtained were often contradictory and questionable. CONCLUSIONS: Although there has been a lot of literature in dancers, we found relatively few studies associating EDs with other performing artists, and most were inconsistent in their information.

Epidemiology of Dance-Related Injuries Presenting to Emergency Departments in the United States, 2000-2013.

Dance is a popular activity associated with many physical and mental health benefits, but injuries are a concern for all skill levels. Previous studies have focused on professional dancers or particular genres, meaning the population-wide characteristics of injuries is unknown. This study's objective was to identify the incidence and types of dance-related injuries evaluated in emergency departments in the United States over the 14-year period 2000-2013. METHODS: Data were obtained from the nationally representative National Electronic Injury Surveillance System from 2000-2013. National estimates of injuries were determined using complex sample design. Trends using 2-year intervals were calculated using linear regression and injury proportion ratios using Pearson's X2. RESULTS: The average annual incidence of dance-related injuries requiring emergency medical attention was 17,145 per year. The number of injuries grew from 14,204 in 2000/1 to 21,356 in 2012/3, a change of 33.4% after accounting for population growth. Lower limb injuries were most common, particularly ankle and knee sprains. Females presented with a greater proportion of ankle (injury proportion ratio [IPR]=1.34, p=0.029) and foot sprains (IPR=2.11, p<0.001) but a lower proportion of shoulder sprains (IPR=0.41, p<0.001) and face lacerations (IPR=0.13, p<0.001). Younger dancers presented with a lower proportion of knee (IPR=0.79, p=0.006) and low back sprains (IPR=0.68, p=0.019). CONCLUSIONS: The average annual incidence of dance-related injuries of a serious enough nature to require presentation to the emergency department in the United States was 17,145 per year, with ankle and knee sprains being the most common. Injury numbers have increased in recent years.

To dance or not to dance? A comparison of balance, physical fitness and quality of life in older Irish set dancers and age-matched controls.

OBJECTIVE: The objective of this study is to determine if older adults regularly participating in Irish set dancing have superior balance, physical fitness and quality of life compared to age-matched controls. STUDY DESIGN: This study used a community-based, observational cross-sectional design. METHODS: Regular set dancers (n = 39) and age-matched controls (n = 33) were recruited. Participants were assessed using the physical activity scale for the elderly (physical activity levels), mini-BESTest (balance) and senior fitness test (battery of functional fitness tests). Quality of life was also assessed using the EuroQol EQ visual analogue scale. RESULTS: When controlling for between-group differences in levels of physical activity (ANCOVA analysis), the dancers had significantly better balance, functional capacity and quality of life (all P < 0.05) compared to controls. No differences between the groups were observed in other measures of functional fitness. CONCLUSION: The findings of this study suggest regular participation in set dancing is associated with health benefits for older adults. These results may inform future studies prospectively examining the role of set dancing for falls prevention, emotional well-being and cognitive function in community-dwelling older adults.

Injuries Among Italian DanceSport Athletes: A Questionnaire Survey.

During training and competition, athletic dancers perform complex artistic movements that can lead to stress on the musculoskeletal system, making them subject to high risk of injury. The purpose of this study was to evaluate the prevalence, location, and nature of musculoskeletal injuries among dancesport athletes and to identify potential risk factors for injury. This cross-sectional study was performed at several national dancesport meetings in Italy. All 168 dancesport athletes who participated at the meetings were invited to complete a questionnaire related to injuries they may have suffered during the previous year; other information collected included demographic data (age, sex, height, weight), dance participation (discipline, categories), training (training duration, years since starting to dance), and injury (location, etiology). Of the 168 dancers, 153 completed the questionnaire. Of the 102 injuries reported, 73 athletes (47.7%) reported at least 1 injury. The locations of the injuries were the lower limbs (n=75, 73.5%), upper limbs (8, 7.8%), and spine (19, 18.7%). Significant differences were found in the injury location (p<0.01) as well as the nature of the injury (p<0.01). No significant differences were found between injured and non-injured athletes in demographic data, dance participation, and training variables (p>0.05). The results indicate that about half of the dancers reported at least 1 injury, with these being located particularly in the lower limbs and predominantly strain and sprain injuries. To reduce the prevalence of injuries, a prevention program may be indicated, with future research needed to identify appropriate strategies to prevent injuries.

Structural vulnerabilities to HIV/STI risk among female exotic dancers in Baltimore, Maryland.

Female exotic dancers (FEDs) are an important, yet understudied group of women who may engage in drug- and sex-related HIV/STI risk behaviors through their work. The study objective was to identify co-occurring indicators of vulnerability (e.g., housing, income, incarceration) associated with HIV/STI risk behavior among FEDs in Baltimore, Maryland. Surveys administered during July 2008-February 2009 captured socio-demographic characteristics, drug use, and sexual practices among dancers (N = 101) aged ≥18 years. Multivariate logistic regression was used to assess the relationship between vulnerability and risk behavior. Dancers with a high vulnerability score (i.e., 2 or more indicators) were more likely to report sex exchange (AOR: 10.7, 95% CIs: 2.9, 39.9) and multiple sex partnerships (AOR: 6.4, 95% CIs: 2.3, 18.3), controlling for demographics and drug use, compared to their less vulnerable counterparts. Findings point to primacy of macro-level factors that need to be addressed in HIV/STI prevention efforts targeting this and other high-risk populations.

Prevalence of myofascial trigger points and diagnostic criteria of different muscles in function of the medial longitudinal arch.

OBJECTIVES: To evaluate the reliability of the used diagnostic criteria of latent trigger points (LTrPs) and pressure pain thresholds and to evaluate the prevalence of LTrPs in several muscles of the lower limb in subjects with a lower medial longitudinal arch (MLA) compared with controls. DESIGN: Cross-sectional study. SETTING: University campus. PARTICIPANTS: Subjects with a lower limb MLA (n=82) and controls (n=82) (N=164). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: The navicular drop test was used to classify subjects with a lower MLA (≥10mm) and controls (5-9mm). The Simons et al recommended specific diagnostic criteria and pressure pain thresholds were used to evaluate the prevalence of LTrPs in several muscles of the lower limb, which was compared between the 2 groups. The reliability was evaluated using Cohen's kappa and intraclass correlation coefficient. The unpaired Student t test and chi-square test were used to evaluate the difference in the LTrP prevalence between the 2 groups. RESULTS: The intrarater reliability of the navicular drop test and the diagnosis of LTrPs was excellent, with the taut band and tender spot being the most reliable diagnostic criteria. In the lower MLA group, 60 subjects (73%) presented at least 1 LTrP whereas 57 controls (70%) presented at least 1 LTrP. The lower MLA group showed more LTrPs (4.46±4.10) than did controls (3.32±3.24) (P<.05). There were significantly (P<.05) more subjects with LTrPs in the flexor digitorum longus, tibialis anterior, and vastus medialis in the lower MLA group than in the control group. CONCLUSIONS: LTrPs are common in the lower limb muscles in both controls and subjects with a lower MLA. A lower MLA is associated with a higher prevalence of LTrPs, which are significant in the flexor digitorum longus, tibialis anterior, and vastus medialis.

Athletes Doing Arabesques: Important Considerations in the Care of Young Dancers.

Dance is as much a sport as an art form. Sports medicine clinicians seeing dancers in their practice will need to be familiar with the unique characteristics of dance in order to provide proper care. Dance encompasses different forms, which vary in equipment and terminology. The epidemiology of dance injuries has historically focused on ballet, but there is increasing research on other dance forms. Lower extremity and back injuries predominate. Injury prevention, both primary and secondary, is at the heart of dance medicine. Primary prevention includes preseason conditioning, identifying risk factors for injury, and recognizing the female athlete triad. Secondary prevention includes a comprehensive approach to injury rehabilitation, an appreciation for the unique demands of dance, and an understanding of the particulars of the injury being treated. Dancers may have difficulty accessing medical care or following prescribed advice; the proactive clinician will anticipate these situations.

Prevalence and predictors of adolescent idiopathic scoliosis in adolescent ballet dancers.

OBJECTIVE: To determine any differences between the prevalence of adolescent idiopathic scoliosis in ballet dancers who are girls compared with age-matched nondancers, and to establish if any relations exist between the presence of scoliosis and generalized joint hypermobility, age of menarche, body mass index (BMI), and the number of hours of dance training per week. DESIGN: Cross-sectional, matched pair study. SETTING: Dance school. PARTICIPANTS: Dancers (n=30) between the ages of 9 and 16 years were recruited from a certified dance school in Western Australia; each dancer provided a consenting age-matched nondancer (n=30). INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Measurements were taken for angle of trunk rotation using a scoliometer (presence of scoliosis) and for height and weight to produce generalized joint hypermobility using Beighton criteria and an age-adjusted BMI, respectively. A subjective questionnaire regarding age of menarche and participation in dance and other sports was completed. RESULTS: Thirty percent of dancers tested positive for scoliosis compared with 3% of nondancers. Odds ratio calculations suggest that dancers were 12.4 times more likely to have scoliosis than nondancers of the same age. There was a higher rate of hypermobility in the dancer group (70%) compared with the nondancers (3%); however, there were no statistically significant relations between scoliosis and hypermobility, age of menarche, BMI, or hours of dance per week. CONCLUSIONS: Adolescent dancers, similar to adult dancers, are at significantly higher risk of developing scoliosis than nondancers of the same age. Vigilant screening and improved education of dance teachers and parents of dance students may be beneficial in earlier detection and, consequently, reducing the risk of requiring surgical intervention.

Perfectionism and eating psychopathology among dancers: the role of high standards and self-criticism.

This study examined the associations between conscientious perfectionism (high standards), self-evaluative perfectionism (self-criticism) and eating psychopathology among dancers. A sample of 244 female dancers, with a mean age of 20.11 years (standard deviation=1.97) completed the Perfectionism Inventory and Eating Disorder Examination Questionnaire. Self-evaluative perfectionism predicted eating psychopathology (eating restraint, eating concern, weight concern and shape concern). This relationship was not moderated by conscientious perfectionism. The mediation analyses showed that although conscientious perfectionism predicted eating psychopathology, this relationship was fully mediated by self-evaluative perfectionism. These findings demonstrate the greater influence of self-evaluative perfectionism, rather than conscientious perfectionism, on eating psychopathology in dancers.

A longitudinal examination of the relationship between perfectionism and motivational climate in dance.

The present study examined the relationship between dance-related perfectionism and perceptions of motivational climate in dance over time. In doing so, three possibilities were tested: (a) perfectionism affects perceptions of the motivational climate, (b) perceptions of the motivational climate affect perfectionism, and (c) the relationship is reciprocal. Two hundred seventy-one young dancers (M = 14.21 years old, SD = 1.96) from UK Centres for Advanced Training completed questionnaires twice, approximately 6 months apart. Cross-lagged analysis indicated that perfectionistic concerns led to increased perceptions of an ego-involving climate and decreased perceptions of a task-involving climate over time. In addition, perceptions of a task-involving climate led to increased perfectionistic strivings over time. The findings suggest that perfectionistic concerns may color perceptions of training/performing environments so that mistakes are deemed unacceptable and only superior performance is valued. They also suggest that perceptions of a task-involving climate in training/performing environments may encourage striving for excellence and perfection without promoting excessive concerns regarding their attainment.

Aerobic exercise, ball sports, dancing, and weight lifting as moderators of the relationship between stress and depressive symptoms: an exploratory cross-sectional study with swiss university students.

This exploratory study was designed to compare four types of exercise activities in Swiss university students. A sample of 201 medical students (136 women, 65 men; M age = 23.2 yr., SD = 2.4) and 250 exercise and health sciences students (144 women, 106 men; M age = 22.3 yr., SD = 2.2) participated in the study. They completed the Perceived Stress Scale, the Depression Scale, and the Office in Motion Questionnaire. Interaction effects between stress and exercise activities were analysed using hierarchical regression analyses, after controlling for age, sex, and academic discipline. Frequent participation in ball sports and dancing were associated with decreased depressive symptoms among students with elevated perceived stress, whereas no such relationship existed among their peers with lower perceived stress. No stress-moderating effect was found for aerobic exercise. Weight lifting was only associated with lower depressive symptoms among students with low perceived stress. The present findings suggest that, among Swiss university students, certain exercises may have better potential to moderate the relationship between perceived stress and depressive symptoms than others. Future research could analyze whether personalized exercise programs created to satisfy participants' individual needs are more beneficial for stress management.