Kinesiophobia in Injured Athletes: A Systematic Review.

Athletes have a high risk of injury. Kinesiophobia is a condition in which an individual experiences a fear of physical movement and activity after an injury occurs. Our purpose was to systematically review the literature about Kinesiophobia in athletes. A systematic review was conducted in February 2023 using PubMed, CINAHL, SPORTDiscus, Web of Science, Cochrane Library, and Medline. Studies were included if they were peer-reviewed, in English, within the last 20 years and included athletes who had been injured and tracked Kinesiophobia. Articles were checked for quality via the modified Downs and Black checklist. Fourteen studies were included in the review and had an average "fair" quality score. Authors examined Kinesiophobia in injured athletes with mostly lower-extremity injuries. Kinesiophobia was associated with lower physical and mental outcomes. Kinesiophobia exists in athletes and can affect both physical and mental factors. The Tampa Scale of Kinesiophobia (TSK) was the most common tool used to examine Kinesiophobia. Common mental factors associated with Kinesiophobia include anxiety, low confidence, and fear avoidance.

Impact of Attentional Focus on Dance Performance: A Critically Appraised Topic.

CLINICAL SCENARIO: Dancing is a demanding esthetic activity with dancers having an 85% annual injury incident rate when performing complex dance motor skills. Teachers and clinicians use a combination of external and internal attentional cues when teaching dancers motor skills and when working on rehabilitation programs with injured dancers, respectively. External attentional focus (ie, focusing on movement outcome) reportedly results in superior performance than internal attentional focus (ie, focus on body movements). Interestingly, dancers reportedly often adopt an internal focus when dancing. Still, limited literature exists examining the effects of attentional focus on dancers' performance. CLINICAL QUESTION: How does attentional focus (external or internal) impact performance in dancers? SUMMARY OF KEY FINDINGS: Four original quasi-experimental studies met inclusion criteria. In the current examination, we found mixed results about the impact of attentional focus in dancers. Specifically, using an external attentional focus resulted in better performance in 2 studies, but these findings were limited to lesser experienced dancers. Experienced dancers did not have any physical performance differences when using external or internal focus. Internal focus also did not negatively affect dancers' performance in 2 studies. Some authors noted positive motivational effects (eg, increased perceived competence) when dancers used external focus. CLINICAL BOTTOM LINE: Low-quality evidence exists supporting the notion that in less experienced dance students, external focus improves performance. In experienced dancers, the type of attentional focus did not impact performance. External focus provides positive mental effects. Thus, clinicians working with dancers can integrate individualized feedback according to dancer level, with a preference toward external focus due to positive mental effects, to design optimal training and rehabilitation programs. STRENGTH OF RECOMMENDATION: Grade B evidence exists supporting the notion that an external attentional focus improves performance in less experienced dance students and also has positive mental effects. Internal attentional focus does not impede experienced dancers' performance.

Multifactorial Exercise Intervention Decreases Falls Risk in High-risk and Low-risk Older Adults.

BACKGROUND: Each year, 1 in 4 people over the age of 65 years of age will experience a fall. It is important to identify and address modifiable risk factors that are associated with falls in adults at high and low risk for falls. HYPOTHESIS: Falls risk improves in both high-risk and low-risk participants with the implementation of Stay Active and Independent for Life (SAIL). STUDY DESIGN: Cohort study. LEVEL OF EVIDENCE: Level 3. METHODS: Seventy-eight older adults (age, 70.9 ± 5.1 years) were included in this study and categorized into high risk and low risk for falling based on the falls risk score from the Physiological Profile Assessment. High risk was defined as having a preintervention falls risk score >1, whereas low risk was defined as having a preintervention falls risk score <1. Both groups had the same 10-week intervention. A multivariate analysis of covariance was used to compare differences pre- and postintervention, using preintervention falls risk score as covariate. RESULTS: Results showed that regardless of preintervention falls risk, participants showed significant improvements in right and left knee extensor strength and sit-to-stand after participation in the 10-week SAIL program. Also, noteworthy is that 15 participants who were considered at high risk for falling preintervention were considered low risk for falling postintervention. CONCLUSION: The positive outcomes noted on modifiable risk factors suggest SAIL can be beneficial for decreasing falls risk in older adults, regardless of risk of falling, using a multifactorial exercise intervention. Our results also showed that it was possible for participants not only to improve falls risk but to improve to such a degree that they change from high risk to low risk of falling. CLINICAL RELEVANCE: Our results demonstrated that SAIL was effective in improving overall fall risk after a 10-week intervention. Targeted community-based interventions for the aging population can bring physical health benefits that can decrease falls risk.

Blood Lactate and Heart Rate Responses Between Active and Passive Recovery Modes Over a 15-Minute Recovery Period in Female Dancers After Kathak Dance.

Introduction: Dance is physically demanding and results in blood lactate (BL) accumulation and elevated Heart Rate (HR). Researchers recommend using either Active Recovery (AR; eg, low-to-moderate intensity-exercise) or Passive Recovery (PR; eg, complete rest) modes after activity. We compared BL and HR responses between AR or PR over a 15-minute recovery period following a Kathak dance. Methods: Twelve female dancers (31.0 ± 6.0 years; 161.5 ± 4.9 cm; 55.5 ± 5.8 kg) performed 2 dance testing sessions (Day 1 = AR, Day 2 = PR) 48 hours apart. Each session started with a 10-minute warm up followed by dancers performing four 2-minute stages of Kathak dance, with three 1-minute periods between stages where we recorded HR and their Rate of Perceived Exertion (RPE:scale = 6-20) to match the intensity of both sessions. Post-dance, we recorded dancers' BL and HR at 1, 3, 5, 10, and 15 minutes while they recovered via AR or PR. Separate 2(mode) × (time) Repeated-Measures-ANOVA followed by simple-main-effects testing and adjusted Bonferroni-pairwise-comparisons examined differences in BL and HR responses across modes and time(α = .05). Results: Dancers' HR and RPE were similar across sessions. No mode × time interaction existed in BL (F4,8 = 3.6, P = .06). BL levels were similar across modes (F1,2 = 0.5, P = .5). BL levels reduced over time (F4,8 = 6.0, P = .02), but Bonferroni-comparisons did not reveal any pairwise differences. In HR a significant mode*time interaction (F4,36 = 11.0, P = .01, η2 = .55) was observed. Both Active and Passive recovery modes achieved absolute HR levels by 15 minutes, with PR mode stabilizing within 5 minutes. Conclusions: Over a 15-minute recovery period after Kathak dance, dancers' BL and HR responses were similar across time in both AR and PR, with HR being higher in AR. Dancers' HR remained similar from 1 to 3 minute post dance recovery and then dropped over time. Thus, dancers can rest up to 3 minutes and still maintain the same elevated HR. Overall, dancers can choose either AR or PR as their recovery mode based on their individual preferences.

Community arts engagement supports perceptions of personal growth in older adults.

PURPOSE: The effects of arts engagement on older adults have been well-documented. However, the ways older adults overcome common situational and dispositional barriers to enhance personal growth and well-being are less known. METHODS: Fifty-six community dwelling older adults (71.3 ± 4.6 years) took part in dance, music, or a control workshop two times/week for ten weeks. Participants' personal growth was examined through focus groups and surveys in this mixed-methods study. RESULTS: Focus group and survey results revealed participants experienced personal growth through engaging in the dance and music arms of the experiment. Participants, especially those in arts workshops, described personal growth experiences aligning with four themes: increased social connections, developed new skills, utilized a growth mindset, and used creativity to overcome situational and dispositional barriers to participation. The barriers included musculoskeletal challenges, hearing impairments, and difficulty retaining new information. CONCLUSIONS: The study yielded high adherence and retention rates, and participants reported increased engagement within their communities. Our observations provide avenues for future practitioners and facilitators to create programming that empowers older adults and utilizes participants' ongoing feedback to support access, inclusion, and sense of community.

Female Collegiate Dancers' Physical Fitness across Their Four-Year Programs: A Prospective Analysis.

Dance is physically demanding, requiring physical fitness (PF) that includes upper body, lower body, core fitness, and balance for successful performance. Whether PF changes as dancers advance from when they enter (freshmen) to when they graduate from their collegiate program (seniors) is unclear. We prospectively compared collegiate dancers' freshman-to-senior PF. We recorded PF in regard to upper body strength endurance (push-ups), core strength endurance (front, left-side, right-side, and extensor plank hold times), lower body power (single leg hop-SLH-distances % height; Leg Symmetry Index: LSI = higher/lower × 100, %), and balance (anterior reach balance, % leg length, LL; LSI balance = higher/lower × 100, %) in 23 female collegiate dancers (freshman age = 18.2 ± 0.6 years). Repeated measures ANOVAs (p ≤ 0.05) were used to compare measures from freshman to senior years. Across their collegiate programs, dancers' PF remained unchanged. Specifically, their upper body strength endurance push-up numbers (p = 0.93), their core strength endurance plank times (left: p = 0.44, right: p = 0.67, front: p = 0.60, p = 0.22), their SLH distances (left: p = 0.44, right: p = 0.85), and their symmetry (p = 0.16) stayed similar. Also, dancers' right leg (p = 0.08) and left leg balance (p = 0.06) remained similar, with better balance symmetry (p < 0.001) in seniors. Overall, dancers' PF did not change across their collegiate programs. Thus, female dancers' freshman PF may be an adequate baseline reference measure when devising rehabilitation programs and determining readiness-to-return-to-activity post injury.

Sleep, Dance Exposure Hours, and Injury Risk in Collegiate Dancers.

INTRODUCTION: Sleep is essential for athletes and dancers to optimize recovery. Poor sleep negatively affects cognitive function and injury risk in athletes. Increased athletic participation (hours) is associated with decreased total sleep and quality in athletes. Still, information about how sleep is related with exposure hours and injury in collegiate dancers remains unclear. We examined the relationships among the Athlete Sleep Behavior Questionnaire (ASBQ), dance exposure hours (DEHr), and injuries in collegiate dancers over a 7 -month period (August 2019-February 2020). METHODS: Seventy-two dancers (58 female, 14 male; 19.7 ± 1.4 years) completed the 18 question ASBQ at the start of each month (Scale:1 = Never, 5 = Always; Global Scores ≤36 = "good sleep behavior" and ≥42 = "poor sleep behavior"). A DEHr was recorded as 1 hour of dance participation in class, rehearsal, or performance. Injuries were defined as any condition where the dancer sought medical attention, and we calculated an injury rate for total injuries (IR/1000 DEHr). Pearson correlations examined relationships among ASBQ, DEHr, and injuries (P ≤ .05). RESULTS: Dancers participated in 467.8 ± 45.7 DEHr over 7 months, with 14 dancers suffering 18 injuries (IR = 0.5/1000-DEHr; 95% CI:0.3-0.8). Overall, dancers reported poor sleep behaviors (42.6 ± 6.4). ASBQ scores, DEHr, and injuries in August-October, and December-February were not related, except for a weak positive relationship between ASBQ scores and DEHr in November (r = .28, P = .04). CONCLUSIONS: Sleep, DEHr, and injuries were inconsistently related in collegiate dancers. Sleep and DEHr were only correlated during the month where dancers had 2 performance weeks. While we did not observe this relationship every month, performance weeks may have negatively affected sleep in November. Despite consistent poor sleep, sleep did not seem to negatively affect injury risk during the 7 -month study period. Future researchers should validate the ASBQ in dancers.

Spinal Counts, Impact, and Partnering Movements in Ballet, Modern, and Hip Hop dance: A YouTube Video Analysis Study.

INTRODUCTION: Dancers have self-reported a link between spinal extension movements and low back pain (LBP). Researchers have not reported the total number or frequency that spinal movements occur in ballet, modern, or hip-hop dance classes or performances. The purpose of this study was to report the number of spinal movements dancers are exposed to in different dance environments. MATERIALS AND METHODS: We analyzed 65 dance videos on YouTube.com for dance movements within 7 dance environments: ballet class and performance, modern class and performance, and hip-hop breaking, ciphers (large groups), and battles ("1v1s"). Two reviewers recorded counts of spinal (spinal flexion, extension, lateral flexion, and rotation), impact (jumps, leaps, and falls), and partnering movements (lifts, catches, and leans). Data analyses were processed in Jamovi (the jamovi project, Sydney, Australia). We reported movement totals, percentages, frequency, ranges, means with standard deviations (SD), and medians with interquartile range (IQR). We calculated significant differences using Mann-Whitney U tests. RESULTS: Video length ranged from 3 to 141 minutes (mean ± SD: 38.4 ± 38.3, range: 138). the average spinal extension movements ranged from 2 ± 0.8 to 7 ± 9.6 movements per minute across genres. Modern dance class had the most spinal flexion (89 ± 53.6), rotation (60 ± 40.8), and lateral flexion (74 ± 20.7) movements. Ballet performance had the most spinal extension movements (77 ± 69.8), jumps (74 ± 48), and leaps (19 ± 18.2). Hip-hop breaking had the highest number of falling movements (2 ± 2.3). Partnering movements were only present in ballet performance, modern dance performance, and hip-hop breaking environments. CONCLUSIONS: Movements that increase LBP occur often in all 3 dance genres. Dancers can expect frequent exposure to spinal extension movements; therefore, we recommend strengthening back and core musculature for all dancers. We recommend that ballet dancers also strengthen their lower extremity muscles. For modern dancers, we recommend strengthening their obliques. For hip-hop dancers, we recommend increasing muscular power and muscular endurance.

Dance, Music, and Social Conversation Program Participation Positively Affects Physical and Mental Health in Community-Dwelling Older Adults: A Randomized Controlled Trial.

INTRODUCTION: As the world population ages, practitioners use community-engaged interventions to help older adults stay healthy. Engaging in arts programs (e.g., dance or music) reportedly improves physical and mental health, but little research exists examining these effects in community-dwelling older adults. Our purposes were to examine how taking part in 10-week, twice per week community arts programs (dance and music) and control (social conversation) affected physical and mental health in community-dwelling older adults and their perceptions after program participation.
Methods: In this randomized controlled trial, 64 older adults over 65 years of age (71.3 ± 4.6 years, 166.9 ± 8.3 cm, 78.1 ± 18.1 kg) took part in community-engaged arts programs: ballroom dance (n = 23), music (ukulele-playing, n = 17), or control (social conversation n = 24), two times per week for 10 weeks. Participants' physical health using the Short Physical Performance Battery (SPPB; score 0 = worst to 12 = best) and mental health using the Montreal Cognitive Assessment (MoCA; score = 0 to 30, where less than 26 = normal) were tested three times: 1. before (pre), 2. at the end of 10 weeks (post-1), and 3. 1 month after intervention (post-2). Separate 3 (group) x 3 (time) ANOVAs and adjusted Bonferroni pairwise comparisons as appropriate examined changes across groups and time. Focus group interviews and surveys were audio recorded, transcribed, and analyzed using inductive thematic analyses to examine participants' perceptions.
Results: Across all groups, participants had an 87.8% attendance and an 87.5% retention rate. Participants' SPPB performance improved over time (pre = 10.5 ± 1.4, post-1 = 10.7 ± 1.3, post-2 = 11.3 ± 1.0; p < 0.001), but similarly across groups (p = 0.40). Post-hoc analyses revealed that performance improved from pre to post-1 (p = 0.002) and pre to post-2 (p < 0.001). Participants' cognition improved over time (pre = 26.3 ± 2.8, post-1 = 27.3 ± 2.6, post-2 = 27.5 ± 2.5, p < 0.001), and similarly across groups (p = 0.60). Post-hoc analyses revealed that cognition improved from pre- to post-1 (p = 0.002), and pre- to post-2 (p = 0.001). Participants consistently mentioned increased social engagement as the major reason for participation.
Conclusions: Overall, taking part in community-engaged arts (dance and music) and social conversation programs positively influenced physical and mental health in older adults. Still, as all groups improved equally, the results may partly be due to participants having normal physical and mental function pre-participation and due to them learning the test over time. These study findings imply that providing fun and free community-engaged programs that empower participants to be more engaged can positively influence physical and mental health and promote successful aging in older adults.

Perceived Severity and Management of Low Back Pain in Adult Dancers in the United States.

INTRODUCTION: Low back pain (LBP) lifetime prevalence in dancers reportedly ranges from 17% to 88%. Low back pain can have negative secondary consequences on dancers' lives and careers. Still, how LBP impacts dancer function and medical care-seeking behaviors and whether these issues differ across dance genres, is understudied.
Materials and Methods: Two hundred and eight-nine ballet, modern, and hip-hop dancers and teachers (median age: 20.3 years; range: 18 to 69 years) in the United States completed an online 24-question survey assessing LBP related self-reported injury history, impact on their lives, and management strategies. We defined LBP as occurrence of acute or chronic pain in the lumbar or sacral regions of the back.
Results: Two hundred and fifty-seven participants (88.9% of 289 total) reported at least one instance of LBP during their lifetime and 220 participants reported LBP in the prior 4 weeks. Of these 220, 72 (32.7%) had LBP severe enough to limit their activities of daily living. Of the 213 who had LBP and danced during that time, 89 (41.8%) reported that LBP limited their dancing. Pain intensity (median: 4 on a 0 to 10 scale, IQR: 3.0) and LBP prevalence were similar across dance genres. Dancers sought multiple medical professionals, most often chiropractors (n = 94, 33.8%), medical doctors (n = 77, 27.7%), and physiotherapists (n = 60, 21.6%). Ninety dancers (35.0% of those with LBP) never sought medical care. Dancers who did seek care reported higher pain intensities (median: 4, IQR: 3.8) than those who did not (median: 3, IQR: 3.0).
Conclusion: Overall, most participants did suffer from LBP. Low back pain negatively impacts dancers' everyday activities and dancing. Pain intensity and loss of function may impact care-seeking. Our findings highlight the need for all dance stakeholders to educate dancers about their health, provide resources for dancer health care, and proactively create an environment that supports injury reporting behaviors in dancers.

Two-megahertz impedance index prediction equation for appendicular lean mass in Korean older people.

BACKGROUND: Whole-body bioelectrical impedance analysis (BIA) has been accepted as an indirect method to estimate appendicular lean mass (ALM) comparable to dual-energy X-ray absorptiometry (DXA). However, single or limited frequencies currently used for these estimates may over or under-estimate ALM. Accordingly, there is a need to measure the impedance parameter with appendicular lean-specific across multiple frequencies to more accurately estimate ALM. We aimed to validate muscle-specific frequency BIA equation for ALM using multifrequency BIA (MF-BIA) with DXA as the reference. METHODS: 195 community-dwelling Korean older people (94 men and 101 women) aged 70 ~ 92y participated in this study. ALM was measured by DXA and bioimpedance measures at frequencies of 5 kHz ~ 3 MHz were assessed for independent predictive variables. Regression analyses were used to find limb-specific frequencies of bioimpedance, to develop the ALM equations and to conduct the internal cross-validation. The six published equations and the final equation of MF-BIA were externally cross-validated. RESULTS: 195 participants completed the measurements of MF-BIA and DXA. Using bivariate regression analysis, the 2 MHz impedance index explained R2 = 91.5% of variability (P < 0.001) in ALM and predictive accuracy of standard error of estimate (SEE) was 1.0822 kg ALM (P < 0.001). Multiple stepwise regression analysis obtained in the development group had an adjusted R2 of 9.28% (P < 0.001) and a SEE of 0.97 kg ALM. The cross-validation group had no significant difference between the measured ALM and the predicted ALM (17.8 ± 3.9 kg vs. 17.7 ± 3.8 kg, P = .486) with 93.1% of R2 (P < 0.001) and 1.00 kg ALM of total error. The final regression equation was as follows: ALM = 0.247ZI@2 MHz + 1.254SEXM1F0 + 0.067Xc@5 kHz + 1.739 with 93% of R2 (P < 0.001), 0.97 kg ALM of SEE (Subjective Rating as "excellent" for men and "very good" for women). In the analysis of the diagnostic level for sarcopenia of the final regression, the overall agreement was 94.9% (k = 0.779, P < 0.001) with 71.4% of sensitivity, 98.8% of specificity, 91.3 of positive prediction value and 95.3% of negative prediction value. CONCLUSION: The newly developed appendicular lean-specific high-frequency BIA prediction equation has a high predictive accuracy, sensitivity, specificity, and agreement for both individual and group measurements. Thus, the high-frequency BIA prediction equation is suitable not only for epidemiological studies, but also for the diagnosis of sarcopenia in clinical settings.

Upper-Body Strength Endurance and Power Norms in Healthy Collegiate Dancers: A 10-year Prospective Study.

ABSTRACT: Coogan, SM, Hansen-Honeycutt, J, Fauntroy, V, and Ambegaonkar, JP. Upper-body strength endurance and power norms in healthy collegiate dancers: A 10-year prospective study. J Strength Cond Res 35(6): 1599-1603, 2021-Dance is physically demanding and requires dancers to have adequate upper body (UB), core, and lower-body fitness to perform successfully. 50-85% of dancers suffer injury during a performance season. Although a large number of dancer's injuries are to the lower body, several dance genres (e.g., modern, hip hop, and salsa) use UB motions such as partner lifts and holds, which may result in a higher risk for UB injury. Health care practitioners often use baseline physical performance normative values to determine their clients' fitness levels and when planning training programs to prevent or rehabilitate postinjury. Still, little information exists regarding UB fitness norms among collegiate dancers. Thus, our purpose was to determine UB strength endurance and power norms in healthy collegiate dancers. We recorded UB muscular fitness in 214 healthy collegiate dancers (males: n = 26, 174.0 ± 6.7 cm, 71.3 ± 9.2 kg and females: n = 188, 163.0 ± 6.1 cm, 59.3 ± 6.8 kg) prospectively over a 10-year period (2008-2018) in a dance program that emphasizes modern and ballet dance. For UB strength endurance, we recorded the number of push-ups a dancer was able to perform without forcibly straining or losing form for 2 consecutive repetitions. For UB power, dancers sat with legs outstretched, backs flat against a wall, and threw a 3-kg ball horizontally from their chest as far as possible (distance thrown normalized to body height, *BH). The best attempt of 3 trials was used for statistical analyses. We report descriptive statistics, interquartile ranges (IQRs), and percentiles for both outcome measures. Dancers performed 20.4 ± 10.6 (range: 2-70, IQR: 12-24; males: 32.5 ± 14.4; females: 18.4 ± 8.4) push-ups and threw the medicine ball 1.8 ± 0.5 *BH (range: 45-3.9, IQR: 1.4-2.1; females: 1.7 ± 0.5; males: 2.3 ± 0.7). Overall, in this long-term prospective study, we developed UB fitness norms for dancers. The push-up test and medicine ball throw test are simple, low-tech, and inexpensive to test dancers UB fitness. Although dancers' UB muscular fitness was lower than previous reports among traditional sport athletes, these values may not necessarily indicate problems, as subjects were all healthy collegiate-level dancers. Rather, our findings reinforce the need to develop dance-specific norms so that practitioners can use these values to assess dancers' UB fitness and devise interventions appropriately. These results provide baseline UB muscular fitness norms among collegiate modern and ballet dancers, and further support the notion that differing norms are needed for different sports and dance genres. Specifically, future researchers should similarly develop norms across different dance genres for preprofessional and professional dancers and also examine whether these norms can predict dancers' injury risk or performance.

Lower extremity biomechanics and muscle activity differ between 'new' and 'dead' pointe shoes in professional ballet dancers.

The purpose of this study was to compare lower extremity (LE) biomechanics and muscle activity between 'new' and 'dead' pointe shoes in professional female ballet dancers performing relevé and arabesque. We compared sway area, peak ankle moments, and tibialis anterior and medial gastrocnemius muscle activation amplitudes. Nine ballet dancers participated (age = 22.2 ± 2.2 years, height = 163.2 ± 6.3 cm, body mass = 50.8 ± 6.5 kg) executed three trials of relevé and arabesque on pointe shoes under two conditions: 'dead' (108-144 training hours) and 'new' (3-36 training hours). While wearing 'dead' pointe shoes, dancers had significantly higher sway area during both relevé and arabesque (p = 0.017 and 0.028, respectively). Dancers exhibit significantly higher tibialis anterior activation (root mean square, %maximum voluntary contraction) during arabesque while wearing 'dead' pointe shoes (p = 0.043). No significant differences were identified in other dependent variables. The increased sway area and tibialis anterior muscle activity when wearing 'dead' pointe shoes during relevé and arabesque movements demonstrates that using 'dead' shoes is more demanding. Our findings provide quantitative evidence of possible deleterious biomechanical changes when wearing dead pointe shoes that may increase LE injury risk in dancers.

Supplemental Training in Dance: A Systematic Review.

Dancing, like athletics, is physically demanding, but dancing also involves aesthetics. Although athletes often use supplemental training, little information exists about its use in dancers. A review of types and effects of supplemental training on dancers' performance and injury risk indicates that, among largely female collegiate dancers, supplemental training enhances the dancers' performance, but limited evidence exists for injury risk reduction.

Nutrition Periodization in Dancers.

Dancers' energy demands fluctuate across the season. Accordingly, dancers should adapt their training and nutrition. Still, how to periodize nutrition in dancers remains unclear. This article aims to (1) introduce nutrition periodization and (2) provide recommendations for nutrition periodization in dancers. During preseason, dancers design, rehearse, and train. During in-season, dancers have one or more daily performances. During postseason, dancers rest and prepare for the next season. Nutrition periodization is the strategic and timed nutrient intake to meet varying seasonal energy demands. Overall, nutrition periodization can support dancers' training goals, enhance their performance, and support optimal recovery.

FUNCTIONAL MOVEMENT SCREEN™ (FMS™) SCORES DO NOT PREDICT OVERALL OR LOWER EXTREMITY INJURY RISK IN COLLEGIATE DANCERS.

PURPOSE: Dance is a physically demanding activity, with 50-85% of dancers suffering injury during a single performance season. The majority of dancers' injuries are in the lower extremity (LE) and chronic in nature. These injuries often arise when causal factors are not identified early and addressed before they ultimately result in an injury. Practitioners often use movement screens such as the Functional Movement Screen™ (FMS™) to detect and quantify kinetic chain dysfunction. Prior researchers have suggested that these screens can stratify at-risk individuals and allow practitioners to devise targeted interventions to reduce their injury risk. However, whether the FMS™ can identify at-risk dancers remains unclear. Thus, the purpose of this study was to examine whether FMS™ scores predicted injury risk in collegiate dancers. METHODS: In this prospective study, 43 collegiate dance majors (34 female, 9 male; 18.3 ± 0.7yrs; 163.9 ± 7.3cm; 60.8 ± 8.1kg) in a program which emphasizes modern dance were scored on the seven FMS™ movements (scale 0-3, total maximum score=21) where 3=movement completed without compensation, 2=movement completed, but with compensation(s), 1=unable to complete movement, 0=pain during movement or during clearing tests as described in prior literature at the start of the academic year. An in-house certified athletic trainer documented dancer's overall and LE injuries over an academic year (40 weeks). Separate Receiver Operator Characteristic (ROC) curve analyses examined whether composite FMS™ score predicted (1) Overall or (2) LE injury status. RESULTS: The subjects FMS™ scores were 16.2 + 1.7 (range=11-19). Twenty dancers were injured, whereas 23 remained injury-free. Injured dancers had 55 overall (1.28 injuries/dancer) and 44 LE injuries (1.02 LE injuries/dancer). FMS™ score did not predict overall (AUC=.28, SE=.08, p=.02, 95%CI=.13-.43) or LE injury risk (AUC=.38, SE=.1, p=.21, 95% CI=.21-.56). DISCUSSION: While nearly half of the dancers in this group suffered from injury over the year, composite FMS™ scores did not predict overall or LE injury risk in collegiate dancers. Dancers face unique and challenging physical demands that distinguish them from traditional sport-athletes including greater ranges of movement during performance. Thus, the FMS™ may not be sensitive enough to distinguish 'appropriate' from 'excessive' mobility and adequately identify injury risk in dancers. Overall, it is suggested that practitioners should use caution before using the FMS™ as a primary screening mechanism to identify collegiate dancers at overall or LE injury risk. LEVEL OF EVIDENCE: 2.

LOW BACK PAIN AND INJURY IN BALLET, MODERN, AND HIP-HOP DANCERS: A SYSTEMATIC REVIEW.

BACKGROUND: Low back pain is believed to be a common complaint among dancers; however, a comparison across recent research is needed to support or disprove this assertion across genres. PURPOSE: To determine the prevalence of low back pain and low back injury in ballet, modern, and hip-hop dancers through a systematic literature review. A secondary goal was to identify trends amongst dance genres, level of mastery, gender, and age, if possible. STUDY DESIGN: Systematic Review of the Literature. METHODS: PRISMA search strategy of terms relating to dance and low back pain was conducted within the Pubmed, MEDLINE, SPORTDiscus, Web of Science, and the archives of the Journal of Dance Medicine and Science databases between November 2017 and March 2018. Inclusion criteria were published articles that addressed low back pain or injury in ballet, modern, or hip-hop dance population. Exclusion criteria included studies relating to specific pathologies or studies that did not report specific dance genre. All included articles were assessed for quality using a modified grading evaluation and a Modified Newcastle-Ottawa Risk of Bias assessment. RESULTS: Twenty-five ballet articles, five modern, and three hip-hop articles met the inclusion criteria, for a total of 33 articles. Twenty-five of the 33 studies relied on a questionnaire to gather data. Risk of bias results ranged from 3-7/10 and quality of studies ranged from Good I to Limited III. Prevalence of low back pain seems relatively high in ballet dance (range: 20.3%-79% of total dancers are affected). Little research exists on the prevalence of back pain in modern or hip-hop dancers, but hip-hop dancers also seem likely to have low back pain (range: 46.6%-85.7% of total dancers are affected). Low back injuries are also present in ballet (range: 2.1%-88% of total injuries), modern (range: 8.6%-21.6% of total injuries), and hip-hop (range: 26.3%-69.6%). CONCLUSION: Ballet dancers seem to be at risk for low back pain or injury independent of gender, age or level of mastery; however, there is not enough evidence to draw any conclusions about modern dancers or hip-hop dancers and their risk for low back pain/injury currently. Future higher-level studies are needed with reduced risk of bias. LEVEL OF EVIDENCE: 2a.

Health Literacy for Collegiate Dancers: Provision and Perceptions of Health-Related Education in University Dance Programs.

Dancers have unique health issues, including high injury rates and functional, nutritional, and psychological concerns. Thererfore, developing dancers with high health literacy is crucial. This study examines 1. the types of health-related information offered in university dance programs, and 2. the perceptions of dance stakeholders (administrators, faculty, and students) toward health-related education provided to dancers in these programs. Participating stakeholders (N = 104) from 11 countries completed a web-based survey examining health-related offerings for dance students at their instituitions. Eighty-four participants (81%) indicated that health-related information was delivered at their instituition. The most commonly offered topics included functional dance anatomy (N = 82, 98%), recognizing dance injuries and illnesses (N = 66, 79%), and strength and conditioning for dancers (N = 61, 73%). Participants rated recognizing dance injuries and illnesses (N = 72, 69%), basic personal health (N = 70, 67%), and nutrition (N = 68, 65%) as the top three "extremely important" topics, even if these were not offered at their institution. Faculty and administrators reported similar attitudes toward topic importance as those reported by students. Fifty-five respondents (65%) reported textbooks were used to deliver health-related information, and content was also provided via journal articles (N = 58, 69%), organizational web sites (N = 39, 46%), and social media (N = 16, 19%). Reported barriers to providing adequate education included lack of dance faculty expertise to deliver course content (N = 7) and receiving care from practitioners lacking in knowledge of dance medicine (N = 5). Participants generally agreed that making health-related information available was important, and 81% of respondants indicated that it was formally offered at their institution. Variability was noted regarding topics rated "highly important," as compared to which topics were already provided. These findings offer insight into the current status of health-related education provided to dance students and can be used to improve curricula in university dance programs.