The Concept of Neuromuscular Repatterning in Dancers: A Systematic Review.

Repatterning is a term that can be used in different fields, including genetics, molecular biology, neurology, psychology, or rehabilitation. Our aim is to identify the key concept of neuromuscular repatterning in somatic training programmes for dancers. A systematic search of eight databases was conducted using the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) guidelines. The Quality Assessment Tool for Quantitative Studies and the Oxford Levels of Evidence scales were used. The search yielded 1218 results, of which 5 met the inclusion criteria. Five studies (n = 5) were related to psychosomatic health (n = 5), two studies highlighted integration and inter-articular connectivity in movement (n = 2), four studies investigated the neurological component of alignment and efficiency in dance practice (n = 4), and two studies investigated self-confidence (n = 2). Five studies (n = 5) used imagery based on the anatomical and physiological experience of body systems as the main analytical method. Four studies (n = 4) used developmental movement through Bartenieff fundamentals as the main technique for this methodology. Developmental movement and imagery are two methodologies strongly connected to the concept of neuromuscular repatterning in somatic training programmes for dancers. The acquisition of further quantitative experimental or quasi-experimental studies is warranted to better define the level of improvement or impact of neuromuscular repatterning in dancers.

A systematic review on the application of Aikido as a psychosomatic tool in therapeutic setting (Part I) / Una revisión sistemática sobre la aplicación del Aikido como una herramienta psicosomática en sectores terapéuticos (Parte I)

It is our contention that Aikido may have sufficient support for its use in complementary therapies in the field of clinicaltreatment. However, as far as we are aware, no extensive scientific studies highlighting the application of Aikido as a psycho-somatic therapy in the field of psychological behavioural disorders has been carried out. Our aim here was to conduct asystematic review of scientific studies associated with the possible psychosomatic benefits of Aikido practice and to examinewhether there is any theoretical basis for this psychosomatic health connection. In terms of methodology, a systematic reviewof published scientific literature on health and Aikido was conducted in adherence with PRISMA guidelines. Three aspectsof the application of Aikido were identified, one corresponding to phases more susceptible to psycho-emotional instabilitysuch as during the period of adolescence; another aspect related to the treatment of overcoming trauma in subjects withpost-traumatic stress disorder and the final aspect related to the improvements as a result of the practical intervention ofmindfulness. It is evident from our review, that the treatment of Aikido as a discipline with psychotherapeutic potential requiresfurther expert analysis from a cross-disciplinary and interdisciplinary perspective, which would involve establishing a suitableintervention model in order to attain a deeper understanding of the discipline of Aikido. Moreover, a mastery of the field ofpsychology and psychiatry is required to understand the internal cognitive processes of the subjects studied.(AU)

Hasta donde tenemos conocimiento no existe un campo de carácter científico extenso de la aplicación terapéutica derelación psicosomática en el Aikido, en el entorno de los trastornos y afecciones psicológicas del comportamiento. Partimosde la hipótesis de que el Aikido podría tener un respaldo suficiente en su uso en terapias complementarias al ámbito de lostratamientos clínicos. Nuestra finalidad fue realizar una revisión sistemática sobre los estudios de carácter científico asociadosa los posibles beneficios psicosomáticos de la práctica del Aikido y comprobar si hay una teoría entre esta conexión de saludpsicosomática. Metodológicamente se realizó una revisión sistemática de la literatura científica publicada en materia de saludy Aikido. Para su elaboración se han seguido las directrices de la declaración PRISMA. Se observan tres vertientes de aplicacióndel Aikido, una correspondiente a fases más susceptibles de inestabilidad psicoemocional como es la adolescencia. Otravertiente relacionada con el tratamiento de superación de traumas en sujetos con trastorno por estrés postraumático y unaúltima relacionada con la mejora de los aspectos relacionado con la intervención práctica de mindfulness. Se evidencia queel tratamiento del Aikido como una disciplina con potencial psicoterapéutico que requiere de un mayor análisis de expertosdesde una perspectiva transdisciplinar e interdisciplinar, que permita encontrar un modelo de intervención idóneo para tenerun conocimiento más profundo de la disciplina del Aikido. Además, se requiere un dominio del campo de la psicología y dela psiquiatría que permita entender los procesos cognitivos internos de los sujetos estudiados.(AU)

A systematic review on the application of Aikido as a psychosomatic tool in therapeutic setting (Part I) / Una revisión sistemática sobre la aplicación del Aikido como una herramienta psicosomática en sectores terapéuticos (Parte II)

It is our contention that Aikido may have sufficient support for its use in complementary therapies in the field of clinicaltreatment. However, as far as we are aware, no extensive scientific studies highlighting the application of Aikido as a psycho-somatic therapy in the field of psychological behavioural disorders has been carried out. Our aim here was to conduct asystematic review of scientific studies associated with the possible psychosomatic benefits of Aikido practice and to examinewhether there is any theoretical basis for this psychosomatic health connection. In terms of methodology, a systematic reviewof published scientific literature on health and Aikido was conducted in adherence with PRISMA guidelines. Three aspectsof the application of Aikido were identified, one corresponding to phases more susceptible to psycho-emotional instabilitysuch as during the period of adolescence; another aspect related to the treatment of overcoming trauma in subjects withpost-traumatic stress disorder and the final aspect related to the improvements as a result of the practical intervention ofmindfulness. It is evident from our review, that the treatment of Aikido as a discipline with psychotherapeutic potential requiresfurther expert analysis from a cross-disciplinary and interdisciplinary perspective, which would involve establishing a suitableintervention model in order to attain a deeper understanding of the discipline of Aikido. Moreover, a mastery of the field ofpsychology and psychiatry is required to understand the internal cognitive processes of the subjects studied.(AU)

Hasta donde tenemos conocimiento no existe un campo de carácter científico extenso de la aplicación terapéutica derelación psicosomática en el Aikido, en el entorno de los trastornos y afecciones psicológicas del comportamiento. Partimosde la hipótesis de que el Aikido podría tener un respaldo suficiente en su uso en terapias complementarias al ámbito de lostratamientos clínicos. Nuestra finalidad fue realizar una revisión sistemática sobre los estudios de carácter científico asociadosa los posibles beneficios psicosomáticos de la práctica del Aikido y comprobar si hay una teoría entre esta conexión de saludpsicosomática. Metodológicamente se realizó una revisión sistemática de la literatura científica publicada en materia de saludy Aikido. Para su elaboración se han seguido las directrices de la declaración PRISMA. Se observan tres vertientes de aplicacióndel Aikido, una correspondiente a fases más susceptibles de inestabilidad psicoemocional como es la adolescencia. Otravertiente relacionada con el tratamiento de superación de traumas en sujetos con trastorno por estrés postraumático y unaúltima relacionada con la mejora de los aspectos relacionado con la intervención práctica de mindfulness. Se evidencia queel tratamiento del Aikido como una disciplina con potencial psicoterapéutico que requiere de un mayor análisis de expertosdesde una perspectiva transdisciplinar e interdisciplinar, que permita encontrar un modelo de intervención idóneo para tenerun conocimiento más profundo de la disciplina del Aikido. Además, se requiere un dominio del campo de la psicología y dela psiquiatría que permita entender los procesos cognitivos internos de los sujetos estudiados.(AU)

Ankle Active Range of Motion as an Essential Factor of Footwork Technique in the Prevention of Overuse Injuries in Flamenco Dancers / Rango de movimiento activo del tobillo como factor esencial de la técnica de zapateado en la prevención de lesiones por sobreuso en bailarinas de flamenco

Flamenco dance is a performing art which is based on footwork technique where the foot and ankle play an important role.The objective of this study was to investigate the effect of ankle active range of motion on external load and its efficacy as apredictor during a flamenco footwork technique, with consideration of accelerometer positions and dance proficiency. Twelveflamenco dancers composed of 6 professional and 6 amateurs participated voluntarily in this study for whom no significantdifferences were detected regarding age, mass or height. Participants completed a 15-second Zap-3 footwork test at a speedof 160 bpm (beats per minute), 180 bpm and as fast as they could. Triaxial accelerometers were positioned at the dominantankle, 5th lumbar vertebrae and 7th cervical vertebrae to calculate accumulated PlayerLoad and uniaxial PlayerLoad of the3 planes (anteroposterior, mediolateral and vertical) for each speed level. Percentage contributions were also calculated. Theeffect of dorsiflexion on the external load of the dominant ankle of both professional and amateur dancers existed only in theanteroposterior axis while dorsiflexion was related to the external load at the 7th cervical vertebrae and only amateurs wereaffected. Plantarflexion only affected the uniaxial contribution of the vertical-axis of professional dancers. These programswould be applied to develop a technique feedback system for the flamenco dancer to follow their own model with respectto the ideal. This would allow intervention in the prevention of overuse injuries in flamenco dance artists.(AU)

El baile flamenco es un arte en el que el zapateado tiene un papel muy relevante. El objetivo de este estudio fue investigar elefecto del rango de movimiento activo del tobillo sobre la carga externa y su eficacia como predictor durante la realizaciónde un zapateado flamenco, en función de las posiciones del acelerómetro y el dominio técnico de los participantes. Un totalde doce bailaoras de flamenco, 6 profesionales y 6 amateurs, participaron voluntariamente en este estudio y en los que nose encontraron diferencias significativas respecto a edad, peso o estatura. Los participantes realizaron un test de zapateadodenominado Zap-3 durante 15 segundos a una velocidad de 160 pulsos por minuto, 180 y tan rápido como pudieron. Secolocaron acelerómetros triaxiales en el tobillo del pie dominante, en la 5ª vértebra lumbar y en la 7ª vértebra cervical paracalcular la PlayerLoad acumulada y la PlayerLoad uniaxial de los 3 planos (anteroposterior, medio-lateral y vertical) en funciónde cada nivel de velocidad, así como sus contribuciones porcentuales. Solamente se ha encontrado relación entre la flexióndorsal del tobillo dominante y la carga externa en el eje anteroposterior, tanto en profesionales como amateurs, mientras quea nivel de la 7ª vértebra cervical sólo se ha encontrado relación entre la dorsiflexión y la carga externa en el grupo de amateurs.Respecto a la flexión plantar solo se ha encontrado relación a nivel uniaxial con el eje vertical de los bailarines profesionales.Estos programas podrían servir de ayuda a desarrollar un sistema de retroalimentación de la técnica para que el practicantede baile flamenco pueda seguir su propio modelo respecto al ideal. Esto permitiría intervenir en la prevención de las lesionespor sobreuso en los artistas de baile flamenco.(AU)

External Load of Flamenco Zap-3 Footwork Test: Use of PlayerLoad Concept with Triaxial Accelerometry.

The intense footwork required in flamenco dance may result in pain and injury. This study aimed to quantify the external load of the flamenco Zapateado-3 (Zap-3) footwork via triaxial accelerometry in the form of PlayerLoad (PL), comparing the difference in external loads at the fifth lumbar vertebra (L5), the seventh cervical vertebra (C7) and the dominant ankle (DA), and to explore whether the speed, position, axis and proficiency level of the flamenco dancer affected the external load. Twelve flamenco dancers, divided into professional and amateur groups, completed a 15-s Zap-3 footwork routine at different speeds. Triaxial accelerometry sensors were positioned at the DA, L5 and C7 and were utilized to calculate the total PlayerLoad (PLTOTAL), uniaxial PlayerLoad (PLUNI) and uniaxial contributions (PL%). For both PLTOTAL and PLUNI, this study identified significant effects of speed and position (p < 0.001), as well as the interaction between speed and position (p ≤ 0.001), and at the DA, values were significantly higher (p < 0.001) than those at C7 and L5. Significant single axis and group effects (p < 0.001) and effects of the interactions between the position and a single axis and the group and speed (p ≤ 0.001) were also identified for PLUNI. Medial-lateral PL% represented a larger contribution compared with anterior-posterior PL% and vertical PL% (p < 0.001). A significant interaction effect of position and PL% (p < 0.001) also existed. In conclusion, the Zap-3 footwork produced a significant external load at different positions, and it was affected by speed, axis and the proficiency level of the flamenco dancer. Although the ankle bears the most external load when dancing the flamenco, some external load caused by significant vibrations is also borne by the lumbar and cervical vertebrae.

Evaluation of the Correlation Between Flamenco Dance and Ankle and Foot Posture.

BACKGROUND: The practice of flamenco dance involves great biomechanical demands, comparable with a high-performance sport. The technical movements of the footwork tap, the jumps, and the turns increase the prevalence of injuries and pathologic disorders of the foot and lower limb. Limited research has examined adaptation of the foot posture and dorsiflexion of the ankle in flamenco dancing. Therefore, the aim of this study was to evaluate whether the practice of flamenco dancing produces modifications in the ankle's dorsiflexion range of motion, Foot Posture Index, or pronation. METHODS: A cross-sectional observational study with intentional sampling was performed with 26 individuals (52 feet) in two groups: professional female flamenco dancers (n = 13) and nondancers (n = 13). The participants were assessed in a single session for ankle dorsiflexion, foot pronation (navicular drop test), and foot posture (Foot Posture Index). RESULTS: Significant differences were found between the two groups for left foot Foot Posture Index (P = .007) and right foot navicular drop test (P = .006). CONCLUSIONS: The results of this study indicate that flamenco dancing can produce modifications in the Foot Posture Index and foot pronation versus nondancers. Further research is required.

Biomechanical Effects of Flamenco Footwork.

Footwork is one of the basic features of flamenco dancing and is performed in traditional high-heeled shoes. The purpose of this study was to analyse the mechanical profile of flamenco dancing in terms of vertical ground reaction force, and knee joint kinematics of the supporting limb in footwork technique in order to understand causes which predispose injuries derived from the practice of flamenco dancing. The participant in our study was a professional female flamenco dancer (34 years, 58 kg, 1.65 m) who performed the ZAP 3 test, a sequence of single strikes of the feet performed continuously for 15 s. 3D lower extremity kinematic data were collected using a five-camera motion analysis system (Vicon; Oxford Metrics Ltd., Oxford, UK). Ground reaction forces were recorded using a Kistler force plate. Our analysis was based on 30 cycles of each lower limb consisting of 177 footwork steps. The vertical component of the ground reaction force did not reveal any significant differences between the left and the right limb. The most dynamic strike was provided by the heel (twice the participant's body weight). The mean angular displacement of the supporting limb's knee was ~27°. Results reveal that these impacts could make the knee joint more prone to injuries.

Sagittal Integral Morphotype of Female Classical Ballet Dancers and Predictors of Sciatica and Low Back Pain.

The aims of this study were to describe the sagittal integral morphotype (SIM) of classical ballet (CB) dancers, and to establish predictor factors and their cut off values for high risk of experiencing sciatica or low back pain (LBP). This retrospective cohort study was performed in 33 female professional CB dancers. Data related to anthropometric parameters, CB dance experience, sciatica or LBP history, and sagittal spine curvatures were collected. A binary logistic regression and receiver-operating characteristic analysis were performed. The main spine misalignments observed in the SIM of CB dancers were thoracic functional hyperkyphosis, hypomobile kyphosis, and hypokyphosis, and those for the lumbar curvature were hyperlordotic attitude and functional hyperkyphosis. The lumbar curvature in slump sitting and trunk forward bending positions, together with the stature, were significant predictor factors of sciatica history, while the years of dance experience was a significant predictor factor of LBP history. The cut off values analysis revealed that dancers with a stature of 161 cm or less, and those with 14 years of experience or more, have a greater probability of experiencing sciatica or LBP history, respectively.

Biomechanical Description of Zapateado Technique in Flamenco.

The main purpose of this study was to identify a dancer's body alignment while performing flamenco footwork to provide a detailed description that could be used by flamenco practitioners: teachers, instructors and students of different levels of advancement. The zapateado technique performed by a professional flamenco dancer was analyzed. The biomechanical analysis was based on 30 cycles composed of six repeating sequences of strikes. Kinematic recordings were performed using a Vicon system, while the measurement of the ground reaction forces (GRF) was accomplished with a Kistler force plate. The following parameters were analyzed: the time of each foot strike, the maximal value of the vertical component of GRF normalized to body weight (BW) for subsequent footwork steps, the impulse of the GRF and the kinematics of pelvis and lower limb joints, and an exemplary waveform view of the sound of footwork strikes was shown. The average values of the vertical component of GRF ranged between 0.6 and 2.7 BW. The maximal anterior pelvic tilt was 29°, with a 6° range of motion (RoM). This mobility was accompanied by 20° hip RoM and by ~40° knee RoM throughout flexion. The conclusions provide practical information that a teacher and flamenco student should receive.

Catastrofismo ante el dolor en estudiantes de baile flamenco de conservatorios profesionales de danza / Pain catastrophizing among professional dance conservatoire flamenco students

Introducción: El baile flamenco se caracteriza por una fuerte impronta emocional y sobre todo por el carácter percutivo desus zapateados realizados con un calzado tradicional de tacón. Esta danza supone altas demandas de esfuerzo con sus con-siguientes riesgos de lesión, dolor y efectos emocionales asociados. El catastrofismo juega un papel esencial en la valoracióndel contexto y la experiencia del dolor. Este estudio tuvo como objetivos; en primer lugar, analizar la incidencia general delcatastrofismo en estudiantes de baile flamenco y; en segundo lugar, determinar la repercusión sobre el catastrofismo de lapráctica profesional en aquellas bailaoras que aun siendo estudiantes actúan escénicamente. Material y método: La muestra analizada consta de 70 alumnas de Conservatorios Profesionales de Danza de Andalucía(17.67±5.65 años); el 44.29% (n=31), también bailaban profesionalmente. Las bailaoras cumplimentaron la Escala de Catas-trofismo ante el Dolor (ECD). Resultados: Los resultados no muestran diferencias significativas en las categorías: rumiación, magnificación, ni en el globaldel catastrofismo ante el dolor al comparar participantes que sólo eran estudiantes de baile y las que además, tenían carácterprofesional. En cambio, en la dimensión de desesperación sí se observa una tendencia significativa entre ambos grupos,estudiantes y profesionales, acentuada en este último grupo. Conclusiones: El desarrollo profesional artístico en escena ante espectadores puede desencadenar estados de ansiedadque pueden llegar a tener una asociación directamente proporcional a los niveles de catastrofismo. Quizás, el hecho de serestudiante y, a la vez, ejercer la profesión de bailaora suponga una mayor carga física y mental que puede desencadenardeterminados procesos psicológicos.(AU)

Introduction: Flamenco is marked by the deep emotional impression it creates and its percussive footwork steps, performedin traditional high-heeled shoes. It places high demands on the dancer which leads to risks of injury, pain and associatedemotional repercussions. Catastrophizing is a key factor determining how the context is valued and pain is experienced. The objectives of this study were: firstly, to analyse the general incidence of catastrophizing among flamenco students andsecondly, to determine the repercussion this has on catastrophizing in professional practice among dancers who perform onstage even though they are still students. Material and method: The sample analyses 70 students from the Conservatorios Profesionales de Danza de Andalucía (Anda-lusian Professional Conservatoires for Dance) (17.67±5.65 years old); 44.29% (n=31) also danced professionally. The dancerscompleted the Pain Catastrophizing Scale (PCS). Results: The results do not show significant differences in categories: rumination, magnification, nor in the overall catastro-phizing of pain when comparing participants who were dance students with those who also danced professionally. However,in terms of helplessness, there is a significant difference between both groups, with those who danced both as students andprofessionals displaying higher levels of helplessness than those who were only students.Conclusions: The artistic professional development on stage before spectators can trigger anxiety states that can have adirectly proportional association to the levels of catastrophism. Perhaps being a student at the same time as dancing profes-sionally signifies a greater physical and mental load which can lead to certain psychological processes.(AU)

Movement concepts approach in studies on flamenco dancing: A systematic review.

BACKGROUND: Flamenco is a highly emotional and demanding dance form. It is important to understand how the dancer's body works in order to improve fitness levels and reduce injuries. Thus, our investigation reviewed studies on kinesiological aspects of flamenco over recent years. METHODS: The review was restricted to experimental studies. Literature searches were conducted using the following databases: PubMed, Scopus, and Ebsco: SPORTDiscus with Full Text, Medline, Health Source: Nursing/Academic Edition, Health Source - Consumer Edition. After limiting the search, 180 potential articles remained for analysis. RESULTS: A total of 27 papers on different aspects of flamenco dance were finally selected: biomechanics (14), podiatry (6), injury incidence (3), anthropometry (2), and physiology (2). These studies have applied well-established methods from sports studies. However, we noted a number of potential limitations when applied to flamenco. CONCLUSIONS: The evidence from this review shows that flamenco dancing demands high levels of effort. Further research is required to understand how the dancer's body works in order to improve fitness levels and reduce injuries. Most of the results presented here are consistent among studies. However, there is a great scarcity of research addressing flamenco movement in a more comprehensive perspective.

Pathologic Disorders of the Foot in Professional Female Flamenco Dancers.

BACKGROUND: The foot is the main element of artistic creation in flamenco dancing. At the professional level, the foot undergoes high musculoskeletal demands, predisposing the development of podiatric pathologic disorders in this group. The principal objective of this study was to determine the most common foot lesions in professional female flamenco dancers. METHODS: In a cross-sectional observational study of 44 female professional flamenco dancers, the participants completed a short questionnaire about their demographic features, number of hours danced per week, and years of professional activity. Any foot lesions presented by the participant were also recorded. RESULTS: Some type of pathologic foot condition was noted in 75% of the women, with a particularly high prevalence of hallux abducto valgus (61.4%), hypermobility of the first ray (43.2%), claw toe (40.9%), and varus fifth toe (37.5%) compared with the general population. No significant differences in the presence of pathologic disorders of the foot were found according to the time dedicated to dance or the years of professional activity. CONCLUSIONS: Female flamenco dancers in this study had a high prevalence of podiatric medical problems: some kind of pathologic abnormality of the foot was present in 75% of the participants. Hallux abducto valgus, claw toe, and hypermobility of the first ray were the most common pathologic disorders observed.

Metatarsal pain and plantar hyperkeratosis in the forefeet of female professional flamenco dancers.

OBJECTIVES: The objectives of this study were to determine the frequency of metatarsal pain and of hyperkeratosis on the plantar forefoot in female professional flamenco dancers, and to determine whether there is a relationship between the two disorders. METHOD: Forty-four female professional flamenco dancers, with a minimum activity of 25 hrs/wk, participated in this cross-sectional study. The presence or absence of metatarsal pain while dancing was recorded, and plantar pressures were measured on a pressure platform, both barefoot and shod with the usual dance shoe. The heel height of the dance shoe was also measured. RESULTS: Of the dancers, 80.7% experienced metatarsal pain while dancing, and 84.1% presented with plantar hyperkeratosis. Plantar hyperkeratosis coincided with the presence of metatarsal pain in 67.04% of the feet studied. The maximum load point in the feet when the dancers were barefoot was located 59.5% in the rearfoot and 40.5% in the forefoot; when dancers wore their specific flamenco dancing shoes, it was located 52.4% in the rearfoot and 47.6% in the forefoot. CONCLUSIONS: Metatarsal pain and plantar hyperkeratosis in the forefoot are common foot disorders in female flamenco dancing. The incidence of the maximum load point being located in the forefoot, and the difference between the results of the tests while shod or barefoot, are both too low to support the idea that the raised heels of flamenco shoes are a major contributing factor for these injuries. Therefore, these disorders may be caused by chronic repetitive trauma suffered during the practice of footwork dancing.