Effects of Textured Balance Board Training in Adolescent Ballet Dancers With Ankle Pathology.

CONTEXT: Ankle sprains are common among adolescent ballet dancers and may be attributed to inadequate ankle proprioception. Thus, a short period of training utilizing proprioceptive activities requires evaluation. OBJECTIVE: To assess training conducted for 3 or 6 weeks on a textured-surface balance board using ankle proprioception scores for ballet dancers with and without chronic ankle instability, and with and without previous ankle sprain (PAS). DESIGN: Intervention study. SETTING: The Australian Ballet School. PARTICIPANTS: Forty-two ballet dancers, aged 14-18 years. INTERVENTIONS: Dancers randomized into 2 groups: group 1 undertook 1 minute of balance board training daily for 3 weeks; group 2 undertook the same training for 6 weeks. MAIN OUTCOME MEASURES: Preintervention, Cumberland Ankle Instability Tool questionnaire data were collected, and PAS during the last 2 years was reported. Active ankle inversion movement discrimination ability was tested immediately pre and post intervention and at 3 and 4 weeks. RESULTS: Ankle discrimination acuity scores improved over time for both groups, with a performance decline associated with the early cessation of training for group 1 (P = .04). While dancers with PAS had significantly worse scores at the first test, before balance board training began (P < .01), no significant differences in scores at any test occasion were found between dancers with and without chronic ankle instability. A significantly faster rate of improvement in ankle discrimination ability score over the 4 test occasions was found for dancers with PAS (P = .002). CONCLUSIONS: Three weeks of textured balance board training improved the ankle discrimination ability of ballet dancers regardless of their reported level of chronic ankle instability and at a faster rate for dancers with PAS. Previous ankle sprain was associated with a lower level of ankle discrimination ability; however, following 3 weeks of balance board training, previously injured dancers had significantly improved their ankle discrimination acuity scores.

Influence of Textured Insoles on Dynamic Postural Balance of Young Dancers.

BACKGROUND: Postural balance (PB) is a significant factor in dance performance and injury prevention. We aimed to determine whether the use of textured insoles inserted into casual walking shoes of dancers improved their dynamic PB and whether dancers with previous injury manifested different dynamic PB compared with non-injured dancers. METHODS: In this crossover design study, 26 ballet dancers from the Australian Ballet School, aged 14-19 yrs, were divided into two groups matched by sex and class levels. Group 1 wore the textured insoles in their walking shoes for at least 2 hrs/day during weeks 1 to 4 of the study, and group 2 wore the textured insoles in their walking shoes during weeks 5 to 8. Reports from the school medical staff identified dancers who had previous injuries. All participants were tested pre-intervention and at 4 and 8 weeks by an accelerometer for dynamic PB (average acceleration magnitude, root mean square acceleration, range, and mean frequency) during single-leg fondu, flexing and extending of the knee. FINDINGS: Interactions (group x time) were found in dynamic PB measured in the mediolateral direction, indicating significant differences between the groups at the three testing times. Furthermore, both previously injured and noninjured dancers manifested significant time effects from pre-intervention to 8 weeks, indicating a significant improvement in their PB after using the textured insoles. CONCLUSION: Textured insoles can improve the dynamic PB of ballet dancers and can also be useful as a routine intervention. PB was improved among both dancers with previous injury and non-injured dancers.

Can textured insoles improve ankle proprioception and performance in dancers?

With the aim of determining both the acute and the chronic effects of textured insoles on the ankle discrimination and performance ability of dancers, 60 ballet dancers from the Australian Ballet School, aged 14-19 years, were divided into three groups (two intervention groups and a control group), age- and level-matched. In the first 5 weeks (weeks 1 to 5), the first intervention group (GRP1) was asked to wear textured insoles in their ballet shoes and the second intervention group (GRP2) was not given textured insoles to wear. In the next 5 weeks (weeks 6 to 10), GRP2 was asked to wear the same type of textured insoles and GRP1 did not wear the textured insoles. The control group (CTRL) did not wear textured insoles during the whole 10 weeks. All participants were tested preintervention, after 5 weeks and after 10 weeks for ankle discrimination score (AUC scores). Dance performance was assessed by 5-7 dance teachers. Pre-to-post change in AUC scores was significantly greater for the groups wearing insoles than for the controls (P = .046) and the size of pre-to-post changes did not differ between the two intervention groups (P = .834). Significant correlation was found between ankle discrimination score and performance scores, using the textured insoles (r = .412; P = .024). In conclusion, the stimulation to the proprioceptive system arising from textured insoles worn for five weeks was sufficient to improve the proprioceptive ability and performance ability of ballet dancers.

Use of a Textured Insole to Improve the Association Between Postural Balance and Ankle Discrimination in Young Male and Female Dancers.

UNLABELLED: Ballet dancers require a high level of postural balance (PB) and proprioception ability during performance. As textured insoles inserted into ballet shoes were found to improve proprioception ability, and better proprioceptive acuity was associated with better PB, the aim of the present study was to investigate whether the association between ankle inversion movement discrimination (AIMD) and PB changed following wearing textured insoles in young male and female dancers. METHODS: Forty-four dancers from the Australian Ballet School, ages 14-19 yrs, were tested for static and dynamic PB and AIMD under two conditions: in ballet shoes, and in ballet shoes with textured insoles inserted. RESULTS: Female dancers demonstrated a significant inverse relationship between AIMD and static PB in the medio-lateral direction when wearing ballet shoes, but not when wearing textured insoles. Male dancers showed a non-monotonic relationship when tested with ballet shoes only, but a significant inverse relationship between AIMD and dynamic PB in the vertical direction and with the waist/head cross-correlation acceleration in the three movement directions when they were tested with textured insoles. CONCLUSIONS: Male dancers demonstrated an improved association between dynamic PB and proprioception ability when using textured insoles, suggesting that the increased afferent information from the plantar surface had a beneficial effect on proprioception feedback about their PB. Conversely, for female dancers, that association was present when wearing ballet shoes, but not when using textured insoles, suggesting that the increased afferent information for female dancers who already had high proprioception ability was "overloaded" by wearing the textured insoles.

Should Ballet Dancers Vary Postures and Underfoot Surfaces When Practicing Postural Balance?

BACKGROUND: Postural balance (PB) is an important component skill for professional dancers. However, the effects of different types of postures and different underfoot surfaces on PB have not adequately been addressed. PURPOSE: The main aim of this study was to investigate the effect of different conditions of footwear, surfaces, and standing positions on static and dynamic PB ability of young ballet dancers. METHODS: A total of 36 male and female young professional ballet dancers (aged 14-19 years) completed static and dynamic balance testing, measured by head and lumbar accelerometers, while standing on one leg in the turnout position, under six different conditions: (1) "relaxed" posture; (2) "ballet" posture; (3) barefoot; (4) ballet shoes with textured insoles; (5) barefoot on a textured mat; and (6) barefoot on a spiky mat. RESULTS: A condition effect was found for static and dynamic PB. Static PB was reduced when dancers stood in the ballet posture compared with standing in the relaxed posture and when standing on a textured mat and on a spiky mat (p < .05), and static PB in the relaxed posture was significantly better than PB in all the other five conditions tested. Dynamic PB was significantly better while standing in ballet shoes with textured insoles and when standing on a spiky mat compared with all other conditions (p < .05). CONCLUSIONS: The practical implications derived from this study are that both male and female dancers should try to be relaxed in their postural muscles when practicing a ballet aligned position, including dance practice on different types of floors and on different types of textured/spiky materials may result in skill transfer to practice on normal floor surfaces, and both static and dynamic PB exercises should be assessed and generalized into practical dance routines.

Is There a Correlation Between Static and Dynamic Postural Balance Among Young Male and Female Dancers?

Aimed to investigate whether young male and female dancers have different patterns of association between static and dynamic postural balance (PB), 60 dancers from the Australian Ballet School (14-19 years old) were tested for static and dynamic PB with head and lumbar accelerometers. Monotonic relationships between static and dynamic PB were found in head movements among young female dancers in all three directions, but were found for young male dancers in the mediolateral (ML) and anteroposterior (AP) directions only. In lumbar movements, monotonic relationships were found for young female dancers in the AP direction only. Comparing head with lumbar movements in static PB, young male dancers demonstrated monotonic relationships between head and lumbar movements in all 3 directions; however, young female dancers demonstrated monotonic relationships in the AP direction only. In the dynamic measurements, both male and female dancers demonstrated monotonic relationships between head and lumbar movements for all parameters measured in the ML and vertical directions (p < .05). In conclusions, among female dancers static PB ability is correlated with their dynamic ability, whereas among male dancers, no relationship between the static and dynamic PB in the AP direction exists. Male dancers showed head and lumbar coordination in the static PB movement, but both genders manifested no head and lumbar coordination in the AP direction measured for dynamic PB.

Recontextualizing Dance Skills: Overcoming Impediments to Motor Learning and Expressivity in Ballet Dancers.

The process of transmitting ballet's complex technique to young dancers can interfere with the innate processes that give rise to efficient, expressive and harmonious movement. With the intention of identifying possible solutions, this article draws on research across the fields of neurology, psychology, motor learning, and education, and considers their relevance to ballet as an art form, a technique, and a training methodology. The integration of dancers' technique and expressivity is a core theme throughout the paper. A brief outline of the historical development of ballet's aesthetics and training methods leads into factors that influence dancers' performance. An exploration of the role of the neuromotor system in motor learning and the acquisition of expert skills reveals the roles of sensory awareness, imagery, and intention in cuing efficient, expressive movement. It also indicates potentially detrimental effects of conscious muscle control, explicit learning and persistent naïve beliefs. Finally, the paper presents a new theory regarding the acquisition of ballet skills. Recontextualization theory proposes that placing a problematic task within a new context may engender a new conceptual approach and/or sensory intention, and hence the genesis of new motor programs; and that these new programs may lead to performance that is more efficient, more rewarding for the dancer, more pleasing aesthetically, and more expressive. From an anecdotal point of view, this theory appears to be supported by the progress of many dancers at various stages of their dancing lives.

The effect of textured ballet shoe insoles on ankle proprioception in dancers.

BACKGROUND: Impaired ankle inversion movement discrimination (AIMD) can lead to ankle sprain injuries. The aim of this study was to explore whether wearing textured insoles improved AIMD compared with barefoot, ballet shoes and smooth insoles, among dancers. METHODS: Forty-four adolescent male and female dancers, aged 13-19, from The Australian Ballet School were tested for AIMD while barefoot, wearing ballet shoes, smooth insoles, and textured insoles. RESULTS: No interaction was found between the four different footwear conditions, the two genders, or the two levels of dancers in AIMD (p > .05). An interaction was found between the four different footwear conditions and the three tertiles when tested in ballet shoes (p = .006). Although significant differences were found between the upper tertiles and the lower tertiles when tested with ballet shoes, barefoot and with smooth insoles (p < .001; p < .001; p = .047, respectively), when testing with textured insoles dancers in the lower tertile obtained similar scores to those obtained by dancers in the upper tertile (p = .911). CONCLUSION: Textured insoles improved the discrimination scores of dancers with low AIMD, suggesting that textured insoles may trigger the cutaneous receptors in the plantar surface, increasing the awareness of ankle positioning, which in turn might decrease the chance of ankle injury.

Are maturation, growth and lower extremity alignment associated with overuse injury in elite adolescent ballet dancers?

OBJECTIVE: To identify growth, maturation and biomechanical risk factors for overuse injury in elite adolescent ballet dancers. METHODS: Maturation (Tanner scale), growth (foot length change) and age at onset of menarche were recorded in elite adolescent ballet dancers. A modified knee valgus angle and lateral tilt of the pelvis were measured using 2D video during two dance movements (fondu, temps levé) to quantify lower extremity alignment. Overuse dance injuries were recorded by a physiotherapist. The injury rate ratio (RR) associated with each variable was estimated using over-dispersed Poisson regression modelling. RESULTS: Changes in right foot length (RR = 1.41, CI = 0.93-2.13), right knee angles during the fondu (RR = 0.68, CI = 0.45-1.03) and temps levé (RR = 0.72, CI = 0.53-0.98), and pelvic angles during the temps levé on the left (RR = 0.52, CI = 0.30-0.90) and fondu on the right (RR = 1.28, CI = 0.91-1.80) were associated with substantial changes in injury risk. CONCLUSIONS: Rate of growth in elite adolescent ballet dancers is likely associated with an increase in risk of lower extremity overuse injury and better right lower extremity alignment is likely associated with a reduction in risk of right lower extremity overuse injury.