bluuebunny/crossref_metadata_2025 huggingface dataset:
Golgi Tendon Organs: Neuroscience Update with Relevance to Stretching and Proprioception in Dancers
Authors: Moore Marjorie
Published: May 2023

This article reviews the neuroscience of the Golgi tendon organ, a type of muscle sensory receptor. The intent is also to update and correct erroneous notions regarding its functional significance, particularly related to its involvement in reflexes, proprioception, and stretching techniques used in dance training. Historical research about the function of the Golgi tendon organ (GTO) has led to four erroneous views: 1. The GTO serves a protective function by responding only to muscle tension at the extreme end-range of motion; 2. Sensations from GTOs do not reach the cerebral cortex and therefore serve no role in conscious proprioception and kines-thesia; 3. The GTO and its reflex circuit (autogenic inhibition) prevent its muscle from contracting by “turning it off”; and 4. During contract-relax stretching, the GTO autogenic inhibition reflex circuit is responsible for the muscle relaxation phase and the accompanying increased range of motion.

Recent research has shown that these early views are inaccurate. There is new evidence regarding the role of the GTO. 1. A GTO responds to even weak active contractions throughout the range of motion, although GTOs are much less sensitive to passive tension than to active tension. 2. GTO sensations probably do reach the cerebral cortex, buried in the fissure between the motor and sensory cortex “strips.” This information allows dancers to know where their limbs are in space. GTOs also provide unconscious proprioception, via the cerebellum, which helps dancers to learn new motor skills and improve execution of movements. 3. The GTO and its reflex (autogenic inhibition) reduce, but do not shut off, the excitability of the motor neuron and its innervated muscle. The ultimate reflex effect depends on the sum of multiple other inputs on the motor neuron. GTO input may reduce muscle activity, but does not “turn it off.” 4. During contract-relax stretching, the GTO autogenic reflex creates inhibition that lasts only as long as the muscle's active contraction. Therefore, GTO activity is unlikely to significantly affect the subsequent relaxation phase of the stretch. Other receptors and spinal circuits likely serve this function. It is hoped that this updated information will correct several erroneous notions about GTOs that have persisted in the dance kinesiology literature. Thus, dance kinesiology teachers, researchers, and health practitioners can provide accurate information to their students, readers, and patients.
Analysis of Pelvic Alignment in University Ballet Majors
Authors: Deckert Jennifer L. , Barry Sarah M. , Welsh Thomas M.
Published: May 2023

Classical ballet technique emphasizes proper alignment of the pelvis to optimize dancer performance. A series of three experiments was conducted in a major university ballet program to determine: 1. the average degree of pelvic tilt for freshman ballet majors, 2. the degree of pelvic tilt acceptable to university ballet teachers, and 3. whether an individual tutoring intervention could improve pelvic alignment in dancers who displayed a high degree of anterior pelvic tilt. Experiment 1 showed that anterior pelvic tilt for 17 freshman ballet majors averaged 13.4°. Experiment 2 revealed a mean anterior tilt of 11.4° for photographs rated as acceptable tilt by ballet teachers at the same university. Experiment 3 showed that three dancers who participated in six hours of individual tutoring improved their pelvic alignment by 3° to 4°, enough to move two of the dancers into the acceptable range. These studies suggest that a moderate degree of anterior pelvic tilt may be common and acceptable for university ballet majors, and they show that dancers with excessive anterior tilt can improve their alignment with as little 6 hours of individual tutoring.
Risk Factors for Bone Mineral Degradation in Young Female Dancers
Authors: Kuennen Matthew R.
Published: May 2023

Research articles on bone mineral characteristics are not scarce in the literature. Authors have quantified many different risk factors that influence these characteristics. Perhaps the most significant contributor to bone mineral characteristics, bone mineral density (BMD), and other bone mineral parameters is lifetime estrogen status. Age at onset of menarche influences bone mineral content (BMC) and BMD, with later menarcheal onset producing bone mineral decrements. Both lifetime estrogen status and age at menarche are significantly influenced by caloric intake and leptin levels. Poor dietary habits have been shown to produce reduced bone mineral parameters. Supplementation with calcium and magnesium, and the use of albuterol for asthma have been shown to significantly increase bone mineral properties. Heritability also greatly influences bone mineral parameters, as does ethnicity. BMD by ethnicity has been shown as highest in American Indians and African Americans, moderate in Caucasians and Hispanics, with the lowest levels being reported in Aians. Increases in Body Mass Index (BMI), lean, and fat mass have been shown to increase BMC and BMD. It has been widely shown that acquisition of BMC and BMD due to physical activity interventions occurs to a greater degree in premenarcheal versus postmenarcheal adolescent females. This increase in bone mineral parameters has been shown to be as high as 30% in adult competitive athletes who have trained since childhood. Specifically, the greatest increases in bone are produced through high intensity, high strain, high ground reaction force, varied type, and multiple bout, short duration activities.
The Relationship between Lateral Ankle Sprain and Ankle Tendinitis in Ballet Dancers
Authors: Ritter Stephanie , Moore Marjorie
Published: May 2023

The lateral ligament complex of the ankle is the most frequently injured structure in the body. Although most simple ankle sprains do not result in long-term disability, a significant number do not completely resolve, leading to residual symptoms that may persist for years. The most commonly reported symptoms, particularly among athletes, include instability, re-injury and tendinitis. Ballet dancers are a combination of artist and high-performance athlete; consequently, they are subjected to the same types of injuries as other athletes, including lateral ankle sprains and their sequelae. Furthermore, ballet dancers perform in unusual positions such as en pointe, which places the ankle in extreme plantar flexion, requiring stabilization by surrounding muscles. Dancers’ extraordinary performance demands place them at risk for other ankle injuries as well, including inflammation of several tendons, especially the peroneals. This report reviews the relevant literature to characterize the scope of lateral ankle sprains and sequelae, discuss the importance of the peroneal muscles in ankle stability, and explore a relationship between lateral ankle sprain and ankle tendinitis in ballet dancers. Informal interviews were conducted with physical therapists who specialize in treating ballet dancers, providing a clinical context for this report. An extensive review of the literature was conducted, including electronic databases, reference lists from papers, and relevant reference texts. Numerous studies have investigated ankle sprains and residual complaints; nearly all report that lateral ankle sprains commonly lead to chronic ankle instability. Studies exploring ankle stability have demonstrated that the peroneal muscles play a crucial role in ankle stabilization; EMC studies confirm they are the first to contract during ankle inversion stress. The dancers need for exceptional ankle stabilization may lead to peroneal overuse and tendinitis. Studies have linked peroneal pathology to a history of ankle sprain, but there is no dance medicine literature linking peroneal tendinitis to prior ankle sprains. A growing body of literature confirms myriad connections between lateral ankle sprains, residual instability, peroneal muscle increased activity, and tendinitis. It is our belief that ankle sprains lead to instability, particular en pointe, for which the peroneal muscles attempt to compensate. Their overuse for this static stabilizing function, as well as for dynamic dance movements, then leads to tendonitis. This knowledge may heighten awareness of the potential for developing tendonitis following ankle sprains, and lead to better rehabilitation of the injured ballet dancer.
The Effects of “Raked” Stages on Standing Posture in Dancers
Authors: Pappas Evangelos , Hagins Marshall
Published: May 2023

Professional dancers performing on “raked” (inclined) stages sustain more injuries than dancers who perform on flat stages. However, the effects of raked stages on standing posture have not been examined. Eight professional dancers stood for four seconds on flat and inclined surfaces while trunk and lower extremity angle data were collected in a controlled laboratory environment. Twelve separate ANOVA procedures were used to evaluate the effect of floor (flat vs. inclined) on kinematic variables. Dancers stood with 3.3° less dorsiflexion in the posterior incline and 4.7° more dorsiflexion in the anterior incline (p < .001). They also stood with increased pronation: 2.1° in the posterior (p = .009), 4.1° in the anterior (p = .006), and 5.2° in the lateral condition (p < .001). With regard to hip abduction, the subjects demonstrated 2.9° more in the medial condition and 2.7° less in the lateral condition (p = .001). External hip rotation was 3.3° higher for the medial (p = .027) and 5.7° lower in the lateral condition (p = .002). Thus, the findings of the present study demonstrate that there are significant hip and ankle angle joint differences between standing on flat and inclined surfaces. Future research should investigate the relationship of these biomechanical differences to overuse injuries.
Clinical Anatomy and Biomechanics of the Ankle in Dance
Authors: Russell Jeffrey A. , McEwan Islay M. , Koutedakis Yiannis , Wyon Matthew A.
Published: May 2023

The ankle is an important joint to understand in the context of dance because it is the connection between the leg and the foot that establishes lower extremity stability. Its function coordinates with the leg and foot and, thus, it is crucial to the dancers ability to perform. Furthermore, the ankle is one of the most commonly injured body regions in dance. An understanding of ankle anatomy and biomechanics is not only important for healthcare providers working with dancers, but for dance scientists, dance instructors, and dancers themselves. The bony architecture, the soft tissue restraints, and the locomotive structures all integrate to allow the athletic artistry of dance. Yet, there is still much research to be carried out in order to more completely understand the ankle of the dancer.
Dance Biomechanics: A Tool for Controlling Health, Fitness, and Training
Authors: Koutedakis Yiannis , Owolabi Emmanuel O. , Apostolos Margo
Published: May 2023

The need for superior performance in dance has impelled teachers and choreographers to use increasingly effective and sophisticated methods of preparation. To that end, such modalities of biomechanics as advanced motion-capture, muscle-function and muscle-strength techniques are being used to provide useful information about which of the dancers’ needs require special attention. This often involves improving aspects of dance technique, which, in turn, may help dancers to prevent disabling injuries, the most frequent cause of notoriously short dance careers. Biomechanics may also help dancers to assess fitness levels, to control overtraining or “burnout,” and assist them and their teachers in the effective scheduling of practice and exercise sessions.
Reliability and Validity of Goniometric Turnout Measurements Compared with MRI and Retro-Reflective Markers
Authors: Grossman Gayanne , Waninger Kevin N. , Voloshin Arkady , Reinus William R. , Ross Rachael , Stoltzfus Jill , Bibalo Kathleen
Published: May 2023

There is no consensus on a valid and reliable method of measuring turnout. However, there is a building awareness that such measures need to exist. Total turnout is the sum of hip rotation, tibial torsion, and contributions from the foot. To our knowledge, there has been no research that directly measures and then sums each individual component of turnout to verify a total turnout value. Furthermore, the tibial torsion component has not previously been confirmed by an imaging study. The purpose of this study was to test the validity and reliability of a single total passive turnout (TPT) test taken with a goniometer by comparing it with the sum of the individual components. Fourteen female dancers were recruited as participants. Measurements of the subjects’ right and left legs were gathered for the components of turn-out. Tibial torsion was measured using Magnetic Resonance Imaging (MRI). Retro-reflective marker assisted measurements were used to calculate the static components of TPT. Hip external rotation, TPT, and total active turnout (TAT) were measured by goniometer. Additional standing turnout values were collected on rotational disks. Tibial torsion and hip rotation were summed and compared with three whole-leg turnout values using Two-Tailed T-Tests and Pearson product-moment correlation coefficients. Tibial torsion measurements in dancers were found to demonstrate substantial variation between subjects and between legs in the same subject. The range on the right leg was 16° to 60°, and the range on the left leg was 16° to 52°. Retro-reflective markers and biomechanical theory demonstrated that when the knee is extended and locked, “screwed home,” it will not factor into a whole-leg turnout value. TAT and turnout on the disks were not statistically significant when compared with the summed total. Statistical significance was achieved in four of the eight measurement series comparing TPT with the summed value of tibial torsion and hip rotation. The advantages of a standard, valid, and reliable method of measuring turnout are many, and the risks are few. Some advantages include improved training techniques, mastery of the use of turnout at an earlier age, better dancer and teacher compliance with suggested turnout rates, understanding the use of parallel position, understanding the etiology of many dance-related injuries, and possible development of preventative measures.
Freiberg's Disease as a Rare Cause of Limited and Painfull Relevé in Dancers
Authors: (Mamie) Air Mary E. , (Boni) Rietveld A.B.M.
Published: May 2023

Freiberg's disease, or osteonecrosis of the second metatarsal head, is an uncommon cause of forefoot pain that can severely limit a dancer's relevé. Dancers may be predisposed to the condition due to repetitive microtrauma to the ball of the foot during routine dance movements. Freiberg's disease is diagnosed by history, physical examination, and plain film radiographs. Conservative treatment in dancers is disappointing, and surgical options fail to produce uniformly good results. Previously published reports of successful surgical outcomes would, for a dancer, result in an unacceptable loss of dorsiflexion of the MTP joint. This first case report of Freiberg's disease in a dancer serves to discuss the orthopaedic and artistic implications of managing the disease in a young, active, adolescent dancer. A new surgical treatment involving modification of Mann's cheilectomy, normally used for hallux rigidus, is presented. The operation corrected the patient's pain, completely normalized the aberrant relevé, allowed her to resume dance training within three weeks, and return to full dance activity within three months.
Preparing to Perform
Authors: Wyon Matthew
Published: May 2023

This article reviews the historical and current literature on periodization in sport before applying the concept to dance from scientific and anecdotal points of view. Preparing the dancer through the use of a periodization model, in a professional or vocational setting, will potentially help prevent overtraining and its link to injury, while improving the dancer's readiness to perform optimally. Practical examples of tapering and periodization of training are discussed for companies and vocational schools.
Spinal Reflex Adaptation in Dancers
Authors: Ryder Rachel , Kitano Koichi , Koceja David M.
Published: May 2023

Dancers undergo specific activity-dependent neuromuscular adaptations following long-term training that allow them to develop the refined motor skills required for success in dance. The spinal stretch reflex circuit has demonstrated specific adaptations following prolonged dance training. Adaptations in the spinal stretch reflex can be studied using H-reflex methodology, first described by Paul Hoffmann in 1910. This article discusses H-reflex methodology and presents data that examine the neural mechanisms that contribute to adaptations in the spinal stretch reflex with dance training. Two groups of subjects, modern dancers (N = 5) and untrained controls (N = 5), were tested. On one-half of the trials common peronal nerve (CPN) conditioning of the soleus H-reflex was used to assess one spinal mechanism, pre-synaptic inhibition; the other half tested the soleus H-reflex only (unconditioned). The dependent variables were the Hmax/Mmax ratios, unconditioned and with CPN conditioning, expressed as percent values. The results revealed three main findings: 1. Modern dancers had smaller Hmax/Mmax ratios than control subjects; 2. The Hmax/ Mmax ratio was smaller in standing posture than in prone among both dancers and controls; and 3. Pre-synaptic inhibition was not different between dancers and controls in standing. In conclusion, modern dancers have smaller H-reflexes than untrained controls, but pre-synaptic inhibition does not appear to explain this difference.
A Within-Subject Analysis of the Effects of Remote Cueing on Pelvic Alignment in Dancers
Authors: Holt Kimberly M. , Welsh Thomas M. , Speights Jaclyn
Published: May 2023

Many professionals who treat and train dancers believe that good alignment at the pelvis can facilitate movement efficiency and reduce injury risk in a variety of dance genres. This study evaluated the effects of a remote cueing technique on pelvic alignment for dancers in a university-based professional training program. Two female dancers participated in 20-minute individualized observation and training sessions twice a week for eight weeks. Pelvic alignment improved to criterion levels for both dancers, suggesting that individualized approaches may have special utility in training dancers.
Pelvis and Hip Three-Dimensional Kinematics in Grand Battement Movements
Authors: Bronner Shaw , Ojofeitimi Sheyi
Published: May 2023

Dancers frequently sustain hip injuries, including labral tears, coxa saltans, stress fractures, tendinosis, and joint disease. High velocity kicks (grand battement), with extreme abduction and external rotation (ER), may stress the hip, sacroiliac joint, and surrounding soft tissue. However, three-dimensional kinematic dance descriptions are limited. The purpose of this study was to describe the kinematics of the pelvis and hip in grand battement movements in healthy dancers. Seventeen advanced-level college dancers performed three battement conditions: battement devant to the front, à la seconde to the side, and derrière to the back. Data were collected with a 5-camera motion capture system. Repeated measures ANOVA (p < 0.05) compared peak pelvis and hip angular displacement and hip and toe velocity for all conditions and planes. Three-dimensional hip to pelvic ratios were calculated. There were differences in pelvic angular displacement between conditions in all planes (p < 0.00). Battement devant posterior pelvic tilt exceeded that of battement seconde. Both were opposite in direction from the anterior pelvic tilt of battement derrière. All conditions demonstrated pelvic obliquity toward the stance limb, with battement derrière greater than devant and seconde. Battement derrière transverse plane pelvic displacement exceeded that found in devant and seconde. There were also differences in hip angular displacement between conditions in all planes (p < 0.00). Battement derrière hip extension differed from battement devant and seconde flexion. The hip abducted in all conditions, with battement seconde exceeding devant and derrière. In the transverse plane, the hip rotated internally in battement seconde and externally in battement derrière and devant. In battement devant and seconde, peak hip ER decreased relative to baseline, while increasing at the peak of battement derrière. Battement peak velocities were relatively low. The ratio of hip to pelvic angular sagittal plane motion was 4.1, 2.6, and 0.5 in battement devant, seconde, and derrière respectively; 0.9, 2.6, and 1.5 in the frontal plane; and 0.6, 8.5, and 0.2 in the transverse plane. This confirms that pelvic motion provides a large proportion of the battement movement.
Injury, Imagery, and Self-esteem in Dance
Authors: Nordin-Bates Sanna M. , Walker Imogen J. , Baker Jo , Garner Jocelyn , Hardy Cinzia , Irvine Sarah , Jola Corinne , Laws Helen , Blevins Peta
Published: May 2023

The purpose of this study was to investigate a selection of psychological variables (help-seeking behaviors, mental imagery, self-esteem) in relation to injury among UK dancers. We recruited 216 participants from eight dance styles and six levels of involvement. It was found that 83.5% of the participants had experienced at least one injury in the past year. The most common response to injury was to inform someone, and most continued to dance when injured, albeit carefully. Physical therapy was the most common treatment sought when an injury occurred (38.1%), and dancers seemed to follow recommendations offered. Injured and non-injured dancers did not differ in their imagery frequencies (facilitative, debilitative, or injury-related) and scored similarly (and relatively high) in self-esteem. Neither facilitative nor debilitative imagery was correlated with self-esteem, but dancers who engaged in more facilitative imagery in general also reported doing so when injured. Altogether, it appears that injury is not related to dancers’ self-esteem or imagery, at least not when injuries are mild or moderate. Even so, such conclusions should be made with caution, given that most dancers do sustain at least one injury each year.
Effect of Footwear on Dancers
Authors: Yan Alycia Fong , Hiller Claire , Smith Richard , Vanwanseele Benedicte
Published: May 2023

Dancers need their feet to be healthy and pain-free; therefore, the footwear they use is of great importance. Footwear has the potential to enhance or restrict movement and impact the dancer's body in various ways. To evaluate the effects of footwear on dancers, in particular the effects on foot motion and injury during dance movements, we undertook a systematic review of the literature. The major databases were searched for articles on theatrical dance styles and dance footwear. Sixteen articles were selected for inclusion in this study, ten on ballet and the remainder covering a variety of other genres. The contribution of dance shoes to the quality of dance movement is a relatively unexplored subject; little experimental research has been done. Prospective scientific evidence is needed to support or disprove traditional beliefs regarding the effects of footwear on dance performance and dancers’ health.
Development, Validity, and Reliability of a Ballet-Specific Aerobic Fitness Test
Authors: Twitchett Emily , Nevill Alan , Angioi Manuela , Koutedakis Yiannis , Wyon Matthew
Published: May 2023

The aim of this study was to develop and assess the reliability and validity of a multi-stage, ballet-specific aerobic fitness test to be used in a dance studio setting. The test consists of five stages, each four minutes long, that increase in intensity. It uses classical ballet movement of an intermediate-level of difficulty, thus emphasizing physiological demand rather than skill. The demand of each stage was determined by calculating the mean oxygen uptake during its final minute using a portable gas analyser. After an initial familiarization period, eight female subjects performed the test twice within seven days. The results showed significant differences in oxygen consumption between stages (p < 0.001), but not between trials. Pearson correlation co-efficients produced a very good linear relationship between trials (r = 0.998, p < 0.001). Bland-Altman reliability analysis revealed the 95% limits of agreement to be ± 6.2 ml·kg-1·min-1, showing good agreement between trials. The oxygen uptake in our subjects equated positively to previous estimates for class and performance, confirming validity. It was concluded that the test is suitable for use among classical ballet dancers, with many possible applications.
Injuries in Professional Modern Dancers Incidence, Risk Factors, and Management
Authors: Shah Selina , Weiss David S. , Burchette Raoul J.
Published: May 2023

Modern (or contemporary) dance has become increasingly popular, yet little has been reported with respect to modern dance injuries and their consequences. The purpose of this study is to define the incidence, risk factors, and management of musculoskeletal injuries in professional modern dancers. A total of 184 dancers in the United States completed an anonymous 17-page questionnaire on their injuries, including extensive details regarding the two most severe injuries that had occurred in the prior 12 months. According to their self-reports, a total of 82% of the dancers had suffered between one and seven injuries. The foot and ankle (40%) was the most common site of injury, followed by the lower back (17%) and the knee (16%). The rate of injuries was 0.59 per 1,000 hours of class and rehearsal. Injured male dancers returned to full dancing after a median of 21 days, while females returned after a median of 18 days. Most dancers missed no performances due to injury. Of the medical consultations sought by dancers for their injuries, 47% were made to physicians, 41% to physical therapists, and 34% to chiropractors. The majority of dancers adhered to the advice given them by consultants (87% of males and 78% of females for the most severe injury). While the majority of injuries were considered work-related (61% of the most severe injury and 69% of the second most severe), few were covered by Workers’ Compensation insurance (12% and 5% respectively). These professional modern dancers suffer from a rate of injury similar to other groups of professional dancers. Most dancers return to a partial level of dancing several weeks before attempting full-capacity dancing.
Differences in Segmental Coordination and Postural Control in a Multi-joint Dance Movement Développé Arabesque
Authors: Bronner Shaw
Published: May 2023

Analysis of skill at multiple points on the learning continuum provides insight into how complex limb and postural organization is modified with extended practice. Dancers at three skill levels were compared performing a domain-specific movement (développé arabesque) to identify motor control parameters underlying skill acquisition of a sequential multi-joint trunk and extremity movement. It was hypothesized that general organization would be similar between groups, but that segmental coordination and postural control would differ with skill level. Twenty-seven expert, advanced, and intermediate dancers performed six repetitions of an arabesque sequence with the right limb. Data were acquired with a five-camera motion analysis system. Differences between groups in pelvis and gesture limb displacement, joint coordination patterns, and variability were determined using ANOVA with post hoc comparisons where applicable. Subjects displayed similar movement organization and timing. Differences were found in postural pelvic control and intra- and inter-limb coordination. These differences were most apparent during the arabesque phase. Control of the pelvis appears to be a key area that requires prolonged practice to master.
Musculoskeletal Injuries and Pain in Dancers a Systematic Review Update
Authors: Jacobs Craig L. , Hincapié Cesar A. , Cassidy J. David
Published: May 2023

The objective of this study was to assemble and synthesize the best available literature from 2004 to 2008 on musculoskeletal injury and pain in dancers. MEDLINE and CINAHL were the primary sources of data. Indexed terms such as dance, dancer, dancing, athletic injuries, occupational injuries, sprains and strains, musculoskel-etal diseases, bone density, menstruation disturbances, and eating disorders were used to search the databases. Citations were screened for relevance using a priori criteria, and relevant studies were critically reviewed for scientific merit by the best-evidence synthesis method. After screening, 19 articles were found to be scientifically admissible. Data from accepted studies were abstracted into evidence tables relating to: prevalence and associated factors; incidence and risk factors; intervention; and injury characteristics and prognosis of musculoskeletal injury and pain in dancers. Principal findings included: a high prevalence and incidence of lower extremity, hip and back injuries; preliminary evidence that psychosocial and psychological issues such as stress and coping strategies affect injury frequency and duration; history of a previous lateral ankle sprain is associated with an increased risk of ankle sprain in the contralateral ankle in dance students; fatigue may play a role in ACL injury in dancers; acute hamstring strains in dancers affect tendon more than muscle tissue, often resulting in prolonged absence from dance. It is concluded that, while there are positive developments in the literature on the epidemiology, diagnosis, prognosis, treatment, and prevention of MSK injuries and pain in dancers, much room for improvement remains. Suggestions for future research are offered.
Achilles Tendinopathy in Dancers
Authors: Maffulli Nicola , Longo Umile Giuseppe , Denaro Vincenzo
Published: May 2023

The Achilles tendon has been proposed to be for the dancer one of the most vulnerable parts of the body. Studies on Achilles tendinopathy in dancers are lacking. Therefore, in the present review, we present the best evidence in the field of diagnosis and management of patients with Achilles tendinopathy. To think that a dancer with this injury is different from other patients may lead to the use of different treatment modalities that are not scientifically proven, and this carries with it an un-quantifiable risk.
Pathoanatomy of Anterior Ankle Impingement in Dancers
Authors: Russell Jeffrey A. , Kruse David W. , Koutedakis Yiannis , Wyon Matthew A.
Published: May 2023

Articles from the anatomy, orthopaedic, and radiology literature since 1943 were reviewed, and possible sources of anterior ankle impingement were identified therein. There are both osseous and soft tissue causes of impingement symptoms. Anterior impingement in dancers may be induced by repetitive dorsiflexion during demi-plié, where the anterior edge of the distal tibial articular surface contacts the dorsal neck of the talus. It also can be associated with the sequelae of lateral ankle sprain, including a hypertrophic tissue response, or simply by impingement of anatomically normal ligamentous structures. Dance medicine clinicians should be familiar with the pathoanatomy and etiologies of this clinical entity in order to provide effective care for dancers who suffer from it.
Assessing and Reporting Dancer Capacities, Risk Factors, and Injuries
Authors: Liederbach Marijeanne , Hagins Marshall , Gamboa Jennifer M. , Welsh Thomas M.
Published: May 2023

This technical report of the Standard Measures Consensus Initiative of the In-ternational Association for Dance Medicine and Science (IADMS) describes the results of the committees multi-year effort to synthesize information regarding the tests and measures used in dance-related research, protocols for reporting injuries, and appropriate use of available technolo-gies to aid in standardizing such matters. Specific recommendations are presented, with accompanying rationales, to facilitate consensus among members of the dance medicine and science community. An Executive Summary of this Technical Report, which contains implementation strategies and appendices, should soon be available on the IADMS website.
Self-Described Differences between Legs in Ballet Dancers
Authors: Mertz Laura , Docherty Carrie
Published: May 2023

Ballet technique classes are designed to train dancers symmetrically, but they may actually create a lateral bias. It is unknown whether dancers in general are functionally asymmetrical, or how an individual dancer's perceived imbalance between legs might manifest itself. The purpose of this study was to examine ballet dancers’ lateral preference by analyzing their postural stability and ground reaction forces in fifth position when landing from dance-specific jumps. Thirty university ballet majors volunteered to participate in this study. The subjects wore their own ballet technique shoes and performed fundamental ballet jumps out of fifth position on a force plate. The force plate recorded center of pressure (COP) and ground reaction force (GRF) data. Each subject completed a laterality questionnaire that determined his or her preferred landing leg for ballet jumps, self-identified stronger leg, and self-identified leg with better balance. All statistical comparisons were made between the leg indicated on the laterality questionnaire and the other leg (i.e., if the dancer's response to a question was “left,” the comparison was made with the left leg as the “preferred” leg and the right leg as the “non-preferred leg”). No significant differences were identified between the limbs in any of the analyses conducted (all statistical comparisons produced ρ values > 0.05). The results of this study indicate that a dancer's preferential use of one limb over the other has no bearing on GRFs or balance ability after landing jumps in ballet. Similarly, dancers’ opinions of their leg characteristics (such as one leg being stronger than the other) seem not to correlate with the dancers’ actual ability to absorb GRFs or to balance when landing from ballet jumps.
The Physics of Toppling and Regaining Balance during a Pirouette
Authors: Melanie Β. Lott , Laws Kenneth L.
Published: May 2023

One of the most common movements in dance is a turn around a vertical axis with one supporting foot on the floor—a pirouette. If the pirouette is not performed with the body on balance, it is not consid-ered successful. Dancers are often taught to perform successful pirouettes by beginning the movement on balance and then keeping the body in that configuration, as opposed to correcting for an imbalance with small adjustments during the turn. Many, even advanced, dancers have significant difficulty performing more than two or three turns in a pirouette before losing balance, despite continued trial and error efforts to improve. To describe the mechanics of toppling and control of toppling during a pirouette, a theoretical model of a dancer in standard pirouette position was created, and an experimental study of real dancers performing pirouettes was conducted. Body segment parameters for the model (mass, length, etc.) were based on anatomical data and adjusted for sex, total body mass, and height. The principal moments of inertia were determined for several hypothetical dancers, and rigid body equations of motion numerically solved to express topple angle vs. time. When dancers reach too large a topple angle, they are forced to compensate by either hopping on the supporting foot in an attempt to regain
A Curricular Model for Dance Wellness Education in Higher Education Dance Programs
Authors: Cardinal Marita K. , Hilsendager Sarah A.
Published: May 2023

Dance wellness is comprised of a wide array of components that share the common goal of the overall health and well-being of the dancer. Drawing from a number of disciplines, dance wellness seeks a balanced, integrative, and interdisciplinary approach to health and well-being; is specific to the individual participant; and is unique to the field of dance. In higher education dance programs, dance wellness has three primary functions — education, service, and research. The rationale supporting the dance wellness curricular model is based on contemporary professional literature in dance medicine, science, and somatics and a review by a panel of ten experts in related fields. The two major dimensions of dance wellness education programs are ten curricular components and four implementation strategies. The definition and importance of each component is described. Methods for implementing the ten components within dance programs, as well as a variety of exemplary supplementary wellness programs, are also described. Based on the dance wellness curricular model presented, specific, minimum guidelines for dance wellness programs in higher education dance programs are recommended which optimize the health, general well-being, and performance potential of dancers.
Acute Low Back Problems in Adults
Authors:   U.S. Department of Health and Human Services Public Health Service Agency for Health Care Policy and Research
Published: May 2023

Findings and recommendations on the assessment and treatment of adults with acute low back problems — activity limitations due to symptoms in the low back and/ or back-related leg symptoms of less than 3 months’ duration — are presented in this clinical practice guideline. The following are the principal conclusions of this guideline:

• The initial assessment of patients with acute low back problems focuses on the detection of “red flags” (indicators of potentially serious spinal pathology or other nonspinal pathology).

• In the absence of red flags, imaging studies and further testing of patients are not usually helpful during the first 4 weeks of low back symptoms.

• Relief of discomfort can be accomplished most safely with nonprescription medication and/or spinal manipulation.

• While some activity modification may be necessary during the acute phase, bed rest >4 days is not helpful and may further debilitate the patient.

• Low-stress aerobic activities can be safely started in the first 2 weeks of symptoms to help avoid debilitation: exercises to condition trunk muscles are commonly delayed at least 2 weeks.

• Patients recovering from acute low back problems are encouraged to return to work or their normal daily activities as soon as possible.

• If low back symptoms persist, further evaluation may be indicated.

• Patients with sciatica may recover more slowly, but further evaluation can also be safely delayed.

• Within the first 3 months of low back symptoms, only patients with evidence of serious spinal pathology or severe, debilitating symptoms of sciatica, and physiologic evidence of specific nerve root compromise corroborated on imaging studies can be expected to benefit from surgery.

• With or without surgery, 80 percent of patients with sciatica recover eventually.

• Nonphysical factors (such as psychological or socio-economic problems) may be addressed in the context of discussing reasonable expectations for recovery.
Scoliosis in Dancers
Authors: Liederbach Marijeanne , Spivak Jeffrey , Rose Donald J.
Published: May 2023

Scoliosis is reportedly a common clinical presentation in classical dancers and has been associated with an increased incidence of stress fracture, hypoestrogenism, and muscle imbalance. However, standardized measurement protocols have not been instituted for the population of dancers in the mass-screening environment, nor have criteria for diagnostic and referral ranges been clearly established in this population. This paper describes a cost-effective, reliable, valid, and clinically relevant method of screening scoliosis in dancers and reports on the findings from 947 classically-trained adult dancers screened for scoliosis using this method over a three year period. By the criteria we established, 8% of the dancers screened possessed a scoliotic curve that merited referral to a spine specialist for further evaluation. Dancers with axial asymmetries also reported a higher incidence of amenorrhea and back pain than dancers without asymmetries.
Dislocated Tibialis Posterior Tendon in a Classical Ballet Dancer
Authors: Khan Karim M. , Gelber Nicholas , Slater Kim , Wark John D.
Published: May 2023

Dislocated tibialis posterior tendon is a rare condition in the absence of trauma. We report a case of a 17-year-old classical ballet dancer who dislocated her tibialis posterior tendon while performing a relevé. She was unable to bear weight on that leg subsequently but she did have full active range of motion and her pain resolved quickly. She reported feeling a “flicking” at the ankle when the injury occurred. On examination it was possible to dislocate the tendon with the foot fully plantar flexed (pointed). Investigations are not diagnostic in this condition. Treatment consisted of surgical repair of the flexor retinaculum, 6 weeks non-weight-bearing, and progressive functional rehabilitation with attention to strengthening foot musculature and regaining ankle range of motion, particularly dorsiflexion (plié). The dancer returned to full ballet performance 5 months after injury.
Position Stand the Female Athlete Triad
Authors:   American College of Sports Medicine
Published: May 2023

The following is a synopsis of the American College of Sports Medicine position stand on the Female Athlete Triad: a syndrome occurring in physically active girls and women. Alone or in combination the three preventable disorders that comprise the Female Athlete Triad are disordered eating, amenorrhea, and osteoporosis.
Youth Resistance Training
Authors:   A Position Paper and Literature Review from the National Strength and Conditioning Association (NSCA)
Published: May 2023

This 22-page paper includes a position statement, a literature review of the benefits and risks of resistance training for young people, recommended youth resistance training guidelines, and an extensive list of 145 related references. Selected points for the Recommended Youth Resistance Training Guidelines follow. For purposes of this position statement, the term youth was broadly defined as an early period of life that includes both the prepubescent and adolescent years. Resistance training was defined as a specialized form of conditioning that is used to increase one's ability to exert or resist force and that is distinct from the competitive sports of powerlifting and weightlifting.
Back Strengthening for Dancers
Authors: Welsh Thomas M. , Jones G. Pierce , Lucker Kim D. , Weaver Brian C.
Published: May 2023

This study evaluated the effects of a back strengthening program for dancers enrolled in a university-based, professional training program. A within-subject research design revealed that the training program increased lumbar extensor strength 14% to 151%. Follow-up measurements taken up to a year after training showed that strength gains were sustained well above baseline levels. Corresponding increases in arabesque height, improvements in dancers’ ratings of their own strength, and a reduction in the number of classes and rehearsals missed due to back pain all suggest the importance of these strength gains. This study replicates prior research with non-dancers and demonstrates a potentially useful strategy for avoiding back problems among dancers.
Effect of Dance Technique Training and Somatic Training on Pelvic Tilt and Lumbar Lordosis Alignment during Quiet Stance and Dynamic Dance Movement
Authors: Gamboian Nancy , Chatfield Steven J. , Woollacott Marjorie H. , Barr Sherrie , Klug Gary A.
Published: May 2023

Proper alignment is emphasized throughout a dancer s training. The literature suggests how proper alignment may reduce injuries, enhance dance performance and biomechanical efficiency, and increase the performance life of a dancer. Somatic training has been used to improve skeletal alignment. However, there is a need for more studies quantifying the effectiveness of somatic training through a controlled research design. Two studies were conducted to examine the effect of dance technique training and somatic training on pelvic tilt (PelT) and lumbar lordosis (LL) alignment measures during quiet stance and dynamic dance movement. Due to high between-subject alignment variability and the unknown standard for PelT and LL comparison, a within-subject analysis was conducted for both studies. There were no improvements found in PelT and LL with dance technique training, with one subject actually indicating a higher degree of lumbar lordosis during both quiet stance and a dynamic condition (e.g., by 3.9° and 4.3° respectively). Improvements in pretest versus posttest mean LL were indicated with somatic training for all three subjects in almost all conditions (e.g., for Subject 1/Condition 1: 45.2 ± 0.71° vs. 32.6 ± 3.28°). An independent relationship was also revealed between PelT and LL in both studies, since variability or changes were indicated with one measure and not the other.
Bone Mineral Density in Active and Retired Ballet Dancers
Authors: Khan Karim M. , Warren Michelle P. , Stiehl Amanda , McKay Heather A. , Wark John D.
Published: May 2023

Many members of both the balletic, and non-balletic worlds believe that ballet dancers are at risk for low bone mineral density (BMD), and therefore, osteoporotic fracture. However, the athletic nature of ballet dancing, particularly the jumping component, provides a substantial osteogenic stimulus. Further, ballet is often commenced at a young age, when physical activity may allow a child to optimize peak bone mass. Thus, we reviewed the literature seeking answers to four key questions: 1. Do dancers exhibit lifestyle risk factors that may cause them to have diminished BMD? 2. What is the effect of prolonged amenorrhea on BMD? 3. Do dancers, as a group, have greater or lesser bone mineral than their non-balletic counterparts? 4. Do the hours spent in childhood ballet classes influence adult BMD?

We concluded that factors such as primary amenorrhea, low body weight, low energy intake, low calcium intake, and eating disorders can all lead to low BMD in dancers. However, in studies of retired dancers the effect of these risk factors on hip and lumbar spine BMD appears to be somewhat modulated, which may reflect that high impact activity during a key prepubertal age has a beneficial effect. The practical implication of these findings is that ballet, in moderation, and not associated with abnormal eating behavior or prolonged menstrual disturbance, can be seen as a positive lifestyle choice that may serve to decrease the risk of osteoporosis in later life.
Strength Training of Dancers during the Adolescent Growth Spurt
Authors: Phillips Craig
Published: May 2023

Although muscular strength training is important to dancers there are many factors that must be considered when working with children during their growing years. Increasing muscle power by maximal loading is inappropriate during those years and submaximal muscle strength or “control” is a safer and more suitable option. Combining “controlled strength” training with a focus on the trunk may also provide a welcome answer to the question of how to work with flexibility, balance, and coordination, issues that are most common during the growth spurt and which may underlie the development of injuries.