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Table 2 Characteristics of the studies included in the literature review

From: Screening Tools as a Predictor of Injury in Dance: Systematic Literature Review and Meta-analysis

Article Population Screening tools Definition of injury Diagnosis of injury Findings
Luke et al. [5] N = 39 (34 females)
Male and female pre-professional dancers
Aged 14–18 years
• Marshall Test/Micheli Score
• Scoliosis
• Ankle plantarflexion (PF) and dorsiflexion (DF)
• Foot arch and type
• First metatarsophalangeal angle
• Hip internal and external rotation
• Popliteal angle
• Hip flexor (Thomas test)
• Iliotibial band (Ober’s)
• Q angle
• Leg length
• Foot/thigh angle
No definition of injury provided
Categorised as:
New, recurrent, overuse and soft tissue
Self-reported No correlations to injuries except age, sex and popliteal angle.
Left popliteal angle was related to self-reported injury (r = 0.340, P = 0.03)
Coplan [24] N = 30 (27 females)
College students and teachers
Injured males
20 ± 0 years 183 ± 0 cm
69 ± 0 kg
Non-injured males 27 ± 7 years
190 ± 14.1 cm
83 ± 11.2 kg
Injured females 19.7 ± 1.6 years
163.2 ± 4.1 cm
53.2 ± 5 kg
Non-injured females 23.8 ± 8.7 years
162 ± 4 cm
54.9 ± 6.2 kg
• Passive hip internal and external rotation
• 1st position turnout
• Functional turnout (the angle of turnout assumed by a dancer in any of the five basic ballet positions)
• Compensated turnout (difference between measured functional turnout and total passive external rotation)
‘Any pain or dysfunction of the low back or lower extremities that impacted ability to perform’ Self-reported by questionnaire Significant difference between injured and non-injured groups for functional turnout (P = 0.004) and compensated turnout (P = 0.006)
Hamilton et al. [26] N = 40 females
Elite dancers at the School of American Ballet
14.92 ± 0.96 years
93% Caucasian
5% Asian
2% Hispanic
• Leg length
• Scoliosis
• Axial alignment
• First position
• Second position
• Fifth position
• Sauté
• Spondylolisthesis (lumbosacral step off)
• Hip motion (prone)
• Turnout
• Quadriceps tightness
• Hamstring tightness
• Recurvatum
• Patellar alignment
• Patella tendinitis
• Ankle PF
• PF sign
• Peroneal weakness
• Foot type
• Turning preference
Categorised according to nature and duration of disability and frequency of occurrence but no specific definition provided Orthopaedist recorded injury history Minor injured dancers had lack of turnout noted in asymmetry in grande plié (12 v 0%, P < 0.05), unequal hip motion (37 v 16%, P < 0.05) and pronation when landing from sauté (62 v 25%, P < 0.05)
Allen et al. [27] N = 52 year 1
N = 58 year 2
N = 53 year 3
Elite, professional ballet company
Year 1
Male 23 ± 4 years
179 ± 4.3 cm
71.5 ± 4.7 kg
Female 25 ± 5 years
162 ± 3.9 cm
49.2 ± 4.04 kg
Year 2
Male 24 ± 4 years
179 ± 1.0 cm
71.5 ± 4.73 kg
Female 25 ± 5 years
162 ± 0.96 cm
49.2 ± 4.05 kg
Year 3
Male 24 ± 4 years
179 ± 5.3 cm
72.7 ± 7.01 kg
Female 26 ± 5 years
164 ± 3.6 cm
51.2 ± 5.59 kg
• Years of training
• Functional Movement Screen
‘Any injury that prevented a dancer from taking full part in all dance-related activities for a period of greater than or equal to 24 h after the injury was sustained’
Categorised as:
Traumatic
Overuse
Recurrent
Physiotherapist diagnosed injury Injury incidence declined from year 1 (4.76/1000 h) to year 2 (2.40/1000 h) and year 3 (1.81/1000 h) (P < 0.001)
Gamboa et al. [28] N = 151 females
Elite pre-professional boarding ballet school dancers
Injured (n = 72)
14.3 ± 1.8 years
Non-injured (n = 125) 14.4 ± 2.1 years
• Posture (forward head, cervical lordosis, thoracic kyphosis, lumbar lordosis, scoliosis, knee hyperextension, foot position)
• Strength (upper, lower, core trunk, core scapula)
• Flexibility (upper and lower)
• Orthopaedic testing (knee, foot, hip, ankle)
• Function (turnout × 3, gesture leg turnout, releve balance time, developpe test, plié turnout alignment, heel raise, pelvic alignment, releve´ raise during developpe)
‘When a dancer sought at least 1 treatment session from the physical therapist’ Physical therapist diagnosed injury Significant differences between injured and non-injured groups for right foot pronation (P = 0.005), lower extremity strength (P = 0.045) and ankle PF on the right side (P = 0.037)
Hamilton et al. [29] N = 28 (14 females)
Elite American Ballet Theatre
Female 29.23 ± 5.25 years
Male 28.42 ± 4.08 years
• Flexibility (elbow hyperextension, external arm rotation, lotus, external leg rotation, knee recurvatum, palms to floor)
• Strength (hip abductors, adductors, abduction/adduction ratio, knee extensors, flexors, ankle PF, DF, PF:DF ratio)
• Range of motion (ROM) (hip external/internal rotation, hip abduction/ adduction, hip flexion, knee hyperextension, tibial torsion, tibial external rotation, tibial internal rotation, ankle plantarflexion/dorsiflexion)
No definition of injury provided Self-reported by questionnaire Males with 4 or more past injuries were more flexible (increased elbow extension P < 0.003 and straight leg raise P < 0.05). Overuse history increased ability to perform the lotus P < 0.005 and increased total turnout P < 0.005
Females with more injuries had less turnout (P < 0.005). Overuse injuries were related to less bilateral plié (P < 0.001) and decreased left ankle DF (P < 0.05)
Negus et al. [30] N = 29 (24 females)
Student dancers
Aged 15–22 years
• Hip external rotation ROM in supine (passive and active)
• Functional turnout in standing
• Active external rotation lag
• Compensated turnout (CT) (= static functional turnout angle (standing in 1st, 5th right,5th left)—total active hip external rotation (supine))
• Static-dynamic turnout (SDTD) (= standing in 1st,5th right,5th left)—dynamic functional turnout angle (landing in same 3 positions after jumping)
‘Any pain, discomfort or other musculoskeletal problem, which required modification of, or time away from, dance training, examinations, or performance’
Categorised as traumatic and non-traumatic
Self-reported
VAS scale used to self-report severity and perceived impact of injury
Number of non-traumatic injuries was positively correlated with 6 of 7 derived turnout variables; compensated turnout in all 3 positions and static dynamic turnout difference in all 3 positions (r = 0.39–0.55, P < 0.039). Severity of non-traumatic injuries was positively correlated with 3 of 7 derived turnout variables: static-dynamic turnout difference in all positions (rho = 0.38–0.47, P < 0.043)
Non-traumatic injuries—
CT first, right fifth, left fifth, SDTD first, SDTD right fifth, SDTD left fifth correlated with number of injuries
SDTD first, SDTD right fifth, SDTD left fifth correlated with injury severity
No correlations to traumatic injury
Zaletel et al. [31] N = 24 females
Ballet high school students
16–18 years
165.3 ± 5.7 cm
55.2 ± 5.4 kg
• Body mass
• Height
• Skinfolds: triceps, subscapular, calf, suprailiac
‘Any physical complaint sustained as a result of performance or training, irrespective of the need for medical attention or time lost from activity’ Self-reported by questionnaire Increased likelihood of ankle injuries for endomorphs (OR = 1.887)
Increased likelihood of foot injury for ectomorph (OR = 1.719)
Toe injuries more prevalent in dancers with higher body mass (OR = 1.688)
Bhakay et al. [32] N = 22 females
Professional ballet dancers attending Indian dance schools
14–30 years
• External hip rotation
• Functional turnout
• Compensated turnout
‘Any pain or dysfunction of the lower extremities that impacted the dancers’ ability to practice or perform’ Self-reported Relationship between total hip external rotation (P = 0.0137), functional turnout (P = 0.0176) and compensated turnout (P = 0.0002) and injury
Wong et al. [33] N = 207
Student dancers resident at a pre-professional ballet academy
• Muscle strength
• Flexibility
• Alingnment
• Posture
• History of injury
• Ankle foot risk screening scores
No definition of injury provided Not reported A screening score of ≥ 19 was attributed to being ‘at risk’ of injury
Thomas et al. [34] N = 239 females
Ballet students attending intensive summer ballet programmes
15 ± 1.5 years
• Body mass index (BMI) No definition of injury provided Self-reported No difference in BMI between injured and non-injured groups
Drężewska et al. [35] N = 71 (45 females)
Enrolled ballet school students
16.5 years
• Sacrum inclination angle
• BMI
No definition of injury provided Self-reported A comparison of sacral inclination angles in a position with the feet placed parallel and in the turnout position showed statistically significant changes in the angle among respondents reporting pain (P < 0.05)
Dancer with sacrum inclination angles of ≥ 30° had higher mean pain intensity scores
Pain was more frequent in female dancers whose BMI was lower than normal (< 18.5 kg m2)
Twitchett et al. [36] N = 42 (31 females)
Ballet students in vocational training
17.3 ± 1.02 years
• Somatotype
• Skin fold thickness
• Body composition
No definition of injury provided Self-reported by questionnaire Ectomorphy was a strong predictor of the number of acute injuries sustained (P = 0.026); these parameters had a significant negative correlation (r = − 0.37, P = 0.016)
Correlations were observed between the dancers’ total time off due to injury and %body fat (r = − 0.31, P = 0.048) and between the total time off resulting from acute injury and both %body fat (r = − 0.32, P = 0.04) and ectomorphy r = − 0.42, P = 0.005)
The number of overuse injuries sustained and time off due to overuse injury were also correlated with mesomorphy (r = − 0.38, P = 0.015 and r = − 0.33, P = 0.032, respectively)
McCormack et al. [37] N = 70 (38 females)
Dance students at the Royal Ballet School, London
• Height
• Weight
• Lower segment length
• Arm span
• Beighton and Contompasis scores
No definition of injury provided Unclear 18 female and 12 male dancers exhibited features (as well as hypermobility and joint pain) to satisfy Brighton Criteria (OR 6.75 CI 1.35–33.66) and (OR 7.8 CI 0.90–67.37)
Bowerman et al. [38] N = 46 (30 females)
Australian ballet School students
16 ± 1.58 years
• Maturation tanner scale
• Height
• Body mass
• Foot length for growth
• Lower extremity alignment during fondu and temps leve
‘Any physical harm resulting in pain or discomfort that required a dancer to modify their dance activity during one or more classes, or which required a dancer to cease all dance related activity’
Only injuries that occurred as a result of dance training were located in the lumbar spine and/or lower extremities of the body and were an overuse injury were included
Physiotherapist diagnosed injury 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
Lin et al. [39] N = 22 females
Ballet school students
Injured dancers
19.7 ± 2.4 years
Uninjured dancers
18.8 ± 3.1 years
• Height
• Weight
• Active and passive ROM (ankle, knee and hip joints)
• Standing turnout angle
• Anterior draw
• Talar tilt
‘…1 or more ankle sprains related to ballet dancing within the past year that interrupted dance training or rehearsal for at least 24 h’ Self-reported No significant difference in any of the physical measures
Frusztajer et al. [40] N = 50 female dancers
Classical ballet dancers
20.5 ± 3.9 years (range 16–29 years)
• Height
• Weight
No definition of injury provided Subjects interviewed by a nurse practitioner on present and past illness and fractures The mean weight of the group with stress fractures fluctuated to a significantly lower weight, 80% of dancers reaching a low weight, at least 25% below ideal (P < 0.005)
Watkins et al. [41] N = 350 (286 females)
Dance students from three pre-professional ballet schools in New England
Age ranged from 11.1 to 23.2 years
• Turnout alingnment
• Angle of deviation
No definition of injury provided Self-reported by questionnaire No significant relationship between deviation in alingnment and injury rate for knee, ankle or foot
McNeal et al. [42] N = 350 (286 females)
Dance students from three pre-professional ballet schools in New England
Age ranged from 11.1 to 23.2 years
• Turnout alingnment
• Angle of deviation
No definition of injury provided Self-reported by questionnaire No significant relationship between deviation in alingnment and injury rate for knee, ankle or foot
Reid et al. [43] N = 30 females
Dancers from a local ballet school
15.4 years (range 13–19 years)
• ROM (passive hip flexion, extension, adduction, abduction, internal rotation and external rotation, knee extension) No definition of injury provided Interviews used to diagnose injury Passive hip abduction was significantly reduced in dancers with lateral pain or snapping hip (P = 0.05)
Baker-Jenkins et al. [44] N = 47 Female
Student dancers
19.9 ± 2.51 years
165 ± 0.05 cm
56.23 ± 6.51 kg
• Functional turnout
• Total passive turnout
• Passive hip external rotation
• Compensated turnout
• Active external rotation
• Muscular = functional turnout/passive hip external rotation
‘Physical damage to the body or body part which prevented completion of one or more entire curriculum class’ Physiotherapist diagnosed injury Compensated turnout and muscular predictors of being in the 2+ injury group
For every 1% increase in compensated turnout, 9% increase in the odds of being in the 2+ group
1% increase in muscular = 8.4% increase in the odds of being in the 2+ group
For every 1% increase in compensated and muscular values, there was a corresponding 9% increase in odds that the dancer would sustain 2 or more injuries compared to 0 or 1 injury
Ruemper and Watkins [45] N = 85 (78 females)
Contemporary dance students
Year 1:
Males
19.33 ± 0.57 years
Females
20.14 ± 1.96 years
Year 3:
Males
23.00 ± 2.16 years
Females
22.59 ± 2.15 years
• Beighton Score
• Brighton Criteria
• Height
• Weight
Physical complaint injury: (1) ability to perform full dance activities; (2) Attended a triage session but not a physiotherapy session
Medical injury: ‘an injury resulting in medical attention (physio, etc.) beyond triage’
Time loss injury: ‘an injury resulting in inability to participate in activities (class etc.)’
Self-reported by questionnaire The total number of injuries and time loss injuries were correlated with Brighton Criteria (P = 0.001)
Physical complaint injuries and Brighton Criteria were correlated (P = 0.005)
Time loss injuries were related to joint hypermobility syndrome (P = 0.001)
Cahalan et al. [46] N = 104 injury questionnaire
N = 84 physical assessment
Elite, competitive and student Irish dancers
Professional
(n = 36) 23 years
50% female
Student
(n = 28) 20 years
85.7% female
Competitive (n = 40) 20 years
80% female
• BMI
• Waist:hip ratio
• Pain pressure threshold
• Navicular drop
• Functional Movement Screen (total of deep squat and in-line lunge scores only)
• Hamstring flexibility
• Gastrocnemius flexibility
• Star Excursion Balance Test (SEBT) Posteromedial reach
• Vertical leap
• Beighton Score
• Number of jumps in 30s
• (% max HR)
• Type and frequency of cross-training
Time loss definition of injury categorised as:
Minor injuries (up to 7 days to resolve)
Moderate injuries (8 to 21 days to resolve)
Severe (21 days + days to resolve)
Self-reported by questionnaire No significant differences between injured and non-injured groups
Cahalan et al. [47] N = 85 (66 female)
Elite, competitive and student Irish dancers
Divided in to more time absent (MTA) from injury (n = 41, 20 years) and less time absent (LTA) from injury (n = 25, 20 years)
• BMI
• Waist:hip ratio
• Navicular drop
• Functional Movement Screen total score
• Hamstring flexibility
• Gastrocnemius flexibility
• SEBT Posteromedial reach
• Vertical leap
• Beighton Score
• Number of jumps per 30 s
• % max heart rate
• Type and frequency of cross-training
‘Any physical complaint that caused absence from one or more rehearsals or performance days’ Self-reported by questionnaire ‘More time absent’ (MTA) group demonstrated a trend towards better performance on Functional Movement Screen (P = 0.062)
Cahalan et al. [48] N = 85 (66 females)
Elite, competitive and student Irish dancers
Divided in to MTA from injury (n = 41, 20 years) and ‘less time absent’ from injury (n = 25, 20 years)
• BMI
• Waist:hip ratio
• Navicular drop
• Functional Movement Screen total score
• Hamstring flexibility
• Gastrocnemius flexibility
• Balance
• Vertical leap
• Beighton score
• Number of jumps per 30 s
‘Any physical complaint that caused absence from one or more rehearsal or performance days’ Self-reported by questionnaire No significant differences between the injured and non-injured groups
Steinberg et al. [49] N = 1288 Females
Non-professional
Aged 8–16 years
• ROM (ankle and foot en-pointe, ankle PF, hip external rotation and abduction, lower back flexibility, hamstring flexibility).
• Anatomical: knee valgus, knee varum, splay foot, forefoot adduction, hindfoot varum, hindfoot valgus, longitudinal arch planus, scoliosis, lordosis
• Dance technique: releve, turnout, plié
• Height and weight
No definition of injury provided Orthopaedic surgeon specialising in dance medicine diagnosed injury Dancers with foot or ankle tendonopathies and dancers with non-categorised injuries manifested hyper hip abduction ROM (P = 0.002)
Scoliosis was significantly related to injury for 8 to 12 years (P < 0.01) and 13 to 16 years (P < 0.01) age groups
Amount of en-pointe (> 60 min/week) related to injury (P < 0.001)
For knee injuries, ankle PF (P = 0.002) and hip abduction (P = 0.0033) were significant predictors of injury
For hip abduction, ROM (P < 0.001) was a significant predictor of injury
For back injuries, scoliosis (P < 0.001), ankle PF (P = 0.026) and poor dance technique (rolling in) (P = 0.021) were significant predictors of injury
For non-categorised injuries, ankle PF (P = 0.017), hip abduction (P < 0.001) and poor dance technique (rolling in) (P = 0.002) were significant predictors of injury
Jacobs et al. [50] N = 260 (145 females)
Professional ballet dancers in 4 countries
178 ballet, 82 modern
Median age range 21–30 years
• BMI ‘…functional inability due to pain’ Self-reported by questionnaire No significant findings for BMI reported
Martin et al. [51] N = 158
Dancers
• Ankle ROM ‘Those severe enough to require medical attention and cause at least 1 day of missed rehearsal’ Self-reported Dancers with previous injuries had significantly lower flexibility. Ankle flexibility was not an injury predictor
Angioi et al. [52] N = 16 females
Professional contemporary dancers dance students
26 ± 4.7 years
165.3 ± 4.8 cm
59.2 ± 7.6 kg
• Anthropometry
• Flexibility (developpe a la seconde, combined hip flexion, and abduction and external rotation)
• Muscle power
• Muscle endurance
• DAFT
If ‘…they were unable to take part in class, rehearsals or performance in the previous 12 months’ Self-reported by questionnaire There was a significant negative correlation between mean score total days off and standing vertical jump (r = − 0.66, P = 0.014)
The strongest predictor of total days off was standing vertical jump (muscle power) (P = 0.014)
Hiller et al. [53] N = 115 (94 females)
Student dancers at a performing arts secondary school and local dance school
4.2 ± 1.8 years
• Ankle inversion, eversion, DF and first metatarsophalangeal extension range
• Ankle anterior draw laxity (0–3 scale)
• Balance (no. of foot lifts in 30 s)
• External hip rotation
• Cumberland ankle instability tool (0–30 scale)
• Balance on demi pointe for 5 s (yes/no)
An ankle sprain: ‘…an inversion injury that had resulted in either swelling or bruising in the area and limping for more than 1 day’ Self-reported Increased passive inversion range (HR = 1.06) and inability to balance on demipointe (HR = 3.75) increased the risk of injury
Van Merkensteijn et al. [54] N = 15 (9 females)
University-level dancers
Females:
21.15 ± 1.268 years
167.45 ± 6.168 cm
60.90 ± 5.428 kg
Males:
22.50 ± 0.707 years
179.00 ± 12.728 cm
72 ± 4.24 kg
• Active hip external rotation
• Functional turnout
• Compensated turnout
‘Any pain, discomfort or musculoskeletal problem that would cause modification of technique or time away from dance class, rehearsal or performance. Only dance-related injuries were analysed’ Self-reported by questionnaire Compensated turnout was related to experiencing more than one injury (r = 0.45, P = 0.004)
There was a relationship between increased compensated turnout and lower back pain (r = 0.50, P = 0.02)
Wiesler et al. [55] N = 148 (119 female)
Dance students at the North Carolina School of Arts
N = 101 ballet
N = 47 modern
Non-injured dancers
17.41 ± 0.41 years, BMI 19.16 ± 0.32 kg m2
Injured dancers
17.75 ± 0.27 years, BMI 19.16 ± 0.25 kg m2
• ROM (ankle inversion, eversion, PF, DF, 1st metatarsophalangeal joint PF, DF and hallux valgus) ‘Any acute or chronic problem warranted attention by the aforementioned healthcare professional’ Physical therapist diagnosed injury Previous injury was predictive of a new injury (P = 0.020)
Previously injured dancers had significantly lower ankle DF on the corresponding lower limb
Kenny et al. [56] N = 155 (90 females)
Pre-professional full-time ballet students at two institutions in Calgary
Median age 15 years (range 11–19 years)
N = 65 (63 females)
Pre-professional full-time contemporary students at two institutions in Calgary
Median age 20 years (range 17–30)
• Previous training
• Previous injury in last 1 year
• Irregular menses
• %BMI < 18.5
• Low total bone mineral density (% < − 2.0 z-score)
• Ankle DF ROM
• Ankle PF ROM
• Active standing turnout
• Active straight leg raise (% with impairment)
• Knee lift abdominal test (%anterior tilt)
• One-leg standing test (% hip hiking)
• Unipedal dynamic balance (seconds)
• Y Balance Test
‘Any dance related physical complaint that required medical attention and/or time loss (i.e. caused the dancer to miss more than 1 day of class, rehearsal or performance in the previous 1 year)’ Three certified physiotherapists and six kinesiology graduate students administered an injury questionnaire to diagnose injury Ankle PF ROM in the right ankle was identified as an important covariate
Lee et al. [57] N = 66 (40 females)
Dancers
18.15 ± 1.45 years
• Movement competency screen (MCS) ‘Any physical complaint sustained by a dancer resulting from performance, rehearsal or class, and resulting in a dancer injury report or triage irrespective of the need for medical attention or time loss from dance activities’
Categorised into:
Time loss, non-time loss, nature of injury, new or recurrent
Injury severity:
S0: no days off
S1: activity modification
S2: ≤ 7 days off
S3: > 7 days off
S4: year ending
Self-reported by questionnaire MCS score < 23 was an increased risk of injury (P = 0.035)
Higher number of injuries more likely to be explained by greater number of trunk injuries (P = 0.036)
Davenport et al. [58] N = 36 (34 females)
Dancers from a University and Arts Conservatory
20.8 ± 1.8 years
• ROM
• Hip strength
• Core strength
• Release swings
• Release lunges
• Developpe a la seconde
‘Any physical impairment sustained during or because of dance activity that caused the dancer to make different movement choices for the way he/she danced on a given day’ Self-reported by questionnaire ROM greater than 15% variability between sides was associated with previous injury (P = 0.04)
Roussel et al. [59] N = 40 (38 females)
Student dancers studying for a professional bachelor degree in Belgium
20.3 ± 2.4 years
1.66 ± 0.06 m
56.43 ± 5.71 kg
• Beighton Score
• Lumbopelvic control (knee lift abdominal test, bent knee fall out)
• Muscle extensibility
• ROM (hip flexion, hip adduction, abduction, Ober’s test)
• Pain provocation tests (Patrick’s test, Gaenslen’s test, compression test gapping test)
‘…any trouble’ Self-reported questionnaire 30% of dancers without a history of lower back pain (LBP) were not able to perform a correct contraction of the transversus abdominus muscle compared to 63% of dancers with a history of LBP (P = 0.048)
Twitchett et al. [60] N = 13 females
Elite dancers who were part of a touring group
19 ± 0.7 years
• Anthropometry
• Flexibility
• Muscle power
• Muscle endurance
• Dance Aerobic Fatigue Test (DAFT)
No definition of injury provided A healthcare professional diagnosed injury There was a significant positive correlation between number of injuries sustained and heart rate observed at the end of the DAFT (r = .590, P = 0.034)
There was a significant negative association between time modifying their activity due to injury and percentage body fat (P = 0.039)
Steinberg et al. [61] N = 806 (588 females)
Dancers at centres for advanced training
14.4 ± 2.1 years
• Body structure parameters (standing height, sitting height, low body length, torso length, leg length, arm length, calf girth, thigh girth, upper arm girth, thigh circumference) No definition of injury provided Self-reported by questionnaire Left thigh circumference of injured dancers aged 11–12 years. was significantly larger when compared to non-injured (P = 0.005)
Roussel et al. [62] N = 32 (26 females)
Student dancers in a full time professional dance programme in Belgium
20 ± 2 years
• Beighton Score
• Lumbopelvic movement control (active straight leg raise, bent knee fall out, knee lift abdominal test and standing bow)
‘Any MSK condition requiring time away from dancing’ Self-reported by questionnaire and subjective evaluation Knee lift abdominal test (P = 0.015) and standing bow (P = 0.029) were significant predictors of injury
Steinberg et al. [63] N = 271 females
Pre-professional dancers at a performing arts centre with patellofemoral pain syndrome (PFPS)
Varying ages from 10 to 16 years
• Weight
• Height
• Leg length
• Joint ROM (passive ankle, hip, knee)
• Lower back/hamstring flexibility
• Knee joint stability
• Patella mobility
• Anatomical malalignment (knee varum/valgus, hind foot varum/valgus, scoliosis, lordosis)
PFPS was defined as ‘(a) knee pain (at anterior, medial and/or retro patella) during movement or exercises that disturbed their dance practice and daily life activities; (b) the knee pain could be reproduced during physical examination; (c) knee swelling was found; and/or (d) when a positive grinding sign and/or positive patellar inhibition test was obtained when the knee, and especially the patella, was palpated, contracted and stretched’ Unclear Significantly greater percentage of hindfoot varum (P = 0.044) and scoliosis (P = 0.15) in the PFPS group
Ankle PF was lower and ankle DF and knee flexion ROM were greater in the PFPS group compared with the control group (P = 0.005)
Factors associated with PFPS among young dancers (aged 10–11 years) were: hip abduction (OR = 0.906), lower back/hamstring flexibility (OR 3.542); among adolescent dancers (12–14 years) were: ankle DF (OR = 0.888), hindfoot varum (OR = 2.66): and in premature dancers (15–16 years) were: ankle PF (OR = 1.060) and hip internal rotation (OR = 1.063)
Steinberg et al. [64] N = 1288 females
Non-professional dancers
13.3 years. (range 8–16)
• Weight
• Height
• Leg length
• Foot length
• Foot width
• BMI
• Anatomical anomalies (knee valgus/varus, genu recurvatum, hallux valgus, splay foot, forefoot adduction, hindfoot varum/valgus, longitudinal arch cavus/planus, lordosis)
‘Reproduction of pain and signs of injury (such as swelling)’ Orthopaedic surgeon confirmed injury The risk of injury was significantly higher for dancers with scoliosis
Knee varum (P = 0.001), knee hyperextension (P = 0.034), long-plantar planus (P = 0.038), splay foot (P = 0.049) and hallux valgus (P = 0.001) values were higher in dancers with scoliosis
Back injuries were higher in dancers with scoliosis (P < 0.001)
Van Seters et al. [65] N = 28 females
First year full-time dance students at Codarts University
8.6 ± 1.1 years
BMI 20.7 ± 1.6 kg m2
• Age
• Height
• Weight
• BMI
• Single-leg squat
• Lower extremity kinematics
• Strength
No definition of injury provided Self-reported by questionnaire Significant association between limited ankle DF (OR = 1.11, 95% CI 1.02–1.20) and substantial lower extremity injuries during follow-up
Significant association between limited DF ankle (OR = 1.25; 95% CI 1.03–1.52) and injury